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Biomedical subjects

J C Posnick

Publications and source records attributed to J C Posnick.

105 records · Page 6Linked to original sources
PubMed1990

Normal cutaneous sensibility of the face.

Normal values for facial sensibility were determined in 36 healthy subjects. Sensation was evaluated using static and moving two-point discrimination and pressure and vibratory threshold in four major regions of the head and neck. Each region was directly related to the area innervated by a particular peripheral sensory nerve (supraorbital, infraorbital, inferior alveolar-mental, or the great auricular nerve). Cutaneous sensibility varied from region to region but was consistent from one normal individual to another and in the same subject on different days. Measurements of pressure and vibratory thresholds provided the most reliable, reproducible data. A relationship of these data to the types of sensory receptors in facial skin and vermilion is postulated.

Adult↗
PubMed1989

Orbital measurements in 63 hyperteloric patients. Differences between the anthropometric and cephalometric findings.

Anthropometric and cephalometric orbital measurements were compared in 63 North American Caucasian patients (24 males, 39 females) aged 3 to 29 years who had 13 craniofacial syndromes involving hypertelorism. The hypertelorism, which was diagnosed anthropometrically, was mild in 11 patients, moderate in 25 and severe in 27. The surface intercanthal width was larger than the bony interorbital distance in all patients (mean 12.2 mm). The differences were smaller in mild cases and larger in severe cases. The soft-tissue binocular width was shorter than the bony lateral orbital distance in 53 patients, by a mean of 4.4 mm; in the other 10 patients the two measurements were identical. The hypertelorism was confirmed by cephalometry in 8 of the 11 cases identified as mild by anthropometry (72.7%), 24 of the 25 moderate cases (96.0%) and 25 of the 27 severe cases (92.6%). The abnormally wide surface intercanthal distance was matched by an abnormally wide bony interorbital distance in 57 of the 63 patients (90.5%). In the other six patients (3 with the mild form, 1 with the moderate form and 2 with the severe form) the bony widths were near the upper limit of the normal range (mean + 2 standard deviations).

Adolescent↗
PubMed1989

Detailed morphometry of the nose in patients with Treacher Collins syndrome.

Patients with Treacher Collins syndrome were studied regarding 10 nasal, 1 orbital, and 4 facial measurements as well as 10 facial proportion indexes. Data from 15 to 24 patients were related to normal values. The most normal feature was found to be the nose, whose basic measurements were optimal. Because harmony between the nose and the face is a basic requirement of aesthetic balance in a healthy face, the nose in these patients is the key for calculating changes in the markedly damaged general framework of the face. Abnormal proportion indexes must be corrected by adjusting the abnormal measurement to its optimal level. Thus, the abnormally short bizygomatic width had to be increased by a mean of 13 to 21 mm. Both the nose and the face were usually normal-long, producing acceptable proportions in these patients. Some size disproportions were found between the root and the soft nose. Their adjustment should be part of the general plan to correct the face of a patient with Treacher Collins syndrome.

Adolescent↗
PubMed1989

Patterns and location of velopharyngeal valving problems: atypical findings on video nasopharyngoscopy.

Patterns of velopharyngeal (VP) valving and the location of velopharyngeal gaps were investigated in 246 consecutive nasopharyngoscopy studies. The predominant pattern of closure was coronal (68 percent), followed by the circular (23 percent), circular with a Passavant's ridge (5 percent), and sagittal (4 percent) patterns. Gaps were found in 181 patients; in 121 they were considered typical (centrally located), in 28 they were in one of the lateral aspects of the valve, and in 32 they were attributed to the shape of the adenoid tissue or to abnormalities in the anatomy or function of the posterior border of the soft palate. Atypical findings occurred primarily in patients with a coronal pattern of valving. These findings raise further questions about treatment for patients with atypical valving problems.

Child↗
PubMed1988

Use of a latissimus dorsi myocutaneous flap for closure of an orocutaneous fistula of the cheek.

