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1.
Plast Reconstr Surg ; 145(4): 944-946, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32221210

RESUMEN

Treatment of nasal deformity and obstruction requires analysis, planning, and precise execution of rhinoplasty techniques. When performed well, rhinoplasty is a powerful tool for achieving appealing nasal morphology and optimizing function. This article aims to highlight an open approach to septorhinoplasty using a number of techniques that are preferred by the senior author (D.M.S.) to successfully correct a congenital nasal deformity and deviated septum.

2.
Plast Reconstr Surg ; 145(1): 80-83, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31881606

RESUMEN

Facial aging patients frequently seek improved neck and jawline definition. Microgenia, or lack of chin support, is often overlooked or underdiagnosed in these patients. The authors propose a simultaneous genioplasty, in addition to platysmaplasty and face/neck lift, to address both soft-tissue and bony components, and enhance the cervicomental area. The platysmaplasty is performed in a novel fashion using the intraoral genioplasty incision. The operative sequence includes intraoral incision, platysmal exposure, fat excision, platysmal tightening, genioplasty osteotomy/fixation, and external skin redraping (face/neck lift). Case examples are shown to illustrate appropriate candidate selection and results. Parameters for success include increased chin-throat distance and definition, improved cervicomental angle, and soft-tissue rejuvenation. The novel approach the authors describe enables discrete access to the platysmal and submental region and provides bony definition to help optimize the soft-tissue drape and definition. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.


Asunto(s)
Mentoplastia/métodos , Boca/cirugía , Ritidoplastia/métodos , Anciano , Femenino , Humanos , Persona de Mediana Edad , Cuello/cirugía , Resultado del Tratamiento
3.
J Wrist Surg ; 8(4): 335-343, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31404192

RESUMEN

Background Length of immobilization after operative fixation of unstable distal radius fractures and management in elderly patients is an area of debate. Purpose The purpose of this study is to delineate common practices of fellowship-trained hand surgeons and how they compare with current evidence-based protocols. Methods Surveys were distributed to American Society for Surgery of the Hand members on preferred methods of fixation, postoperative immobilization, and variations in treatment of elderly patients with unstable distal radius fractures. Responses were analyzed in comparison to a literature review. Subgroups were compared with regard to training, practice type, and years in practice. Results Four-hundred eighty-five surveys were analyzed. Volar fixed-angle plating was the most common choice of fixation (84.7%). Patients are most often immobilized for 1 to 2 weeks (40.0%) with range of motion (ROM) therapy begun most commonly between 1 and 4 weeks (47.2%). The majority of surgeons do not treat fractures differently in patients more than 65 years old. Physicians with more than 20 years of experience were significantly more likely to begin wrist ROM sooner with volar plating versus other fixation techniques compared with physicians with less than 20 years of experience (40.7% vs. 34.2%, respectively). Also, physicians in academic-only practices were more likely to immobilize patients for a shorter time after volar plating compared with those in privademics. Conclusion Volar fixed-angle plating is the dominant fixation method for unstable distal radius fractures among fellowship-trained hand surgeons. Elderly patients are not treated more conservatively and rigid immobilization after operative fixation remains the treatment of choice despite current evidence-based protocols.

4.
J Craniofac Surg ; 30(8): 2601-2603, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31449227

RESUMEN

Correction of facial asymmetry caused by active unilateral condylar hyperplasia (CH) requires proper diagnosis, arrested ongoing condylar growth, and ultimately orthognathic surgery. Traditionally, prior to performing orthognathic surgery, active CH is addressed either by: awaiting natural cessation of condylar overgrowth, or performing an interval high condylectomy (to stop growth). However, these strategies both add to the total treatment time, by either waiting and confirming no active growth, or performing a first stage growth-arresting procedure. In this report, the authors describe concurrent high condylectomy, and 3-jaw orthognathic surgery, to address the root of the problem and provide aesthetic correction in the same setting. This clinical series illustrates a detailed description of this approach, highlighting operative order, and an analysis of outcomes.


