Craniomaxillofacial Trauma & Reconstruction

4 pages, 85 KiB

Open AccessArticle

Complications in Mandibular Midline Distraction

by Jan Pieter de Gijt, Atilla Gül, Eppo B. Wolvius, Karel G. H. van der Wal and Maarten J. Koudstaal

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 204-207; https://doi.org/10.1055/s-0037-1600902 - 31 Mar 2017

Cited by 5 | Viewed by 69

Abstract

Mandibular midline distraction (MMD) is a relatively new surgical technique for correction of transverse discrepancies of the mandible. This study assesses the amount and burden of complications in MMD. A retrospective cohort study was performed on patients who underwent MMD between 2002 and [...] Read more.

Mandibular midline distraction (MMD) is a relatively new surgical technique for correction of transverse discrepancies of the mandible. This study assesses the amount and burden of complications in MMD. A retrospective cohort study was performed on patients who underwent MMD between 2002 and 2014. Patients with congenital deformities or a history of radiation therapy in the area of interest were excluded. Patient records were obtained and individually assessed for any complications. Complications were graded using the Clavien-Dindo classification system (CDS). Seventy-three patients were included of which 33 were males and 40 were females. The mean follow-up was 2.1 years. Twenty-nine patients had minor complications, grades I and II. Two patients had a grade IIIa and three patients had a grade IIIb complication. Common complications were pressure ulcers, dehiscence, and (transient) sensory disturbances of the mental nerve. This study shows that although MMD is a relatively safe method, complications can occur. Mostly the complications are mild, transient, and manageable without the need for any reoperation. Full article

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7 pages, 169 KiB

Open AccessArticle

Helmet Wear and Craniofacial Trauma Burden: A Plea for Regulations Mandating Protective Helmet Wear

by Jamison Anne Harvey, Waleed Gibreel, Ali Charafeddine and Basel Sharaf

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 197-203; https://doi.org/10.1055/s-0037-1601430 - 29 Mar 2017

Cited by 10 | Viewed by 41

Abstract

Helmet wear offers protection in various ways against craniomaxillofacial and brain trauma. The specific pattern and overall burden of craniofacial trauma among helmeted and unhelmeted patients has not been well defined. This is a retrospective review of trauma patients involved in documented helmet-associated [...] Read more.

Helmet wear offers protection in various ways against craniomaxillofacial and brain trauma. The specific pattern and overall burden of craniofacial trauma among helmeted and unhelmeted patients has not been well defined. This is a retrospective review of trauma patients involved in documented helmet-associated injuries that presented to the Mayo Clinic Emergency Department in Rochester, Minnesota, and completed initial trauma evaluation between 1999 and 2015. A total of 417 patients (50% unhelmeted, 82% male) were identified. The median age at injury was 22.9 years (interquartile range [IQR]: 15.2–44.2]) and median follow-up was 26 months ([IQR: 2.2–64.8]). The majority of injuries involved motorcycle accidents (57.6%), bicycles (30.2%), and other modes of injury (12.7%). The mean Glasgow Coma Score (GSC) at the time of presentation was 14.2 (SD ± 2.4) and mean injury severity score (ISS) was 10.2 (SD ± 7.5). Motorcycle accidents had a higher mean ISS compared with other modes of injury (p = 0.048). Unhelmeted patients were more likely to sustain scalp lacerations (p < 0.0001), facial bone fractures (p = 0.01), scalp hemato- mas (p = 0.041), skull fractures (p = 0.017), and are more likely to require hospital admission (p = 0.0003). Unhelmeted patients’ hospital length of stay was on average 2 days longer than helmeted patients’ stay (p = 0.0721). Unhelmeted patients were more likely to require out-of-home placement than helmeted patients. Among trauma patients, helmet use was associated with less scalp lacerations and hematomas, facial bones fractures, skull fractures, and need for hospital admission. Adoption of legislation and regulations mandating protective helmet use in all states are strongly encouraged to minimize the burden of craniofacial injuries among unhelmeted patients. Full article

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9 pages, 165 KiB

Open AccessArticle

Treatment of Mandibular Angle Fractures with Single Three-Dimensional Locking Miniplates without Maxillomandibular Fixation: How Much Fixation is Required?

by Sanjay Rastogi, Sam Paul, Sumedha Kukreja, Karun Aggarwal, Rupshikha Choudhury, Amit Bhugra, Niranjana Prasad Indra B and Moazzam Jawaid

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 188-196; https://doi.org/10.1055/s-0037-1600904 - 29 Mar 2017

Cited by 8

Abstract

The aim of this simple nonrandomized and observational study was to evaluate the efficacy of single three-dimensional (3D) plate for the treatment of mandibular angle fractures without maxillomandibular fixation. A total of 30 patients with noncomminuted fractures of mandibular angle requiring open reduction [...] Read more.

