In vitro investigation of heat transfer in calf spinal cord during polymethylmethacrylate application for vertebral body reconstruction.
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The objective of this experimental study was to investigate the temperature variations within the spinal cord of calf cadavers during polymethlymethacrylate (PMMA) application for vertebral body reconstruction. Cervical spines including the cervical spinal cord of ten fresh cadavers were used. Corpectomy and laminectomy were performed and dura was exposed at the same level for proper placement of thermal sensors. Sensors were placed in multiple holes in the spinal cord at depths of 3, 6, 9 and 12 mm, respectively. Whether the thermal sensors were placed in the gray or white matter was determined by computerized tomography. The white and gray matters of the spinal cord exhibited different thermal properties. The white matter was more conductive and absorbed less heat than the gray matter. The heat sensor nearest to PMMA exhibited temperatures of 42-44 degrees C. The second heat sensor placed at 9 mm depth within the gray matter showed 44 degrees C. The third sensor, which was placed at 6 mm depth within the spinal cord recorded the same temperature as the first, i.e., nearest to PMMA sensor. The fourth heat sensor, which was at the farthest location from PMMA demonstrated 37-39 degrees C. The temperature distribution within the gray matter was inversely proportional to the distance from the heat source. The temperature at the dorsal white matter, which was distant from the heating source, remained nearly constant and was not elevated. Our data suggest that thermal injury to the spinal cord during PMMA application may be expected to be more significant in the gray matter when compared with other neural tissues. (+info)
Combining chin-jowl implants with local anesthesia facial rejuvenation.
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Mandibular implantation is an outpatient procedure that can be used in combination with other minimally invasive cosmetic interventions. Specifically, silastic chin implants can help create a strong chin and smooth the jaw-line in carefully selected patients. A standard surgical excision tray plus a few additional simple instruments are required, and a variety of commercially available implants are available for placement via an intraoral or submental approach. Meticulous technique minimizes the small risk of nerve injury and numbness. Chin-jowl implants may be preceded by neck liposuction and immediately followed by a face-lift to achieve overall facial enhancement. (+info)
Functional outcomes in patients reconstructed with flaps following surgery for hypopharyngeal cancer.
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Following oncologic surgery for advanced cancer of the hypopharynx, primary closure of the defect of the upper aerodigestive tract is difficult to achieve. Usually locoregional or free flaps are used, the choice being determined by the extent of the surgical defect, the expertise of the surgeons and the general condition of the patient. Aim of the present study was to evaluate the functional recovery of patients who underwent surgical reconstruction, following hypopharyngeal cancer resection, with pedicled or free flaps. A retrospective analysis was conducted examining hospital records of the patients submitted to surgical treatment for hypopharyngeal cancer and reconstruction with pedicled or free flaps in the period between January 1995 and July 2004. Free flaps showed less severe complications, shorter hospital stay, less time to resume oral feeding compared with pedicled flaps. For this reason, we consider free flaps the gold standard for hypopharyngeal reconstruction, while pedicled flaps as the pectoralis major or other locoregional flaps should be used in those cases in which free flap reconstruction is not feasible or contraindicated. (+info)
Early postoperative bone scintigraphy in the evaluation of microvascular bone grafts in head and neck reconstruction.
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BACKGROUND: Bone scintigraphy was performed to monitor anastomotic patency and bone viability. METHODS: In this retrospective study, bone scans were carried out during the first three postoperative days in a series of 60 patients who underwent microvascular bone grafting for reconstruction of the mandible or maxilla. RESULTS: In our series, early bone scans detected a compromised vascular supply to the bone with high accuracy (p < 10-6) and a sensitivity that was superior to the sensitivity of clinical monitoring (92% and 75% respectively). CONCLUSION: When performing bone scintigraphy during the first three postoperative days, it not only helps to detect complications with high accuracy, as described in earlier studies, but it is also an additional reliable monitoring tool to decide whether or not microvascular revision surgery should be performed. Bone scans were especially useful in buried free flaps where early postoperative monitoring depended exclusively on scans. According to our experience, we recommend bone scans as soon as possible after surgery and immediately in cases suspicious of vascularized bone graft failure. (+info)
Successful surgical management of a delayed pharyngo-esophageal perforation after anterior cervical spine plating.
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