Biomedical subjects

B Guyuron

Publications and source records attributed to B Guyuron.

At least 19 recordsLinked to original sources

PubMed1992

G syndrome: a review of the literature and a case report.

In 1969, Opitz et al. reported the first case of G Syndrome (Opitz-Frias Syndrome). They presented their clinical observations on 4 brothers from the 'G Family' who shared a constellation of findings with a generalised tendency to midline defects. Major manifestations of this multiple congenital anomaly syndrome include hypertelorism, prominent forehead, cleft lip and palate, narrow palpebral fissures with epicanthal folds, dysphagia, stridor, laryngotracheal oesophageal clefts, and hypospadias. The most significant manifestation of a midline field developmental defect in these infants is aspiration which poses the greatest threat to life. Urgent evaluation should include a water-soluble contrast oesophagram and aerodigestive endoscopy. In addition to repair of the laryngeal cleft, which occurs in approximately 30% of the cases, a tracheostomy, feeding gastrostomy, and Nissen fundoplication are often needed. We report a male infant born with G. syndrome. BBB Syndrome (Opitz Syndrome) is also discussed which bears a striking resemblance to the G Syndrome; in fact, they may be variants of the same allelic syndrome.

Abnormalities, Multiple↗

PubMed1992

Noncompression unicortical miniplate osteosynthesis of mandibular fractures.

The use of transoral noncompression unicortical miniplates in treating 42 consecutive patients with 64 displaced mandibular fractures (excluding subcondylar) was reviewed. Titanium miniplates (Wurzburg) were used for fixation. The principles set forth by Champy and colleagues, with two plates for body and symphyseal fracture fixation and one plate superiorly along the oblique ridge for angle fractures, were performed. Intermaxillary fixation was not used postoperatively. Results compared favorably with other forms of treatment with no evidence of postoperative malocclusion, with an overall complication rate of 3%. The advantage of no external incision, avoidance of intermaxillary fixation, and normal postoperative incisal opening and occlusion make this technique our treatment of choice.

Adolescent↗

PubMed1992

A comparison of absorbable and nonabsorbable suture materials for skin repair.

This prospective clinical study was conducted to compare the outcome of elective surgical wound repair in the occipital region during rhytidectomy using absorbable and nonabsorbable suture materials. On an alternative basis, 6-0 polypropylene and 6-0 plain catgut were used to repair the incisions on the upper and lower half of the surgical wounds in 80 sites. These sites were then compared for stitch marks, erythema, hypertrophic scars, infection, and wound necrosis. This study revealed slightly visible stitch marks in 4 of 40 (10 percent) sites repaired with catgut and in 10 of 40 (25 percent) sites repaired with polypropylene material (p less than 0.10); however, this was not statistically significant. There were five incidences of suture-site erythema (12.5 percent) noted in the group of catgut repairs in comparison with three incidences (7.5 percent) in the group repaired using polypropylene. Furthermore, there was no statistically significant difference in hypertrophic scarring or infection rate between these groups. The incidence of erythema following repair with catgut was higher, but this was also not statistically significant. Considering these findings, coupled with the avoidance of patient discomfort, suture removal, and time spared for the surgeon and staff when absorbable suture material is used, the superiority of plain catgut over nonabsorbable material becomes evident.

Catgut↗

PubMed1992

Reaction to stainless steel wire following orthognathic surgery.

A patient is reported in whom, following orthognathic surgery, developed a bilateral burning sensation and pain along the masseteric muscles and preauricular region in the sight of the mandibular osteotomy where the lateral segment was tied to the medial segment using a single wire loop. This patient also had previous Kirschner wires used for a metatarsal osteotomy that needed to be removed because of similar symptoms. Removal of the mandibular wires resulted in elimination of the symptoms from the mandibular region as well. The patient's subsequent skin test proved a nickel allergy.

Adult↗

PubMed1992

Problem neck, hyoid bone, and submental myotomy.

