Biomedical subjects

J Maegawa

Publications and source records attributed to J Maegawa.

7 recordsLinked to original sources

PubMed2000

Successful closure of recurrent traumatic csf rhinorrhea using the free rectus abdominis muscle flap.

BACKGROUND: We present two patients in whom a free rectus abdominis muscle flap was used to close recurrent traumatic CSF rhinorrhea. CASE DESCRIPTION: CT scan of both patients showed frontal lobe atrophy and porencephaly after contusional hematoma. In the first patient, because the site of CSF leakage was not identified and the patient underwent three unsuccessful attempts to close the fistula using the fascia lata, we treated the patient by unifying all paranasal sinuses and by filling them with a free rectus abdominis muscle flap. In the second patient, CSF rhinorrhea recurred 6 years after closure of the fistula using the fascia lata. The patient underwent separation of a porencephalic cyst from the paranasal sinus and a free muscle flap was placed extradurally, because the CSF pulse pressure in the enlarged left anterior horn eroded the previously repaired fascia lata, resulting in the recurrence of CSF leakage. CONCLUSION: Although duraplasty is the primary procedure for repairing dural fistulas, the vascularized free muscle flap is an alternative method when the location of the fistula is not identified or the patient with recurrent CSF rhinorrhea has severe frontal lobe atrophy and porencephaly.

Adult↗

PubMed1999

Reverse U-shaped split temporalis musculofascial flap in cranial base reconstruction.

To extend the versatility and range of the temporalis muscle, a new type of temporalis musculofascial flap was developed. This was achieved by dividing the muscle into two portions--anterior and posterior-while maintaining vascular communication between the deep and the middle temporal arteries. This flap is reverse U-shaped with one of the arms of the "U" corresponding to a pedicle, which supplies the blood, and the other corresponding to the recipient region. The bottom of the U corresponds to continuity between the anterior and posterior portions of the muscle, which contains the vascular communication. In two patients with meningioma, the flap was applied to occupy the extradural dead space combined with a pericranial flap to prevent leakage of cerebral spinal fluid to the dural defect. The reverse U-shaped split temporalis musculofascial flap has some advantages for intracranial reconstruction: sufficient rotational arc, adequate thickness, and rich vascularity. A reverse U-shaped split temporalis musculofascial flap is useful and of benefit, especially for reconstruction at the region of the anterior midline skull base.

Aged↗

PubMed1999

A simple distraction device for finger lengthening.

A simple, light distraction device was developed for digital lengthening. Materials for this device are one piece of 1.5-mm K-wire, two five-hole miniplates, one one-hole miniplate, two bolts and nuts, and a nonabsorbable suture or surgical wire. These components are easily obtainable, and the device can be assembled easily for each patient during surgery. The principle of distraction using this device is unique: A distal bone segment is pulled straight forward by a suture or surgical wire. This minimizes scar formation on the finger. Finger elongation using commercially available distraction devices needs two transfixations of K-wires, two each for the proximal and distal bone segments, which create scars where the K-wires move. The authors report a clinical application in which their distraction device was used.

Amputation, Traumatic↗

PubMed1999

Muscle bow traction method for dynamic facial reanimation.

A muscle bow traction method was developed for dynamic facial reanimation utilizing the masseter muscle and a fascial sling. The principle of this method is that the sling around the muscle pulls the oral commissure laterally and backward by the restoring force of the muscle from its relaxed position to its contracted position. The surgical procedure is simple. The sling is passed around the anterior half of the muscle so that the muscle can be bowed anteriorly at its center by the sling. One end of the sling is sutured to the center of the orbicularis oris and the dermis in front of the nasolabial fold, and the other end is sutured to the lower lip and oral commissure. This method was applied to 3 patients with facial palsy and to 1 patient with oral cancer. The restored motion of the oral commissure ranged from 5 to 8 mm when clenching the jaws. The concept of this method differs from those of other muscle transposition methods for facial reanimation in that the force acts at a right angle to the muscle contraction. The advantage of this method is that it is less invasive to the muscle and is a simpler procedure than other conventional muscle transposition methods.

Aged↗

PubMed1998

Speech changes after maxillary advancement in 40 cleft lip and palate patients.

