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Biomedical subjects

B Guyuron

Publications and source records attributed to B Guyuron.

At least 91 records · Page 5Linked to original sources
PubMed1988

Experience with the modified Putterman procedure.

Results using our modification of the Putterman procedure are reported in 43 eyelids. The procedure is very effective in cases of minimal to moderate eyelid ptosis (3 mm or less) and in the presence of normal levator function. The patients, following a thorough clinical evaluation, are tested using 2.5% phenylephrine eyedrop solution, which acts as an extremely useful prognostic indicator. Depending on the degree of ptosis and the response to phenylephrine, 6 to 9 mm of combined Müller's muscle and conjunctiva is resected using a specially designed clamp under local or attended local anesthesia (no tarsal plate is resected). The incision is repaired using a running 6-0 Prolene horizontal mattress technique, and the ends are brought up through the skin and tied over the tarsal plate. In the treatment of 43 eyelids, with the exception of one slight overcorrection, there were no complications encountered with this simple procedure. Excellent results can be expected in properly selected patients, and recovery time is minimal. Our success in the last 4 years with this modified procedure allows us to strongly recommend it for the correction of mild to moderate ptosis when there is an acceptable response to phenylephrine.

Adolescent↗
PubMed1988

Management of extensive and difficult cranial defects.

The procedure of split-skull cranioplasty was first investigated at the turn of the century. The present authors first reported their technique of split-skull cranioplasty in 1983, and describe here their experience with this procedure in the management of extensive and difficult cranial defects. Twenty-nine patients (11 females and 18 males) are reviewed. Ten patients had histories of infection before reconstruction surgery. Eleven patients received radiation therapy at the grafted areas. The postoperative follow-up period ranged from 6 months to 4 1/2 years. There was no evidence of bone resorption during that time, and minor complications occurred in only two of the patients. This procedure offered several advantages: 1) the bone graft, an autogenous material, can be used in previously infected areas; 2) the reconstruction contour is smooth and natural; 3) there was no morbidity or scarring at the donor site; 4) surgery time is much shorter than with split-rib cranioplasty. The primary disadvantage of split-skull cranioplasty is the decreased thickness of the skull at the donor site.

Adolescent↗
PubMed1988

Craniocarpotarsal dysplasia: the whistling face syndrome.

Currently, 50 cases of craniocarpotarsal dysplasia, or whistling face syndrome (WFS), have been reported, with more than 60 anatomical anomalies involving the head, hands, and feet, in addition to the face. In spite of the fact that there is much information concerning the surgical correction of many of these deformities, such as the surgical program for the hands outlined by Call and Strickland in 1981, there is little information concerning the surgical correction of facial deformities. In view of this, we present here a case report of a patient with WFS and our surgical approach to the facial deformities involved. Since January 24, 1983, when this 7-year-old girl first came into our care, she has successfully undergone a total forehead reshaping, correction of congenital upper eyelid ptosis, and a bilateral commissuroplasty. Follow-up for more than three years has shown stable surgical results.

Abnormalities, Multiple↗
PubMed1988

Precision rhinoplasty. Part I: The role of life-size photographs and soft-tissue cephalometric analysis.

I describe a simple technique of full-scale life-size photography using marker/stickers and a ruler at the side of the face as an index for magnification. I also report a technique of soft-tissue cephalometric analysis that consists of some new proportion and some old angles and measurements. This technique will enable the plastic surgeon, even if not artistically inclined, to draw an aesthetically pleasing and very proportionate profile outline of the nose and measure the proportions of the front view on the majority of patients. The difference between the patient's nasal outline and the planned nasal definition is then measured and expressed in quarters of millimeters to give the surgeon a very precise numeric guide for surgery. This will help the plastic surgeon define the aesthetic goals very accurately and also might be helpful in detecting other facial disharmonies that might be influential in the outcome of the rhinoplasty. Using this technique of analysis, along with the prediction guidelines extrapolated from my study on soft-tissue response to surgical alteration, one can develop a fairly predictable approach to rhinoplasty.

Cephalometry↗
PubMed1987

Multiple metastases from basal cell naevus syndrome.

