Biomedical subjects

B A Toth

Publications and source records attributed to B A Toth.

At least 19 recordsLinked to original sources

PubMed1999

Advancement of the midface using distraction techniques.

Fourteen patients underwent Le Fort III midface advancement using distraction techniques. Six have cephalometric documentation extending beyond 1 year postoperatively, and the positions of cephalometric points A and orbitale over time are reported here. Excellent stability of advancement at the occlusal level and some relapse at the level of orbitale are documented. Elimination or diminution of obstructive sleep apnea occurred in all patients so affected, and one of two patients with tracheostomy has been decannulated. Speech effects have been mild or transient. No untoward effects on extraocular muscle function have occurred.

Cephalometry↗

PubMed1999

Retrospective study of the skin-sparing mastectomy in breast reconstruction.

The final appearance of the reconstructed breast is greatly dependent on the relative amounts of skin and breast tissue excised at the time of the mastectomy and on the exact location of the skin incision. A complete mastectomy may be performed using modified skin incisions to avoid the sacrifice of unnecessary breast skin. The type of skin-sparing incision used varies based on the exact location of the tumor and the size of the breast, but it always includes the nipple-areola complex and the biopsy site. The presence of local recurrence, distant disease, or death was determined in 50 consecutive patients who had skin-sparing mastectomies and immediate breast reconstruction between 1985 and 1991 to ascertain the safety of the procedure. The period of follow-up ranged from 23 to 121 months, with a mean of 57 months and a median of 51.5 months. There was no local recurrence, active distant disease was present in five patients, two patients died of distant disease, and there were two unrelated deaths.

Breast Neoplasms↗

PubMed1998

Recycling stacked TRAM flaps for contralateral breast reconstruction.

The transverse rectus abdominis musculocutaneous (TRAM) flap is a reliable tool in breast reconstruction. However, the necessary transverse excision of abdominal tissue involves the use or sacrifice of both the ipsilateral and contralateral flaps at the time of reconstruction, thereby limiting future options for reconstruction of the opposite breast in the event of a second primary cancer. As illustrated by this patient report, stacked TRAM flaps can be unstacked should future contralateral breast reconstruction become necessary.

Breast Implantation↗

PubMed1998

Distraction osteogenesis and its application to the midface and bony orbit in craniosynostosis syndromes.

The purpose of this study was to demonstrate the potential advantages of applying distraction osteogenesis techniques to the correction of orbital and midfacial hypoplasia in craniosynostosis syndromes. Fifteen children with various craniosynostosis syndromes underwent Le Fort III advancement assisted by gradual distraction utilizing a pair of internal distraction devices custom-fabricated for each child. The surgical procedure consisted of a Le Fort III osteotomy, implantation of internal devices with initiation of distraction intraoperatively, and an accelerated rate of midfacial advancement over the next 3 to 5 days. Activation of the distraction hardware was accomplished by a percutaneous pin, which was removed at the end of the distraction protocol, allowing the internal devices to fixate the fragment for a minimum of 6 months during the period of consolidation. With follow-up ranging between 3 to 38 months, the average orbital and midfacial advancement was 19.7 mm (range, 12.0-30.0 mm). Proptosis was lessened and facial proportions significantly improved in all patients. Serious complications were not encountered. The modified distraction protocol utilized in this group of patients was aimed at addressing the unique requirements of pediatric craniofacial surgery, and resulted in almost twice the amount of correction previously reported for traditional rigid fixation techniques.

Adolescent↗

PubMed1997

Le Fort III advancement with gradual distraction using internal devices.

