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Biomedical subjects

J A Lehman

Publications and source records attributed to J A Lehman.

At least 19 recordsLinked to original sources
PubMed1995

Treatment of cleft palate associated with Robin sequence: appraisal of risk factors.

Mandibular hypoplasia, airway obstruction, and a typical wide U-shaped cleft palate comprise the Robin sequence. Although much has been written regarding the treatment of these patients in the neonatal period, the literature reveals little information regarding later care of the cleft palate in these patients. The purpose of this study is to examine patients with the Robin sequence and evaluate the risk of postsurgical problems and outcome related to the neonatal period. Thirty-six patients with the Robin sequence presenting from 1972 through 1990 were reviewed. A majority of patients had feeding and respiratory difficulties, to varying degrees, following birth. These problems were treated successfully by maneuvers ranging from positioning to two infants who eventually required tracheostomy. Thirty-four patients had palate repair. Age at repair averaged 16.2 months, and one third of patients had associated anomalies. Infants who experienced problems following palatoplasty were those who had histories of severe difficulties and complications in the early months of life. In addition, patients with associated congenital anomalies has significantly more problems at the time of palate repair than those without anomalies. Those patients with the Robin sequence, who historically had minimal difficulty following birth, experienced few complications at the time of palate repair. Of the 34 patients with repaired palates, 23 demonstrated sufficient follow-up to allow for evaluation of speech outcome. Satisfactory or normal speech production was noted in 65.4%. This is not significantly different from that observed in all patients undergoing cleft palate repair during this same time period (74.9%). Secondary pharyngoplasty procedures were required in 17.4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Cleft Palate↗
PubMed1993

Orthognathic surgery in the cleft lip and palate patient.

Orthognathic surgery for the cleft lip and palate patient should be designed to achieve good facial aesthetics and a stable, functional occlusion. Maxillary and mandibular osteotomies, which benefit cleft lip and palate patients with associated dentofacial deformities, should be modified to meet the needs of the individual patient. Soft-tissue correction of the upper lip and nose adds to the overall aesthetic result, but should be performed as a separate procedure.

Adolescent↗
PubMed1992

Comparison of Nasometer and listener judgments of nasality in the assessment of velopharyngeal function after pharyngeal flap surgery.

This study examined the relationship between nasalance scores as derived from the Model 6200 Nasometer and listener judgments of perceived nasality for individuals with pharyngeal flaps. Sixteen individuals with pharyngeal flaps read a speech sample consisting of seven sentences for which associated nasalance scores were obtained. In addition, 10 trained listeners were asked to judge the subjects' audiorecorded speech samples for the degree of both hypernasality and hyponasality using two 6-point scales. The mean judges' ratings of hypernasality did not increase systematically with increasing nasalance scores or with decreasing hyponasality ratings. However, as the nasalance scores associated with nasal loaded sentences increased, a systematic decrease in listener perception of hyponasality occurred.

Adolescent↗
PubMed1990

One-stage closure of the entire primary palate.

Timing of the closure of the anterior palate and alveolus is a subject of debate. Late repair of this defect is complicated by high fistula formation and subjects the patient to the problems of palate fistula for extended periods of time. We have utilized a single procedure performed when the child is 3 months of age that completely closes the anterior hard palate and alveolus along with the cleft lip. Our series consisted of 61 consecutive patients with unilateral clefts of the primary and secondary palate. Mucosal turnover flaps from the vomer along with lateral nasal mucosal flaps provide the nasal lining. A buccal sulcus flap with a Veau flap completes the oral repair. Ninety-five percent (58 of 61) of the patients had complete and stable closure of their anterior palate and alveolus after 1 year. The incidence of fistula formation in our series (3 of 61) is much lower than that reported with the utilization of other protocols. Excellent exposure of the anterior palate and alveolar defect during lip repair, early restoration of anatomic relationships, establishment of a good nostril floor and sill, and very low fistula formation are among the benefits of this procedure. The increase in operative time is considered minimal in light of aforementioned advantages.

Cleft Lip↗
PubMed1990

Surgical-orthodontic correction of transverse maxillary deficiency.

A conservative osteotomy of the zygomaticomaxillary buttress in combination with a rapid palatal expansion appliance is a dependable technique for the treatment of horizontal maxillary deficiency in adults. This procedure has been used successfully in 56 patients in our series, but 17 patients (30 per cent) required a midpalatal osteotomy. In two patients, overexpansion was not achieved because of necrosis of the mucosa. In three other patients, expansion had to proceed at a slower pace because of mucosal ulceration. There have been no other complications. The procedure is indicated mainly in those patients with a horizontal deficiency who do not require subsequent surgery, but for some patients it may be the preliminary procedure. Twelve patients (21 per cent) had subsequent orthognathic surgery. Follow-up has been from 1 to 12 years and there has been no relapse. In our opinion, the zygomaticomaxillary buttress is the primary area of resistance to lateral movement of the maxilla by rapid maxillary expansion appliances.

