Craniomaxillofacial Trauma & Reconstruction

4 pages, 239 KiB

Open AccessArticle

Variations in Emergence and Course of the Inferior Palpebral Nerve

by Joseph Nderitu, Fawzia Butt and Hassan Saidi

Craniomaxillofac. Trauma Reconstr. 2014, 7(3), 233-236; https://doi.org/10.1055/s-0034-1374062 - 22 May 2014

Cited by 4 | Viewed by 78

Comprehensive understanding of the anatomy of the inferior palpebral (IP) nerve is crucial to preservation of sensation in the inferior eyelid and conjunctiva. Iatrogenic injuries may occur during blepharoplasty, repair of orbitozygomatic fracture and other maxillofacial surgeries involving this region. Although several studies [...] Read more.

Comprehensive understanding of the anatomy of the inferior palpebral (IP) nerve is crucial to preservation of sensation in the inferior eyelid and conjunctiva. Iatrogenic injuries may occur during blepharoplasty, repair of orbitozygomatic fracture and other maxillofacial surgeries involving this region. Although several studies depict the anatomical variations of the main infraorbital nerve (ION), little information exclusive to the IP nerve exists. This study provides information on the additional variations of the ION with reference to the IP nerve. The study was performed on 84 IP nerves by dissection of 42 formalin-fixed cadavers from the laboratory of topographic anatomy, Department of Human Anatomy, University of Nairobi, Kenya. Each of the nerves were exposed at the emergence and followed to their termination. Variations encountered involved emergence, course, and even absence. Variant emergence was through an accessory infraorbital foramen, an infraorbital notch, and as a common trunk with the external nasal nerve. This nerve shows high anatomical variability that may account for the difficulties and complications encountered in clinical interventions. It is believed that this information will improve clinical management of conditions affecting the region of distribution of the IP nerve. Full article

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15 pages, 424 KiB

Open AccessReview

Management of Carotid Artery Trauma

by Thomas S. Lee, Yadranko Ducic, Eli Gordin and David Stroman

Craniomaxillofac. Trauma Reconstr. 2014, 7(3), 175-189; https://doi.org/10.1055/s-0034-1372521 - 22 May 2014

Cited by 71 | Viewed by 268

Abstract

With increased awareness and liberal screening of trauma patients with identified risk factors, recent case series demonstrate improved early diagnosis of carotid artery trauma before they become problematio. There remains a need for unified screening criteria for both intracranial and extracranial carotid trauma. [...] Read more.

With increased awareness and liberal screening of trauma patients with identified risk factors, recent case series demonstrate improved early diagnosis of carotid artery trauma before they become problematio. There remains a need for unified screening criteria for both intracranial and extracranial carotid trauma. In the absence of contraindications, antithrombotic agents should be considered in blunt carotid artery injuries, as there is a significant risk of progression of vessel injury with observation alone. Despite CTA being used as a common screening modality, it appears to lack sufficient sensitivity. DSA remains to be the gold standard in screening. Endovascular techniques are becoming more widely accepted as the primary surgical modality in the treatment of blunt extracranial carotid injuries and penetrating/blunt intracranial carotid lessions. Nonetheless, open surgical approaches are still needed for the treatment of penetrating extracranial carotid injuries and in patients with unfavorable lesions for endovascular intervention. Full article

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6 pages, 276 KiB

Open AccessReview

Transconjunctival Inferior Orbitotomy: Indications, Surgical Technique, and Complications

by Brett W. Davies, Eric M. Hink and Vikram D. Durairaj

Craniomaxillofac. Trauma Reconstr. 2014, 7(3), 169-174; https://doi.org/10.1055/s-0034-1374063 - 22 May 2014

Cited by 14 | Viewed by 86

Abstract

Surgical access to the inferior orbit can be accomplished through either a transcutaneous or transconjunctival incision. The preferred approach should provide adequate surgical exposure with the fewest adverse effects. The purpose of this article is to review the literature on the transconjunctival incision [...] Read more.

Surgical access to the inferior orbit can be accomplished through either a transcutaneous or transconjunctival incision. The preferred approach should provide adequate surgical exposure with the fewest adverse effects. The purpose of this article is to review the literature on the transconjunctival incision and to discuss the indications and complications of the approach. The authors also discuss their preferred technique and provide a step-by-step instruction. The transconjunctival approach provides good surgical access with a low incidence of complications and a better aesthetic outcome than transcutaneous approaches. Full article

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9 pages, 249 KiB

Open AccessArticle

Incidence, Etiology, and Patterns of Maxillofacial Fractures in Ain-Shams University, Cairo, Egypt: A 4-Year Retrospective Study

by Amr Mabrouk, Hesham Helal, Abdel Rahman Mohamed and Nada Mahmoud

Craniomaxillofac. Trauma Reconstr. 2014, 7(3), 224-232; https://doi.org/10.1055/s-0034-1374061 - 21 May 2014

Cited by 20 | Viewed by 80

Abstract

Although there is a worldwide increase in maxillofacial trauma incidence; the pattern and etiology of these injuries varies from one country to another depending on socioeconomic, cultural, and environmental factors. This study aims to realize the epidemiological characteristics of maxillofacial fractures in our [...] Read more.

