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Biomedical subjects

B L Eppley

Publications and source records attributed to B L Eppley.

At least 109 records · Page 6Linked to original sources
PubMed1991

Microanatomic analysis of the trigeminal nerve and potential nerve graft donor sites.

A histologic study was undertaken to define the microanatomic characteristics of two commonly injured peripheral trigeminal nerve branches (lingual and mandibular nerves) and the two nerves most frequently procured for use in their interpositional graft repair (sural and greater auricular nerves). Nerves, obtained from fresh human cadavers, were evaluated for total fascicular area, fascicle number, axon number, axon size, and axon density. The peripheral branches of the trigeminal nerve (third division) were morphometrically similar, with only a slight decrease in axon density in the lingual nerve. Comparisons between the donor nerves, however, showed numerous discrepancies at the axonal level. While the fascicular area of the sural nerve was only slightly smaller, axon numbers and densities were only one-half that of the trigeminal nerves. Although the greater auricular nerve was appreciably smaller in overall size, a much better correlation existed with the trigeminal nerve in axonal qualities. These microanatomic findings raise questions about the potential capability of these graft choices to optimally restore axonal connections between nerve ends in trigeminal nerve repair.

Axons↗
PubMed1991

A comparison of human recombinant tissue-type plasminogen activator and urokinase in microsurgical thrombolysis in the rat.

A comparison was made between several characteristics of tissue-type plasminogen activator (t-PA) and urokinase (UK), potentially useful in microsurgery to restore perfusion to ischemic free-tissue transfers. An intraarterial infusion of one of the drugs (or normal saline [NS] as a control) was performed in conjunction with a rat femoral vein clot model. Both t-PA and urokinase were effective in lysing 100 percent of the venous clots on the side of infusion. This occurred in only 25 percent of controls (p = .0035). Thrombolysis on the contralateral side, a measure of systemic effect, occurred in 38 percent, 50 percent, and 13 percent of veins using t-PA, UK, and NS, respectively (t-PA vs. UK p = 1.0, t-PA vs. NS p = .28, UK vs. NS p = .14). Rethrombosis occurred in 13 percent and 25 percent of ipsilateral veins treated with t-PA and urokinase, respectively, and in one of the two veins that had resumed flow during saline infusion (t-PA vs. UK p = .30) Scanning electron microscopy was performed 4 hr and 48 hr after thrombolysis. No differences between thrombolytic agents was noted in terms of residual thrombus and vessel characteristics. The data suggest that t-PA and urokinase are effective, with no clear advantage of one agent over the other.

Anastomosis, Surgical↗
PubMed1991

Microfixation techniques in pediatric craniomaxillofacial surgery.

Microfixation represents a technical advance that has been developed for the specific needs of the infantile and pediatric craniomaxillofacial skeleton. The microplates provide significant skeletal stability despite their size and are relatively easy to apply and adjust after placement. The advantages and the technical aspects of microfixation use versus those of minifixation in smaller skeletal structures are presented. The range of applications in pediatric craniofacial surgery is demonstrated and reviewed in our series of 65 children, with a greater than 1-year follow-up.

Bone Plates↗
PubMed1991

Obstructive congenital epulis in a newborn.

A neonate, with a rare, large, congenital epulis of the anterior maxilla, which resulted in oral feeding obstruction, is presented. Due to its easy accessibility, narrow pedicle to the alveolus, and benign clinical behavior, permanent eradication of the tumor by simple excision under local anesthesia was performed.

Female↗
PubMed1991

Free bone graft reconstruction of irradiated facial tissue: experimental effects of basic fibroblast growth factor stimulation.

A study was undertaken to evaluate the potential utility of basic fibroblast growth factor in the induction of angiogenesis and osseous healing in bone previously exposed to high doses of irradiation. Thirty New Zealand rabbits were evaluated by introducing basic fibroblast growth factor into irradiated mandibular resection sites either prior to or simultaneous with reconstruction by corticocancellous autografts harvested from the ilium. The fate of the free bone grafts was then evaluated at 90 days postoperatively by microangiographic, histologic, and fluorochrome bone-labeling techniques. Sequestration, necrosis, and failure to heal to recipient osseous margins was observed both clinically and histologically in all nontreated irradiated graft sites as well as those receiving simultaneous angiogenic stimulation at the time of graft placement. No fluorescent activity was seen in these graft groups. In the recipient sites pretreated with basic fibroblast growth factor prior to placement of the graft, healing and reestablishment of mandibular contour occurred in nearly 50 percent of the animals. Active bone formation was evident at cortical margins adjacent to the recipient sites but was absent in the more central cancellous regions of the grafts.

Animals↗
PubMed1991

Orbital teratoma associated with trigonocephaly.

A rare case of congenital orbital teratoma that developed concurrently with the clinical findings of metopic sutural synostosis in an infant is presented. A cause-and-effect and/or embryologic relationship between these two cephalic malformations is possible, although coincidental occurrence is equally probable. The proximity of these congenital anomalies permitted complete resolution in a one-stage craniofacial procedure without alteration in the surgical technique.

Craniosynostoses↗
PubMed1991

Hemifacial microsomia: assessment of classification systems.

Hemifacial microsomia (HFM) represents a spectrum of congenital malformations involving embryological derivatives of the first and second branchial arches. The multiple anomalies that may exist in HFM present considerable variability in patients with the diagnosis. Numerous classification systems have been devised to facilitate the individualized components of this complex condition. Because multiple HFM classification systems exist, their utility is frequently confusing and selection of a particular system is indeterminate. Several of the better known systems are evaluated using patients with variable expressivity of HFM. This review suggests that there currently exists no ideal classification system for this association of developmental malformations. The systems that were found to be most complete are acknowledged and recommendations or modifications are suggested.

