Craniomaxillofacial Trauma & Reconstruction

11 pages, 707 KiB

Open AccessArticle

Penetrating Foreign Bodies in Head and Neck Trauma: A Surgical Challenge

by Jan Oliver Voss, Nadine Thieme, Christian Doll, Stefan Hartwig, Nicolai Adolphs, Max Heiland and Jan-Dirk Raguse

Craniomaxillofac. Trauma Reconstr. 2018, 11(3), 172-182; https://doi.org/10.1055/s-0038-1642035 - 24 Apr 2018

Cited by 25 | Viewed by 56

Abstract

Penetrating foreign bodies of different origins in the head and neck are rare and potentially dangerous injuries, which might pose problems for their detection, primary care, and final treatment. Depending on the severity of the underlying trauma, some injuries present a higher risk [...] Read more.

Penetrating foreign bodies of different origins in the head and neck are rare and potentially dangerous injuries, which might pose problems for their detection, primary care, and final treatment. Depending on the severity of the underlying trauma, some injuries present a higher risk for the presence of foreign bodies. Minor wounds, including common lacerations, are likely to be contaminated with loose gravel debris or dental fragments, and need to be distinguished from severe wounds caused by impalement, shootings, stabbings, and explosions. Blast injuries resulting from terror attacks are challenging recent therapeutic concepts. Even though these injury patterns are uncommon, they carry the risk of impacted objects with dramatic consequences. Despite improving medical imaging techniques, detection remains a challenge as it is dependent on the material of the foreign body, the affected anatomical site, and the injury severity. Therefore, a detailed history of the circumstances leading to trauma is essential when foreign objects are not visible during clinical examination. Precise detection of the foreign body, its anatomical position, and the affected surrounding structures are vital, especially for impalement injuries of the head and neck area. Therefore, an interdisciplinary planning approach is essential prior to removal of the foreign object. Finally, tension-free anatomical adaptation of the corresponding structures is crucial for maintaining and restoring aesthetic and function. Here, we give an overview of the diagnosis and treatment of cases of foreign body injuries encountered in our department. Full article

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7 pages, 264 KiB

Open AccessArticle

Prospective Randomized Controlled Pilot Study on Orbital Blowout Fracture

by Babak Alinasab, Karl-Johan Borstedt, Rebecka Rudström, Michael Ryott, Abdul Rashid Qureshi and Pär Stjärne

Craniomaxillofac. Trauma Reconstr. 2018, 11(3), 165-171; https://doi.org/10.1055/s-0038-1641170 - 2 Apr 2018

Cited by 8 | Viewed by 31

Abstract

To clarify the conflicting recommendations for care of blowout fracture (BOF), a prospective randomized study is required. Here, we present a prospective randomized pilot study on BOF. This article aimed to evaluate which computed tomography (CT) findings predict late functional and/or cosmetic symptoms [...] Read more.

To clarify the conflicting recommendations for care of blowout fracture (BOF), a prospective randomized study is required. Here, we present a prospective randomized pilot study on BOF. This article aimed to evaluate which computed tomography (CT) findings predict late functional and/or cosmetic symptoms in BOF patients with ≥ 1.0 mL herniation of orbital content into maxillary and/or ethmoidal sinuses. It also aimed to evaluate which patients with BOF would benefit from surgical treatment or observational follow-up. Twenty-six patients with BOF ≥ 1.0 mL herniation were randomized to observational (n = 10) or surgical treatments (n = 16) and were followed up for functional and cosmetic symptoms for at least 1 year. The results from CT scan measurements were correlated to the patients’ symptoms and clinical findings which we report in this pilot study. Of the 10 patients randomized to observation, five had an inferomedial BOF with a herniation of ≥ 1.3 mL and all patients developed cosmetic deformities and required surgery. The remaining five patients in the observational group had inferior BOF and one of them had a distance of 3.3 cm from the inferior orbital rim to the posterior edge of the fracture and developed a cosmetic deformity but was unwilling to proceed to surgical treatment, and four patients had a median distance of 2.9 cm from the inferior orbital rim to the posterior edge of the fracture and did not develop cosmetic deformities. The median time from injury to surgery was 13 (3–17) days for the surgical group and 37 (17–170) days for the patients who underwent surgery in the observational group. The surgical results were similar for all the operated patients at the final control. Diplopia decreased and remained partly in one patient in the surgical group and in two patients in the observational group. Hypoesthesia of the infraorbital nerve decreased in nonsurgically treated patients, but surgery seemed to induce hypoesthesia. In this prospective randomized controlled pilot study on BOF, all patients in the observational group with inferomedial fractures developed visible deformity. Diplopia in BOF, without ocular motility limitation, is believed to be due to edema. Diplopia is not an indication for surgery as long as it reduces over time. Full article