The purpose of this report is to demonstrate a practical clinical method for advancement of the midface using a combination of Le Fort III osteotomy and gradual distraction. Use of internal, submergible distraction devices and modification of the Ilizarov distraction protocol are presented. Case reports show the effect of departing from the Ilizarov protocol by eliminating the latency period, initiating distraction intraoperatively, and rapidly distracting the segments postoperatively. A method of controlling fragment distraction rate by regulating pressures within the osteotomy site is described. The design and surgical application of internal distraction devices are shown. Nine patients with midface hypoplasia related to craniofacial anomalies underwent Le Fort III osteotomies assisted by gradual distraction. Ages ranged from 4 to 13 years. Custom internal distraction devices were employed to meet the unique requirements of each patient. Activation of the distraction device was accomplished by a percutaneous pin that remained in place for 3 to 5 days. The rate of transport was determined by regulating the forces within the distraction site. The internal devices remained in place for 6 months for fixation of the transported fragment. Midface advancement, measured as the anterior displacement of the infraorbital rim, ranged from 16 to 30 mm, with a mean of 20 mm. The typical force required to produce incremental movement of the Le Fort III osteotomy was found to be between 7 and 9 kg as transport exceeded 10 mm. Four patients with obstructive sleep apnea prior to surgery had resolution of the disorder. All the midface advancements remained clinically stable. Establishment of osseous continuity was verified by surgical examination in the four patients in whom the distraction devices have been removed. Combining intraoperative advancement of the Le Fort III osteotomy with gradual distraction consistently resulted in larger movements than could be achieved with conventional osteotomies and rigid fixation alone. The pediatric craniofacial skeleton responds differently to distraction than does the orthopedic skeleton. Eliminating the latency period, establishing a substantial bone gap intraoperatively, and rapidly distracting the fragment postoperatively did not adversely affect the osseous union in these patients. The internal, submergible feature of the device design offers advantages in patient acceptance, fixation stability, and wound management. This method of Le Fort III midface advancement has been shown to be clinically practical and effective.

Adolescent↗

PubMed1996

Distraction osteogenesis in maxillofacial surgery using internal devices: review of five cases.

PURPOSE: The purpose of this report is to show the feasibility and potential advantages of using internal devices for distraction osteogenesis in the management of maxillofacial skeletal deficiencies. PATIENTS AND METHODS: Distraction osteogenesis was used to correct a variety of maxillofacial skeletal deformities in five patients. One patient underwent bilateral Le Fort III advancement aided by distraction, three patients underwent mandibular ramus lengthening, and one patient underwent segmental alveolar reconstruction by distraction. The devices were activated by either a transcutaneous or transmucosal pin. After achievement of the desired skeletal transport, the activating pins were disengaged and removed from the distraction device. This allowed the distraction device to remain submerged and to stabilize the site of the consolidating bone. RESULTS: All patients achieved lengthening of their jaws. However, premature consolidation was noted in two patients, and one patient had significant relapse. CONCLUSIONS: Development of internal distraction devices is important to address the limitations of currently available biphasic systems. Potential benefits of internal devices include 1) elimination of skin scarring caused by translation of transcutaneous fixation pins, 2) improved patient compliance during the fixation or consolidation phase because there is no external component, and 3) improved stability of the attachment of the device to the bone.

Acrocephalosyndactylia↗

PubMed1992

Temporoparietal fascial flap for orbital and eyelid reconstruction.

The temporoparietal fascial flap is a recognized technique for the transfer of vascularized tissue in the craniofacial region. The flap has a predictable axial vessel, provides thin vascularized tissue, and can be harvested with minimal donor-site morbidity. The temporoparietal fascial flap is well suited for orbital or eyelid reconstruction because of its proximity to the orbit. The flap is useful for reconstruction of anatomic barriers between the orbit, intracranial cavity, and paranasal sinus spaces. We present four patients in whom the temporoparietal fascial flap was used for orbital reconstruction following extirpative surgery for orbital neoplasm and two patients in whom the flap was used for lower eyelid and malar reconstruction.

Adult↗

PubMed1992

Three dimensional imaging and computer-designed prostheses in the evaluation and management of orbitocranial deformities.

