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Biomedical subjects

T C Tung

Publications and source records attributed to T C Tung.

At least 19 recordsLinked to original sources
PubMed1999

Endoscopically assisted mandibular subcondylar fracture repair.

The endoscope has been widely used in aesthetic surgery in recent years, but rarely has it been used in cases of facial trauma. From July of 1996 to December of 1996, the endoscope was used successfully to assist in the repair of mandibular subcondylar fractures in eight patients (five men and three women). Their ages ranged from 15 to 60 years with an average age of 31 years. Six of the patients had other associated mandibular fractures including angular, parasymphyseal, and contralateral subcondylar fractures. A 4.0-mm, 30-degree telescope was introduced to visualize the fracture site by means of an intraoral incision over the ascending ramus. A miniplate was used to stabilize the fracture site with the help of a percutaneous trocar. Intermaxillary fixation was applied for 3 to 6 days. Functionally, all patients returned to normal range of motion within 8 weeks. A slight deviation to the trauma site was noted on maximal opening in three patients, but this condition returned to normal 3 months after surgery. There was no facial palsy or lip numbness. The benefits of the endoscopic approach include not only the provision of better visualization and precise anatomic alignment of bony segments but also the avoidance of large facial scars and facial nerve injuries.

Adolescent↗
PubMed1999

Endoscopically assisted reconstruction of orbital medial wall fractures.

Traditional surgical approaches to orbital medial wall fractures are either direct extraocular skin incisions or indirect bicoronal flap. However, these methods can leave remarkable orbital scars or scalp alopecia with the possible associated complications. A minimally invasive endoscopic technique with the assistance of a 2.7-mm, 30-degree telescope through a medial transconjunctival incision has been successfully used to reconstruct the orbital medial wall fractures. This technique was applied to four patients who had orbital medial wall fractures. Three patients also had concomitant orbital floor fractures. The other had associated superior orbital fissure syndrome. All patients were presented with limited eye movement, positive forced duction test, horizontal diplopia, and enophthalmos (3 mm to 6 mm) preoperatively. The entrapped periorbital tissues in the ethmoid sinus were completely reduced endoscopically. The bone defect of orbital medial wall was reconstructed with autogenous rib bone grafts under endoscopic control. The patients were followed up for 8 to 16 months with an average of 11 months. Three patients recovered completely without any residual eye symptoms after intervention. Clinically significant residual enophthalmos of 3 mm occurred in the patient with the superior orbital fissure syndrome. His eye movement limitation caused by entrapment of medial rectus muscle was relieved postoperatively. There was no donor-site morbidity or any complications related to the endoscopically assisted procedure. Endoscopically assisted medial transconjunctival approach to the orbital medial wall fractures is an excellent adjunct for the exposure and complete reduction of herniated periorbital tissue and bony reconstruction of the medial orbital wall.

Adult↗
PubMed1998

Preformed IgG antibodies against major histocompatibility complex class II antigens are major risk factors for high-grade cellular rejection in recipients of heart transplantation.

BACKGROUND: Preformed anti-HLA antibodies reacting specifically with donor lymphocytes have been associated with acute vascular rejection and early cardiac allograft failure. However, the effect of preformed anti-HLA antibodies directed against allogeneic major histocompatibility complex (MHC) class I or II antigens of a donor panel on heart transplantation outcome has not been extensively studied. METHODS AND RESULTS: The study group consisted of 68 patients who received cardiac transplants between 1989 and 1996 and who were at high risk for developing anti-HLA antibodies before transplantation. The effect of preformed antibodies against allogeneic MHC class I or class II antigens on the development of early high-grade cellular rejection and on cumulative annual rejection frequency was determined. Both patients with left ventricular assist devices and retransplantation candidates had a similar increase in the frequency of IgG anti-MHC class II antibodies (IgG anti-II) compared with control subjects (P<0.0001), whereas the frequency of IgG anti-MHC class I antibodies (IgG anti-I) was elevated only in patients with left ventricular assist devices. Pretransplantation IgG anti-II predicted early development of high-grade cellular rejection (P=0.006) and higher cumulative annual rejection frequency (P<0.001) in both of these sensitized patient groups. Among retransplantation recipients, a match between donors 1 and 2 at HLA-A additionally predicted an earlier time to a high-grade cellular rejection. CONCLUSIONS: These results emphasize the importance of specifically screening heart transplantation candidates for the presence of IgG antibodies directed against MHC class II molecules and suggest that strategies aimed at their reduction may have an impact on the onset and frequency of high-grade cellular rejections after transplantation.

Adolescent↗
PubMed1998

An immunological algorithm to predict risk of high-grade rejection in cardiac transplant recipients.

BACKGROUND: Transplant-related coronary-artery disease (TCAD) develops frequently in cardiac-allograft recipients, and limits long-term survival. We examined the relation between this disorder and cumulative frequency of high-grade rejection, and investigated whether concomitant use of three immunological factors at the time of a low-grade endomyocardial biopsy can predict progression to high-grade rejection. METHODS: We investigated the relation between the cumulative annual frequency of high-grade rejection and TCAD in 198 recipients of cardiac transplantation between 1992 and 1996 by means of Kaplan-Meier actuarial life-tables. Endomyocardial biopsy, lymphocyte-growth assays, and anti-HLA antibody measurements were compiled over 12 months in 102 patients during their first post-transplant year. We calculated predictive values for high-grade rejection within 90 days by chi2, Kaplan Meier survival curves, and by multivariable logistic regression analyses. FINDINGS: We found a direct correlation between cumulative annual frequency of rejection and TCAD onset with highest risk in those with more than 0.75 rejections per year (p=0.0002). After a low-grade endomyocardial biopsy (0 or 1A), one or more donor-recipient HLA-DR matches protected against high-grade rejections (p<0.001). Among individuals with one or two DR matches, the negative predictive value for progression from a low-grade biopsy to a high-grade rejection was 87% in the presence of a negative lymphocyte-growth assay. Among individuals with no DR matches, the presence of either a positive lymphocyte-growth assay or IgG anti-major-histocompatibility complex (MHC) class II antibodies was independently associated with high probability of progression to rejection (64% and 66%, respectively, p<0.0005). When both assays were positive, concomitantly with a low-grade endomyocardial biopsy, the positive predictive value for progression to a high-grade rejection was 86% (p<0.0001). For endomyocardial-biopsy grades 1B or 2, a positive lymphocyte-growth assay alone was associated with high-grade rejection in 100% of cases. INTERPRETATION: Use of an algorithm combining three immunological factors at the time of a low-grade endomyocardial biopsy enables prospective stratification of cardiac transplant recipients into risk categories for progression to high-grade rejection. Low-risk individuals require fewer biopsies, moderate-risk individuals require an ongoing schedule of surveillance biopsies, and high-risk individuals require rational organisation of interventional strategies aimed at preventing rejection. Additional predictive factors are needed to identify moderate-risk individuals who will progress to rejection. Ultimately, successful intervention may have an impact on the subsequent complication of TCAD.

Adult↗
PubMed1998

Silicone molar block used as a fulcrum in condylar surgery.

The narrowness of the temporomandibular joint (TMJ) can cause difficulty in open reduction and fixation of condylar fracture. The authors designed a silicone block that acts as a fulcrum to create more space around the TMJ. The block is made of high-quality silicone that is firm, elastic, nontoxic, autoclave tolerant, and harmless to dental tissue. This block has been used successfully in facilitating reduction and fixation of condylar fractures in 27 patients, and for releasing spastic muscles during closed reduction in 2 patients with prolonged TMJ dislocation. In edentulous patients, the silicone molar block can be used as a mouth opener to facilitate most intraoral procedures without injury to the gum.

Adult↗
PubMed1998

Successful replantation of an avulsed middle finger.

In avulsion amputations of the digits, soft-tissue injuries are extensive and often require tendon, nerve, and vessel transfers or grafts. The functional results of such digital replantations are frequently less than ideal. Therefore, avulsion amputation of a single digit proximal to the insertion of the flexor digitorum superficialis has been a contraindication to replantation, because the anticipated poor functional result may interfere with overall hand function, and is not worth the sacrifice of a tendon, nerve, or vessel from another digit or transfer. The authors report a patient with avulsion amputation of the middle finger at the proximal interphalangeal joint. The digit was replanted successfully without any tissue transfers other than a radial digital artery from the ring finger. The functional results were good, and the authors believe that good functional and cosmetic results can be achieved in select patients with isolated digital avulsions, provided that an experienced hand microsurgeon and a skillful hand therapist are available for a compliant patient.

