Biomedical subjects
Publications and source records attributed to J Mühling.
The orbitotomy has a central importance in craniofacial surgery. It is indicated for premature craniosynostoses, malformations and tumor surgery. The aim of the treatment is to correct functional disturbances and aesthetic impairments. Anatomical structures must be respected. Functional and anatomical aspects of the orbitotomy in craniofacial surgery are described.
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Routine CT scanning in 221 patients with craniosynostosis revealed ventricular dilation in 40. In 5 hydrocephalus was obviously unrelated to the craniostenosis. The remaining 35 cases were associated almost exclusively with syndromic craniosynostosis. Ventricular dilation was mild in 22, moderate in 9, and marked in 4 patients. Clinical and radiological findings strongly suggest that three different mechanisms are involved in the pathogenesis of hydrocephalus: primary cerebral maldevelopment, brain atrophy, and CSF outflow obstruction. In the diagnosis of hydrostatic hydrocephalus with craniosynostosis, head circumference is no indicator of progressive hydrocephalus, and intracranial hypertension may be due either to CSF accumulation or to craniostenosis. The present study indicates that shunt treatment prior to correction of synostosis should be restricted to a few cases of rapidly progressing hydrocephalus. Secondary shunting of hydrocephalus may be considered if intracranial pressure remains high despite adequate cranial decompression. Shunting is not an appropriate treatment for craniostenosis--even in cases of concurrent ventricular dilation.
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The technique of lateral canthal advancement for the treatment of premature coronal craniosynostoses has been employed in 12 cases. In patients with high intracranial pressure aesthetic problems after the operation were observed. The frontolateral area did not reossify and the brain bulged forward. For secondary correction in these cases the bilateral advancement of Marchac and Renier was used. A sufficient increase of intracranial volume could be achieved by complete osteotomy of the skull base. The bone segments were stabilized by miniplate osteosynthesis. The results were thereby improved.
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In an animal experiment performed on 25 rabbits, normal suture of dermal incisions was compared with wound closure by means of a new adhesive system. This system consisted of a fibrinogen cryoprecipitate and a thrombin solution, which were mixed. After 2, 4, 6, 9, 14 and 21 days, macroscopical and histological studies were performed. The bonded wounds showed less scar formation. In the clinical cases, the new method was used for the closure of incisions at the lateral and inferior orbital rim after osteosynthesis of Le Fort II and III midface fractures. Bonding was combined with a subcutaneous suture to avoid stress and yield good adaptation of deeper wound layers. Improved functional and esthetic results were demonstrated.
In an experiment testing the resorption of Poly-l-lactate in the back muscles of Cara rats a foreign body sarcoma occurred in two rats. 20 months after implantation of a body of high molecular weight poly-l-lactate a malignant fibrous histiocytoma developed in one rat. A soft tissue tumor, which was classified according to the immune-histiochemical analysis as a neurogenic sarcoma, developed 23 months after the implantation of a body of injection-casted poly-l-lactate of high molecular weight in a second rat.
The causes of TMJ ankylosis after collum mandibulae fractures in the early childhood are discussed and two different surgical treatment approaches are presented. In cases of unilateral involvement it often suffices to separate the ankylosed area while the rest of the joint is spared; where as in cases of pronounced bilateral ankyloses wide reactions with temporary implantation of bone cement are carried out.
The basic principles of anatomy and materials science, forming the foundation for the application of the Würzburg titanium miniplate system, are described in detail. Based on 252 midfacial fractures and 315 mandibular fractures treated with this Miniplate system between 1984 and 1987, the clinical results of using this system in traumatology are discussed.
The causes leading to ankylosis are reviewed and operative approaches to avoid "block-resection" are briefly outlined. 2 patients with fibrous ankylosis are presented, with the affected area visualized through computer-tomograms. Each patient underwent only resection of the lateral exostosis causing restricted movement. Follow-up tomograms of the 2 patients are offered.