Craniomaxillofacial Trauma & Reconstruction

7 pages, 397 KiB

Open AccessArticle

Treatment of Edentulous Mandibular Fractures with Rigid Internal Fixation: Case Series and Literature Review

by Edgardo Franciosi, Eduardo Mazzaro, Juan Larranaga, Alfredo Rios, Pedro Picco and Marcelo Figari

Craniomaxillofac. Trauma Reconstr. 2014, 7(1), 35-41; https://doi.org/10.1055/s-0033-1364195 - 14 Jan 2014

Cited by 14 | Viewed by 61

Abstract

The aim of the study is to analyze the effectiveness of rigid internal fixation (RIF) for treating edentulous mandibular fractures. Because of the low incidence of fractures in edentulous mandible, there is no consensus of the optimal treatment for it. This study included [...] Read more.

The aim of the study is to analyze the effectiveness of rigid internal fixation (RIF) for treating edentulous mandibular fractures. Because of the low incidence of fractures in edentulous mandible, there is no consensus of the optimal treatment for it. This study included all edentulous patients with mandibular fracture diagnosis, who were treated with internal fixation at the Hospital Italiano de Buenos Aires from November 1991 to July 2011. Data such as age, gender, etiology and location of fracture, surgical approach, type of osteosynthesis used, and postoperative complications were analyzed. A total of 18 patients, 76.2 years mean age, 12 females (66.6%), presented a total of 35 mandibular fractures. The mandibular body was the most common localization of the fractures. Twenty-five fractures received surgical treatment with RIF, mainly approached extraorally. Reconstruction plates were the most common type of fixation used. Fracture reduction was considered satisfactory in 96.5%, with 22.2% of complications and 11.1% of reoperations needed. Open reduction and RIF demonstrated to be a reliable method for treating edentulous mandibular fractures. Nevertheless, there is lack of high-level recommendation publication to support this. Full article

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7 pages, 417 KiB

Open AccessCase Report

Immediate Loading of One-Piece Implants in Conjunction with a Modified Technique of Inferior Alveolar Nerve Lateralization: 10 Years Follow-Up

by Riham Eldibany and Joaquin G. Rodriguez

Craniomaxillofac. Trauma Reconstr. 2014, 7(1), 55-61; https://doi.org/10.1055/s-0033-1364198 - 13 Jan 2014

Cited by 4 | Viewed by 54

Abstract

This report describes a treatment modification for a patient presented with severely resorbed bilateral edentulous posterior mandible and mobility of the anterior teeth. There was less than 8 mm of bone between the crest of the alveolar ridge and the mandibular canal as [...] Read more.

This report describes a treatment modification for a patient presented with severely resorbed bilateral edentulous posterior mandible and mobility of the anterior teeth. There was less than 8 mm of bone between the crest of the alveolar ridge and the mandibular canal as revealed by radiographic examination. A modified technique for inferior alveolar nerve lateralization (IANL) in conjunction with ridge expansion was performed using threaded bone expanders, which allowed for better primary stability and placing longer implants. A total of four postextraction implants were in the anterior region of the mandible. The mandible received a total of nine one-piece implants to allow for immediate nonfunctional loading. The definitive ceramometallic prosthesis was delivered 3 months postoperatively. The 10 years clinical and radiographic assessment showed minimal bone resorption around osseointegrated implants. One-piece implants showed great success rate and minimal bone resorption following the modified technique of IANL and immediate implantation. Full article

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5 pages, 400 KiB

Open AccessShort Note

A Simple Method for the Repair of Frontal Sinus Fracture: The Bone Mesh Pull-Up Technique

by Massimo Robiony, Lorenzo Della Pietra, Dario Bertossi, Massimo Albanese and Arsa Fresku

Craniomaxillofac. Trauma Reconstr. 2014, 7(1), 79-83; https://doi.org/10.1055/s-0033-1364201 - 9 Jan 2014

Cited by 2 | Viewed by 69

Abstract

Accurate reduction and stable fixation are important in the treatment of frontal sinus fracture. In this article, we introduce a rapid and simple method for the treatment of frontal fractures and restoration of normal forehead contour, named the “bone mesh pull-up technique” (BMPUT). [...] Read more.

