Maxillofacial Trauma Surgery Research Articles

3D computed tomographic analysis of frontal recess anatomy in patients without frontal sinusitis

Describe frontal sinus pneumatization in patients with no history of frontal sinus disease. All 1-mm axial sinus CT scans performed from 2001 through 2003 were eligible for review on a CBYON Suite workstation (CBYON, Mountain View, CA). Exclusion criteria included frontal sinusitis, sinonasal polyposis, age < 18 years, sinus malignancy, fibroosseous lesions, maxillofacial trauma, congenital anomaly, and sinus surgery. A total of 50 patients met the inclusion criteria. The prevalence of each structure was: agger nasi cell (89%), type 1 frontal cell (37%), type 2 frontal cell (19%), type 3 frontal cell (8%), type 4 frontal cell (0%), supraorbital ethmoid cell (62%), suprabullarcell (15%), frontal bullar cell (9%), interfrontal septal cell (14%), and recessus terminalis (22%). This study describes frontal pneumatization in patients without a history of conditions that influence frontal pneumatization. The results characterize normal frontal recess/sinus pneumatization patterns.

Advances in theory and practice of oral and maxillofacial trauma surgery in the past three years

Advances in theory and practice of oral and maxillofacial trauma surgery in the past three years

The past and future of oral and maxillofacial trauma and reconstruction surgery in China

20世纪 50年代以前,我国口腔颌面部创伤及修复外科学还未建立,1949年以后随着战伤的救治和工伤、交通事故及其他意外损伤不断增加,促使口腔颌面部损伤及修复外科不断发展.如朝鲜战争时,上海和天津志愿医疗队、西南整形外科手术队以及后来的南京医疗队等参加了颌面创伤的抢救工作,开创了我国口腔颌面部创伤及修复外科学,随后在高等医学院校建立了专科病房和举办了各类的专科班,培养了大量的专业人员,尤以1955年我国教育部聘请前苏联莫洛托夫口腔医学院柯什赫教授在北京医科大学举办的全国口腔颌面外科学高级师资班,系统地介绍了苏联在第二次世界大战中抢救口腔颌面部损伤患者的经验.20世纪70年代后期对越自卫反击战中,在救治颌面部伤员过程中,进一步促进我国口腔颌面部损伤与修复外科的发展.随后,我国教育体系调整,学位制度和研究生培养体制的建立对我国口腔颌面部损伤与修复外科学方面的高质量的人才培养,学术水平、临床工作质量的提高起到很重要的作用。

The fixation of sagittal split osteotomies with miniplates: the versatility of a technique

Rigid internal fixation has become the mainstay in both maxillofacial trauma and orthognathic surgery. For both categories of patients, the advantages are obvious. No rigid intermaxillary fixation (IMF) is necessary, which contributes to patient comfort, while fragments tend not to displace after they have been rigidly, internally fixed, compared with fixation with wire osteosynthesis. The latter advantage is extremely important because pull of the masticatory and other muscles tends to displace the fragments, particularly in the mandible when advancing the mandible after a bilateral sagittal split osteotomy (BSSO).

Miniplate removal in trauma and orthognathic surgery—a retrospective study

Records of patients undergoing the surgical removal of miniplates placed during the management of maxillofacial trauma (n=49) and orthognathic surgery (n=16) in a single unit, over a 2-year period have been analysed.Data concerning indications for plating, age and sex distribution, site of plating, time between insertion and removal, antibiotic prophylaxis, general medical factors and clinical indications for plate removal were evaluated for all patients. In addition, data for trauma patients included the site of fracture, and time delay between injury and plate insertion.Infection and/or wound dehiscence were the predominant causes for plate removal in both groups, in spite of the routine use of prophylactic antibiotics in a predominantly young, healthy cohort of patients.A removal rate of approximately 10% was found in the two groups of patients. This low rate would seem to imply that the routine removal of miniplates is not clinically indicated.

