ISSN:1049-2275    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Craniosynostosis may occur in conjunction with limb and visceral anomalies in more than 100 syndromes and may include anomalies of the elbow. Apert's, Pfeiffer's, Crouzon's, and Saethre-Chotzen syndrome have been linked with anomalies of the elbow, but the incidence and severity of such anomalies is unknown. A prospective radiographic study was undertaken to establish the types, incidence, and severity of elbow anomalies in patients with either Apert's, Pfeiffer's, Crouzon's, or Saethre-Chotzen syndrome attending the Craniofacial Centre at Great Ormond Street Hospital during a 12-month period. This study showed that elbow anomalies were very common in Apert's and Pfeiffer's syndrome, but less so in Crouzon's syndrome. The elbows in all patients with Saethre-Chotzen syndrome were normal. A range of anomalies was seen, with overlap between the syndromes. The severest anomaly seen in children with Crouzon's, Pfeiffer's, and Apert's syndrome was complete synostosis, which may require surgical intervention in due course. The results of this study suggest that the incidence of elbow anomalies in Apert's, Pfeiffer's, and Crouzon's syndrome is higher than the current literature suggests. Synostosis can be so severe that orthopedic review as part of the management of these children may be beneficial and may become increasingly important as more of these children survive into adulthood.

ISSN:1049-2275    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1049-2275    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

For four of the most well-known craniosynostosis syndromes—Apert's, Crouzon's, Pfeiffer's, and Jackson-Weiss' syndromes—mutations in the fibroblast growth factor receptors (FGFRs) have been described. These substitutions arise mainly in the FGFR-2 gene and to a much lesser degree in the FGFR-1 and FGFR-3 genes. We present a patient with an apparently sporadic type of Pfeiffer's syndrome, exhibiting nearly all associated features of this syndrome. A mutation in the FGFR-2 gene was found, namely serine351-cysteine. This mutation has been reported in only one patient so far, whose phenotype could match both Crouzon's and Pfeiffer's syndromes.

ISSN:1049-2275    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We review our experience with resorbable fixation in Le Fort I osteotomies. We used resorbable plates and screws for fixation of 29 Le Fort I osteotomies over a 1-year period (October 1996-November 1997). Patients ages ranged from 13 to 38 years (mean, 24.7 years). The postoperative follow-up ranged from 2 weeks to 1 year. At the time of surgery, the fixation devices were evaluated for stability and satisfactory placement of fixation. Postoperatively, they were evaluated for wound healing, fixation stability, signs of infection, and patient satisfaction. Postoperative evaluations consisted of 1-,3-, and 6-week clinical exams with radiographic analysis at 3, 6, and 12 months. There have been no complications as of this writing. In one instance, an L plate was palpable in the paranasal region and resolved after 6 months. Our early experience with resorbable fixation is favorable and has offered us an additional option for stabilization of the maxilla.

ISSN:1049-2275    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Mandibulomaxillary fixation (MMF) is an essential technique for accurate treatment of maxillary and mandibular fractures. Traditional techniques of obtaining MMF (circumdental wires and load-distributing arch bars with or without plastic splints) often work poorly in children and adults with partial or absent dentition, require significant operative time, are at risk for glove puncture, and are painful to patients at time of removal. We have developed two new techniques for the rapid establishment of MMF in all ages and all types of dentition with or without splints. These techniques use four bone anchors—two placed in the pyriform rim of the maxilla and two in the mandibular symphysis. “Microlugs” are anchors constructed from Luhr Vitallium mesh and are fixated to bone with 0.8-mm microscrews in primary- and mixed-dentition patients. Mitek MiniGII bone anchors are placed for treatment of secondary-dentition patients. Central skeletal MMF is achieved by linking each maxillary bone anchor to each mandibular bone anchor with suture ligatures and heavy orthodontic elastics. In this study, 112 patients (age range, 15 months-75 years) with maxillary and mandibular fractures underwent central skeletal MMF with one of the two new techniques described. Central skeletal MMF was maintained intraoperatively and for up to 6 weeks postoperatively, according to pathological anatomy. Our techniques succeeded with primary, mixed, and secondary dentition, and with splints and dentures, resulting in functional bone healing in 110 of 112 patients. Malocclusion occurred in 2 patients (1.8%), constituting treatment failure. Microlug central skeletal MMF required 15 to 20 minutes to place, and Mitek anchor central skeletal MMF required 7 to 12 minutes to place. There were no glove punctures noted during the course of treatment. Patient satisfaction has been clearly superior with these two techniques, since MMF may be released in the office with minimal discomfort, even without topical anesthesia.