Accurate reduction and stable fixation are important in the treatment of frontal sinus fracture. In this article, we introduce a rapid and simple method for the treatment of frontal fractures and restoration of normal forehead contour, named the “bone mesh pull-up technique” (BMPUT). We describe our experience with this technique in frontal trauma cases, with emphasis on the technical aspects and clinical results of this simple method. Postoperative computed tomography scans showed adequate reduction of displaced bone fragments in all cases. Esthetic results were satisfactory and no complications related to this procedure, such as uncontrollable sinus bleeding, infection, and posterior table and brain injuries, were observed. Follow-ups ranged from 1 to 24 months, with an average of 12 months. Contour deformities were effectively restored and cosmetic results were very good. The BMPUT is a safe procedure that can be performed with minimal morbidity and offers, good access, and excellent esthetic results. Full article

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7 pages, 421 KiB

Open AccessArticle

Local Foreign-Body Reaction to Commercial Biodegradable Implants: An In Vivo Animal Study

by Amy S. Xue, John C. Koshy, William M. Weathers, Erik M. Wolfswinkel, Yoav Kaufman, Safa E. Sharabi, Rodger H. Brown, M. John Hicks and Larry H. Hollier, Jr.

Craniomaxillofac. Trauma Reconstr. 2014, 7(1), 27-33; https://doi.org/10.1055/s-0033-1364199 - 9 Jan 2014

Cited by 45 | Viewed by 76

Abstract

Biodegradable plates have been used extensively in fracture fixation since the 1960s. They rarely cause stress-protection atrophy or problems requiring secondary plate removal, common complications seen with metallic plates. However, aseptic foreign-body reactions have been reported, sometimes years after the original implantation. Both [...] Read more.

Biodegradable plates have been used extensively in fracture fixation since the 1960s. They rarely cause stress-protection atrophy or problems requiring secondary plate removal, common complications seen with metallic plates. However, aseptic foreign-body reactions have been reported, sometimes years after the original implantation. Both inadequate polymer degradation and debris accumulation have been implicated as causes. The current generation of commercial biodegradable plates is formulated to minimize this complication by altering the ratio of polylactic and polyglycolic acids. This in vivo study compares the degree of local foreign-body reaction of two commercially available resorbable plates in rabbits. Two types of biodegradable plates were examined: poly(D/L)lactide acid (PDLLA) and polylactide-co-glycolide acid (PLGA). Each plate was placed into a periosteal pericalvarial pocket created beneath the anterior or posterior scalp of a rabbit. Humane killing occurred at 3, 6, and 12 months postoperatively. Foreign-body reaction was evaluated histologically. The PDLLA plates demonstrated marked local foreign-body reactions within the implant capsule as early as 3 months after implantation, with presence of inflammatory cells and granulomatous giant cells in close association with the implant material. All local foreign-body reactions were subclinical with no corresponding tissue swelling requiring drainage. PLGA plates did not demonstrate any signs of inflammatory reactions. In addition, the PLGA plates did not appear to resorb or integrate at 12 months. Neither PDLLA nor PLGA plates demonstrated inflammation of the soft tissue or adjacent bone outside the implant capsule. In our study, the PDLLA plates demonstrated histological evidence of foreign-body reaction that is confined within the implant capsule, which was not seen with the PLGA plates. This finding may be attributable to the lack of significant resorption seen in the PLGA plates. Both PDLLA and PLGA plates were biocompatible with the rabbit tissue environment and should be considered for continued use in craniofacial, maxillofacial, and orthopedic reconstruction. Full article

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4 pages, 329 KiB

Open AccessCase Report

Open Surgical Management of an Asymptomatic Giant Frontal Sinus Osteoma

by Paolo Boffano, Emanuele Zavattero, Fabio Roccia and Guglielmo Ramieri

Craniomaxillofac. Trauma Reconstr. 2014, 7(1), 51-54; https://doi.org/10.1055/s-0033-1364200 - 8 Jan 2014

Cited by 7 | Viewed by 73

Abstract

Osteomas are benign, slow-growing tumors that arise most frequently in the craniomaxillofacial region, and in particular in correspondence of the nose and paranasal sinuses. Osteomas may be asymptomatic for a long time until they cause deformation of the bone or compress adjacent structures. [...] Read more.

