Craniomaxillofacial Trauma & Reconstruction

9 pages, 822 KiB

Open AccessArticle

Complication of Anterior Iliac Bone Graft Harvesting in 372 Adult Patients from May 2006 to May 2011 and a Literature Review

by Manar Almaiman, Hamed H. Al-Bargi and Paul Manson

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 257-265; https://doi.org/10.1055/s-0033-1357510 - 7 Oct 2013

Cited by 63 | Viewed by 99

Abstract

Autogenous bone graft from the iliac is considered the gold standard graft material in maxillofacial surgery. The common and the rare complications associated with harvesting bone from anterior iliac crest were reviewed; we recommend a safe technique to avoid these complications. A retrospective [...] Read more.

Autogenous bone graft from the iliac is considered the gold standard graft material in maxillofacial surgery. The common and the rare complications associated with harvesting bone from anterior iliac crest were reviewed; we recommend a safe technique to avoid these complications. A retrospective analysis of 372 adult patients who had undergone anterior iliac bone graft harvesting from May 2006 to May 2011. The patients age range from 21 to 63 years. Out of the 372 patients, 200 were male with age range from 21 to 63 years and 172 were female with age range from 22 to 59 years. Two major complications (fracture and seroma) occurred, a fracture of the anterior superior iliac spine was observed in two patients (0.538%); one male and one female. One female patient (0.269%) developed seroma. One minor complication occurred in three patients (0.806%); one female and two females who suffered from temporary sensory disturbance. All patients (100%) suffered pain maximum for the first 15 days postoperative. In our study; the morbidity after anterior iliac bone graft harvesting was found to be low due to the technique, utilizing the proper instruments, gentle and minimal mobilization of the graft. Full article

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6 pages, 289 KiB

Open AccessCase Report

Use of a Three-Dimensional Model to Optimize a MEDPOR Implant for Delayed Reconstruction of a Suprastructure Maxillectomy Defect

by Anthony Echo, Erik M. Wolfswinkel, William Weathers, Aisha McKnight and Shayan Izaddoost

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 275-280; https://doi.org/10.1055/s-0033-1356762 - 26 Sep 2013

Cited by 5 | Viewed by 58

Abstract

The use of a three-dimensional (3-D) model has been well described for craniomaxillofacial reconstruction, especially with the preoperative planning of free fibula flaps. This article reports the application of an innovative 3-D model approach for the calculation of the exact contours, angles, length, [...] Read more.

The use of a three-dimensional (3-D) model has been well described for craniomaxillofacial reconstruction, especially with the preoperative planning of free fibula flaps. This article reports the application of an innovative 3-D model approach for the calculation of the exact contours, angles, length, and general morphology of a prefabricated MEDPOR 2/3 orbital implant for reconstruction of a suprastructure maxillectomy defect. The 3-D model allowed intraoperative modification of the MEDPOR implant which decreased the risk of iatrogenic harm, contamination while also improving aesthetic results and function. With the aid of preoperative 3-D models, porous polypropylene facial implants can be contoured efficiently intraoperatively to precisely reconstruct complex craniomaxillofacial defects. Full article

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4 pages, 83 KiB

Open AccessArticle

Assessment of Masticatory Function Using Bite Force Measurements in Patients Treated for Mandibular Fractures

by Deborah Sybil and K. Gopalkrishnan

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 247-250; https://doi.org/10.1055/s-0033-1356755 - 26 Sep 2013

Cited by 17 | Viewed by 73

Abstract

Bite force measurements are excellent criteria for assessment of masticatory efficiency. The purpose of this study was to assess the effect of mandibular fractures on the bite forces of patients treated for such fractures. Patients who were surgically treated for isolated mandibular fractures [...] Read more.