Amputation, Traumatic↗
PubMed1997

Massive intratumor hemorrhage in facial plexiform neurofibroma.

BACKGROUND: Plexiform neurofibromatosis is a feature of von Recklinghausen's disease. Head and neck lesions may produce varying degrees of cosmetic and functional deformity. However, life-threatening hemorrhage into facial plexiform neurofibromas has not been previously reported. METHOD: We report two patients with von Recklinghausen's disease who experienced massive hemorrhage into facial neurofibromas, one following a blunt injury and the other without a known initiating event. RESULTS: Conservative management did not stop the hemorrhage into facial neurofibromas in either instance. Surgical exploration was mandated for hemorrhage control and evacuation of blood clots. Hemostasis was attained by a combination of hypotensive anesthesia and chromic catgut suture ligatures. CONCLUSIONS: These case reports demonstrate a potentially lethal complication in patients with facial plexiform neurofibroma. Where a competent and experienced interventional neuroradiologist is not available, surgical exploration should be undertaken to control bleeding.

Adolescent↗
PubMed1997

Step-wise lengthening for delayed repair of avulsion of the flexor pollicis longus.

Repair of late avulsion of the flexor pollicis longus tendon at insertion is a rare but difficult problem. A 52-year-old female labourer presented with a 3-month history of inability to flex her right thumb at the interphalangeal joint. Avulsion of the flexor pollicis longus tendon at its insertion was noted on exploration. Because the tendon had contracted and could not be reinserted directly, a technique of step-wise lengthening was used for reinsertion. Two months after operation, the patient resumed her daily activities and went back to work with satisfactory use of her right thumb. This report highlights the possibility of using a simple technique when there is no other alternative.

Female↗
PubMed1997

Excision of subcutaneous tissue for the treatment of axillary osmidrosis.

Axillary osmidrosis is a distressing problem. Medical treatment is often inadequate. Local excision of the apocrine and eccrine glands is the most effective method available but is often accompanied by significant morbidity. We report a modified surgical technique for the treatment of this condition. From January 1994 to December 1995, 46 patients (38 females, 8 males) with axillary osmidrosis have been treated by excision of the subcutaneous tissue via two transverse incisions, without removing skin. Sutures are used to anchor the skin to the axillary fascia. There is no need for a complicated tie-over dressing and postoperative arm restriction. All patients were followed up for a minimum of 6 months (average 11.6 months). The patients were asked to complete a questionnaire. The results of malodour elimination were classified as good, fair and poor. Forty-one (89.1%) of the patients had good results, four (8.7%) had fair results, and one (2.2%) had a poor result. The average convalescent time was 9.2 days. Twenty-six patients (57%) were very satisfied and recommended this procedure. Only one patient (2%) regretted having the operation. This operation has the advantages of a high success rate, low complication rate, and rapid recovery for the treatment of axillary osmidrosis.

Adolescent↗
PubMed1997

Reverse pedicled lateral arm flap for reconstruction of posterior soft-tissue defects of the elbow.

Posterior soft-tissue defects of the elbow are difficult to reconstruct by conventional techniques such as closure by approximation or skin graft. An ideal technique should be an easy and reliable one-stage procedure that provides predictable surgical results with regard to elbow function and cosmesis. This report details our experience in 7 patients who underwent a one-stage procedure for coverage of the posterior elbow employing the reverse pedicled lateral arm flap. All flaps survived and all patients were able to resume full range of motion of the elbow joint at the 6-month follow-up. Complications included forearm paraesthesia in 3 patients and conspicuous scarring in a young female patient. We emphasize two valuable refinements in surgical technique including measuring posterior elbow defect in full flexion and postoperative elbow extension splinting. In trauma-related defects of the posterior elbow, a preoperative angiogram is important before raising this flap.

Adolescent↗
PubMed1997

Maxillary myxoma treated with wide resection and immediate reconstruction: a case report.

Myxoma of the jaw is a rare, benign bone tumor of odontogenic origin. Given the locally aggressive nature of the myxoma and the high rate of recurrence, there is a tendency to choose radical resection of the jaw segment containing the tumor mass as the treatment modality. As they appear to attain a considerable size prior to diagnosis because of their insidious growth characteristics, particularly in the maxilla, treatment requiring a hemimaxillectomy often results in a significant functional and aesthetic disability. This is particularly distressing as this condition usually affects the young. We present the case of a 16-year-old female who suffered a large maxillary myxoma with swelling of the left cheek for 2 years. Wide resection of the tumor tissue including the maxillary medial and lateral buttresses and part of the hard palate with preservation of maxillary alveolar bone and teeth was undertaken, and the maxillary buttresses were reconstructed with autogenous rib grafts. At the 3.5-year follow-up there was no local recurrence and no tooth loss. Both the functional result and aesthetic contour proved satisfactory. Wide resection with preservation of vital structures and simultaneous autogenous bone graft reconstruction is our preferred method. A long-term follow-up is needed.

Adolescent↗
PubMed1997

Full intrusion of a tooth after facial trauma.

We report two cases of fully intruded tooth after facial fracture in adults. In the first case, the lateral incisor was intruded into the nasal cavity and slipped into the pyriform sinus during operation. The second case involved full intrusion of a molar into the maxillary sinus, resulting in infection. The importance of a thorough intraoral examination for patients with facial trauma is emphasized. All missing teeth should be accounted for to ensure that they have not dislodged inside the body. When full intrusion of a tooth is suspected, facial computed tomography scan may provide assistance with definite diagnosis. If an incisor is completely intruded into the nasal cavity, removal through the floor of the nostril should be considered.

Accidents, Traffic↗
PubMed1996

Chronic volar dislocation of the metacarpophalangeal joint of the thumb: a case report and review of the literature.

A 61-year-old man sustained a chronic volar dislocation of the metacarpophalangeal joint of the thumb. He did not present for treatment until he experienced recently progressive joint pain 2 year after injury. Arthrodesis of the metacarpophalangeal joint was performed to correct the deformity of the thumb because of its extensive tissue scarring and erosion of the articular cartilage of the metacarpal head. Six weeks of splint immobilization followed by a physiotherapy program allowed the patient to resume his daily activities with his right hand.

Arthrodesis↗
PubMed1995

Polyotia.

Polyotia is an extremely rare congenital anomaly of the external ear. Only four case reports are documented in the literature. A 13-month-old child with a mirror-image duplication of the left auricle was operated on in a one-stage corrective procedure. The duplicated portion of the affected ear was positioned anteriorly and measured approximately two-thirds the size of the posterior, normally oriented portion. There were two fully developed conchae and one fully developed and one partially developed anthelix and lobule. The entire complex had a single external auditory meatus and no tragus. There were no other congenital anomalies, and the child was developmentally normal. The technique for surgical correction is described, and a review of the literature is presented.

Ear, External↗
PubMed1995

Facial plaque-type blue nevus and its reconstruction.

Blue nevi rarely appear in a plaque form. Because of their rarity and unusual clinical appearance, these nevi may present a diagnostic problem. We described a large plaque-type blue nevus measuring about 9 x 6 cm on the right cheek of a 22-year-old man. It was characterized by several dark-blue macules and papules with intervening areas of faint blue discoloration. Excision of this unusual plaque-type blue nevus with reconstruction using tissue expander was performed successfully. A 6-year postoperative follow-up revealed satisfactory results.

Adult↗
PubMed1995

Surgical complications of the Le Fort I osteotomy--a retrospective review of 146 cases.

A retrospective review of 146 cases with Le Fort I osteotomy performed between 1981 and 1990 is presented. A complication of 6.1% was recorded. These complications include intraoperative hemorrhage, trigeminal nerve injury, oronasal fistula and dental injury. Although the Le Fort I osteotomy has proven to be relatively safe, improvements in technique will further reduce the incidence and the severity of complications.

Adolescent↗
PubMed1995

Intramuscular cavernous hemangioma of the masseter muscle.

Intramuscular hemangioma is relatively uncommon and frequently misdiagnosed, and even rarer in the head and neck region. The masseter muscle is the most frequent site for such hemangioma in the head and neck. A retrospective chart-review of intramuscular hemangioma in Keelung Chang Gung Memorial Hospital from 1983 through 1992 revealed the incidence of masseter muscle hemangioma is approximately 8% of all intramuscular hemangioma. Because of the rarity of these tumors, their vague presentations, inaccurate preoperative diagnosis and inappropriate surgical planning are common problems. This paper described five hemangiomas involving the masseter muscle with a review of the current literature on masseter muscle hemangioma.

Adult↗