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Biomedical subjects

B J Michelow

Publications and source records attributed to B J Michelow.

17 recordsLinked to original sources
PubMed2000

Corrugator supercilii muscle resection and migraine headaches.

This study was conducted to determine whether there is an association between the removal of the corrugator supercilii muscle and the elimination or significant improvement of migraine headaches. Questionnaires were sent to 314 consecutive patients who had undergone corrugator supercilii muscle resection during endoscopic, transpalpebral, or open forehead rejuvenation procedures. The patients were queried as to whether they had a history of migraine headaches and, if so, whether the headaches significantly improved or disappeared after surgery. If the answer was affirmative, then the patients were further questioned about the duration of the improvement or cessation of the headaches and the relationship to the timing of the surgery. After an initial evaluation of the completed questionnaires, a telephone interview was conducted to confirm the initial answers and to obtain further information necessary to ensure that the patients had a proper diagnosis based on the International Headache Society criteria for migraine headaches. The charts of the patients who had migraine headaches were studied to ascertain and classify the type of surgery they had undergone. Patient demographics were reviewed, and the results were statistically analyzed. Of the 314 patients, 265 (84.4 percent) either responded to the questionnaire, were interviewed, or both responded to the questionnaire and were interviewed. Of this group, 16 patients were excluded because of the provision of insufficient information to meet the International Headache Society criteria, the presence of organic problems, and other exclusions mandated by study design. Thirty-nine (15.7 percent) of the remaining 249 patients had migraine headaches that fulfilled the Society criteria. Thirty-one of the 39 (79.5 percent) with preoperative migraine noted elimination or improvement in migraine headaches immediately after surgery (p < 0.0001; McNemar), and the benefits lasted over a mean follow-up period of 47 months. When the respondents with a positive history of migraine headaches were further divided, 16 patients (p < 0.0001; McNemar) noticed improvement over a mean follow-up period of 47 months, and 15 (p < 0.0001; McNemar) experienced total elimination of their migraine headaches over a mean follow-up period of 46.5 months. When divided by migraine headache type, 29 patients (74 percent) had nonaura migraine headaches. Of these patients, the headaches disappeared in 11 patients, improved in 13 patients, and did not change in five patients (p < 0.0001). Ten patients experienced aura-type headaches, which disappeared or improved in seven of the patients and did not change in three of the patients (p < 0.0001). This study proves for the first time that there is indeed a strong correlation between the removal of the corrugator supercilii muscle and the elimination or significant improvement of migraine headaches.

Adult↗
PubMed1998

Fire hazards and CO2 laser resurfacing.

The purpose of this study was to investigate the fire risk of laser resurfacing in the presence of supplemental oxygen. This study aims at defining safety parameters of variables such as laser energy level, oxygen flow rate, and "oxygen to laser target distance" when oxygen is delivered through a nasal cannula or nasopharyngeal tube. The typical operating room environment was simulated in the laboratory using the Yucatan minipig animal model. The energy source was a Coherent Ultrapulse CO2 laser. It was found that combustion did not occur at laser settings of 500 mJ, 50 W, 100 kHz, and a density of 5, used in conjunction with an oxygen flow rate of 6 liter/minute with the target area as close as 0.5 cm to the oxygen delivery. A total of 400 computer pattern generator treatments were delivered using this energy setting without observation of any combustion (p < 0.001). This provides evidence that while using even somewhat high laser settings and oxygen flow rate, laser induced fires can be avoided. We conclude that use of the laser in the presence of oxygen is safe, provided the target area is free of combustible fuels. Despite this assurance, laser mishaps are serious because they lead to both morbidity and mortality. It is our recommendation that close attention be constantly paid to all details, thus reducing the hazard potential of laser energy on local factors in an oxygen-rich environment.

Animals↗
PubMed1998

Upper lateral splay graft.

Middle vault collapse narrows the internal nasal valve and impairs airflow through the nose. Loss of structural integrity of the upper lateral cartilaginous vault, the cause of the middle vault collapse, is classically corrected by inserting anterior spreader grafts, resulting in variable success. The desire to reconstruct the natural "T" of the upper lateral and septal cartilages culminated in the development of the upper lateral splay graft. The splay graft spans the dorsal septum but is deep to the left and right upper lateral cartilages. The intrinsic spring in the splay graft elevates each upper lateral cartilage with the septum as the fulcrum, thus correcting the middle vault collapse and opening the internal valve. The procedure, a physiologic substitute for the device "Breathe Right" applied externally, has been performed on nine patients and proved to be a prodigious functional boon to all of them. The powerful splay effect, however, can result in excessive widening of the caudal portion of the dorsum with imprudent use of the technique. Two case reports illustrate the subjective and objective improvement that was shared in all but one patient. Excess widening in one patient resulted in a suboptimal aesthetic improvement, although the functional objectives were met. Identification of suitable patients, preoperative assessment, choice of cartilage donor site, and the surgical technique are discussed. Improved internal valve function, predictability, and reliability are some of the distinct advantages of using a splay graft.

