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Biomedical subjects

R H Mathog

Publications and source records attributed to R H Mathog.

At least 55 records · Page 3Linked to original sources
PubMed1988

Self-inflicted shotgun wounds of the face: surgical and psychiatric considerations.

This study reviews the evaluation and treatment of patients with extensive self-inflicted shotgun wounds to the face. Five cases are presented and assessed with regard to reason for suicide, psychological reaction to facial reconstruction, and the potential for social rehabilitation. Mechanisms of injury, acute management, and definitive surgical and psychiatric treatment programs are discussed. Survival is expected for most patients, and carefully planned surgical reconstruction must be coordinated with skilled psychiatric intervention.

Adult↗
PubMed1987

Open treatment of condylar fractures with biphase technique.

Most fractures of the condyle of the mandible are managed by closed reduction techniques. Commonly used methods include intermaxillary fixation with a natural dentition or with dentures or splints. Fixation for a variable period of time provides for union of the fragments. In patients in whom the condyle is badly displaced and/or the adjoining mandibular segment is unstable, open techniques are often applied. This article discusses the indications for surgery and presents a method of reducing and maintaining fixation with an external device. Although the approach requires a major surgical procedure and can potentially cause injury to the facial nerve, there is a decided advantage in the direct visualization of the reduction and immobilization of the fracture. Several cases are presented to demonstrate the method and result.

Adult↗
PubMed1987

Detection and quantification of laryngotracheopulmonary aspiration with scintigraphy.

Aspiration is analyzed by a new scintigraphic technique and standard videofluoroscopy in 78 patients with head and neck pathology and neurologic disorders. When both methods are compared to clinical aspiration and a positive x-ray film of pneumonia, they appear to complement each other and provide a very accurate evaluation. Scintigraphy is a more sensitive method for detecting aspiration below the vocal cords and also provides for flow dynamics and a method of quantifying the amount of aspirated material. Videofluoroscopy shows more clearly the mechanism of the swallowing disorder and how the bolus enters the tracheobronchial tree. Studies in patients following head and neck surgery demonstrate a high incidence of dysphagia, aspiration, and pneumonia.

Deglutition↗
PubMed1987

Temporalis muscle-galea flap in craniofacial reconstruction.

With the advent of increasing technological and surgical sophistication in craniofacial surgery, reconstructive efforts are challenged to provide a reliable means of compartmentalization. When dural integrity is compromised in the face of nasopharyngeal or paranasal communication, the risk of ascending infection and potential life-threatening meningitis mandate cranial and facial compartments, separated by sufficient and healthy soft tissues. This paper describes a method of providing pedicled soft tissue coverage and support for the contents of the anterior cranial fossa using a temporalis muscle-galea rotation flap. The vascularized myofascial tissues, capable of carrying skin and bone grafts, are well suited to cover and protect large areas of the skull base. Several cases are described to show the advantages and disadvantages of the technique.

Adult↗
PubMed1986

Posttraumatic enophthalmos and diplopia.

Malposition of the globe and failure to fuse visual images are late-developing complications of orbital injury. This article reviews the causes of specific sequelae, such as enophthalmos, hypophthalmos, and diplopia, and describes a procedure of strategic implantation of autogenous bone grafts to correct the condition(s). Using quantifiable methods of assessing globe position and motility, the authors demonstrate improvement in 18 of 19 patients. Vision is reported unchanged or improved in 13 sighted patients. Several cases are presented with analyses of preoperative and postoperative photographs. Indications, contraindications, advantages, and disadvantages of the surgical procedure are described and compared to others.

Adolescent↗
PubMed1985

Temporalis muscle-galea flap in facial reanimation.

When substantial destruction of the facial nerve occurs as a result of trauma, measures to animate the face, such as transfer of masticatory muscles, must be considered. Unfortunately, these techniques have been limited by a difficult reeducation process for the patient and failure of these muscles to reach sufficiently large areas. A method of extending the temporalis muscle with galea allows rotation into important areas of the face. Case presentations illustrate specific indications, advantages, and disadvantages of this technique.

Adult↗
PubMed1985

Malar fractures associated with exophthalmos.

Although fracture of the malar bone is often associated with enlargement of the orbit and subsequent development of enophthalmos, occasionally, a blowin type of orbital floor fracture and exophthalmos occurs. The causes of the injury and the differential diagnosis of the blowin fracture are reviewed. An explanation is offered for the development of the symptoms. Early recognition, open reduction and fixation of the malar bone, and repair of the floor of the orbit defect are important for successful management of the injury.

Adolescent↗
PubMed1984

Hazards encountered in management of basal cell carcinomas of the midface.

Basal cell carcinomas often exhibit aggressive and destructive behavior on the midface, with invasion into the orbit, paranasal sinuses, and even the frontal fossa. Minor modifications in surgical procedures for cosmetic considerations may have devastating consequences on the patient's survival. Tumor extirpation should not be compromised by preoperative planning of the method of reconstruction to be used. Margin control intraoperatively with either conventional frozen sections or the fresh tissue Mohs technique is mandatory for success. If any margin is questionable, reconstruction should be delayed at least until permanent sections confirm complete tumor removal. Ten cases are presented and the literature reviewed to emphasize that inadequate initial management probably contributes more to the observed destructiveness of these lesions than histologic aggressiveness or embryologic patterns of the midface.

