1/12. 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 = 1keywords = dura (Clic here for more details about this article) |
2/12. The management of orbital roof fractures.The nature and aetiology of orbital roof fractures is discussed and a strategy for their successful management outlined with reference to five clinical cases. Early recognition and treatment of these fractures reduces the high incidence of intra-cranial and ocular complications and the importance of a combined approach involving maxillofacial surgeons, neurosurgeons and ophthalmologists is emphasised. A coronal flap together with frontal craniotomy is recommended for surgical access to the orbital roof and overlying dura. When reconstruction is indicated, autogenous bone harvested from the inner table of the calvarium provides an ideal graft material.- - - - - - - - - - ranking = 6.2371436192926keywords = mater, dura (Clic here for more details about this article) |
3/12. Two-stage reconstructive surgery of a patient with head trauma resulting in extensive cranial bone and dura mater loss caused by postoperative infection: usefulness of a pericranial flap for dura mater reconstruction.After external decompression for a case of head trauma, epidural abscess formation resulted in extensive cranial bone and dura mater loss, for which two-stage reconstructive surgery was conducted. In the first operation, after thorough debridement of the infected wound, the dura mater was reconstructed using a bipedicle pericranial flap with posterior and anterior pedicles. After the infection had completely subsided, the second operation was performed, reconstructing the cranium with grafted outer-table calvarial bone and cutting bone to reposition an old zygomatic fracture. At this point, the pericranial flap used for dura mater reconstruction in the first operation became a satisfactory graft bed for the grafted bone. The postoperative course was satisfactory, and there was no cranial bone absorption after roughly 2 year, and a favorable shape has been maintained for an extremely satisfying result.- - - - - - - - - - ranking = 338.68747318917keywords = dura mater, mater, dura (Clic here for more details about this article) |
4/12. 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 = 6.2371436192926keywords = mater, dura (Clic here for more details about this article) |
5/12. Treatment of 813 zygoma-lateral orbital complex fractures. New aspects.A 10-year experience with surgical treatment of 813 zygomalateral orbital complex fractures is reviewed. Regardless of the type or severity of the fracture pattern, concomitant fractures of the orbital floor and rim were approached exclusively through the transconjunctival approach without a lateral canthotomy. The advantages of this approach compared with the subciliary access are the avoidance of a visible scar and markedly reduced incidence of postoperative lower eyelid complications such as ectropion and edema. Implants of lyophilized dura or cartilage and autogenous bone were used to reconstruct orbital floor defects. Malar asymmetry is a frequent complication of zygoma fractures resulting from inadequate three-dimensional reduction. methods for accurate reduction and stabilization, indications for closed and open reduction, and management of the fractured infraorbital rim are emphasized. The indications for miniplates vs wire ligatures for the infraorbital rim are discussed. Long-term follow up and evaluation of the results with regard to the fracture pattern, complications, maxillary sinus dysfunction, and facial and orbital symmetry are presented.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
6/12. optic nerve decompression via the lateral facial approach.Two cases of visual loss after lateral orbital wall fracture are presented: one with retrobulbar hematoma and evidence of optic nerve compression who failed to respond to lateral canthotomy and high-dose corticosteroid administration, and the second with immediate, total blindness associated with fracture of the bony optic canal. In both, extradural decompression of the orbit and optic nerve was achieved through the lateral facial approach with partial return of visual acuity and without surgical complications. The role of orbital and optic nerve decompression in the management of patients with blindness following orbital trauma is controversial. Orbital decompression may be of value for cases of post-traumatic visual loss unresponsive to medical management. If optic nerve injury is suspected as the cause, the additional step of decompression of the optic nerve is a logical but unproven procedure. The indications for optic nerve decompression are not established and should be considered only within the context of the specific needs of the individual patient.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
7/12. Management of upper midfacial injuries.Midfacial fractures may extend into orbital roofs, frontal sinus walls, and ethmoidal and sphenoidal bones if the traumatic impact is of sufficient force. The cranium and facial skull are affected and there is the risk of intracranial complications. Management thus requires a teamwork approach. Isolated compound fractures of the anterior frontal sinus may be reconstructed by direct access through the wound. We prefer a coronal hairline incision in most cases. In isolated (compound) fractures of the orbital roof, combined frontomaxillary fractures without dural involvement, and frontobasal fractures that necessitate an intracranial approach for dural closure, primary upper midfacial reconstruction is attempted. In frontal comminution, preservation of the frontal bone or orbital roof is impossible. Secondary management is indicated after an interval of at least six months for fronto-orbital reconstruction with autologous or alloplastic material.- - - - - - - - - - ranking = 7.2371436192926keywords = mater, dura (Clic here for more details about this article) |
8/12. proplast augmentation for posttraumatic zygomatic deficiency.Facial deformities following fractures of the zygomatic complex are common. Included in this article are the indications, work-up, and surgical technique for placement of proplast implant material to correct the deformity of the malunited zygomatic complex. Three cases are presented to illustrate this approach.- - - - - - - - - - ranking = 5.2371436192926keywords = mater (Clic here for more details about this article) |
9/12. Combined cranio-facial fractures.Clinically, fronto-maxillary injuries may constitute a diagnostic problem, as their severity need not correlate with the patient's general condition. To establish a definitive radiological diagnosis, both normal standard films and tomographs are required. These will help to identify fracture lines involving the base of the skull. Most serious among the complications which may be associated with fronto-maxillary injuries is the occurrence of cerebrospinal rhinorrhoea with potential ascending infection. Other complications include oculomotor dysfunction, obstruction of lacrimal drainage and nasal airways as well as dental malocclusion. Primary surgical management is indicated in compound fractures, suspected intracranial haemorrhage and compression of the optic nerve, while fractures with associated dural injuries and involvement of orbital roofs as well as all other combined maxillo-facial fractures with functional impairment require early secondary management. Open exposure of the fracture site is best obtained through a coronal hair-line incision. Dural injuries are preferentially approached through craniotomies.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
10/12. Reconstruction of traumatic orbital floor defects using irradiated cartilage homografts.The important role of orbital shape and volume reconstruction has been studied by many investigators. There is, however, no consensus on the material that should be used in the reconstruction of the orbit. Both biologic and alloplastic materials have been used, each with its advantages and disadvantages. Here we report our experience with irradiated costal cartilage homograft in the reconstruction of the orbital floor. Irradiated cartilage grafts were used in 31 patients with significant traumatic defects in the orbital floor. Long-term follow-up in 21 patients up to 48 months revealed no incidence of graft infections, extrusions, or clinically detectable graft distortion or resorption. Irradiated cartilage homograft appears to be an excellent material for reconstruction of the orbital floor.- - - - - - - - - - ranking = 15.711430857878keywords = mater (Clic here for more details about this article) |
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