The aim of this simple nonrandomized and observational study was to evaluate the efficacy of single three-dimensional (3D) plate for the treatment of mandibular angle fractures without maxillomandibular fixation. A total of 30 patients with noncomminuted fractures of mandibular angle requiring open reduction and internal fixation were included in the study. All the patients were treated by open reduction and internal fixation using single 3D titanium locking miniplate placed with the help of transbuccal trocar or Synthes 90-degree hand piece and screw driver. 3D locking titanium miniplates used in our study was four-holed, box-shaped plate, and screws with 2 mm diameter and 8 mm length. The following clinical parameters were assessed for each patient at each follow-up visit: pain (visual analog scale: 0–5), swelling (visual analog scale: 0–5), mouth opening, infection, paresthesia, hardware failure (plate fracture), occlusal discrepancies, and mobility between fracture fragments. A significant decrease in pain level was seen during the follow-up visits. No statistically significant changes were seen in swelling, but mouth opening increased in the subsequent visits. Also better results were seen in terms of fracture stability and occlusion in the postoperative period. Two cases of infection and two cases of hardware failure were noted in sixth postoperative week. Full article

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5 pages, 297 KiB

Open AccessArticle

Did King Philip II of Ancient Macedonia Suffer a Zygomatico-Orbital Fracture? A Maxillofacial Surgeon's Approach

by Panagiotis Stathopoulos

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 183-187; https://doi.org/10.1055/s-0037-1601431 - 24 Mar 2017

Cited by 3 | Viewed by 55

Abstract

Philip II, father of Alexander the Great, succeeded his brother, Perdiccas III, to the throne of Macedonia in 360 BC. He has been described by historians as a generous king and military genius who managed to achieve his ambitious plans by expanding the [...] Read more.

Philip II, father of Alexander the Great, succeeded his brother, Perdiccas III, to the throne of Macedonia in 360 BC. He has been described by historians as a generous king and military genius who managed to achieve his ambitious plans by expanding the Macedonian city-state over the whole Greek territory and the greater part of the Balkan Peninsula. The aim of our study was to present the evidence with regard to the facial injury of King Philip II of Macedonia and discuss the treatment of the wound by his famous physician, Critobulos. We reviewed the literature for historical, archaeological, and paleopathological evidence of King Philip's facial injury. We include a modern reconstruction of Philip's face based on the evidence of his injury by a team of anatomists and archaeologists from the Universities of Bristol and Manchester. In the light of the archaeological findings by Professor Andronikos and the paleopathological evidence by Musgrave, it can be claimed with confidence that King Philip II suffered a significant injury of his zygomaticomaxillary complex and supraorbital rim caused by an arrow as can be confirmed in many historical sources. To the best of our knowledge, this is the first attempt to present the trauma of King Philip II from a maxillofacial surgeon's point of view. Full article

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8 pages, 370 KiB

Open AccessArticle

Nasal Valve Reconstruction Using a Titanium Implant: An Outcomes Study

by Neal D. Goldman, Richard Alexander, Laura F. Sandoval and Steven R. Feldman

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 175-182; https://doi.org/10.1055/s-0037-1600900 - 22 Mar 2017

Cited by 5 | Viewed by 62

Abstract

Septoplasty alone is not always sufficient to correct nasal obstruction. Various techniques have been employed to repair nasal valve collapse and improve airflow. This article aimed to evaluate outcomes and quality of life following nasal valve reconstruction using a titanium implant in patients [...] Read more.

