Craniomaxillofacial Trauma & Reconstruction

6 pages, 218 KiB

Open AccessArticle

The Thickness of Parietal Bones in a New Zealand Sample of Cadaveric Skulls in Relation to Calvarial Bone Graft

by Han J. Choi, Rohana K. De Silva, Darryl C. Tong, Harsha L. De Silva, Robert M. Love and Josie Athens

Craniomaxillofac. Trauma Reconstr. 2013, 6(2), 115-120; https://doi.org/10.1055/s-0033-1343788 - 9 May 2013

Cited by 5 | Viewed by 34

Abstract

Objectives To evaluate the average thickness of the parietal bones in their different regions to identify the ideal site(s) for calvarial bone graft harvest. Methods and Materials Thickness of the parietal bones of 25 wet cranial vaults of New Zealand European origin was [...] Read more.

Objectives To evaluate the average thickness of the parietal bones in their different regions to identify the ideal site(s) for calvarial bone graft harvest. Methods and Materials Thickness of the parietal bones of 25 wet cranial vaults of New Zealand European origin was measured in 135 different locations using an electronic caliper. Analyses to identify the ideal harvest sites were conducted so that the sites fit the features of an ideal harvest site described in the literature as: (1) 6 mm of minimum thickness and (2) 2 cm away from the midline. Results and Conclusion The overall average thickness was 6.69 ± 0.22 mm. The average thickness at different sites within the same bone ranged from 2.85 to 6.93 mm. In keeping with previous studies, the report observed a progressive thickening of the parietal bone in medial and posterior directions. Of the 135 different locations measured, only 20% exceeded an average thickness of 6 mm as well as being 2 cm away fromthe sagittalmidline. These locations were mainly located between 6 to 11 cm posterior to the coronal suture and 2 to 5 cm away from the sagittal suture. Conclusion Harvesting the calvarial bone graft in the area 6 to 11 cm posterior to the coronal suture and 2 cm away from the midline is recommended based on our study using cadaveric cranial vaults of New Zealand Europeans. Full article

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11 pages, 523 KiB

Open AccessReview

Optic Nerve Monitoring

by Paul Schumann, Horst Kokemüller, Frank Tavassol, Daniel Lindhorst, Juliana Lemound, Harald Essig, Martin Rücker and Nils-Claudius Gellrich

Craniomaxillofac. Trauma Reconstr. 2013, 6(2), 75-85; https://doi.org/10.1055/s-0033-1343783 - 1 May 2013

Cited by 7 | Viewed by 32

Abstract

Orbital and anterior skull base surgery is generally performed close to the prechiasmatic visual pathway, and clear strategies for detecting and handling visual pathway damage are essential. To overcome the common problem of a missed clinical examination because of an uncooperative or unresponsive [...] Read more.

Orbital and anterior skull base surgery is generally performed close to the prechiasmatic visual pathway, and clear strategies for detecting and handling visual pathway damage are essential. To overcome the common problem of a missed clinical examination because of an uncooperative or unresponsive patient, flash visual evoked potentials and electroretinograms should be used. These electrophysiologic examination techniques can provide evidence of intact, pathologic, or absent conductivity of the visual pathway when clinical assessment is not feasible. Visual evoked potentials and electroretinograms are thus essential diagnostic procedures not only for primary diagnosis but also for intraoperative evaluation. A decision for or against treatment of a visual pathway injury has to be made as fast as possible due to the enormous importance of the time elapsed with such injuries; this can be achieved additionally using multislice spiral computed tomography. The first-line conservative treatment of choice for such injuries is megadose methylprednisolone therapy. Surgery is used to decompress the orbital compartment by exposure of the intracanalicular part of the optic nerve in the case of optic canal compression. Modern craniomaxillofacial surgery requires detailed consideration of the diagnosis and treatment of traumatic visual pathway damage with the ultimate goal of preserving visual acuity. Full article

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5 pages, 226 KiB

Open AccessCase Report

Midline Mandibulotomy for Reduction of Long-Standing Temporomandibular Joint Dislocation

by Vidya Rattan, Sachin Rai and Amit Sethi

Craniomaxillofac. Trauma Reconstr. 2013, 6(2), 127-131; https://doi.org/10.1055/s-0033-1343786 - 30 Apr 2013

Cited by 13 | Viewed by 45

Abstract

Long-standing temporomandibular joint (TMJ) dislocation is an uncommon condition, and due to its rarity, no definitive guidelines have been developed for its management. Various reduction techniques ranging from indirect traction techniques to direct exposure of the TMJ have been used. Indirect traction techniques [...] Read more.