Osteomas are benign, slow-growing tumors that arise most frequently in the craniomaxillofacial region, and in particular in correspondence of the nose and paranasal sinuses. Osteomas may be asymptomatic for a long time until they cause deformation of the bone or compress adjacent structures. The treatment of osteomas of the frontal sinus may involve endoscopic approach or open approach. Although endoscopic treatment is the most common approach for frontal sinus osteomas, a coronal approach combined with the use of titanium mesh may still constitute a valuable option for the reconstruction of the anterior wall of the frontal sinus. This intervention is extremely important and delicate because the restoration of the integrity of the frontal sinus is crucial for its function. The purpose of this article is to present a case of frontal sinus osteoma that was treated by a coronal approach and a titanium mesh to restore frontal sinus contour. Full article

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10 pages, 430 KiB

Open AccessArticle

Efficacy of Transcutaneous Transseptal Orbital Decompression in Treating Acute Retrobulbar Hemorrhage and a Literature Review

by Rüdiger Zimmerer, Katrin Schattmann, Harald Essig, Philipp Jehn, Marc Metzger, Horst Kokemüller, Nils-Claudius Gellrich and Frank Tavassol

Craniomaxillofac. Trauma Reconstr. 2014, 7(1), 17-26; https://doi.org/10.1055/s-0033-1356754 - 20 Nov 2013

Cited by 20 | Viewed by 85

Abstract

Decreasing visual acuity secondary to orbital trauma may be caused by sudden space-occupying or expanding intraorbital lesions, including retrobulbar hemorrhage (RBH), herniation, or swelling. RBH must be diagnosed and treated immediately. This article addresses the efficacy of transcutaneous transseptal orbital decompression in a [...] Read more.

Decreasing visual acuity secondary to orbital trauma may be caused by sudden space-occupying or expanding intraorbital lesions, including retrobulbar hemorrhage (RBH), herniation, or swelling. RBH must be diagnosed and treated immediately. This article addresses the efficacy of transcutaneous transseptal orbital decompression in a combination with a systematic review of the literature for a comparison of this method with existing treatment options. For this study the department’s database was retrospectively screened for patients with acute RBH who were treated between 2009 and 2011 using the authors’ approach. Patients presenting with RBH were classified into RBH classes I to III according to three different clinical and radiological manifestations of acute RBH. The efficacy of transcutaneous transseptal orbital decompression was assessed by postoperative visual acuities. The literature review was performed by using the MEDLINE database. The time period for the study was between 2009 and 2011 during which 10 patients were diagnosed with suspected RBH and 9 were treated with the authors’ technique. Visual acuities were reconstituted or maintained in almost 86% of patients who were diagnosed and treated according to the authors approach and who survived initial trauma. It was concluded that transcutaneous transseptal orbital decompression provides an efficient and rapid approach for treating patients with acute RBH. By distinguishing three different manifestations of acute RBH, the authors present a diagnostic tool that may facilitate classification of RBH and determination of treatment options. Full article

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7 pages, 129 KiB

Open AccessArticle

Skeletal Stability after Bilateral Sagittal Split Advancement and Setback Osteotomy of the Mandible with Miniplate Fixation

by Srinivasan Hanumantha Rao, Loganathan Selvaraj and Arathy S. Lankupalli

Craniomaxillofac. Trauma Reconstr. 2014, 7(1), 9-15; https://doi.org/10.1055/s-0033-1356763 - 20 Nov 2013

Cited by 7 | Viewed by 87

Abstract

The purpose of this study was to evaluate intraorally placed mini plates and monocortical screws in terms of postoperative skeletal stability after bilateral sagittal split advancement and setback osteotomy of the mandible. Ten patients were included in this study with five requiring advancement [...] Read more.

