Craniomaxillofacial Trauma & Reconstruction

8 pages, 296 KiB

Open AccessArticle

Anterior Submandibular Approach for Transmylohyoid Endotracheal Intubation: A Reappraisal with Prospective Study in 206 Cases of Craniomaxillofacial Fractures

by Nitin Bhola, Anendd Jadhav, Atul Kala, Rahul Deshmukh, Umesh Bhutekar and G. S. V. Prasad

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 255-262; https://doi.org/10.1055/s-0037-1607063 - 27 Sep 2017

Cited by 6 | Viewed by 63

Abstract

Despite a paradigm shift in anesthesia and trauma airway management, the craniomaxillofacial fracture (CMF) patients continue to pose a challenge. A prospective study was planned between April 2007 and March 2015 to investigate the safety, efficacy, utility, and complications of anterior submandibular approach [...] Read more.

Despite a paradigm shift in anesthesia and trauma airway management, the craniomaxillofacial fracture (CMF) patients continue to pose a challenge. A prospective study was planned between April 2007 and March 2015 to investigate the safety, efficacy, utility, and complications of anterior submandibular approach for transmylohyoid intubation (TMI) in CMFs using an armored endotracheal tube (ETT). Out of 1207 maxillofacial trauma cases reported, this study recruited 206 patients (152 males and 54 females) aged between 21 and 60 years. No episode of oxygen desaturation was noted intraoperatively. Mean time to perform TMI was 6 ± 2 minutes. The mean transmylohyoid ETT withdrawal time/disconnection time from ventilator was approximately 1.5 minutes. Accidental partial extubation of ETT was noted in two patients (0.97%), and three patients (1.45%) developed abscess formations at anterior submandibular site which were managed by incision and drainage. The anterior submandibular approach for TMI was successfully used and provided stable airway in all elective CMF surgery cases, where oral or nasal intubations were not indicated/feasible and long-term ventilation support was not required. It permitted simultaneous dental occlusion-guided reduction and fixation of all the facial fractures without interference from the tube during the surgery with unhindered maintenance of the anesthesia and airway. The advantages include easy, swift, efficient, and reliable approach with a small learning curve. Full article

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8 pages, 646 KiB

Open AccessArticle

Pedicle Flaps Contribute to Endoscopic Skull-Base Surgery and Facial Soft-Tissue Repair: The Diuturnity of Johannes Fredericus Samuel Esser (1877–1946)

by Richard A. Pollock and M. Douglas Gossman

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 263-270; https://doi.org/10.1055/s-0037-1604167 - 7 Aug 2017

Viewed by 60

Abstract

Pedicle flaps based on the external maxillary (facial) artery were introduced during the World War I, precisely a century ago. Today they remain effective tools in facial soft-tissue repair. Recently, pedicle flaps based on the internal maxillary (sphenopalatine) artery have been chosen to [...] Read more.

Pedicle flaps based on the external maxillary (facial) artery were introduced during the World War I, precisely a century ago. Today they remain effective tools in facial soft-tissue repair. Recently, pedicle flaps based on the internal maxillary (sphenopalatine) artery have been chosen to reliably close dural defects after endoscopic skull-base surgery. Pedicle flaps, “biologic” to the extent they are based on a defined arterial blood supply, are the lasting contributions—the diuturnity”of Johannes (“Jan”) Fredericus Samuel Esser (1877–1946) of Leiden, Holland, and Chicago (IL). Full article

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5 pages, 111 KiB

Open AccessArticle

Hearing and Mortality Outcomes following Temporal Bone Fractures

by Adam Honeybrook, Aniruddha Patki, Nikita Chapurin and Charles Woodard

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 281-285; https://doi.org/10.1055/s-0037-1601885 - 19 Apr 2017

Cited by 13 | Viewed by 55

Abstract

The aim of this article is to determine hearing and mortality outcomes following temporal bone fractures. Retrospective chart review was performed of 152 patients diagnosed with a temporal bone fracture presenting to the emergency room at a tertiary care referral center over a [...] Read more.

