Biomedical subjects

B Guyuron

Publications and source records attributed to B Guyuron.

At least 37 records · Page 2Linked to original sources

PubMed1997

Rejuvenation of the upper face. A logical gamut of surgical options.

The prime objective of forehead rejuvenation is to correct the factors that accentuate the impression of aging, namely, eyebrow ptosis, glabella frown lines, forehead wrinkles, and asymmetry. Options for forehead rejuvenation are undergoing a renaissance. With the wide variety of choices currently available, accurate analysis of the presenting problem is mandatory so that the appropriate surgical technique can be chosen. The less invasive endoscopic procedures have a low morbidity rate and great patient satisfaction. Not all patients are candidates for these procedures, however. A thorough knowledge of alternative methods, including botulinum injection, fat injection, fat grafting, and subcutaneous approaches to the brow, are necessary if optimal aesthetic results are to be accomplished. Having an armamentarium of forehead rejuvenation techniques is, therefore, the key to individualizing treatment for each patient.

Adipose Tissue↗

PubMed1997

Problems following genioplasty. Diagnosis and treatment.

Both alloplastic and osteoplastic genioplasty harbor the potential for outcomes that may mandate a revision. A successful reversal of this often enigmatic situation requires a thorough and trenchant analysis of the clinical condition, as well as the emotional motive leading the patient to seek a revision surgery. The selected corrective procedure has to offer the highest potential for success with the least invasion possible. The goals should be set with the scar tissue, distorted anatomy, and reduced circulation in mind. The limitations should be recognized, and the related concerns should be shared with the patient. Many of these, often imperfections and sometimes gross deformities, can be corrected, as long as the problem is identified and a suitable solution is culled out.

Facial Asymmetry↗

PubMed1996

Resection of bilateral orbital and cranial base basal cell carcinoma with preservation of vision.

The surgical resection of skull base tumors often presents technically challenging problems and can result in major deformities. In planning the operation, each individual patient must be evaluated not only with respect to the extent of the disease, but also with respect to the functional losses, which may severely affect the patient's quality of life. The patient presented is an elderly woman with a malignant anterior skull base basal cell carcinoma and multiple recurrences. The tumor extended to the orbits bilaterally, resulting in blindness in the right eye. The objective was to resect the tumor from the skull base and the orbits, while preserving vision in the left eye. Utilizing intraoperative frozen sections, extensive tumor resection in the left orbit was accomplished without compromising vision. This was followed by the reconstruction of the eyelids and periorbital tissues. Exenteration of the right orbit, anterior craniectomy, and partial dural resection were also performed. Ten years later, the patient remains free of tumor recurrence and has good vision in her left eye.

Aged↗

PubMed1996

Management of an extensive cervicofacial lymphovenous malformation of the maxillofacial region.

The operative approach to extensive vascular anomalies of the maxillofacial region with significant skeletal involvement demands considerable preoperative planning and orthodontic intervention guided by a creative surgical design. A case of a 17-year-old male with a middle and lower face lymphovenous malformation, requiring a complex orthodontic and surgical approach, is reported here. Details regarding the preoperative examination, orthodontic maneuvering, and the surgical procedures are given. An overview of the classification and clinical implications of craniofacial vascular anomalies is also presented.

Adult↗

PubMed1996

The role of DDAVP (desmopressin) in orthognathic surgery.

Desmopressin (1-deamino-8-D-argininevasopressin, DDAVP) is a synthetic analog of the antidiuretic hormone L-argininevasopressin. DDAVP has been shown to increase the plasma concentration of endothelial factor VIII, thus increasing coagulant activity. There is evidence from controlled clinical trials indicating that DDAVP can reduce blood loss and transfusion requirements for individuals with normal coagulation profiles undergoing various surgical procedures. This study was conducted to evaluate the efficacy of the DDAVP in reduction of blood loss during orthognathic surgery. Twenty patients, 15 females and 5 males, undergoing bimaxillary osteotomy were randomized into two groups of ten. Perioperatively, group 1 patients received 20 micrograms of DDAVP infused over one-half hour. Group II patients did not receive DDAVP. Hypotensive anesthesia (mean arterial pressure < 60 mm Hg) was routinely employed for both groups. On average, the blood loss in group I patients was 144 ml less per patient than group II patients (p < 0.50). Only 2 of 10 patients in group I lost in excess of 750 ml, while 6 to 10 group II patients experienced blood loss greater than 750 ml (p < 0.20). The average postoperative hematocrit for patients in group I dropped by 6.17 of the preoperative mean hematocrit (p < 0.001). The average drop in hematocrits among the group II patients was 11.61 (p < 0.001). When collated, this hematocrit drop of 11.61 for group II and 6.17 for group I (recipients of DDAVP) proved to be significantly different (p < 0.01). It is concluded from this study that patients receiving a standard dose of DDAVP prior to bimaxillary osteotomy would experience reduced intraoperative blood loss, providing that blood pressure is well controlled and fluid replacement is carefully managed. No significant adverse side effects of desmopressin acetate were observed.

