Craniomaxillofacial Trauma & Reconstruction

5 pages, 124 KiB

Open AccessReview

Smile Train: Making the Grade in Global Cleft Care

by Matthew Louis, Ryan M. Dickey and Larry H. Hollier, Jr.

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 1-5; https://doi.org/10.1055/s-0037-1608700 - 11 Dec 2017

Cited by 20 | Viewed by 60

The global medical and psychological burden of cleft lip and palate is large, especially in low- and middle-income countries. For decades, medical missions have sought to alleviate this burden; however, there are significant barriers to providing sustainable, high-quality cleft care using the mission [...] Read more.

The global medical and psychological burden of cleft lip and palate is large, especially in low- and middle-income countries. For decades, medical missions have sought to alleviate this burden; however, there are significant barriers to providing sustainable, high-quality cleft care using the mission model. Smile Train, an international children’s charity founded in 1999, has developed a scalable model which provides support to local partner hospitals and surgeons around the world. Smile Train partners with hospitals to support cleft care treatment across the developing world. Partner hospitals are held to strict safety and quality standards. Local or regional providers are primarily used to train medical personnel. A quality assurance process developed by the Smile Train’s Medical Advisory Board is used to assess cleft surgery cases and suggest additional review and training as needed. Surgical candidates are systematically evaluated and must meet specific medical criteria to ensure safety. Experienced anesthetists adhere to Smile Train’s safety and quality protocols including anesthesia guidelines. Smile Train and its partners have provided more than 1.2 million safe, high-quality cleft surgical treatments since 1999. Smile Train has sponsored more than 3000 hands-on training opportunities, 30,000 opportunities to participate in cleft conferences, and 40,000 virtual cleft training opportunities. Through rigorous self-governance and its sustainable, scalable model, this organization has elevated the standard of cleft care in the developing world. Full article

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6 pages, 93 KiB

Open AccessReview

Psychological Impact of Facial Trauma

by Vaibhav Sahni

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 15-20; https://doi.org/10.1055/s-0037-1603464 - 12 Jun 2017

Cited by 34 | Viewed by 75

Abstract

Examination of the mental state of patients suffering from facial trauma is rarely ever recorded, let alone screening them for posttraumatic stress disorders (PTSDs) or generalized anxiety disorder. Providing early support to the patient in light of such psychological conditions can improve the [...] Read more.

Examination of the mental state of patients suffering from facial trauma is rarely ever recorded, let alone screening them for posttraumatic stress disorders (PTSDs) or generalized anxiety disorder. Providing early support to the patient in light of such psychological conditions can improve the overall quality of life. The aim of this study was to perform a literature review to assess the relation of mental state disorders to facial trauma in terms of their prevalence, assess screening methodology, and also to evaluate the prognosis of individuals subjected to psychological intervention/screening at an early stage of clinical examination. Research databases such as ScienceDirect, Google Scholar, PubMed, and Medline were searched using the keywords “psychological trauma”, “facial trauma”, and “PTSD.” Only meta-analyses, systematic reviews, and original research articles in the English language were included in the study. Correspondence to journal editors and clinician opinions were excluded from the study. Out of a total of 459 results, only 8 articles satisfied the inclusion criteria of the study. The literature review showed that patients suffering from orofacial trauma had significantly increased levels of mental state disorders such as PTSD and generalized anxiety disorder, more so in victims of assault. The results of this literature review clearly point toward an increased prevalence of mental state disorders in patients suffering from facial trauma, which warrants for early intervention in this regard to improve the quality of life of these patients. Full article

8 pages, 135 KiB

Open AccessArticle

Multi-Institutional Analysis of Surgical Management and Outcomes of Mandibular Fracture Repair in Adults

by Dmitry Zavlin, Kevin T. Jubbal, Anthony Echo, Shayan A. Izaddoost, Jeffrey D. Friedman and Olushola Olorunnipa

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 41-48; https://doi.org/10.1055/s-0037-1603460 - 8 Jun 2017

Cited by 17 | Viewed by 51

Abstract

Mandibular fractures are rare, most commonly occurring in young male patients who present with facial trauma. The etiology, incidence, and presentation vary among previous publications depending on cultural and socioeconomic factors of the region of origin. This multi-institutional study aims to present demographic [...] Read more.