Bite force measurements are excellent criteria for assessment of masticatory efficiency. The purpose of this study was to assess the effect of mandibular fractures on the bite forces of patients treated for such fractures. Patients who were surgically treated for isolated mandibular fractures in the Department of Oral and Maxillofacial Surgery from January 2006 to December 2007 were included in the study. Patients were asked to bite on a bite force transducer on the first, fourth, sixth, and ninth postoperative weeks. The bite force values were compared with those of age, sex, and weight-matched controls. A total of 60 patients were included in the study. It was found that maximum bite forces in patients were significantly less than in controls for several weeks after surgery. After the ninth postoperative week, the maximum bite force measured <65% the normal in patients with isolated angle fractures and >80% the normal in patients with isolated parasymphysis fractures. The same values reduced to <60% in patients with fractures of angle and parasymphysis and <70% in patients with fractures of parasymphysis and condylar complex. An inverse relationship was found between the bite force values and the number of fractures of the mandible. We also found lower bite forces and longer period for normalization in patients who had fractures in those regions of the mandible which are more significantly associated with the masticatory apparatus for example angle or condyle of the mandible. Full article

5 pages, 174 KiB

Open AccessArticle

Ratio of Simple Versus Comminuted Lateral Wall Fractures of the Orbit

by Ruth J. Barta and Warren Schubert

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 241-245; https://doi.org/10.1055/s-0033-1356761 - 24 Sep 2013

Cited by 2 | Viewed by 55

Abstract

Reduction of a fracture may be relatively easy with a simple, noncomminuted fracture along the zygomaticofrontal suture, zygomaticomaxillary buttress, or the inferior rim of the orbit. When one or more of these key landmarks is comminuted, it becomes more important to confirm that [...] Read more.

Reduction of a fracture may be relatively easy with a simple, noncomminuted fracture along the zygomaticofrontal suture, zygomaticomaxillary buttress, or the inferior rim of the orbit. When one or more of these key landmarks is comminuted, it becomes more important to confirm that the fracture commonly seen between the greater wing of the sphenoid and the zygoma is properly repositioned. The zygomaticosphenoidal suture is an excellent landmark with a simple lateral orbital wall fracture (LOWF), but it may not be reliable in patients with a comminuted fracture. The purpose of this study is to determine the frequency that the lateral orbital wall (LOW) is a reliable landmark in the reduction of a zygoma fracture by determining the ratio between simple versus comminuted LOWF. To identify 100 patients with a LOWF, the authors reviewed consecutive midface computed tomography images of 877 patients performed over a 25-month period from one of our city's primary Level I trauma and teaching hospitals. A total of 121 LOWF were identified in 100 patients. In 60.3% of cases the facture was a simple, noncomminuted LOWF. In 39.7% of cases the fracture was comminuted (p = 0.023). Simple LOWF are significantly more common than comminuted fractures. In 39.7% of fractures the LOW is comminuted. This suggests that there are many fractures in which other modalities may be much more important to use to confirm the proper reduction of the zygoma. Full article

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3 pages, 66 KiB

Open AccessArticle

Nasofrontal Outflow Tract Visibility in Computed Tomography Imaging of Frontal Sinus Fractures

by Kevin Bush, Menno Huikeshoven and Nathan Wong

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 237-239; https://doi.org/10.1055/s-0033-1349214 - 24 Sep 2013

Cited by 2 | Viewed by 85

Abstract

The choice of frontal sinus fracture treatment is based on multiple factors, one of which is injury to the nasofrontal outflow tract (NFOT). Computed tomography (CT) imaging of the NFOT can play an important role in the decision process. We sought to assess [...] Read more.

The choice of frontal sinus fracture treatment is based on multiple factors, one of which is injury to the nasofrontal outflow tract (NFOT). Computed tomography (CT) imaging of the NFOT can play an important role in the decision process. We sought to assess the visibility of the NFOT on CT scans in frontal sinus fractures. Patients with frontal sinus fractures (including the posterior table) receiving a CT scan from 1 April 2001 to 31 December 2009 were included. Scans were retrospectively assessed for available views (axial, coronal, and sagittal), slice thickness, inclusion of the anatomical NFOT region in the scanned area, and visibility of the NFOT. A total of 170 patients were included. In majority (71%) of patients NFOT was visible on one or more views, whereas in 33% (N = 56) of patients had three complete views (complete anatomical NFOT region scanned in three views). In this subgroup, the ability to assess the NFOT increased to 89%. When selecting patients with three complete views of ≤ 2 mm slice thickness (N = 47), the ability to assess the NFOT increased to 96%. In conclusion, when assessing the NFOT using CT imaging, having three complete views (axial, coronal, and sagittal) and a ≤ 2 mm slice thickness greatly increases the NFOT visibility. Full article

