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Evaluation of the condyle remodelling after lateral arthroplasty in growing children with temporomandibular joint ankylosis
81 patients who presented to the outpatient department and the accident and emergency department. The data was reviewed for the demographics, associated injuries, treatment given and complications. Findings: We reviewed 14 consecutive cases of frontal sinus fractures managed at our institution. All patients were male with the mean age of 32 years. 13 (93%) of 14 patients received injury due to road traffic accident. 50% of patients (n = 7) had isolated anterior table fracture and the remaining 50% of patients had fractures at both anterior and posterior tables. Majority of the patients (n = 8, 57%) had associated panfacial injuries. Nine (64%) patients had brain injury in various forms like pneumocephalus, etc. Seven patients (50%) underwent surgical intervention, while others were managed conservatively. Complication was seen in two (14%) patients. Conclusions: The correct diagnosis and thorough assessment of the frontal sinus fractures is important for the successful treatment planning. Various treatment methods are available to offer the patient depending on the severity of injury. The management of frontal sinus fracture requires a team approach for the successful outcome and reduced complications. http://dx.doi.org/10.1016/j.ijom.2017.02.289 Minimal access percutaneous approach for the management of zygomatic arch fractures A. Gupta ∗ , G. Lehl
Pearls fat graft as additional procedure in reconstruction of maxillofacial: a case series A. Hafiz Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Andalas University, Padang, West Sumatera, Indonesia Background: Pearls fat graft is a graft procedure using a patient’s own fat for reconstruction, cosmetics, and for additional procedures after reconstruction. Objectives: In patients with loss of volume or form of soft tissue caused by aging proses, disease, trauma, congenital defects, defects after tumour extirpation. Methods: Compared to other reconstruction techniques pearls fat graft is more simple, safer and more natural results. Findings: Reported two cases of patients who underwent pearls fat graft procedure. The first case in a man 35 years old with multiple maxillofacial fractures, had been performed open reduction internal fixation (ORIF) because there was still defect after ORIF, the defect was closed by fat graft. The second case in female patients 20 years with posttraumatic saddle nose that performed costal cartilage augmentation because there was still depressed nose. This was enhanced with fat graft. Conclusion: Pearls fat graft is a procedure that is effective for improvement of the small size of the maxillofacial defect and because the material is instantly available, the result is more natural, inexpensive, safe and acceptable by the body.
Government Medical College Hospital, Chandigarh, India http://dx.doi.org/10.1016/j.ijom.2017.02.291 Background and Objectives: Zygomatic arch fractures are traditionally treated using either closed approach or using the open approaches like preauricular and hemicoronal approaches. Percutaneous minimal access approach is a novel approach which gives direct access to the fracture site with minimal morbidity. The authors share their technique and experience by reviewing the cases operated at their centre. Methods: This retrospective cohort study was conducted at the Oral Health Centre, Government Medical College Hospital, Chandigarh. The data was collected from the trauma records of patients who presented to the outpatient department and the emergency department. The data was reviewed and evaluated for the benefits and outcomes of this novel approach. Findings: We reviewed eight consecutive cases of zygomatic arch fracture operated using the percutaneous minimal access approach at our centre. All cases had tetrapodal zygomatic complex fracture with gross displacement at zygomatic arch. All patients had successful osteosynthesis with early recovery in the postoperative period. Neither temporary nor permanent facial nerve injury was seen in any of the cases. Aesthetic outcome was very good as evaluated from the patients’ perspective and scar was imperceptible in most of the cases. Conclusions: This approach for the management of zygomatic arch fractures has many advantages like minimal imperceptible scar, minimal stripping of zygomatic arch, quick access to the fracture, minimal risk to the facial nerve, reduced risk of infection and early recovery. This approach is easy to master. The right case selection, good assessment of fracture and controlled technique is the key of success. http://dx.doi.org/10.1016/j.ijom.2017.02.290
Evaluation of the condyle remodelling after lateral arthroplasty in growing children with temporomandibular joint ankylosis D. He ∗ , C. Lu Shanghai 9th People’s Hospital, China Background: Temporomandibular joint (TMJ) ankylosis in growing patients can cause both mouth opening limitation and jaw bone deformity. Lateral arthroplasty (LAP) can restore the medially displaced condyle and thus keep its growth potential. But can the condyle grow as normal is unknown. Objectives: This study was to evaluate the long-term result after LAP in growing children. Methods: Patients from 2010 to 2014 were evaluated. Their computed tomography data within 1 week after operation and during at least 1-year follow-up were measured by ProPlan CMF 1.4 software. The condyle-ramus length of both sides and angles and the chin deviation before and after operation were compared. SPSS 17.0 software was used for statistical analysis. Findings: A total of nine patients with a mean age of 10.2 years were included in the study. The mean follow-up period was 1.94 years. The mean condyle-ramus growth was 2.90 mm in the affected side and 2.50 mm in the unaffected side (P = 0.31). All of the affected side exhibited growth and remodelling of the condyle and ramus. All 9 cases had a mean chin deviation of 3.69 mm before operation and 2.92 mm during follow-up (P = 0.16).