Blood Loss, Surgical↗

PubMed1996

Comparison of polydioxanone and polyglactin 910 in intradermal repair.

A prospective clinical study was undertaken to compare the results of intradermal layer closure using two popular absorbable suture materials, polydioxanone and polyglactin 910. On an alternating basis, 6-0 polydioxanone and 6-0 polyglactin 910 were used to repair 80 surgical sites of the temple and occipital regions in 20 patients undergoing facial rhytidectomy. In all instances, the superficial skin layer was repaired with 6-0 plain catgut. These sites were evaluated by a double-blind method for erythema, induration, infection, scar spread, and hypertrophic scarring at approximately 5 months and at least 1 year postoperatively. Scar spread was indicated at widths greater than 1 mm. Any raised scar was labeled hypertrophic. Scar spread, as defined above, was observed in 6 of 38 incisions repaired with polyglactin 910, and 3 sites developed scar hypertrophy. Conversely, 3 of 38 incisions closed with polydioxanone revealed scar spread (p < 0.25), and 3 were hypertrophic (p < 0.35). Sixty-one sites healed with undiscernible scars. This study does not disclose any statistically significant difference in the quality of the scars when polyglactin 910 is used compared with polydioxanone.

Cicatrix↗

PubMed1996

Dynamic interplays during rhinoplasty.

One of the complicating factors in rhinoplasty procedures is its intricate dynamics. Not only is there a complex interaction between the soft tissue and nasal bone frame on each nasal zone, there is an intriguing interaction between the different zones of the nose and the surrounding facial structures. Understanding these interplays is mandatory to proper design and execution of the aesthetic surgical plans. This article has covered the dynamic effects that occur along the different nasal zones, elucidated the control that the nasal frame has on the soft tissue, and reviewed the different ways in which the intended aesthetic objectives can be obtained.

Esthetics↗

PubMed1996

Alar base abnormalities. Classification and correction.

Abnormalities of the alar base may be a consequence of base deformities, a secondary result of reduction of nasal base projection, or a consequence of maxillary abnormalities. A thorough clinical observation coupled with information procured from the analyzed lifesized photographs provides a consistent method for the evaluation of the alar base and the structures that affect its position. A critical step in choosing the surgical technique for correction is the classification of abnormalities. A systemic approach to such a classification is presented in this article and is accompanied by a description of the dynamic changes and optimal surgical procedures that would best benefit patients within each category.

Congenital Abnormalities↗

PubMed1995

Use of a rectus abdominis osteomyocutaneous double island flap based on internal mammary vessels.

A very rare condition of osteoma cutis was presented by a patient who required an unusual solution to an unusual problem. Multiple surgical procedures were performed during the treatment of the disease, thereby prohibiting the use of more common regional or distant flaps to achieve successful mandibular reconstruction. Microvascular tissue transfer was also not feasible because of two previously-failed free flaps and an operative field that was densely fibrotic. A pedicled rectus abdominis myocutaneous flap with incorporated vascularized rib graft is described as a last resort approach for simultaneous reconstruction of the mandible and oral soft tissue.

Adult↗

PubMed1995

Blepharolabioanal syndrome.

A previously unreported syndrome of congenital craniofacial and anorectal anomalies affecting a woman and her two daughters is described. Features include bilateral cleft lip, cleft palate, bilateral upper and lower lid lag, and imperforate anus. The findings are consistent with an autosomal dominant pattern of inheritance. There were no identifiable intrauterine fetal insults. A detailed description of these anomalies, the subsequent surgical corrections, and a discussion of previously unreported syndromes with isolated features are the subject of this report.

Abnormalities, Multiple↗

PubMed1995

Medical-grade tattooing to camouflage depigmented scars.