4 pages, 310 KiB

Open AccessArticle

Tunneling Technique for Expedited Fibula Free Tissue Harvest

by Yadranko Ducic, Robert DeFatta, Erik M. Wolfswinkel, William M. Weathers and Larry H. Hollier, Jr.

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 233-236; https://doi.org/10.1055/s-0033-1349208 - 16 Sep 2013

Viewed by 53

Abstract

Free fibula transfer can be associated with a slow and tedious dissection/harvest due to difficulty in visualizing the deeper structures. The purpose of this article is to review the first author's (Y.D.) experience with a novel technique for expedited harvest of fibula free [...] Read more.

Free fibula transfer can be associated with a slow and tedious dissection/harvest due to difficulty in visualizing the deeper structures. The purpose of this article is to review the first author's (Y.D.) experience with a novel technique for expedited harvest of fibula free flaps for mandibular reconstruction. A retrospective chart review was performed using the first author's clinical practice using chart data from September 1997 to August of 2007. All patients with available chart data who had undergone free fibular transfer for oromandibular reconstruction were included in this study. Charts that met the specified inclusion criteria were reviewed for patient demographic information, reason for free tissue transfer, flap loss rates (partial and total) and reasons for flap loss, average fibula harvest time (tourniquet time), and foot and ankle function postoperatively. During this time, a total of 283 fibula free flaps were performed in 276 patients. The average fibula harvest time (tourniquet time) for all cases was 22.6 minutes, with a range of 14 to 29 minutes. A total of 13 flaps were unsuccessful (failure rate of 4.6%, with 5 total and 8 partial flap losses). This newly described technique will allow for expedited and simplified harvest of fibula free flaps. Full article

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3 pages, 139 KiB

Open AccessTechnical Note

Use of a Mandibular Plate to Maintain Intergonial Width in a Partially Edentulous Patient Undergoing Mandibular Symphysis Reconstruction

by Srinivas Susarla, Paul E. Gordon, Ali R. Attarpour, Jonathan M. Winograd and Zachary S. Peacock

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 281-283; https://doi.org/10.1055/s-0033-1349207 - 13 Sep 2013

Cited by 1 | Viewed by 63

Abstract

One of the most challenging and essential aspects of management of patients with traumatic or ablative deformities involving the mandibular symphysis is maintenance of intergonial width. Classically, the use of occlusal splints has been a simple and cost-effective solution to this problem. Patients [...] Read more.

One of the most challenging and essential aspects of management of patients with traumatic or ablative deformities involving the mandibular symphysis is maintenance of intergonial width. Classically, the use of occlusal splints has been a simple and cost-effective solution to this problem. Patients who are edentulous, the use of Gunning splints with circummandibular wires is an alternative strategy. In the present report, we describe the use of a mandibular fixation plate for maintenance of intergonial width in an edentulous patient with a postablative mandibular symphysis defect. Full article

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7 pages, 139 KiB

Open AccessArticle

Analysis of Pediatric Facial Dog Bites

by Henry H. Chen, Anna T. Neumeier, Brett W. Davies and Vikram D. Durairaj

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 225-231; https://doi.org/10.1055/s-0033-1349211 - 3 Sep 2013

Cited by 48 | Viewed by 117

Abstract

The aim of this study was to characterize and report the epidemiological data regarding pediatric facial dog bites. For this study, a retrospective chart review was used. This study was performed at a large tertiary pediatric hospital. All children younger than 18 years [...] Read more.

