Experimental facial edema: treatment with methylprednisolone.
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Biomedical subjects
Publications and source records attributed to M B Habal.
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The optic nerve can be injured indirectly by blunt trauma to the frontoorbital region. The mechanism of injury is related to trauma of the nerve in the tight, bony optic canal. Neurovisual transmission in the canal is interrupted by pressure on the nerve. The conventional management includes careful observation and supportive treatment. Recent interest in this unique clinical problem has prompted the development of new techniques to decompress the injured optic canal extracranially; these approaches have produced encouraging results. Another dividend of the method has been the mapping of the optic nerve region under magnification using the operating room microscope. Any gain of vision, partial or complete, is well appreciated by the patient and the physician.
We present a method for repairing defects in the craniofacial region in which an elastomer-coated mesh is used as a template with bone paste. The method was developed by animal experimentation first, and then successfully used in the maxillofacial and mandibular regions. We have used this method to repair 16 craniofacial defects with satisfactory results, and complications have been kept to a minimum.
Biostereometry is the measurement of living things (especially the human body) in 3 dimensions. Moire topography provides a simple, one-step method for mapping contours of the face, or other parts of the body--a method which has potential value for the plastic surgeon. A prospective study of the value and the uses of this method is now under way at our institution.
The human optic canal, an intricate anatomical structure with several normal variations, was studied in 83 individual cadaver specimens. The landmarks and dimensions of the adjacent structures were noted and correlated with surgical exposure of the area. The transorbital-ethmoidal route for extracranial decompression of the optic canal was also studied.
A planned treatment program for burned hands has been developed and was used in 72 burns of the dorsum of the hands. Treatment was individualized on the basis of whether hand burns were superficial or deep. In the former, there was evidence of spontaneous reepithelialization within 14 to 21 days. In the latter, immediate or delayed excision, followed by resurfacing with autografts was done. Both groups received topical antibiotic creaming, elevation, an exercise program as soon as they were able, and splinting of the burned hand in the antideformity position. Hypertrophic scars and unacceptable epithelium were excised when they interfered with function. Initially, this program allowed us to avoid unnecessary surgical procedures in 94% of the second-degree burns of the dorsum of the hand. The third-degree burned hand needed excision and autografting in 100% of the burned hands. This treatment program has as its goals: prevention of deformity by early motion and protection of the unburned and regenerating epithelium by creaming with topical antibiotic ointment.
A simple, inexpensive, readily assembled device that provides immediate temporary access to the subglottic airway for oxygenation or anesthesia induction has been presented. The device can be used in emergency clinical situations, in difficult anesthesia inductions and in children where it is difficult to introduce an endotracheal tube because of supraglottic disorders. The child can be anesthetized via this device prior to securing the airway by tracheostomy. There has been no morbidity or mortality associated with use of this device.
We present an unusual complication of rhytidectomy in which several salivary cyst formed in the region of one parotid duct. Treatment with drainage and presure resolved the problem.
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A simple trocar with inner canula is used in limited exposure sites for transcutaneous drilling. The trocar has an outer cannula which allows the special "air-powered" drill tip to pass through for transcutaneous interosseous drilling. No complications have been encountered by its use on numerous occasions.
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Our experience using a new technique for reconstructing contour defects of facial bones has been presented. It employs particulate, cancellous bone and an implantable prosthesis accurately fabricated of polyether urethane and polyethylene terephthalate cloth mesh which can be produced in a variety of configurations. A mannequin made of these materials displaying the various parts of the craniofacial complex that have been restored or are currently under investigation is shown in Figure 10. Large cranial vault defects, orbital floors, mandibles including chin augmentation, and nasal bone deformities have been successfully restored in man. Restoration of the pinna of the ear is currently being evaluated in laboratory animals.
The effect of three electric current levels (3 mamp, 500 micronamp, and 960 mmicronamp) on the growth of A-Mel-4 tumor was evaluated in hamsters as a mode of therapy. Direct current (dc) was applied for one hour a day from the third to sixth posttumor implant day by the introduction of a shielded point electrode directly into the tumor site. Tumor growth was inhibited, and metastases were reduced in the exposed animals. The higher dl levels produced necrosis in the tumors, and in several animals, the implantation site tumor was completely destroyed. These effects were most pronounced with the positive electrode.
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A technique for closing large meningomyelocele defects without tension has recently been developed by the authors. The technique utilizes bilateral bipedicle flaps developed from verticle flank incisions. The bipedicle flaps are advanced medially and approximated in the midline. The lateral defects created by this maneuver are closed transversely. The outer margins of the bipedicle flaps are left free until the flaps become adherent to the underlying tissue. This technique has been used in the repair of 12 large meningomyeloceles. The width of the average lesion was 6-7 centimeters, the largest lesion was 11 centimeters. In each case the width of the lesion exceeded one-half the width of the back. In all cases a tension free closure was achieved. There were no significant wound complications. The use of this technique has greatly facilitated the treatment of children with large meningomyelocele defects.
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In a series of patients who underwent closed rupture of fibrous capsules surrounding mammary prostheses, 3 patients developed hematomas or rupture of the implant, with or without infection. These complications and their management are discussed. Closed capsulotomy is a valuable procedure, simple to apply and easy to learn, but it is not devoid of complications.