82 Conclusion: The residual condyle grows after LAP, which can reduce the gravity of jaw bone deformity. http://dx.doi.org/10.1016/j.ijom.2017.02.292 Intraoperative arthroscopy of temporomandibular joint in patients with condylar head fracture D. Hirjak ∗ , M. Beno, V. Machon, B. Galis Department of Oral and Maxillofacial Surgery, Comenius University University Hospital Ruzinov, Bratislava, Slovakia Background: There is a general understanding that condylar trauma results in both hard and soft tissue injuries. Plain films and computed tomography (CT) are standard for radiographic evaluation of facial bone fractures. The bony elements have historically been the focus of the diagnosis and treatment. Magnetic resonance imaging (MRI) can detect both bone and soft tissue pathology. We have used perioperative arthroscopic evaluation of upper joint compartment during open surgery in cases with condylar head fracture. Methods: Arthroscopy of upper compartment was performed in 24 patients with dislocated condylar head fractures. We have evaluated disc position, disc perforation, cartilage damage, haemorrhagic clots, hypervascularity and synovitis. Patients were divided to two groups, depending on the period from trauma, less than five days and more than five days. Results: In majority of the cases the disc was dislocated anteromedially following fragment dislocation. We have had no case with disc perforation or disc rupture. Hyperemia, haemorrhagic clots and cartilage erosions were the most frequent changes. Conclusions: Information from this study is useful in furthering the understanding of intraarticular damage occurring in acute trauma. Presence of haematoma after acute joint trauma and its evacuation and early movement may prevent later pathology. http://dx.doi.org/10.1016/j.ijom.2017.02.293 Planes of reference for orbital fractures: computed tomographic assessment of orbital fractures made easy J. Hung ∗ , E.Z. Cai, L.S.F. Chan, X.T. Chong, W.L. Ong, J.Y. Goh, E.C.H. Hing, W.K. Leow, Y.H. Chan, H.J. Lee, V. Nallathamby, Y.L. Yap, W.C. Ong, J. Lim, S. Gangadhara, T.C. Lim Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore Background: The posterior ledge (PL) is the portion of the orbital floor left after a fracture. It is important for implant placement during orbital reconstruction. Correct placement involves resting its posterior aspect on PL. Without knowledge of its location, dissection to PL is challenging. Inaccurate placement leads to postoperative complications. We developed a novel technique (Planes of Reference for Orbital Fractures [PROF]) to determine the most common location of PL from infraorbital margin (IM). Methods: This retrospective study evaluates 104 consecutive patients with unilateral orbital floor fractures who underwent orbital floor reconstruction from 2008 to 2013. Of 104 cases, 52 had intact IM and 52 had fractured IM. We excluded patients with
pre-existing orbital pathologies. Facial computed tomography ® (CT) scans were analysed using Osirix Lite Digital Imaging and Communications in Medicine (DICOM) Viewer v7.0.1 (Geneva, Switzerland). The skull was positioned upright according to the Frankfurt and midsagittal planes. Measurements were taken on the sagittal view corresponding to the midorbital line (MOL) bisecting the fractured orbit. Without intact IM, MOL of the nonfractured orbit was reflected and superimposed onto the fractured orbit. The location of PL is determined from the reflected intact IM. Results: Orbits with intact IM, PL were located 15.0 mm to 25.0 mm from IM (mean, 22.1 mm; 95% CI, 21.2–23.0 mm). Fractured IM, PL located 15.0 mm to 25.0 mm from IM (mean, 21.1 mm; 95% CI, 20.2–21.9 mm). Conclusion: PROF is an efficient technique in locating PL, avoiding insufficient or overaggressive dissections during orbital reconstructions. The mean distance of PL from IM is 22.1 mm and 21.1 mm for intact and fractured IM, respectively. http://dx.doi.org/10.1016/j.ijom.2017.02.294 Comparison of titanium mesh versus polycaprolactone-tricalcium phosphate implant in orbital fracture reconstruction J. Hung ∗ , A.C. Han, E. Cai, L.T. Chye Division of Plastic, Reconstructive and Aesthetic Surgery, National University Health Systems, Singapore Background: Controversy exists regarding the choice of implant material for orbital floor reconstructions. This study aims to compare the effectiveness of titanium mesh and polycaprolactonetricalcium phosphate (PCL/TCP) implant for repairing traumatic orbital fractures. Methods: A total of 19 patients with orbital floor reconstructions operated at the National University Health System, Singapore were included in this prospective study between November 2010 and June 2013. Titanium mesh was used in 10 patients, while PCL/TCP implant was used in the other nine patients. Patients were evaluated for the worsening of visual acuity, presence or absence of infraorbital nerve paraesthesia, extraocular muscle function, enophthalmos and diplopia. Postoperative complications such as infection, early resorption, extrusion and persistent pain were also recorded. Results: Restoration of orbital wall continuity was successful in all patients. Follow-up duration was at least one year. There was no statistically significant difference in worsening of visual acuity, presence or absence of infraorbital nerve paraesthesia, extraocular muscle function and enophthalmos. Even though there was no statistically significant difference in diplopia between the two treatment groups preoperatively, there were more patients who had diplopia following titanium mesh postoperatively (P < 0.05). One patient had persistent diplopia, enopthalmos and lateral rectus muscle dysfunction postoperatively, but declined further corrective surgery. There was no infection, early resorption, extrusion or persistent pain. Conclusions: Both groups showed satisfactory results. PCL/TCP composite can be used to fabricate biodegradable fixators for the reconstruction of orbital wall fractures. http://dx.doi.org/10.1016/j.ijom.2017.02.295
