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Biomedical subjects

B L Eppley

Publications and source records attributed to B L Eppley.

At least 37 records · Page 2Linked 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↗
PubMed1999

Craniofacial correction of giant frontoethmoidal encephalomeningocele.

The surgical treatment of a very large anterior encephalocele in an infant is presented. Because of the large size of the encephalocele, a combined transfacial-transcranial approach was used for correction of the associated intracranial, cranioorbitonasal bone, and facial skin deformities.

Craniotomy↗
PubMed1999

Resorbable PLLA-PGA screw fixation of mandibular sagittal split osteotomies.

The purpose of this study was to evaluate the intraoperative placement and clinical effectiveness of resorbable copolymeric screws for mandibular sagittal split ramus osteotomies. Thirty-seven patients who underwent bilateral sagittal split osteotomies of the mandible were fixated with three 2.5-mm copolymeric poly-L-lactic-polyglycolic (PLLA-PGA) screws on each side. No postoperative maxillomandibular fixation was applied. Twenty-five patients experienced mandibular advancement and 12 patients had setbacks. The average advancement was 6.5 mm (range, 3-17 mm) and the average set-back was 5.2 mm (range, 3-8 mm). Intraoperative placement was uncomplicated and no screws were stripped during placement. No problems in immediate postoperative stability were encountered and relapse was not evident in any patient. Follow-up ranged from 3 to 17 months. The screw holes remained evident radiographically after 1 year. Two and one-half-millimeter copolymeric PLLA-PGA resorbable screws for mandibular ramus osteotomies appear to offer clinical results comparable with metallic screw fixation.

Absorbable Implants↗
PubMed1999

Preventing postoperative noise in saline breast implants.

The occurrence of postoperative noise in saline breast implants is caused by inadvertent retention or injection of air during filling at the time of implantation. A volume of air as small as 2 cc in most breast implant sizes can result in this phenomenon. A simple method of prefilling and aspiration of saline before implantation can completely eliminate the possibility of its postoperative occurrence.

Breast Implantation↗
PubMed1999

Alloplastic implantation.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Define an alloplastic material and know the differences between an alloplast and other types of implants available for surgical use. 2. Determine the biologic response to alloplastic implantation and the material and host characteristics that contribute to long-term reconstruction success with their use. 3. Review the criteria for choosing a specific alloplastic material for a reconstruction site and the principles of surgical technique for its proper placement. 4. Evaluate the various alloplastic material types that are currently available for surgical use and be able to discuss several physical properties of each as they relate to handling and clinical implantation. 5. Discuss the complication of alloplastic infection, its pathogenesis, preoperative and intraoperative measures for its avoidance, and the postoperative management of its occurrence.

Biocompatible Materials↗
PubMed1998

Use of a resorbable fixation technique for maxillary fractures.

The use of nonmetallic rigid fixation (plate and screws) composed of resorbable polymers (poly L-lactic acid and polyglycolic acid) for the repair of isolated maxillary (LeFort I) fractures was studied in 11 patients. Provided good bone (noncomminuted) was available for fixation placement, no differences were observed in intraoperative maxillary stability or long-term postoperative results.

Absorbable Implants↗
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

Nonmetallic fixation in traumatic midfacial fractures.

The possibility of resorbable plate and screw fixation devices that provide adequate strength to allow facial fracture healing and are completely degraded thereafter has long had significant appeal. Favorable clinical experiences, however, have been very limited, and their use in the traumatized facial skeleton has yet to be proven a useful technology in the actual patient. In this regard, we review our experience in the management of orbital, zygomatic, and maxillary skeletal injuries with resorbable fixation.

Absorbable Implants↗
PubMed1997

Degradation characteristics of PLLA-PGA bone fixation devices.

Parietal craniotomies of the mature rabbit skull were repositioned and fixed with resorbable plate and screws made of LactoSorb (Walter Lorenz Surgical, Jacksonville, FL) poly L-lactic acid (PLLA) and polyglycolic acid (PGA) in 20 mature rabbits. Changes in the resorbable devices as well as at the tissue-implant interface were evaluated at 2, 6, 9, and 12 months postoperatively. At 2 months, no change in the size of the implants was seen with a noninflammatory layer of surrounding fibrous tissue and intense birefringence of the screws. At 6 months, substantial loss of implant size had occurred, accompanied by fibrovascular and a macrophage cellular infiltrate. At 9 months, more than 95% of the implant was resorbed, with a small amount remaining in the screw hole. Other than macrophages within the remaining material, very few giant cells were seen. By 1 year, no evidence of birefringent macromolecular polymer debris could be found. No contraindications for the clinical use of this specific PLLA-PGA copolyer could be found when implanted on craniofacial bone surface.

Absorbable Implants↗
PubMed1997

Acrocephalosyndactyly syndromes: a review.

Over the last quarter century, a revision has taken place in the classification of the acrocephalosyndactyly syndromes. This reflects the advances in molecular biology that have led to improved genetic mapping of these syndromes. In this review we provide an overview of these major acrocephalosyndactyly syndromes, including the current classification system. The craniofacial, neurological, cardiac, pulmonary, visceral, and extremity anomalies are discussed with special emphasis on hand anomalies. Hand reconstruction techniques, including specific surgical procedures, the timing of the surgical reconstruction, and postoperative therapy are discussed. The need for coordinated care of the multidisciplinary disorders of these patients cannot be overemphasized, especially in the perioperative period.

Acrocephalosyndactylia↗
PubMed1997

Resorbable fixation plates in head and neck surgery.

A skeletal fixation system employing plates made of polylactic and polyglycolic acid has been employed at Indiana University Medical Center since July 1993 in 105 craniofacial reconstructions, 45 cases of maxillofacial trauma, 10 craniotomy flap repairs, and five cases involving reconstruction of the laryngotrachea. Because these plates eventually resorb, they offer significant theoretical advantages. No inhibition of structural growth should occur when using this system in children. Tissue tolerance of these plates has been excellent. The technical details of using heat to allow reshaping of the plates as well as the methods of fixation of the plates are discussed.

Bone Plates↗
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↗