ISSN:0148-6403    

DOI:10.1002/hed.2890060402

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractThis study examines the relative risks and benefits of conservative and surgical management of dural tear secondary to middle third facial fracture and ascertains the type of skull and facial injury most often associated with the development of posttraumatic meningitis. Two projects were undertaken. First, the histories of 247 cases of major middle third facial fracture were reviewed with a recent follow‐up of those patients who also sustained a dural tear. Second, 280 cases of bacterial meningitis were reviewed and particular attention was given to cases of posttraumatic meningitis. Of the 247 cases of middle third facial fractures studied, 43% (107/247) had evidence of a dural tear; of this group, 76 patients were managed conservatively and 31 patients were managed surgically. In the former group, there were three instances of recurrent cerebrospinal fluid rhinorrhea (CFR). In the surgically managed group, 77% (24/31) sustained surgical complications including two cases of posttraumatic meningitis and 21 cases of neurological deficit. Of the 280 cases of bacterial meningitis, 48 patients had sustained dural tear following trauma. The prognosis for posttraumatic meningitis is considerably better than for other forms of meningitis. The preceding trauma involved the vault of the skull in 90% (43/48) of cases, and discrete middle third facial fracture in one case (2.1%). Posttraumatic meningitis followed a previous operative repair in 15% (7/48) of the patients. The results of this study indicate that dural tear subsequent to middle third facial fractures is a different proposition than dural tear subsequent to direct skull trauma. In the former, spontaneous repair most often occurs following reduction and immobilization of the fracture, and surgical repair with its attendant complications is thereby usually not warranted. Spontaneous repair is unlikely to occur where there is gross damage to the anterior cranial fossa, aerocele, significant frontal fracture separate from the facial injury, and in cases of definite persistent or recurrent CFR and late meningitis. In these cases surgical repair is indicate

ISSN:0148-6403    

DOI:10.1002/hed.2890060403

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractEighty‐three episodes of osteoradionecrosis are reported. Of those episodes affecting the mandible (78), 23 (29.5%) required radical resection. The most common precipitating factors were postradiation extractions (22/83), periodontal disease (19/83), and preradiation extractions (17/83). Those episodes initially located within the zone of attached mucosa fared well with conservative measures while those initially located beyond the zone of attached mucosa fared poorly. In bone necroses where the external radiation dose to the affected bone exceeded 7,000 rad, the mandibular resection rate was high (44%). The most effective way of resolving advanced bone necroses was achieved with a course of hyperbaric oxygen therapy combined with a surgical sequestrectom

ISSN:0148-6403    

DOI:10.1002/hed.2890060404

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractThe treatment of advanced cancer of the maxillary sinus often requires extensive ablation and orbital exenteration that results in large fullthickness defects of the upper cheek and orbital regions. Reconstruction of such defects with local flaps is usually difficult because of the need for a large flap. Several regional flaps such as the deltopectoral flap, the temporal flap, and the shoulder flap may be used, but these techniques frequently require surgery in stages and result in severe deformity of the donor site. The island pedicled, pectoralis major myocutaneous flap may be rotated up to the orbital region; however, the uncertain blood supply to the skin in the distal area of the pectoralis may cause unexpected marginal necrosis of the flap. Reconstruction of large orbital‐maxillary defects can readily be accomplished in one stage using microsurgical free transfer of latissimus dorsi myocutaneous flaps. The thoracodorsal artery and vein that form the nutrient pedicle of the flap approaches 2 mm in external diameter and up to 10 cm in length, allowing greater versatility in head and neck reconstruction. The muscle may be used to fill the orbital and maxillary cavities and will accept a skin graft on its deep surface. The donor defect is closed primarily and the resulting scar is well concealed beneath the arm. If necessary, extremely large flaps may be transferred by harvesting the entire latissimus dorsi muscle and the overlying skin based on the thoracodorsal syste

ISSN:0148-6403    

DOI:10.1002/hed.2890060405

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractRadiation‐induced skin changes are commonly seen in patients who have been treated for head and neck malignancies. Some of these skin changes can progress into chronic postradiation ulcers, which despite aggressive medical wound management will not resolve spontaneously. Skin grafts and local cutaneous flaps located within the radiation field are unreliable and rarely provide adequate stable coverage. In this article, the authors report a combined experience of 52 patients whose postradiation cervical ulcers were successfully and reliably treated with myocutaneous flap

ISSN:0148-6403    

DOI:10.1002/hed.2890060406

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractNeurofibromatosis (von Recklinghausen's disease) is an autosomal dominant disease that affects one in 2,500–3,000 births. Because the head and neck is unique in its anatomical compartmentalization of the central and peripheral nervous systems, the potential for involvement of these areas with neurofibromas is substantial and accounts for a myriad of clinicopathologic presentations. In the present study, the incidence of involvement in the head and neck is 37%. We found 81% of the patients had café au lait spots, 63% had positive family histories, and 66% had multiple cutaneous nodules. An incidence of malignant transformation was documented in 3.5% of the cases. Management of benign neurofibromatosis must be individualized for each patient and ranges from incisional biopsy to wide local excision. In every case, the risk of severe neurologic deficit must be weighed against the benefits of surgical resection, which is usually incomplete. Genetic counseling is advised for all patients with this disease, since no cure is availab

ISSN:0148-6403    

DOI:10.1002/hed.2890060407

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractThe growth of hemangiomas of the orbital region varies greatly; it is unpredictable. Most lesions never reach sufficient size to impair vision; a few, however, may grow sufficiently to cause disastrous complications. Nine children with complete or partial occlusion of the vision by hemangioma of one eye are reported. (Functional vision was preserved only in those patients who had early subtotal excision of the eyelid hemangioma.) Two children with complete occlusion developed amblyopia in the involved eye. One had optic nerve atrophy. One of the four children with partial occlusion of vision had a permanent decrease in visual acuity. Of the remaining three children with normal vision, two had been operatively treated early, and one had unusually rapid involution of the hemangioma. We recommend that when a child has complete or partial visual occlusion due to hemangioma, subtotal or total excision of the hemangioma should be carried out within 1 week of the onset of visual occlusion to prevent amblyopia.

ISSN:0148-6403    

DOI:10.1002/hed.2890060408

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractMethylphenidate (Ritalin) abuse has been and continues to be a major medical and social problem. In the past 6 months, we have seen five deep neck abscesses secondary to intravenous Ritalin abuse. This constitutes more than 50% of the deep neck abscesses seen by us in the same time period. The pathogenesis is related to an inflammatory foreign‐body reaction to the fillers in the methylphenidate tablets, followed by superinfection by oral or cutaneous flora. Mixed flora infections with weakly pathogenic organisms may also occu

ISSN:0148-6403    

DOI:10.1002/hed.2890060409

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

摘要:

AbstractA wide variety of methods have been described for the treatment of laryngeal papillomatosis. This attests to the difficulties encountered in controlling this often refractory disease. Recent trends have been directed toward immunotherapy and improved techniques of endoscopic excision. The various treatment modalities are reviewed to provide the reader with updated information and a perspective of the current management of this perplexing disease.

ISSN:0148-6403    

DOI:10.1002/hed.2890060410

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY

ISSN:0148-6403    

DOI:10.1002/hed.2890060411

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1984

数据来源: WILEY