Epilepsy management

J Oral Maxillofac

Surg

56:689 692, 1998

Abstracts Management. Sperling MR, Bucurescu Postgrad Med 102:102, 1997

Epilepsy

G, Kim B.

with alloplastic materials is an effective technique for the correction of irregularities in this area. Isolated zygomatic effects may be addressed by osteotomies or augmentation with alloplasts and/or autografts. The malar-midface complex should be divided into lateral, middle, and medial thirds. Each should be evaluated individually when address-

In the first of four update articles on seizures, the authors address several important aspects of managing seizure patients, including when antiepileptic drugs should be initiated, risk factors for recurrence, efficacy of medications, selection of appropriate drugs, withdrawal of drugs, surgical criteria, criteria for medical intractability, presurgical evaluation, and surgical outcomes. After a single seizure, about 40% of patients will have recurrence. Antiepileptic drugs should be considered when there is a reasonable chance that seizures will recur, but drugs do not prevent seizures. They reduce the probability of seizures. Most seizures pose no risk to the patient. A recent study found only 15% of 560 seizures resulted in injuries, most of them minor. But 1.2% resulted in death and 1.4% experienced bone fractures. It is debatable whether self-limited seizures cause brain damage, but there can by psychosocial problems, such as loss of driving privileges, unemployment, reduced social interactions, effects

and of

so on. These must be weighed the medications. Patients with

against partial

ing

Reprint Tower,

the side seizures,

ways

to taper

drug

regimens,

but withdrawal

Avoiding thetic

Pitfalls Contouring

and

Bartlett SP, Whitaker

Managing Complications the Facial Skeleton.

Although

osteotomy

has been

requests to Dr Bartlett: University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104. for Shaping

10 Penn

Jntraoperative of Polyethyl-

M. Plast Reconstr

Surg

The authors describe a method of fabricating an implant to be used for facial contour restoration with the use of bone

from

wax

as the template.

AU patients

are operated

under

general

anesthesia and facial defects arc approached through a scar revision incision. A subperiosteal pocket is created over the defective region and an appropriate amount of bone wax is placed and molded to the defect. The skin is then closed with a few silk sutures and the area is massaged to allow the wax to fully adapt to the defect. The wax is then removed and the polyethylene implant is trimmed to match the wax stent. The authors conclude that this method is a simple, accurate, and inexpensive way to adapt and fit polyethylene implants for facial contour restoration.-R. HOLLOWAY Reprint Ankara

Epilepsy S 11th St,

requests to Dr Mavili: 06540, Turkey.

The Treatment Deformities tic Therapy.

of Aes-

Bucky LP, LA. Clin Plast Surg 24:613, 1997 of

area.

100:1247,1997

medication is successful in 60% to 70% of patients. In 30% to 40% of epileptic patients, seizures are not completely controlled by medical therapy alone, and some may be candidates for surgery to stop or ameliorate the seizures. Patients that are candidates for surgery typically have seizures that impair consciousness, cause falling with injury, have adverse psychosocial or social effects, or persist after 2 to 3 medications have been tried. Such patients should be referred to a multidisciplinary, tertiary seizure treatment center for evaluation. The most common operation is the anterior temporal lobectomy, which is successful 70% of the time.-Rooks E. ALEXANUEK Reprint requests to Dr Sperling: Jefferson Comprehensive Center, Thomas Jefferson University Hospital, 111 Philadelphia, PA 19107.

in this

Use of Bone Wax as a Template Evaluation of Facial Defects and ene Implants. Mavili E, Akyiirek

abnormal electrocardiogram (EEG), and abnormal neurologic findings have a 90% chance for recurrence, whereas patients with generalized seizures, normal EEG, and normal neurologic findings have only a 30% chance. There are currently no adequately controlled studies examining the different

deformity

described and used for augmentation and reduction in this area, this procedure is often complicated by asymmetry and is an extensive and formidable undertaking. Autogenous and synthetic materials are generally satisfactory. Posterior mandible augmentation and reduction, including the angle, ramus, and body, is performed through intraoral incisions. Contouring of the facial skeleton has become applicable to a wide spectrum of patients. Although complications do occur, they now can be managed in safe and predictable fashions.-R.H. HAUG

Paris Cas. No. 60/7,

Kavaklidere,

of Secondary and Residual Dentofacial in the Cleft Patient: Surgical and Orthodon-

Posnick JC. Clin Plast Surg 24:583, 1997

These tend to be divided into bone problems and soft tissue problems. The most frequent forehead procedure is a reduction of the frontal prominence. Complications associated with it are palpability of hardware, mucocele formation, and adnexal injury. Frontal augmentation is frequently fraught with palpability of the grafting materials. Temporal augmentation is occasionally fraught with infection, resorp-

The prevalence and extent of residual maxillofacial deformities in the adolescent born with a cleft vary widely depending on a team’s philosophy about staging of reconstruction and/or available technical expertise. Management of alveolar and hard palate clefts and per&alveolar and residual palatal oronasal fistulas is by filling the bony defects with autogenous iliac bone and closing all oronasal fistulas at each cleft site and throughout the palate. It should be performed in the mixed dentition before eruption of the canine teeth. The procedure is preceded by interceptive orthodontic widening of collapsed maxillary segments, and followed by orthodontic closure of the cleft-dental gap(s) whenever possible. The adolescent with a hypoplastic

tion

maxilka

Aesthetic surgery of the facial skeleton has developed from a merger of aesthetic and craniofacial surgery. Complications occur occasionally, and tend to be unique to the particular

procedure

of autografts,

and anatomic

and contour

area undergoing

irregularities.

surgery.

Augmenlation

689

may

then

undergo

a standard

maxillary

osteotomy.