Craniomaxillofacial Trauma & Reconstruction

2 pages, 579 KiB

Open AccessEditorial

Embracing Evolutions in Craniomaxillofacial Trauma and Reconstruction

by Florian M. Thieringer, Switzerland Mike Y. Y. Leung and Kathleen Fan

Craniomaxillofac. Trauma Reconstr. 2023, 16(3), 165-166; https://doi.org/10.1177/19433875231205722 - 4 Oct 2023

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In this issue of the Journal of Craniomaxillofacial Trauma and Reconstruction (CMTR), we find ourselves at a transformative juncture: Not only do we cover a wide range of topics from the clinical to the computational, but we’re also experiencing a significant transition [...] Read more.

In this issue of the Journal of Craniomaxillofacial Trauma and Reconstruction (CMTR), we find ourselves at a transformative juncture: Not only do we cover a wide range of topics from the clinical to the computational, but we’re also experiencing a significant transition within our Editorial Board, marking a change in leadership [...] Full article

6 pages, 533 KiB

Open AccessArticle

30-Day Post-Operative Complications of Facial Fracture Repairs: A United States Database Study

by Matthew D. Rich, W. Nicholas Jungbauer, Jr. and Warren Schubert

Craniomaxillofac. Trauma Reconstr. 2023, 16(3), 239-244; https://doi.org/10.1177/19433875221128535 - 17 Sep 2022

Cited by 3 | Viewed by 64

Abstract

Study Design: Cross-sectional database analysis. Objective: To define post-operative complication rates in facial fracture repair and to assess this data for patient characteristics which may be associated with post-operative complications. Methods: We performed a retrospective cohort analysis of the National Surgical Quality Improvement [...] Read more.

Study Design: Cross-sectional database analysis. Objective: To define post-operative complication rates in facial fracture repair and to assess this data for patient characteristics which may be associated with post-operative complications. Methods: We performed a retrospective cohort analysis of the National Surgical Quality Improvement Program (NSQIP) database between 1 January 2015, and 31 December 2019. All patients included in this study sample must have (a) been ≥18 years old and (b) underwent surgical repair of a facial fracture during the study period by a plastic surgeon or otolaryngologist. Adverse outcomes at 30 days were characterized into four groups: superficial surgical site infection (SSI), deep SSI, organ space infection, and wound disruption. Results: In total, 2481 patients met the primary outcome of facial fracture. Among the four fracture types assessed, 1090 fractures (43.9%) were mandibular, 721 were zygomatic (29.1%), 638 were orbital (25.7%), and 32 (1.3%) were Lefort. Of the entire cohort, 25 patients (1.01%) experienced a superficial SSI, 14 patients (0.56%) presented with a deep SSI, 25 fractures (1.01%) returned with an organ space infection, and 23 patients (0.93%) experienced some type of wound disruption. Smokers had a significantly higher risk of superficial SSIs (p < 0.05) and organ space infections (p < 0.05). Conclusions: The majority of facial fracture patients do not experience post-operative complications. However, smokers and patients with diabetes mellitus were shown to be at an elevated risk of developing complications. Future research should further investigate this relationship and focus on developing interventions to improve post-operative outcomes. Full article

9 pages, 787 KiB

Open AccessReview

E-Scooters and Craniofacial Trauma: A Systematic Review

by Elizabeth Z. Goh, Nicholas Beech and Nigel R. Johnson

Craniomaxillofac. Trauma Reconstr. 2023, 16(3), 245-253; https://doi.org/10.1177/19433875221118790 - 10 Aug 2022

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Abstract

Study Design: Systematic review. Objective: Standing electric scooters (e-scooters) provide a cheap and environmentally friendly transport alternative, but also elicit substantial concern regarding their volume of associated injuries especially in the craniofacial region. This review aims to explore the demographics, risk factors, types [...] Read more.