Asunto(s)
Asimetría Facial/cirugía , Mandíbula/cirugía , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Adulto , Femenino , Humanos , Cóndilo Mandibular/cirugía , Persona de Mediana Edad , Procedimientos Quirúrgicos Ortognáticos/métodos , Adulto Joven
5.
J Craniofac Surg ; 30(5): 1488-1491, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31299750

RESUMEN

PURPOSE: Orthognathic surgery for dentofacial deformities is typically preceded and followed by orthodontic treatment. Traditionally, orthodontic hardware is secured to the dentition to allow dental movement and stabilization. Clear-aligner therapy (eg, Invisalign) provides an aesthetic alternative, consisting of a series of transparent trays. Its use has not been described in complex triple-jaw orthognathic surgery. The purpose of this study is to evaluate perioperative outcomes and 3-dimensionally quantify postoperative edema in Invisalign patients undergoing triple-jaw orthognathic procedures, comparing this to patients treated with conventional fixed appliances. The surgical approach to patients with clear-aligners is also outlined. METHODS: The authors conducted a retrospective chart review and 3-dimensional morphometric study of Invisalign patients undergoing triple-jaw surgery (LeFort I osteotomy, bilateral sagittal split osteotomy, and genioplasty). An identical assessment of demographically matched patients treated with conventional fixed appliances was performed and compared with the Invisalign group. RESULTS: Thirty-three patients, with a mean age of 19.99 years, were included: 13 with Invisalign and 20 with conventional fixed appliances. No significant difference was observed in operating time, concurrent extraction of teeth, fat grafting, duration of hospital stay, diet advancement, and use of narcotic analgesics between the 2 groups. Nine patients had sufficient 3-dimensional images for volumetric analysis (4 with Invisalign and 5 with conventional fixed appliances). Postoperative edema was not significantly different (P = 0.712) when comparing conventional fixed appliances (44.29 ±â€Š23.16 cm) to Invisalign (37.36 ±â€Š31.19 cm). CONCLUSION: The present study demonstrates that complex multiple-jaw orthognathic procedures can be successfully performed in Invisalign patients. Perioperative and short-term clinical outcomes are not compromised.


Asunto(s)
Aparatos Ortodóncicos Fijos , Cirugía Ortognática , Femenino , Mentoplastia , Humanos , Tempo Operativo , Aparatos Ortodóncicos Removibles , Osteotomía , Periodo Posoperatorio , Estudios Retrospectivos , Resultado del Tratamiento
6.
J Craniofac Surg ; 2019 Apr 24.
Artículo en Inglés | MEDLINE | ID: mdl-31033684

RESUMEN

PURPOSE: Orthognathic surgery for dentofacial deformities is typically preceded and followed by orthodontic treatment. Traditionally, orthodontic hardware is secured to the dentition to allow dental movement and stabilization. Clear-aligner therapy (eg, Invisalign) provides an aesthetic alternative, consisting of a series of transparent trays. Its use has not been described in complex triple-jaw orthognathic surgery. The purpose of this study is to evaluate perioperative outcomes and 3-dimensionally quantify postoperative edema in Invisalign patients undergoing triple-jaw orthognathic procedures, comparing this to patients treated with conventional fixed appliances. The surgical approach to patients with clear-aligners is also outlined. METHODS: The authors conducted a retrospective chart review and 3-dimensional morphometric study of Invisalign patients undergoing triple-jaw surgery (LeFort I osteotomy, bilateral sagittal split osteotomy, and genioplasty). An identical assessment of demographically matched patients treated with conventional fixed appliances was performed and compared with the Invisalign group. RESULTS: Thirty-three patients, with a mean age of 19.99 years, were included: 13 with Invisalign and 20 with conventional fixed appliances. No significant difference was observed in operating time, concurrent extraction of teeth, fat grafting, duration of hospital stay, diet advancement, and use of narcotic analgesics between the 2 groups. Nine patients had sufficient 3-dimensional images for volumetric analysis (4 with Invisalign and 5 with conventional fixed appliances). Postoperative edema was not significantly different (P = 0.712) when comparing conventional fixed appliances (44.29 ±â€Š23.16 cm) to Invisalign (37.36 ±â€Š31.19 cm). CONCLUSION: The present study demonstrates that complex multiple-jaw orthognathic procedures can be successfully performed in Invisalign patients. Perioperative and short-term clinical outcomes are not compromised.

