Craniomaxillofacial Trauma & Reconstruction

3 pages, 57 KiB

Open AccessComment

Commentary On: The Opioid Epidemic: Who Is Responsible and What Is the Solution?

by Warren Schubert

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 111-113; https://doi.org/10.1055/s-0038-1653952 - 15 May 2018

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Nadeau et al. highlight the extent of the opioid crises in the United States and address their protocol at the University of Minnesota School of Dentistry to reduce the number of opioid prescriptions by more than 46% over 1 year [...] Full article

7 pages, 348 KiB

Open AccessArticle

Addressing the Opioid Epidemic: Impact of Opioid Prescribing Protocol at the University of Minnesota School of Dentistry

by Robert Nadeau, Kristopher Hasstedt, Ashley Brooke Sunstrum, Chad Wagner and Harold Tu

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 104-110; https://doi.org/10.1055/s-0038-1649498 - 15 May 2018

Cited by 8 | Viewed by 47

Abstract

Prescription opioid medications continue to be abused on an epidemic level and have been shown to be a “gateway” drug to heroin abuse. Individuals experimenting with opioids commonly fall in the 10- to 19-year age range in which dentists are the highest prescribers. [...] Read more.

Prescription opioid medications continue to be abused on an epidemic level and have been shown to be a “gateway” drug to heroin abuse. Individuals experimenting with opioids commonly fall in the 10- to 19-year age range in which dentists are the highest prescribers. To reduce the number of excess opioids, the Department of Oral and Maxillofacial Surgery, University of Minnesota, developed and implemented an evidence-based opioid prescribing policy. Data were collected via electronic health record for the previous year and compared with the year following the protocol implementation. The results showed a drastic decrease (>46%) in the number of prescriptions given over a 1-year period. All departments reported a decrease in opioid prescriptions and the average number of tablets per prescription. The concern of undertreating pain was not found to be significant, as there was no increase in after-hours calls, recall appointments, or documentable emergency room visits. The results support the efficacy of an opioid prescribing policy's ability to lower the frequency and number of opioids given to patients, while still adequately treating patients’ pain. Continued evaluation and modifications of the protocol and close monitoring of prescriber habits will enhance patients’ pain control while also limiting the number of opioids available for abuse. Full article

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2 pages, 43 KiB

Open AccessCommentary

Commentary On: The Role of Postoperative Imaging After Orbital Floor Repair

by Paul N. Manson

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 102-103; https://doi.org/10.1055/s-0038-1645864 - 15 May 2018

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Abstract

This article was reviewed several times, and, as in an increasing number of articles recently processed by JCMFTR, the reviewers were widely divided in their opinions, with some for, and some against, publication [...] Full article

4 pages, 134 KiB

Open AccessShort Note

Arthroscopic Eminoplasty of Temporomandibular Joint: Surgical Technique

by Paolo Cariati, Blas Garcia Medina, Pablo Galvez, Almudena Cabello Serrano, Miguel Garcia Martin and Guillermo Valencia Moya

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 161-164; https://doi.org/10.1055/s-0038-1639349 - 7 May 2018

Cited by 6 | Viewed by 66

Abstract

Temporomandibular joint (TMJ) is one of the most used joint of the body. Moreover, it is common knowledge that TMJ may show degenerative changes 10 years earlier than other joints. Recently, the use of arthroscopic surgery is revolutionizing the classic management of TMJ [...] Read more.

Temporomandibular joint (TMJ) is one of the most used joint of the body. Moreover, it is common knowledge that TMJ may show degenerative changes 10 years earlier than other joints. Recently, the use of arthroscopic surgery is revolutionizing the classic management of TMJ pathologies. In fact, the minimal invasiveness of this procedure allows faster results and fewer complications than other procedures. In this article, we present our arthroscopic technique. In this line, we would like to emphasize that we used this approach in different temporomandibular disorders such as anchored disk syndrome, habitual dislocation of TMJ, and internal derangement. Furthermore, we wish to underline that our efforts have been rewarded with great results. Full article

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2 pages, 44 KiB

Open AccessBook Review

Aesthetic Nasal Reconstruction Principles and Practice

by Paul N. Manson

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 83-84; https://doi.org/10.1055/s-0038-1645865 - 17 Mar 2018

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Abstract

There are a few publications in Surgery which are legendary and masterworks, distillations of an entire career of a dedicated artist devoted to perfection in a limited sequence of operations in Plastic and Reconstructive Surgery [...] Full article

6 pages, 141 KiB

Open AccessArticle

The Role of Postoperative Imaging After Orbital Floor Fracture Repair

by David Carpenter, Ronnie Shammas, Adam Honeybrook, C. Scott Brown, Nikita Chapurin and Charles R. Woodard

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 96-101; https://doi.org/10.1055/s-0038-1625949 - 5 Feb 2018

Cited by 7 | Viewed by 73

Abstract

Obtaining postoperative images of maxillofacial fractures does not affect the clinical management of asymptomatic patients; however, few studies have evaluated the role of postoperative imaging in the context of orbital floor fractures. In this study, we evaluate current practice techniques and the role [...] Read more.

