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Biomedical subjects

R W Riley

Publications and source records attributed to R W Riley.

At least 55 records · Page 3Linked to original sources
PubMed1989

Pericranial free grafts in the face.

The pericranium is a thin connective tissue coating of the neurocranium that can be used as a free graft for selected facial surgery. To assess the potential use of this graft in the face, we describe our experience over a period of 33 months on 34 patients. Eighty-two individual pericranial grafts were used, with an average of 2.4 grafts per patient. The pericranium was used for augmentations, coatings, and suspensions, with the latter two proving to be the most useful. Like other autogenous grafts, the pericranium may eventually undergo some resorption; however, with experience, overcorrection can be planned. The graft is convenient and easy to harvest, with little or no defect at the donor site. With a mean follow-up of 13.6 months, rejection or infection has not been experienced to date.

Adolescent↗
PubMed1989

Facial contouring with outer-table calvarial bone. A 4-year experience.

The long-term fate of outer table calvarial bone has not been previously well established in terms of graft resorption and resultant contour in the face. A 4-year experience is presented with an emphasis on these areas. Eight hundred fifty grafts were placed in the face on 170 patients during this study period. A subgroup consisting of the nasal region was selected for a detailed analysis, since this complex could be readily evaluated, and the results have paralleled the remaining group. Although partial resorption is seen at most sites, ranging from insignificant to 30%, excellent contour has been achieved throughout the face and maintained in all but a few cases. The areas of maximum resorption and contour change were seen at the nasal dorsum and lateral posterior mandible.

Adult↗
PubMed1989

Inferior mandibular osteotomy and hyoid myotomy suspension for obstructive sleep apnea: a review of 55 patients.

Fifty-five patients with obstructive sleep apnea syndrome (OSAS) were evaluated following inferior mandibular osteotomy with hyoid myotomy and suspension. Patients were objectively examined by polysomnography before and 6 months following the surgical procedure. Thirty-seven patients (67%) had a good response from surgery, and 18 patients (33%) were considered nonresponders. Lung disease, mandibular deficiency, and obesity were factors found to affect the success of surgical treatment.

Adult↗
PubMed1989

Maxillofacial surgery and obstructive sleep apnea: a review of 80 patients.

To determine the effectiveness of the surgical treatment of obstructive sleep apnea, we retrospectively evaluated 80 patients. One group consisted of 55 patients who had undergone a limited osteotomy of the anterior mandible: inferior sagittal osteotomy with hyoid myotomy and suspension. Important criteria for the selection of these patients were normal pulmonary function, normal mandibular skeletal development, and the absence of morbid obesity. Polysomnography revealed that 37 patients (67%) had responded to the surgical treatment and 18 patients (33%) had not. The second group of 25 patients, selected for morbid obesity, severe mandibular deficiency, and failure of other surgical procedures, had undergone maxillomandibular osteotomy with hyoid advancement. All patients in the second group showed good results, as determined by polysomnography.

Adult↗
PubMed1989

Maxillo-mandibular surgery for obstructive sleep apnoea.

Many therapeutic approaches, including mandibular surgery, have been proposed for the treatment of obstructive sleep apnoea syndrome. In the largest study of its type yet reported, 54 patients (population A) underwent mandibular surgery: 36 had palato-pharyngoplasty and inferior sagittal osteotomy of the mandible with hyoid myotomy and resuspension, and 18 (population B) had maxillo-mandibular hyoid advancement, a procedure consisting of palato-pharyngoplasty, inferior sagittal osteotomy of the mandible with hyoid myotomy and, several months later, a maxillo-mandibular osteotomy. Criteria for procedure selection and for evaluation of results were pre-set, and clinical and polygraphic follow-up occurred 6-8 months after final surgery. In population A, 32 of the 36 patients had improved; but only 20 were evaluated as "satisfactory". In contrast, all of the population B patients were judged satisfactory. Four of the population B patients received nasal continuous positive airway pressure (CPAP) before any surgery, and both approaches gave similar good polygraphic results. The degree of skeletal cranio-facial deficiencies, particularly retrognathia, is crucial for procedure selection. We describe potential procedural risks and problems.

Adolescent↗
PubMed1988

A new approach to evaluation and surgery of the malar complex.

Prominent malar eminences are considered aesthetic and have been equated with a more youthful appearance. The precise area for accentuation and the surgical method for altering contour have not been universally agreed upon. A new technique for evaluation is suggested, and a surgical osteotomy for malar contouring is described. Twenty-one patients have undergone treatment; 16 procedures were bilateral and 5 were unilateral. The longest postoperative follow-up is 20 months and the shortest, 6 months. Results have shown symmetry, natural contour, good patient acceptance, and no significant complications. These two new techniques, when combined with existing knowledge and experience, should enhance the ability to analyze and alter the malar complex.

Adolescent↗
PubMed1988

Obstructive sleep apnea, continuous positive airway pressure, and surgery.

