Biomedical subjects

Philip J Miller

Publications and source records attributed to Philip J Miller.

5 recordsLinked to original sources

PubMed2006

Direct Facial-to-Hypoglossal Neurorrhaphy with Parotid Release.

OBJECTIVE: Facial nerve paralysis or compromise can be caused by lesions of the temporal bone and cerebellopontine angle and their treatment. When the facial nerve is transected or severely compromised and primary end-to-end repair is not possible, hypoglossal-facial nerve anastomosis remains the most popular method for accomplishing three main goals: restoring facial tone, restoring facial symmetry, and facilitating return of voluntary facial movement. Our objectives are to evaluate the surgical feasibility and long-term outcomes of our technique of direct facial-to-hypoglossal neurorrhaphy with a parotid-release maneuver. DESIGN: Prospective cohort. SETTING: Academic tertiary care referral center. PATIENTS: Ten patients with facial paralysis from proximal nerve injury underwent the facial-hypoglossal neurorrhaphy with a parotid-release maneuver. MAIN OUTCOME MEASURES: The Repaired Facial Nerve Recovery Scale, questionnaires, and photographs. RESULTS: Facial-hypoglossal neurorrhaphy with parotid release was technically feasible in all cases, and anastomosis was performed distal to the origin of the ansa hypoglossi. All patients had good return of facial nerve function. Nine patients had scores of C or better, indicating strong eyelid and oral sphincter closure and mass motion. There was no hemilingual atrophy and no subjective tongue dysfunction. CONCLUSIONS: The parotid-release maneuver mobilizes additional length to the facial nerve, facilitating a tensionless communication distal to the ansa hypoglossi. The technique is a viable option for facial reanimation, and our patients achieved good clinical outcomes with continual improvement.

Journal Article↗

PubMed2006

Structural approach to endonasal rhinoplasty.

The marriage of endonasal rhinoplasty with structural grafting has resulted in more consistent rhinoplasty results. The nasal base can be stabilized by tongue-in-groove techniques, a columellar strut, or extended columellar strut. The middle vault can be addressed with spreader grafts or butterfly grafts. Lower lateral cartilage weakness can be supported with alar batten grafts or repositioning of the lower lateral cartilages.

Cartilage↗

PubMed2004

Computerized plastic surgery office.

PURPOSE OF REVIEW: Technology in general and computer capabilities in particular are growing at an exponential rate. Keeping current with the latest technological capacities and means of incorporating this technology into the facial plastic surgeon's office poses a significant challenge. This review will document the most appropriate method of incorporation and the latest available technological tools. RECENT FINDINGS: Recent developments in wireless networking, systems integration, digital photography and video, powerful inexpensive computer systems, and the growth of personal digital assistant integration have all contributed to a surge in technological advances. Implementing any or all can significantly benefit the busy facial plastic surgery office. SUMMARY: Keeping abreast of technological advances is a daunting task. Adaptation of these advances into the office can at times be overwhelming. This review will assist the practicing physician in incorporating selective technological tools to streamline his or her systems and increase efficiency.

Ambulatory Care Information Systems↗

PubMed2003

Expanded polytetrafluoroethylene implants in rhinoplasty: literature review, operative techniques, and outcome.

Gore-Tex, a form of expanded polytetrafluoroethylene (ePTFE), over the past 30 years has attracted much attention as an alloplast for use in rhinoplasty, both from advocates and opponents of its use. It has many desirable traits as an alloplast implant, but many surgeons harbor hesitation and reluctance for alloplast use in rhinoplasty based on historical data of previous nasal implants. Only when objective data from large series of patients with long-term follow-up become available will such skepticism be resolved. Large series of patients with Gore-Tex implant placement during rhinoplasty are beginning to emerge in the literature. The purpose of this article is twofold. The first is to provide the reader with an up-to-date review of the literature on the host response to polymer implants and, second, of the current indications and operative techniques for use and outcomes of Gore-Tex implants in rhinoplasty.

Biocompatible Materials↗

PubMed2002

A simple and reliable method of patient evaluation in the surgical treatment of nasal obstruction.

We have developed a simple method of evaluating nasal obstruction both before and after corrective surgery. With our system, patients self-rate their nasal patency on a 10-point visual analog scale under different conditions. After a baseline self-assessment, patients rate their breathing while the examiner lifts the lower lateral nasal cartilage with an ear curette and again during lifting of the upper lateral cartilage. Separate assessments during cartilage support are made before and after the patient has received nasal decongestion therapy. The results of these manipulations help identify the specific structural abnormality and its anatomic site, thereby serving as a reliable aid to planning surgery (i.e., open septorhinoplasty, turbinoplasty, external valve surgery with alar batten grafts, and/or internal valve surgery with spreader grafts with or without composite skin/cartilage grafts). We tested our method in preoperative evaluation and surgical planning on 19 patients with nasal obstructions. Our method was just as useful in making postoperative assessments, and it allowed us to judge the effectiveness of specific procedures in restoring nasal patency. Of the 19 patients, 18 (94.7%) reported that their nasal breathing had improved following surgery.

Adolescent↗