Scars are apparent, in part, as a result of the loss of cutaneous pigments. This disfigurement can be concealed successfully with medical-grade tattooing. This treatment was evaluated on 39 scars in 18 patients. The procedure was performed under local anesthesia on an outpatient basis, unless carried out in conjunction with other procedures. The medical-grade tattooing dye was selected during the initial consultation to match the skin color in a natural light ambiance. An electric tattooing machine was used to implant the medical-grade dye in the dermis. Successful concealment of the depigmented scars was achieved subsequent to the first procedure in all but 4 patients. Two of the 4 patients exhibited inadequate camouflage of scars, and 2 were judged to have excess pigmentation following treatment. Both these conditions required revision.

Adolescent↗

PubMed1995

Corrugator supercilii muscle resection through blepharoplasty incision.

Corrugator supercilii muscle resection through an upper blepharoplasty incision, with or without concomitant blepharoplasty, is suitable for patients who have significant corrugator hyperactivity and deep frown lines without eyebrow or forehead ptosis. This procedure is also appropriate for patients who decline a forehead rhytidectomy. After infiltration of local anesthesia with intravenous sedation, skin and fat are excised when a concurrent blepharoplasty is planned. The plane between the orbicularis oculi muscle and the orbital septum is dissected until the corrugator supercilii muscle is exposed. This muscle is identified immediately cephalad to the medial half of the superior orbital rim. The muscle is resected carefully to prevent injury to the supratrochlear nerve medially and the supraorbital nerve laterally. The resultant depression is eliminated with fat removed during the blepharoplasty, or fat or dermis from other sites should the aesthetic plan not include eyelid surgery. Eight patients, seven females and one male, underwent this procedure. The follow-up period ranged from 11 to 19 months, with a mean of 14.5 months. Patients' ages ranged from 25 to 66 years, with a mean of 51.3 years. A scale of 1 to 5, with 5 being excellent, was used to rate postoperative appearance, producing a mean of 4.25. The advantages of fewer skin incisions, less tissue mobilization, and a direct approach to the origin of the problem make this procedure a valuable adjunct to the cosmetic surgery armamentarium.

Adult↗

PubMed1995

The armamentarium to battle the recalcitrant nasolabial fold.

The nasolabial fold is the consequence of thinning of the skin, ptosis or deposition of fat laterally, and presence of excess skin. The ideal procedure for combatting this defiant and undesirable aging change would be to eliminate the excess skin, add to the thickness of the skin under the crease, and shield the bands from adherence to the dermis, with or without repositioning or resection of the fat laterally. However, under particular conditions, the patient or physician may choose alternative techniques. These include injection of fat, addition of fat graft, or direct excision. Patients with extremely thin skin are better candidates for direct excision, whereas those with thicker skin may more suitably benefit from fat injection or fat graft.

Adipose Tissue↗

PubMed1995

The chin: skeletal and soft-tissue components.

The quantity of soft tissue overlying the symphysis menti affords an important attribute that can aid in determination of the correct surgical approach for optimal facial harmony. Xerograms of the facial profile of 100 patients with normal occlusion were analyzed by accepted radiographic cephalometric techniques. The relative contribution of skeletal structures and soft tissue of the chin was evaluated. All linear measurements were noted to be larger in males than in females, but in both groups, facial features were in proportion. In both males and females, the average thickness of the soft tissue overlying the symphysis menti progressively increased from the B point to midway between the B point and the pogonion. The soft tissue at the pogonion was thinner than at the B point. The soft tissue over the chin in males was significantly thicker than in females in all areas measured. When compared with patients over 60 years of age, the soft tissue at the B point was significantly thinner in patients 50 years of age and younger (p = 0.005), while the soft tissue at the pogonion was significantly thinner in patients 40 years of age and younger (p = 0.04). Pseudomacrogenia was noted in 6 percent of the patients, a diagnosis only possible with cephalometric analysis. An understanding of the relative contribution of the soft tissue to the chin can aid in the diagnosis and appropriate surgical management of chin incongruity. Furthermore, there is significant variation in skin thickness, which will influence the soft-tissue response to skeletal alteration. This has to be considered in planning a predictable surgical result.

Adolescent↗

PubMed1994

Management of intraoperative nasal septal tears and perforations.

An organized technique for managing intraoperative septal tears was developed based on 98 patients who endured septal tears. Small nonopposing perforations are allowed to heal spontaneously. Opposing tears, with sizes varying from less than 1 cm to greater than 2 cm, are repaired first on one side of the mucoperichondrium with the reinsertion of a straight piece of septal cartilage; the other side of the mucoperichondrium is then repaired.