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6 pages, 383 KiB

Open AccessShort Note

A Novel Approach for the Management and Prevention of Self-Induced Masticatory Lingual Trauma in the Neurologically Injured Patient

by Yash Avashia, Peter Bittar, Visakha Suresh and David B. Powers

Craniomaxillofac. Trauma Reconstr. 2018, 11(3), 242-247; https://doi.org/10.1055/s-0037-1606300 - 19 Sep 2017

Cited by 1 | Viewed by 38

Abstract

Self-induced masticatory trauma is an unfortunate complication of a variety of neurologic disorders, including epileptic seizures, cerebral palsy, mental retardation, psychiatric disease, and brain trauma, in addition to other described etiologies. While single or occasional occurrences of tongue biting are relatively benign, recurrent [...] Read more.

Self-induced masticatory trauma is an unfortunate complication of a variety of neurologic disorders, including epileptic seizures, cerebral palsy, mental retardation, psychiatric disease, and brain trauma, in addition to other described etiologies. While single or occasional occurrences of tongue biting are relatively benign, recurrent self-injury can pose major issues and predispose a patient to chronic, severe complications. To prevent the complications associated with ongoing trauma to the tongue, steps must be taken to protect individuals from chronic self-injurious behavior. Often, these interventions cause significant morbidity to the patient, such as elective removal of the dentition or complications in gaining access to the oral cavity/airway associated with maxillomandibular fixation. In the neurologically impaired patient, immobilization of the jaws is frequently associated with higher rates of agitation, aspiration, or development of complicating infections of the gingival tissues. We report a case of self-induced masticatory trauma managed with the fabrication of a custom-fabricated oral appliance. This treatment modality successfully prevents the recurrence or incidence of self-induced masticatory trauma to the tongue. The benefits of this modality are that it allows access to the oral cavity, prevents immobilization of the jaws, has minimal to no morbidity, and is completely reversible. Full article

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4 pages, 170 KiB

Open AccessCase Report

Temporoparietal Fascia Free Flap for Nasoseptal Perforation Repair

by Samuel Helman, Sameep Kadakia, Ashley Guthrie, Moustafa Mourad and Grigoriy Mashkevich

Craniomaxillofac. Trauma Reconstr. 2018, 11(3), 238-241; https://doi.org/10.1055/s-0037-1604425 - 25 Aug 2017

Cited by 4 | Viewed by 40

Abstract

Nasoseptal perforations can be a challenging defect for the reconstructive surgeon, with repair limited by the surrounding tissue availability and the defect size. In patients with a history of cocaine use, often the integrity of surrounding vasculature is questionable and large defects may [...] Read more.

Nasoseptal perforations can be a challenging defect for the reconstructive surgeon, with repair limited by the surrounding tissue availability and the defect size. In patients with a history of cocaine use, often the integrity of surrounding vasculature is questionable and large defects may not be well suited for local reconstruction. In the otolaryngology literature, several reconstructive options using local tissue and synthetic materials have been described, but there have been no reports of microvascular free flaps utilized in this regard. We present a unique case of a 37-year-old woman with a 3.0 cm × 3.5 cm nasoseptal perforation secondary to cocaine use successfully reconstructed with a temporoparietal fascia free flap anastomosed to the facial artery and vein. Postoperatively, the patient had a well-healed septal defect from the free flap reconstruction This new technique shows promise as a feasible option for patients with large defects and for those with limited local reconstructive options. The ease of harvest and low donor-site morbidity make the temporoparietal fascia flap a suitable option for repair of complex nasoseptal defects. Full article

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6 pages, 151 KiB

Open AccessArticle

A Comparative Evaluation of Closed and Open Treatment in the Management of Unilateral Displaced Mandibular Subcondylar Fractures: A Prospective Randomized Study

by Virendra Singh, Neeraj Kumar, Amrish Bhagol and Neha Jajodia

Craniomaxillofac. Trauma Reconstr. 2018, 11(3), 205-210; https://doi.org/10.1055/s-0037-1603499 - 25 Jul 2017

Cited by 12 | Viewed by 42

Abstract

The aim of the study is to evaluate closed and open treatment in the management of unilateral displaced mandibular subcondylar fractures. Twenty patients with unilateral subcondylar fractures of the mandible were evaluated with degree of displacement of more than 20 degrees and ramal [...] Read more.