Mandibular fractures are rare, most commonly occurring in young male patients who present with facial trauma. The etiology, incidence, and presentation vary among previous publications depending on cultural and socioeconomic factors of the region of origin. This multi-institutional study aims to present demographic characteristics, surgical treatment, and clinical outcomes of surgical repair of mandible fractures in the United States. An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) adult databases of the years 2006 through 2014 was performed identifying 940 patients with an International Classification of Diseases, version 9 (ICD-9) diagnosis of either closed or open fracture of the mandible. Preoperative, perioperative, and postoperative details were categorized and evaluated for these two cohorts. Multivariate analysis was performed to detect risk factors related to any complications. Patients were predominantly male (85.7%), young with a mean age of 34.0 ± 14.8 years, and relatively healthy with body mass index of 23.6 ± 8.2 and an American Society of Anesthesiologists (ASA) class of 1 or 2 (84.4%). However, more than half were regular smokers (51.1%). The top five most frequent procedures performed for mandibular repair were exclusively open surgical approaches with internal, external, or interdental fixation in both cohorts. Patients with open fractures were more often admitted as emergencies, treated inpatient, required longer operative times, and presented with more contaminated wounds (p < 0.05). Overall, medical (1.7%) and surgical complications (3.7%) were low. A high ASA class 3 or above and emergency operations were identified as risk factors for medical adverse events. Despite frequent concomitant injuries after trauma and a diverse array of mandibular injury types, our patient sample demonstrated favorable outcomes and low complication rates. Open surgical techniques were the most common procedures in this study representing the American population. Full article

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6 pages, 129 KiB

Open AccessArticle

Systemic Preoperative Antibiotics with Mandible Fractures: Are They Indicated at the Time of Injury?

by Andrew D. Linkugel, Elizabeth B. Odom, Rebecca A. Bavolek, Alison K. Snyder-Warwick and Kamlesh B. Patel

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 35-40; https://doi.org/10.1055/s-0037-1603458 - 24 May 2017

Cited by 18 | Viewed by 54

Abstract

Mandible fractures are the most common result of facial trauma. The proximity of oral flora to the site of both the injury and resulting surgical instrumentation makes managing infection a unique challenge. The benefit of antibiotic prophylaxis at the time of surgical treatment [...] Read more.

Mandible fractures are the most common result of facial trauma. The proximity of oral flora to the site of both the injury and resulting surgical instrumentation makes managing infection a unique challenge. The benefit of antibiotic prophylaxis at the time of surgical treatment of mandible fractures is well established. However, the routine use of antibiotics between the time of injury and surgery is of unclear benefit. We aim to define the role of antibiotics in the preoperative period: from the time of injury to surgical intervention. Demographic and clinical data were collected retrospectively on all patients who were treated for mandible fracture by the Division of Plastic and Reconstructive Surgery at our institution between 2003 and 2013. The use of both preoperative (between injury and surgery) and perioperative (at the time of surgery) systemic antibiotics was recorded along with the incidence of postoperative infections and other complications. Complete data were available for 269 patients. Of the 216 patients who received preoperative antibiotics, 22 (10%) developed an infection postoperatively. Of the 53 patients who did not receive preoperative antibiotics, 2 (4%) developed infection (p = 0.184). Likewise, preoperative antibiotics were not significantly associated with hardware complication rates. In our retrospective review, the use of antibiotics between injury and surgical repair had no impact on postoperative infection rates. These data suggest that preoperative antibiotic use may actually be associated with an increased incidence of postoperative infection. Our results do not support the routine use of antibiotics between injury and surgical repair in patients with mandible fractures. Full article

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9 pages, 284 KiB

Open AccessReview

Prosthetics in Facial Reconstruction

by Jaclyn Klimczak, Samuel Helman, Sameep Kadakia, Raja Sawhney, Manoj Abraham, Allison K. Vest and Yadranko Ducic

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 6-14; https://doi.org/10.1055/s-0037-1603459 - 22 May 2017

Cited by 26 | Viewed by 60

Abstract

Reconstruction of the head and neck can be a challenging undertaking owing to numerous considerations for successful rehabilitation. Although head and neck defects were once considered irretrievably morbid and associated with a poor quality of life, advances in surgical technique has immensely contributed [...] Read more.

