Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery
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J Craniomaxillofac Surg · Dec 1999
Comparative StudyThe role of thorax imaging in staging head and neck squamous cell carcinoma.
The overall survival rate for patients with head neck squamous cell carcinoma remains disappointingly static despite improved locoregional control. This has been attributed to the development of distant metastases and second primary malignancies in these patients, a large proportion of which occur in the thorax. We retrospectively analysed the incidence of thoracic malignancies in 138 patients presenting with newly diagnosed (n = 107) or recurrent (n = 31) cancer of the head and neck over a 4-year period. ⋯ The primary site (laryngeal, oral or pharyngeal) or presence of nodal disease did not have an effect on the incidence of simultaneous thoracic malignancies. The presence of distant metastases and second primary malignancies has major implications in the management and prognosis of patients presenting with head and neck squamous cell carcinoma, with a large proportion of such patients succumbing to their disease within one year of diagnosis. As CT scanning of the thorax was a more effective screening investigation than standard chest X-ray in the detection of simultaneous thoracic malignancy, we recommend it for use in the staging of patients presenting with cancer of the head and neck.
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J Craniomaxillofac Surg · Aug 1999
Case ReportsExperience with regional flaps in the comprehensive treatment of maxillofacial soft-tissue injuries in war victims.
This article presents our experience with regional flaps in the treatment of facial soft-tissue defects and deformities in 33 patients with various facial injuries from warfare during the period from 1986 to 1999. Thirty-two males and 1 female aged between 8 and 53 years (mean 24.18 years) were treated with facial soft-tissue injuries from high velocity projectiles and varying degrees of associated hard-tissue injuries. Bullets were the most common cause (70%), followed by injuries from shrapnel (21%), land mines (6%), and breech blocks (3%). ⋯ None required facial nerve grafting as only the terminal branches were injured in our cases and functional recovery was acceptable. Application of local tissue transfer procedures in our series of facial warfare injuries yielded acceptable tissue form, texture, and colour match, especially when these procedures were used in combination, and tailored to surgically fit the individual case. Moreover, application of these procedures is relatively easy and postoperative morbidity is limited, provided the general condition of the patient is stable, and the surgical techniques used have good indications and flap principles.
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J Craniomaxillofac Surg · Dec 1998
A simple nasal splint to assist the stability of nasopharyngeal tubes in the Pierre Robin sequence associated airway obstruction: technical innovation.
Upper airway obstruction in association with the Pierre Robin sequence presents at or shortly after birth. The airway difficulty can be managed in a number of ways from postural nursing to surgical intervention with tracheostomy, however, each method has its disadvantages. A technique is described whereby the airway obstruction is relieved with the use of paediatric nasopharyngeal airways which are stabilized with an individually constructed acrylic nasal splint. This technique has been successfully applied in two cases of the Pierre Robin sequence presenting with airway obstruction.
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J Craniomaxillofac Surg · Oct 1998
Review Case ReportsOlfactory groove meningioma with paranasal sinus and nasal cavity extension: removal by combined subfrontal and nasal approach.
A very unusual case of olfactory groove meningioma with recurrence extending into the paranasal sinuses and nasal cavities, 15 years after the first transcranial operation, is described. The patient was successfully treated by a combined subfrontal and nasal approach. ⋯ The nasal extent of these meningiomas is more often asymptomatic, although signs of sinus obstruction and epistaxis have been described. Although small paranasal sinus extensions of the meningioma may be removed by the transcranial route, a combined subfrontal and nasal approach is necessary in cases with large tumour masses extending into the nasal cavities, as in our own one.
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J Craniomaxillofac Surg · Apr 1998
Preoperative autologous blood donation in orthognathic surgery: a follow-up study of 179 patients.
Although there have been recent advances in maxillofacial surgery and anaesthetic techniques, blood replacement is still common in orthognathic surgery. 179 patients underwent elective orthognathic surgery and donated autologous blood preoperatively. Standardized questionnaires about the preoperative blood donation were distributed to the patients. Haemoglobin, haematocrit, red blood cells and platelets were measured before blood donation, presurgically and postsurgically, as well as one year after surgery. ⋯ After a postsurgical decrease, the mean haemoglobin and mean haematocrit levels regained the levels determined prior to the donation. Preoperative autologous blood donation of 2 to 3 units (900-1350 ml +/- 10%) of blood is recommended in bimaxillary osteotomies and 1 to 2 units (450-900 ml +/- 10%) of blood for upper jaw osteotomies. In lower jaw surgery, the acute isovolaemic haemodilution should be considered.