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Biomedical subjects

J S Gruss

Publications and source records attributed to J S Gruss.

At least 19 recordsLinked to original sources
PubMed1992

The surgical management of Melkersson-Rosenthal syndrome.

A triad of facial palsy, orofacial edema, and furrowed tongue constitutes an uncommon condition known as Melkersson-Rosenthal syndrome (MRS). We report on 14 patients with Melkersson-Rosenthal syndrome. Two patients had facial palsy, 12 had orofacial edema, and 1 patient had a furrowed tongue. Nine patients were treated medically. Intralesional steroid therapy had a 75 percent recurrence rate. Systemic steroid therapy resulted in remission in two of three patients. Surgical excision and reconstruction were carried out in five patients with chronic lip or eyelid edema. This provided relief in all cases. The etiology, clinical presentation, and histologic features are discussed. Three illustrative cases are presented. An algorithm is provided that guides the surgeon with regard to both the medical and surgical treatment of the patient with Melkersson-Rosenthal syndrome.

Adolescent↗
PubMed1992

Craniofacial fractures. An algorithm to optimize results.

The aim of treatment of combined injuries of the cranium and face is the correct anatomic restoration of the maxilla in relation to the cranial base above and the mandible below and the reconstruction of any associated craniofacial, naso-orbitoethmoidal, and zygomatic fractures. The plethora of techniques described in this article for the management of these injuries attests to the controversy and confusion surrounding the management of these patients.

Algorithms↗
PubMed1992

Current concepts in the use of bone grafts in facial fractures. Basic science considerations.

In choosing the ideal donor site for bone replacement, attention must be given to the recipient site's revascularization potential and mechanical needs. Based on histologic differences in architecture as related to these two factors, the most appropriate graft type may be harvested. Future potential exists for bone replacement by distraction osteogenesis without the need for remote site harvesting. This may provide for the most identical bone replacement.

Biomechanical Phenomena↗
PubMed1992

A stereotactic system for guiding complex craniofacial reconstruction.

A stereotactic system has been designed to address the problem of achieving symmetry in complex and extensive craniofacial defects. Preliminary testing suggests that such a system, which allows for the intraoperative application of preoperative CT planning, will be useful in guiding the reconstruction of congenital or acquired bony time, is being used to investigate the correlation of intraoperative globe position following enophthalmos correction with long-term outcome, particularly as it relates to the size and location of the orbital defect, and the timing of the procedure.

Adult↗
PubMed1991

Early definitive bone and soft-tissue reconstruction of major gunshot wounds of the face.

The use of craniofacial surgical techniques, extended open reduction, rigid fixation with plates and screws, and the replacement of severely damaged or missing bone with immediate bone grafting in the treatment of complex facial fractures has been applied to the management of severe gunshot wounds of the face. Early definitive bone and soft-tissue reconstruction has been performed in 37 patients. One-hundred and seventy-seven primary bone grafts were utilized in 33 patients for orbital, nasal, zygomatic, and maxillary reconstruction. Twenty-six patients required mandibular repair with compression or reconstruction plates. Soft-tissue reconstruction was provided by a combination of flaps. Four patients had extensive soft-tissue loss replaced by free vascularized omental flaps. The omentum provided circumferential coverage of the mandibular reconstruction and reconstruction of the floor of the mouth and was then tunneled in a circle through both cheeks into the middle and upper face. The omentum reconstructed deficits in the hard palate and upper buccal sulcus and was then wrapped around all zygomatic, orbital, and midfacial bone grafts and used to fill in dead space in the maxillary, ethmoid, and frontal sinuses. The omentum is not used to provide contour and bulk, but to cover bone grafts and plates and fill in dead space. Carefully shaped bone grafts provide the correct craniofacial scaffold. Early restoration of a midfacial bony scaffold and the prevention of soft-tissue contraction facilitate secondary reconstruction. Four late total nasal reconstructions with tissue-expanded forehead skin wrapped around bone grafts were performed.

Adolescent↗
PubMed1991

Periosteal suspension of the lower eyelid and cheek following subciliary exposure of facial fractures.

