Craniomaxillofacial Trauma & Reconstruction

4 pages, 248 KiB

Open AccessCase Report

Robot-Assisted Surgery Avoids Mandibulotomy in a Case of Adenoid Cystic Carcinoma of Base of the Tongue

by Sivakumar Vidhyadharan, Krishnakumar Thankappan, Narayana Subramaniam, Janarthanan Ramu, Arya Ajith, Deepak Balasubramanian and Subramania Iyer

Craniomaxillofac. Trauma Reconstr. 2019, 12(2), 163-166; https://doi.org/10.1055/s-0039-1683410 - 5 Mar 2019

Cited by 3 | Viewed by 51

Abstract

Surgical management is increasingly preferred in human papilloma–related oropharyngeal squamous cell carcinoma. Robotic surgery has a different role to play in oropharyngeal salivary origin tumors, where surgery is the primary essential modality. This modality may be used for better access to the oropharynx, [...] Read more.

Surgical management is increasingly preferred in human papilloma–related oropharyngeal squamous cell carcinoma. Robotic surgery has a different role to play in oropharyngeal salivary origin tumors, where surgery is the primary essential modality. This modality may be used for better access to the oropharynx, avoiding a lip split approach with mandibulotomy. The organ preservation approach such as in oropharyngeal squamous cell carcinoma, with nonsurgical modalities like chemoradiotherapy, is not preferred in such cancers, as in the present case. In this context, robot-assisted surgery helps in reducing the morbidity by avoiding the mandibulotomy. Full article

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13 pages, 1319 KiB

Open AccessReview

Anatomical Revelations in 1921 Kindled Operative Repair of the Orbit, Eyelids, and Periorbit over the Ensuing 100 Years: The Diuturnity of Ernest Whitnall (1876–1950) of Oxford, Montreal, and Bristol

by Richard A. Pollock and M. Douglas Gossman

Craniomaxillofac. Trauma Reconstr. 2019, 12(2), 95-107; https://doi.org/10.1055/s-0039-1677696 - 1 Mar 2019

Cited by 1 | Viewed by 58

Abstract

Revelations of orbital, intraorbital, and periorbital anatomy by a single author in 1921 kindled attempts at operative repair of the orbit, eyelids, and periorbit over the ensuing 100 years. They are the lasting contributions—the diuturnity—of Samuel Ernest Whitnall (1876–1950) of Oxford, Montreal, and [...] Read more.

Revelations of orbital, intraorbital, and periorbital anatomy by a single author in 1921 kindled attempts at operative repair of the orbit, eyelids, and periorbit over the ensuing 100 years. They are the lasting contributions—the diuturnity—of Samuel Ernest Whitnall (1876–1950) of Oxford, Montreal, and Bristol. Full article

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7 pages, 512 KiB

Open AccessCase Report

Virtual Surgical Planning and Hardware Fabrication Prior to Open Reduction and Internal Fixation of Atrophic Edentulous Mandible Fractures

by Karl Daniel Maloney and Torin Rutner

Craniomaxillofac. Trauma Reconstr. 2019, 12(2), 156-162; https://doi.org/10.1055/s-0039-1677723 - 8 Feb 2019

Cited by 18 | Viewed by 75

Abstract

Mandibular fractures are a common injury encountered by facial trauma surgeons. A majority of these cases are in dentate patients and can predictably be treated with several different open or closed techniques. Edentulous mandible fractures can be challenging as maxillomandibular fixation, either as [...] Read more.

Mandibular fractures are a common injury encountered by facial trauma surgeons. A majority of these cases are in dentate patients and can predictably be treated with several different open or closed techniques. Edentulous mandible fractures can be challenging as maxillomandibular fixation, either as the sole treatment or used for fracture reduction and stabilization prior to internal fixation, is not possible. The atrophic edentulous mandible fracture poses an even greater challenge, as there is more sclerotic bone present and less bone volume for bony contact, both of which can impair healing. In addition, with less bone mass, available plate adaptation and fixation are difficult. In recent years, virtual surgical planning (VSP) has been increasingly used in craniofacial and maxillofacial surgeries as well as in dentistry. Utilizing VSP to fabricate the necessary hardware prior to open reduction and internal fixation of atrophic edentulous mandible fractures can be helpful in treating these cases. Two cases where this method was used are presented. Full article

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10 pages, 330 KiB

Open AccessReview

Frontal Sinus Fractures: Evolving Clinical Considerations and Surgical Approaches

by Mark A. Arnold and Sherard A. Tatum III

Craniomaxillofac. Trauma Reconstr. 2019, 12(2), 85-94; https://doi.org/10.1055/s-0039-1678660 - 4 Feb 2019

Cited by 21 | Viewed by 67

Abstract

Frontal sinus fractures are an uncommon injury of the maxillofacial skeleton, and account for 5–15% of all maxillofacial fractures. As the force of impact increases, fractures may extend beyond the anterior table to involve adjacent skull, posterior table and frontal sinus outflow tract [...] Read more.

Frontal sinus fractures are an uncommon injury of the maxillofacial skeleton, and account for 5–15% of all maxillofacial fractures. As the force of impact increases, fractures may extend beyond the anterior table to involve adjacent skull, posterior table and frontal sinus outflow tract (FSOT). Fractures at these subsites should be evaluated independently to assess the need for and type of operative intervention. Historically, these fractures were managed aggressively with open techniques resulting in obliteration or cranialization. With significant injuries, these approaches are still indispensable. However, the treatment of frontal sinus fractures has changed dramatically over the past half-century, and recent case series have demonstrated favorable outcomes with conservative management. Concurrently, there has been an increasing role of minimally invasive endoscopic techniques, both for primary and expectant management, with a focus on sinus preservation. Here, we review the diagnosis and management of frontal sinus fractures, with an emphasis on subsite evaluation. Following a detailed assessment, an appropriate treatment strategy is selected from a variety of open and minimally invasive approaches available in the surgeon’s armamentarium. Full article

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6 pages, 334 KiB

Open AccessCase Report

Autologous Reconstruction of a Face Transplant Candidate

by William J. Rifkin, Justin L. Bellamy, Rami S. Kantar, Scott J. Farber, J. Rodrigo Diaz-Siso, Lawrence E. Brecht and Eduardo D. Rodriguez

Craniomaxillofac. Trauma Reconstr. 2019, 12(2), 150-155; https://doi.org/10.1055/s-0038-1675844 - 21 Dec 2018

Cited by 4 | Viewed by 61

Abstract

Since 2005, facial transplantation has emerged as a viable reconstructive option for the most severe defects not amenable to conventional reconstructive techniques, with promising aesthetic and functional outcomes to date. Key facial subunits and midface structures such as the eyelids, lips, and nose [...] Read more.

Since 2005, facial transplantation has emerged as a viable reconstructive option for the most severe defects not amenable to conventional reconstructive techniques, with promising aesthetic and functional outcomes to date. Key facial subunits and midface structures such as the eyelids, lips, and nose are now able to be successfully replaced rather than reconstructed, enabling adequate functional outcomes in even the most extensive defects. However, even in cases of severe facial disfigurement, the decision to proceed with transplantation versus autologous reconstruction remains a source of debate, with no current consensus regarding precise indications and inclusion/exclusion criteria. This report details the case of a candidate referred for face transplantation who ultimately underwent autologous facial reconstruction. Through this representative case, our objective is to clarify the criteria that make a patient a suitable face transplant candidate, as well as to demonstrate the outcomes achievable with a conventional autologous reconstruction, using a methodically planned, multistaged approach. Full article

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4 pages, 308 KiB

Open AccessCase Report

Beta-Catenin Mutation with Complex Chromosomal Changes in Desmoid Tumor of the Scalp: A Case Report

by Gary Liu, Howard L. Weiner, William C. Pederson, Lesley Davies and Edward P. Buchanan

Craniomaxillofac. Trauma Reconstr. 2019, 12(2), 146-149; https://doi.org/10.1055/s-0038-1676078 - 16 Nov 2018

Viewed by 33

Abstract

Gain-of-function mutations in the beta-catenin gene (CTNNB1) drive genomic instability within different cancers. However, it is unclear whether alterations in beta-catenin signaling can still lead to chromosomal rearrangements in neoplasms without metastatic potential. Here, we report a unique case, whereby a [...] Read more.

