Craniomaxillofacial Trauma & Reconstruction

7 pages, 364 KiB

Open AccessArticle

Assessment of Fixation of Mandibular Interforaminal Fractures by Using a Single Second-Generation Headless Compression Screw: A Pilot Study

by Rangila Ram, Razi Ahsan, Yogesh Bhardwaj, Narotam Ghezta and Santosh Kumar

Craniomaxillofac. Trauma Reconstr. 2017, 10(2), 138-144; https://doi.org/10.1055/s-0036-1594276 - 22 Mar 2017

Cited by 3 | Viewed by 43

Abstract

The aim of this article is to evaluate the efficacy of a single second-generation headless compression screw along with a lower arch bar in the fixation of interforaminal mandible fractures. A total of seven patients were included in the study. An open approach [...] Read more.

The aim of this article is to evaluate the efficacy of a single second-generation headless compression screw along with a lower arch bar in the fixation of interforaminal mandible fractures. A total of seven patients were included in the study. An open approach was used either intraorally or extraorally. A second-generation 3.0 HCS (headless compression screw), 24 to 32 mm in length, diameter at the head of 3.5 mm, smooth shaft with 2.0 mm and at the leading edge 3.0 mm (Synthes, Paoli, PA) was used for the fixation along with a lower arch bar. Postoperative clinical and radiographic follow-up was performed at 3 weeks, 3 months, 6 months, and 1 year. A single, cannulated HCS was found to be effective in fixation of interforaminal mandible fractures except in one case where a miniplate had to be applied subapically. Clinical and radiographic follow-up revealed accurate reduction and fixation in all cases and no postoperative occlusal disturbances. A single, second-generation HCS along with a lower arch bar provides good results when used for the fixation of interforaminal mandible fractures. Headless compression screw fixation of interforaminal mandible fracture is a simple, quick, economic, and efficient method of rigid fixation with minimum complications. Full article

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5 pages, 204 KiB

Open AccessReview

Management of a Life Threatening Bleeding Following Extraction of Deciduous Second Molar Related to a Capillary Haemangioma

by Amr Amin Ghanem and Yasser Nabil el Hadidi

Craniomaxillofac. Trauma Reconstr. 2017, 10(2), 166-170; https://doi.org/10.1055/s-0037-1598102 - 16 Mar 2017

Cited by 7 | Viewed by 55

Abstract

Various forms of vascular lesion affect the head and neck region. The head and neck vascular lesions are classified into neoplasms and malformations. Neoplasm presents either as hemangioma or lymphangioma; neoplasm usually presents in young age compared with vascular malformation. A 9-year-old female [...] Read more.

Various forms of vascular lesion affect the head and neck region. The head and neck vascular lesions are classified into neoplasms and malformations. Neoplasm presents either as hemangioma or lymphangioma; neoplasm usually presents in young age compared with vascular malformation. A 9-year-old female patient presented to the outpatient clinic referred from the department of pedodontics after extraction of a right mandibular second deciduous molar. Extraction was done by dental GP in outpatient clinic. Massive bleeding followed the extraction. Bleeding was controlled by electrocoagulation of bleeding site and systemic and local application of antifibrinolytic agent. An intravenous line was placed to provide fluid replacement. Injection of intravenous cyklokapron was given to stabilize the blood clot. Selective embolization was performed 24 hours prior to surgical resection of lesion and the lesion was removed under general anesthesia followed by peripheral ostectomy of bone to remove any feeders. Different protocols are used to control life-threatening bleeding. Primary local measures such as Gelfoam packing, Tranexamic or Aminocaproic topical application, Surgicel application, Electrocautery, Bone wax, Ligation of External Carotid or Common Carotid Artery, or Selective Embolization of feeder vessel may be used to control the bleeding. Interventional radiographic blockage of feeder vessel currently shows high success rate in the management of life-threatening bleeding compared with previous techniques. Full article

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8 pages, 332 KiB

Open AccessArticle

A 14-Year Review of Craniomaxillofacial Gunshot Wounds in a Resource-Limited Setting

by Olushola Amole, Otasowie Osunde, Benjamin Akhiwu, Akinwale Efunkoya, Kelvin Omeje, Taiwo Amole and Zubairu Iliyasu