The aim of this article is to determine hearing and mortality outcomes following temporal bone fractures. Retrospective chart review was performed of 152 patients diagnosed with a temporal bone fracture presenting to the emergency room at a tertiary care referral center over a 10-year period. Utilizing Patients’ previously obtained temporal bone computed tomographic scans and audiograms, fractures were classified based on several classification schemes. Correlations between fracture patterns, mortality, and hearing outcomes were analyzed using χ² tests. Ossicular chain disruption was seen in 11.8% of patients, and otic capsule violation was seen in 5.9%; 22.7% of patients presented for audiologic follow-up. Seventeen patients with conductive hearing loss had air–bone gaps of 26 ± 7.5 dB (500 Hz), 27 ± 6.8 dB (1,000 Hz), 18 ± 6.2 dB (2,000 Hz), and 32 ± 7.7 dB (4,000 Hz). Two cases of profound sensorineural hearing loss were associated with otic capsule violation. No fracture classification scheme was predictive of hearing loss, although longitudinal fractures were statistically associated with ossicular chain disruption (p < 0.01). Temporal bone fractures in patients older than 60 years carried a relative risk of death of 3.15 compared with those younger than 60 years. The average magnitude of conductive hearing loss resulting from temporal bone fracture ranged from 18 to 32 dB in this cohort. Classification of fracture type was not predictive of hearing loss, despite the statistical association between ossicular chain disruption and longitudinal fractures. This finding may be due to the low follow-up rates of this patient population. Physicians should make a concerted effort to ensure that audiological monitoring is executed to prevent and manage long-term hearing impairment. Full article

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3 pages, 154 KiB

Open AccessArticle

Treatment Outcomes for Isolated Maxillary Complex Fractures with Maxillomandibular Screws

by Rahul Gorka, Amish Jayantilal Gohil, Ashish Kumar Gupta and Santosh Koshy

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 278-280; https://doi.org/10.1055/s-0037-1601864 - 12 Apr 2017

Cited by 1 | Viewed by 39

Abstract

Intermaxillary fixation (IMF) is a basic and fundamental principle in the management of patients with fractures of the maxillomandibular complex. There are several shortcomings related to the conventionally recommended tooth-mounted devices that are used to achieve IMF. To circumvent these, the use of [...] Read more.

Intermaxillary fixation (IMF) is a basic and fundamental principle in the management of patients with fractures of the maxillomandibular complex. There are several shortcomings related to the conventionally recommended tooth-mounted devices that are used to achieve IMF. To circumvent these, the use of bone-borne screws has been advocated. We present a series of maxillary fractures treated with IMF screws. Over a 12-month period, 15 cases of maxillary fracture were managed with open reduction and bone plate fixation. IMF screws were used to achieve IMF intraoperatively and for a short duration postoperatively. Eight cortical titanium screws were inserted transmucosally, two for each quadrant at the junction of the attached and mobile mucosa. Satisfactory occlusion was achieved in all the patients with few complications. IMF screw fixation was observed to be a safe and quick method for open reduction of maxillary fractures. Tooth-borne devices are associated with problems such as poor oral hygiene and periodontal health, extrusion of teeth, loss of tooth vitality, traumatic ulcers of buccal and labial mucosa, and needle stick injury to the operator. These procedures are also time consuming. The use of cortical bone screws is a quicker and safe alternative for achieving satisfactory IMF. Full article

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7 pages, 108 KiB

Open AccessArticle

Comparing Plastic Surgery and Otolaryngology Management in Cleft Care: An Analysis of 4999 Cases

by Kevin T. Jubbal, Dmitry Zavlin, Shola Olorunnipa, Anthony Echo, Edward P. Buchanan and Larry H. Hollier

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 271-277; https://doi.org/10.1055/s-0037-1601429 - 3 Apr 2017

Cited by 9 | Viewed by 64

Abstract

Care for patients with cleft lip and palate is best managed by a craniofacial team consisting of a variety of specialists, including surgeons, who are generally plastic surgeons or otolaryngologists trained in the United States. The goal of this study was to compare [...] Read more.

Care for patients with cleft lip and palate is best managed by a craniofacial team consisting of a variety of specialists, including surgeons, who are generally plastic surgeons or otolaryngologists trained in the United States. The goal of this study was to compare the surgical approaches and management algorithms of cleft lip, cleft palate, and nasal reconstruction between plastic surgeons and otolaryngologists. We performed a retrospective analysis of the American College of Surgeons’ National Surgical Quality Improvement Program Pediatric database between 2012 and 2014 to identify patients undergoing primary repair of cleft lip, cleft palate, and associated rhinoplasty. Two cohorts based on primary specialty, plastic surgeons and otolaryng-ologists, were compared in relation to patient characteristics, 30-day postoperative outcomes, procedure type, and intraoperative variables. Plastic surgeons performed the majority of surgical repairs, with 85.5% (n = 1472) of cleft lip, 79.3% (n = 2179) of cleft palate, and 87.9% (n = 465) of rhinoplasty procedures. There was no difference in the age of primary cleft lip repair or rhinoplasty. However, plastic surgeons performed primary cleft palate repair earlier than otolaryngologists (p = 0.03). Procedure type varied between the specialties. In rhinoplasty, otolaryngologists were more likely to use septal or ear cartilage, whereas plastic surgeons preferred rib cartilage. Results were similar, with no statistically significant difference in terms of mortality, reoperation, readmission, or complications. Significant variation exists in the treatment of cleft lip and palate based on specialty service with regard to procedure timing and type. However, short-term rates of mortality, wound occurrence, reoperation, readmission, and surgical or medical complications remain similar. Full article

