Craniomaxillofacial Trauma & Reconstruction

11 pages, 494 KiB

Open AccessArticle

New Algorithm for the Management of Orbital Blowout Fracture Based on Prospective Study

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

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 285-295; https://doi.org/10.1055/s-0038-1641714 - 1 May 2018

Cited by 23 | Viewed by 53

Abstract

Despite extensive debate and publications in the management of blowout fracture (BOF), there are still considerable differences in the surgeons’ management of BOF due to a lack of reliable evidence-based studies. This article aimed to evaluate which BOF patients require surgical treatment due [...] Read more.

Despite extensive debate and publications in the management of blowout fracture (BOF), there are still considerable differences in the surgeons’ management of BOF due to a lack of reliable evidence-based studies. This article aimed to evaluate which BOF patients require surgical treatment due to functional and/or cosmetic deformities; evaluate which computed tomography (CT) scan findings predict these problems; and provide an algorithm in the management of BOF. Seventy-nine patients with BOF were treated conservatively and followed up prospectively regarding functional and cosmetic deformities for at least 1 year. The patients’ CT scans were analyzed and several measurements were performed. Patients’ symptoms and the clinical findings were correlated to the CT scan measurements. We found visible deformity in 37% of the patients, but only 10% chose to proceed to surgery due to cosmetic deformities. In patients with inferior BOF and a herniation < 1.0 mL, a visible deformity was found when the ratio between fracture and the fractured orbital wall areas was ≥42%, or the total area of the fracture was ≥ 2.3 cm². In patients with inferior BOF and a herniation ≥ 1.0 mL, a visible deformity was found when the distance from the inferior orbital rim to the posterior edge of the fracture was ≥ 3.0 cm. In patients with inferomedial fracture, a visible deformity was found when the herniation was ≥ 0.9 mL. Diplopia improved significantly and remained in only 3% of the patients in nonoperated group. Hypoesthesia of the infraorbital nerve improved significantly, but 23% of the nonoperated and 50% of the operated patients still experienced loss of sensation at final control. In this prospective study, we found that not only herniated orbital volume but also other CT scan findings in BOF were crucial to predict late visible deformities. Based on these findings, we propose an algorithm for the prediction of late visible deformity with 83% accuracy. There are indications that diplopia without ocular motility disorder is due to edema and we recommend observation as long as the diplopia improves gradually. Full article

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7 pages, 421 KiB

Open AccessCase Report

Repair of Occipital Bone Defects in Neurofibromatosis Type 1 by Means of CAD/CAM Prefabricated Titanium Plates

by Reinhard E. Friedrich, Pedram Emami, Christian Hagel, Johannes Wikner and Henning Hanken

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 324-330; https://doi.org/10.1055/s-0037-1608699 - 4 Dec 2017

Cited by 5

Abstract

Certain skeletal defects may develop in neurofibromatosis type 1 (NF1), a common tumor-suppressor syndrome, such as cranial lesions confined to the lambdoid suture region. Here, we report on the repair of osseous defects of occipital bone in a NF1 patient with history of [...] Read more.

Certain skeletal defects may develop in neurofibromatosis type 1 (NF1), a common tumor-suppressor syndrome, such as cranial lesions confined to the lambdoid suture region. Here, we report on the repair of osseous defects of occipital bone in a NF1 patient with history of skull trauma and tumorous hemorrhage. Computer-aided design and computer-aided manufacturing (CAD/CAM)-assisted devices were applied to safely close the bone defects. The variable phenotype of NF1 in the occipital skull region is discussed and a brief review is presented on NF1-related therapies for tumors and malformations of the occipitoparietal skull region. Full article

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4 pages, 277 KiB

Open AccessCase Report

Posttraumatic Glabellar Mucocele: Case Report

by Stefano Mandrioli, Luisa Valente and Manlio Galiè

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 320-323; https://doi.org/10.1055/s-0037-1608698 - 21 Nov 2017

Abstract

Mucoceles are benign, expansile cystic masses covered by respiratory epithelium filled with mucus secreted by goblet cells interspersed in the ciliated mucosa. Mucoceles result from the accumulation and retention of the products of secretion, desquamation, and inflammation in cases where the drainage is [...] Read more.