Septoplasty alone is not always sufficient to correct nasal obstruction. Various techniques have been employed to repair nasal valve collapse and improve airflow. This article aimed to evaluate outcomes and quality of life following nasal valve reconstruction using a titanium implant in patients with nasal valve collapse. This is a single-center retrospective study that consisted of a telephone questionnaire of 37 quality-of-life measures and questions related to the surgical procedure and recovery process to evaluate postsurgical outcomes. Fifteen patients completed the survey. There was a significant improvement in nasal blockage/obstruction, breathing through the nose, sleeping, breathing through nose during exercise, the need to blow nose, sneezing, facial pain/pressure, fatigue, productivity, and restlessness/irritability after surgery. Overall, 100% of patients were satisfied with the results and would recommend this procedure. The most common postoperative complaints were pain (33%) and difficulty breathing (33%). Patients noticed no increase (20%) or a slight increase (73%) in the size of their nose. Sixty percent of patients cannot see the implant and 13% report the implant is barely noticeable. Nasal valve repair with a titanium implant was successful at improving symptoms of nasal obstruction and other quality-of-life issues. Satisfaction was high among all patients. The implants are palpable, thought to be visible by some patients, yet accepted by the majority of patients. This approach may be especially important in patients with prior nasal surgery but continue to experience refractory symptoms. Full article

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4 pages, 82 KiB

Open AccessArticle

A Comparative Assessment of Postoperative Analgesic Efficacy of Lornoxicam versus Tramadol after Open Reduction and Internal Fixation of Mandibular Fractures

by Ankesh Dilip Jain, Ravisankar V. S. M., Siva Bharani K. S. N., Sudheesh K. M. and Nisha Tewathia

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 171-174; https://doi.org/10.1055/s-0037-1600901 - 22 Mar 2017

Cited by 4 | Viewed by 76

Abstract

Pain after any surgical procedure is inevitable but can be controlled by administration of analgesics in most cases. Postoperative pain after surgical treatment of mandibular fractures can be treated by nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. The purpose of this study is [...] Read more.

Pain after any surgical procedure is inevitable but can be controlled by administration of analgesics in most cases. Postoperative pain after surgical treatment of mandibular fractures can be treated by nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. The purpose of this study is to critically compare the postoperative analgesic efficacy of small doses of intravenous TRAMADOL (opioid analgesic) versus LORNOXICAM (NSAID) in patients with mandibular trauma undergoing open reduction and internal fixation (ORIF) and to assess the presence of any adverse effects due to NSAID or opioid use. Forty adult ASA grade I–II patients with mandibular trauma, scheduled for ORIF under general anesthesia in the Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, were selected for the study. The patients were randomly assigned into a tramadol group (Group T) and a lornoxicam group (Group L) and were administered intravenous tramadol 50 mg and intravenous lornoxicam 8 mg, respectively, at specific postoperative intervals. Pain intensity was quantitatively assessed at the 2nd, 4th, 6th, 12th, and 24th postoperative hours using a visual analog scale of 10 cm. Adverse effects of the analgesics were also recorded and compared. Both the drugs resulted in a significant decrease in pain intensity from 2nd to 24th postoperative hours, but better pain control was observed in Group L at 24th postoperative hour. Only two patients experienced nausea and vomiting in Group T and one patient experienced gastric acidity in Group L. The comparative results clearly demonstrate that pain control by intravenous lornoxicam is significantly better than by intravenous tramadol at 24th postoperative hour after ORIF of mandibular trauma. Side effects produced by both the drugs were minor and had no apparent effect on the study results. Full article

5 pages, 1536 KiB

Open AccessCase Report

Orbital Compartment Syndrome despite Significant Traumatic Expansion of the Orbital Cavity

by Deepak Gupta and Bijan Beigi

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 239-243; https://doi.org/10.1055/s-0036-1592084 - 16 Sep 2016

Cited by 4 | Viewed by 58

Abstract

Periorbital injury can present with various permutations of bone trauma, soft-tissue edema, and hematomas that might involve proptosis and restricted motility. We report a case of a 32-year-old patient who sustained a traumatic orbital compartment syndrome simultaneously with a large, significantly displaced, orbital-floor [...] Read more.

Periorbital injury can present with various permutations of bone trauma, soft-tissue edema, and hematomas that might involve proptosis and restricted motility. We report a case of a 32-year-old patient who sustained a traumatic orbital compartment syndrome simultaneously with a large, significantly displaced, orbital-floor blow-out fracture. Clinical signs consistent with both conditions were elicited. The initial management was as for orbital compartment syndrome. The clinical diagnosis was confirmed with computed tomographic imaging. This is an unusual and unexpected presentation. It would be expected that a hemorrhage would self-decompress in the presence of a large fracture. Physicians should be aware that such a combination of pathology might arise. Physicians likely to encounter periocular trauma should be prepared for its management: urgent lateral canthotomy and cantholysis. Differential diagnoses of periocular trauma are compared and contrasted. Full article

