The pinch scissors technique for motor nerve dissection.
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Facial Nerve↗
Biomedical subjects
J Conley
Publications and source records attributed to J Conley.
Microvascular free dermis-fat flaps for reconstruction after ablative head and neck surgery.
Reconstruction of the head and neck region following radical parotidectomy with or without mandibulectomy may be a difficult procedure. Facial skin is usually preserved, but the underlying soft-tissue structures and bone are deficient. The challenge is to augment the facial defect while the overlying skin is preserved with a high success rate, minimal time, one operative stage, and reduced secondary deformity to the patient. In certain instances, a microvascular free flap is ideal. We have used a de-epithelialized microvascular free groin flap successfully to reconstruct large parotid-mandibular defects in nine patients. A small bridge of epithelium is left to relieve tension from edema and to monitor the flap postoperatively. The high success rate, minimal complications, and acceptable donor site defect make the microvascular free dermis-fat flap an ideal choice for this type of reconstruction.
Adolescent↗
Head and neck surgery--1960 to 1980.
The years 1960 to 1980 represent a period of assessment and advancement in head and neck surgery. Basic operations were broadly applied and extended in their radicality. These techniques were standardized and more recently have been modified by conservatism and the strong introduction of preoperative and postoperative irradiation for advanced neoplasms and those persons at high risk. Chemotherapy is attempting to gain a role. The greatest innovation during this period was the discovery and use of a great variety of regional flaps to assist in the rehabilitation of these large and dangerous wounds.
Head and Neck Neoplasms↗
Recurrent mixed tumors of the parotid.
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Face↗
Interaction of increased pressures of oxygen and sulfonamides on the in vitro and in vivo growth of pathogenic bacteria.
The objective of these experiments was to determine whether synergism will occur between increased oxygen tensions and PABA-folic acid inhibitors in vitro and in vivo. Initial in vitro experiments indicated that PO2 greater than or equal to 2.2 ATA alone exerts marked growth-inhibitory (static) effects. Oxygen at 2.2 ATA decreased the minimal inhibitory concentrations (MIC) of sodium sulfisoxazole (NaS) fivefold and trimethoprim (TMP), a sulfonamide potentiator, twofold. At 3.2 ATA O2, there was a twenty-fivefold decrease in MIC of NaS and a tenfold decrease for TMP: cidal effects were also obtained. There is a PO2 dependent increase in effectiveness of the combination of NaS + TMP, including cidal effects, in situations where static effects were noted in absence of increased oxygen levels. Similar effects were not obtained with air pressure controls. In goldfish infected with Vibrio anquillarum, 3.2 ATA O2 in combination with NaS increased survival from 20% to 75%. Similar results were not obtained with air pressure controls. Trimethoprim was toxic to goldfish. We conclude that increased oxygen tensions synergize with NaS or TMP, or both, in vitro to decrease their MIC and to produce bactericidal effects where bacteriostatic effects are normally found: oxygen also synergizes with NaS in vivo to markedly increase survival of goldfish.
Animals↗
Facial nerve in recurrent benign pleomorphic adenoma.
Improvements in the treatment of benign and malignant tumors in the parotid gland have substantially reduced the incidence of recurrence. This has come about primarily be the abandonment of the enucleation techniques and the development of lateral lobectomy operation. The recurrence rate for benign mixed tumor in the parotid gland is variously reported in the ranges of 0.5% to 10%. Because the benign mixed tumor comprises approximately 65% of the tumors in this gland, this complication assumes an important and specific role. A review of this problem establishes the principles of management, extending from simple reexcision through total parotidectomy with preservation of the facial nerve, and radical parotidectomy with resection of the facial nerve and immediate nerve grafting.
Adenoma, Pleomorphic↗
Thread augmentation.
A review of thread augmentation has added helpful points to the technique and given an opportunity to assess the long-range results. It is obvious at this stage that there is no panacea for the wrinkling process. Each technique has advantages and disadvantages. The simplicity and low complication rate of thread augmentation supports this appeal. It is reasonable to state that the full application of the concept of this type of augmentation has not as yet been realized with this ongoing principle. This technique has been found of value when used as a single procedure or in combination with blepharoplasty or rhytidectomy.
Biocompatible Materials↗
Management of the eye socket in cancer of the paranasal sinuses.
There are several basic techniques for obtaining acceptable closure of the orbital defect following exenteration. The approach to reconstructing a socket in the method chosen should be the one that gives the best cosmetic result while not compromising the surgical excision and the possibility of cure. Few surgeons have attempted to correct the deformity of orbital exenteration so that an artificial eye can be worn. We have found that approximately 20% of those patients undergoing radical ablation of the orbit quality for simultaneous reconstruction of the eye socket. The technique of a cheek-eyelid-conjunctiva flap allows for immediate reconsturction of the eye socket and the fitting of a prosthesis.
Eye, Artificial↗
Surgical treatment of hypopharyngeal stenosis in children.
