Craniomaxillofacial Trauma & Reconstruction

14 pages, 337 KiB

Open AccessReview

Bioactive-Glass in Oral and Maxillofacial Surgery

by Andrea Corrado Profeta and Christoph Huppa

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 1-14; https://doi.org/10.1055/s-0035-1551543 - 21 May 2016

Cited by 26

The use of synthetic materials to repair craniofacial defects is increasing today and will increase further in the future. Because of the complexity of the anatomy in the head and neck region, reconstruction and augmentation of this area pose a challenge to the [...] Read more.

The use of synthetic materials to repair craniofacial defects is increasing today and will increase further in the future. Because of the complexity of the anatomy in the head and neck region, reconstruction and augmentation of this area pose a challenge to the surgeon. This review discusses key facts and applications of traditional reconstruction bone substitutes, also offering comparative information. It then describes the properties and clinical applications of bioactive-glass (B-G) and its variants in oral and maxillofacial surgery, and provides clinical findings. The discussion of each compound includes a description of its composition and structure, the advantages and shortcomings of the material, and its current uses in the field of osteoplastic and reconstructive surgery. With a better understanding of the available alloplastic implants, the surgeon can make a more informed decision as to which implant would be most suitable in a particular patient. Full article

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6 pages, 212 KiB

Open AccessArticle

Opportunity Cost of Surgical Management of Craniomaxillofacial Trauma

by Helen Moses, David Powers, Jarrod Keeler, Detlev Erdmann, Jeff Marcus, Liana Puscas and Charles Woodard

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 76-81; https://doi.org/10.1055/s-0035-1566160 - 28 Oct 2015

Cited by 25 | Viewed by 58

Abstract

The provision of trauma care is a financial burden, continually associated with low reimbursement, and shifts the economic burden to major trauma centers and providers. Meanwhile, the volume of craniomaxillofacial (CMF) trauma and the number of surgically managed facial fractures are unchanged. Past [...] Read more.

The provision of trauma care is a financial burden, continually associated with low reimbursement, and shifts the economic burden to major trauma centers and providers. Meanwhile, the volume of craniomaxillofacial (CMF) trauma and the number of surgically managed facial fractures are unchanged. Past financial analyses of cost and reimbursement for facial trauma are limited to mandibular and midface injuries, consistently revealing low reimbursement. The incurred financial burden also coincides with the changing landscape of health insurance. The goal of this study is to determine the opportunity cost of operative management of facial trauma at our institution. From our CMF database of greater than 3000 facial fractures, the physician charges, collections, and relative value units (RVUs) for CMF trauma per year from 2007 to 2013 were compared with a general plastic surgery and otolaryngology population undergoing operative management during this same period. Collection rates were analyzed to assess if a significant difference exists between reimbursement for CMF and non-CMF cases. Results revealed a significant difference between the professional collection rate for operative CMF trauma and that for other operative procedures (17.25 vs. 29.61%, respectively; p < 0.0001). The average number of RVUs billed per provider for CMF trauma declines significantly, from greater than 700 RVUs to 300 over the study period, despite a stable volume. Surgical management of CMF trauma generates an unfavorable financial environment. The large opportunity cost associated with offering this service is a potential threat to the sustainability of providing care for this population. Full article

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7 pages, 280 KiB

Open AccessArticle

Assessment of Mandibular Distraction Regenerate Using Ultrasonography and Cone Beam Computed Tomography: A Clinical Study

by Jitender Dabas, Sujata Mohanty, Zainab Chaudhary and Amita Rani

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 69-75; https://doi.org/10.1055/s-0035-1563700 - 24 Sep 2015

Cited by 6 | Viewed by 65

Abstract

Distraction osteogenesis (DO) is becoming a popular method of reconstruction for maxillofacial bony deformities or defects secondary to trauma or surgical tumor ablation. However, the technique is very sensitive in terms of the rate and rhythm of distraction. Because of this, there is [...] Read more.

