[Surgical treatment of neurofibromatosis in the area of the face].
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Biomedical subjects
Publications and source records attributed to J Reuther.
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The technique of lateral canthal advancement for the treatment of premature coronal craniosynostoses has been employed in 12 cases. In patients with high intracranial pressure aesthetic problems after the operation were observed. The frontolateral area did not reossify and the brain bulged forward. For secondary correction in these cases the bilateral advancement of Marchac and Renier was used. A sufficient increase of intracranial volume could be achieved by complete osteotomy of the skull base. The bone segments were stabilized by miniplate osteosynthesis. The results were thereby improved.
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A screw implant and a blade-vent implant were developed for the alloplastic substitution of teeth. Forty implants were observed for 18 months in five beagles; these implants were under maximal functional mastication. No implant was lost. The screw implant showed a tight attachment of bone over the whole implant surface. With the blade-vent implant we observed a partial interposition of connective tissue. This difference seems to depend on the different insertion techniques. Photoelastic studies showed a good stress distribution through enlarged and rounded off attachment surfaces. The described insertion techniques allowed a primary tight attachment of the implant surface and bone support, which led to an immediate stability of position. In the screw implant the physiologic mobility of teeth was imitated by means of a resilient element. Data from 30 cases were gained in a clinical 3-year follow-up. One case failed. For conclusive judgement, a longer period of time and more clinical cases are necessary, but existing data are encouraging.
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Reliable anastomosis of the smallest vessels up to an external diameter of 0.5 mm is possible today through the introduction of the operating microscope and a special microsurgical technique for angiorrhaphy. We carried out a model experiment for free skin-flap transplantation using rats, whereby skin-fat flaps from the groin were transplanted on the thorax of the animals. The vascularization was re-established by end-to-side anastomosis of the epigastric artery and vein with the common carotid artery and the jugular vein. The rate of success for our experimental series of 12 free skin transplants was 83%.
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The use of the operating microscope and special microsurgical instruments make it possible to achieve successful anastomosis of blood vessels of less than 1 mm in diameter. Microvascular surgery offers newer possibilities in the transplantation of dermisfat grafts, and has led to an unusually high degree of success in the reimplantation of tissues. This paper describes a technique for microvascular anastomosis in animal experiment, using as a model the reimplantation of a completely amputated rabbit ear. In 10 amputated rabbit ears, the central auricular artery with a diameter of 0.5 mm and the two marginal auricular veins with diameter of 0.5-1.0 mm were microsurgically anastomosed. Of the 10 reimplanted ears, 8 survived. The postoperative angiogram showed an unrestricted patency of all the vessels.
Primary reconstruction of the mandible after extensive tumor resection is necessary when the median part is lost; in lateral defects of the mandible, however, it is not always indicated. Our own functionally stable plate system with the instruments used for mandibular reconstruction is described. Clinical cases are presented in which this system was applied in combination with silastic interposed as a temporary replacement of the mandible.
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Sialolithiasis of the submaxillary gland is a rare entity in children. At the present time we found 21 documented cases of submaxillary gland sialolithiasis in children reported. A case report of a 7 2/3-year-old female with calculus in Warthon's duct was presented. Diagnosis, differential diagnosis and therapy of the disease was discussed.