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Biomedical subjects

J L Frodel

Publications and source records attributed to J L Frodel.

30 records · Page 2Linked to original sources
PubMed1993

Lag screw fixation in the upper craniomaxillofacial skeleton.

Rigid internal fixation of the craniomaxillofacial skeleton has become commonplace in osseous reconstructive procedures of the face. While miniplates are useful in many traumatic, reconstructive, and congenital anomaly cases, they are often unnecessary. Lag screw fixation is routinely used in the mandible and has the advantage of maximal stability when compared with other fixation techniques. These principles can similarly be applied in a variety of situations in the upper facial skeleton, including fracture and bone graft fixation, as well as in pediatric craniofacial surgery. We review the technique and appropriate indications and demonstrate via case examples this diversity of applicability for using lag screw techniques. Finally, results of 83 cases in which this technique has been used will be reviewed, including complications.

Bone Screws↗
PubMed1993

Comparative postoperative infection rates in midfacial trauma using intermaxillary fixation, wire fixation, and rigid internal fixation implants.

The use of rigid internal fixation implants in the repair of midfacial fractures requires more extensive bone exposure, soft-tissue manipulation, and operative time. We wished to determine the relative contribution of this method of repair to postoperative infection rates. Midfacial trauma cases occurring between the years 1984 and 1991 at the University of Iowa Hospitals and Clinics, Iowa City, were reviewed. Patients were grouped according to method of repair (intermaxillary fixation, open reduction with wire fixation, or open reduction with rigid internal fixation plates). Postoperative infection data (wound infections, sinusitis, etc) were obtained by chart review and telephone interview. Minimum follow-up for inclusion in the study was 3 months, with an average follow-up for all groups of 28.8 months. We found no significant difference in the rate, or the type, of postoperative infections in all three groups. We conclude that rigid internal fixation implants do not contribute increased postoperative infection rates in midfacial trauma.

Adult↗
PubMed1993

Primary reconstruction of congenital facial lesion defects with tissue expansion.

BACKGROUND: Congenital facial lesions may require surgical intervention to correct deformity or to decrease the potential for malignant degeneration. OBJECTIVE: Hemangiomata and melanocytic and sebaceous nevi are among the most common congenital facial defects. The techniques and outcome of serial tissue expansion in the management of facial lesions were evaluated. METHODS: Seven pediatric patients had congenital facial defects treated with tissue expansion and subsequent excision and reconstruction. RESULTS: All patients had a satisfactory outcome. Complications are reviewed, and in this patient population were minor. CONCLUSIONS: Tissue expansion has a role in surgical management of congenital facial lesions. Staged excision, skin grafting and nonintervention are also options which must be individualized to the case at hand.

Child↗
PubMed1993

Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps.

Primary and secondary reconstruction of mandibular continuity defects with vascularized bone is currently the standard of care at many institutions. The most commonly utilized donor sites for such bone flaps include the scapula, iliac crest, fibula, and radius. Recently, interest has grown in the placement of osseointegrated implants into these flaps to facilitate functional dental rehabilitation. There are no studies comparing the bone available from each of these flaps into which osseointegrated implants can be placed. In this cadaver study, the dimensions of bone available for implant placement from the iliac crest, scapula, fibula, and radius osseous flaps were measured. The iliac crest and fibula flaps had bone dimensions consistently adequate for implant placement. Bone available for the safe placement of implants into the scapula flap was found in the majority of specimens. The radius flap group had the highest number of specimens that were inadequate for implant placement. The majority of the specimens with bone inadequate for implantation were from females. Clinical implications of this study regarding flap selection are discussed.

Aged↗
PubMed1991

Recent advances in the management of orbital trauma: reconstruction and complications.

Orbital reconstruction has advanced significantly in the past decade. Proper reconstruction can be undertaken if the surgeon clearly understands the functional orbital anatomy and pathophysiology, the importance of "aggressive" radiographic evaluation, and is comfortable with deep orbital dissection with implant placement such that precise anatomic reconstruction of orbital defects is accomplished.

Humans↗
PubMed1986

End-to-end and end-to-side microvascular anastomoses: a comparative study.

The decision to use an end-to-end versus end-to-side anastomosis remains a controversial issue in microvascular surgery, although it is generally accepted that certain clinical situations require skills in both techniques (eg, vessel size discrepancy or the need to preserve donor vessel distal flow). Using rats, this investigation presents a unique free flap model comparing not only arterial end-to-end and end-to-side anastomoses, but venous anastomoses as well. There were 15 animals in each anastomosis group with a greater than 80% flap survival rate in each group. This supports findings of earlier studies that suggested no difference in survival when these two anastomosis types were compared. Equally important was the assessment of dermofluorometry as an immediate postoperative perfusion monitoring device. In this model, fluorometry was not found to be useful for predicting flap viability in an early period after completion of the anastomoses.

Animals↗
PubMedDate not supplied

Facial suspension with acellular human dermal allograft.

OBJECTIVE: To study the efficacy of acellular human dermal (AHD) allograft as a material for static slings used to treat ptosis of the oral commissure after facial paralysis. DESIGN: In the university facial plastic surgery practices (Baltimore, Md, and Albuquerque, NM) of the senior author (J.L.F.), 11 consecutive patients with facial paralysis were treated with AHD allograft slings. Follow-up was 4 to 14 months with 1 patient excluded for inadequate follow-up. Six of the remaining 10 patients received radiation therapy. Results were considered excellent and designated grade 1 when the affected oral commissure was at the same level as the normal commissure. Complete ptosis was designated grade 4. Grades 2 and 3 were designated between these extremes. RESULTS: All 10 patients showed improvement in the position of the oral commissure, in oral competence, and in cheek ptosis. Four patients were grade 1; 5, grade 2; and 1, grade 3. There were no implant extrusions or infections. CONCLUSIONS: The increased biointegration of AHD allografts in comparison with alloplastic materials may account for the absence of infection reported in this study and the relatively high success rate, especially in patients receiving radiation therapy.

Facial Paralysis↗
PubMedDate not supplied

Management of aggressive midface and orbital fibrous dysplasia.

OBJECTIVE: To discuss cosmetic and functional implications in the evaluation and treatment planning of large, aggressive midfacial fibrous dysplasias. PATIENTS AND METHODS: Eight patients (aged 2-38 years) with large fibrous dysplasias of the maxilla, zygomatic, and ethmoid bones requiring varying degrees of intervention and reconstruction were retrospectively reviewed. Patients with smaller lesions of these regions not requiring resection and reconstruction, as well those requiring sinus surgery alone were excluded from this review. RESULTS: All fibrous dysplasias in this review were monostotic, 6 originating in the maxilla, 1 in the zygoma, and 1 in the ethmoid. Five lesions (4 maxillary, 1 zygomatic) caused cosmetic deformity without functional deficits and required resection and/or contouring only with minimal reconstruction. The remaining lesions were invasive such that function of the eye and/or dentition was affected. These lesions were treated by aggressive resection and various degrees of reconstruction to optimize function. CONCLUSIONS: While fibrous dyplasia is classified as a benign process, local expansion can cause significant functional and aesthetic deformities. Each lesion should be thoroughly evaluated and, when vital structures are involved or threatened, total or subtotal resection should be considered. A variety of options should be available to the surgeon for definitive primary reconstruction.

Adolescent↗