Biomedical subjects
Publications and source records attributed to P A Hilger.
Large nasal defects resulting from trauma or oncologic resection are a difficult reconstructive challenge, requiring special structural and aesthetic considerations. This article reviews reconstructive options by anatomic site and discusses techniques that address more complex defects, such as those involving multiple aesthetic units.
This prospective study compared the sensitivity of panoramic tomography (zonography) and helical computed tomography (CT) in diagnosing 73 mandibular fractures in 42 consecutive patients and correlated the results with known surgical findings. The purpose of the study was to determine the optimal radiologic examination for the diagnosis and operative management of mandibular fractures. The attending surgeons' interpretations of panoramic tomograms and helical CT images in the axial plane were compared with the patients' known surgical findings. A series of questions assessed the relative contribution of these two radiologic examinations in formulating an optimal operative plan for each patient. In the 42 patients studied, the sensitivity of helical CT was 100 percent in diagnosing mandibular fractures; this compared with 86 percent (36 of 42) for panoramic tomography, in which significantly more fractures were missed (p = 0.0412). In the six patients with fractures not visualized, the operative management was altered because of the new fracture visualized on helical CT. Of the seven missed fractures, six were in the posterior portion of the mandible. Comparing fracture detection by region, seven fractures found on helical CT were not visualized on panoramic tomography. Helical CT improved the understanding of the nature of mandibular fractures by providing additional information regarding fracture displacement and comminution and by locating injuries missed using panoramic tomography. This study suggests that helical CT alone may be more diagnostic than panoramic tomography alone in evaluating mandibular fractures. Helical CT sufficiently demonstrated details of fractures in 41 of 42 patients; in one patient, the nature of a dental root fracture was better delineated by panoramic tomography.
Congenital nasal anomalies are rare disorders that may present challenges to the facial plastic and reconstructive surgeon. These anomalies are extremely varied and result from a wide range of disordered embryonic development. A basic understanding of nasal and facial development is helpful in understanding these anomalies. In addition, proper respect for the unique challenges of nasal surgery on infants and children is crucial to best serve the patient. This allows a proper work-up and consideration of appropriate treatment options before surgical repair.
Previous studies comparing the sensitivity between different radiological exams have concluded that conventional axial computed tomography (CT; nonhelical) is unsuitable in the assessment of mandibular fractures. Axial CT was shown to have a reduced sensitivity compared with plain radiographs and panoramic tomography because it missed nondisplaced fractures in the posterior portion of the mandible. Because the resolution of CT has improved from the time of these previous studies, the authors were interested in assessing whether axial CT (nonhelical) could now provide additional clinically useful information and enhance our understanding of mandibular fractures, beyond that obtained from panoramic tomography alone. In their study, 5 staff surgeons initially evaluated the panoramic tomograms and then the CT scans of 39 patients with 66 fractures. A series of four questions assessed the relative contribution of these two radiological exams in formulating an optimal operative plan for each patient. The authors found that axial CT provided supplementary information regarding missed fractures, comminution, and the exact size and degree of displacement of fracture fragments. This additional data could have changed the operative plan in a substantial proportion of patients (17 of 39). Axial CT demonstrated two missed parasymphyseal fractures (2 of 39 patients) that were not seen on these patients' panoramic tomograms. Axial CT also revealed undiscovered comminution or demonstrated fracture displacement more precisely in 39% of patients (15 of 39) and 24% of fractures (16 of 66). This study demonstrates that axial CT was clinically useful as an additional investigation to panoramic tomography. Axial CT helped elucidate further the nature of suspected mandibular fractures.
PURPOSE: The purpose of this study was to develop and assess the potential feasibility of reconstructing composite defects of the mandible with a local pedicled osteomyocutaneous mandibular flap. MATERIALS AND METHODS: The flap design was established based on anatomic principles. A prospective evaluation of the flap was then performed in a fresh cadaver model, and, subsequently, its vascular integrity was documented with angiography. RESULTS: The pedicled osteomyocutaneous mandibular flap was technically simple to raise and had an exceptionally long arc of rotation, which should enable it to fill most compound segmental defects of the mandible. Angiographic studies of the harvested flaps done under fluoroscopic guidance confirmed that excellent vascularity of all components of the flap was present. CONCLUSIONS: The pedicled osteomyocutaneous mandibular flap appears to have a sound anatomic basis. Clinical evaluation is needed to fully elucidate its potential role in head and neck reconstruction.
OBJECTIVE: Techniques of otoplasty may be arbitrarily divided into cartilage-molding or cartilage-splitting categories. In this article, we describe our personal experience in over 100 otoplasties using a combination of these two methods. We highlight the step-by-step approach, as well as a number of previously unreported techniques, that have enabled us to consistently achieve permanent, esthetically pleasing results in both younger patients, as well as in older adults.
The maintenance of comminuted or otherwise unstable nasal bones in proper position following adequate operative reduction, may, on occasion, be a frustrating experience for both the patient and the surgeon. Migration of the fragments may compromise the aesthetic and functional results of well executed corrective nasal surgery. In this article, we will outline our successful, inexpensive approach to this occasionally challenging problem utilising an absorbable intranasal customised Surgicel bolster.