Pearls fat graft as additional procedure in reconstruction of maxillofacial: a case series A. Hafiz Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Andalas University, Padang, West Sumatera, Indonesia Background: Pearls fat graft is a graft procedure using a patient’s own fat for reconstruction, cosmetics, and for additional procedures after reconstruction. Objectives: In patients with loss of volume or form of soft tissue caused by aging proses, disease, trauma, congenital defects, defects after tumour extirpation. Methods: Compared to other reconstruction techniques pearls fat graft is more simple, safer and more natural results. Findings: Reported two cases of patients who underwent pearls fat graft procedure. The first case in a man 35 years old with multiple maxillofacial fractures, had been performed open reduction internal fixation (ORIF) because there was still defect after ORIF, the defect was closed by fat graft. The second case in female patients 20 years with posttraumatic saddle nose that performed costal cartilage augmentation because there was still depressed nose. This was enhanced with fat graft. Conclusion: Pearls fat graft is a procedure that is effective for improvement of the small size of the maxillofacial defect and because the material is instantly available, the result is more natural, inexpensive, safe and acceptable by the body.
Government Medical College Hospital, Chandigarh, India http://dx.doi.org/10.1016/j.ijom.2017.02.291 Background and Objectives: Zygomatic arch fractures are traditionally treated using either closed approach or using the open approaches like preauricular and hemicoronal approaches. Percutaneous minimal access approach is a novel approach which gives direct access to the fracture site with minimal morbidity. The authors share their technique and experience by reviewing the cases operated at their centre. Methods: This retrospective cohort study was conducted at the Oral Health Centre, Government Medical College Hospital, Chandigarh. The data was collected from the trauma records of patients who presented to the outpatient department and the emergency department. The data was reviewed and evaluated for the benefits and outcomes of this novel approach. Findings: We reviewed eight consecutive cases of zygomatic arch fracture operated using the percutaneous minimal access approach at our centre. All cases had tetrapodal zygomatic complex fracture with gross displacement at zygomatic arch. All patients had successful osteosynthesis with early recovery in the postoperative period. Neither temporary nor permanent facial nerve injury was seen in any of the cases. Aesthetic outcome was very good as evaluated from the patients’ perspective and scar was imperceptible in most of the cases. Conclusions: This approach for the management of zygomatic arch fractures has many advantages like minimal imperceptible scar, minimal stripping of zygomatic arch, quick access to the fracture, minimal risk to the facial nerve, reduced risk of infection and early recovery. This approach is easy to master. The right case selection, good assessment of fracture and controlled technique is the key of success. http://dx.doi.org/10.1016/j.ijom.2017.02.290
Evaluation of the condyle remodelling after lateral arthroplasty in growing children with temporomandibular joint ankylosis D. He ∗ , C. Lu Shanghai 9th People’s Hospital, China Background: Temporomandibular joint (TMJ) ankylosis in growing patients can cause both mouth opening limitation and jaw bone deformity. Lateral arthroplasty (LAP) can restore the medially displaced condyle and thus keep its growth potential. But can the condyle grow as normal is unknown. Objectives: This study was to evaluate the long-term result after LAP in growing children. Methods: Patients from 2010 to 2014 were evaluated. Their computed tomography data within 1 week after operation and during at least 1-year follow-up were measured by ProPlan CMF 1.4 software. The condyle-ramus length of both sides and angles and the chin deviation before and after operation were compared. SPSS 17.0 software was used for statistical analysis. Findings: A total of nine patients with a mean age of 10.2 years were included in the study. The mean follow-up period was 1.94 years. The mean condyle-ramus growth was 2.90 mm in the affected side and 2.50 mm in the unaffected side (P = 0.31). All of the affected side exhibited growth and remodelling of the condyle and ramus. All 9 cases had a mean chin deviation of 3.69 mm before operation and 2.92 mm during follow-up (P = 0.16).
82 Conclusion: The residual condyle grows after LAP, which can reduce the gravity of jaw bone deformity. http://dx.doi.org/10.1016/j.ijom.2017.02.292 Intraoperative arthroscopy of temporomandibular joint in patients with condylar head fracture D. