External filling ports in tissue expansion: confirming their safety and convenience.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
Ian T Jackson
Publications and source records attributed to Ian T Jackson.
Assessment of cleft lip and palate patients treated with presurgical orthopedic correction and either primary bone grafts, gingivoperiosteoplasty, or without alveolar grafting procedures.
The effects of alveolar grafting on the development of the craniofacial complex have been reported by numerous investigators. The reported results vary in the literature from significant to very little impediment of maxillary growth. The present work evaluates and compares facial form at age six years in complete unilateral cleft lip and palate patients treated with presurgical orthopedic correction and primary reconstruction with (1) primary bone grafts (n = 14), (2) gingivoperiosteoplasty (n = II), or (3) without alveolar grafting procedures at the time of lip repair (n = 13). The cohort groups were analyzed with a one-way analysis of variance (ANOV A). Statistical analysis revealed significant differences between the three groups for only one of the 12 parameters analyzed. The primary bone grafted group demonstrated less vertical descent-of the anterior maxilla compared to the gingivoperiosteoplasty and non-grafted groups (P = .0027).
Alveoloplasty↗
Fixation of the split calvarial graft in nasal reconstruction.
Reconstruction of nasal contour where skeletal support is deficient or absent has usually been achieved using autogenous bone. Membranous bone taken from the cranium is clearly superior to rib or iliac crest when used as autografting material to the craniofacial skeleton. Conventionally, the bone graft is rigidly fixated to the recipient nasal bone with either metal plate-screw systems or Kirschner wires. Reported here are the results of a single biodegradable screw fixation of the split calvarial graft that is used for nasal reconstruction. Ten patients with moderate to severe saddle nose deformity underwent reconstruction using the open rhinoplasty approach. The graft was harvested from the outer cortex of the parietal bone, shaped, and secured in place with a single bioresorbable screw. No significant resorption has been observed in the grafts and a favorable aesthetic result was achieved in all of the cases. Described modification in fixation of the bone graft in nasal reconstruction avoids some of the disadvantages of permanent materials while preserving the advantages of rigid fixation.
Absorbable Implants↗
Treatment of chronic frontal sinus disease with the galeal-frontalis flap: a long-term follow-up.
BACKGROUND: Management of benign chronic frontal sinus disease is difficult. Patients are frequently seen by multiple specialties for medical treatment and endonasal procedures before they seek or require definitive treatment with frontal sinus obliteration. The progression of the disease may lead to serious or life-threatening conditions such as local bone destruction, periorbital abscess, osteomyelitis, meningitis, cranial epidural abscess, or septicemia. This study presents the use of the galeal-frontalis myofascial flap as part of the treatment of this disease. METHODS: Thirty-one patients with chronic frontal sinus disease requiring obliteration were included in this study; all were approached through a coronal incision. The anterior wall of the frontal sinus was removed and the frontal sinus disease was evacuated. The sinus mucosa was completely removed, and the frontal sinus and nasofrontal duct were totally obliterated with either a unilateral flap or a bilateral galeal-frontalis flap. RESULTS: All patients had failed medical therapy and many had failed endonasal and endoscopic procedures. The mean follow-up was 43.6 months (range, 1 to 125 months). There were two early complications, a seroma and a hematoma. Sinus infection recurred in one patient 3 months postoperatively. The recurrent infection was treated in the same manner, using the available and viable galeal-frontalis flap to obliterate the frontal sinus, with no recurrence after 40 months. CONCLUSIONS: The galeal-frontalis flap has been investigated by angiography and is based on the supratrochlear and supraorbital vessels. Its location and vascularity make it reliable and effective for frontal sinus obliteration. In the head and neck area and elsewhere, filling defects with vascularized tissue prevents infection. A further advantage is that any residual defects are usually well tolerated by patients, and those requesting correction can be easily accommodated. The risks and complications from using exogenous materials and from performing secondary procedures for graft harvest are avoided. Considering that most patients presented with complications from advanced disease and that after one revision no patients have had recurrence of disease, obliterative treatment with the galeal-frontalis myofascial flap should be contemplated earlier in treating patients with chronic frontal sinus disease.