The correction of the twisted nose remains a challenge from both the functional and aesthetic points of view. It is well recognized that complete correction of this nasal deformity often necessitates not only reconfiguration of the external nasal framework, but also realignment of the septum. The occasional patient will, in addition, require concurrent middle turbinate resection and/or ethmoidectomy to enable one to achieve full correction of both his/her external and septal deformities. We will briefly outline the rationale for this approach w ith an illustrative case example.
OBJECTIVE: In this article, we describe a new flap for use in lower nasal reconstruction. METHOD: This technique consists of a planned heminasal transposition rotation flap, with both laterally based and glabellar components. Esthetically favourable incisions are made to follow at the junction between the esthetic subunits. RESULTS: Gratifying early results are achievable, resulting in little postoperative edema due to maintenance of laterally based lymphatic and venous outflow. Likewise, pleasing long-term outcomes have been noted in each of the ten patients in whom we have utilized this flap for nasal reconstruction. Complete flap survival has been noted in every patients. CONCLUSIONS: Our experience with the use of this flap technique suggests that it provides consistently rewarding, esthetically pleasing results in patients with cutaneous defects of the lower half of the nose.
In this paper we present our positive experience with use of Aquaplast thermoplastic as a tie-down dressing for securing and maintaining skin grafts in good position against their nutrient recipient beds. This unique polymer is safe to use, simple to apply, and maintains uniform pressure across the entire surface of the skin graft, no matter how contoured the shape of the anatomical region.
Aquaplast thermoplastic (Opti-Mold), a unique moldable "tie-down" dressing, can be heated, shaped, and sutured in place over full-thickness skin grafts. It allows for excellent uniform pressure over a skin graft while also allowing for drainage from the graft bed, and is particularly useful for the contoured surfaces of the nose and ears.
Twelve patients with surgically proven otosclerosis and sensorineural hearing loss were studied with high-resolution computed tomography (CT). The purpose was to identify abnormal bony changes that could be diagnostic of cochlear otosclerosis. Of the 24 temporal bones thus studied, 10 showed positive findings. The findings in our study--as well as those of others--show a pericochlear zone of radiolucency. The precise origin of this is undetermined.
At the University of Minnesota and affiliated hospitals several methods of mandibular reconstruction have been used. From October 1978 through March 1984, 11 patients have undergone reconstruction with the A-O plate technique. These patients had both traumatic and oncologic defects. All patients treated with this technique have achieved a solid mandibular arch. Included is a discussion of the theoretical advantages, preoperative prerequisites, and the operative technique.
Critical analysis of an aesthetic surgeon's presurgical and postsurgical photographs may provide an excellent tool for self-assessment, research, and teaching. Techniques are presented that allowed precise definition by personnel other than the surgeon of each patient's deformities and the effects of surgery on them. Trigonometric formulas were developed and a computer was programmed to use the X and Y coordinates for facial landmarks to perform many calculations providing distances, angles, projections, and rotations relating to the rhinoplastic surgery. Cases are reported showing typical changes and some results not readily apparent in the photographs. Such data provide not only current analysis of individual cases, but they eventually will become a large data base that may be used to select groups of rhinoplastic cases having common degrees of deformity or of postoperative changes.
Two techniques for reconstructing the external auditory canal are presented; to our knowledge they have not been described previously. The first technique can be used for disease that does not affect the conchal bowl. The canal is reconstructed with an inferiorly based conchal bowl flap. A second inferiorly based postauricular flap, tunneled through the conchal cartilage, resurfaces the conchal bowl. The postauricular defect is closed primarily. The second technique can be used for disease affecting the conchal bowl. A posteriorly based flap that includes skin overlying the mastoid and posterior surfaces of the pinna is tunneled through the conchal cartilage and resurfaces the conchal bowl and external auditory canal. The defect on the posterior surface of the pinna is closed with tissue advanced from the anterior surface of the pinna at the conchal bowl-antihelical fold junction. The remainder of the retroauricular defect is closed primarily. The advantages of these techniques over current methods are described and illustrative cases presented.
Forty-five patients were evaluated for reconstruction of the mandible. Thirty-four patients had a particulate cancellous bone and marrow (PCM) crib graft placed. Thirty of 34 were successful at the primary operation producing a success rate of 88%. By using secondary procedures all 33 patients repaired to date have been rehabilitated. A dynamic bendable defect bridging plate with cancellous cortical graft (DBDB plate with CCG) was used in 7 patients, 4 of whom had tumor surgery and 3 of whom were operated on after trauma to the anterior mandible. All 7 cases were successfully rehabilitated in achieving a stable, functioning mandibular arch. An osteomyocutaneous flap was planned to reconstruct the anterior mandible in 4 cases; 1 in this group was not reconstructed. The PCM graft has been our first line approach to the mandibular non-union but with experience we are beginning to rely on the DBDB plate with CCG for large bony defects after both trauma and secondarily after tumor surgery. When indicated, the osteomyocutaneous flap has been eminently successful in restoring function and form in the tumor patient.
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