Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery
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J Craniomaxillofac Surg · Sep 2011
Microsurgical reconstruction of the head and neck--current practice of maxillofacial units in Germany, Austria, and Switzerland.
Refinement in microvascular reconstructive techniques over the last 30 years has enabled an increasing number of patients to be rehabilitated for both functional and aesthetic reasons. The purpose of this study was to evaluate different microsurgical practice, including perioperative management, in Germany, Austria, and Switzerland. The DÖSAK collaborative group for Microsurgical Reconstruction developed a detailed questionnaire which was circulated to units in the three countries. ⋯ In the postoperative course, 15.8% of hospitals use inhibitors of platelet aggregation, most hospitals use low molecular heparin (52.6%) or other heparin products (44.7%). This survey shows variation in the performance, management, and care of microsurgical reconstructions of patients. This is due in part to the microvascular surgeons available in the unit but it is also due to different types of hospitals where various types of care can be performed in these patients needing special perioperative care.
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J Craniomaxillofac Surg · Sep 2011
A treatment algorithm for patients with large skull bone defects and first results.
Large skull bone defects resulting from craniotomies due to cerebral insults, trauma or tumours create functional and aesthetic disturbances to the patient. The reconstruction of large osseous defects is still challenging. A treatment algorithm is presented based on the close interaction of radiologists, computer engineers and cranio-maxillofacial surgeons. ⋯ The treatment algorithm is proved to be reliable. No corrections had to be performed either to the skull bone or to the implant. Short operations and hospitalization periods are essential prerequisites for treatment success and justify the high expenses.
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J Craniomaxillofac Surg · Jul 2011
Case ReportsDescending necrotizing mediastinitis following dental extraction. Radiological features and surgical treatment considerations.
Descending necrotizing mediastinitis (DNM) following dental extraction is an extremely serious infection with a high mortality rate. Oral infection may rapidly descend into the mediastinum across the retropharyngeal and retrovisceral spaces. ⋯ After this, prompt control of the upper airway with tracheostomy, aggressive surgical debridement of the deep cervical spaces and mediastinum, and intravenous broad spectrum antibiotic therapy are mandatory. The present paper reports two new cases of DNM following dental extraction, and focuses on radiological features of abscess progression through the cervical spaces down into the mediastinum.
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J Craniomaxillofac Surg · Jul 2011
Panel and patient perceptions of nasal aesthetics after secondary cleft rhinoplasty with versus without columellar grafting.
Cleft-lip nasal deformity alters patient's self-image, as well as posing unique challenges for the rhinoplastic surgeon. ⋯ Our results suggest that caudal septal extension grafting improves the nasal aesthetics of the cleft patients, as judged by the panel. Patient's self-assessment seems unreliable to be used as an outcome measure.
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J Craniomaxillofac Surg · Jul 2011
Case ReportsTwo cases of emergent endovascular treatment for carotid blowout syndrome after free flap reconstruction for neck cancer.
Carotid blowout is a devastating complication in patients with head and neck malignancy, and is associated with high morbidity and mortality. For patients with bleeding originating in the internal or common carotid artery, treatment options are limited. ⋯ They underwent immediate coil embolization and wall stent deployment and, which resulted in the successful control of bleeding. Although these endovascular treatments often result in recurrent carotid blowout syndrome, they can be useful and effective in treating emergent carotid rupture in patients for whom balloon occlusion test is contraindicated.