Craniomaxillofacial Trauma & Reconstruction

5 pages, 89 KiB

Open AccessArticle

Ophthalmologic Findings in Patients with Non-Surgically Treated Blowout Fractures

by Tony Pansell, Babak Alinasab, Anders Westermark, Mats Beckman and Saber Abdi

Craniomaxillofac. Trauma Reconstr. 2012, 5(1), 1-5; https://doi.org/10.1055/s-0031-1300963 - 7 Feb 2012

Cited by 10 | Viewed by 59

We evaluated the ocular and visual status in a group of patients with a non-surgically treated blowout fracture. Clinical examination with refraction, test of binocular function, and tear film evaluation was performed in 23 patients. These values were statistically correlated with the orbital [...] Read more.

We evaluated the ocular and visual status in a group of patients with a non-surgically treated blowout fracture. Clinical examination with refraction, test of binocular function, and tear film evaluation was performed in 23 patients. These values were statistically correlated with the orbital volume measurements and ocular finding from the patient records at presentation. About 50% of the study group was symptomatic due to low visual acuity from refractive errors and decompensated phorias as a consequence of the blowout fracture. Several patients displayed changes in tear film production. There was no strong correlation between the measured parameters and orbital volume measurements. Patients with a non-surgically treated blowout fracture often display ocular and visual changes after discharge. A routine visual exam is advocated in all patients after the ocular status has stabilized after a blowout fracture. Full article

6 pages, 288 KiB

Open AccessArticle

Bilateral Mandibular Distraction Osteogenesis in the Neonate with Pierre Robin Sequence and Airway Obstruction: A Primary Option

by Horácio Zenha, Luis Azevedo, Leonor Rios, Alberto Pereira, Armindo Pinto, Maria Luz Barroso and Horácio Costa

Craniomaxillofac. Trauma Reconstr. 2012, 5(1), 25-30; https://doi.org/10.1055/s-0031-1300960 - 30 Jan 2012

Cited by 17 | Viewed by 100

Abstract

Children with craniofacial abnormalities associated with retromicrognathia and glossoptosis often have compromised upper airway flow. In severe cases, emergency intubation is necessary immediately after birth, and tracheostomy is advocated to manage the airway in the neonatal period and to allow for feeding. Early [...] Read more.

Children with craniofacial abnormalities associated with retromicrognathia and glossoptosis often have compromised upper airway flow. In severe cases, emergency intubation is necessary immediately after birth, and tracheostomy is advocated to manage the airway in the neonatal period and to allow for feeding. Early intervention with bilateral mandibular osteogenesis avoids the need for tracheostomy, along with its complications, and it targets the primary etiologic factor of the problem—the anomalous anatomy of the mandible. We report two neonates with severe Pierre Robin sequence managed with bilateral mandibular distraction osteogenesis on day 9 and day 11 of life. The surgical techniques and distraction and consolidation periods were similar apart from the distraction devices used. The procedures were successful with early extubation (day 5 and day 7), oral feeding tolerance (day 11 and day 13) and hospital discharge (day 19 and day 18). Total mandibular distraction was 19 mm and 23.45 mm, respectively. No major complications were reported. Medium to long-term results were good. Bilateral mandibular distraction osteogenesis in the neonate is a safe and accurate procedure and is the primary option in cases of selected severe Pierre Robin sequence. Full article

5 pages, 381 KiB

Open AccessArticle

Reconstruction of Periparotid Defects Using Temporoparietal Fascia Flap with Layered Acellular Human Dermal Allograft

by Johnathan M. Winstead, Garth T. Olson and John L. Frodel

Craniomaxillofac. Trauma Reconstr. 2012, 5(1), 19-23; https://doi.org/10.1055/s-0031-1300959 - 30 Jan 2012

Cited by 3 | Viewed by 42

Abstract

Excision of lesions in the periparotid area can leave a sizable concavity of the preauricular area with skeletonization of the mandible. To achieve the bulk necessary to fill this defect, we propose using a composite graft. Acellular human dermal allograft provides the thickness [...] Read more.

Excision of lesions in the periparotid area can leave a sizable concavity of the preauricular area with skeletonization of the mandible. To achieve the bulk necessary to fill this defect, we propose using a composite graft. Acellular human dermal allograft provides the thickness of the graft, and the temporoparietal fascia flap provides blood supply to the dermal graft. Our hypothesis is that vascularization of the graft will promote greater ingrowth of native tissue and prevent breakdown and absorption of the graft. Four representative patients are described. Full article

7 pages, 434 KiB

Open AccessArticle

Titanium Mesh Reconstruction of Orbital Roof Fracture with Traumatic Encephalocele: A Case Report and Review of Literature

by Nitin J. Mokal and Mahinoor F. Desai

Craniomaxillofac. Trauma Reconstr. 2012, 5(1), 11-17; https://doi.org/10.1055/s-0031-1300958 - 30 Jan 2012

Cited by 24 | Viewed by 56

Abstract

Orbital roof fractures are rare. Traumatic encephaloceles in the orbital cavity are even rarer, with only 21 cases published to date. Orbital roof fractures are generally encountered in males between 20 and 40 years of age following automobile collision. We report a case [...] Read more.