Double gloving and a system for identifying glove perforations in maxillofacial trauma surgery

The treatment of some maxillofacial fractures has an incidence of glove perforation as high as 50%, with over 80% going unnoticed at the time of operation. We investigated double gloving and a glove perforation indication system to ascertain whether the latter offered any additional protection.1061 gloves used for 113 patients were examined. The outer glove perforation rate was significantly higher than the inner glove (0.48 compared with 0.10,P <0.0001). There were fewer unnoticed perforations in the glove perforation indication group than the standard surgical glove group (19% compared with 79%, P<0.0001). The indication system was most effective in wet operating fields.The perforation rate varied with the type of fracture and treatment. Mandibular fractures that were ‘hand-held’, while bone-plated had a lower mean number of outer glove perforations/operation than fractures treated with temporary intermaxillary fixation (0.43 compared with 4.62, P<0.0001).

The behaviour of titanium as a biomaterial: microscopy study of plates and surrounding tissues in facial osteosynthesis

Titanium has become the biomaterial of choice for facial osteosynthesis. Titanium is considered a highly biocompatible and corrosion resistant material, although the ultrastructural behaviour of titanium in human tissues after bone fixation is not well documented. A prospective scanning electron microscopy study was carried out on 37 commercially pure titanium miniplates which were removed from 23 patients who had undergone surgery for maxillofacial trauma or deformity. Twenty two cases were used as a control group. Implant-bone specimens were excised using tungsten burs and studied with a scanning electron microscope (Jeol JSM-T-300). Findings at the bone-titanium interface were analyzed, as well as the presence of contaminating bodies on the specimen surface. Biopsies were also obtained from the soft tissues adjacent to 20 miniplates, then sectioned and stained with Haematoxilin-Eosin for histological evaluation by light microscopy. The results showed good ultrastructural osseointegration of the osteosynthesis material in most cases (81.8%). Mobility was found upon removal in 80% of plates which showed clinical complications. A significant correlation was found between the degree of microscopical osseointegration and macroscopic fixation of the plate. Microscopical contamination was found in 100% of the nine plates with intraoral exposure, while only 36% of the 22 miniplates of the control group had contaminating elements (P < 0.001). Thirty-five point one percent of the plates showed hole-like substance loss images, whose size ranged from 10-25 mu. Light microscopy showed granular deposits in soft tissues surrounding the plates in 80% of the 20 specimens investigated. Our findings suggest a higher development of corrosion in titanium than previously reported. These findings are not correlated, however with the clinical complications.

Infrahyoid myocutaneous flap in reconstructive maxillofacial cancer and trauma surgery

We report the use of an island infrahyoid myocutaneous flap, pedicled on the superior thyroid vessels, in a group of 21 patients. This flap allows reconstruction of intraoral defects or defects of the lower portion of the face, as large as 10×4 cm. We used it in 15 cases to repair parts of the oral cavity, after tumour resection, in 2 patients with mandibular osteoradionecrosis and in 4 patients with gunshot injuries. Among the 21 flaps, no muscular necrosis was observed; however, 4 total necrosis and 4 partial necrosis (≤25% of the skin area) of the skin paddle were recorded. Loss of the skin paddle was primarily attributable to the anatomical variations of the veins draining this flap.

Evolution of fixation methods in oral and maxillofacial surgery

Records of patients undergoing the surgical removal of miniplates placed during the management of maxillofacial trauma (n=49) and orthognathic surgery (n=16) in a single unit, over a 2-year period have been analysed.Data concerning indications for plating, age and sex distribution, site of plating, time between insertion and removal, antibiotic prophylaxis, general medical factors and clinical indications for plate removal were evaluated for all patients. In addition, data for trauma patients included the site of fracture, and time delay between injury and plate insertion.Infection and/or wound dehiscence were the predominant causes for plate removal in both groups, in spite of the routine use of prophylactic antibiotics in a predominantly young, healthy cohort of patients.A removal rate of approximately 10% was found in the two groups of patients. This low rate would seem to imply that the routine removal of miniplates is not clinically indicated.

