Craniomaxillofacial Trauma & Reconstruction

10 pages, 704 KiB

Open AccessCase Report

Investigation of Severe Craniomaxillofacial Battle Injuries Sustained by U.S. Service Members: A Case Series

by Pamela R. Brown Baer, Joseph C. Wenke, Steven J. Thomas and Colonel Robert G. Hale

Craniomaxillofac. Trauma Reconstr. 2012, 5(4), 243-252; https://doi.org/10.1055/s-0032-1329542 - 5 Nov 2012

Cited by 11 | Viewed by 36

This case series describes craniomaxillofacial battle injuries, currently available surgical techniques, and the compromised outcomes of four service members who sustained severe craniomaxillofacial battle injuries in Iraq or Afghanistan. Demographic information, diagnostic evaluation, surgical procedures, and outcomes were collected and detailed with a [...] Read more.

This case series describes craniomaxillofacial battle injuries, currently available surgical techniques, and the compromised outcomes of four service members who sustained severe craniomaxillofacial battle injuries in Iraq or Afghanistan. Demographic information, diagnostic evaluation, surgical procedures, and outcomes were collected and detailed with a follow-up of over 2 years. Reconstructive efforts with advanced, multidisciplinary, and multiple revision procedures were indicated; the full scope of conventional surgical options and resources were utilized. Patients experienced surgical complications, including postoperative wound dehiscence, infection, flap failure, inadequate mandibular healing, and failure of fixation. These complications required multiple revisions and salvage interventions. In addition, facial burns complicated reconstructive efforts by delaying treatment, decreasing surgical options, and increasing procedural numbers. All patients, despite multiple surgeries, continue to have functional and aesthetic deficits as a result of their injuries. Currently, no conventional treatments are available to satisfactorily reconstruct the face severely ravaged by explosive devices to an acceptable level, much less to natural form and function. Full article

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4 pages, 344 KiB

Open AccessCase Report

A Rare Case of Multiple Oblique Facial Clefts with Supernumerary Teeth: Case Report

by Manikandhan Ramanathan, Ananthnarayanan Parameswaran, Naveen Jayakumar, Pendem Sneha and H. F. Sailer

Craniomaxillofac. Trauma Reconstr. 2012, 5(4), 239-242; https://doi.org/10.1055/s-0032-1329541 - 2 Nov 2012

Cited by 4 | Viewed by 65

Abstract

Oblique facial clefts are rare congenital anomalies that can present alone or in association with other craniofacial anomalies. A high degree of clefting in the embryo may lead to hyperdontia secondary to dichotomy of the dental lamina. Multiple facial clefts with hyperdontia are [...] Read more.

Oblique facial clefts are rare congenital anomalies that can present alone or in association with other craniofacial anomalies. A high degree of clefting in the embryo may lead to hyperdontia secondary to dichotomy of the dental lamina. Multiple facial clefts with hyperdontia are clinically challenging and demand comprehensive rehabilitation. This article reports a case of multiple oblique facial clefts of variable severity with multiple supernumerary teeth in a 12-year-old boy. The varied clinical presentation along with the rarity of the occurrence mandate documentation. Full article

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2 pages, 133 KiB

Open AccessShort Note

Soft Tissue Coverage for Mandibular Fractures Using Two Miniplates

by Ajul Shah, Anup Patel and Derek Steinbacher

Craniomaxillofac. Trauma Reconstr. 2012, 5(4), 253-254; https://doi.org/10.1055/s-0032-1329543 - 23 Oct 2012

Cited by 2 | Viewed by 51

Abstract

Recent reports have raised the concern that the two miniplate fixation technique for mandibular symphysis and body fractures may lead to greater complications than previously thought. However, it is possible that the surgical exposure and methods of soft tissue closure may be a [...] Read more.