Distraction osteogenesis (DO) is becoming a popular method of reconstruction for maxillofacial bony deformities or defects secondary to trauma or surgical tumor ablation. However, the technique is very sensitive in terms of the rate and rhythm of distraction. Because of this, there is a need for monitoring of the distraction regenerate during the distraction as well as the consolidation period. The present study was conducted to assess the regenerate using two imaging modalities, namely, ultrasonography (USG) and cone beam computed tomography (CBCT) to determine their relative efficacies and to weigh their clinical usefulness in assessment of DO regenerate. The study was conducted on 12 patients (18 sites) who underwent mandibular distraction for correction of facial deformities. The results showed that overall USG correlated better with the condition of regenerate (r = 0.606) as compared with CBCT (r = 0.476). However, USG was less effective as compared with CBCT in assessing the regenerate once corticomedullary differentiation occurred in the bone. Full article

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7 pages, 114 KiB

Open AccessArticle

Assessment of Bite Force in Patients Treated with 2.0-mm Traditional Miniplates Versus 2.0-mm Locking Plates for Mandibular Fracture

by Sanjay Rastogi, Mahendra Parvath Reddy, Azeez Gaurav Swarup, Divya Swarup and Rupshikha Choudhury

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 62-68; https://doi.org/10.1055/s-0035-1563697 - 21 Sep 2015

Cited by 6 | Viewed by 67

Abstract

The objective of this study is to analyze the difference in bite forces in patients treated for mandibular fractures with 2.0 mm conventional and locking titanium plating system. A randomized study was performed for the treatment of fractures of mandible. In this study, [...] Read more.

The objective of this study is to analyze the difference in bite forces in patients treated for mandibular fractures with 2.0 mm conventional and locking titanium plating system. A randomized study was performed for the treatment of fractures of mandible. In this study, 20 adult patients with isolated mandibular fracture were included. The patients were randomly allocated into two groups, that is, Group I-2.0 mm nonlocking (traditional) and Group II-2.0 mm locking plates. Bite force was evaluated at 1st, 3rd, and 6th weeks. Comparison of all the assessed parameters between both the groups depicted no significant difference in terms of pain, swelling including the incidence of infection, paresthesia, and hardware failure. Although same was true in case of bite force between both the groups at various time intervals, there was statistically significant increase in the bite force within the group comprising patients in whom locking plates was used between 1st and 3rd weeks follow-up period and highly significant increase in bite force between 1st and 6th weeks of follow-up period. The rapid improvement of bite force values when locking plates were used implies that the locking plate can be used in preference to conventional plates to achieve early mobilization with assured stability in the treatment of mandibular fractures. Full article

7 pages, 339 KiB

Open AccessArticle

Orbital Wall Reconstruction with Two-Piece Puzzle 3D Printed Implants: Technical Note

by Maurice Y. Mommaerts, Michael Büttner, Herman Vercruysse, Jr., Lauri Wauters and Maikel Beerens

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 55-61; https://doi.org/10.1055/s-0035-1563392 - 2 Sep 2015

Cited by 32 | Viewed by 68

Abstract

The purpose of this article is to describe a technique for secondary reconstruction of traumatic orbital wall defects using titanium implants that act as three-dimensional (3D) puzzle pieces. We present three cases of large defect reconstruction using implants produced by Xilloc Medical B.V. [...] Read more.

The purpose of this article is to describe a technique for secondary reconstruction of traumatic orbital wall defects using titanium implants that act as three-dimensional (3D) puzzle pieces. We present three cases of large defect reconstruction using implants produced by Xilloc Medical B.V. (Maastricht, The Netherlands) with a 3D printer manufactured by LayerWise (3D Systems; Heverlee, Belgium), and designed using the biomedical engineering software programs ProPlan and 3-Matic (Materialise, Heverlee, Belgium). The smaller size of the implants allowed sequential implantation for the reconstruction of extensive two-wall defects via a limited transconjunctival incision. The precise fit of the implants with regard to the surrounding ledges and each other was confirmed by intraoperative 3D imaging (Mobile C-arm Systems B.V. Pulsera, Philips Medical Systems, Eindhoven, The Netherlands). The patients showed near-complete restoration of orbital volume and ocular motility. However, challenges remain, including traumatic fat atrophy and fibrosis. Full article

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9 pages, 471 KiB

Open AccessArticle

Transcaruncular Approach for Treatment of Medial Wall and Large Orbital Blowout Fractures

by Dennis C. Nguyen, Farooq Shahzad, Alison Snyder-Warwick, Kamlesh B. Patel and Albert S. Woo

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 46-54; https://doi.org/10.1055/s-0035-1563390 - 19 Aug 2015

Cited by 17 | Viewed by 71

Abstract

We evaluate the safety and efficacy of the transcaruncular approach for reconstruction of medial orbital wall fractures and the combined transcaruncular-transconjunctival approach for reconstruction of large orbital defects involving the medial wall and floor. A retrospective review of the clinical and radiographic data [...] Read more.

