Craniomaxillofacial Trauma & Reconstruction

4 pages, 254 KiB

Open AccessArticle

A Giant Pleomorphic Adenoma of the Submandibular Salivary Gland: A Case Report

by Colin J. Perumal, Mark Meyer and Ashraf Mohamed

Craniomaxillofac. Trauma Reconstr. 2012, 5(3), 185-188; https://doi.org/10.1055/s-0032-1322530 - 27 Jul 2012

Cited by 12 | Viewed by 86

The most common benign salivary gland tumor is the pleomorphic adenoma (PA). They can attain grotesque proportions and weigh several kilograms. They can cause facial disfigurement and, if untreated, could lead to airway compromise. We report a case of a large PA arising [...] Read more.

The most common benign salivary gland tumor is the pleomorphic adenoma (PA). They can attain grotesque proportions and weigh several kilograms. They can cause facial disfigurement and, if untreated, could lead to airway compromise. We report a case of a large PA arising from the left submandibular salivary gland in a 20-year-old black female. The lesion measured ∼16 × 15 ×12 cm. Full article

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10 pages, 547 KiB

Open AccessArticle

The Nasal Artery Musculomucosal Cutaneous Flap in Difficult Palatal Fistula Closure

by Percy Rossell-Perry and Hector Mondragon Arrascue

Craniomaxillofac. Trauma Reconstr. 2012, 5(3), 175-184; https://doi.org/10.1055/s-0032-1322533 - 27 Jul 2012

Cited by 9 | Viewed by 59

Abstract

Background: After cleft palate repair is performed, oronasal fistulas are potential consequences with resultant regurgitation of fluid and food, hearing loss, and velopharyngeal insufficiency. Treatment of oronasal fistulas is a challenge for plastic surgeons especially when the fistulas are large and scarring is [...] Read more.

Background: After cleft palate repair is performed, oronasal fistulas are potential consequences with resultant regurgitation of fluid and food, hearing loss, and velopharyngeal insufficiency. Treatment of oronasal fistulas is a challenge for plastic surgeons especially when the fistulas are large and scarring is significant. The facial artery musculomucosal (FAMM) flap, introduced by Pribaz in 1992, is a reliable and useful procedure for the closure of wide palatal fistulas. A new modification of facial artery composite flap is presented here including a skin component that avoids extended procedures for nasal layer reconstruction and reduces the mucosal component size. The flap described here is the nasal arterymusculomucosal (NAMMC) flap; the main blood supply comes from the lateral nasal artery, a terminal branch of facial artery. Methods: We present a series of anteriorly and posteriorly based NAMMC flaps, which were used to close large palatal fistulas after cleft palate repair in 12 patients. Results: All flaps were successful. One flap had an anterior wound dehiscence in a bilateral case, and we have seen no total flap failure or postoperative palatal fistulas. The aesthetic appearance of the skin donor site was acceptable in all cases. Conclusions: The NAMMC flap is a good alternative for closing wide and recurrent fistulas. It is associated with a high rate of success. The traditional FAMM flap should be named as “nasal (lateral) artery musculomucosal flap” because the distal branch of the facial artery is the main blood supply of the flap. Full article

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5 pages, 385 KiB

Open AccessArticle

Ameloblastic Carcinoma of the Maxilla with Extension into the Ethmoidal Air Cells and Close Proximity to the Anterior Skull Base: A Rare Case Presentation

by Colin J. Perumal

Craniomaxillofac. Trauma Reconstr. 2012, 5(3), 169-173; https://doi.org/10.1055/s-0032-1322531 - 26 Jul 2012

Cited by 4 | Viewed by 42

Abstract

A case of an ameloblastic carcinoma with extension to the anterior skull base as a result of prolonged misdiagnosis is being presented. Radical surgery and radiotherapy was performed due to involvement of the ethmoidal air sinuses and close proximity to the cranial fossa. [...] Read more.

A case of an ameloblastic carcinoma with extension to the anterior skull base as a result of prolonged misdiagnosis is being presented. Radical surgery and radiotherapy was performed due to involvement of the ethmoidal air sinuses and close proximity to the cranial fossa. Diagnostic tests showed no evidence of metastasis. The patient was treated with surgery, adjuvant radiotherapy, and prosthetic rehabilitation. Full article

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8 pages, 254 KiB

Open AccessArticle

A Review of Literature on Ameloblastoma in Children and Adolescents and a Rare Case Report of Ameloblastoma in a 3-Year-Old Child

by Zainab Chaudhary, Sriram Krishnan, Pankaj Sharma, Rakesh Sharma and Priya Kumar

Craniomaxillofac. Trauma Reconstr. 2012, 5(3), 161-168; https://doi.org/10.1055/s-0032-1313358 - 9 Jul 2012

Cited by 10 | Viewed by 83

Abstract

A rare case report of a plexiform unicystic ameloblastoma in a 3-year-old girl stimulated us to conduct a review of literature to understand the correlation of this tumor with various factors such as that of age, sex, histopathological correlation, and its incidence rates [...] Read more.

A rare case report of a plexiform unicystic ameloblastoma in a 3-year-old girl stimulated us to conduct a review of literature to understand the correlation of this tumor with various factors such as that of age, sex, histopathological correlation, and its incidence rates pertaining to children and adolescent population. This is a case report of ameloblastoma in a 3-year-old patient, along with a literature review of ameloblastoma in relation to age. A computerized literature search using Medline was conducted for published articles on treatment of ameloblastoma. MeSH phrases used in search were ameloblastoma AND age; ameloblastoma AND children. The search was restricted to published articles from 1970 to 2010, as the histological features were not clearly defined until 1st edition of WHO histological classification of odontogenic tumors of 1971, search parameter was also set to select literatures under English language only. An additional systematic hand search was also conducted simultaneously to identify other published articles, considering similar parameters as used for Medline search. Most of search result yielded literatures in which primary importance were given to treatment patterns and prognosis of intervention, there were not much specific article or meta analysis which reviewed on the affected age range of ameloblastoma exclusively. We reviewed the identified literatures with patients’ age, case numbers, incidence, sex, location, and histopathology. The statistical data collected were exported to SPSS 16.0 for windows software which performed a descriptive analysis giving an average mean age of 14.1 years (range from 4 to 20); with maximum mean age being 16.0 and minimum mean age being 10.8 with standard deviation of 1.60. Majority of lesions 91.86% (327 of 356) were found between the age group of 11 and 20 years, only 8.14% (29 of 356) were below the age of 10 years. This rare case report highlights occurrence of plexiform unicystic ameloblastoma in maxilla of a 3-year-old girl, which is very much incongruent with the various review of literature on ameloblastoma in children and adolescents. We have emphasized the significance of patient's age and histopathological pattern of the tumor as it has its influence on the treatment plan. However, there is much of research needed with focus in respect to age, histological pattern, and treatment outcomes. Full article

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15 pages, 877 KiB

Open AccessArticle

The Versatility of the Tongue Flap in the Closure of Palatal Fistula

by Sathish M. S. Vasishta, Gopal Krishnan, Y. S. Rai and Anil Desai

Craniomaxillofac. Trauma Reconstr. 2012, 5(3), 145-159; https://doi.org/10.1055/s-0032-1313352 - 5 Jul 2012

Cited by 25

Abstract

Aims: Tongue flaps were introduced for intraoral reconstruction by Lexer in 1909. A retrospective study was performed in the Department of Oral and Maxillofacial Surgery, S.D.M. College of Dental Sciences (Dharwad, India), to assess the use of tongue flap in closure of palatal [...] Read more.

Aims: Tongue flaps were introduced for intraoral reconstruction by Lexer in 1909. A retrospective study was performed in the Department of Oral and Maxillofacial Surgery, S.D.M. College of Dental Sciences (Dharwad, India), to assess the use of tongue flap in closure of palatal fistula. Material and Methods: A total of 40 patients treated for palatal fistulas were included in this study from the period of 1 January 2000, to 1 January 2007; fistulas present in anterior and midpalate were considered. Patients' preoperative photographs, clinical records, and preoperative speech analysis were recorded. Following completion of fistula closure, patients were assessed over 6 months to check flap viability, fistula closure, residual tongue function, aesthetics, and speech impediment. Results: A total of 40 (24male and 16 female) patients with palatal fistulas were treated with tongue flap in our study. Six patients were 4 to 6 years old, three were 7 to 10 years old, and 22 were 11 to 20 years old, which accounts for 68% of study subjects. There were nine patients 21 to 30 years old. In the early postoperative period, we encountered bleeding in one patient and sloughing in one patient. There are three recurrences, and two flaps were detached; all remaining cases showed satisfactory healing, and donor site morbidity was minimal. No speech deficits were evident. Conclusion: Tongue flaps are used in cleft palate surgery because of their excellent vascularity, and the large amount of tissue that they provide has made tongue flaps particularly appropriate for the repair of large fistulas in palates scarred by previous surgery. Full article

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7 pages, 295 KiB

Open AccessArticle

Imaging, Virtual Planning, Design, and Production of Patient-Specific Implants and Clinical Validation in Craniomaxillofacial Surgery

by Per Dérand III, Lars-Erik Rännar and Jan-M. Hirsch

Craniomaxillofac. Trauma Reconstr. 2012, 5(3), 137-143; https://doi.org/10.1055/s-0032-1313357 - 5 Jun 2012

Cited by 76 | Viewed by 133

Abstract

The purpose of this article was to describe the workflow from imaging, via virtual design, to manufacturing of patient-specific titanium reconstruction plates, cutting guide and mesh, and its utility in connection with surgical treatment of acquired bone defects in the mandible using additive [...] Read more.

