Craniomaxillofacial Trauma & Reconstruction

12 pages, 486 KiB

Open AccessArticle

Choice of Internal Rigid Fixation Materials in the Treatment of Facial Fractures

by Mirko S. Gilardino, Elliot Chen and Scott P. Bartlett

Craniomaxillofac. Trauma Reconstr. 2009, 2(1), 49-60; https://doi.org/10.1055/s-0029-1202591 - 1 Mar 2009

Cited by 44 | Viewed by 62

The surgical treatment of craniomaxillofacial trauma involves the restoration of both form and function via a complex interplay between the facial bony skeleton and its soft tissue envelope [...] Full article

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7 pages, 87 KiB

Open AccessArticle

Complications of Rigid Internal Fixation

by Chris A. Campbell and Kant Y. Lin

Craniomaxillofac. Trauma Reconstr. 2009, 2(1), 41-47; https://doi.org/10.1055/s-0029-1202596 - 1 Mar 2009

Cited by 29 | Viewed by 51

Abstract

Over the past 20 years, there have been many advances in the development of bone fixation systems used in the practice of craniomaxillofacial surgery. As surgical practices have evolved, the complications of each technologic advance have changed accordingly. Interfragmentary instability of interosseous wiring has been replaced by the risk of exposure, infection, and palpability of plate and screw fixation systems. The improved rigidity of plate fixation requires anatomic alignment of fracture fragments. Failure to obtain proper alignment has led to the phenomenon known as “open internal fixation” of fracture fragments without proper reduction. The size of the plates has decreased to minimize palpability and exposure. However limitations in their application have been encountered due to the physiologic forces of the muscles of mastication and bone healing. In the pediatric population, the long-standing presence of plates in the cranial vault resulted in reports of transcranial migration and growth restriction. These findings led to the development of resorbable plating systems, which are associated with self-limited plate palpability and soft tissue inflammatory reactions. Any rigid system including these produces growth restriction in varying amounts. In this discussion, we review the reported complication rates of miniplating and microplating systems as well as absorptive plating systems in elective and traumatic craniofacial surgery. Full article

6 pages, 522 KiB

Open AccessArticle

Extended Transcaruncular Approach Using Detachment and Repositioning of the Inferior Oblique Muscle for the Traumatic Repair of the Medial Orbital Wall

by Javier Rodriguez, Ramon Galan, Gabriel Forteza, Mario Mateos, Jens Mommsen, Olga Vazquez Bouso and Veronica Piera

Craniomaxillofac. Trauma Reconstr. 2009, 2(1), 35-40; https://doi.org/10.1055/s-0029-1202598 - 1 Mar 2009

Cited by 14 | Viewed by 35

Abstract

The fracture of the medial orbital wall is relatively common in orbital trauma. Titanium mesh is possibly the actual standard material for orbital wall reconstruction. When the floor of the orbit and the medial wall are simultaneously affected, one larger mesh gives better results than two independent meshes that need to be fixated independently. However, large meshes need a wider surgical field. To gain sufficient exposure to the medial and inferior orbital walls simultaneously, we present an approach that combines the transconjunctival and transcaruncular incisions, detaching if needed the inferior oblique muscle and, placing our mesh, repositioning it beside the lacrimal duct. This technique should not entirely displace traditional approaches, but it widens the surgical exposure for middle- and upper-third facial trauma. This alternative has minimum morbidity and can save a great deal of surgery time. Full article

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8 pages, 1160 KiB

Open AccessArticle

Complications of Frontal Sinus Fractures

by Stephen E. Metzinger and Rebecca C. Metzinger

Craniomaxillofac. Trauma Reconstr. 2009, 2(1), 27-34; https://doi.org/10.1055/s-0029-1202597 - 1 Mar 2009

Cited by 21 | Viewed by 93

Abstract

Frontal sinus fracture represents 5 to 12% of all maxillofacial fractures. Because of the anatomic position of the frontal sinus and the enormous amount of force required to create a fracture in this area, these injuries are often devastating and associated with other trauma. Associated injuries include skull base, intracranial, ophthalmologic, and maxillofacial. Complications should be categorized to address these four areas as well as the skin—soft tissue envelope, muscle, and bone. Other variables that should be examined are age of the patient, gender, mechanism of injury, fracture pattern, method of repair, and associated injuries. Management of frontal sinus fractures is so controversial that the indications, timing, method of repair, and surveillance remain disputable among several surgical specialties. The one universal truth that is agreed upon is that all patients undergoing reconstructive surgery of the frontal sinus have a lifelong risk for delayed complications. It is hoped that when patients do experience the first symptoms of a complication, they seek immediate medical attention and avoid potentially life-threatening situations and the need for crippling or disfiguring surgery. The best way to facilitate this is through long-term follow-up and routine surveillance. Full article

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7 pages, 1182 KiB

Open AccessArticle

Application of Skeletal Buttress Analogy in Composite Facial Reconstruction

by Rachel Bluebond-Langner and Eduardo D. Rodriguez

Craniomaxillofac. Trauma Reconstr. 2009, 2(1), 19-25; https://doi.org/10.1055/s-0028-1098966 - 1 Mar 2009

Cited by 15 | Viewed by 42

Abstract

Reconstructive algorithms for composite craniofacial defects have focused on soft tissue flaps with or without bone grafts. However, volumetric loss over time limits long-term preservation of facial contour. Application of craniofacial skeletal buttress principles to high-energy trauma or oncologic defects with composite vascularized bone flaps restores the soft tissue as well as the buttresses and ultimately preserves facial contour. We conducted a retrospective review of 34 patients with craniofacial defects treated by a single surgeon with composite bone flaps at R Adams Cowley Shock Trauma Center and Johns Hopkins Hospital from 2001 to 2007. Data collected included age, sex, mechanism of injury, type of defect, type of reconstructive procedures, and outcome. Thirty-four patients with composite tissue loss, primarily males (n = 24) with an average age of 37.4 years, underwent reconstruction with vascularized bone flaps (28 fibula flaps and 6 iliac crest flaps). There were 4 cranial defects, 8 periorbital defects, 18 maxillary defects, and 4 maxillary and periorbital defects. Flap survival rate was 94.1% with an average follow-up time of 20.5 months. Restoration of facial height, width, and projection is achieved through replacement of skeletal buttresses and is essential for facial harmony. Since 2001, our unit has undergone a paradigm shift with regard to treatment of composite oncologic and traumatic defects, advocating vascularized bone flaps to achieve predictable long-term outcomes. Full article

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18 pages, 1933 KiB

Open AccessArticle

Treatment of Malocclusion and TMJ Dysfunction Secondary to Condylar Fractures

by Edward Ellis and Robert V. Walker

Craniomaxillofac. Trauma Reconstr. 2009, 2(1), 1-18; https://doi.org/10.1055/s-0028-1102900 - 1 Mar 2009

Cited by 23 | Viewed by 58

Abstract

Unfavorable sequelae from mandibular fractures includes malocclusion and temporomandibular joint dysfunction. The management of these complications is presented in this article and is largely based on the authors’ experience. Cases that provide details on treatment methods are shown. Finally, an algorithm for treatment [...] Read more.

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Craniomaxillofac. Trauma Reconstr., Volume 2, Issue 1 (March 2009) – 6 articles

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