Long-standing temporomandibular joint (TMJ) dislocation is an uncommon condition, and due to its rarity, no definitive guidelines have been developed for its management. Various reduction techniques ranging from indirect traction techniques to direct exposure of the TMJ have been used. Indirect traction techniques for reduction may fail in long-standing dislocation. Management of two cases of long-standing TMJ dislocation with midline mandibulotomy is discussed in which other indirect reduction techniques had failed. Midline osteotomy of the mandible can be used for reduction in difficult TMJ dislocations. An algorithm for the management of long-standing TMJ dislocation is proposed and related literature is reviewed. Full article

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8 pages, 328 KiB

Open AccessArticle

Orbital Floor Reconstruction with Free Flaps After Maxillectomy

by Leela Mohan C. S. R. Sampathirao, Krishnakumar Thankappan, Sriprakash Duraisamy, Naveen Hedne, Mohit Sharma, Jimmy Mathew and Subramania Iyer

Craniomaxillofac. Trauma Reconstr. 2013, 6(2), 99-106; https://doi.org/10.1055/s-0033-1343777 - 30 Apr 2013

Cited by 10 | Viewed by 31

Abstract

Background The purpose of this study is to evaluate the outcome of orbital floor reconstruction with free flaps after maxillectomy. Methods This was a retrospective analysis of 34 consecutive patients who underwent maxillectomy with orbital floor removal for malignancies, reconstructed with free flaps. [...] Read more.

Background The purpose of this study is to evaluate the outcome of orbital floor reconstruction with free flaps after maxillectomy. Methods This was a retrospective analysis of 34 consecutive patients who underwent maxillectomy with orbital floor removal for malignancies, reconstructed with free flaps. A cross-sectional survey to assess the functional and esthetic outcome was done in 28 patients who were alive and disease-free, with a minimum of 6 months of follow-up. Results Twenty-six patients had bony reconstruction, and eight had soft tissue reconstruction. Free fibula flap was the commonest flap used (n = 14). Visual acuity was normal in 86%. Eye movements were normal in 92%. Abnormal globe position resulted in nine patients. Esthetic satisfaction was good in 19 patients (68%). Though there was no statistically significant difference in outcome of visual acuity, eye movement, and patient esthetic satisfaction between patients with bony and soft tissue reconstruction, more patients without bony reconstruction had abnormal globe position (p = 0.040). Conclusion Free tissue transfer has improved the results of orbital floor reconstruction after total maxillectomy, preserving the eye. Good functional and esthetic outcome was achieved. Though our study favors a bony orbital reconstruction, a larger study with adequate power and equal distribution of patients among the groups would be needed to determine this. Free fibula flap remains the commonest choice when a bony reconstruction is contemplated. Full article

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5 pages, 270 KiB

Open AccessArticle

Finite Element Analysis Comparison of Plate Designs in Managing Fractures Involving the Mental Foramen

by Neralla Mahathi, Emmanuel Azariah and C. Ravindran

Craniomaxillofac. Trauma Reconstr. 2013, 6(2), 93-97; https://doi.org/10.1055/s-0033-1343789 - 30 Apr 2013

Cited by 4 | Viewed by 33

Abstract

Introduction The aim of the study was to propose an ideal plating design for fractures running through the mental foramen. Methods The study compared three plating designs—two four-holeminiplates, 2 × 2-hole three-dimensional (3D) plate, and modified 2 × 2-hole 3D plate (posterior strut [...] Read more.