Reconstruction of the head and neck can be a challenging undertaking owing to numerous considerations for successful rehabilitation. Although head and neck defects were once considered irretrievably morbid and associated with a poor quality of life, advances in surgical technique has immensely contributed to the well-being of these patients. However, all patients are not suitable surgical candidates and many have sought nonsurgical options for functional and cosmetic restoration. As such, the advent of prostheses has ameliorated those concerns and provided a viable alternative for select patient populations. Prosthetic reconstruction has evolved significantly over the past decade. Advances in biocompatible materials and imaging adjuncts have spurred further discovery and forward progress. A multidisciplinary approach to head and neck reconstruction focused on appropriate expectations and patient-centered goals is most successfully coordinated by a team of head and neck surgeons, maxillofacial surgeons, and prosthetic specialists. The aim of this article is to provide a comprehensive review of the current trends for prosthetic rehabilitation of head and neck defects, and further elaborate on the limitations and advancements in the field. Full article

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7 pages, 238 KiB

Open AccessArticle

Incidence and Risk Factors of Inferior Rectus Muscle Palsy in Pediatric Orbital Blowout Fractures

by Stephanie M. Young, Yan Tong Koh, Errol W. Chan and Shantha Amrith

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 28-34; https://doi.org/10.1055/s-0037-1601884 - 2 May 2017

Cited by 5 | Viewed by 42

Abstract

The aim of this study was to evaluate the incidence, clinical features, and risk factors of sustaining inferior rectus (IR) palsy in a group of pediatric patients with orbital floor blowout fractures. We performed a retrospective case review of sequential cases of pediatric [...] Read more.

The aim of this study was to evaluate the incidence, clinical features, and risk factors of sustaining inferior rectus (IR) palsy in a group of pediatric patients with orbital floor blowout fractures. We performed a retrospective case review of sequential cases of pediatric orbital floor blowout fractures (<18 years old) from 2000 to 2013 in a tertiary ophthalmic center in Singapore. A total of 48 patients were included in our study, of whom 5 had IR palsy (10.4%). Patients with IR palsy had a higher mean age (16.4 ± 1.5 years) compared with patients without IR palsy (12.4 ± 3.3 years), had significantly (p < 0.05) worse preoperative motility, and had significantly greater proportion developing postoperative hypertropia (100%) compared with patients without IR palsy (4.7%). Our series of pediatric blowout fractures demonstrated IR palsy prevalence and clinical features for IR palsy which may be distinct to the pediatric group. Full article

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7 pages, 453 KiB

Open AccessArticle

Surgical Anatomy of the Cervical Part of the Hypoglossal Nerve

by Brian Ngure Kariuki, Fawzia Butt, Pamela Mandela and Paul Odula

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 21-27; https://doi.org/10.1055/s-0037-1601863 - 2 May 2017

Cited by 10 | Viewed by 63

Abstract

Iatrogenic injuries to cranial nerves, half of which affect the hypoglossal nerve, occur in up to 20% of surgical procedures involving the neck. The risk of injury could be minimized by in-depth knowledge of its positional and relational anatomy. Forty-one hypoglossal nerves were [...] Read more.

Iatrogenic injuries to cranial nerves, half of which affect the hypoglossal nerve, occur in up to 20% of surgical procedures involving the neck. The risk of injury could be minimized by in-depth knowledge of its positional and relational anatomy. Forty-one hypoglossal nerves were dissected from cadaveric specimens and positions described in relation to the internal carotid artery (ICA), external carotid artery (ECA), carotid bifurcation, mandible, hyoid bone, mastoid process, and the digastric tendon. The distance of the nerve from where it crossed the ICA and ECA to the carotid bifurcation was 29.93 (±5.99) mm and 15.19 (±6.68) mm, respectively. The point where it crossed the ICA was 12.24 (±3.71) mm superior to the greater horn of hyoid, 17.16 (±4.40) mm inferior to the angle of the mandible, and 39.08 (±5.69) mm from tip of the mastoid. The hypoglossal nerve loop was inferior to the digastric tendon in 73% of the cases. The hypoglossal nerves formed high loops in this study population. Caution should be exercised during surgical procedures in the neck. The study also revealed that the mastoid process is a reliable fixed landmark to locate the hypoglossal nerve. Full article

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5 pages, 312 KiB

Open AccessOther

Correction of a Posttraumatic Orbital Deformity Using Three-Dimensional Modeling, Virtual Surgical Planning with Computer-Assisted Design, and Three-Dimensional Printing of Custom Implants

by Kristopher M. Day, Paul M. Phillips and Larry A. Sargent

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 78-82; https://doi.org/10.1055/s-0037-1601432 - 3 Apr 2017

Cited by 28 | Viewed by 49

Abstract

We describe a case of complex, posttraumatic skull and orbital deformities that were evaluated and treated with advanced computer technology, including virtual surgical planning, three-dimensional (3D) modeling, and printed patient custom implants (PCI) fabricated by 3D printing. A 50-year-old man presented to our [...] Read more.