Although there is a worldwide increase in maxillofacial trauma incidence; the pattern and etiology of these injuries varies from one country to another depending on socioeconomic, cultural, and environmental factors. This study aims to realize the epidemiological characteristics of maxillofacial fractures in our department. A retrospective cross-sectional study of all facial trauma patients admitted to our department during 2009 to 2012. Patients’ data including gender, age, etiology of trauma, the pattern and demographic distribution of fractures of maxillofacial skeleton, and associated injuries were analyzed and compared with previously published data. The chi-square test was used with a p value of less than 0.05, which was considered statistically significant. There is a significant increase in maxillofacial fractures incidence in the past 2 years than former ones. There is a male predominance with highest incidence in the age group of 20 to 40 years. Road traffic accident is the most common etiological factor followed by violence. There is increase in mandibular fracture incidence compared with midface. The significant increased incidence of maxillofacial fracture due to motor car accidents and assaults in the past 2 years reflects a behavioral change within the community. Full article

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2 pages, 127 KiB

Open AccessCase Report

Interesting Case: Displacement of Fractured Maxilla into Pharyngeal Space

by Balasubramanian Krishnan, Pradipta Kumar Parida and Surianarayanan Gopalakrishnan

Craniomaxillofac. Trauma Reconstr. 2014, 7(3), 249-250; https://doi.org/10.1055/s-0034-1375170 - 18 Apr 2014

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Abstract

Atypical fracture patterns of the facial region have been reported infrequently. An unusual displacement of fractured posterior maxillary segment into the lateral pharyngeal space is described. Full article

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6 pages, 280 KiB

Open AccessArticle

A Biomechanical Comparison of Three 1.5-mm Plate and Screw Configurations and a Single 2.0-mm Plate for Internal Fixation of a Mandibular Condylar Fracture

by Peter Aquilina, William C.H. Parr, Uphar Chamoli, Stephen Wroe and Philip Clausen

Craniomaxillofac. Trauma Reconstr. 2014, 7(3), 218-223; https://doi.org/10.1055/s-0034-1375172 - 18 Apr 2014

Cited by 6 | Viewed by 89

Abstract

The most stable pattern of internal fixation for mandibular condyle fractures is an area of ongoing discussion. This study investigates the stability of three patterns of plate fixation using readily available, commercially pure titanium implants. Finite element models of a simulated mandibular condyle [...] Read more.

The most stable pattern of internal fixation for mandibular condyle fractures is an area of ongoing discussion. This study investigates the stability of three patterns of plate fixation using readily available, commercially pure titanium implants. Finite element models of a simulated mandibular condyle fracture were constructed. The completed models were heterogeneous in bone material properties, contained approximately 1.2 million elements and incorporated simulated jaw adducting musculature. Models were run assuming linear elasticity and isotropic material properties for bone. No human subjects were involved in this investigation. The stability of the simulated condylar fracture reduced with the different implant configurations, and the von Mises stresses of a 1.5-mm X-shaped plate, a 1.5-mm rectangular plate, and a 1.5-mm square plate (all Synthes (Synthes GmbH, Zuchwil, Switzerland) were compared. The 1.5-mm X plate was the most stable of the three 1.5-mm profile plate configurations examined and had comparable mechanical performance to a single 2.0-mm straight four-hole plate. This study does not support the use of rectangular or square plate patterns in the open reduction and internal fixation of mandibular condyle fractures. It does provide some support for the use of a 1.5-mm X plate to reduce condylar fractures in selected clinical cases. Full article

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5 pages, 251 KiB

Open AccessArticle

Versatility of Adipofascial Anterolateral Thigh Flap for Reconstruction of Maxillary Defects with Infratemporal Fossa Extension

by Vikram D. Kekatpure, Naveen Hedne, Sachin Chavre, Vijay Pillai, Nirav Trivedi and Moni Abraham Kuriakose

Craniomaxillofac. Trauma Reconstr. 2014, 7(3), 213-217; https://doi.org/10.1055/s-0034-1371973 - 24 Mar 2014

Cited by 4 | Viewed by 68

Abstract

Tumors arising from the posterior hard palate or posterolateral maxilla may extend to involve the infratemporal fossa (ITF). Resection of these tumors results in infrastructural maxillectomy with ITF defects. In this study, we describe the use of an adipofascial anterolateral thigh flap (ALT) [...] Read more.

