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Search Results: 1 - 10 of 4810 matches for " Lun-Jou Lo "
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Primary Correction of the Unilateral Cleft Lip Nasal Deformity: Achieving the Excellence
Lun-Jou Lo
Chang Gung Medical Journal , 2006,
Abstract: Unilateral cleft lip nasal deformity is characterized by prominent asymmetry resultingfrom distorted and displaced structures. Primary correction of the nasal deformity at thesame time of lip repair has gained popularity, aiming at early restoration of the symmetry bylifting the alar cartilage and lengthening the columella on the cleft side. Postoperativerelapse is a frequent finding due to the elasticity of the deformed alar cartilage. A variety ofstrategies have been proposed to treat this type of condition, including preoperativenasoalveolar molding, overcorrection of the nostril and alar cartilage, Tajima method ofrhinoplasty, and postoperative nasal splinting. The results have been promising. Long-termassessments need to be performed to determine the final outcomes.
Facial Reconstruction after a Complicated Gunshot Injury
Vanna Long,Lun-Jou Lo,Yu-Ray Chen
Chang Gung Medical Journal , 2002,
Abstract: Facial gunshot injuries are unusual and complicated clinical entities. Because of themechanism of injury, early aggressive primary reconstruction might not be ideal. Initial conservativemanagement followed by staged secondary reconstruction could be performed toobtain satisfactory functional and aesthetic results. Reconstruction of the cranio-maxillofacialdeformities requires a multi-disciplinary approach, the same way as for patients withcleft lip/palate deformities. We present a male patient with severe facial gunshot injuries. Ateam approach revealed maxilla recession, dental malocclusion, a large oronasal fistula overhis hard palate, velopharyngeal insufficiency, and a stable psychosocial status. His mainconcern was facial appearance, which included the nose, lip, and scars. Staged reconstructionswere performed, consisting of orthognathic surgery, rhinoplasty, lip-switch flap, andrevisions of scars. A satisfactory outcome was obtained. The results indicated the importanceof preoperative evaluation and treatment planning for this uncommon problem.
Palatoplasty: Evolution and Controversies
Aik-Ming Leow,Lun-Jou Lo
Chang Gung Medical Journal , 2008,
Abstract: Treatment of cleft palate has evolved over a long period oftime. Various techniques of cleft palate repair that are practicedtoday are the results of principles learned through many yearsof modifications. The challenge in the art of modern palatoplastyis no longer successful closure of the cleft palate but anoptimal speech outcome without compromising maxillofacialgrowth. Throughout these periods of evolution in the treatmentof cleft palate, the effectiveness of various treatment protocolshas been challenged by controversies concerning speech andmaxillofacial growth. This article reviews the history of cleftpalate surgery from its humble beginnings to modern-daypalatoplasty, and describes various palatoplasty techniques andcommonly used modifications. Current controversial issues onthe timing of cleft palate repair, and the effects on speech andmaxillofacial growth are also discussed.
Cleft Oronasal Fistula: A Review of Treatment Results and A Surgical Management Algorithm Proposal
Enrina Diah,Lun-Jou Lo,Claudia Yun,Ruby Wang
Chang Gung Medical Journal , 2007,
Abstract: Background: Oronasal fistulas (ONF) following cleft palate repair are commonly encounteredand remain a challenging problem. With reported recurrence ratesbetween 33% and 37%, this urges us to critically evaluate the current treatmentand propose a surgical management protocol.Methods: A retrospective study of patients treated for ONF by a single surgeonbetween 1995 and 2005 was performed. Data regarding cleft type, age atpalate repair, complications, location and size of fistula, tissue condition, surgicaltechnique employed, and success rate were gathered.Results: There were 64 patients (33 male and 31 female), and 44% of them had bilateralcleft lip and palate. Hypernasality and regurgitation were the major presentingsymptoms of these patients with ONF. Fistulas mostly occurred inthe hard palate area (53.1%). Severe scarring surrounding the ONF wasreported in 31.2% of patients. Local flap and two-flap palatoplasty were themost common techniques (62.5%) used for closure of the ONF. Twenty-fivepercent of patients needed more than one repair to close the fistula. However,the overall success rate of closure was high (90.5%). Velopharyngeal (VP)function was significantly improved: only 26.8% of patients had adequateVP function before ONF closure and 64.3% patients had adequate VP functionafter ONF closure. However, the VP function of twenty patientsremained inadequate or marginal.Conclusions: A high success rate was achieved for closure of cleft ONF, although a certainpercentage of patients required re-operation. Multiple fistulas and severelyscarred palates made closure difficult. Successful closure of a fistulaimproved VP function but VP surgery was still indicated in certain patients.Based on the findings, an algorithm for management of cleft ONF was proposed.
