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Biomedical subjects

B Guyuron

Publications and source records attributed to B Guyuron.

At least 73 records · Page 4Linked to original sources
PubMed1991

Dynamics of rhinoplasty.

Nasal dynamics were studied on 87 patients undergoing rhinoplasty of one zone or two distant nasal zones. Statistical analysis of the result revealed that reduction of the nasion area, besides setting the soft tissue back, gave the appearance of increased intercanthal distance and lengthened the nose. Reduction of the nasal bridge resulted in a wider appearance on front view and a cephalically rotated tip on profile. Augmentation of the bridge affected the nose reversely. Tip cephalad rotation was achieved by resecting one of the three areas: the cephalad portion of the lower lateral cartilages (affecting the rims more), the caudal septum (affecting the central portion more), and the caudal portion of the medial crura of the lower lateral cartilages (affecting the central portion only). Resection of the alar base not only narrowed the nostrils but also moved the alar rim caudally. Furthermore, it reduced tip projection when a large alar base reduction was done. Reduction of the nasal spine increased the upper lip length on profile and reduced tip projection when a large reduction took place. Significant reduction in caudal nose projection resulted in widening of the alar base.

Adolescent↗
PubMed1990

A critical comparison of osteoplastic and alloplastic augmentation genioplasty.

This retrospective study was undertaken in order to compare the objective and subjective outcomes of the osteoplastic and alloplastic genioplasties. Of the 76 patients that underwent augmentation or advancement genioplasty, 34 were subjects of osteoplastic genioplasty and 42 received implants. Twenty seven of 34 patients who underwent osteotomy and 32 of 42 patients whose chins were augmented with an implant responded to the questionnaires. The results revealed that both groups were highly satisfied, with a slightly higher satisfaction rate for those who underwent osteotomy. The morbidity was the same for both procedures. However, the soft tissue response was more predictable for the osteoplastic genioplasty. The cervicomental angle improved more with the osteoplastic genioplasty. Based on our experience and conclusions from this study, we recommend the osteoplastic genioplasty for every patient. However, for patients in the older age group, particularly those with a small degree of microgenia, alloplastic genioplastic can be justified.

Adolescent↗
PubMed1990

The hourglass facial deformity.

The "Hourglass Facial Deformity" is the result of bilateral irradiation of the orbits and anterior cranial base during infancy. The deformity is uniformly characterized by a distinctly misshapen upper face at the level of the orbits, with depression of the temporal region, hypotelorism, and flattened nasal root. These patients exhibited varying degrees of frontal bossing. Since they had previous enucleation, the orbital soft-tissue can be dissected off the eye socket, lateral orbital walls, and if necessary, the orbital cone, through a bicoronal incision. The deformity is then easily corrected with implantation of acrylic alloplastic material. Four cases are presented which had varying degrees of the same deformity and were successfully corrected using the operative procedure described. No complications have been encountered. Two patients required eye socket revisions.

Acrylic Resins↗
PubMed1990

A severe fibrotic reaction after cosmetic liquid silicone injection. A case report.

A case of a severe, locally aggressive fibroblastic reaction to cosmetic silicone injection involving the orbital cone and anterior cranial base is presented. Included is a brief history and description of silicone injection and its complications. Though many facts remain to be discovered, speculation into the possible pathogenesis, with a review of the literature, shows that while silicone continues to be a useful tool for the plastic surgeon, an awareness of the risks, as well as a search for clues to avoid complications, must continue before further liberal use of this material is encouraged.

Facial Bones↗
PubMed1990

Long-term survival following nodal metastases from basal cell carcinoma.

A case of long-term survival with metastatic basal cell carcinoma to regional lymph nodes is presented. The literature has been briefly reviewed. When a metastatic basal cell carcinoma is discovered, the average survival is only 8 to 10 months. The patient in this case report has been followed for 10 years from the initial metastatic discovery and 7 years from the last metastatic surgery by one of the authors. There has been no evidence of recurrent disease. The topic of metastatic basal cell carcinoma is detailed in this report.

Adult↗
PubMed1990

Pseudomeningocele as a complication of teratoma resection and aseptic meningitis following craniofacial reconstruction: a case report.