5 pages, 367 KiB

Open AccessTechnical Note

A Hemangioma of the Zygomatic Bone: Management Ensuring Good Reconstructive and Aesthetic Results

by Gabriele Bocchialini, Andrea Castellani, Anna Bozzola and Alessandro Rossi

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 332-336; https://doi.org/10.1055/s-0036-1594274 - 11 Jan 2017

Cited by 4 | Viewed by 44

Abstract

Hemangiomas are benign tumors representing only 0.7 to 1% of all bone tumors; those that arise in the zygomatic region are rarely described in the literature. Here, we describe the case of a 55-year-old woman with a mass in the right orbitozygomatic region. [...] Read more.

Hemangiomas are benign tumors representing only 0.7 to 1% of all bone tumors; those that arise in the zygomatic region are rarely described in the literature. Here, we describe the case of a 55-year-old woman with a mass in the right orbitozygomatic region. She was diagnosed on the basis of preoperative clinical manifestations, data from an earlier histopathological examination, and computed tomography (CT). The CT scan revealed a lesion in the right zygomatic region at the level of the cancellous component. This caused thinning and remodeling of the deformed cortex both medially and laterally. Surgery was performed. We describe the clinical characteristics of our case with an emphasis on surgical management of the lesion using a titanium grid prepared by reference to a stereolithographic model. Full article

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5 pages, 309 KiB

Open AccessTechnical Note

Porcine Urinary Bladder Extracellular Matrix for the Salvage of Fibula Free Flap Skin Paddle: Technical Note and Description of a Case

by Rabie M. Shanti, Ryan J. Smart, Andrew Meram and David Kim

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 318-322; https://doi.org/10.1055/s-0036-1593473 - 14 Dec 2016

Cited by 6 | Viewed by 46

Abstract

This report establishes a novel application of a commercially available porcine urinary bladder extracellular matrix, MatriStem (ACell, Inc., Columbia, MD, USA), in the salvage of partial loss of the skin paddle of a fibula osteoseptocutaneous free flap that was utilized for mandibular reconstruction. [...] Read more.

This report establishes a novel application of a commercially available porcine urinary bladder extracellular matrix, MatriStem (ACell, Inc., Columbia, MD, USA), in the salvage of partial loss of the skin paddle of a fibula osteoseptocutaneous free flap that was utilized for mandibular reconstruction. Full article

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4 pages, 256 KiB

Open AccessCase Report

Posttraumatic Parotid Sialocele Complicating a Mandibular Fracture: A Case Report

by Jesse Falk, Ryan Borgwardt and Stephen MacLeod

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 314-317; https://doi.org/10.1055/s-0036-1593891 - 13 Dec 2016

Cited by 2 | Viewed by 56

Abstract

Blunt trauma to the parotid resulting in the formation of a sialocele is rare, with only three cases identified in the literature. We present a unique case involving a 32-year-old man with blunt trauma resulting in a left mandibular angle fracture. The patient [...] Read more.

Blunt trauma to the parotid resulting in the formation of a sialocele is rare, with only three cases identified in the literature. We present a unique case involving a 32-year-old man with blunt trauma resulting in a left mandibular angle fracture. The patient underwent open reduction and internal fixation of the left mandibular angle fracture via transoral approach. At follow-up, after resolution of the edema from the injury, a sialocele was noted in the region of the left anterior parotid gland. The patient was treated conservatively with antisialagogues, pressure dressings, and multiple percutaneous aspirations that ultimately resulted in resolution of the sialocele. Full article

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3 pages, 241 KiB

Open AccessTechnical Note

The Pull-Through Technique: A Viable Option for Preserving the Inferior Alveolar Nerve During Surgical Resection

by Gustavo Boehmer Leite, Suelen Cristina Sartoretto, Fernando César Amazonas Lima, Mônica Calasans-Maia and Rafael Seabra Louro

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 329-331; https://doi.org/10.1055/s-0036-1593893 - 11 Nov 2016

Cited by 5 | Viewed by 58

Abstract

The aim of this study was to present a new surgical technique used to remove benign mandibular tumors with minimal damage to the inferior alveolar nerve. The pull-through technique was shown using an ameloblastoma surgical resection as an example. This technique consisted in [...] Read more.

