Division Of Maxillofacial Surgery Research Articles

Discussion

Durham, N.C. Received for publication July 6, 2005. L. Scott Levin, M.D., Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Duke University Medical Center, Box 3945, Durham, N.C. 27710, [email protected]

Delayed Reverse Sural Flap for Staged Reconstruction of the Foot and Lower Leg

Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, N.C. Correspondence to Dr. Erdmann, Department of Surgery, Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke University Medical Center, P.O. Box 3181, Durham, N.C. 27710, [email protected]

Maxillary Distraction Osteogenesis Combined with Mandibular Osteotomy to Correct Asymmetry of the Maxillomandibular Complex

Fukuoka, Japan From the Division of Oral and Maxillofacial Reconstructive Surgery, Kyusyu Dental College. Received for publication May 17, 2005; accepted July 27, 2005. Kensuke Yamauchi, D.D.S., Division of Oral and Maxillofacial Reconstructive Surgery, Kyusyu Dental College, 2-6-1 Manazuru Kokurakitaku, Kitakyusyu, Fukuoka 803-8580, Japan, [email protected]

Epidemiological analysis of maxillofacial fractures in Brazil: A 5-year prospective study

The aim of this study was to assess the characteristics of maxillofacial fractures in the Piracicaba region of Brazil during a 5-year period and to delineate comparisons with worldwide facial fracture patterns. A descriptive statistical analysis was developed based on data collected using a specifically designed clinical survey of all patients who attended the Division of Oral and Maxillofacial Surgery at the Piracicaba Dental School from 1999 to 2004. Information regarding age, gender, etiology, and type of maxillofacial injury and its associated lesions were evaluated. In addition, treatment modalities and complication rates during patient follow-up were assessed. A total of 1024 patients presenting 1399 maxillofacial fractures were analyzed. Patients' ages ranged from 0 to 88 years (mean age, 28 +/- 16.4 years). The ratio of men to women was 4:1. Most fractures were caused by traffic accidents (45%), followed by assaults (22.6%), falls (17.9%), sports accidents (7.8%), and work accidents (4.5%). The prevalent anatomic regions of facial fractures (in percentages) were the mandible (44.2%), the zygomatic complex (32.5%), and the nasal bones (16.2%). Associated systemic lesions were found in 41.9% of patients, with prevalence for injuries to the upper (24.1%) and lower limbs (15.4%). Patient management was considered to be conservative in 490 patients (47.9%), and surgical therapy was performed in 493 patients (48.1%), of whom 399 (80.9%) were treated with open reduction and rigid internal fixation. Complications occurred in 76 patients (7.4%), mainly due to infection and malocclusion. The findings of this study indicated that epidemiological research of maxillofacial fractures allows the presentation patterns of the most affected individuals and the nature of their lesions to be outlined according to the region evaluated. Furthermore, treatment evaluation and complication rate analysis permits a more realistic interpretation of how patients should be managed.

A 5-Year Retrospective Study of Zygomatico-Orbital Complex and Zygomatic Arch Fractures in Sao Paulo State, Brazil

This descriptive analytical study evaluated the cause, type, incidence, demographic, and treatment data of zygomatico-orbital complex and zygomatic arch fractures managed at our program during a 5-year period. A total of 1,857 charts of patients presenting maxillofacial trauma and treated by the Division of Oral and Maxillofacial Surgery, from the Piracicaba Dental School (UNICAMP), were reviewed. A total of 371 patients presented with zygomatico-orbital complex and/or zygomatic arch fractures. Patients with isolated orbital fractures were excluded. The patients ranged in age from 2 to 88 years. Epidemiological data including age, gender, etiology, site of injury, and details of treatment were collected and tabulated in Excel software (Microsoft). All maxillofacial injuries were assessed and treated by residents and staff surgeons. Other concomitant bodily injuries were treated by pertinent consulting specialists. The majority of fractures were sustained by males between 21 and 40 years old, usually resulting from falls, altercations, and bicycle accidents. Unilateral fractures of zygomatico-orbital complex were present in 266 patients (71.69%). Bilateral fractures were found in 22 cases (5.93%). Unilateral zygomatic arch fractures occurred in 39 cases (10.51%). A total of 210 patients (56.60%) did not receive surgical treatment. Surgical intervention was done in 161 patients (43.40%). The surgical treatment was conducted using the approach as reported by Ellis and Kittidumkerng in 1996. A complication incidence of 6.47% was observed, which is compatible with related articles in the literature. The study revealed interesting features about etiology, demonstrated by the high occurrence of bicycle accidents. The treatment protocol proposed to the patients showed adequate results as evidenced by low complication frequency. The findings of this study bring information about an area in Sao Paulo State, Brazil, that is valuable in reaffirming previously established trends and identifying new patterns of disease frequency.

