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Biomedical subjects

D J David

Publications and source records attributed to D J David.

At least 19 recordsLinked to original sources
PubMed1992

Aggressive surgical management of sleep apnea syndrome in the syndromal craniosynostoses.

Obstructive sleep apnea syndrome (OSAS) frequently develops in patients with craniosynostosis and associated midfacial stenosis. In the past, conservative measures or tracheostomy have been used to manage this condition. Although the course of OSAS in these patients is multifactorial, a major factor is the marrow nasopharyngeal space. Aggressive surgical intervention to enlarge the nasopharyngeal space can reduce the severity of OSAS and therefore avoid the need for tracheostomy. Surgical approaches include adenotonsillectomy, uvulopalatopharyngoplasty, and midface advancement.

Child, Preschool↗
PubMed1991

Crouzon twins with cloverleaf skull malformations.

We describe unique monozygotic twins with Crouzon's disease and cloverleaf-shaped skull deformities who have been closely followed since birth. Their abnormal skull shapes were identified during antenatal ultrasound examination. The twins had gross exophthalmos and hydrocephalus with papilledema, so early calvarial decompression surgery was required. Although born to healthy parents of normal appearance, a third cousin of the twins had a milder form of Crouzon's disease, and there was a family history of high-arched palate on the twins' paternal side. Because Crouzon's disease is an uncommon condition and the cloverleaf skull shape is unusual in patients with Crouzon's disease, identical twins with this constellation of deformities must be exceptionally rare.

Airway Obstruction↗
PubMed1991

Craniofacial clefting and sutural dystopia.

Sutural anomalies in conjunction with craniofacial clefting are unusual. A case of median frontal clefting is presented in which there was an absence of a normal metopic suture and replacement by paramedian frontal sutures. The association of an underlying brain anomaly, with attendant surgical difficulties, is noted, as are the radiological techniques of preoperative diagnosis.

Abnormalities, Multiple↗
PubMed1991

The treatment of facial disharmony and malocclusion by jaw surgery. Case reports.

Examples are given of the Australian Cranio-Facial Unit's methods of dealing with facial disharmony and malocclusion by orthognathic surgery. Members of the Unit specialize in different aspects of craniofacial structure and function, and their teamwork is described. Treatment planning and assessment are illustrated by traditional cephalometric and other analytical procedures, and by pattern profile analysis. An appraisal is made of the Unit's increasing use of computer technology to facilitate these analyses, and to integrate various sources of information about facial disharmony.

Adolescent↗
PubMed1991

Frontofacial advancement with a free flap: deadspace versus drainage.

Presented is an adult case of Crouzon's syndrome undergoing a single stage frontofacial advancement where the employment of a microvascular free flap for extradural deadspace obliteration and to seal any communication with the nose may have contributed to the development of a major extradural infection.

Adult↗
PubMed1991

The missing maxilla: restoring aesthetic balance with mandibular surgery.

Traumatic loss of large portions of the maxilla remains uncommon. Reconstruction demands careful attention to both the anatomy of the primary deformity as well as the associated secondary changes if there is to be acceptable restoration of facial aesthetics and function. In concert with rebuilding the missing maxilla, reconstruction may frequently involve repositioning the apparently undisturbed mandible.

Adult↗
PubMed1990

Oblique craniofacial fractures in children.

The protected childhood environment and the anatomy of the craniofacial skeleton largely protect children from experiencing facial fractures. However, when major trauma to the head and face is sustained, an oblique pattern of fractures has been observed, distinct from those common in adults and explicable in terms of the anatomic differences between the child's and the adult's head and face. This difference in pattern of facial fracturing is relevant in terms of the examination, investigation and treatment of the primary injury, and prevention of any subsequent facial growth disturbances.

Accidents, Traffic↗
PubMed1990

Craniofacial deformation in cystic hygroma.

Mandibular and dentoalveolar deformities associated with cystic hygroma of the head and neck have previously been described. This small series has identified changes involving the entire craniofacial skeleton, attributable to both the local and distant effects of massive facial lymphangiomas, without evidence of any actual soft tissue ingrowth into bone. In view of the inability to excise such lesions and normalize the soft tissue anatomy, the surgical approach to the craniofacial skeletal abnormality should be to reserve the required osteotomies or ostectomies until the completion of facial growth.

Adolescent↗
PubMed1990

Application and comparison of techniques for three-dimensional analysis of craniofacial anomalies.

Traditionally, cephalometric analysis has been limited to data determined from two-dimensional (2-D) cephalograms. With imaging facilities such as CT and biplanar radiography now available, the natural extension has been towards the use of three-dimensional (3-D) coordinate positions of landmarks for comparative purposes. While these data have been potentially available for several years, the accurate and reproducible extraction of anatomic landmarks suitable for comparative purposes has been limited. This paper presents results of the application of traditional comparative techniques to well determined 3-D coordinate data acquired from biplanar radiography and CT for a patient with Treacher Collins syndrome and further provides a comparison with the technique of strain analysis, often referred to as finite element analysis, which has been applied recently to craniofacial data. Comparisons of distances and angles between landmarks, landmark coordinate positions, and strains of the patient relative to experimental reference standards reveal that the essential skeletal features of Treacher Collins syndrome have been identified and quantified by the analysis techniques. Further, a measure of the significance of the deviations has been determined by comparisons with the experimental reference standards.

