ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01308.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01309.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The surgical treatment of the mandibular and maxillary deformities in patients with hemifacial microsomia requires some form of mandibular lengthening. This is usually either via ramus interpositional bone grafting or end‐on bone grafting. In a few cases, ramus lengthening may be completed by a sagittal split. Once the mandible has been reconstructed, the maxillary surgery can be completed. In previous forms of treatment, mandibular bone grafting was completed without regard to function and neuromuscular adaptation and a significant percentage of such procedures completed failed. Egil harvold and his colleagues developed a method by which changes in form and function are co‐ordinated by using a functional appliance resulting in neuromuscular adaptation. After the bone grafting is completed, as the second of six phases of treatment, a specially designed registration bite‐block further facilitates neuromuscular adaptation by controlling mandibular movements (function), but in addition it protects the bone graft from excessive forces thereby aiding in osteogenesis (third phase). The theoretical basis, classification of deformities, and phases of treatment developed are presented and the surgery is described in detail. The results of a consecutive group of patients treated by these methods is then presented. While this form of treatment is not the only one possible, it is the only one that has been tested in the laboratory, proven in patient care, and stood the test of

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01310.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Surgical'orthodontic strategies in patients with hypoplastic midfaces and cleft of lip, alveolus and palates after completion of skeletal growth are guided by cephalometric data, with the soft‐tissue profile playing the most important role. The le fort i, the extended le fort i and, less frequently, the le fort ii procedure depend on the extent of rnidfacial hypoplasia. Osteotomy planning should consider that in cleft patient's maxilla, the anterior nasal spine and a‐point need to be advanced and caudally rotated to a larger extent than is necessary in non‐cleft patients. A slight overcorrection of anb‐angle is necessary to achieve a harmonious and attractive soft‐tissue profile since upper lip and nasal soft tissue require more bony support. In severe bimaxillary disturbances the midfacial advancement has to be combined with mandibular osteotomies. Stabilization after midfacial osteotomies should be done by corrosion‐resistant vitallium or titanium miniplates. This technique provides sufficient stability to restore early function immediately after surgery. Intermaxillary fixation following surgery is no longer necessary. Several decisive advantages are provided by this technique over the previously applied wire suspension concepts or wire suturing techniques. The most advantageous points are: no intermaxillary fixation is required immediately postoperatively; normal soft food intake is resumed after 8–10 days when wound healing is completed; rigid plate fixation leads to a considerable improvement in bone healing, while ‘pumping‐effects’ induced by micromovements from the masticatory muscles are avoided; plate fixation allows immediate functional ‘antirelapse‐treatmenl’ against relapse tendencies, using functional treatment by means of sof

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01311.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Three‐dimensional reconstruction of computed tomography has been available since 1979. The brief history of the clinical implementation of this modality is trace

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01312.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

This paper reports the clinical description of a case of tessier type ii clefting and the surgical principles used in correcting the associated deformities.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01313.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Oesophageal injury secondary to gastro‐oesophageal reflux is unlikely to be due to the effects of hydrochloric acid alone. The present authors have investigated the development of acid and bile salt‐induced oesophageal mucosal injury in a rabbit model. Solutions of hydrochloric acid and sodium taurocholate (st) were perfused through an isolated oesophageal preparation and mucosal injury was determined by measuring the rate of h+disappearance. Perfusion with acid alone in concentrations up to 10 mmol/1 did not affect the h+disappearance rate. Addition of 1 mmol/1 st to an acid perfusate resulted in loss of h+from the system. The increase in h+disappearance rate was associated with loss of st from the perfusate. Sodium taurocholate was only lost from the system when in an acid medium. Increased rate of h+disappearance occurred even after the bile salt had been washed out of the perfused oesophagus. The mechanism of bile salt‐induced mucosal injury was unlikely to be due to mucosal disruption secondary to micelle formation since the critical micellar concentration of taurocholate was found to be greater than that used in the perfusate. These findings indicate that bile salts may be an important factor in hydrochloric acid‐related damage to oesophageal mucosa, by acting through mechanisms unrelated to micelle fo

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01314.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The present authors have studied the light and electron microscopic changes in rabbit oesophageal mucosa which has been exposed to solutions of hydrochloric acid and sodium taurocholate (st). In anin vivomodel the oesophagus was perfused with saline, acid (0.1–40 mmol/1 of h+) or taurocholate (0.1–1.0 mmol/1 at ph 2.0 or 1.0 mmol/1 at neutral ph). At the end of each perfusion experiment the oesophagus was removed and assessed by the naked eye, light and electron microscopy. Some desquamation of superficial stratum corneum cells occurred in all specimens perfused for 5 h. Injury was more evident to the stratum spinosum and basal cell layers. Damage was more severe in the bile salt plus acid perfused specimens, varying between margination of nuclear chromatin in the basal cells to complete necrosis and separation of the overlying layers. Taurocholate in neutral solution did not damage the oesophageal epithelium. Electron microscopy revealed that damage to cells in the basal layers and stratum granulosum occurred within 30 min of exposure to acidified taurocholate, this damage increasing with time. It is concluded that taurocholate is able to damage oesophageal mucosa, that the damage first occurs in the deeper layers of the oesophageal mucosa and that the damage may occur in the absence of gross or light microscopic changes in the muc

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01315.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01316.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A case report is presented illustrating the use of a recently developed composite free flap from the chest wall to reconstruct a complex defect involving the scalp, cranial vault and orbit following the excision of a malignant tumour.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1987.tb01317.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY