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Biomedical subjects

R E Marx

Publications and source records attributed to R E Marx.

At least 37 records · Page 2Linked to original sources
PubMed1990

Introducing the 'walk-up' flap.

Reconstructive oral and maxillofacial surgeons often find the need for additional soft tissue even when a myocutaneous flap has been previously placed. This article introduces the principles, technique, and results of 32 "walk-up" muscle flaps derived from existing myocutaneous flaps. The anastomotic vascular ingrowth at the original myocutaneous flap's distal end permits its proximal detachment and axial vessel ligation to rotate the proximal two thirds to a tissue-deficient site. In our experience at the University of Miami, these flaps have been predictable (97% viable transfer rate), have provided vascular soft tissue in deficient areas, and have been skin grafted at their surface to increase oral lining or skin cover, among several other uses.

Axillary Artery↗
PubMed1990

An improved technique for development of the pectoralis major myocutaneous flap.

The pectoralis major myocutaneous flap is the most commonly employed muscle skin transfer used in soft-tissue reconstruction of defects of the upper neck and jaw region. This article presents conceptual and technical changes in the development of the pectoralis major myocutaneous flap that preserve a greater vascular pedicle and enhance the flap's arc of rotation. Data from 54 consecutive cases using this modified approach show a reduction in complications, a greater range of use, and consistent healing in radiated and nonradiated tissues without requiring sectioning or removing the clavicle or causing significant chest deformities. These modifications have produced a more predictable transfer compared with other reported techniques.

Adolescent↗
PubMed1990

Relationship of oxygen dose to angiogenesis induction in irradiated tissue.

This study was accomplished in an irradiated rabbit model to assess the angiogenic properties of normobaric oxygen and hyperbaric oxygen as compared with air-breathing controls. Results indicated that normobaric oxygen had no angiogenic properties above normal revascularization of irradiated tissue than did air-breathing controls (p = 0.89). Hyperbaric oxygen demonstrated an eight- to ninefold increased vascular density over both normobaric oxygen and air-breathing controls (p = 0.001). Irradiated tissue develops a hypovascular-hypocellular-hypoxic tissue that does not revascularize spontaneously. Results failed to demonstrate an angiogenic effect of normobaric oxygen. It is suggested that oxygen in this sense is a drug requiring hyperbaric pressures to generate therapeutic effects on chronically hypovascular irradiated tissue.

Air↗
PubMed1990

Simulated nasoalveolar palatal defects: a canine model to study bone grafts.

A simple, surgical technique to create a simulated nasoalveolar palatal defect in the canine is described. The procedure has been performed in 60 canines, and we have not experienced closure of the created clefts. The surgically created clefts had to fulfill five criteria: (1) bilateral maxillary alveolar clefts had to exist in each research animal; (2) each cleft had to have a 1-cm bony width; (3) a demonstrable oronasal communication had to be present; (4) each cleft had to be lined by healthy epithelialized mucosa; (5) there had to be functional teeth adjacent to each side of every cleft.

Animals↗
PubMed1990

Use of hyperbaric oxygen in postradiation head and neck surgery.

Data are presented to indicate the value of hyperbaric oxygen in all stages of treatment of patients with irradiation complications following head and neck surgery. Hyperbaric oxygen stimulates angiogenesis, with increased neovascularization and optimization of cellular levels of oxygen for osteoblast and fibroblast proliferation, collagen formation, and support of ingrowing blood vessels. The hypoxic, acellular matrix in the postirradiated field is changed to a hypercellular, hyperoxic/normoxic situation. Oxygen is used as an adjunct to appropriate surgery. By using the two modalities together, the salvage rate for osteoradionecrosis and its complications of orocutaneous fistula, pathological fractures, and severe bone losses can be increased dramatically. It may also be used prophylactically in patients with periodontal disease or teeth requiring extraction in a previously irradiated area. Finally, the use of oxygen helps support tissue flaps and grafts placed into previously irradiated areas. Economically, there is considerable cost savings in the use of hyperbaric oxygen therapy with appropriate surgery. From the patient's point of view, pain relief is achieved, function is returned, and prognosis improves in a relatively short time.

Combined Modality Therapy↗
PubMed1988

Morbidity from bone harvest in major jaw reconstruction: a randomized trial comparing the lateral anterior and posterior approaches to the ilium.

A randomized prospective study was done to compare bone harvest morbidity in the lateral anterior versus the lateral posterior approach to the ilium. One hundred consecutive patients, requiring at least 60 ml of bone for continuity defects of the mandible, were randomly placed in equal groups in these two categories. Assessment of morbidity vectors included pain, ambulation, seroma, and blood loss. Results, in part, identified the posterior ilium harvest to have decreased morbidity in all variables. The reduced morbidity encountered, and the greater quantity of available bone, are both related to the anatomic differences between the anterior and posterior ilium. Accepted disadvantages were increased operating time and the need to turn the patient.

