Craniomaxillofacial Trauma & Reconstruction

1 pages, 41 KiB

Open AccessErratum

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

by Menno Huikeshoven, Nathan Wong and Kevin L. Bush

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 167; https://doi.org/10.1055/s-0034-1372421 - 1 Jun 2014

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The publisher regrets an error with the order of the author names in the above article in Craniomaxillofacial Trauma & Reconstruction, Volume 6, Number 4, 2013. p. 237 [...] Full article

7 pages, 173 KiB

Open AccessReview

Application of Digital Anthropometry for Craniofacial Assessment

by Yasas S. N. Jayaratne and Roger A. Zwahlen

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 101-107; https://doi.org/10.1055/s-0034-1371540 - 17 Mar 2014

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Abstract

Craniofacial anthropometry is an objective technique based on a series of measurements and proportions, which facilitate the characterization of phenotypic variation and quantification of dysmorphology. With the introduction of stereophotography, it is possible to acquire a lifelike three-dimensional (3D) image of the face [...] Read more.

Craniofacial anthropometry is an objective technique based on a series of measurements and proportions, which facilitate the characterization of phenotypic variation and quantification of dysmorphology. With the introduction of stereophotography, it is possible to acquire a lifelike three-dimensional (3D) image of the face with natural color and texture. Most of the traditional anthropometric landmarks can be identified on these 3D photographs using specialized software. Therefore, it has become possible to compute new digital measurements, which were not feasible with traditional instruments. The term “digital anthropometry” has been used by researchers based on such systems to separate their methods from conventional manual measurements. Anthropometry has been traditionally used as a research tool. With the advent of digital anthropometry, this technique can be employed in several disciplines as a noninvasive tool for quantifying facial morphology. The aim of this review is to provide a broad overview of digital anthropometry and discuss its clinical applications. Full article

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4 pages, 114 KiB

Open AccessCase Report

Retained Broken Implants in the Craniomaxillofacial Skeleton

by Vigneswaran Nallathamby, Hanjing Lee, Yap Yan Lin, Jane Lim, Wei Chen Ong and Thiam-Chye Lim

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 154-157; https://doi.org/10.1055/s-0034-1371551 - 11 Mar 2014

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Abstract

Facial fracture patients are seen in a Level 1 trauma hospital. In our institution, we manage many patients with facial fractures and carry out more than 150 surgical procedures every year. Open reduction and internal fixation is our management of choice. All surgical [...] Read more.

Facial fracture patients are seen in a Level 1 trauma hospital. In our institution, we manage many patients with facial fractures and carry out more than 150 surgical procedures every year. Open reduction and internal fixation is our management of choice. All surgical procedures involve drilling of bone and implant insertion to keep the fractured bones in an anatomically reduced position to aid healing. Occasionally, drill bits used to create the pilot hole break and are embedded in the bone. We present a situation in which such an incident occurred and review the literature on retained broken implants and devices. Full article

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9 pages, 192 KiB

Open AccessReview

Current Opinions on Surgical Treatment of Fractures of the Condylar Head

by Paolo Boffano, Rodolfo Benech, Cesare Gallesio, Francesco Arcuri and Arnaldo Benech

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 92-100; https://doi.org/10.1055/s-0034-1371772 - 11 Mar 2014

Cited by 29 | Viewed by 93

Abstract

Treatment of mandibular condyle fractures is still controversial, with surgical treatment slowly becoming the preferred option. However, fractures of the condylar head (diacapitular fractures) are still treated conservatively at many institutions. Recently, more and more surgeons have begun to perform open treatment for [...] Read more.

Treatment of mandibular condyle fractures is still controversial, with surgical treatment slowly becoming the preferred option. However, fractures of the condylar head (diacapitular fractures) are still treated conservatively at many institutions. Recently, more and more surgeons have begun to perform open treatment for diacapitular fractures because it allows to restore the anatomical position of the fragments and disc, it allows an immediate functional movement of the jaw, and avoid the ankylosis of the temporomandibular joint induced by the trauma. Several techniques have been proposed to reduce and fix fractures of the condylar head, such as standard bone screws, resorbable screws, resorbable pins, and cannulated lag screws. Therefore, the aim of this article is to review the literature about the surgical treatment of fractures of the condylar head to resume the current knowledge about open treatment of such fractures. Full article