Three dimensional images reconstructed from two dimensional CT scans allow improved analysis of complex orbitocranial bony deformities. This evaluation may be useful in patients with defects resulting from trauma, tumor, congenital abnormalities, or developmental disorders. Diagnosis, surgical management, and long-term follow-up evaluation may be aided by improved understanding of bony contour and volume analysis. Computer designed prostheses can be fabricated to precisely match bony defects and may be used as an alloplastic implant or as a model to aid intraoperative contouring of an autogenous bone graft. The limitations of three dimensional imaging include artifacts in the reconstructed images, increased radiation exposure, and increased cost. The technology is still evolving and the indications and benefits remain undefined at the present time.

Adolescent↗

PubMed1991

Split bipedicle transverse rectus abdominis flaps: expanding their uses in breast reconstruction.

A total of 34 breasts were reconstructed in 21 women, with the bipedicle transverse rectus abdominis island flap technique. Thirteen women had bilateral breast reconstructions and 8 had unilateral reconstructions. The indications for using this technique are (1) bilateral breast defects, (2) a radical mastectomy defect, (3) limited donor tissue or tissue compromised by prior abdominal surgery, and (4) a large, remaining breast that requires matching. Four selected women are presented to illustrate each indication. In all but 1 woman, the abdominal islands were bisected and transferred to the chest defects with their respective rectus muscles and vascular pedicles. Complications included 2 women with abdominal wall hernia, 3 women with minimal peripheral skin necrosis of the reconstructed breasts, and 1 woman with Raynaud's disease with partial flap loss. Follow-up ranged from 3 to 57 months. Bipedicle rectus abdominis flaps provide improved vascularity and allow greater flexibility in bilateral and unilateral breast reconstruction.

Abdominal Muscles↗

PubMed1991

Orbital exenteration. The reconstructive ladder.

Following orbital exenteration, there is a spectrum of immediate and delayed options for orbital reconstruction. Goals of reconstruction after exenteration include detection of recurrent disease, restoration of boundaries between the orbit and surrounding structures, and optimal aesthetics. Local solutions to problems of the exenterated orbit, such as healing by granulation or application of split-thickness skin grafts, are advantageous for detecting recurrent disease. Regional solutions, involving transfer of periorbital tissue into the orbit, may mask recurrent disease and create adjacent deformity; however, these solutions can be used to restore orbital boundaries and shallow the orbital cavity. Distant solutions, such as skin-muscle flaps and free tissue grafts, allow for facial reconstruction in patients with extensive orbital and periorbital defects.

Adipose Tissue↗

PubMed1991

A micro system for rigid bony fixation in orbital surgery.

Plates and screws are effective for rigid internal fixation of bone fractures and osteotomies in the midface, orbit, and cranium. We describe our experience with the Luhr Micro System. This is the newest generation of Luhr Systems and is the smallest system available for rigid internal fixation. The self-tapping screws are 0.8 mm in diameter, with lengths of 2-8 mm. The plates have an extremely flat profile. We have used the Micro System for closure of elective osteotomies following resection of orbital neoplasm, bony orbital reconstruction, and repair of congenital craniofacial deformities. Because the orbital bones have minimal functional stress, the Micro System provides adequate support. The plates are not apparent through the thin periorbital skin. For bony fixation in the periorbital region, the Micro System appears superior to larger systems and to wire or nonabsorbable sutures.

Adult↗

PubMed1991

Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning.

Skin-sparing mastectomy by definition describes the procedure of mastectomy, either simple or modified radical, with a minimum amount of skin excision. The surgical skin excision must: (1) include the nipple-areola complex, (2) include the biopsy site, and (3) allow for access to the axilla for possible dissection. In 27 mastectomies, the senior author has had direct input in the preoperative skin planning. All patients underwent immediate breast reconstruction. In large-breasted women, the mastectomy was performed to a Wise-type pattern. In small-breasted women, the mastectomy involved minimal skin excision followed by reconstruction. Non-continuous incisions were frequently used in small-breasted women, thereby minimizing breast scarring. When appropriately applied, skin-sparing mastectomy can greatly improve the final aesthetic result of the breast.

Adult↗

PubMed1990

Immediate breast reconstruction with deepithelialized TRAM flaps: techniques for improving breast reconstruction.