Telemedicine in Maxillofacial Trauma: A 2-Year Clinical Experience

The authors report the 2-year experience of use of the PATATRAC telemedicine system in managing maxillofacial trauma. Thirty-five regional hospitals on-line with PATATRAC in the period from January 2002-January 2004 have sent 18 consultations (11 men and 7 women) to the Maxillofacial Surgery Division of San Giovanni Battista Hospital in Turin for telemedicine evaluation of patients with maxillofacial trauma. Only 50% of the consultations (9 patients) sent via PATATRAC indicated maxillofacial treatment, and only one case resulted in immediate transfer. Of the remaining 8 transfers, 2 patients were transferred after treatment of associated lesions in the receiving hospital, and the other 6 patients were transferred as scheduled based on the availability of beds in the specialist center. The results obtained, despite the poor number of telemedicine maxillofacial consultations, have mainly proved the usefulness of PATATRAC in drastically reducing expensive and unnecessary transfers of maxillofacial patients, without indications for either immediate or deferred treatment, thus also avoiding discomfort to the patient with other injuries.

Estabilidade do reposicionamento anterior da maxila através de análise cefalométrica lateral

Este estudo cefalométrico retrospectivo foi proposto objetivando analisar a estabilidade do reposicionamento anterior da maxila, utilizando-se a osteotomia Le Fort I. A amostra consistiu de 30 telerradiografias de dez pacientes submetidos a um avanço cirúrgico da maxila, sem segmentação desta ou associação com qualquer cirurgia na mandíbula, realizado pela Área de Cirurgia Buco-Maxilo-Facial da Faculdade de Odontologia de Piracicaba - Unicamp. A mesma técnica de fixação interna rígida foi utilizada para todos os pacientes, e nenhum enxerto ou substituto ósseo foi usado. Três radiografias cefalométricas laterais foram realizadas para cada paciente, nos períodos pré e pós-operatórios imediatos, e com, no mínimo, seis meses após a cirurgia. Sobre estas radiografias foram feitas linhas de referência horizontal e vertical. Os pontos cefalométricos utilizados para calcular as mudanças de posição da maxila foram tanto esqueléticos, quanto dentários. A análise estatística (teste t de student pareado) não demonstrou diferença estatística significante entre os intervalos pós-operatórios imediato e com no mínimo seis meses. Concluímos que o reposicionamento anterior da maxila, utilizando-se a osteotomia Le Fort I, com fixação interna rígida e sem o uso de enxertos autógenos ou qualquer substituto ósseo, é um procedimento estável.

Comparison of 2 preferred methods used for frontal sinus obliteration

This study was undertaken to compare total operating room cost, total operating time, and potential complications in frontal sinus obliteration using 2 different techniques. Hospital records of all patients with frontal sinus fractures treated by the Division of Maxillofacial Surgery at the University of Florida, Jacksonville between October 1998 and December 2003 were reviewed. Twelve patients required frontal sinus obliteration based on the severity and location of injury. All cases were caused by traumatic etiology. Patients were divided into group A or B. Six patients (group A) were treated using autogenous abdominal fat for obliteration purposes, while the other 6 patients (group B) underwent frontal sinus obliteration using a hydroxyapatite cement. Total operating cost, total operating time, and any complications were recorded and analyzed for each group and then statistically evaluated using a t test. Follow-up ranged from 2 weeks to 6 months. Patients in group A had a lower total operating cost compared with group B. This cost difference was statistically significant. Total operating time was slightly greater in group A versus group B, although this was not statistically significant. Frontal sinus obliteration using autogenous abdominal fat appears to be more cost effective compared with hydroxyapatite cement. The slight difference in total operating time was not statistically significant and this factor alone should not be a deterrent from performing this surgical procedure.

Hyperbaric oxygen: its uses, mechanisms of action and outcomes.

Hyperbaric oxygen therapy (HBO) is increasingly used in a number of areas of medical practice. It is a unique intervention whose method of action is not well understood. Clinicians may request its use for their patients, but often will not fully understand its mechanisms. It is hoped that this review and discussion of HBO and the literature surrounding its use may be useful to clinicians who are unsure whether their patients will benefit from this exciting intervention. Hyperbaric oxygen therapy is defined by the Undersea and Hyperbaric Medical Society (UHMS) as a treatment in which a patient intermittently breathes 100% oxygen while the treatment chamber is pressurized to a pressure greater than sea level (1 atmosphere absolute, ATA).1 The pressure increase must be systemic, and may be applied in monoplace (single person) or multiplace chambers. Multiplace chambers are pressurized with air, with oxygen given via face-mask, hood tent or endotracheal tube; while monoplace chambers are pressurized with oxygen. We began by obtaining the most recent UHMS committee report,1 and performed Medline searches (1966 to present), with the search terms ‘hyperbaric’ and ‘oxygen’, combining this basic search with searches for each of the thirteen indications recommended by the UHMS. Using information from these papers, and the resulting references, this paper outlines the history, physiology, current indications for and effects of hyperbaric oxygen therapy. Hyperbaric therapy was first documented in 1662, when Henshaw built the first hyperbaric chamber, or ‘domicilium’.2 Since this time, reports of beneficial effects from increased pressure have increased, and by 1877, chambers were used widely for many conditions, though there was little scientific rationale or evidence. In 1879, the surgical application of hyperbaric therapy in prolonging safe anaesthesia was realized and explored.3 In 1927, Cunningham4 reported improvement in circulatory disorders at sea level … Address correspondence to Dr C.N.A. Bell, Division of Oral & Maxillo-Facial Surgery, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY. e-mail: chris.bell{at}bristol.ac.uk

Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic

Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic

Bone autografting of the calvaria and craniofacial skeleton: historical background, surgical results in a series of 15 patients, and review of the literature

Background Although the use of autologous bone for reconstruction of the cranial and facial skeleton underwent a partial reappraisal following the introduction of a vast range of alloplastic materials for this purpose, it has demonstrated definite advantages over the last century and, particularly, during the last decade. Methods Fifteen patients underwent cranial and/or cranio-facial reconstruction using autologous bone grafting in the Department of Neurologic Sciences-Neurosurgery and the Division of Maxillo-Facial Surgery of the Rome “La Sapienza” University between 1987 and 1995. This group of patients consisted of 8 females and 7 males whose average age was 29.5 years (range 7.5 to 59 years, mean age 30). In all these patients cranioplasty and/or cranio-facial reconstruction had been performed to repair bone defects secondary to benign tumors or tumor-like lesions (12 cases), trauma (2 cases), or, in the remaining case, to wound infection after craniotomy for a neurosurgical operation. Results The results obtained in a series of 15 patients treated using this method are described with reference to the abundant data published on this topic. Conclusion The mechanical, immunologic, and technical-grafting properties of autologous bone, together with its superior esthetic and psychological effects, probably make it the best material for cranioplasty.

