Craniomaxillofacial Trauma & Reconstruction

3 pages, 152 KiB

Open AccessArticle

A New and Easy Technique of Maxillomandibular Fixation in Treatment of Mandibular Fractures

by Virendra Singh and Amrish Bhagol

Craniomaxillofac. Trauma Reconstr. 2011, 4(3), 175-177; https://doi.org/10.1055/s-0031-1286121 - 19 Aug 2011

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The present work evaluated the success of maxillomandibular fixation (MMF) by a new and simplified technique in management of minimally displaced mandibular fractures. A total of 20 patients who sustained various types of mandibular fractures were treated at the Government Dental College, Rohtak, [...] Read more.

The present work evaluated the success of maxillomandibular fixation (MMF) by a new and simplified technique in management of minimally displaced mandibular fractures. A total of 20 patients who sustained various types of mandibular fractures were treated at the Government Dental College, Rohtak, India by a new MMF technique. The patients were evaluated by preoperative and postoperative radiography, and clinical testing was performed to assess the degree of tooth mobility adjacent to the site of MMF. The time required for MMF was also noted. Patient recovery was uneventful in all 20 cases, and the period of MMF ranged from 2 to 4 weeks (mean 21 days). The outcome was good. The mean time for performing MMF was 12 min (range, 10 to 15 min). It is a simple, quick, economical, and minimally invasive technique. Its mechanical principle provides an advantage in preventing postoperative periodontal problems. Full article

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4 pages, 205 KiB

Open AccessArticle

Dendritic Myxofibrolipoma: Often Misdiagnosed as Sarcoma

by Awatif Y. Al-Maskery, Salem M. Al-Sidairy and Aisha S. Al-Hamadani

Craniomaxillofac. Trauma Reconstr. 2011, 4(3), 171-174; https://doi.org/10.1055/s-0031-1286122 - 19 Aug 2011

Cited by 7 | Viewed by 50

Abstract

The author describes a benign soft tissue tumor that could be easily mistaken for sarcoma. It represents a combined feature of solitary fibrous tumor and spindle cell lipoma. The clinical presentation, diagnosis, and management of this lesion are discussed. It highlights the importance [...] Read more.

The author describes a benign soft tissue tumor that could be easily mistaken for sarcoma. It represents a combined feature of solitary fibrous tumor and spindle cell lipoma. The clinical presentation, diagnosis, and management of this lesion are discussed. It highlights the importance of proper diagnosis to prevent unnecessary and ineffective treatment by clinicians as the complete excision of this lesion is the treatment of choice and recurrence is very unlikely. It is believed that this case is the first reported case of dendritic myxofibrolipoma occurring in the lower lip mucosa in an Omani patient. Full article

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10 pages, 920 KiB

Open AccessArticle

An Aesthetically Possible Alternative Approach for Craniomaxillofacial Trauma: The “Pretrichial Incision”

by Olindo Massarelli, Roberta Gobbi, Damiano Soma, Maria Teresa Raho and Antonio Tullio

Craniomaxillofac. Trauma Reconstr. 2011, 4(3), 161-170; https://doi.org/10.1055/s-0031-1286118 - 18 Aug 2011

Cited by 7 | Viewed by 74

Abstract

Frontal sinus and supraorbital rim fractures are common in facial trauma patients. Coronal incision is the standard approach for surgical management of these injuries. Nevertheless, with this incision, complications can occur as wide scars and alopecia. Because surgical repair of fronto-orbital fractures is [...] Read more.

Frontal sinus and supraorbital rim fractures are common in facial trauma patients. Coronal incision is the standard approach for surgical management of these injuries. Nevertheless, with this incision, complications can occur as wide scars and alopecia. Because surgical repair of fronto-orbital fractures is often indicated for aesthetic reasons, surgical incision might be an “aesthetic incision”. So we have adopted the pretrichial incision, already used in brow-lift and foreheadplasty but never described in craniomaxillofacial trauma surgery. Nineteen upper-third facial trauma patients were treated: five cases were approached via an existing laceration, four cases via a coronal incision, and 10 cases via a unilateral zigzag pretrichial incision. To assess the postsurgical scar, the Patient and Observer Scar Assessment Scale was used and the scar's width was measured. In all cases, a wide surgical field was obtained to perform correct fracture reduction. Unlike straight or stealth coronal incisions, with pretrichial incision no wide scar or alopecia was registered. We think that pretrichial incision is an aesthetically reasonable alternative to the standard coronal approach for craniomaxillofacial trauma patients. Full article

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3 pages, 242 KiB

Open AccessArticle

The Horizontal and Stepped Osteotomy Technique for Mandibular Reconstruction Using Fibular Free Flap

by Wesam Aleid, Keith Jones and David Laugharne

Craniomaxillofac. Trauma Reconstr. 2011, 4(3), 157-159; https://doi.org/10.1055/s-0031-1286112 - 18 Aug 2011

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Abstract

The mandible is an important component of the orofacial skeleton, and resection of part of the mandible as part of head and neck oncological procedures can have dramatic impact on both function and cosmesis. In this article, we describe a new technique in [...] Read more.

The mandible is an important component of the orofacial skeleton, and resection of part of the mandible as part of head and neck oncological procedures can have dramatic impact on both function and cosmesis. In this article, we describe a new technique in the resection osteotomy and flap fixation that improves the stability and aesthetic outcome of the reconstruction. The mandibular resection is performed utilizing a horizontal osteotomy above the mandibular angle on one side and a stepped body or angle osteotomy on the other side. Our technique is unique as it allows flexibility in adjusting the chin point projection to give the best possible aesthetic outcome; it allows more bone-to-bone contact, which increases the stability; it reduces rotation; and it allows for use of miniplate fixation, facilitating future rehabilitation with implants. We have been using this technique with great success in our hospital, and we recommend its use for its improved flexibility, stability, and aesthetic outcome. Full article

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6 pages, 169 KiB

Open AccessArticle

Orbital Wall Reconstruction with Titanium Mesh: Retrospective Study of 24 Patients

by Mario Francisco Gabrielli, Marcelo Silva Monnazzi, Luis Augusto Passeri, Waldner Ricardo Carvalho, Marisa Gabrielli and Eduardo Hochuli-Vieira

Craniomaxillofac. Trauma Reconstr. 2011, 4(3), 151-156; https://doi.org/10.1055/s-0031-1286120 - 17 Aug 2011

Cited by 17 | Viewed by 65

Abstract

The aim of this study was to evaluate the efficacy and safety of traumatic orbital defect reconstruction with titanium mesh. A retrospective study was made. Evaluations were made after a minimum postoperative follow-up of 12 months, looking for the main complications. Twenty-four patients [...] Read more.

The aim of this study was to evaluate the efficacy and safety of traumatic orbital defect reconstruction with titanium mesh. A retrospective study was made. Evaluations were made after a minimum postoperative follow-up of 12 months, looking for the main complications. Twenty-four patients were included in this evaluation; 19 were male (79.1%) and 5 (20.8%) were female. The main injury etiology was vehicle accidents (50%) followed by other causes. Fourteen patients (58.3%) presented orbital floor fractures, and 10 had more than one wall fractured (41.6%). Permanent infraorbital nerve hypoesthesia was observed in two patients (8.3%), enophthalmos occurred in five patients (20.8%), and exophthalmos was found in two patients (8.3%). Four patients (16.6%) still presented evidence of residual prolapsed intraorbital content, and one of those needed further surgical correction; sinusitis occurred in one patient (4.1%). Titanium mesh is a reliable option for orbital reconstruction, despite some complications found in this sample. Full article

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6 pages, 411 KiB

Open AccessArticle

Failed Fixation in Atrophic Mandibular Fractures: The Case against Miniplates

by Matthew J. Madsen, George M. Kushner and Brian Alpert

Craniomaxillofac. Trauma Reconstr. 2011, 4(3), 145-150; https://doi.org/10.1055/s-0031-1286114 - 17 Aug 2011

Cited by 11 | Viewed by 57

Abstract

Despite advances in the treatment of the fractured atrophic edentulous mandible, treatment continues to be difficult. Patient management is more complicated due to patients often being elderly with more complex medical problems. Rigid internal fixation has greatly improved outcomes with shorter treatment times, [...] Read more.

Despite advances in the treatment of the fractured atrophic edentulous mandible, treatment continues to be difficult. Patient management is more complicated due to patients often being elderly with more complex medical problems. Rigid internal fixation has greatly improved outcomes with shorter treatment times, yet a consensus has yet to be reached regarding which method yields the most predictable results. Options include using small miniplates to larger reconstruction plates. Although each method has advantages, we present our experience with retreatment of failed miniplate fixation using load-bearing reconstruction plates of fractured atrophic edentulous mandibles. Full article

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7 pages, 368 KiB

Open AccessArticle

Degloving Injuries of the Oral Cavity Change the Operative Approach to Fractures of the Anterior Segment of the Mandible

by Richard A. Pollock, Katherine M. Huber and Joseph E. Van Sickels

Craniomaxillofac. Trauma Reconstr. 2011, 4(3), 137-143; https://doi.org/10.1055/s-0031-1286116 - 17 Aug 2011

Cited by 2 | Viewed by 62

Abstract

No report to date describes the added risk traumatic, degloving injuries of the oral cavity may pose when treating fractures of the mandible. The authors describe the oral degloving injury, characterized by separation of periosteum and soft tissue of the anterior floor of [...] Read more.