The aim of this study was to present a new surgical technique used to remove benign mandibular tumors with minimal damage to the inferior alveolar nerve. The pull-through technique was shown using an ameloblastoma surgical resection as an example. This technique consisted in the reconstruction of the lower jaw associating the resection of the lesion with nerve repair at the same surgical time. The resection was performed using the pull-through technique and the inferior alveolar nerve was preserved. After 6 months, the patient presented a recovery of approximately 80% of sensory function. The surgical technique presented should be considered an important method by which to produce a higher functional outcome to remove benign mandibular tumors with minimal damage to the inferior alveolar nerve and allows the maintenance of quality of life for the patient, as the consequences of this type of surgery are minimized. Full article

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8 pages, 901 KiB

Open AccessCase Report

Bone Allograft: An Option for Total Mandibular Reconstruction

by Masoud Fallahi Motlagh, Mohamad Bayat and Siamak Naji

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 306-313; https://doi.org/10.1055/s-0036-1593474 - 4 Nov 2016

Cited by 6 | Viewed by 56

Abstract

Total mandibular reconstruction is one of the most challenging modalities in maxillofacial surgery. In this article, we try to introduce a method of total mandible reconstruction. We report a 25-year-old male patient with complete involvement of the mandible by Langerhans cell tumor. The [...] Read more.

Total mandibular reconstruction is one of the most challenging modalities in maxillofacial surgery. In this article, we try to introduce a method of total mandible reconstruction. We report a 25-year-old male patient with complete involvement of the mandible by Langerhans cell tumor. The patient underwent total mandibulectomy and reconstruction with bone allograft harvested from a donor who had died the day before. The patient has good functional and aesthetic results in a long time. It seems that bone allograft can be a good alternative to other methods in total mandibular reconstruction. Full article

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4 pages, 201 KiB

Open AccessTechnical Note

New Management in Bilateral Masseter Muscle Hypertrophy

by Gabriele Bocchialini, Andrea Castellani, Stefano Negrini and Alessandro Rossi

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 325-328; https://doi.org/10.1055/s-0036-1592089 - 1 Nov 2016

Cited by 10 | Viewed by 59

Abstract

Bilateral masseter muscle hypertrophy is an alteration in shape and thickness of the masseter muscles that can modify the width of the lower face causing aesthetic and functional problems. A 21-year-old man was referred to the Department of Maxillofacial Surgery at the Civil [...] Read more.

Bilateral masseter muscle hypertrophy is an alteration in shape and thickness of the masseter muscles that can modify the width of the lower face causing aesthetic and functional problems. A 21-year-old man was referred to the Department of Maxillofacial Surgery at the Civil Hospital in Brescia by his dentist for an evaluation of his facial appearance with a square-face type. To reduce the undesirable facial appearance, a surgical intraoral approach was performed; the procedure includes the bilateral dissection of the masseter muscle, partial lipectomy, and the ostectomy of the mandibular angle assisted by a surgical guide built on a stereolithographic model. The patient was satisfied with the functional and aesthetic outcomes of both the profile and the frontal views. There was no evidence of complication at a 1-year follow-up. This new method yields optimal aesthetic results with an enhanced outline of the lower face. Full article

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7 pages, 748 KiB

Open AccessCase Report

Submental Perforator Flap for Soft-Tissue Reconstruction in Bisphosphonate-Related Osteonecrosis of the Jaws

by Jose-Antonio García-de Marcos and Juan Rey-Biel

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 299-305; https://doi.org/10.1055/s-0036-1593472 - 1 Nov 2016

Cited by 7 | Viewed by 51

Abstract

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) has emerged as an important and increasingly common comorbidity, especially in patients undergoing long-term treatment with high doses of bisphosphonates. The management of BRONJ remains controversial. Surgical treatment is necessary in severe cases. Treatment of the bone [...] Read more.

