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Article
RISK OF FACIAL PARALYSIS FOLLOWING PAROTIDECTOMY

Authors: Ayad A Hasan اياد عبد الخالق حسن --- Ammar Y Khudhir عمار ياس خضر
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2012 Volume: 10 Issue: 2 Pages: 183 -190
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: The facial nerve should be sacrificed only if there is strong indication. Sometimes it is possible to sacrifice only part of the facial nerve and this termed "semiconservative parotidectomy". The commonest operation performed is superficial conservative parotidectomy, which is removal of the parotid superficial to the facial nerve with nerve preservation. A total conservative parotidectomy was performed only if clearly indicated by the pathological condition, since the complete freeing of the facial nerve in this operation increases the incidence of nerve paralysis.Objective: To demonstrate under what circumstances is the surgeon likely to be called upon to sacrifice the facial nerve deliberately, and mentioning what be done to reduce the risk of functional facial paralysis following conservative parotidectomy.Methods: The material comprises 30 cases of parotidectomy of all types. We analysed the incidence and degree of functional facial paralysis following conservative parotidectomy and also we reported some experimental work attempting to elucidate its etiology. We classify the degree of facial nerve paralysis to grade I, absent or slight, grade II moderate, grade III complete.Results: We did superficial parotidectomies for 22 cases, 19 had grade I, two had grade II and only one had grade III facial nerve paralysis. Conservative total parotidectomies done for 2 cases, one had grade I and one had grade III facial nerve paralysis. Semiconservative parotidectomies done for 4 cases all had grade I facial nerve paralysis and lastly radical parotidectomies done for 2 cases, the results had grade III for two cases facial nerve paralysis.Conclusion: To reduce the incidence of facial paralysis after conservative parotidectomy: carrying total parotidectomy only when clearly demanded by pathological condition by avoiding washing out the wound, and by measures designed to preserve the blood supply of the trunk of the facial nerve. The present study support that ischemia is the principal factor in post-parotidectomy functional facial paralysis.Key words: Parotidectomy, Facial nerve, Mixed tumor


Article
ILIAC CREST BONE GRAFT IN MAXILLOFACIAL BONY DEFECTS

Authors: Ayad A. Hasan اياد عبدالخالق حسن --- Ammar Y. Khudhir عمار ياس خضر
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 3 Pages: 216-224
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:The reconstruction of facial deformity has been of paramount clinical concern for many years and one of the most difficult and challenging tasks facing the maxillofacial surgeon. The ultimate goal in the treatment is the relief of suffering, restoration of function of jaw, restoration of speech, regain of the normal looking contour and improvement in the quality of life.Objective:To obtain more knowledge on autogenous on lay bone graft behavior in different facial defects and to evaluate the lateral and medial surgical approaches to the iliac crest.Methods:A prospective study was conducted during the period from January 2009 to January 2012 on 20 patients with facial defects, in the orbit, zygoma, maxilla and mandible. The causes of defects were trauma, odontogenic tumors and alveolar cleft. Types of bone graft used were either block cortico-cancellous or chips cancellous bone, the block was either monocortical or bicortical bone graft.Results:Complications associated with donor site harvesting procedure included pain 5% and gait disturbance 5%. Failure of bone graft was observed in 3 patients (15%) while the rest, 17 patients, (85%) ended with functional and esthetic successful graft. Causes of failure were due to sequestration (5%), inflammation due to osteomesh (5%) and soft tissue breakdown (5%).Conclusion:Iliac crest graft has evolved as a safe, well accepted procedure, with relatively low morbidity that can be used for a wide variety of maxillofacial procedures.Keywords:Iliac crest, bone graft, facial defects

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