Mimis Cohen

University of Illinois at Chicago | UIC · Surgey

Autologous reconstruction for major facial defects is primarily considered for patient's lifetime care. There are situations, however, when autologous reconstruction is not ideal or feasible, and prosthetic reconstruction is necessary to reconstruct missing anatomy or to complement surgical reconstruction. The history of facial prosthetic reconstru...

Fat grafting has become a well-accepted surgical modality to correct soft tissue facial defects and asymmetries with overall good results. Several techniques have been reported over the last few years to assist in improving accurate evaluation of facial defects and in the preoperative planning of the reconstruction. Such techniques include among ot...

This chapter provides an operative dictation template for a superiorly based pharyngeal flap. It outlines the indications for the procedure and potential complications and provides a detailed guide to the individual steps of the procedure.

This chapter provides an operative dictation template for a double opposing palatoplasty. It outlines the indications for the procedure potential complications and provides a detailed guide to the individual steps of the procedure.

This chapter provides an operative dictation template for a two-flap palatoplasty. It outlines the indications for the procedure potential complications and provides a detailed guide to the individual steps of the procedure.

This chapter provides an operative dictation template for a sphincter pharyngoplasty. It outlines the indications for the procedure and potential complications and provides a detailed guide to the individual steps of the procedure.

Osseointegrated titanium implants to the cranial skeleton for retention of facial prostheses have proven to be a reliable replacement for adhesive systems. However, improper placement of the implants can jeopardize prosthetic outcomes, and long-term success of an implant-retained prosthesis. Three-dimensional (3D) computer imaging, virtual planning...

Facial injuries result from physical trauma to the face and can manifest themselves with various symptoms such as lacerations, ecchymosis, epistaxis, and eye injuries and fractures of the facial bones. These injuries require prompt evaluation and treatment in order to reduce morbidity, minimize disfigurement and loss of function, as well as prevent...

With technologic progress in imaging for patients with trauma, isolated medial orbital wall fractures have become an increasingly appreciated injury. Given that these injuries may cause deformity and functional deficit, reconstruction is warranted in some cases. Surgical approaches to the medial orbit have evolved, and there are particular benefits...

The superomedial pedicle vertical scar breast reduction is gaining popularity for its round, projecting breast and shorter incision when compared with the traditional Wise-pattern reduction using an inferior pedicle. However, there is a paucity of large-volume institutional outcomes studies identifying how this technique fares against more traditio...

Unlabelled: The postoperative course of surgical patients can have a tremendous impact on the surgical outcome and on patient satisfaction. One of the most significant issues is postoperative nausea and vomiting (PONV) which, despite being a common side effect of general anesthesia, has received little attention in the plastic surgery literature....

Pediatric facial fractures account for only 5% of all facial fractures, with even a much lower incidence in children younger than 5 years (1%-1.5%). The evolution of principles in the management of pediatric facial fractures and the differences in management between adult and pediatric patients have been well documented in the literature. Pediatric...

Computer aided design and manufacturing (CAD/CAM) technology today is the standard in manufacturing industry. The application of the CAD/CAM technology, together with the emerging 3D medical images based virtual surgical planning (VSP) technology, to craniomaxillofacial reconstruction has been gaining increasing attention to reconstructive surgeons...

Oncologic mandibular reconstruction has changed significantly over the years and continues to evolve with the introduction of newer technologies and techniques. Patient demographic, reconstructive, and complication data were obtained from a prospectively maintained clinical database of patients who underwent head and neck reconstruction at our inst...

Unlabelled: Fibular osteotomy remains a challenging aspect of mandibular microsurgical reconstruction, dependent largely on surgeon experience, intraoperative judgment, and technical speed. Virtual surgical planning and stereolithographic modeling is a relatively new technique that can allow for reduction in the learning curve associated with neom...

Background: Fibular osteotomy remains a challenging aspect of mandibular microsurgical reconstruction, largely dependent on surgeon experience, intraoperative judgment, and technical speed. Virtual surgical planning and stereolithographic modeling allowing for: reduction in the learning curve associated with neomandible contouring, enhanced levels...

