Biomedical subjects

R D Cooter

Publications and source records attributed to R D Cooter.

12 recordsLinked to original sources

PubMed1991

Crouzon twins with cloverleaf skull malformations.

We describe unique monozygotic twins with Crouzon's disease and cloverleaf-shaped skull deformities who have been closely followed since birth. Their abnormal skull shapes were identified during antenatal ultrasound examination. The twins had gross exophthalmos and hydrocephalus with papilledema, so early calvarial decompression surgery was required. Although born to healthy parents of normal appearance, a third cousin of the twins had a milder form of Crouzon's disease, and there was a family history of high-arched palate on the twins' paternal side. Because Crouzon's disease is an uncommon condition and the cloverleaf skull shape is unusual in patients with Crouzon's disease, identical twins with this constellation of deformities must be exceptionally rare.

Airway Obstruction↗

PubMed1990

Oblique craniofacial fractures in children.

The protected childhood environment and the anatomy of the craniofacial skeleton largely protect children from experiencing facial fractures. However, when major trauma to the head and face is sustained, an oblique pattern of fractures has been observed, distinct from those common in adults and explicable in terms of the anatomic differences between the child's and the adult's head and face. This difference in pattern of facial fracturing is relevant in terms of the examination, investigation and treatment of the primary injury, and prevention of any subsequent facial growth disturbances.

Accidents, Traffic↗

PubMed1990

Computed tomography in the assessment of protective helmet deformation.

Damage to a helmet worn by a motorcyclist or pedal cyclist involved in a crash can provide information of importance to those investigating impact responses of the helmeted head. In the past the retrieval of this information has been incomplete as it has involved the destructive dismantling of a helmet into its component layers. Conventional radiology, whilst being noninvasive, has the disadvantage that all structures traversed by the X-ray beam are superimposed in the final image. In an attempt to overcome the limitations of existing methods, computed tomography (CT) was evaluated in a study of 25 protective helmets. This was found to be an informative, noninvasive technique of investigation that provided faithful images of each helmet layer and delineated helmet damage that was not observed with other methods. Additional advantages of CT include the ease of computed data storage, the ability to reformat CT data into a variety of planes as either two- or three- dimensional images, and the facility to measure distance and density. Limiting factors include scanning cost and artefacts produced by metal in the helmet.

Adolescent↗

PubMed1990

Burn wound zygomycosis caused by Apophysomyces elegans.

A case of zygomycosis caused by Apophysomyces elegans in a patient having 25% full-thickness burns is described. Amputation of the leg was necessary to control rapid tissue invasion. The fungus was isolated from soil in the burn environment.

Amputation, Surgical↗

PubMed1989

Computer-based coding of fractures in the craniofacial region.

A systematic approach to the coding of fractures in the craniofacial region is presented. An alpha-numeric code is formulated from an alpha component depicting the anatomical region of interest and a number which reflects the degree of disruption.

Accidents, Traffic↗

PubMed1989

Pontomedullary tears and other gross brainstem injuries after vehicular accidents.

In a series of 988 autopsied victims of road crashes, there were 36 (3.6%) cases of gross primary brainstem injury. These fell into three groups. The first comprised eight cases of pontomedullary tearing without other gross brain injury: in seven of these, there were associated atlanto-occipital dislocations and/or high cervical fracture-dislocations. The usual cause appeared to be facial impact inducing acute hyperextension. Second, there were 17 cases of pontomedullary tearing associated with other brainstem lacerations and/or major damage elsewhere in the brain: in all, there were fractures of the skull base, typically transverse middle fossa fractures. Most of these injuries appeared to be due to facial impacts transmitting force to the anterior skull base, although hyperextension was also a factor in some. There was a third heterogeneous group of 11 cases with brainstem lacerations in sites other than the pontomedullary junction: in some of these it appeared that the impacts had caused skull base fractures by inducing calvarial torsion. In this series, the proportion of motorcyclists (41.7%) was double the expected figure. The use of a helmet modifies the mechanisms of impact head injury; the overall benefits of helmet use are well established, but there is need for more research on helmet design.

Accidents, Traffic↗

PubMed1989

The Tessier number 9 cleft.

