Chin augmentation/genioplasty: chin deformities in the aging patient.
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Age Factors↗
Biomedical subjects
J L Frodel
Publications and source records attributed to J L Frodel.
Free-tissue transfer reconstruction of midfacial and cranio-orbito-facial defects.
OBJECTIVE: To review our results using free-tissue transfer to reconstruct midfacial and cranio-orbito-facial defects. DESIGN: Case series. SETTING: The University of Iowa Hospitals and Clinics, Iowa City. PATIENTS: Fourteen of 21 patients had defects that resulted from ablative oncologic surgery; six had severe mid-facial trauma; and one had Romberg's disease. INTERVENTIONS: Four latissimus dorsi, 11 rectus abdominis, three scapula, and four forearm free-tissue transfer flaps were used. MAIN OUTCOME MEASURES: Adequate flap separation of vital structures (intracranial contents and carotid artery) from the sinonasal or oropharyngeal cavities; restoration of palatal competence, oral diet, and speech intelligibility; maxillary dental rehabilitation; aesthetic results; complications; and the patient's return to social activities outside the home after surgery. RESULTS: The intracranial contents (six cases) or carotid artery (four cases) were protected from sinonasal or oropharyngeal contamination by the reconstructive flap in all cases in which this was required. Functional closure of the palate with the flap or a prosthesis was possible in 12 of the 13 patients with a palatal defect; seven of these 13 patients have had full maxillary dental rehabilitation. Twenty patients take an oral diet. Sixteen patients have normal or easily understood speech. Fourteen patients engage in social activities outside the home, and eight have returned to full-time employment. No vascular flap failures occurred in this series. CONCLUSIONS: The use of free-tissue transfer flaps is a safe and effective technique for repairing large midfacial and cranio-orbito-facial defects resulting from ablative oncologic surgery or trauma.
Adult↗
Management of the nasal dorsum in central facial injuries. Indications for calvarial bone grafting.
OBJECTIVE: To demonstrate criteria for primary calvarial bone grafting in central facial fractures. DESIGN: Retrospective, cohort study. SETTING: University of Iowa Hospitals and Clinics (Iowa City) and The Johns Hopkins Hospital (Baltimore, Md). PATIENTS: Consecutive sample of 27 patients with nasoethmoidal fractures. INTERVENTION: Preoperative and intraoperative analysis with surgical intervention. Patients with the following criterion received primal dorsal calvarial bone grafts: loss of dorsal nasal support in the upper bony and lower cartilaginous dorsum. MAIN OUTCOME MEASURE: Prevention of cicatricial soft-tissue contraction of the nose with primary bony dorsal reconstruction and/or nasal bone grafting. CONCLUSION: In certain severe cases of nasal bony and cartilaginous comminution, primary dorsal nasal calvarial bone grafts are indicated.
Bone Transplantation↗
Comparison of implant materials used in maxillofacial rigid internal fixation.
The concept of using metal plates for the alteration or repair of the craniomaxillofacial (CMF) skeleton is based on the ability to mimic the support and protective functions of bone, either temporarily or permanently, with minimal effect on bone healing, remodeling, and growth while avoiding toxicity to surrounding and distant tissues. Plating systems currently available for CMF rigid internal fixation are made from stainless steel, cobalt-chromium alloys, and titanium alloys. Each material exhibits the basic biomechanical and biocompatibility requirements to be acceptable clinically, but there are subtle and significant differences that may influence the choice of one material over another for a given clinical situation. This article reviews concepts of strength, corrosion resistance, biocompatibility, adverse reactions, and imaging characteristics for all three plating materials in addition to how these factors influence clinical choices.
Biocompatible Materials↗
Calvarial bone graft harvest. Techniques, considerations, and morbidity.
The importance of calvarial bone grafting in craniomaxillofacial trauma and facial reconstructive surgery is now widely recognized. Numerous harvesting techniques have evolved to optimize the desired thickness, size, shape, and curvature for a particular reconstructive need. At the same time, donor site selection and morbidity must be considered. This report includes a discussion of several currently utilized calvarial bone graft harvesting techniques, with emphasis on minimizing complications and morbidity. Choice of optimal harvesting technique and donor site for specific reconstructive situations will likewise be discussed. Finally, the specific morbidity in our multi-institutional calvarial bone graft harvest series of 121 patients and over 350 grafts will be reviewed.
Bone Transplantation↗
The coronal approach. Anatomic and technical considerations and morbidity.
The coronal flap has recently become a preferred approach for the otolaryngologist-head and neck surgeon requiring access to the craniofacial skeleton and orbit. The variety of cases in which it has proven indispensable include craniofacial reconstruction, facial trauma, and tumor resection. This method of exposure has become particularly useful with increased indications for rigid internal fixation and primary bone grafting in the management of complex facial fractures. Our experience is reviewed in terms of indications for and benefits of the coronal approach, with a detailed description of the technique emphasizing anatomic planes and neurovascular structures. Careful attention to the latter should allow prevention of potential complications.