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The treatment of patients with unilateral cleft lip has undergone significant development during the last decades. With better understanding of the anatomy of the unilateral cleft lip and nasal deformities, primary correction of the nasal deformity at the time of lip repair, critical evaluation of short and long-term results following various treat...

The treatment of patients with unilateral cleft lip has undergone significant development during the last decades. With better understanding of the anatomy of the unilateral cleft lip and nasal deformities, primary correction of the nasal deformity at the time of lip repair, critical evaluation of short and long-term results following various treat...

Primary closure of the abdominal wall after combined liver and intestine transplantation from a living donor into a pediatric patient is usually not possible, because of the size of the donor organ, graft edema, and preexisting scars or stomas of the abdominal wall. Closure under tension may lead to abdominal compartment syndrome with vascular comp...

Multiple options exist for managing complex abdominal wall defects. These options range from the use of autologous tissue with rearrangement procedures to the use of prosthetic or bioprosthetic materials. All options rely on a thorough understanding of the structural and functional anatomy of the abdominal wall and the relationship of varying anato...

Large ventral or incisional hernias are often difficult to manage. Most commonly patients are referred to reconstructive surgeons after multiple failed attempts of hernia repair. The use of prosthetic and bioprosthetic materials have aided greatly in the management of complex abdominal wall defects. A full understanding of the advantages and disadv...

This article presents the author's personal philosophy for treatment of various abdominal wall defects resulting from surgical complications and unfavorable results of previous abdominal interventions. The purpose is not to discuss and analyze care and management of all soft tissue complications encountered after abdominal surgery, but to present t...

Enterocutaneous fistulas can result from various conditions. Although some heal spontaneously, others persist or recur. This article describes how using muscle flaps may aid in managing recalcitrant gastrointestinal fistulas. Specific cases are cited.

The surface laser scanner has great potential as a method for documentation of cleft infant due to its accuracy, ease of use, and convenience. The image scan be stored in the computer for easy access. As purchasing costs decrease, its acquisition will be facilitated, resulting in an increase in its use.

Every effort should be made to achieve the best possible results at the time of lip and palate repair. Appropriate and extensive evaluation, short- and long-term planning with optimal timing for each procedure, close cooperation with the members of the craniofacial team, selection of the most appropriate technique(s), careful execution, and close f...

Despite advances in surgery, a significant number of patients who undergo cleft palate repair have residual velopharyngeal insufficiency. Maxillary advancement may also result in velopharyngeal openings during speech. Instrumental approaches providing objective measures of palatal function assisting in the accurate diagnosis of these patients inclu...

Nasal alveolar molding is used effectively to reshape the nasal cartilage and mold the maxillary arch before cleft lip repair and primary rhinoplasty. It provides aesthetic and functional benefits of nasal tip and alar symmetry and improved dental arch form. At The Craniofacial Center at the University of Illinois at Chicago, the authors have devel...

Recent innovations in technology have generated a variety of techniques for medical imaging. One of these initially developed for industry is laser surface scanning. Laser surface scanning is a noninvasive method for acquiring three-dimensional (3D) images. In this article, the technology of 3D laser surface scanning is described, and a few applica...

Secondary correction of residual unilateral cleft lip nasal deformities is necessary in a number of patients for functional and cosmetic purposes. Myriads of techniques and modifications have been reported. Most of these publications, however, deal with the correction of the esthetic aspects of the deformity, and little attention has been given to...

Immediate closure of abdominal incisions after exploration and treatment of gunshot wounds is not always feasible or advisable. Significant bowel edema after massive fluid resuscitation might preclude primary closure, whereas any attempt to close under tension might result in complications ranging from wound dehiscence, infection, and necrosis to t...

Oribasius was an eminent Byzantine physician who lived in the fourth century. His greatest contribution to medical history was his anthology of all important medical works of his time, entitled Synagogue Medicae. This complete medical encyclopedia of his era consisted of more than 70 volumes. A significant part of this work has been lost. What rema...

