Craniomaxillofacial Trauma & Reconstruction

6 pages, 179 KiB

Open AccessArticle

Evaluation of the Mandibular Function, After Nonsurgical Treatment of Unilateral Subcondylar Fracture: A 1-Year Follow-Up Study

by Sudheesh K. M., Rajendra Desai, Siva Bharani K. S. N. and Subhalakshmi S.

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 229-234; https://doi.org/10.1055/s-0036-1584399 - 8 Jul 2016

Cited by 8

Abstract

There are no clearly defined guidelines for when an open or closed treatment is indicated for treatment of mandibular condylar fractures. The aim of the study is to analyze the mandibular function after nonsurgical treatment of unilateral subcondylar fractures, in a prospective study. [...] Read more.

There are no clearly defined guidelines for when an open or closed treatment is indicated for treatment of mandibular condylar fractures. The aim of the study is to analyze the mandibular function after nonsurgical treatment of unilateral subcondylar fractures, in a prospective study. A prospective study was conducted on 30 patients with unilateral mandibular subcondylar fracture undergoing nonsurgical treatment. Clinical and radiographic examinations were done prior to treatment and at 12-month follow-up. Pain, perceived occlusion, mouth opening, protrusion, and horizontal movements of the mandible were evaluated by clinical examination. Radiologic evaluation was done using Panoramic and Reverse Towne's radiographs. At 12-month follow-up, there was minimal pain in the temporomandibular joint region, there was an improvement in the perceived occlusion, and mouth opening did not reduce. There was insignificant absolute difference between left and right lateral mandibular movements. The amount of increase in the protrusion of mandible was insignificant. On radiographic evaluation, the degree of coronal and sagittal displacement was insignificant at follow-up. Mean ramus height pretreatment and 12 months posttreatment were 0.98 ± 0.50 and 0.87 ± 0.47, respectively. Based on this study, patients had adequate mandibular function and minimal pain after nonsurgical treatment. Unilateral subcondylar fractures of the mandible can be treated nonsurgically in patients with minimal occlusal discrepancies, adequate mouth opening, minimal displacement of condyle, and minimal ramus height shortening. Full article

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5 pages, 132 KiB

Open AccessArticle

Correlation of Third Molar Status with Incidence of Condylar and Angle Fractures

by Suresh Menon, Veerendra Kumar, Srihari V. and Yogitha Priyadarshini

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 224-228; https://doi.org/10.1055/s-0036-1584400 - 1 Jul 2016

Cited by 7

Abstract

The mandibular angle and condylar regions are most prone to fractures and this has been attributed to the presence/absence or the position of the third molars. This retrospective study was undertaken to analyze the correlation between the third molars and incidence of condylar [...] Read more.

The mandibular angle and condylar regions are most prone to fractures and this has been attributed to the presence/absence or the position of the third molars. This retrospective study was undertaken to analyze the correlation between the third molars and incidence of condylar and angle fractures in 104 patients treated for these fractures during the period from June 2009 to December 2013. Clinical and radiographic records of these patients were studied to look for the presence and position of third molars and their relation to incidence of condylar or angle fractures. There was a definite positive relation to impacted third molars and increased incidence of angle fractures. The condylar fractures were more commonly seen when the third molars were fully erupted or missing. Third molar impactions predispose to angle fractures and missing or fully erupted third molars predispose to condylar fractures. Full article

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7 pages, 271 KiB

Open AccessArticle

Indications for Computer-Aided Design and Manufacturing in Congenital Craniofacial Reconstruction

by Mark Fisher, Miguel Medina III, Branko Bojovic, Edward Ahn and Amir H. Dorafshar

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 235-241; https://doi.org/10.1055/s-0036-1584391 - 29 Jun 2016

Cited by 21

Abstract

The complex three-dimensional relationships in congenital craniofacial reconstruction uniquely lend themselves to the ability to accurately plan and model the result provided by computer-aided design and manufacturing (CAD/CAM). The goal of this study was to illustrate indications where CAD/CAM would be helpful in [...] Read more.