Orbital roof fractures are rare. Traumatic encephaloceles in the orbital cavity are even rarer, with only 21 cases published to date. Orbital roof fractures are generally encountered in males between 20 and 40 years of age following automobile collision. We report a case of an orbital roof fracture with traumatic encephalocele into the left orbit. Early diagnosis and treatment are very important because the raised intraorbital pressure may irreversibly damage the optic nerve. Computed tomography with 3-D reconstruction, the imaging modality of choice, showed the displaced fracture fragment deep into the orbit. Reconstruction of the orbital roof should be performed in every case. We used an extracranial approach to elevate the fracture with titanium mesh to stabilize the fragment. The cosmetic results were excellent but delay in treatment was responsible for delayed recovery of vision. The case report is followed by a brief overview of orbital roof fractures including pertinent review of literature. Full article

4 pages, 148 KiB

Open AccessArticle

A Novel Technique for Attaining Maxillomandibular Fixation in the Edentulous Mandible Fracture

by Christopher Knotts, Meredith Workman, Kamal Sawan and Christian El Amm

Craniomaxillofac. Trauma Reconstr. 2012, 5(1), 7-10; https://doi.org/10.1055/s-0031-1300962 - 30 Jan 2012

Cited by 5 | Viewed by 52

Abstract

Edentulous mandible fractures present a unique and challenging surgical problem, particularly because of lack of occlusive dental surfaces to capitalize upon maxillomandibular fixation (MMF). We present a novel technique to achieve MMF using rigid plates spanning the oral cavity to fixate the maxilla [...] Read more.

Edentulous mandible fractures present a unique and challenging surgical problem, particularly because of lack of occlusive dental surfaces to capitalize upon maxillomandibular fixation (MMF). We present a novel technique to achieve MMF using rigid plates spanning the oral cavity to fixate the maxilla to the mandible. The process is rapid and allows stability using the established principles of rigidity, external fixation, and osteosynthesis. This technique allows for a faster MMF than with a Gunning splint and allows for easier oral hygiene. An illustrative case and pre- and postoperative imaging are provided. Full article

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10 pages, 368 KiB

Open AccessArticle

Treatment Protocol for High Velocity/High Energy Gunshot Injuries to the Face

by Micha Peled, Yoav Leiser, Omri Emodi and Amir Krausz

Craniomaxillofac. Trauma Reconstr. 2012, 5(1), 31-40; https://doi.org/10.1055/s-0031-1293518 - 17 Nov 2011

Cited by 42 | Viewed by 77

Abstract

Major causes of facial combat injuries include blasts, high-velocity/high-energy missiles, and low-velocity missiles. High-velocity bullets fired from assault rifles encompass special ballistic properties, creating a transient cavitation space with a small entrance wound and a much larger exit wound. There is no dispute [...] Read more.

Major causes of facial combat injuries include blasts, high-velocity/high-energy missiles, and low-velocity missiles. High-velocity bullets fired from assault rifles encompass special ballistic properties, creating a transient cavitation space with a small entrance wound and a much larger exit wound. There is no dispute regarding the fact that primary emergency treatment of ballistic injuries to the face commences in accordance with the current advanced trauma life support (ATLS) recommendations; the main areas in which disputes do exist concern the question of the timing, sequence, and modes of surgical treatment. The aim of the present study is to present the treatment outcome of high-velocity/high-energy gunshot injuries to the face, using a protocol based on the experience of a single level I trauma center. A group of 23 injured combat soldiers who sustained bullet and shrapnel injuries to the maxillofacial region during a 3-week regional military conflict were evaluated in this study. Nine patients met the inclusion criteria (high-velocity/high-energy injuries) and were included in the study. According to our protocol, upon arrival patients underwent endotracheal intubation and were hemodynamically stabilized in the shock-trauma unit and underwent total-body computed tomography with 3-D reconstruction of the head and neck and computed tomography angiography. All patients underwent maxillofacial surgery upon the day of arrival according to the protocol we present. In view of our treatment outcomes, results, and low complication rates, we conclude that strict adherence to a well-founded and structured treatment protocol based on clinical experience is mandatory in providing efficient, appropriate, and successful treatment to a relatively large group of patients who sustain various degrees of maxillofacial injuries during a short period of time. Full article

9 pages, 492 KiB

Open AccessArticle

Craniomaxillofacial Trauma: Synopsis of 14,654 Cases with 35,129 Injuries in 15 Years

by Anna Kraft, Elisabeth Abermann, Robert Stigler, Clemens Zsifkovits, Florian Pedross, Frank Kloss and Robert Gassner

Craniomaxillofac. Trauma Reconstr. 2012, 5(1), 41-49; https://doi.org/10.1055/s-0031-1293520 - 10 Nov 2011

Cited by 58 | Viewed by 66

Abstract

Craniomaxillofacial (CMF) trauma occurs in isolation or in combination with other serious injuries, including intracranial, spinal, and upper- and lower-body injuries. It is a major cause of expensive treatment and rehabilitation requirements, temporary or lifelong morbidity, and loss of human productivity. The aim [...] Read more.