Craniomaxillofac. Trauma Reconstr. 2017, 10(2), 130-137; https://doi.org/10.1055/s-0037-1601341 - 6 Mar 2017

Cited by 4 | Viewed by 52

Abstract

This study analyzed the prevalence, clinical characteristics, and management of civilian-type craniomaxillofacial gunshot wounds (CGSWs) seen over a 14-year period in a Northern Nigerian teaching hospital. A retrospective study of all hospital records relating to CGSWs from January 2000 to December 2013 was [...] Read more.

This study analyzed the prevalence, clinical characteristics, and management of civilian-type craniomaxillofacial gunshot wounds (CGSWs) seen over a 14-year period in a Northern Nigerian teaching hospital. A retrospective study of all hospital records relating to CGSWs from January 2000 to December 2013 was conducted to determine the prevalence of CGSWs. Information retrieved included site of injury, type of projectile, management protocol, as well as duration of hospitalization. A total of 46 admissions for CGSWs were recorded during the period under review from a total of 2228 maxillofacial admissions. This gave a prevalence of 2.1% for CGSWs (95% confidence interval = 1.56–2.81). Sex distribution was 14.3:1 (M:F) with overall mean age of 32.9 ± 8.4 years. Average length of hospitalization was 17.7 (±15.56) days. Management of CGSWs consisted of emergency care, preliminary intervention, definitive reconstruction, revisions, and rehabilitation. Conclusively, analysis of the yearly incidence of CGSWs showed that the incidence and severity increased within the past 2 years under review (18 cases, 39.13%; χ² trend = 7.7, p = 0.006). This period was noted to correspond with heightened violence within the region mostly due to the acts of unknown gunmen and insurgents. Full article

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7 pages, 4139 KiB

Open AccessArticle

In Situ Splitting of a Rib Bone Graft for Reconstruction of Orbital Floor and Medial Wall

by Tetsuji Uemura, Tetsu Yanai, Masato Yasuta, Yoshimi Harada, Aya Morikawa, Hidetaka Watanabe and Masato Kurokawa

Craniomaxillofac. Trauma Reconstr. 2017, 10(2), 123-129; https://doi.org/10.1055/s-0036-1597915 - 1 Mar 2017

Cited by 2 | Viewed by 50

Abstract

In situ splitting of rib bone graft was conducted in 22 patients for the repair of orbital fracture with no other complicating fractures. A bone graft was harvested from the sixth or seventh rib in the right side. The repair of the orbital [...] Read more.

In situ splitting of rib bone graft was conducted in 22 patients for the repair of orbital fracture with no other complicating fractures. A bone graft was harvested from the sixth or seventh rib in the right side. The repair of the orbital floor and medial wall was successful in all the cases. Ten patients had bone grafting to the orbital floor, eight had it done onto medial wall, and 4 onto both floor and wall after reduction. The mean length of in situ rib bone graft was 40.9 mm (range, 20–70 mm), the mean width of these was 14.9 mm (range, 8–20 mm). The bone grafting was done by one leaf for 15 cases and two leafs for 7 cases in size of defects. The technique of in situ splitting of a rib bone graft for the repair of the orbital floor and medial wall is a simple and safe procedure, easily taking out the in situ splitting of a rib, and less pain in donor site. It has proved to be an optimal choice in craniofacial reconstruction, especially the defects of orbital floor and medial wall. Full article

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6 pages, 2710 KiB

Open AccessArticle

Free Bone Grafts for Mandibular Reconstruction in Patients Who Have Not Received Radiotherapy: The 6-cm Rule—Myth or Reality?

by Baljeet Nandra, Tirbod Fattahi, Tim Martin, Prav Praveen, Rui Fernandes and Sat Parmar

Craniomaxillofac. Trauma Reconstr. 2017, 10(2), 117-122; https://doi.org/10.1055/s-0036-1597583 - 7 Feb 2017

Cited by 15 | Viewed by 51

Abstract

Bony reconstruction of the mandible after surgical resection results in improved rehabilitation and aesthetics. Composite tissue transfer has transformed reconstruction, particularly in patients who have received radiotherapy. However, there is morbidity related to free tissue transfer. Free nonvascularized bone grafts have much lower [...] Read more.

