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PubMed2001

Surgical reconstruction of the temporomandibular joint for chronic subluxation and dislocation.

This paper describes the use of an inferiorly based pedicled flap from the temporal fascia sutured to the anterior-lateral wall of the capsule and augmentation of the zygomatic root of the temporal bone by a bone graft from the iliac crest to prevent forward movement of the condyle beyond the eminence. It may be used for treatment of patients with chronic subluxation and dislocation of the temporomandibular joint.

Adult↗
PubMed2001

Wooden foreign bodies in facial injury: a radiological pitfall.

Foreign bodies can present a diagnostic challenge to the maxillofacial surgeon. Three patients, who suffered from a penetrating injury with a wooden foreign body, were examined and treated. Their preoperative CT and MRI scans were evaluated. In an acute case, the penetrating wooden body mimicked air bubbles. In the other two patients, the wood was retained for several months and appeared with a much higher density on CT. In MRI the wooden foreign bodies gave a low signal intensity. In all injuries removal of the foreign body was delayed, because it was initially radiologically missed or misdiagnosed. In the appropriate trauma setting a penetrating wooden body must always be considered. Its attenuation value increases with time as water is absorbed from the surrounding tissues. Although the radiological appearance may show a great variety, CT imaging is the basic diagnostic technique. MRI is the method of second choice.

Adult↗
PubMed2003

Versatility of temporalis myofascial flap in maxillofacial reconstruction--analysis of 30 cases.

Temporalis myofascial flap holds great promise for the reconstruction of various defects of the maxillofacial region-either congenital or surgical. The dependable blood supply through the middle and deep temporal arteries, proximity to the maxillofacial region, possibility to mobilize it to the oral cavity through the under surface of zygomatic arch and its fanned out nature permits the surgeon to use this flap for the reconstruction of various maxillofacial defects and even as an interposing tissue. In this series of 30 cases, we have used the temporalis myofascial flap for the reconstruction of different types of maxillofacial defects and as an interposing material in TMJ surgeries. We found that this flap is very valuable in maxillofacial reconstruction.

Ankylosis↗
PubMed1999

Technical refinements in surgical treatment of benign parotid tumours.

Over the last 15 years, a number of techniques have been developed that make it possible to treat benign parotid tumours surgically with virtually no morphofunctional sequelae. Given that the main objectives of the intervention are the complete removal of the lesion as well as isolation and preservation of the facial nerve and its branches, the authors recommend the following procedure: a face-lifting type of incision in order to disguise the cutaneous scar better; preservation of the posterior branch of the great auricular nerve, in order to maintain the sensitivity of the ear lobe; coverage of the residual defect by means of a flap composed of superficial and deep temporalis fascia in order to reduce the postoperative depression in the parotid region and the onset of Frey's syndrome.

Adenolymphoma↗
PubMed2001

Temporal galeal fascia cover of custom-made gold lid weights for correction of paralytic lagophthalmos: long-term evaluation of an improved technique.

BACKGROUND: Chronic paralytic lagophthalmos is a condition that is often conservatively treated with ophthalmic ointments and eye drops, but usually requires definitive surgical correction. PURPOSE: An effective modification of the gold lid loading technique is described, which we have found to be the simplest and most reliable method for lid reanimation. MATERIAL: After empiric evaluations with lead fisherman's weights 'glued' to the eyelid, a custom-made gold lid weight is made by a jeweller on the basis of the tarsal dimensions of the individual patient, and then sutured to the tarsus under local anaesthesia and covered with a fine sheet of temporal galea. Other ancillary procedures (lower lid suspension, lateral tarsal strip, lateral tarsoplasty) are added as required. METHODS: Between 1990 and 1996, 27 patients underwent this type of surgery, of whom 24 were re-evaluated after a mean follow-up period of 73.2 months (range 36-96 months), 14 of these for a minimum of 5 years. RESULTS: None of the gold weights was extruded, all 24 patients experienced marked improvement of their dry-eye symptoms and expressed a high degree of satisfaction. Six patients underwent further minor surgery (lateral McLaughlin tarsorrhaphy) in order to improve relative underaction. Two patients had ptosis (less than 2 mm of asymmetry) of the affected side but refused further correction. CONCLUSION: The use of custom-made gold lid weights and a protective galeal layer is a simple, reliable and successful means for permanently rehabilitating paralysed eyelids.

Adult↗
PubMed1979

Brain neovascularization with temporalis muscle in dogs.

Nine mongrel adult dogs underwent temporalis muscle transposition on the surface of the left hemisphere, the arachnoid having been removed. Histological confirmation of vessel networks connecting muscle and brain was achieved after 90 days.

Animals↗
PubMed2000

Microtia reconstruction using a porous polyethylene framework.

We describe our method for reconstructing microtic auricles using a porous polyethylene framework in two stages. The first stage of the procedure involves rotating a superficial temporoparietal fascial (TPF) flap over the framework. The inferior two-thirds of this framework is next inset into a local temporal skin pocket, while the superior one-third is covered with a full thickness skin graft from the contralateral postauricular sulcus. Lobular transposition is commenced in a second stage procedure at the three-month postoperative period. Hearing restoration surgery is encouraged at a later date in selected patients with unilateral microtia. Use of the porous polyethylene framework permits a more expedient, less invasive, and more reliable method for auricular reconstruction than does the traditional method that employs costal cartilage.

Child↗
PubMed2006

Anatomic and aesthetic considerations in midfacial rejuvenation.

An early sign of the aging process involves changes to the midface. The loss of the lid-cheek continuum begins with underlying laxity in the orbitomalar ligament. As the face continues to age, the malar pad drops inferomedially in position. The approach to the midface has evolved over the past 15 years with the advent of endoscopically assisted techniques of midfacial elevation. Further technology, such as thread-lifting procedures and the Endotine Midfacetrade mark, have supplemented the choices for surgical correction of this facial segment. Descriptions of the different approaches to the aging midface are reviewed.

Adipose Tissue↗
PubMed1995

Entire scalp replantation: case report and review of the literature.

A case of successful replantation of a totally avulsed scalp in a 40-year-old woman is presented. During a 19-hr surgical procedure, bilateral superficial temporal arteries and veins were anastomosed. The postoperative course was uneventful, except for partial necrosis of the distal end of the avulsed flap, i.e., the occipital region. Since the first successful scalp replantation using microsurgical technique was reported in 1976, the authors have found at least 32 subsequently reported cases. Of these, there were 22 cases of entire scalp avulsion (more than 80 percent of the scalp), including 15 females and seven males. A summary of these cases is included. From analysis of the reported cases of entire scalp avulsion, the keys to success in scalp replantation are considered to be the adequate selection of vessels for repair and the use of vein grafts, if necessary.

Adult↗
PubMed2001

Facial translocation approach to the skull base: the viability of translocated facial bone graft.

OBJECTIVES: A retrospective review of 56 patients who were operated through a facial translocation approach was carried out to assess the viability of the translocated facial bone segment. METHODS: Eleven patients had preoperative radiotherapy, and 26 had postoperative radiotherapy. In 14 patients the translocated bone segment was kept attached to the anterior cheek, and in 42 patients the bone segment was detached and then implanted. A vascularized flap was used to obliterate the defect in the paranasal sinuses in 15 patients. RESULTS: Twelve (21.4%) patients had devitalized bone segment and required sequestrectomy. The incidence of devitalized bone segment was higher in the patients who received postoperative radiotherapy (P = 0.04) and lower in the patients in whom the defect in the paranasal sinuses was reconstructed with a vascularized flap (P = 0.006). CONCLUSIONS: The translocated facial bone segment should be kept attached to the cheek soft tissue when possible, or the defect in the paranasal sinuses should be reconstructed with a vascularized flap.

Adolescent↗
PubMed2005

Endoscopic vocal cord medialization: a new surgical technique without neck incision for laryngeal palsy.

