A Comprehensive Approach To Alloplastic Cranioplasty: Novel Implant Design And Refinement of Soft Tissue Management

FACE ◽  
2021 ◽  
pp. 273250162110643
Author(s):  
Kaylee O’Connor ◽  
Cole Holan ◽  
Nikita Choudhary ◽  
Eileen Curry ◽  
Raymond Harshbarger
Keyword(s):  
Large Scale ◽  
Intraoperative Complications ◽  
Patient Characteristics ◽  
Implant Design ◽  
Brain Protection ◽  
Temporalis Muscle ◽  
The Past ◽  
Cosmetic Outcomes ◽  
A New Technique

Background: Large scale craniectomy defects are commonly reconstructed with alloplastic implants, which can restore brain protection and promote cosmesis. However, esthetic outcomes can be subpar due to skin contour abnormalities and temporal hollowing. Herein we describe a senior craniofacial surgeon’s experience using a custom composite polyetheretherketone (PEEK) and porous polyethylene (Medpor) implant for alloplastic cranioplasty. Methods: A retrospective review was conducted of all PEEK-Medpor cranioplasty cases performed over the past 2 years. Patient characteristics, intraoperative information, surgical outcomes, and cosmetic outcomes were reviewed. Results: Sixteen patients (18-70 years of age) underwent surgery. Indications for cranioplasty included craniectomy due to trauma, stroke, or tumor, and bone resorption after a prior autologous cranioplasty. Augmentation of the temporalis area using alloderm or a muscle graft was performed in 7 cases. There were no intraoperative complications. Ultimately, all implants were maintained. One implant was temporarily removed due to infection, but successfully replaced. Three minor complications occurred. At an average follow-up of 9 months, 93.8% of surgical sites showed no significant temporal hollow. Conclusion: We describe a series of 16 implants using a composite PEEK Medpor implant for alloplastic cranioplasty, which resulted in a low infection rate and improved postoperative regional contour. Use of this implant with suspension of the temporalis muscle is a new technique that may allow for better adherence of the temporalis muscle to its anatomic position, while still providing good brain protection.

scholarly journals Mapping YouTube

First Monday ◽  
2020 ◽  
Author(s):  
Bernhard Rieder ◽  
Òscar Coromina ◽  
Ariadna Matamoros-Fernández
Keyword(s):  
Social Media ◽  
Large Scale ◽  
Networked Systems ◽  
Relative Importance ◽  
The Past ◽  
Media System ◽  
Inductive Character ◽  
Social Media Service ◽  
The Many

Over the past 15 years, YouTube has emerged as a large and dominant social media service, giving rise to a ‘platformed media system’ within its technical and regulatory infrastructures. This paper relies on a large-scale sample of channels (n=36M+) to explore this media system along three main lines. First, we investigate stratification and hierarchization in broadly quantitative terms, connecting to well-known tropes on structural hierarchies emerging in networked systems, where a small number of elite actors often dominate visibility. Second, we inquire into YouTube’s channel categories, their relationships, and their proportions as a means to better understand the topics on offer and their relative importance. Third, we analyze channels according to country affiliation to gain insights into the dynamics and fault lines that align with country and language. Throughout the paper, we emphasize the inductive character of this research, by highlighting the many follow-up questions that emerge from our findings.

Frontozygomatic Titanium Cranioplasty in Frontosphenotemporal (“Pterional”) Craniotomy

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS262-ONS265 ◽  
Author(s):  
Shaan M. Raza ◽  
Quoc-Anh Thai ◽  
Gustavo Pradilla ◽  
Rafael J. Tamargo
Keyword(s):  
Vascular Malformations ◽  
Titanium Plate ◽  
Temporalis Muscle ◽  
Pterional Craniotomy ◽  
Orbital Pain ◽  
Definitive Solution ◽  
Cosmetic Outcomes ◽  
Common Problems ◽  
Titanium Cranioplasty

Abstract Objective: One of the most common problems after frontosphenotemporal, or pterional, craniotomy is the marked depression of the frontozygomatic fossa caused by atrophy of the temporalis muscle. Although temporalis muscle reconstruction techniques have been proposed to prevent this problem, a definitive solution has not been achieved. We report the results of a titanium cranioplasty technique in a prospective series of patients who underwent frontosphenotemporal craniotomy. Methods: Between April 2002 and June 2006, 209 consecutive patients underwent a frontosphenotemporal craniotomy for aneurysms, vascular malformations, or tumors. At the time of surgery, the patients underwent a frontozygomatic fossa cranioplasty with a titanium plate, to which the temporalis muscle was attached. In this series, 194 patients had documented follow-up periods averaging 9.5 months (range, 1 mo–4 yr; median, 7.5 mo), and the cosmetic results of the cranioplasty have been assessed. Results: The cosmetic outcomes have been outstanding in all patients treated to date. Two patients had the cranioplasty removed due to either orbital pain or local infection secondary to sepsis. Conclusion: The frontozygomatic cranioplasty during frontosphenotemporal craniotomy prevents the characteristic depression at the frontozygomatic fossa and accomplishes an outstanding cosmetic result.