Adolescent↗
Reinforcement of subcuticular continuous suture closure with surgical adhesive strips and gum mastic: Is there any additional strength provided?
BACKGROUND: This study aimed to compare the burst strength of suture closure versus the use of suture and strip together. METHODS: On cadavers, 50 skin incisions were closed as follows: group 1--subcuticular continuous suture; group 2--same suturing with placement of strips; group 3--same as group 2 except gum mastic was applied prior to strips; group 4--strips alone; and group 5--strips with gum mastic application. The separation forces were measured using a tensilometer. RESULTS: The mean separation forces were as follows: group 1, 14.17 kg; group 2, 14.37 kg; group 3, 15.39 kg; group 4, 1.52 kg; and group 5, 3.85 kg. There were no statistically significant differences between groups 1, 2, and 3. When compared with group 4, group 5 required markedly more force to separate the wound. CONCLUSIONS: Strip reinforcement with/without gum mastic did not provide any additional strength when sutures were used. Gum mastic increased the adherence of strips and this was important when strips were the only means of wound closure.
Adult↗
Evaluation of 45S5 bioactive glass combined as a bone substitute in the reconstruction of critical size calvarial defects in rabbits.
Biomaterial research and tissue engineering have guided new developments in bone replacement. In this study, the osteoconductive and osteoinductive properties of 45S5 Bioglass (Novabone-C/M, Porex Surg., Newnan, GA), granules as a bone replacement material for large calvarial defects were evaluated. Rabbit periosteal cells were expanded in culture and used in vivo. Alkaline-phosphatase assay, collagen type I, and calcium expression were applied to confirm osteoblast phenotype. In the in vivo phase, a 15-mm diameter critical size calvarial defect was created in rabbits (n = 14). The defect was reconstructed according to four treatment groups: autogenous bone (n = 2), Bioglass alone (n = 2), Bioglass + bone (n = 5), Bioglass + periosteal cells (n = 5). The animals were killed 12 weeks after surgery, and the samples were analyzed. Periosteal cells grew successfully in vitro. Because of their fast proliferation and potential to differentiate into osteoblasts, they were an excellent source of cells for bone tissue engineering. The best ossification was seen when autogenous bone was used (79.4% ossified), whereas only 8.2% of the defect in the Bioglass group showed ossification. Addition of bone or cells to the Bioglass increased the area of ossification to 42.7% and 30.2%, respectively. Defects replaced with Bioglass showed varying degrees of inflammatory reaction because of the intense cell-mediated biodegradation process. Based on these findings, the use of Bioglass granules to repair large craniofacial defects cannot be advised.
Alkaline Phosphatase↗
Cranial bone grafting for orbital reconstruction: is it still the best?
A variety of etiologies may result in functional and aesthetic deficiencies requiring orbital reconstruction. These are discussed, as are some of the possible repair techniques. In the current study, a randomized, retrospective chart review of one surgeon's experience with orbital reconstruction using cranial bone grafts was performed. The results of the chart reviews are presented, including preoperative diagnosis, clinical signs and symptoms, and postoperative findings. This study allowed a comparison and contrast to be made between exogenous materials and autogenous bone for orbital reconstruction. The differences between cranial and iliac bone as autogenous sources of reconstructive material were examined. The study indicates that cranial bone grafting for reconstruction of the orbit remains the material of choice.
Adolescent↗
The central lip flap and nasal mucosal rotation advancement: important aspects of composite correction of the bilateral cleft lip nose deformity.
The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of (1) lengthening the columella by a central lip advancement flap; (2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary; (3) nasal mucosal advancement; (4) alar base narrowing; and (5) reconstruction of the orbicularis oris as required. Depending on the individual assessment of the patients, some of these steps were not performed, leaving the nasal mucosal advancement the most important aspect of the reconstruction. In a consecutive series of 72 patients with repaired bilateral cleft lip and palate, 17 patients have been treated with nasal mucosal rotation advancement and followed up for a maximum period of 10 years. With the use of this technique, the secondary bilateral cleft lip nose deformity has been successfully corrected.
