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Biomedical subjects

Yadranko Ducic

Publications and source records attributed to Yadranko Ducic.

At least 37 records · Page 2Linked to original sources
PubMed2004

Orbitozygomatic resection of meningiomas of the orbit.

OBJECTIVE: To review our experience with the surgical treatment of orbital meningiomas. METHODS: A retrospective review of all patients presenting to the author for treatment of orbital meningiomas over a 5 year period with a minimum of 1 year follow-up were included in this review. Demographic data, surgical approaches, and recurrence rates were documented. RESULTS: A total of seven patients were treated for this condition. Complete surgical resection was achieved with the outlined technique in 71% of the patients, and gross tumor removal was achieved in the remaining 29% of patients. This latter group received postoperative gamma-knife treatment, and only a single patient has evidence of persistent disease that is nonprogressive at 3-year follow-up. CONCLUSIONS: Meningioma of the orbit, whether primary (ectopic) or secondary. should be treated as at other sites with complete surgical excision if possible. Gamma knife or intensity modulated radiotherapy may be useful for residual microscopic disease. Surgical clearance is facilitated with the broad field exposure afforded by the orbitozygomatic approach outlined in the article, with particular attention directed at positive identification of key landmarks particularly in retro-orbital and cavernous sinus extension.

Adult↗
PubMed2003

Fibula microvascular free tissue reconstruction of the severely comminuted atrophic mandible fracture--case report.

Severely atrophic comminuted fractures of the mandible often have inadequate bone stock available to allow for adequate rigid fixation and subsequent progression to union. Grafting with rib, iliac crest or a variety of allograft materials is required in order to increase the success rate of the repair in this patient population. In this article, we report our favourable experience in using a fibula microvascular free tissue transfer for the treatment of a particularly challenging patient with a fractured atrophic mandible. Secondary implant rehabilitation completed the reconstruction. This method may represent an alternative in the treatment of fractures of the severely atrophic mandible in select individuals.

Aged↗
PubMed2003

Management of osteomyelitis of the anterior skull base and craniovertebral junction.

OBJECTIVES: The study goals were to determine the patient demographics, identify predisposing factors, and determine efficacy of treatment for nonotologic osteomyelitis of the skull base and craniovertebral junction. STUDY DESIGN: All patients with a biopsy-proven diagnosis of osteomyelitis of the skull base treated by the author from 1997 through 2001 were retrospectively evaluated. RESULTS: Six patients were identified on review. The average age at presentation was 56.7 years (age range, 38 to 70 years), and all except one patient had an underlying immunocompromising condition (diabetes mellitus, human immunodeficiency virus infection, steroid use). Most presented with neurologic deficits associated with a destructive lesion of the osseous skull base. Aggressive debridement of involved bone enabled through the use of broad field standard skull base approaches was associated with clinical resolution of symptoms in each case. Systemic antibacterial/antifungal therapy and medical optimization remain important adjuncts in the treatment of this group of patients. CONCLUSION: The diagnosis of this entity may be difficult to discern from neoplastic involvement of the skull base. Standard skull base approaches are useful for both the diagnosis and the treatment of nonotologic osteomyelitis.

Adult↗
PubMed2003

Lipotransfer as an adjunct in head and neck reconstruction.

