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Biomedical subjects

L F Stassen

Publications and source records attributed to L F Stassen.

At least 19 recordsLinked to original sources
PubMed2001

Influence of routine bone grafting on the stability of the non-cleft Le Fort 1 osteotomy.

Although bone grafting is known to improve stability after midface cleft osteotomy, it is advocated only rarely for people without clefts. To assess the influence of routine bone grafting on stability in such patients we analysed radiographic data of 112 patients retrospectively. All patients had had Le Fort 1 osteotomy with autogenous bone grafts harvested by trephine from the iliac crest, and 76 had had concurrent mandibular procedures. Rigid internal fixation was adopted throughout. Impaction proved to be the most stable move. While there was little postoperative relapse of the anterior maxilla (0.9%), the posterior maxilla tended to move further upwards with time (2.3%). Overall relapse after advancement and inferior repositioning was low (3.5% and 5%, respectively). The only complication noted at the iliac crest donor site was spread of the scar, which affected three patients. When we compared these results with previously published data, they suggested that in patients without clefts rigid internal fixation combined with bone grafting may improve stability after selected Le Fort 1 osteotomy moves.

Adolescent↗
PubMed2000

New surgical technique for the correction of congenital muscular torticollis (wry neck).

Congenital muscular torticollis (wry neck) results from shortening of the sternocleidomastoid muscle and may lead to limitation of neck movement and craniofacial deformity. If conservative treatment is started early, with a regimen of passive stretching exercises and active strengthening of the contralateral muscle, about 95% of patients achieve an acceptable range of neck movement. The surgical management of patients who do not respond to physiotherapy remains controversial. Its aim is to provide a long-term, cosmetic restoration of neck mobility while minimizing the development of craniofacial deformity and upper cervical scoliosis; few previously advocated techniques achieve both these goals. We describe a technique that combines subperiosteal lengthening of the sternocleidomastoid muscle at its mastoid insertion, and division of lower fibrotic bands with minimal postoperative fibrosis. As the sternomastoid muscle is reattached lower down on the mastoid process, the lengthening of the muscle is stable, because the tendency to fibrosis and shortening is minimized. Comparison of the results with previous series shows that this technique provides immediate benefit and good long-term results.

Adolescent↗
PubMed2000

The bicoronal flap (craniofacial access): an audit of morbidity and a proposed surgical modification in male pattern baldness.

Maxillofacial surgeons have used the bicoronal flap for nearly three decades to gain access to the craniofacial skeleton. A retrospective analysis of 68 bicoronal flaps done over a five-year period showed that our incidence of permanent morbidity was low. Although 24 patients (35%) experienced some form of sensory abnormality immediately after the operation, this persisted for longer than two years in only one. Complete motor recovery occurred by one year in all 15 patients (22%) who developed postoperative frontalis weakness. Three patients developed male pattern baldness postoperatively, which resulted in exposure of the scar and poor cosmesis. This prompted a cadaveric study in which we assessed the feasibility of modifying the position of the standard bicoronal incision in people who are prone to hair loss. The pivotal point of the bicoronal flap was found to lie at its most inferior aspect. By extending the incision into the skin crease in front of the lobe of the ear it was possible to adjust the anteroposterior position of the bicoronal incision without limiting access to the facial skeleton. We therefore advocate occipitally placed incisions with preauricular extensions in patients who are prone to male pattern baldness.

Adolescent↗
PubMed1998

Cross-matched blood for major head and neck surgery: an analysis of requirements.

We retrospectively analysed our blood ordering practice; the number of units of cross-matched blood requested was compared with the number transfused, in 70 patients undergoing a total of 82 ablative operations for malignant disease. Patients undergoing neck dissection alone, or excision of tumour with free revascularized flap reconstruction without neck dissection, are unlikely to require blood transfusion. Operations that include excision of tumour with primary closure and neck dissection, excision of tumour with pedicled flap reconstruction and excision of tumour with any form of flap reconstruction and neck dissection in continuity, will probably require transfusion. If atypical antibodies are present in the patient's serum on screening, cross-matched blood should always be available preoperatively. Provided that atypical antibodies are not present and that blood is available within 40 minutes from the blood bank, our results show that it is safe to adopt a policy of blood grouping and saving serum, for patients undergoing neck dissection alone, but cross-matching two or more units of blood for patients who are to have more extensive operations.

