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Biomedical subjects

J E Murray

Publications and source records attributed to J E Murray.

At least 73 records · Page 4Linked to original sources
PubMed1982

The evolution of techniques for reconstruction of full-thickness cheek defects.

Our experience with 20 full-thickness cheek reconstruction in 17 patients over the past 27 years is presented. The evolution of techniques for management of full-thickness cheek defects reflects our gradual appreciation of the longitudinal artery concept within axial and musculocutaneous flap units. During the 1950s, defects were managed by random flaps. Popularization of the forehead flap and introduction of the medially based deltopectoral flap during the 1960s heralded the current application of axial flaps. The 1970s saw an explosion of new techniques, including the musculocutaneous flaps and microvascular free tissue transfers, based on the longitudinal vessel concept. A method simultaneously employing the pectoralis major musculocutaneous flap for intraoral lining and the deltopectoral flap for external coverage has been described. A modification of the latissimus dorsi free flap to allow a one-stage watertight closure of large full-thickness cheek defects has been outlined. Our challenge for the 1980s lies in the improvement of techniques to reanimate the reconstructed cheek.

Adolescent↗
PubMed1981

Application of the biological principle of induced osteogenesis for craniofacial defects.

Demineralised bone implants were used for cranio-maxillofacial reconstruction and construction in 34 patients, 28 with congenital deformities and 6 with acquired defects. The patients' ages ranged from 15 months to 59 years (mean 18 years). In 33 cases, the implants were obtained from cadaver femurs; in 1 case, the implant was prepared from the patient's own skull. Early healing was assessed by clinical and radiographic examination and, when appropriate, by biopsy. Longer follow-up will be required to determine whether resorption has been avoided. The clinical advantages are rapid union, healing of large defects, avoidance of harvesting procedures, and the potentially unlimited supply of banked material.

Adolescent↗
PubMed1981

Optic atrophy and visual loss in craniometaphyseal dysplasia.

Four members of one family had craniometaphyseal dysplasia. Two of the four had severe optic atrophy with profound loss of vision as a complication of this disorder. Optic nerve decompression attempted in one patient may have caused a reduction in the vision of that eye. Eight years later this patient underwent craniofacial surgery uneventfully for contouring of her facial and cranial bones, but osteotomies and intracranial surgery were specifically avoided because of bony over-growth in the foramen magnum region.

Adolescent↗
PubMed1981

Use of demineralized allogeneic bone implants for the correction of maxillocraniofacial deformities.

Two major problems in maxillocraniofacial surgery are the limited amount of fresh autogenous bone, the standard material for bone grafting, and the resorption of the grafted bone. Experimental studies with demineralized, devitalized bone matrix have shown induction of endochondral ossification. Fifty-five demineralized allogeneic implants have been used in 44 patients over the past two years for a variety of congenital (n = 37) and acquired (n = 7) defects. The allogeneic bone was obtained from cadavers, prepared as powders, chips or blocks, and was demineralized. After having been sterilized by irradiation, they were used to augment contour, fill defects, or construct bone within soft tissue. Of implanted sites that could be evaluated by physical examination, 31 of 31 were solid by three months. By radiographic examination three of 19 were healed by three months, and an additional 11 were positive by six months. Induced bone was seen in four of four biopsy specimens. Infection occurred in four of 44 patients (9%), comparable with conventional grafts. Implant resorption occurred in four instances. Allogeneic demineralized implants offer several advantages over conventional bone grafting, such as avoidance of a harvesting operation, ease of manipulation, and potentially unlimited material in banked form. In addition, healing by induced osteogenesis may bypass the resorption seen with healing of mineral-containing grafts.

Adolescent↗
PubMed1981

Three-dimensional approach to analysis and treatment of hemifacial microsomia.

Based on our experience with 40 patients with hemifacial microsomia (first and second branchial arch deformity), we have developed a three-dimensional analytic approach to the skeletal deformity. The sagittal plane x-ray views (lateral cephalogram and panorex) demonstrate the anatomy of the temporomandibular joint as well as the shape and height of the mandibular rami. The frontal plane is demonstrated by the anterio-posterior (A-P) cephalogram, which shows the discrepancy in ramus height and the abnormal arc of mandibular rotation toward the affected side. The transverse plane is evaluated with a submental vertex radiograph, which shows the shape of the mandibular body and medial displacement of the temporomandibular joint. Three-plane radiographic analysis demonstrates the total anatomic distortion and the abnormal growth vectors. We hypothesize that abnormal mandibular growth is of primary importance in this deformity. Application of this analysis has influenced the timing of intervention and the design of corrective procedures.

Adult↗
PubMed1980

Restoration of facial contour using free vascularized omental transfer.

Three cases are described in which free omental transfer was utilized for facial soft tissue augmentation. Dissections in 30 cadavers confirmed the five patterns of vascular distribution, the diameter of the omental vessels, and the fat distribution within the greater omentum. The versatile omentum offers many advantages over the "deepithelialized" groin flap: long pedicle, larger vessel size, less bulk, and tissue that can be layered upon itself. Retention of septae along the natural facial contour lines has improved the placement and minimized the late migration of transferred omental tissue.

Adolescent↗
PubMed1979

Body image and the process of reconstructive surgery.

Newer craniofacial operative techniques produce rapid changes in objective appearance and permit the study of body-image change. In 21 patients with either Crouzon's disease or Alpert's syndrome, a four-factor model of body-image development was applied that emphasizes cognitive growth, perception of body stimuli, stimuli from the environment in the form of comparison, and the response from others. Before a child is of school age, he has substantially defined his body image, therefore corrective surgery must be considered earlier. Although surgical intervention may produce significant objective physical change, there is not a correspondingly rapid change in body image. Four phases in the modification of body image are (1) the decision to undergo surgery, (2) the operative experience, (3) the immediate postoperative period, and (4) the reintegration stage. Recognition of this phasic process will help integrate care of these patients.

Acrocephalosyndactylia↗
PubMed1979

Twenty year experience in maxillocraniofacial surgery. An evaluation of early surgery on growth, function and body image.

We have analyzed 404 patients with a wide variety of maxillary and craniofacial deformities. These do not include head and neck cancer patients as generally defined. Satisfaction has been high as judged by the patients, surgeons and psychiatrists. The complication rate has been significant, approximately 30%, the most common being infection or loss of bone grafts. As experience accumulated, the concept of earlier operative intervention has emerged as an aid in unlocking growth potential, diminishing secondary deformity and improving the development of body image.

Blindness↗