[Value of horizontal tomography in the tomographical diagnosis of lesions of facial bones and of the base of the cranium].
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The application of the Mitek Anchor System for bony fixation of the flap in the cheek area is described. The cervicofacial rotation-advancement flap is fixated to the malar bone using Mini Anchors for the purpose of diminishing the downward traction on the lower eyelid. They reduced the tension in the distal part of the flap and avoided distal-edge necrosis and ectropion. In another patient the free vascularized musculocutaneous flap, which had been grafted previously for a surgical defect in the cheek and resulted in ectropion of the lower eyelid, was fixated to the malar bone, and the ectropion was corrected. The Mitek Anchor System is useful in flap fixation to the bone because it provides a simple, fast, and reliable method for flap fixation with minimal dissection and precise placement.
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Using cephalometric radiography, facial bony structure of a group of pediatric renal transplant recipients immunosuppressed with cyclosporine (CsA) and prednisone was studied and compared with a control group of children. A pattern of abnormal facial growth was demonstrated on cephalometry in eight of nine transplant recipients receiving CsA. The abnormalities included shortening of posterior facial height and increased anterior facial height with a deep mandibular plane angle. There was also an absolute shortening in the mandibular body and mandibular retrognathia. These findings may be consistent with inhibition of mandibular condylar growth inhibiting the anteroinferior growth of the mandible. Similar changes were present in two children with end-stage renal disease and none of the remaining nine control patients (P less than 0.01, chi-squared analysis). The affected area appears to be the lower third of the face. The role of CsA in affecting facial bony growth in children needs to be evaluated further.
A high resolution cadmium telluride probe was used in conjunction with standard bone imaging methods in two cases of facial asymmetry. The probe improved localization of the abnormalities and led to rational treatment.
32 patients with lesions of the facial skeleton, the neck and the parapharyngeal space were examined with NMR (Nuclear Magnetic Response). The results are compared with CT scanning. NMR offers high soft tissue contrast. Multiplanar imaging easily distinguishes tumours and lymph nodes from the cervical vessels and muscles. In contrast CT, is more useful for the imaging of destruction of the facial skeleton and the skull base.
The anterior iliac crest has been the traditional source of pelvic bone for autogenous bone grafting in the maxillo-facial skeleton. Although the posterior iliac crest is frequently utilized by our orthopaedic colleagues, little attention has been given this site in the oral and maxillo-facial literature. As the posterior crest affords an almost unlimited amount of bone for autogenous grafting in the maxillo-facial region, we feel its use is indicated when very large amounts of bone are required. The techniques for removal of cancellous and cortico-cancellous posterior crest grafts are described in detail. Morbidity of the posterior crest donor site includes possible difficulties with patient positioning, injury to the sacro-iliac joint, injury to the sciatic or cluneal nerves, and severe haemorrhage. Ambulation following the use of the posterior crest has not been a problem. Significant blood loss can be adequately controlled with proper exposure, electrocautery, and bone wax.
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In a series of 25 patients 20 had a maxillary sinus not containing air at radiography, in 11 due to purulent and in 9 to non-purulent inflammatory lesion. At scintigraphy a definitely abnormal, high uptake of 99TcmDP was found in 10 and a probably high accumulation in one of the 11 with purulent sinuitis. Of the 9 patients with non-purulent inflammation 5 had a definitely normal and 4 a probably normal uptake. Thus, a differentiation between purulent and non-purulent sinuitis would seem to be possible by means of facial bone scintigraphy.