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Biomedical subjects

L A Whitaker

Publications and source records attributed to L A Whitaker.

At least 91 records · Page 5Linked to original sources
PubMed1982

Social and psychological effects of craniofacial deformity and surgical reconstruction.

Psychosocial evaluations of patients undergoing surgery for congenital craniofacial anomalies are being conducted preoperatively and postoperatively to document functioning prior to and following surgery. Our findings to date indicate that presurgically younger patients, those between 6 and 13, fare better than those 14 years and over. The former, for the most part, appear to be functioning adequately and test within normal range on standardized psychometric measures. The latter are more prone to social isolation and problems in self-concept and mood state. Postoperative evaluations are reported only for the younger group because of the small sample size of the older. Overall postoperative adjustment appears improved on several psychometric tests. The majority of patients and families are pleased with outcome. Improvement in appearance postoperatively as rated by independent judges has not reached statistical significance; however, there are significant correlations between changes in appearance and changes on several measures including self-concept and trait anxiety. This finding would tend to support the contention that improvement in appearance brought about by craniofacial surgery is associated with improvement in psychosocial adjustment.

Adaptation, Psychological↗
PubMed1981

Effects of training on response latency and accuracy for a difficult visual discrimination.

The learning of a difficult discrimination task was investigated in a laboratory simulation of a quality control task. In an earlier experiment, observers were trained to discriminate between 2 brief, masked stimulus patterns. Then, a trained and an untrained group of observers were tested on the same stimulus-discrimination task. Response latency as well as P(Dis) were measured in a forced-choice reaction time paradigm. Untrained observers responded with a mean probability of correct discrimination, P(Dis), = .65 for stimuli with 30-msec. duration and mean P(Dis) greater than or equal to .90 those stimuli with 100-msec. duration. Trained observers produced discrimination scores of P(Dis) greater than or equal to .90 for all stimulus durations tested. Despite this large, reliable training effect of P(Dis), response latencies did not differ reliably between the two groups but instead were a negative function of stimulus duration for both trained and untrained observers.

Discrimination Learning↗
PubMed1981

Congenital craniofacial asymmetry: early treatment.

Congenital craniofacial asymmetry has two dominant causes: isolated synostosis and craniofacial clefts. Treatment considerations in these problems differ from those with isolated cranial or isolated facial defects. Isolated cranial defects are most frequently treated by the neurosurgeon with craniectomy alone. Isolated facial asymmetry when congenital in origin usually manifests as hemifacial microsomia and based on our experience with 40 such patients, is best treated in later childhood. Treatment timing of craniofacial asymmetry varies with the cause, but is best done in the first two years of life. Nasofrontal encephaloceles are usually best treated in the first few weeks of life; synostosis syndromes are treated at six months of age after the facial sutures have had time to stabilize sufficiently for adequate dissection and mobilization; and other craniofacial clefts at approximately two years of age following descent of the teeth and better homeostatic capability of the patient. Based on our series of 58 patients, 40 treated with isolated synostosis at less than one year of age, eight at more than one year of age, and ten patients with craniofacial clefts, the guidelines for timing and methods of treatment have evolved. Liberal use of craniectomy bone with expected regrowth is possible in the first year of life, and more limited use in the second year of life. This bone is used to hold the repositioned orbit, augment hypoplastic zygomas, and reconstruct noses, or for other uses. In isolated synostosis, repositioning provides a form of immediate catch-up growth then proceeds normally. In craniofacial clefts, repositioning puts structures into normal relations and growth likewise proceeds normally. The isolated synostosis syndromes treated at a later age are done with more difficulty, though may be effectively cared for. Complications other than incomplete structural correction have been nonexistent in the group two years of age and less.

Abnormalities, Multiple↗
PubMed1981

Traumatic craniofacial deformity. Late treatment.

Traumatic craniofacial deformity should be reconstructed acutely when possible, though it may be done effectively secondarily if certain principles are followed. These principles involve extensive mobilization of the soft tissue for repositioning and reshaping, liberal use of onlay split rib grafts about the orbits, nose, and zygomas, and segmental repositioning of larger bone segments about the jaws and cranium. Simultaneous scar revisions, addition to deficient soft tissue bulk and nose, mouth, and canthal repositioning should be done. Upper eyelid ptosis, strabismus, and nasolacrimal obstruction corrections should be delayed for at least 6 months following major bony reconstructive procedures.

Bone Transplantation↗
PubMed1980

Variations in extraocular muscle number and structure in craniofacial dysostosis.

Five of 12 patients with craniofacial dysostosis who needed strabismus surgery had anomalies of extraocular muscle structure and number. Two cul-de-sac incisions per eye are sufficient to investigate all muscles for anomalies and add little time or risk to the planned strabismus procedure. The origin of these anomalies and their frequency in craniofacial stenosis are unknown.

Adolescent↗
PubMed1980

Improvements in craniofacial reconstruction: methods evolved in 235 consecutive patients.