Mucoceles are benign, expansile cystic masses covered by respiratory epithelium filled with mucus secreted by goblet cells interspersed in the ciliated mucosa. Mucoceles result from the accumulation and retention of the products of secretion, desquamation, and inflammation in cases where the drainage is obstructed. We present a case of a nasal mucocele that developed in a 50-year-old man, possibly related to a craniofacial trauma that had occurred 24 years earlier. This is an unusual case of posttraumatic glabellar mucocele with subcutaneous extension and nasal bone erosion without any neurologic or ophthalmologic involvement. Full article

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6 pages, 354 KiB

Open AccessCase Report

Surgical Treatment of Fibroosseous Lesion in Young Patient with Reduced Mouth Opening

by Pedro Henrique de Azambuja Carvalho, Marcos Antonio Torriani, Letícia Kirst Post and Otacílio Luiz Chagas, Júnior

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 314-319; https://doi.org/10.1055/s-0037-1608697 - 16 Nov 2017

Cited by 1 | Viewed by 46

Abstract

Fibrous dysplasia is a benign fibroosseous disorder that can affect the maxillary bones, causing aesthetic deformity and functional impairment. This article reports the case of a 13-year-old male patient at the time of diagnosis. The patient showed increased facial volume with relevant asymmetry, [...] Read more.

Fibrous dysplasia is a benign fibroosseous disorder that can affect the maxillary bones, causing aesthetic deformity and functional impairment. This article reports the case of a 13-year-old male patient at the time of diagnosis. The patient showed increased facial volume with relevant asymmetry, having reported the onset of the condition 12 months before. Upon examination, the patient presented an 8-mm mouth opening and an acute inflammatory process associated with tooth 37 pericoronal hood. Upon imaging exam, exuberant bone growth in the left mandibular ramus area of ground glass aspect was observed. After incisional biopsy, fibrous dysplasia was diagnosed and sequentially treated with osteoplasty and coronoid process removal. The patient evolved to a 43-mm mouth opening and favorable aesthetics without recurrence in a 3-year follow-up period. In this case, coronoidectomy and bone plasty proved to be effective, returning aesthetics and function. The patient is supposed to be followed up in the long term. Full article

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9 pages, 905 KiB

Open AccessCase Report

Removal of a Frontal Sinus Osteoma and Reconstruction by a Custom-Made Implant with Neuronavigation Assistance

by Vincenzo Palazzolo, Anita Tronchet, Stefano Valsecchi, Silvio Bellocchi, Carlo Gervasoni, Stefano Spotti, Andrea Di Francesco, Luigi Colombo, Stefano Riccio and Paolo Ronchi

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 305-313; https://doi.org/10.1055/s-0037-1607066 - 2 Nov 2017

Cited by 6 | Viewed by 54

Abstract

The authors report the surgical treatment of an extensive right frontal sinus osteoma assisted by neuronavigation and reconstruction by a hydroxyapatite custom-made implant. The patient presents with ptosis, hypoglobus, and proptosis of the right eye, without any visual impairment. Computed tomographic (CT) scan [...] Read more.

The authors report the surgical treatment of an extensive right frontal sinus osteoma assisted by neuronavigation and reconstruction by a hydroxyapatite custom-made implant. The patient presents with ptosis, hypoglobus, and proptosis of the right eye, without any visual impairment. Computed tomographic (CT) scan showed a very large bony mass involving right frontal sinus and displacing the orbital roof. A stereolithographic model–guided planning was carried out to obtain a practical simulation of the surgical operation and it was submitted to a new CT scan to acquire the reference point to realize the neuronavigation assistance, and to achieve the template to realize the hydroxyapatite custom-made implant. Intraoperatively, with the help of neuronavigation assistance, osteotomies were performed by piezoelectric device. The reconstruction was made using a hydroxyapatite custom-made implant. The procedure was damage free, the bony mass was excised, and the orbital roof was repaired without any adverse effects. Postsurgical CT scan and scintigraphy showed a good reconstruction and a good-quality osteoblasts activity on the borders of the implant. Osteoma is a benign slow-growing bone tumor, usually involving the frontal sinus. Navigational assistance offers a very important help to perform safe osteotomies. Hydroxyapatite custom-made implant seems to be an excellent reconstructive method. Full article

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3 pages, 114 KiB

Open AccessCase Report

Pseudoaneurysm following Endoscopic-Assisted Repair of Subcondylar Fracture

by Emily Ambrose, Mofiyinfolu Sokoya and Marcia Eustaquio

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 302-304; https://doi.org/10.1055/s-0037-1607064 - 27 Oct 2017

Cited by 1

Abstract

Pseudoaneurysms are a known complication following facial trauma and orthognathic surgery. Few reports exist of this clinical entity following traditional open techniques of repair, and none have been associated with endoscopic-assisted open reduction and internal fixation (ORIF) of a subcondylar fracture. We present [...] Read more.