Obtaining postoperative images of maxillofacial fractures does not affect the clinical management of asymptomatic patients; however, few studies have evaluated the role of postoperative imaging in the context of orbital floor fractures. In this study, we evaluate current practice techniques and the role of postoperative imaging in the management of orbital floor fractures in isolation and with concomitant facial fractures. Retrospective review of patients who underwent open reduction and internal fixation of orbital floor fractures between 2005 and 2015 at a single medical institution. Operative and perioperative records were reviewed to characterize postoperative imaging as routine or as indicated by concerning clinical symptoms, and to correlate clinical outcomes to postoperative imaging patterns across all identified orbital floor fractures. A total of 139 patients underwent open reduction and internal fixation of orbital floor fractures. Of these, 75 (54%) had zygomaticomaxillary (ZMC) involvement. The remaining 64 (46%) were isolated orbital floor fractures. Overall, 54 (39%) patients underwent postoperative imaging. Of these, 38 (70%) had postoperative imaging in the absence of concerning clinical symptoms. There was no observed difference in complication rates in those who underwent postoperative imaging, and those who did not. Patients with orbital + ZMC fractures underwent a significantly higher number of postoperative imaging studies (p < 0.001); however, there was no observed difference in complications between isolated orbital and orbital + ZMC fractures. Routine postoperative imaging is not warranted in the absence of persistent clinical symptoms following open reduction and internal fixation of orbital floor fractures. Full article

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11 pages, 233 KiB

Open AccessReview

Thromboprophylaxis in Head and Neck Microvascular Reconstruction

by Manoj Abraham, Arvind Badhey, Shirley Hu, Sameep Kadakia, J. K. Rasamny, Augustine Moscatello and Yadranko Ducic

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 85-95; https://doi.org/10.1055/s-0037-1607068 - 31 Oct 2017

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Abstract

Head and neck patients undergoing microvascular reconstruction are at high risk for thromboembolism. While the prevention of thromboembolism has become an essential aspect of care, within the field of microsurgery, concern for anastomotic complications have hindered the creation of an accepted regimen. The [...] Read more.

Head and neck patients undergoing microvascular reconstruction are at high risk for thromboembolism. While the prevention of thromboembolism has become an essential aspect of care, within the field of microsurgery, concern for anastomotic complications have hindered the creation of an accepted regimen. The aim of this review was to evaluate the risks and benefits of prophylactic agents for thromboprophylaxis. A literature search was conducted in MEDLINE, Cochrane Library, and PubMed/NCBI databases. Articles discussing thromboprophylaxis in otolaryngology, head and neck surgery, or microvascular reconstruction were considered in the review from the past 30 years. The majority of patients undergoing microvascular surgery have multiple risk factors for thrombus formation. Several consensus guidelines exist for the prophylaxis in patients who are critically ill, undergoing surgery, or with malignancy. Significant evidence supports the routine use of mechanical means, such as early mobilization and pneumatic compression along with subcutaneous heparin. Low-molecular-weight heparin is also frequently utilized, although results are largely divided. Data on aspirin remain equivocal. Studies on microvascular failure and flap loss have demonstrated little to no association with chemoprophylaxis. The evidence for postoperative thromboprophylaxis regimens in patients undergoing head and neck free tissue transfer is variable. Multiple studies have supported the use of unfractionated heparin or low-molecular-weight heparin. There appears to be an expert consensus for the combined use of mechanical prophylactic methods and chemical prophylaxis. Prospective randomized trials are required to validate the most effective combination of chemoprophylaxis agents. Full article

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7 pages, 442 KiB

Open AccessCase Report

Maxillomandibular Syngnathia: 3D Planning and Review of the Literature

by Josep Rubio-Palau, Alejandra Prieto-Gundin, Leydi Mar de Abreu Graterol and Herman Vercruysse, Jr.