We evaluate the safety and efficacy of the transcaruncular approach for reconstruction of medial orbital wall fractures and the combined transcaruncular-transconjunctival approach for reconstruction of large orbital defects involving the medial wall and floor. A retrospective review of the clinical and radiographic data of patients who underwent either a transcaruncular or a combined transcaruncular-transconjunctival approach by a single surgeon for orbital fractures between June 2007 and June 2013 was undertaken. Seven patients with isolated medial wall fractures underwent a transcaruncular approach, and nine patients with combined medial wall and floor fractures underwent a transcaruncular-transconjunctival approach with a lateral canthotomy. Reconstruction was performed using a porous polyethylene implant. All patients with isolated medial wall fractures presented with enophthalmos. In the combined medial wall and floor group, five out of eight patients had enophthalmos with two also demonstrating hypoglobus. The size of the medial wall defect on preoperative computed tomography (CT) scan ranged from 2.6 to 4.6 cm²; the defect size of combined medial wall and floor fractures was 4.5 to 12.7 cm². Of the 11 patients in whom postoperative CT scans were obtained, all were noted to have acceptable placement of the implant. All patients had correction of enophthalmos and hypoglobus. One complication was noted, with a retrobulbar hematoma having developed 2 days postoperatively. The transcaruncular approach is a safe and effective method for reconstruction of medial orbital floor fractures. Even large fractures involving the orbital medial wall and floor can be adequately exposed and reconstructed with a combined transcaruncular-transconjunctival-lateral canthotomy approach. The level of evidence of this study is IV (case series with pre/posttest). Full article

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11 pages, 357 KiB

Open AccessCase Report

Nevoid Basal Cell Carcinoma Syndrome: A Long-Term Study in a Family

by Thiago de Santana Santos, André Vajgel, Paulo Ricardo Saquete Martins-Filho, AlmirWalter de Albuquerque Maranhao Filho, Ricardo José De Holanda Vasconcellos, Riedel Frota and José Rodrigues Laureano Filho

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 94-104; https://doi.org/10.1055/s-0035-1558454 (registering DOI) - 3 Aug 2015

Cited by 3 | Viewed by 62

Abstract

We present a family case series with 10 individuals having nevoid basal cell carcinoma syndrome (NBCCS) with a 10-year follow-up. All articles published in the literature between 1967 and 2011 on familial Gorlin-Goltz syndrome in any language were surveyed to determine the mapping [...] Read more.

We present a family case series with 10 individuals having nevoid basal cell carcinoma syndrome (NBCCS) with a 10-year follow-up. All articles published in the literature between 1967 and 2011 on familial Gorlin-Goltz syndrome in any language were surveyed to determine the mapping of cases per country of occurrence of this disease. All patients in the present series were presented with calcification of the falx cerebri, mild hypertelorism, and frontal bossing. Odontogenic keratocystic tumors, palmar and plantar pits, and multiple basal cell carcinomas occurred in 90, 40, and 20%, respectively, of the patients. One of the patients died of skin cancer. Diagnosis of odontogenic keratocyst tumors was confirmed by histopathological examination. NBCCS is a rare autosomal dominant cancer predisposition syndrome; it is important to recognize it when a patient has multiple odontogenic keratocyst tumors because life-long monitoring is essential for patient management. Full article

6 pages, 409 KiB

Open AccessArticle

Reconstructive Indications of Anterolateral Thigh Free Flaps in Head and Neck Reconstruction

by Dhiraj Khadakban, Akshay Kudpaje, Krishnakumar Thankappan, Kiran Jayaprasad, Tejal Gorasia, Sivakumar Vidhyadharan, Jimmy Mathew, Mohit Sharma and Subramania Iyer

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 40-45; https://doi.org/10.1055/s-0035-1558455 - 24 Jul 2015

Cited by 17 | Viewed by 75

Abstract

Anterolateral thigh (ALT) free flap is a common flap with multitude of indications. The purpose of this article is to review the reconstructive indications of the flap in head and neck defects. This is a retrospective study of 194 consecutive ALT flaps. Data [...] Read more.

