Craniomaxillofacial Trauma & Reconstruction

6 pages, 339 KiB

Open AccessCase Report

Isolated Bilateral Mandibular Angle Fractures: An Extensive Literature Review of the Rare Clinical Phenomenon with Presentation of a Classical Clinical Model

by P. Elavenil, S. Mohanavalli, B. Sasikala, R. Ashok Prasanna and Raja V. B. Krishnakumar

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 153-158; https://doi.org/10.1055/s-0034-1393738 - 24 Nov 2014

Cited by 12

Abstract

Bilateral angle fractures are a rare clinical phenomenon in contrast to the incidence of unilateral angle fractures. However, the rarity has garnered less attention in spite of the uniqueness of fracture pattern and distinctive biomechanics. This article is a detailed review on the [...] Read more.

Bilateral angle fractures are a rare clinical phenomenon in contrast to the incidence of unilateral angle fractures. However, the rarity has garnered less attention in spite of the uniqueness of fracture pattern and distinctive biomechanics. This article is a detailed review on the etiology, clinical presentation, and management of bilateral angle fractures with the presentation of an interesting case. The bilateral angle fracture reported is a untreated, malunited fracture representing an ideal clinical model to study its biomechanics. The clinical features were anterior open bite, increased facial height, and temporomandibular joint tenderness. The management included osteotomy at the malunion and miniplate osteosynthesis. Bilateral angle fracture presents mandible in three independent fragments (left angle, right angle, and intermediate corpus), each with strong muscles acting in different vectors. This makes the fracture vulnerable to severe displacing forces and unfavorable to achieve the optimal reduction, stability, and healing. This necessitates comprehension of the biomechanical forces involved to avoid malunion following fixation. The article details the complex biomechanics of mandibular angle and its clinical implications in the rare event of bilateral angle fractures. It describes the necessity for a systematic approach and ideal osteosynthesis principles to achieve maximal treatment outcomes and minimal complications. Full article

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12 pages, 691 KiB

Open AccessArticle

Cranioplasty for Large-Sized Calvarial Defects in the Pediatric Population: A Review

by Sandi Lam, Justin Kuether, Abigail Fong and Russell Reid

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 159-170; https://doi.org/10.1055/s-0034-1395880 - 20 Nov 2014

Cited by 53

Abstract

Large-sized calvarial defects in pediatric patients pose a reconstructive challenge because of children's unique physiology, developing anatomy, and dynamic growth. We review the current literature and outcomes with autologous and alloplastic cranioplasty in the pediatric population. Full article

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6 pages, 232 KiB

Open AccessArticle

Biomechanical Comparison of Four Mandibular Angle Fracture Fixation Techniques

by Jose Luis Muñante-Cardenas and Luis Augusto Passeri

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 123-128; https://doi.org/10.1055/s-0034-1393737 - 20 Nov 2014

Cited by 6

Abstract

The aim of this study was to make a comparison of the biomechanical behavior of four different internal fixation systems for mandibular angle fractures. A total of 40 polyurethane mandible replicas were employed with different fixation methods: group 1SP, one 2.0-mm four-hole miniplate; [...] Read more.

The aim of this study was to make a comparison of the biomechanical behavior of four different internal fixation systems for mandibular angle fractures. A total of 40 polyurethane mandible replicas were employed with different fixation methods: group 1SP, one 2.0-mm four-hole miniplate; group 2PPL, two 2.0-mm four-hole parallel miniplates; group 3DP, one 3D 2.0-mm four-hole miniplate; and group 3DPP, one 3D 2.0-mm eight-hole miniplate. Each group was subjected to incisal or homolateral molar region loading. The load resistance values were measured at load application causing tip displacement of 1, 3, and 5 mm, and at the time at which the system achieves its maximum strength (MS). Means and standard deviations were compared among groups using analysis of variance and the Tukey test. Group 2PPL showed higher strength for all the displacements. For incisal loading, no statistically significant differences were found between groups 1SP, 3DP, and 3DPP. For molar loading, group 1SP and 3DPP showed statistically significant differences. For MS testing, group 1SP and 2PPL showed statistically significant differences in incisal loading; group 1SP and 3DP showed no statistically significant differences; and group 3DPP showed lower values of strength. Two parallel miniplates provide the most favorable mechanical behavior under the conditions tested. Full article

