Craniomaxillofacial Trauma & Reconstruction

4 pages, 187 KiB

Open AccessArticle

A Surgical Approach to Treat Painful Neuromas of the Supraorbital and Supratrochlear Nerves with Implantation of the Proximal Stump into the Orbit

by Philip Hanwright, Robin Yang, Karan Chopra, Amir Dorafshar, A. Lee Dellon and Eric Williams

Craniomaxillofac. Trauma Reconstr. 2019, 12(4), 305-308; https://doi.org/10.1055/s-0039-1688697 - 22 May 2019

Cited by 1 | Viewed by 39

Abstract

Frontal neuralgia causally related to trauma to the supraorbital and supratrochlear nerves remains a difficult problem to resolve. A peripheral nerve approach to this problem would involve neuroma resection and relocation of the proximal nerve stump to a location away from the vulnerable [...] Read more.

Frontal neuralgia causally related to trauma to the supraorbital and supratrochlear nerves remains a difficult problem to resolve. A peripheral nerve approach to this problem would involve neuroma resection and relocation of the proximal nerve stump to a location away from the vulnerable supraorbital ridge. A retrospective chart review was done to identify patients with frontal pain related to supraorbital trauma who underwent operative interventions to solve this problem by neuroma resection and relocation of the proximal stumps into the orbit. Eight patients were identified for inclusion in this study. At a mean of 16 months after surgery, there was a significant change in the visual analog score from a mean of 9.4 to 2.8 (p < 0.05), with 88% of the patients reporting a >50% reduction in pain postoperatively. There was one treatment failure. There were no postoperative complications. The strategy of relocating the proximal end of the supraorbital and supratrochlear nerves into the posterior orbit after resecting the painful neuromas can successfully manage posttraumatic craniofacial pain related to these injured nerves. Full article

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4 pages, 214 KiB

Open AccessArticle

Management of Life-Threatening Hemorrhage from Maxillofacial Firearm Injuries Using Foley Catheter Balloon Tamponade

by Anson Jose, Saurabh Arya, Shakil Ahmed Nagori and Himanshu Thukral

Craniomaxillofac. Trauma Reconstr. 2019, 12(4), 301-304; https://doi.org/10.1055/s-0039-1685461 - 16 Apr 2019

Cited by 7 | Viewed by 52

Abstract

The aim of this study is to evaluate the efficacy of Foley catheter in the management of hemorrhage from penetrating maxillofacial injuries in austere environment. This retrospective cohort study evaluated all penetrating head and neck trauma caused by firearm injuries reported to a [...] Read more.

The aim of this study is to evaluate the efficacy of Foley catheter in the management of hemorrhage from penetrating maxillofacial injuries in austere environment. This retrospective cohort study evaluated all penetrating head and neck trauma caused by firearm injuries reported to a military hospital at a forward aid location during 2015–2017. Foley catheter was used in the emergency management of bleeding in 11 cases. The effectiveness of this technique in controlling hemorrhage, its indication, contraindications, and complications has been explained. Out of 26 penetrating injuries received during the time period, 11 patients underwent Foley catheter balloon tamponade for the control of hemorrhage. Ten out of 11 patients responded adequately to balloon tamponade. One patient with a bullet lodged inside the neck underwent immediate surgical exploration for its removal and repair of internal jugular vein. No neurological deficits or complications were noted in any of the patients. Foley catheter balloon tamponade is very effective in managing hemorrhage from head and neck penetrating injuries. It significantly reduces the mortality by controlling bleeding from the major vessels especially in a combat environment. Full article

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10 pages, 396 KiB

Open AccessArticle

Impacted Mandibular Third Molars and Their Influence on Mandibular Angle and Condyle Fractures

by Anhad Mehra, Venkatesh Anehosur and Niranjan Kumar

Craniomaxillofac. Trauma Reconstr. 2019, 12(4), 291-300; https://doi.org/10.1055/s-0039-1685459 - 2 Apr 2019

Cited by 9 | Viewed by 60

Abstract

The aim of this study is to retrospectively analyze the effect unerupted or partially erupted third molars have on the angle and condyle fracture patterns of the mandible. It also focuses on evaluating the type of impaction that causes angle fracture and the [...] Read more.

The aim of this study is to retrospectively analyze the effect unerupted or partially erupted third molars have on the angle and condyle fracture patterns of the mandible. It also focuses on evaluating the type of impaction that causes angle fracture and the level at which the condyle most commonly fractures. The study involves all the patients who had undergone treatment for condylar and angle of the mandible fractures from 2010 to 2017 in our craniofacial center. The case records and orthopantomograms of each patient were taken into consideration and a correlation was established based on gender, age, etiology, presence of third molars, position of third molars, angulation, and root development of third molars. Of the 150 angle fracture patients, 146 had third molars and 4 did not, whereas of the 130 condyle fractures, third molar was present in 54 patients and absent in 76. The prevalence of angle fractures was statistically significant when a third molar was present, whereas the prevalence of condyle fractures was higher when third molar was absent. The results of age, etiology, angulation, position, and root development of third molars were also statistically significant. However, sex of the patient did not influence the fracture pattern. The presence of an impacted third molar or a completely erupted one has a definite influence on the fracture pattern of the mandible. The occurrence of angle and condyle fractures was mostly affected by the continuity of the cortical bone at the angle of the mandible. Hence, prophylactic removal of mandibular third molars does increase the risk of condyle fractures. Full article

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7 pages, 167 KiB

Open AccessArticle

The Role of Helmet Fastening in Motorcycle Road Traffic Accidents

by Md. Zeeshan Arif, B. R. Rajanikanth and Kavitha Prasad

Craniomaxillofac. Trauma Reconstr. 2019, 12(4), 284-290; https://doi.org/10.1055/s-0039-1685458 - 29 Mar 2019

Cited by 17 | Viewed by 60

Abstract

Road traffic accidents are the leading cause of death among the Indian population. Motorcycle accidents are the most prominent type of injuries among road traffic accidents in India. In this prospective cross-sectional study, all the patients attending three centers in north Bangalore, with [...] Read more.

Road traffic accidents are the leading cause of death among the Indian population. Motorcycle accidents are the most prominent type of injuries among road traffic accidents in India. In this prospective cross-sectional study, all the patients attending three centers in north Bangalore, with facial injuries occurring from a motorcycle accident, were included. The subjects were analyzed for the type of collision, helmet use, type of helmet use, and fastening status of the helmets. A total of 311 motorcyclists were included in this study for a period of 18 months (December 2015 to June 2017). There were 79.7% males and 20.3% females. The most prominent age group was 21 to 30 years. The percentage of riders sustaining facial injuries was significantly more in the non-helmeted group. The most common injuries in open face helmets were in the middle and lower third of the face, whereas in closed face helmets it was in the middle third of the face. The numbers of injuries were significantly higher in the nonfastened helmet group as compared with fastened helmet group. Helmet fixation is an important characteristic along with helmet type for the better effectiveness and safety of the helmets for the motorcyclists. Full article

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10 pages, 740 KiB

Open AccessArticle

Salvage Secondary Reconstruction of the Mandible with Vascularized Fibula Flap

by Dinesh Kadam

Craniomaxillofac. Trauma Reconstr. 2019, 12(4), 274-283; https://doi.org/10.1055/s-0039-1685460 - 29 Mar 2019

Cited by 10 | Viewed by 63

Abstract

Primary restoration of the mandibular continuity remains the standard of care for defects, and yet several constraints preclude this objective. Interim reconstructions with plate and nonvascular bone grafts have high failure rates. The secondary reconstruction, when becomes inevitable, remains a formidable task. This [...] Read more.

Primary restoration of the mandibular continuity remains the standard of care for defects, and yet several constraints preclude this objective. Interim reconstructions with plate and nonvascular bone grafts have high failure rates. The secondary reconstruction, when becomes inevitable, remains a formidable task. This retrospective study evaluates various issues to address secondary reconstruction. Twenty-one patients following mandibulectomy presented with various complications between 2012 and 2016 were included in the study. The profile of primary reconstruction includes reconstruction plate (n = 9), reconstruction plate with rib graft (n = 3), soft tissue only reconstruction (n = 4), free fibula (n = 2), inadequate growth of reconstructed free fibula during adolescence (n = 1), nonvascular bone graft alone (n = 1), and no reconstruction (n = 1). All had problems or complications related to unsatisfactory primary reconstruction such as plate fracture, recurrent infection, plate exposure, deformity, malocclusion, and failed fibula reconstruction. All were reconstructed with osteocutaneous free fibula flap with repair of soft-tissue loss. All flaps survived and had satisfactory outcome functionally and aesthetically. Dental rehabilitation was done in four patients. One flap was reexplored for thrombosis and salvaged. The challenges in secondary reconstruction include difficulty in recreating true defects, extensive fibrosis and loss of planes, unanticipated soft-tissue and skeletal defects, reestablishing the contour and occlusion, insufficient bone strength, dearth of suitable recipient vessels, nonpliable skin, tissue contraction to accommodate new mandible, need of additional flap for defect closure, and postirradiation effects. Notwithstanding them, the reasonable successful outcome can be attainable. Full article