Pseudoaneurysms are a known complication following facial trauma and orthognathic surgery. Few reports exist of this clinical entity following traditional open techniques of repair, and none have been associated with endoscopic-assisted open reduction and internal fixation (ORIF) of a subcondylar fracture. We present a case of a 33-year-old man who developed pseudoaneurysm after endoscopic-assisted ORIF as well as a review of the literature on this topic. While uncommon, this is a potential complication that should be recognized with the use of endoscopic-assisted repair of mandibular fractures. Full article

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6 pages, 354 KiB

Open AccessCase Report

Traumatic Anterosuperior Dislocation of the Intact Mandibular Condyle into the Temporal Fossa

by Roger Lanes Silveira, Ivan Ranuzia, Marcelo Fernandes S. Melo, Rogerio Araujo de Oliveira, Antonio Alburquerque de Brito and Victor Laviola Vidigal

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 296-301; https://doi.org/10.1055/s-0037-1607067 - 27 Oct 2017

Cited by 4

Abstract

Temporomandibular joint (TMJ) dislocation, or luxation, occurs when the condyle crosses the articular eminence in such a way that it does not return to its correct anatomical position, unless aided by a reduction in external forces for TMJ. The diagnosis of condylar luxation [...] Read more.

Temporomandibular joint (TMJ) dislocation, or luxation, occurs when the condyle crosses the articular eminence in such a way that it does not return to its correct anatomical position, unless aided by a reduction in external forces for TMJ. The diagnosis of condylar luxation is clinical; however, image exams are important in classifying the types of condylar luxation and associated fractures. Displacement of the TMJ can occur due to either an exaggerated mouth opening or a forced opening and occasionally is associated with a high-impact trauma to the jaw, the latter being an extremely rare condition. Few cases of anterosuperior dislocation of the intact mandibular condyles into the temporal fossa (ADIMC) have been documented in medical literature, many of which are associated with craniofacial trauma. This study describes the case of an ADIMC of the left side combined with facial fractures, as well as the treatment performed. A review of cases found in the literature from 1969 to 2017 was conducted through a detailed bibliographical study. Full article

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7 pages, 345 KiB

Open AccessArticle

Cartilage Graft Donor Site Morbidity Following Rhinoplasty and Nasal Reconstruction

by Thuy-Van Tina Ho, Kevin Sykes, J. David Kriet and Clinton Humphrey

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 278-284; https://doi.org/10.1055/s-0037-1607065 - 25 Oct 2017

Cited by 14 | Viewed by 77

Abstract

Although surgical techniques for rhinoplasty and nasal reconstruction are well established, prospective research on postoperative morbidity remains limited. The aim of this pilot study was to assess costal and auricular cartilage donor site pain and morbidity in patients undergoing rhinoplasty and nasal reconstruction. [...] Read more.

Although surgical techniques for rhinoplasty and nasal reconstruction are well established, prospective research on postoperative morbidity remains limited. The aim of this pilot study was to assess costal and auricular cartilage donor site pain and morbidity in patients undergoing rhinoplasty and nasal reconstruction. In this prospective cohort study, we enrolled 55 patients undergoing nasal surgery that required costal or auricular cartilage harvest from February 2015 through May 2016. Each patient was given a symptom-specific patient survey that assessed general pain, nasal pain, graft donor site pain, graft donor site itching, color variation, skin stiffness and thickness, and graft donor site appearance at 1, 4, and 12 weeks after surgery. Our patient group was 55% female (n = 30); the mean age was 47 years. Rib cartilage graft patients had significantly greater nasal pain than cartilage donor site pain. There was no significant difference in rib versus ear cartilage donor site pain. Nearly all patients reported that they were not at all concerned about their scar appearance or ear shape and appearance. No prior studies compare cartilage donor site morbidity in patients undergoing nasal surgery. Our findings challenge the conventional wisdom that utilizing auricular and costal cartilage results in high levels of donor site pain. Surgeons should have a low threshold to harvest rib or ear cartilage when it can improve surgical outcome. Full article