Anterolateral thigh (ALT) free flap is a common flap with multitude of indications. The purpose of this article is to review the reconstructive indications of the flap in head and neck defects. This is a retrospective study of 194 consecutive ALT flaps. Data including patient characteristics (age, sex, comorbidities), disease characteristics (histology, T stage), and flap characteristics (size of the flap, type of closure of ALT donor site) were collected. The outcome in terms of flap success rate, surgical, and donor site morbidity were studied. A total of 194 flaps were performed in 193 patients over a period of 10 years. Mean age of the patients was 55 years (range 16–80 years). Out of the 193 patients, 91 (47.1%) patients had oromandibular defects, 52 (26.9%) had tongue defects, 15 (7.7%) had pharyngeal defects, 17 (8.8%) had skull base defects, 4 (2%) had scalp defects, and 14 (7.2%) had contour defects of the neck. The overall flap success rate was 95.8% (8 total flap loss out of 194). Hypertrophic scar was the commonest donor site problem seen in 20 (10.3%) patients. This study shows the versatility of free ALT flap in head and neck reconstruction. It is a reliable and safe. Donor site morbidity is minimal. Full article

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5 pages, 107 KiB

Open AccessArticle

Patterns of Intracranial Hemorrhage in Pediatric Patients with Facial Fractures

by Andrew A. Marano, Ian C. Hoppe, Jordan N. Halsey, Anthony M. Kordahi, Mark S. Granick and Edward S. Lee

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 35-39; https://doi.org/10.1055/s-0035-1558453 - 24 Jul 2015

Cited by 6 | Viewed by 72

Abstract

Intracranial hemorrhage (ICH) is a potentially fatal injury accompanying fractures of the cranium and facial skeleton. When occurring at a young age, ICH can lead to developmental delay, cerebral palsy, epilepsy, and death. It is therefore important for clinicians to recognize the presence [...] Read more.

Intracranial hemorrhage (ICH) is a potentially fatal injury accompanying fractures of the cranium and facial skeleton. When occurring at a young age, ICH can lead to developmental delay, cerebral palsy, epilepsy, and death. It is therefore important for clinicians to recognize the presence of ICH early, and understand the factors that affect its prognosis. In this study, we aim to identify diagnostic and prognostic signs for ICH in pediatric facial fracture patients by examining aspects of patient presentation, concomitant injuries, and fracture patterns. Data were collected for all radiologically diagnosed facial fractures between January 2000 and December 2012 at a level I trauma center in Newark, NJ. This was then further refined to include only patients 18 years of age or younger who had a documented ICH. Patient age, Glasgow coma scale (GCS) on presentation, fracture location, type of hemorrhage, and certain aspects of management were collected from these records. Data were then analyzed by either Pearson chi-square test or a t-test to determine significant relationships. A total of 285 pediatric patients were found to have sustained a facial fracture during this time period, 67 of which had concomitant ICH; 46 of these patients were male and 21 were female, with average ages of 14.26 and 9.52 (p < 0.01), respectively. Causes of injury included motor vehicle accidents, pedestrians struck, assault, falls, gunshot injuries, and sports-related injuries. All patients who suffered injuries as a result of violent crimes (assault and gunshot injuries) were male. Although nearly all fracture patterns were significantly associated with the presence of ICH, mandibular fractures showed a significant negative association with the presence of ICH. In addition, patients who received surgical intervention were significantly younger than those who did not (7.7 vs. 13.7, p < 0.05). The GCS was significantly lower in patients who underwent ICP (intracranial pressure) monitoring or EVD (external ventricular drain) placement, suffered intraventricular hemorrhage, experienced worsening of hemorrhage on repeat imaging, and suffered fatal injuries. Our data also showed a significant association between the need for intubation in the emergency department and fatality. Because the consequence of ICH can be life threatening, proper diagnosis and management are imperative. The purpose of this study is to describe patterns associated with ICH in pediatric facial fracture patients to promote early recognition of the injury and understanding of poor prognostic signs. Full article

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6 pages, 221 KiB

Open AccessArticle

Modified Transconjunctival Approach to the Lower Eyelid: Technical Details for Predictable Results

by Steven Bonawitz, William Crawley, Jaimie T. Shores and Paul N. Manson

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 29-34; https://doi.org/10.1055/s-0035-1556051 - 22 Jun 2015

Cited by 4 | Viewed by 74

Abstract

The transconjunctival approach to the lower orbit is well described in the literature and has been used for both cosmetic and reconstructive purposes. When properly performed, it allows access to the orbital floor and inferior orbital rim with minimal lower lid morbidity and [...] Read more.