The clinical, radiologic, and operative examination of two patients with the Tessier number 9 cleft has allowed the first complete description of this, the rarest of the rare craniofacial clefts. Soft-tissue disruption extends from the lateral third of the upper eyelid through a distorted lateral end of the eyebrow to the temporal scalp, with an associated hairline indicator. The skeletal disturbance similarly radiates superolaterally from the superolateral orbital rim across the greater wing of the splenoid to the upper squamous temporal. The three-dimensional extent of the bony disruption is associated with distortion of the cranial base and calvaria above.

Abnormalities, Multiple↗

PubMed1989

Tessier clefts revisited with a third dimension.

The classification by Tessier of rare craniofacial clefts brought, for the surgeon, order to a previously confusing array of anatomic and developmental descriptions. An ordered two-dimensional categorization of severe clefting malformations evolved from his clinical, radiologic, and surgical observations. The purpose of this paper is to report a complete series of facial clefts studied with computed tomography (CT) and three-dimensional reconstruction. The CT analysis supports some, but contradicts other, hypotheses and speculations presented by Tessier. The CT data reveal the scale of the reconstructive challenge and allow the assessment of our therapeutic interventions.

Adolescent↗

PubMed1988

Helmet-induced skull base fracture in a motorcyclist.

Observations after a fatal motorcycle accident suggested that the face bar of a full-face helmet may transmit an impacting force to the skull base via the chin strap and the mandibular rami and condyles, bypassing the energy-absorbing facial bones. If this mechanism is confirmed, the structural properties of these face bars will need to be reassessed.

Accidents, Traffic↗

PubMed1988

Hairline indicators of craniofacial clefts.

The review of a complete series of Tessier craniofacial cleft patients presenting to the South Australian Cranio-facial Unit has identified within the hairline a regular marker of clefting. Tongue-like projections of the temporal and frontal hairline pointing in the direction of their respective clefts have been identified for Tessier clefts numbered 7 to 14. No hairline indicator was revealed in "southbound" clefts numbered 0 to 6 without "northbound" extension. The hairline markers of laterally and superiorly bound clefts are a complementary element of the Tessier classification system.

Craniofacial Dysostosis↗

PubMed1987

Craniofacial infection in 10 years of transcranial surgery.

Infection following transcranial surgery may be devastating. A review of 170 transcranial operations is presented with a focus on postoperative infection and its relationship to patient age, preoperative microbiology, pattern of operation, length of operation, and the use of antibiotic prophylaxis. The overall postoperative infection rate was 6.5 percent, but the infection rate in adults (23.5 percent) was much higher than in children (2.2 percent). Higher infection rates were found in adults with craniofacial dysostoses undergoing lengthy frontofacial advancements which required tracheostomy airway management. The residual frontal extradural dead space following advancement in adults is a sanctuary to infecting organisms from the respiratory tract--especially Pseudomonas transferred from the tracheostomy site into the upper airway and intracranial dead space by ventilation forces. Operating times for patients who became infected were 2 1/2 hours longer than average operating times for transcranial operations. Preoperative microbiology of the craniofacial region was not a good predictor of subsequent infection. Recommendations include operative intervention at an early age, short preoperative hospital stay, antibiotic prophylaxis to include gram-negative cover, surgical measures to either fill or isolate the dead space, and strict tracheostomy care--preferably with the patient being barrier-nursed.

Adolescent↗

PubMed1987

Hemifacial microsomia: a multisystem classification.

Variability of deformities in hemifacial microsomia has precluded the general acceptance of any classification based on one reference organ. We present a review of hemifacial microsomia classifications and propose a TNM-style multisystem classification. This alphanumeric coding system, SAT, provides cohesion to existing hemifacial microsomia classifications. The acronym SAT is derived as follows: S = skeletal, A = auricle, and T = soft tissue. There are five levels of skeletal deformity (S1 through S5), four levels of auricular deformity (A0 through A3), and three levels of soft-tissue deformity (T1 through T3). Hence a patient with minimal deformity would be classified S1A0T1, whereas a patient with the most severe deformity would be S5A3T3.

Ear, External↗