The purpose of this study is to explore the possibility of bone formation in distraction osteogenesis of the free interpositional membranous bone. Three canine dogs were used as subjects. Two mandibular osteotomies were made in the mandibular body. The oral soft tissue and periosteum of the segment between the two osteotomies were freed from perios...

This study was conducted to determine whether development of individual maxillary teeth in subjects with complete unilateral alveolar clefts was significantly different from that found in unaffected children. Retrospective, mixed longitudinal. Craniofacial Center, university based. A sample of 179 panoramic radiographs obtained during the mixed den...

Objective This study was conducted to determine whether development of individual maxillary teeth in subjects with complete unilateral alveolar clefts was significantly different from that found in unaffected children. Design Retrospective, mixed longitudinal. Setting Craniofacial Center, university based. Materials and Methods A sample of 179 p...

Fifty-five patients with unilateral cleft lip nasal deformities were operated on from March 1992 to June 1996. Thirty-one patients were male and 24 were female. Three patients were 2 to 5 years of age, 7 patients were 6 to 10 years old, 12 patients were 11 to 15 years old, 13 were 16 to 20 years old, and 20 were greater than 21 years of age. The av...

Reconstruction of the mandible is one of the key elements in the skeletal rehabilitation of patients with hemifacial microsomia. Unfortunately, knowledge about long-term mandibular skeletal growth in these patients is lacking. The purpose of this study was to analyze mandibular skeletal growth longitudinally in unoperated hemifacial microsomia pati...

Management of the protrusive premaxilla in patients with bilateral cleft lip is challenging for the reconstructive team. Several intra- and extraoral orthopedic techniques to reposition the protrusive premaxilla prior to bilateral cleft lip repair have been presented in the literature. A modification to a previously described tissue-borne palatal p...

Restoring facial balance in patients with severe facial asymmetry is a challenging problem for the craniofacial team. Attention to bony reconstruction as well as soft-tissue contouring is required for patients with moderate to severe deformities. Traditionally, facial skeletal reconstruction was performed with osteotomies and bone grafting. More re...

Management of the protrusive premaxilla in patients with bilateral cleft lip is challenging for the reconstructive team. Several intra- and extraoral orthopedic techniques to reposition the protrusive premaxilla prior to bilateral cleft lip repair have been presented In the literature. A modification to a previously described tissue-borne palatal p...

Mandibular distraction osteogenesis has gained popularity for the treatment of mandibular hypoplasia and asymmetry. With this technique, significant skeletal and soft tissue changes in the lower face can be produced in a relatively short time period without the need for extensive surgery. Despite general acceptance, the long-term sequelae of the pr...

Surgical access to the anterior skull base for resection of midline tumors is commonly performed through a transfacial approach. We describe a new, open transnasal approach to the midline skull base and adjacent pituitary region. This technique, devised through our experience with open septorhinoplasty, was initially studied on fresh cadaver heads....

Secondary bone grafting of the maxilla and closure of the residual oronasal fistula at the stage of transitional dentition has become a well-accepted treatment modality. This procedure, in conjunction with orthodontic treatment, has been incorporated into the management protocol of many cleft teams around the world in an effort to further improve f...

Secondary bone grafting of the maxilla and closure of the residual oronasal fistula at the stage of transitional dentition has become a well-accepted treatment modality. This procedure, in conjunction with orthodontic treatment, has been incorporated into the management protocol of many cleft teams around the world in an effort to further improve f...

A technique for reactivating the Howmedica mini-lengthening device is presented. This procedure, performed in the clinic, allows for mandibular distraction in excess of the standard maximum of 25 mm.

Severe craniofacial synostosis can be a devastating problem for a newborn infant. Reasons for early surgical intervention include cranial stenosis, hydrocephalus, inadequate globe and corneal protection, compromised airway patency, and feeding problems. In this preliminary report, we describe the management of severe craniofacial synostosis in a ne...

Combining the authority of a textbook with the step-by-step, illustrative detail of an atlas, this extraordinary reference presents surgical techniques practiced and perfected by the most respected plastic surgeons in the field. With the aid of nearly 5,000 photographs, these master plastic surgeons discuss how to perform the latest reconstructive...

