Biomedical subjects
Publications and source records attributed to J Ferri.
The Cook airway exchange catheter is mainly used in ICU patients to exchange endotracheal tubes. We report three cases where this device was used during anaesthesia in patients with damaged tubes in critical circumstances (oropharyngeal bleeding, head and neck surgery). It allowed a fast and atraumatic exchange of the tubes.
This study discusses the morphologic evolution of the cranio-facial and cervical bone structures throughout life. A cephalometric study was made on lateral radiographs. The population studied included 84 males and 102 females. Ages ranged from 21 to 101. The cranial structures, superior facial structure, mandible and cervical vertebral column were successively examined. The anteroposterior diameter of the calvarium does not seem to undergo any modification during life. On the other hand, a highly significant increase of the thickness of this structure can be noted. The upper facial structure presents some modification, namely a significant increase of its posterior height. The palatine processus seems to change direction and pivot downwards and forwards. The maxillary sinus does not undergo any changes. The mandible, which is stable in its major axes, shows more malleable sectors which are more especially situated at the level of its body. The study of the cervical vertebral column reveals a loss of overall height, and an increase in the lordosis. The most numerous and most evident morphologic modifications were observed around the age of fifty in both males and females. The fact that these transformations are always commoned and greater in the latter reveals the plausible influence of the menopause. It appears that bone structures of membranous origin are the site of significant modifications compared with structures of endochondral origin, which benefit from a greater stability.
PURPOSE: The authors analyze the advantages and disadvantages of mandibular reconstruction with a fibula free flap in a retrospective study of 29 cases, and make comparisons with the iliac free flap and the lateral brachial free flap. MATERIAL AND METHODS: Twenty-nine patients (22 male, 7 female) aged 5 to 70 years were studied. Functional and esthetic evaluations were performed together with radiologic examination of the bony calluses. RESULTS: The fibula free flap has advantages for mandibular reconstruction, such as the length of bone available, low morbidity of the donor site, and the possibility of using a skin paddle. However, there is the disadvantage of not being able to reconstruct large soft tissue defects. In addition, bone vascularization is reduced when a large number of osteotomies are required. CONCLUSION: This reconstruction technique is satisfactory for mandibular defects measuring over 20 cm.
Although sutures have been identified as being important growth sites of the craniofacial complex, some points are still debated. The aim of our work was to analyze coronal suture response after immobilization in 24 New Zealand White rabbits. This immobilization was induced by an adhesive that bridged the coronal suture under investigation. Contrary to the reports of several authors, our procedure did not promote craniostenosis. The sutural space remains present even if it appears considerably reduced. Our cytometric examination clearly demonstrates that growth reduction localized on the external cortex of the calvaria whereas the internal cortex have a subnormal evolution. These findings favor a different evolving profile of both tables of the calvaria. They also suggest that one should be very careful before considering this procedure, as it may induce craniostenosis.
Local or block anesthesia can be used satisfactorily in many implant procedures. However, when advanced implant techniques or pre-prosthetic reconstruction surgery of the maxillofacial bones are required, local or regional anesthesia is insufficient. The "day-hospital" concept is a rational approach which meets the requirements for anesthesia and deep sedation with criteria for patient safety and comfort while guaranteeing optimal operating conditions. Intravenous sedation, both "conscious" and "deep" sedation, is a very well adapted form of anesthesia for implant recipients. Local or block anesthesia is enhanced or reinforced prior to surgery by the intravenous administration of a sedative and anxiolytic agent (single-drug concept), such as a benzodiazepine, associated or not with a morphinomimetic agent and an antihistaminic substance (multiple-drug concept). The main goal is to maintain spontaneous respiration while obtaining postoperative amnesia of the entire procedure. Mandatory use of a pulse oximeter has greatly contributed to improved safety of intravenous sedation, essentially indicated for operations not lasting more than 2 and a half hours in patients in good general health (scoring 1 or 2 in the American Society of Anesthesiology (ASA) classification) and with a low risk of postoperative complications. This concept requires an adapted technical facility. The operating theatre should have all the equipment necessary for cardiovascular, neurological and respiratory emergency care. The postoperative recovery room should also be equipped with cardiovascular monitoring devices and be able to accommodate an intensive care unit. Under these strict rules, short duration surgical procedures (< 150') can be performed : 1) with the best conditions of medical safety, 2) with improved operating conditions for the implant surgeon (the patient responds immediately to vocal orders when necessary) while asepsis is maintained as easily as with general anesthesia, 3) with better conditions for postoperative care and patient comfort (the anesthetist is continuously present). 4) better psychological conditions for the patient who will be discharged the same day, 5) with total amnesia of the entire surgical procedure, 6) elimination of a usually disproportionately long hospitalization. Day hospitalization also helps contain health care costs by cutting out the need for overnight care and accommodation. We underline the safety of current intravenous sedation techniques and present two series of data related to the use of this technique by an anesthetist and an operating surgeon in a day hospital from 1986 to 1995.