Despite significant attention to the cervical region over the last two decades, the hyoid bone has not received deserved recognition. In this report, the anatomy and role of the hyoid bone and suprahyoid muscles in cervicomental morphology are reviewed. From an analysis of cephaloxerograms on 54 patients, it was concluded that on a balanced neck, the most caudal border of the hyoid body is located at or above a line parallel to the Frankfort horizontal line passing through the most caudal border of the mandibular symphysis (menton). Of the muscles that control the position of the hyoid bone, the anterior belly of the diagastric, geniohyoid, and mylohyoid muscles pull the hyoid bone cephalad and anteriorly. The stylohyoid muscles, on the other hand, pull this bone cephalad and posteriorly, while the sternohyoid and omohyoid muscles pull it caudally. Transection of the first three muscles at their attachment to the posterior aspect of the mandible in patients with dysmorphic necks due to caudal and anterior hyoid position will allow posterior and cephalad relocation of this bone, which improves the neck contour. Sixteen patients, with an average follow-up of 27 months, have undergone this procedure, with cervicomental contour improvement in all cases. The degree of improvement ranged from 1 to 5 (5 being excellent): One patient was ranked 1, two patients were ranked 2, two patients were ranked 3, and the rest were ranked 4 or 5. One patient had overcorrection as a result of an aggressive concomitant submental lipectomy. Another patient had central depression in the submental area. None of the patients had difficulties with mandibular movement or swallowing.

Adult↗

PubMed1992

Unpredictable growth pattern of costochondral graft.

Costochondral grafts have gained increasing popularity in reconstruction of the temporomandibular joint and condyle in children. This is a report on the long-term follow-up of eight adolescent patients who underwent reconstruction of the temporomandibular joint and ramus for correction of hemifacial microsomia or trauma-related temporomandibular joint ankylosis during varying periods of growth. Six patients had hemifacial microsomia, and two suffered from posttraumatic temporomandibular joint ankylosis. Average follow-up was 80.4 months. Four patients had excessive growth of the graft, one patient had suboptimal growth, and three patients had no growth. In addition, one patient had undergone four procedures for significant graft overgrowth. Based on this study and review of the literature, we have concluded that the growth pattern of the costochondral graft is extremely unpredictable, ankylosis is a common problem following a temporomandibular joint reconstruction with costochondral graft, and mandibular overgrowth on the grafted site can actually be more troublesome than the lack of growth. Furthermore, maxillary growth is proportionately influenced by vertical mandibular growth of the graft, while the horizontal maxillary growth is not altered. Ankylosis is a result of ossification of the cartilaginous portion and the three-dimensional graft overgrowth, aggressively extending beyond the cartilage graft boundary. Based on this study, we recommend that this procedure be performed only on severe deficiencies. Adequate amounts of soft tissue should be retained between the skull base and the graft, and we further recommend harvesting the graft from the fourth or fifth rib, which may reduce the potential for overgrowth.(ABSTRACT TRUNCATED AT 250 WORDS)

Ankylosis↗

PubMed1992

The role of flaps in the management of contracted eye sockets.

Based on the pathology of the eye socket and periorbital deficiencies, three distinct classes of patients can be recognized: I. Those who solely have eye socket deficiency with normal orbital and periorbital tissue. The suggested surgical treatment for this class of patient would be a skin or mucosa graft. II. Patients who have inadequate lining, as well as orbital volume deficiency. The preferred reconstructive approach includes cartilage (rib or ear) with or without fat graft, and skin or mucosa grafts for eye socket expansion. III. For failed reconstructions of classes I and II or for patients with severe orbital and periorbital deficiencies, the choice is one of three flaps: If the superficial temporal vessels and the postauricular skin is intact, the ideal flap is postauricular fasciocutaneous. If the postauricular skin has previously been used yet the superficial vasculature is intact, a secondary flap is the better choice. In cases where both postauricular skin and superficial temporal vessels have been sacrificed the recommended flap is a free flap with microvascular anastomosis.

Adipose Tissue↗

PubMed1992

Subcutaneous approach to forehead, brow, and modified temple incision.

Placing the incision at the hairline or just posterior to the boundary of the hair, with subcutaneous elevation of the flaps, is a more effective way to correct the aging upper face, whether it be "crow's feet," excess forehead skin, or eyebrow ptosis. Furthermore, by placing the facial rhytidectomy incision at the sideburn boundary caudally and anteriorly, the sideburn can be preserved, regardless of the amount of skin removed. Patient selection and procedure have been described. Patients who are candidates for this type of surgery include those who have a long forehead, a short forehead, deep wrinkles, or thinner skin, as well as patients with deep frown lines and hyperactive corrugator muscles. The scars are generally minimal but can be camouflaged in one of many ways if they are visible. The most effective method is medical-grade tattooing. There are many advantages to the technique, the most important of which is control of forehead length and preservation of sensory and motor nerves. The results are far superior to most other available techniques in properly selected cases. In today's world of aesthetic surgery finesse, those who have expertise with a variety of approaches are more equipped to best serve the patients, and the techniques described here should be part of the aesthetic surgery armamentarium.