Tumors arising from the posterior hard palate or posterolateral maxilla may extend to involve the infratemporal fossa (ITF). Resection of these tumors results in infrastructural maxillectomy with ITF defects. In this study, we describe the use of an adipofascial anterolateral thigh flap (ALT) specifically for such defects. This case series includes four patients who underwent an infrastructure maxillectomy with ITF clearance and the resultant defects were reconstructed using adipofascial anterolateral thigh flaps. The complications as well as the functional outcomes were assessed. This study included patients with lesions involving the hard palate, posterolateral part of maxilla with extension into the ITF. The mean flap dimension was 150 cm² (range, 120–180 cm²). All flaps were harvested based on a single perforator. The flap was used to obliterate the ITF defect and also to achieve oroantral separation. All flaps mucosalized well within 6 weeks. All patients were on oral diet and had adequate mouth opening. There were no donor-site complications. Adipofascial ALT is an excellent choice for infrastructural maxillectomy defects with ITF extension. The intraoral part got mucosalized well and provided a smooth and taut surface. A large adipofascial tissue flap helps obliterate the ITF, thus minimizing complications. Full article

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10 pages, 487 KiB

Open AccessArticle

Managing the Frontal Sinus in the Endoscopic Age: Has the Endoscope Changed the Algorithm?

by Robert Kellman and Parul Goyal

Craniomaxillofac. Trauma Reconstr. 2014, 7(3), 203-212; https://doi.org/10.1055/s-0034-1371773 - 19 Mar 2014

Cited by 10 | Viewed by 60

Abstract

Management of fractures involving the frontal sinus seems to be more complex than merely obtaining an ideal reduction of the bony injuries. Multiple articles on the management of these fractures suggest that a great deal of controversy persists despite many years of surgical [...] Read more.

Management of fractures involving the frontal sinus seems to be more complex than merely obtaining an ideal reduction of the bony injuries. Multiple articles on the management of these fractures suggest that a great deal of controversy persists despite many years of surgical experience. The question posed in this article is whether or not the advent of endoscopic approaches has changed or should change the approaches/algorithms used in the management of these challenging fractures. It is the conclusion of these authors that endoscopic techniques can indeed allow us to change the algorithm for management of frontal sinus trauma. New algorithms are proposed that should provide guidance to craniomaxillofacial surgeons treating these injuries in the endoscopic age. Full article

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4 pages, 352 KiB

Open AccessCase Report

Subclavicular Pectoralis Major Myocutaneous Flap for Optimal Reconstruction of Large Orbitozygomatic Defects: A Case Report

by Lorena Pingarron, Julian Ruiz, Juan Rey, Lourdes Maniegas, Silvia Roson and Dolores Martinez

Craniomaxillofac. Trauma Reconstr. 2014, 7(3), 245-248; https://doi.org/10.1055/s-0034-1371975 - 17 Mar 2014

Cited by 1 | Viewed by 56

Abstract

Since the introduction of microvascular free flaps, the pectoralis major myocutaneous flap (PMMF) has been relegated to background for most reconstructive surgeons. The objective of this article is to show the advantages of cervicofacial defects reconstruction with PMMF using the subclavicular plane route [...] Read more.

Since the introduction of microvascular free flaps, the pectoralis major myocutaneous flap (PMMF) has been relegated to background for most reconstructive surgeons. The objective of this article is to show the advantages of cervicofacial defects reconstruction with PMMF using the subclavicular plane route in a challenging clinical case. An 83-year-old man presented with cutaneous temporomalar lesion with orbital spread. Tumor resection was performed, including 12 × 11 cm skin and subcutaneous tissue, overlying zygomatic and malar bone, and orbital exenteration. Radical parotidectomy and functional neck dissection were performed. PMMF was chosen as reconstructive option routing the pedicle to the subclavicular plane. The length of the pedicle was 31 cm. The subclavicular route for PMMF increases the flap's length and arc of rotation compared with the conventional supraclavicular one. This procedure decreases the bulk of the PMMF pedicle which makes it functionally and cosmetically favorable. By using this modification, we may widen the “safe” reconstructive possibilities. Full article

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8 pages, 407 KiB

Open AccessCase Report

Orbital Fracture Leading to Severe Multifascial Space Infection Including the Parapharyngeal Space: A Report of a Case and Review of the Literature

by Chan Park, Erica Marchiori, Jacob Barber and Curtis Cardon

Craniomaxillofac. Trauma Reconstr. 2014, 7(3), 237-244; https://doi.org/10.1055/s-0034-1371974 - 17 Mar 2014

Cited by 1 | Viewed by 61

Abstract

Orbital trauma can result in periorbital and orbital infections. Orbital infections have been classified by Chandler et al in 1970 to their anatomic location and boundaries. This case report describes a patient who developed a severe orbital infection following orbital fractures. The infection [...] Read more.