Patients with obstructive sleep apnea (OSA) who have undergone upper airway surgery could be expected to improve if surgery alleviated some or all of the anatomic obstructions, or continue to desaturate at preoperative levels if the surgery was not corrective. Factors such as morbid obesity, general anesthesia recovery, and operative edema can potentially cause desaturations below preoperative levels. Because of this risk, patients with severe OSA have been considered for protective tracheostomy. The findings of our study suggest that selected patients who would have been past candidates for protective tracheostomy while undergoing surgery for severe OSA can, as an alternative, be considered for immediate postoperative use of nasal continuous positive airway pressure (CPAP). Ten surgical patients with severe OSA who elected surgical treatment were successfully treated with CPAP immediately after extubation and postoperatively to assist with airway patency and hemoglobin saturation. Postoperative followup included monitoring of continuous pulse oximetry, cardiac activity, and intermittent arterial blood gases. Preoperatively, all ten patients had marked decrease in oxygen desaturation levels during sleep, with a mean nadir oxygen saturation (SaO2) to 51.5%. After surgery, all patients in this group maintained SaO2 levels to no lower than 90%, with a mean SaO2 level of 93% while using CPAP on room air (F10(2) 21%) only.

Adult↗
PubMed1987

Cranial bone grafting in facial aesthetic and reconstructive contouring.

Harvesting of outer-table cranial bone for major craniofacial surgery can be an extensive surgical undertaking. However, when it is used for facial cosmetic and reconstructive contouring, it can be a relatively minor procedure. Our experience with harvesting outer-table calvarial bone and its placement in the face will support a more liberal use of this material. Over a period of 24 months, we have performed outer-table calvarial bone grafts on 62 patients, totaling 367 individual grafts, which were placed in an average of three separate facial sites per patient. The grafts have been easily taken in a prompt fashion with little postoperative discomfort or graft-site deformity. We have not experienced significant complications in harvesting or in placement of cranial bone. The contour provided in the face is quite natural and predictable.

Adolescent↗
PubMed1987

Current surgical concepts for treating obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome is a relatively common disorder with potentially serious psychologic and physiologic consequences. A comprehensive method of evaluation is described. Presurgical tests are mandatory in order to logically direct surgical treatment. Current surgical treatment and new techniques are discussed.

Electrodiagnosis↗
PubMed1986

Maxillary, mandibular, and hyoid advancement: an alternative to tracheostomy in obstructive sleep apnea syndrome.

Nine patients with severe obstructive sleep apnea syndrome (OSAS)--for whom several therapeutic approaches, including palatopharyngoplasty, had failed--were treated with a combined maxillary, mandibular, and hyoid advancement. Objective evaluation--performed before and 4 to 18 months after surgery, using nocturnal polysomography--indicated that the OSAS had improved or had disappeared. This surgical approach is beneficial for specific cases of OSAS, which can be identified by mandatory presurgical tests.

Female↗
PubMed1986

Inferior sagittal osteotomy of the mandible with hyoid myotomy-suspension: a new procedure for obstructive sleep apnea.

Five patients were treated by inferior sagittal osteotomy and hyoid myotomy-suspension. In three of the patients, palatopharyngoplasty had previously failed. One of the patients was noted to have mandibular deficiency; the others had normal skeletal development. Nocturnal polysomnograms were performed preoperatively and postoperatively. All patients showed significant improvement.

Adult↗
PubMed1984

The temporomandibular joint: true sagittal computed tomography with meniscus visualization.

Accessory patient support equipment was constructed that allows patient positioning for true sagittal projection of the temporomandibular joint using a GE 8800 CT/T scanner. Range of motion abnormalities, osseous alterations of the mandibular condyle and temporal bone, joint-space narrowing, and meniscal configuration may be demonstrated. The technique has potential advantages over other CT projections and sagittal reconstruction for evaluation of temporomandibular joint dysfunction.

Adolescent↗
PubMed1983

A century of editors.

They are unalike and far apart, these 13 past editors of The Journal. Between Nathan S. Davis's first issue and William R. Barclay's retirement, there was almost a century of change in medicine, society, the American Medical Association, prose style, and editorial needs. During these years, the editors ranged from the brilliant organizers John B. Hamilton and George H. Simmons to the diligent John H. Hollister and the devoted Johnson F. Hammond. There were editors with the hot determination of James C. Culbertson, John H. Talbott, and Robert H. Moser, and there were those with the cool precision of Austin Smith and Hugh H. Hussey. They varied from Morris Fishbein, who wrote and spoke "with the grade of an eagle in its unhindered soar," to Truman W. Miller, who wrote scarcely a word. Here, briefly, they are together.

American Medical Association↗
PubMed1983

Squamous cell carcinoma of the base of the tongue.

The squamous cell carcinomas of 119 patients treated between 1958 and 1980 were retrospectively reclassified according to the 1977 American Joint Committee for Cancer Staging-End Results Reporting guidelines. Analysis of the information was performed with an interactive computer program that allows the analysis of a large number of medical factors with numerous variables. The following factors show the statistically significant improved survival rates: well-differentiated histopathologic findings, small T-stage lesions, and clinically negative neck disease. Although the survival curve was similar in the planned combined therapy and radiation therapy groups, local control was statistically superior in the combined therapy group. A similar trend is seen in those patients who receive interstitial implants in addition to external beam therapy. A randomized prospective study is needed to determine the optimum mode of therapy.

Adult↗
PubMed1977

Oral surgery program university of california, san francisco.

The two cases presented here demonstrate a successful therapeutic modality with resection followed by immediate reconstruction with bone grafts. At least one of the cases presented seems to indicate that the tumor is relatively less aggressive than the simple ameloblastoma. The histopathology of the two cases suggests that this odontogenic tumor has a wider histologic variation than originally described by Pindborg.

Adult↗