Recent reports have raised the concern that the two miniplate fixation technique for mandibular symphysis and body fractures may lead to greater complications than previously thought. However, it is possible that the surgical exposure and methods of soft tissue closure may be a major contributor to plate exposure. In this article, we detail a technique for vascularized tissue coverage of the hardware used to repair these mandibular fractures. We believe that this soft tissue coverage is crucial for minimizing complications associated with plate fixation. Full article

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4 pages, 80 KiB

Open AccessArticle

An Analysis of Malar Fat Volume in Two Age Groups: Implications for Craniofacial Surgery

by Christina L. Corey, Gerald R. Popelka, Jose E. Barrera and Sam P. Most

Craniomaxillofac. Trauma Reconstr. 2012, 5(4), 231-234; https://doi.org/10.1055/s-0032-1329545 - 22 Oct 2012

Cited by 8 | Viewed by 51

Abstract

Objective: To evaluate how malar fat pad (MFP) volumes vary with age, after controlling for gender and body mass index (BMI). Study Design: A prospective case–control study evaluating volume of the MFP in women of two age groups. Methods: Soft tissue dimensions were [...] Read more.

Objective: To evaluate how malar fat pad (MFP) volumes vary with age, after controlling for gender and body mass index (BMI). Study Design: A prospective case–control study evaluating volume of the MFP in women of two age groups. Methods: Soft tissue dimensions were measured in eight subjects using magnetic resonance imaging. A multiplanar localizing sequence, followed in sagittal and coronal orientations using a turbo spin echo sequence, was performed to define the MFP. Volumetric calculations were then performed using a 3D image analysis application (Dextroscope, Volume Interactions, Republic of Singapore) to circumscribe areas, orient dimensions, and calculate volumes of the MFP. Results: These data reveal no significant difference in the mean (standard deviation) right MFP (p = 0.50), left MFP (p = 0.41), or total MFP (p = 0.45) volumes when comparing the two age groups. In addition, these data indicate that there was no correlation between age and total MFP volume (Pearson correlation coefficient 0.27). Moreover, there was no correlation between age and the ratio of total volume/BMI (Pearson correlation coefficient −0.18). Conclusions: Although the sample size of this study was small, these data indicate that ptosis of midfacial fat is more important than volume loss inmidfacial aging. These data would suggest repositioning as the primary modality for craniofacial reconstruction. Full article

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7 pages, 291 KiB

Open AccessArticle

Radiomorphometric Quantitative Analysis of Vasculature Utilizing Micro-Computed Tomography and Vessel Perfusion in the Murine Mandible

by Xi Lin Jing, Aaron S. Farberg, Laura A. Monson, Alexis Donneys, Catherine N. Tchanque-Fossuo and Steven R. Buchman

Craniomaxillofac. Trauma Reconstr. 2012, 5(4), 223-229; https://doi.org/10.1055/s-0032-1329540 - 22 Oct 2012

Cited by 8 | Viewed by 54

Abstract

Purpose: Biomechanical, densitometric, and histological analyses have been the mainstay for reproducible outcome measures for investigation of new bone formation and osseous healing. Here we report the addition of radiomorphometric vascular analysis as a quantitative measure of vascularity in the murine mandible. To [...] Read more.

Purpose: Biomechanical, densitometric, and histological analyses have been the mainstay for reproducible outcome measures for investigation of new bone formation and osseous healing. Here we report the addition of radiomorphometric vascular analysis as a quantitative measure of vascularity in the murine mandible. To our knowledge this is the first description of using micro–computed tomography (micro-CT) to evaluate the temporal and spatial pattern of angiogenesis in the craniofacial skeleton. Methods: The vessel perfusion technique was performed on 10 Sprague-Dawley rats using Microfil (MV-122, Flow Tech; Carver, MA). After decalcification, hemimandibles were imaged using high-resolution micro-CT. Six separate radiomorphometric vascular metrics were calculated. Results: Radiomorphometric values were analyzed using three different thresholds on micro-CT. Experimentally, 1000 Hounsfield units was found to be the optimal threshold for analysis to capture the maximal vascular content of the bone. Data from seven hemimandibles were analyzed. Minimal statistical variance in each of the quantitative measures of vascularity resulted in reproducible metrics for each of the radiomorphometric parameters. Conclusions: We have demonstrated that micro-CT vascular imaging provides a robust methodology for evaluation of vascular networks in the craniofacial skeleton. This technique provides 3D quantitative data analysis that differs significantly from laser Doppler and microsphere methods, which simply measure flow. This technique is advantageous over labor-intensive 2D conventional analyses using histology and X-ray microangiography. Our data establish the appropriate thresholding for optimal vascular analyses and provide baseline measurements that can be used to analyze the role of angiogenesis in bone regeneration and repair in the craniofacial skeleton. Full article

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10 pages, 261 KiB

Open AccessArticle

Global Trends in Maxillofacial Fractures

by Kai Lee

Craniomaxillofac. Trauma Reconstr. 2012, 5(4), 213-222; https://doi.org/10.1055/s-0032-1322535 - 18 Oct 2012

Cited by 75 | Viewed by 75

Abstract

Background: The etiology, demographics, fracture site in facial injury patients have been reported worldwide. However, few studies have attempted to identify changes in maxillofacial fractures over time periods and between countries. The statistics are vastly different due to variations in social, environmental, and [...] Read more.