The purpose of this study was to evaluate intraorally placed mini plates and monocortical screws in terms of postoperative skeletal stability after bilateral sagittal split advancement and setback osteotomy of the mandible. Ten patients were included in this study with five requiring advancement (group I) and five requiring setback of the mandible (group II). Bell and Epker modified surgical technique was followed for all the patients. All the patients underwent pre- and postsurgical orthodontics. Cephalometric radiographs were taken preoperatively, immediate, 3, 6, and 12 months postoperatively. Cephalometric tracings were performed by one individual examiner using a modified burstone analysis. Statistical analysis was performed using the student paired t-test. In advancement patients, SNB (sella, Nasion, B point) angle showed relapse at 12th month postoperative period which was statistically significant (2.4 degrees). No changes were observed in anterior facial height, posterior facial height, Frankfort-mandibular incisor angle (FmiA), and overjet during the follow-up period. In setback patients, posterior facial height (p < 0.05), angles between the lower incisors and mandibular plane and pogonion had a statistically significant change position of 1.4 mm (paired t-test, p = 0.03). The SNB angle, anterior facial height, interincisal angle, and FmiA remained constant (0.8–1.2 degrees) during the follow-up period. In advancement cases, the relapse was seen from the third month postoperative period but in setback cases, the relapse was noted from the sixth month onward and the skeletal relapse in these cases were noticed cephalometrically. Full article

8 pages, 243 KiB

Open AccessCase Report

Myositis Ossificans of the Left Medial Pterygoid Muscle: Case Report and Review of the Literature of Myositis Ossificans of Masticatory Muscles

by Paolo Boffano, Emanuele Zavattero, Giovanni Bosco and Sid Berrone

Craniomaxillofac. Trauma Reconstr. 2014, 7(1), 43-50; https://doi.org/10.1055/s-0033-1356760 - 14 Nov 2013

Cited by 15 | Viewed by 61

Abstract

Myositis ossificans is a disease that is characterized by nonneoplastic, heterotopic bone formation within a muscle. Myositis ossificans traumatica, also called myositis ossificans circumscripta, is a disease in which muscles are ossified presumably following acute trauma, burns, surgical manipulation, or repeated injury. It [...] Read more.

Myositis ossificans is a disease that is characterized by nonneoplastic, heterotopic bone formation within a muscle. Myositis ossificans traumatica, also called myositis ossificans circumscripta, is a disease in which muscles are ossified presumably following acute trauma, burns, surgical manipulation, or repeated injury. It is often remitted after surgical excision though some patients have repeated recurrences. Myositis ossificans traumatica of masticatory muscles is not frequently reported in the literature, with the most common clinical finding being a progressive limitation of motion in the mandible. The aim of this article is to present and discuss a case of myositis ossificans traumatica of the left medial pterygoid muscle and to review the literature of myositis ossificans of the masticatory muscles. Full article

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7 pages, 215 KiB

Open AccessArticle

A Novel Quantitative Method for Evaluating Surgical Outcomes in Craniosynostosis: Pilot Analysis for Metopic Synostosis

by William M. Weathers, David Khechoyan, Erik M. Wolfswinkel, Kriti Mohan, Andrew Nagy, Robert J. Bollo, Edward P. Buchanan and Larry H. Hollier, Jr.

Craniomaxillofac. Trauma Reconstr. 2014, 7(1), 1-7; https://doi.org/10.1055/s-0033-1356758 - 14 Nov 2013

Cited by 28 | Viewed by 78

Abstract

Objective assessment of head shape has been an elusive goal in the management of craniosynostosis patients. Clinical judgment, craniometric indices, and computed tomography scans are the primary means through which a surgeon assesses this patient population. The purpose of this study was to [...] Read more.