The latissimus dorsi myocutaneous flap can be used successfully for external cover in the cheek region when the nature of the defect precludes the use of other local or regional flaps. It is exceedingly useful when a large amount of well-vascularized tissue is needed. The flap is extremely reliable and versatile as a one-stage reconstruction. Its major drawbacks are its bulkiness and the necessity to reposition the patient intraoperatively.

Back↗
PubMed1987

Surgical closure of end-stage palatal fistulas using anteriorly-based dorsal tongue flaps.

Effective closure of the recurrent palatal fistula demands proper diagnosis and anatomically-based classification, combined with an appreciation of surgical options. The anteriorly-based dorsal tongue flap is recommended to close large and/or compromised end-stage residual palatal fistula, provided that patient selection and surgical technique are meticulous. It has proved to be a safe and effective method of solving a difficult problem.

Child↗
PubMed1987

Useful arterialized flaps for head and neck reconstruction.

During the past 10 years, there have been extensive developments in both "island" muscle and musculocutaneous flaps and in "free" microvascular transfers. Competition still exists between these two schools of surgical methodology, even though both methods are known to be complementary and have comparable success rates. Each individual procedure has its commending features, and the reconstructive surgeon should be conversant with both techniques to plan the best reconstruction for each patient. It is therefore important first to place each local flap into context with other local flaps, so that comparisons can then be made with the several free microvascular flaps that are available.

Adult↗
PubMed1987

Prosthetic replacement of the condylar head for temporomandibular joint disease.

Temporomandibular joint replacement was performed in 8 adults who had intraarticular ankylosis, 6 who had end-stage osteoarthritis, and 12 who had rheumatoid arthritis. Three methods of replacement were used; an ulnar head prosthesis (8 patients), an interpositional implant (11 patients), and a Proplast-coated metallic prosthesis (7 patients). The mean age of the 26 patients (19 women and 7 men) at surgery was 38 years (range 17 to 58 years), and the mean follow-up was 36 months (range 3 to 84 months). Relief of pain was experienced by 23 patients, and maintenance or improvement of incisal opening was experienced by 21. Prosthetic replacement of the condylar head for end-stage disease is highly successful in the patients for whom it is indicated.

Adolescent↗
PubMed1986

Cancer of the floor of the mouth and buccal cavity.

The ability of the surgeon to use the entire armamentarium of reconstructive techniques is essential in head and neck reconstruction. Each modality has its advantages and disadvantages. The decision of which technique to use is, of course, left to the individual surgeon's best judgment. Many new ideas will be explored in the future as the challenge of reconstruction awaits the perfect answer.

Adult↗
PubMed1983

Early results of secondary bone grafts in 106 alveolar clefts.

Eighty-three patients with cleft lip and cleft palate were treated by secondary bone grafts to the 106 alveolar clefts. In 98% of the alveolar clefts, the graft was successful and the oronasal fistula was closed. There were only occasional other complications, all but one of which were minor and did not affect the final result. Morbidity was low. Compared with older patients, the pre-teen group of patients not only had no complications of consequence but experienced less morbidity. The 100% success rate and the lower morbidity in the pre-teen group of patients thus favor operating on patients at the younger age.

Adult↗
PubMedDate not supplied

Hydrocephalus in Apert syndrome: a retrospective review.

A retrospective evaluation was carried out to define the incidence of hydrocephalus and associated factors in 44 patients with Apert syndrome treated at The Hospital for Sick Children in Toronto over a 22-year period. Forty-three of these patients underwent cranioorbital decompressive procedures within 1 year of birth. Fifteen of 25 (60%) patients who had either a computed tomography scan or pneumoencephalogram had ventriculomegaly, and 3 of the 25 (12%) had associated brain anomalies. Ten of the 44 (23%) patients had cerebrospinal fluid (CSF) shunts placed, 7 lumboperitoneal and 3 ventriculoperitoneal. Six of the shunts were placed early after cranioorbital procedures (CSF leaks in 5 cases and a subgaleal fluid collection in 1 case). The average IQ of 15 patients evaluated by the Wechsler Intelligence Scale was 72.5, indicative of significant intellectual impairment. There was no correlation between IQ and ventricular size. Although hydrocephalus characterized by progressive ventricular dilatation is uncommon in Apert syndrome, postoperative problems related to impaired CSF circulation are common and may indicate an underlying CSF absorptive deficit.

Acrocephalosyndactylia↗
PubMedDate not supplied

Childhood fibrous dysplasia presenting as blindness: a skull base approach for resection and immediate reconstruction.

Fibrous dysplasia is an abnormal fibroosseous process of bone of unknown cause. The incidence of skull involvement varies, painless enlargement being the most common presenting symptom. Change in vision is a rare but recognized finding. We report a 3-year-old boy with extreme fibrous dysplasia involving the skull base, who presented with blindness. He underwent exposure osteotomies of the frontal bones and orbits to provide access for skull base tumor removal. The orbital roofs were reconstructed with microplate-fixed cranial grafts. One and one half years after tumor excision followed by immediate reconstruction, the boy retains facial symmetry, and his ocular function has not deteriorated.

Blindness↗
PubMedDate not supplied

Melanotic neuroectodermal tumor of infancy: clinical, radiologic, and pathologic findings in five cases.

Five pathologically proved melanotic neuroectodermal tumors of infancy are reported. These rare neoplasms of infancy exhibit a distinct predilection for the maxillary bone. Three tumors originated in the maxilla, one in the calvaria, and one in the cerebellar vermis. Those occurring in bone did not metastasize but were locally invasive, as reflected in their radiologic appearance. Bone erosion, expansion, hyperostosis, and osteogenesis can occur in the same neoplasm and were appreciated best on CT. MR imaging showed the soft-tissue component and extent of the neoplasm better than CT did. The pathologic findings from all five cases (and one possibly related melanotic tumor of the face) revealed abundant melanin. MR imaging of two melanotic tumors showed isointense T1-weighted and slightly hyperintense T2-weighted signals. This appearance is contrary to that of most melanin-containing tumors, which exhibit enhanced T1 and T2 relaxation, and indicates that variables other than the absolute amount of melanin may determine the MR signal. Clinically, rapid neoplastic growth and excessive melanin production by the tumor cells caused facial disfigurement and visible blue black discoloration. All five melanotic neuroectodermal tumors were resected and the vermian tumor was also irradiated. Four of five children were well and free from disease 1 month to 7 years after resection. The calvarial tumor was incompletely resected and involved the underlying brain, eventually causing death. The clinical, radiologic, and pathologic features of melanotic neuroectodermal tumors of infancy are reviewed. Melanotic neuroectodermal tumors of infancy that involve bone can be diagnosed from the clinical and radiologic findings. Prompt diagnosis and surgical resection are essential for cure.

Cerebellar Neoplasms↗
PubMedDate not supplied

Orbital protrusion index in Treacher-Collins syndrome: a tool for determining the degree of soft-tissue damage.

The relationship of measurements of the intercanthal width (en-en), the biocular width (ex-ex) and both eye fissures (ex-en), constituting the orbital protrusion index ex-ex x 100 (en-en) + (en-ex, r) + (en-ex, l) was used to analyze preoperative morphological developments in the orbits of 23 patients with Treacher Collins syndrome. The index permitted distinction between mildly and severely defective orbits, based on the degree of defective measurements and variations in relative sagittal positions. Optimal index values (mean, 94.0) were seen in 11 subjects with a slightly different sagittal level between the inner and outer commissures of the eye fissures, which created slightly protruding but still normal soft-tissue relief. The eye fissures in seven patients were moderately reduced in length. Orbits with higher indices (mean 98.1) (12 subjects) showed less differences in level between the two commissures of the eye fissures, producing a flattening in the surface relief. Eye fissure length was markedly subnormal in all patients.

Adolescent↗