OBJECTIVES: To present our technique of lipotransfer and to evaluate a single center's experience in the use of lipotransfer as an adjunct to head and neck reconstruction. STUDY DESIGN: A retrospective review of all patients undergoing lipotransfer over a 5-year period by the senior author was undertaken. A total of 23 patients with a minimum follow-up of 1 year were available for analysis. METHODS: Patient records were retrospectively reviewed to assess functional (in the case of palate augmentation) and esthetic outcomes. RESULTS: Twenty-three patients undergoing lipotransfer as part of their reconstructive effort included (1) eight patients undergoing temporal fossa augmentation following temporalis muscle flap reconstruction for extirpative skull base surgery, (2) six patients undergoing facial defect augmentation following traumatic atrophy, (3) three patients undergoing palatal augmentation for correction of velopharyngeal insufficiency, and (4) six patients undergoing soft tissue augmentation following flap reconstruction of the face. Twenty of the 23 patients had excellent maintenance of graft volume. An adequately vascularized recipient bed appears to be an important factor in determining ultimate graft survival using our technique. CONCLUSIONS: Lipotransfer of the head and neck represents a simple, effective adjunctive technique providing for large amounts of readily available, well-tolerated soft tissue filler material. Patient selection is important, specifically in regard to determining that there is adequate vascularity of the recipient bed.

Adipose Tissue↗
PubMed2003

Genioglossus muscle advancement with the genioglossus bone advancement technique for base of tongue obstruction.

OBJECTIVE: To report our early experience evaluating the efficacy of genioglossus muscle advancement using the genioglossus bone advancement technique (GBAT) for symptomatic base of tongue obstruction and sleep-disordered breathing. STUDY DESIGN: Retrospective, nonrandomized study. METHODS: Patient data were obtained from the hospital records of 13 patients undergoing genioglossus muscle advancement with the GBAT system. RESULTS: Thirteen patients underwent genioglossus muscle advancement with the GBAT system. All patients demonstrated greater than 75% obstruction at the base of the tongue as determined by preoperative Müller's manoeuvre. Nine patients demonstrated obstructive sleep apnea syndrome and four demonstrated severe upper airway resistance syndrome on nocturnal polysomnography. Postoperatively, all patients reported improvement of snoring and hypersomnolence and greater than 90% improvement of collapse at the base of the tongue. Minor complications (3/13) included haematoma and transient tooth paresthesia. There was one case of infection requiring plate removal and one case of airway obstruction secondary to angioedema. CONCLUSIONS: Genioglossus muscle advancement using the GBAT system is a safe, simple, and rapid method for improving symptomatic base of tongue obstruction in sleep-disordered breathing.

Adult↗
PubMed2002

Titanium mesh and hydroxyapatite cement cranioplasty: a report of 20 cases.

PURPOSE: This article describes the use of titanium mesh and hydroxyapatite cement constructs for the treatment of large through-and-through calvarial defects. PATIENTS AND METHODS: Twenty consecutive calvarial defects (10 to 156 cm(2)) that resulted from surgical removal of neoplasms or were secondary to trauma were reviewed retrospectively after reconstruction with titanium mesh and hydroxyapatite cement. All patients were followed up by clinical examination and periodic radiographic studies for a minimum of 6 months (range, 6 months to 3 years). Three patients underwent biopsy of the construct at various points during their follow-up. RESULTS: There was no evidence of adverse healing, wound infection, or implant exposure or extrusion in any of the patients reviewed. Adequate 3-dimensional aesthetic restoration of calvarial contour was noted in each case. There was evidence of osseous ingrowth into the titanium mesh and hydroxyapatite cement construct in all 3 patients who underwent biopsy. CONCLUSION: Titanium mesh and hydroxyapatite cement cranioplasty appears to be a reasonable method for the reconstruction of significant calvarial defects.

Bone Cements↗
PubMed2002

Congenital tracheocutaneous fistulas.

OBJECTIVE: To outline two cases of congenital tracheocutaneous fistula and discuss the potential pathogenesis of this previously unreported developmental abnormality. METHODS: Two cases of tracheocutaneous fistula evaluated at John Peter Smith Hospital (Fort Worth, TX) from May to October 2001 were reviewed. The surgical treatment of one infant is described. RESULTS: Two infants were evaluated with a congenital fistula extending from the suprasternal region of the neck dorsally to the trachea in the midline. The infants were otherwise developmentally normal with unremarkable prenatal histories. Primary surgical closure of a fistula was accomplished without complication. CONCLUSIONS: Congenital tracheocutaneous fistula appears to be an isolated developmental abnormality not associated with the same degree of morbidity as acquired tracheocutaneous fistula. The development of a congenital tracheocutaneous fistula may be the result of abnormal epidermal migration secondary to a localized midline mesodermal defect. Congenital tracheocutaneous fistula may be successfully treated with primary closure. Observation and close follow-up of asymptomatic fistulas may be reasonable.