Adult↗
PubMed1997

Refinements in endoscopic forehead rejuvenation.

Endoscopic forehead technique provides an effective method for rejuvenation of the upper face. Distinct advantages of this technique over classic methods of forehead rejuvenation such as coronal or subcutaneous approaches include significant reduction of incisional scars. Described here are three refinements related to (1) control of hair, (2) differential release of the periosteum, and (3) advanced fixation methods. Control of hair can be achieved simply by braiding and the use of an Endoscopic Access Device. Extensive release of the periosteum and arcus marginalis is recommended laterally, while elevating the medial periosteum either intact or with conservative release. Different and technologically more advanced fixation methods are described to provide better control of elevated forehead. Incorporation of these refinements strives to optimize aesthetic results while minimizing operative morbidity. These refinements have been implemented during the care of 29 patients and have proven to be of major value in achieving greater patient satisfaction and technical advancement.

Endoscopes↗
PubMed1997

Rejuvenation of the upper face. A logical gamut of surgical options.

The prime objective of forehead rejuvenation is to correct the factors that accentuate the impression of aging, namely, eyebrow ptosis, glabella frown lines, forehead wrinkles, and asymmetry. Options for forehead rejuvenation are undergoing a renaissance. With the wide variety of choices currently available, accurate analysis of the presenting problem is mandatory so that the appropriate surgical technique can be chosen. The less invasive endoscopic procedures have a low morbidity rate and great patient satisfaction. Not all patients are candidates for these procedures, however. A thorough knowledge of alternative methods, including botulinum injection, fat injection, fat grafting, and subcutaneous approaches to the brow, are necessary if optimal aesthetic results are to be accomplished. Having an armamentarium of forehead rejuvenation techniques is, therefore, the key to individualizing treatment for each patient.

Adipose Tissue↗
PubMed1995

Corrugator supercilii muscle resection through blepharoplasty incision.

Corrugator supercilii muscle resection through an upper blepharoplasty incision, with or without concomitant blepharoplasty, is suitable for patients who have significant corrugator hyperactivity and deep frown lines without eyebrow or forehead ptosis. This procedure is also appropriate for patients who decline a forehead rhytidectomy. After infiltration of local anesthesia with intravenous sedation, skin and fat are excised when a concurrent blepharoplasty is planned. The plane between the orbicularis oculi muscle and the orbital septum is dissected until the corrugator supercilii muscle is exposed. This muscle is identified immediately cephalad to the medial half of the superior orbital rim. The muscle is resected carefully to prevent injury to the supratrochlear nerve medially and the supraorbital nerve laterally. The resultant depression is eliminated with fat removed during the blepharoplasty, or fat or dermis from other sites should the aesthetic plan not include eyelid surgery. Eight patients, seven females and one male, underwent this procedure. The follow-up period ranged from 11 to 19 months, with a mean of 14.5 months. Patients' ages ranged from 25 to 66 years, with a mean of 51.3 years. A scale of 1 to 5, with 5 being excellent, was used to rate postoperative appearance, producing a mean of 4.25. The advantages of fewer skin incisions, less tissue mobilization, and a direct approach to the origin of the problem make this procedure a valuable adjunct to the cosmetic surgery armamentarium.

Adult↗
PubMed1995

The chin: skeletal and soft-tissue components.

The quantity of soft tissue overlying the symphysis menti affords an important attribute that can aid in determination of the correct surgical approach for optimal facial harmony. Xerograms of the facial profile of 100 patients with normal occlusion were analyzed by accepted radiographic cephalometric techniques. The relative contribution of skeletal structures and soft tissue of the chin was evaluated. All linear measurements were noted to be larger in males than in females, but in both groups, facial features were in proportion. In both males and females, the average thickness of the soft tissue overlying the symphysis menti progressively increased from the B point to midway between the B point and the pogonion. The soft tissue at the pogonion was thinner than at the B point. The soft tissue over the chin in males was significantly thicker than in females in all areas measured. When compared with patients over 60 years of age, the soft tissue at the B point was significantly thinner in patients 50 years of age and younger (p = 0.005), while the soft tissue at the pogonion was significantly thinner in patients 40 years of age and younger (p = 0.04). Pseudomacrogenia was noted in 6 percent of the patients, a diagnosis only possible with cephalometric analysis. An understanding of the relative contribution of the soft tissue to the chin can aid in the diagnosis and appropriate surgical management of chin incongruity. Furthermore, there is significant variation in skin thickness, which will influence the soft-tissue response to skeletal alteration. This has to be considered in planning a predictable surgical result.