This is a report of two extremely unusual complications of craniofacial surgery on a single patient. A 14-year-old female underwent resection of a recurrent teratoma four times within the first 9 years of life. This left her with two large cranial cavities in the left temple and posterior to the orbit communicating with the subarachnoid space constituting a pseudomeningocele and pulsatile mass in the left temple--an unusual complication. Following resection of the pseudoepithelial cavity linings, the spaces were filled with a split temporalis muscle. Two weeks following surgery, she developed signs and symptoms of meningitis with negative cultures from the drain sites and lumbar puncture. Six days following an unsuccessful attempt to treat her with wide spectrum antibiotics, she was treated with dexamethasone. As a result, there was a dramatic disappearance of signs and symptoms in less than 36 hours; she has not experienced any recurrence since. We feel that this aseptic meningitis was the result of cerebrospinal fluid exposure to muscle--a rare, yet, previously reported complication. The details of the case history and discussion of complications and the way in which they can be avoided, are subjects of this report.

Adolescent↗
PubMed1990

Undetected diabetes and the plastic surgeon.

Plastic surgery candidates are generally healthy. Therefore, major postoperative complications are rare. Should they happen, the surgeon should search for possible causes, one of which is undetected diabetes mellitus. Six patients are presented who, based on the individual or family history or the unusual nature of their complications, were suspected of having diabetic tendencies. This experience necessitated our in-depth search into the role of silent or undetected diabetes. This report emphasizes the importance of positive family history of diabetes and the role of glucose tolerance tests on suspected cases. Even with normal glucose tolerance tests, however, some of these patients with a positive family history of diabetes and history of previous infections suffer from deficiencies in the chemotactic immune system. We recommend full discussion of the increased risk of infection and delayed healing with these patients, conservatism during surgical procedures, and prophylactic use of antibiotics perioperatively.

Aged↗
PubMed1989

Rhytidectomy in patients with facial lipodystrophy: a review of the literature with case presentations.

Partial lipodystrophy continues to be a baffling disorder. Procedures used for facial contour restoration have varied. Dermal-fat grafts, fat injections, microvascular free-flap grafts, and occasional injections of medical-grade liquid silicone are currently the most common methods of facial contour restoration, and although these techniques have resulted in good cosmetic results, there are drawbacks to each. We present a review of the medical literature concerning facial lipodystrophy and its cosmetic correction along with case reports of contour restoration in two facial lipodystrophic patients.

Female↗
PubMed1989

Guarded burr for deepening of nasofrontal junction.

Appropriate deepening of the nasofrontal junction remains one of the most difficult parts of rhinoplasty. A guarded burr is introduced that provides a safe and effective means of deepening or creating a shallow nasofrontal groove. The burr has a special guard that prevents the cutting of soft tissue. The guarded burr is introduced in position through the routine elevation of the bridge soft tissue subperiosteally. The safety latch is used for orientation. With gentle movement along the line connecting the canthi, the desired amount of bone can be removed from the nasofrontal junction with little time consumed. It is important to avoid continuous friction, since this might result in significant heat production and thereby thermal injury to the soft tissue and fluid collection.

Equipment Design↗
PubMed1989

Combined maxillary and mandibular osteotomies.

In certain patient categories single-jaw surgery will not result in the optimal outcome that can be achieved through bimaxillary surgery. These include patients with asymmetrical facial deformities (usually mid and lower face), long face deformity with vertical maxillary excess and significant mandibular retrognathism, and bimaxillary protrusion or retrusion. To correct such deformities a well-planned and orchestrated orthodontic preparation followed by bimaxillary orthognathic surgery is necessary. An interim occlusal splint will guide the surgeon in moving the maxilla, and the final splint will position the mandible. Precise attention to detail throughout the operative course is essential to an optimal outcome. Rigid fixation will minimize the need for traditional intermaxillary wiring.

Facial Asymmetry↗
PubMed1989

Is packing after septorhinoplasty necessary? A randomized study.