Adolescent↗
Skull base tumors: a comprehensive review of transfacial swing osteotomy approaches.
Numerous techniques have been proposed for the resection of skull base tumors, each one unique with regard to the region exposed and degree of technical complexity. This study describes the use of transfacial swing osteotomies in accessing lesions located at various levels of the cranial base. Eight patients who underwent transfacial swings for exposure and resection of cranial base lesions between 1996 and 2002 were studied. The mandible was the choice when wide exposure of nasopharyngeal and midline skull base tumors was necessary, especially when they involved the infratemporal fossa. The midfacial swing osteotomy was an option when access to the entire clivus was necessary. An orbital swing approach was used to access large orbital tumors lying inferior to the optic nerve and posterior to the globe, a region that is often difficult to visualize. Gross total tumor excision was possible in all patients. Six patients achieved disease control and two had recurrences. The complications of cerebrospinal fluid leak, infection, hematoma, or cranial nerve damage did not occur. After surgery, some patients experienced temporary symptoms caused by local swelling. The aesthetic result was considered good. Transfacial swing osteotomies provide a wide exposure to tumors that occur in the central skull base area. Excellent knowledge of the detailed anatomy of this region is paramount to the success of this surgery. The team concept is essential; it is built around the craniofacial surgeon and an experienced skull base neurosurgeon.
Adult↗
Hypertelorism: the importance of three-dimensional imaging and trends in the surgical correction by facial bipartition.
BACKGROUND: The technique of facial bipartition has been considered a great advance in achieving a more natural appearance in hypertelorism correction. METHODS: Fourteen patients who had undergone hypertelorism correction by facial bipartition were retrospectively studied to analyze the role of three-dimensional computed tomographic reconstruction in the evaluation of the deformity and preoperative planning. The procedure and surgical details that can improve the outcome were described. A reproducible set of three-dimensional measurements that can help in preoperative patient evaluation was determined based on information obtained using the Analyze/AVW 3.1 system (Biomedical Imaging Resource, Mayo Foundation, Rochester, Minn.). RESULTS: In this series, the most common diagnosis was frontonasal dysplasia (64.3 percent). Five patients had second-degree (35.7 percent) and nine had third-degree hypertelorism (64.3 percent). The three-dimensional scans were shown to be highly accurate in predicting the degree of deformity. There was a significant difference in the preoperative and postoperative interdacryon distance and midface height (p < 0.05) but not in the bitemporal distance (p = 0.08). The simulation correlated significantly with the postoperative result when interdacryon distance and midface height were analyzed (0.736 and 0.999). CONCLUSIONS: Facial bipartition provided a three-dimensional correction of hypertelorism. Three-dimensional imaging can definitely be considered an extra tool for accurate surgical planning and helping the family understand the surgical procedure and the end result.
Acrocephalosyndactylia↗
Management of frontal sinus fractures.
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the radiographic and clinical diagnosis of frontal sinus fractures. 2. Identify various management approaches to the frontal sinus fracture and the indications for each. 3. Understand the rationale behind the decision of sinus obliteration when needed. 4. Recognize the most common complications arising from frontal sinus fracture treatment and the methods of avoiding or managing these complications. SUMMARY: Frontal sinus fracture management is still controversial and involves preserving function when feasible or obliterating the sinus and duct, depending on the fracture pattern. There is no single algorithm for the choice of management, but appropriate treatment depends on an accurate diagnosis using physical examination, computed tomography data, and the findings of intraoperative exploration. The amount and location of fixation and the need for frontonasal duct and sinus obliteration or elimination of the entire sinus depend on the anatomy of the fracture in general and the extent of involvement of the anterior wall of the sinus, the frontonasal duct, and the posterior wall in particular. This article discusses an algorithm for frontal sinus fractures that was obtained from the literature and modified according to the authors' experience. The decision-making process presented by the authors has withstood the test of time over a period of more than 20 years in their practice and has been proven to be safe and efficacious in treating frontal sinus fractures of all types.
