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Biomedical subjects

R H Haug

Publications and source records attributed to R H Haug.

At least 37 records · Page 2Linked to original sources
PubMed1997

Diagnosis and management of blunt carotid artery injury in oral and maxillofacial surgery.

PURPOSE: Traumatic occlusion of the internal carotid artery (ICA) is a rare complication of maxillofacial trauma or surgery. This investigation evaluated patient demographics, diagnostic methods, and effective therapeutic modalities associated with blunt carotid injury (BCI). PATIENTS AND METHODS: This was a retrospective analysis of patient records with an ICD-9-CM diagnosis of carotid injury conducted at MetroHealth Medical Center during the 24-month period between August 1993 and July 1995. Carotid injuries attributable to penetrating trauma were excluded. Age, gender, cause of injury, Glasgow Coma Scale score, Injury Severity Score, type and location of injury, concomitant injury, diagnostic methods, treatment modalities, and outcome were identified, recorded, and analyzed. RESULTS: During the 24-month period, 12 patients (seven males and five females) suffered BCI. These patients were divided into two groups based on cause of the problem. In group I, there were 3,214 blunt trauma patients admitted during the 2-year study, of which 10 patients had BCI, representing 0.31% of blunt trauma patients, and 1.2% of patients with head injuries. Seven patients presented with hemiplegia, two with cranial nerve palsy, and one with perceptual neglect. Ninety percent of the patients had associated injuries. Two patients had surgical intervention, three received anticoagulation, and five had only supportive care. Four of the 10 patients died, four had moderate neurologic deficits, and two survived with only minor neurologic deficits. In group II, two patients developed BCI after surgery. A 52-year-old woman had a carotid injury after right total temporomandibular joint replacement, and a 48-year-old man who underwent surgical removal of a third molar became hemiplegic postoperatively. The first patient recovered after anticoagulation, whereas the second patient, who received only supportive care, has severe neurologic deficits. CONCLUSIONS: BCI is an uncommon entity. It is usually recognized when a patient develops an unexplained neurologic deficit, most often hemiplegia, subsequent to trauma or surgery of the head, face, or neck. In the early stages, the diagnosis can be missed by carotid ultrasound or computed tomography. The injury is unrelated to Glasgow Coma Scale score. Symptoms may not develop for days after injury in 50% of patients. Anticoagulation appears to be the most beneficial therapeutic modality.

Adolescent↗
PubMed1997

An in vitro comparison of the mechanical characteristics of three sagittal ramus osteotomy fixation techniques.

PURPOSE: The purpose of this in vitro investigation was to compare the mechanical characteristics of three techniques for the rigid internal fixation of simulated sagittal ramus osteotomies in terms of their ability to resist vertical loads resembling masticatory forces. MATERIALS AND METHODS: Fifteen bovine ribs of similar size and shape were subjected to uniform osteotomies resembling a sagittal ramus osteotomy. They were divided into three groups and fixed with three 2.0-mm bicortical positional screws in an inverted L-pattern, eight monocortical screws and a sagittal strut plate, or a hybrid system using three 2.0-mm bicortical positional screws, five 2.0-mm monocortical screws, and a sagittal strut plate. The repaired ribs were secured in a jig, subjected to vertically deforming forces, and evaluated for yield load, yield point, maximum load, displacement at maximum load, load at 3.0 mm displacement, and stiffness. The various groups were compared statistically with a Scheffe multiple comparison test. RESULTS: No statistically significant differences existed between the positional screw group and the hybrid group (P > .05). No statistically significant differences were noted in yield displacement, yield load, displacement at maximum load, for any of the groups (P > .05). There were differences noted between the monocortical strut group and other groups in maximum load, load at 3.0 mm displacement, and stiffness (P > .05). CONCLUSIONS: The monocortically fixed sagittal strut plate offers less resistance to maximum load and loads at 3.0 mm displacement and is less stiff than either a three-positional screw system or a hybrid system. No differences existed between the three positional screw systems and the hybrid system. However, given the low yield loads and yield displacements, these differences may not be clinically important.

Animals↗
PubMed1996

Retention of asymptomatic bone plates used for orthognathic surgery and facial fractures.

Over the past three decades there has been an improvement in biomaterials that has virtually replaced the use of stainless steel with titanium and its alloys. Based on the possibility of causing corrosion, toxicity, hypersensitivity, and stress protection, stainless steel should not be considered as a permanent implant in maxillofacial fixation. However, because of their superior corrosion resistance, noncarcinogenicity, hyposensitivity, nontoxicity, and excellent tissue compatibility, titanium and Ti-6Al-4V may be retained as permanent implants in maxillofacial fixation. The stress protection offered by such devices, and the possible complications associated with their removal, also support this concept. Finally, the costs incurred in removal do not justify the benefits derived.

Alloys↗
PubMed1996

A comparison of mandibular angle fracture plating techniques.