Introduction The aim of the study was to propose an ideal plating design for fractures running through the mental foramen. Methods The study compared three plating designs—two four-holeminiplates, 2 × 2-hole three-dimensional (3D) plate, and modified 2 × 2-hole 3D plate (posterior strut removed)—using finite element analysis. Von Mises stresses generated around the plates and bone were measured, as well as the mobility that is generated between the fracture fragments by applying muscle forces to generate bite force in one test and applying a force of 500 N over the premolars and first molar region in the second test. Results Von Mises stress in bone with miniplates measured 9.24 MPa in test 1 and 131.99 MPa in test 2. The stress with unmodified 3D plates measured 34.9 MPa in test 1 and150.03 MPa in test 2. The stress with modified 3D platesmeasured 24.98 MPa in test 1 and 150.59 MPa in test 2. Von Mises stress on the plates and screws measured 28.23 MPa, 95.97 MPa, 72.93 MPa in test 1 and 458.63 MPa, 779.01 MPa, 742.39 MPa in test 2 on miniplates, unmodified 3D plates, and modified 3D plates, respectively. The fracture mobility generated in the model with miniplates measured 0.001 mm in test 1 and 0.01 mmin test 2 and 0.007 mmand 0.02 mmin themodel with unmodified 3D plates in test 1 and in test 2, respectively. In the model with modified 3D plates, the value was 0.001 mm and 0.01 mm in tests 1 and 2, respectively. Conclusion The ideal plate design is the two-plate technique with minimal stress generation on the bone and the hardware. The modified 3D plate has adequate strength to be used in the region but needs to be studied in detail. Full article

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6 pages, 185 KiB

Open AccessArticle

Utility of Stereolithographic Models in Osteocutaneous Free Flap Reconstruction of the Head and Neck

by L. Morris, Mofiyinfolu Sokoya, Larry Cunningham and Thomas J. Gal

Craniomaxillofac. Trauma Reconstr. 2013, 6(2), 87-92; https://doi.org/10.1055/s-0033-1343787 - 30 Apr 2013

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Abstract

Background Stereolithographic (SLA) models have become a valuable resource in preoperative planning in maxillofacial reconstruction. The objective of this study was to performa defect specific analysis of the utility of SLA models. The goal was to determine the manner in which the perceived [...] Read more.

Background Stereolithographic (SLA) models have become a valuable resource in preoperative planning in maxillofacial reconstruction. The objective of this study was to performa defect specific analysis of the utility of SLA models. The goal was to determine the manner in which the perceived benefit of preoperative modeling translates to measurable clinical advantages. Methods Patients who underwent reconstruction of defects of the mandible or midface using SLA modeling between 2006 and 2011 were identified through billing records. Based on the nature and extent of bony defect, cases requiring nearly identical reconstruction, but without modeling, were matched case by case for comparison. Given the presumed efficiency of SLA modeling, a comparison of total and reconstructive operative times was performed to see if this could offset the cost of the model. Results There were 10 patients each in the “model” and “nonmodel” group. No significant differences were observed for total operative time between groups. Surprisingly, the total reconstructive time was lower in the group not using SLA models (p = 0.05). Conclusions SLA models provide several operative planning advantages, but did not appear to decrease operative time enough to sufficiently offset the cost of the model in this group. Full article

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4 pages, 278 KiB

Open AccessTechnical Note

Le Fort I Osteotomy with Bone Grafts in Preprosthetic Surgery: Technical Note

by Lorena Pingarron-Martin, Javier Arias-Gallo, Hui Shan Ong and Manuel Chamorro Pons

Craniomaxillofac. Trauma Reconstr. 2013, 6(2), 143-146; https://doi.org/10.1055/s-0033-1333876 - 14 Mar 2013

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Abstract

Background Being edentulous causes progressive bony resorption in maxillae, which can lead to altered maxillomandibular relationships. Discussion should consider Le Fort I osteotomy with inlay grafts for a better success rate. Thus, this article introduces a technical note in improving the success rate. [...] Read more.