Controversies in the management of pediatric facial fractures : Bartlett S.P.; DeLozier J.B. IIIClin. Plast. Surg. (1992) 19/1 (245–258)

The oral and maxillofacial region has a complicated anatomy with critical contiguous organs, including the brain, eyes, vital teeth, and complex networks of nerves and blood vessels. Therefore, advances in basic scientific research within the field of intraoperative oral and maxillofacial surgery have enabled the introduction of the features of these techniques into routine clinical practice to ensure safe and reliable surgery. A navigation system provides a useful guide for safer and more accurate complex in oral and maxillofacial surgery. The effectiveness of a navigation system for oral and maxillofacial surgery has been indicated by clinical applications in maxillofacial trauma surgery including complex midfacial fractures and orbital trauma reconstruction, foreign body removal, complex dentoalveolar surgery, skull base surgery including surgery of the temporomandibular joint (TMJ), and orthognathic surgery. However, some fundamental issues remain involving the mobility of the mandible and difficulty in updating images intraoperatively. This report presents an overview and feasible applications of available navigation systems with a focus on the clinical feasibility of the application of navigation systems in the field of oral and maxillofacial surgery and solutions to current problems.

A clinical and biomechanical assessment of the Hall surgical miniplate system

The Hall surgical miniplating system has been evaluated for use in maxillofacial trauma and orthognathic surgery. The biomechanical characteristics of the plates have been examined and experience gained, using 53 plates, in 25 patients is presented. The feature which distinguishes these plates is the narrow bridge between paired screw platforms. The specially designed screwdriver has a splined head which allows screw transfer to be carried out as a one-handed procedure. The plates show considerable advantages over existing small plate systems in their size, malleability and consequent ease of handling.

Carotid-cavernous sinus fistula following maxillofacial trauma and orthognathic surgery

Carotid-cavernous sinus fistula following maxillofacial trauma and orthognathic surgery

Carotid-cavernous sinus of the fistula following maxillofacial trauma and orthognathic surgery : J Hes, K deMan. Int J Oral Maxillofac Surg 1988; 17:295–297

Carotid-cavernous sinus of the fistula following maxillofacial trauma and orthognathic surgery : J Hes, K deMan. Int J Oral Maxillofac Surg 1988; 17:295–297

The fate of miniplates in facial trauma and orthognathic surgery: A retrospective study

The fate of 279 Champy miniplates used routinely as permanent implants over a 5-year-period in the management of maxillofacial trauma and orthognathic surgery has been analysed retrospectively. Trauma patients (62) and orthognathic patients (47) were analysed separately; in each group those patients who had plates removed were compared to the patients with retained plates. This study indicates that the morbidity of retaining plates is within acceptable limits and that the routine removal of plates at 3 months may be unnecessary.

Carotid-cavernous sinus fistula following maxillofacial trauma and orthognathic surgery

The presence of a carotid-cavernous sinus fistula after maxillofacial trauma or orthognathic surgery is uncommon. 2 patients are described who developed a carotid-cavernous sinus fistula. Early diagnosis is important, since delay in treatment may cause irreversible neurological and/or ophthalmological damage. The etiology of the carotid-cavernous sinus fistulas is discussed, in the cases described.

Severe late-onset epistaxis following le Fort I osteotomy: angiographic localization and embolization

Epistaxis following maxillofacial trauma or maxillofacial surgery is uncommon. It usually occurs within 24 hours of the injury and can usually be controlled by packing. Rarely internal maxillary artery ligation is necessary and embolization has been used in some cases of severe trauma. We present a case of severe late-onset epistaxis following Le Fort I osteotomy. The diagnostic approach and treatment are discussed.

Intraoral skeletal fixation appliance.

Abstract The intraoral skeletal fixation appliance is introduced as a new and versatile instrument in oral and maxillofacial surgery. The device is described and its uses in maxillofacial pathologic conditions, maxillofacial trauma, and orthognathic surgery are discussed. Case presentations are included to illustrate the clinical feasibility and effectiveness of the intraoral skeletal fixation appliance.