Female↗

PubMed1991

Mycobacterial infection following blepharoplasty.

A case of exceedingly rare mycobacterial infection following blepharoplasty is recorded. This nursing home employee underwent a combined blepharoplasty, eyelid ptosis correction, and replacement of breast implants. One month later, she developed localized abscesses of both eyelids. Cultures revealed nontuberculous mycobacterial infection. The infection was controlled after ten months of antibacterial therapy using doxycycline. We believe that the patient's exposure to debilitated individuals due to her nursing profession and the presence of a Jones tube in the right lacrimal system were major contributing factors.

Abscess↗

PubMed1991

The role of lidocaine, epinephrine, and flap elevation in wound healing after chemical peel.

We have observed 5 patients with hypertrophic scarring at the lateral boundaries of the chemically peeled area when circumoral peel was combined with facial rhytidectomy. Some of the potential contributory factors include flap elevation, epinephrine, and lidocaine hydrochloride. To discover whether any one of these three factors or a combination played a role, a rat model study was designed. Initially, 40, 400-gm Sprague-Dawley rats were divided into 4 groups, each comprised by 10 rats. Injections with lidocaine or lidocaine with epinephrine, and chemical peel were done in 2 groups. The same injections were used in the remaining 2 groups together with simultaneous preliminary flap elevations and chemical peeling. After the review of the initial study results, another 40 Sprague-Dawley rats were used to repeat the study and compare on a larger scale the effects of lidocaine with and without epinephrine on the depth of chemical peel. The findings of the rat model studies indicate that preliminary injections with lidocaine containing solution (with or without epinephrine) result in a major delay in healing time. Flap elevation and chemical peeling were associated with major morbidity and mortality in the test rats. The presence of epinephrine in lidocaine solution had no significant role in increasing the delay in the healing process.

Animals↗

PubMed1991

Dynamics of rhinoplasty.

Nasal dynamics were studied on 87 patients undergoing rhinoplasty of one zone or two distant nasal zones. Statistical analysis of the result revealed that reduction of the nasion area, besides setting the soft tissue back, gave the appearance of increased intercanthal distance and lengthened the nose. Reduction of the nasal bridge resulted in a wider appearance on front view and a cephalically rotated tip on profile. Augmentation of the bridge affected the nose reversely. Tip cephalad rotation was achieved by resecting one of the three areas: the cephalad portion of the lower lateral cartilages (affecting the rims more), the caudal septum (affecting the central portion more), and the caudal portion of the medial crura of the lower lateral cartilages (affecting the central portion only). Resection of the alar base not only narrowed the nostrils but also moved the alar rim caudally. Furthermore, it reduced tip projection when a large alar base reduction was done. Reduction of the nasal spine increased the upper lip length on profile and reduced tip projection when a large reduction took place. Significant reduction in caudal nose projection resulted in widening of the alar base.

Adolescent↗

PubMed1990

A critical comparison of osteoplastic and alloplastic augmentation genioplasty.

This retrospective study was undertaken in order to compare the objective and subjective outcomes of the osteoplastic and alloplastic genioplasties. Of the 76 patients that underwent augmentation or advancement genioplasty, 34 were subjects of osteoplastic genioplasty and 42 received implants. Twenty seven of 34 patients who underwent osteotomy and 32 of 42 patients whose chins were augmented with an implant responded to the questionnaires. The results revealed that both groups were highly satisfied, with a slightly higher satisfaction rate for those who underwent osteotomy. The morbidity was the same for both procedures. However, the soft tissue response was more predictable for the osteoplastic genioplasty. The cervicomental angle improved more with the osteoplastic genioplasty. Based on our experience and conclusions from this study, we recommend the osteoplastic genioplasty for every patient. However, for patients in the older age group, particularly those with a small degree of microgenia, alloplastic genioplastic can be justified.

Adolescent↗

PubMed1990

The hourglass facial deformity.

