Techniques for penile elongation.
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Bladder Exstrophy↗
Biomedical subjects
I T Jackson
Publications and source records attributed to I T Jackson.
Metallic plate stabilisation of bone grafts in craniofacial surgery.
The use of Champy miniplates to stabilise bone grafts in osseous defects following craniofacial and orbital osteotomies is discussed. The advantages of these methods are decrease in operating time, accurate fit of the bone graft and the fixation of the bone graft in the plane of the plate, thus placing it exactly into the correct position in relation to the osteotomy. Total stability is obtained and, in maxillary advancement, intermaxillary fixation may not be necessary. This is useful in children and at all ages adds to the postoperative safety. There may be less relapse with this rigid internal fixation. Long term follow-up will be required to determine whether this statement is true. Although the plates are expensive, it is felt that the reduction in operating time outweighs this.
Bone Plates↗
Craniofacial osteotomies to facilitate skull base tumour resection.
In order to expose deeply situated tumours of the skull base in various regions, the concept of osteotomies of segments of the facial skeleton has been developed. The portion of skeleton overlying the tumour is removed, the lesion is resected and the removed bony structure is then reinserted. This has greatly facilitated tumour removal in difficult areas. The advantages of this approach are, to the surgeon, total en bloc resection of deeply situated tumours with few complications; for the patient, an improvement in the quality of the aesthetic result following resection of recurrent or potentially lethal tumours.
Facial Bones↗
Mandibular asymmetry associated with congenital muscular torticollis.
An unusual case involving an adult patient with marked facial and mandibular asymmetry secondary to congenital muscular torticollis is presented. The etiology and pathology of congenital muscular torticollis are reviewed. A team approach was used to correct this deformity. Procedures included a transcranial total orbital osteotomy, open distal myectomy of the sternocleidomastoid muscle, and a mandibular horizontal osteotomy.
Adult↗
Therapeutic embolization angiography for extra-axial lesions in the head.
Percutaneous transcatheter arterial embolization has played an increasingly important role in the management of vascular lesions in the head. Embolization can promote thrombosis within vascular tumors and malformations, reduce bleeding and decrease the need for transfusion intraoperatively, and facilitate surgical approaches to otherwise unresectable lesions. It is important for the clinician to be aware of this interventional technique because many of the patients who are considered for embolization are triaged through several different clinical areas, and much can be gained from the collaboration of the clinician, the surgeon, and the angiographer. We performed 31 therapeutic particulate embolization procedures for extra-axial head lesions in 23 patients by using flow-directed techniques. Of these procedures, 11 resulted in vascular occlusion and 15 resulted in 80 to 95% obstruction, as demonstrated by angiography. In 14 patients, embolization was performed preoperatively both to decrease blood loss and to occlude inaccessible or unresectable portions of a lesion. In nine patients, embolization was the sole means of treatment for occluding an abnormal vascular shunt. Two patients (9%) experienced a minor transient neurologic change after the procedure.
Adolescent↗
Three-dimensional computed tomographic scanning and major surgical reconstruction of the head and neck.
The major advantage of three-dimensional computed tomographic imaging is the ability to obtain accurate anatomic measurements of distance, area, and volume. This accuracy is possible because the three-dimensional relationships of soft tissue and skeleton are retained. This feature is particularly useful in reconstruction of the upper facial skeleton, where standard roentgenograms and computed tomographic scans are of limited value. Computer-interactive surgical procedures have been used for correction of congenital deformities and for removal of orbital neurofibromas and subsequent reconstruction. Because three-dimensional imaging is expensive and exposes the patient to high levels of irradiation, this approach is recommended only when a specific indication exists and when it can contribute to problem solving.
Bone Transplantation↗
Skull bone grafts in maxillofacial and craniofacial surgery.
The various techniques of harvesting skull bone grafts are presented, and the numerous advantages of this type of graft are illustrated and discussed.
Bone Transplantation↗
Bilateral rhomboid flaps for reconstruction of the external genitalia in epispadias-exstrophy.
In ten young males with the epispadias-exstrophy complex, a new technique of bilateral rhomboid flaps was used for penile elongation and genital reconstruction. This approach offers less chance of injury to the verumontanum and ejaculatory ducts and accurately defines the penopubic angle. Cosmetic and functional results were satisfactory in all patients.
Adolescent↗
Merkel cell tumor: diagnosis, prognosis, and management.
The histologic features of the Merkel cell and the pathologic characteristics of the Merkel cell tumor are described. From a literature review, 68 cases are examined; 23 cases that have been followed up accurately are presented from the Mayo Clinic. A representative case is used to demonstrate the problems of diagnosis and suggested treatment. The latter should be wide local resection with removal of nodal metastases if present. When indicated, this should be followed up with radiation therapy. Chemotherapy is of little or no value. Survival rates are presented.
Adenocarcinoma↗
A new method for fixation of external prostheses.
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.
