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Biomedical subjects

Chien-Tzung Chen

Publications and source records attributed to Chien-Tzung Chen.

16 recordsLinked to original sources
PubMed2007

A safe and effective way for reduction of temporomandibular joint dislocation.

Anterior dislocation of the temporomandibular joint (TMJ) is a common problem which demands immediate reduction to relieve the discomfort. The most popular technique is to put the operator's thumbs over the molar teeth of the patient and push the dislocated jaw downward and backward. This maneuver takes a lot of effort and usually needs sedation. Failure to reduction is not uncommon. Furthermore, the physician has to take the risk of being bitten and disease transmission. A novel method for reduction of the dislocated TMJ via extraoral route is presented, based on the observation that once the mandible is dislocated anteriorly, the coronoid process and anterior border of the ramus can be palpated easily over the cheek. By applying steady pressure over this prominent part, the anteriorly dislocated mandible can be reduced easily. From May 2000 to July 2005, there were 7 anterior mandible dislocations treated successfully by this method in Chang Gung Memorial Hospital. None of the patients need any adjuvant medication for sedation or relaxation. This technique is simple and effective, and the physicians are spared from the risk of bite trauma and unexpected disease transmission.

Adolescent↗
PubMed2006

Endoscopic approach to medial orbital wall fractures.

Repair of medial orbital wall fractures can be challenging with traditional open techniques. This article describes different endoscopic-assisted approaches-transcaruncular and intranasal-which have been used to successfully repair these fractures.

Endoscopy↗
PubMed2006

Free flap reconstruction of foot and ankle defects in pediatric patients: long-term outcome in 91 cases.

BACKGROUND: Free tissue transfer has not been fully adopted as the primary mode of treating foot and ankle defects in potentially indicated patients, partly because of the lack of sizable vessels and the potential in the long term of differential growth in the flap and the recipient site. Also lacking are long-term outcome studies in these growing patients. METHODS: Between 1989 and 2002, 91 children with 93 foot and ankle defects underwent microsurgical reconstructions. The patients underwent reconstruction with flaps with a cutaneous component or with muscle flaps (skin-grafted). RESULTS: Fifty-eight defects were reconstructed with cutaneous/musculocutaneous flaps (37 fasciocutaneous and 21 musculocutaneous flaps), and 35 were reconstructed with skin-grafted muscle flaps. Thirteen patients underwent secondary free flap surgery, for a total of 106 flaps used to complete the reconstructions. Twelve cases underwent reexploration, and overall survival was 95.3 percent (101 of 106). Secondary deformities were present in 37.9 percent of skin/musculocutaneous flaps and 58.9 percent of skin-grafted muscle flaps (p = 0.029). More resurfacing procedures were performed in skin-grafted muscle flaps than in skin/musculocutaneous flaps (32.4 percent versus 12.1 percent; p = 0.0386). CONCLUSIONS: Free tissue transfer in pediatric patients is a viable and reliable option. Skin/musculocutaneous flaps and skin-grafted muscle flaps both had equal survival rates; however, flaps with a skin component required fewer secondary procedures to correct deformities. Whenever a skin component was present, it provided useful tissue during the secondary procedure and minimized complications. For plantar foot reconstructions, skin-grafted muscle flaps demonstrated a higher incidence of trophic ulcers and a higher need for resurfacing procedures than flaps with a skin component. Reconstructions of tendons in the immediate setting led to fewer secondary operations than staged tendon reconstructions.

Adolescent↗
PubMed2006

Frontal sinus fractures: a treatment algorithm and assessment of outcomes based on 78 clinical cases.