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5 pages, 322 KiB

Open AccessCase Report

Bilateral Alloplastic Prostheses for Temporomandibular Joint Reconstruction in a Patient with Ankylosing Spondylitis

by Patrício Jose de Oliveira-Neto, Erica Cristina Marchiori, Maria Candida de Almeida Lopes and Roger William Fernandes Moreira

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 149-153; https://doi.org/10.1055/s-0034-1371546 - 4 Mar 2014

Cited by 9 | Viewed by 76

Abstract

Ankylosing spondylitis (AS) or Bechterew disease is a chronic, usually progressive, systemic inflammatory joint disease, which predominantly affects the spine and sacroiliac joints. In these joints, early inflammatory changes are followed by lumbosacral pain and progressive restriction of spinal movement associated with radiologically [...] Read more.

Ankylosing spondylitis (AS) or Bechterew disease is a chronic, usually progressive, systemic inflammatory joint disease, which predominantly affects the spine and sacroiliac joints. In these joints, early inflammatory changes are followed by lumbosacral pain and progressive restriction of spinal movement associated with radiologically visible intervertebral ossification. Peripheral joint involvement occurs in 10 to 30% of patients and shows a predilection for the shoulders, knees, ankles, feet, and wrists. Temporomandibular joint (TMJ) involvement has been described, and its reported frequency varies from 11 to 35%. However, ankylosis is uncommon with a single documented case utilizing an alloplastic prosthesis for total joint replacement. A case report of bilateral ankylosis of the jaw treated with alloplastic prostheses for total TMJ replacement using a Brazilian system in a patient with AS is presented. Full article

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2 pages, 114 KiB

Open AccessCase Report

Extraction of Fronto-Orbital Shower Hook Through Transcranial Orbitotomy

by Maxwell D. Elia, Murat Gunel, Juan J. Servat and Flora Levin

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 147-148; https://doi.org/10.1055/s-0034-1371545 - 4 Mar 2014

Cited by 2 | Viewed by 44

Abstract

Transorbital foreign bodies threaten both the integrity of the globe and the brain. We present an unusual case of a penetrating right frontal lobe-orbital metallic shower hook. Extensive intracranial involvement necessitated transcranial orbitotomy allowing for the removal of the object without loss of [...] Read more.

Transorbital foreign bodies threaten both the integrity of the globe and the brain. We present an unusual case of a penetrating right frontal lobe-orbital metallic shower hook. Extensive intracranial involvement necessitated transcranial orbitotomy allowing for the removal of the object without loss of the globe. Full article

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7 pages, 299 KiB

Open AccessReview

A Diagnosis of Maxillary Sinus Fracture with Cone-Beam CT: Case Report and Literature Review

by Selmi Yardimci Yilmaz, Melda Misirlioglu and Mehmet Zahit Adisen

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 85-91; https://doi.org/10.1055/s-0034-1371550 - 4 Mar 2014

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Abstract

The purpose of this article is to present the case of maxillofacial trauma patient with maxillary sinus fracture diagnosed with cone-beam computed tomography (CBCT) and to explore the applications of this technique in evaluating the maxillofacial region. A 23-year-old male patient attempted to [...] Read more.

The purpose of this article is to present the case of maxillofacial trauma patient with maxillary sinus fracture diagnosed with cone-beam computed tomography (CBCT) and to explore the applications of this technique in evaluating the maxillofacial region. A 23-year-old male patient attempted to our clinic who had an injury at midface with complaints of swelling, numbness. The patient was examined before in emergency center but any diagnosis was made about the maxillofacial trauma. The patient re-examined clinically and radiographically. A fracture on the frontal wall of maxillary sinus is determined with the aid of CBCT. The patient consulted with the department of maxillofacial surgery and it is decided that any surgical treatment was not necessary. The emerging technique CBCT would not be the primary choice of imaging maxillofacial trauma. Nevertheless, when advantages considered this imaging procedure could be the modality of choice according to the case. Full article

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Open AccessArticle

Treatment Effects of Dexmedetomidine and Ketamine on Postoperative Analgesia After Cleft Palate Repair

by Talal A. Kayyal, Erik M. Wolfswinkel, William M. Weathers, Samantha J. Capehart, Laura A. Monson, Edward P. Buchanan and Chris D. Glover

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 131-138; https://doi.org/10.1055/s-0034-1371446 - 28 Feb 2014

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Abstract

Primary cleft palate repair may result in significant pain in the immediate postoperative period, which can lead to vigorous crying resulting in wound dehiscence and pulmonary complications. Effective pain control with opioids is the mainstay but administration on the floor has to be [...] Read more.

Primary cleft palate repair may result in significant pain in the immediate postoperative period, which can lead to vigorous crying resulting in wound dehiscence and pulmonary complications. Effective pain control with opioids is the mainstay but administration on the floor has to be countered with the complications associated with their use, chiefly respiratory depression and sedation. We retrospectively examined the efficacies of intraoperative administration of intravenous (IV) dexmedetomidine (DEX) and ketamine (KET) to prevent early postoperative pain in children undergoing primary cleft palate repair and compared the results against relevant literature. The Texas Children’s Hospital anesthesia database was queried to identify children undergoing a palatal surgery from December 2011 to December 2012. Inclusion criteria permitted completed primary palatal surgery without major complications and intraoperative administration of DEX or KET. The control group (CTRL) received no additional drug. A comprehensive literature review was performed. A total of 71 pediatric patients underwent palatal surgery during the study period with 46 patients qualifying for analysis. Although results were not significant, consistent trends were observed with regards to lower opioid requirements during the first 24 hours for both medications compared with the CTRL. KET also had shorter time to discharge. The literature review resulted in several studies supporting decreased postoperative pain end points for both DEX and KET. In our sample, DEX and KET reduced postoperative opioid requirements. KET seems to have the added benefit of a shorter hospital stay. These finding are supported in the literature. With further investigation, the addition of these drugs may serve to provide improved pain relief without over sedation in patients undergoing cleft palate repair. Full article

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5 pages, 147 KiB

Open AccessArticle

Burden of Maxillofacial Trauma at Level 1 Trauma Center

by Ruchi Pathak Kaul, Sushma Sagar, Maneesh Singhal, Abhishek Kumar, Jiten Jaipuria and Mahesh Misra

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 126-130; https://doi.org/10.1055/s-0034-1371539 - 26 Feb 2014

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Abstract

There is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide. This study was performed to evaluate the pattern of maxillofacial [...] Read more.

There is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide. This study was performed to evaluate the pattern of maxillofacial fractures, associated injuries, and treatment used at Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India, between January 2007 and June 2010. The study provides basis for establishment of trauma as major etiology of maxillofacial injuries and planning for preventive strategies. A retrospective study of patients seen and treated at JPNATC, AIIMS, New Delhi, between January 2007 and June 2010 was performed. Data extracted from patient records included etiology, age, sex, types and sites of fractures, treatment modality, and concomitant injuries. There were 795 fractures of the maxillofacial skeleton and 86 concomitant injuries from 542 patients. Road traffic accident (RTA) (56.8%) was the most common etiologic factor, followed by falls (22.3%) and fights (18.5%). The age range was from 3 to 75 years (mean, 34.7 years) with a peak incidence in the third decade with a male-to-female ratio of 3.7:1. The most common location of maxillofacial fractures was the mandible 615 (77%) and middle third 180 (23%). With regard to mandibular fractures, the body (29.6%) was the most common site, followed by the angle (24.4%), ramus (19.5%), dentoalveolar (14.6%), symphysis (11.0%), condyle (0.8%) while in the middle third, the nasal bone (36.7%) was the most common, followed by zygomatic bone (27.8), Lefort II (14.4), Lefort I (7.8%), dentoalveolar (10.0%), and Lefort III (3.3%). Majority of the patients were treated by open reduction and internal fixation (70.6). Concomitant injuries were 84 (10.8%) with orthopedic injuries accounting for the majority (63.9%). Head injury was associated in 16.3% of cases. RTA was the major etiologic factor of maxillofacial injuries in our setting and the young adult males were the main victims. Henceforth, establishment of regionalized, efficient, and focused trauma centers in various parts of the country particularly for acute trauma should be emphasized. Also, the laws regarding the precautions such as seat belts, speed limits, and traffic rules must be observed strictly to reduce the incidence of RTA. Full article

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9 pages, 505 KiB

Open AccessShort Note

Computer-Assisted Mandibular Reconstruction Using a Patient-Specific Reconstruction Plate Fabricated with Computer-Aided Design and Manufacturing Techniques

by Frank Wilde, Carl-Peter Cornelius and Alexander Schramm

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 158-166; https://doi.org/10.1055/s-0034-1371356 - 25 Feb 2014

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Abstract

We investigated the workflow of computer-assistedmandibular reconstruction that was performed with a patient-specific mandibular reconstruction plate fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM) techniques and a fibula flap. We assessed the feasibility of this technique from virtual planning to the completion of [...] Read more.

We investigated the workflow of computer-assistedmandibular reconstruction that was performed with a patient-specific mandibular reconstruction plate fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM) techniques and a fibula flap. We assessed the feasibility of this technique from virtual planning to the completion of surgery. Computed tomography (CT) scans of a cadaveric skull and fibula were obtained for the virtual simulation of mandibular resection and reconstruction using ProPlan CMF software (Materialise^®/DePuy Synthes^®). The virtual model of the reconstructed mandible provided the basis for the computer-aided design of a patient-specific reconstruction plate that was milled from titanium using a five-axis milling machine and CAM techniques. CAD/CAM techniques were used for producing resection guides for mandibular resection and cutting guides for harvesting a fibula flap. Mandibular reconstruction was simulated in a cadaveric wet laboratory. No problems were encountered during the procedure. The plate was fixed accurately to the residual bone without difficulty. The fibula segments were attached to the plate rapidly and reliably. The fusion of preoperative and postoperative CT datasets demonstrated high reconstruction precision. Computer-assisted mandibular reconstruction with CAD/CAM-fabricated patient-specific reconstruction plates appears to be a promising approach for mandibular reconstruction. Clinical trials are required to determine whether these promising results can be translated into successful practice and what further developments are needed. Full article

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4 pages, 169 KiB

Open AccessCase Report

Rapid Prototyping Technology in Orbital Floor Reconstruction: Application in Three Patients

by Christopher G. T. Lim, Duncan I. Campbell and Don M. Clucas

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 143-146; https://doi.org/10.1055/s-0034-1371080 - 25 Feb 2014

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Abstract

Rapid prototyping entails the fabrication of three-dimensional anatomical models which provide an accurate and cost-effective method to visualize complex anatomical structures. Our unit has been using this to assist in the diagnosis, planning, and preoperative titanium plate adaptation for orbital reconstruction surgery following [...] Read more.

Rapid prototyping entails the fabrication of three-dimensional anatomical models which provide an accurate and cost-effective method to visualize complex anatomical structures. Our unit has been using this to assist in the diagnosis, planning, and preoperative titanium plate adaptation for orbital reconstruction surgery following traumatic injury. The aim of this article is to demonstrate the potential clinical and cost-saving benefits of this technology. Full article

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4 pages, 75 KiB

Open AccessReview

Informed Consent in Orthognathic Surgery

by Paolo Boffano, Cesare Gallesio, Massimiliano Garzaro and Giancarlo Pecorari

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 108-111; https://doi.org/10.1055/s-0034-1371447 - 24 Feb 2014

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Abstract

Historically, the patient–doctor relationship has been based on trust. Adequately informing a patient confirms this relationship and fulfills the legal obligation of the physician to inform the patient to the best of his knowledge. Informed consent is the process of providing patients with [...] Read more.

Historically, the patient–doctor relationship has been based on trust. Adequately informing a patient confirms this relationship and fulfills the legal obligation of the physician to inform the patient to the best of his knowledge. Informed consent is the process of providing patients with the realistic and necessary information in a manner which they can understand and recall and allows them voluntarily to make an informed choice on the treatment. In this article, the current knowledge about informed consent in orthognathic surgery is reviewed and discussed. Full article

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Open AccessReview

The Delay Phenomenon: A Compilation of Knowledge Across Specialties

by Kristy Hamilton, Erik M. Wolfswinkel, William M. Weathers, Amy S. Xue, Daniel A. Hatef, Shayan Izaddoost and Larry H. Hollier, Jr.

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 112-118; https://doi.org/10.1055/s-0034-1371355 - 21 Feb 2014

Cited by 53 | Viewed by 106

Abstract

Objective: The purpose of this article is to review and integrate the available literature in different fields to gain a better understanding of the basic physiology and optimize vascular delay as a reconstructive surgery technique. Methods: A broad search of the literature was [...] Read more.