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 124-130; https://doi.org/10.1055/s-0037-1606248 - 25 Aug 2017

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Abstract

Congenital maxillomandibular fusion or syngnathia is a rare craniofacial disorder with only 26 cases reported in the literature. We present a case of a congenital complex zygomatico-mandibular syngnathia associated with a palatal cleft, posterior maxilla and turbinate agenesia, mild hemifacial microsomia, and a [...] Read more.

Congenital maxillomandibular fusion or syngnathia is a rare craniofacial disorder with only 26 cases reported in the literature. We present a case of a congenital complex zygomatico-mandibular syngnathia associated with a palatal cleft, posterior maxilla and turbinate agenesia, mild hemifacial microsomia, and a disordered dental eruption. The patient has the highest age (15 years) at diagnosis described in the literature. 3D planning of the surgery was performed to study the patient's anatomy and design the necessary osteotomies to separate the jaws. En bloc removal of the fused fragment with bilateral coronoidectomy and aggressive long-term physiotherapy for 3 months led to a stable increase in mouth opening from 0 to 21 mm inter-incisor distance. The patient reported an improvement in speech, was able to eat without restriction regarding food consistency, and could maintain a good oral hygiene. Full article

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4 pages, 192 KiB

Open AccessShort Note

Contralateral Islanded Facial Artery Myomucosal Flap for the Reconstruction of Floor of the Mouth Defect

by Naveen B. Shivanand, Mihir T. Mohan and Shawn T. Joseph

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 157-160; https://doi.org/10.1055/s-0037-1604071 - 21 Jul 2017

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Abstract

Reconstruction of floor of the mouth and ventral surface of the tongue defects can be challenging because inadequate correction can lead to mobility restriction of the tongue and resultant impairment of speech and swallowing. Ideal flap should be pliable, provide adequate bulk, be [...] Read more.

Reconstruction of floor of the mouth and ventral surface of the tongue defects can be challenging because inadequate correction can lead to mobility restriction of the tongue and resultant impairment of speech and swallowing. Ideal flap should be pliable, provide adequate bulk, be easy to harvest, and cosmetically acceptable. Commonly used ipsilateral facial artery–based myomucosal flaps may not be ideal if facial vessels need resection. We share our experience in a case of simultaneous primary mucoepidermoid carcinoma of right submandibular and sublingual glands, with a postsurgical defect involving floor of the mouth and ventral surface of the tongue, reconstructed with islanded facial artery myomucosal flap raised from left buccal mucosa and tunneled into the right floor of the mouth defect medial to mandible. The case is being reported to share the method of reconstruction as well as for the rare presentation of simultaneous primary mucoepidermoid carcinoma of multiple major salivary glands. Full article

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6 pages, 234 KiB

Open AccessArticle

Comparative Evaluation of the Embrasure Wire Versus Arch Bar Maxillomandibular Fixation in the Management of Mandibular Fractures: Are Arch Bars Replaceable?

by Sanjay Rastogi, Tousif Ahmed, Kolli Giri, Ramakant Dandriyal, Niranjana Prasad Indra B., Ankur Joshi, Shouvik Choudhury and Sunil Mall

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 118-123; https://doi.org/10.1055/s-0037-1603453 - 8 Jun 2017

Cited by 4 | Viewed by 53

Abstract

The aim of this prospective study was to appraise the role of embrasure wiring in the treatment of mandibular fractures over the arch bar as adjunctive techniques of maxillomandibular fixation (MMF). This study was conducted on 40 patients who were surgically treated for [...] Read more.

The aim of this prospective study was to appraise the role of embrasure wiring in the treatment of mandibular fractures over the arch bar as adjunctive techniques of maxillomandibular fixation (MMF). This study was conducted on 40 patients who were surgically treated for mandibular fractures with accessory use of MMF (embrasure: group A vs. arch bars: group B). All patients were evaluated for demographic data, etiology, and location of fracture. Characteristically, the complications, including wire injury, infection, and malocclusion, were recorded. The data were analyzed using Student's t-test and chi-square test as appropriate. Statistical significance was set at p < 0.05). In this study, data from 40 patients were included. In group A (embrasure wiring), time required for placement of MMF was significantly less than (7.85 ± 0.81 min) that in group B, and also there was less incidence of wire prick to the operator in group A than in group B (p < 0.05). However, in terms of wire prick and malocclusion, no statistically significant difference was noted in groups A and B (p > 0.05). Patient treated with embrasure wiring intermaxillary fixation had better outcomes especially in terms of time of placement and less incidence of wire prick injury when compared with arch bar. Full article

