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Biomedical subjects

J M Sykes

Publications and source records attributed to J M Sykes.

At least 19 recordsLinked to original sources
PubMed2001

Rejuvenation of the aging neck.

Patients seeking rejuvenation of the face are influenced by youthful faces commonly seen in the media and entertainment world. Although standards of beauty evolve over time, classical facial features such as symmetry, high cheek bones, and an angular jaw-neck line remain as ideals. As the human face ages, a relatively consistent series of anatomic events occurs. Although the rate of change varies from person to person, the process of facial aging is predictable. This process involves a loss of tone of the elastic fibers of the face, resulting in sagging of the skin and soft tissues of the face and neck. Additionally, aging of the lower face often includes ptosis of the soft tissues of the chin and banding or cording of the muscles of the anterior neck. Aesthetic rejuvenation of the face and neck involves repositioning of poorly supported soft tissues. To accurately treat facial aging, an individualized diagnosis and anatomically based problem list is compiled. This should include analysis of the skin quality, bone structure, amount and distribution of subcutaneous fat, and relationship of the superficial muscles to the overlying skin. After a detailed diagnosis is made, a surgical treatment plan is outlined to improve the face and restore a youthful appearance. This article describes the applied anatomy associated with facial aging and explains the author's specific techniques to obtain a natural postoperative appearance. Avoidance of common problems associated with aging face surgery is emphasized.

Aging↗
PubMed2001

The embryology, classification, epidemiology, and genetics of facial clefting.

Facial clefting results from a variety of genetic and environmental causes. It occurs when developing facial processes fail to fuse, merge, or interact; the clefts range from mild to severe. The embryology and classification of these clefts have been characterized. Moreover, the epidemiology has been determined from population data. Unfortunately, complete understanding of the genetics of facial clefting has not been completely uncovered. Facial clefts exist within more than 300 syndromes with only a few being commented on in this article. As the human genome project continues, the understanding of facial clefting and its syndromes may continue to improve. Such knowledge could advance diagnosis and treatment of the patient and counseling of the affected family. Other articles within this issue address the management of these clefts.

Child, Preschool↗
PubMed2001

Management of the cleft lip deformity.

Repair of the unilateral cleft lip deformity is a challenging and rewarding procedure. Historically, many techniques have been described to reconstruct the unilateral cleft lip. These have included straight-line repairs and various geometric flap closures. The rotation-advancement flap technique of Millard is a reliable and versatile method for repair of the unilateral cleft lip deformity. This technique allows lip repair and tip rhinoplasty while camouflaging the scars in the newly formed philtral border. If properly applied, the rotation-advancement repair produces excellent functional and aesthetic results (Figs. 18A and 18B).

Cleft Lip↗
PubMed1999

Considerations before rhinoplasty.

Patient evaluation and selection for aesthetic facial surgery and rhinoplasty in particular goes beyond assessment of anatomical indications. The selection of appropriate candidates involves an understanding of the patient's motivations for the procedure, expectations for the surgical outcome, and ego strength for tolerating the stress of operative intervention. The patient interview must be structured to give the surgeon ample information to determine the psychological and emotional stability of the candidate. Psychiatric consultation may be required if evidence is uncovered indicating psychiatric illness. Time spent informing the patient preoperatively will pay off great dividends in the postoperative period. If patient dissatisfaction does occur, validate and address the patient's concerns with a nondefensive posture.

Communication↗
PubMed1999

Repairing the twisted nose.

Correction of the deviated nose presents a challenge to even the experienced rhinoplastic surgeon. This article describes the etiology, analysis, and surgical treatment for the severely twisted nose. The applied anatomy of the deviated nose is discussed in detail. Finally, a graduated approach to surgical management is described.

Humans↗
PubMed1999

Surgical rejuvenation of the brow and forehead.

The position and orientation of eyebrows plays an important part in the overall appearance of the face. Many incisions and approaches have been described to elevate a ptotic eyebrow. It is essential to understand the periorbital anatomy and the biomechanics of elevation and fixation of the brow and forehead soft tissues. If properly planned and executed, surgical brow lifts can restore a youthful appearance to eyelids and the orbit.

Biomechanical Phenomena↗
PubMed1999

The efficacy of perioperative steroid therapy in pediatric primary palatoplasty.

OBJECTIVE: To determine if perioperative steroid therapy benefits pediatric primary palatoplasty patients. DESIGN: A prospective, double-blind, randomized trial with a placebo control. SETTING: An academic medical center. PATIENTS: Forty-five children undergoing primary repair of their cleft palate between 1989 and 1996 who were under the age of 48 months and without developmental delay or any associated syndrome. INTERVENTIONS: Intravenous dexamethasone sodium phosphate (0.25 mg/kg) or a placebo (5% dextrose in water) immediately preoperatively and once every 8 hours for two doses postoperatively. MAIN OUTCOME MEASURES: Postoperative airway distress, fever, oral fluid intake, discharge eligibility, and palatal fistula formation. RESULTS: Perioperative steroid therapy significantly reduced the incidence of postoperative airway distress (p = .05) and postoperative fever (p = .02); postoperative oral fluid intake, discharge eligibility, and palatal fistula formation were not significantly affected. CONCLUSIONS: Perioperative steroids effectively lower the risk of postoperative airway distress and postoperative fever in children undergoing the primary repair of their cleft palate. This finding favors a customary role for perioperative steroid therapy in pediatric primary palatoplasty.