Adolescent↗
PubMed1994

Management of intraoperative nasal septal tears and perforations.

An organized technique for managing intraoperative septal tears was developed based on 98 patients who endured septal tears. Small nonopposing perforations are allowed to heal spontaneously. Opposing tears, with sizes varying from less than 1 cm to greater than 2 cm, are repaired first on one side of the mucoperichondrium with the reinsertion of a straight piece of septal cartilage; the other side of the mucoperichondrium is then repaired.

Female↗
PubMed1994

The natural history of obstetrical brachial plexus palsy.

Obstetrical brachial plexus palsy remains an unfortunate consequence of difficult childbirth. Sixty-six such patients were reviewed. Included were 28 patients (42 percent) with upper plexus involvement and 38 (58 percent) with total plexopathy. The natural history of spontaneous recovery in all of these patients has been determined using an appropriate grading mechanism. Sixty-one patients (92 percent) recovered spontaneously and five patients (8 percent) required primary brachial plexus exploration and reconstruction (median age 12 months), demonstrating that most patients do well. Additional analysis was undertaken to examine ways in which outcome might be predicted. The analysis does not consider whether or not the patient was operated upon. Good or poor recovery was determined by the spontaneous recovery observed. Discriminant analysis revealed that whereas elbow flexion at 3 months correlated well with spontaneous recovery at 12 months, when used as a single parameter it incorrectly predicted recovery in 12.8 percent of cases. Shoulder abduction was not a significant predictor of recovery. Numerous other early parameters correlated well with spontaneous recovery. When elbow flexion and elbow, wrist, thumb, and finger extension at 3 months were combined into a test score, the proportion of patients whose recovery was incorrectly predicted was reduced to 5.2 percent.

Brachial Plexus↗
PubMed1993

Management of major penetrating glass injuries to the upper extremities in children and adolescents.

Penetrating glass injuries are a common cause of severe neurovascular damage, both in adults and in children. Frequently, an innocent skin wound disguises the extensive nature of the injuries beneath. Nineteen children and adolescents (ages 3-16 years) with a mean age of 9 years who sustained upper extremity penetrating glass wounds were evaluated retrospectively in order (1) to determine the incidence of unappreciated significant neurologic, musculotendonous, or vascular injury; (2) to provide indications for intraoperative evaluation under anesthesia; and (3) to further define the role of microneurorrhaphy in this population. Twelve patients sustained injuries above the elbow and seven patients injuries distal to the elbow. Above the elbow, the structures injured in order of frequency were the median nerve (75%), the brachial artery (58%), the ulnar nerve (50%), the musculocutaneous nerve (33%), sensory nerves of the arm and forearm and venae commitantes (42% each), the radial nerve (25%), and the chords of the brachial plexus (8%). Distal to the elbow, the ulnar nerve was the most frequently involved (71%), followed by the ulnar artery (57%), the flexor carpi ulnaris (57%), the superficialis and profundus flexor tendons (43%), the median nerve (43%), and the palmaris longus and flexor carpi radialis (14% each). Early exploration is critical to successful management. Vascular repairs and or microneurorrhaphy were necessary in all cases. A detailed follow-up evaluation to assess the results of these repairs was carried out from 4 to 9 years postsurgery. There were no clinical problems related to the vascular reconstructions. The results of the nerve repairs in this small series of children and adolescents were remarkably good.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Home↗
PubMed1993

Tissue expansion in the pediatric patient.

Although tissue expansion has many advantages over other reconstructive options, potential complications require consideration. The purpose of this study was to evaluate the experience of tissue expansion in the infant and child. During the 6-year period from 1985 to 1990, a total of 147 expanders were placed in 76 patients. Age of the patients at the time of insertion of the expanders ranged from 1 to 18 years (median, 8 yr). Twenty of the 76 patients studied suffered from complications, a rate of 26%. Despite the high complication rate, complications did not compromise the final result because they occurred near the end of the expansion period and usually involved one of the many implanted expanders. With the appropriate selection of patients, tissue expansion has proved extremely valuable as a reconstructive option in the pediatric patient.