Following craniofacial procedures that involve stripping of the periosteum and soft tissue over the zygomatic maxillary complex, descent of soft tissue with a decrease in anterior projection over the malar area and increase in fullness in the nasolabial fold have been seen to be a problem by these authors. Simple repositioning of the soft tissues to their normal anatomic position may be used to alleviate this problem.

Cheek↗
PubMed1991

The biomechanical effects of deep tissue support as related to brow and facelift procedures.

The adverse effects of increased tension across a healing wound are well known. However, the effect of closing a wound in layers in order to decrease tension on the epidermis has been a source of controversy. It is hypothesized that deep tissue support decreases skin tension upon wound closure. In order to clarify this issue, a two-part study was designed to address the immediate effects of deep tissue support in vitro using fresh-frozen cadavers and in vivo on patients undergoing scheduled surgery. Closing skin tension was measured at standard reference points in coronal brow lift and rhytidectomy procedures performed with and without galeal closure and superficial musculoaponeurotic system (SMAS) procedures, respectively. Deep tissue support was found to significantly (p less than 0.05) decrease skin tension at the time of skin closure at standard reference points in coronal brow lift and rhytidectomy procedures performed on fresh-frozen cadavers. Similar significant (p less than 0.05) decreases in closing skin tension also were found in vivo in patients undergoing similar surgical procedures. Stress relaxation was not found to play a significant role in contributing to this immediate decrease in closing skin tension. It would appear, therefore, that deep tissue support, in the form of galeal closure and an SMAS procedure in coronal brow lift and rhytidectomy procedures, respectively, provides increased viscoelastic support, producing immediate significant decreases in closing skin tension in these procedures. The beneficial effects on wound healing, scar formation, tension-related trophic skin changes, and possible improved long-term results are discussed.

Adult↗
PubMed1990

Isolated blow-in fracture of the lateral orbit causing globe rupture.

A blow-in fracture is a less common consequence of orbital trauma. Fragments of orbital bone may increase the orbital pressure, causing direct or indirect damage to the globe. This paper describes a blow-in fracture where a bone fragment perforated the globe causing globe disorganization and necessitating enucleation.

Accidents, Traffic↗
PubMed1990

The importance of the zygomatic arch in complex midfacial fracture repair and correction of posttraumatic orbitozygomatic deformities.

Collapse of the zygomatic arch following trauma results in inadequate anteroposterior projection of the zygomatic body and an increase in facial width. Accurate assessment of the position of the zygomatic arch in relation to the cranial base posteriorly and the midface anteriorly is the key to the acute repair of complex midfacial fractures and the secondary reconstruction of posttraumatic deformities of the orbitozygomaticomaxillary complex. Loss of projection of the zygomatic arch may occur with injuries confined to the orbitozygomaticomaxillary region or in association with complex midfacial fractures. A safe anatomic approach to the zygomatic arch allows exact anatomic restoration of the zygomatic arch using miniplates and screws and results in the reconstruction of an outer facial frame with a correct anteroposterior projection and facial width. The zygomatic arch injury is diagnosed using axial CT scanning. Three-hundred and seventeen arches have been exposed through a coronal incision following acute trauma and 47 arches have been exposed in patients requiring late correction of a posttraumatic orbitozygomaticomaxillary deformity. Permanent palsy to the frontal branch of the facial nerve has occurred in one patient following the exact definition of the anatomy of this region.

Facial Bones↗
PubMed1990

Treatment of severe lower eyelid retraction with scleral and free skin grafts and bipedicle orbicularis flap.

Surgical repair of lamellar shortening must treat the anterior and posterior shortening, plus the scarring between Mueller's muscle, capsulopalpebral fascia, and periosteum. We describe a repair method in which a full-thickness, free skin graft is used to correct the anterior lamellar defect, and a homologous scleral graft is used to correct the posterior defect. Vascular support for the two free grafts is provided by a bipedicular orbicularis muscle flap.

Eyelid Diseases↗
PubMed1989

Combined injuries of the cranium and face.