Five cases are presented of severe scarring, in the hypopharynx in children, which did not respond to conservative measures. These patients were treated by excision of the scar tissue and reconstitution of the area by Z-plasty, local mucosal flaps, regional chest flaps and colon transfer depending upon the severity of the problem. All had rehabilitation undertaken of the structural integrity of deglutive, respiratory, and vocal mechanisms. It is recommended that in this type of problem early rehabilitation is warranted rather than subjecting the child to prolonged gastrostomy and tracheotomy into puberty. When extended, the morbidity has a physical and psychological affect on these children.
Child↗
Reconstruction of radical parotidectomy defects.
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Adolescent↗
Treatment of massive deep lobe parotid tumors.
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Adolescent↗
Sublabial approach to the nasal and nasopharyngeal cavities.
A sublabial transnasal degloving approach to the mid-face, nasal cavity, septum, paranasal sinuses, and nasopharynx is described. This approach provides adequate exposure and ample facility for management of tumors in these areas. The pterygomaxillary space and infratemporal fossa ard readily accessible for hemostasis and management of tumor extensions. Children, adolescents, and women with benign and low-grade malignant tumors of these areas are the ideal candidates for this procedure. Twenty-six patients have been managed in this fashion, with no major complication. The cosmetic results have been excellent. This approach to the mid-third of the face, nasal, paranasal, and nasopharyngeal cavities should receive more attention and use.
Adolescent↗
Thread augmentation for facial rhytides.
Thread augmentation, a subsurface technique for correcting facial rhytides, is especially applicable to perioral wrinkles, melolabial furrows, and frown lines about the forehead. It is basically an augmentation technique which places a volume of well-tolerated, slowly absorbable or nonabsorbable sutures underneath the wrinkle. These threads produce augmentation by their volume and the mild local reaction of edema, lymphocytic infiltration, and fibrosis. This process gradually progresses to internal scar formation as the suture material is dissolved by slow hydrolysis in the presence of tissue fluid over a period of months; the nonabsorbable suture remains as a permanent implant. A high level of patient satisfaction with minimal complications has proved the value of this technique in over 100 cases.
Absorption↗
Surgical approach to retromandibular parotid tumors.
Because of the anatomy of the deep lobe of the parotid and its restrictive boundaries, retromandibular tumors may be asymptomatic until reaching massive size. Removal by an intraoral approach may be not only disappointing but also disastrous, with disintegration of the tumor and generalized spillage in the wound. Our experience suggests that the best approach to any type of tumor in this region is through the upper lateral cervical tissues with consideration of a mandibular osteotomy if the tumor extends into the retropharynx or the nasopharynx. This review of 12 patients who required osteotomy describes a high success rate with minimal complications.
Adenoma, Pleomorphic↗
Hypoglossal-facial nerve anastomosis for reinnervation of the paralyzed face.
The hypoglossal-facial nerve crossover is a valuable surgical procedure for the treatment of certain types of facial paralysis. It is most effective when used as an integral part of a primary ablative operation for the treatment of cancer in this region. In the treatment of long-standing facial paralysis, its application requires an intact peripheral facial nerve system and some functioning mimetic muscles with an obliterated proximal facial nerve segment. It is recognized that other procedures are available for repair in patients who meet essentially these same criteria. The disadvantages are minimal intraoral crippling, mass movements of the face and, in some instances, hypertonia of the face. The advantages are improved facial tone, protection of the eye, intentional facial movements controlled by the tongue, and movements associated with physiological functions of the tongue.
Adolescent↗
Avoiding facial nerve injuries in rhytidectomy. Anatomical variations and pitfalls.
Injury to the facial nerve in rhytidectomy has been occurring in less than one percent of the cases, and a spontaneous return of function in more than 80 percent of these injuries has resulted within 6 months. With the introduction of the newer and more aggressive techniques of platysmal and subplatysmal flaps and SMAS dissections, the risk of injury to facial nerve branches is obviously increased. Though there has not yet been an increase in the facial nerve injuries reported, these techniques are still relatively recent additions to the face-lift operation-and usually they have been done by more experienced surgeons, taking more time and working under direct vision with a more careful dissection. More care is needed to prevent injuries. We discuss here the detailed anatomy of the muscular branches of the facial nerve, how to prevent injuries to them during rhytidectomy, and how to manage injuries when they do occur.
Face↗
Facial rehabilitation: new potentials.
There is some clinical evidence to support the theory that in the immediate rehabilitation of the paralyzed face some regionalization and separate movement of the eye, lips, and cheek may be produced. This is not accomplished by specific fascicular connections. It is postulated that a combination of intracranial and extracranial connections, which have not been identified to date, contribute to this phenomenon.
Cerebellopontine Angle↗
Regional muscle transposition for rehabilitation of the paralyzed face.
Masseter and temporalis muscle transpositions may be considered in cases of longstanding facial paralysis and in the congenital absence of the facial nerve or muscles. The basic advantage of this technique is the introduction of a large volume of living and dynamic muscle into the face. Additional advantages include simplicity, the support provided, enhancement of the possibility of myoneurotization, and no loss of other significant function. In many instances, facial movement improves for a period of approximately two years, and the long-range effect would suggest some degree of rehabilitation of the facial muscles. Our combined experience with over 100 muscle transpositions indicates the efficacy and success of this technique in selected patients.
Facial Muscles↗