Cutaneous Fistula↗
PubMedDate not supplied

The cervicodeltopectoral flap for single-stage resurfacing of anterolateral defects of the face and neck.

OBJECTIVE: To evaluate prospectively the feasibility and utility of adding a cervical extension to the standard deltopectoral flap. We postulated that this cervicodeltopectoral (CDP) flap will allow for single-stage reconstruction of large defects of the anterolateral face and neck. METHODS: As is the case with the deltopectoral flap, the CDP flap is based on the perforating branches of the internal mammary artery. However, the superior and posterior limbs of the CDP flap are not limited by the clavicle and the deltoid muscle. Instead, they extend in a subcutaneous tissue plane to the margins of the neck or facial defect and transfer the entire intervening skin bridge with the deltopectoral flap. RESULTS: Eighteen patients underwent closure of complex cutaneous defects of the face and neck with the CDP flap. We found no evidence of flap loss in any of these patients. Twelve patients had received preoperative radiation therapy encompassing the cervical extension of the CDP flap. No evidence of adverse healing was noted in this subset of patients. CONCLUSIONS: The CDP flap may represent an alternative in the surgical treatment of various cutaneous defects of the face and neck. It allows for single-stage, reliable reconstruction of these defects. The transfer of intervening cervical skin in conjunction with the deltopectoral flap provides for a more aesthetically pleasing reconstruction, as skin immediately adjacent to the defect is more closely related to the excised skin in terms of color and texture.

Arm↗
PubMedDate not supplied

Use of the endoscopic forehead-lift to improve brow position in persistent facial paralysis.

Traditionally, the asymmetrical brow in facial paralysis has been treated with open procedures. There are few data that support the use of endoscopic procedures to treat patients with facial palsy or paralysis. We sought to evaluate a single surgeon's experience with the use of endoscopic forehead-lifts to treat asymmetrical brow positioning resulting from facial nerve disorders. All cases involving patients who underwent endoscopic brow-lifts by the senior author (Y.D.) from 1997 through 2003 with a minimum follow-up of 12 months were retrospectively reviewed. Demographic data were collected, and patient satisfaction was determined from postoperative interviews conducted at follow-up visits. Standard photographs were used to measure the degree of preoperative and postoperative brow asymmetry. A total of 31 cases were available for review. The average age of our patient population was 47 years (age range, 22-76 years), with a male-female ratio of almost 1.5:1. Twenty-three patients had a complete paralysis, and 8 patients had a palsy. The average preoperative difference in height at the desired apex of brow was 5.9 mm, with a range of 3.0 to 9.0 mm. The average postoperative difference (as measured at 12 months) in brow position was only 1.3 mm, with a range of 0 to 3 mm. Adjunctive periorbital procedures were performed in the majority of patients (90%) at the time of endoscopic brow-lifting. All patients felt that their brow position was much improved after surgery. No major complications were encountered. A single patient underwent a secondary open direct browpexy to optimize his result. Endoscopic brow-lifting may be associated with favorable outcomes in the majority of patients with facial nerve palsy or paralysis. Performing concurrent adjunctive periorbital procedures as deemed necessary to optimize lower eyelid position, eyelid closure, and upper eyelid symmetry appears to be safe and reliable.

Endoscopy↗
PubMedDate not supplied

Use of fibula-free tissue transfer with preoperative 2-vessel runoff to the lower extremity.

