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Biomedical subjects

L B Kaban

Publications and source records attributed to L B Kaban.

At least 55 records · Page 3Linked to original sources
PubMed1997

Recommendations for management of trigeminal nerve defects based on a critical appraisal of the literature.

PURPOSE: Management of trigeminal nerve injuries continues to challenge oral and maxillofacial surgeons. The purpose of this review article is to apply the principles of evidence-based medicine (E-BM) to determine the optimal operative technique for managing defects involving the inferior alveolar (IAN) or lingual nerves when direct (ie, primary) repair is not feasible. METHODS: To address the research purpose, the four steps of the E-BM critical appraisal process were applied: 1) identify the clinical problem, 2) efficiently search the literature, 3) select relevant articles and apply rules of evidence, and 4) apply the findings to patient care. Parameters for the literature search included using Medline to identify English language articles, publication dates from 1986 through 1996, and studies involving human subjects. RESULTS: The studies reviewed showed that the clinical literature on operative management of trigeminal nerve injuries is sparse, preoperative and postoperative neurosensory examinations are poorly documented, and the data are derived completely from reports using case series methods. Given these limitations, the available literature suggests that 1) tension-free, primary (direct) suture repair of an injured nerve, if possible, provides optimal results; 2) if direct repair is not possible, autogenous nerve grafts should be used for acute injuries, for example, immediate nerve repair after tumor resection or at the time of acute repair after traumatic injury; and 3) if direct repair is not possible, autogenous nerve grafts or hollow conduits (entubulization) to bridge the defect are equally successful for delayed reconstruction of gaps of 3 cm or smaller. CONCLUSIONS: Based on the weakness of the current literature, recommendations for future research include 1) better standardization and documentation of sensory deficits resulting from nerve injuries and their recovery, 2) using multicenter studies to accumulate large samples of patients rapidly, 3) using case series or prospective cohort study designs to assess the value of operative management of nerve injuries, and 4) progressing to randomized clinical trials to ascertain the optimal operative management of nerve injuries.

Adolescent↗
PubMed1997

Placement of endosseous implants in grafted alveolar clefts.

OBJECTIVE: The purpose of this study was to determine the optimal timing for placement and to evaluate short- and long-term outcomes of endosseous implants in bone-grafted alveolar clefts. DESIGN: Fourteen patients who underwent alveolar cleft bone grafting (ACBG) and closure of an oronasal fistula followed by restoration of the missing lateral incisor tooth using endosseous implants (EI) were studied. The oronasal fistulae were closed using local flaps, and the alveolus was grafted with fresh autogenous iliac marrow. Endosseous implants were placed a minimum of 4 months following ACBG. The average age at ACBG was 20.35 years (range, 12-65 yr), and at implant placement 22.2 years (range, 15-66 yr). It was necessary to regraft the alveolar cleft region in six patients to provide adequate bone volume for implant placement. Those who required alveolar regrafting had an increased mean interval between the initial ACBG and planned implant placement compared to the patients with adequate bone available for implant placement 26.4 months (range, 4-46 mo) versus 15.75 months (range, 4-36 mo). RESULTS: Twenty-nine implants were placed in 14 patients, 9 outside of the cleft region and 20 in grafted alveolar clefts. Eighteen of 20 (90%) implants in the bone-grafted alveolar clefts have been successfully restored. The mean follow-up after implant placement was 39.1 months (range, 1-54 mo), and after restoration 28.5 months (range, 1-47 mo). CONCLUSIONS: Endosseous implants can be placed in bone-grafted alveolar clefts. Consideration should be given to the adequacy of graft volume and ridge morphology at the time of ACBG. The interval between ACBG and implant placement is important. The greater the interval beyond 4 months, the more likely there will be inadequate bone volume to accept an implant.

Adolescent↗
PubMed1996

Supratarsal fold incision for approach to the superior lateral orbit.

OBJECTIVE: To report and evaluate the use of the supratarsal fold incision for access to the lateral and superior orbit. DESIGN: This is a retrospective evaluation of seven patients with zygomatic and orbital fractures who underwent repair with the supratarsal fold incision used to expose the frontozygomatic region or supraorbital rim. Data were obtained by review of hospital charts, radiographs, and by clinical examination. RESULTS: Excellent exposure and access were obtained because of the proximity of the incision to the lateral and superior orbit. Mobility of the eyelid tissue allowed for atraumatic manipulation and retraction. All fractures were adequately reduced by clinical and radiographic examination without complication. CONCLUSION: The supratarsal fold incision is a versatile incision for access to the zygomaticofrontal suture and supraorbital rim. In addition to providing excellent exposure, it produces a superb cosmetic result with a scar well-hidden in the skin folds of the upper eyelid.

