Craniomaxillofacial Trauma & Reconstruction

4 pages, 135 KiB

Open AccessArticle

Bite Force Measurement in Mandibular Parasymphyseal Fractures: A Preliminary Clinical Study

by Rajesh Kshirsagar, Nitin Jaggi and Rajshekhar Halli

Craniomaxillofac. Trauma Reconstr. 2011, 4(4), 241-244; https://doi.org/10.1055/s-0031-1293521 - 4 Nov 2011

Cited by 16 | Viewed by 63

We measured the amount of bite force generated by patients treated for parasymphyseal fractures of the mandible by open reduction and internal fixation at various predetermined time intervals. Sixty volunteers ranging from 18 to 60 years old were selected as the control group. [...] Read more.

We measured the amount of bite force generated by patients treated for parasymphyseal fractures of the mandible by open reduction and internal fixation at various predetermined time intervals. Sixty volunteers ranging from 18 to 60 years old were selected as the control group. All measurements were made on a bite force measurement device with the head in an upright position and in an unsupported natural position. Bite forces were measured at the incisor and right and left molar regions. These bite forces were compared with six patients with isolated mandibular unilateral parasymphyseal fractures. All patients were operated using open reduction and internal fixation using two miniplates at the fracture site. In the volunteer group, bite forces ranged from 22 to 50 kg in the molar region and 3 to 27 kg in the incisor region. Mean adult healthy values (male and female) in the molar region were 36 kg and in the incisor region, 15 kg. In mandibular parasymphyseal fractures, incisor bite forces were reduced significantly when compared with the control group in the first 2 postoperative weeks and regained significantly thereafter till 4 to 6 weeks. Bite forces in the molar region took ∼6 to 12 weeks to regain maximum bite forces when compared with the volunteer group. Restoration of functional bite forces was evident by 6 to 8 weeks. However, the restoration of maximum bite forces may require up to 12 weeks in parasymphyseal fractures. Full article

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6 pages, 374 KiB

Open AccessArticle

A Novel Application of Calcium Phosphate-Based Bone Cement as an Adjunct Procedure in Adult Craniofacial Reconstruction

by Samuel Ho, Vigneswaran Nallathamby, Huiwen Ng, Michelle Ho and Marcus Wong

Craniomaxillofac. Trauma Reconstr. 2011, 4(4), 235-240; https://doi.org/10.1055/s-0031-1293516 - 1 Nov 2011

Cited by 6 | Viewed by 62

Abstract

Secondary corrective osteotomy of malunited craniofacial fractures can be a challenging proposition. The exposure, extrusion, and palpability of the titanium implants used become a genuine concern especially in areas of relatively thin skin, such as the periorbital region. Restoring a satisfactory contour to [...] Read more.

Secondary corrective osteotomy of malunited craniofacial fractures can be a challenging proposition. The exposure, extrusion, and palpability of the titanium implants used become a genuine concern especially in areas of relatively thin skin, such as the periorbital region. Restoring a satisfactory contour to the midface is another major task for the plastic surgeon. Bone cement used to reconstruct craniofacial defects has existed for many years. However, most applications have been as a substitute for autogenous bone grafts for defects less than 25 cm². In this article, we present two cases of malunited facial fractures that underwent corrective osteotomy, during which we felt that despite the conventional osteotomy and reduction techniques, there was still either a small remnant step deformity or suboptimal contour smoothness due to prominence of the implants used. We thus used bone cement as a resurfacing medium over titanium implants to restore good malar contour and reduce the palpability and exposure rate of the titanium implants. We report good patient satisfaction with contour correction with no increase in wound infection rates or any delay in wound healing. There was initial chemosis associated with the use of the bone cement, which resolved in both patients within 3 to 4 weeks. Postoperative computed tomography showed some degree of osteointegration but no fraction of the bone cement. Calcium phosphate bone cement thus presents an attractive adjunctive method for midfacial contour resurfacing, when used in conjunction with conventional osteotomy procedures and as an onlay over prominent titanium implants. Full article

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11 pages, 787 KiB

Open AccessArticle

Virtual Bending of Titanium Reconstructive Plates for Mandibular Defect Bridging: Review of Three Clinical Cases

by Chingiz Rahimov and Ismayil Farzaliyev

Craniomaxillofac. Trauma Reconstr. 2011, 4(4), 223-233; https://doi.org/10.1055/s-0031-1293523 - 28 Oct 2011

Cited by 10 | Viewed by 50

Abstract

The reconstruction of acquired mandibular defects due to ablative tumor surgery or traumatic injuries is still challenging. The gold standard in such treatment is application of reconstructive titanium plates, which should be contoured and adapted to the defect as much as possible because [...] Read more.