The purpose of this article was to describe the workflow from imaging, via virtual design, to manufacturing of patient-specific titanium reconstruction plates, cutting guide and mesh, and its utility in connection with surgical treatment of acquired bone defects in the mandible using additive manufacturing by electron beam melting (EBM). Based on computed tomography scans, polygon skulls were created. Following that virtual treatment plans entailing free microvascular transfer of fibula flaps using patient-specific reconstruction plates, mesh, and cutting guides were designed. The design was based on the specification of a Compact UniLOCK 2.4 Large (Synthes^®, Switzerland). The obtained polygon plates were bent virtually round the reconstructed mandibles. Next, the resections of the mandibles were planned virtually. A cutting guide was outlined to facilitate resection, as well as plates and titanium mesh for insertion of bone or bone substitutes. Polygon plates and meshes were converted to stereolithography format and used in the software Magics for preparation of input files for the successive step, additive manufacturing. EBM was used to manufacture the customized implants in a biocompatible titanium grade, Ti6Al4V ELI. The implants and the cutting guide were cleaned and sterilized, then transferred to the operating theater, and applied during surgery. Commercially available software programs are sufficient in order to virtually plan for production of patient-specific implants. Furthermore, EBM-produced implants are fully usable under clinical conditions in reconstruction of acquired defects in the mandible. A good compliance between the treatment plan and the fit was demonstrated during operation. Within the constraints of this article, the authors describe a workflow for production of patient-specific implants, using EBM manufacturing. Titanium cutting guides, reconstruction plates for fixation of microvascular transfer of osteomyocutaneous bone grafts, and mesh to replace resected bone that can function as a carrier for bone or bone substitutes were designed and tested during reconstructive maxillofacial surgery. A clinically fit, well within the requirements for what is needed and obtained using traditional free hand bending of commercially available devices, or even higher precision, was demonstrated in ablative surgery in four patients. Full article

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9 pages, 509 KiB

Open AccessArticle

Does the Relationship Between Retained Mandibular Third Molar and Mandibular Angle Fracture Exist? An Assessment of Three Possible Causes

by Bruno G. Duarte, Diogo Assis, Paulo Ribeiro-Júnior and Eduardo Sanches Gonçales

Craniomaxillofac. Trauma Reconstr. 2012, 5(3), 127-135; https://doi.org/10.1055/s-0032-1313355 - 5 Jun 2012

Cited by 6 | Viewed by 48

Abstract

The objective of this study is to discuss problems associated with dental retention through three clinical cases of mandible fractures related to the presence of retained lower third molars, emphasizing the possibility of mandible fractures resulting from this or from the extraction procedure. [...] Read more.

The objective of this study is to discuss problems associated with dental retention through three clinical cases of mandible fractures related to the presence of retained lower third molars, emphasizing the possibility of mandible fractures resulting from this or from the extraction procedure. The three evaluated patients had a fracture in the mandible angle. The third molars were present in all the cases, as was the relationship of the fracture with the teeth. After evaluating the three cases and reviewing literature, it is believed that the presence of the retained lower third molars and the surgical procedures for their extraction increase the risk of mandible angle fractures. Full article

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4 pages, 217 KiB

Open AccessArticle

Stabilization of Mobile Mandibular Segments in Mandibular Reconstruction: Use of Spanning Reconstruction Plate

by Yan Lin Yap, Jane Lim, Wei Chen Ong, Matthew Yeo, Hanjing Lee and Thiam Chye Lim

Craniomaxillofac. Trauma Reconstr. 2012, 5(3), 123-126; https://doi.org/10.1055/s-0032-1313354 - 5 Jun 2012

Cited by 3 | Viewed by 53

Abstract

The fibular free flap is the gold standard for mandibular reconstruction. Accurate 3-dimensional contouring and precise alignment of the fibula is critical for reestablishing native occlusion and facial symmetry. Following segmental mandibulectomy, the remaining mandibular fragments become freely mobile. Various stabilization methods including [...] Read more.

The fibular free flap is the gold standard for mandibular reconstruction. Accurate 3-dimensional contouring and precise alignment of the fibula is critical for reestablishing native occlusion and facial symmetry. Following segmental mandibulectomy, the remaining mandibular fragments become freely mobile. Various stabilization methods including external fixation, intermaxillary fixation, and preplating with reconstruction plate have been used. We describe a modification to the preplating technique. After wide resection of buccal squamous cell carcinoma, our patient had an 11-cm mandibular defect from the angle of the left mandible to the right midparasymphyseal region. A single 2.0-mm Unilock^® (Synthes, Singapore) plate was used to span the defect. This was placed on the vestibular aspect of the superior border of the mandibular remnants before resection. Segmental mandibulectomy was then performed with the plate removed. The spanning plate was then reattached to provide rigid fixation. The fibular bone was contoured with a single osteotomy and reattached. The conventional technique involves molding of the plate at the inferior border of the mandible. This is time-consuming and not possible in patients with distorted mandibular contour. It is also difficult to fit the osteotomized fibula to the contoured plate. In comparison, the superiorly positioned spanning plate achieve rigid fixation of the mandible while leaving the defect completely free and unhampered by hardware, allowing space for planning osteotomies and easier fixation of the neomandible. Using this modified technique, we are able to recreate the original mandibular profile with ease. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 5, Issue 3 (September 2012) – 8 articles

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