Background: The etiology, demographics, fracture site in facial injury patients have been reported worldwide. However, few studies have attempted to identify changes in maxillofacial fractures over time periods and between countries. The statistics are vastly different due to variations in social, environmental, and cultural factors. Methods: Data were collected from departmental records between 1996 and 2006 for patients treated at Christchurch Hospital for facial fractures. Variables examined included incidence, demographics, site of fracture, and treatment methods. Results: A total of 2563 patients presented during the study period, 1158 patients in the first half and 1404 patients in the second half. Male-to-female ratio was 4:1 in both periods and males in 16- to 30-year group accounted for about half of all patients. Interpersonal violence was themost common cause of injuries, and there was a decrease in injuries caused by motor vehicle accidents. Approximately half of all patients required hospitalization and surgery, and the most common method of treatment was open reduction and internal fixation. Conclusion: Maxillofacial fracture is a common injury in young males following interpersonal violence in New Zealand. Studies in other countries and over different time periods yield interesting differences in the etiology, demographics, and fractures patterns. These are due to environmental, societal, cultural, and legislative differences. Full article

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8 pages, 252 KiB

Open AccessReview

Maxillofacial Trauma in Central Karnataka, India: An Outcome of 95 Cases in a Regional Trauma Care Centre

by Rajay A. D. Kamath, Shiva Bharani, Reshma Hammannavar, Sumit P. Ingle and Ankit G. Shah

Craniomaxillofac. Trauma Reconstr. 2012, 5(4), 197-204; https://doi.org/10.1055/s-0032-1322536 - 31 Jul 2012

Cited by 19 | Viewed by 57

Abstract

Materials and Methods: A 6-year retrospective analysis of 111 patients treated for maxillofacial fractures in Davangere, Karnataka from January 2004 to December 2009 was performed. Variables like age, gender, occupation, type of fracture andmechanism of injury, concomitant injury, mode of treatment, and complications [...] Read more.

Materials and Methods: A 6-year retrospective analysis of 111 patients treated for maxillofacial fractures in Davangere, Karnataka from January 2004 to December 2009 was performed. Variables like age, gender, occupation, type of fracture andmechanism of injury, concomitant injury, mode of treatment, and complications were recorded and assessed. Results: Men between 21 and 30 years were mostly affected (male-to-female ratio = 10:1; age range = 17.60 years; mean 31.7 ± 9.8 [standard deviation]). Most fractures were caused by road traffic accidents (RTAs; 74.7%), followed by interpersonal violence (IPV; 15.8%), falls (4.2%), industrial hazards and animal attacks (2.1% each), and self-inflicted injury (1.1%). Forty-two cases were isolated zygomaticomaxillary complex (ZMC) fractures. The total number of facial fractures documented was 316, of which 222 were purely related to the ZMC; however, 11 were confined only to the midface. Fiftythree cases had concomitant lower jaw fractures, totaling 83. Ophthalmic injuries occurred in 30.52% of cases. Ninety-two cases were treated with open reduction and internal fixation (ORIF), and three cases were managed conservatively. The complication rate observed was 25.26%. Conclusion: RTA continues to be the chief etiological factor in maxillofacial injury with males being affected predominantly. IPV and falls next contribute significantly to the incidence of such injuries. Concomitant injuries, however, require prompt recognition and appropriate management. ORIF still remains the mainstay of treatment; however, fixation devices are constantly being improved upon in an attempt to reduce immobilization time thereby facilitating early return to function with minimal morbidity. Nevertheless, future advances in maxillofacial trauma diagnosis and management are likely to reduce associated morbidity. Full article

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7 pages, 580 KiB

Open AccessArticle

Free Flap Reconstruction for Complex Scalp and Forehead Defects with Associated Full-Thickness Calvarial Bone Resections

by Juan Larrañaga, Alfredo Rios, Edgardo Franciosi, Eduardo Mazzaro and Marcelo Figari

Craniomaxillofac. Trauma Reconstr. 2012, 5(4), 205-211; https://doi.org/10.1055/s-0032-1322534 - 26 Jul 2012

Cited by 18 | Viewed by 44

Abstract

Extensive defects of the scalp and forehead associated with calvarial bone resections demand complex reconstructions. Free flaps offer vascularized tissue of excellent quality and quantity. We report six patients with extensive scalp and forehead defects associated with calvarial bone resections reconstructed with free [...] Read more.