Cephalometry↗
PubMed1990

Neuropsychologic outcome after craniofacial fracture.

Forty eight patients with facial fractures resulting from trauma were admitted to a Plastic Surgical Unit. The fractures were treated on standard lines and ten of the patients required craniotomy for CSF rhinorrhea or repair of depressed frontal fractures. Neuropsychologic assessment was carried out on all patients approximately 17 months after the initial injury. An assessment of the extent to which the trauma had affected the personality and social adjustment of each individual was also carried out at that time. In four patients there was no evidence of any neuropsychologic impairment on any of the tests administered. The neuropsychologic deficits were most noticeable in those who had suffered a cranial fracture. In patients with facial fractures but no evidence of cranial fractures, there was no association between neuropsychologic impairment and site of injury. Loss of consciousness was associated with poor social adjustment and a marked change in personality. The best predictor of subsequent neuropsychologic deficits and social maladjustment was found to be the Glasgow Coma Score at the point of admission to the hospital after injury. It is concluded that with this type of injury careful neuropsychologic assessment is important in identifying the subtle deficits that might otherwise remain undetected.

Adolescent↗
PubMed1990

Surgical correction of Crouzon syndrome.

This study analyzes the results of surgical treatment in 39 patients with the Crouzon syndrome. Early fronto-orbital advancement and craniectomy were universally successful in relieving raised intracranial pressure and in reducing ocular proptosis. However, definitive cosmetic correction was not achieved, and early cranial surgery was not able to prevent the development of midface hypoplasia. Thirty-two midfacial advancements have been performed in 30 patients. Sixteen patients had sufficient follow-up data for more than 2 years postoperatively. In all patients, a satisfactory early postoperative result was achieved. In the long-term follow-up group, 11 patients have maintained a satisfactory appearance, while 5 have developed recurrent deformity. Analysis shows this to be associated with a younger age at operation and continued mandibular growth. Frontofacial advancement in adults achieves good long-term results but is associated with a higher incidence of complications.

Adolescent↗
PubMed1990

Obstructive sleep apnea in Apert's and Pfeiffer's syndromes: more than a craniofacial abnormality.

Nine acrocephalosyndactyly type I patients (Apert's syndrome) and three acrocephalosyndactyly type V patients (Pfeiffer's syndrome) were evaluated for the relative importance of upper and lower airway abnormalities in the generation of obstructive sleep apnea. All patients were found to have a combination of upper and lower abnormalities. The influence of lower pathology was greater in the infants, and the influence of upper airway, specifically pharyngeal, was greater in the adults. A comparison between preoperative and postoperative polysomnography revealed little improvement with standard craniofacial advancements. Furthermore, three patients are described who succumbed to pulmonary death despite tracheostomy. Conservative treatment with prone or lateral positioning and medical pulmonary regimens is advocated. Finally, the pathogenesis of this diffuse airway pathology is discussed.

Acrocephalosyndactylia↗
PubMed1990

Monocortical non-compression miniplate osteosynthesis of mandibular angle fractures.

The technique of monocortical non-compression miniplate fixation of mandibular angle fractures is reviewed. A study of our first 50 patients treated using this technique reveals that consistent reduction and stabilization of these mandibular fractures can be achieved without the requirement for intermaxillary fixation. Such results were produced with minimal postoperative morbidity.

Adolescent↗
PubMed1990

Craniofacial osseous landmark determination from stereo computer tomography reconstructions.

The accurate and reproducible determination of the three dimensional (3D) co-ordinate positions of anatomical landmarks from computer tomography (CT) images has been limited even though potentially the data have been available for several years. This paper describes a method of acquisition of osseous landmark positions using an off-line computing technique based on multiple stereo images of 3D CT reconstructions. The use of stereo pairs greatly enhances the consistent identification of osseous landmarks. Further, the technique is of particular value where access to the CT scanner is restricted due to heavy clinical demand and separate high quality graphics facilities are unavailable. Osseous landmark position data were determined for dried skulls and patients with craniofacial conditions. Accuracies of the order 1.7mm (median) were obtained. These results encourage the use of the technique for acquisition of landmark positions for the study of the craniofacial complex in three dimensions.

Acrocephalosyndactylia↗
PubMed1989

Hydrocephalus in Crouzon's syndrome.

We reviewed 42 cases of Crouzon's syndrome. There were 16 cases with ventricular dilation. We believe that shunt should be inserted after fronto-orbital advancement if there are persistent signs of raised intracranial pressure. However, in cases presenting with severe ventricular dilation and papilloedema, a shunt is inserted prior to fronto-orbital advancement. Medium- or high-pressure systems should be used.

Cerebrospinal Fluid Shunts↗