1/9. 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 = craniofacial (Clic here for more details about this article) |
2/9. Hydroxyapatite cement in craniofacial trauma surgery: indications and early experience.BACKGROUND AND OBJECTIVES: Reconstruction of the nonstress-bearing portions of the craniofacial skeleton has recently utilized several alloplastic compounds. One such recent compound is hydroxyapatite cement (HAC)--a calcium-phosphate-based product. Its chemical structure consists primarily of calcium phosphate, as does human bone, and this similarity in the mineral structure renders it biocompatible. methods AND MATERIALS: Based on clinical indications for HAC, the authors have classified acquired craniofacial defects into four types. This article presents 5 clinical cases with craniofacial fractures, sustained in various accidents, in which hydroxyapatite cement was used to prevent cranial deformities or to reinstate contour. RESULTS AND/OR CONCLUSIONS: Complications were encountered in some of these cases, but all patients healed without any secondary complications. While the short-term experience using hydroxyapatite cement in craniofacial trauma surgery has been favorable, long-term studies in humans are required to validate the safety and efficacy of this product.- - - - - - - - - - ranking = 8keywords = craniofacial (Clic here for more details about this article) |
3/9. Orbital deformity after craniofacial fracture repair: avoidance and treatment.BACKGROUND AND OBJECTIVES: To achieve the optimal preoperative appearance following craniofacial fracture repair, the surgeon must be facile in the most sophisticated reconstructive techniques and able to determine their application. The purpose of this article is to describe the common deformities following such repairs, outline a strategy to avoid them, and review the surgical techniques to correct them. methods AND MATERIALS: The deformities are categorized by the anatomic zones of the orbit, i.e., zygomatic, frontal, and nasoethmoidal, affected by low-, middle-, and high-energy impact. The common types of deformity and acute and late treatments are discussed for each category. RESULTS AND/OR CONCLUSIONS: The optimal time to correct posttraumatic orbital deformities is during the acute phase. Extended open reduction and rigid fixation techniques have their own morbidity, which must not outweigh the deformity of an untreated or partially treated injury. The results of late reconstruction are always limited by scarring of the overlaying soft tissue envelope.- - - - - - - - - - ranking = 5keywords = craniofacial (Clic here for more details about this article) |
4/9. Superior orbital fissure syndrome: current management concepts.The superior orbital fissure syndrome is an uncommon complication of craniofacial fractures: middle-third facial fractures and lesions of the retrobulbar space. This article reviews the anatomy and etiology of the superior orbital fissure as it relates to pathophysiology and physical findings. Cases reported in the literature are reviewed, emphasizing diagnosis and established treatment options. Two cases are presented and their management discussed, including the use of pre- and postoperative steroids as an adjunct to standard fracture reduction and stabilization therapy.- - - - - - - - - - ranking = 1keywords = craniofacial (Clic here for more details about this article) |
5/9. 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 = 1keywords = craniofacial (Clic here for more details about this article) |
6/9. Optimizing the management of orbitozygomatic fractures.Our understanding of the biomechanics and current management of orbitozygomatic fractures has evolved with the development of craniomaxillofacial surgery. Early management was minimal, with reduction alone as the uniform treatment, and the only variation was the approach used. However, a critical review of the literature using these methods revealed that many of these fractures were unstable after simple reduction alone. Using the principles of craniofacial surgery, our clinical experience, and the data presented in this article, a pragmatic algorithm for optimizing the management of orbitozygomatic fractures is presented. Our approach to this problem has been graduated, with orbitozygomatic fractures being divided into two general categories: nondisplaced and displaced. The nondisplaced orbitozygomatic fracture is treated nonoperatively, with close patient follow-up to detect signs of malunion. Displaced fractures are openly reduced and rigidly fixed internally with mini- and/or microplates. The orbit is routinely explored, especially in high-velocity injuries. The orbit is anatomically as well as volumetrically reconstructed with bone grafts, if needed, to prevent postoperative enophthalmos.- - - - - - - - - - ranking = 1keywords = craniofacial (Clic here for more details about this article) |
7/9. Rigid facial skeletal fixation: advances in treatment.Rigid facial skeletal fixation with miniplates, combined with craniofacial reconstruction techniques, has dramatically changed the treatment of facial fractures. Our use of these newer techniques in 142 facial fractures treated during the past 14 months has resulted in improved aesthetics and function, with a low complication rate. Advances over other techniques include (1) craniofacial incisions with wide subperiosteal exposure, (2) rigid skeletal fixation that virtually eliminates the need for continued intermaxillary fixation, suspension wires, or tracheostomy, (3) primary bone grafting with cranial bone, and (4) early definitive treatment. These innovative techniques establish a higher standard of care for facial fractures, as illustrated by the three cases we review.- - - - - - - - - - ranking = 2keywords = craniofacial (Clic here for more details about this article) |
8/9. Abducent nerve palsy following transverse fracture of the middle cranial fossa.Transverse sphenoidal fractures may be associated with a variety of skull base injuries and neural deficits. Among those nerve injuries, oculomotor palsies and particularly sixth cranial nerve palsy, are quite common. Blows on the side of the head in the squamous temporal region may run across the floor of the middle cranial fossa through the greater wing of the sphenoid in the transverse cranial axis. We report three cases of patients who had sustained craniofacial injury which included a transverse fracture of the middle cranial fossa through the sphenoid sinus, extending to the petrous apex and producing abducent, facial, and eighth nerve dysfunction. Spontaneous recovery from diplopia occurred in all cases within 4 months. The management of the patients and the patterns of transverse cranial base fractures and their associated clinical features are discussed.- - - - - - - - - - ranking = 1keywords = craniofacial (Clic here for more details about this article) |
9/9. Evolving thoughts on correcting posttraumatic enophthalmos.Posttraumatic enophthalmos, though a difficult problem, is correctable by traditional craniofacial techniques. Based on considerable experience with these wide exposure operations, our surgical strategy has evolved and has been distilled into one of limited exposure via lateral upper blepharoplasty, transconjunctival without canthotomy and intraoral incisions. The advantages of this approach are reduced morbidity and hospital stay, shorter operating time, and avoidance of blood transfusions. However, this technique should be reserved until valuable insight is gained using the more conventional coronal approach.- - - - - - - - - - ranking = 1keywords = craniofacial (Clic here for more details about this article) |