7.
J Oral Maxillofac Surg ; 73(2): 274-83, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25579010

RESUMEN

PURPOSE: Inborn errors of metabolism (IEMs) are genetic disorders that alter normal physiologic functioning. Deficiency of 3-methylcrotonyl-coenzyme A carboxylase is one such IEM that can lead to major episodes of metabolic dysfunction. Certain IEMs are associated with characteristic congenital dysmorphic facial features. This can be problematic, because these dysmorphisms can mask underlying tumor growth. Literature is lacking on a causal relation between IEM and odontogenic tumor development. MATERIALS AND METHODS: This case was explained in detail and a review of the literature was undertaken. PubMed was used to search for articles involving surgical management of odontogenic myxoma (OM) and associations between odontogenic tumors and IEM. RESULTS: It was determined that the development of odontogenic tumors, specifically OM, is associated with IEMs. These tumors can easily be overlooked as a common dysmorphic feature of an IEM. CONCLUSION: IEMs lead to major metabolic disturbances and, thus, can alter the cellular microenvironment. Hypothetically, these alterations can lead to the development of odontogenic tumors. With the diagnosis of IEM becoming more common owing to improved newborn screening, careful attention should be given to these patients because of the possibility that dysmorphologic facial features could be masking underlying tumor growth.


Asunto(s)
Cara/anomalías , Cara/patología , Errores Innatos del Metabolismo/patología , Tumores Odontogénicos/patología , Preescolar , Humanos , Masculino , Errores Innatos del Metabolismo/cirugía , Tumores Odontogénicos/complicaciones , Tumores Odontogénicos/cirugía
8.
J Oral Maxillofac Surg ; 71(12): 2039.e1-6, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24095008

RESUMEN

PURPOSE: Takotsubo cardiomyopathy (TCM) is a syndrome characterized by a transient episode of heart failure. The specific etiology of this condition is widely speculated. The purpose of this case report and literature review was to investigate the incidence of TCM with regard to general anesthesia, especially those cases involving operative procedures within the realm of oral and maxillofacial surgery. It is intended that the present case serve as a guide for fellow surgeons to identify and manage this syndrome. MATERIALS AND METHODS: The present case was explained and a review of the literature was performed. PubMed was used to search for articles involving surgical procedures under general anesthesia, including oral and maxillofacial surgery. RESULTS: It was determined that TCM rarely occurs in conjunction with surgical procedures under general anesthesia, especially those of the head and neck region. CONCLUSIONS: TCM is an uncommon medical condition with significant morbidity and mortality when managed incorrectly. The occurrence of this syndrome in relation to oral and maxillofacial procedures is also rare, although it is imperative that surgeons be able to recognize and treat this condition appropriately.


Asunto(s)
Anestesia General/efectos adversos , Hipotensión/etiología , Traumatismos Maxilofaciales/cirugía , Procedimientos Quirúrgicos Orales/efectos adversos , Cardiomiopatía de Takotsubo/etiología , Accidentes de Tránsito , Asimetría Facial/etiología , Femenino , Humanos , Incisivo/lesiones , Maloclusión/etiología , Traumatismos de los Dientes/cirugía , Adulto Joven
9.
Artículo en Inglés | MEDLINE | ID: mdl-20813562

RESUMEN

OBJECTIVES: The development of oral squamous cell carcinoma (OSCC) is a complex, multistep process. To date, numerous oncogenes and tumor-suppressor genes have been implicated in oral carcinogenesis. Of particular interest in this regard are genes involved in cell cycling and apoptosis, such BRAF, KRAS, and PIK3CA genes. STUDY DESIGN: Mutations of BRAF, KRAS, and PIK3CA were evaluated by direct genomic sequencing of exons 1 of KRAS, 11 and 15 of BRAF, and 9 and 20 of PIK3CA in OSCC specimens. RESULTS: Both BRAF and KRAS mutations were detected with a mutation frequency of 2% (1/42). PIK3CA mutations were detected at 3% (1/35). CONCLUSIONS: This is the first report implicating BRAF mutation in OSCC. Our study supports that mutations in the BRAF, KRAS, and PIK3CA genes make at least a minor contribution to OSCC tumorigenesis, and pathway-specific therapies targeting these 2 pathways should be considered for OSCC in a subset of patients with these mutations.


Asunto(s)
Carcinoma de Células Escamosas/genética , Neoplasias de la Boca/genética , Mutación/genética , Fosfatidilinositol 3-Quinasas/genética , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas/genética , Proteínas ras/genética , Adulto , Anciano , Anciano de 80 o más Años , Apoptosis/genética , Biomarcadores de Tumor/genética , Ciclo Celular/genética , Fosfatidilinositol 3-Quinasa Clase I , Estudios de Cohortes , Análisis Mutacional de ADN , Exones/genética , Femenino , Amplificación de Genes , Neoplasias Gingivales/genética , Humanos , Masculino , Neoplasias Mandibulares/genética , Neoplasias Maxilares/genética , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Proteínas Proto-Oncogénicas p21(ras) , Análisis de Secuencia de ADN , Neoplasias de la Lengua/genética
10.
N Y State Dent J ; 74(2): 47-9, 2008 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-18450190

RESUMEN

This investigation evaluated preferred treatment methods for primary tooth vital pulpotomies. One hundred and thirty surveys were sent to a randomly selected sample of board-certified pediatric dentists practicing in the United States. Ninety-two questionnaires were returned, for a 71% response rate. This yielded a sample group of 92 board-certified pediatric dentists. The most commonly used medicament was formocresol. Seventy-three percent using formocresol said they were not concerned about adverse side effects of formocresol and formaldehyde. Sixty-one percent of respondents used formocresol for primary tooth vital pulpotomies. Twenty-eight percent of respondents used undiluted, and 33% used diluted. The results of this survey suggest that the majority of dentists who used formocresol were not concerned with any adverse effects.


Asunto(s)
Pautas de la Práctica en Odontología , Pulpotomía/métodos , Niño , Preescolar , Compuestos Férricos/uso terapéutico , Formocresoles/uso terapéutico , Humanos , Encuestas y Cuestionarios , Diente Primario
11.
Cancer Lett ; 249(2): 242-8, 2007 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-17097223

RESUMEN

The Raf/MEK/ERK (MAPK) signal transduction is an important mediator of a number of cellular fates including growth, proliferation, and survival. The BRAF gene is activated by oncogenic RAS, leading to cooperative effects in cells responding to growth factor signals. Our study was performed to elucidate a possible role of BRAF in the development of IPMN (Intraductal Papillary Mucinous Neoplasm) and IPMC (Intraductal Papillary Mucinous Carcinoma) of the pancreas. Mutations of BRAF and KRAS were evaluated in 36 IPMN/IPMC samples and two mucinous cystadenomas by direct genomic sequencing. Exons 1 for KRAS, and 5, 11, and 15 for BRAF were examined. Totally we identified 17 (47%) KRAS mutations in exon 1, codon 12 and one missense mutation (2.7%) within exon 15 of BRAF. The mutations appear to be somatic since the same alterations were not detected in the corresponding normal tissues. Our data provide evidence that oncogenic properties of BRAF contribute to the tumorigenesis of IPMN/IPMC, but at a lower frequency than KRAS.


Asunto(s)
Adenocarcinoma Mucinoso/genética , Adenocarcinoma Papilar/genética , Carcinoma Ductal Pancreático/genética , Genes ras/genética , Neoplasias Pancreáticas/genética , Proteínas Proto-Oncogénicas B-raf/genética , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mutación
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