OBJECTIVE: To present our experience with fibula-free tissue transfer in patients with documented 2-vessel runoff to the lower extremity on preoperative angiography. METHODS: A case series of 16 patients with segmental mandibular defects reconstructed with a fibula-free flap by the senior author with 100% stenosis of the anterior or posterior tibial arteries were retrospectively reviewed for radiographic data and complications. RESULTS: All flaps performed were successful, and there were no donor site complications. Angiography documented flow of contrast to the foot by a patent anterior or posterior tibial artery in all patients. Occlusive arteriosclerotic disease was identified in the anterior tibial artery in 10 patients and in the posterior tibial artery in 6 patients. CONCLUSIONS: Using our specific criteria, we experienced no complications with the use of a fibula-free flap in extremities with 100% obstructive vascular disease in the anterior or posterior tibial artery. Preoperative angiography is indicated to select appropriate candidates for fibula-free tissue transfer with 2-vessel lower extremity runoff to avoid potential donor site ischemic complications.

Angiography↗
PubMedDate not supplied

The split orbicularis myomucosal flap for lower lip reconstruction.

OBJECTIVES: To describe the split orbicularis myomucosal flap and to review our center's experience with this technique for large defects of the lower lip. METHODS: All patients presenting to the senior author (Y.D.) for lower lip reconstruction using this flap were reviewed in a retrospective fashion. RESULTS: A total of 14 patients with a minimum follow-up of 6 months (mean, 3.4 years; range, 6 months to 5 years) underwent lower lip reconstruction using the split orbicularis myomucosal flap from May 1999 to May 2004. Twelve of the defects arose as a result of cancer resection (squamous cell carcinoma [n = 8], basal cell carcinoma [n = 3], and melanoma [n = 1]), and 2 arose secondary to trauma. The defect crossed the vermilion in two thirds of the cases, extending for a variable distance onto the cutaneous portion of the lower lip. The defect size varied from 50% to 80% of the transverse dimension of the lower lip (mean, 68%) and involved the commissure in 4 patients. There were no flap failures, facial nerve palsies or paralyses, oral incompetence, or need for scar revision in any of our study population. CONCLUSION: The split orbicularis myomucosal flap is a reliable method of reconstructing significant defects of up to 80% of the lower lip with minimal risks of microstomia or functional impairment.

Adult↗
PubMedDate not supplied

Use of precontoured positioning plates and pericranial flaps in midfacial reconstruction to optimize aesthetic and functional outcomes.

OBJECTIVES: To present our experience with reconstruction of midfacial defects using "precontoured positioning plates" with or without pericranial flaps and to describe our technique in detail. METHODS: Thirty-two consecutive patients with midfacial defects subsequent to oncologic resection that were reconstructed primarily with cranial bone grafts and precontoured positioning plates were reviewed for type of defect, functional outcome, complications, and postoperative appearance. RESULTS: Primary reconstruction of all defects in this series was performed. Defects involved the orbital rim, orbital floor, or both in 28 patients (88%), the body of the zygoma in 24 patients (75%), and extended to the skull base in 16 patients (50%). Pericranial flaps were used to cover the bone grafts in 22 patients (69%). Postoperative radiotherapy was performed in 22 patients (69%), preoperative radiotherapy in 5 (16%), and the other 5 (16%) had no radiotherapy. There were no intraoperative complications, and postoperative complications included plate exposure (n = 2), ectropion (n = 3), and partial bone graft loss or resorption subsequent to completion of radiotherapy (n = 2). Postoperatively, appearance was excellent in 24 patients, fair in 6 patients, and poor in 2 patients. Secondary reconstructive procedures were performed in 4 patients (12%). Follow-up ranged from 12 months to 6 years (median, 4.2 years). CONCLUSIONS: Precontoured positioning plates with or without pericranial flaps enable precise reconstruction of midfacial defects with precise incorporation of cranial bone grafts. In our series we routinely covered the bone grafts with well-vascularized tissues, leading to a low incidence of complications and excellent aesthetic results.

Adolescent↗