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3 pages, 68 KiB

Open AccessArticle

The Effect of Deep Vein Thrombosis Prophylaxis on Bleeding in Periorbital Surgery in Trauma Patients

by Timothy Charles Woernley, Blake Maida, James Melville, Jose Marchena and Nagi Demian

Craniomaxillofac. Trauma Reconstr. 2019, 12(4), 271-273; https://doi.org/10.1055/s-0039-1683915 - 19 Mar 2019

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Abstract

The aim of this study is to assess if there is an increase in postoperative venous thromboembolism (VTE) or bleeding complications in patients who received perioperative chemical thromboprophylaxis compared with patients in whom chemical thromboprophylaxis was held during periorbital trauma surgery. This is [...] Read more.

The aim of this study is to assess if there is an increase in postoperative venous thromboembolism (VTE) or bleeding complications in patients who received perioperative chemical thromboprophylaxis compared with patients in whom chemical thromboprophylaxis was held during periorbital trauma surgery. This is a retrospective chart review of patients undergoing periorbital surgery treated in three different city hospitals, by the Department of Oral and Maxillofacial Surgery, University of Texas, between August 2014 and December 2016. A total of 237 patients were included in this study. None of these patients suffered a postoperative VTE. A total of 102 patients received perioperative pharmacologic thromboprophylaxis in the form of enoxaparin or heparin. In this group, one patient suffered a buccal space hematoma. Chemical thromboprophylaxis was held in 135 patients preoperatively and for at least 24 hours postoperatively. In this group, one patient suffered a retrobulbar hematoma after repair of an orbital floor fracture. The rate of postoperative bleeding complications was compared by the chi-square test and was not statistically significant (p = 0.8417). Full article

5 pages, 101 KiB

Open AccessArticle

On the Court: A Comprehensive Analysis of Basketball Facial Trauma

by Sammy Othman, Jason E. Cohn and Brian McKinnon

Craniomaxillofac. Trauma Reconstr. 2019, 12(4), 266-270; https://doi.org/10.1055/s-0039-1679930 - 5 Mar 2019

Cited by 16 | Viewed by 48

Abstract

With basketball gradually becoming increasingly popular across the United States, it is necessary for health care providers to understand injuries associated with the sport. We aim to determine the incidence of basketball-related facial injuries and further describe their patterns with regard to age, [...] Read more.

With basketball gradually becoming increasingly popular across the United States, it is necessary for health care providers to understand injuries associated with the sport. We aim to determine the incidence of basketball-related facial injuries and further describe their patterns with regard to age, mechanism of injury, and degree of injury. An analysis of emergency department visits under the National Electronic Injury Surveillance System was conducted from 2015 through 2017. Chi-squared testing (χ²) was performed to compare categorical variables. After a review of results, a total of 4578 patients were included for analysis spanning a 3-year time period (2015–2017). Lacerations were the most common injury overall (57.9%). Nasal fractures were by far the most common fracture (76.1%), and elbows to the face and collisions with other players were the most common types of injury mechanisms (31 and 28.7%, respectively). Adolescents (aged 12–18 years) were the most frequently injured group (42.5%), although young adults (aged 19–34 years) were also frequently affected (30.1%). Basketball facial trauma remains a prominent issue. Our research, in correlation with previous research, shows that current precautions to injury are not widely observed or are ineffective to the extent of need for further reform. It thus becomes necessary to provide patient education and develop more practical methods for decreasing player injury. Full article

12 pages, 641 KiB

Open AccessArticle

The Comprehensive AO CMF Classification System for Mandibular Fractures: A Multicenter Validation Study

by Paul A. Mittermiller, Serena S. Bidwell, Florian M. Thieringer, Carl-Peter Cornelius, Amber W. Trickey, Risto Kontio, Sabine Girod and the AO Trauma Classification Study Group

Craniomaxillofac. Trauma Reconstr. 2019, 12(4), 254-265; https://doi.org/10.1055/s-0038-1677459 - 31 Jan 2019

Cited by 9 | Viewed by 170

Abstract

The AO CMF has recently launched the first comprehensive classification system for craniomaxillofacial (CMF) fractures. The AO CMF classification system uses a hierarchical framework with three levels of growing complexity (levels 1, 2, and 3). Level 1 of the system identifies the presence [...] Read more.