No report to date describes the added risk traumatic, degloving injuries of the oral cavity may pose when treating fractures of the mandible. The authors describe the oral degloving injury, characterized by separation of periosteum and soft tissue of the anterior floor of the mouth from the inner cortex of the anterior segment. Vascular anatomy of the floor of the mouth is reviewed as a prelude to a description of pathomechanics of the injury and a case report. The higher incidence of oral degloving in youth and in young adulthood and parallels in elective, orthognathic surgery are identified. When this unusual clinical presentation occurs, and when open reduction of fractures of the anterior segment is chosen, a vestibular incision is best avoided. Instead, a submental or upper neck incision is chosen for sufficient exposure to allow reduction and the application of appliances. Meticulous closure of the intraoral void is achieved using one of two techniques, depending on the level of degloving. Full article

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8 pages, 418 KiB

Open AccessArticle

Safe Osteocutaneous Radial Forearm Flap Harvest with Prophylactic Internal Fixation

by Yelizaveta Shnayder, Terance T. Tsue, E. Bruce Toby, Andreas H. Werle and Douglas A. Girod

Craniomaxillofac. Trauma Reconstr. 2011, 4(3), 129-136; https://doi.org/10.1055/s-0031-1279675 - 13 May 2011

Cited by 20 | Viewed by 56

Abstract

We studied the efficacy of prophylactic plate fixation technique and a modified harvest of the osteocutaneous radial forearm free flap (OCRFFF) to minimize the incidence of postoperative donor radius pathological fracture. We retrospectively studied of the first 70 consecutive patients undergoing OCRFFF harvest [...] Read more.

We studied the efficacy of prophylactic plate fixation technique and a modified harvest of the osteocutaneous radial forearm free flap (OCRFFF) to minimize the incidence of postoperative donor radius pathological fracture. We retrospectively studied of the first 70 consecutive patients undergoing OCRFFF harvest by the University of Kansas Head and Neck Microvascular Reconstruction Team. Mean follow-up was 13 months. One of two patients undergoing OCRFFF harvest without prophylactic fixation developed a pathological radius fracture. The 68 subsequent OCRFFF patients underwent prophylactic fixation of the donor radius, and none developed a symptomatic radius fracture. Five of 68 patients did have a radiographically visible fracture requiring no intervention. The plate fixation technique was further modified to exclude monocortical screws in the radius bone donor defect (subsequent 39 patients), without any further fractures detected. One patient required forearm hardware removal for an attritional extensor tendon tear. The described modified OCRFFF harvest and prophylactic plate fixation technique may eliminate postoperative pathological fracture of the donor radius. Donor morbidity is similar to that of the fasciocutaneous radial forearm free flap , affording safe use of OCRFFF in head and neck reconstruction. Full article

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8 pages, 496 KiB

Open AccessArticle

The Importance of Accurate, Early Bony Reconstruction in Orbital Injuries with Globe Loss

by Craig Birgfeld and Joseph Gruss

Craniomaxillofac. Trauma Reconstr. 2011, 4(3), 121-128; https://doi.org/10.1055/s-0031-1279673 - 12 May 2011

Cited by 6 | Viewed by 55

Abstract

Patients who sustain facial fractures frequently suffer from visual disturbance. Additionally, orbital fractures often involve ocular injury, which, not infrequently, may require enucleation. Yet an anophthalmic orbit does not obviate the need for aggressive orbital fracture treatment. In fact, treatment of the sequelae [...] Read more.

Patients who sustain facial fractures frequently suffer from visual disturbance. Additionally, orbital fractures often involve ocular injury, which, not infrequently, may require enucleation. Yet an anophthalmic orbit does not obviate the need for aggressive orbital fracture treatment. In fact, treatment of the sequelae of the anophthalmic orbit can be difficult and require multiple surgeries. Intraoperative use of a conformer after accurate bony reduction and orbital reconstruction with bone grafts or orbital implants are essential steps to allow for prosthetic rehabilitation of the anophthalmic orbit. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 4, Issue 3 (September 2011) – 9 articles

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