A simple hair-braiding technique is presented as an adjunct for the intraoperative management of the scalp in patients undergoing craniofacial reconstruction with exposure through a coronal incision. The method is described, and its practical advantages over standard approaches are discussed.

Rigid microfixation has enhanced the immediate results in pediatric craniomaxillofacial surgery. The effects of rigid fixation on the development of the craniofacial skeleton, however, remain uncertain. The long-term effects of rigid microfixation on the growing craniofacial skeleton in the rabbit model were evaluated in this study. Bifrontal crani...

Free radicals have been implicated in the cause of ischemia-reperfusion injury. Various agents have been used in an attempt to reduce ischemia-reperfusion injury pharmacologically, including free radical scavengers. Vitamin C (ascorbic acid), a well-known free radical scavenger, has not, to the best of our knowledge, been evaluated in this respect....

Use of rigid fixation systems in craniomaxillofacial surgery has significantly improved clinical results. We describe the technical application of utilizing rigid fixation systems in the actual process of reshaping bone flaps and grafts. We call the use of this technique form-fitting fixation, and describe its application in a wide variety of crani...

The reconstruction of severe craniofacial anomalies in patients who will not accept blood transfusions presents a considerable challenge to the craniofacial team. Traditionally, these patients have been refused major reconstructions, receiving no treatment or a highly compromised substitute. A management protocol was developed utilizing preoperativ...

Charts from 86 patients treated for carcinoma of the tongue were reviewed to identify strategies that might improve patient outcome. Seventy-one patients (83%) were black and 69 patients (80%) were male. Overall 2- and 5-year survival rates were 20% and 12%, with stage-specific 2-year survivals of 71% (I and II, n = 7), 33% (III, n = 15), and 11% (...

The transcoronal surgical approach for the treatment of orbital disease has become increasingly popular since it affords excellent surgical exposure through a cosmetically acceptable incision. Exposure of the inferior orbit, however, can be difficult due to limited flap mobility in the frontal plane. Increased inferior exposure may be obtained by e...

An intraoperative patient stabilization device is described for use in aesthetic breast surgery. This simple device maintains the patient in the vertical position throughout the many positional changes during aesthetic breast surgery.

Pericranial flaps based on the musuloaponeurotic or myofacial layers of the scalp have great utility in the management of acquired and congenital craniofacial deformities. Their use in traumatic deformities is indicated in the presence of craniopharyngeal communications and significant anterior cranial fossa dead space created from frontal sinus ob...

Postoperative feeding regimens after cleft lip and palate repair continue to be a controversial issue. This study was designed to test the feasibility of immediate unrestricted feeding after lip and palate closure with attention to operative outcome or complications. A retrospective analysis of two feeding protocols involved 80 infants with both un...

Oropharyngocutaneous fistulas remain a serious and potentially lethal complication. Advantages from surgical repair and the use of musculocutaneous flaps have been demonstrated. Timing of the procedure, however, has not been adequately addressed or emphasized. This report presents our experience with early, aggressive management of postoperative or...

The coronal incision has been modified so that if it needs to be extended to improve exposure, the extension will be behind the ear and therefore less noticeable. The incision has been used in 25 adults and 30 children with no complications. Its cosmetic appearance is superior to the preauricular coronal incision, and it is preferred especially by...

Chronic wounds may be due to a wide variety of causes ranging from wounds with an overt organic origin to wounds with a factitial basis. With increasing numbers of patients abusing or addicted to illicit substances, the self-induced wounds of intravenous or cutaneous injection are relatively common. The purpose of this report is to bring to the att...

Fixation of craniomaxillofacial bones with plates and screws is becoming an increasingly popular method of managing patients with maxillofacial fractures, congenital anomalies, and skeletal defects after tumor extirpation. The effects of rigid fixation on growth, however, are not well defined and remain controversial. This experimental work was des...