The complex three-dimensional relationships in congenital craniofacial reconstruction uniquely lend themselves to the ability to accurately plan and model the result provided by computer-aided design and manufacturing (CAD/CAM). The goal of this study was to illustrate indications where CAD/CAM would be helpful in the treatment of congenital craniofacial anomalies reconstruction and to discuss the application of this technology and its outcomes. A retrospective review was performed of all congenital craniofacial cases performed by the senior author between 2010 and 2014. Cases where CAD/CAM was used were identified, and illustrative cases to demonstrate the benefits of CAD/CAM were selected. Preoperative appearance, computerized plan, intraoperative course, and final outcome were analyzed. Preoperative planning enabled efficient execution of the operative plan with predictable results. Risk factors which made these patients good candidates for CAD/CAM were identified and compiled. Several indications, including multisuture and revisional craniosynostosis, facial bipartition, four-wall box osteotomy, reduction cranioplasty, and distraction osteogenesis could benefit most from this technology. We illustrate the use of CAD/CAM for these applications and describe the decision-making process both before and during surgery. We explore why we believe that CAD/CAM is indicated in these scenarios as well as the disadvantages and risks. Full article

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6 pages, 572 KiB

Open AccessTechnical Note

Orbital Osteoblastoma: Technical Innovations in Resection and Reconstruction Using Virtual Surgery Simulation

by Giorgio Novelli, Marco Gramegna, Gabriele Tonellini, Gabriella Valente, Pietro Boni, Alberto Bozzetti and Davide Sozzi

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 271-276; https://doi.org/10.1055/s-0036-1584397 - 22 Jun 2016

Cited by 8

Abstract

Osteoblastoma is a benign tumor of bone, representing less than 1% of bone tumors. Craniomaxillofacial localizations account for up to 15% of the total and frequently involve the posterior mandible. Endo-orbital localization is very rare, with most occurring in young patients. Very few [...] Read more.

Osteoblastoma is a benign tumor of bone, representing less than 1% of bone tumors. Craniomaxillofacial localizations account for up to 15% of the total and frequently involve the posterior mandible. Endo-orbital localization is very rare, with most occurring in young patients. Very few of these tumors become malignant. Orbital localization requires radical removal of the tumor followed by careful surgical reconstruction of the orbit to avoid subsequent aesthetic or functional problems. Here, we present a clinical case of this condition and describe a surgical protocol that uses and integrates state-of-the art technologies to achieve orbital reconstruction. Full article

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5 pages, 138 KiB

Open AccessArticle

Early Posterior Vault Distraction Osteogenesis for the Treatment of Syndromic Craniosynostosis

by Dana Johns, Erin Anstadt, Daniel Donato, John Kestle, Jay Riva-Cambrin, Faizi Siddiqi and Barbu Gociman

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 219-223; https://doi.org/10.1055/s-0036-1582455 - 21 Apr 2016

Cited by 8

Abstract

Posterior cranial vault distraction (PCVD) has become an important modality in the management of complex craniosynostosis to increase intracranial volume and improve the cranial vault appearance. This technique can safely be performed as early as 3 months of age for the initial management [...] Read more.

Posterior cranial vault distraction (PCVD) has become an important modality in the management of complex craniosynostosis to increase intracranial volume and improve the cranial vault appearance. This technique can safely be performed as early as 3 months of age for the initial management of patients with complex craniosynostosis. A retrospective review was performed of all the patients with syndromic, multiple-suture synostosis treated with PCVD at Primary Children's Hospital in Salt Lake City, Utah, between 2012 and 2014. During this time period, a total of nine children with an average corrected age of 21.4 weeks were treated. Demographics, intraoperative data, and postoperative distraction data were collected. Occipital frontal head circumferences (OFCs) were recorded pre- and postdistraction, and at 3- and 6-month follow-up examinations. All patients had a substantial increase in head circumference with subjective improvement of the posterior calvarium shape. The average increase in OFC from preoperative to postdistraction was 4.9 cm. Only two significant postoperative complications were encountered, one hardware infection and one cerebrospinal fluid leak. PCVD is an effective procedure in the management of complex craniosynostosis and can be safely initiated very early in life. Full article

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8 pages, 303 KiB

Open AccessArticle

The Ever-Evolving State of the Art: A Look Back at the AONA Facial Reconstruction and Transplantation Meetings

by J. Rodrigo Diaz-Siso, Natalie M. Plana, Paul N. Manson and Eduardo D. Rodriguez

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 211-218; https://doi.org/10.1055/s-0036-1582461 - 15 Apr 2016

Cited by 1

Abstract

Historically, periodic academic meetings held by surgical societies have set the stage for discussion and exchange of ideas, which in turn have led to advancement of clinical practices. Since 2007, the AONA State of the Art: Facial Reconstruction and Transplantation Meeting (FRTM) has [...] Read more.

Historically, periodic academic meetings held by surgical societies have set the stage for discussion and exchange of ideas, which in turn have led to advancement of clinical practices. Since 2007, the AONA State of the Art: Facial Reconstruction and Transplantation Meeting (FRTM) has been organized to provide a forum for specialists around the world to engage in open conversation about the approaches currently at the forefront of facial reconstruction. Review of registration data of FRTM iterations from 2007 to 2015 was performed. The total number of participants, along with their level of medical training, location of practice, and medical specialty, was recorded. Additionally, academic programs and 2015 participant feedback were evaluated. From 2007 to 2011, there was a decrease in the overall number of participants, with a slight increase in the number of clinical specialties present. In 2013, a sharp increase in total participants, international attendance, and represented clinical specialties was observed. This trend continued in 2015. Adjustments to academic programs have included reorganization of lectures and optimization of content. FRTM is a unique forum for multidisciplinary professionals to discuss the evolving field of facial reconstruction and join forces to accelerate progress and improve patient care. Full article

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5 pages, 131 KiB

Open AccessArticle

Management of Mandibular Angle Fractures by Two Conventional 2.0-mm Miniplates: A Retrospective Study of 389 Patients

by Giuseppe Spinelli, Davide Lazzeri, Francesco Arcuri, Domenico Valente and Tommaso Agostini

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 206-210; https://doi.org/10.1055/s-0036-1582457 - 14 Apr 2016

Cited by 12

Abstract

Fractures of the mandibular angle account for 23 to 42% of all facial fractures with a high complication rate (0–32%). Although the ideal treatment remains debatable, two main procedures are commonly used to manage the majority of mandibular angle fractures that are open [...] Read more.

Fractures of the mandibular angle account for 23 to 42% of all facial fractures with a high complication rate (0–32%). Although the ideal treatment remains debatable, two main procedures are commonly used to manage the majority of mandibular angle fractures that are open reduction and internal fixation by a noncompression miniplate placed on the external oblique ridge with or without a second miniplate on the outer cortex. The purpose of this study was to describe our management of mandibular angle fractures by two noncompression miniplates placed on the outer cortex via a transbuccal approach. Medical records and radiographic examination of 389 patients (258 males [66.3%] and 131 females [33.7%]) operated from January 2000 to December 2012 were retrospectively reviewed. Postoperative complications including malocclusion, infection, wound dehiscence, nonunion, and reoperative surgery were recorded and analyzed. Fifty-three patients developed postoperative complications (overall complication rate: 13.6%). No significant difference was found in the complication rate by age and gender variables and regarding the interval between the trauma and the operation and the presence of the teeth in the line of fracture. A higher rate of complications was found among patients with alcohol/drug addiction and in patients with multiple-site involvement. The findings of this study suggest that the use of two transbuccal miniplates placed on the outer cortex for the internal fixation of mandibular angle fracture provided a low rate of complications. The global incidence of screw loosening, wound dehiscence, plate exposure, infection, reoperation, and plate removal were similar with the data reported in the literature with improved health outcomes, lower postoperative morbidity, and a faster return to normal life. Full article

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5 pages, 308 KiB

Open AccessCase Report

Mandibular Reconstruction Using a Custom-Made Titanium Prosthesis: A Case Report on the Use of Virtual Surgical Planning and Computer-Aided Design/Computer-Aided Manufacturing

by Andrew Ow, Winston Tan and Lukasz Pienkowski

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 246-250; https://doi.org/10.1055/s-0036-1581060 - 31 Mar 2016

Cited by 10

Abstract

The use of virtual surgical planning and computer-aided design/computer-aided manufacturing has been reported to enhance the planning for the reconstruction of mandibular continuity defects. This case report illustrates the use of this technology in the fabrication of a custom-made titanium prosthesis to restore [...] Read more.

The use of virtual surgical planning and computer-aided design/computer-aided manufacturing has been reported to enhance the planning for the reconstruction of mandibular continuity defects. This case report illustrates the use of this technology in the fabrication of a custom-made titanium prosthesis to restore a segmental mandibular defect. The design specifications and sequence of the custom-made titanium prosthesis are discussed. Although successful in this case, there are limitations in its application and case selection is of vital importance. Full article

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4 pages, 221 KiB

Open AccessCase Report

Patient-Specific Implant for Residual Facial Asymmetry Following Orthognathic Surgery in Unilateral Craniofacial Microsomia

by Femke Staal, Britt Pluijmers, Eppo Wolvius and Maarten Koudstaal

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 264-267; https://doi.org/10.1055/s-0036-1581061 - 28 Mar 2016

Cited by 15

Abstract

Craniofacial microsomia (CFM) is a congenital anomaly with a variable phenotype. The most prominent feature of CFM is a predominantly unilateral hypoplasia of the mandible, leading to facial asymmetry. Even after correction of the midline, there is often a remaining hard- and soft-tissue [...] Read more.

