ISSN:1049-2275    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We have completed a retrospective analysis of our experience with the pi procedure to determine the complications of the technique. Forty-five children underwent correction of scaphocephaly during the last 4 years. The average patient age was 9.2 months. The modified prone position with beanbag head support was used in 40 of 45 patients. Accompanied by barrel-stave and radial osteotomies, the reverse procedure was performed in 18 patients and frontal pulling in 27 patients. The average anteroposterior skull reduction was 1.44 cm, and mean blood loss was 96 ml, 11 ml/kg, replaced in 36 patients. Complications included three durai injuries, and air embolism was not detected by Doppler or end-tidal monitoring. A single child had a postoperative seizure. We conclude that complications of the pi procedure are limited and compare favorably with other repair techniques. We consider the pi procedure the technique of choice for correction of sagittal cranio-synostosis in patients older than 3 months.

ISSN:1049-2275    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Growing skull fractures occur most commonly after head injury; however, their “craniofacial equivalents” may occur after neurosurgical or craniofacial operations in pediatric patients. Experience with five separate cases is reviewed, including one case that involved the anterior cranial base and presented with vertical dystopia and proptosis. Necessary contributing factors appear to include (1) cranial bone defect, (2) durai tear, and (3) expanding intracranial process (e.g., growth of the brain). Prompt recognition and diagnosis of the problem are essential to prevent the development of progressive neurological complications. The pathophysiology and the principles of surgical management of these complex problems are explored in detail.

ISSN:1049-2275    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1049-2275    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1049-2275    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We compared autologous bicortical iliac and cranial bone grafts onlaid to the facial skeleton in 60 adult New Zealand rabbits to evaluate the initial phase of incorporation of these grafts. The animals were distributed in two equal groups in which either cranial or iliac grafts were harvested and fixated, devoid of their periosteum, in direct contact with the nasal bone with micro screws. Each of these two groups were then subdivided into three groups, which corresponded to the three times the animals were killed: 18 days, 30 days, and 60 days. The grafts were measured in their linear dimensions and weighed before fixation and after harvesting when the animals were killed. Undecalcified histológical sections were prepared, and histomorphometric parameters of bone formation (bone volume, osteoid volume, surface thickness, and osteoblastic surface) and résorption (osteoclastic surface and eroded surface) were measured. The results confirmed those of previous studies in that cortical grafts maintained their volumes to a greater extent than their cancellous counterparts, indicating that the remodeling process may be uncoupled in the transplanted iliac grafts. It is postulated that the significant decrease in mechanical stimulus that the cancellous grafts undergo determines this imbalance in the remodeling activity, which results in greater bone résorption than formation and thus the decreased volume.

ISSN:1049-2275    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1049-2275    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We have developed a strategy for concurrent correction of multiple secondary clefting deformities based on the model proposed by Henderson and Jackson [1] which combines several cleft-related procedures. We have expanded this concept significantly to include as many as eleven procedures. The selected procedures are dictated individually by patients' needs. The constellation of corrective cleft-related surgeries has been given the name “cleft cluster” in the interest of simplicity. We are reporting on our experience with 85 consecutive patients using this approach. All patients in this series received bone grafting of the alveolar cleft as the primary procedure, plus multiple additional procedures as necessary. None of the patients reported received primary lip or palate surgery by the authors. The average number of procedures performed was 7.2. The average hospitalization was 4.1 days. The patients have been followed from 1 to 7 yrs. The fistula recurrence rate was 8%. Average patient age was 16.8 yrs with a range of 8 to 54 yrs. This approach eliminates multiple hospitalizations and outpatient procedures, allows flexibility to individualize patient care, provides consistent results, and is cost-effective.

ISSN:1049-2275    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Potential for scarless wound healing in fetal surgeries has aroused interest in fetal repair of malformations such as cleft lip. However, current protocols for fetal surgery have entailed fetal externalization, imparting significant risks for mother and fetus. We have developed a unique silver microclip that rapidly approximates tissue, is nonpenetrating, and is well suited for endoscopie use. Using standardized intrauterine surgical techniques, we compared suture versus microclip in the repair of surgically created cleft lip-like defects in fetal lambs at 124 days' gestation (term, 145 days). Nine fetal lambs were analyzed with bilateral cleft lips; the right cleft was repaired by microclip, seven of the left clefts were repaired by suture, and the remaining two left clefts were not approximated (controls). Results demonstrated excellent wound healing and smooth lip continuity with minimal scar formation after repair by either microclip or suture. The most striking result, however, was in the comparison of intraoperative repair time; the total time for cleft lip repair by microclip averaged 2.5 minutes in contrast to 9.8 minutes for suture. These data suggest a distinct advantage of the microclip in reduction of operative time. Furthermore, its endoscopie application has the potential for making endoscopie fetal surgery a more viable option.

ISSN:1049-2275    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Rigid microfixation has enhanced the immediate results in pediatric Craniomaxillofacial surgery. The effects of rigid fixation on the development of the craniofacial skeleton, however, remain uncertain. The long-term effects of rigid microfixation on the growing craniofacial skeleton in the rabbit model were evaluated in this study. Bifrontal craniectomies were performed in 9-day-old rabbits. The frontal bones were replaced orthotopically and fixed both anteriorly and posteriorly with either wire osteosyn-thesis or titanium microplates and screws. The animals were allowed to grow to craniofacial maturity, and craniofacial development was evaluated with both cephalometric and craniometric analyses. All data were statistically analyzed through analysis of variance. Regional adverse growth effects on the craniofacial skeleton with the use of both wire and rigid fixation were observed. The adverse effects were greatest with the use of rigid fixation.

ISSN:1049-2275    

出版商:OVID    

年代:1995

数据来源: OVID