The neurosurgeon and plastic surgeon are increasingly called upon to manage the care of patients with combined injuries of the cranium and face. The authors briefly review the pathogenesis and classification of craniofacial fractures and outline historical approaches to them. Current principles of management are then discussed. Experience with 167 patients is presented with emphasis on surgical technique, the sequence of repair and early primary reconstruction. The controversial issue of fontal sinus fracture repair is addressed. The authors favour preservation of the frontal sinus cavity, where possible, and do not obliterate the nasofrontal duct. With injuries to the floor of the sinus, the base of the sinus and frontonasal duct are sealed with bone graft and a vascularised soft tissue flap and the sinus is cranialised. Immediate bone grafts, using split skull or rib, are used to reconstruct areas of bony destruction or loss. Ninety-eight patients required 402 grafts. Immediate bone grafting resulted in few complications and low incidence of secondary deformities needing correction.

Facial Bones↗
PubMed1989

Facial sensibility testing in the normal and posttraumatic population.

A reliable, reproducible, simple examination of facial sensibility is described. Evaluation of 60 healthy subjects established normal values, trends, and variations of facial sensibility. Comparison of these normal values with 20 posttraumatic patients revealed that postfacial fracture sensibility testing was abnormal. Abnormalities in pressure threshold testing was most consistently associated with functional sensory complaints. Twelve of the 20 patients had significant sensory complaints at one year following the trauma.

Adolescent↗
PubMed1989

Blow-in fractures of the orbit.

A blow-in fracture is an inwardly displaced fracture of the orbital rim or wall resulting in decreased orbital volume. The purpose of this study is to classify orbital blow-in fractures, describe the distinguishing clinical and radiologic features, and review the result of treatment. The series consists of 41 patients with blow-in fractures (34 males and 7 females). The mean age of the patients was 36 years. All were treated between 1979 and December of 1986 at Sunnybrook Medical Centre in Toronto. Clinical features of blow-in fractures were primarily related to the decrease in volume of the orbital cavity. Proptosis was a consistent finding, and in 27 percent of patients, the globe was further displaced in a coronal plane. Restricted ocular motility and diplopia were documented in 24 and 32 percent of patients, respectively. Fracture fragments displaced into the orbit resulted in globe rupture in 12 percent of patients, superior orbital fissure syndrome in 10 percent, and optic nerve injury in 1 patient. Blow-in orbital injuries were classified as pure fractures, consisting of an isolated blow-in of a segment of the roof, floor, or walls, or impure fractures, where the orbital rim itself was disrupted. In all cases, early decompression of the orbit and open reduction of fractures was necessary. Late sequelae of blow-in fractures were primarily related to injuries of intraorbital contents. Twelve percent of patients underwent enucleation and 8 percent reported persistent diplopia. Despite the presence of superior orbital fissure syndrome and complete ophthalmoplegia in 10 percent of patients, early orbital decompression resulted in resolution of nerve palsies in all but one patient.

Adolescent↗
PubMed1989

Complex facial trauma: the evolving role of rigid fixation and immediate bone graft reconstruction.

The problem of high velocity facial injuries with multiple facial fractures concerns the severity of the bony injury. Attempts at closed reduction of the large comminuted segments common to these fractures result in eventual bony collapse and soft tissue shrinkage. The solution to these problems lies in the early exposure of all fracture segments and their repair using internal fixation techniques.

Bone Plates↗
PubMed1989

Complex orbital fractures: a critical analysis of immediate bone graft reconstruction.

The present study reviews the long-term results of immediate reconstruction and primary grafting in 49 complex orbital fractures. The clinical features of these injuries are defined, and methods of investigation and surgical correction are outlined. The residual postoperative abnormalities, including enophthalmos, strabismus, and telecanthus, are critically analyzed. Recent modifications in fracture fixation, in orbital cavity reconstruction, and in the use of various types of autogenous grafts are discussed in detail.

Bone Transplantation↗
PubMed1989

Angiolymphoid hyperplasia with eosinophilia: a case report and literature review.

Angiolymphoid hyperplasia with eosinophilia is a rare, benign vascular tumor affecting principally the head and neck region of young adult females. Microscopic analysis reveals hyperplastic blood vessels lined by a hypertrophic endothelium. An inflammatory infiltrate rich in eosinophils is also present. Etiology of the lesion is unknown. Various treatment modalities have been described. We describe a case successfully treated by extensive excision and reconstruction.

Adult↗