This randomized study was conducted to evaluate the role of nasal packing following septorhinoplasty. Fifty septorhinoplasty patients were selected (on a random basis) to either receive or not receive nasal packing. Twenty-three of 25 patients with nasal packing and 22 of 25 patients without nasal packing were available for follow-up. This study suggests that patients with nasal packing are less likely to develop recurrent septal deviation and synechia and more likely to have improvement in the nasal airway. Only one of the patients with nasal packing found the removal of the packing the most uncomfortable part of the surgery. The most impressive and statistically significant finding, however, was the significant difference between the two groups in terms of airway improvement, which was 96 percent in the nasal packing group and 64 percent in the group without nasal packing. There was also a higher incidence of recurrent or residual septal deviation in the group without nasal packing (41 percent), while the group with nasal packing had only (13 percent) recurrent or residual deviation.

Adolescent↗
PubMed1988

Subcutaneous anterior hairline forehead rhytidectomy.

An anterior hairline incision with subcutaneous (superficial to the frontalis muscle) dissection is recommended for certain categories of rhytidectomy patients. Patient selection is a very important preoperative procedure. The technique and results are described and illustrated. Advantages and disadvantages are discussed.

Adult↗
PubMed1988

Modified temple incision for facial rhytidectomy.

A modified temple incision is discussed. The incision has been used on 286 patients. The incision starts cephalad in the temple hair, continues caudally parallel to the ear axis along the caudal border of the sideburn, turns cephalad close to the helix, and then continues along the anterior border of the ear. The advantages of the incision are numerous. First, it virtually eliminates any possibility for injury to the temporal branches of the facial nerve and preserves the temporal vessels. Second, the temple and sideburn skin flap is not elevated so the chance of hair loss is minimal. Third, the incision significantly increases the distribution length of the excised area; this minimizes any possibility of "dog ear" formation. Midface and upperface rhytidectomies are more effective because the skin is pulled a shorter distance. The drawbacks of the incision are the possibility of a visible scar in the most caudal portion of the sideburns and added surgical time because of the need for meticulous incision repair.

Face↗
PubMed1988

Precision rhinoplasty. Part II: Prediction.

This retrospective study was undertaken to investigate the soft-tissue response rate to the skeletal and soft-tissue alterations following a rhinoplasty. Ninety-eight patients, 80 females and 18 males, with a mean follow-up of 13 months, were included in this study. The tracings of the outline of preoperative cephaloxerograms and life-size photographs were superimposed on the postoperative ones, and the differences were measured and confirmed with measurements of intraoperative resected segments. The soft-tissue response to skeletal alterations was measured in seven different zones. Zone 1 (nasion) and zone 7 (nasal spine area) had the lowest mean response rate of approximately 25 percent. Zone 2 (proximal bridge) and zone 3 (midbridge) had a 60 percent response rate. Zone 4 (supratip area) had a 43 percent response, zone 5 had a 41 percent response, and zone 6 had a 40 percent response rate. There were statistically significant differences among the response rates of thick, medium, and thin noses. Age was an important factor in zones 1, 4, 5, 6, and 7. The patient's sex did not influence the soft-tissue response rate to skeletal alterations. The soft-tissue response in relation to the alar base narrowing was about 52 percent. This study reveals a predictable soft-tissue response to skeletal alterations on all zones except zone 7 (nasal spine area).

Adolescent↗
PubMed1988

Foreign-body granuloma following bilateral facial reconstruction with an omental flap.

Bilateral facial reconstruction using an omental free-flap transfer for soft-tissue augmentation was performed on a 23-year-old man who had undergone previous surgical resection of an embryonal-cell rhabdomyosarcoma followed by radiation and chemotherapy. Eight weeks following surgery, the patient presented with pain and edema from a foreign-body reaction documented by electron microscopy. This was successfully managed with a course of steroid administration. The patient has remained symptom-free for 5 years.

Adult↗
PubMed1988

Facial deformity of juvenile rheumatoid arthritis.

Arthritis of the temporomandibular joint and resulting deficient mandibular growth are seen in as many as 25 percent of patients with juvenile rheumatoid arthritis. The magnitude of joint involvement and resulting growth deficiency varies significantly. These patients typically develop a "birdface" deformity with retruding mandible, alteration of the cervicofacial angle, and class II occlusion with limitation of the bite opening. A multidisciplinary approach, including the surgeon, a dentist, an orthodontist, and a rheumatologist, is necessary to ensure a safe and successful surgical outcome. The side effects of pharmacologic agents used to control the disease on coagulation, healing, and bone density should be considered seriously.

Adult↗