Accidents, Traffic↗
Pre-expansion of mucosa-lined flap for lower eyelid reconstruction.
Explore the source record for details and available documents.
Adult↗
Compartmentalization of massive vascular malformations.
A total of 18 patients with massive vascular malformations of the head and neck region were treated with compartmentalization using nonabsorbable sutures followed by injection of a sclerosant agent into each compartment. The indication for compartmentalization was either to stop potentially uncontrollable, life-threatening hemorrhage during the dissection of the lesion or to reduce its vascularity to allow a less dangerous subsequent resection. Compartmentalization was used in both high-flow and low-flow vascular malformations. In this technique, large nonabsorbable sutures are placed deeply in multiple areas within the lesion. The aim is to divide the malformation into multiple compartments by changing the direction of the suturing; in this way the sclerosing agent is provided with a more effective environment. The sclerosant used was either sodium tetradecyl sulfate 3%, absolute alcohol, or both. The total amount of infiltrate varied from 3 to 35 cc, according to the size of malformation. After compartmentalization, swelling was the most noticeable complication. With this technique, it was possible to treat what were considered untreatable malformations using standard techniques and to control the inevitable serious bleeding.
Adult↗
Vascular iliac crest with inner table of the ilium as an option in maxillary reconstruction.
Reconstruction of large maxillary defects has been a long-standing challenge to the reconstructive surgeon. Total maxillary reconstruction is desirable but often not possible; ideally, this would provide all the anatomical structural support, function, and esthetics missing because of the defect. A case is presented in which all the criteria for total maxillary reconstruction have been fulfilled. The patient is a 60-year-old man who had wide excision of his maxilla for ameloblastoma, followed by temporal bone flap reconstruction, which failed. He presented to our institution for further evaluation and possible treatment options; these were discussed with the patient and the multidisciplinary team that deals with congenital and acquired deformities in the head and neck area. An iliac crest free flap that included the inner table of the ilium based on the deep circumflex iliac artery was used for the reconstruction. The procedure is described, including restoration of a nasal lining. Osseointegrated implants were used for dental rehabilitation. Ameloblastoma is briefly discussed. The goals of maxillary rehabilitation and obstacles to obtaining those goals are presented. Options available for maxillary reconstruction are discussed, along with some of their advantages and disadvantages, as is the reason why the iliac crest free flap with the inner table of the ilium was chosen. An iliac crest free flap with microvascular anastomosis to facial vessels was used to reconstruct a large maxillary defect. Osseointegrated implants were used to facilitate dental rehabilitation. Our patient has excellent restoration of oronasal function with a satisfactory esthetic result.
Ameloblastoma↗
Clinical outcome of perioperative airway and ventilatory management in children undergoing craniofacial surgery.