The reconstruction of acquired mandibular defects due to ablative tumor surgery or traumatic injuries is still challenging. The gold standard in such treatment is application of reconstructive titanium plates, which should be contoured and adapted to the defect as much as possible because of their influence on postoperative functional and esthetic results. Traditionally, plate bending is achieved by trial and error intraoperatively. Use of stereolitography (STL) models potentially could reduce the risk of incorrect contouring as well as operating time. On the other hand, fabrication of STL is time-consuming and costly. However, we found only one experimental study dedicating to virtual plate bending in the literature. The aim of this article was to demonstrate clinical application of a method of virtual bending of reconstructive plate for mandibular defect bridging. No significant complications occurred, and satisfactory functional and esthetic results were achieved in all cases. We found this technique precise and applicable in cases of reconstruction of mandibular defects. Full article

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6 pages, 357 KiB

Open AccessArticle

The Use of a Kirschner Wire in the Treatment of a Comminuted Le Fort I Fracture: A Case Report

by Griet De Temmerman, Bart Falter, Serge Schepers, Luc Vrielinck, Johan Orye and Constantinus Politis

Craniomaxillofac. Trauma Reconstr. 2011, 4(4), 217-222; https://doi.org/10.1055/s-0031-1293517 - 25 Oct 2011

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Abstract

Simultaneous fracture of the maxilla and cervical vertebrae rarely occurs in bicycling accidents. The following case report describes a simple technique for closed reduction of a severely comminuted maxillary fracture with shattering of the dentoalveolar process. The combination of a rigid external distractor [...] Read more.

Simultaneous fracture of the maxilla and cervical vertebrae rarely occurs in bicycling accidents. The following case report describes a simple technique for closed reduction of a severely comminuted maxillary fracture with shattering of the dentoalveolar process. The combination of a rigid external distractor halo frame on the skull, a Kirschner wire through the maxilla, and an intermaxillary wire fixation resulted in stable vertical and sagittal correction of the fragmented maxilla with adequate access and minimal manipulation and without necessitating removal of the cervical collar. Full article

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4 pages, 111 KiB

Open AccessArticle

Use of Orthodontic Mini-Implants for Maxillomandibular Fixation in Mandibular Fracture

by Mario Sergio Medeiros Pires, Leandro Calcagno Reinhardt, Guilherme de Marco Antonello and Ricardo Torres do Couto

Craniomaxillofac. Trauma Reconstr. 2011, 4(4), 213-216; https://doi.org/10.1055/s-0031-1293522 - 25 Oct 2011

Cited by 4 | Viewed by 49

Abstract

Orthodontic appliances for skeletal anchorage are becoming increasingly more common in clinical practice. Similarly, different terms such as mini-implants, microimplants, and miniscrews have been used. There is a wide array of appliances currently on the market, in different designs and sizes, [...] Read more.

Orthodontic appliances for skeletal anchorage are becoming increasingly more common in clinical practice. Similarly, different terms such as mini-implants, microimplants, and miniscrews have been used. There is a wide array of appliances currently on the market, in different designs and sizes, diameters, degree of titanium purity, and surface treatment. These appliances have been used for a variety of indications, including tooth retraction, intrusion, and traction. This study aimed to report the clinical case of a 19-year-old patient with a fractured mandible and to propose a novel use of mini-implants: the perioperative placement of mini-implants as anchors for maxillomandibular fixation steel wire ligatures. We concluded that this appliance provides an effective maxillomandibular fixation in patients with mandibular fracture, with little increase in the cost of surgery. Full article

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9 pages, 356 KiB

Open AccessArticle

Relative Difference in Orbital Volume as an Indication for Surgical Reconstruction in Isolated Orbital Floor Fractures

by Babak Alinasab, Mats O. Beckman, Tony Pansell, Saber Abdi, Anders H. Westermark and Pär Stjärne

Craniomaxillofac. Trauma Reconstr. 2011, 4(4), 203-211; https://doi.org/10.1055/s-0031-1286117 - 29 Sep 2011

Cited by 36 | Viewed by 49

Abstract

In orbital floor fractures, the estimation of the herniated orbital content in the maxillary sinus has traditionally been the dividing line between surgical and nonsurgical management. In this study, we evaluated whether a relative change in volume would function as an indicator for [...] Read more.