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3 pages, 226 KiB

Open AccessCase Report

Ascher Syndrome: Report of a Case with Early Manifestations

by Santiago Molina, Pablo Medard and Marcelo Galdeano

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 150-152; https://doi.org/10.1055/s-0034-1395881 - 18 Nov 2014

Cited by 6

Abstract

Ascher syndrome is a disease of unknown etiology first described in 1920 by Ascher, an ophthalmologist from Prague. It presents with recurrent edema of the lip and upper eyelid resulting in double lip and blepharochalasis. In 10% of cases the idiopathic nontoxic thyroid [...] Read more.

Ascher syndrome is a disease of unknown etiology first described in 1920 by Ascher, an ophthalmologist from Prague. It presents with recurrent edema of the lip and upper eyelid resulting in double lip and blepharochalasis. In 10% of cases the idiopathic nontoxic thyroid enlargement also occurs. Because of its rarity, it is often undiagnosed. A case of early onset is presented with its respective surgical treatment and outcome. Full article

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6 pages, 365 KiB

Open AccessArticle

Experience with Mandibular Reconstruction Using Transport-Disc-Distraction Osteogenesis

by Lorena Pingarrón-Martín, T. González Otero and L. J.Arias Gallo

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 117-122; https://doi.org/10.1055/s-0034-1393729 - 18 Nov 2014

Cited by 3

Abstract

The goal of transport-disc-distraction osteogenesis (TDDO) is to restore bone continuity by using in-situ bone. It may be useful following trauma, gunshot injuries, or tumor ablation, especially when there may be contraindications at the donor site or for prolonged surgery. To the best [...] Read more.

The goal of transport-disc-distraction osteogenesis (TDDO) is to restore bone continuity by using in-situ bone. It may be useful following trauma, gunshot injuries, or tumor ablation, especially when there may be contraindications at the donor site or for prolonged surgery. To the best of the authors’ knowledge, this is the first time TDDO has been used for mandibular reconstruction reporting additional procedures, which include osseointegrated dental implants rehabilitation and orthognathic surgery. A retrospective study is performed analyzing all mandibular reconstruction cases that may be suitable for distraction from January 2006 to December 2011. A thorough description of the documented cases includes details about sex, gender, complications, duration of hospitalization, etiology, size, and location of the defect. Eight cases of mandibular reconstruction were included. Six cases correspond to mandibular ameloblastoma. The remaining two cases were mandibular gunshot comminuted fractures. Range of the defects was from 45 to 60 mm. Length of the transport disc was 15 to 20 mm. Protocolized technique consisted of 5 days of latency period, 19 to 45 days of activation term (average 30 days), and 8 to 12 weeks for consolidation. Mean distraction length achieved was 40.45 mm. We can conclude that TDDO is an alternative to conventional and more invasive procedures, when we face severe segmental mandibular defects reconstruction. It shows the potential to restore a better anatomical bone regeneration, also providing soft tissues and reducing donor-site morbidity. Patients’ education and awareness about the proper use of the transport-disc-distraction device is important to optimize functional outcomes. Full article

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6 pages, 193 KiB

Open AccessArticle

Finite Element Analysis of Patient-Specific Condyle Fracture Plates: A Preliminary Study

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

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 111-116; https://doi.org/10.1055/s-0034-1395385 - 14 Nov 2014

Cited by 18

Abstract

Various patterns of internal fixation of mandibular condyle fractures have been proposed in the literature. This study investigates the stability of two patient-specific implants (PSIs) for the open reduction and internal fixation of a subcondylar fracture of the mandible. A subcondylar fracture of [...] Read more.