Adolescent↗
PubMed1995

A protocol for the management of failed alloplastic temporomandibular joint disc implants.

PURPOSE: This is a retrospective evaluation of a protocol for management of failed alloplastic temporomandibular joint (TMJ) disc implants. PATIENTS AND METHODS: The criteria for implant failure were defined as any one or combination of the following symptoms and signs: TMJ pain, jaw hypomobility, occlusal changes, and radiographic evidence of bone pathology related to the implant. The protocol consisted of removal of the implant, aggressive joint debridement, recontouring of the articulating surfaces, and placement of a pedicled temporalis muscle/fascia flap (TF) for joint lining. Arch bars and maxillomandibular guiding elastics were used if extensive condylar recontouring was necessary. No attempt was made to reconstruct the condyle or correct occlusal abnormalities at the time of implant removal. All 27 patients (42 joints) treated by this protocol during the study period were included for evaluation. There were 24 Proplast/Teflon (PTI) (Vitek, Inc, Houston, TX), 11 Silastic (SI) (Dow Corning, Midland, MI), and 7 Christensen Fossa implants (CFI) (TMJ Implants, Golden, CO) implants removed. RESULTS: The mean follow-up period was 38.3 months (range, 3 to 65 months). Pain was well controlled in 24 of 27 patients (88.9%). Preoperative and postoperative mean maximal incisal opening (MIO) was 32.1 mm and 39.8 mm, respectively. Two patients (7.4%) required a second TMJ operation for persistent pain and limitation of opening. To date, 7 patients (25.9%) have required a secondary procedure (unilateral vertical ramus osteotomy, n = 1; Le Fort I osteotomy, n = 6) to correct occlusal prematurity on the operated side or bilateral open bite. The remaining patients have required no additional surgical treatment. CONCLUSIONS: The results of this study indicate that a proposed protocol is an effective means of controlling pain and improving jaw motion in patients with failed alloplastic TMJ disc implants.

Adult↗
PubMed1995

Infection following treatment of mandibular fractures in human immunodeficiency virus seropositive patients.

PURPOSE: There are little data available on the prevalence of human immunodeficiency virus (HIV) disease and its relationship to postoperative infection in patients presenting with mandibular fractures. This retrospective study assesses these parameters. PATIENTS: The study population consisted of 251 patients treated for mandibular fractures at San Francisco General Hospital (SFGH) between January 1990 and December 1993. Group 1 (n = 20) was composed of patients with documented HIV infection and group 2 (n = 231) served as controls. The groups were comparable with regard to age, sex, etiology, and number and types of fractures. RESULTS: HIV prevalence for this population was 7.9%, and was consistent with previously documented prevalence studies in SFGH surgical patients. In the HIV-positive group, 6 of 20 patients (30%) developed postoperative infection: 2 soft tissue (10%) and 4 bone-related (20%). In the control group, 22 of 231 patients (9.5%) developed postoperative infections: 16 soft tissue (6.9%) and 6 bone-related (2.6%). Statistical analysis showed a significant difference between the two groups with regard to overall (P = .016) and to bone-related (P = .001) infection rates. There was no statistically significant difference in soft tissue infections between the two groups (P = .953). The rate of postoperative infection was significantly higher in those patients (both HIV-positive and controls) who had open reduction and internal fixation (ORIF; 25/155; 16%) versus those who had closed reduction and maxillomandibular fixation (3/96; 3.1%; P = .003). The postoperative infection rate after ORIF was significantly higher in the HIV-positive (5/11; 45%) compared with the control group (20/144; 13.9%; P = .02). CONCLUSIONS: The results of this study indicate that the overall rate of postoperative infection after treatment of mandibular fractures is significantly higher in HIV-positive than in HIV-negative patients. Specifically, the use of ORIF in HIV-positive patients represents a significant risk.

Acquired Immunodeficiency Syndrome↗
PubMed1995

"Atypical" fibro-osseous lesions: diagnostic challenges and treatment concepts.

The term fibro-osseous lesion is a generic designation of a group of jaw disorders (ranging from inflammatory to neoplastic) that microscopically exhibit, a connective-tissue matrix and islands/trabeculae of bone. Although the histologic appearance, and frequently the clinical and radiographic features, may be similar for many of these lesions, they demonstrate a wide range of biologic behavior. Treatment therefore is varied, and there are few well-established guidelines to help the surgeon. Five fibro-osseous lesions with atypical features are presented to demonstrate the diagnostic difficulties associated with these lesions and to show the need for accurate classification in order to help direct treatment and predict outcome. Final diagnoses for "atypical" fibro-osseous lesions included: multiple ossifying fibromas, unclassifiable fibro-osseous lesion, osteosarcoma with concomitant multiple ossifying fibromas, juvenile or psammomatoid ossifying fibroma, and central low-grade osteosarcoma. "Fibro-osseous lesion" should be viewed as a working diagnosis, and a definitive diagnosis should be actively sought; the addition of "atypical" to this designation suggests the likelihood of an aggressive lesion. Treatment of lesions having atypical and nonclassical microscopic features must be based on the biologic behavior of the tumor.