Blood Grouping and Crossmatching↗
PubMed1998

A prospective study of trephined bone grafts of the tibial shaft and iliac crest.

Autogenous cancellous bone grafting is a common procedure in maxillofacial surgery. Open harvesting usually results in a long scar and considerable morbidity, but harvesting using a trephine can be done through a smaller scar with minimal morbidity. The commonly used anatomical areas for trephine harvesting are the iliac crest and the tibial shaft. A prospective study was carried out in 30 patients to compare the technique and the morbidity as perceived by patients using a visual analogue scale (VAS) and by an independent observer. The surgical anatomy and techniques are described. The results show no significant difference between the two groups, but the tibial trephine procedure is easier, quicker, and causes less blood loss. The total scores for pain and difficulty in walking were much less for tibial than that for the iliac grafts.

Adolescent↗
PubMed1997

A microbiological study of pre- and postoperative apicoectomy sites.

There is little information on the microbiology of periapical lesions, and no data on the residual microbial flora in the periapex, if any, after apicoectomy procedures. Hence, 64 patients treated by apicoectomy procedures were prospectively studied to assess the bacterial flora in the periapex and to evaluate the residual bacteria in postoperative apicoectomy sites. Of the 64 lesions studied, 14 (22%) were sterile and 50 (78%) yielded bacteria preoperatively. Bacteria could be recovered from 28 (56%) of the latter lesions after apicoectomy and curettage. A total of 105 bacterial strains was isolated from 50 lesions, yielding a range of 1-4 (mean 2.1) species per sample. The isolates comprised 84 (80%) facultative anaerobes and 21 (20%) strict anaerobes. A polymicrobial growth was obtained from 39 lesions whilst 11 lesions yielded pure cultures. On detailed microbiological analyses of 29 lesions, 40% of the isolates were identified as alpha-haemolytic streptococci, half of which were Streptococcus sanguis; anaerobic streptococci were the predominant anaerobes. None of the organisms or group(s) of organisms emerged as recalcitrant colonisers which were difficult to dislodge after surgical debridement. These data indicate that the majority of periapical lesions harbour a variety of flora which cannot be eradicated despite thorough apicoectomy procedures.

Actinomyces↗
PubMed1996

Bilateral block: is it safe and more efficient during removal of third molars?

OBJECTIVE- to assess the safety, acceptability, and efficacy of removing bilaterally impacted wisdom teeth as a one-stage rather than a two-stage procedure. DESIGN- randomised controlled trial. Setting - district hospital. SUBJECTS- 100 consecutive patients who required removal of bilaterally impacted third molars. INTERVENTIONS- 50 patients were randomised to have the teeth removed in two stages, 3-4 weeks apart, the other 50 to have the teeth removed at one visit. All operations were done under local anaesthetic (2% lignocaine and 1/80 000 adrenaline) and intravenous midazolam 0.07-0.13 mg/kg titrated against sedative effect individually. Main outcome measures - morbidity, time off work, anxiety scores (assessed by visual analogue scale), and patient opinions. RESULTS- 5 patients were withdrawn because they were not given the randomised treatment, and 10 were lost to follow-up, leaving 40 in the two-stage group and 45 in the one-stage group for analysis. Two patients in the one stage group developed SaO2 of less than 90% which was corrected by deep breathing, and another had a temporary parasthesia of the inferior alveolar nerve that resolved within a week. One patient in the two stage group had a haemorrhage after the first stage that required packing of the socket in the emergency department, and this patient refused to have the second tooth removed. The mean number of days taken off work was significantly less in the one stage group (mean 3 days compared with 5 days (P < 0.005), and the anxiety scores did not differ significantly between the two groups. A quarter of the patients in the two-stage group would have preferred a one-stage procedure, but none in the one-stage group would have preferred a two-stage operation. CONCLUSIONS- removal of bilaterally impacted wisdom teeth under local anaesthesia and sedation in one session is safe, cost effective and acceptable to patients.

Absenteeism↗
PubMed1996

Sebaceous carcinoma of the parotid gland.

