Biomedical subjects
Publications and source records attributed to D S Precious.
Steroid acne is a common unwanted effect in patients undergoing corticosteroid therapy. Eight women in a series of 1276 adult patients had acne after orthognathic surgery in which short-course parenteral corticosteroid therapy was used to reduce postoperative swelling. Steroid-induced acneiform eruption is different from acne vulgaris in that the former usually resolves on its own, without scar formation, after withdrawal of the drug.
The form of the anterior mandible in 45 patients was assessed before, immediately after, and 1 year after genioplasty. A specific, consistent pattern of bone apposition and resorption was observed after advancement genioplasty. A consistent but inverse apposition-resorption pattern was observed after reduction genioplasty. In view of the observed pattern of bony change, it is recommended that fixation devices for genioplasty be placed in areas of future bone deposition.
Mandibular symphyseal bone (MSB) is useful in alveolar cleft grafting and orthognathic surgery. This paper reports on the application and techniques using MSB.
In part I of this critical review of the literature on the risks and benefits of removing impacted third molars, we have dealt with: I--Risks of non-intervention. This second part is about: II--Risks of intervention, III--Benefits of non-intervention, and, finally, IV--Benefits of intervention.
Because of the ever-increasing enthusiasm that new graduates have demonstrated for practising minor oral surgery procedures, the authors believed that it would be useful to translate the results of a research project done in 1990 by Drs. David S. Precious and Paul Mercier, who are well-known oral and maxillofacial surgeons. This paper is about the risks and benefits associated with the removal of impacted third molars.
A modified outline of Lefort 1 osteotomy using an "inverse step" design is proposed which ensures simple and effective down-fracture and pterygo-maxillary separation. Osteosynthesis of the mobilized fragment is facilitated due to the improved contact of bone surfaces, particularly laterally. Combined rigid and supple osteosyntheses allow some degree of post-operative adjustment.
Inadequate primary surgery, or a failure to establish muscular balance of the anterior face, causes muscular dysfunction. Muscular dysfunction has a nefarious effect on subsequent facial growth. Establishment of muscular balance, as early as possible, provides the best foundation for good esthetics.
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Cardiac asystole, bradycardia and other dysrhythmias are complications associated with surgery of the craniofacial and maxillofacial structures. These dysrhythmias have been discussed frequently in ophthalmology but less attention has been paid to this problem in the maxillofacial surgery literature. Eight patients, 6 men and 2 women, who underwent maxillofacial surgery during a 16-month period at the Victoria General Hospital, Halifax, Canada demonstrated either asystole or bradycardia. This group of patients represents 1.6% of the total number of patients treated during the 16-month period. Six patients demonstrated either asystole or bradycardia during stretching of the soft tissues associated with advancement of the maxilla after bony mobilization. Two patients had either asystole or bradycardia during manipulation of the temporalis muscle fibres during surgery to correct total bony ankylosis of the temporomandibular joint. The etiology of this relatively rare but troublesome complication is discussed.
This article presents a brief review of several principles which Delaire has shown to be important in both craniofacial growth and cranio-maxillofacial balance. In light of these events, we propose that the maxillofacial surgeon either avoids, if possible, the use of rigid fixation in functional genioplasty or that he removes the screws and plate at a later date. The specific patterns of bone apposition and resorption observed following functional genioplasty form the basis for this recommendation.
Vasodepressor syncope is the fulminant expression of the behavioral disorder "Blood-Injury Phobia". Vasodepressor syncope or the "common faint" is characterized by a diphasic autonomic hyperactivity that begins with anxiety and leads to a transient loss of consciousness. Recognition of the behavioral etiology of this disorder suggests the possibility of prevention through psychotherapy. Understanding the pathophysiology of the diphasic autonomic hyperactivity allows for rational management of the "common faint".
This article presents a simple rapid and practical method, based both on clinical and radiographic examinations, which the dentist can use to the patient's advantage in differentiating dental from skeletal malocclusion.
A case of duplication of the mental nerve in a patient with cleft lip, cleft palate, and rubella syndrome is presented. The most vulnerable period of fetal infection by rubella virus corresponds with the critical period of development of the maxilla, mandible, and corresponding orofacial structures. The significance of duplication of the mental nerve is discussed in relation to the influence that this anatomic structure has on the growth and development of the mandible. The concept of activisms to explain such anomalies is reviewed.
The appearance of results of injury to the columella, the nasal septum, and the nasal bones, in particular, has been well described. Anomalies of the maxilla and global facial balance secondary to nasomaxillary injury are less well known. Three cases involving children, aged 11, 14, and 17 years, who had suffered nasomaxillary injury at least 8 years earlier as a result of physical beating, were studied with the use of photographs and architectural craniofacial lateral cephalometric radiographic analysis. The architectural craniofacial analysis of Delaire produced a graphic representation of the resultant maxillofacial deformities rather than a description of the deformities in terms of deviation from a statistical mean. Traumatic injury to the nasomaxillary complex provides an experimental model that implicates the role of the cartilaginous nasal septum and local functional conditions in the growth of the nasomaxillary complex. The importance of the functional premaxillary skeletal unit in balanced facial growth allows better understanding of the pathophysiology of malformation of this region.
Wide subperiosteal undermining in primary surgical correction of labio-maxillary clefts not only enhances the osteogenic activity of the periosteum but in addition, if the exposure is extended from the superior limit of the ascending maxillary process and the nasal bone to the inferior orbital rim above the infra-orbital foramen and the malar eminence, good suppleness of the overlying muscles can be achieved.
This article reviews some of the complications associated with the use of a chisel to achieve separation of the pterygomaxillary region during the Lefort I osteotomy. A modification of this surgical procedure is proposed whereby no chisel is used to complete the maxillary disjunction. A series of more than 200 consecutive Lefort I osteotomies using this technique confirms the value of this modification.
A technique is presented that allows the clinician to produce a lateral skull cephalometric radiograph that is suitable for construction of the architectural and structural analysis of Delaire involving only minor alterations in existing equipment. An appropriate combination of film type screen and cassette is recommended.
The authors report a case of a 36 year old black American male, who was operated for a fracture of the mandibular angle. A second surgical procedure was necessary, because of post-operative infectious complications. An hemolytic anemia occurred which was linked to a glucose-6-phosphate dehydrogenase (G6PD) deficiency. Clinical and general aspects of the disease are discussed.