Objective: The purpose of this article is to review and integrate the available literature in different fields to gain a better understanding of the basic physiology and optimize vascular delay as a reconstructive surgery technique. Methods: A broad search of the literature was performed using the Medline database. Two queries were performed using “vascular delay”, a search expected to yield perspectives from the field of plastic and reconstructive surgery, and “ischemic preconditioning”, (IPC) which was expected to yield research on the same topic in other fields. Results: The combined searches yielded a total of 1824 abstracts. The “vascular delay” query yielded 76 articles from 1984 to 2011. The “ischemic preconditioning” query yielded 6534 articles, ranging from 1980 to 2012. The abstracts were screened for those from other specialties in addition to reconstructive surgery, analyzed potential or current uses of vascular delay in practice, or provided developments in understanding the pathophysiology of vascular delay. 70 articles were identified that met inclusion criteria and were applicable to vascular delay or ischemic preconditioning. Conclusion: An understanding of IPC’s implementation and mechanisms in other fields has beneficial implications for the field of reconstructive surgery in the context of the delay phenomenon. Despite an incomplete model of IPC’s pathways, the anti-oxidative, anti-apoptotic and anti-inflammatory benefits of IPC are well recognized. The activation of angiogenic genes through IPC could allow for complex flap design, even in poorly vascularized regions. IPC’s promotion of angiogenesis and reduction of endothelial dysfunction remain most applicable to reconstructive surgery in reducing graft-related complications and flap failure. Full article

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7 pages, 217 KiB

Open AccessArticle

Evaluation of 2.0-mm Titanium Three-Dimensional Curved Angle Strut Plate in the Fixation of Mandibular Angle Fractures—A Prospective Clinical and Radiological Analysis

by Gaurav Chhabaria, Rajshekhar Halli, Sanjay Chandan, Samir Joshi, Sneha Setiya and Anand Shah

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 119-125; https://doi.org/10.1055/s-0034-1371002 - 20 Feb 2014

Cited by 9 | Viewed by 56

Abstract

The aim of the study was to evaluate the efficacy and complication rate with use of 2.0-mm titanium three-dimensional (3D) curved angle strut plate for mandibular angle fractures. Twenty cases requiring internal fixation of the mandibular angle by 2.0-mm titanium 3D curved angle [...] Read more.

The aim of the study was to evaluate the efficacy and complication rate with use of 2.0-mm titanium three-dimensional (3D) curved angle strut plate for mandibular angle fractures. Twenty cases requiring internal fixation of the mandibular angle by 2.0-mm titanium 3D curved angle strut plates were evaluated. Postoperative clinical and radiological analyses were done on 1st, 2nd, 4th, and 6th weeks, which included wound healing, transmitted movements, difficulty in function and occlusion, and neurosensory changes, if any. Reasonable level of success in terms of immediate jaw function was noted in all cases. Transient inferior alveolar nerve dysfunction was observed in three cases, which recovered gradually in 2 months, and surgical site infection was observed in two cases, which resolved with appropriate course of antibiotics and wound care. Fixation of mandibular angle fractures with a 2.0-mm titanium 3D curved angle strut plate is predictable, expeditious, and has less complication rate. Full article

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4 pages, 294 KiB

Open AccessCase Report

Two Stage Enucleation and Deflation of a Large Unicystic Ameloblastoma with Mural Invasion in Mandible

by Ryo Sasaki, Yorikatsu Watanabe, Tomohiro Ando and Tanetaka Akizuki

Craniomaxillofac. Trauma Reconstr. 2014, 7(2), 139-142; https://doi.org/10.1055/s-0033-1364197 - 13 Jan 2014

Cited by 6 | Viewed by 84

Abstract

A treatment for strategy of unicystic ameloblastoma (UA) should be decided by its pathology type including luminal or mural type. Luminal type of UA can be treated only by enucleation alone, but UA with mural invasion should be treated aggressively like conventional ameloblastomas. [...] Read more.

A treatment for strategy of unicystic ameloblastoma (UA) should be decided by its pathology type including luminal or mural type. Luminal type of UA can be treated only by enucleation alone, but UA with mural invasion should be treated aggressively like conventional ameloblastomas. However, it is difficult to diagnose the subtype of UA by an initial biopsy. There is a possibility that the lesion is an ordinary cyst or keratocystic odontogenic tumor, leading to a possible overtreatment. Therefore, this study performed the enucleation of the cyst wall and deflation at first, and the pathological finding confirmed mural invasion into the cystic wall, leading to the second surgery. The second surgery enucleated scar tissue, bone curettage, and deflation, and was able to contribute to the reduction of the recurrence rate by removing tumor nest in scar tissue or new bone, enhancing new bone formation, and shrinking the mandibular expanding by fenestration. In this study, a large UA with mural invasion including condyle was treated by “two-stage enucleation and deflation” in a 20-year-old patient. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 7, Issue 2 (June 2014) – 15 articles

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