In orbital floor fractures, the estimation of the herniated orbital content in the maxillary sinus has traditionally been the dividing line between surgical and nonsurgical management. In this study, we evaluated whether a relative change in volume would function as an indicator for surgical versus nonsurgical treatment of orbital floor fractures. This was a follow-up study in patients with untreated unilateral isolated orbital floor fractures admitted to our department from March 2003 to April 2007. Patients were contacted by regular mail and invited to have a clinical eye examination. The volume of the orbital content was calculated digitally from the patients’ computed tomography scans at the time of their injury. Eighteen subjects with no facial skeleton fracture were included for reference of orbital content volumes. Five of 23 patients showed 2 to 4 mm of enophthalmos, and only three of them had intermittent diplopia. No statistical correlation was found between the herniated volume and enophthalmos. No statistical correlation supporting the supposition that 1 mL of herniated orbital content would result in 1 mm of enophthalmos was found. The relative volume change between the fractured and nonfractured orbit in an individual does not appear to be a useful criterion for surgery. The importance of the herniated orbital tissue for the development of enophthalmos is unclear. Full article

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2 pages, 125 KiB

Open AccessArticle

The Use of Detachable Flanges on Customized Titanium Orbital Implants: A Technical Note

by Shakir F. Mustafa, A. Bocca, Adrian W. Sugar and Steven J. Key

Craniomaxillofac. Trauma Reconstr. 2011, 4(4), 201-202; https://doi.org/10.1055/s-0031-1286115 - 29 Sep 2011

Cited by 2 | Viewed by 41

Abstract

The combined use of three-dimensional reformatted images, stereolithographic models, and rapid prototyping allows the construction of an accurate, individually made titanium implant for the reconstruction of orbital floor defects. Despite the perfect fit of the custom-made plate to the model, there might be [...] Read more.

The combined use of three-dimensional reformatted images, stereolithographic models, and rapid prototyping allows the construction of an accurate, individually made titanium implant for the reconstruction of orbital floor defects. Despite the perfect fit of the custom-made plate to the model, there might be several locations on the bone where the plate may reside intraoperatively. Most titanium orbital plates therefore contain extensions over the inferior orbital rim to help locate and stabilize the plate in its position on the bone. Such over-the-rim extensions may be palpable and can cause discomfort postoperatively. We describe the use of two small detachable flanges that help to accurately locate the orbital plate in place and allow its fixation. The locating flanges are then detached and discarded, leaving a smooth implant surface within the confines of the bony orbit. Full article

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8 pages, 593 KiB

Open AccessArticle

Spheno-Orbital Meningioma Resection and Reconstruction: The Role of Piezosurgery and Premolded Titanium Mesh

by Susana Heredero Jung, Alicia Dean Ferrer, Juan Solivera Vela and Francisco Alamillos Granados

Craniomaxillofac. Trauma Reconstr. 2011, 4(4), 193-200; https://doi.org/10.1055/s-0031-1286113 - 24 Aug 2011

Cited by 20 | Viewed by 59

Abstract

We present the clinical case of a patient with a spheno-orbital meningioma. Literature review of the treatment options, including the application of piezoelectric or ultrasound surgery and orbital reconstruction after meningioma resection, is also presented. Complete resection was performed by means of a [...] Read more.