Various patterns of internal fixation of mandibular condyle fractures have been proposed in the literature. This study investigates the stability of two patient-specific implants (PSIs) for the open reduction and internal fixation of a subcondylar fracture of the mandible. A subcondylar fracture of a mandible was simulated by a series of finite element models. These models contained approximately 1.2 million elements, were heterogeneous in bone material properties, and also modeled the muscles of mastication. Models were run assuming linear elasticity and isotropic material properties for bone. The stability and von Mises stresses of the simulated condylar fracture reduced with each of the PSIs were compared. The most stable of the plate configurations examined was PSI 1, which had comparable mechanical performance to a single 2.0 mm straight four-hole plate. Full article

9 pages, 580 KiB

Open AccessCase Report

Beveled Osteotomies in Lateral Orbitotomy Using a Customized Rotating Bone Saw for Orbital Neoplasms

by Maria Donna Damo Santiago and Prospero Maria Tuano

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 141-149; https://doi.org/10.1055/s-0034-1393723 - 12 Nov 2014

Abstract

This study aims to develop a novel method of beveled osteotomy for lateral orbitotomy using a customized 21-mm stainless steel rotating saw in lateral orbitotomy and to evaluate the outcome of a novel beveled osteotomy in lateral orbitotomy. This article presents a case [...] Read more.

This study aims to develop a novel method of beveled osteotomy for lateral orbitotomy using a customized 21-mm stainless steel rotating saw in lateral orbitotomy and to evaluate the outcome of a novel beveled osteotomy in lateral orbitotomy. This article presents a case series (19 orbits from 18 patients) of lateral orbitotomies for excision biopsy of orbital neoplasms, over a 10-year period (from September 2001 to October 2011). It is a retrospective observational study. The surgeries were performed under the primary service of one surgeon (M. D. D. S.), the author of this study. All patients were treated via beveled osteotomies in lateral orbitotomy using a stainless steel, 21 mm diameter, customized rotating bone saw. Preoperative and postoperative measurements were tabulated and statistically analyzed. The case series demonstrated that beveled osteotomies in lateral orbitotomy using a stainless steel, 21 mm diameter, customized rotating bone saw was technically possible and provided access to lateral subperiorbital, peripheral, and central surgical spaces. The exposure was ample for excision biopsy of all neoplasms in this study. No patient needed the use of miniplate hardware in repositioning the lateral orbital wall nor complained of a palpable deformity of the lateral orbital wall. The wound healing was rapid, with minimal tissue distortion or scars. There were two patients who developed skin burns, but neither required a cosmetic surgery to correct scarring from the burn. It was concluded that the modified technique of beveled osteotomies in lateral orbitotomy provides excellent access to the lateral subperiorbital, peripheral and central surgical spaces. The exposure was adequate for excision biopsy of all neoplasms in this study. The technique promotes osseous union without the use of miniplate hardware. The use of a stainless steel 21 mm diameter customized rotating bone saw facilitated the successful outcome of the beveled technique. Full article

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6 pages, 276 KiB

Open AccessArticle

A Case Series of Rapid Prototyping and Intraoperative Imaging in Orbital Reconstruction

by Christopher G. T. Lim, Duncan I. Campbell, Nicholas Cook and Jason Erasmus

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 105-110; https://doi.org/10.1055/s-0034-1395384 - 3 Nov 2014

Cited by 18

Abstract

In Christchurch Hospital, rapid prototyping (RP) and intraoperative imaging are the standard of care in orbital trauma and has been used since February 2013. RP allows the fabrication of an anatomical model to visualize complex anatomical structures which is dimensionally accurate and cost [...] Read more.

In Christchurch Hospital, rapid prototyping (RP) and intraoperative imaging are the standard of care in orbital trauma and has been used since February 2013. RP allows the fabrication of an anatomical model to visualize complex anatomical structures which is dimensionally accurate and cost effective. This assists diagnosis, planning, and preoperative implant adaptation for orbital reconstruction. Intraoperative imaging involves a computed tomography scan during surgery to evaluate surgical implants and restored anatomy and allows the clinician to correct errors in implant positioning that may occur during the same procedure. This article aims to demonstrate the potential clinical and cost saving benefits when both these technologies are used in orbital reconstruction which minimize the need for revision surgery. Full article

6 pages, 238 KiB

Open AccessArticle

Development and Clinical Evaluation of MatrixMANDIBLE Subcondylar Plates System (Synthes)

by Roberto Cortelazzi, Mario Altacera, Monica Turco, Viviana Antonicelli and Michele De Benedittis

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 94-99; https://doi.org/10.1055/s-0034-1395382 - 31 Oct 2014

Cited by 29

Abstract

In this article, authors report the different steps of development and clinical validation of MatrixMANDIBLE Subcondylar Plates (Synthes, Soletta, Switzerland), a specialized osteosynthesis system developed by Synthes during the past 4 years. Between 2009 and 2013, a total of 62 patients were treated [...] Read more.