The aim of this study was to characterize and report the epidemiological data regarding pediatric facial dog bites. For this study, a retrospective chart review was used. This study was performed at a large tertiary pediatric hospital. All children younger than 18 years who sought medical attention after a facial dog bite between January 1, 2003, and December 31, 2008, were included. Demographic and epidemiologic data were collected and analyzed. A total of 537 children were identified. The average age was 4.59 ± 3.36 years, with a slight male preponderance (52.0%). The majority of dog bites occurred in children 5 years of age or younger (68.0%). Almost all (89.8%) of the dogs were known to the children. When circumstances surrounding the bite were documented, over half (53.2%) of the cases were provoked. The most common breeds were mixed breed (23.0%), Labrador retriever (13.7%), Rottweiler (4.9%), and German shepherd (4.4%). Inpatient treatment was required in 121 (22.5%) patients with an average length of stay of 2.96 ± 2.77 days. Children 5 years or younger were more likely to be hospitalized than older children. Children 5 years old and younger are at high risk for being bitten in the face by a familiar dog and are more likely to require hospitalization than older children. Certain dog breeds are more likely to bite, and there is often a history of provocation. There is a tremendous financial and psychosocial burden associated with dog bites, and prevention strategies should focus on education with the aid of public policies and better documentation and reporting systems. Full article

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3 pages, 91 KiB

Open AccessArticle

Utility of Computed Tomography Scans in Predicting Need for Surgery in Nasal Injuries

by Benjamin E. Peterson and Timothy D. Doerr

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 221-223; https://doi.org/10.1055/s-0033-1349206 - 3 Sep 2013

Cited by 4 | Viewed by 57

Abstract

In many centers, computed tomography (CT) scan is preferred over plain film radiographs in the setting of acute nasal injury because CT scan is thought to be more sensitive in predicting nasal bone fracture. However, the usefulness of CT scans in predicting the [...] Read more.

In many centers, computed tomography (CT) scan is preferred over plain film radiographs in the setting of acute nasal injury because CT scan is thought to be more sensitive in predicting nasal bone fracture. However, the usefulness of CT scans in predicting the need for surgery in acute nasal injury has not been well-studied. We conducted a retrospective review of 232 patients with known nasal bone fracture and found very similar rates of surgery in patients with a diagnosis of nasal fracture by CT scan as by nasal radiographs (41 and 37%, respectively). This suggests that experienced clinical examination remains the gold standard for determining the need for surgery in isolated nasal trauma, regardless of CT findings. Full article

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3 pages, 125 KiB

Open AccessCase Report

Pseudoaneurysm of the Internal Maxillary Artery: A Rare Complication of Condylar Fracture

by Sujata Mohanty, Ujjwal Gulati and Sanjeev Kathuria

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 271-273; https://doi.org/10.1055/s-0033-1349209 - 30 Aug 2013

Cited by 9 | Viewed by 73

Abstract

Pseudoaneurysms are among very rare complications of maxillofacial trauma. When encountered, they have the potential to cause life-threatening hemorrhage. A wise surgeon should consider the possibility of underlying aneurysm even if the classic sign of pulsatile mass is not present. The role of [...] Read more.

Pseudoaneurysms are among very rare complications of maxillofacial trauma. When encountered, they have the potential to cause life-threatening hemorrhage. A wise surgeon should consider the possibility of underlying aneurysm even if the classic sign of pulsatile mass is not present. The role of interventional radiology is immaculate in the management of these aneurysms. Full article

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3 pages, 114 KiB

Open AccessCase Report

Facial Gel Complication After Dental Injection: A Case Report

by Fereydoun Pourdanesh, Shahin Shams and Hasan Mir Mohammad Sadeghi

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 267-269; https://doi.org/10.1055/s-0033-1349204 - 29 Aug 2013

Cited by 1 | Viewed by 60

Abstract

Injectable gel is becoming increasingly popular for cosmetic reasons. The polyacrylamide gel (PAAG) is a permanent filler material used worldwide. In spite of the fact that the filler materials used today are considered quite safe, various complications have been reported in the literature. [...] Read more.