Different types of surgery have been reported for glottal insufficiency due to unilateral vocal cord paralysis. We recently developed a new surgical technique of fascia implantation known as vocal cord medialization. This new method achieves a wide glottal gap during phonation, without the use of an external approach. This new technique is described in detail herein, together with the satisfactory results we obtained in six cases of unilateral vocal cord paralysis with a wide glottal gap during phonation. We recommend this technique in cases of unilateral vocal cord paralysis in which both a satisfactory clinical result and an aesthetically pleasing cosmetic result are required.

Fascia↗
PubMed2000

Efficacy of temporal musculopericranial flap for reconstruction of the anterior base of the skull.

Since March 1988 the temporal musculopericranial (TMP) flap has been used as our flap of choice to reconstruct defects of the anterior base of the skull that are larger than 2 x 3 cm, including the dura mater, in 33 patients. The primary diseases were malignant head and neck tumours (n = 16), trauma (n = 15), meningioma (n = 1), and teratoma (n = 1). The dura mater was reconstructed with a unilateral TMP flap, after which the cranial and nasal cavities were closed with the opposite TMP flap. In addition, bone was grafted by sandwiching the bone between the two flaps and fixing it to the surrounding residual bone. When a large area was resected, making it impossible to use a TMP flap, a frontal musculopericranial (FMP) flap or a free flap (usually the rectus abdominis myocutaneous flap) was used to close the cranial and nasal cavities. Thirty of the 33 patients recovered with no postoperative complications. Two patients developed extradural abscesses in the anterior base of the skull and one developed mild meningitis, but they were successfully treated conservatively. When bilateral TMP flaps were used for the reconstruction, no patient had aesthetic problems in the forehead region. The TMP flap is extremely effective for the reconstruction of the anterior base of the skull because it is minimally invasive and causes few aesthetic problems in the forehead region.

Adolescent↗
PubMed1990

Changes in posture control across the life span--a systems approach.

In this article, a systems approach to the development of posture control across the life span and its integration with voluntary tasks such as walking is described. Research shows a clear cephalocaudal gradient in the development of postural responses. Postural muscle synergies develop appropriate temporal organization through experience in each new level of postural skill development. Sensory inputs contributing to posture control influence postural responses very early in development, with responses being elicited by vision alone, or by somatosensory and vestibular cues in isolation. Studies of older adults indicate small, but significant, increases in onset latencies and disruptions in the temporal organization of postural muscle responses when subjects are given external threats to balance. In addition, older adults, like young children, use antagonist muscles more often in coactivation with agonist muscles. Older adults also have more difficulty balancing when sensory inputs are reduced experimentally or pathologically. Ankle dorsiflexor muscle weakness is also a factor in balance dysfunction in the older adult.

Aging↗
PubMed1998

Effects of lighting conditions on sleep and wakefulness in albino Lewis and pigmented Brown Norway rats.

STUDY OBJECTIVES: Previous studies have demonstrated that albino but not pigmented rats show acute increases in REM sleep following light-to-dark transitions. Light and dark have also been shown to have direct effects on NREM sleep and wakefulness in albino rats. Little is known, however, about the direct light-dark effects on sleep patterns in pigmented animals. The purpose of the present study was to compare the direct effects of light and dark on REM sleep, NREM sleep, and waking in albino Lewis and pigmented Brown Norway (BN) rats. DESIGN: Groups of albino Lewis and pigmented Brown Norway (BN) rats were exposed to various light-dark (LD) schedules. In the first experiment, the lighting schedules were LD 12:12 and LD 3:3. The second experiment compared LD 12:12 with an irregular schedule consisting of short light and dark periods of unequal length. MEASUREMENTS AND RESULTS: Both Lewis and BN rats slept more during the light and were awake more during the dark on all schedules. REM sleep patterns in light and dark periods were opposite, however. Lewis rats spent more of their sleep in REM sleep during dark than the light, whereas BN rats had a higher proportion of REM sleep in the light. CONCLUSIONS: The results suggest that there are substantial direct effects of light and dark on sleep in pigmented as well as in albino rats, although these effects are not always the same in magnitude or even in direction.

Animals↗