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Biomedical subjects

M E Sachs

Publications and source records attributed to M E Sachs.

At least 19 recordsLinked to original sources
PubMed1989

Post-rhinoplastic nasal obstruction.

Successful rhinoplasty achieves both aesthetic and functional goals. This article outlines the pitfalls that cause postoperative obstruction that can occur during the process of cosmetic rhinoplasty. It is my sincere hope that iatrogenic nasal obstruction can be reduced by awareness of these problems and careful attention and planning. The aspects of rhinoplasty that maintain a balance between aesthetics and functional integrity are specifically described. These techniques can be incorporated into the rhinoplastic repertoire of any surgeon and will improve the results dramatically.

Airway Obstruction↗
PubMed1988

Repair of nasal septal perforation utilizing the midface degloving technique.

A technique utilizing the midfacial degloving approach in the repair of nasal septal perforations in 24 patients is reported. The midface degloving approach was limited to patients with septal perforations greater than 3 cm and failed prior attempts at surgical closure. Bilateral posteriorly based unipedicled flaps were utilized in the septal closure. Complete closure was accomplished in 75% (18/24) of cases, with a follow-up of one to three years. Complications included reperforation in 25% (6/24) of cases and partial vestibular stenosis in 20% (5/24) of cases. A modification of our technique, relining the nasal floor with postauricular full-thickness skin grafts, has alleviated vestibular stenosis.

Evaluation Studies as Topic↗
PubMed1987

'Tissue clay'. A new technique for augmentation rhinoplasty.

A new technique for dorsal augmentation during rhinoplasty was utilized in 58 patients over a period of four years. Microfibrillar collagen (Avitene) was combined immediately before the operation with autogenous whole blood, forming a "tissue clay," which was then sculpted into the desired dorsal contour. Tissue clay solidifies after one week and becomes palpably similar to bone. Long-standing results of four years have documented the ability of the substance to augment the nose up to 1 cm in height. There have been no complications to date, and the average resorption rate over a two- to four-year period was 16%. The esthetic and functional results in 58 cases were deemed excellent, safe, and effective.

Blood↗
PubMed1987

Orbital floor fractures: the maxillary approach.

The repair of orbital floor fractures is complicated not only by the technical aspects of the procedure, but by the decision-making process one must initiate to determine when and if the fracture should be repaired. This article examines the indications for repairing orbital floor fractures through the maxillary approach and describes the technical aspects and results that can be achieved with this technique.

Humans↗
PubMed1986

Correction of true periorbital fat herniation in cosmetic lower lid blepharoplasty.

The presence of puffy, baggy lower eyelids is one of the first signs of the aging face. Baggy eyelids can result from excessive eyelid skin, hypertrophied orbicularis muscle, and/or periorbital fat herniation. An exact diagnosis of which components are contributing to the problem must be made in the preoperative period so that proper correction can be made during surgery. The concept of true periorbital fat herniation in the causation of baggy lower eyelids is presented. The surgical correction of this anatomic defect involves identification and approximation of the dehiscent orbital septum to the capsulopalpebral ligament. Thirty-five patients who presented with true lower eyelid fat herniation and who underwent direct suture repair are reviewed.

Adipose Tissue↗
PubMed1986

Treatment of recurrent squamous papillomata of the conjunctiva by carbon dioxide laser vaporization.

Complete resection of recurrent conjunctival squamous papillomata frequently may be exceedingly difficult, since such lesions are typically friable and multilobulated. Recurrent lesions often fill the fornicies and spill onto the lid margins. Moreover, since the human papillomavirus (HPV) has been linked to some of these lesions, there remains the further possibility of spread with "cold knife" resection. We discuss the benefits of carbon dioxide laser vaporization therapy for recurrent squamous papillomata of the conjunctiva that have not responded to resection and cryotherapy or topical immunotherapy. The carbon dioxide laser facilitates resection by providing a bloodless field, and reduces the possibility of viral seeding of the conjunctiva by sterilizing the operative site and sealing the lymphatics.

Adult↗
PubMed1986

Nonsurgical fat removal in cosmetic blepharoplasty: a new technique.

A new technique of minimally invasive fat removal during cosmetic blepharoplasty is described. This lipolytic diathermy technique has been used successfully in more than 100 patients during the last 3 years and is compared with routine excisional fat removal. The main advantage of this technique lies in its ability to dissolve the fat without surgical excision, thus obviating the inherent complications that arise from such dissection. The technique uses a diathermy unit to cause lipolysis of the fat pockets within their intact septal compartments and can be used for both upper and lower lid herniated fat. This procedure has been found to be exceptionally efficient and predictable and adds another level of safety to cosmetic blepharoplasty.

Adipose Tissue↗
PubMed1985

Enbucrilate as cartilage adhesive in augmentation rhinoplasty.

Enbucrilate (Histoacryl) as a cartilage adhesive in augmentation rhinoplasty was used in 39 cases. The unique properties of this tissue adhesive enhances the ability to augment the nose during cosmetic and reconstructive rhinoplasty. Enbucrilate interacts superbly well with local tissues, causing no systemic or local untoward effects. Its main attribute stems from its ability to bond cartilage instantaneously and with great reliability, which allows for intricate fabrication of cartilage implant components. Five subcategories of dorsal, tip, and columella augmentation are presented with their technical details outlined. The aesthetic and functional results in 39 cases were deemed excellent, safe, and effective.

Enbucrilate↗
PubMed1985

Reconstruction of the horizontal palpebral aperture after failed ectropion surgery with temporal migration of punctum.