Injectable gel is becoming increasingly popular for cosmetic reasons. The polyacrylamide gel (PAAG) is a permanent filler material used worldwide. In spite of the fact that the filler materials used today are considered quite safe, various complications have been reported in the literature. Hence PAAG use in the United States is not popular. As the area is very close to the dental field, a large complication potential is relatively considered following buccal dental injections. The aim of this article is to highlight a rare complication observed following a local anesthetic administration of a simple molar restoration in a healthy 33-year-old woman who had history of a filler augmentation in her cheek approximately 6 years ago. Full article

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6 pages, 502 KiB

Open AccessArticle

Screw-Wire Osteo-Traction: An Adjunctive or Alternative Method of Anatomical Reduction of Multisegment Midfacial Fractures? A Description of Technique and Prospective Study of 40 Patients

by Barry O'Regan, Maria Devine and Sats Bhopal

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 215-220; https://doi.org/10.1055/s-0033-1349212 - 29 Aug 2013

Cited by 1 | Viewed by 50

Abstract

Stable anatomical fracture reduction and segment control before miniplate fixation can be difficult to achieve in comminuted midfacial fractures. Fracture mobilization and reduction methods include Gillies elevation, malar hook, and Dingman elevators. No single method is used universally. Disadvantages include imprecise segment alignment [...] Read more.

Stable anatomical fracture reduction and segment control before miniplate fixation can be difficult to achieve in comminuted midfacial fractures. Fracture mobilization and reduction methods include Gillies elevation, malar hook, and Dingman elevators. No single method is used universally. Disadvantages include imprecise segment alignment and poor segment stability/control. We have employed screw-wire osteo-traction (SWOT) to address this problem. A literature review revealed two published reports. The aims were to evaluate the SWOT technique effectiveness as a fracture reduction method and to examine rates of revision fixation and plate removal. We recruited 40 consecutive patients requiring open reduction and internal fixation of multisegment midfacial fractures (2009–2012) and employed miniplate osteosynthesis in all patients. SWOT was used as a default reduction method in all patients. The rates of successful fracture reduction achieved by SWOT alone or in combination and of revision fixation and plate removal, were used as outcome indices of the reduction method effectiveness. The SWOT technique achieved satisfactory anatomical reduction in 27/40 patients when used alone. Other reduction methods were also used in 13/40 patients. No patient required revision fixation and three patients required late plate removal. SWOT can be used across the midface fracture pattern in conjunction with other methods or as a sole reduction method before miniplate fixation. Full article

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6 pages, 318 KiB

Open AccessArticle

Branching Pattern of the Extraosseous Mental Nerve in a Kenyan Population

by Poonamjeet Kaur Loyal, Fawzia Butt and Julius Alexander Ogeng'o

Craniomaxillofac. Trauma Reconstr. 2013, 6(4), 251-256; https://doi.org/10.1055/s-0033-1356756 - 8 Aug 2013

Cited by 1 | Viewed by 65

Abstract

Knowledge of the branching pattern of the mental nerve is an important consideration during placement of tooth implants and reconstructive plates. It is known to display population variations and data for the same is scarce form the sub-Saharan region. With the recent increase [...] Read more.

Knowledge of the branching pattern of the mental nerve is an important consideration during placement of tooth implants and reconstructive plates. It is known to display population variations and data for the same is scarce form the sub-Saharan region. With the recent increase in surgical interventions in the mandibular region in Kenya, a detailed description of mental nerve is warranted. A total of 64 mental nerves were dissected and branching pattern was noted. Single mental nerve was present in 60 (93.7%) cadavers while double mental nerves occurred in 3 (4.7%) and accessory in 1 (1.6%). Most common pattern was bifurcation (39%) followed by trifurcation (34%), single (19%), and quadrification (8%). The double and triple branches were seen to further divide into two to three subbranches with diverse patterns. Side symmetry in branching was seen in four (6.25%). These are important anatomical considerations during placement of reconstructive plates for mandibular trauma and administration of mental nerve blocks. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 6, Issue 4 (December 2013) – 13 articles

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