Quality evaluation following craniofacial operative procedures is largely aesthetic and almost impossible to measure. Relapse rates are measurable, and morbidity and mortality can be determined. In our series, infections have decreased from 12.5 to 1.3 percent; operating times have been reduced from a mean of 7 1/2 to 4 hours; and blood loss has been reduced from 86 to 56 percent of the total blood volume. Methods we feel are largely responsible for these improvements are (1) maintaining separation of cranial from oronasal cavities, (2) modification of osteotomies around the orbits, (3) infant surgery and extensive use of craniectomy bone, (4) frequent use of onlay bone grafts, (5) a variety of lesser technical refinements, (6) antibiotic use and anesthetic modifications, and (7) consistent team organization. No deaths or blindness have occurred in any patients in the entire series.

Age Factors↗
PubMed1979

Combined report of problems and complications in 793 craniofacial operations.

We report the experiences in 6 major craniofacial centers, with similar teams but in different parts of the world, in a total of 793 craniofacial operations. The mortality rate was 1.6%. Complications developed in 16.5% of the cases (including infections in 4.4%). This surgery has many potential advantages, not least of which is its psychosocial effects on previously disfigured patients. Certain problems seem inherent, however, for there are not yet any satisfactory solutions to them. Some of the factors that reduce morbidity and improve results include the use of hypotensive anesthesia, a reduction in operating time, rigid stabilization of the mobilized bones at the end of the operation, a diminution in the number of incisions, and extensive antibiotic therapy.

Adult↗
PubMed1979

Airway management in the repair of craniofacial defects.

The operative repair of craniofacial defects presents the surgeon with critical problems regarding airway management. Thirty-seven per cent of our series of 100 children operated upon for a variety of cranofacial deformities had some difficulty in airway management. Those patients with mandibular dysostoses and those requiring midface advancement (Le Fort III) had the highest incidence of airway problems. Our suggested management of the airway is described with emphasis upon the importance of close cooperation between the plastic surgeon, otolaryngologist and anesthesiologist.

Adolescent↗
PubMed1979

The social effects of craniofacial deformity and its correction.

A survey of our first 50 patients having craniofacial surgery was done. An attempt was made to determine the impact of facial deformity on social function for both the patient and his family and how function was altered by surgical correction. This was accomplished by a uniform series of questions. All patients were at least one year postoperative. The results emphasize that facial deformity played a dominant role in patients' lives prior to surgery and that surgical intervention led to improved social functioning in a number of areas. Meaningful data was collected on three groups of patients: 11 adults, 18 adolescents, and 17 children. Changes perceived were strikingly different in the three groups. Eight-seven percent of all patients would make the decision to have surgery again, and at least 50 percent had objective evidence of improved function. However, the survey also suggests that the extreme stress produced by the treatment may create family problems for which support is necessary.

Adolescent↗
PubMed1978

The case for the inferiorly based posterior pharyngeal flap.

The superiorly based and inferiorly based posterior pharyngeal flaps are compared. Reasons for choosing one or the other in specific cases are given. The complications with each are enumerated. The results obtained in speech comparing the two flaps in two retrospective series and one prospective series of cases failed to show a significant difference between them. Therefore, with little difference in the results and some good reasons for preferring one or the other under certain conditions, it would seem logical to select the one best suited for the particular problem.

Age Factors↗
PubMed1977

Applications of reconstructive craniofacial techniques to acute craniofacial trauma.

Increasing familiarity with elective reconstructive approaches to craniofacial deformity has led to the application of a similar multispecialty approach to repair of selected cases of massive frontal and upper facial trauma. The fundamental steps in craniofacial reconstruction are outlined. The process of patient selection is emphasized. Illustrative case histories review the management of this type of injury. Contributions from anesthesiology, neurosurgery, ophthalmology, and plastic surgery are required. Specialized facilities for postoperative care are mandatory.

Adult↗
PubMed1977

Severe traumatic oculo-orbital displacement. Diagnosis and secondary treatment.

We have treated 12 patients with severe oculo-orbital trauma during the past 3 years. The structural problems, produced by disruption or displacement of the orbital cone, were treated effectively (and, on occasion, preferentially) with onlay bone grafts. For an effective correction, we advise radical mobilization of the soft tissue and simultaneous correction on the ocular adnexal deformities. Ocular muscle problems are produced by direct injury to the extraocular muscles, or oculomotor nerve, and were possible these should be corrected early. The structural damage to the eye and orbit falls into certain patterns, related to weak points about the orbit. These have been described.

Adult↗
PubMed1977

Early surgery for isolated craniofacial dysostosis. Improvement and possible prevention of increasing deformity.

We describe our experiences with craniofacial surgery at less than 9 months of age in 8 patients with isolated craniofacial dysostosis. We believe that the early release (preferably before the age of 6 months) of the constricting forces in bound or underdeveloped areas of bone will allow subsequent better development of these faces. The molding and expansile influences of the rapidly developing brain and eyes can exert a greater effect on facial growth. The operations are easier and more rapidly performed than those in older children, and no distant bone grafts are necessary.

Age Factors↗