Craniomaxillofacial Trauma & Reconstruction

4 pages, 257 KiB

Open AccessShort Note

Clinical Notes on Herbert Screw Fixation for Fracture of Anterior Mandible

by Ahmed ElMinshawi, Salah Abdelfattah and Fahmy Mubarak

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 81-84; https://doi.org/10.1055/s-0038-1670673 - 28 Sep 2018

Cited by 2 | Viewed by 65

This article aims to present the outcomes of treating anterior mandibular fractures using Herbert's screw. A total of 10 patients were treated for fractures of anterior mandible by open reduction and internal fixation using the Herbert screw. The patients were collected starting from [...] Read more.

This article aims to present the outcomes of treating anterior mandibular fractures using Herbert's screw. A total of 10 patients were treated for fractures of anterior mandible by open reduction and internal fixation using the Herbert screw. The patients were collected starting from June 2016 to November 2017, at the Department of Craniomaxillofacial Surgery, Nasser Institute for Research and Treatment, Cairo, and Faculty of Dentistry, Ain Shams University, Cairo, Egypt. The follow-up plan was done to evaluate the postoperative clinical outcomes for malocclusion, neurosensory status, hardware failure, malunion/nonunion, pain, and edema. There were no intraoperative or postoperative complications, except for one case where the Herbert screw was insufficient and needed additional 2.0-mm miniplate at the superior border. The postoperative orthopantomograms revealed satisfactory reduction and fixation of the fractures of all cases. The Herbert screw fixation of anterior mandibular fracture is a reliable technique but sensitive and surgeon dependent and needs further clinical investigation. Full article

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6 pages, 165 KiB

Open AccessReview

Behavior of Buccal Mucosal Squamous Cell Carcinoma: A Retrospective Study of 53 Carcinomas of this Anatomical Region

by Paolo Cariati, Almudena Cabello Serrano, Ana Marin Fernandez, Miguel Angel Julia Martinez, Jose Fernandez Solis and Ildefonso Martinez Lara

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 8-13; https://doi.org/10.1055/s-0038-1668583 - 17 Aug 2018

Cited by 8

Abstract

The main aim of the present report is to study the pattern of distribution of cervical metastasis in buccal mucosa cancer and to discuss the various therapeutic options available. Fifty-three patients with squamous cell carcinoma of the buccal mucosa treated with tumorectomy and [...] Read more.

The main aim of the present report is to study the pattern of distribution of cervical metastasis in buccal mucosa cancer and to discuss the various therapeutic options available. Fifty-three patients with squamous cell carcinoma of the buccal mucosa treated with tumorectomy and selective neck dissection were included in the study. We also studied the relationship between specific pathological features and overall survival. Level Ib was the most affected level, followed by level IIa. T stage, N stage, N involvement tumor thickness, extracapsular spread (ECS), and vascular invasion were associated with poorer outcomes regarding overall survival (p < 0.001). Carcinoma of the buccal mucosa should be treated aggressively from the early stages. A large tumorectomy of the primary tumor is required to reduce the number of local recurrences. Moreover, we recommend performing a supraomohyoid neck dissection even in cT1N0 if there is a suspicion that the tumor thickness may be greater than 0.4 cm. The high risk of local recurrence obliges protection of the neck from a future cervical recurrence even in T1 small tumors. This could reduce the risk of cervical involvement during the follow-up and improve overall survival rates. Full article

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6 pages, 298 KiB

Open AccessCase Report

Short Runs for a Long Slide: Principalization in Complex Facial Restoration after Acid Attack Burn Injury

by Christopher D. Hughes, Robert Jaroslaw Dabek, Johanna N. Riesel, Nemanja Baletic, James Chodosh and Branko Bojovic

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 75-80; https://doi.org/10.1055/s-0038-1668511 - 3 Aug 2018

Cited by 3 | Viewed by 76

Abstract

Burn injuries are responsible for a significant portion of surgically treatable morbidity throughout the world and particularly in underdeveloped and developing countries. Intentional flame, chemical, and contact burns are unfortunately a common mechanism of injury. It is estimated that intentional chemical burns are [...] Read more.

Burn injuries are responsible for a significant portion of surgically treatable morbidity throughout the world and particularly in underdeveloped and developing countries. Intentional flame, chemical, and contact burns are unfortunately a common mechanism of injury. It is estimated that intentional chemical burns are responsible for between 2 and 20% of burn injuries seen at burn centers in lower income countries. Women are commonly targeted and the perpetrators are often known to the victims. The combination of a high disease prevalence, limited surgical and anesthetic resources, a vulnerable patient population, and largely disfiguring, nonlethal injuries present unique challenges for the reconstructive surgeon who may not encounter such cases regularly. In this article, we present a case of a 16-year-old female who sustained severe, full-thickness burns to the face including eyelids, neck, abdomen, and upper extremities after an intentional acid attack. She began her treatment course with us approximately 1 year after the injury. The deformities of her oral and periorbital regions presented particularly difficult reconstructive problems, including impending visual loss. Using plastic surgical principalization, we provided our patient adequate restoration of facial form and function through numbers of interventions using fundamental and state-of-the-art techniques. Full article

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7 pages, 202 KiB

Open AccessReview

Plastic Surgery Pioneers of the Central Powers in the Great War

by Robert Llewellyn Thomas, Anton Fries and Darryl Hodgkinson

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 1-7; https://doi.org/10.1055/s-0038-1660443 - 2 Aug 2018

Cited by 8

Abstract

Plastic surgical techniques were described in antiquity and the Middle Ages; however, the genesis of modern plastic surgery is in the early 20th century. The exigencies of trench warfare, combined with medical and technological advances at that time, enabled pioneers such as Sir [...] Read more.

Plastic surgical techniques were described in antiquity and the Middle Ages; however, the genesis of modern plastic surgery is in the early 20th century. The exigencies of trench warfare, combined with medical and technological advances at that time, enabled pioneers such as Sir Harold Gillies to establish what is now recognized as plastic and reconstructive surgery. The physicians of Germany, Russia, and the Ottoman Empire were faced with the same challenges; it is fascinating to consider parallel developments in these countries. A literature review was performed relating to the work of Esser, Lanz, Joseph, Morestin, and Filatov. Their original textbooks were reviewed. We describe the clinical, logistical, and psychological approaches to managing plastic surgical patients of these physicians and compare and contrast them to those of the Allies, identifying areas of influence such as Gillies’ adoption of Filatov's tube pedicle flap. Full article

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5 pages, 199 KiB

Open AccessCase Report

Acute Hyponasality (Closed Rhinolalia) and Craniomaxillofacial Fracture Suggest the Coexistence of Retropharyngeal Emphysema and Pneumomediastinum

by Ioannis Papadiochos, Stavros-Evangelos Sarivalasis and Nickolaos Papadogeorgakis

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 70-74; https://doi.org/10.1055/s-0038-1667017 - 26 Jul 2018

Cited by 1 | Viewed by 81

Abstract

Pneumomediastinum (PM) implies an abnormal condition where a collection of free air or gas is entrapped within the fascial planes of mediastinal cavity. It is considered as benign entity, but an uncommonly seen complication of craniofacial injuries. We report a case of a [...] Read more.