scholarly journals Assertive outreach teams in London: Patient characteristics and outcomes

2003 ◽  
Vol 183 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Stefan Priebe ◽  
Walid Fakhoury ◽  
Joanna Watts ◽  
Paul Bebbington ◽  
Tom Burns ◽  
...  
Keyword(s):  
Substance Misuse ◽  
Patient Characteristics ◽  
Violent Behaviour ◽  
Assertive Outreach ◽  
The Past ◽  
Outreach Services ◽  
Wide Range ◽  
The Uk ◽  
Team Types

BackgroundAlthough the model of assertive outreach has been widely adopted, it is unclear who receives assertive outreach in practice and what outcomes can be expected under routine conditions.AimsTo assess patient characteristics and outcome in routine assertive outreach services in the UK.MethodPatients (n=580) were sampled from 24 assertive outreach teams in London. Outcomes – days spent in hospital and compulsory hospitalisation – were assessed over a 9-month follow-up.ResultsThe 6-month prevalence rate of substance misuse was 29%, and 35% of patients had been physically violent in the past 2 years. During follow-up, 39% were hospitalised and 25% compulsorily admitted. Outcome varied significantly between team types. These differences did not hold true when baseline differences in patient characteristics were controlled for.ConclusionsRoutine assertive outreach serves a wide range of patients with significant rates of substance misuse and violent behaviour. Over a 9-month period an average of 25% of assertive outreach patients can be expected to be hospitalised compulsorily. Differences in outcome between team types can be explained by differences in patient characteristics.

Percutaneous Placement of Ventriculoatrial Shunts: Four-Year Case Experience

Neurosurgery ◽  
1986 ◽  
Vol 18 (3) ◽  
pp. 348-349 ◽  
Author(s):  
Mark Carol ◽  
Walker Robinson ◽  
Bruce S. Harris
Keyword(s):  
Operative Time ◽  
Intraoperative Complications ◽  
Venous Access ◽  
The Past ◽  
Atrial Catheter ◽  
Adolescents And Adults ◽  
Sheath Introducer ◽  
Average Operative Time ◽  
Age Range

Abstract During the past 4 years, we have used percutaneous placement of the atrial catheter in 39 patients who have undergone ventriculoatrial shunting. The age range of our patients has been from 9 to 74 years of age, with routine indications existing. Both subclavian and internal jugular venous access have been utilized, with the latter being our preferred route of access for reasons of safety. Average operative time has been approximately 35 to 40 minutes. Both traditional and split-sheath introducer catheters have been used. Patient follow-up has been up to 4 years. Intraoperative complications have been limited to puncture of the carotid artery on two occasions; neither affected the ultimate performance of the procedure. Postoperative complications have been limited to those peculiar to shunt procedures in general and have required revision in four instances. One patient suffered an infection secondary to shunting. The benefits of this procedure seem to include safety, decreased operative site exposure, and decreased operative time, all factors that may contribute to a lower than normal infection rate and may warrant consideration of this procedure in adolescents and adults for whom ventriculoatrial shunting is indicated.

S149 – Sinonasal Mucosal Melanoma: A 12-Year Experience

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P126-P126
Author(s):  
Kailash Narasimhan ◽  
Omer Kucuk ◽  
Robert Mathog ◽  
Michael A Carron
Keyword(s):  
Patient Characteristics ◽  
Mucosal Melanoma ◽  
Recurrence Rates ◽  
Patients Âgés ◽  
The Past ◽  
Medial Maxillectomy ◽  
Melanoma Patients ◽  
Anatomic Locations ◽  
Disease Free

Objectives 1) Describe the Sinonasal Mucosal Melanoma patients (SNMM) our institution has treated. 2) Assess outcomes of surgical and adjuvant therapies for this disease. Methods Records of 18 patients diagnosed between 1995 and 2007 were reviewed, with a focus on patient characteristics, treatment outcomes, and modalities. Results Patients’ ages ranged from 31 to 85. Most common anatomic locations were maxillary sinus in 12 patients and lateral nasal walls in 6. 5 patients had cribriform plate involvement, and 3 had orbital involvement. Tumor thickness averaged 3.1 cm. 15 of the 18 patients had definitive surgical resection of their primary. Most common surgical procedure was medial maxillectomy. 6 patients were operated on despite disease in prognostically poor locations such as skull base, orbit, cribiform plate, and nasopharynx. Margins ranged from 0.5 to 4 cm. 10 patients received chemo- or immunotherapy, 11 received radiotherapy, and 6 received both. Recurrence rate was 10/18 (55%), while distant metastatic rate was 6/18 (33%), the lung being the most common metastatic location (4 patients). Average follow-up was 38.6 months, with disease-free intervals ranging from 8 to 39 months in patients with recurrences. After 2000, patients only received limited surgical resections, and were treated at stages I-II. Conclusions Despite the poor prognosis of SNMM, over the past 13 years at our institution the trend has been towards patients being diagnosed and treated at an earlier stage and having less extensive surgical resections. Advances in imaging, negative margins, radiation, and the use of immunotherapy may have influenced patient outcomes and recurrence rates.

scholarly journals Modified everting sutures combined with reattachment to the inferior tarsal plate for involutional lower eyelid entropion: A new technique

2020 ◽  
Vol 47 (4) ◽  
pp. 347-353
Author(s):  
Emine Malkoc Sen ◽  
Kubra Ozdemir Yalcinsoy
Keyword(s):  
Recurrence Rate ◽  
Intraoperative Complications ◽  
Case Series ◽  
Lower Eyelid ◽  
New Technique ◽  
Before And After ◽  
A New Technique ◽  
The Right ◽  
Horizontal Eyelid Laxity

Background This study evaluated the outcomes of a new modified Wies technique for patients with involutional lower eyelid entropion without horizontal eyelid laxity.Methods This case series retrospectively analyzed consecutive patients with entropion who underwent surgery between January 2014 and March 2019 by the same experienced surgeon. Horizontal eyelid laxity, lower eyelid retractor function, and orbicularis muscle overriding were recorded before and after surgery. The recurrence rate and complications were also evaluated. This technique consisted of modified everting sutures combined with reattachment of the lower eyelid retractors to the inferior tarsal plate.Results This new technique was performed on 28 eyes in 25 patients (mean age, 71.0±8.0 years; range, 56–87 years). Nine patients (36%) were women and 16 (64%) were men. Lower lid entropion was present in the right eye in 14 patients (56%), the left eye in eight patients (32%), and both eyes in three patients (12%). The mean follow-up period was 27.3±12.4 months (range, 6–60 months). No intraoperative complications were observed. All patients’ symptoms were alleviated. One patient (3.6%) had recurrence after 2 years (success rate, 96.4%). The remaining 27 eyes maintained a satisfactory and comfortable eyelid position. No patients had problems with scarring.Conclusions The approach described herein proved to be safe and feasible in eyes with involutional lower eyelid entropion without horizontal eyelid laxity. These advantages of this procedure include the lack of a conjunctival scar, punctal eversion, and lateral canthal angle deformation. A low recurrence rate and a long interval to recurrence were also observed.

scholarly journals Management of Adult Unilateral TMJ Ankylosis with Temporalis Muscle and Fascia Flap: Review of 51 Cases

2012 ◽  
Vol 3 (3) ◽  
pp. 133-136
Author(s):  
Sobhan Mishra ◽  
Ramanupam Tripathy ◽  
Samrat Sabhlok ◽  
Ritesh Roy
Keyword(s):  
Treatment Options ◽  
Mouth Opening ◽  
Early Mobilization ◽  
Functional Results ◽  
Temporalis Muscle ◽  
Tmj Ankylosis ◽  
Study Support ◽  
Cosmetic Outcomes ◽  
Fascia Flap

ABSTRACT Purpose This study is aimed to determine the efficacy of temporalis muscle and fascia flap in the treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults. Treatment of TMJ ankylosis has been a topic of debate and the treatment options are multidimensional. Achieving good postoperative mouth opening and functional and cosmetic outcomes of surgery, depends on the method of reconstruction. The need of study is to give the best possible solutions with minimal morbidity to the underlying deformity. Materials and methods A retrospective study was done on 51 patients to evaluate the postoperative results for unilateral TMJ ankylosis. Parameters such as etiology, postoperative mouth opening on 1st, 2nd, 6th week and 6 months and intraoperative and postoperative complications were recorded. The operative protocol for unilateral TMJ ankylosis entailed: (1) Resection of the ankylotic mass, (2) intraoral ipsilateral coronoidectomy, (3) contralateral coronoidectomy when necessary, (4) interpositional tissue transfer to the TMJ with temporalis muscle and fascia flap, (5) maxillomandibular fixation (MMF) and (6) early mobilization and aggressive physiotherapy. Results The results were encouraging and functional results of interpositional arthroplasty were satisfying with minimal complications. Early postoperative initial aggressive exercise, physiotherapy, and strict follow-up play an important role in preventing postoperative adhesions. Conclusion The findings of this study support the use of temporalis muscle and fascia flap in adult patients with unilateral TMJ ankylosis. How to cite this article Mishra S, Tripathy R, Sabhlok S, Roy R. Management of Adult Unilateral TMJ Ankylosis with Temporalis Muscle and Fascia Flap: Review of 51 Cases. Int J Head and Neck Surg 2012;3(3):133-136.

