Craniomaxillofacial Trauma & Reconstruction

6 pages, 283 KiB

Open AccessReview

Frontal Sinus Fractures: A Conservative Shift

by William M. Weathers, Erik M. Wolfswinkel, Daniel A. Hatef, Edward I. Lee, Rodger H. Brown and Larry H. Hollier, Jr.

Craniomaxillofac. Trauma Reconstr. 2013, 6(3), 155-160; https://doi.org/10.1055/s-0033-1349210 - 26 Jun 2013

Cited by 15 | Viewed by 36

Abstract

This article reflects on the changing management of frontal sinus fractures. Severity of these injuries has decreased tremendously since the universal adoption of seat belts and air bags. Recently, there has been a shift from aggressive surgical management to more conservative management strategies, [...] Read more.

This article reflects on the changing management of frontal sinus fractures. Severity of these injuries has decreased tremendously since the universal adoption of seat belts and air bags. Recently, there has been a shift from aggressive surgical management to more conservative management strategies, some forgoing surgery all together. New technologies, such as bioabsorbable plates and endoscopic sinus surgery, are leading the way in improved surgical management strategies and offer promising alternatives to the more traditional approaches. Full article

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6 pages, 209 KiB

Open AccessArticle

A Prospective Study of Strut Versus Miniplate for Fractures of Mandibular Angle

by Amy S. Xue, John C. Koshy, Erik M. Wolfswinkel, William M. Weathers, Kristina P. Marsack and Larry H. Hollier, Jr.

Craniomaxillofac. Trauma Reconstr. 2013, 6(3), 191-196; https://doi.org/10.1055/s-0033-1349213 - 24 Jun 2013

Cited by 22 | Viewed by 43

Abstract

This prospective randomized clinical trial compared the treatment outcomes of strut plate and Champy miniplate in fixation of mandibular angle fractures. Patients with mandibular angle fracture were consented and enrolled into this study. Exclusion criteria include patients with severely comminuted fractures. The patients [...] Read more.

This prospective randomized clinical trial compared the treatment outcomes of strut plate and Champy miniplate in fixation of mandibular angle fractures. Patients with mandibular angle fracture were consented and enrolled into this study. Exclusion criteria include patients with severely comminuted fractures. The patients were randomly assigned to receive the strut plate or Champy miniplate for angle fracture fixation. Patient demographics, fracture characteristics, operative and postoperative outcomes were collected prospectively. Statistical analysis was performed to evaluate the significance of the outcome. A total of 18 patients were included in this study and randomly assigned to receive either the strut plate or Champy miniplate. Out of which five patients were excluded postoperatively due to complex fracture resulting in postoperative maxillomandibular fixation. The final enrollment was 13 patients, N = 6 (strut) and N = 7 (Champy). There was no statistically significant difference in the pretreatment variables. Nine of these patients had other associated facial fractures, including parasymphyseal and subcondylar fractures. Most of the (11) patients had sufficient follow-up after surgery. Both groups exhibited successful clinical unions of the mandibular angle fractures. The complications associated with the mandibular angle were 20% in the strut plate group and 16.7% in the Champy group. One patient in the strut plate group had a parasymphyseal infection, requiring hardware removal. The strut plate demonstrated comparable surgical outcome as the Champyminiplate. It is a safe and effective alternative for management of mandibular angle fracture. Full article

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4 pages, 201 KiB

Open AccessArticle

Evaluation of the Biodegradable Plates (PG910/PDO) for Reconstruction of Various Sizes of Orbital Floor Defects in the Blow-Out Fractures

by Reza Tabrizi, Nicole J. Langner, Ayatollah Pouzesh and Hamidreza Arabion

Craniomaxillofac. Trauma Reconstr. 2013, 6(3), 187-190; https://doi.org/10.1055/s-0033-1349205 - 24 Jun 2013

Cited by 7 | Viewed by 31

Abstract

The aim of our study was to evaluate the biodegradable plates (PG910/PDO) for reconstruction of various sizes of the orbital floor defects in the blow-out fractures. We included patients who had an impure blow-out fracture. All patients had a recent trauma and also [...] Read more.