BACKGROUND: The purposes of this article were to retrospectively review frontal sinus fractures at the authors' center, to assess the final outcomes, and to establish a treatment algorithm. METHODS: A retrospective chart review was performed on 78 consecutive frontal sinus fractures treated by the same surgeon between January 1, 1994, and January 1, 2002. RESULTS: In this study, 57.7 percent of fractures occurred as a result of motorcycle accidents and 75.6 percent of those patients were not wearing helmets at the time of injury. The use of helmets did not significantly affect the fracture pattern. Frontal sinus fractures were commonly associated with orbital fractures (71 percent), intracranial injuries (39 percent), and severe ophthalmic injuries (26 percent). Associated injuries were more common when the fractures involved the posterior tables. The method of management comprised four groups: no surgical intervention (n = 6), open reduction and internal fixation of the anterior table with sinus preservation (n = 40), partial sinus obliteration (n = 18), and cranialization (n = 14). The complication rate was 16.7 percent (n = 13), including postoperative cerebrospinal fluid leaks (n = 6), wound infections (n = 4), meningitis (n = 1), sinusitis (n = 1), and pyomucocele (n = 1). CONCLUSIONS: Involvement of the nasofrontal duct and persistence of cerebrospinal fluid leaks are two key determinants of the treatment algorithm. The amount of displacement of the posterior table has not been found to be a key determinant of the need for surgical intervention. When the sinus is to be obliterated, partial obliteration can achieve a good result, with limited sinus complication and minimal donor-site morbidity.

Adolescent↗
PubMed2006

Lateral circumflex femoral artery system: warehouse for functional composite free-tissue reconstruction of the lower leg.

BACKGROUND: Microsurgical free-flap surgery has progressed from simply providing wound coverage to restoring a high level of function. The concepts and practice of using compound, composite, and chimeric flaps have recently further enhanced the versatility of free flaps in reconstructive surgery. A lateral circumflex femoral arterial (LCFA) system can provide a potential single composite free-tissue transfer for restoration of functional and structural integrity. METHODS: Between 1997 and 2003, we used 44 free flaps to restore functional and structural defects in the lower limbs. The versatility of the LCFA system allowed utilization of the anterolateral thigh, vastus lateralis, tensor fascia lata, rectus femoris, and iliac crest. Combinations of tissues from this system were employed to restore defects in the patellar tendon (14), Achilles tendon (13), extensor hallucis tendon (2), anterior compartment with/without lateral compartment muscle (11), anterior compartment muscle and segmental tibial bone (3), and composite calcaneus (1). RESULTS: The free-flap success rate was 97.7%. Four re-explorations were performed with one subsequent failure. Eight patients (18.2%) developed wound infections, of which two required secondary amputations, resulting in a limb salvage rate of 95.4%. CONCLUSION: The LCFA system provides a predictable and versatile surplus of tissue necessary to restore functional and structural integrity of the posttraumatic lower extremity in a single stage.

Femoral Artery↗
PubMed2004

Outcome for traumatic optic neuropathy--surgical versus nonsurgical treatment.

This study was performed to identify factors that can affect the final outcome and to recognize the proper management for patients with traumatic optic neuropathy (TON). This retrospective study included 42 consecutive patients with TON after maxillofacial trauma. Megadose methylprednisolone was administered to all patients during the first 3 days after diagnosis. Twenty-four patients received treatment with megadose steroids combined with optic nerve decompression and the remaining 18 with megadose methylprednisolone alone. Initial visual acuity (IVA) was the statistically significant factor affecting the outcome of TON (P = 0.006 for improvement rate). Patients treated within 7 days after injury had a better improvement degree, P = 0.056. Patients in a surgical group with an IVA of no light perception (NLP) had a better improvement rate and degree (31.3%; 59.34 +/- 22.18%) than those in nonsurgical group (0%, 0%; P = 0.272). Initial visual acuity is the critical factor that affects the outcome of TON. Surgical optic nerve decompression is considerable in maxillofacial trauma patients with an IVA of NLP.

Adolescent↗
PubMed2004

Composite palmaris longus-venous flap for simultaneous reconstruction of extensor tendon and dorsal surface defects of the hand--long-term functional result.

Soft tissue loss in the dorsum of the hand resulting from trauma often involves the extensor mechanism due to its thin skin coverage. When such composite skin and extensor tendon defects occur, the wound could be reconstructed with an ipsilateral forearm venous flap with accompanying palmaris longus tendon. Eighteen dorsal finger defects in 12 patients underwent composite venous flap and tendon transfers in the acute stage. We used both Buck-Gram-cko and Tubiana's methods for objective functional assessments. With the former method, the average composite flexion, extension deficit, and total active motion were 207.2 degrees, 39.0 degrees, and 164.7 degrees, respectively. The average score was 12.1 points, which qualified for a "good" result. With Tubiana's method, the average active flexion was 4.9, and the average extension defect was 2.3. The average score was 7.2 point, which also qualified for a "good" result. Thus, a one-stage composite forearm venous flap could be used to reconstruct dorsal skin and tendon defects of the finger with a predictably good functional outcome.