Adolescent↗
PubMed1988

A prospective study comparing incisional labial to incisional parotid biopsies in the detection and confirmation of sarcoidosis, Sjögren's disease, sialosis and lymphoma.

Simultaneous incisional biopsies of labial minor salivary glands and the superficial lobe of the parotid were accomplished in patients suspicious for sarcoidosis, Sjögren's disease, sialosis and lymphomatous changes in Sjögren's disease. Labial minor salivary gland biopsies identified sarcoidosis in 11 of 31 (36%) patients, compared to 29 of 31 (93%) patients using the parotid biopsy (p = 0.005). Similarly, the labial minor salivary gland biopsy confirmed 21 of 36 (58%) patients to have Sjögren's disease, compared to 36 of 36 (100%) (p = 0.005) patients confirmed using the parotid biopsy. Five patients with normal labial salivary gland biopsies were shown to have idiopathic hypertrophic sialosis with enlarged parotids identified by the parotid biopsy. Five additional patients were diagnosed with lymphoma occurring within the parotid glands of patients with Sjögren's disease, via the parotid biopsies, that were not identifiable with the labial minor salivary gland biopsy. The parotid biopsy consistently identified each disease entity in an earlier stage, and with more evident histopathology. Neither technique showed appreciable morbidity. Three of 77 patients showed a sensory loss related to labial salivary gland biopsy. No sensory or motor nerve loss was associated with the parotid biopsy.

Biopsy↗
PubMed1987

Studies in the radiobiology of osteoradionecrosis and their clinical significance.

The radiobiology of osteoradionecrosis is a complex of cellular death and cellular functional impairments from radiation energy transfers. Four studies of irradiated patients and a data base from 536 patients with osteoradionecrosis revealed separate pathophysiologic conditions for osteoradionecrosis induced by early trauma, osteoradionecrosis induced by late trauma, and spontaneous osteoradionecrosis. A large body of data suggested useful clinical guidelines for the management of irradiated patients. The guidelines, in part, include a recommendation for deferring radiation treatment for 21 days after tissue wounding, if possible; a relative contraindication to wounding tissue during a radiation course; a recommendation for the use of hyperbaric oxygen before wounding; and a strong recommendation to provide comprehensive dental care to the irradiated patient.

Biophysical Phenomena↗
PubMed1987

Effects of pre- and postoperative irradiation on the healing of bone grafts in the rabbit.

Healing of cellular bone grafts irradiated at various times in the postsurgical course was compared to the healing characteristics of bone grafts placed into already irradiated tissue and to controls of irradiated host mandible in a rabbit model. Physical graft consolidation was assessed by load stress characteristics and serial histologic examination. Results indicated that grafts placed into already irradiated tissues failed to form bone in both phases of expected regeneration resulting in structurally weakened and histologically deficient ossicles. Bone grafts irradiated after placement were tolerant of irradiation. Bone grafts irradiated after four weeks were found to be less affected by irradiation than those irradiated within the first four weeks, forming an ossicle structurally and histologically superior to that of bone ossicles developed from grafts placed into irradiated tissues.

Animals↗
PubMed1985

The diagnostic dilemma of barodontalgia. Report of two cases.

Although rare, barodontalgia can be a problem for those who fly. Two cases are presented, one which occurred during simulated high-altitude flight in the altitude chamber and the other during actual flight. The case that occurred during actual flight was resolved by treatment of the most suspect tooth after diagnostic tests failed to identify the problem. The other case was eventually treated successfully when symptoms became localized. The difficulties encountered in making a diagnosis are described.

Adult↗
PubMed1985

Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin.

A prospective randomized trial comparing hyperbaric oxygen and systemic antibiotics in the prevention of osteoradionecrosis was presented. The results indicated, in a high-risk population who required tooth removal in irradiated mandibles, that up-front hyperbaric oxygen produced an incidence of osteoradionecrosis of 5.4% as compared with the antibiotic group of 29.9% (P = .005). Hyperbaric oxygen should be considered a prophylactic measure when post-irradiation dental care involving trauma to tissue is necessary.

Clinical Trials as Topic↗
PubMed1984

A comparison of particulate allogeneic and particulate autogenous bone grafts into maxillary alveolar clefts in dogs.

Bilateral complete mature alveolar clefts with oronasal fistulae were surgically created in dogs to directly compare the rate and quantity of bone formation between autogenous particulate bone and cancellous marrow, undecalcified freeze-dried allogeneic bone, and controls of repaired clefts without bone graft material. This study demonstrated autogenous particulate bone and marrow to be the superior graft material, although the allogeneic bone demonstrated bone formation through inductive mechanisms. The bone formation through induction was delayed compared with the autogenous graft system, and was quantitatively insufficient to support eruptive or orthopedic forces.

Animals↗