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9 pages, 1200 KiB

Open AccessCase Report

An Alternative Route for Entrapped Inferior Orbital Nerve in Orbital Floor Fracture

by Anantheswar Y. N. Rao and Joyce Jesudas

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 230-238; https://doi.org/10.1055/s-0036-1592090 - 31 Aug 2016

Cited by 1 | Viewed by 48

Abstract

Orbital floor fractures pose a grave threat for injury to the infraorbital nerve, resulting in the patient suffering from a disturbing paraesthesia. It is challenging for the operating surgeon to release and secure the entrapped nerve with reconstruction of the orbital floor. We [...] Read more.

Orbital floor fractures pose a grave threat for injury to the infraorbital nerve, resulting in the patient suffering from a disturbing paraesthesia. It is challenging for the operating surgeon to release and secure the entrapped nerve with reconstruction of the orbital floor. We present an interesting case of orbital floor fracture with entrapped infraorbital nerve, wherein we have decompressed the nerve and provided it, a new course. Full article

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5 pages, 1710 KiB

Open AccessCase Report

Orbitocerebral Impalement: Case Discussion and Management Algorithm

by Matthew Gordon Crowson, Miles Berger, Grace C. McCarthy and David B. Powers

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 225-229; https://doi.org/10.1055/s-0036-1592098 - 29 Aug 2016

Cited by 2 | Viewed by 48

Abstract

Orbitocerebral impalement by inanimate objects is a relatively uncommon event. If orbitocerebral impalement is suspected, management entails prompt referral to a trauma facility with neurosurgical, neuroanesthesiological, craniomaxillofacial, and ophthalmological expertise. The aim of this report is to describe the unique mechanism and perioperative [...] Read more.

Orbitocerebral impalement by inanimate objects is a relatively uncommon event. If orbitocerebral impalement is suspected, management entails prompt referral to a trauma facility with neurosurgical, neuroanesthesiological, craniomaxillofacial, and ophthalmological expertise. The aim of this report is to describe the unique mechanism and perioperative considerations of a remarkable, deep orbitocerebral impalement from a walker brake lever through the orbital roof after a fall from standing. We discuss clinical vignette, evaluation, anesthetic approach, and considerations and review the literature on the epidemiology, pathophysiology, surgical and anesthetic management, and prognosis of this traumatic mechanism. We also offer a management algorithm that aims to streamline management. Full article

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9 pages, 1070 KiB

Open AccessCase Report

Reconstruction of the Cranial Vault Contour Using Tissue Expander and Castor Oil Prosthesis

by Sylvio Luiz Costa de Moraes, Alexandre Maurity de Paula Afonso, Roberto Gomes dos Santos, Ricardo Pereira Mattos and e Bruno Gomes Duarte

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 216-224; https://doi.org/10.1055/s-0036-1584403 - 29 Aug 2016

Cited by 2 | Viewed by 56

Abstract

Nowadays the reconstruction of craniofacial defects can be performed with different kinds of materials, which include the bone and the so-called biomaterials, which have the advantage of not needing a surgical site donor. Among these materials, great attention is given to polymers. In [...] Read more.

Nowadays the reconstruction of craniofacial defects can be performed with different kinds of materials, which include the bone and the so-called biomaterials, which have the advantage of not needing a surgical site donor. Among these materials, great attention is given to polymers. In this large group, current attention is focused on the castor oil polymer, since this polymer is biocompatible, low cost, and has adequate strength for reconstruction of the craniomaxillofacial complex. This study aims to report the use of a prosthetic castor oil polymer for reconstruction of extensive defect, caused by a trauma, in the temporoparietal region. Full article

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4 pages, 1137 KiB

Open AccessCase Report

Concomitant “Ear Bleed and Styloid Fracture”: An Unusual Complication of Impacted Mandibular Third Molar Removal

by Krishnakumar Raja, Gayathri Gopi, Elavenil Panneerselvam, Jegatheesan Ramamoorthy, Guruprasad Thulasi Doss and Aditi Rajendra Sharma

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 212-215; https://doi.org/10.1055/s-0036-1592086 - 26 Aug 2016

Cited by 3 | Viewed by 43

Abstract

The removal of impacted mandibular third molar is associated with potential complications such as dry socket, paresthesia, uncontrolled socket bleeding, angle fracture, etc., which are commonly encountered in dental practice. This article presents a peculiar case of “ear bleed” concomitant with “isolated styloid” [...] Read more.