We present the clinical case of a patient with a spheno-orbital meningioma. Literature review of the treatment options, including the application of piezoelectric or ultrasound surgery and orbital reconstruction after meningioma resection, is also presented. Complete resection was performed by means of a frontotemporal craniotomy and an orbitozygomatic approach. Piezoelectric osteotomy was used around the optic nerve canal and the superior orbital fissure to minimize the damage to soft tissues. Orbital wall reconstruction was done using a titanium mesh previously premolded using a skull model. The superior orbital rim was reconstructed with calvarial bone grafts, and the sphenotemporal bone defect was covered with a titanium mesh cranioplasty. Ultrasonic vibrations to perform osteotomies in craniofacial surgery provide an interesting tool to reduce damage to surrounding soft tissues. Reconstruction of the roof and lateral orbital wall with premolded titanium meshes with a skull model is a safe and easy method to achieve a good orbital reconstruction and to avoid secondary sequelae. Full article

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3 pages, 92 KiB

Open AccessArticle

Acute Orbital Hemorrhage as a Presentation of a Lytic Bony Lesion

by Radwan Almousa, Chao Shuen and Gangadhara Sundar

Craniomaxillofac. Trauma Reconstr. 2011, 4(4), 189-191; https://doi.org/10.1055/s-0031-1286123 - 22 Aug 2011

Cited by 3 | Viewed by 44

Abstract

A 61-year-old Chinese man presented to the emergency department with a 1-day history of painful swelling of the right eyelid with loss of vision. He had been treated earlier for an isolated pathological fracture of the T7 vertebra from plasmacytoma. Computed tomography was [...] Read more.

A 61-year-old Chinese man presented to the emergency department with a 1-day history of painful swelling of the right eyelid with loss of vision. He had been treated earlier for an isolated pathological fracture of the T7 vertebra from plasmacytoma. Computed tomography was suggestive of superior orbital hematoma with bony erosion of the inner and outer tables of an isolated frontal cell, and urgent drainage of the hematoma resulted in relief of the pain and improvement of the vision. A formal orbitotomy was performed to evacuate the hematoma, followed by combined endoscopic sinus surgery and external anterior frontal table trephine to connect the isolated cell to the frontal sinus. The histology did not show evidence of myeloma, and the orbital hematoma was probably a result of an acute hemorrhage into the mucocele of an isolated cell in the frontal bone. However, in patients with a history of multiple myeloma, it is important to consider lytic bony involvement as the cause of an orbital hemorrhage. Full article

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9 pages, 733 KiB

Open AccessArticle

Microvascular Free Tissue Transfer in the Reconstruction of Scalp and Lateral Temporal Bone Defects

by Daniel A. O'Connell, Marita S. Teng, Eduardo Mendez and Neal D. Futran

Craniomaxillofac. Trauma Reconstr. 2011, 4(4), 179-187; https://doi.org/10.1055/s-0031-1286119 - 22 Aug 2011

Cited by 31 | Viewed by 80

Abstract

Defects of the scalp and lateral temporal bone (LTB) represent a unique challenge to the reconstructive surgeon. Simple reconstructive methods such as skin grafts, locoregional flaps, or tissue expanders are often not feasible due to a myriad of reasons. Vascularized free tissue transfer [...] Read more.

Defects of the scalp and lateral temporal bone (LTB) represent a unique challenge to the reconstructive surgeon. Simple reconstructive methods such as skin grafts, locoregional flaps, or tissue expanders are often not feasible due to a myriad of reasons. Vascularized free tissue transfer coverage offers distinct advantages in managing these defects. A retrospective case series was performed on all patients at the University of Washington Medical Center who had scalp or LTB defects reconstructed with free tissue transfer from May 1996 to July 2009. Cases were analyzed for defect characteristics, flap type, vessel selection, radiation status, dural exposure, complications, and outcomes. Sixty-eight free flaps were performed in 65 patients with scalp or LTB defects. Twenty-two resections included craniotomy, and 48 patients had pre- or postoperative radiation. Defects ranged from 6 to 836 cm². All flaps (46 latissimus, 11 rectus, 4 radial forearm, 6 anterolateral thigh, and 1 omental) were transferred successfully. Vein grafts were required in five cases. Complications included delayed flap failure requiring secondary reconstruction, neck hematoma, venous thrombosis, skull base infection, large wound dehiscence, small wound dehiscence, donor site hematoma and seroma, and cerebrospinal fluid leak. Cosmetic results were consistent and durable. Microvascular free tissue transfer is a safe, reliable method of reconstructing scalp and LTB defects and offers favorable cosmetic results. We favor the use of latissimus muscle-only flap with skin graft coverage for large scalp defects and rectus or anterolateral thigh free flaps for lateral temporal bone defects. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 4, Issue 4 (December 2011) – 10 articles

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