Craniofacial microsomia (CFM) is a congenital anomaly with a variable phenotype. The most prominent feature of CFM is a predominantly unilateral hypoplasia of the mandible, leading to facial asymmetry. Even after correction of the midline, there is often a remaining hard- and soft-tissue deficiency over the body of the mandible and cheek on the affected side. This clinical report describes the skeletal augmentation of the mandible with a patient-specific implant to treat residual facial asymmetry in two female patients with unilateral CFM. Good aesthetic results were achieved in both patients treated with either a Medpor or polyetheretherketone implant without complications after a follow-up time of 55 and 30 months, respectively. Full article

4 pages, 216 KiB

Open AccessCase Report

Unusual Case of Sinusitis Related to Ectopic Teeth in the Maxillary Sinus Roof/Orbital Floor: A Report

by Otacílio Luiz Chagas Júnior, Lucas Borin Moura, Camila Leal Sonego, Eduardo Oliveira Campos de Farias, Caroline Comis Giongo and Alisson André Robe Fonseca

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 260-263; https://doi.org/10.1055/s-0036-1581063 - 28 Mar 2016

Cited by 11

Abstract

This article presents a case report of an adult patient with chronic sinusitis related to the presence of two erupted ectopic teeth located atypically in the maxillary sinus roof/orbital floor after a long latency period associated with childhood facial trauma. This article aims [...] Read more.

This article presents a case report of an adult patient with chronic sinusitis related to the presence of two erupted ectopic teeth located atypically in the maxillary sinus roof/orbital floor after a long latency period associated with childhood facial trauma. This article aims to show the treatment of chronic sinusitis of odontogenic origin by surgical removal of ectopic teeth in an unusual position by direct visualization. This case report discusses the signs and symptoms of chronic sinusitis linked to the presence of ectopic elements and associated with an inflammatory cyst, the choice of complementary tests for diagnosis and surgical treatment through the Caldwell-Luc procedure. After a 2-year follow-up period, the patient presently shows clinical improvement, thus demonstrating the success of the chosen treatment. Full article

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5 pages, 214 KiB

Open AccessCase Report

Long-Term Results of Orbital Roof Repair with Titanium Mesh in a Case of Traumatic Intraorbital Encephalocele: A Case Report and Review of Literature

by Erhan Arslan, Selçuk Arslan, Selçuk Kalkısım, Ahmet Arslan and Kayhan Kuzeyli

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 255-259; https://doi.org/10.1055/s-0036-1581064 - 28 Mar 2016

Cited by 12

Abstract

Orbital roof fractures associated with cranial and maxillofacial trauma are rarely encountered. Traumatic intraorbital encephaloceles due to orbital roof fractures developing in the early posttraumatic period are even rarer. A variety of materials, such as alloplastic implants or autogenous materials, have been used [...] Read more.

Orbital roof fractures associated with cranial and maxillofacial trauma are rarely encountered. Traumatic intraorbital encephaloceles due to orbital roof fractures developing in the early posttraumatic period are even rarer. A variety of materials, such as alloplastic implants or autogenous materials, have been used for the reconstruction of orbital roof, but data regarding the long-term results of these materials are very limited. We report a case of intraorbital encephalocele developing in the early posttraumatic period (2 days) in a child patient and the long-term results of titanium mesh used for the reconstruction of the orbital roof. The case is presented with a pertinent review of literature. Full article

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4 pages, 141 KiB

Open AccessCase Report

Anesthetic Complication During Maxillofacial Trauma Surgery: A Case Report of Intraoperative Tension Pneumothorax

by Al Haitham Al Shetawi, Leonard Golden and Michael Turner

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 251-254; https://doi.org/10.1055/s-0036-1572504 - 28 Mar 2016

Abstract

Tension pneumothorax is a life-threatening emergency that requires a high index of suspension and immediate intervention to prevent circulatory collapse and death. Only five cases of pneumothorax were described in the Oral and Maxillofacial Surgery literature. All cases were postoperative complications associated with [...] Read more.