Aged↗
PubMed1983

Evaluation and correction of combined orbital trauma syndrome.

Injuries to the inferior and lateral orbital walls are traditionally classified as either "blow-out" or trimalar fractures. This simplified system has helped considerably in the understanding of the causes of the two types of injury and methods of repair. Unfortunately, simultaneous occurrence can cause immediate and delayed problems that potentiate each other. Enophthalmos and globe ptosis, in combination with a depressed malar eminence, present a major challenge to the reconstructive surgeon's efforts to achieve satisfactory function and appearance. This paper reports the results of combined orbital floor and lateral wall injuries as an important clinical trauma syndrome. The interaction of the two fractures with regard to pathophysiology, sequelae, and methods of correction will be discussed. A review of cases will be used to describe the authors' techniques of repair, and to illustrate the preferred methods of bone grafting for correction of retrusion and depression of the globe, muscle entrapment and depression of the malar eminence.

Adult↗
PubMed1981

Repair of orbital blowout fractures with Marlex mesh and Gelfilm.

Thirty patients with surgically treated blowout fractures are reviewed. Of these, 3 had Caldwell-Luc procedures with antral packing, 23 had allograft implantation over the orbital floor fracture, and 4 required neither implantation nor antral packing. In 11 patients, with extensive defects, Marlex mesh was employed as the only support. Gelfilm implants were placed in 7 patients with relatively smaller defects. Three patients had Selastic implants and 2 had Mersilene allografts. There were no major complications in any of the 30 patients in the series, and overall results with allograft implants were satisfactory. Properties of the various allografts and indications for their use are discussed.

Adolescent↗
PubMed1980

Surgical correction of Goldenhar's syndrome.

Goldenhar's syndrome is a variant of hemifacial microsomia - one of the more common congenital syndromes of the first and second arch. The Goldenhar's type is characterized by varying degrees of underdevelopment of craniofacial structures. The major deformities involve the mandible and the ear; but they also include the orbit and vertebral column, specific defects pathognomonic of this condition. Medical management requires reconstructive surgery of which treatment must take into consideration the timing of surgery and the effects of surgery upon the growth and development of the poorly formed structures. This paper presents a discussion of the pathogenesis and the favorable and unfavorable factors affecting the selection and timing of surgery. The literature is reviewed and two additional cases are added with an evaluation of the effects of early reconstruction. A single-stage procedure, utilizing rib autograft, is described for correction of the defective hemimandible, glenoid fossa, and zygoma. The results are evaluated by means of photographs and radiographs with a follow-up period of at least one and one-half years. The data suggest a remodeling of the grafts to resemble normal structures, and a downward growth of the maxilla to fill a space created by the reconstruction of the mandible and expansion of the lower portion of the face. Multiple stages of surgery as well as unnecessary delays in performing surgical procedures are challenged by the report.

Child↗
PubMed1979

Posttraumatic pseudohypertelorism. (Telecanthus).

Telecanthus was evaluated in a large series of patients with midfacial trauma. Nine patients were selected for detailed analysis of cause, degree of injury, and results of surgical treatment. The evaluation suggests that fractures causing the medial canthal injury are extensive, often resulting in ocular and CNS damage. Late repairs are plagued with difficulty in identification of the ligament and mobilization of soft tissues in the medial canthal area. Satisfactory function and appearance can usually be obtained by early exploration of the injury, reduction of bone fragments, and restoration of the medial canthal ligament to its normal position.

Adolescent↗
PubMed1979

Surgical correction of maxillary hypoplasia.

In this report the pathophysiology of maxillary hypoplasia is reviewed, and two patients who underwent surgical treatment described. Included in the analyses are illustrations and photographs of the face, cephalometric measurements, predictive tracings, and model surgery. Corrective surgical techniques, consisting primarily of LeForte III osteotomies, are presented in detail. Segmental osteotomy of the lower jaw, sliding genioplasty, and augmentation rhinoplasty are discussed and shown as various adjunctive procedures in the correction of associated deformities. Postoperative tracings and photographs are used to illustrate the predictive changes and improved cosmetic and functional results.

Adolescent↗
PubMed1979

Head and neck manifestations of Maffucci's syndrome.

Maffucci's syndrome consists of multiple cutaneous hemangiomas, dyschondroplasia, and often enchondroma. Once considered as a rare disorder, the syndrome has been frequently recognized and reported in the last 20 years. We report a case of multiple neoplasms of the head and neck and review the literature with regard to those manifestations of Maffucci's syndrome in the head and neck area. We also discuss treatment and the potential for malignant change.

Adult↗
PubMed1977

Tympanostomy tube protection with ear plugs.

Protection by ear plugs from water-borne infection was evaluated in 35 patients with "tympanostomy" tubes, tympanic membrane perforations, or mastoid bowls. Stock and custom-made ear plugs were found to be equally effective up to four months during a period of frequent swimming and bathing activities. Infections were only noted to occur in those patients who did not follow instructions on appropriate use of the plugs.

Adolescent↗