Basal Cell Carcinoma↗
The use of Champy miniplates for osteosynthesis in craniofacial deformities and trauma.
Champy miniplates have been used in the treatment of craniofacial fractures and in osteotomies for correction of posttraumatic deformities, congenital craniofacial deformities, and secondary bony deformities due to pathologies such as hemangioma and neurofibroma. An additional use has been to stabilize free and vascularized bone grafts. The total number of cases reviewed were 50 (25 acute trauma, 4 vascularized mandible reconstruction, and 21 osteotomies of varied types). There were three infections, two in mandibular fractures that were comminuted and compound into the mouth and one in a compound comminuted fracture of the frontal and maxillary area that was judged to be infected when the plate was placed in position. Two plates have been obvious under the skin. No patient has requested plate removal. The advantages of plating in selected cases are decreased operating time, rigid fixation at surgery, good fixation of bone grafts, and the ability to remove intermaxillary fixation in children at the end of the procedure or within the first few postoperative days.
Adolescent↗
Use of the galeal frontalis myofascial flap in craniofacial surgery.
The anatomy and the technique of raising the galeal frontalis myofascial flap is described. In 38 patients with various pathologies, congenital anomalies, tumors, and trauma, this technique was employed. There were no extradural infections. The applications and complications of the flap are discussed. It is highly recommended wherever there is a possibility of direct intracranial nasopharyngeal communication.
Craniofacial Dysostosis↗
Contouring of a solid silicone block: a new use for the Shaw scalpel.
The use of the Shaw hemostatic scalpel eliminates the frustration and physical fatigue formerly associated with the carving of solid silicone implants from blocks of silicone of all grades. It enables very accurate shaping and saves operating and anesthesia time. The smooth end product may, in many cases, eliminate the need for factory-made implants. This method of shaping silicone block is highly recommended. It is not suggested that the instrument should be purchased for this purpose alone, but if purchase of the scalpel is being considered for other purposes, this may be a significant factor in the decision.
Silicones↗
Multidisciplinary management of acromegaly and its deformities.
The skeletal deformities associated with acromegaly are not reversed by correction of abnormal growth hormone dynamic. We describe a patient with acromegaly in whom facial reconstruction was undertaken after successful removal of a pituitary adenoma.
Acromegaly↗
Advances and innovations in craniofacial surgery.
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Face↗
Orbital volume measurements in enophthalmos using three-dimensional CT imaging.
The purpose of this study was to investigate enophthalmos by measuring the volume of various orbital structures using off-line computer techniques on images generated by a CT scanner. Eleven patients with enophthalmos had CT scans of the orbits consisting of 30 to 40 adjacent 1.5-mm slices. The data from the scans were analyzed on a Nova 830 stand-alone computer system using software programs that allowed measurement of total bony orbital volume, total soft-tissue volume, globe volume, orbital fat volume, neuromuscular tissue volume, and apex-to-globe distance in the horizontal plane. These data were analyzed comparing the volumes in the normal eye with the volumes in the enophthalmic eye in each patient. The analysis demonstrated a statistically significant increase in bony orbital volume in the enophthalmic eye, but the total soft-tissue volume, fat volume, neuromuscular tissue volume, and globe volume were the same as in the normal eye. The apex-to-globe distance, a measure of the degree of enophthalmos, was less in the enophthalmic eye than in the normal eye. These results suggest that in the majority of patients, the cause of posttraumatic enophthalmos is increased bony orbital volume rather than by soft-tissue loss or fat necrosis. (Several patients showed no volume discrepancies, and it is likely that cicatricial contracture is responsible for the enophthalmos in these cases.) This study suggests that the objective of surgery for correction of enophthalmos in patients with a volume discrepancy should be to decrease the volume of the bony orbit and to increase the anterior projection of the globe.
Adipose Tissue↗
Volume measurements of normal orbital structures by computed tomographic analysis.
Computed tomographic digital data and special off-line computer graphic analysis were used to measure volumes of normal orbital soft tissue, extraocular muscle, orbital fat, and total bony orbit in vivo in 29 patients (58 orbits). The upper limits of normal for adult bony orbit, soft tissue exclusive of the globe, orbital fat, and muscle are 30.1 cm3, 20.0 cm3, 14.4 cm3, and 6.5 cm3, respectively. There are small differences in men as a group compared with women but minimal difference between right and left orbits in the same person. The accuracy of the techniques was established at 7%-8% for these orbit structural volumes in physical phantoms and in simulated silicone orbit phantoms in dry skulls. Mean values and upper limits of normal for volumes were determined in adult orbital structures for future comparison with changes due to endocrine ophthalmopathy, trauma, and congenital deformity.
Adult↗
Sphincter pharyngoplasty.
A modified version of sphincter pharyngoplasty, based on the work of Hynes and especially Orticochea, is described. The main benefit accruing from this technique is a scar-free sphincter mechanism in the correct position and therefore, it is hoped, with more physiologic function.
Cleft Palate↗