A patient with basal cell naevus syndrome (Gorlin-Goltz Syndrome) is presented. Of note in the case was the extensive symmetrical tumour invasion of both external auditory canals requiring bilateral radical resection. The patient expired 14 months later, at which time the autopsy revealed widespread metastases to the pleura, diaphragm, pericardium, epicardium and myocardium. Although lung metastases have been reported in this syndrome, no cases have been reported of metastases to these sites.

Basal Cell Nevus Syndrome↗
PubMed1987

Soft-tissue frontal bossing.

An unusual case of frontal bossing due to excess subcutaneous fibroadipose tissue in a 38-year-old woman with Möbius syndrome is presented. A relatively simple transcoronal resection of soft tissue resulted in successful elimination of this type of frontal bossing.

Adipose Tissue↗
PubMed1986

Simplified harvesting of the ear cartilage graft.

A simplified technique of harvesting of the ear cartilage graft is described which (1) uses a postauricular incision to minimize the visible scars, (2) removes the whole floor of the conchal fossa to avoid the irregularities, and (3) uses a tie-over dressing to eliminate the need for a head dressing. This technique has been used on 88 patients with one visible and tender medial irregularity, and three minor palpable, but invisible irregularities.

Bandages↗
PubMed1985

Retroauricular island flap for eye socket reconstruction.

This paper describes the use of a flap which is the random portion of an island flap based on superficial temporal vessels. The flap has three distinct anatomic portions: the cutaneous portion, which includes the postauricular skin, the triangular deepithelialized scalp and fascia above the ear, which augments random-pattern blood circulation to the cutaneous portion, and the superficial temporal fascia encompassing the vascular pedicle, which is dissected down to the upper pole of the parotid gland and unfolded using a cutback incision between the vascular pedicle and the second portion of the flap in order to increase the reach of the cutaneous portion. The flap has been successfully used in eight patients for reconstruction of missing or contracted eye sockets. In two patients, inconsequential superficial loss of the distal portion of the distal flap was observed. This flap can also be used for reconstruction of the external face, eyelid, and palate as well as soft-tissue augmentation.

Face↗
PubMed1984

Fasciocutaneous flap, secondary axial pattern flap, and microvascular free flap in socket reconstruction.

Three techniques are described to rebuild a missing or recurrently contracted socket, the selection of which is based on the anatomy of the periorbital tissue and vascular supply. When the superficial temporal vessels are present, the ipsilateral fasciocutaneous postauricular flap is used. When the vessels are present but the postauricular flap has been used, a secondary axial pattern flap is used. When the superficial temporal vessels are absent or not suitable, the dorsalis pedis vascularized free flap is used.

Fascia↗
PubMed1983

Bronchoscopic intubation of patients with trismus.

Endotracheal intubation of patients with limited bite opening is a serious task for the caring physician. Blind intubation can be frustrating and, very often, unsuccessful. Tracheostomy, even under ideal conditions, can create serious complications. Fiberoptic bronchoscopy has opened up a new era in intubation of patients with trismus. In this article, we discuss an organized illustrated procedure for intubation of such patients. We have used this procedure successfully in 16 patients over the last sixteen months in our craniofacial unit, with no complications and no failures.

Bronchoscopy↗
PubMed1983

Effect of irradiation on facial growth: a 7- to 25-year follow-up.

This retrospective study is a review of 41 patients who had received irradiation to the head and face during the growth period. Not only is growth of soft tissue and bone of the irradiated area noticeably affected, but other parts of the face can also be involved, especially if the dose is to the upper face and the cranial base. We were able to define a definite cutoff point for a harmful dose for growing facial bones, but the harmful dose for soft tissue could not be determined and may be as low as 400 rads.

Adolescent↗
PubMed1983

Transcutaneous stitch for transperiosteal identification of the medial canthal ligament.

This paper presents a technique whereby the canthal ligament can be identified through the periosteum without creating an external incision. Prior to releasing the tendon from the bones, the assistant will stretch the lateral canthal ligament while the surgeon places a stitch through the medial canthal ligament and tattoos the ligament and the underlying bone. After the forehead flap is mobilized and the ligament is detached from the bone by elevation of the periosteum, the previous stitch on the medial canthal ligament is pulled, which will provide a firmer consistency to the ligament, thereby facilitating the differentiation of the ligament from the surrounding soft tissue. Using this and the tract tattooed previously, the ligament can be identified easily without creating any external scars.