Study Design: Systematic review. Objective: Standing electric scooters (e-scooters) provide a cheap and environmentally friendly transport alternative, but also elicit substantial concern regarding their volume of associated injuries especially in the craniofacial region. This review aims to explore the demographics, risk factors, types of injury and surgical management of craniofacial trauma associated with e-scooters. Methods: PubMed and Scopus databases were systematically searched. Inclusion criteria were clinical studies investigating craniofacial trauma associated with e-scooters. Exclusion criteria were duplicates; non-English publications; non-full-text publications; studies with insufficient data. Results: Of the 73 articles identified, 10 eligible articles representing 539 patients were included. The mean age was 31.5 years. Most cases were male (63.7%). Common risk factors were alcohol/drug intoxication, absence of distal extremity injuries and lack of helmet use. The most common mechanism of injury was mechanical falls (72.4%). The most common facial fracture pattern was middle third fractures (58.3%). Surgical management was required for 43.3% of fractures. Other types of injuries reported were traumatic brain injuries (17.6%), soft tissue injuries (58.3%), dental injuries (32.9%) and ophthalmological injuries (20.6%). Conclusions: The findings of this review suggest common presentations for craniofacial trauma associated with e-scooters. Robust longitudinal evaluations with standardised descriptions of types of injuries are required. Gaps in knowledge relate to surgical management, post-operative complications and associated risk factors. Full article

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5 pages, 849 KiB

Open AccessArticle

Implant Survival in Tissue-Engineered Mandibular Reconstruction—Early Experiences

by Victoria A. Mañón, Nicholas Oda, Emeric Boudreaux, Huy Tran, Simon Young and James C. Melville

Craniomaxillofac. Trauma Reconstr. 2023, 16(3), 234-238; https://doi.org/10.1177/19433875221116962 - 21 Jul 2022

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Abstract

Study Design: This article is to evaluate the early outcomes of dental implants placed in bone generated with tissueengineering techniques, specifically recombinant human bone morphogenic protein-2 (rhBMP-2), allogeneicbone particulate, and bone marrow aspirate concentrate (BMAC) in patients with resection of benignpathology. Objective: To [...] Read more.

Study Design: This article is to evaluate the early outcomes of dental implants placed in bone generated with tissueengineering techniques, specifically recombinant human bone morphogenic protein-2 (rhBMP-2), allogeneicbone particulate, and bone marrow aspirate concentrate (BMAC) in patients with resection of benignpathology. Objective: To evaluate the long-term prognosis of dental implants placed in tissue engineered mandibular reconstruction. Methods: We retrospectively evaluated 12 patient records, all of whom underwent segmental mandibular resection of benign pathology and reconstruction with a combination of BMAC, rhBMP-2, and allogeneic bone. Collecteddata points included the patient's age, gender, medical and social histories, implant site and placement date, resection/reconstruction date, final prosthesis, pathology resected, and follow-up dates (average 25 monthsof follow-up). Implant success was defined as clinical osseointegration (immobility), absence of peri-implantradiolucency, and absence of infection. Results: Twelve patients met inclusion criteria with a total of 46 implants. The overall implant survival rate was 91.3%. There were 4 implant failures occurring in two patients: 1 failure in Patient 3 and 3 failures in Patient 8. Neitherpatient had any existing medical comorbidities or social history known to increase the risk for implant failure. The average implant placement occurred 11.6 months after mandibular reconstruction. Conclusions: Preliminary findings of implant placement in bone generated with tissue engineering techniques have shown to be another predictable alternative for orofacial rehabilitation. Practical Implications: Dental rehabilitationusing dental implants is a predictable treatment option for patients that have required reconstruction of largebony defects status post resection of benign pathology using novel tissue engineering techniques. Full article

11 pages, 568 KiB

Open AccessArticle

Reconstruction in Salvage Surgery for Head and Neck Cancers

by Nageswara R. Noothanapati, Nisha R. Akali, Rahul Buggaveeti, Deepak Balasubramanian, Jimmy Mathew, Subramania Iyer and Krishnakumar Thankappan

Craniomaxillofac. Trauma Reconstr. 2023, 16(3), 211-221; https://doi.org/10.1177/19433875221109248 - 16 Jun 2022

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Abstract

Introduction: Salvage surgery is the treatment option in recurrences and second primary tumors. This paper aimed to study the options and outcomes of reconstruction and the predictors of poor reconstructive outcomes in salvage surgery for head and neck cancers. Study Design: This is [...] Read more.

