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Biomedical subjects

A M Sadove

Publications and source records attributed to A M Sadove.

At least 19 recordsLinked to original sources
PubMed1999

Primary alveolar cleft bone grafting in unilateral cleft lip and palate: arch dimensions at age 8.

The purpose of this investigation is to determine whether primary alveolar cleft bone grafting in infants with unilateral cleft lip and palate (N = 17) leads to less favorable dental arch dimensions at age 8 when compared with other 8-year-old patients with unilateral cleft lip and palate who received no alveolar bone grafting procedures (N = 49). Dental casts were obtained for the primary grafted group, and arch lengths and widths were digitally recorded with a reflex microscope. These arch dimensions were then compared with the reported data for a nongrafted group and a noncleft group of 8-year-old children. The major findings were: 1) that the dental arches of both cleft groups generally demonstrated a significant diminution in length and width (P < 0.05) compared with the noncleft groups, and 2) that the patients who underwent primary alveolar cleft bone grafting showed no statistically significant difference for any arch dimension (P < 0.05) when compared with the nongrafted group lacking this additional surgical procedure.

Alveolar Process↗
PubMed1999

Primary alveolar cleft bone grafting in unilateral cleft lip and palate: craniofacial form at age 8.

Counterpart analysis can be advantageous for the clinician interested in the underlying determinants of the craniofacial form for any given person. This analysis was performed for a group of patients who underwent primary alveolar cleft bone grafting (N = 18) and a group of patients who did not undergo grafting (N = 19) who were 8 years of age (+/- 6 months). The primary grafting group more frequently noted maxillary retrusion, but of a nonsignificant magnitude. Also, the primary grafting group had greater mean magnitudes of mandibular opening as a compensatory adjustment in some patients, but this could not be generalized to all patients who had underdone primary grafting. The mean magnitude of craniofacial vertical shortening was also greater for some patients who had undergone primary grafting, but it, too, did not exhibit a generalized pattern for all patients who had undergone primary alveolar cleft bone grafting procedures. This study emphasizes the great diversity of craniofacial skeletal adjustments made within each group of patients with unilateral cleft lip and palate and cautions the clinician against generalizations concerning a particular treatment protocol.

Alveolar Process↗
PubMed1998

Amniotic band facies.

Craniofacial deformities of 14 patients with amniotic band syndrome at one institution were reviewed for morphologic similarities. In addition to associated cleft lip and palate, vertical and oblique facial clefts, which were not associated with embryologic lines of fusion, were seen. It is hypothesized that the prominence of the nasal processes combined with the adjacent stomodeal orifice results in utero surfaces, which can lead to free band attachment and adherence, resulting in a spectrum of similarly oriented facial defects.

Amniotic Band Syndrome↗
PubMed1998

Computer-generated patient models for reconstruction of cranial and facial deformities.

The use of three-dimensional, computer-generated anatomic models can be used in the diagnosis and reconstruction of a variety of craniofacial problems. They are readily manufactured from computed tomography scans at a reasonable cost with only several weeks of preparation and delivery time. Their contemporary value is in the preoperative treatment planning, intraoperative implant fashioning, and preoperative implant fabrication in appropriately selected patients.

Adolescent↗
PubMed1997

Resorbable plate fixation in pediatric craniofacial surgery.

Resorbable bone plates composed of a copolymer of polylactic and polyglycolic acids stabilized into position with metallic microscrews were used in the reconstruction of pediatric craniofacial deformities. In 100 patients between 4 and 15 months of age, a total of 912 resorbable plates were implanted over a 2 1/2-year period. Their application was simple and rapid and required no special instrumentation. Currently, 85 patients are more than 1 year postimplantation, which is the known time for complete resorption of this copolymeric compound. No complications have been seen with this use, including infection, overlying soft-tissue reactions, reconstructive instability, or underlying osteolysis around the screws, as determined by postoperative plain radiographs at 6 months and 1 year postoperative time periods. Four patients have had screws removed due to either palpability or secondary reconstructive surgery between 9 and 18 months postoperatively, all of whom exhibited complete polymer resorption and normal bone healing. These clinical results demonstrate the safety and effectiveness of this copolymeric material for pediatric craniofacial applications.