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4 pages, 164 KiB

Open AccessArticle

Comparison of the Stability of Mandibular Sagittal Osteotomy Fixation between Two Types of Titanium Miniplates: A Biomechanical Study in Sheep Mandibles

by Guilherme dos Santos Trento, Felipe Andrade Pires, Fábio André dos Santos, Delson João da Costa, Nelson Luis Barbosa Rebellato and Leandro Eduardo Klüppel

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 114-117; https://doi.org/10.1055/s-0037-1603455 - 18 May 2017

Cited by 1 | Viewed by 40

Abstract

This study aimed to compare the biomechanical stability of the fixation of mandibular sagittal split osteotomy of the ramus by two types of titanium miniplates in sheep mandibles. Seven preserved sheep mandibles with similar weight and size were selected, dissected with complete removal [...] Read more.

This study aimed to compare the biomechanical stability of the fixation of mandibular sagittal split osteotomy of the ramus by two types of titanium miniplates in sheep mandibles. Seven preserved sheep mandibles with similar weight and size were selected, dissected with complete removal of soft-tissue structures, and sectioned in their midline. After performing sagittal split osteotomy, 5 mm of advancement was standardized and samples were divided into two groups according to the type of titanium miniplate (GI = seven hemimandibles were fixed with straight titanium miniplate, GII = seven hemimandibles were fixed with L-shaped titanium miniplates), and then subjected to compressive load. The means (standard deviation) of the compressive load and extension values were 70.68 N (22.26) and 63.36 mm (15.60) to straight miniplates, and 78.80 N (32.54) and 70.55 mm (5.42) to L-shaped miniplates. After comparison and statistical analysis, the results showed no significant difference between the two types of titanium miniplates. Full article

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7 pages, 505 KiB

Open AccessCase Report

Virtual Surgical Planning for the Management of Severe Atrophic Mandible Fractures

by Jaime Castro-Núñez, Jared M. Shelton, Susan Snyder and Joseph Van Sickels

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 150-156; https://doi.org/10.1055/s-0037-1601865 - 19 Apr 2017

Cited by 28 | Viewed by 71

Abstract

Severely atrophic mandible fractures are frequently a challenge to treat. Virtual surgical planning (VSP) uses three-dimensional computed tomographic (CT) scans that can be translated into stereolithographic models to fabricate surgical templates, facilitating intraoperative procedures. The purpose of this article is to describe the [...] Read more.

Severely atrophic mandible fractures are frequently a challenge to treat. Virtual surgical planning (VSP) uses three-dimensional computed tomographic (CT) scans that can be translated into stereolithographic models to fabricate surgical templates, facilitating intraoperative procedures. The purpose of this article is to describe the reconstruction of two cases of severe atrophic mandible fracture using VSP. Two elderly edentulous/partially dentate patients who presented with fractures of their mandibles and who underwent reconstruction using VSP were included. Both had Class III atrophy at the region of the fracture. While both fractures were complex, the mechanism of injury differed with one being a tractor accident and the other being a pathologic fracture. Both patients presented with critical medical conditions. CT scans were obtained on both. The displaced segments were aligned virtually using mirror images and the midline of the maxilla. Three-dimensional models were fabricated to allow preoperative contouring of 2.5-mm reconstruction plates. Patients were operated under general anesthesia and fractures reduced and stabilized with 2.5-mm reconstruction plates placed at the lateral border of the mandible. Average treatment time for both patients was a little over 2 h. There was good reduction with both. VSP is a valuable tool to assess and reduce complex fractures with less surgical time and predictable results. Full article

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5 pages, 261 KiB

Open AccessCase Report

Delayed Management of Unrecognized Bilateral Temporomandibular Joint Dislocation: A Case Report

by Siok Yoong Chin, Nazer Bin Berahim, Khairulzaman Bin Adnan and Sundrarajan Naidu Ramasamy

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 145-149; https://doi.org/10.1055/s-0037-1601862 - 12 Apr 2017

Cited by 3 | Viewed by 79

Abstract

Temporomandibular joint (TMJ) dislocation is a common occurrence, but diagnosis can be missed if patients do not complain. Delayed presentation complicates the management of a straightforward reduction. We present a case of a 24-year-old man who had bilateral TMJ dislocation of unknown duration [...] Read more.