Facial Nerve↗
Lag screw fixation in the upper craniomaxillofacial skeleton.
Rigid internal fixation of the craniomaxillofacial skeleton has become commonplace in osseous reconstructive procedures of the face. While miniplates are useful in many traumatic, reconstructive, and congenital anomaly cases, they are often unnecessary. Lag screw fixation is routinely used in the mandible and has the advantage of maximal stability when compared with other fixation techniques. These principles can similarly be applied in a variety of situations in the upper facial skeleton, including fracture and bone graft fixation, as well as in pediatric craniofacial surgery. We review the technique and appropriate indications and demonstrate via case examples this diversity of applicability for using lag screw techniques. Finally, results of 83 cases in which this technique has been used will be reviewed, including complications.
Bone Screws↗
Comparative postoperative infection rates in midfacial trauma using intermaxillary fixation, wire fixation, and rigid internal fixation implants.
The use of rigid internal fixation implants in the repair of midfacial fractures requires more extensive bone exposure, soft-tissue manipulation, and operative time. We wished to determine the relative contribution of this method of repair to postoperative infection rates. Midfacial trauma cases occurring between the years 1984 and 1991 at the University of Iowa Hospitals and Clinics, Iowa City, were reviewed. Patients were grouped according to method of repair (intermaxillary fixation, open reduction with wire fixation, or open reduction with rigid internal fixation plates). Postoperative infection data (wound infections, sinusitis, etc) were obtained by chart review and telephone interview. Minimum follow-up for inclusion in the study was 3 months, with an average follow-up for all groups of 28.8 months. We found no significant difference in the rate, or the type, of postoperative infections in all three groups. We conclude that rigid internal fixation implants do not contribute increased postoperative infection rates in midfacial trauma.
Adult↗
Primary reconstruction of congenital facial lesion defects with tissue expansion.
BACKGROUND: Congenital facial lesions may require surgical intervention to correct deformity or to decrease the potential for malignant degeneration. OBJECTIVE: Hemangiomata and melanocytic and sebaceous nevi are among the most common congenital facial defects. The techniques and outcome of serial tissue expansion in the management of facial lesions were evaluated. METHODS: Seven pediatric patients had congenital facial defects treated with tissue expansion and subsequent excision and reconstruction. RESULTS: All patients had a satisfactory outcome. Complications are reviewed, and in this patient population were minor. CONCLUSIONS: Tissue expansion has a role in surgical management of congenital facial lesions. Staged excision, skin grafting and nonintervention are also options which must be individualized to the case at hand.
Child↗
Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps.
Primary and secondary reconstruction of mandibular continuity defects with vascularized bone is currently the standard of care at many institutions. The most commonly utilized donor sites for such bone flaps include the scapula, iliac crest, fibula, and radius. Recently, interest has grown in the placement of osseointegrated implants into these flaps to facilitate functional dental rehabilitation. There are no studies comparing the bone available from each of these flaps into which osseointegrated implants can be placed. In this cadaver study, the dimensions of bone available for implant placement from the iliac crest, scapula, fibula, and radius osseous flaps were measured. The iliac crest and fibula flaps had bone dimensions consistently adequate for implant placement. Bone available for the safe placement of implants into the scapula flap was found in the majority of specimens. The radius flap group had the highest number of specimens that were inadequate for implant placement. The majority of the specimens with bone inadequate for implantation were from females. Clinical implications of this study regarding flap selection are discussed.
Aged↗
Primary and secondary nasal bone grafting after major facial trauma.
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Bone Transplantation↗
Recent advances in the management of orbital trauma: reconstruction and complications.
Orbital reconstruction has advanced significantly in the past decade. Proper reconstruction can be undertaken if the surgeon clearly understands the functional orbital anatomy and pathophysiology, the importance of "aggressive" radiographic evaluation, and is comfortable with deep orbital dissection with implant placement such that precise anatomic reconstruction of orbital defects is accomplished.
Humans↗
End-to-end and end-to-side microvascular anastomoses: a comparative study.
The decision to use an end-to-end versus end-to-side anastomosis remains a controversial issue in microvascular surgery, although it is generally accepted that certain clinical situations require skills in both techniques (eg, vessel size discrepancy or the need to preserve donor vessel distal flow). Using rats, this investigation presents a unique free flap model comparing not only arterial end-to-end and end-to-side anastomoses, but venous anastomoses as well. There were 15 animals in each anastomosis group with a greater than 80% flap survival rate in each group. This supports findings of earlier studies that suggested no difference in survival when these two anastomosis types were compared. Equally important was the assessment of dermofluorometry as an immediate postoperative perfusion monitoring device. In this model, fluorometry was not found to be useful for predicting flap viability in an early period after completion of the anastomoses.
Animals↗