The aim of the study is to evaluate closed and open treatment in the management of unilateral displaced mandibular subcondylar fractures. Twenty patients with unilateral subcondylar fractures of the mandible were evaluated with degree of displacement of more than 20 degrees and ramal height shortening of more than 10 mm. They were informed of the need for 6-month follow-up. Patients were thoroughly informed, explaining the possible advantages and disadvantages of the open and closed treatment options. Radiographic parameters included the level of fracture, deviation of fragment, and ramal height shortening. Correct anatomical reduction is achieved by open treatment as compared with closed treatment. Regarding pain, mouth opening, and lateral excursion movement, statistically significant difference was found in both groups (p < 0.01). In radiographic assessment of ramal height shortening and fracture displacement, statistically significant difference was found (p < 0.01). And no significant complication is found in both treatment groups. The results of this study favor the open treatment for the management of displaced subcondylar fractures. However, the treatment results are also acceptable for closed group. Full article

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8 pages, 469 KiB

Open AccessCase Report

The Use of Virtual Surgical Planning in Total Facial Skeletal Reconstruction of Treacher Collins Syndrome: A Case Report

by Yifan Guo, Joseph Lopez, Robin Yang, Alexandra Macmillan and Amir H. Dorafshar

Craniomaxillofac. Trauma Reconstr. 2018, 11(3), 230-237; https://doi.org/10.1055/s-0037-1604424 - 21 Jul 2017

Cited by 6 | Viewed by 46

Abstract

Facial skeletal reconstruction of patients with severe Treacher Collins syndrome (TCS) requires correction of both midface and mandibular deficiencies. Implementing virtual surgical planning can provide an accurate three-dimensional analysis of craniofacial abnormalities, creating calvarial donors that match the anatomy of the desired malar [...] Read more.

Facial skeletal reconstruction of patients with severe Treacher Collins syndrome (TCS) requires correction of both midface and mandibular deficiencies. Implementing virtual surgical planning can provide an accurate three-dimensional analysis of craniofacial abnormalities, creating calvarial donors that match the anatomy of the desired malar augmentation and facilitating bimaxillary movements, positioning, and fixation in orthognathic surgery. We present a case of an 18-year-old patient with TCS, who underwent staged zygomaticomaxillary reconstruction and double-jaw osteotomy with sliding genioplasty, using computer-assisted surgical planning. Following these operations, the patient achieved not only improved facial harmony but also class I occlusion. Full article

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6 pages, 126 KiB

Open AccessArticle

Psychological Consequences of Maxillofacial Trauma in the Indian Population: A Preliminary Study

by Balasubramanian Krishnan and Ravi Philip Rajkumar

Craniomaxillofac. Trauma Reconstr. 2018, 11(3), 199-204; https://doi.org/10.1055/s-0037-1604426 - 19 Jul 2017

Cited by 8 | Viewed by 46

Abstract

The aim of this article is to identify the prevalence of posttraumatic psychological symptoms following maxillofacial trauma among an Indian population sample and assess changes in these symptoms over a period of time. Forty-eight adult patients were assessed within 2 weeks of injury [...] Read more.

The aim of this article is to identify the prevalence of posttraumatic psychological symptoms following maxillofacial trauma among an Indian population sample and assess changes in these symptoms over a period of time. Forty-eight adult patients were assessed within 2 weeks of injury with two follow-up visits (4–6 weeks and 12–14 weeks). Patients were administered three self-reporting questionnaires in local language (GHQ-12; HADS; TSQ) on all occasions. Relevant sociodemographic and clinical data were obtained. Forty patients were included in the final analysis. Emotional distress was present in nine participants and five participants satisfied the TSQ criteria for a diagnosis of stress disorder. Anxiety and depression were observed in 10 and 4 patients, respectively. Characteristics associated with abnormal high scores included substance abuse, low education and income levels, facial scars, and complications needing additional intervention. These findings reveal the abnormal psychological response to maxillofacial trauma in immediate and follow-up periods. The use of such screening tools can be considered by the maxillofacial surgeon for early identification of psychological symptoms and referral to the psychiatrist. Full article