Three-Dimensional Computed Tomography Imaging in Craniofacial Surgery:Morphological Study and Clinical Applications
Lun-Jou Lo,Yu-Ray Chen
Chang Gung Medical Journal , 2003,
Abstract: Three-dimensional carniofacial CT imaging has been developed and progressed duringthe past two decades. The advancement of the hardware and software has made the imagingstudy more convenient, user friendly, and affordable. Processing and analysis of the imagingdata are readily performed on personal computers. Accuracy of the 3-dimensional measurementhas been validated. Collaborative study can be achieved with other departments ordisciplines, such as orthopedic, otolaryngologic, and dental departments, as well as mechanicalengineering department. All the data should be adequately archived as medical imagingdata bank for later use. The data can be transferred for production of rapid prototyping modelsto enhance clinical application. Inter-center sharing of imaging data can be done throughcommon image format. Comprehensive morphological study and clinical information mayhelp to improve or refine treatment planning, which in turn yield better treatment outcome.
Osseous Regeneration after Embolization of Mandibular Arteriovenous Malformation.
Vuthy Chhoeurn,Glenda H. de Villa,Lun-Jou Lo
Chang Gung Medical Journal , 2003,
Abstract: A mandibular arteriovenous malformation (AVM) is rare, and unawareness of this conditioncan lead to catastrophic complications. Embolization is an effective means to treatthese lesions. The osseous changes and long-term outcomes among the pediatric patientsafter embolization treatment remain unclear. We present a 6-year-old patient with mandibulararteriovenous malformation who had sustained hemorrhagic shock after a tooth extraction.She was referred to us after stabilization of the hemodynamic condition. The patientreceived transarterial and direct intralesional embolization. Local infection occurred 3months after embolization, but was well controlled. Serial computed tomography andpanoramic radiographs were performed during follow-up examinations. The imaging studiesshowed gradual obliteration of the vascular space followed by normal bone regeneration andremodeling. The processes were complete during a period of 2 years. There was no recurrenceof the vascular malformation and no abnormal growth of the right side of the mandibleafter 4 years and 4 months of observation.
Facial Asymmetry: Etiology, Evaluation, and Management
You-Wei Cheong,Lun-Jou Lo
Chang Gung Medical Journal , 2011,
Abstract: Facial asymmetry is common in humans. Significantfacial asymmetry causes both functional as well as estheticproblems. When patients complain of facial asymmetry, theu n d e r l y i n g c a u s e s h o u l d b e i n v e s t i g a t e d . T h e e t i o l o g yincludes congenital disorders, acquired diseases, and traumatic and developmental deformities. The causes of many casesof developmental facial asymmetry are indistinct. Assessmentof facial asymmetry consists of a patient history, physicalexamination, and medical imaging. Medical imaging is helpful for objective diagnosis and measurement of the asymmetry, as well as for treatment planning. Components of soft tissue, dental and skeletal differences contributing to facialasymmetry are evaluated. Frequently dental malocclusion,canting of the occlusal level and midline shift are found.Management of facial asymmetry first aims at correcting theunderlying disorder. Orthognathic surgery is performed for the treatment of facial asymmetry combined with dental occlusal problems. A symmetrical facial midline, harmoniousfacial profile and dental occlusion are obtained from treatment. Additional surgical procedures may be required to increase or reduce the volume of skeletal and soft tissue components on both sides to achieve better symmetry
Computer-Aided Reconstruction of Traumatic Fronto-Orbital Osseous Defects: Aesthetic Considerations.