The AO CMF has recently launched the first comprehensive classification system for craniomaxillofacial (CMF) fractures. The AO CMF classification system uses a hierarchical framework with three levels of growing complexity (levels 1, 2, and 3). Level 1 of the system identifies the presence of fractures in four anatomic areas (mandible, midface, skull base, and cranial vault). Level 2 variables describe the location of the fractures within those defined areas. Level 3 variables describe details of fracture morphology such as fragmentation, displacement, and dislocation. This multiplanar radiographic image-based AO CMF trauma classification system is constantly evolving and beginning to enter worldwide application. A validation of the system is mandatory prior to a reliable communication and data processing in clinical and research environments. This interobserver reliability and accuracy study is aiming to validate the three current modules of the AO CMF classification system for mandible trauma in adults. To assess the performance of the system at the different precision levels, it focuses on the fracture location within the mandibular regions and condylar process subregions as core components giving only secondary attention to morphologic variables. A total of 15 subjects individually assigned the location and features of mandibular fractures in 200 CT scans using the AO CMF classification system. The results of these ratings were then statistically evaluated for interobserver reliability by Fleiss’ kappa and accuracy by percentage agreement with an experienced reference assessor. The scores were used to determine if the variables of levels 2 and 3 were appropriate tools for valid classification. Interobserver reliability and accuracy were compared by hierarchy of variables (level 2 vs. level 3), by anatomical region and subregion, and by assessor experience level using Kruskal–Wallis and Wilcoxon's rank-sum tests. The AO CMF classification system was determined to be reliable and accurate for classifying mandibular fractures for most levels 2 and 3 variables. Level 2 variables had significantly higher interobserver reliability than level 3 variables (median kappa: 0.69 vs. 0.59, p < 0.001) as well as higher accuracy (median agreement: 94 vs. 91%, p < 0.001). Accuracy was adequate for most variables, but lower reliability was observed for condylar head fractures, fragmentation of condylar neck fractures, displacement types and direction of the condylar process overall, as well as the condylar neck and base fractures. Assessors with more clinical experience demonstrated higher reliability (median kappa high experience 0.66 vs. medium 0.59 vs. low 0.48, p < 0.001). Assessors with experience using the classification software also had higher reliability than their less experienced counterparts (median kappa: 0.76 vs. 0.57, p < 0.001). At present, the AO CMF classification system for mandibular fractures is suited for both clinical and research settings for level 2 variables. Accuracy and reliability decrease for level 3 variables specifically concerning fractures and displacement of condylar process fractures. This will require further investigation into why these fractures were characterized unreliably, which would guide modifications of the system and future instructions for its usage. Full article

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5 pages, 135 KiB

Open AccessArticle

Posttraumatic Lateral Dislocation of Mandibular Condyle: A Proposed New Classification with Report of 14 Dislocated Condyles

by Tabishur Rahman, Ghulam Sarwar Hashmi, Syed Saeed Ahmed and Sajjad Abdur Rahman

Craniomaxillofac. Trauma Reconstr. 2019, 12(4), 249-253; https://doi.org/10.1055/s-0039-1677725 - 16 Jan 2019

Cited by 1 | Viewed by 50

Abstract

Lateral dislocation of the intact mandibular condyle is a relatively uncommon clinical condition. Since the first description and classification of these dislocations given by Allen and Young, few classification systems have been proposed in literature with incorporation of different patterns of dislocations identified [...] Read more.

Lateral dislocation of the intact mandibular condyle is a relatively uncommon clinical condition. Since the first description and classification of these dislocations given by Allen and Young, few classification systems have been proposed in literature with incorporation of different patterns of dislocations identified over the years. We share our clinical experience of nine cases of such dislocations with 14 dislocated condyles, and on the basis of clinical and radiological findings coupled with the review of existing classification systems, we propose a new classification system which includes all the possible patterns of such dislocations overcoming the major shortcomings of preexisting classification systems identified by the authors. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 12, Issue 4 (December 2019) – 9 articles

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