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Biomedical subjects

I D Papel

Publications and source records attributed to I D Papel.

18 recordsLinked to original sources

Complications of injectable synthetic polymers in facial augmentation.

BACKGROUND: Injectable synthetic materials have been used for augmentation of soft tissue defects, correction of wrinkles, and augmentation of facial features such as the nasal dorsum. Success has been limited by inflammatory reactions, material migration, and the difficulty of removal should complications occur. OBJECTIVE: To evaluate complications resulting from soft tissue augmentation with injectable alloplastic materials. METHODS: Retrospective review of seven cases. Clinical history, treatment, histopathologic findings, and outcomes are assessed. RESULTS: Inflammatory reaction and tissue damage were refractory to antibiotics and steroids, and surgery was required to remove the foreign material. Histologic examination revealed giant cell foreign body reaction in all cases. CONCLUSION: Injectable synthetic polymers can produce significant complications including deformity and inflammatory tissue destruction, the control of which is complicated by the difficulty of removing the materials. Removable tissue fillers, such as e-PTFE, or natural materials such as collagen, autologous, fat, or Alloderm, should be considered instead.

Adult

The male facelift: considerations and techniques.

Facelift in the male patient presents unique challenges with respect to maintenance of normal hairline and management of bearded skin. With careful psychological preparation, surgical planning, and attention to detail, these male characteristics can be retained with a good rejuvenative result. The combination of a deep-plane rhytidectomy technique with modified incisions and endoscopic brow intervention has provided the authors with consistent surgical results. Complications have been minimal, with no significant hematomas, skin loss, or nerve injuries to date.

Face

A graduated method of tip graft fixation in rhinoplasty.

Projection of the nasal tip has gained increased recognition as a measurable and visual characteristic that has an impact on the results of aesthetic rhinoplasty. Autologous cartilage tip grafts have been used in many techniques to increase tip projection and contour the tip during rhinoplasty. This article introduces a graduated method of tip graft fixation correlated with specific clinical measurements related to tip projection. After careful analysis of tip projection and contour, a predictable graft fixation technique can be selected to obtain the desired degree of nasal tip projection and sculpting.

Cartilage

Rehabilitation of the paralyzed face.

Rehabilitation for facial paralysis is a highly individualized task that relies on a complex set of physical, physiologic, social, and emotional factors. A wide range of surgical techniques exist for establishing partial rehabilitation of facial expression and motion. The facial surgeon must analyze these factors and work with the patient in a realistic approach to the problem.

Facial Paralysis

Computer imaging for instruction in facial plastic surgery in a residency program.

Aesthetic analysis of the face has advanced from a purely subjective opinion to complicated formulas based on measuring various combinations of angles, distances, and ratios. These concepts of facial harmony and surgical alterations have been difficult to teach in a residency program, especially regarding preoperative evaluation and a clear idea of the desired surgical results. The authors have utilized a computer imaging system to facilitate the preoperative facial analysis and to project what the postoperative surgical result should achieve based on these measurements. The use of this system has helped enhance the communication between resident and attending surgeon as well as educate the resident in important facial relationships. A degree of experimental freedom in alteration of facial features is provided. The methods of facial analysis and the advantages of computer imaging in a residency program are discussed.

Adult

Compression plates in the treatment of advanced anterior floor of mouth carcinoma.

Advanced anterior floor of mouth squamous cell carcinoma has been traditionally treated with wide excision in conjunction with mandibulectomy and radical neck dissection. This has resulted in significant mandibulofacial defects with functional and cosmetic significance. Efforts at primary reconstruction in the past using bone grafts, osteomyocutaneous flaps, and other methods have yielded unsatisfactory results. A history of prior irradiation has made this problem even more refractory. We present a series of 11 patients who underwent composite resection for advanced anterior floor of mouth carcinoma (T2-T4), with primary reconstruction using a dynamic compression plating system in conjunction with local and regional tissue flaps. The clinical courses, complications, and surgical techniques are discussed. The issues of reconstruction at primary treatment, irradiation with a metal plate in the field, and the early restoration of oral function are addressed. Experience in this series shows that compression plates can be an effective method of primary reconstruction for advanced anterior floor of mouth lesions.

Adult

Max Brödel's contributions to otolaryngology-head and neck surgery.

Max Brödel arrived in the United States in 1894 to work as a medical illustrator at the Johns Hopkins Hospital. He brought with him an extensive background in medical sciences and illustration. This allowed him to develop an advanced style and technique that would greatly influence the profession of medical illustration. Much of Brödel's work concerned the head and neck region and is of particular interest to otolaryngologists. This article reviews the historical aspects of Brödel's career and highlights his contributions to Otolaryngology-Head and Neck Surgery.

Germany

Transsphenoidal approach to the sella: the Johns Hopkins experience.

The transsphenoidal hypophysectomy has become a relatively frequent procedure in recent years, with the otolaryngologist playing a major role in its renewed popularity. This paper reviews the evolution of pituitary surgery, discusses the surgical technique currently used, and reviews the results and complications of 114 cases over a 13-year period. Of the 129 procedures performed at Johns Hopkins Hospital between 1970 and 1983, 114 charts were available for review. Twelve of these were palliative hypophysectomies and 102 were for sella tumors. Sixty-eight patients were treated with surgery alone, and 34 received surgery and postoperative irradiation. Significant complications such as CSF rhinorrhea, diabetes insipidus, meningitis, septal perforation, anosmia, and visual field defects are discussed. The mortality rate for the series was 1.7%. These results are compared with those of previously published series and the differences are discussed in detail. In analyzing these data we feel that the transseptal, transsphenoidal hypophysectomy has become a safe and effective therapy for sella lesions.

History, 20th Century