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Biomedical subjects

E Bradley Strong

Publications and source records attributed to E Bradley Strong.

12 recordsLinked to original sources
PubMed2006

Endoscopic repair of anterior table--frontal sinus fractures.

Frontal sinus fractures account for 5% to 15% of all maxillofacial injuries. Historically, a large percentage of these injuries were treated aggressively because of the long term risk of mucocele formation. This required a coronal incision with the associated surgical sequelae including a large scar, alopecia, and paresthesias. In light of these sequelae and recent advances in CT diagnosis and endoscopic treatment of mucoceles, some surgeons are starting to manage isolated anterior table fractures through an endoscopic approach. The endoscopic repair significantly reduces patient morbidity because it requires only 2 small incisions behind the frontal hairline. The endoscopic approach can be divided into two types: acute fracture reduction (covered elsewhere in this issue) and fracture camouflage. This article reviews the indications, techniques, and advantages of frontal sinus fracture camouflage.

Bone Substitutes↗
PubMed2006

Endoscopic repair of orbital floor fractures.

Significant orbital trauma can result in orbital floor fractures with subsequent prolapse of the orbital contents into the paranasal sinuses. Prolapse of the periorbita can result in extraocular muscle entrapment, diplopia, enophthalmos, and even visual loss. Management of orbital floor fractures traditionally has been accomplished through transconjunctival and subciliary incisions. These approaches provide adequate visualization and cosmetically acceptable scars. Unfortunately, post-operative lid malposition can occur in a small percentage of cases. Another limitation is easy visibility of the posterior orbit, which often is obscured by prolapsed orbital fat. In light of these limitations, some surgeons have begun to evaluate an endoscopic approach to orbital floor fractures. The endoscopic approach offers a hidden incision, improved fracture visualization, and avoidance of post-operative eyelid malposition. This article reviews the indications, technique, and potential complications of endoscopic orbital blow-out fracture repair.

Endoscopy↗
PubMed2006

Frontal sinus fractures: a 28-year retrospective review.

OBJECTIVES: To analyze 202 consecutive frontal sinus fracture (FSF) patients treated between 1974 and 2002 at the University of California, Davis. METHODS: A retrospective chart review was performed, including all patients with frontal sinus fractures from 1987 to 2002. This and 72 previously reported patients (1974-1986) were analyzed, comparing age, gender, fracture type, associated fractures, procedure type, and complications. RESULTS: Frontal sinus fractures resulting from motor vehicle accidents (MVAs) decreased from 71% to 52% (P < 0.05). Fractures from assaults increased from 9% to 21% (P < 0.05). The incidence of "through and through" fractures decreased from 40% to 11% (P < 0.05). Whereas combined anterior/posterior table fractures increased from 36% to 57% (P < 0.05). CONCLUSION: The etiology and severity of FSF has changed from 1974 to 2002. This is reflected in a reduced number of fractures resulting from MVAs as well as a reduced severity of injury. The most likely explanation is the use of safety belts and airbags.

Accidents, Traffic↗
PubMed2006

Endoscopic management of facial fractures.

PURPOSE OF REVIEW: Endoscopic applications in otolaryngology continue to expand, most recently in the area of maxillofacial trauma. Endoscopic management of orbital blow-out, frontal sinus, zygomatic arch, and subcondylar fractures has been described. This paper reviews the current literature including new techniques, indications, and outcomes in endoscopic management of facial fractures. RECENT FINDINGS: Very few large studies of endoscopic fracture repair exist. The current literature, however, suggests that, when compared with an open approach, smaller endoscopic incisions result in reduced patient morbidity with similar outcomes. Dedicated endoscopic instrumentation and novel surgical approaches continue to be developed. SUMMARY: Endoscopic repair of facial fractures is a new and evolving technique that offers the potential for reduced patient morbidity and operating time, as well as quicker patient recovery. Current applications include the management of orbital blow-out, frontal sinus, zygomatic arch, and subcondylar fractures. It should be emphasized that endoscopy augments, rather than replaces, the 'time tested' principles of adequate skeletal exposure, accurate fracture reduction, and appropriate internal fixation.