Introduction: Salvage surgery is the treatment option in recurrences and second primary tumors. This paper aimed to study the options and outcomes of reconstruction and the predictors of poor reconstructive outcomes in salvage surgery for head and neck cancers. Study Design: This is a retrospective study of all patients who underwent reconstructive flap surgery as part of salvage surgery for head and neck cancers between the years 2004 and 2017. Methods: The initial treatment may be single modality radiotherapy or surgery or multimodality with combinations of surgery, radiotherapy, and chemotherapy. Any pathology that required surgical salvage was included. Any procedures done purely as reconstructive surgery were excluded. Predictor variables included demographical, clinical, and treatment factors. The outcome parameter was the occurrence of any flap-related complication or not. The complications and morbidity related to the procedures are reported. Results: Ninety-three patients underwent loco-regional flaps (LRF group), and 100 had free flaps (FF group). Pectoralis major flap was the commonest flap used in 68 patients (73.1%). Anterolateral thigh (ALT) flap was the commonest free flap and comprised 41% of the FF group. Any skin-related complication was seen in 35 patients (37.6%) and 41 (41%), respectively, in LRF and FF subsets. Any flap-related complication was seen in 16 patients (17.2%) and 29 patients (29%), respectively, in LRF and FF subsets. A summary measure “any one of the complications” was seen in 46 (49.5%) and 57 (57%), respectively, in LRF and FF subsets. Univariate and multivariate analysis for any flap-related complication identified no statistically significant predictor. Conclusions: Soft tissue flaps were preferred in salvage reconstruction, though the defects had a bony component. In the microvascular free flap reconstruction era, pectoralis major flap has shifted its role from a “workhorse flap” to a “salvage flap.” About half of the patients develop some complications. Flap-related complications are also common. In salvage surgery, it is important that an appropriate flap is selected, suitable for the setting, according to the indications, neck, and patient conditions. Full article

12 pages, 1370 KiB

Open AccessArticle

Anatomical Patterns of the Nasopalatine Canal and Incisive Foramen in an African Setting: A Cross-Sectional Study

by Krishan Sarna, Merna A. Estreed, Khushboo J. Sonigra, Thomas Amuti, Florence Opondo, Martin Kamau and Wei C. Ngeow

Craniomaxillofac. Trauma Reconstr. 2023, 16(3), 222-233; https://doi.org/10.1177/19433875221100943 - 27 May 2022

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Abstract

Study Design: Descriptive cross-sectional. Objective: To determine the morphology and morphometry of the nasopalatine canal (NPC) and incisive foramen (IF) in an African population. Methods: Measurements of the NPC and the IF were carried out on 150 Cone-Beam computed tomography (CBCT) scans. The [...] Read more.

Study Design: Descriptive cross-sectional. Objective: To determine the morphology and morphometry of the nasopalatine canal (NPC) and incisive foramen (IF) in an African population. Methods: Measurements of the NPC and the IF were carried out on 150 Cone-Beam computed tomography (CBCT) scans. The maxillary bone thickness anterior to the NPC was measured at 3 levels. Independent t-test and Chi-square test were performed to determine the presence of sexual dimorphism. Results: The presence of one Stenson’s foramen was most prevalent. The mean length of NPC was 13.21 ± 3.25 mm with significantly longer canals in males. The most prevalent shape of NPC was cylindrical in sagittal view and a single canal in coronal view. The mean angulation of NPC was 118.42° to the horizontal plane. The average dimensions of the IF were 3.53 mm and 3.07 mm in the anteroposterior and mediolateral diameter, respectively, while the most common shape was round. The anterior maxillary bone was thicker in males and generally reduced in thickness from the anterior nasal spine superiorly towards the alveolar crest inferiorly. Conclusion: This study highlights the anatomical characteristics of the NPC and IF, with significant sexual dimorphism observed regarding the number of Stenson’s foramina, length of NPC, shapes of the NPC and IF, as well as alveolar bone thickness anterior to NPC. Full article

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6 pages, 754 KiB

Open AccessArticle

The Effect of Chitohem Bleeding Inhibitor Powder on Pain and Bleeding After Tonsillectomy by Suturing Method

by Seied-Reza Seied-Mohammad Doulabi, Alireza Moradi, Navid Ahmady Roozbahany, Sohbat Rezaei, Niloufar Khoshfetrat, Fahime Shamsian and Mehran Baghi

Craniomaxillofac. Trauma Reconstr. 2023, 16(3), 205-210; https://doi.org/10.1177/19433875221092571 - 15 May 2022

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Abstract

Study Design and Objectives: This study aimed to investigate Triamcinolone ointment’s effect on pain and bleeding after tonsillectomy by suturing method. Methods: The present study was performed as a single-blind clinical trial on 200 patients who underwent a total tonsillectomy in the ENT [...] Read more.