In this study, we retrospectively investigated speech intelligibility changes in 40 patients at the Australian Cranio-Facial Unit who underwent Le Fort I maxillary advancement between 1978 and 1995. Resonance, articulation, and velopharyngeal sphincteric function, which were assessed before and after surgery, were analyzed in conjunction with details of the surgery in an attempt to identify the factors affecting speech intelligibility. Of the 40 patients, 10 experienced improved speech (improved intelligibility group), 18 demonstrated no detectable changes in speech (unchanged intelligibility group), and 12 presented with worsened speech intelligibility (deteriorated intelligibility group). The average amount of advancement was 9.4 mm in the improved and unchanged intelligibility groups and 12.2 mm in the deteriorated intelligibility group. There was a statistically significant difference in the average amount of advancement between the improved and unchanged groups and the deteriorated intelligibility group. In the improved intelligibility group, 9 patients demonstrated improved articulation and 7 had reduced hyponasality. Conversely, in the deteriorated intelligibility group, 10 patients demonstrated increased hypernasality. Intelligibility ratings appeared to depend on the balance between the benefits of amelioration of hyponasality and misarticulations and the debit of increased hypernasality. The amount of maxillary advancement has a direct bearing on speech intelligibility. The amelioration of speech intelligibility improves if the amelioration of distorted articulation and hyponasality overrides any increase in hypernasality.

Adolescent↗

PubMed1998

Pharyngoplasty in patients with cleft lip and palate after maxillary advancement.

The development of velopharyngeal incompetence and increased hypernasality after maxillary advancement has been described previously by several authors. If speech and velopharyngeal function deteriorate after maxillary advancement, pharyngoplasty is frequently the treatment procedure of choice because of the natural cause of the deficit. Of 91 cleft lip and palate patients who have undergone maxillary advancement at the Australian Cranio-Facial Unit, 23 patients received a pharyngoplasty after surgery. Thirteen of these patients who had pre- and postoperative speech evaluations were included in this study. Of the 13 patients, six patients received a superiorly based pharyngeal flap, two patients underwent an orticocheal pharyngoplasty, and five patients received either a revision or augmentation of the previous flap based on results of preoperative examinations. Serial nasendoscopic evaluations were available for 11 of these 13 patients, and they demonstrated that velopharyngeal function improved after pharyngoplasty in six patients and was unchanged in five patients. Of the 13 patients, 10 improved and three patients were unchanged on an intelligibility rating. Nine of the 13 patients demonstrated decreased hypernasality and four patients were unchanged. Hyponasality decreased in two patients increased in one patient, and was unchanged in one patient. Because the results obtained are considered acceptable, the authors conclude that pharyngoplasty can be used effectively to treat velopharyngeal dysfunction subsequent to Le Fort I maxillary advancement.

Adolescent↗

PubMed1994

[Relationship between nutritional depletion and cell-mediated immune function in active pulmonary tuberculosis].

A survey on the nutritional status and cell-mediated immune function of 47 hospitalized patients with active pulmonary tuberculosis and healthy controls was conducted. In the patients group: 1) Anthropometric measurements, such as %ideal body weight (%IBW), %arm circumference (%AC), %arm muscle circumference (%AMC) and %triceps skin fold (%TSF), were significantly reduced. 2) Visceral proteins including serum albumin (Alb), transferrin (Tf), prealbumin (PA) and retinol binding protein (RBP) were significantly reduced. 3) The imbalance of plasma amino acids, which was characterized by the depression of Fischer ratio, a molar ratio of branched chain amino acids (BCAA) to aromatic amino acids (AAA), was observed. Fischer ratio was significantly correlated with anthropometric measurements (%IBW, %AC and %AMC). Delayed-type hypersensitivity to DNCB (2,4-dinitrochlorobenzene) and lymphocyte transformation to phytohemagglutinin (PHA) and concanavalin A (Con A) were significantly impaired in the patients group, whereas NK cell activity was higher than that of controls. Alb, PA, RBP and Fischer ratio were significantly lower in the patients with reduced DNCB reaction than in those with normal responses. Lymphocyte transformation was significantly correlated with Fischer ratio, and NK cell activity was significantly correlated with Alb, PA, RBP. These data may suggest that the imbalance of plasma amino acids represented by the reduction of Fischer ratio and the depletion of visceral proteins are closely related to the impairment of lymphocyte function in the patients with active pulmonary tuberculosis.

Adult↗