Craniomaxillofacial (CMF) trauma occurs in isolation or in combination with other serious injuries, including intracranial, spinal, and upper- and lower-body injuries. It is a major cause of expensive treatment and rehabilitation requirements, temporary or lifelong morbidity, and loss of human productivity. The aim of this study was to evaluate patterns of CMF trauma in a large patient sample within a 15-year time frame. Between 1991 and 2005, CMF trauma data were collected from 14,654 patients with 35,129 injuries at the Department of Cranio-Maxillofacial and Oral Surgery in Innsbruck, assessing a plethora of parameters such as injury type and mechanism as well as age and gender distribution over time. Three main groups of CMF trauma were evaluated: facial bone fractures, dentoalveolar trauma, and soft tissue injuries. Statistical comparisons were carried out using a chi-square test. This was followed by a logistic regression analysis to determine the impact of the five main causes for CMF injury. Older people were more prone to soft tissue lesions with a rising risk of 2.1% per year older, showing no significant difference between male and female patients. Younger patients were at higher risk of suffering from dentoalveolar trauma with an increase of 4.4% per year younger. This number was even higher (by 19.6%) for female patients. The risk of sustaining facial bone fractures increased each year by 4.6%. Male patients had a 66.4% times higher risk of suffering from this type of injury. In addition, 2550 patients (17.4%) suffered from 3834 concomitant injuries of other body parts. In summary, we observed changing patterns of CMF trauma over the last 15 years, paralleled by advances in refined treatment and management options for rehabilitation and reconstruction of patients suffering from CMF trauma. Full article

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8 pages, 494 KiB

Open AccessArticle

Personal Technique for Primary Repair of Alveolar Clefts

by Hassan A. Badran, Hazem M. Ali and Amir S. Elbarbary

Craniomaxillofac. Trauma Reconstr. 2012, 5(1), 51-58; https://doi.org/10.1055/s-0031-1293524 - 7 Nov 2011

Cited by 1 | Viewed by 53

Abstract

From 1969, the senior author (H.B.) has developed a technique for the repair of alveolar clefts during primary cheiloplasty at patient age of 3 months. The operation used palatally hinged mucoperiosteal flaps from the edges of the cleft to reconstruct the posterior and [...] Read more.

From 1969, the senior author (H.B.) has developed a technique for the repair of alveolar clefts during primary cheiloplasty at patient age of 3 months. The operation used palatally hinged mucoperiosteal flaps from the edges of the cleft to reconstruct the posterior and inferior walls of the alveolar box. The roof was reconstructed by repairing the nasal floor, and the anterior wall was reconstructed using a buccal mucosal flap from the undersurface of the lateral lip segment. Fourteen operated patients were selected to scientifically follow the long-term results of the technique. The results indicated restoration of the arch form, varying degrees of ossification in the repaired alveolar box, and eruption of canines through the repaired alveolus. One case of anterior cross-bite was observed in these selected cases. However, a limited cross-bite was present at the site of the repaired cleft in many cases. Full article

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5 pages, 215 KiB

Open AccessArticle

New Bone Formation After Ligation of the External Carotid Artery and Resection of a Large Aneurysmal Bone Cyst of the Mandible with Reconstruction: A Case Report

by Colin Perumal, Ashraf Mohamed and Avin Singh

Craniomaxillofac. Trauma Reconstr. 2012, 5(1), 59-63; https://doi.org/10.1055/s-0031-1293519 (registering DOI) - 27 Oct 2011

Cited by 3 | Viewed by 56

Abstract

The aneurysmal bone cyst (ABC) is a benign cystic and expanding osteolytic lesion consisting of bone-filled spaces of variable size, separated by connective tissue containing trabeculae of bone or osteoid tissue and osteoclast giant cells. Radiographic findings may vary from unicystic or moth-eaten [...] Read more.

The aneurysmal bone cyst (ABC) is a benign cystic and expanding osteolytic lesion consisting of bone-filled spaces of variable size, separated by connective tissue containing trabeculae of bone or osteoid tissue and osteoclast giant cells. Radiographic findings may vary from unicystic or moth-eaten radiolucencies to extensive multilocular lesions with bilateral expansion and destruction of mandibular cortices. Treatment modalities include curettage (with reported recurrences) and resection with immediate reconstruction. The main arterial and feeder vessels may be embolized to prevent profuse intraoperative blood loss and achieve a bloodless surgical field. Failed embolization may necessitate ligation of the external carotid artery of the affected side. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 5, Issue 1 (March 2012) – 9 articles

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