The transconjunctival approach to the lower orbit is well described in the literature and has been used for both cosmetic and reconstructive purposes. When properly performed, it allows access to the orbital floor and inferior orbital rim with minimal lower lid morbidity and an inconspicuous scar. Many variations of this approach have been described and these can lead to confusion and uncertainty regarding the surgical technique including when and how to best utilize this approach in the traumatized eyelid. Residents and less experienced attendings employing this approach often fail to fully understand the technical and anatomic details that can make this a very fast and simple way to gain complete access to the inferior, medial, and lateral orbit while minimizing complications such as postoperative lid malposition and canthal deformities. We describe our method for transconjunctival access to the inferior orbital rim and orbital floor with specific attention to several precise surgical aspects that make this a fast and reliable technique with low morbidity and predictable architecture of closure. Full article

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9 pages, 256 KiB

Open AccessArticle

The Role of a Conservative Minimal Interventional Management Protocol in the Fractures of the Dentate Portion of the Adult Mandible

by Balasubramanian Krishnan

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 20-28; https://doi.org/10.1055/s-0035-1556050 - 22 Jun 2015

Cited by 4 | Viewed by 56

Abstract

Mandibular fractures are commonly encountered by the maxillofacial surgeon. Maxillomandibular fixation (MMF) and open reduction and internal fixation (ORIF), or a combination of both, are the accepted standard treatments. This study aims to assess the role of a conservative minimal intervention protocol in [...] Read more.

Mandibular fractures are commonly encountered by the maxillofacial surgeon. Maxillomandibular fixation (MMF) and open reduction and internal fixation (ORIF), or a combination of both, are the accepted standard treatments. This study aims to assess the role of a conservative minimal intervention protocol in the management of undisplaced/minimally displaced fractures of the dentate portion of the adult mandible and the complications associated with such minimalistic intervention. Thirty-four patients with undisplaced/minimally displaced fractures of the dentate portion of the adult mandible were advised to restrict mouth opening and limit themselves to a soft diet for a minimum of 4 weeks. All patients were advised follow-up at regular intervals for at least 3 months. Five patients were lost to follow-up. Symphysis and parasymphysis fractures were the most common fracture locations. Fourteen patients needed tension band stabilization with a mandibular arch bar/bridle wiring and three patients required extraction of luxated teeth. All patients showed satisfactory healing except three in whom additional intervention (ORIF) was performed. The improvement in mouth opening was statistically significant. Complications were seen more frequently among smokers and alcoholics. For patients with minimally displaced mandibular fractures, it is necessary to consider if the perceived benefits of intervention justify the associated added costs and possible complications. Patients have to be fully informed about the possible complications while using this minimal intervention protocol. This study concludes that a conservative minimal intervention management protocol for such fractures of the dentate portion of the mandible can produce satisfactory results. Full article

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5 pages, 272 KiB

Open AccessArticle

Mandibular Symphyseal/Parasymphyseal Fracture with Incisor Tooth Loss: Preventing Lower Arch Constriction

by Amin Rahpeyma, Saeedeh Khajehahmadi and Somayeh Abdollahpour

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 15-19; https://doi.org/10.1055/s-0035-1551542 - 21 May 2015

Cited by 4

Abstract

Mandibular fractures are the second most common fractures of the face after the nasal bone. Mandibular symphyseal/parasymphyseal fracture comprises 15.6 to 29.3% of mandibular fractures. Tooth loss in the fracture line is a known phenomenon, but space loss has not been evaluated comprehensively [...] Read more.