In this article, authors report the different steps of development and clinical validation of MatrixMANDIBLE Subcondylar Plates (Synthes, Soletta, Switzerland), a specialized osteosynthesis system developed by Synthes during the past 4 years. Between 2009 and 2013, a total of 62 patients were treated for subcondylar and condylar neck fractures via a preauricular or retromandibular/transparotid approach. The MatrixMANDIBLE Subcondylar Plates System consists of a Trapezoidal Plate, a three-dimensional (3D) 4-hole 1.0-mm plate for smaller fracture areas, the Lambda Plate, a 7-hole 1.0-mm linear plate which mimics the two miniplates technique, and the Strut Plate, a 3D 1.0-mm plate with great versatility of employment. All devices satisfy the principles of a functionally stable osteosynthesis as stated by Champy et al. None of the plates broke and no macroscopic condylar displacement was noted on radiological follow-up. Clinical and functional parameters assessed at 6 months postoperative (mandibular range of motion, pain, dental occlusion) were almost restored. MatrixMANDIBLE Subcondylar Plates System (Synthes) has proved to provide sufficient mechanical stiffness and anatomically accurate fracture reduction to avoid major postoperative drawbacks of subcondylar and condylar neck fractures. Full article

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6 pages, 131 KiB

Open AccessArticle

Retrospective Study of Facial Nerve Function Following Temporomandibular Joint Arthroplasty Using the Endaural Approach

by Frederick Liu, Helen Giannakopoulos, Peter D. Quinn and Eric J. Granquist

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 88-93; https://doi.org/10.1055/s-0034-1393726 - 31 Oct 2014

Cited by 11

Abstract

The aim of this retrospective case–control study is to evaluate the incidence of facial nerve injury associated with temporomandibular joint (TMJ) arthroplasty using the endaural approach for the treatment of TMJ pathology. The sample consisted of 36 consecutive patients who underwent TMJ arthroplasty. [...] Read more.

The aim of this retrospective case–control study is to evaluate the incidence of facial nerve injury associated with temporomandibular joint (TMJ) arthroplasty using the endaural approach for the treatment of TMJ pathology. The sample consisted of 36 consecutive patients who underwent TMJ arthroplasty. A total of 39 approaches were performed through an endaural incision. Patients undergoing total joint replacement and/or with preexisting facial nerve dysfunction were excluded from the study. Five patients were lost to follow-up and were excluded from the study. Facial nerve function of all patients was clinically evaluated by resident physicians preoperatively, postoperatively, and at follow-up appointments. Facial nerve injury was determined to have occurred if the patient was unable to raise the eyebrow or wrinkle the forehead (temporalis branch), completely close the eyelids (zygomatic branch), or frown (marginal mandibular branch). Twenty-one of the 36 patients or 22 of the 39 approaches showed signs of facial nerve dysfunction following TMJ arthroplasty. This included 12 of the 21 patients who had undergone previous TMJ surgery. The most common facial nerve branch injured was the temporal branch, which was dysfunctional in all patients either as the only branch injured or in combination with other branches. By the 18th postoperative month, normal function had returned in 19 of the 22 TMJ approaches. Three of the 22 TMJ approaches resulted in persistent signs of facial nerve weakness 6 months after the surgery. This epidemiological study revealed a low incidence of permanent facial nerve dysfunction. A high incidence of temporary facial nerve dysfunction was seen with TMJ arthroplasty using the endaural approach. Current literature reveals that the incidence of facial nerve injury associated with open TMJ surgery ranges from 12.5 to 32%. The temporal branch of the facial nerve was most commonly affected, followed by 4 of the 22 approaches with temporary zygomatic branch weakness. Having undergone previous TMJ surgery did not increase the incidence of facial nerve injury using the endaural approach. This information is important for patients and surgeons in the postoperative period, as a majority of patients will experience recovery of nerve function. Full article