Restoration of the temporal defect using laser stereolithography technique

J Oral Maxillofac Surg 60:1374-1376, 2002

Impacted third molars and risk of angle fracture

Abstract.The purpose of this study was to assess the influence of the presence, position, and severity of impaction of the mandibular third molars, on the incidence of mandibular angle fractures. A retrospective cohort study was designed for patients presenting to the Division of Oral and Maxillofacial Surgery, Toronto General Hospital (Toronto, Canada), for treatment of mandibular fractures from January 1995 to June 2000. The independent variables in this study were the presence, position and severity of impaction of third molars. The outcome variable was the incidence of mandibular angle fractures. Hospital charts and panoramic radiographs were used to determine and classify these variables. The demographic data included age, sex, mechanism of injury and number of mandibular fractures. The study sample comprised 413 mandibular fractures in 214 patients. The incidence of angle fractures was found to be significantly higher in the male population and was most commonly seen in the third decade of life. Assault remained the most significant aetiological factor. Patients with third molars had thrice the increased risk of angle fractures when compared to patients without (P< 0.001). Impaction of third molars significantly increased the incidence of angle fractures (P< 0.001). The severity and angulation of third molar impactions were not significantly associated with angle fractures. This study provides evidence that patients with retained impacted third molars are significantly more susceptible to angle fracture than those without. The risk for angle fracture, however, does not seem to be influenced by the severity of impaction.

Delayed and Inadequately Treated Malar Fractures: Evolution in the Treatment, Presentation of 77 Cases, and Review of the Literature

Seventy-seven cases of delayed or inadequately treated zygoma fractures, treated between 1977 and 1999 in the Maxillofacial Surgery Division of the La Sapienza University in Rome, are presented. The functional and aesthetic problems caused by this pathology are analyzed. The results achieved resolve some of the various aspects of inadequately treated malar fractures. These are possible because of the development of great biomaterials and the introduction of rigid internal fixation. As a consequence the surgical techniques have been revolutionized. Cases, with functional-aesthetic deficits or only aesthetic deficits, are studied separately. An accurate preoperative study permits the operation suitable for the specific features of the individual case to be carried out.

Recurrent radiolucent-radiopaque lesion of the mandible

A 29-year-old black man presented to the Division of Oral and Maxillofacial Surgery at Henry Ford Hospital with a chief complaint of swelling of the left body of the mandible. The patient stated that the swelling had been present for the last 4 months and had been mildly painful. His medical history was noncontributory. The patient denied a history of smoking and alcohol use; however, he did give a history of being a boxer. He denied any direct trauma to the area within the last 6 months. He was taking no medications and had no known drug allergies.

Analysis of 158 frontal sinus fractures: current surgical management and complications

A retrospective analysis is presented of 158 patients who sustained frontal sinus fractures and were subsequently treated in the Division of Maxillofacial Surgery, University of Turin, from 1987 to 1998. The fractures were subdivided according to involvement of anterior and posterior walls, and of the nasofrontal duct. While treatment involving only the anterior wall is well standardized and without complications, management of anterior plus posterior wall fractures or involving the nasofrontal duct is still controversial. In dislocated posterior wall fractures, cranialization and obliteration of the remaining dead space and of the nasofrontal ducts using bone grafts, combined with the use of a pericranium flap, allow separation of the nasal cavity from the anterior cranial fossa, preventing ascending infections and thus reducing the rate of complications. When the fracture involves the nasofrontal duct with the posterior wall substantially intact, it is better to re-establish patency of the nasofrontal duct with a drainage tube and preserve the function of the sinus. A protocol used in the management of each group of fractures, clinical and radiological results, timing of operation, surgical procedures, outcomes, and long-term complications are all discussed.

Maxillofacial trauma in the elderly

Purpose: This article gives a general description of the incidence, causes, and complexity of maxillofacial fractures in the elderly and discusses whether modification is required in assessment, surgical indications, and techniques in such cases. Patients and Methods: A retrospective clinical and radiologic study evaluated 222 patients older than 60 years of age (mean age, 70.3) hospitalized with maxillofacial trauma over the period 1987 to 1996 in the Division of Maxillofacial Surgery, University of Turin. The patients were classified according to the following parameters: age, cause of injury, site of trauma, presence of associated fractures, pertinent medical history, type of treatment, length of hospitalization, and complications. The data were compared with those from a control group consisting of 178 adult patients younger than 60 years of age. Results: The presence of a preexisting systemic pathologic condition was the most important factor in determining hospitalization time, which was greater than in the control group. In 89 patients (40.1%), no treatment was considered necessary, whereas 133 patients (59.9%) were treated by surgery. In 115 patients (86.5%), the fractures were treated by open reduction and internal fixation, whereas closed reduction was used in 18 patients (13.5%). There were complications with six patients (2.7%), and one died in the hospital. Conclusions: The findings of this study suggest that surgical intervention is less frequently indicated in facial trauma of the elderly because of physiologic, psychologic, and social changes brought on by the aging process. The principles of treatment, the results, and the complications do not differ greatly in this group when compared with the normal adult population.

九州歯科大学附属病院口腔外科入院患者における心電図異常

We investigated the prevalence of abnormality on electrocardiograms of the 296 patients hospitalized in oral and maxillofacial surgery division of the Kyushu Dental College Hospital. Its relationship with their age or medical complications (hypertension, diabetes mellitus, and hyperlipidemia, which were diagnosed from not only their histories but their blood pressure and laboratory data) was studied. They were 147 males and 149 females, and their mean age was 42 years old. Dysrhythmia, cardiomegalic change, atrioventricular block, intraventricular block (except incomplete right branch block), and ischemic change were regarded as abnormal on electrocardiogram. Abnormality on electrocardiogram was found in fifty-seven or 19% of the patients, and 84% of them were ischemic change. Aging increased the frequency of abnormal findings and ischemic change (both P<.0001), and among the patients older than 60 years abnormality was found in 36% and ischemic change was found in 31%. Hypertension increased the prevalence of abnormality (p=0.0003) and ischemic change (p<0.0001), and overlap of medical complications increased the frequency of ischemic change (p=0.0008). Thirty-eight percent of the patients older than 60 years complicated with hypertension showed high prevalence (38%) of ischemic change. In conclusion, aging and medical complication especially hypertension increase the prevalence of abnormality or ischemic change on electrocardiogram. These risk factors should be checked, and electrocardiogram is recommended before surgical dental procedures.

Temporomandibular joint symptoms in an orthognathic surgery population

The records of 317 consecutive patients who underwent orthognathic surgery in the Division of Maxillo-Facial Surgery of the General Hospital St. John, Bruges, Belgium, between 1.10.90 and 1.10.92 were evaluated for pre- and postoperative temporomandibular joint (TMJ) symptoms. Only 143 patients, with a normal/low angle mandibular deficiency deformity, treated by mandibular advancement, and 53 high angle absolute mandibular retrognathism patients having bimaxillary operations, were selected. Fewer TMJ symptoms were found postoperatively, than preoperatively in the total group (17.8% vs 26.5% p = 0.025, Mc Nemar). In the normal/low angle group, there was a decrease in TMJ symptoms after surgery from 30.0% to 14.6% (p = 0.0001, Mc Nemar). In the high angle group, however, more TMJ symptoms are seen postoperatively 26.4% versus 16.8% (p = 0.228, Mc Nemar). Possible hypothetical explanations are given.

Cervical spine fractures and maxillofacial trauma

Cervical spine fractures are a serious complication of maxillofacial trauma because of the high potential for mortality and neurologic morbidity. This study reviewed 563 patients with facial fractures treated by the Division of Oral and Maxillofacial Surgery at a level I trauma center and identified 11 concomitant cervical spine fractures (2.0%). These patients were almost exclusively male (91%), white (100%), between 20 and 35 years of age (64%), involved in a motor vehicle accident (91%), with a concomitant mandibular fracture (91%). The examination, diagnosis, and management of patients with cervical spine injuries are discussed.