The Journal of craniofacial surgery
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Randomized Controlled Trial Comparative Study
Successful blood conservation during craniosynostotic correction with dual therapy using procrit and cell saver.
Craniosynostotic correction typically performed around infant physiologic nadir of hemoglobin (approximately 3-6 months of age) is associated with high transfusion rates of packed red blood cells and other blood products. As a blood conserving strategy, we studied the use of 1) recombinant human erythropoietin or Procrit (to optimize preoperative hematocrit) and 2) Cell Saver (to recycle the slow, constant ooze of blood during the prolonged case). ⋯ Our data showed that for elective craniosynostotic correction, successful blood conserving dual therapy with Procrit and Cell Saver might be used to decrease transfusion rates and the need for any blood products.
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Case Reports Comparative Study
A comparison of vascularized fibular flap and iliac crest flap for mandibular reconstruction.
Segmental mandibular defects, which are caused either by ablative surgery or trauma, are usually accompanied by different degrees of skin, soft tissue or mucosa losses. The reconstruction of such defects requires complicated surgical procedures. An ideal mandibular reconstruction method must support the insertion osseointegrated dental implants which is necessary for total oral rehabilitation. ⋯ Functional and aesthetic results also showed that oral continence, social activities, and facial appearance rates of fibula flap were superior to iliac crest flap. Lower complication rates of fibula flap group may be associated with patients' higher satisfaction rate. Both flaps are commonly used in mandibular reconstruction, however, many parameters including defect localization, defect size, presence of soft tissue defect should be considered.
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Case Reports Comparative Study
Mandibular reconstruction in Goldenhar syndrome using temporalis muscle osteofascial flap.
Goldenhar syndrome is a well-known developmental anomaly of the maxillofacial skeleton and hemifacial soft tissue. Maxillofacial anomalies of that syndrome can be managed by a variety of means such as inlay- or onlay-applied nonvascularized bone grafts, vascularized osteocutaneous/osseous flaps, or distraction osteogenesis. Vascularized full-thickness calvarial bone grafting is an important option for mandibular reconstruction for cases in which, for one reason or another, other techniques are not available, not applicable, or have failed. ⋯ Sequential bone scintigraphies, performed to assess the vascularity of the grafts 1 week, 1 month, and 1 year after the operation, demonstrated the viability of transferred vascularized bone graft. The temporalis muscle osteofascial flap is a reliable method for mandibular reconstruction. It lessens the operative time, lessens surgical team labor, minimizes postoperative morbidity and discomfort, minimizes the hospital stay period, and minimizes financial expenses without renouncing the bone-healing capacity and increases aesthetic outcome by camouflaging the donor site scar in scalp and minimizing the facial scarring.
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Patients with syndromic craniosynostosis are at risk for elevated intracranial pressure because of various physiologic and anatomic abnormalities. The aims of this study were to determine the prevalence of papilledema in syndromic craniosynostosis, to evaluate the results of the treatment, and to examine the risk factors. This is a retrospective study on 84 patients with Apert, Crouzon, or Pfeiffer syndrome. ⋯ The prevalence of papilledema in patients with Apert, Crouzon, or Pfeiffer syndrome is high, not only before cranial decompression but also after vault expansion. Annual fundoscopy is recommended to screen for papilledema. We consider that early decompressive surgery (within the first year of age) prevents the development of papilledema and, most likely, elevated intracranial pressure.
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Palsy of the lingual nerve (LN) during third molar extractions, ramus osteotomies, anesthetic injections, procedures of orthognathic, preprosthetic, and periodontal surgery are important complications reported with varying frequency. The purpose of this study is to present quantitative data describing the position and shape of the LN in the third molar area. In the course of dissection, the LN was noted, as well as the furcation pattern, position, course, and anatomic relations under 2.5X loupe magnification in 21 adult male human cadavers. ⋯ The horizontal distance of the LN from the lingual plate of the mandible was greater in this study than in previous studies. This study provided measurable objective criteria for the relationship of LN in the third molar region. The knowledge of the relationship between the LN and third molar region is useful for the surgeon in avoiding unexpected complications.