OBJECTIVE: The purpose of this investigation was to compare the conventional technique of mandibular angle fracture plating with two biomechanically dissimilar techniques in their abilities to resist vertical loads similar to masticatory forces. STUDY DESIGN: Three groups of five synthetic hemimandibles with simulated fracture repairs were compared for their capabilities to resist vertical deformation. The conventional group was stabilized with a thin tension band system at the superior border and thick stabilization plate system at the inferior border. The nontraditional group was stabilized with a thick tension band system at the superior border and thin stabilization plate system at the inferior border. The two miniplate group was stabilized with a thin tension band system at the superior border and thin stabilization plate at the inferior border. A cantilever beam design was used. Testing was performed with an instron 8511.20 (Instron Corp., Canton, Mass.) mechanical testing device. The three groups were compared with a two way analysis of variance. RESULTS: The forces resisted by the conventional group (167.6 +/- 18.2 N), the nontraditional group (156.3 +/- 33.9 N), and two miniplate group (154.0 +/- 18.4 N) were not statistically different (F = 0.44, p > 0.66). All failures occurred at the tension bands secured with monocortical screws. CONCLUSIONS: Under the conditions described in this in vitro investigation, plate thickness or pattern made no difference. All failures in this experiment occurred with monocortical screws in the superior border tension band system.

Analysis of Variance↗
PubMed1995

Comparison of the morbidity associated with maxillary fractures treated by maxillomandibular and rigid internal fixation.

OBJECTIVE: To compare the type and incidence of morbidity encountered by two groups of patients with maxillary fractures, one treated by closed reduction and maxillomandibular fixation and the other by open reduction and rigid internal fixation. STUDY DESIGN: This was a retrospective review of records for all patients with maxillary fractures treated over a 10-year period. Age, sex, mechanism of injury, anatomic location of fracture, treatment modality, and complications were identified. Two populations of patients, those treated with closed reduction and maxillomandibular fixation and those treated with open reduction and rigid internal fixation, that were similar in size (n = 50), age, sex, and anatomic distribution of fractures were compared. RESULTS AND CONCLUSIONS: This study indicates that patients with maxillary fractures treated with either closed reduction and maxillomandibular fixation or open reduction and rigid internal fixation will encounter postoperative problems with a near equal frequency (60% to 64%). Regardless of the technique used, no relationship could be established between age, sex, or cause of injury. The more superior the level of the fracture, the higher the rate of adverse sequelae.

Adolescent↗
PubMed1994

Fibrous union of the mandible: a review of 27 patients.

OBJECTIVE: To identify personal data, social traits, fracture characteristics, and treatment modalities that result in the development of mandibular fibrous union. MATERIALS AND METHODS: Hospital charts and radiographs for 714 patients with mandibular fractures treated between March 1984 and August 1993 were retrospectively reviewed for the presence of fibrous union. The charts were evaluated for age, sex, race, fracture etiology, fracture location, personal habits, medical compromise, compliance, type and timing of treatment, type and timing of antibiotics, the presence of infection, type of fibrous union, and definitive care. The data were recorded and analyzed. RESULTS: A 3.2% incidence of fibrous union was identified. The body of the mandible was the most frequent site of fibrous union (66%). Twenty-one of the 24 patients surgically treated had a tooth in the line of fracture. Only five had teeth removed at the time of the initial procedure. Thirteen developed a post-operative infection. Ninety-four percent of the patients with fibrous union had at least one medical or social risk factor, which included alcohol abuse (63%), intravenous drug abuse (26%), noncompliance (37%), pulmonary problems (37%), smoking (41%), and others (37%). CONCLUSIONS: Age, race, sex, mechanism of injury, and failure to use antibiotics were not factors in the development of fibrous union. Medical and social risk factors (especially self-abusive habits), inadequate immobilization, anatomic location, teeth in the line of fracture, and the occurrence of late postsurgical infections were factors that contributed to the development of fibrous union.

Adolescent↗
PubMed1994

Cranial fractures associated with facial fractures: a review of mechanism, type, and severity of injury.

A 100-month retrospective review was undertaken to identify the population characteristics of patients with both facial and cranial fractures and to establish the relationships between them. A 4.4% incidence of cranial fractures was found in the 882 patients with facial fractures. These patients tended to be males (85%) between the ages of 16 and 30 years (54%) who were involved in motor vehicle accidents (64%). Patients with midfacial fractures predominated (70%), and these injuries were most frequently associated with fractures of the frontal (38%), sphenoid (24%), or temporal (22%) bones. No relationship was noted between mandibular fractures and cranial fractures. Midfacial fractures were related to individual cranial bone fractures by sutural attachment. The presence of cranial fractures did not play a role in the development of complications associated with facial fractures.

Accidents, Traffic↗
PubMed1993

Effect of screw number on reconstruction plating.

Recently sacrificed bovine ribs and a hydraulic press were used to evaluate the effect that the number of screws has upon reconstruction plating. Reconstructed segments were subjected to five trials each for one, two, three, four, five, six, seven, and eight screws with increasing weights until failure. Increasing the number of screws increased the amount of weight resisted up to four screws per segment after which no additional benefits were realized (P < .001).

Analysis of Variance↗
PubMed1993

The effects of screw number and length on two methods of tension band plating.

Bovine ribs were used to evaluate the effects that screw length and number have on two types of tension bands. Five trials each were done with one, two, three, or four screws per segment, using screws 4, 8, 12, or 16 mm in length and 2-mm adaptation plates or 2-mm mini-dynamic compression plates. The fractured ribs were subjected to increasing weights until failure. With the 2-mm adaptation plate, screw length played no role in the amount of weight resisted. Increasing the number of screws per segment increased the weight resisted to up to three screws per segment, after which no additional benefit was realized (P < .001). For the 2-mm mini-dynamic compression plate, increasing screw length increased the weight resisted up to three screws per segment, after which length had no effect (P < .001). Increasing the number of screws per segment increased the weight resisted up to three screws per segment, after which no additional benefit was realized (P < .001).

Analysis of Variance↗