Background Being edentulous causes progressive bony resorption in maxillae, which can lead to altered maxillomandibular relationships. Discussion should consider Le Fort I osteotomy with inlay grafts for a better success rate. Thus, this article introduces a technical note in improving the success rate. Case Report The presented technical note permits transformation of the surgery in a conventional Le Fort I with a simple fixation not only of the grafts but also of the osteotomy. The surgical steps are explained as well as the follow-up results. Discussion Adding additional wire anchorage around bone grafts greatly improved our success rate and reduced our operative time. Bone grafting concurrently with Le Fort I osteotomy immediately improved the facial skeletal profile. Several in vitro studies have shown that galvanic corrosion does not play a significant role when combining stainless steel and titanium. Our novel technique is relatively simple and can be easily picked up by young surgeons. Full article

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7 pages, 197 KiB

Open AccessArticle

Transoral Miniplate Fixation of Mandibular Angle Fracture with and Without 2 Weeks of Maxillomandibular Fixation: A Clinical Trial Study

by Kazem S. Khiabani and Meghdad Khanian Mehmandoost

Craniomaxillofac. Trauma Reconstr. 2013, 6(2), 107-113; https://doi.org/10.1055/s-0033-1333878 - 13 Mar 2013

Cited by 9 | Viewed by 35

Abstract

Background and Objectives The ideal line of osteosynthesis in mandibular angle fractures indicates that a plate might be placed either along or just below the external oblique ridge. Some authors believe that using one miniplate at this line at the mandibular angle region [...] Read more.

Background and Objectives The ideal line of osteosynthesis in mandibular angle fractures indicates that a plate might be placed either along or just below the external oblique ridge. Some authors believe that using one miniplate at this line at the mandibular angle region provides sufficient strength to stabilize the fracture but others imply a second plate is required. Such controversies exist in the use of maxillomandibular fixation (MMF). The intention of the present study was to compare efficiency and complications of using one miniplate with and without MMF in mandibular angle fractures. Methods and Materials Forty patients with facial trauma with mandibular angle fractures including displaced and unfavorable fractures were categorized into two groups of 20 persons. In all patients, one miniplate was placed on the external oblique ridge. In the first group, patients had light maxillomandibular elastic bands just after surgery but no rigid MMF. In the second group, patients had rigid MMF for 2 weeks after surgery. Patients were followed to evaluate complications and treatment efficiency. Conclusions Our study showed that use of a single miniplate in the external oblique ridge is a functionally stable treatment for all types of angle fractures (including displaced and unfavorable fractures) except comminuted and long oblique fractures, which were not included in our study. Use of postoperative MMF did not improve the results. Full article

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8 pages, 482 KiB

Open AccessReview

Endoscopic Dacryocystorhinostomy

by E. Bradley Strong

Craniomaxillofac. Trauma Reconstr. 2013, 6(2), 67-74; https://doi.org/10.1055/s-0032-1332212 - 13 Mar 2013

Cited by 10 | Viewed by 34

Abstract

External dacryocystorhinostomy was described in early 20th century. The introduction of nasal endoscopy and endoscopic sinus surgery in the 1980s paved the way for a transnasal endoscopic approach to lacrimal system. This article will review the indications and surgical techniques used for endoscopic [...] Read more.

External dacryocystorhinostomy was described in early 20th century. The introduction of nasal endoscopy and endoscopic sinus surgery in the 1980s paved the way for a transnasal endoscopic approach to lacrimal system. This article will review the indications and surgical techniques used for endoscopic dacryocystorhinostomy. Full article

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4 pages, 160 KiB

Open AccessCase Report

Blowout Fracture in a 3-Year-Old

by Britt I. Pluijmers, Maarten J. Koudstaal, Dion Paridaens and Karel G.H. van der Wal

Craniomaxillofac. Trauma Reconstr. 2013, 6(2), 133-136; https://doi.org/10.1055/s-0033-1333880 - 8 Mar 2013

Cited by 2 | Viewed by 25

Abstract

A 3-year-old patient was referred to the oral and maxillofacial department with a fracture of the orbital floor. Due to the lack of clinical symptoms, a conservative approach was chosen. After 3 weeks, an enophthalmos developed. The orbital floor reconstruction was successfully performed [...] Read more.