Temporomandibular joint (TMJ) dislocation is a common occurrence, but diagnosis can be missed if patients do not complain. Delayed presentation complicates the management of a straightforward reduction. We present a case of a 24-year-old man who had bilateral TMJ dislocation of unknown duration after motor vehicle accident. The accident left him bedridden with speech difficulty. He was totally dependent on Ryles’ and percutaneous endoscopic gastrotomy tubes for feeding. Computed tomography revealed dislocation of condyles anterior to articular eminences. The bilateral TMJ dislocations were reduced surgically via bicoronal with preauricular extension approaches. However, the surgery was challenging due to tissue changes around the joint accompanied by masticatory muscles atrophy. Postoperatively, he was placed on intermaxillary fixation for 2 weeks followed by elastics training. Three months later, the patient's mastication returned completely to function. Delayed management of bilateral TMJ dislocation is undoubtedly challenging and somewhat frustrating; nevertheless, we manage to achieve satisfactory outcome in improving the patient's quality of life. Full article

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3 pages, 104 KiB

Open AccessCase Report

Unusual Superolateral Dislocation of Mandibular Condyle

by Tabishur Rahman

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 142-144; https://doi.org/10.1055/s-0037-1601433 - 3 Apr 2017

Cited by 3 | Viewed by 42

Abstract

We describe a case of maxillofacial trauma in a pediatric patient in whom the mandibular condyle was superolaterally displaced into the temporal fossa, medial to the zygomatic arch which was intact. In addition, there was an associated mandibular symphyseal fracture. To our knowledge, [...] Read more.

We describe a case of maxillofacial trauma in a pediatric patient in whom the mandibular condyle was superolaterally displaced into the temporal fossa, medial to the zygomatic arch which was intact. In addition, there was an associated mandibular symphyseal fracture. To our knowledge, this case is the first of its kind to be reported in the literature. We also observed a complication in the form of development of ankylosis in the involved joint which required another surgery. Full article

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4 pages, 186 KiB

Open AccessCase Report

Fracture of the Clavicle Following Radical Neck Dissection and Reconstruction Using Pectoralis Major Myocutaneous Flap Accompanied by Postoperative Radiotherapy

by Yoshiki Nariai, Sho Odawara, Tomoko Ichiyama, Jun-ichi Akutsu, Takahiro Kanno and Joji Sekine

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 138-141; https://doi.org/10.1055/s-0037-1600903 - 29 Mar 2017

Cited by 3 | Viewed by 49

Abstract

Fracture of the clavicle following radical neck dissection (RND) and/or radiotherapy is a rare complication. Several causes of fracture of the clavicle after treatment of head and neck cancer were postulated in previous reports. We present a case of fracture of the clavicle [...] Read more.

Fracture of the clavicle following radical neck dissection (RND) and/or radiotherapy is a rare complication. Several causes of fracture of the clavicle after treatment of head and neck cancer were postulated in previous reports. We present a case of fracture of the clavicle after treatment of squamous cell carcinoma of the tongue. An 81-year-old Japanese woman underwent RND, subtotal glossectomy, reconstruction using a pectoralis major myocutaneous flap (PMMCF), and postoperative radiotherapy (50.4 Gy). One month after the primary treatment, fracture of the clavicle occurred. It was thought that muscular dynamic factor and reduction of blood supply in the clavicle associated with RND and PMMCF were the causes of the fracture. We have to recognize the occurrence of this complication and try to reduce the factors related to the complication. Full article

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7 pages, 302 KiB

Open AccessCase Report

A Case of an Extensive Keratocystic Odontogenic Tumor in the Mandible Reconstructed with a Custom-Made Total Joint Prosthesis

by Payam Farzad

Craniomaxillofac. Trauma Reconstr. 2018, 11(2), 131-137; https://doi.org/10.1055/s-0036-1597585 - 5 Jan 2017

Cited by 4 | Viewed by 42

Abstract

The use of virtual surgical planning and computer-aided design/computer-aided manufacturing has previously been reported to enhance the planning for the reconstruction of mandibular continuity defects and to reduce surgical time. Reported is a case of a large keratocystic odontogenic tumor (KOT) affecting right [...] Read more.

The use of virtual surgical planning and computer-aided design/computer-aided manufacturing has previously been reported to enhance the planning for the reconstruction of mandibular continuity defects and to reduce surgical time. Reported is a case of a large keratocystic odontogenic tumor (KOT) affecting right hemimandible including the condylar neck. This case was initially reconstructed with a condyle-bearing reconstruction plate, but because of fatigue fracture 15 years later, a new reconstruction with a custom-made total joint temporomandibular prosthesis was performed. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 11, Issue 2 (June 2018) – 16 articles

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