Abnormalities, Multiple↗
PubMed1990

An improved draping method for otoplastic surgery.

An alternative method of draping of the ears is presented in which a mesh gauze dressing is used as an adjunctive method for restraining hair from the surgical field. Its use is rapid and permits exposure and visibility of the ears bilaterally.

Ear, External↗
PubMed1990

Experimental effects of graft revascularization and consistency on cervicofacial fat transplant survival.

An experimental study evaluating the contributions of graft composition (particulate vs. whole) and revascularization (immediate reanastomosis vs. delayed) to cervicofacial fat transplantation was conducted in rats. Distant (inguinal fat) grafts were bilaterally transplanted to a muscular bed in the cervicofacial region as a free flap (anastomosis to carotid and jugular vessels) or as a free graft (either particulate or whole). Postoperative assessment was made by comparison of pre- and post-operative weights and histologic examination of all specimens, and by acrylic microangiography in select animals of each group. The fat flaps exhibited minimal loss of tissue volume, and showed a normal histologic appearance of the adipocytes and extensive vascular elements within the grafts. Conversely, considerable volume loss occurred in both the particulate and whole fat grafts. Histologically, the free graft was characterized by cellular disruption, atrophic adipocytes, and areas of acellularity. Whole grafts had histologic evidence of vessels located primarily at the periphery, whereas particulate grafts had increased intragraft vessels. Only the fat flaps showed observable intragraft vasculature by microangiography. These findings suggest that reduction of fat grafts into smaller components, eg, by liposuction harvesting, does not improve graft survival or decrease posttransplant resorption.

Adipose Tissue↗
PubMed1990

Stimulation of craniofacial and intramedullary bone formation by negatively charged beads.

To test for their osteogenic stimulating capacity, charged beads were implanted into cranial or mandibular defects, used as an onlay on the nasal bone surface, or injected into femoral medullary cavities of young adult rats. One month later, negatively charged beads were found to have stimulated extensive bone formation resulting in closure of craniofacial defects, a new layer of bone on the nasal bone surface, and a bead-bone lattice within marrow cavities of long bones. Positively charged beads were nonosteogenic, but elicited a pronounced fibroblastic response in the craniofacial skeleton. Positively charged beads were found associated with multinucleated giant cells at all implantation sites. Uncharged beads failed to elicit formation of new bone and were associated with connective tissue that was less cellular and less organized than was seen with positively charged beads. It was concluded that beads that have ben chemically treated to confer either a negative or positive surface charge, when placed in contact with bone, evoke osteogenesis or formation of dense connective tissue, the response depending on the surface charge of the bead. The mechanism(s) by which the charged beads foster the osteogenic or fibroblastic response is not clear. The use, however, of alloplastic materials with charged surfaces in repair and augmentation of bone, and in wound repair, warrants further investigation.

Animals↗
PubMed1990

Cutaneous approaches to the orbital skeleton and periorbital structures.

Multiple cutaneous approaches to both the superior and inferior orbit have been reviewed. Incisional choices are optimally based on both facial esthetics and orbital function, which are achieved by an understanding of the unique anatomy of this region. The superior orbit is best approached by a blepharoplasty (lid crease) incision in conjunction with a lateral extension if additional exposure is necessary. Almost all aspects of the bony orbit can be reached with the exception of the frontal bone superior to the supraorbital rim. When wide exposure of the orbital skeleton is necessary, a bicoronal scalp flap is most effective in a nonalopecic patient. The inferior orbit can be approached by a ciliary, blepharoplasty, or conjunctival incision with a lateral canthotomy. None has proven esthetic advantages over the others, with the exception of the conjunctival incision when used alone. The lid incisions must be used with the understanding that orbital function must be assessed both pre- and postoperatively and meticulous attention paid to protection and care of the anterior globe. In addition, because of the thinness of the tissues being manipulated, edema, bruising, and final settling of lid form may require more postoperative time than is typical of more peripheral approaches.

Conjunctiva↗
PubMed1990

Total scalp, ear, and eyebrow avulsion: aesthetic adjustment of the replanted tissue.

A case of successful replantation of a total scalp avulsion, including both ears and one eyebrow, is presented with bilateral anastomoses to the superficial temporal vessels. While over 90 percent of the replant survived, partial loss of occipital and posterior neck skin and the inferior half of the left ear occurred. The patient subsequently required additional procedures, including skin grafting, scar revisions, and staged ear reconstructions. Thus, while microsurgery often provides the only hope for tissue salvage, there is a frequent need for additional revisions and aesthetic adjustment of portions of the replanted tissue.

Adult↗
PubMed1990

Effects of material porosity on implant bonding strength in a craniofacial model.

Alloplastic craniofacial implantation is a developing surgical option. Several alloplastic materials are available with a porous feature. While porosity may permit bone ingrowth, it is unclear whether it offers improved implant fixation over that of nonporous bone substitutes in the craniofacial skeleton. Bilateral mandibular ramus defects were created and reconstructed with porous and nonporous block implants in the mature rabbit. At 3, 6, and 12 months postoperatively, the mandibles were removed and prepared so that only the bone-implant interface connected the proximal and distal segments. The anterior mandible was then loaded to destruction. The fatigue load (in kg) for each implant was obtained and statistically compared. Significant differences in fatigue loads between the implant types occurred at all postoperative periods with the porous block material consistently exhibiting the greater resistance to separation. Resistance to fatigue fracturing for either implant type did not increase after the sixth postoperative month.

Acrylic Resins↗