Use of tissue expansion to facilitate liver and small bowel transplant in young children with contracted abdominal cavities

Liver and small bowel transplant is an established treatment for infants with IFALD. Despite organ reduction techniques, mortality on the waiting list remains high due to shortage of size‐matched pediatric donors. Small abdominal cavity volume due to previous intestinal resection poses a significant challenge to achieve abdominal closure post‐transplant. Seven children underwent tissue expansion of abdominal skin prior to multiorgan transplant. In total, 17 tissue expanders were placed subcutaneously in seven children. All seven subjects underwent re‐exploration to deal with complications: hematoma, extrusion, infection, or port related. Three expanders had to be removed. Four children went on to have successful combined liver and small bowel transplant. Two children died on the waiting list of causes not related to the expander and one child died from sepsis attributed to an infected expander. Tissue expansion can generate skin to facilitate closure of abdomen post‐transplant, thus allowing infants with small abdominal volumes to be considered for transplant surgery. Tissue expansion in children with end‐stage liver disease and portal hypertension is associated with a very high complication rate and needs to be closely monitored during the expansion process.     

固定支架式扩弓器扩大上下颌牙弓初探

目的 探讨替牙(牙合)早期采用固定支架式扩弓器扩大上下颌牙弓矫治牙列拥挤的方法.方法 在1例9岁男童的上下颌同时黏结固定支架式螺旋扩弓器,上颌扩弓1个月,下颌扩弓2.5个月后,用"2×4"技术排齐拥挤的上下颌前牙,并用Hawley保持器保持.结果 上颌尖牙间宽度扩大5.4 mm,磨牙间宽度扩大9.0 mm;下颌尖牙间宽度扩大3.4 mm,磨牙间宽度扩大6.6 mm;上下牙列排列整齐,咬合关系良好.结论 对于基骨丰满、牙弓狭窄的轻度或边缘性中度牙列拥挤拟不拔牙患者,可在替牙(牙合)早期或中期试行上下颌同时扩弓治疗.     

Novel use of tissue expander for dilation of oropharyngeal stenosis

Naso/oropharyngeal stenoses are uncommon surgical complications. We present a child having undergone previous adenoidectomy without complication who developed naso/oropharyngeal scarring after subsequent tonsillectomy. She presented with nasal obstruction and frequent gasping at night worrisome for obstructive sleep apnea. Scar was initially excised and the defect allografted. Conventional esophageal dilators were undersized, and ultimately a tissue expander was used intraoperatively as a balloon dilator. The patient's symptoms and sleep apnea resolved. We found use of a tissue expander as a balloon dilator to be at least minimally effective in dilating the oropharynx when all other methods at our disposal proved ineffective.     

Use of tissue expander in pelvic Ewing's sarcoma treated with radiotherapy

Introduction

The local treatment option for pelvic Ewing sarcoma (ES) remains uncertain and challenging as surgery is often disabling while radiotherapy alone has a higher risk of local recurrence but not necessarily a worse survival. The aim is to analyse the outcome of patients with pelvic ES after radiotherapy as the primary local treatment in combination with a temporary intrapelvic surgically placed tissue expander (TE) to reduce bowel complications.

Materials and methods

20 patients were retrospectively analysed. All patients had neoadjuvant and adjuvant chemotherapy. We identified survival, time to develop local recurrence and metastasis, dose of radiotherapy administered, local complications related to the use of the tissue expander and bowel effects of radiotherapy.

Results

The median follow-up was 41 months. 14 patients were stage IIb and six stage III. There were no problems after insertion of the TE and only one patient who developed mild diarrhoea. Local recurrence occurred in six patients. At the last follow-up 12 patients have died from sarcoma, five are disease free and three have had recurrent disease.

Conclusions

In this paper we reviewed pelvic Ewing sarcoma with all the special considerations that this entails. We think that tissue expander can be safely used when radiotherapy is chosen to treat pelvic ES. It does appear to prevent bowel problems and is a low morbidity procedure. New treatment approaches should be considered to give a chance of cure to those patients with “bad prognostic” pelvic ES.     

上斜肌延长术治疗Brown综合征

目的 探讨上斜肌延长手术在Brown综合征治疗中的应用.方法 对6例Brown综合征的患者施行上斜肌延长术,合并水平斜视者同时矫正水平斜视.对比观察术前术后的眼位、双眼视觉、上斜肌的功能状态及眼球运动情况.结果 术后6例患者第一眼位均正位;眼球运动明显改善,未出现上斜肌功能不足;代偿头位均消失,无A-V型斜视发生;有双眼视觉的5例,其中4例有融合功能,2例恢复立体视觉.结论 上斜肌延长手术治疗Brown综合征安全有效.     