We describe a case of complex, posttraumatic skull and orbital deformities that were evaluated and treated with advanced computer technology, including virtual surgical planning, three-dimensional (3D) modeling, and printed patient custom implants (PCI) fabricated by 3D printing. A 50-year-old man presented to our craniofacial referral center 1 year after failed reduction of complex left orbital, zygomatic, and frontal bone fractures due to a motorcycle collision. The patient’s chief complaint was debilitating diplopia in all fields of gaze. On examination, he had left enophthalmos, left canthal displacement, lower eyelid ectropion, vertical orbital dystopia, and a laterally and inferiorly displaced, comminuted zygoma with orbital rim and frontal bone defects. The normal orbit was mirrored to precisely guide repositioning of the globe, orbital reconstruction, and cranioplasty. Preinjury appearance with normal globe position was restored with complete resolution of diplopia. Modern 3D technology allows the surgeon to better analyze complex orbital deformities and precisely plan surgical correction with the option of printing a PCI. These techniques were successfully applied to resolve a case of debilitating diplopia and aesthetic deficits after facial trauma. Further application of advanced 3D computer technology can potentially improve the results of severe orbital and craniofacial trauma reconstruction. Full article

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6 pages, 266 KiB

Open AccessCase Report

Bone Allograft Segment Covered with a Vascularized Fibular Periosteal Flap: A New Technique for Pediatric Mandibular Reconstruction

by Nicolas E. Sierra, Paula Diaz-Gallardo, Jorge Knörr, Vasco Mascarenhas, Eloy García-Diez, Montserrat Munill-Ferrer, Maria S. Bescós-Atín and Francisco Soldado

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 65-70; https://doi.org/10.1055/s-0036-1593992 - 5 Jan 2017

Cited by 6 | Viewed by 42

Abstract

The free vascularized fibular graft is nowadays the preferred technique for pediatric mandibular reconstruction. Despite the versatility and proven efficacy for restoring the facial appearance and maxillomandibular function, those mandibular reconstructions with free vascularized fibula associate difficulties for a simultaneous restoration of the [...] Read more.

The free vascularized fibular graft is nowadays the preferred technique for pediatric mandibular reconstruction. Despite the versatility and proven efficacy for restoring the facial appearance and maxillomandibular function, those mandibular reconstructions with free vascularized fibula associate difficulties for a simultaneous restoration of the alveolar height and facial contour, which are derived from the height discrepancy between the fibula and the native mandible. In addition, the donor-site growth and morbidity are of special concern in the pediatric patient. We report a novel technique for pediatric mandibular reconstruction, in an 11-year-old girl, using a combination of a bone allograft segment with a vascularized fibular periosteal flap (VFPF), after resection of an Ewing sarcoma located at the right body of the mandible. The patient has showed optimal cosmetic, functional, and radiological outcomes, which have been maintained for 2.5 years, without detecting donor-site complications. Through this original technique, and based on the powerful osteogenic and vasculogenic properties of the pediatric VFPFs, we could effectively reconstruct a large mandibular defect providing a functional and aesthetic reconstruction, while avoiding the potential morbidity associated with the fibula resection. Full article

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6 pages, 290 KiB

Open AccessCase Report

Ectopic Molar Removal from the Ramus/Condyle Unit: A Minimally Invasive Approach

by Gary A. Forgach and Stephen P.R. MacLeod

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 59-64; https://doi.org/10.1055/s-0036-1594275 - 3 Jan 2017

Cited by 5 | Viewed by 43

Abstract

Ectopic molars within the mandibular ramus/condyle unit, although rare, present a unique challenge to the surgeon. Multiple approaches have been described in the literature for their removal. A review of the English literature on the subject of mandibular ectopic molars and their epidemiology, [...] Read more.

