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Biomedical subjects

R B Stanley

Publications and source records attributed to R B Stanley.

At least 37 records · Page 2Linked to original sources
PubMed1989

Immediate reconstruction of contaminated central craniofacial injuries with free autogenous grafts.

Free autogenous osseous and soft tissue grafts were used for the immediate, one-stage reconstruction of central craniofacial injuries involving the frontal sinus in 95 patients with wounds contaminated by either skin or nasal bacteria. Graft removal and delayed reconstruction were necessary in only one patient who suffered an infection in the first postoperative week. To date, no delayed complications are known to have occurred in any patient. As anticipated, long-term follow-up has been erratic (6 weeks to 5 years) and only suggestions rather than definite guidelines for the management of the sinus component of the injury can be made. However, this group of patients clearly demonstrates that multiple free autogenous grafts can be safely used for the acute reconstruction of contaminated central craniofacial fractures that are intimately related to the intracranial structures.

Adipose Tissue↗
PubMed1989

Fractures of the frontal sinus.

It is not possible to establish rigid guidelines for the treatment of frontal sinus fractures. However, this series demonstrates that aggressive treatment of the sinus with damage to the frontal sinus drainage system will produce a "safe" sinus. The individual surgeon must base his or her treatment philosophy on the type and severity of injuries being treated, the patient population involved, and his or her experience with each of the treatment options. All patients must be made to realize that they have a life-long risk for delayed complications following any type of reconstructive procedure on the frontal sinus. It is hoped that patients who do experience complications will seek treatment when the first symptoms of a frontal sinusitis arise, rather than allowing the infection to progress to a more severe state that is life-threatening or may require disfiguring surgery.

Frontal Sinus↗
PubMed1988

The temporal approach to impacted lateral orbital wall fractures.

Impact forces centered over the lateral orbital rim may cause fracture dislocations of the frontal process of the zygoma and the orbital plate of the sphenoid bone. These two major components of the lateral orbital wall may be impacted separately or as a unit into the posterior orbit to cause severe injuries to the eyeball or optic nerve. These ophthalmic injuries may be worsened by attempts to manipulate the bony fragments through the standard periorbital incisions. A safer approach is the temporal approach that exposes the entire lateral zygomatico-orbital region through a hemicoronal incision. This allows for manipulation of the lateral wall fragments under direct visualization and without retraction pressure on the globe. This larger operation appears justified in selected cases by the reduced risks to an already compromised eyeball or optic nerve.

Accidents, Traffic↗
PubMed1988

Rigid internal fixation for fractures involving tooth-bearing maxillary segments.

Fracture dislocations of the middle third of the face usually involve a complex combination of the three types of fractures initially described by LeFort. Treatment of these injuries requires a six- to eight-week period of intermaxillary fixation, unless rigid internal fixation devices (plates and screws) are used to stabilize the fractures. However, rigid fixation carries the risk of producing a malunion and serious malocclusion if not performed correctly. A review of 22 patients with complex LeFort fractures treated with rigid fixation revealed that the only absolute contraindication to its use is difficulty in interdigitating the maxillary and mandibular teeth in a passive fashion at the time of fracture reduction. Rigid internal fixation should therefore be considered as an alternative treatment for most fractures of the middle third of the face.

Fracture Fixation, Internal↗
PubMed1988

Knife wounds into the airspaces of the laryngeal trapezium.

The trapezoidal-shaped area of the neck bounded by the hyoid bone, cricoid cartilage, and medial borders of the sternocleidomastoid muscles is widely exposed to knife slash and stab injuries. Suicidal or homicidal throat slashes involving this area may produce serious horizontal laryngeal injuries, whereas homicidal stab wounds may produce serious vertical laryngeal or hypopharyngeal injuries. The extent of such injuries often cannot be predicted from the entrance wounds and presenting symptoms. Therefore special guidelines should be followed to insure the safety of selective exploration of knife wounds penetrating into the airspaces within this trapezium. In addition, repair of serious laryngeal injuries may require use of laryngoplasty or partial laryngectomy techniques rather than simple repair.

Female↗
PubMed1988

Orbital rehabilitation: surgical and prosthetic.

Restoration of facial symmetry is the goal in rehabilitation of an orbit disfigured by trauma or tumor extirpation. Successful rehabilitation may require replacement of repositioning of the orbital walls and/or construction of a complex orbital prosthesis. Preoperative communication among the head and neck surgeon, ophthalmologist, and maxillofacial prosthodontist is essential.

Eye, Artificial↗
PubMed1987

Injuries of the nasofrontal orifices in frontal sinus fractures.

Disruption of the nasofrontal ostia or ducts is an important factor in the development of immediate and delayed complications following frontal sinus fractures. Thorough evaluation of 50 consecutive patients with frontal sinus injuries caused by blunt trauma revealed several fracture patterns that frequently include injury to the drainage system. Anterior table fractures, even when displaced, do not produce such injuries unless associated with a fracture of the supraorbital rim or nasoethmoidal complex. Combined fractures of the anterior and posterior tables are almost always accompanied by injuries to the orifices. Severity of these injuries is variable but can be predicted from the sinus wall fracture patterns. Although CT scanning is incapable of directly imaging involvement of the ostia or ducts, it will give sufficient information to allow for accurate prediction of disruption of the drainage system.