Face↗
PubMed1983

Excision and grafting in treatment of recurrent pilonidal sinus disease.

Most failure and recurrences after excision and grafting occur during the first five months postoperatively. We concluded that this most likely indicated inadequate excision rather than inefficacy of the procedure. For small pilonidal sinus with minor sinus tract and shallow natal cleft, excision with primary closure would seem to be the best procedure. However, for extensive or recurrent sacrococcygeal pilonidal disease, wide excision with primary split thickness skin grafting is superior. We reviewed 58 patients who had undergone excision of extensive or recurrent pilonidal disease, with primary skin grafting. More than 72 per cent of these patients had recurrent disease when first seen at the Cleveland Clinic. The average hospital stay was 9.8 days; the total disability period, time off work, was 28 days; recurrence rate, 1.7 per cent, and failure rate, 3.4 per cent. This procedure is recommended for recurrent or extensive pilonidal disease.

Female↗
PubMed1982

Muscle flaps and the vascular detour principle: the soleus.

We present a concept in muscle and myocutaneous flap transfer whereby distally based flaps can, under very special circumstances, be transferred with an augmented arc of rotation and more reliable circulation. The concept is the inclusion of adjacent longitudinal vessels in the elevation, within which vessels the flow is reversed. To our knowledge this concept has not been previously described. The soleus muscle and eight other muscles have been found to be potentially useful in this regard. We report here our experience with 3 clinical cases of the distally-based soleus flap with a reversed pedicle, exemplifying the vascular detour principle. Our limited experience indicates no impairment of blood supply to the limb in short-term follow-up. Until further studies confirm the safety of major vessel sacrifice in a limb, we recommend only judicious use of this flap in highly selected situations.

Adult↗
PubMed1981

Split-rib cranioplasty.

Cranioplasty using a synthetic material is less than ideal, especially if there is a history of infection at the defect site. Split-rib cranioplasty is a practical approach even in patients with a positive history of infection at or around the defect. We briefly review the historical background of split-rib cranioplasty and report our experience with this procedure in 12 patients. Forty-two pieces of rib, with an average length of 13 cm. were used for reconstruction. We had only 1 complication-a pneumothorax following removal of the rib graft. The follow-up period ranged from three to thirty-six months. All patients had complete regeneration of the donor rib and solid protection of the brain.

Adolescent↗
PubMedDate not supplied

The lower trapezius myocutaneous flap for head and neck reconstruction.

The lower trapezius myocutaneous flap has proved to be another useful adjunct in the reconstructive armamentarium of the head and neck surgeon. The flap is based on the descending branch of the transverse cervical artery and vein. Providing these structures are protected during neck dissection, this flap may well become the first consideration of flaps for reconstruction of extensive defects of the head and neck. The flap is safe, reliable, and easy to raise, with constant vascular anatomy. The donor site functional deficit is minimal and the donor site may be closed by direct closure without the necessity of skin graft. Its cutaneous reach and arc of rotation make it a suitable source for skin and muscle replacement for the entire neck, face, and occipital region of the scalp and oral cavity.

Carcinoma, Adenoid Cystic↗
PubMedDate not supplied

Long-term effects of orbital irradiation.

This retrospective study is a review of 18 patients who received radiotherapy to the orbit between the ages of 1 month and 10 years. Patients were followed for 7-21 years in an attempt to define the effects of orbital irradiation on a growing child. None of the patients in the study was spared injurious effects on soft tissue or bone, but soft tissue appeared to be more vulnerable to radiation than bone. Orbital irradiation caused soft tissue deficits of the upper face in 100% of the patients. Sixty-seven percent of patients had soft tissue deformities of the midface, and 13% had soft tissue deformities of the lower face. Bony deficits were found in the upper face in 67% of the patients, the midface in 50%, and the lower face in 6%. This study found no correlation between age and time of radiotherapy on the effects of facial growth.

Adolescent↗