A report of an 87-year-old Caucasian female with an extensive sebaceous carcinoma of the parotid gland is presented. The computed tomographic characteristics of this rare neoplasm are reported for the first time.

Adenocarcinoma, Sebaceous↗
PubMed1995

Acceptance and perception of percutaneous endoscopic gastrostomy by patients with upper aerodigestive tract cancer.

Surgeons have identified a role for percutaneous endoscopic gastrostomy (PEG) in selected patients with upper aerodigestive tract cancer, but little is known about the patient's acceptance and perception of PEG. Nineteen patients with upper aerodigestive tract cancer had placement of a PEG and were asked about their perceptions via a series of descriptors and associated questions. The 13 patients who had PEG placement under local anaesthesia and intravenous midazolam were questioned 12-16 h later and reported that the procedure was comfortable and not as bad as expected. These patients together with a further 6 patients who had placement under general anaesthesia were questioned about their acceptance of the PEG tube after 10 days. Comfort, ease of use and maintenance, and coverage by clothing confirms that PEG is an acceptable delivery system for enteral nutrition in patients with upper aerodigestive tract cancer.

Adult↗
PubMed1995

An unusual cause of trismus.

This paper reports a case of limited mandibular movement caused by the rare condition of bilateral coronoid hyperplasia. Dental surgeons should be aware of the possibility of this condition when encountering patients with movement problems in the mandible.

Adult↗
PubMed1994

A pilot study of the use of eminectomy in the treatment of closed lock.

There are many treatments described for closed lock of the temporomandibular joint. Eminectomy has been described in the treatment of recurrent dislocation of the jaw. The use of a 'true' eminectomy alone, as the treatment of closed lock has not been previously described. Eighteen patients, three male and 15 female, with a mean age of 28 years, underwent 22 eminectomy procedures. The mean follow-up period was 7 months, assessment was both subjective, using a retrospective Visual Analogue Scale (VAS), and objective with measurement of the Inter Incisal Distance (IID). Overall the subjective improvement in symptoms was high with a score of 85.5 on a 100 mm VAS. The mean improvement in Inter Incisal Distance, was 17.9 mm a statistically significant result using a paired t test (p < 0.001).

Adult↗
PubMed1994

Closure of radial forearm free flap defect using full-thickness skin from the anterior abdominal wall.

One of the major problems associated with the radial forearm free flap is donor site morbidity. Traditionally the defect is repaired using a split-thickness skin graft which gives poor coverage of the underlying structures, is unsightly, and in the long term may result in marked scarring. There is also morbidity associated with the skin graft donor site. We describe an alternative technique for closure of the donor site using full-thickness skin from the anterior abdominal wall. We believe this technique reduces not only donor site morbidity but also morbidity at the graft site.

Abdominal Muscles↗
PubMed1994

Treatment of oral cancers using iridium-192 interstitial irradiation.

OBJECTIVE: To assess retrospectively the outcome and morbidity of Iridium-192 brachytherapy in the treatment of oral cancers. DESIGN: Retrospective audit of cases treated between 1981 and 1991. SETTING: Newcastle upon Tyne, England. SUBJECTS: 73 patients with oral cancer treated with Iridium-192. MAIN OUTCOME MEASURES: Local control, crude and cause specific survival, and local morbidity. RESULTS: Seventy four cases of squamous cell carcinoma of the oral cavity were treated using interstitial Iridium-192. The disease specific 5-year survival rates were 69% for T1, 67% for T2, and 0% for T3 tumours. Mortality from recurrent cancer was 20%, and from intercurrent disease was 28%. The incidence of major radiation induced morbidity was 11%, and the local control rate was 81% for T1, 69% for T2, and 50% for T3 tumours. CONCLUSION: Interstitial radiotherapy remains a viable and valuable mode of treatment for a small proportion of patients presenting with early (T1 and T2) oral cancers.

Adolescent↗
PubMed1994

Meningioma--an unusual forehead swelling: a case report.

Meningiomas are rarely encountered by head and neck clinicians. This report describes a patient with a meningioma presenting uncommonly as a long-standing forehead mass with minimal symptoms. Investigation identified a large bifrontal meningioma with extra-cranial extension involving the right orbit and forehead. The literature is reviewed with particular reference to extra-cranial meningioma and the case is discussed.

Aged↗