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Biomedical subjects

J F Teichgraeber

Publications and source records attributed to J F Teichgraeber.

At least 19 recordsLinked to original sources
PubMed2000

An in vitro study of the accuracy of a new protocol for planning distraction osteogenesis of the mandible.

PURPOSE: The purpose of this study was to determine the in vitro accuracy of a new protocol for distraction osteogenesis of the mandible that involves a planning process and a surgical technique. MATERIALS AND METHODS: An experimental design was developed to simulate distraction osteogenesis on stereolithographic models of patients with craniofacial deformities. All patients had previously undergone 3-dimensional computerized scans of the craniofacial skeleton. The data from these scans were used to generate stereolithographic models. Before the fabrication of the models, the computed tomography (CT) data were manipulated to add a series of rulers and markers to the models. The 3-dimensional computerized scans were also used as the basis of the planning process. They were imported into an animation software (3D-Studio Max; Discreet, Montreal, Canada), and a virtual distractor was built and installed on the model, and the osteotomies and distraction processes were simulated. Finally, a recipe for sequencing the linear and angular changes of the distractor were calculated. A surgical technique was developed to facilitate the precise installation of the distractor as indicated in the presurgical plan. The transfer of information regarding pin position and orientation from the computer model to the patient was accomplished by creating a surgical template. This template was designed in the computer and fabricated by use of stereolithography. Mock surgery was performed on the stereolithographic models, and the results were compared with those predicted by the computer. The difference between the actual position and the predicted position was recorded. RESULTS: On the X-axis, the difference between the predicted position for the condylar marker and the actual position of the marker on the stereolithographic models was 0.6 +/- 1.1 mm. On the Y-axis, the difference between the predicted position for the condylar marker and the actual position of the marker on the stereolithographic models was -0.9 +/- 2.6. On the Z-axis, the difference between the predicted position for the condylar marker and the actual position of the marker on the stereolithographic models was 0.04 +/- 0.8 mm. There was excellent correlation between the predicted and the actual measurements for the X, Y, and Z axes: 0.98, 0.93, and 0.98, respectively. CONCLUSIONS: The results indicate that the combination of this planning process and surgical technique was very accurate. This in vitro study is the first step in determining the clinical usefulness of this protocol. If the results of this study are validated in clinical practice, this protocol will allow clinicians to improve the clinical outcomes of patients treated with distraction osteogenesis.

Analysis of Variance↗
PubMed2000

Computer planning for distraction osteogenesis.

Distraction osteogenesis of the mandible has found an application in the treatment of patients with a variety of different mandibular deformities. Compared with the relatively simple unidirectional distraction of long bones as described by Ilizarov, the three-dimensional distraction of the mandible is extremely complex. Whereas experience with orthognathic surgery clearly demonstrates that careful presurgical planning is necessary to achieve predictable outcomes, there are few reported methods for the planning of mandibular distraction. The authors have developed a method for planning distraction osteogenesis of the mandible that involves the use of three-dimensional modeling and animation to simulate distraction osteogenesis in virtual reality. The first step in the authors' treatment planning process is to obtain a three-dimensional computerized scan of the facial skeleton. From this scan, a three-dimensional wire-mesh model is built using animation software. With the same software, a virtual distractor is built and installed on the wire-mesh model. The osteotomies and the distraction process are then simulated. Finally, a recipe for sequencing the linear and angular changes of the distractor is calculated. The authors have used this planning process in seven patients (age range, 4 to 10 years): four with unilateral mandibular deformities and three with bilateral. The planning process has yielded predictable and reproducible results.

Child↗
PubMed2000

Distraction osteogenesis: a new surgical technique for use with the multiplanar mandibular distractor.

If distraction osteogenesis is to reach its full potential and achieve the level of accuracy that is possible with orthognathic surgery, its outcomes need to be as predictable. To this end, the authors developed a planning process for distraction osteogenesis similar to that used in orthognathic surgery. However, the success of the planning process depends on the authors' ability to execute the plan at the time of surgery. As a result, the authors needed to develop a surgical technique that would enable them to precisely install the distractor as indicated in the presurgical plan. The surgical technique presented in this article was developed for this purpose. The authors used this technique in seven patients (four boys and three girls; age range, 4 to 10 years). Four patients presented with unilateral deformities, and three patients presented with bilateral deformities. The follow-up period in this group of patients ranged from 12 to 33 months. The purpose of the technique is to replicate the position of the distractor on the mandible as determined by the presurgical plan. To this purpose, a custom drill guide and a surgical template have been developed. Both of these are used following the principles of triangulation to establish the pin position and orientation of the distractor. In the authors' hands, the use of this surgical technique has resulted in outcomes close to those predicted by the planning process.