Orbital trauma can result in periorbital and orbital infections. Orbital infections have been classified by Chandler et al in 1970 to their anatomic location and boundaries. This case report describes a patient who developed a severe orbital infection following orbital fractures. The infection progressed to the parapharyngeal space. The patient required multiple incision and drainage surgeries and tissue debridements to have clinical resolution. To our knowledge, there has not been a case described in the literature of an orbital infection progressing to the parapharyngeal space. A literature review of orbital trauma leading to infection discusses the pathogenesis of the infections. This case demonstrates that close clinical follow-up and appropriate medical management of comorbidities that put a patient at higher risk of developing an infection is of the utmost importance in the treatment of maxillofacial trauma patients. Full article

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6 pages, 136 KiB

Open AccessArticle

Survey of Common Practices Among Oculofacial Surgeons in the Asia-Pacific Region: Management of Orbital Floor Blowout Fractures

by Victor Koh, Nathalie Chiam and Gangadhara Sundar

Craniomaxillofac. Trauma Reconstr. 2014, 7(3), 197-202; https://doi.org/10.1055/s-0034-1371774 - 17 Mar 2014

Cited by 12 | Viewed by 58

Abstract

A web-based anonymous survey was performed to assess common practices of oculofacial surgeons in the management of traumatic orbital floor blowout fractures. A questionnaire which contained questions on several controversial topics in the management of orbital floor fractures was sent out via e-mail [...] Read more.

A web-based anonymous survey was performed to assess common practices of oculofacial surgeons in the management of traumatic orbital floor blowout fractures. A questionnaire which contained questions on several controversial topics in the management of orbital floor fractures was sent out via e-mail to 131 oculofacial surgeons in 14 countries in the Asia-Pacific region. A total response rate of 58.3% was achieved from May to December 2012. The preferred time for surgical intervention was within 2 weeks for adult patients, porous polyethylene implant was the most popular choice, and most surgeons preferred the transconjunctival approach. Postoperatively, diplopia was the most commonly encountered complication and most oculofacial surgeons reviewed their patients regularly for up to 12 months. We report the results of the first survey of oculofacial surgeons within the Asia-Pacific region on the management of orbital floor blowout fractures. Compared with previous surveys (from year 2000 to 2004), the duration to surgical intervention was comparable but there was a contrasting change in preferred surgical approach and choice of orbital implant. Full article

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7 pages, 400 KiB

Open AccessArticle

Reconstruction of Irradiated Mandible After Segmental Resection of Osteoradionecrosis—A Technique Employing a Microvascular Latissimus Dorsi Flap and Subsequent Particulate Iliac Bone Grafting

by Soren Hillerup, Jens Jorgen Elberg, Jens Jorgen Thorn and Mikael Andersen

Craniomaxillofac. Trauma Reconstr. 2014, 7(3), 190-196; https://doi.org/10.1055/s-0034-1371003 - 11 Mar 2014

Cited by 5 | Viewed by 91

Abstract

The fibula osteocutaneous flap has revolutionized the options of mandibular segmental defect bridging in osteoradionecrosis (ORN). In selected cases, however, the fibula flap is not an option because of atherosclerosis or other features that compromise the vascularity of the lower leg and foot. [...] Read more.

The fibula osteocutaneous flap has revolutionized the options of mandibular segmental defect bridging in osteoradionecrosis (ORN). In selected cases, however, the fibula flap is not an option because of atherosclerosis or other features that compromise the vascularity of the lower leg and foot. The aim of this study is to present an alternative method of mandibular segmental reconstruction employing a latissimus dorsi (LD) flap and subsequent particulate iliac free bone graft reconstruction. In 15 patients with ORN, a mandibular segmental defect was bridged with a reconstruction plate, and the defect site was primed with a LD musculocutaneous flap wrapped around the reconstruction plate to bring in vascularized tissue and optimize healing conditions for a subsequent particulate iliac free bone graft reconstruction. The management of defect closure was successful in all 15 patients. Twelve patients had a subsequent bone grafting from the posterior ileum for repair of defects up to 14 cm length. Three patients had no bone graft for various reasons. In three patients dental rehabilitation was achieved with implant supported prosthodontic appliances. Ten patients met the success criteria of uneventful graft healing with restitution of osseous continuity, mandibular height, symmetry and function, and avoidance of reconstruction plate fracture. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 7, Issue 3 (September 2014) – 12 articles

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