Pneumomediastinum (PM) implies an abnormal condition where a collection of free air or gas is entrapped within the fascial planes of mediastinal cavity. It is considered as benign entity, but an uncommonly seen complication of craniofacial injuries. We report a case of a 63-year-old male patient with the presenting sign of closed rhinolalia who was diagnosed with retropharyngeal emphysema and PM due to a linear and nondisplaced fracture of midface. The patient cited multiple efforts of intense nasal blowing shortly after a facial injury by virtue of a motorcycle accident. He was admitted in our clinic for closer observation and further treatment. The use of a face mask for continuous positive airway pressure was temporarily interrupted, and high concentrations of oxygen were delivered via non-rebreather mask. Patient’s course was uncomplicated and he was discharged few days later, with almost complete resolution of cervicofacial emphysema and absence of residual PM in follow-up imaging tests. Closed rhinolalia (or any acute alteration of voice) in maxillofacial trauma patients should be recognized, assessed, and considered within the algorithm for PM and retropharyngeal emphysema diagnosis and management. For every single case of cervicofacial emphysema secondary to facial injury, clinicians should maintain suspicion for retropharyngeal emphysema or PM development. Full article

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3 pages, 118 KiB

Open AccessCase Report

Nasal Septal Spur Associated with Rhinogenic Contact Point Otalgia and Tinnitus

by Aleksandar Perić

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 67-69; https://doi.org/10.1055/s-0038-1660440 - 27 Jun 2018

Cited by 1 | Viewed by 98

Abstract

Rhinogenic contact point otalgia is a new term in medicine and it represents earache as a form of facial pain that is caused by intranasal mucosal contact points between the nasal septal spur or septal deviation and lateral nasal wall. It is a [...] Read more.

Rhinogenic contact point otalgia is a new term in medicine and it represents earache as a form of facial pain that is caused by intranasal mucosal contact points between the nasal septal spur or septal deviation and lateral nasal wall. It is a referred otalgia without any signs of inflammation. The author reports an unusual case of a 19-year-old male who complained of a 5-year history of right-sided otalgia and tinnitus. On physical exam, a big, right-sided nasal septal spur was seen in contact with the right lateral nasal wall. Other findings are unremarkable. Placement of anesthetic and vasoconstrictor solution provided relief of symptoms. After the exclusion of other causes of otalgia, and after surgical removal of septal spur, the patient experienced a significant relief of symptoms. Full article

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9 pages, 227 KiB

Open AccessArticle

Facial Fractures as a Result of Falls in the Elderly: Concomitant Injuries and Management Strategies

by Farrah C. Liu, Jordan N. Halsey, Nicholas C. Oleck, Edward S. Lee and Mark S. Granick

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 45-53; https://doi.org/10.1055/s-0038-1642034 - 17 May 2018

Cited by 24 | Viewed by 123

Abstract

Mechanical falls are a common cause of facial trauma in the elderly population. It has been shown that the likelihood of sustaining a facial fracture due to a fall or activities of daily life significantly increases with age. Craniomaxillofacial fractures are most common [...] Read more.

Mechanical falls are a common cause of facial trauma in the elderly population. It has been shown that the likelihood of sustaining a facial fracture due to a fall or activities of daily life significantly increases with age. Craniomaxillofacial fractures are most common during the first three decades of life; however, elderly patients more frequently require lengthy hospital stays and surgical intervention, and have shown increased complication rates compared with younger patients. The objective of this study was to examine the prevalence of facial fractures secondary to mechanical falls in the elderly population to analyze mechanism of injury, comorbidities, and fracture management. A retrospective review of all facial fractures as a result of falls in the elderly population in a level 1 trauma center in an urban environment was performed for the years 2002 to 2012. Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies. During the time period examined, 139 patients were identified as greater than 60 years of age and having sustained a fracture of the facial skeleton as the result of a fall. The average age was 75.7 (range, 60–103) years, with no gender predominance of 50.4% female and 49.6% male. There were a total of 205 fractures recorded. The most common fractures were those of the orbit (42.0%), nasal bone (23.4%), zygoma (13.2%), and zygomaticomaxillary complex (7.32%). The average Glasgow Coma Scale on arrival was 12.8 (range, 3–15). Uncontrolled hemorrhage was noted on presentation to the trauma bay in five patients. Twenty-one patients were intubated on, or prior to, arrival to the trauma bay, and 44 required a surgical airway. The most common concomitant injury was a long bone fracture (23.5%), followed by cervical spine fracture (18.5%), skull fracture (17.3%), intracerebral hemorrhage (17.3%), rib fracture (17.3%), ophthalmologic injuries (6.2%), short bone fracture (4.9%), pelvic fracture (2.9%), thoracic spine fracture (1.2%), and lumbar spine fracture (1.2%). Of the 114 patients admitted to the hospital, 53 were admitted to an intensive care setting. The average hospital length of stay was 8.97 days (range, 0–125). Sixteen patients expired. Surgical management of fractures in the operating room was required in 47 of the 139 patients. Of the patients treated, 36.2% required an open reduction and internal fixation procedure. Facial fractures as a result of falls in the geriatric population represent an increasing number of cases in clinical practice as life expectancy steadily rises. These patients require a specific standard of treatment since they are more susceptible to nosocomial infections, as well as have higher complication rates and longer recovery time. Concomitant injuries such as cervical spine and pelvic fractures can greatly increase risk of mortality. Surgical and soft tissue management must be approached with caution to optimize function and aesthetics while preventing secondary infection. The authors hope that this study can provide some insight and further investigation as there is a dearth of literature to the management of facial fractures in falls in elderly patients. Full article

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5 pages, 298 KiB

Open AccessCase Report

Oral Epignathus with Maxilla Duplication: Report of a Rare Case

by Roberto S. Tunes, Gabriel Z. Cavalcanti, José Mauro O. Squarisi and Lucas G. Patrocinio

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 62-66; https://doi.org/10.1055/s-0038-1649497 - 1 May 2018

Cited by 4 | Viewed by 73

Abstract

Epignathus is a rare congenital oropharyngeal teratoma that arises from the oropharynx, especially the sphenoid, palatine, and ethmoid bones. Teratomas are benign tumors containing cells from ectodermal, mesodermal, and endodermal layers. The incidence of epignathus is between 1:35,000 and 1:200,000 live births with [...] Read more.

Epignathus is a rare congenital oropharyngeal teratoma that arises from the oropharynx, especially the sphenoid, palatine, and ethmoid bones. Teratomas are benign tumors containing cells from ectodermal, mesodermal, and endodermal layers. The incidence of epignathus is between 1:35,000 and 1:200,000 live births with a female predominance. We reported an uncommon case of epignathus in a female newborn baby with an ill-defined oral mass protruding through a cleft in the hard palate. Computed tomography scan showed a contrast-enhanced solid mass with areas of calcification simulating a unique case of maxilla duplication. Surgery was performed, the mass was excised successfully, and microscopic analysis confirmed the diagnosis of mature teratoma. The patient evolved with good general health and showed no clinical signs of recurrence. Although epignathus is a rare condition, it should be diagnosed in the fetus as early as possible, especially to avoid fatal airway obstruction. In such cases, the treatment option is exclusively surgical, and complete resection is curative in most cases during the early neonatal period. Full article

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6 pages, 192 KiB

Open AccessArticle

Facial Fracture Patterns Associated with Traumatic Optic Neuropathy

by Shahrooz S. Kelishadi, Matthew R. Zeiderman, Karan Chopra, Joseph A. Kelamis, Gerhard S. Mundinger and Eduardo D. Rodriguez

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 39-44; https://doi.org/10.1055/s-0038-1641172 - 30 Mar 2018

Cited by 13 | Viewed by 94

Abstract

Traumatic optic neuropathy (TON) is rare. The heterogeneity of injury patterns and patient condition on presentation makes diagnosis difficult. Fracture patterns associated with TON have never been evaluated. Retrospective review of 42 patients diagnosed with TON at the R. Adams Cowley Shock Trauma [...] Read more.

Traumatic optic neuropathy (TON) is rare. The heterogeneity of injury patterns and patient condition on presentation makes diagnosis difficult. Fracture patterns associated with TON have never been evaluated. Retrospective review of 42 patients diagnosed with TON at the R. Adams Cowley Shock Trauma Center from May 1998 to August 2010 was performed. Thirty-three patients met criteria for study inclusion of fracture patterns. Additional variables measured included patient demographics and mechanism. Cluster analysis was used to form homogenous groups of patients based on different fracture patterns. Fracture frequency was analyzed by group and study population. Visual depiction of fracture patterns was created for each group. Cluster analysis of fracture patterns yielded five common “groups” or fracture patterns among the study population. Group 1 (n = 3, 9%) revealed contralateral lateral orbital wall (100%), zygoma (67%), and nasal bone (67%) fractures. Group 2 (n = 7, 21%) demonstrated fractures of the frontal bone (86%), nasal bones (71%), and ipsilateral orbital roof (57%). Group 3 (n = 14, 43%) involved fractures of the ipsilateral zygoma (100%), lateral orbital wall (29%), as well as frontal and nasal bones (21% each). Group 4 (n = 5, 15%) consisted of mid- and upper-face fractures; 100% fractured the ipsilateral orbital floor, medial and lateral walls, maxilla, and zygoma; 80% fractured the orbital roof and bilateral zygoma. Group 5 (n = 4, 12%) was characterized by fractures of the ipsilateral orbital floor, medial and lateral orbital walls (75% each), and orbital roof (50%). A notably high 15 of 33 patients (45%) sustained penetrating trauma. Our study demonstrates five fracture pattern groups associated with TON. Zygomatic, frontal, nasal, and orbital fractures were the most common. Fractures with a combination of frontal, nasal, and orbital fractures are particularly concerning and warrant close attention to the eye. Full article

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5 pages, 380 KiB

Open AccessArticle

Refined Approach to Preservation of the Inferior Alveolar Nerve During Resection and Primary Reconstruction of the Mandible

by Sergey Tereshchuk and Vladimir Sukharev

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 34-38; https://doi.org/10.1055/s-0038-1639348 - 28 Mar 2018

Cited by 6 | Viewed by 66

Abstract

Sacrifice of the inferior alveolar nerve (IAN) during resection of the mandible is taken as a rule. In 1987, Jensen and Nock described a technique that permitted placement of dental implants in the atrophied mandibular alveolar ridge that lacked sufficient vertical height superior [...] Read more.

Sacrifice of the inferior alveolar nerve (IAN) during resection of the mandible is taken as a rule. In 1987, Jensen and Nock described a technique that permitted placement of dental implants in the atrophied mandibular alveolar ridge that lacked sufficient vertical height superior to the mandibular canal. This technique was used by some authors to preserve continuity of the IAN during resection of the mandible in patients with benign tumors. The described techniques are traumatic, time-consuming, and not precise. We propose a new refined technique of preservation of IAN with use of a guide to approach mandibular canal, cutting guides with a slot for a relocated IAN, and a new approach to positioning of the fixating screws. We assessed the effectiveness of this new technique with use of an electro-odontometer. In 21 cases, we demonstrated a refined approach to preservation of the IAN. In 7 patients (33%), the IAN was preserved on one side and in 14 patients (67%), on both sides. Sensation in the lower lip was restored in 18 patients (86%). These patients generally recovered sensation within 22 days postoperatively. This proposed technique makes preservation of IAN easier, faster, less traumatic, and more predictable. In this article, we describe criteria for the patients with cancer of oral mucosa to be admitted for this procedure. Restored sensation in the lower lip of the patients who have undergone resection of the mandible significantly improves their quality of life. Full article

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7 pages, 272 KiB

Open AccessArticle

Use of Transgingival Lag Screw Osteosynthesis in the Management of Alveolar Process Fracture

by Ashish Sharma, Sanjay Rastogi, Manish Shukla, Rupshikha Choudhury, Siddhi Tripathi and Jawed Iqbal

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 27-33; https://doi.org/10.1055/s-0038-1629906 - 15 Feb 2018

Cited by 3 | Viewed by 72

Abstract

The purpose of this study is to check the efficacy of transgingival lag screw osteosynthesis in alveolar process fractures of maxilla and mandible. A single-arm nonrandomized observational study was performed for the treatment of alveolar process fractures of maxilla and mandible. In this [...] Read more.

The purpose of this study is to check the efficacy of transgingival lag screw osteosynthesis in alveolar process fractures of maxilla and mandible. A single-arm nonrandomized observational study was performed for the treatment of alveolar process fractures of maxilla and mandible. In this study, 20 mixed age group patients with alveolar process fracture were included. All the patients were treated by a 2.0-mm transgingival screw fixation under local or general anesthesia. All the patients were evaluated for fracture stability, anatomical reduction, bone loss and bone resorption of alveolar process, tooth loss, and wound infection at 3 months of follow-up. A simple descriptive statistical analysis was done to evaluate the parameters and it was shown that the treatment of alveolar process fracture with two or three lag screws provides adequate fracture stability and anatomical reduction with no signs of bone loss and tooth loss, and wound infections were noted post lag screw fixation. The study concludes that transgingival lag screw fixation is a suitable alternative for alveolar process fractures in all the age groups and two to three lag screws are generally sufficient to fix fractured alveolar process either under local anesthesia or general anesthesia. Full article

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8 pages, 445 KiB

Open AccessCase Report

Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

by Ioannis Papadiochos, Vasilis Petsinis, Jason Tasoulas and Lampros Goutzanis

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 54-61; https://doi.org/10.1055/s-0038-1625965 - 13 Feb 2018

Cited by 4 | Viewed by 93

Abstract

Orbital trapdoor fractures (OTFs) entail entrapment of intraorbital soft tissues with minimal or no displacement of the affected bones and are almost exclusively seen in children. This article aimed to report the diagnosis and treatment of an OTF of the floor in an [...] Read more.

Orbital trapdoor fractures (OTFs) entail entrapment of intraorbital soft tissues with minimal or no displacement of the affected bones and are almost exclusively seen in children. This article aimed to report the diagnosis and treatment of an OTF of the floor in an adult patient and to critically review the literature regarding the management aspects of this specific subset of orbital blowout fractures in adults. A 29-year-old man presented with limitations of vertical right eye movements owing to blunt orbital trauma. The patient mainly complained of double vision in upper gazes and some episodes of nausea. Neither floor defect nor significant bone displacement found on orbital computed tomography, while edema of inferior rectus muscle was apparent. The patient underwent surgical repair 5 days later; a linear minimally displaced fracture of the floor was recognized and complete release of the entrapped perimuscular tissues was followed. Within the first week postoperatively, full range of ocular motility was restored, without residual diplopia. This case was the only identified pure OTF over a 6-year period in our department (0.6% of 159 orbital fractures in patients > 18 years). By reviewing the literature indexed in PubMed, a very limited number of either of isolated case reports or retrospective case series of pure OTFs has been reported in adults. Contrary to the typical white-eyed blowout fractures, the literature indicates that OTFs in adults seem to not always constitute absolute emergency conditions. Although such fractures need to be emergently/ immediately treated in children, in the absence of true muscle incarceration, adults may undergo successful treatment within a wider but either early or urgent frame of time. Adults frequently exhibit vagal manifestations and marked signs of local soft tissues injury. Full article

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7 pages, 254 KiB

Open AccessArticle

Conservative Versus Surgical Therapy in Managing Patients with Facial Nerve Palsy Due to the Temporal Bone Fracture

by Ali Abbaszadeh-Kasbi, Ali Kouhi, Mohammad Taghi Khorsandi Ashtiani, Mahtab Rabbani Anari, Alireza Karimi Yazdi and Hamed Emami

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 20-26; https://doi.org/10.1055/s-0038-1625966 - 30 Jan 2018

Cited by 9 | Viewed by 89

Abstract

Facial nerve paralysis is classified into immediate or delayed-onset palsy, and affected patients should be treated through conservative or surgical therapy. Appropriate treatment is somewhat debated as well as proper time for performing surgery. This study aimed to assess treatment outcome between conservatively [...] Read more.

Facial nerve paralysis is classified into immediate or delayed-onset palsy, and affected patients should be treated through conservative or surgical therapy. Appropriate treatment is somewhat debated as well as proper time for performing surgery. This study aimed to assess treatment outcome between conservatively and surgically treated groups and to determine the appropriate time of surgery in selected patients for surgery. Twenty-four patients from April 2008 to July 2015 were included. Performing decompression surgery within the first 2 months following the trauma accompanies a better prognosis (p-value < 0.05). Eleven patients were managed conservatively, and 4 of them demonstrated immediate onset and 7 indicated delayed onset. Nine patients obtained normal nerve function, one patient had partial palsy, and one of them had complete palsy. There was no significant difference in the rate of recovery between types of the treatment (p-value > 0.05). Decompression surgery is recommended in the first 2 months after the trauma for immediate onset and also complete degeneration on electroneuronography. Full article

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6 pages, 212 KiB

Open AccessArticle

Midface Fracture Simulation and Repair: A Computer-Based Algorithm

by Virginia E. Drake, Christopher J. Rizzi, Jewel D. Greywoode, Kavita T. Vakharia and Kalpesh T. Vakharia

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 14-19; https://doi.org/10.1055/s-0037-1608696 - 29 Nov 2017

Cited by 2

Abstract

We introduce a novel computer-based method to digitally fixate midfacial fractures to facilitate more efficient intraoperative fixation. This article aims to describe a novel computer-based algorithm that can be utilized to model midface fracture reduction and fixation and to evaluate the algorithm's ability [...] Read more.

We introduce a novel computer-based method to digitally fixate midfacial fractures to facilitate more efficient intraoperative fixation. This article aims to describe a novel computer-based algorithm that can be utilized to model midface fracture reduction and fixation and to evaluate the algorithm's ability to produce images similar to true postoperative images. This is a retrospective review combined with cross-sectional survey from 1 January 2010, to 31 December 2015. This study was performed at a single tertiary care, level-I trauma center. Ten patients presenting with acute midfacial traumatic fractures were evaluated. Thirty-five physicians were surveyed regarding the accuracy of the images obtained using the algorithm. A computer algorithm utilizing AquariusNet (TeraRecon, Inc., Foster City, CA) and Adobe Photoshop (Adobe Systems Inc., San Jose, CA) was developed to model midface fracture repair. Preoperative three-dimensional computed tomographic (CT) images were processed using the algorithm. Fractures were virtually reduced and fixated to generate a virtual postoperative image. A survey comparing the virtual postoperative and the actual postoperative images was produced. A Likert-type scale rating system of 0 to 10 (0 being completely different and 10 being identical) was utilized. Survey participants evaluated the similarity of fracture reduction and fixation plate appearance. The algorithm's capacity for future clinical utility was also assessed. Survey response results from 35 physicians were collected and analyzed to determine the accuracy of the algorithm. Ten patients were evaluated. Fracture types included zygomaticomaxillary complex, LeFort, and naso-orbito-ethmoidal complex. Thirty-four images were assessed by a group of 35 physicians from the fields of otolaryngology, oral and maxillofacial surgery, and radiology. Mean response for fracture reduction similarity was 7.8 ± 2.5 and fixation plate similarity was 8.3 ± 1.9. All respondents reported interest in the tool for clinical use. This computer-based algorithm is able to produce virtual images that resemble actual postoperative images. It has the ability to model midface fracture repair and hardware placement. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 12, Issue 1 (March 2019) – 14 articles

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