Study Design and Objectives: This study aimed to investigate Triamcinolone ointment’s effect on pain and bleeding after tonsillectomy by suturing method. Methods: The present study was performed as a single-blind clinical trial on 200 patients who underwent a total tonsillectomy in the ENT department of Loghman Hakim Hospital in Tehran during 2016. Candidates for total tonsillectomy were randomized into 2 groups one by one. Participants were randomly divided into 2 groups. Both groups matched homologically. Patients in both groups (intervention and control) underwent cold dissection total tonsillectomy. In addition to suturing, in the intervention group, Triamcinolone ointment was used to control the local bleeding at the surgical site. In the control group, only sutures were used to control bleeding. The studied variables included: bleeding and pain 24 hours after surgery, Time to start oral feeding. Result: The frequency of bleeding cases in the first 24 hours are included: 4 patients (5.63%) in the intervention group and 6 patients (8.45%) in the control group (p = 0.01). The average time to start eating for patients who were treated with topical triamcinolone ointment was significantly less than those who were not treated with this ointment. Only 2 patients (2.77%) in the intervention group took analgesics in the first 24 hours after surgery, while and 11 patients (15.3%) in the control group received analgesics in the same time period. Conclusion: In general, the results of this study showed that the use of Triamcinolone ointment in total tonsillectomy could reduce bleeding, analgesics usage, and the time of feeding onset. Full article

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10 pages, 2039 KiB

Open AccessArticle

Mathematical Modeling of Vessel Geometry and Circumference in Microvascular Surgery

by Stacey Nedrud, Yoram Fleissig, Alba Sanjuan-Sanjuan, Anthony Bunnell and Rui Fernandes

Craniomaxillofac. Trauma Reconstr. 2023, 16(3), 195-204; https://doi.org/10.1177/19433875221097252 - 15 May 2022

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Abstract

Introduction: Microvascular anastomosis has traditionally been executed with a perpendicular transection through the vessel at the widest diameter to increase circumference and thus increase blood flow while decreasing resistance. In Chen’s 2015 article, it was suggested that an “open Y” would improve vessel [...] Read more.

Introduction: Microvascular anastomosis has traditionally been executed with a perpendicular transection through the vessel at the widest diameter to increase circumference and thus increase blood flow while decreasing resistance. In Chen’s 2015 article, it was suggested that an “open Y” would improve vessel size match, and Wei and Mardini discuss angled transections of the vessels. This project aims to explore the geometric configurations feasible at the anastomotic transection and mathematically model the resulting hypothetical increases in circumference. Materials and Methods: The mathematical models were theoretically developed by our team. The formulas model increases in circumference of the transection at different distances in relation to the bifurcation of a blood vessel, as well as changes in circumference at different transection angulations. An in vitro exploration as to the anastomotic feasibility of each geometric cut was completed on ten poultry tissue specimens. Results: The mathematical models demonstrated the change in vessel circumference, with multiple geometric designs calculated, best shown through diagrams. For example, if the vessel width is 1 mm, the distance from the increasing vessel diameter to the final bifurcation is 1 mm, and the bifurcation angle is 45°, the circumference of the transected vessel increases by 82.8%. Models of transections at different angulations, for instance 30°, 45°, and 60°, yield an increase in elliptical circumference of 8.0%, 22.5%, and 58.1%, respectively. Additional derivations calculate the elliptical circumference at any angle in a single vessel, and at any angle in a bifurcating vessel. Conclusion: The theoretical and clinical aim of this project is to increase awareness of the anastomotic creativity and mathematically demonstrate the optimal anastomotic geometry, which has not been objectively explored to our knowledge. An in vivo study would further support clinical improvements, with the aim to map postoperative fluid dynamics through the geometric anastomoses. Full article

