1/21. Reconstructive surgery for complex midface trauma using titanium miniplates: Le Fort I fracture of the maxilla, zygomatico-maxillary complex fracture and nasomaxillary complex fracture, resulting from a motor vehicle accident.maxillofacial injuries resulting from trauma can be a challenge to the Maxillo-Facial Surgeon. Frequent causes of these injuries are attributed to automobile accidents, physical altercations, gunshot wounds, home accidents, athletic injuries, work injuries and other injuries. Motor vehicle accidents tend to be the primary cause of most midface fractures and lacerations due to the face hitting the dashboard, windshield and steering wheel or the back of the front seat for passengers in the rear. Seatbelts have been shown to drastically reduce the incidence and severity of these injuries. In the united states seatbelt laws have been enacted in several states thus markedly impacting on the reduction of such trauma. In the philippines rare is the individual who wears seat belts. Metro city traffic, however, has played a major role in reducing daytime MVA related trauma, as usually there is insufficient speed in traffic areas to cause severe impact damage, the same however cannot be said for night driving, or for driving outside of the city proper where it is not uncommon for drivers to zip into the lane of on-coming traffic in order to overtake the car in front ... often at high speeds. Thus, the potential for severe maxillofacial injuries and other trauma related injuries increases in these circumstances. It is however unfortunate that outside of Metro Manila or other major cities there is no ready access to trauma or tertiary care centers, thus these injuries can be catastrophic if not addressed adequately. With the exception of Le Fort II and III craniofacial fractures, most maxillofacial injuries are not life threatening by themselves, and therefore treatment can be delayed until more serious cerebral or visceral, potentially life threatening injuries are addressed first. Our patient was involved in an MVA in Zambales, seen and stabilized in a provincial primary care center initially, then referred to a provincial secondary care center for further stabilization before his transfer to Manila and then ultimately to our Maxillo-Facial Unit. There was a two week-plus delay in the definitive management because of this. As a result of the delay, fibrous tissue and bone callus formation occurred between the various fracture lines, thus once definitive fracture management was attempted, it took on a more reconstructive nature. Hospital based Oral and Maxillo-Facial Surgeons are uniquely trained to manage all aspects of the maxillo-facial trauma, and their dental background uniquely qualifies them in functional restoration of lower and midface fractures where occlusion plays a most important role. Likewise, their training in clinical medicine which is usually integrated into their residency education (12 months or more) puts them in a unique position to comfortably manage the basic medical needs of these patients. In instances where trauma may affect other regions of the body, an inter-multi-disciplinary approach may be taken or consults called for. In this instance, an opthalmology consult was important. In fresh trauma, often seen in major trauma centers (i.e. overseas), a "Trauma Team" is on standby 24 hours a day, and is prepared to assess and manage trauma patients almost immediately upon their arrival in the ER. The trauma team is usually composed of a Trauma Surgeon who is a general surgeon with subspecialty training in traumatology who assesses and manages the visceral injuries, an Orthopedic Surgeon who manages fractures of the extremities, a Neurosurgeon for cerebral injuries and an Oral and Maxillo-Facial Surgeon for facial injuries. In some institutions, facial trauma call is alternated between the "three major head and neck specialty services", namely Oral and Maxillo-facial Surgery, otolaryngology-head & neck Surgery and Plastic & Reconstructive Surgery. (ABSTRACT TRUNCATED)- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/21. C-shape extended transconjunctival approach for the exposure and osteotomy of traumatic orbitozygomaticomaxillary deformities.In the treatment of post-traumatic deformities of the orbitozygomaticomaxillary complex resulting from trauma, the most appropriate exposure must be used. The choice of exposures includes the bicoronal approach and the periorbital incisions. When the whole orbitozygomatic complex is malpositioned, the bicoronal approach is desirable; this can be combined with buccal and eyelid incisions. However, the bicoronal approach is complicated by a longer duration of operation time, post-surgical scars that tend to show, and potential damage to the temporal branch of the facial nerve. A new approach using a C-shape extended transconjunctival approach is possible to have one field of vision to osteotomize the frontozygomatic suture, the lateral orbital wall, inferior orbital rim, lateral maxillary buttress, and zygomatic arch. It takes less operating time and the post-surgical scars are shorter than the bicoronal approach.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
3/21. Pediatric zygomatico-orbital complex fractures: the use of resorbable plating systems. A case report.Maxillofacial trauma in the pediatric population is infrequent--only 5% of all facial fractures occur in children. Operative intervention is indicated when a displacement of normal structures is present, resulting in either a functional or cosmetic deformity. Some midface fractures in children may be managed with closed reduction and maxillomandibular fixation. When open reduction is indicated, plate-and-screw fixation has been the preferred method of stabilization. This article presents a case of an isolated zygomatico-orbital complex fracture in a 6-year-old boy. Open reduction and internal fixation of the fractures through a preexisting facial wound were performed using a resorbable plate-and-screw system. A review of the literature and a discussion of the technique precede the case presentation. The rapid healing of pediatric facial bones does not obviate the need for fracture reduction and fixation with titanium plates and screws. The resorbable system offers an alternative with excellent results.- - - - - - - - - - ranking = 0.41666666666667keywords = complex (Clic here for more details about this article) |