The aim of our study was to evaluate the biodegradable plates (PG910/PDO) for reconstruction of various sizes of the orbital floor defects in the blow-out fractures. We included patients who had an impure blow-out fracture. All patients had a recent trauma and also the surgical intervention was done between 1 and 10 days after trauma. The amount of the orbital floor defect was measured in each case through computed tomography scan. In the surgical intervention, a biodegradable plate was used for the reconstruction of the orbital floor defect along with titanium miniplates used for bone fixation in orbital rim. Due to aesthetic reasons, all patients underwent secondary surgery including removal of titanium miniplates after 18 months. The orbital floor was reevaluated during the removal of the miniplates. The clinical evaluation of remnant defects and biodegradable plates (presence of complete or partial resorption) were documented for each patient. In our study a total of 15 patients (10 males and 5 females) underwent the orbital floor reconstruction using biodegradable miniplates. The size of the orbital floor defects was meanly 3.51 ± 1.29 cm². Results demonstrated that 4 out of 15 patients had a remnant defect after resorption of the biodegradable plate. In 10 out of 15 patients, the biodegradable plates completely replaced with fibrous tissues after 18 months. Remaining five patients had partial resorption of plates. There was not any relationship between the defect size and the remnant defects (p > 0.05). A significant relationship was seen between the defect size and the plates’ resorption rate (p < 0.001). There is a significant relationship between the resorption rate and the remnant defect. The risk to have remnant defects have been increased as the plates had incomplete resorption. The use of biodegradable plates is an appropriate option for reconstruction of the orbital floor defects. The defect size does not have any effect on the stability of the plate. However, incomplete plate resorption increases the risk of remnant defects in the orbital floor. The larger defects lead to slow degradation of biodegradable plates. Full article

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6 pages, 318 KiB

Open AccessCase Report

Superolateral Dislocation of Bilateral Intact Condyles—An Unusual Presentation: Report of a Case and Review of Literature

by Virendra Singh, Pranav Gupta, Shruti Khatana and Amrish Bhagol

Craniomaxillofac. Trauma Reconstr. 2013, 6(3), 205-210; https://doi.org/10.1055/s-0033-1343780 - 6 Jun 2013

Cited by 9 | Viewed by 37

Abstract

Dislocation of the mandibular condyle is the clinical condition of the condyle head being displaced out of the glenoid fossa but still remaining within the joint capsule. However, the anatomy of the mandibular condyle, glenoid fossa, and zygomatic arch usually prevent the dislocation [...] Read more.

Dislocation of the mandibular condyle is the clinical condition of the condyle head being displaced out of the glenoid fossa but still remaining within the joint capsule. However, the anatomy of the mandibular condyle, glenoid fossa, and zygomatic arch usually prevent the dislocation of intact condyles out of the glenoid fossa whenever the mandible is subjected to high impact. Complete dislocation of the mandibular condyle from the glenoid fossa can be classified into four groups: anterior, posterior, lateral, and superior dislocation. All the groups except anterior dislocation are rare. Superolateral dislocation of the intact mandibular condyle occurs very rarely. We report a case of lateral dislocation of bilateral intact condyles associated with left parasymphysis fracture. The purpose of this report is to review all of the available English literature on this dislocation and discuss the possible causative mechanism and diagnostic features, as well as clinical management. Full article

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8 pages, 400 KiB

Open AccessArticle

Sphenoid Sinus and Sphenoid Bone Fractures in Patients with Craniomaxillofacial Trauma

by Jorge Ernesto Cantini Ardila, Miguel Ángel Rivera Mendoza and Viviana Gómez Ortega

Craniomaxillofac. Trauma Reconstr. 2013, 6(3), 179-186; https://doi.org/10.1055/s-0033-1343778 - 5 Jun 2013

Cited by 4 | Viewed by 39

Abstract

Background and Purpose Sphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is [...] Read more.