A 3-year-old patient was referred to the oral and maxillofacial department with a fracture of the orbital floor. Due to the lack of clinical symptoms, a conservative approach was chosen. After 3 weeks, an enophthalmos developed. The orbital floor reconstruction was successfully performed through a transconjunctival approach. This case highlights the rarity of pure blowout fractures in young children. The specific presentation and diagnostics of orbital floor fractures in children and the related surgical planning and intervention are discussed. Full article

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5 pages, 251 KiB

Open AccessArticle

The Role of Fat Grafting in the Treatment of Posttraumatic Maxillofacial Deformities

by Francesco Arcuri, Matteo Brucoli, Nicola Baragiotta, Livia Stellin, Mariangela Giarda and Arnaldo Benech

Craniomaxillofac. Trauma Reconstr. 2013, 6(2), 121-125; https://doi.org/10.1055/s-0033-1333877 - 8 Mar 2013

Cited by 24 | Viewed by 34

Abstract

Purpose The first autologous adipose tissue grafting was performed by Neuber in 1893 with an open approach. In the early 1980s, Illouz and Fournier introduced closed liposuction. In the 1990s, Coleman published a new method of atraumatic fat transplantation. Recently, immunohistochemical studies of [...] Read more.

Purpose The first autologous adipose tissue grafting was performed by Neuber in 1893 with an open approach. In the early 1980s, Illouz and Fournier introduced closed liposuction. In the 1990s, Coleman published a new method of atraumatic fat transplantation. Recently, immunohistochemical studies of the extracellular matrix of the lipoaspirate showed the presence of adipose-derived stem cells. The purpose of this study is to describe the role of fat grafting in the management of posttraumatic facial deformities. Methods The study population was composed of all patients who underwent facial fat grafting between March 2008 and November 2010 as a secondary reconstructive procedure after an initial unsatisfactory treatment of the skeletal fractures. We analyzed the postoperative morphological changes by comparing the grafted side of the face to the contralateral side with the aid of a software package. Results Nineteen patients were surgically treated with fat transplantation for facial asymmetry due to a pathological postoperative healing of the soft tissue. Clinical examination and software analysis showed adequate postoperative facial balance without major complications. Conclusion Fat grafting is a very powerful tool to correct posttraumatic maxillofacial deformities and to ensure a long-term follow-up. Although we have achieved excellent clinical results in our reconstructive clinical cases, we are convinced that more complex prospective studies, enriched by long-term radiological controls, are needed to fully understand the biological behavior of the transplanted fat in the posttraumatic face. Full article

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5 pages, 313 KiB

Open AccessCase Report

Mandible and Zygomatic Fracture in a 2-Year-Old Patient Due to Dog Bite

by Jesús R. Manzani Baldi and Daniel A. Wolff de Freitas

Craniomaxillofac. Trauma Reconstr. 2013, 6(2), 137-141; https://doi.org/10.1055/s-0033-1333879 - 5 Mar 2013

Cited by 4 | Viewed by 27

Abstract

Dog bite injury frequently occurs in children, and many of these bites involve the facial region. On the other hand, facial fractures due to dog attacks are a rare complication, with the orbital, nasal, and maxillary bones most often affected. We present a [...] Read more.

Dog bite injury frequently occurs in children, and many of these bites involve the facial region. On the other hand, facial fractures due to dog attacks are a rare complication, with the orbital, nasal, and maxillary bones most often affected. We present a case report of a child who suffered a double facial fracture, mandible and left zygoma, due to a dog bite. The clinical diagnosis was supported by X-rays and computed tomography, which also provided information about the characteristics of the fracture. Internal fixation was done with titanium miniplates. Finally, the pathophysiological mechanism and the biomechanics of the fracture, as well as the use of resorbable versus nonresorbable material on infants, are discussed. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 6, Issue 2 (June 2013) – 12 articles

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