Cleft Palate↗
PubMed1998

Multispecialty approach to complex dermatofibrosarcoma protuberans of the forehead.

We describe a 38-year-old woman with extensive dermatofibrosarcoma protuberans of the forehead and discuss the advantages of using a multispecialty approach in the treatment of this case. The patient had had an incomplete resection 15 years previously, with a misdiagnosis of the actual tumor type. After undergoing a biopsy and a computed tomographic scan, the patient underwent Mohs micrographic surgery, followed by split-thickness grafting. Ultimate reconstruction was performed 15 months later using bilateral temporoparietal fascial flaps, in addition to split-thickness grafting. The patient remains tumor-free 3 years after resection.

Adult↗
PubMed1998

Zygoma complex fractures.

The zygomaticomaxillary complex (ZMC) has integral structure and function in the bony skeleton of the face. The prominent convex shape of the ZMC makes it particularly vulnerable to injury. Facial trauma can result in fractures limited to a single buttress of the ZMC but more commonly results in a tetrapod fracture involving all four buttresses. Accurate clinical diagnosis is based on a thorough head and neck examination with ophthalmologic consultation when indicated. Computed tomography is the gold standard for confirmation of the clinical diagnosis and for surgical planning. Multiple surgical approaches to the ZMC are discussed, including the hemicoronal approach to the zygomatic arch, the transconjunctival and subciliary approaches to the orbital rim, and the sublabial approach to the zygomaticomaxillary suture line. The topics of one-, two-, or three-point fixation, as well as plate versus wire fixation, are discussed. Finally, the diagnosis and management of complications such as diplopia and ectropion are discussed.

Bone Plates↗
PubMed1998

Subtotal nasal reconstruction using a bi valved paramedian forehead flap.

Many surgical options have been proposed for total or subtotal reconstruction of the nose after extirpative surgery or trauma. Careful replacement of all anatomic layers including the structural framework and internal and external nasal lining is essential to successful reconstruction. If adequate internal lining is present, reconstruction of the structure of the nose and the external nasal lining is often straightforward. Difficulty arises with providing sufficient internal nasal lining in patients who underwent full thickness reconstruction of half of the nose with a bi-valved paramedian forehead flap. A different plane of dissection is used for the flap and structural grafts are placed between the layers of the axial pattern flap. The anatomy, plane of flap dissection, and biomechanics of flap transfer are presented as well as the specific technique for nasal reconstruction. The bi-valved paramedian forehead flap presents another surgical option for reconstruction of full thickness defects of the nose.

Adult↗
PubMed1998

Latissimus dorsi pedicled graft. An unusual cause of shoulder pain.

An unusual complication after the use of a pedicled latissimus dorsi flap is reported. The flap was used to reconstruct a facial defect after excision of a high grade mucoepidermoid carcinoma of a parotid gland. The tendinous insertion of the latissimus dorsi on the humerus was left intact and the flap pivoted around this point. Subsequent use of his arm caused the patient disabling shoulder pain from traction on the tendon. Symptoms resolved after the tendon was divided.

Carcinoma, Mucoepidermoid↗
PubMed1997

Concepts in scalp and forehead reconstruction.

Reconstruction of forehead and scalp defects are challenging. A thorough understanding of the anatomy and dissection planes of the scalp is essential. The ability to use a variety of techniques allows the facial plastic surgeon to maximize functional and aesthetic results. Techniques such as tissue expansion, free tissue transfer, and flaps used for covering exposed bone are useful adjuncts for optimal results.

Alopecia↗
PubMed1996

A prospective, double-blind, randomized study of the effects of perioperative steroids on palatoplasty patients.

OBJECTIVE: To determine whether perioperative steroids affect the outcome of patients who undergo palatoplasty. DESIGN: A prospective, double-blind, randomized study. SETTING: A university medical center. PATIENTS: Twenty patients undergoing primary repair of a cleft palate. INTERVENTION: A prospective double-blind technique was used to randomly assign patients to receive a placebo or dexamethasone sodium phosphate perioperatively. MAIN OUTCOME MEASURE: Patients were monitored for postoperative airway distress, fever, oral fluid intake, days of hospitalization, and wound healing. RESULTS: The use of perioperative steroids was associated with shorter hospitalizations. No adverse sequelae from the administration of steroids were identified. CONCLUSIONS: In our current managed care environment, the use of perioperative steroids may play an important role in reducing health care costs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Modifications of the Furlow palatoplasty (six- and seven-flap palatoplasties).

OBJECTIVE: To assess and compare the Furlow palatoplasty, a modified Furlow palatoplasty, and traditional palatoplasty methods. DESIGN: A retrospective analysis of the results. MAIN OUTCOME MEASURES: Cases were evaluated for operating time and complications, including oronasal fistula and blood loss. RESULTS: There were no fistulas in any of the 19 patients who were included in our study. The modified Furlow palatoplasty was found to increase operating time and blood loss. CONCLUSION: The use of the modified Furlow palatoplasty is feasible in select cases; however, this technique increases operating time and blood loss, which must be balanced against the theoretical advantages of increased palatal function with the Furlow palatoplasty.

Blood Loss, Surgical↗