Acute Disease↗
PubMed2004

Endoscopically assisted removal of tumors in the frontal region.

BACKGROUND: Advancements in endoscopic surgery, due in part to patient demands and in part to provision of superior medical care by surgeons, have significantly contributed to improvements in patients' quality of life. An endoscopic operation is minimally invasive, associated with faster recovery, and produces less postoperative morbidity. It is a well-accepted procedure in the field of plastic surgery. By applying the principle of endoscopic surgery used in facelift operations, we performed tumor excision in the forehead region. METHODS: Two 1.5-cm slit incisions were made in the anterior hairline. One incision was to allow access for the 4.0-mm, 30 degrees endoscope, and the other was for surgical instrumentation. These incisions, determined by the plane of dissection, were more superficial and below the subgaleal layer for soft tissue tumors and deeper into the subperiosteal layer for bone tumors. With good illumination and magnified monitor viewing, the tumors could clearly be visualized and were completely excised. RESULTS: Seven patients with either dermoid cysts (3), osteomas (2), or lipomas (2) underwent endoscopically assisted procedures. In all cases, tumors were successfully excised with no acute or chronic complications. The average postoperative follow-up period was 7 months. No incidence of tumor recurrence was reported. All patients were satisfied with the resultant forehead contour and surgical scars. CONCLUSIONS: The main advantage of this procedure is the fact that it is minimally invasive, thus reducing the incidence of injury to the neurovascular structures of the forehead as well as minimization of scar visibility. In conclusion, an endoscope-assisted approach is a good alternative method for managing benign soft-tissue and bone tumors in the forehead and brow region.

Adolescent↗
PubMed2003

Endoscopic orbital surgery.

Various applications of endoscopy to orbital surgery are described in this article. The endoscopic approach offers improved surgical exposure, enhanced illumination, simultaneous visualization of operative field by multiple members of surgical team, and superior cosmesis compared with conventional surgical interventions. The procedure can be performed with minimal morbidity. The endoscopic orbital surgery, however, is technique dependent and should be performed only by surgeons who are familiar with orbital anatomy and basic endoscopic technique. It would be beneficial to surgeons to have previous experience in the traditional technique before adopting endoscopic orbital surgery to their armamentarium.

Decompression, Surgical↗
PubMed2003

Endoscopically assisted repair of frontal sinus fracture.

BACKGROUND: Classic approaches to frontal sinus fracture involve bicoronal or direct forehead incisions. However, these incisions cause paresthesia, scarring, and even alopecia. In the field of plastic and reconstructive surgery, endoscopically assisted surgery is now widely accepted, particularly for esthetic surgery. It also is applied for the management of midface and lower-face fractures, but rarely for treatment of the frontal area. The authors present their experience with the repair of frontal sinus fractures using the endoscopically assisted method. METHODS: The surgery was performed with the patients under general anesthesia. Two slit incisions were placed in the hair-bearing area, through which a 4-mm 30 degrees endoscope was inserted. The subperiosteal dissection was performed toward the fracture site using an endoscopic periosteal elevator. The depressed fracture segments of the anterior table of the frontal sinus were reduced and fixed with microplates to restore the contour of the forehead. Seven consecutive patients received endoscopic correction of frontal sinus depressed fractures. RESULTS: No patients required conversion conventional bicoronal incisions. Good anatomic reduction of the fracture sites, acceptable surgical scar, and esthetic recontour were obtained in all the patients. The postoperative course was uneventful, without any complications. CONCLUSION: The endoscopically assisted method allows feasible reduction and fixation of a frontal sinus fracture. It avoids the complications of traditional methods and yields improved convalescence and esthetic results. It also helps in the diagnosis of unsuspected cerebrospinal fluid leaks. Thus, for anterior table fractures with an intact nasofrontal duct, endoscopically assisted surgery provides an alternative option of treatment.

Adult↗
PubMed2003

Spontaneous bone regeneration of the mandible in an elderly patient: a case report and review of the literature.