scholarly journals Conference Summary

2013 ◽  
Vol 9 (S304) ◽  
pp. 426-431 ◽  
Author(s):  
David B. Sanders
Keyword(s):  
Active Galactic Nuclei ◽  
Galaxy Evolution ◽  
Gamma Rays ◽  
Time Domain ◽  
Large Scale ◽  
Galactic Nuclei ◽  
The Past ◽  
Multi Wavelength ◽  
Objective Prism

AbstractThis conference on “Multi-wavelength AGN Surveys and Studies” has provided a detailed look at the explosive growth over the past decade, of available astronomical data from a growing list of large scale sky surveys, from radio-to-gamma rays. We are entering an era were multi-epoch (months to weeks) surveys of the entire sky, and near-instantaneous follow-up observations of variable sources, are elevating time-domain astronomy to where it is becoming a major contributor to our understanding of Active Galactic Nuclei (AGN). While we can marvel at the range of extragalactic phenomena dispayed by sources discovered in the original “Markarian Survey” – the first large-scale objective prism survey of the Northern Sky carried out at the Byurakan Astronomical Observtory almost a half-century ago – it is clear from the talks and posters presented at this meeting that the data to be be obtained over the next decade will be needed if we are to finally understand which phase of galaxy evolution each Markarian Galaxy represents.

scholarly journals A Quest to Identify Prostate Cancer Circulating Biomarkers with a Bench-to-Bedside Potential

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Jaspreet Singh Batra ◽  
Swati Girdhani ◽  
Lynn Hlatky
Keyword(s):  
Prostate Cancer ◽  
Large Scale ◽  
Specific Antigen ◽  
Health Concern ◽  
Treatment Modalities ◽  
Potential Candidate ◽  
Circulating Biomarkers ◽  
Major Health ◽  
The Past

Prostate cancer (PCA) is a major health concern in current times. Ever since prostate specific antigen (PSA) was introduced in clinical practice almost three decades ago, the diagnosis and management of PCA have been revolutionized. With time, concerns arose as to the inherent shortcomings of this biomarker and alternatives were actively sought. Over the past decade new PCA biomarkers have been identified in tissue, blood, urine, and other body fluids that offer improved specificity and supplement our knowledge of disease progression. This review focuses on superiority of circulating biomarkers over tissue biomarkers due to the advantages of being more readily accessible, minimally invasive (blood) or noninvasive (urine), accessible for sampling on regular intervals, and easily utilized for follow-up after surgery or other treatment modalities. Some of the circulating biomarkers like PCA3, IL-6, and TMPRSS2-ERG are now detectable by commercially available kits while others like microRNAs (miR-21, -221, -141) and exosomes hold potential to become available as multiplexed assays. In this paper, we will review some of these potential candidate circulating biomarkers that either individually or in combination, once validated with large-scale trials, may eventually get utilized clinically for improved diagnosis, risk stratification, and treatment.

scholarly journals Characteristics of teams, staff and patients: associations with outcomes of patients in assertive outreach

2004 ◽  
Vol 185 (4) ◽  
pp. 306-311 ◽  
Author(s):  
Stefan Priebe ◽  
Walid Fakhoury ◽  
Ian White ◽  
Joanna Watts ◽  
Paul Bebbington ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Favourable Outcome ◽  
Assertive Outreach ◽  
The Past ◽  
Eleven Patient ◽  
Team Working ◽  
Outreach Services ◽  
Burn Out ◽  
The Uk

BackgroundLittle is known about what characteristics of teams, staff and patients are associated with a favourable outcome of severe mental illness managed by assertive outreach.AimsTo identify predictors of voluntary and compulsory admissions in routine assertive outreach services in the UK.MethodNine features of team organisation and policy, five variables assessing staff satisfaction and burn-out and eleven patient characteristics taken from the baseline data of the Pan-London Assertive Outreach Study were tested as predictors of voluntary and compulsory admissions within a 9-month follow-up period.ResultsWeekend working, staff burn-out and lack of contact of the patient with other services were associated independently with a higher probability of both voluntary and compulsory admission. In addition, admissions in the past predicted further voluntary and compulsory admissions, and teams not working extended hours predicted compulsory admissions in the follow-up period.ConclusionsCharacteristics of team working practice, staff burn-out and patients' history are associated independently with outcome. Patient contact with other services is a positive prognostic factor.

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