Adolescent↗
PubMed1995

A comparison of single-photon emission computed tomography and planar imaging for quantitative skeletal scintigraphy of the mandibular condyle.

A prospective study was designed to compare two methods of quantifying technetium-99m methylene diphosphonate uptake in the mandibular condyle. The standard technique expresses condylar activity as a ratio of condylar uptake to a reference (often the fourth lumbar vertebra) with planar scans (lateral images of the mandible). The experimental technique quantifies condylar activity as a ratio of condyle to clivus uptake with single-photon emission computed tomography (SPECT). The results of this study indicated that the uptake ratio of condyle/clivus by SPECT scintigram was positively correlated (p = 0.039) with the planar scan technique. The SPECT technique, similar to an axial computed tomography scan, was easier to perform with better reproducibility than the standard planar technique. In addition, activity in the clivus showed less variation than activity in the fourth lumbar vertebrae. With the development of normal uptake standards in the clivus, the SPECT technique may replace the planar image technique in nongrowing patients.

Adolescent↗
PubMed1995

Costochondral reconstruction of mandibular condyles in nongrowing primates.

The aim of this study was to develop a reproducible model in nongrowing animals to document morphological and histological changes after costochondral reconstruction of the mandibular condyle. Seven adult monkeys underwent a unilateral condylectomy followed by costochondral reconstruction. Dimensional changes of the thorax and reconstructed ramus-condyle unit were documented by in situ and radiographic analysis. Morphological and histological analysis were completed after removal at 4 (n = 2), 8 (n = 2), and 12 months (n = 3). In situ measurements demonstrated no dimensional changes of the thorax, but the reconstructed ramus-condyle unit decreased in height an average of 3.2 +/- 1.4 mm. The original graft remained unchanged morphologically, but new bone and cartilage progressively encompassed it, creating a form similar to the native condyle. Histologically, the transplanted cartilage remained unchanged. However, the articulating surface progressively took the appearance of the native condyle. Results of this study indicated that, in nongrowing animals, the reconstructed ramus-condyle unit decreases in height slightly but remodels to a size and shape morphologically and histologically similar to the native condyle.

Animals↗
PubMed1994

Stability of sagittal split osteotomies. A comparison of three stabilization techniques.

The objective of this study was to retrospectively evaluate stability of mandibular advancement after bilateral sagittal split osteotomies were performed. Three different fixation and immobilization protocols were examined. Thirty-three patients were evaluated with preoperative, immediate postoperative, and long-term (mean, 13 months) lateral cephalometric radiographs. The patients were divided into three groups: group 1 (n = 10) had nonrigid internal fixation and 6 weeks of maxillomandibular fixation, group 2 (n = 12) had rigid internal fixation and immediate postoperative function, and group 3 (n = 11) had rigid internal fixation with maxillomandibular fixation for a mean of 14 days. Group 3 had the least amount of sagittal and vertical relapse. Differences in sagittal relapse were statistically significant between groups 1 and 3. Group 2 demonstrated greater sagittal relapse than did group 3, although the result was not statistically significant. This study suggests that the use of rigid internal fixation with a period of maxillomandibular fixation appears to be more stable than nonrigid internal fixation with maxillomandibular fixation or rigid internal fixation without maxillomandibular fixation.

Adolescent↗
PubMed1994

Rigid fixation of mandibular fractures: does operator experience reduce complications?

Rigid internal fixation (RIF) is a frequently used method of reduction and immobilization of mandibular fractures. It has been postulated that the unexpectedly high complication rates reported in early studies of RIF were related to operator inexperience. The objective of this study was to determine if increased operator experience with RIF would result in a lower complication rate. Two 24-month patient care periods, separated by an intervening 12 months to avoid overlap, were evaluated retrospectively. Group 1 (n = 69 patients) represented the early experience and group 2 (n = 76 patients) the more recent data. The results of the study demonstrate a downward trend in the complication rate as surgeon experience increased. This improvement, however, was not statistically significant, and other factors may play a more important role in reducing complications.

Adult↗
PubMed1994

The use of rigid internal fixation in mandibular fractures complicated by osteomyelitis.