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5 pages, 262 KiB

Open AccessCase Report

Condylar Osteochondroma Treated with Total Condylectomy and Preservation of the Articular Disc: A Case Report

by Manuel Fernandez Dominguez, Jose Luis Del Castillo, Mario Muñoz Guerra, Ruth Sanchez Sanchez and Maria Mancha De La Plata

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 136-140; https://doi.org/10.1055/s-0034-1393727 - 27 Oct 2014

Cited by 9

Abstract

Osteochondroma is frequently found in the general skeleton but is rare in the condylar region of the mandible. We report a case of an osteochondroma of large size and rapid growth in the mandibular condyle, which was treated with total condylectomy and condylar [...] Read more.

Osteochondroma is frequently found in the general skeleton but is rare in the condylar region of the mandible. We report a case of an osteochondroma of large size and rapid growth in the mandibular condyle, which was treated with total condylectomy and condylar replacement with a costochondral graft and preservation of the articular disc. In cases with a healthy and well-positioned articular disc, it may be preserved with no need of disc repositioning. Full article

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4 pages, 141 KiB

Open AccessCase Report

Ellis–van Creveld Syndrome with Sagittal Craniosynostosis

by Andrew S. Fischer, William M. Weathers, Erik M. Wolfswinkel, Robert J. Bollo, Larry H. Hollier, Jr. and Edward P. Buchanan

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 132-135; https://doi.org/10.1055/s-0034-1393733 - 27 Oct 2014

Cited by 7

Abstract

Ellis–van Creveld syndrome (EVC) is a rare disorder (the incidence is estimated at around 7/1,000,000) characterized by the clinical tetrad of chondrodystrophy, polydactyly, ectodermal dysplasia, and cardiac anomalies. Sagittal synostosis is characterized by a dolichocephalic head shape resulting from premature fusion of the [...] Read more.

Ellis–van Creveld syndrome (EVC) is a rare disorder (the incidence is estimated at around 7/1,000,000) characterized by the clinical tetrad of chondrodystrophy, polydactyly, ectodermal dysplasia, and cardiac anomalies. Sagittal synostosis is characterized by a dolichocephalic head shape resulting from premature fusion of the sagittal suture. Both are rare disorders, which have never been reported together. We present a case of EVC and sagittal synostosis. We report the clinical features of a Hispanic boy with EVC and sagittal craniosynostosis who underwent cranial vault remodeling. The presentation of this patient is gone over in detail. A never before reported case of EVC and sagittal synostosis is presented in detail. Full article

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5 pages, 96 KiB

Open AccessArticle

Alcohol Consumption and Interpersonal Injury in a Pediatric Oral and Maxillofacial Trauma Population: A Retrospective Review of 1192 Trauma Patients

by Peter McAllister, Sean Laverick, Boikanyo Makubate and David Carl Jones

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 83-87; https://doi.org/10.1055/s-0034-1393730 - 27 Oct 2014

Cited by 3

Abstract

The social, financial, and health implications of adult alcohol-related oral and maxillofacial trauma have been recognized for several years. Affordability and widespread accessibility of alcohol and issues of misuse in the pediatric trauma population have fostered concerns alcohol may be similarly implicated in [...] Read more.

The social, financial, and health implications of adult alcohol-related oral and maxillofacial trauma have been recognized for several years. Affordability and widespread accessibility of alcohol and issues of misuse in the pediatric trauma population have fostered concerns alcohol may be similarly implicated in young patients with orofacial trauma. The aim of this study was to review data of pediatric facial injuries at a regional maxillofacial unit, assess the prevalence of alcohol use, and review data of patients sustaining injury secondary to interpersonal violence. This study is a retrospective, 3-year review of a Regional Maxillofacial Unit (RMU) trauma database. Inclusion criterion was consecutive facial trauma patients under 16 years of age, referred to RMU for further assessment and/or management. Alcohol use and injuries sustained were reviewed. Of 1192 pediatric facial trauma patients, 35 (2.9%) were associated with alcohol intake. A total of 145 (12.2%) alleged assault as the mechanism of injury, with older (12–15 years) (n = 129; 88.9%), male (n = 124; 85.5%) (p < 0.001) patients commonly involved and alcohol use implicated in 26 (17.9%) presentations. A proportion of vulnerable adolescents misuse alcohol to the risk of traumatic facial injury, and prospective research to accurately determine any role of alcohol in the pediatric trauma population is essential. Full article