Objective assessment of head shape has been an elusive goal in the management of craniosynostosis patients. Clinical judgment, craniometric indices, and computed tomography scans are the primary means through which a surgeon assesses this patient population. The purpose of this study was to examine and discuss the utility of the STARscanner for evaluation of surgical outcomes in metopic synostosis patients. A retrospective chart review of patients with metopic synostosis who underwent fronto-orbital advancement with pre- and postoperative STARscanner imaging at Texas Children’s Hospital was performed. Two patients were identified and evaluation and discussion of the data produced by the STARscanner was undertaken. A novel symmetry index created by the authors, called the anterior–posterior volume ratio (APVR), was discussed for use in metopic synostosis patients. The postoperative growth metrics demonstrated an interval increase compared with the preoperative data. The anterior symmetry ratio, posterior symmetry ratio, overall symmetry ratio, cranial vault volumes, cranial vault asymmetry index, and cephalic ratio were not found to be useful in evaluating resolution of dysmorphology after fronto-orbital advancement in metopic synostosis. The APVR does not characterize dysmorphology, but may help show degree of expansion of the anterior cranial vault after fronto-orbital advancement. The STARscanner imaging device does not appear to have significant utility in characterizing head shape for surgical outcomes assessment in metopic synostosis. The minor utility of this device may be that it is a safe and fast way to derive growth parameters for both short-term and long-term follow-up of cranial vault remodeling. Full article

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7 pages, 380 KiB

Open AccessShort Note

Management of Temporomandibular Joint Reankylosis in Syndromic Patients Corrected with Joint Prostheses: Surgical and Rehabilitation Protocols

by Luigi C. Clauser, Giuseppe Consorti, Giovanni Elia, Riccardo Tieghi and Manlio Galiè

Craniomaxillofac. Trauma Reconstr. 2014, 7(1), 71-77; https://doi.org/10.1055/s-0033-1356759 - 23 Oct 2013

Cited by 8 | Viewed by 62

Abstract

Temporomandibular joint ankylosis (TMJA) is a severe disorder described as an intracapsular union of the disc-condyle complex to the temporal articular surface with bony fusion. The management of this disability is challenging and rarely based on surgical and rehabilitation protocols. We describe the [...] Read more.

Temporomandibular joint ankylosis (TMJA) is a severe disorder described as an intracapsular union of the disc-condyle complex to the temporal articular surface with bony fusion. The management of this disability is challenging and rarely based on surgical and rehabilitation protocols. We describe the treatment in two young adults affected by Goldenhar syndrome and Pierre Robin sequence with reankylosis after previous surgical treatments. There are three main surgical procedures for the treatment of TMJA: gap arthroplasty, interpositional arthroplasty, and joint reconstruction. Various authors have described reankylosis as a frequent event after treatment. Treatment failure could be associated with surgical errors and/or inadequate intensive postoperative physiotherapy. Surgical treatment should be individually tailored and adequate postoperative physiotherapy protocol is mandatory for success. Full article

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7 pages, 416 KiB

Open AccessShort Note

Three-Dimensional Volumetric Restoration by Structural Fat Grafting

by Luigi C. Clauser, Giuseppe Consorti, Giovanni Elia, Manlio Galié and Riccardo Tieghi

Craniomaxillofac. Trauma Reconstr. 2014, 7(1), 63-69; https://doi.org/10.1055/s-0033-1356757 - 23 Oct 2013

Cited by 8 | Viewed by 61

Abstract

The use of adipose tissue transfer for correction of maxillofacial defects was reported for the first time at the end of the 19th century. Structural fat grafting (SFG) was introduced as a way to improve facial esthetics and in recent years has evolved [...] Read more.

The use of adipose tissue transfer for correction of maxillofacial defects was reported for the first time at the end of the 19th century. Structural fat grafting (SFG) was introduced as a way to improve facial esthetics and in recent years has evolved into applications in craniomaxillofacial reconstructive surgery. Several techniques have been proposed for harvesting and grafting the fat. However, owing to the damage of many adipocytes during these maneuvers, the results have not been satisfactory and have required several fat injection procedures for small corrections. The author’s (L.C.) overview the application of SFG in the management of volumetric deficit in the craniomaxillofacial in patients treated with a long-term follow-up. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 7, Issue 1 (March 2014) – 11 articles

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