Bony reconstruction of the mandible after surgical resection results in improved rehabilitation and aesthetics. Composite tissue transfer has transformed reconstruction, particularly in patients who have received radiotherapy. However, there is morbidity related to free tissue transfer. Free nonvascularized bone grafts have much lower morbidity. Surgeons believe that free bone grafts greater than 6.0 cm are prone to failure. The aims of this study was to assess whether bone grafts greater than 6.0 cm in length have a high risk of failure. A retrospective study was performed on all patients who had free bone grafts greater than 6.0 cm in length at Birmingham, UK, and Florida, the United States. None of the patients received radiotherapy. A total of 14 patients had undergone bone grafts for mandibular defects greater than 6.0 cm in length; 13 of the bone grafts were successful. Of these 13, none were infected and there was radiographic evidence of bony union. Some of the patients have been dentally rehabilitated with implants. Contrary to much of the literature and many surgeons belief, our study has shown that long mandibular defects (>6.0 cm) are not a contraindication to the use of free bone grafts. Key principles to achieve success are discussed in this article. Full article

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7 pages, 850 KiB

Open AccessReview

Association of Midfacial Fractures with Ophthalmic Injury

by Constantinus Politis, Alexandra Kluyskens and Titiaan Dormaar

Craniomaxillofac. Trauma Reconstr. 2017, 10(2), 99-105; https://doi.org/10.1055/s-0037-1599228 - 7 Feb 2017

Cited by 7 | Viewed by 45

Abstract

The aim of this study is to evaluate the incidence of ophthalmic complications following midfacial fractures and investigate its relation to surgical or nonsurgical treatment. This article is a retrospective study, describing the spectrum and incidence of ophthalmic injury in 106 patients presenting [...] Read more.

The aim of this study is to evaluate the incidence of ophthalmic complications following midfacial fractures and investigate its relation to surgical or nonsurgical treatment. This article is a retrospective study, describing the spectrum and incidence of ophthalmic injury in 106 patients presenting with midfacial fractures at the Department of Oral and Maxillofacial Surgery of the University Hospitals Leuven over a period of 16 months (January 2013 to April 2014). The mean age of the patients was 45.6 years with a gender distribution of 68 men and 38 women. The main cause of trauma was road traffic accidents. Forty-one patients suffered an ophthalmic injury following the fracture. Twelve of them had a persistent ophthalmic problem. Ophthalmic examination is necessary during the initial management. The time window for preservation of sight is small and treatment should be started immediately. Development of an emergency trauma scale that includes fractures, symptoms of visual impairment, and patient history is recommended and should stimulate a multidisciplinary approach of complex cases. Full article

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11 pages, 4169 KiB

Open AccessArticle

Survey of Current Practice Patterns in the Management of Frontal Sinus Fractures

by Kevin J. Choi, Bora Chang, Charles R. Woodard, David B. Powers, Jeffrey R. Marcus and Liana Puscas

Craniomaxillofac. Trauma Reconstr. 2017, 10(2), 106-116; https://doi.org/10.1055/s-0037-1599196 - 3 Feb 2017

Cited by 18 | Viewed by 49

Abstract

The management of frontal sinus fractures has evolved in the endoscopic era. The development of functional endoscopic sinus surgery (FESS) has been incorporated into management algorithms proposed by otolaryngologists, but the extent of its influence on plastic surgeons and oral and maxillofacial surgeons [...] Read more.