4/21. Orbital volumetric analysis: clinical application in orbitozygomatic complex injuries.Fifteen patients with unilateral orbitozygomatic complex fractures and five with bilateral injuries were analyzed with respect to the differences in orbital volume between the affected and the uninjured, or other, side. The study was conducted using the ALLEGRO Workstation and software package from ISG Technologies, which was capable of calculating volume partitions from either axial or coronal images. patients without postoperative enophthalmos demonstrated a maximum volume difference of 3.8%; those with enophthalmos demonstrated differences of 4% or greater. The Critical Volume Difference at which enophthalmos becomes clinically apparent (whereby the orbital-corneal distance measured by Hertel exophthalmometry is greater than 3 mm on the affected side) is in the range of 4% to 5%. Volume analysis of the orbits by manipulation of the computed tomography data may allow a better understanding of changes in orbital configuration, which can result in better-directed primary and secondary reconstructions.- - - - - - - - - - ranking = 0.41666666666667keywords = complex (Clic here for more details about this article) |
5/21. Computer-aided reduction of zygomatic fractures.Reconstruction of the craniofacial skeleton after traumatic injury relies on immediate adjacent nondisplaced bone for restoration of contour. In complex fractures, neighboring bone may be lost or significantly fragmented, leaving little guidance to the 3-dimensional skeletal architecture. Recently, image guidance systems have been used in neurosurgery and sinus and spine surgery for intraoperative corroboration using preoperative radiologic images. We report the intraoperative use of an image guidance system for real-time localization of displaced facial skeletal segments during reduction and internal fixation.- - - - - - - - - - ranking = 0.083333333333333keywords = complex (Clic here for more details about this article) |
6/21. zygomatic fractures: reduction with the T-bar screw.The prominent zygomatic bone is one of the most commonly fractured. Fracture with displacement of the bone results in a cosmetic and functional deformity. The fractured zygomatic bone is usually dislocated in an inferomedial and posterior direction, which results in a cosmetic deformity with loss of ipsilateral malar prominence, possible depression of the zygomatic arch, asymmetry of the bony orbital circumference, and possible enophthalmos. Fracture of the zygomatic bone may result in ocular, maxillary antral, and mandibular dysfunction; diplopia, restricted extraocular muscle movement, or intraocular injuries; infection or obstruction of the maxillary antrum; and restricted mandibular function and malocclusion. Various surgical methods have been used to reduce the displaced fractured zygomatic bone. Our preferred method for reduction is the T-bar (Carroll-Girard) screw. This clinical study reviews 30 cases of zygomatic complex fractures, outlines the surgical technique used, illustrates the proper use of the T-bar screw with anatomic schematics and clinical cases, and presents illustrative case summaries.- - - - - - - - - - ranking = 0.083333333333333keywords = complex (Clic here for more details about this article) |
7/21. An unusual cause of oro-antral fistula.A case of oro-antral fistula associated with an apparent foreign body following antral packing for a zygomatic complex fracture 10 years previously is presented. This was treated by antral exploration, removal of the antral contents and repair of the fistula. The complications of antral packing for zygomatic and orbital floor fractures are reviewed and those situations where antral packing may be the treatment of choice are defined.- - - - - - - - - - ranking = 0.083333333333333keywords = complex (Clic here for more details about this article) |
8/21. C-arm for accurate reduction of zygomatic arch fracture--a case report.Fracture of the zygomatic arch is usually treated using blind methods. As the fracture lines cannot be visualised directly in closed reduction, digital exploration and crepitus noise or conventional radiographic imaging are used clinically as a guide to reposition the fragments. Successful closed reductions are often difficult to evaluate clinically because of the great amount of swelling that often accompanies these fractures. Postoperative radiographs are often the only way to assess the adequacy of the reduction. This article describes a technique that uses the C-arm to quickly and accurately evaluate the reduction intraoperatively so that appropriate corrections can be made. A case report of a patient who suffered a w-shaped depressed fracture of the left zygomatic arch and zygomatico-maxillary complex fracture is presented.- - - - - - - - - - ranking = 0.083333333333333keywords = complex (Clic here for more details about this article) |
9/21. The rationale and technique of endoscopic approach to the zygomatic arch in facial trauma.The reliable form and strategic position of the zygomatic arch make it a valuable landmark in midfacial trauma management. The benefits of arch repair have been used infrequently, mainly because traditional coronal access to this structure is fraught with undesirable sequelae. Endoscope-assisted zygomatic arch realignment and fixation allow anatomic repair without sustaining the drawbacks of extensive access incisions. The relative importance of this approach increases with trauma complexity, being most useful in Le Fort III and complex zygoma injuries.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
10/21. Maxillary antral bone grafts for repair of orbital fractures.Use of bone from the maxillary antrum to repair defects in the orbital floor was described more than 20 years ago but has not been reported for correction of orbital rim fractures. The method is appealing because the source is contiguous with the recipient site; enhanced exposure might allow better fracture reduction and evacuation of debris and hematoma from the maxillary sinus. The intraoral approach also avoids an external incision and scar, prevents such complications as pneumothorax or dural perforation, and reduces postoperative pain. In 60 cases of orbital and zygomatic complex fractures seen between 1985 and 1990, less than 8% required more extensive graft material than the maxillary antra could provide. To assess the potential advantages of local over extraanatomical bone grafts, we evaluated maxillary antral bone grafts obtained through buccal sulcus incisions in 14 patients for restoration following fractures of the orbit. Several of these patients are described. Bone union was complete in all patients and there was no morbidity related to infection, oroantral fistula formation, dehiscence, or disfigurement. Sufficient bone was available from the uninvolved contralateral side to repair even severely comminuted fractures. In zygomatic complex fractures, maxillary antral grafts appeared to provide additional strength in the region of the fractured maxillary buttress. The success of the procedure in our experience, coupled with the safety of bone harvesting from this source, and the avoidance of an external scar make maxillary antral bone well suited to reconstruction of all areas of the orbit.- - - - - - - - - - ranking = 0.16666666666667keywords = complex (Clic here for more details about this article) |
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