A case of immature teratoma involving mandible in a 56 year old woman is reported. This teratoma is composed of ameloblastoma structures mixed with some usual components of teratoma: osseous and cartilaginous foetal tissue, indifferenciated blastema, neuroblastic structures, acinous glands and melanotic cells. A lymph node is involved by metastatic mature glial tissue. This patient is treated by pelvimandibulectomy and irradiation. Histogenesis of this teratoma unusual by this ameloblastic component and this mandibular localization is reviewed.
Explore the source record for details and available documents.
We report a case of metastasis in the masseter muscle secondary to stomach carcinoma. Second neoplastic invasion in skeletal muscle is an exceptional phenomenon. And this frequency is paradoxical against corporeal muscular mass. Immune hypothesis is conjure up for explain this fact. Symptoms are not specific and the diagnosis is not often recognized. However, systematic postmortem investigation is positive in one per cent of the cases. Consequently, every painful and nodular induration involved in carcinoma supervision must do perform a systematic biopsy.
The persistence of a residual communication between mouth and nose, is an important sequela a after primary closing of cleft palate. This retrospective study reports twenty-one cases of a new technique (retro-incisive flap) used for closing this residual communication. This flap is an easy and reliable method with an 85% success rate, so we recommend it as the first choice in this indication.
We report an osteotomy technique for the maxilla using an iliac graft and simultaneous implantation for correction of atrophic class III dysmorphosis of the maxilla. The advantages and disadvantages of this technique are discussed on the bases of a 3-year experience.
Explore the source record for details and available documents.
Though clinic examination gives us much information, radiology still is essential in head trauma. Many standard radiographic projections have been described in the past and yet since the eighties it appears that C.T. scanner (C.T.) has become absolutely necessary to a great number of us. In fact, C.T. is indispensable when there is a matter of vital urgency or when a functional problem appears (diplopia). But most of the time high quality standard radiographic projections are sufficient. We have selected five radiographic projections: the occipito-mental's such as Mahoney's or Blondeau or Louisette, the submento-vertical's, the rotated occipito-mental's. For each of these radiographic projections we have specified the angular definition, the realization techniques, the criterions of quality and the results. The use of conventional radiology gives us images of which the quality is high enough to allow a precise topographical diagnosis and is far cheaper than C.T. So we can assert that standard radiographic projections are necessary and sufficient and that the use of C.T. becomes indispensable only in the few cases of diplopia or enophthalmia or complicated maxillary fracture. In the case of a lateral head trauma, our strategy of radiographic exploration will be represented as indicated on picture n degrees 20.
We present a technique for treating extensive frontal bone loss after chronic osteitis and subsequent treatment. Unlike the technique usually performed in such cases (exclusion and filling), the frontal sinuses were conserved by isolating them from the reconstructed frontal vault. Isolation was achieved by means of a temporal galea and periosteum flap with a pedicle arising from the superficial temporal vessels. The study concerned 14 patients operated on from two to seven times for osteitis, which persisted in many patients for more than 10 years.
Trauma to the condylar area is rather frequent and the stomatologist should be capable of performing a standard radiographic exploration. Two incidences performed in the stomatologist's office using a dental tube appear to be essential. The modified Parma and the transorbitary Zimmer incidences are needed for lateral and anteroposterior views respectively. The equipment required for these views are described together with several examples.
Orthognathic surgery in patients with missing teeth can be divided into two categories. In the first case after tooth loss, specially designed bridging is required using the prosthesis already in place. In the second case in patients with congenital deficiencies, usually sequellae of cleft palate, there is a wider range of therapeutic options which are discussed on the basis of observed cases.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.