The removal of impacted mandibular third molar is associated with potential complications such as dry socket, paresthesia, uncontrolled socket bleeding, angle fracture, etc., which are commonly encountered in dental practice. This article presents a peculiar case of “ear bleed” concomitant with “isolated styloid” fracture following removal of impacted mandibular third molar, not reported in the literature till date. Ear bleed is a bothersome clinical sign that requires thorough investigation and prompt treatment because it is frequently related to fractures of the skull base. Isolated fracture of the styloid process is rare; its diagnosis, impact on adjacent vital structures, and treatment protocol are less discussed in maxillofacial literature. The case report elucidates the etiopathogenesis of ear bleed and styloid fracture which have great clinical implications. The clinical correlation between the two entities and dental extraction is discussed in this report to guide a dental practitioner in its management. Full article

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4 pages, 1584 KiB

Open AccessCase Report

Injured Anterior Superior Alveolar Nerve Endoscopically Resected Within Maxillary Sinus

by Amir H. Dorafshar, A. Lee Dellon, Eric Lee Wan, Sashank Reddy and Victor W. Wong

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 208-211; https://doi.org/10.1055/s-0036-1592088 - 23 Aug 2016

Cited by 5 | Viewed by 65

Abstract

Posttraumatic facial pain is due to an injured nerve, most often a branch of the trigeminal nerve. While surgical approaches to injuries of the supraorbital, supratrochlear, infraorbital, and inferior alveolar nerves have been reported, an injury to the anterior superior alveolar nerve (ASAN) [...] Read more.

Posttraumatic facial pain is due to an injured nerve, most often a branch of the trigeminal nerve. While surgical approaches to injuries of the supraorbital, supratrochlear, infraorbital, and inferior alveolar nerves have been reported, an injury to the anterior superior alveolar nerve (ASAN) has not been reported. An algorithm is proposed for the diagnosis of injury to the ASAN versus the infraorbital nerve itself. A case is reported in which pain relief was achieved by dividing the ASAN within the maxillary sinus, leaving the proximal end exposed within the sinus at the level of the orbital floor. Full article

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9 pages, 797 KiB

Open AccessTechnical Note

In-Office Guided Implant Placement for Prosthetically Driven Implant Surgery

by Daryoush Karami, Hamid Reza Alborzinia, Reza Amid, Mahdi Kadkhodazadeh, Navid Yousefi and Sarina Badakhshan

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 246-254; https://doi.org/10.1055/s-0036-1584891 - 19 Jul 2016

Cited by 6 | Viewed by 52

Abstract

Application of surgical stents for implant placement via guided flapless surgery is increasing. However, high cost, need for some professional machines, and not taking into account the soft-tissue parameters have limited their application. We sought to design and introduce a technique named in-office [...] Read more.

Application of surgical stents for implant placement via guided flapless surgery is increasing. However, high cost, need for some professional machines, and not taking into account the soft-tissue parameters have limited their application. We sought to design and introduce a technique named in-office guided implant placement (iGIP) to decrease the cost by using available devices in office and enhance the applicability of surgical stents. A customized surgical stent was fabricated based on prosthetic, soft- and hard-tissue parameters by taking into account the amount of available bone (using the computed tomographic [CT] data), soft-tissue thickness and contour (using a composite-covered radiographic stent), and position of the final crown (by diagnostic cast wax up and marking the final crown position with composite). The efficacy of iGIP, in terms of the accuracy of the three-dimensional position of the implant placed in the study cast and in patient's mouth, was confirmed by direct observation and postoperative CT. The iGIP can enhance implant placement in the prosthetically desired position in various types of edentulism. Using this technique minimizes the risk of unwanted consequences, as the soft-tissue thickness and contour are taken into account when fabricating a surgical stent. Full article

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2 pages, 1309 KiB

Open AccessTechnical Note

Narrow-Bladed “Endo” Sagittal Split Osteotomy Retractor

by Maurice Yves Mommaerts

Craniomaxillofac. Trauma Reconstr. 2017, 10(3), 244-245; https://doi.org/10.1055/s-0036-1584889 - 30 Jun 2016

Viewed by 43

Abstract

A modification of the Obwegeser sagittal split retractor is presented. It is slender while still protecting the soft tissues and is particularly suitable for endoscopically assisted surgery. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 10, Issue 3 (September 2017) – 14 articles

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