Mandibular fractures are the second most common fractures of the face after the nasal bone. Mandibular symphyseal/parasymphyseal fracture comprises 15.6 to 29.3% of mandibular fractures. Tooth loss in the fracture line is a known phenomenon, but space loss has not been evaluated comprehensively in the literature. In a retrospective study, patients with mandibular symphyseal/parasymphyseal fractures, who had been treated from 2012 to 2013 in Mashhad University, Iran, Emdadi Hospital, were recalled. Patients with mandibular incisor tooth/teeth loss were included in the study. Space loss, the technique used to replace the lost tooth/teeth, upper and lower dental midline relationship, combination fracture or fractures in other facial skeleton, and type of treatment were evaluated. Of 98 patients with mandibular symphyseal/parasymphyseal fractures, 22.5% had incisor tooth/teeth loss. In this group, 73% had space loss. Only four patients had replaced the lost tooth/teeth. Dental midlines did not match each other in patients whose feature was evaluated. Open reduction and internal fixation with miniplates were used in symphyseal/parasymphyseal fractures except one. Space loss after mandibular symphyseal/parasymphyseal fracture with incisor tooth loss is a common error. The most important factor to prevent complications related to space loss following mandibular symphyseal/parasymphyseal fracture accompanying incisor tooth loss is space preservation. Full article

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6 pages, 273 KiB

Open AccessCase Report

Guided Bone Regeneration of an Atrophic Mandible with a Heterologous Bone Block

by Danilo Alessio Di Stefano, Gian Battista Greco and Francesco Riboli

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 88-93; https://doi.org/10.1055/s-0035-1551544 - 1 May 2015

Cited by 5

Abstract

The aim of this work was to test the effectiveness of using enzymatically deantigenated equine bone block as a scaffold for guided bone regeneration (GBR) during a horizontal augmentation of the lower jaw. A partially edentulous atrophic mandible was augmented using an equine-derived [...] Read more.

The aim of this work was to test the effectiveness of using enzymatically deantigenated equine bone block as a scaffold for guided bone regeneration (GBR) during a horizontal augmentation of the lower jaw. A partially edentulous atrophic mandible was augmented using an equine-derived block with an expanded polytetrafluoroethylene membrane. After 8.5 months, two bone core samples were collected at the augmentation site, and implants were placed. A definitive prosthesis delivered 6 months after implant placement provided excellent functional and aesthetic rehabilitation throughout the follow-up period. Histological and histomorphometrical analysis of the biopsies showed newly formed bone to be present and the residual biomaterial was still undergoing remodeling. Comparison of cone beam computed tomography scans taken before augmentation and 26 months later showed maintenance of ridge width and possible corticalization of the vestibular augmented ridge side. The equine-derived bone block placed in accordance with GBR principles provided a successful clinical, radiographic, and histological outcome. Full article

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6 pages, 244 KiB

Open AccessCase Report

Custom Anatomical 3D Spacer for Temporomandibular Joint Resection and Reconstruction

by John Marshall Green III, Sarah T. Lawson, Peter C. Liacouras, Edward M. Wise, Michael A. Gentile and Gerald Thomas Grant

Craniomaxillofac. Trauma Reconstr. 2016, 9(1), 82-87; https://doi.org/10.1055/s-0035-1546814 - 5 Mar 2015

Cited by 11 | Viewed by 74

Abstract

Two cases are presented using a two-stage approach and a custom antibiotic spacer placement. Temporomandibular reconstruction can be very demanding and accomplished with a variety of methods in preparation of a total joint and ramus reconstruction with total joint prostheses (TMJ Concepts, Ventura, [...] Read more.

Two cases are presented using a two-stage approach and a custom antibiotic spacer placement. Temporomandibular reconstruction can be very demanding and accomplished with a variety of methods in preparation of a total joint and ramus reconstruction with total joint prostheses (TMJ Concepts, Ventura, CA, USA). Three-dimensional reconstructions from diagnostic computed tomography were used to establish a virtually planned resection which included the entire condyle-ramus complex. From these data, digital designs were used to manufacture molds to facilitate intraoperative fabrication of precise custom anatomic spacers from rapidly setting antibiotic-impregnated polymethyl methacrylate. Molds were manufactured using vat polymerization (stereolithography) with a photopolymer in the first case and powder bed fusion (electron beam melting) with Ti6AL4V for the second. Surgical methodology and the use of molds for intraoperative spacer fabrication for each case are discussed. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 9, Issue 1 (March 2016) – 14 articles

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