Child↗
PubMed1994

Changing patterns in the epidemiology and treatment of zygoma fractures: 10-year review.

A ten year retrospective review of 259 zygoma fractures is presented to highlight changes in epidemiology and treatment. Motor vehicle-related trauma resulted in a majority of the injuries (80.6%), with a high incidence of multiple facial fractures (43.2%). The number of zygomatic and other facial fractures decreased over the duration of the study (by 50.0% and 20.1%, respectively, p < 0.05), perhaps reflecting lowered speed limits and the increased use of seat belts. The proportion of fractures receiving open reduction and internal fixation (ORIF) remained relatively constant (46.3%). At present, miniplate fixation is the preferred surgical treatment, accounting for 61.5% of cases in 1988 and 1989. There was a trend toward the use of multiple fixation sites and more frequent use of the lateral maxillary buttress (20.0% increase over the study period). The need for orbital floor exploration decreased by almost half, possibly reflecting improved preoperative radiologic evaluation. Despite the recent popularity of cranial bone grafting for facial reconstruction, silicone rubber was the preferred material for orbital floor repair (59.6% of cases). Although overall surgical complications were few (1.5%) there was a high incidence of associated ocular injuries (36.3%).

Adolescent↗
PubMed1994

The treatment of nasal valve obstruction.

The purpose of this study is to present the authors' experience with nasal valve obstruction and their management scheme. Between July 1, 1988 and June 30, 1991, 27 patients were seen for nasal valve obstruction. There were 17 males and 10 females, with a median age of 39.2 years. The internal valve alone was involved in 14 patients, the external valve was involved in 2 patients, both valves were involved in 11 patients, and significant septal deviation was seen in 15 patients. Nasal valve obstruction resulted from previous surgery in 13 patients, from trauma in 8 patients, and from a "narrow nose" in 4 patients. Twenty-four patients were treated successfully, while 3 patients, seen early in the series, failed to improve. All patients were followed for a minimum of 1 year. Surgery in the nasal valve is done through an open approach and involves a systematic approach to all the structures surrounding the nasal valve. Surgical repositioning and cartilage grafting are used to reconstruct the nasal valve.

Adult↗
PubMed1993

Treatment of nasal surgery complications.

There are numerous articles on how to prevent and manage the untoward aesthetic and functional results of nasal surgery. However, little has been written on the disabling or life-threatening complications of nasal surgery. Recent series have reported the incidence of these complications to be between 5% and 18%. Severe complications from nasal surgery can be divided into the following four categories: hemorrhagic, infectious, traumatic, and miscellaneous. Postoperative hemorrhage is the most commonly seen problem. However, there are numerous case reports of toxic shock syndrome associated with nasal surgery and even of intracranial complications. In this article, we provide an overview of these complications and their treatment.

Anesthesia↗
PubMed1993

The management of septal perforations.

Twenty-five patients with septal perforations were seen between July 1, 1983, and June 30, 1989. There were 16 males and 9 females, who ranged in age from 21 to 72 years, with the median age of 41.7 years. The majority of the perforations were traumatic in origin, with 19 cases seen following septal surgery, and were between 1.5 and 2.5 cm (20), with a range of 0.5 to 4 cm. All were located at the posterior border of the quadrilateral cartilage at the vomer-ethmoid junction. All but 3 patients underwent surgical repair, and successful closure was achieved in all but 3. However, only 1 patient remained symptomatic after surgery. The surgical technique employed includes an external rhinoplasty approach, septal and intranasal mucosal flaps, and an autograft of mastoid periosteum or temporalis fascia.

Adult↗
PubMed1992

External rhinoplasties: indications for use.

The technique, indications and role of external rhinoplasty in nasal surgery are presented. The technique has been utilised in 563 patients with a minimum follow-up of 18 months. The external approach has been especially helpful in the severely twisted nose, secondary rhinoplasty, augmentation rhinoplasty, congenital deformities of the nose, closure of septal perforations and in the teaching and learning of rhinoplasty. In this series there were no reported complications attributable to the external approach.

Adolescent↗
PubMed1991

The radiology of upper airway obstruction in maxillofacial trauma.

One of the prime considerations in the management of maxillofacial trauma is the diagnosis and prevention of acute upper airway obstruction. Each division of the upper aerodigestive tract may cause respiratory obstruction. In the oral cavity, a "flail" mandible, an "Andy Gump" deformity, and a sublingual hematoma may occur. In the nasopharnynx, an impacted midface, a split palate, and a nasopharyngeal hematoma may result. In the oropharynx and hypopharynx, an expanding hematoma in the retropharyngeal or lateral pharyngeal spaces may be seen. Although airway obstruction in maxillofacial trauma is a clinical diagnosis, the judicious use of radiographs helps to identify patients at risk. In this study, we review the anatomy of the upper aerodigestive tract and the potential sites of airway obstruction. A review of the radiology of airway obstruction in maxillofacial trauma will also be presented.

Acute Disease↗
PubMed1990

External rhinoplasty technique.

External rhinoplasty is a valuable tool in the surgical armamentarium of all nasal surgeons. It does not change the dynamics of the operation but offers a new method of exposure. The purpose of this paper is to present our experience with the external rhinoplasty technique in 601 patients, and review the results and complications of this approach to nasal surgery. Two patient reports are presented to demonstrate use of the technique in nasal surgery.

Adolescent↗
PubMed1990

Nasal surgery complications.

This study examines the incidence of serious complications in nasal surgery and discusses the diagnosis and management of these complications. The authors review 259 consecutive cases performed between January 1, 1983, and August 31, 1988. One-hundred and ninety-five patients had septorhinoplasties, 29 had septoplasties, and 35 had rhinoplasties. Thirteen of these cases involved serious complications as follows: hemorrhage (5), perforation (4), infections (3), and pneumocephalus (1). All the patients with these serious complications had associated septal and/or turbinate surgery. The diagnosis and management of these complications will be discussed. In this small series of nasal surgery patients, the incidence of serious complications was 5.0 percent, with no fatalities reported. The higher incidence of serious complications occurred when associated septal and/or turbinate surgery was required. Awareness of these complications is essential because of the increasing number of patients presenting to plastic surgeons for nasal surgery in whom associated septal and/or turbinate surgery is necessary.

Adolescent↗
PubMed1990

Rhinectomy: timing and reconstruction.

Cancer of the nasal skin is usually well-circumscribed, superficial, and has an excellent prognosis. However, a small number of aggressive lesions require a partial or total rhinectomy. We retrospectively reviewed patients seen at the M.D. Anderson Cancer Center between January 1, 1970, and December 31, 1980, for nasal cancer. There were 147 patients identified as requiring full-thickness nasal resections, of whom 68 (46.3%) required a hemi- or complete rhinectomy. Lesions requiring extensive rhinectomy usually involved the ala or were recurrent multicentric, squamous cell carcinomas greater than 4 cm. These patients had significantly poorer prognoses than the group in general. Recurrence developed in 45 patients (30.6%), and two thirds of all recurrences were seen within 2 years. In this series, the histology of the malignancy and its size, in the case of large basal cell carcinomas, were both predictive of a poor prognosis. Only the primary site was significant in predicting recurrence, whereas tumor size and histology were significant predictors of the need for an extensive rhinectomy. Delayed reconstruction is recommended in patients who are in poor health and have large recurrent lesions that are multicentric or involve the ala or dorsum. The timing of reconstruction is individualized, but a 2-year wait after surgery is recommended. Prosthetic rehabilitation is a good interim measure.

Aged↗
PubMed1989

Primary skin closure in large myelomeningoceles.

Numerous reconstructive methods have been described for the soft tissue closure of large myelomeningoceles. Recent advances in techniques of soft tissue expansion provide yet another reconstructive option. Tissue expansion allows for primary closure of the defect with surrounding tissue, resulting in minimal donor site morbidity. This report illustrates the technique of tissue expansion in the closure of a large myelomeningocele.

Humans↗
PubMed1988

Some oncologic considerations in the treatment of lip cancer.

We evaluated the treatment and results of 46 patients with lip cancer of commissure origin or extension. The patients were evaluated by clinical stage and pathologic findings. Treatment was predominantly by surgery for T1 and T2 lesions (31 of 37 patients), whereas combined resection and radiation therapy was used for larger tumors. The results showed control of both very large and very small lesions, but T2 lesions had repeated recurrences. We therefore recommended aggressive therapy for T2 and higher classifications of lip cancer with commissure involvement.

Adolescent↗
PubMed1987

A comparison of three methods of oral reconstruction.

A protocol is presented that was designed to provide comparative data on the two primary oral cavity functions affected by surgery: speech and swallowing. Three types of reconstruction (skin grafts, hemitongue flaps, and myocutaneous flaps) and results of a series of tests given to 15 surgical patients with T2 and T3 tongue and/or floor of mouth lesions were evaluated. The patients who had split-thickness skin grafts had the best oral function results. The study suggests that tongue mobility is the most significant variable in determining post-operative speech results.

Deglutition↗