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Mario J Imola

Publications and source records attributed to Mario J Imola.

5 recordsLinked to original sources
PubMed2003

Skull base reconstruction.

Reconstruction of skull base defects following tumor resection is of paramount importance in avoiding serious and life-threatening complications. Cranial base surgery has evolved and outcomes have steadily improved as increasingly reliable reconstructive techniques have been adapted to repair the challenging wounds in this complex anatomic region. The most significant development has been the introduction and refinement of microvascular free tissue transfer to the skull base over the past 15 to 20 years. Free flaps can reliably provide the requisite tissue to not only seal the intracranial space from the subjacent cavities, but also to restore complex craniofacial defects that often result from skull base tumor excision. Advances in alloplast technology have also expanded the armamentarium available to the reconstructive surgeon. In particular, bone substitutes, titanium hardware, and resorbable plate fixation have been shown to be very efficacious when used in carefully selected situations. Finally, tissue sealants and adhesives have become widely used as an adjunctive method to achieve a water-tight dural repair.

Biomedical and Dental Materials↗
PubMed2002

Orbital preservation in surgical management of sinonasal malignancy.

OBJECTIVE: To determine the oncological and functional outcome when applying defined criteria for orbital preservation during surgical treatment of sinonasal malignancy encroaching on the orbital structures. STUDY DESIGN: Retrospective consecutive review of patients in tertiary care center setting. METHODS: Analysis of 66 patients undergoing surgical treatment for sinonasal malignancy encroaching on the orbit. Orbital preservation was performed in all patients with tumor extension up to and including resectable periorbital involvement. Minimum follow-up was 2 years. Detailed analysis of oncological and functional outcomes is included. RESULTS: Of 66 tumors abutting or invading into the orbit, 54 were amenable for surgical treatment with orbital preservation and the remaining 12 underwent orbital exenteration. Histopathological findings were divided into five subgroups: squamous cell carcinoma, adenomatous carcinomas, sinonasal undifferentiated carcinoma, sarcoma, and other. Squamous cell carcinoma represented the largest subgroup (24 patients), and 5-year overall actuarial survival was not statistically different (P = 1.4; relative risk, 0.713) between patients treated with orbital preservation (53%) versus those undergoing exenteration (46%). Similarly, no difference in survival was found in the adenomatous carcinoma subgroup. Within the orbital preservation group as a whole, local recurrence occurred in 30% patients (16 of 54) compared with 33% patients (4 of 12) treated with orbital exenteration. Of note, eye-sparing surgery was associated with local recurrence at the original site of orbital involvement in only 7.8% of cases (4 of 54). Overall eye function was graded as functional without impairment in 54% of patients (29 of 54), functional with impairment in 37% (20 of 54), and nonfunctional in 9% (5 of 54). The most common abnormality was globe malposition (enophthalmos or hypophthalmos) that was seen in 34 patients (63%) and was associated with the lack of adequate rigid reconstruction of subtotal or total orbital floor or multisegment orbital defects. However, enophthalmos was asymptomatic in the majority of cases, and persistent diplopia occurred in only five patients (9%). Various ocular sequelae were present in 20 of the 49 patients (41%) with functional eyes. Radiation therapy increased the risk of ocular complications, in particular, optic atrophy, cataract formation, excessive dryness, and ectropion. CONCLUSIONS: Selective orbital preservation is oncologically safe and is a worthwhile undertaking in attempting to maintain a functionally useful eye with surgical management of sinonasal malignancy encroaching on the orbit. Consideration should be given to rigid orbital reconstruction in larger defects resulting from subtotal or total orbital floor resection or resections involving two or more orbital walls.

Adolescent↗
PubMedDate not supplied

The versatility of distraction osteogenesis in craniofacial surgery.

OBJECTIVES: To review our preliminary results using distraction osteogenesis for the correction of craniofacial deformities and to determine its role in treating anatomic deformities and functional deficits relative to conventional craniofacial surgery. DESIGN AND SETTING: Retrospective clinical review; tertiary care center. METHODS: Twenty-four consecutive patients were treated with distraction osteogenesis during a 34-month period. Outcomes were compared with preexisting anatomic deformities and functional deficits using records of clinical assessments, photodocumentation, diagnostic imaging, and treatment planning aids. MAIN OUTCOME MEASURES: Distraction achieved vs planned distraction based on clinical and radiographic assessment, clinical status of functional deficits before and after treatment, and objective rating of aesthetic improvement. CONCLUSIONS: Preliminary results demonstrated good-to-excellent outcome in correcting facial skeletal deformity in 80% of patients. Functional outcomes included resolution or significant improvement of upper airway obstruction in 13 of 14 patients and correction of corneal exposure for all 5 patients with preexisting exorbitism. Correction of malocclusion was less reliable. Problems related to the distraction devices, including failure of the advancement mechanism and fixation, were the most prevalent complications. Distraction osteogenesis represents an exciting new development in craniofacial surgery with several potential benefits, including less invasive surgery, the ability for earlier intervention, and the potential for correction of more severe deformities with improved posttreatment stability. The exact role of distraction osteogenesis relative to conventional techniques requires ongoing assessment.

Child↗