The management of frontal sinus fractures has evolved in the endoscopic era. The development of functional endoscopic sinus surgery (FESS) has been incorporated into management algorithms proposed by otolaryngologists, but the extent of its influence on plastic surgeons and oral and maxillofacial surgeons is heretofore unknown. A cross-sectional survey was performed to assess the practice pattern variations in frontal sinus fracture management across multiple surgical disciplines. A total of 298 surveys were reviewed. 33.5% were facial plastic surgeons with otolaryngology training, 25.8% general otolaryngologists, 25.5% plastic surgeons, and 15.1% oral and maxillofacial surgeons. 74.8% of respondents practiced in an academic setting. 61.7% felt endoscopic sinus surgery changed their management of frontal sinus fractures. 91.8% of respondents favored observation for uncomplicated, nondisplaced frontal sinus outflow tract fractures. 36.4% favored observation and 35.9% favored endoscopic sinus surgery for uncomplicated, displaced frontal sinus outflow tract fractures. For complicated, displaced frontal sinus outflow tract fractures, obliteration was more frequently favored by plastic surgeons and oral and maxillofacial surgeons than those with otolaryngology training. The utility of FESS in managing frontal sinus fractures appears to be recognized across multiple surgical disciplines. Full article

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10 pages, 10802 KiB

Open AccessReview

Three-Dimensional Printing: Custom-Made Implants for Craniomaxillofacial Reconstructive Surgery

by Mariana Matias, Horácio Zenha and Horácio Costa

Craniomaxillofac. Trauma Reconstr. 2017, 10(2), 89-98; https://doi.org/10.1055/s-0036-1594277 - 3 Jan 2017

Cited by 21 | Viewed by 56

Abstract

Craniomaxillofacial reconstructive surgery is a challenging field. First it aims to restore primary functions and second to preserve craniofacial anatomical features like symmetry and harmony. Three-dimensional (3D) printed biomodels have been widely adopted in medical fields by providing tactile feedback and a superior [...] Read more.

Craniomaxillofacial reconstructive surgery is a challenging field. First it aims to restore primary functions and second to preserve craniofacial anatomical features like symmetry and harmony. Three-dimensional (3D) printed biomodels have been widely adopted in medical fields by providing tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. Craniomaxillofacial reconstructive surgery was one of the first areas to implement 3D printing technology in their practice. Biomodeling has been used in craniofacial reconstruction of traumatic injuries, congenital disorders, tumor removal, iatrogenic injuries (e.g., decompressive craniectomies), orthognathic surgery, and implantology. 3D printing has proven to improve and enable an optimization of preoperative planning, develop intraoperative guidance tools, reduce operative time, and significantly improve the biofunctional and the aesthetic outcome. This technology has also shown great potential in enriching the teaching of medical students and surgical residents. The aim of this review is to present the current status of 3D printing technology and its practical and innovative applications, specifically in craniomaxillofacial reconstructive surgery, illustrated with two clinical cases where the 3D printing technology was successfully used. Full article

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4 pages, 2615 KiB

Open AccessCase Report

Basal Cell Adenoma of Retromolar Region from Minor Salivary Gland Origin in a 45-Year-Old Female: A Case Report

by Velavan Krishnan, Karthik Shunmugavelu, Jamila Rose and Kumaravel Subramaniam

Craniomaxillofac. Trauma Reconstr. 2017, 10(2), 162-165; https://doi.org/10.1055/s-0036-1584394 - 18 Jul 2016

Cited by 3 | Viewed by 37

Abstract

Basal cell adenoma is a rare benign salivary gland neoplasm. The most common location is in parotid region. Clinically, gradual growth and firm consistency are seen. They account for 1 to 3% among all salivary gland neoplasms. Prominent basaloid cells with cluster of [...] Read more.

Basal cell adenoma is a rare benign salivary gland neoplasm. The most common location is in parotid region. Clinically, gradual growth and firm consistency are seen. They account for 1 to 3% among all salivary gland neoplasms. Prominent basaloid cells with cluster of isomorphic cells and interspersed trabeculae are present histopathologically. In this article, we present a rare case of basal cell adenoma of retromolar region from minor salivary gland origin. Full article

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3 pages, 1234 KiB

Open AccessCase Report

Penetrating Craniomaxillofacial Injury Caused by a Pneumatic Nail Gun

by Kevin Jae Choi, Marisa Ann Ryan, Tracy Cheng and David Powers

Craniomaxillofac. Trauma Reconstr. 2017, 10(2), 159-161; https://doi.org/10.1055/s-0036-1584405 - 27 Jun 2016

Cited by 2 | Viewed by 43

Abstract

Craniomaxillofacial injuries can be complex, requiring a multidisciplinary approach. The primary survey is always the first step in trauma management prior to proceeding with further evaluation and treatment. A 26-year-old man presented with a penetrating nail gun injury through the oral and nasal [...] Read more.