Background and Purpose Sphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is any relationship between various isolated or combined fractures of facial skeleton and sphenoid bone and sphenoid sinus fractures. Methods We retrospectively studied hospital charts of all patients who reported to the trauma center at Hospital de San José with facial fractures from December 2009 to August 2011. All patients were evaluated by computed tomography scan and classified into low-, medium-, and high-energy trauma fractures, according to the classification described by Manson. Design This is a retrospective descriptive study. Results The study data were collected as part of retrospective analysis. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Thirtyeight patients were excluded. A total of 212 patients had facial fractures; 33 had a combination of sphenoid sinus and sphenoid bone fractures, and facial fractures were identified within this group (15.5%). Gender predilection was seen to favor males (77.3%) more than females (22.7%). The mean age of the patients was 37 years. Orbital fractures (78.8%) and maxillary fractures (57.5%) were found more commonly associated with sphenoid sinus and sphenoid bone fractures. Conclusions High-energy trauma is more frequently associated with sphenoid fractures when compared with medium- and low-energy trauma. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. A more exhaustive multicentric case–control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures. Full article

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7 pages, 285 KiB

Open AccessArticle

Evaluation of Temporomandibular Joint Total Replacement with Alloplastic Prosthesis: Observational Study of 27 Patients

by Fernando Briceño, Ronmell Ayala, Karlina Delgado and Sabrina Piñango

Craniomaxillofac. Trauma Reconstr. 2013, 6(3), 171-177; https://doi.org/10.1055/s-0033-1343779 - 4 Jun 2013

Cited by 17 | Viewed by 31

Abstract

Background Temporomandibular joint (TMJ) total replacement with alloplastic prostheses has been performed since 1960s. Research in these last two decades has achieved important improvement in the development of biomaterials, design, adaptation, and fixation of the prosthesis components. Objective To evaluate total TMJ replacement [...] Read more.

Background Temporomandibular joint (TMJ) total replacement with alloplastic prostheses has been performed since 1960s. Research in these last two decades has achieved important improvement in the development of biomaterials, design, adaptation, and fixation of the prosthesis components. Objective To evaluate total TMJ replacement with alloplastic prostheses. Methods We studied 27 patients, between 19 and 73 years old, who had total TMJ unior bilateral replacement surgery with custom-made alloplastic prostheses manufactured by TMJ Concepts, Inc. (Ventura, CA) between 1996 and 2011. The general data and preoperative measurements were taken from medical records. Subjective data related to pain, diet consistency, and current quality of life were collected with a questionnaire answered by the patients;measures ofmaximum interincisal opening and lateral mandibular movements were obtained from direct examination. Results We found significant difference (p < 0.05) comparing pre- to postoperative results about improvement in mouth opening, pain relief, and satisfaction with the surgery and diet consistency. Conclusion The results of this study show that total alloplastic TMJ prostheses are an efficient, safe, and stable long-term solution for patients who need TMJ total replacement. Full article

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4 pages, 233 KiB

Open AccessTechnical Note

Simplified Transoral Load-Bearing Osteosynthesis with Preformed Mandible Reconstruction Plates

by Sebastian Schiel, Sven Otto, Christoph Pautke, Carl-Peter Cornelius and Florian A. Probst

Craniomaxillofac. Trauma Reconstr. 2013, 6(3), 211-214; https://doi.org/10.1055/s-0033-1343784 - 31 May 2013

Cited by 4 | Viewed by 31

Abstract

Transcutaneous submandibular approaches are the preferred technique for the application of load-bearing mandibular osteosynthesis plates. However, an extraoral approach is associated with several shortcomings, like the risk of harming the facial nerve and scarring. This technical note presents a specialized mandibular reconstruction plate [...] Read more.