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) has emerged as an important and increasingly common comorbidity, especially in patients undergoing long-term treatment with high doses of bisphosphonates. The management of BRONJ remains controversial. Surgical treatment is necessary in severe cases. Treatment of the bone requires sequestrectomy or resection. Given the lack of sufficient mucosa to perform the operation and fragility of margins in many patients, local flaps are crucial. We report two cases of stage-3 BRONJ presenting secondary infection with Actinomyces, receiving treatment consisting of marginal resection of the necrotic bone, reinforcement with a reconstruction plate, and reconstruction of soft tissues using a submental perforator artery flap ipsilateral to the lesion. Total cure was achieved in both cases, achieving favorable aesthetic and functional outcomes. Full article

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7 pages, 2542 KiB

Open AccessCase Report

Mandibular Reconstruction with Lateral Tibial Bone Graft: An Excellent Option for Oral and Maxillofacial Surgery

by Ana Lucia Carpi Miceli, Livia Costa Pereira, Thiago da Silva Torres, Mônica Diuana Calasans-Maia and Rafael Seabra Louro

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 292-298; https://doi.org/10.1055/s-0036-1593475 - 1 Nov 2016

Cited by 7 | Viewed by 71

Abstract

Autogenous bone grafts are the gold standard for reconstruction of atrophic jaws, pseudoarthroses, alveolar clefts, orthognathic surgery, mandibular discontinuity, and augmentation of sinus maxillary. Bone graft can be harvested from iliac bone, calvarium, tibial bone, rib, and intraoral bone. Proximal tibia is a [...] Read more.

Autogenous bone grafts are the gold standard for reconstruction of atrophic jaws, pseudoarthroses, alveolar clefts, orthognathic surgery, mandibular discontinuity, and augmentation of sinus maxillary. Bone graft can be harvested from iliac bone, calvarium, tibial bone, rib, and intraoral bone. Proximal tibia is a common donor site with few reported problems compared with other sites. The aim of this study was to evaluate the use of proximal tibia as a donor area for maxillofacial reconstructions, focusing on quantifying the volume of cancellous graft harvested by a lateral approach and to assess the complications of this technique. In a retrospective study, we collected data from 31 patients, 18 women and 13 men (mean age: 36 years, range: 19–64), who were referred to the Department of Oral and Maxillofacial Surgery at the Servidores do Estado Federal Hospital. Patients were treated for sequelae of orthognathic surgery, jaw fracture, nonunion, malunion, pathology, and augmentation of bone volume to oral implant. The technique of choice was lateral access of proximal tibia metaphysis for graft removal from Gerdy tubercle under general anesthesia. The mean volume of bone harvested was 13.0 ± 3.7 mL (ranged: 8–23 mL). Only five patients (16%) had minor complications, which included superficial infection, pain, suture dehiscence, and unwanted scar. However, none of these complications decreases the result and resolved completely. We conclude that proximal tibia metaphysis for harvesting cancellous bone graft provides sufficient volume for procedures in oral and maxillofacial surgery with minimal postoperative morbidity. Full article

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6 pages, 5680 KiB

Open AccessCase Report

Identical Twins with Crouzon Syndrome: Eight-Year Follow-Up, Genetic Considerations, and Operative Management

by Mark S. Lloyd, Jeffrey G. Trost, David Y. Khechoyan, Larry H. Hollier, Jr. and Edward P. Buchanan

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 286-291; https://doi.org/10.1055/s-0036-1592091 - 2 Sep 2016

Cited by 2 | Viewed by 67

Abstract

A case report of monozygotic (MZ) twins with Crouzon syndrome was previously published to highlight variables in clinical presentation. The postnatal and epigenetic causes for this variation are not well understood. An 8-year follow-up discusses their pertinent clinic course with consideration of genetic [...] Read more.

A case report of monozygotic (MZ) twins with Crouzon syndrome was previously published to highlight variables in clinical presentation. The postnatal and epigenetic causes for this variation are not well understood. An 8-year follow-up discusses their pertinent clinic course with consideration of genetic and nongenetic variables. The phenotypic and symptomatic obstacles encountered since their initial assessment are reviewed, and the use of three-dimensional Medical Modeling (Golden, CO) as a preoperative planning strategy is addressed. Analyzing the longitudinal clinical course of MZ twins with syndromic craniosynostosis will help better predict and provide optimal treatment. Full article

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2 pages, 409 KiB

Open AccessTechnical Note

Le Fort I–Type Osteotomy Retractor

by Maurice Yves Mommaerts

Craniomaxillofac. Trauma Reconstr. 2017, 10(4), 323-324; https://doi.org/10.1055/s-0036-1592097 - 23 Aug 2016

Cited by 1 | Viewed by 40

Abstract

A new instrument for retracting the maxilla after mobilization is described. It does neither compress nor inadvertently pierce the lower lip and it does neither obliterate the view nor hinder access to bone removing instruments. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 10, Issue 4 (December 2017) – 15 articles

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