Endoscopy↗
PubMed2004

Evaluation of the FrameLock reference-arc fixation device for image-guided surgery.

OBJECTIVES: The FrameLock (FL) is a bone anchored, reference arc fixation device for image guided surgery. This study compares the stability of the FL to the FESS frame (FF), a friction fit device. METHODS: The FL and FF were independently applied to a cadaver. Fifteen sequentially larger impulse forces were applied to each device (0.39-5.8 N*s). Following each impulse, anatomic drift was recorded. A 29 patient prospective clinical trial tested the accuracy of each device before and after surgery. RESULTS: The FL showed significantly less anatomic drift for all weights except 0.39 N*s ( P < 0.01). The average clinical displacement of the FL was 0.07 mm, and of the FF was 1.02 mm ( P < 0.0009). Linear regression analysis of anatomic drift as a function of the procedure duration revealed a positive correlation for the FF (y = 0.61x), but not for the FL (y = 0.02x). Conclusions The bone anchored FL is significantly more stable than the friction fit FF.

Cadaver↗
PubMed2004

Endoscopic approach to orbital blowout fracture repair.

OBJECTIVES: Transconjunctival and subciliary approaches to orbital floor blowout fractures (OBF) have known risks of postoperative eyelid malposition. This study evaluates the endoscopic transmaxillary repair of OBFs in a cadaveric model and clinical setting. METHODS: Sixteen cadaveric and 10 clinical OBFs were repaired endoscopically. A Caldwell-Luc approach and modified sinus surgery instrumentation were used to repair each fracture. Variations in fracture pattern, instrumentation, and surgical technique were evaluated. RESULTS: Endoscopic repair was achieved in all 16 cadaveric orbits and in 9 of 10 patients. Fracture patterns were classified as either medial or lateral to the infraorbital nerve. Average clinical operating time was 1:38. Of 9 postoperative CT scans, 5 were rated as excellent, 3 as good, and 1 as poor. CONCLUSIONS: The endoscopic transmaxillary approach is a safe, viable technique for OBF repair. It offers improved visualization, anatomic fracture repair, no risk of postoperative eyelid complications, and good clinical results. EBM RATING: C.

Adolescent↗
PubMed2004

Endoscopic repair of orbital blow-out fractures.

Orbital floor blow-out fractures (OBFs) result from trauma to the globe and periorbita. These fractures occur in repeatable patterns that can be endoscopically classified as either medial or lateral to the infraorbital nerve (V2). Medial fractures are the most common and can be separated into "trap door" and "blow-out" fractures. Fractures that extend lateral to V2 are generally higher velocity injuries that result in comminution of the entire orbital floor. The key to successful surgical repair of these injuries is adequate exposure, visualization of the posterior bone shelf, and anatomic repair of the entire defect. Visualization of the posterior shelf can be challenging through traditional transconjunctival and subciliary approaches. These approaches also have known risks of postoperative eyelid malposition. The transmaxillary endoscopic approach to OBFs offers excellent visualization of the entire orbital floor. Fracture types can be evaluated and repaired endoscopically without the need for an eyelid incision. Although this is a new and evolving technique, early experience suggests that the endoscopic approach is a safe, efficacious technique for OBF repair. It offers improved visualization, anatomic fracture repair, no risk of postoperative eyelid complications, and good clinical results.

Endoscopes↗
PubMed2003

Mandibular reconstruction with an alloplastic bone tray in dogs.

OBJECTIVE: Mandibular alloplastic bone trays have an unacceptably high rate of extrusion. The introduction of resorbable mesh has renewed interest in such trays. This study evaluates the effect of resorbable trays on bone graft healing in a dog model. DESIGN: Unilateral, 20-mm mandibular body defects were created in 10 dogs, and repaired with cancellous bone grafts. A resorbable mesh bone tray was applied to 5 animals. All mandibles underwent gross examination, 4-point stress testing, and histologic and radiographic analysis. RESULTS: All animals had excellent bony unions. There was one intraoral mesh exposure. There was no difference between the control and treatment groups with regard to clinical findings, radiologic analysis, stress testing (P = 0.17), or histologic analysis (P = 0.66). CONCLUSION: The metabolic breakdown products of the resorbable mesh do not inhibit bone healing or strength. Resorbable mesh trays are a viable modality for reconstruction of segmental mandibular defects in a dog model.