Transcutaneous submandibular approaches are the preferred technique for the application of load-bearing mandibular osteosynthesis plates. However, an extraoral approach is associated with several shortcomings, like the risk of harming the facial nerve and scarring. This technical note presents a specialized mandibular reconstruction plate (MatrixMANDIBLE Preformed Reconstruction Plate [Synthes Maxillofacial, Paoli, PA]), simplifying the transoral application by its design with a preformed curvature along the lateral surface of the mandible. The application of wide-spanning plates reaching from the posterior margin of the ramus even into the contralateral body region is facilitated. Transoral application of preformed mandibular reconstruction plates seems to be a promising option to bypass external incisions and to reduce operating room time. Full article

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4 pages, 245 KiB

Open AccessCase Report

Pathologic Fracture of the Mandible Secondary to Traumatic Bone Cyst

by Eric Ahlers, Dhave Setabutr, Frank Garritano, Eelam Adil and Johnathan McGinn

Craniomaxillofac. Trauma Reconstr. 2013, 6(3), 201-204; https://doi.org/10.1055/s-0033-1343782 - 31 May 2013

Cited by 8 | Viewed by 42

Abstract

The traumatic bone cyst (TBC) is an uncommon and poorly understood lesion. First described in 1929, TBCs lack an epithelial lining, typically occur during the second decade of life, and are most frequently located in the jaw. Although the majority of TBCs are [...] Read more.

The traumatic bone cyst (TBC) is an uncommon and poorly understood lesion. First described in 1929, TBCs lack an epithelial lining, typically occur during the second decade of life, and are most frequently located in the jaw. Although the majority of TBCs are asymptomatic, rarely a TBC can cause a pathologic fracture of the mandible. We present a case of an adolescent suffering a sports-related pathologic mandible fracture secondary to a traumatic bone cyst. Full article

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4 pages, 200 KiB

Open AccessCase Report

Chronic Suppurative Osteomyelitis of Mandible: A Case Report

by Hemant Mehra, Sumit Gupta, Hemant Gupta, V. Sinha and Jasmeet Singh

Craniomaxillofac. Trauma Reconstr. 2013, 6(3), 197-200; https://doi.org/10.1055/s-0033-1343781 - 31 May 2013

Cited by 11 | Viewed by 55

Abstract

Osteomyelitis is an inflammatory disease of the bone that usually begins as an infection of the medullary cavity, rapidly involves the haversian system, and quickly extends to the periosteum of the area. It develops in the jaws after a chronic odontogenic infection or [...] Read more.

Osteomyelitis is an inflammatory disease of the bone that usually begins as an infection of the medullary cavity, rapidly involves the haversian system, and quickly extends to the periosteum of the area. It develops in the jaws after a chronic odontogenic infection or for a variety of other reasons such as trauma, inadequate treatment of fracture, or irradiation to the mandible. When antimicrobial agents or drainage prove unsuccessful, acute osteomyelitis may become chronic. Conventional radiography, culture, bone biopsy, radioisotope bone scan, laser Doppler flowmetry, computed tomography, and magnetic resonance imaging are used for its diagnosis. We present a case of chronic suppurative osteomyelitis associated with a draining extraoral sinus, which was successfully treated with surgical debridement and stabilization with a 10-hole reconstruction plate and bicortical screws using AO principles. Full article

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9 pages, 417 KiB

Open AccessArticle

Combined Orbital Floor and Medial Wall Fractures Involving the Inferomedial Strut: Repair Technique and Case Series Using Preshaped Porous Polyethylene/Titanium Implants

by Raymond I. Cho and Brett W. Davies

Craniomaxillofac. Trauma Reconstr. 2013, 6(3), 161-169; https://doi.org/10.1055/s-0033-1343785 - 31 May 2013

Cited by 29 | Viewed by 28

Abstract

Background Combined orbital floor and medial wall fractures can be technically challenging to repair, particularly when the inferomedial strut is involved. A surgical repair technique is described utilizing a single preshaped porous polyethylene/titanium implant to span both defects. Methods Retrospective interventional case series. [...] Read more.

Background Combined orbital floor and medial wall fractures can be technically challenging to repair, particularly when the inferomedial strut is involved. A surgical repair technique is described utilizing a single preshaped porous polyethylene/titanium implant to span both defects. Methods Retrospective interventional case series. Results Fracture repair was performed on 17 orbits (16 patients) between October 2009 and February 2012. Subsequent surgical revision was required in three cases (18%). Visual acuity was stable or improved in all cases. Of 7 patients with preoperative diplopia, 5 improved and 2 remained stable postoperatively, and there were no cases of new or worsened diplopia following surgery. Postoperative asymmetry in Hertel exophthalmometry averaged 1.0 mm (range 0 to 2 mm). Preoperatively, average orbital volume was 122.7% compared with control (range 109 to 147%, standard deviation [SD] 9.6), which improved to 100.3% postoperatively (range 92 to 110%, SD 5.7). The average decrease in orbital volume was 22.5% (range 10 to 54%, SD 11.4, p < 0.001). Conclusions With careful preoperative planning and meticulous surgical technique, combined orbital floor and medial wall fractures involving the inferomedial strut can be successfully repaired with a preshaped porous polyethylene/titanium implant through a transconjunctival/transcaruncular approach with inferior oblique disinsertion. Full article

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8 pages, 404 KiB

Open AccessReview

Pathologic Fractures in Bisphosphonate-Related Osteonecrosis of the Jaw—Review of the Literature and Review of Our Own Cases

by Sven Otto, Christoph Pautke, Sigurd Hafner, Ronny Hesse, Lea Franziska Reichardt, Gerson Mast, Michael Ehrenfeld and Carl-Peter Cornelius

Craniomaxillofac. Trauma Reconstr. 2013, 6(3), 147-154; https://doi.org/10.1055/s-0033-1343776 - 31 May 2013

Cited by 18 | Viewed by 40

Abstract

Background Bisphosphonates are powerful drugs used for the management of osteoporosis and metastatic bone disease to avoid skeletal-related complications. Side effects are rare but potentially serious such as the bisphosphonate-related osteonecrosis of the jaws (BRONJ). BRONJ impairs the quality of life and can [...] Read more.

Background Bisphosphonates are powerful drugs used for the management of osteoporosis and metastatic bone disease to avoid skeletal-related complications. Side effects are rare but potentially serious such as the bisphosphonate-related osteonecrosis of the jaws (BRONJ). BRONJ impairs the quality of life and can even lead to pathologic fractures of the mandible. Management of BRONJ is difficult per se. If complicated with pathologic mandibular fractures in advanced stages, the treatment options are controversially discussed. This review delineates the epidemiology and pathogenesis of BRONJ to put the various modalities for the treatment of pathologic mandible fractures into perspective. Methods Various case reports and case series in the literature were reviewed. Cases were reviewed of patients suffering from pathologic fracture due to bisphosphonaterelated osteonecrosis of the jaw treated in the Department of Oral and Maxillofacial Surgery (Ludwig-Maximilians-University of Munich) from 2003 to 2010. Of 140 patients suffering from BRONJ, four were identified with pathologic fracture of the mandible. Results Management of pathologic mandibular fractures in patients suffering from BRONJ is an unsolved issue. At present there is a paucity of information to establish reliable therapy guidelines. The published strategies range from conservative treatment to major bone resections with or without internal or external fixation and with or without autogenous reconstruction. There is no evidence for the superiority of a single therapeutic mode, however. Conclusion Further understanding of BRONJ is mandatory to establish a sound rationale for the treatment of associated mandibular fractures. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 6, Issue 3 (September 2013) – 11 articles

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