Female↗

PubMed1994

The fate of fresh and preserved, noncrushed and crushed autogenous cartilage in the rabbit model.

This study was conducted to investigate volume retention and chondrocyte survival rate in autogenous fresh noncrushed, fresh crushed, preserved noncrushed, and preserved crushed cartilage grafts in rabbits. During the first phase of this investigation, cartilage was harvested from the right ear of 20 New Zealand white rabbits, then preserved. Four months later during the second phase, two 6-mm discs of previously harvested and preserved cartilage, one crushed and one noncrushed, were applied to the right ear. At the same time, two 6-mm discs of fresh cartilage graft were harvested from the left ear and then placed at a higher level on the same side, one crushed and one noncrushed. Three months after implantation, the rabbits were sacrificed and the grafts were evaluated. The preserved noncrushed cartilage retained 91.34% of the volume (SD = 2.46). Although most of the chondrocytes were nonviable, vascular ingrowth occurred with a significant repopulation of chondrocytes peripherally, in association with vascular endothelial ingrowth. The preserved crushed cartilage retained 74.19% of the volume (SD = 3.06). Most of the original chondrocytes were lost, but vascular ingrowth did occur and some osteoid formation occurred on the crushed cartilages. All chondrocytes on the fresh noncrushed cartilage grafts were viable and the grafts retained 94.54% of the volume (SD = 2.46). Crushed fresh cartilage retained 69.73% of its volume and the amount of viable chondrocytes ranged from 70% to 90% in the specimens evaluated (SD = 5.15). Although there is no question that noncrushed cartilage is superior, crushed cartilage can be used with a fair degree of predictability to attain the aesthetic goal.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1994

The role of preserved autogenous cartilage graft in septorhinoplasty.

Previous reports have established the role of fresh autogenous cartilage grafts harvested at the time of surgery. This report describes the value of autogenous preserved cartilage, removed and stored at the time of initial surgery, for use in secondary surgery. This study also compares fresh and preserved cartilage used in crushed and noncrushed states in secondary rhinoplasties. From 1983 to 1990, 256 of 1,185 patients who had undergone septorhinoplasty required a revision procedure. Cartilage graft was used in 186 (72.7%) patients. Cartilage removed during the primary surgery was stored in a saline and antibiotic solution at 0 degree F to 2 degrees F. The average time interval from primary to secondary surgery was 11.97 months (SD, 10.63 mo). Follow-up after graft placement averaged 44.71 months (SD, 26.21 mo). Two hundred seventy-seven pieces of cartilage were used, consisting of 16 noncrushed fresh, 136 crushed fresh, 8 noncrushed preserved, and 117 crushed preserved. Graft success rate was 93.8% for noncrushed fresh cartilage grafts, 87.5% for crushed fresh, 87.5% for noncrushed preserved, and 85.5% for crushed preserved graft. We conclude that preserved autogenous cartilage retains almost as much graft volume as fresh cartilage in rhinoplasties and eliminates the need for harvesting a graft. Cartilage removed during nasal surgery, particularly when a septoplasty is being performed, is valuable and should be stored for possible later use.

Adult↗

PubMed1994

von Willebrand's disease and plastic surgery.

Von Willebrand's disease (VWD) is the most commonly inherited coagulopathy. In a group of 1,000 plastic surgery patients, 8 or 9 individuals are affected by this disease, making basic knowledge of VWD and its management imperative. In this investigation, 1,000 plastic surgery patients were studied for details of their clinical evaluation, history of bleeding and bruising, and excessive bleeding during or after surgery. If the patient reported a history of easy bleeding or bruising, in addition to routine coagulation studies such as PT, PTT, and platelet count, the bleeding time was measured. When the index of suspicion dictated, more extensive coagulation studies, such as factor VIII assay, were conducted. This resulted in the detection of VWD in 9 patients (8 female and 1 male). All patients had a positive history of easy bleeding or bruising. Six of the 9 patients had a bleeding time greater than 6 minutes. Seven patients were diagnosed to have VWD type I, 1 had type II-a, and 1 suffered from type II-b disease. Perioperative bleeding was controlled in all patients in this study with the administration of 0.3 microgram/kg of body weight (usually a total dose of 20 micrograms) of 1-deamino-8-D-arginine-vasopressin intravenously every 12 hours for the first 24 hours. Two patients with type II VWD required fresh frozen plasma and cryoprecipitate 1 week subsequent to surgery to control late bleeding.

Adolescent↗