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2 pages, 92 KiB

Open AccessShort Note

Glossopharyngeal Nerve Block: The Premolar Approach

by Sruthi Rao and Santhosh Rao

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 331-332; https://doi.org/10.1055/s-0037-1606249 - 25 Aug 2017

Cited by 7 | Viewed by 56

Abstract

This is a technical note describing hard tissue landmarks to simplify the intraoral glossopharyngeal nerve block. Our literature review revealed no specific mention of the same procedure in documented data. Full article

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5 pages, 237 KiB

Open AccessArticle

Comparison of Imaging Softwares for Upper Airway Evaluation: Preliminary Study

by Guilherme dos Santos Trento, Lucas Borin Moura, Rubens Spin-Neto, Philipp Christian Jürgens, Marisa Aparecida Cabrini Gabrielli and Valfrido Antônio Pereira-Filho

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 273-277; https://doi.org/10.1055/s-0037-1606247 - 25 Aug 2017

Cited by 6 | Viewed by 39

Abstract

The interest about upper airway evaluation has increased lately. Therefore, many softwares have been developed aiming to improve and facilitate the analysis of airway volume. The objective of this study was to compare two different softwares packages, Mimics and Dolphin, in their accuracy [...] Read more.

The interest about upper airway evaluation has increased lately. Therefore, many softwares have been developed aiming to improve and facilitate the analysis of airway volume. The objective of this study was to compare two different softwares packages, Mimics and Dolphin, in their accuracy and precision in upper airway space measurements. Preoperative cone beam computed tomography scans of nine nonsyndromic patients submitted to surgically assisted rapid maxillary expansion were included in this study. The imaging exams were converted to DICOM (digital imaging and communications in medicine) files and imported to the softwares. The mean volume for the Dolphin group (G1) was 10.791 cm³ (SD = 4.269 cm³) and for the Mimics group (G2) was 10.553 cm³ (SD = 4.564 cm³). There was no statistically significant difference between the two groups (p = 0.105). Full article

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8 pages, 446 KiB

Open AccessArticle

Analysis of the Changing Patterns of Midface Fractures Using 3D Computed Tomography: An Observational Study

by Preeti Satish, Kavitha Prasad, R. M. Lalitha, Krishnappa Ranganath and Parimala Sagar

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 265-272; https://doi.org/10.1055/s-0037-1606250 - 25 Aug 2017

Cited by 8 | Viewed by 54

Abstract

This article aims to analyze the changing Le Fort fracture patterns using computed tomography (CT) scans with three-dimensional (3D) reconstruction. A prospective observational study was conducted on 60 patients with midface trauma, who had reported to MS Ramaiah Group of Hospitals, Bangalore, between [...] Read more.

This article aims to analyze the changing Le Fort fracture patterns using computed tomography (CT) scans with three-dimensional (3D) reconstruction. A prospective observational study was conducted on 60 patients with midface trauma, who had reported to MS Ramaiah Group of Hospitals, Bangalore, between January 2015 and October 2016. CT scans using 1.6 mm axial, sagittal, coronal sections were taken and their 3D reconstruction was made. The images were studied and compared with the standard Le Fort lines. The deviations from the classical Le Fort lines were analyzed and recorded. A note was also made of any additional fixation that was required for these deviations. Descriptive analysis was done and the results expressed in numbers and percentages. Study revealed that the most common cause for the midface fractures was found to be road traffic accidents (81.7%) with a male preponderance (88.3%) and peak incidence in 21 to 30 years of age (40%). Among the 60 patients, 18 (30%) patients had fracture patterns similar to the ideal Le Fort lines, 4 (6.6%) had a combination of Le Fort patterns, and 38 (66.3%) patients had deviations seen from the ideal Le Fort lines. Four types of deviations were recorded, namely, D1(60%), D2(5.4%), D3(10.9%), and D4(23.6%). It was observed that D1 and D3 required additional fixation. Majority of the cases presented as a deviation from ideal Le Fort fractures. CT was a valuable tool in the assessment of these fracture patterns. Deviations, if any, could be better analyzed using the 3D reconstruction images. Proper diagnosis and detection of these deviations make the planning for fixation easier. Repetition of these deviations could propose a newer or modified classification system for Le Fort fractures. Full article