Secondary bone grafting of the maxilla in the mixed transitional dentition stage has become a well-accepted procedure in the surgical protocol for rehabilitation of patients with residual alveolar clefts. This retrospective study was undertaken to evaluate and compare the long-term results obtained with iliac or cranial cancellous bone graft materi...

Secondary bone grafting of alveolar clefts has become a well-established procedure. However, little attention has been given to the soft-tissue coverage of these grafts. We present our experience with 32 patients in which gingival mucoperiosteal flaps were used exclusively in conjunction with bone grafting for patients with residual alveolar clefts...

Tissue expansion has become firmly established as an acceptable and useful modality in the treatment of various soft tissue defects. This article relates our experience with this technique for the reconstruction of secondary burn deformities in 26 patients. Details of expander placement and use are discussed, as well as the results and complication...

Prolonged vascularized organ allograft survival and an improved quality of life are now possible for many transplant recipients. These advances are due largely to greater understanding of the immune response, the development of potent immunosuppressive agents (cyclosporin A), and improved surgical techniques. Thus more of these patients may require...

The steadily increasing level of urban violence and attempted suicides in the recent past has resulted in large numbers of gunshot injuries to the face from small-caliber weapons. Our experience with 35 consecutive cases of civilian gunshot wounds involving primarily the lower face is presented. Initial management included securing of the airway, c...

A staged reconstructive procedure is described for the reconstruction of the entire thoracic esophagus. All primary alternatives for esophageal reconstruction were not applicable. The patient's thoracic esophagus was successfully reconstructed in two stages with a lined pectoralis major muscle tube, and it remains, eight months postoperatively, in...

Tissue expansion has emerged recently as an alternative reconstructive procedure and has been used for the treatment of a variety of defects. This paper presents our experience with the use of tissue expansion exclusively for the treatment of secondary burn defects. The technique was used in 22 consecutive patients. The technical aspects of the pro...

A unique case of repair of a full-thickness cardiac defect and simultaneous reconstruction of an infected median sternotomy wound is presented. A right ventricular defect, 6 cm in diameter, was closed with a fascia lata graft and reinforced with a rectus abdominis muscle flap. The superior portion of the mediastinum was obliterated with a pectorali...

A unique case of congenital embryonal rhabdomyosarcoma of the hand in a patient with Apert's syndrome is presented. Immediately after birth a 1 cm soft, bluish mass of the right thenar eminence was clinically diagnosed as a hemangioma. Several months later when the lesion started rapidly enlarging the nature of the tumor was identified, and it was...

• Infected median sternotomy represents a major complication of cardiac surgery, with significant morbidity and mortality. The treatment of choice is immediate drainage and closure over suction irrigation catheters. However, when this conservative approach fails or radical débridement makes primary closure impossible, muscle flap closure is indicat...

Dissecting cellulitis of the scalp or perifolliculitis capitis abscedens et suffodiens is a rare, chronic, progressive, suppurative disease of the scalp of unknown etiology. It is characterized by painful nodules, purulent drainage, burrowing interconnecting abscesses, and cicatricial alopecia. The pathogenesis is unknown, although it is probably r...

Voice-quality (i.e., nasality) judgments are commonly used to evaluate the results of pharyngeal flap surgery. However, these are subjective judgments of questionable validity and reliability. This project was designed to systematically evaluate the outcome of pharyngeal flap surgery utilizing objective, quantifiable physiologic (pressure-flow) inf...

We present a modified version of the cervical collar that can be used immediately postoperatively and accommodates bulky bolster dressings. Its benefits include immediate neck hyperextension and immobilization and parallel monitoring of a skin graft or free flap.

The conventional postoperative care of patients undergoing pressure ulcer operations is complicated and unsatisfactory. In an effort to improve this care, we used the Clinitron therapy unit, which provides a true flotation environment for the patient. The surface pressure on the skin constantly remains below the capillary closure pressure of 32 mm...

Identification and preservation of the facial nerve during extirpative and reconstructive surgery represents a challenge even for the experienced surgeon. We present an experimental intraoperative technique for staining the facial nerve and its branches that is safe, accurate, and inexpensive. Leucomethylene blue is injected into the precise region...