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Biomedical subjects

J Raveh

Publications and source records attributed to J Raveh.

At least 19 recordsLinked to original sources
PubMed2001

Evaluation of the Contribution of CAS in Combination with the Subcranial/Subfrontal Approach in Anterior Skull Base Surgery.

In this study, 31 cases with different anterior skull base lesions mandating broad exposure, including the sphenoidal, parasellar, and clival region, were surgically treated using the frameless computer assisted surgery (CAS) system. The contribution of navigated surgery in relation to the broad exposure and direct visualization of this region rendered by the subcranial-subfrontal approach was evaluated. In group I, consisting of extensive tumors, the contribution of CAS was only given in five cases for the exposure of the tumor extensions located to the parasellar sphenoclival complex with concomitant distortion of the anatomic landmarks. No advantages were experienced in the more anterior locations along the ethmoidal compartment and frontal sinus. In the cases in group II, consisting of congenital anomaly implying fronto-orbital advancement and a meningoencephalocele as well as extensive mucoceles, the CAS was only helpful in those cases with an extremely aberrative anatomy in these regions.

Journal Article↗
PubMed2000

Endovascular treatment of acute and subacute hemorrhage in the head and neck.

OBJECTIVE: Acute and subacute hemorrhage in the head and neck often represent a life-threatening situation. The goal of this study is to evaluate the indications for and contributions of endovascular techniques in the diagnosis and management of such severe cases. DESIGN: Seventy-two patients with acute or subacute intractable hemorrhage of the head and neck were treated over a period of 5 years: 2 patients had experienced trauma; in 6 cases the cause of bleeding was iatrogenic; and in 2 patients intraosseous arteriovenous malformations were manifested. Fifteen patients had tumors, 9 of whom had prior radiotherapy. Forty-seven patients presented with epistaxis (41 idiopathic and 6 during anticoagulation therapy). The endovascular therapy was performed using polyvinyl alcohol particles, fibered platinum or electrolytically detachable coils (Guglielmi detachable coils; Target Therapeutics, Fremont, Calif), a stent, glue (Ethibloc; Ethicon GmbH, Norderstedt, Germany, and Histoacryl; B. Braun Melsungen AG, Melsungen, Germany), or with a combination of these different embolic materials. RESULTS: The acute bleeding was successfully controlled in all cases. Fourteen patients (7 with epistaxis, 5 with tumors, and 2 with arteriovenous malformations) had to be embolized more than once before the bleeding could be controlled. The idiopathic, traumatic, iatrogenic, and remaining tumoral cases were treated only once. The long-term morbidity was 1.9%. CONCLUSIONS: Owing to the recent continuous advances in interventional radiologic techniques, it is possible to treat both acute and subacute life-threatening head and neck hemorrhage most efficiently. In many cases the endovascular therapy complements surgery.

Acute Disease↗
PubMed1998

Open reduction without fixation of dislocated condylar process fractures: long-term clinical and radiologic analysis.

PURPOSE: This study evaluates the long-term results of open reduction without fixation for displaced fractures of the condylar process. PATIENTS AND METHODS: Clinical and radiologic examinations were performed on 27 patients with 29 operated joints an average of 6.7 years postoperatively. The postoperative result was evaluated on the basis of occlusal and joint function, as well as radiographic assessment of condylar changes. RESULTS: Clinically, satisfactory results were achieved. Radiologically, despite correct intraoperative alignment of the fractured segments, a slight medial deviation of the condylar process was found on the posteroanterior radiograph. However, in only two cases was a 20-degree deviation observed. On final follow-up, 48% of the cases had a normal condylar configuration radiologically, and in the remaining cases, normal function was established even though there were condylar changes. Fully exposed and devascularized condylar processes generally showed more severe changes than those in which partial vascularization was maintained. CONCLUSION: The surgical management described enables a satisfactory outcome to be achieved with dislocated condylar process fractures.

Adolescent↗
PubMed1996

Preoperative embolization of paragangliomas and angiofibromas. Measurement of intratumoral arteriovenous shunts.

OBJECTIVE: To determine if technetium Tc 99m-labeled macroaggregated albumin selective angioscintigraphy enables estimation of microparticle-arteriovenous shunt in branchial paragangliomas and nasopharyngeal angiofibromas. DESIGN: Technetium Tc 99m-labeled macroaggregated albumin particles with calibrated diameters between 25 and 50 microns were administered during selective catheterization of the feeding arteries in 4 branchial paragangliomas (glomus tumors) and 4 nasopharyngeal angiofibromas. Preliminary measures of the activity of the tumor region and of the lungs were obtained in the angiography suite using a hand-held detector. Without changing the position of the microcatheter, definitive embolization was performed. After endovascular treatment, scintigraphy was performed and the pulmonary shunt index was calculated with the use of a gamma camera and a dedicated computer program. RESULTS: The pulmonary shunt index varied between 0% and 36% for branchial paragangliomas (glomus tumors) and between 82% and 95% for angiofibromas. CONCLUSIONS: Our results provide new evidence that the incidence of microparticle-arteriovenous shunt in nasopharyngeal angiofibromas is much higher than in paragangliomas.

Adolescent↗
PubMed1995

Extended anterior subcranial approach for skull base tumors: long-term results.

The extended anterior subcranial approach differs significantly from more traditional surgical approaches to the skull base in that it allows a broad inferior access to the anterior skull base planes with tumor exposure from below rather than via the transfrontal route. The authors initially used the subcranial approach in 1978 for the treatment of high-velocity skull base trauma and certain craniofacial anomalies. In 1980 they expanded the indications to include the combined neurosurgical-otolaryngological resection of various skull base tumors. Osteotomy of the frontonasoorbital external skeletal frame provides optimum anterior access to the orbital and sphenoethmoidal planes as well as to the nasal and paranasal cavities while avoiding frontal lobe retraction and the external facial incisions characteristic of transcranial and transfacial approaches. The improved visualization of the anterior skull base and clival-sphenoidal region facilitates en bloc tumor removal, optic nerve decompression, exposure of the medial aspect of the cavernous sinus, and watertight realignment of the anterior cranial base dura. In this report the authors present their experience over the past 13 years with 104 patients who underwent operation via the extended subcranial approach. Because extensive frontal lobe manipulation and external facial incisions are avoided with this approach, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced. The extended anterior subcranial method is therefore an excellent alternative to traditional transfacial-transcranial skull base approaches for the removal of selected skull base tumors.

Adolescent↗
PubMed1995

[Biocem--a new material for retrograde root filling. The 5-year clinical results].

This paper describes the application of a new material, Biocem, for retrograde root canal filling. A total of 234 roots in 222 teeth were treated during the period 1987-1992. Biocem consists of two components and once mixed, the autopolymerisation results in a three-dimensional structure. The biomechanical and histologic properties and a clinical longterm follow-up confirm the optimal qualities of this material. It fulfills the requirements in regard to biocompatibility, watertight sealing and application. The material proved superior in comparison to conventional materials and ceramics. The evaluation of the results are most encouraging.

Adolescent↗
PubMed1995

[Biocem--a new material for retrograde tooth root filling].

This paper describes the application of a new material, Biocem, for retrograde root-canal filling. The series included 222 teeth, including 234 roots treated during the period 1987-1992. This material consists of two components and once mixed, the autopolymerisation results in a three-dimensional structure. The biomechanical, histological and clinical longterm follow-up confirms the optimal qualities of this material, fulfilling the requirements in regard to biocompatibility, watertight sealing and application. The material proved to be superior in comparison to conventional materials and ceramics. The significant reduction of complications and the new apposition, as well as the evaluation of the results are most encouraging.

Calcium Phosphates↗
PubMed1994

Degenerative temporomandibular joint disease: surgical treatment and long-term results.

PURPOSE: In this study, the long-term evaluation after surgical treatment of temporomandibular joint with manifested degenerative changes and internal derangement is described. The surgical procedure, including extensive exploration and remodeling of the joint, with interposition of lyophilized human costochondral cartilage, is described. MATERIALS AND METHODS: Thirty-two cases (37 joints) were evaluated at a mean follow-up time of 3.1 and 8.6 years after the surgical treatment. RESULTS: A significant reduction of dysfunction and pain symptoms was achieved in most cases.

Adolescent↗
PubMed1994

Revascularized bone grafts for craniofacial reconstruction.

Reconstruction of craniomaxillofacial defects caused by injury, tumor ablation, or congenital deformities can be accomplished by a variety of methods. Nonvascularized (free), vascularized (pedicled), and revascularized (microvascular) bone grafts have been employed for osseous restoration of the upper, mid, and lower facial skeleton. In comprised recipient tissue beds or when rapid functional restoration is desired, revascularized flaps hold certain advantages over their nonrevascularized counterparts. The revascularized flaps used most commonly for craniofacial reconstruction are discussed with regard to anatomy, clinical applications, and aesthetic and functional limitations.