Adult↗
PubMed1989

Surgical-orthodontic correction of transverse maxillary deficiency.

A conservative osteotomy of the zygomaticomaxillary buttress in combination with a rapid palatal expansion appliance is a dependable technique for the treatment of horizontal maxillary deficiency in adults. This procedure has been used successfully in 56 patients in our series, but 17 patients (30 percent) required a midpalatal osteotomy. In two patients, overexpansion was not achieved because of necrosis of the mucosa. In three other patients, expansion had to proceed at a slower pace because of mucosal ulceration. There have been no other complications. The procedure is indicated mainly in those patients with a horizontal deficiency who do not require subsequent surgery, but for some patients it may be the preliminary procedure. Twelve patients (21 per cent) had subsequent orthognathic surgery. Follow-up has been from 1 to 12 years and there has been no relapse. In our opinion, the zygomaticomaxillary buttress is the primary area of resistance to lateral movement of the maxilla by rapid maxillary expansion appliances.

Adult↗
PubMed1989

Mandibular prognathism.

The use of the vertical subcondylar osteotomy for correction of uncomplicated mandibular prognathism is reviewed. Techniques for use in more complicated cases such as when a set back of greater than 10 mm is required are also described.

Humans↗
PubMed1985

The syndrome of inappropriate secretion of antidiuretic hormone in the pharyngeal flap operation.

A prospective study was undertaken to determine whether there was a relationship between the pharyngeal flap operation and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). From August 1982 to November 1983, 25 patients underwent pharyngeal flap procedures. They were compared to a control group made up of five patients who underwent major cleft lip revisions. Twelve of the twenty-five patients (48%) who underwent pharyngeal flap procedures had inappropriately elevated serum ADH levels, low serum osmolality, and hyponatremia in the postoperative period. There was a statistically significant (p less than 0.001) drop in the serum sodium levels in the pharyngeal flap group from the preoperative to postoperative period. There was neither a statistically significant change in the serum sodium levels nor inappropriate elevation of ADH levels in the control group. Two patients who underwent pharyngeal flap procedures developed SIADH. To our knowledge this complication has not been reported in association with the pharyngeal flap operation. No specific causes were found that would explain why SIADH developed.

Adolescent↗
PubMed1984

Surgical orthodontic correction of transverse maxillary deficiency: a simplified approach.

Osteotomy of the zygomaticomaxillary buttress in combination with a rapid palatal exapnsion appliance is a dependable technique for the treatment of horizontal maxillary deficiency in adults. This procedure has been used in 18 patients with excellent expansion in 17. In one patient, expansion was discontinued prior to overcorrection because of pressure necrosis on the palate related to the appliance. This was the only complication. The procedure is indicated mainly in those patients with a horizontal deficiency who do not require subsequent surgery, but for some patients it may be the preliminary procedure. Three patients in this series had subsequent orthognathic surgery. Follow-up has been from 1 to 6 years, and there has been no relapse. In our opinion, the zygomaticomaxillary buttress is the primary area of resistance to lateral movement of the maxilla by rapid maxillary expansion appliances.

Humans↗
PubMed1983

Gynecomastia.

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Gynecomastia↗
PubMed1981

The combined surgical and orthodontic treatment of mandibular prognathism.

Patients with severe mandibular prognathism are best managed with a combined orthodontic-surgical approach. In our patients, the orthodontic treatment consisted of six to eighteen months of presurgical preparation, which in some patients may accentuate the dental deformity. This is done to provide two well-aligned dental arches that will fit accurately at surgery. The surgical procedure used was an oblique subcondylar osteotomy. This was followed by six to eight months of orthodontic treatment to complete dental alignment. Thirty patients were treated using this combined approach, with excellent results and few complications.

Adolescent↗
PubMed1981

Does infection play a role in breast capsular contracture?

The formation of capsular contracture around silicone implants continues to be the most common complication of augmentation mammaplasty. To date, the etiologic factors in the formation of capsular contractures have remained inconclusive. In the present study, the role of subclinical infection with S. epidermidis as a cause of capsular contracture was evaluated in 16 rabbits using miniature silicone implants. All the implants on the side contaminated with varying concentrations of S. epidermidis developed breast capsular contractures. Using Baker's classification, they were graded III or IV, while the controls were all considered to be either grade I or II. Grossly, the capsules on the contaminated side were firm, fibrous, and 2 to 3 times thicker than the controls, and this was confirmed histologically using micrometry. Implants contaminated with 10(7) bacteria uniformly extruded. The present study seems to indicate that subclinical infection with Staphylococcus epidermidis may be one of the causes of capsular contracture around breast implants.

Animals↗