PURPOSE: Reports on treatment of "infected" mandibular fractures with open reduction and rigid internal fixation (RIF) consist of either isolated cases or mixed series of patients with soft tissue infections or inadequately documented osteomyelitis. The definition of "infected fracture" is often vague and may include both soft tissue or bone sepsis. MATERIALS AND METHODS: In this retrospective study, seven patients with mandibular fractures and documented osteomyelitis were treated by a protocol that included open reduction and RIF. Technetium-99m methylene diphosphonate (99mTc) and Indium 111 (111In) radionuclide scans, bone cultures, and microscopic examination were used to document the diagnosis of osteomyelitis. The infections were treated with antibiotics, incision and drainage, and surgical debridement. Reconstruction plates that were large enough to provide four holes in each bone segment were used for RIF of the fractures and simultaneous reconstruction of the osseous defects. RESULTS: After an average follow-up of 26 months, all patients remained infection free, and the fracture sites were stable. Five of the seven patients had inferior alveolar nerve dysfunction after treatment; no other significant complications were noted. CONCLUSION: The results of this study indicate that the protocol of simultaneous debridement, reduction, and RIF is a satisfactory method for treatment of mandibular fractures complicated by osteomyelitis. Prospective studies and longitudinal follow-up of larger numbers of patients would be desirable to confirm these findings.

Adult↗
PubMed1994

Costochondral graft construction/reconstruction of the ramus/condyle unit: long-term follow-up.

This is a retrospective study of 26 patients (seven growing and 19 non-growing) who received costochondral grafts (n = 33) for construction or reconstruction of the ramus/condyle unit (RCU). Facial appearance, jaw motion, occlusion, contour, and linear growth changes were documented preoperatively, immediately postoperatively, and long-term (> 1 year). Average follow-up was 48.6 months for growing and 46.4 months for nongrowing patients. Facial asymmetry and malocclusion were successfully corrected in all patients except for those with hemifacial microsomia, where partial correction was most common. For the growing patients mean change in RCU length (n = 8) during the observation period was +3.1 mm on the constructed/reconstructed side and +3.2 mm on the unoperated side. For nongrowing patients, mean change in the RCU length (n = 25) was -5.7 mm for the reconstructed side. Three patients developed lateral contour overgrowth of the articulating surface; no patients developed clinically significant linear overgrowth with malocclusion. The results of this study indicate that a costochondral graft may be used successfully to construct/reconstruct the RCU and that linear overgrowth of the graft does not appear to be a clinical problem with the method described in this paper.

Adolescent↗
PubMed1994

Human immunodeficiency virus serostatus and the risk of postextraction complications.

Despite the increasing prevalence of human immunodeficiency virus (HIV) disease in the population and the increasing likelihood that HIV-positive (HIV+) patients may have an extraction, little is known about the risk of postoperative complications in this group. The goal of this investigation was to assess the risk of postoperative complications in HIV+ patients after tooth extraction. The study was designed as a retrospective cohort study with a sample consisting of 145 males who underwent tooth extraction. The patients' medical and dental records were reviewed to identify HIV serostatus, to document the frequency and type of postoperative complications, and to collect data on potential confounding variables. Forty-four patients were identified as HIV+. The postoperative complication rate in HIV+ patients was 20.9% and for HIV-negative (HIV-) patients 2.9% (relative risk = 7.0, 95% confidence interval = 2.0-25.0, P = 0.001). Furthermore, as the manifestations of the symptoms of HIV infection became more severe, the postextraction complication rate also increased (P = 0.008). The results of this study suggest that HIV+ patients have an increased risk of postextraction complications and as the level of HIV disease increases, the risk of complications also increases. While the findings of this study are consistent with studies based on case series, prospective cohort studies are required to confirm the findings.

AIDS-Related Complex↗
PubMed1993

Prevalence of HIV infection in oral and maxillofacial surgery patients.

To date there have been no systematic reports of the prevalence of HIV infection in dental surgery patients. The purpose of this study was to estimate the prevalence of (1) HIV infection and (2) the risk factors for HIV infection in a sample of patients who went an oral and maxillofacial surgery outpatient clinic in an urban hospital setting. Using a cross-sectional study design and anonymous self-administered patient questionnaires, we estimated the prevalence of HIV infection to be 4.8% (95% confidence interval = 2.3% to 9.7%) in our sample of 165 patients. Prevalence estimates for HIV risk factors were: (1) homosexual/bisexual preference (17.3%), (2) history of sexually transmitted disease (20.0%), (3) history of intravenous drug abuse (10.0%), and (4) history of blood transfusion (3.8%). In general, one might anticipate the prevalence of HIV infection in the patient sample to reflect the community prevalence of HIV infection. Consequently, the prevalence estimates of HIV infection in a sample of patients who live in San Francisco may not be applicable to the reader's local community. Given the known risk factors of HIV infection, however, a well-directed, frank patient history may be useful in identifying patients at risk for HIV infection.

Bisexuality↗