Data on the management of perioperative airway and ventilatory support in children undergoing craniofacial surgery are limited. The purpose of this study was to review the authors' experience with airway management and ventilatory support during the perioperative period in children undergoing craniofacial surgery. Ninety-five consecutive children underwent 99 craniofacial procedures from July 1, 1999, through June 30, 2002. Direct laryngoscopy was successfully used to establish an airway in 86 (86.8%) cases, whereas 13 (13.1%) cases required the use of fiberoptic bronchoscopy to establish an airway before surgery. The oral route was used in 82 (83%) cases, and the nasal route was used in 17 (17%) cases. Length of anesthesia was 330 +/- 160 minutes, and the actual surgical time was 246 +/- 151 minutes. The volume of crystalloids infused during surgery was 87 +/- 78 mL/kg body weight (BW), and the volume of packed red blood cells infused during surgery was 10 +/- 14 mL/kg BW (range, 0-60 mL/kg BW). Tracheal extubation was successfully accomplished in the postanesthesia recovery unit (PACU) in 57 (58%) patients, whereas 42 patients were admitted to the pediatric intensive care unit (PICU) and received mechanical ventilation for 10 +/- 9 hours (range, 1-60 hours). Of these, 37 (37%) were extubated in the PICU, whereas 5 patients were extubated in the operating room with the craniofacial surgeon in attendance in the event an emergency tracheostomy was needed. However, none of these patients required tracheostomy to maintain a secure airway. Three patients required reintubation after the first attempt at tracheal extubation in the PICU. All three of those patients subsequently were extubated without the need for tracheostomy. The length of tracheal intubation and mechanical ventilation was longer (24 +/- 13 hours versus 8.6 +/- 7 hours, P < 0.001) in patients who required bronchoscopic intubation than in those who were intubated using direct laryngoscopy. The length of hospital stay, although clinically relevant, did not reach statistical significance between the two groups (5 +/- 7 days versus 3.7 +/- 2.7 days, P = 0.5). A positive correlation was observed between the duration of tracheal intubation and mechanical ventilation and the following perioperative factors: anesthesia time (rho = 0.6, P < 0.01), surgical time (rho = 0.55, P < 0.01), volume of crystalloids (rho = 0.5, P < 0.01), and the volume of packed red blood cells infused (rho = 0.55, P < 0.01) during surgery. No episodes of cardiorespiratory arrest or death occurred in any of the patients. This study demonstrates that when performing complex craniofacial procedures in children, a thorough evaluation of the airway before surgery and continuous communication between specialists during the perioperative period is imperative for a successful outcome. Furthermore, most pediatric patients who require mechanical ventilation during the postoperative period do so for a short period of time following surgery.
Adolescent↗
Medial canthopexy: a proven technique.
The medial canthus comprises three limbs and functions to maintain the shape of the eye and to assist in drainage of the lacrimal sac. Repair of the medial canthal tendon is often complicated by canthal drift, extrusion of wires or sutures, and in-fracture of the contralateral orbital bones from pressure by transnasal wires. A technique used successfully for more than 25 years with a low rate of complications is described in a stepwise manner. The long-term outcomes of using this technique are reviewed. Thirty-three patient charts were reviewed. The mean age of patients was 22.4 years (range, 3 to 59 years). The surgical indications were trauma, neoplasm, and congenital deformity. Only 2 cases of canthal drift were noted after this procedure and were corrected with the same technique without recurrence. Traditional methods of medial canthopexy frequently result in complications; the technique described eliminates most if not all of these.
Adolescent↗
Self-involution of giant keratoacanthoma on the tip of the nose.
Explore the source record for details and available documents.
Carcinoma, Squamous Cell↗
Epidemiology of cleft lip and cleft palate in Pakistan.
Clinical and epidemiologic studies of defined geographic populations can serve as a means of establishing data important for the diagnosis, treatment, and counseling of patients with cleft lip and cleft palate. Several descriptive epidemiologic studies have been carried out in many countries worldwide; however, no such study has ever been performed in Pakistan. Population-based data on the incidence of cleft lip and palate were obtained from birth registry information in northern Pakistan. A total of 117 cases from 61,156 live births reported were identified. The incidence for cleft lip and/or cleft palate was 1.91 per 1000 births (one per 523 births). Cleft lip alone (42 percent) was noted more frequently than isolated cleft palate (24 percent) and combined cleft lip and palate deformities (34 percent). Boys were more commonly affected by cleft lip and cleft lip with cleft palate, whereas girls predominated in the isolated cleft palate cases. Consanguineous marriages were observed in 32 percent of parents versus 18 percent in matched controls. Only 32 percent of cleft mothers received formal prenatal counseling, monthly examinations, and regular laboratory testing during the entirety of the pregnancy. Nutritional and vitamin supplements were given to only 28 percent of mothers of cleft children versus 59 percent in matched controls. Descriptive statistics were used to assess pertinent risk factors associated with cleft lip and palate. The acquisition of incidence and associated data has generated baseline information on the magnitude of cleft lip and cleft palate in Pakistan. It is hoped that this information can be used for appropriate resource use, cleft lip and cleft palate prevention programs, and counseling programs with Pakistan-specific data.
Adult↗