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15 pages, 3792 KiB

Open AccessArticle

Extended Total Temporomandibular Joint Replacement—A Feasible Option for Functional and Aesthetic Reconstruction of Mandibular Defects Involving the Temporomandibular Joint

by Juergen Schlabe, Rhodri O. H. L. Davies, Esben Aagaard, Gary Cousin, Andrew Ian Edwards, Kenneth McAlister and Luke Cascarini

Craniomaxillofac. Trauma Reconstr. 2023, 16(3), 180-194; https://doi.org/10.1177/19433875221094971 - 14 May 2022

Cited by 2 | Viewed by 66

Abstract

Study design: Retrospective case series. Objective: Alloplastic temporomandibular joint replacement has been established as a standard technique for end- stage temporomandibular (TMJ) pathologies. Joint replacement when there are extensive mandibular defects remains a challenging clinical problem. Custom-made extended temporomandibular joint replacement is a [...] Read more.

Study design: Retrospective case series. Objective: Alloplastic temporomandibular joint replacement has been established as a standard technique for end- stage temporomandibular (TMJ) pathologies. Joint replacement when there are extensive mandibular defects remains a challenging clinical problem. Custom-made extended temporomandibular joint replacement is a feasible option but there is limited information about this emerging technique. Methods: Included were all patients undergoing extended TMJ-replacements (TMJe), all operatrions were carried out by the senior author. Surgical technique was either single stage or two stage protocol. Surgical details and pitfalls and outcome of more than 2 years follow-up with reference to thirteen including twelve patients were recorded. Results: The most common diagnosis was ameloblastoma of the mandibular ramus. Single stage or two stagge regime were carried out depending on resection requirements and involvement of teeth. Improved mouth opening of more than 30mm was achieved in 10 of 12 patients. One patient with previous TMJ replacement reported temporary weakness of the facial nerve, which resolved after 10 months. Conclusions: The authors suggest a simplified anatomically based single-stage or two-stage regime, with both regimes achieved excellent anatomic reconstruction, facial appearance and function with low surgical morbidity. Custom-made extended temporomandibular joint protheses appear an advanced and reliable solution for reconstruction of combined complex mandibular defects including the temporomandibular joint. If surgical clearance of the pathology can be achieved, a single-stage regime is favoured. Full article

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13 pages, 670 KiB

Open AccessArticle

What Factors Influence the Hospitalization of Self-Inflicted Craniomaxillofacial Gunshot Wounds?

by Dani Stanbouly and Sung-Kiang Chuang

Craniomaxillofac. Trauma Reconstr. 2023, 16(3), 167-179; https://doi.org/10.1177/19433875221094975 - 10 May 2022

Cited by 1 | Viewed by 42

Abstract

Study Design: The following retrospective cohort study was competed using data from the Nationwide Inpatient Sample a database from the Healthcare Cost and Utilization Project (HCUP). Objective: The objective of this retrospective cohort study is to compare the hospitalization outcomes of managing maxillofacial [...] Read more.

Study Design: The following retrospective cohort study was competed using data from the Nationwide Inpatient Sample a database from the Healthcare Cost and Utilization Project (HCUP). Objective: The objective of this retrospective cohort study is to compare the hospitalization outcomes of managing maxillofacial trauma attempted suicide among handguns, shotguns, and hunting rifles. Methods: The primary predictor variablewas the type of firearm. The outcome variableswere the hospital charges (U.S. dollars) and length of stay (days). We used SPSS version 25 for Mac (IBM Corp., Armonk, NY, USA) to conduct all statistical analyses. Results: A final sample of 223 patients was statistically analyzed. Relative to patients within the Q2 median household income quartile, patients in the Q4 median household income quartile added +$ 172,609 (p < 0.05) in hospital charges. Relative to patients living in “central” counties of metro areas, patients in micropolitan counties added +13.18 days (p < 0.05) to the length of stay. Relative to patients in the Q2 median household income quartile, patients in Q3 added +9.54 days (p < 0.05) while patients in Q4 added +11.49 days (p < 0.05) to the length of stay. Conclusions: Being within the highest income quartile was associated with increased hospital charges. Patients living in micropolitan counties have prolonged hospitalization relative to patients in metropolitan counties. Relative to the second income quartile, length of stay was higher in the third income quartile and highest in the fourth income quartile. Increase income grants access to deadlier firearms. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 16, Issue 3 (September 2023) – 10 articles

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