On the treatment of blow-out fractures of the orbit.
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Biomedical subjects
Publications and source records attributed to J M Converse.
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We describe our experience with early skeletal release in 10 infants with craniofacial dysostosis. The cranial base is the key to the deformity, and we extend the release toward it as well as resecting strips from the calvarium. Three procedures are described. The early results are encouraging.
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We present a case of enophthalmos from a posterior orbital blow-out fracture. The entrapped tissues were released surgically, resulting in disappearance of the enophthalmos and restoration of ocular motility.
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Three patients are reported, two of whom had mothers who revealed ingestion of abortifacient drugs during pregnancy. All patients resemble one another and those described earlier with malformations that were probably either aminopterin- or methotrexate-induced. It is likely that Patients I and II have abnormalities associated with the teratogenic action of these folic-acid antagonists. The etiology of Patient III's defects remains uncertain.
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The photographic unit described requires a modest investment in equipment and space, and the photographs can be taken by an office aide after suitable instruction. It provides a means for obtaining clear, comparable photographs--without disrupting office routine. The key to success is consistency in camera settings, lighting, alignment, and positioning. Figures 8 and 9 show representative examples of long-term records.
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Moebius syndrome is uncommon, as reported in the literature. A patient with Moebius syndrome is reported, showing a 30-year follow-up after initial surgical treatment by bilateral partial transfers of the Masseter muscles.
Computerized axial tomography is a new radiologic technique that permits noninvasive study of the skull, brain, and cerebral ventricles. This technique has been applied to the study of craniofacial malformations prior to intracranial surgical correction. The assessment of the cerebral ventricles is valuable as a base line study as well as helpful in detecting unsuspected abnormalities in the brain prior to surgery.
A longitudinal study was conducted on 85 patients who received silicone rubber implants to the chin. Over half of these patients were found to have some absorption of the bone beneath the implants, and much other information was obtained. There were no concomitant changes in the soft tissue profile in the patients who demonstrated bone absorption under their implants. It appeared that the bone absorption was less when the implant was placed over the hard bone of the lower part of the mandible, rather than higher or over alveolar bone.
We describe a repair that preserves the vermilion border of the upper lip, after a full-thickness excision of a tumor of the upper lip which did not require excision of this structure. A bridge flap technique was employed, similar to the Cutler-Beard technique of eyelid reconstruction.
Mandibular antegonial notching is a concavity of the undersurface of the body just anterior to the angular process (gonion) seen in congenital and acquired disorders. The notch tends to be longer in the congenital than in the acquired state, and the ascending ramus is at a more obtuse angle to the body.
Four patients with clinical features of Goldenhar-Gorlin syndrome who showed facial paralysis on clinical examination are presented. The fourth case died following surgery for cleft lip. Autopsy revealed hypoplasia of the right facial nerve in its intracranial segment, with small right facial nucleus in the brain stem. Nosological aspects of the Goldenhar-Gorlin syndrome are discussed. Peripheral facial paralysis, as a part of this syndrome, is reviewed in the light of clinical and pathological findings and in its relationship to cardiac anomalies. It is suggested that Goldenhar-Gorlin syndrome is a part of a so-called cardiofacial syndrome.
Skeletal dysplasia of the maxilla and/or mandible is responsible for prognathism or retrognathism. The severity of either condition is in direct proportion to the degree of dysplasia noted within each jaw. Mandibular prognathism is real or apparent. Some of the patients described in this article demonstrate this quite clearly when the jaws are analyzed individually and related to each other. A differential diagnosis is essential to determine whether the abnormality is in the maxilla or the mandible, or both. When recognized early in the formative years, it permits the orthodontist to employ guidance and full therapy procedures in a treatment plan that is programmed to include surgical procedures specifically for the skeletal aberration to be corrected. The treatment skills of the orthodontist and his knowledge of growth of the skeletal and dental structures aid in diagnosis and treatment planning in the areas of both orthodontics and surgery. Close cooperation between the orthodontist and the surgeon permits a more definitive resolution of the existing and potential skeletal and dentoalveolar abnormalities.
From the combined procedures of skin stereomicroscopy of in situ grafts in rats, graft removal and supravital intracardiac injection of a contrast medium, the data suggest that the revascularisation of skin grafts is an orderly sequence of events which include: active invasion of the graft dermis by the ingrowing host capillary sprouts; development of anastomoses between the graft and host vasculatures; entry of blood into the graft through the vascular anastomoses by 48 hours after transplantation.
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