Spontaneous bone regeneration is an unexpected phenomenon that may take place in large mandibular defects secondary to trauma and tumor resection. One explanation for this unusual healing course is that it may be derived from the mechanism of fracture healing. A review of the literature presents several factors that may influence this process, such as the presence of periosteum and bony fragments, mandibular stabilization, soft tissue protection, the presence of infection, and a young age. Previous reports of spontaneous mandibular regeneration have all taken place in relatively young patients (5-35 years old). This paper reports a case of spontaneous bone regeneration in a 58-year-old woman who sustained an injury to her mandible from an explosive blast, and presents some explanations on how such an event could take place.

Bone Regeneration↗
PubMed2002

Functional results of unilateral mandibular condylar process fractures after open and closed treatment.

BACKGROUND: This retrospective study compared the functional results of unilateral mandibular condylar process fractures treated either by open reduction or by closed treatment. METHODS: Sixty-six patients with unilateral mandibular condylar process fractures were reviewed. Thirty-six patients received open reduction, and the other 30 underwent closed treatment (intermaxillary fixation only). Each group was further divided into condylar and subcondylar subgroups according to fracture level. The functional outcome was evaluated by posttreatment occlusion status, maximal mouth opening, facial symmetry, chin deviation, and temporomandibular joint symptoms. RESULTS: Patients undergoing closed treatment exhibited more condylar motility than those treated by open reduction. Patients in the condylar subgroup with open reduction presented less chin deviation (21.43%) compared with those with closed treatment (56.25%; p = 0.072). Although a greater severity of subcondylar fractures existed in patients treated with open reduction, patients treated with open reduction or closed treatment did not reveal a significantly functional difference. CONCLUSION: The present study revealed that patients with condylar neck or head fractures gained more benefits from open reduction in terms of chin deviation and temporomandibular joint pain. For subcondylar fractures, open reduction provides satisfactory functional results in patients with severely displaced fractures.

Adolescent↗
PubMedDate not supplied

Management of posttraumatic enophthalmos.

Posttraumatic enophthalmos is one of the common sequelae that appears after facial injury and remains a challenge to treat for craniomaxillofacial surgeons. Several theories have been advocated regarding enophthalmos; however, the most well accepted concept is the enlargement of the orbital cavity after displacement due to orbital fractures. Generally, a 1 cm3 increase in orbital volume causes 0.8 mm of enophthalmos. Thorough knowledge of the orbital anatomy is fundamental and critical for the successful surgical correction of enophthalmos because most treatment failures are due to inadequate orbital dissection from fear of injuring the optic nerve and globe. A complete preoperative plan should be built on a comprehensive clinical examination of the periorbital soft tissue and bony components, detailed ophthalmic examination, and high resolution computed tomography scans in the axial, coronal and reformatted sagittal planes. Based on the anatomic deformities, there are two major fracture types including orbital blow out fractures and zygomatico-orbital fractures, resulting in posttraumatic enophthalmos. Treatment modalities and methods of approach are adapted according to the severity of the orbital deformities. Minor complications include ectropion, entropion, dystopia, diplopia, and residual enophthalmos. Rare but severe complications such as intraconal misplacement of the bone graft or retrobulbar hemorrhage with subsequent blindness may be encountered. The success of the procedures depend on adequate dissection and mobilization of the displaced soft tissue, correct repositioning of the dislocated or malunited bony orbit, and proper intra-orbital grafting.

Enophthalmos↗
PubMedDate not supplied

Vastus lateralis muscle flap used for reconstruction of the maxilla after radical resection of recurrent ameloblastoma.

Maxillary ameloblastoma is a benign odontogenic neoplasm. Excision should involve wide margins because of its high recurrence rate and, ideally, be followed by reconstruction. A 23 year-old female patient presented with recurrent ameloblastoma. Two years previously, she had undergone a curettage excision. The recurrent lesion was managed by a total maxillectomy including inferior orbital rim. Simultaneous reconstruction was performed with an iliac crest bone graft for the orbital floor, and a vastus lateralis muscle flap for obliteration of the maxillary sinus and repair the oral and nasal cavities. The transferred vastus lateralis muscle already had spontaneous mucosalization over its surface two weeks after surgery. Postoperative follow up after fourteen months revealed no recurrence and no diplopia. The patient was satisfied with her appearance. The use of a single vastus lateralis muscle flap to repair both oral and nasal cavities is advantageous. It helps avoid hyper-nasal speech and maintain the stability of removable partial dentures. The conventional iliac bone graft supported by a well vascularized muscle eventually survived and provided a good functional and cosmetic result.

Adult↗