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9 pages, 247 KiB

Open AccessArticle

Two- Versus Three-Point Internal Fixation of Displaced Zygomaticomaxillary Complex Fractures

by Wail Fayez Nasr, Ezzeddin ElSheikh, Mohammad Waheed El-Anwar, Ahmed Hassan Sweed, Awad Bessar and Nillie Ezzeldin

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 256-264; https://doi.org/10.1055/s-0037-1604199 - 27 Jul 2017

Cited by 20 | Viewed by 43

Abstract

Despite the high frequency of the zygomaticomaxillary complex (ZMC) fractures, there is no consensus among facial reconstructive surgeons regarding the best surgical management; thus, surgical choice for ZMC fractures is still challenging. This study included 40 patients with displaced ZMC fracture. Twenty patients [...] Read more.

Despite the high frequency of the zygomaticomaxillary complex (ZMC) fractures, there is no consensus among facial reconstructive surgeons regarding the best surgical management; thus, surgical choice for ZMC fractures is still challenging. This study included 40 patients with displaced ZMC fracture. Twenty patients were treated with open reduction and internal fixation (OR/IF) using two-point fixation technique (at infraorbital margin and zygomaticofrontal buttress region) and the remaining 20 patients were treated with OR/IF using three-point fixation technique (at frontozygomatic suture, infraorbital margin, and zygomatico maxillary buttress). The results of both types of ZMC fractures repair were then statistically compared. No statistical differences between the two types regarding malar eminence asymmetry; projection (forward displacement) and width (medial displacement) in axial CT; inferior displacement; superior displacement and width (medial displacement) in coronal CT; angle of displacement (outward displacement) in 3D CT; masseter and temporalis muscles power electromyography; actual duration of surgery; and patient satisfaction. On the other hand, the total cost of the used plates and screws was significantly higher with three-point repair than two-point repair (p = 0.003). Moreover, postoperative CT lateral zygoma displacement was statistically significantly better in three-point fixation. Two-point fixation modality for displaced ZMC fractures is as effective as three-point method in fixation and prevents postreduction rotation or clinical displacement with significantly lower cost. Full article

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7 pages, 116 KiB

Open AccessArticle

by Robert Saadi, Benjamin S. Oberman and Jessyka G. Lighthall

Craniomaxillofac. Trauma Reconstr. 2018, 11(4), 249-255; https://doi.org/10.1055/s-0037-1604073 - 21 Jul 2017

Cited by 16 | Viewed by 48

Abstract

Dog bites in the pediatric population commonly cause injuries to the head and can be associated with fractures, often leading to prolonged hospital stays, multiple surgical interventions, and long-term complications. Our goal was to evaluate our experience with dog-bite—related craniofacial fractures, understand frequency [...] Read more.

Dog bites in the pediatric population commonly cause injuries to the head and can be associated with fractures, often leading to prolonged hospital stays, multiple surgical interventions, and long-term complications. Our goal was to evaluate our experience with dog-bite—related craniofacial fractures, understand frequency and demographics of these fractures, identify common fracture patterns, and provide recommendations based on management and complications encountered. The institution's electronic medical record was reviewed. A review of the English literature for the past 20 years was also conducted. A retrospective chart review was conducted using ICD-9 codes to include all patients with head and neck dog bites and craniofacial fractures. Fractures resulting from canine bites to the face and scalp were rare, occurring in our study in less than 1% of total facial dog bites (1069 cases) and 1.5% of pediatric facial dog bites (462 cases). Ages ranged from 5 months to 9 years at the time of presentation. A total of seven patients, all pediatric, were documented. All seven patients required operative intervention for their wounds, and five patients required at least two operative interventions. Midface and skull fractures were the most commonly encountered fracture sites. Dog bite injuries to the face in young children, especially when severe, should raise suspicion for fracture of underlying bone. Management of these injuries should include a multidisciplinary approach and focus on repair of soft tissue and skeletal deformities. Furthermore, it is prudent to follow up patients who require operative management after injury to monitor for long-term complications, given the significant proportion of complications and operative takebacks in this study. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 11, Issue 4 (December 2018) – 13 articles

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