Involutional ectropion of the lower lid is the result of progressive stretching and elongation of the lid margin and medial and lateral canthal tendons. The relative laxities of the components of the lower lid-canthal tendon complex will determine the location and extent of the ectropion. Whereas inadequate canthal tightening or horizontal lid shortening will result in recurrent ectropion, overzealous lid shortening without tendon plication will result in a noticeably narrower horizontal palpebral fissure, a persistent ectropion, or temporal migration of the punctum. We used lateral cantholysis, medial canthal tendon plication, and punctal rotation to return the punctum to its normal position and temporalis muscle to support the lower lid in eight cases in which previous procedures had failed to correct the lid malposition. In all eight cases there was improvement of the lid position. In one case of severe medial ectropion, the punctal eversion was not completely corrected. This technique is not recommended as an initial procedure for ectropion repair. It is only used to manage previous surgical failures. It is a new application and combination of well-accepted techniques.

Aged↗
PubMed1985

Metastatic basal cell carcinoma of the head and neck.

Five new cases of metastatic basal cell carcinoma are presented to highlight the potential of this tumor to develop malignant metastases. Histologic criteria of the primary and metastatic site are presented along with a review of the pertinent world literature.

Adult↗
PubMed1984

Functional and aesthetic consequences of total platysma resection.

The functional and aesthetic effects of total unilateral platysma resection during ablative surgery is described and outlined for the first time (to our knowledge). The consequences of this resection are analyzed with respect to the partial facial paralysis that is evident. A model describing the dynamics of this paralysis is presented. These data are important in understanding the contribution of the platysma to the smile and the effects of manipulating this muscle during aesthetic and reconstructive neck surgery.

Facial Muscles↗
PubMed1984

Degloving approach for total excision of inverted papilloma.

Inverted papilloma, because of its insidious and aggressive clinical course, must be completely excised. Previously, the customary procedure advocated for this goal was a lateral rhinotomy. The degloving approach, which consists of lifting the soft tissues from the mid portion of the face, thereby furnishing unlimited exposure to the pyriform fossae and the lateral nasal walls, offers an excellent alternative to the lateral rhinotomy technique. The degloving procedure involves no external scarring and improves the visibility of the total operative field. En bloc dissection of the lateral nasal wall is then accomplished and extended to include a sphenoethmoidectomy or partial excision of the medial orbital wall, as dictated by the extent of disease. The procedure has been performed by the authors in 46 cases, and has proved to be an extremely valuable technique, displaying excellent cosmetic and functional results with minimal complications.

Cartilage↗
PubMed1983

Dual simultaneous systems for facial reanimation.

Successful reanimation of the paralyzed face requires a specific yet adaptable procedural armamentarium. Usually, in the treatment of regional paralysis, one distinct technique is deemed most appropriate and dependable. In cases of total hemiparesis secondary to surgical ablation or trauma, however, the simultaneous use of two separate but complementary rehabilitative systems has proved valuable in 15 patients. The reconstructive concept described divides the face into two functional spheres, an upper periorbital area and a lower perioral region. The integral system includes a direct facial nerve-to-cable graft reanastomosis for the upper division combined with a masseter muscle transfer for the lower facial region. The immediate supportive effects of the masseter transposition integrated with its long-term ability to rehabilitate via myoneurotization complement the more physiologically exacting effects of the nerve anastomosis.

Adult↗
PubMed1983

Mini alar myocutaneous flaps for nasolabial-columella reconstruction.

A new midfacial myocutaneous flap that is particularly useful in nasolabial-columella reconstruction is described. The mini alar flap is a randomized myocutaneous island flap incorporating portions of the orbicularis oris, levator labi superioris alae (labial portion), levator labi superioris, and zygomaticus minor, based on a vascular supply from the terminal branches of the facial artery. The flaps allow for a bilateral elipse of skin and underlying muscle to be transferred from the lateral nasal area into the midportion of the columella and the upper lip for reconstruction of ablative, traumatic, or congenital defects. The primary advantage of the mini alar flap lies in the ability to transpose moderate quantities of viable, well-matched tissue with minimal donor area deformity.

Female↗
PubMed1982

Intraoral masseter muscle transposition: use with reconstruction of regional facial paralysis.

The treatment of regional facial paralysis of the lips and commissure by masseter muscle transposition is well accepted and usually accomplished by an external approach. The intraoral transfer demonstrates distinct advantages for the rehabilitation of midfacial regional paresis. The procedure is performed totally intraorally, which exposes the masseter muscle before transposing the anterior portion in a subcutaneous tunnel to the upper and lower lips. The effects of this transposition are direct support and immediate contraction, with eventual myoneurotization of the surrounding perioral musculature. The indications, operative considerations, and results in 22 cases are reported. This technique considerably advances the procedural approaches of the reconstructive surgeon and in used either in conjunction with other reconstructive modalities or as a primary procedure in selected cases.

Facial Paralysis↗
PubMed1981

A composite hair-bearing and non-hair-bearing sideburn flap.

A versatile and dependable composite hair-bering and non-hair-bearing flap is described that allows for immediate reconstruction in the highly visible temple and preauricular areas. A combined hair-bearing and non-hair-bearing flap is transferred from the postauricular region to the area of the temple and laterally to the orbit. Modification of the flap by harvesting additional tissue from the posterior conchal region assures greater reconstructive potential and variability.

Face↗
PubMedDate not supplied

Intralaryngeal release for tracheal anastomosis.

An operation for obtaining additional length in order to achieve end-to-end anastomosis of the trachea without significant suture-line tension is described. The intralaryngeal procedure lengthens the larynx approximately 1 to 2 cm without restricting its function. It is an expedient, effective technique when used primarily, or adjunctively, with a suprahyoid or mediastinal release.

Female↗