Extensive defects of the scalp and forehead associated with calvarial bone resections demand complex reconstructions. Free flaps offer vascularized tissue of excellent quality and quantity. We report six patients with extensive scalp and forehead defects associated with calvarial bone resections reconstructed with free flaps. Five patients also required a cranioplasty. The flaps used were two anterolateral thigh flaps, one vastus lateralis flap, one myocutaneous latissimus dorsi flap, one latissimus dorsi flap, and one radial forearm flap. All flaps survived with no partial necrosis. There were no donor site complications. One patient presented an exposure of the alloplastic material used for cranioplasty. We strongly recommend the use of free flaps for this kind of reconstruction. Full article

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3 pages, 115 KiB

Open AccessCase Report

Iatrogenic Oculocardiac Reflex in a Patient with Head Injury

by Panagiotis Stathopoulos, Michael Mezitis, George Kostakis and George Rallis

Craniomaxillofac. Trauma Reconstr. 2012, 5(4), 235-237; https://doi.org/10.1055/s-0032-1322532 - 24 Jul 2012

Cited by 1 | Viewed by 39

Abstract

A 16-year-old girl with a history of a recent fall from the third floor was transferred to the emergency room. On presentation, the patient, who had sustained multiple facial fractures, was in clinical shock with a blood pressure 80/40 mm Hg, heart rate [...] Read more.

A 16-year-old girl with a history of a recent fall from the third floor was transferred to the emergency room. On presentation, the patient, who had sustained multiple facial fractures, was in clinical shock with a blood pressure 80/40 mm Hg, heart rate 130/min, tachypnea (>30/min), PO₂ 50 mm Hg, and SO₂ 82%, and she was intubated for airway protection. Severe nasal hemorrhage was detected (hematocrit: 22%), therefore a bilateral anteroposterior balloon nasal catheter was inserted and inflated with air. Bleeding was controlled. A few minutes later, her heart rate dropped to 40/min. Atropine was administered intravenously and the rate increased to 60/min. Computed tomography of the head revealed brain and subarachnoid hemorrhage, multiple fractures of the facial skeleton, and a round foreign body, full of air, compressing the left eye. The medial wall and the floor of the ipsilateral orbit were also fractured, establishing a naso-orbital communication. The left catheter was immediately removed. Heart rate was restored to normal. Facial fractures were addressed surgically. Patient's vision is intact. Full article

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7 pages, 332 KiB

Open AccessReview

Salivary Gland Trauma: A Review of Diagnosis and Treatment

by Maria Lazaridou, Christos Iliopoulos, Kostas Antoniades, Ioannis Tilaveridis, Ioannis Dimitrakopoulos and Nicolas Lazaridis

Craniomaxillofac. Trauma Reconstr. 2012, 5(4), 189-195; https://doi.org/10.1055/s-0032-1313356 - 6 Jul 2012

Cited by 35 | Viewed by 100

Abstract

Salivary gland trauma is uncommon. Parotid gland and duct injuries are far more common than injuries to submandibular and sublingual glands due to anatomic position. Several methods of treating salivary duct injuries and their complications have been advocated. Optimal treatment outcomes can be [...] Read more.

Salivary gland trauma is uncommon. Parotid gland and duct injuries are far more common than injuries to submandibular and sublingual glands due to anatomic position. Several methods of treating salivary duct injuries and their complications have been advocated. Optimal treatment outcomes can be achieved with early diagnosis, adequate evaluation, and proper management. This article presents current diagnostic and treatment protocols of salivary gland trauma. The anatomy of the salivary glands is briefly described and clinical cases are also presented to illustrate the treatment options described. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 5, Issue 4 (December 2012) – 10 articles

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