In selected patients with lower quadrant breast masses, large breasts, and sufficient abdominal tissue, standard techniques for breast reconstruction can be modified to improve overall results. The transverse abdominal island flap can be deepithelialized and mobilized to reconstruct unilateral or bilateral defects. Furthermore, skin markings prior to mastectomy that conform to a modified Wise pattern will allow for more aesthetic positioning of eventual scars. We present a case report of a patient who underwent immediate breast reconstruction with bilateral deepithelialized lower rectus abdominis myodermal flaps.

Adenocarcinoma, Mucinous↗

PubMed1990

The role of tissue expansion in the treatment of atypical facial clefting.

Tissue expansion can be a valuable tool in the reconstruction of soft-tissue defects in craniofacial clefts. To our knowledge, there have been no reports in the literature of the use of tissue expanders to help solve this problem. We report the case of a child with an atypical Tessier no. 3 craniofacial cleft who had a forehead tissue expander placed, inflated, and thus used to provide sufficient local facial skin for repair of the soft-tissue defect.

Cleft Lip↗

PubMed1989

Aesthetic refinements in reconstructive microsurgery.

The vast array of free tissue options available to reconstructive surgeons plus our knowledge of vascular systems now provide us with the wherewithal to not only fill a defect but to do so aesthetically and with minimal donor site morbidity. The authors discuss setting reconstructive goals that include refined and aesthetic results for deficit and donor site alike and demonstrate how, in many situations, these goals can be achieved.

Esthetics↗

PubMed1988

Orbital surgery. The technique of coronal scalp flap approach to the qateral orbitotomy.

Lateral orbitotomy may be performed using a coronal scalp flap to provide exposure of the lateral orbital wall and rim. A coronal incision is made across the scalp. The scalp flap is developed anteriorly to expose the orbital margin from the superior orbital rim to the zygomatic arch. The temporalis muscle is dissected from its bony attachments and bluntly retracted, providing maximal exposure of the lateral orbital wall. The orbitotomy proceeds as required. The case concludes with a layered closure. In selected patients, the coronal scalp flap provides improved exposure and postoperative aesthetics compared with approaches in which the skin and muscle layer are incised directly over the lateral orbit. Complications are infrequent.

Humans↗

PubMed1988

Multidisciplinary approach to the management of complex bony and soft tissue orbitocranial disorders.

Orbital reconstructive surgery is entering a new age as progress in surgical techniques and diagnostic imaging are applied to the patient with severe acquired orbital and periorbital deformities. The authors present a series of six patients with orbitocranial neoplasms and congenital and traumatic deformities whose management involved a multidisciplinary approach. Particular emphasis is placed on the use of reformatting two-dimensional orbital scans into three-dimensional images and surgical techniques using composite flaps and periorbital microsurgical vascular anastomoses. Advancements in technology and sophisticated reconstructive surgical techniques have exciting potential. Ophthalmologists can play an important role in this expanding field since they frequently serve as the entry point or provide long-term follow-up to patients with these complex problems.

Adult↗

PubMed1988

Computer-designed prostheses for orbitocranial reconstruction.

Three-dimensional imaging is an adjunct to preoperative evaluation and surgical management in some patients with complex anatomic defects of various etiologies. Deformities defined by conventional computerized tomography can be viewed as accurate three-dimensional images calculated from the original scan. The images are viewed on a high-resolution video monitor and can be photographed for a permanent record. A computer-controlled milling device can use these data to fabricate prostheses. The prostheses aid reconstructive surgery through use as an alloplastic implant, as a template to fashion autogenous bone grafts, or as a model for tissue removal. We have utilized three-dimensional imaging in combination with computer-assisted prosthesis manufacture in six patients with complex orbitocranial deformities. Four patients have undergone reconstructive surgery with satisfactory results and no complications thus far. The use of computer-designed prostheses adds a new aspect to orbitocranial reconstructive surgery that facilitates increased accuracy in the correction of anatomic defects.

Adolescent↗