Ectopic molars within the mandibular ramus/condyle unit, although rare, present a unique challenge to the surgeon. Multiple approaches have been described in the literature for their removal. A review of the English literature on the subject of mandibular ectopic molars and their epidemiology, etiology, indications for removal, and surgical techniques was completed. In addition, a case report is presented of an ectopic mandibular molar in the mid-ramus region which was removed via a minimally invasive, intraoral, technique combining the use of endoscopy and piezoelectric surgery. The authors advocate this technique as it offers the following advantages: avoidance of injury to branches of the facial nerve, unaesthetic scars, and sialocele formation; maximization of surgical field visualization with limited dissection; ability for safe sectioning of the tooth with minimal risks to adjacent structures; and precise bone removal, reducing the risk of iatrogenic or postoperative mandible fracture. Full article

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5 pages, 271 KiB

Open AccessCase Report

Craniomaxillofacial Fibrous Dysplasia: Conservative Treatment and Maxillary Osteotomy Using the Schuchardt-Kufner Technique

by Manlio Galiè, Giulia Carnevali, Giovanni Elia, Massimo Pedriali and Luigi C. Clauser

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 54-58; https://doi.org/10.1055/s-0036-1597584 - 23 Dec 2016

Viewed by 43

Abstract

Fibrous dysplasia (FD) is a disturbance of the mesenchymal tissue that accounts for 2.5% of all bone tumors and more than 7% of nonmalignant bone tumors. In the craniomaxillofacial region, FD affects the calvaria, skull base, zygoma, and jaws, the prevalent site being [...] Read more.

Fibrous dysplasia (FD) is a disturbance of the mesenchymal tissue that accounts for 2.5% of all bone tumors and more than 7% of nonmalignant bone tumors. In the craniomaxillofacial region, FD affects the calvaria, skull base, zygoma, and jaws, the prevalent site being the maxilla (50% of cases). Therapy for craniomaxillofacial FD is surgical. The goals of surgery are to prevent functional disorders and restore facial symmetry, volume, and contour. In this article, we present a case of a young female patient affected by right orbital-zygomatic-maxillary FD. She had developed facial asymmetry and malocclusion that were corrected using the Schuchardt-Kufner osteotomy technique. Full article

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5 pages, 402 KiB

Open AccessCase Report

Soft-Tissue Chondroma in the Preauricular Region: An Unusual Presentation

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

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 49-53; https://doi.org/10.1055/s-0036-1593892 - 14 Dec 2016

Cited by 1 | Viewed by 53

Abstract

Chondroma is a benign cartilaginous tumor composed of mature hyaline cartilage and represents only 2.38% of all osteocartilaginous tumors; cases that arise in the preauricular region are rarely found in the literature. This article presents an 80-year-old man with preauricular swelling on the [...] Read more.

Chondroma is a benign cartilaginous tumor composed of mature hyaline cartilage and represents only 2.38% of all osteocartilaginous tumors; cases that arise in the preauricular region are rarely found in the literature. This article presents an 80-year-old man with preauricular swelling on the right side and pain with no limitation of joint motion. This patient was evaluated by preoperative clinical manifestation, fine needle aspiration, ultrasound, and magnetic resonance imaging (MRI) scans. The MRI shows a solid lobulated lesion between the masseter muscle and the parotid gland whereas fine-needle aspiration did not provide a diagnosis. Based on these images and the patient’s indications and symptoms, a surgical intervention was performed. It is possible to identify three different types of chondromas in the parotid region based on their location. Among the cases of chondroma in the literature, only six originating in the soft tissue of the parotid region have been reported, including this one. Full article

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7 pages, 109 KiB

Open AccessOther

Contemporary Trends in the Management of Posttraumatic Cerebrospinal Fluid Leaks

by Moustafa Mourad, Jared C. Inman, David M. Chan and Yadranko Ducic

Craniomaxillofac. Trauma Reconstr. 2018, 11(1), 71-77; https://doi.org/10.1055/s-0036-1584890 - 1 Nov 2016

Cited by 14 | Viewed by 56

Abstract

The objective of this review is to provide an overview on the diagnosis and management of traumatic cerebrospinal fluid (CSF) leaks. This comprehensive review explores controversies associated with the management of CSF leaks as well as a review of the most contemporary literature. [...] Read more.

The objective of this review is to provide an overview on the diagnosis and management of traumatic cerebrospinal fluid (CSF) leaks. This comprehensive review explores controversies associated with the management of CSF leaks as well as a review of the most contemporary literature. The scope of this article covers both traumatic CSF leaks of the middle and anterior cranial fossae. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 11, Issue 1 (March 2018) – 13 articles

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