5 pages, 128 KiB

Open AccessArticle

Retrocaruncular Approach for the Repair of Medial Orbital Wall Fractures: An Anatomical and Clinical Study

by Yun-Dun Shen, Daniel Paskowitz, Shannath L. Merbs and Michael P. Grant

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 100-104; https://doi.org/10.1055/s-0034-1375168 - 2 Jun 2014

Cited by 11

Abstract

The aim of this article is to investigate a retrocaruncular approach for repairing medial orbital wall fractures. A total of 10 fresh cadaver orbits were dissected to investigate a transconjunctival approach to the orbit posterior to the caruncle. Medical records of consecutive patients [...] Read more.

The aim of this article is to investigate a retrocaruncular approach for repairing medial orbital wall fractures. A total of 10 fresh cadaver orbits were dissected to investigate a transconjunctival approach to the orbit posterior to the caruncle. Medical records of consecutive patients with medial orbital wall fractures repaired via a retrocaruncular incision at Wilmer Eye Institute over a 10-year period were retrospectively reviewed. The study was approved by the Johns Hopkins Medical Institution's Institutional Review Board. Feasibility of this approach was clearly demonstrated on all cadavers. Horner muscle was observed to be directly attached to the caruncle and remained undisturbed throughout the retrocaruncular approach. For each of the 174 patients reviewed, this approach allowed successful access to the fracture and proper implant placement. The origin of the inferior oblique muscle was divided in only 19 patients. Sutures were not used for conjunctival incision closure in any patient. For 120 patients who underwent acute repair, the percentage with enophthalmos (≥2 mm) decreased from 34% preoperatively to 4% postoperatively; extraocular motility deficit decreased from 41 to 11%. Postoperative complications included recurrence of the preexisting retrobulbar hemorrhage, conjunctival granuloma, and temporary torsional diplopia, each in one patient. The retrocaruncular transconjunctival incision is an effective and safe approach for repairing medial orbital wall fractures with minimal complications. The retrocaruncular incision offers advantages over dividing the caruncle because Horner muscle is left undisturbed, and the incision heals well without suturing. Full article

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3 pages, 111 KiB

Open AccessCase Report

Remarkable Triple Pleomorphic Adenoma Affecting Both Parotid and Submandibular Glands

by Lorena Pingarrón-Martín, L. J. Arias-Gallo, G. Demaría-Martínez and M. Chamorro Pons

Craniomaxillofac. Trauma Reconstr. 2015, 8(2), 129-131; https://doi.org/10.1055/s-0034-1378184 - 29 May 2014

Cited by 2

Abstract

The objective of this article is to present the first case reported in the literature of metachronous pleomorphic adenoma of bilateral parotid glands and submaxillary gland. The authors report the case of a 27-year-old female with metachronous mixed tumors in her right parotid [...] Read more.

The objective of this article is to present the first case reported in the literature of metachronous pleomorphic adenoma of bilateral parotid glands and submaxillary gland. The authors report the case of a 27-year-old female with metachronous mixed tumors in her right parotid and submandibular glands. The patient has no history of previous radiotherapy. All three lesions were diagnosed by fine-needle aspiration. The histopathologic evaluation of all three major salivary gland masses demonstrated pleomorphic adenomas, with no occult malignancy observed on serial sections. The presentation of pleomorphic adenomas in the parotids and submandibular glands probably represents three unrelated primary sites of tumor, yet the possibility of metastasis from one gland to the other cannot be excluded. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 8, Issue 2 (June 2015) – 15 articles

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