Lun-Jou Lo,Yu-Ray Chen,Ching-Shiow Tseng,Ming-Yih Lee
Chang Gung Medical Journal , 2004,
Abstract: Background: In addition to functional goals, a satisfactory aesthetic outcome is importantfor reconstruction of fronto-orbital osseous defects. The purpose of this studyis to report on a method for presurgical fabrication of custom implants using3-dimensional (3-D) imaging data and computer-assisted manufacturingtechniques.Methods: Preoperative 3-D computed tomography data were processed and displayedfor evaluation of defects. Implants were created by a computer-aideddesign/computer-aided manufacturing (CAD/CAM) program. A rapid prototypingsystem was applied for production of the physical models. Rehearsalof surgery was performed using the implants and skull models. Negativecastings were created and were used during the operations to prepare the surgicalimplant utilizing methyl methacrylate. Traumatic fronto-orbital defectsin 4 patients were reconstructed using this method. The follow-up periodranged from 29 to 55 months.Results: Results showed that the custom implants perfectly fit the defects during theoperation. Symmetry and normal fronto-orbital contours were achieved.There were no peri- or postoperative complications. All patients were satisfiedwith the results.Conclusions: Computer-aided presurgical simulation and fabrication of implants is a reliableand effective method for the reconstruction of traumatic fronto-orbitaldefects, with reduced anesthesia time and improved aesthetic outcomes.
Dental and Skeletal Changes Following Surgically Assisted Rapid Maxillary Anteriorposterior Expansion
Cheng-Ting Ho,Lun-Jou Lo,Eric JW Liou,Chiung Shing Huang
Chang Gung Medical Journal , 2008,
Abstract: Background: Lengthening the maxillary dental arch as a treatment approach for patientswith maxillary deficiency and dental crowding is seldom reported. The purposeof this study was to assess dental and skeletal changes in the maxilla inthe correction of maxillary deficiency associated with a retruded maxillaryarch using a surgically assisted rapid maxillary anterior-posterior expansionappliance.Methods: Predistraction and postraction lateral cephalometric and periapical radiographsand maxillary dental casts of six young adolescents (four boys, twogirls, mean age 11 years, 2 months) were examined. These patients receiveda maxillary anterior segmental osteotomy and distraction osteogenesis withan anteroposteriorly oriented Hyrax expansion appliance based on the biologicalprinciples of bone distraction.Results: The retruded dental arch and dental crowding were successfully corrected.Significant forward movement of the point anterior nasal spine, point A, centralincisors and first premolars was noted. The maxillary dental arch depthincreased an average of 4.2 mm while the arch width remained unchanged.In total, 11.5 mm of dental space was created in the maxillary arch whichwas sufficient to resolve dental crowding. New bone formation along the distractionsite was observed three months after distraction.Conclusions: The use of maxillary anterior segmental osteotomy combined with a Hyraxexpansion distraction appliance was effective in arch lengthening and creationof dental space. An overcorrection in this interdental distraction osteogenesiscould be a good treatment option for children with maxillary deficiencycombined with crowded maxillary dentition.
Vascular Abnormalities in the Head and Neck Area in Velocardiofacial Syndrome.
Jui-Pin Lai,Lun-Jou Lo,Ho-Fai Wong,Shu-Ruby Wang
Chang Gung Medical Journal , 2004,
Abstract: Background: Velocardiofacial syndrome (VCFS) is a disorder commonly associated with acharacteristic facial appearance, congenital heart disease, and velopharyngealinsufficiency. An association with vascular anomalies in the cervical area andskull base has been reported. In this study, we evaluated 7 consecutivepatients who received vascular imaging for preoperative planning ofvelopharyngeal surgery.Methods: From January 1996 to September 1997, 7 patients with VCFS were found in1 of the senior author's service. All had documented velopharyngeal insufficiencyand visible pulsations over the posterior pharyngeal wall by nasoendoscopy.Two patients had magnetic resonance angiography (MRA), 2patients had computed tomographic angiography (CTA), and 3 patients hadboth.Results: The angiographic study revealed abnormalities of the carotid and vertebralarteries in 5 patients (71%). Kinking and tortuosity of the internal carotidartery and its medial displacement were common. The observed pulsationsdid not correlate well with the angiographic findings. For surgical correctionof the velopharyngeal sufficiency, a regular pharyngeal flap was used in 4patients, a modified pharyngeal flap was used in 2 patients, and the surgerywas abandoned in the remaining 1 patient.Conclusions: Expression of cervical vascular anomalies in VCFS was varied and did notcorrelate well with the observed pulsations from the nasopharyngoscopicexamination. Preoperative vascular imaging study is essential for the purposeof planning and safety of surgical interventions in this area.
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