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7 pages, 553 KiB

Open AccessArticle

The Effect of Bone Marrow Mesenchymal Stem Cells Application on Distracted Bone Quality during Rapid Rate of Distraction Osteogenesis

by Marwa El Kassaby, Khaled Abd El Kader, Nahed Khamis, Alaa Al Hammoud, Alaa Ben Talb and Yasser Nabil el Hadidi

Craniomaxillofac. Trauma Reconstr. 2018, 11(3), 192-198; https://doi.org/10.1055/s-0037-1604070 - 19 Jul 2017

Cited by 5 | Viewed by 56

Abstract

Distraction osteogenesis (DO) bone regenerate usually suffers from an inferior quality especially with rapid rate. This study was conducted to investigate the effect of mesenchymal stem cells (MSCs) application on different rates of distraction bone quality. Twenty-four goats were divided into group A [...] Read more.

Distraction osteogenesis (DO) bone regenerate usually suffers from an inferior quality especially with rapid rate. This study was conducted to investigate the effect of mesenchymal stem cells (MSCs) application on different rates of distraction bone quality. Twenty-four goats were divided into group A with standard DO and group B with rapid distraction osteogenesis (RDO) both aided by MSCs. Group C with standard DO and group (D) with RDO were controls. Kruskal–Wallis test and Conover's post hoc analysis was used to evaluate significance (p = 0.05). Histomorphometry showed a strongly significant (SS) increase (p = 0.00036) in trabecular bone (TB) in group A (TB = 174.7 μm, SD = 33.5) and group B (TB = 166.8 μm, SD = 14) compared with group C (TB = 115.4 μm, SD = 19.6) and group D (TB = 86.1 μm, SD = 9.3). There was SS decrease (p = 0.00093) in osteoid percentage (OP) in group A (OP = 13.4%, SD = 2) and group B (OP = 11.5%, SD = 6.5) compared with group C (OP = 27.3, SD = 3.5) and group D (OP = 26.2%, SD = 2.6). Energy dispersive X-ray showed a nonsignificant increase (p = 0.11) in calcification (Ca²⁺%) in group A (Ca²⁺% = 17.6%, SD = 4.9) and group B (Ca²⁺% = 17.6%, SD = 4.3) compared with group C (Ca²⁺ % = 14.2%, SD = 6.7) and group D (Ca²⁺% = 11.5%, SD = 2.4). MSCs application improved microscopic bone quality during standard DO and RDO. However, macroscopic bone quality improvement still needs further investigation. Full article

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6 pages, 488 KiB

Open AccessCase Report

Subacute Granulation Tissue of the Fornix After Resorbable Orbital Implant: An Unusual Case and Review of the Literature

by Jaime Castro-Núñez, Trent Clifton and Joseph Van Sickels

Craniomaxillofac. Trauma Reconstr. 2018, 11(3), 224-229; https://doi.org/10.1055/s-0037-1604069 - 17 Jul 2017

Viewed by 43

Abstract

Orbital blow-out fractures are very common. Goals of surgical treatment are to reestablish form and function with excellent cosmetic results. Materials used for orbital floor repair include autologous grafts and a variety of alloplastic materials. In this article, we present a case of [...] Read more.

Orbital blow-out fractures are very common. Goals of surgical treatment are to reestablish form and function with excellent cosmetic results. Materials used for orbital floor repair include autologous grafts and a variety of alloplastic materials. In this article, we present a case of subacute granulation tissue of the fornix that developed as a foreign body reaction 4 months after placing a resorbable implant to repair an orbital floor fracture. The implant was removed and the patient continued to heal uneventfully. Management of the case and biomaterials employed are discussed in light of current research. Full article

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9 pages, 369 KiB

Open AccessArticle

Endoscopic-Assisted Intraoral Open Reduction Internal Fixation of Mandibular Subcondylar Fractures: Initial Experiences from a Tertiary-Care Maxillofacial Center in India

by Venkatesh Anehosur, Abhijit Joshi and Saravanan Rajendiran

Craniomaxillofac. Trauma Reconstr. 2018, 11(3), 183-191; https://doi.org/10.1055/s-0037-1603457 - 12 Jun 2017

Cited by 7 | Viewed by 43

Abstract

Management of condylar fractures is a highly controversial and debatable area. Open reduction and internal fixation (ORIF) using an extraoral approach has certain benefits over the nonsurgical treatment. Risk of damage to the facial nerve and an extraoral scar remains constant deterrents. An [...] Read more.