Bone Transplantation↗
PubMed1993

The subcranial approach for fronto-orbital and anteroposterior skull-base tumors.

We describe 78 patients with fronto-orbital and sphenoethmoidal tumors surgically treated with the subcranial approach. This approach was developed by us in 1978 primarily for the treatment of skull-base trauma and craniofacial anomalies. Since 1980, we have extended the indications to include tumor resections. This extended anterior exposure of the anterior fossa skull base, including the sphenoidal and clival planes, enables an en bloc tumor removal obviating the transfrontal approach or lateral rhinotomy. In contrast with the conventional transcranial approach, the anterior subcranial approach provides an extended exposure of these locations, avoiding frontal lobe retraction. Reduction of complications, such as recurrent cerebrospinal fluid leaks, postoperative brain edema, damage to cranial nerves, and infection plus decreased hospitalization, are the major advantages of this procedure.

Adolescent↗
PubMed1993

Linkage of Van der Woude syndrome (VWS) to REN and exclusion of the candidate gene TGFB2 from the disease locus in a large pedigree.

Van der Woude syndrome (VWS) is an autosomal dominant disorder associated with one or more of the following features: clefting of the primary or secondary palate, hypodontia or lower lip pits. It has been estimated to account for 2% of all cases of cleft lip and palate. VWS is one of the rare disorders in which clefting of the primary and secondary palate may be seen to segregate as components associated with the same gene. Because of its autosomal dominant inheritance, VWS is readily accessable to linkage analysis as a preliminary step in the identification of the molecular abnormality underlying the clefting effect in the primary and secondary palate. A reported linkage between REN and VWS has promoted us to use pHRnX3.6 (REN) and several markers surrounding REN for a linkage analysis in a large Swiss family. In a second step, linkage analysis was performed to study restriction fragment length polymorphisms for the candidate gene TGFB2 and other loci recently mapped to the candidate region 1q32-1q41. Evidence for linkage (theta = 0.00, lod score = 3.01) between REN and VWS could be confirmed in this pedigree. TGFB2 demonstrated recombination with the disease locus and is unlikely to be causative in VWS. The results of a multipoint linkage analysis showed that VWS was flanked by D1S65 and TGFB2 at a maximum location score of 20.3.

Adolescent↗
PubMed1992

Management of combined frontonaso-orbital/skull base fractures and telecanthus in 355 cases.

In regard to the multiple problems of reconstruction concerning this fracture pattern, we developed various methods to achieve optimal results. As various vital regions, apart from the nasoethmoidal fractures and aesthetics, are involved, the proposed classification has direct implication for the surgical procedure. Even in intracranial fragment dislocations, cerebral contusion, and elevated intracranial pressure, the subcranial approach, in contrast with the transfrontal access, enables early definitive management of the skull base and the external facial frame in a one-stage procedure. Another method, the symmetrical centripetal compression of the canthal ligaments and naso-orbital bone fragments, enables correct reduction of the telecanthus. The significant reduction of morbidity and complication rate to a minimum confirms the efficiency of our treatment modalities.

Anthropometry↗
PubMed1992

Early surgical intervention for orbital floor fractures: a clinical evaluation of lyophilized dura and cartilage reconstruction.

Experience in the management of 77 isolated orbital floor fractures is presented. The transconjunctival approach was used exclusively to access the orbital floor and lyophilized dura and cartilage were used to reconstruct the floor, when indicated. Follow-up for an average of 36 months showed excellent cosmetic and functional results. A 20% complication rate was noted, which compares favorably with what is reported in the literature. There were no graft extrusions or infections and only one case of graft displacement. These findings support the concept of early treatment of orbital floor fractures, even in "minimally symptomatic" patients. Lyophilized dura and cartilage proved to be safe and effective materials for orbital reconstruction.

Adolescent↗
PubMed1992

Classification and treatment of zygomatic fractures: a review of 1,025 cases.

The treatment of zygomatic fractures varies among surgeons, and the cosmetic and functional results are frequently less than optimal. A treatment guideline based on a simple classification of zygomatic fractures is presented. The emphasis is placed on the indications for closed and open reduction, consistent methods of three-dimensional alignment and fixation, and the management of concomitant infraorbital rim and orbital floor fractures. Postoperative results with regard to infraorbital nerve and maxillary sinus dysfunction, malar asymmetry, and orbital complications in the treatment of 1,025 consecutive zygomatic fractures are presented.

Adolescent↗