ISSN:1049-2275    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

To determine for what deformity and utility the computer-generated acrylic (CGA) skull replica has the greatest value, we analyzed retrospectively a consecutive series of patients with craniomaxillofacial deformities (N = 54) whose treatment involved the utilization of CGA skull replicas. Application of the CGA skull replica was divided retrospectively into four groups: (1) use as an aid for preoperative analysis of osseous deformity, (2) use as material for preoperative surgical simulation, (3) use as a navigational aid during an operation, and (4) use as a negative template. Based on the aspects of these utilizations, we evaluated for what deformity the CGA skull replica was useful. Analysis of the data led us to conclude the following. First, the CGA skull replica is a valuable tool in craniomaxillofacial surgery, especially for patients with asymmetrical deformities and delicate convexities and concavities of the skull surface. Second, the largest function that CGA skull replicas can satisfy is standardization of craniomaxillofacial surgery. In carrying out preoperative surgical simulation utilizing a replica, drawing osteotomy lines on it, sterilizing it, and then bringing it to the operating table for consultation whenever required during an operation, we are able to proceed with greater precision and speed than if it was not available.

ISSN:1049-2275    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The malignant tumors of the external auditory canal often invade the middle ear area through the narrow canal, so it is difficult to determine the surgical excisional margin. A patient undergoing external auditory canal reconstruction following excision of a squamous cell carcinoma using a chondrocutaneous flap and fiberscope-assisted preoperative and postoperative diagnoses are described. We obtained good patency of the canal postoperatively. This technique is quite simple and easy to use. We believe fiberscope-assisted surgery is useful for extracting lesions in small areas. In the future, its application will extend to the area of plastic surgery.

ISSN:1049-2275    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1049-2275    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Although craniosynostosis alters brain growth direction resulting in compensatory changes in the neurocranium, it has been suggested that such compensations occur with little reduction in intracranial volume (ICV). This hypothesis was tested in a rabbit model with nonsyndromic, familial coronal suture synostosis. Cross-sectional three-dimensional computed tomographic head scans were obtained from 79 rabbits (25 normal, 28 with delayed-onset synostosis, and 26 with early-onset synostosis) at 25, 42, and 126 days of age. Intracranial contents were reconstructed and indirect ICV was calculated. Results revealed that by 25 days of age the intracranial contents from early-onset synostosed rabbit skulls showed rostral (anterior) constrictions and a “beaten copper” morphology in the parietal and temporal regions compared with the other two groups. These deformities increased in severity with age. Quantitatively, ICV was significantly reduced (p< 0.05) by 7% in rabbits with early-onset synostosis compared with both control rabbits and rabbits with delayed-onset synostosis at 25 days of age. By 126 days of age, ICV in rabbits with synostosis was significantly reduced (p< 0.05) by 11% in early-onset synostosis and by 8% in delayed-onset synostosis compared with normal rabbits. Results suggest that in rabbits with uncorrected craniosynostosis, compensatory changes in the neurocranium were not adequate to allow normal expansion of the neurocapsular matrix. Further research is needed to determine if ICV reduction is correlated with cerebral atrophy or cerebral spinal fluid (i.e., ventricular or subarachnoid) space compression in this model.

ISSN:1049-2275    

出版商:OVID    

年代:1998

数据来源: OVID