Craniomaxillofacial injuries can be complex, requiring a multidisciplinary approach. The primary survey is always the first step in trauma management prior to proceeding with further evaluation and treatment. A 26-year-old man presented with a penetrating nail gun injury through the oral and nasal cavities. He did not present in extremis but required elective endotracheal intubation for intraoperative assessment and treatment. Airway management was enhanced by the use of lingual nerve and inferior alveolar nerve blocks via the Vazirani-Akinosi technique to maintain spontaneous respiration while the tongue was distracted from the palate. The nail was removed and rapid sequence induction initiated for orotracheal intubation. Local nerve blocks can be an effective tool in the armamentarium of the craniomaxillofacial trauma surgeon in managing blunt and penetrating injuries. We demonstrate its utility in airway management when a penetrating foreign body in the upper airway precludes orotracheal or nasotracheal intubation. Full article

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8 pages, 4724 KiB

Open AccessCase Report

Immediate Surgical Management of Traumatic Dislocation of the Eye Globe into the Maxillary Sinus: Report of a Rare Case and Literature Review

by Samer Abduljabar Noman and Mostafa Ibrahim Shindy

Craniomaxillofac. Trauma Reconstr. 2017, 10(2), 151-158; https://doi.org/10.1055/s-0036-1584393 - 24 Jun 2016

Cited by 10 | Viewed by 37

Abstract

We report a case of complete dislocation of the globe into the maxillary sinus, with immediate repositioning of the globe. This report highlights the importance of early surgical repair of orbital fracture and globe repositioning to regain the maximum amount of ocular functions. [...] Read more.

We report a case of complete dislocation of the globe into the maxillary sinus, with immediate repositioning of the globe. This report highlights the importance of early surgical repair of orbital fracture and globe repositioning to regain the maximum amount of ocular functions. A review of literature found 19 cases of globe dislocation into the maxillary sinus: One case was enucleated 2 months after misdiagnosis as traumatic enucleation, six cases were documented no vision or no light perception, three cases did not have reported vision (patients did not survive), and nine cases with postoperative vision. We recommend early surgical intervention to restore the cosmetic and visual function of the dislocated eye. Full article

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6 pages, 4861 KiB

Open AccessCase Report

Treatment of a Large Traumatic Encephalocele with Titanium Mesh

by Alan Motta do Canto, Manuela Monteiro Pinotti, Fernando Alves Maciel, Alexandre Bossi Todeschini, Guilherme Brasileiro Aguiar and Ronaldo Rodrigues de Freitas

Craniomaxillofac. Trauma Reconstr. 2017, 10(2), 145-150; https://doi.org/10.1055/s-0036-1582452 - 5 May 2016

Cited by 2 | Viewed by 47

Abstract

Encephalocele is defined as protrusion of cranial contents beyond the normal confines of the skull. Although most encephalocele cases have a congenital etiology, fractures of the skull base can cause traumatic encephalocele. In most encephalocele cases, the bone defect presents reduced dimensions and [...] Read more.

Encephalocele is defined as protrusion of cranial contents beyond the normal confines of the skull. Although most encephalocele cases have a congenital etiology, fractures of the skull base can cause traumatic encephalocele. In most encephalocele cases, the bone defect presents reduced dimensions and the endoscopic treatment is generally performed to reconstruct the area using mucosal and/or fat grafts. This article sought to report on a rare case of traumatic encephalocele associated with an extensive defect of the anterior skull base. This case was treated via transcranial access, and reconstruction was performed using titanium mesh in conjunction with a pericranium flap. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 10, Issue 2 (June 2017) – 12 articles

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