Frontal Sinus↗
PubMed1986

Unilateral degloving injuries of the arytenoid cartilage.

Arytenoid cartilage dislocations and avulsions are often seen as a part of severe laryngeal injuries due to blunt trauma. An uncommon type of injury is the unilateral degloving of an arytenoid cartilage following laterally directed trauma to the thyroid cartilage. It may occur without additional cartilaginous or mucosal damage. The arytenoid cartilage is squeezed between the thyroid ala and the cervical spine and stripped of its mucosal covering. It may retain mobility and be exposed only on adduction, or it may lose mobility due to dislocation and be tipped into the laryngeal lumen. Prognosis for vocal cord mobility and voice production is good for the degloving injury alone, but poor if the arytenoid cartilage is also dislocated. Cases are discussed to illustrate the mechanism, treatment, and outcome of such injuries.

Adolescent↗
PubMed1986

Reconstruction of large fronto-orbital defects with Dacron polyurethane custom prosthesis and autogenous bone.

Reconstruction of large defects of the frontal bone and bony orbit may be required following trauma or ablative tumor surgery. Autogenous bone or alloplastic implants used alone may prove inadequate due to difficulties obtaining symmetric contours with bone and lack of strength and resistance to infection with alloplastic materials. These problems can be overcome with the combined use of a prefabricated Dacron polyurethane mesh prosthesis (Osteo-Mesh, Xomed, Inc.) to establish contour of the forehead and superciliary ridges, and underlying split-rib grafts to protect the brain and isolate the paranasal sinuses. This technique is not indicated for small frontal defects, but it should be considered for use by the head and neck surgeon who is faced with the challenge of reconstructing a major fronto-orbital defect.

Adult↗
PubMed1985

Midfacial fractures: importance of angle of impact to horizontal craniofacial buttresses.

The complex nature of midfacial fractures is a result of the interaction of impact forces and inherent resistance of the facial bones to displacement. Analysis of fractures created in cadavers shows that impact forces angled obliquely to the horizontal craniofacial buttresses cause LeFort III fractures with inferior and posterior displacement of the midface. Forces directed head-on to the buttresses cause LeFort II-I fractures with inferior rotation of the midface around the lower ends of the pterygoid plates. It appears that the point of impact is of lesser importance in creating midfacial fractures than is the angle of impact in relation to the horizontal craniofacial buttresses. This may explain why victims of equal impact forces at the same level on the face suffer widely varying injuries.

Biomechanical Phenomena↗
PubMed1984

Reconstruction of the midfacial vertical dimension following Le Fort fractures.

Fracture dislocations of the middle third of the face usually involve a complex combination of Le Fort's three great weak lines of the facial skeleton. The fracture lines transverse the vertical buttresses of the middle third of the face at near right angles and strong impact forces can cause displacement and malalignment of the buttresses. The vertical dimension of the midfacial skeleton may be shortened or lengthened and the maxilla may be rotated. Direct realignment and stabilization of the zygomaticomaxillary buttresses with rigid fragment-to-fragment fixation gives precise reconstruction of the vertical dimension and excellent mechanical stability without craniofacial suspension or external fixation. The principles were first demonstrated in a cadaver study and then applied to a prospective group of 20 patients with Le Fort midfacial fractures. These findings fully justify the increased operative time required to place the transosseous wires.

Facial Bones↗
PubMed1984

Value of computed tomography in management of acute laryngeal injury.

Blunt trauma to the larynx is an uncommon injury that results in a wide spectrum of damage to the endolaryngeal soft tissues as well as underlying cartilaginous skeleton. Recognition of these injuries is essential if long-term problems with compromised airway and voice quality are to be avoided. Although minor soft-tissue injuries do not mandate surgery, severe soft-tissue damage or cartilaginous fracture-dislocations require exploration and repair. Treatment is less clearly defined for the injured larynx with moderate damage. Frequently, the degree of soft-tissue injury is used to judge the likelihood of damage to the thyroid and cricoid cartilages. Computed tomography (CT) is an excellent noninvasive technique for examining the laryngeal skeleton. Laryngeal CT may be successfully used to determine the need for open exploration and repair in selected cases of blunt trauma to the larynx when clinical findings are equivocal for cartilaginous damage.

Adult↗
PubMed1984

Hazards encountered in management of basal cell carcinomas of the midface.

Basal cell carcinomas often exhibit aggressive and destructive behavior on the midface, with invasion into the orbit, paranasal sinuses, and even the frontal fossa. Minor modifications in surgical procedures for cosmetic considerations may have devastating consequences on the patient's survival. Tumor extirpation should not be compromised by preoperative planning of the method of reconstruction to be used. Margin control intraoperatively with either conventional frozen sections or the fresh tissue Mohs technique is mandatory for success. If any margin is questionable, reconstruction should be delayed at least until permanent sections confirm complete tumor removal. Ten cases are presented and the literature reviewed to emphasize that inadequate initial management probably contributes more to the observed destructiveness of these lesions than histologic aggressiveness or embryologic patterns of the midface.

Aged↗