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Biomedical subjects

L A Whitaker

Publications and source records attributed to L A Whitaker.

At least 109 records · Page 6Linked to original sources
PubMed1976

Problems in cranio-facial surgery.

Four geographically widely separated medical centres with a primary interest in cranio-facial surgery present their combined complications to illustrate the dangers and unsolved problems of this surgery. There wre 149 cases with 2 deaths and 3 other life threatening situations (infections). Approximately 60% of the patients had no complications (90/149). Secondary corrections are often necessary to obtain the desired result or correct problems produced by the surgery. The complexity and rarity of the surgery and supporting disciplines is such that in the interest of the patient and the speciality concentration of this surgery in a few centres is desirable.

Bone Resorption↗
PubMed1976

Craniofacial surgery: present and future.

The possibilities for radical craniofacial restructuring have increased dramatically in the past 6 years with the development of craniofacial surgery. The field developed from a background of patients with major craniofacial birth defects allowing orderly planning and expansion to correction of a multitude of other craniofacial structural problems. The procedures concentrate upon changing the skeletal structures using extensive subperiostial dissection of soft tissue, and adding bone to fill in areas of deficiency. There are three grades of complexity in craniofacial procedures. After extensive soft tissue sub-periostial stripping about the orbits and upper face, the simplest form consists of onlay bone grafts. The next most complicated involves osteotomies to shift the face into a more normal position. In its most complicated form, abnormal proportions of bone are removed and the orbits or cranium are shifted into a new or normal position. We have had experience with 69 patients since September, 1972. Thirty-six have had intracranial procedures. Infection has been the most serious problem, and there have been no instances of death or blindness. A number of lesser problems occur. Future applications of craniofacial surgery are appearing with great frequency as more experience is gained with its uses. It has particular application in acute and late reconstruction of patients with traumatic defects about the face. Preventive osteotomies are an area with great potential, by releasing stenotic areas of bone and allowing the developing brain to mold the upper face and orbits. There is also applicability in surgery of tumors about the craniofacial structure and in cosmetic surgery.

Adolescent↗
PubMed1976

Mandibular fractures: the problem patient.

Of 110 adult patients with 163 mandibular fractures treated at University of Pennsylvania Graduate Hospital from 1964 to 1974, 17% had a history of previous mandibular fractures. All patients' medical records and X-rays were reviewed. Because of the characteristics of this patient population, it seems well suited for discussion as a problem group. Mandibular fractures in this urban area are most commonly caused by blows of a fist and the patient is often intoxicated, which impedes diagnosis, delays treatment, and probably results in further complications from injuries. Patients frequently do not comply with treatment recommendations, do discontinue immobilization, and fail to return for followup, even for removal of intermaxillary fixation. Almost one third had insufficient teeth for fixation; many had poor oral hygiene, and teeth in the fracture line, which led to complications. Osteomyelitis resulting in nonunion and requiring bone grafting occurred in seven patients. Recommended are: simplest fixation methods, minimal amounts of surgery, and as few extractions as possible. Experience from this patient group may be of help whenever a problem patient is seen with a mandibular fracture.

Adolescent↗
PubMed1975

Structural goals in craniofacial surgery.

Major craniofacial abnormalities can be considered as a group for purposes of operative planning. Known normal relations define what is abnormal and indicate goals to be achieved with the craniofacial operative procedures. The principle syndromes with significant facial structural changes amenable to such surgical corrective procedures are craniofacial stenoses, hypertelorism, mandibulofacial dysostoses, median facial clefts, residua of encephaloceles, and trauma. Deformities primarily involve the middle and upper thirds of the face. In planning, abnormal relations and structures must be clearly defined utilizing patient examination, x-rays, dental study models, and photography. Standards of norm indicating goals for the corrective procedure are also based on studies using these tools, data from previous publications, and measurements directly from skulls. Precise measurements about the orbits and maxillary-mandibular relation are the keystone for planning. Soft tissue, nose, and ear alterations are based on already widely known concepts of norm and symmetry. Bony interocular distance, medial intercanthal distance, height and width at the orbital rim of the bony orbits, orbital shape, orbital axis, and orbital volume as determined by measurement with an exophthalmometer are useful in determining what is to be done about the orbits. Cribiform plate level, anterior cranial base, length and contour, and size of the zygomatic arches are important dimension considerations. Paranasal sinus size and location is important. These considerations are essential prior to any major facial structural changes.

Adult↗
PubMed1975

Difficulties and problems to be solved in the approach to craniofacial malformations.

Orbitocraniofacial surgery offers great possibilities to some grossly deformed patients. It is unlike any other aspect of plastic surgery, meriting the creation of a new full-time specialty. The development of a few regional clinical basic science teams located strategically throughout North America is suggested. The primary aim of the teams should be a broad interdisciplinary approach involving basic and clinical research focused on craniofacial anomalies. However, to bring all the necessary multidisciplinary groups into an interdisciplinary team requires central funding to make available the necessary commitment of time to organize a unified thrust of research effort.

Craniofacial Dysostosis↗