瘢痕下直接扩张术治疗体表中小面积瘢痕

目的探讨瘢痕下直接扩张美容术在体表中小面积增生性瘢痕治疗中的临床应用价值。方法回顾分析我科2004年至今采用瘢痕下直接扩张美容术治疗的12例的患者临床资料。计算瘢痕面积及所需扩张的容量,选择合适大小及形状的扩张器,一期手术将扩张器直接置入瘢痕区域下面,扩张满意后2~4周取出扩张器、切除瘢痕、处理周围纤维囊、延长周围扩张软组织并充分止血后直接缝合。结果12例患者共治疗15处瘢痕,置入扩张器15个。修复面积最大8 cm×6 cm,所有患者均得到有效治疗,未发生严重并发症。结论瘢痕下直接扩张美容术对体表中小面积增生性瘢痕治疗效果显著。     

Comparison of facemask therapy effects using skeletal and tooth-borne anchorage:: A longitudinal retrospective study

ObjectivesTo investigate long-term outcomes of dentoskeletal changes induced by facemask therapy using skeletal anchorage in Class III patients and compare them to those of conventional tooth-borne anchorage.Materials and MethodsThis retrospective study included 20 patients who received facemask (FM) therapy with miniplates as anchorage for maxillary protraction (Miniplate/FM group, 10.6 ± 1.1 years old [mean ± SD]) and 23 patients who were treated with facemask with rapid maxillary expander (RME/FM group, 10.0 ± 1.5 years old [mean ± SD]). Dentoskeletal changes were evaluated using lateral cephalograms at pretreatment (T1), after facemask therapy (T2), and at the post-pubertal stage (T3). Cephalometric changes were compared between groups and clinical success rates at T3 were evaluated.ResultsSNA and A to N perpendicular to FH increased significantly more in the Miniplate/FM group than in the RME/FM group when comparing short-term effects of facemask therapy (T1–T2). ANB, Wits appraisal, Angle of convexity, mandibular plane angle, and overjet decreased significantly more in the RME/FM group than in the Miniplate/FM group after facemask therapy (T2–T3). A more favorable intermaxillary relationship was observed in the Miniplate/FM group than in the RME/FM group in long-term observations (T1–T3). Clinical success rate at T3 was 95% in the Miniplate/FM group and 85% in the RME/FM group.ConclusionsFacemask therapy with skeletal anchorage showed a greater advancement of the maxilla and more favorable stability for correction of Class III malocclusion in the long-term than conventional facemask therapy with tooth-borne anchorage.     

种植体支抗辅助上颌扩弓器(MSE)治疗成人上颌骨横向发育不良的效果

目的 探究对成人上颌骨横向发育不良（MTD）采用种植体支抗辅助上颌扩弓器（MSE）治疗 的效果。方法 选取2019年3月-2023年1月我院收治的80例成人MTD患者,随机分为对照组和观察组,各 40例。对照组采用支架式固定螺旋扩弓器,观察组采用种植体支抗辅助MSE,比较两组临床疗效、颌面 结构指标、上气道结构指标及并发症发生情况。结果 观察组治疗总有效率为97.50%,高于对照组的 87.50%（P ＜0.05）;两组治疗1年后ANB、MP-SN角均高于治疗前及治疗6个月后,且观察组高于对照 组（P ＜0.05）;两组治疗1年后U1-SN、L1-MP角均低于治疗前及治疗6个月后,且观察组低于对照组 （P ＜0.05）;两组治疗3个月后SPL、OP-V均小于治疗前,且观察组小于对照组（P ＜0.05）;两组 治疗3个月后OP-A均大于治疗前,且观察组大于对照组（P＜0.05）;两组治疗1年后SPL、OP-V、OP-A比 较,差异无统计学意义（P＞0.05）;观察组并发症发生率为7.50%,低于对照组的20.00%（P＜0.05）。结论 种植体支抗辅助MSE治疗成人MTD的效果良好,可有效改善患者的上气道、颌面结构,且治疗后并发症 发生风险较低,应用安全性较高。     

两脚和四脚快速腭扩张器疗效的比较研究

目的:本研究比较了两脚和四脚腭快速扩张器在打开腭中缝和牙齿扩张的效果.方法:本研究包括30例患者,随机分配在两脚扩张器组和四脚扩张器组,在扩张器戴入前,扩弓结束后和扩张器拆除时,拍摄标准咬合片和采取上颌模型,并对测量数据进行统计分析.结果:研究发现两组间的磨牙尖宽度、磨牙龈宽度、尖牙尖宽度、尖牙龈宽度和中切牙间裂隙间没有统计学差异;在牙弓的周长和腭中缝打开上略有差异.结论:两脚扩张器和四脚扩张器对腭中缝和牙列的作用相同.