Management of condylar fractures is a highly controversial and debatable area. Open reduction and internal fixation (ORIF) using an extraoral approach has certain benefits over the nonsurgical treatment. Risk of damage to the facial nerve and an extraoral scar remains constant deterrents. An endoscopic-assisted ORIF offers an intraoral approach, thus eliminating consequences such as scarring. Though this technique offers unparalleled advantages, it is associated with a steep learning curve. Surgical results improve only with patience and experience. Patients with condylar fractures reported to SDM Craniofacial Unit, Dharwad, India, from 2013 to 2015 are included. Patients were treated with endoscopic-assisted ORIF and were evaluated for functional outcomes that included occlusion, maximal interincisal opening, and deviation of mouth and complications such as facial nerve pareses, postsurgical infection, and morbidity. Fifteen patients included in the study: 4 left sided and 11 right sided fractures. Nine patients had associated other mandibular fracture. Mean age of the patients was 28.2 years. Mean mouth opening at the end of 1 week, 6 weeks, and 6 months was 32.6, 37.8, and 40.5 mm, respectively. Transient facial nerve pareses were noted in one patient, and an extraoral draining sinus was noted in another. Endoscopic-assisted ORIF has a definite scope in management of condylar fractures. Results are more predictable with appropriate case selection due to a steep learning curve and intraoperative technical challenges. An initial experience in ORIF using extraoral approaches would greatly benefit a surgeon in utilizing this novel and alternate tool. Full article

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5 pages, 266 KiB

Open AccessCase Report

Lingual Artery Pseudoaneurysm After Severe Facial Trauma

by Leyre Margallo, Estibaliz Ortiz de Zárate, Maria Franco, Maria Garcia-Iruretagoyena, Rosa Cherro, Luis Barbier, Josu Mendiola and Thomas Constantinescu

Craniomaxillofac. Trauma Reconstr. 2018, 11(3), 219-223; https://doi.org/10.1055/s-0037-1603454 - 18 May 2017

Cited by 4 | Viewed by 51

Abstract

The mortality associated with high-energy trauma has several time peaks and variable prognosis. In the particular case of isolated head and neck trauma, management initially includes stabilizing the patient, especially the airway and circulation, and then proceeding to treat injured structures with debridement [...] Read more.

The mortality associated with high-energy trauma has several time peaks and variable prognosis. In the particular case of isolated head and neck trauma, management initially includes stabilizing the patient, especially the airway and circulation, and then proceeding to treat injured structures with debridement and often fracture fixation and coverage. We present a case of a male patient who suffered a severe facial trauma at his workplace. He underwent an initial uneventful emergency surgery for control of bleeding and mandibular osteosynthesis. At 2 weeks postoperatively, a second emergency surgery was required to treat a previously undiagnosed lingual pseudoaneurysm that ruptured spontaneously, with massive oral bleeding. The case highlights the clinical significance and timing of pseudoaneurysm formation, and the surveillance and high index of suspicion required for potentially life-threatening bleeding at later time peaks. Diagnostic and therapeutic angiography effectively treated the late complication. Multidisciplinary management options are reviewed, emphasizing the need for rapid decision making and collaboration to improve outcomes in such significant surgical trauma patients. Full article

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8 pages, 424 KiB

Open AccessCase Report

Surgical Treatment of Posttraumatic Laterognathia: A Case Report and a Literature Review, Focused on the Effects of a Condylar Fracture on the Face

by Felipe Ladeira Pereira, Luísa de Marilac de Alencar Pinheiro, Phelype Maia Araújo, Letícia Liana Chihara, Renato Luiz Maia Nogueira and Eduardo Sant'Ana

Craniomaxillofac. Trauma Reconstr. 2018, 11(3), 211-218; https://doi.org/10.1055/s-0037-1601861 - 18 May 2017

Cited by 1 | Viewed by 57

Abstract

Facial asymmetry, following early childhood condylar trauma, is a common complaint among patients who seek surgical treatment. G.D.M., a 27-year-old male patient, sought professional help to correct his cosmetic flaw, caused by a condylar fracture when he was 8-years-old. After the proper orthodontic [...] Read more.

Facial asymmetry, following early childhood condylar trauma, is a common complaint among patients who seek surgical treatment. G.D.M., a 27-year-old male patient, sought professional help to correct his cosmetic flaw, caused by a condylar fracture when he was 8-years-old. After the proper orthodontic treatment, he underwent a double jaw orthognathic surgery and, 9 months later, a second one to correct the remaining asymmetry. Two years after this second procedure, the patient is still under surveillance and has no complaints. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 11, Issue 3 (September 2018) – 12 articles

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