Animals↗
PubMed2003

Surgery for severe rhinosinusitis.

Sinusitis is one of the most common reasons patients visit their primary care physician. The etiology of sinusitis is multifactorial in most cases. However, the final common pathway of disruption is usually made with a thorough history. The physical examination is often unremarkable. Complaints of nasal obstruction, mucopuluent nasal drainage, and facial pain/pressure are most diagnostic chronic sinusitis. Isolated headache is an uncommon presenting symptom. Computed tomography scans are the gold standard for diagnostic imaging. They can be used both for diagnosis and surgical treatment. All chronic sinusitis patients, being considered for endoscopic sinus surgery, should have failed a trial of maximal medical therapy. This includes a 4-6 wk course of oral antibiotics, nasal steroids, topical nasal decongestants, and oral prednisone if possible. Patients who fail maximal medical therapy have persistent symptoms that significantly effect their daily activities, have chronic abnormalities on computed tomography scan, and are candidates for endoscopic sinus surgery. Appropriate patient selection and preoperative counseling are key factors in patient satisfaction. Most patients with symptoms that significantly impact their daily activities will receive marked improvement in symptoms after sinus surgery. Endoscopic sinus surgery has undergone radical changes in the last 15 yr. Minimally invasive techniques, combined with advances in instrumentation and computers have reduced postoperative discomfort and improved patient satisfaction.

Endoscopy↗
PubMed2003

The surgical treatment of obstructive sleep apnea.

Obstructive sleep apnea is a highly prevalent disorder that significantly increases mortality when it is moderate to severe. Continuous positive airway pressure (CPAP) provides excellent relief to sleep apnea in the majority of patients. Unfortunately, many patients cannot tolerate CPAP and seek surgical alternatives. The reported surgical success rates range between 25 and 100% with most studies achieving a 50-70% success rate. The severity of the sleep apnea, as well as the patient's physical features influence the surgical success rate. Patients with mild sleep apnea should be treated if systematic. Treatment should be encouraged for patients with moderate to severe sleep apnea because of the decrease in life expectancy and other associated morbidities. Current surgical procedures include uvulopalatopharyngoplasty, genioglossus advancement, radiofrequency ablation to the base of tongue, tongue suspension, maxillomandibular advancement, and tracheostomy.

Follow-Up Studies↗
PubMedDate not supplied

Endoscopic repair of isolated anterior table frontal sinus fractures.

BACKGROUND: Recently developed endoscopic brow-lifting techniques and instrumentation are being used for treatment of anterior table frontal sinus fractures. Potential endoscopic treatment options include fracture reduction with or without plating and fracture repair with hydroxyapatite bone cement (HA). OBJECTIVE: To evaluate the efficacy of miniplates and HA for repair of anterior table fractures. METHODS: Frontal sinus fractures were generated in 11 cadavers. Standard endoscopic brow-lifting techniques were used to visualize the fracture from above. A 1-cm Lynch incision was used to apply instrumentation from below. Fractures were repaired with either miniplate reduction or HA recontouring. RESULTS: All fractures were exposed without difficulty. Miniplates were applied in 5 specimens: 1 specimen had a complete reduction, 2 specimens had partial reductions, and 2 specimens had incomplete reductions. Bone cement was applied in 9 specimens: 4 specimens were rated as excellent and 5 specimens as good. CONCLUSIONS: Frontal sinus fractures can be successfully exposed and repaired with an endoscopic technique. Endoscopic miniplate reduction of frontal sinus fractures can be accomplished. However, it is challenging, and success rates vary depending on fracture comminution. Endoscopic HA recontouring offered the best results, with good or excellent outcomes in all specimens.

Bone Cements↗