Adolescent↗
PubMed1991

Double-pedicle TRAM flap for unilateral breast reconstruction.

Autogenous breast reconstruction with the pedicled TRAM flap has been employed in 500 patients in our series. We have developed and refined indications for use of the single-pedicle TRAM flap and double-pedicle TRAM flap in unilateral breast reconstruction. In our experience with 341 unilateral breast reconstructions, we used a double-pedicle TRAM flap 19 percent of the time; however, in our most recent 50 unilateral modified radical mastectomy reconstructions, the double-pedicle technique has been employed 60 percent of the time. In general, when a TRAM flap is chosen for unilateral reconstruction of a modified radical mastectomy defect, we feel the single-pedicle TRAM flap is the procedure of choice. Carefully selected patients will benefit from the added safety of a double-pedicle TRAM procedure. The indications for the double-pedicle TRAM flap, the technique, and our results are described in detail.

Abdominal Muscles↗
PubMed1990

TRAM flap safety optimized with intraoperative Doppler.

Anatomic studies have clearly documented the variable position of the deep superior epigastric vessels in the rectus abdominis muscle. In our opinion, only that part of the rectus abdominis muscle containing the vascular pedicle should be transposed with the TRAM flap. The Doppler probe provides a simple method of identifying the dominant intramuscular vascular axis. It consistently alerts the surgeon to any unusual position of a vessel at the costal margin or within the rectus abdominis muscle. This knowledge enables a conservative yet safe dissection of the vascular pedicle, rectus abdominis muscle, and its sheath. This in turn will enable a competent abdominal closure. The Doppler technique is safe, simple, quick, noninvasive, familiar to most surgeons, and applicable to all patients.

Abdominal Muscles↗
PubMed1987

Penetrating cardiac injuries: selective conservatism--favorable or foolish?

In a current review of the literature regarding the management of patients with suspected penetrating cardiac injuries there appears to be no place for conservative management. Nine patients with penetrating cardiac injuries were successfully treated conservatively and are reported. This series aims to emphasize the point that there is a place for conservative management of selected cases.

Adult↗
PubMedDate not supplied

Practical classification of chin deformities.

A visually pleasing chin is an important component of facial harmony. This study was undertaken to introduce a practical classification of chin dysmorphology, which can be used to guide the surgeon toward the appropriate surgical approach to chin repair. Analysis of life-size photography, based on standard anthropometric measurements, was completed on 2,879 patients from 1981 to 1991. Six hundred eighty-four patients were noted to have normal occlusion with some form of chin deformity. Analysis of this group of patients identified seven categories of chin dysmorphism: Class I, macrogenia (n = 170, 24.9%); Class II, microgenia (n = 435, 63.6%); Class III, combination of macrogenia in one direction and microgenia in the other direction (n = 54, 7.9%); Class IV, asymmetry (n = 4, 0.6%); Class V, soft tissue ptosis ("witch's chin") (n = 13, 1.9%); Class VI, pseudomacrogenia (normal skeletal symphysis menti with excess soft tissue covering) (n = 5, 0.73%); and Class VII, pseudomicrogenia (long-face deformity producing clockwise rotation of the normal mandible) (n = 3, 0.4%). Having diagnosed the dysmorphism, logical surgical recommendations for lower face improvement were postulated. Only patients with Class II chin deformity can be corrected with augmentation. Classes I, III, and IV require an osteotomy of the chin. Classes V and VI benefit from soft tissue correction. Class VII deformity can be corrected with a maxillary osteotomy.

Adolescent↗
PubMedDate not supplied

The relative risk of tissue expansion in the pediatric patient with burns.

Tissue expansion has been successfully used for reconstruction after burn injury. The purpose of this study was to investigate the relative risk of complications of tissue expansion in the pediatric population. Children with burns who underwent reconstruction with tissue expansion were studied (37 expanders in 14 patients). Patients without burns who were also treated with tissue expansion served as a comparative group. The patients without burns included children with congenital anomalies (70 expanders in 37 patients) and acquired problems (40 expanders in 25 patients). Complications occurred in 10.8% of the expanders in the burn group, in 11.2% of the expanders in the congenital anomalies group, and in 7.5% of the expanders in the acquired problems group. No significant difference between the groups was noted. We conclude, therefore, that the child with burns is at no greater risk of complications from tissue expansion than are other children.

Adolescent↗