Gain-of-function mutations in the beta-catenin gene (CTNNB1) drive genomic instability within different cancers. However, it is unclear whether alterations in beta-catenin signaling can still lead to chromosomal rearrangements in neoplasms without metastatic potential. Here, we report a unique case, whereby a desmoid tumor of the scalp contains a missense mutation in CTNNB1. This mutation is located at the T41 phosphorylation site—previously reported to be necessary for proper beta-catenin degradation. Online database analysis then revealed that our mutation is likely causative of many different cancers and also absent in the healthy public. Karyotyping of the desmoid tumor cells then showed complex chromosomal changes in 16 out of 20 cells examined. To treat this patient, we surgically removed both the neoplasm and underlying calvarium and then successfully reconstructed the skull and scalp. Taken together, our data suggest that increased beta-catenin signaling can lead to genomic instability in the absence of metastatic potential. Full article

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5 pages, 356 KiB

Open AccessCase Report

Extranasopharyngeal Angiofibroma Arising from the Anterior Nasal Septum in a 35-Year-Old Woman

by Tarik Kujundžić, Aleksandar Perić and Biserka Vukomanović Đurđević

Craniomaxillofac. Trauma Reconstr. 2019, 12(2), 141-145; https://doi.org/10.1055/s-0038-1675809 - 12 Nov 2018

Cited by 6 | Viewed by 46

Abstract

Angiofibroma is a relatively rare vascular lesion originating predominantly in the nasopharynx and occurs typically in male adolescents. Extranasopharyngeal sites of origin, such as nasal cavity, paranasal sinuses, pharynx, and larynx, are extremely rarely seen in clinical practice. In the nasal cavity, extranasopharyngeal [...] Read more.

Angiofibroma is a relatively rare vascular lesion originating predominantly in the nasopharynx and occurs typically in male adolescents. Extranasopharyngeal sites of origin, such as nasal cavity, paranasal sinuses, pharynx, and larynx, are extremely rarely seen in clinical practice. In the nasal cavity, extranasopharyngeal angiofibromas (ENAs) have been reported to originate from the nasal septum, as well as from the middle and inferior turbinate. In this study, we report a case of a 35-year-old female patient with angiofibroma originating from the anterior part of the nasal septum with left-sided nasal obstruction and mild-to-moderate epistaxis as main complaints. After the radiological diagnostics and embolization of sphenopalatine artery, we performed the excision of the lesion with removal of small part of septal mucosa and perichondrium around the attachment of tumor pedicle. Histopathological examination suggested the presence of angiofibroma and diagnosis was confirmed by immunohistochemical analysis. This is the fifth reported case of septal ENA in female population in the English-language literature. Full article

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7 pages, 246 KiB

Open AccessArticle

Craniomaxillofacial Trauma Experience in Otolaryngology Residency: A National Survey of Program Directors

by Melissa S. Oh, Anita B. Sethna and Oswaldo A. Henriquez

Craniomaxillofac. Trauma Reconstr. 2019, 12(2), 134-140; https://doi.org/10.1055/s-0038-1660442 - 22 Jun 2018

Cited by 1 | Viewed by 31

Abstract

This article aimed to assess the depth and volume of craniomaxillofacial (CMF) trauma exposure and education in otolaryngology residency training in the United States. This is a cross-sectional survey. A 15-question web-based survey was distributed to program directors of 106 Accreditation Council for [...] Read more.

This article aimed to assess the depth and volume of craniomaxillofacial (CMF) trauma exposure and education in otolaryngology residency training in the United States. This is a cross-sectional survey. A 15-question web-based survey was distributed to program directors of 106 Accreditation Council for Graduate Medical Education (ACGME)-approved otolaryngology residency programs to inquire about program size and demographics, trauma coverage, case volume, and education. Responses were collected anonymously. A total of 77 responses were received, representing 73% of residency programs. Seventy-five programs (97%) reported that their residents rotated at a level 1 trauma center, and 72 (94%) covered CMF trauma. Sixty-one programs (79%) included pediatric CMF trauma. The majority of programs (76%) allocated less than 10% of residency-dedicated didactic lecture time to CMF trauma. Residents in all programs typically logged at least 11 to 20 cases before graduation with 24% of programs averaging more than 50 cases per resident. Ninety percent of respondents described the training as “somewhat” to “very adequate.” CMF coverage by the otolaryngology department, number of cases, and dedicated didactic lecture time to CMF trauma were significant factors on the perception of adequate training. The majority of program directors felt that the training in CMF trauma was adequate. Reasons for this may include that most residents rotate at level 1 trauma centers, have exposure to pediatric trauma, encounter an adequate volume of cases, and have dedicated didactic time to CMF education. Full article

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6 pages, 135 KiB

Open AccessArticle

The Hybrid Arch Bar is a Cost-Beneficial Alternative in the Open Treatment of Mandibular Fractures

by Renata Khelemsky, David Powers, Seth Greenberg, Visakha Suresh, Ellen Johnson Silver and Michael Turner

Craniomaxillofac. Trauma Reconstr. 2019, 12(2), 128-133; https://doi.org/10.1055/s-0038-1639351 - 12 Apr 2018

Cited by 8 | Viewed by 73

Abstract

Obtaining maxillomandibular fixation (MMF) to achieve fracture reduction and functional occlusion is essential in the management of maxillofacial trauma. The aims of this retrospective review were to compare the total time spent in the operating room (OR) when using the Erich arch bar [...] Read more.

Obtaining maxillomandibular fixation (MMF) to achieve fracture reduction and functional occlusion is essential in the management of maxillofacial trauma. The aims of this retrospective review were to compare the total time spent in the operating room (OR) when using the Erich arch bar (EAB) versus the bone anchored hybrid arch bar (HAB) as well as performing a cost–benefit analysis (CBA). The study sample comprised patients older than 18 years who underwent open reduction internal fixation of mandible fractures at two separate institutions over a 5-year period. The primary outcome variable was total surgical time in minutes, defined as the time from incision to the completion of closure. Average operative time was significantly longer for the EAB than for the HAB (186.74 ± 70.73 vs. 135.98 ± 2.69 min, p < 0.001). A significant amount of time was saved by using the HAB for unilateral (37.17 ± 13.19 min; p = 0.007) and bilateral fractures (55.83 ± 18.89 min; p = 0.005). In-depth CBA showed that, for average OR fees of $60 per minute, the HAB produced savings of at least 4.01 and 11.63% of the total cost of surgery for unilateral and bilateral fractures. These results support the hypothesis that the HAB is a time-saving maneuver in the open treatment of mandible fractures. The HAB saves more time in bilateral fracture cases despite the longer overall operative times. This study shows the differential time-saving effect of the HAB regardless of fracture laterality as well as its cost minimization benefit compared with the EAB. Full article

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6 pages, 175 KiB

Open AccessArticle

Comparative Evaluation Between Single Noncompression Miniplate and Two Noncompression Miniplates in the Treatment of Mandibular Angle Fractures

by Shubhamoy Mondal, Gaurav Singh, Madan Mishra, Amit Gaur and Abhinav Srivastava

Craniomaxillofac. Trauma Reconstr. 2019, 12(2), 122-127; https://doi.org/10.1055/s-0038-1629907 - 12 Apr 2018

Cited by 10 | Viewed by 44

Abstract

This study was conducted to compare the outcome of single noncompression miniplate versus two noncompression miniplates in the treatment of mandibular angle fracture. A total of 40 patients were divided into two groups: Group I (n = 20), patients were treated by [...] Read more.

This study was conducted to compare the outcome of single noncompression miniplate versus two noncompression miniplates in the treatment of mandibular angle fracture. A total of 40 patients were divided into two groups: Group I (n = 20), patients were treated by single miniplate at superior border of mandible by intraoral approach; Group II (n = 20), patients were treated by one miniplate at superior border of mandible, intraorally, and another at the lateral aspect of angle, transbuccally by trocar and cannula. Comparative evaluation was done at 1, 2, 4, 6, and 12 weeks and 6 months. The findings of this study suggest that there was no significant difference in postoperative complications (malocclusion, pain, swelling, infection, facial nerve injury, wound dehiscence, plate exposure) and bite force between the two groups. Full article

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10 pages, 151 KiB

Open AccessArticle

Isolated Orbital Floor Fracture Management: A Survey and Comparison of American Oculofacial and Facial Plastic Surgeon Preferences

by Liza M. Cohen, David A. Shaye and Michael K. Yoon

Craniomaxillofac. Trauma Reconstr. 2019, 12(2), 112-121; https://doi.org/10.1055/s-0038-1639350 - 9 Apr 2018

Cited by 13 | Viewed by 71

Abstract

This article aimed to characterize, compare, and contrast the management of isolated orbital floor fractures among oculofacial and facial plastic surgeons in the United States. An anonymous 17-question multiple-choice web-based survey was distributed to all 590 members of the American Society of Ophthalmic [...] Read more.

This article aimed to characterize, compare, and contrast the management of isolated orbital floor fractures among oculofacial and facial plastic surgeons in the United States. An anonymous 17-question multiple-choice web-based survey was distributed to all 590 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and all 1300 members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) using each society’s email database from November 2016 to January 2017. Two-hundred twenty-five oculofacial and 135 facial plastic surgeons completed the survey. The most important indications for surgery among both oculofacial and facial plastic surgeons were motility restriction, enophthalmos, and diplopia at 2 weeks. The most common preferred time to surgical intervention was 8 to 14 days; however, facial plastic surgeons were more likely to operate after 4 to 7 days (p < 0.001). The most common choices of orbital implant material were porous polyethylene and porous polyethylene plus titanium for both oculofacial and facial plastic surgeons, nylon for oculofacial surgeons, and titanium for facial plastic surgeons. The majority rarely/never used intraoperative computed tomography imaging or navigation. Facial plastic surgeons were more likely to perform postoperative imaging (p < 0.001). We report results of the first survey of isolated orbital floor fracture management among oculofacial and facial plastic surgeons in the United States. This survey characterizes practice patterns and areas of similarities/differences among oculofacial and facial plastic surgeons in the management of isolated orbital floor fractures, which may help define the current standard of care. Full article

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4 pages, 221 KiB

Open AccessArticle

The Relation of the Extracranial Spinal Accessory Nerve to the Sternocleidomastoid Muscle and the Internal Jugular Vein

by Thomas Mombo Amuti, Fawzia Butt, Beda Olabu Otieno and Julius Alexander Ogeng'o

Craniomaxillofac. Trauma Reconstr. 2019, 12(2), 108-111; https://doi.org/10.1055/s-0038-1641171 - 4 Apr 2018

Cited by 6 | Viewed by 63

Abstract

The spinal accessory nerve (SAN) exhibits variant anatomy in its relation to the internal jugular vein (IJV) as well as the sternocleidomastoid muscle (SCM). These variations are important in locating the nerve during surgical neck procedures to avoid its inadvertent injury. These variations, [...] Read more.

The spinal accessory nerve (SAN) exhibits variant anatomy in its relation to the internal jugular vein (IJV) as well as the sternocleidomastoid muscle (SCM). These variations are important in locating the nerve during surgical neck procedures to avoid its inadvertent injury. These variations, however, are not conserved among different populations and data from the Kenyan setting are partly elucidated. This study, therefore, aims to determine the variant anatomical relationship of the SAN to the SCM and IJV in a select Kenyan population. Forty cadaveric necks were studied bilaterally during routine dissection and the data collected were analyzed using SPSS version 21. Means and modes were calculated for the point of entry of the SAN into the posterior triangle of the neck as well as for its relation to the SCM. Side variations for both of these were analyzed using Student’s t-test. Data relating the SAN to the IJV were represented in percentages and side variations were analyzed using the chi-square test. The SAN point of entry into the posterior triangle of the neck was 5.38 cm (3.501–8.008 cm) on the left side and 5.637 cm (3.504–9.173 cm) on the right side (p = 0.785) from the mastoid process. The nerve perforated the SCM in four cases (10%) on the left side and in eight cases (20%) on the right (p = 0.253). The SAN lay predominantly medial to the IJV on both sides of the neck, 87.5% on the left side of the neck versus 82.5% on the right (p = 0.831). In conclusion, the variant relation of the SAN to the IJV and SCM as observed in this setting is an important consideration during radical neck procedures and node biopsies. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 12, Issue 2 (June 2019) – 12 articles

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