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Biomedical subjects

B T Evans

Publications and source records attributed to B T Evans.

34 records · Page 2Linked to original sources

The orbitozygomatic infratemporal fossa approach: a quantitative anatomical study.

Using detailed cadaveric dissections this study has demonstrated and quantified the increase in exposure and additional access gained by using the orbitozygomatic infratemporal fossa approach for neurosurgical access. The surgical window of exposure can be increased by up to 300% when this technique is utilised to facilitate access via either a subtemporal (to access the P2 segment of the posterior cerebral artery) or transsylvian (to access the basilar bifurcation) approach. In addition the distance between the surgeon and the operative field can be decreased by approximately 2-3 cm. The orbitozygomatic infratemporal fossa approach is a relatively simple technique which can readily increase neurosurgical exposure of the skull base. It also provides simultaneous access to the infratemporal fossa, pterygopalatine fossa and the orbit.

Craniotomy↗

The transzygomatic approach: a long-term clinical review.

The transzygomatic approach has been utilised to improve access to the skull base, infratemporal fossa and orbit for a number of years. It provides a low anterolateral approach to the skull base, along the floor of the middle fossa. It allows both a transsylvian and subtemporal approach with a reduction in brain retraction and better exposure of adjacent neurovasculature structures. A long term review of 53 patients is presented highlighting outcome at two years post surgery and morbidity of the approach. It is concluded that the technique is versatile and can be used to improve exposure of a variety of anatomical locations. There is minimal long term morbidity attributable to the surgery of access and the majority of patients have had good outcomes.

Adolescent↗

Craniofacial osteotomies for skull base access.

During a five year period 150 craniofacial access osteotomies for skull base access have been performed allowing direct exposure of pathology in difficult anatomical acreas with minimal complications. These approaches have been developed by considering the craniofacial skeleton as a single osteoplastic structure. Bone segments are mobilised and replaced using rigid fixation. In this way osteotomies can be planned which significantly improve access and preserve form and function in the complex region of the skull base.

Adult↗

A multidisciplinary approach to tumours involving the orbit: orbital re-construction, a 3-dimensional concept.

Radical tumour removal in the region of the anterior skull base with involvement of the orbit requires not only good exposure but also acceptable reconstruction with good cosmesis, no visible scars and no injury to the eye. The possible approaches, which should be flexible and adapted to the location and extent of the pathology and the appropriate methods of reconstruction, are illustrated by four patients. The relevant literature is reviewed. Emphasis on the need for a 3-dimensional concept in the reconstruction and the importance of a multi disciplinary team is stressed.

Adult↗

Perforating vessel(s) of the orbital floor: a cadaveric study.

Brisk haemorrhage is occasionally encountered in subperiosteal orbital floor exploration. Personal experience of the authors of a vessel perforating the orbital floor in a roughly similar position in a number of cases prompted further study. Twelve fresh cadavers (24 orbits) were dissected specifically to identify any vessel(s) perforating the orbital floor. In this study a vessel was identified in 83% of the dissections.

Adult↗

The management of orbital roof fractures.

The nature and aetiology of orbital roof fractures is discussed and a strategy for their successful management outlined with reference to five clinical cases. Early recognition and treatment of these fractures reduces the high incidence of intra-cranial and ocular complications and the importance of a combined approach involving maxillofacial surgeons, neurosurgeons and ophthalmologists is emphasised. A coronal flap together with frontal craniotomy is recommended for surgical access to the orbital roof and overlying dura. When reconstruction is indicated, autogenous bone harvested from the inner table of the calvarium provides an ideal graft material.

Adult↗

The zygomatico-temporal approach to the skull base: a critical review of 11 patients.

The zygomatico-temporal approach to the base of the skull is a relatively new but established surgical technique. The approach involves the removal of the zygomatic bone to provide access to the skull base, middle cranial fossa, parasellar region and interpeduncular cistern with minimal brain retraction. An excellent view of the bifurcation of the basilar artery and suprasellar region is provided. The outcome of 11 patients undergoing this procedure is reported with particular reference to the post-operative morbidity and the cosmetic result.

Adenoma↗

Breastfeeding multiples.

Although breastfeeding two or more infants requires greater organization and presents a challenge to the family, it may in the long run save time. Fatigue, the greatest deterrent to breastfeeding multiples, is common among all new mothers. It is essential for the nurse to demonstrate all of the potential positions for feeding, to stress adequate nutrition, and to encourage getting help from others so that the mother has time to rest each day. Nurses are in an optimal position for influencing successful breastfeeding for multiple birth parents. The dearth of knowledge about breastfeeding twins or other multiples indicates the need for research in this area.

Breast Feeding↗

Effects of proprietary oral rinses containing chlorhexidine, hexetidine and benzydamine on the proliferation of human buccal epithelial cells in culture.

Cell cultures were established from small samples of buccal tissue, using a 3T3 fibroblast feeder-layer technique. After exposure to increasing dilutions of three proprietary oral rinses for 22 h or 2 h, the effects upon cell proliferation were studied by measurement of [3H]-thymidine incorporation into cellular DNA. Cell membrane damage was assessed by measurement of lactate dehydrogenase content. Cultures exposed to hexetidine-containing or chlorhexidine-containing rinses for 22 h at dilutions of 250-fold or lower showed almost complete inhibition of [3H]-thymidine incorporation. Cultures treated with benzydamine-containing rinse at the same dilutions showed no significant inhibition of incorporation. Exposure to the same dilutions of hexetidine- and chlorhexidine-containing rinses for 2 h resulted in 65% and 20% inhibition of incorporation, respectively. Lactate dehydrogenase content decreased to negligible levels after exposure to the rinse containing hexetidine at a 250-fold dilution, but was unaffected by the other two rinses. Thus dividing buccal epithelial cells in vitro may be adversely affected by exposure to certain commercial oral rinses.

Benzydamine↗