Nasotracheal intubation in the presence of facial fractures.
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Contraindications↗
Biomedical subjects
R C Schultz
Publications and source records attributed to R C Schultz.
Cleft palate fistula repair. Improved results by the addition of bone.
The treatment of cleft palate fistulas is currently unstandardized, and the outcome is often unsuccessful. Conventional surgical techniques for the repair of such fistulas involving bony defects have essentially been abandoned by the author. Current protocol calls for their repair in early adolescence (before the age of 10 years) following completion of any required orthodontic expansion of the maxillary dental arch. At the time of fistula repair, all scar tissue is excised between the maxillary segments. Both palatal and gingival soft-tissue flaps are developed to cover either free cancellous bone grafts or free periosteal grafts used to bridge the maxillary defect. This change in technique has resulted in osteogenic filling of the maxillary bony defect and has markedly improved the success rate of fistula repair. Furthermore, it has enhanced the aesthetic correction of the nasal alar base cleft stigmas.
Bone Transplantation↗
Cleft palate fistula repair. Improved results by the addition of bone.
A retrospective study of cleft palate repairs showed a 22% fistula incidence. Of these 49% were judged to be symptomatic. Of the fistulae, approximately half required treatment. Of the conventional type surgical closures, there was only a 35% success rate. Conventional methods of surgical repair of anterior hard palate fistulae were seen to result in the very poorest permanent closure. As a result of this study, a new protocol was developed which has resulted in marked improvement in the surgical repair of anterior fistulae. We now close these fistulae in early adolescence following completion of orthodontic expansion using gingival and palatal flaps after the addition of free periosteal grafts or cancellous bone grafts.
Bone Transplantation↗
Further applications of Archimedes' principle in the correction of asymmetrical breasts.
Archimedes' law of buoyancy has been extended to the preoperative bedside assessment of volume differences between breasts, whatever their cause. The simple method described has proved to be a helpful aid in surgical procedures for the correction of breast asymmetry.
Biophysical Phenomena↗
The use of uniform simulated models in the reconstruction of craniopagus twins.
A unique approach to the planning of the separation and subsequent reconstruction of craniopagus twins is presented. In consultation with medical artists and prosthetists, exact models of our patients were fabricated preoperatively. Models were made of a hard acrylic to simulate bone and silicone rubber to simulate skin. In this fashion, the surgical teams were given an opportunity to preplan the bony separation of the heads, as well as to design the best possible coverage for reconstruction of the resulting defects. Physiological, mechanical, and aesthetic considerations are discussed. Two surgical delay procedures were performed without complication prior to neurosurgical separation. A broad segment of inextricably interconnected cerebellar tissue and a shared sagittal sinus could not be overcome at the time of final separation and proved to be fatal for both twins. Owing to the untimely deaths, we can only postulate that the delayed compound musculocutaneous flaps would have produced the best possible results and physiological protection for the extensive bony defects in both skulls resulting from this separation.
Humans↗
Frontal sinus fracture following osteoplastic frontal sinus obliteration.
A patient who sustained frontal sinus fracture and who earlier had undergone an osteoplastic fat obliteration procedure is described. The literature is reviewed and recommendations are made for management of this and other cases of frontal sinus fractures with posterior table involvement.
Athletic Injuries↗
Medial thigh lift.
Medial thigh ptosis, characterized by rhytidosis and seen commonly from aging and great weight loss, is seldom improved by lateral or posterior thigh lift. A simple procedure has been developed to correct this laxity of the upper, inner thighs. This consists of symmetrical resection of a crescent-shaped segment of skin and subcutaneous tissue having the distribution of an L1 embryological dermatome, just inferior to the inguinal crease. Despite temporary sensory loss and spreading of scars in some patients, the procedure has been gratifying to both patient and surgeon. Patients must be carefully selected, as the procedure does not correct either trochanteric lipodystrophy or ptosis, or lipodystrophy medial to and just superior to the knee.
Female↗
Restoration of frontal contour with methyl methacrylate.
Of the various materials currently available for reconstruction of bony frontal deformities, bone cement (methyl methacrylate) has been judged to be superior in its simplicity, reliability, and aesthetic potential. It is uniquely suited to reconstruction of irregular defects of the forehead. Its biological characteristics, advantages, and hazards are presented along with the techniques of its use. Clinical examples illustrate the results obtained with minimal preparation, surgical time, and morbidity.
Forehead↗
Biocompatible materials in reconstructive surgery.
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Biocompatible Materials↗
Body sculpturing.
Significant improvements in body contour can be accomplished by surgical procedures having reliable, predictable results. Similar to the modern sculptor of inanimate art forms, plastic surgeons have utilized new materials and devised new techniques to achieve aesthetic improvement of the face, trunk, and extremities. The goals of the surgical sculptor are perhaps more challenging than those of the pure artistic sculptor, not only because they must result in improved appearance but also because the surgeon is limited at all times by considerations of regional anatomy, the availability of viable tissue materials, and the safety of his patient.
Abdominal Muscles↗
Midfacial fractures from vehicular accidents.
An effort is made to simplify, categorize, and outline the various forms and treatment of midfacial trauma from automotive crashes. Panfacial fractures resulting from high speed automotive accidents will continue to be a challenge to the innovative and persistent surgeon seeking the best possible results.
Accidents, Traffic↗
Frontal sinus and supraorbital fractures from vehicle accidents.
Fractures of the upper third of the face from vehicle accidents are relatively uncommon but can have serious associated injuries of the dura and frontal lobe when they do occur. The injury may result from the victim's face either striking the dashboard or bouncing violently off the lower broken edge of the penetrated windshield.
Accidents, Traffic↗
Recurrent problems in emergency room management of maxillofacial injuries.
Some of the problems that currently plaque emergency rooms are outlined, as well as possible solutions. Steps in the emergency room management of maxillofacial injuries are also presented.
Accidents↗
Maxillofacial injuries from vehicular accidents. Foreword.
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Accidents, Traffic↗