Absorption↗
PubMed1996

Pediatric plastic surgery.

Pediatric plastic surgery has seen widespread advances during the past decade. These have been primarily in the biologic understanding of certain disease processes as well as in diagnostic and therapeutic technologies. These advances have contributed to a potential new array of treatment options for congenital deformities and traumatic injuries. This review identifies several of the most significant new trends and treatment concepts in pediatric plastic surgery from anesthesia to wound healing.

Anesthesia↗
PubMed1995

Resorbable coupling fixation in craniosynostosis surgery: experimental and clinical applications.

The use of resorbable bone fixation devices composed of a copolymer of polyglycolic acid and polylactic acid were investigated in an animal model as well as in human application. We used resorbable plates and metallic microscrews in immature rabbits; plating of the coronal suture resulted in complete device resorption and increased interscrew distances (i.e., growth across the suture) after 8 postoperative months. In 20 infants with calvarial deformities, thin, straight resorbable plates were used for skeletal fixation after osteotomies and repositioning. A total of 231 fixation devices were implanted without complications after 12 postoperative months. These encouraging results have led to further clinical application in craniosynostosis deformities.

Animals↗
PubMed1995

A comparison of resorbable and metallic fixation in healing of calvarial bone grafts.

The effects of a resorbable fixation plate composed of a polylactic acid-polyglycolic acid copolymer were compared with those of a metallic fixation plate of similar dimensions in an animal calvarial bone-graft healing model. Bilateral parietal bone grafts in 20 mature rabbits were fixed into position with a titanium mesh plate on one side and a polymer mesh plate on the other side. After 2, 6, 9, and 12 months, cross-sectional histology was used to compare osteotomy line healing, tissue response to the fixation material, and the amount of resorbable plate degradation. After 2 months, no changes in the dimensions of the resorbable plate were observed. The bone grafts fixed by both metal and polymer plates exhibited incomplete healing along the osteotomy lines. After 6 months, there was a 66 percent reduction in the dimensions of the resorbable plate and vertical shortening of screw length. Complete healing was seen along all osteotomy lines of both bone grafts. After 9 months, less than 1 percent of the resorbable mesh plate remained as a small film underneath a collagenous capsule. No polymer was seen within the confines of the screw holes. After 1 year, no evidence of polymer was seen either on the external cranial surface or within any of the screw holes. Bony union was observed across all osteotomy sites. The screw hole outlines persisted. The resorbable plate demonstrated fixation stability similar to that of metal with comparable osteotomy line healing. No adverse local inflammatory reactions were seen as the polymer composite progressed to complete degradation by 1 year.

Animals↗
PubMed1994

Effects of a positively charged biomaterial for dermal and subcutaneous augmentation.

Based on previous experimental connective tissue work, the use of a positively charged dextran-based biomaterial in subcutaneous tissue sites was evaluated. After hydration with saline, the biomaterial was injected beneath the abdominal skin in rats. A robust macrophage response was initially seen at 30 days without acute inflammation. By one year postoperatively, extensive intermaterial fibroblast and collagen ingrowth had occurred. No evidence of a foreign-body or chronic inflammatory response was seen. These preliminary findings suggest good tissue compatibility of this biomaterial and suggests that when combined with a biocompatible liquid medium, the potential for development of a bioactive dermal and subcutaneous injectable substance exists.

Animals↗
PubMed1994

A potential biomaterial composite for dermal and subcutaneous augmentation.

Based on previous experimental connective tissue work in cutaneous wound healing, cell culture, and fat transplantation, the use of positively charged dextran beads for subcutaneous and dermal augmentation was evaluated. When combined with a biocompatible liquid medium, the material easily flowed through small-gauge needles. When injected beneath the facial skin in rats, a profound macrophage response was initially seen at 30 days accompanied by fibroblast proliferation and new collagen formation. By 1 year, a quiescent noninflammatory cellular response with extensive intermaterial collagen deposition was evident. No adverse reactions were seen in the contralateral facial sites, which were injected with only the liquid medium. These preliminary findings suggest good tissue compatibility of this composite biomaterial and provide further evidence of the significant regulatory role of the macrophage in the tissue response to implanted biomaterials.

Animals↗
PubMed1994

Biomechanical comparison of wire osteosynthesis techniques in craniofacial surgery.

The biomechanical stability of 20 different craniofacial wire osteosynthesis methods were tested in a simulated bone model. Utilizing wire fixation across a curved osteotomy site of an acrylic bar fixed at one end, compressive loading at the suspended end was used to test the resistance of the ligatures to stretch failure. Twenty-eight- and 30-gauge ligature patterns tested included single loops, double loops, and figure-eights across both 1- and 2-cm distances. A two-way analysis of variance was then used to determine the various effects of wire diameter, configuration, and loop length. The extensional deformation of ligature fixation was shown to be reduced by increasing the number of wire loops, reducing intraloop distances, or employing a slightly larger gauge diameter. The complex wiring configuration of a figure-eight technique was of no advantage over simple wire loops. In comparative strengths, two double loops were stronger than one double loop, and two single loops were stronger than one single loop or figure-eight. Comparable reductions in fixation strength were seen in all groups; there were larger intrabony distances between the burr holes or with the smaller gauge wire. These biomechanical ligature testing results are useful in those craniofacial skeletal sites where the use of more rigid fixation is either contraindicated or not desired.

Analysis of Variance↗
PubMed1994

Effects of resorbable fixation on craniofacial skeletal growth: modifications in plate size.

On the basis of previous experimental work in young rabbits, modifications in the polymer fixation used (i.e., smaller plate size, change in ratio of polymer components) were studied for potential alleviation of known growth restriction in this model. Ten juvenile rabbits with metallic markers placed at the calvarial sutural junctions were plated across the left coronal suture. At 6 months of age, measurements were taken of both intermarker distances radiographically (growth) and the plates directly. Unlike previous reports, these resorbable plates permitted symmetrical frontal bone development, unaffected growth across the coronal suture, and a histologically normal underlying suture. These changes appear to be the result of elongation of the fixation plate across a growth site. These results indicate that the change in shape of resorbable fixation after initiation of degradation is more important than complete degradation of the material in rapidly growing bone sites.

Animals↗
PubMed1994

Cranial reconstruction in osteogenesis imperfecta.

Although osteogenesis imperfecta (OI) is recognized as a cause of craniosynostosis, therapeutic endeavors have not been reported. We present an 8-month-old girl with type 3 OI, in whom bilateral occipital flattening, biparietal widening, and frontal narrowing were effectively managed with a combined surgical release and reconstruction and molding cap therapy. The quality of the calvarial bone in OI requires a modified approach to the conventional bone techniques commonly used in the correction of craniosynostosis deformities.

Craniosynostoses↗
PubMed1994

Systemic effects of photothermolysis of large port-wine stains in infants and children.

Fifteen patients who were 5 years of age or younger with large port-wine stain lesions were studied after flashlamp pulsed-dye laser therapy. Matched serum haptoglobin assays were obtained immediately prior to and after the laser treatments intraoperatively. Combined with the testing for hemosiderin from urine samples collected within 2 hours postoperatively, the amount of intravascular hemolysis present after early photothermolysis was assessed. Mean preoperative haptoglobin levels were within normal ranges (116 +/- 13 mg/dl), which then averaged a 9.5 percent decrease (105 +/- 8 mg/dl) at the conclusion of laser therapy. The decline in haptoglobin levels was higher in the youngest patient but did not exceed the renal threshold for hemoglobin. No evidence of hemoglobin was found in the urine or urine sediment of any patient. These results indicate that although hemoglobinemia does occur after port-wine stains ablation with the flashlamp pulsed-dye laser, the level of intravascular hemolysis obtained is not injurious to the infant or child with large cutaneous involvement. Flashlamp pulsed-dye laser therapy, therefore, may be undertaken safely at very young ages to obtain maximum clinical and psychological benefit.

Child, Preschool↗