The "Hourglass Facial Deformity" is the result of bilateral irradiation of the orbits and anterior cranial base during infancy. The deformity is uniformly characterized by a distinctly misshapen upper face at the level of the orbits, with depression of the temporal region, hypotelorism, and flattened nasal root. These patients exhibited varying degrees of frontal bossing. Since they had previous enucleation, the orbital soft-tissue can be dissected off the eye socket, lateral orbital walls, and if necessary, the orbital cone, through a bicoronal incision. The deformity is then easily corrected with implantation of acrylic alloplastic material. Four cases are presented which had varying degrees of the same deformity and were successfully corrected using the operative procedure described. No complications have been encountered. Two patients required eye socket revisions.

Acrylic Resins↗

PubMed1990

A severe fibrotic reaction after cosmetic liquid silicone injection. A case report.

A case of a severe, locally aggressive fibroblastic reaction to cosmetic silicone injection involving the orbital cone and anterior cranial base is presented. Included is a brief history and description of silicone injection and its complications. Though many facts remain to be discovered, speculation into the possible pathogenesis, with a review of the literature, shows that while silicone continues to be a useful tool for the plastic surgeon, an awareness of the risks, as well as a search for clues to avoid complications, must continue before further liberal use of this material is encouraged.

Facial Bones↗

PubMed1990

Long-term survival following nodal metastases from basal cell carcinoma.

A case of long-term survival with metastatic basal cell carcinoma to regional lymph nodes is presented. The literature has been briefly reviewed. When a metastatic basal cell carcinoma is discovered, the average survival is only 8 to 10 months. The patient in this case report has been followed for 10 years from the initial metastatic discovery and 7 years from the last metastatic surgery by one of the authors. There has been no evidence of recurrent disease. The topic of metastatic basal cell carcinoma is detailed in this report.

Adult↗

PubMed1990

Pseudomeningocele as a complication of teratoma resection and aseptic meningitis following craniofacial reconstruction: a case report.

This is a report of two extremely unusual complications of craniofacial surgery on a single patient. A 14-year-old female underwent resection of a recurrent teratoma four times within the first 9 years of life. This left her with two large cranial cavities in the left temple and posterior to the orbit communicating with the subarachnoid space constituting a pseudomeningocele and pulsatile mass in the left temple--an unusual complication. Following resection of the pseudoepithelial cavity linings, the spaces were filled with a split temporalis muscle. Two weeks following surgery, she developed signs and symptoms of meningitis with negative cultures from the drain sites and lumbar puncture. Six days following an unsuccessful attempt to treat her with wide spectrum antibiotics, she was treated with dexamethasone. As a result, there was a dramatic disappearance of signs and symptoms in less than 36 hours; she has not experienced any recurrence since. We feel that this aseptic meningitis was the result of cerebrospinal fluid exposure to muscle--a rare, yet, previously reported complication. The details of the case history and discussion of complications and the way in which they can be avoided, are subjects of this report.

Adolescent↗

PubMed1990

Undetected diabetes and the plastic surgeon.

Plastic surgery candidates are generally healthy. Therefore, major postoperative complications are rare. Should they happen, the surgeon should search for possible causes, one of which is undetected diabetes mellitus. Six patients are presented who, based on the individual or family history or the unusual nature of their complications, were suspected of having diabetic tendencies. This experience necessitated our in-depth search into the role of silent or undetected diabetes. This report emphasizes the importance of positive family history of diabetes and the role of glucose tolerance tests on suspected cases. Even with normal glucose tolerance tests, however, some of these patients with a positive family history of diabetes and history of previous infections suffer from deficiencies in the chemotactic immune system. We recommend full discussion of the increased risk of infection and delayed healing with these patients, conservatism during surgical procedures, and prophylactic use of antibiotics perioperatively.

Aged↗

PubMed1989

Rhytidectomy in patients with facial lipodystrophy: a review of the literature with case presentations.

Partial lipodystrophy continues to be a baffling disorder. Procedures used for facial contour restoration have varied. Dermal-fat grafts, fat injections, microvascular free-flap grafts, and occasional injections of medical-grade liquid silicone are currently the most common methods of facial contour restoration, and although these techniques have resulted in good cosmetic results, there are drawbacks to each. We present a review of the medical literature concerning facial lipodystrophy and its cosmetic correction along with case reports of contour restoration in two facial lipodystrophic patients.

Female↗