Biomedical subjects
Publications and source records attributed to M B Habal.
A rare complication of iliac bone graft procurement is described, in which the lateral femoral cutaneous nerve can be injured during the procedure, or it can be entrapped in healing scar after the closure. The surgical anatomy of this nerve is described, as is the pathophysiology and the treatment of the lesion. Suggestions are made as to means to avoid this complication.
Success in the use of custom-fabricated Silastic implants in patients with facial contour defects led us to utilize this method in reconstructing mandibular defects. However, mandibular reconstruction with alloplastic material is quite difficult because of the presence of continous stress and motion in that region. The evolution in the use in the use of the mandibular implant from the commercially available one to the K-wire reinforced, prefabricated, silicone implant was largely dependent on the availability of silicone and the ultimate result obtained. In the past few years, about 30 subdermal implants were inserted. Some of those implants were placed immediately into patients undergoing resection for tumor. The implant was prefabricated prior to surgery from x-ray measurements of the anticipated segment to be resected; it was then used to reconstruct the defect prior to the final closure of the operative wound. Other implants were manufactured 6-18 months after resection for tumor or for deformity as a result of trauma. The implants were used to reconstruct the facial defects and to correct the funtional abnormality, such as drooling or deviation of the affected side by the unstable mandibular segment. Patients with severe congenital malformation have soft tissue deficiency in association with their bony malformation. Therefore, implants in such conditions were doomed to failure. Patient selection is the key to successful implantation.
An alloplastic tray made of poly(ethylene terephthalate) cloth mesh and poly(ether urethane) used in conjunction with cancellous bone-chip grafts is the basis for this new method of reconstructing facial osseous contour defects. The tray can be prefabricated in quantity and at low cost for standard defects, such as discontinuity defects of the mandible or for chin augmentation. It can be custom-fabricated for specific defects in individual patients as, for example, gunshot wounds to the forehead. The materials were chosen because of their known histocompatibility, the ease of fabrication, and because the materials can be molded to form esthetic contours. The can be easily modified at the time of surgery. Sterilization is by autoclaving. Initial studied were undertaken in mongrel dogs where mandibular discontinuity defects in the range of 2-4 cm were reconstructed. In man, the technique has been used to reconstruct discontinuity defects of the mandible ranging in size from 1.5-12 cm in 16 patients. Atrophic mandibular alveolar ridges have been augmented using this technique in 7 patients, thus providing an adequate alveolar ridge for dentures. Two patients with defects of the skull secondary to gunshot wounds have had frontal bone restoration using this method. Reconstructions of the ear, the chin, and the orbital floor are currently being evaluated. This technique overcomes many problems of esthetic contour reconstruction and combines the use of autogenous cancellous particulate bone and a tissue-compatible synthetic composite material.
The use of autogenous bone graft to repair major defects is most feasible biologically. When the bone could not be shaped or carved to fit a given defect, the use of solid alloplastic biomaterial implants gained wide popularity. We are describing a new method wherein a "combination" graft is used. It possesses the advantage of the dependence on autogenous cancellous bone graft, and the added bone inducing capability of a recently developing biomaterial implant (Polyurethane-Terephthalate). The results obtained in the repair of major defects in patients after ablative surgery, or as sequelae of trauma, document the advantages of this new mode of treatment. In selected patients with major defects due to deficiency or absence of the osseous framework of the face, the use of "combination" grafts has proven to be the most appropriate form of repair.
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A new method for reconstruction of cranial vault defects is described. A combination graft made of both alloplastic and autogenous materials combines several advantages to produce adequate strength and a smooth contour.
The transconjunctival approach for surgical exploration of the orbital region is a simple, direct and uncomplicated method. It is in accordance with the desired goals of the surgeon, which is the avoidance of a conspicuous incision. Usually, the resulting scar is barely noticeable. This special approach can be used for a variety of clinical problems. A small number of complications may arise through the use of the transconjunctival approach, but with experience, appropriate maneuvers can be learned to avoid these minor problems. The transconjunctival approach to the orbital region should be used in carefully selected patients by those physicians who are well acquainted with the surgical anatomy of the orbit.
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We present our experiences with 7 patients in whom we did arytenoid-epiglottic flaps for the treatment of chronic aspiration pneumonia. The indications for the operation are outlined, and some technical suggestions are made.
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"Turban" nevoid basal cell syndrome is a congenital disease that presents with multiple subepidermal epitheliomas, primarily on the scalp. Other secondary findings may be present such as cysts in the mandible and bifid synostotic rib. A combination of treatments proved beneficial in this disease. Surgical excision was used for treatment of large symptomatic lesions such as painful ulcerating and enlarging tumors. Chemotherapy was used to arrest and cause regression of small and dormant lesions. Immunotherapy was used to control the primary disease. Such treatment cured most of the disease and offered a fruitful life to the patient, who is presented to illustrate this multiple disciplinary approach.
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