Biomedical subjects
Publications and source records attributed to D E Tolman.
As more extensive craniofacial resections for recurrent orbital and nasoethmoidal carcinoma are performed, the need for complex external prostheses increases. A new method of stabilization for large prostheses using osseointegrated implants is presented. This is illustrated in a typical patient who underwent a large naso-orbital maxillary resection for recurrent basal cell carcinoma.
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A study of 79 patients with keratocysts of the jaws revealed that 72% of the cysts were in the mandible, predominantly in the ramus. The most common symptom was a painful swelling in the jaw. Enucleation was used in 69.2% of the cases. The recurrence rate was 39%. Total removal of the lining of the keratocyst is essential to prevent recurrence.
The efficacy of self-curing acrylic resin in the fixation of fractured mandibles was studied in eight adult mongrel dogs. Three dogs were killed at 1 month, two at 3 months, and three at 6 months after insertion of the resin. Roentgenograms taken after operation and after the dogs had been put to death demonstrated satisfactory fracture reduction and bony healing. The retentive grooves appeared larger on the postmortem roentgenograms, apparently from fibrous tissue that formed between the acrylic resin and the bone. Sections through the groove and fracture site did not show any fibrocartilage formation between the bone and the resin. Active osteoblastic activity was present at the fibrous capsule-bone interface as well as in the fracture calluses. Most sections showed acute inflammation, with a few giant cells. Whether the inflammatory component resulted from tissue breakdown over the acrylic resin or from the polymethylmethacrylate itself was not determined. There was no evidence of abnormal healing or nonunion along the fracture line and no evidence of necrotic bone. The undecalcified tetracycline-labeled sections confirmed active bone formation at the fibrous capsule-bone interface and in the fracture calluses at 1, 3, and 6 months. No mobility could be detected across the fracture site at any time after the insertion of the acrylic resin. Two of the three dogs that were killed at 1 month had incomplete bony union, as demonstrated by mobility along the fracture line seen in the resected specimens. Mucosal dehiscence over the superior acrylic fixation bar was a consistent finding. Once the resin had been either exfoliated or removed, the mucosa healed uneventfully. The insertion of methylmethacrylate did not result in blood pressure change in the dogs. The dogs maintained their preoperative weight, appetite, and jaw mobility. Although satisfactory bony healing resulted from the intraoral open reduction and fixation with self-curing acrylic resin in dogs, several factors need additional investigation before this technique can be considered for use in human subjects. The following findings in this study may contribute to healing complications in man: (1) loosening of the acrylic resin due to fibrous tissue formation between it and the bone, (2) mucosal dehiscence, (3) inflammation in and around the fibrous tissue adjacent to the acrylic resin, and (4) the necessity of bone removal to facilitate the insertion of the resin.
Results of a study in eight dogs indicate that a combination of cancellous bone and marrow contained within autoclaved bone can produce a successful graft. Four implants failed because of breakdown of the oral mucosa and exposure of the graft; rejection may have been the cause of the breakdown in one instance. Although most of the factors that caused exposure of the grafts probably could be controlled in a clinical situation, the technique cannot be recommended without reservation.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
During a 12-year period (1984 to 1997), 32 consecutive patients with advanced maxillary bone compromise received surgical-prosthodontic rehabilitation. The most frequent procedure used was maxillary augmentation with a free nonvascularized autogenous onlay block bone graft, and the average time of prosthesis function was 67 months. Twenty-eight patients underwent a 1-stage procedure, in which endosseous implants were placed simultaneously for internal rigid skeletal fixation of the onlay bone graft, and 4 patients underwent a 2-stage procedure, in which endosseous implants were placed secondarily 6 months after complete healing of the previously placed onlay bone graft, which initially was stabilized by titanium miniplates and lag screws. Treatment success was evaluated separately for the first 7 consecutively treated patients (developmental group) and for the next 25 consecutive patients (routine group). Assessment was made of implant survival relative to etiology of bone loss, implant type and length, type of prosthesis, type of opposing occlusion, type of surgical procedure, and presence of discontinuity. The implant survival rate was 91% in the 25 routine patients and 65% in the 7 developmental patients. Implant type and length, prosthesis type, opposing occlusion, and the presence or absence of discontinuity significantly impacted treatment outcome. Onlay block bone graft success (96%) in all 32 treated patients and prosthetic success (96%) in the last 25 patients was recorded.