Tension pneumothorax is a life-threatening emergency that requires a high index of suspension and immediate intervention to prevent circulatory collapse and death. Only five cases of pneumothorax were described in the Oral and Maxillofacial Surgery literature. All cases were postoperative complications associated with orthognathic surgery. We report a case of intraoperative tension pneumothorax during a routine facial trauma surgery requiring emergency chest decompression. The possible causes, classification, and reported cases will be presented. Full article

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11 pages, 240 KiB

Open AccessReview

Reconstruction of Continuity Defects of the Mandible with Non-Vascularized Bone Grafts—Systematic Literature Review

by Babatunde Olayemi Akinbami

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 195-205; https://doi.org/10.1055/s-0036-1572494 - 3 Mar 2016

Cited by 28

Abstract

Background The use of NVBG formandibular defects seems to be gradually giving way for more advanced reconstructive techniques but it has the advantages of shorter operating time and lesser amount of blood loss. The aim of this study was to review the available [...] Read more.

Background The use of NVBG formandibular defects seems to be gradually giving way for more advanced reconstructive techniques but it has the advantages of shorter operating time and lesser amount of blood loss. The aim of this study was to review the available data on the success and failure rates of use of NVBG and factors associated with failure. Method Studies published from 1978 to 2014 regarding the use of NVBG were searched. Most important information was graft success and failure outcomes. Information on graft success with particular focus on large defects was extracted and the quality of papers was rated. Defects > 6 cm were considered long defects. Results Twenty publications were included in this review. The quality of the studies was low and there was high heterogeneity. All articles reported high graft success rates ranging from 67 to 100%. Success in defects > 6 cm was considerable, the range was 72–100%. Three main factors were associated with failure; these were defect length, fixation method and infection. Infection contributed the highest complication rate which was 48.2%. Conclusion NVBG seems to be appropriate for mandible reconstruction when there is vascular recipient bed and sufficient soft tissue cover and mucosal lining are achievable. Full article

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3 pages, 140 KiB

Open AccessCase Report

Persistent Upgaze Restriction After Orbital Floor Fracture Repair

by Sarah Willcox DeParis, F. Lawson Grumbine, M. Reza Vagefi and Robert C. Kersten

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 268-270; https://doi.org/10.1055/s-0035-1570076 - 13 Jan 2016

Cited by 1

Abstract

Here we present two cases of marked postoperative upgaze restriction after successful repair of orbital floor fracture and release of inferior rectus entrapment. In both cases, follow-up imaging showed enlargement of the inferior rectus, and gradual resolution of gaze limitation was observed over [...] Read more.

Here we present two cases of marked postoperative upgaze restriction after successful repair of orbital floor fracture and release of inferior rectus entrapment. In both cases, follow-up imaging showed enlargement of the inferior rectus, and gradual resolution of gaze limitation was observed over several months of conservative management. Thus, in patients with postoperative findings suggestive of residual inferior rectus entrapment, follow-up imaging is indicated prior to returning to the operating room. With a markedly swollen inferior rectus muscle but no radiographic evidence of residual muscle entrapment in the fracture, a trial of conservative management may be warranted. Full article

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4 pages, 296 KiB

Open AccessCase Report

Bolt from the Blue: A Large Foreign Body in the Maxillary Antrum Necessitating Delayed Primary Reconstruction with Split Cranial Bone Graft

by Ramesh K. Sharma, Guru Karna Vemula and Jerry R. John

Craniomaxillofac. Trauma Reconstr. 2016, 9(3), 242-245; https://doi.org/10.1055/s-0035-1563699 - 1 Sep 2015

Abstract

We report an unusual case of a large metallic foreign body embedded in the maxillary antrum leading to extensive bony destruction of the mid-face following a road side accident in a 12-year-old boy. There was extensive bony loss that necessitated reconstruction for both [...] Read more.

We report an unusual case of a large metallic foreign body embedded in the maxillary antrum leading to extensive bony destruction of the mid-face following a road side accident in a 12-year-old boy. There was extensive bony loss that necessitated reconstruction for both aesthetic and functional reasons. The same was accomplished by using split cranial bone graft in a delayed primary manner after a gap of 7 days following initial debridement. There was primary healing with good aesthetic and functional results. Full article

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Craniomaxillofac. Trauma Reconstr., Volume 9, Issue 3 (September 2016) – 15 articles

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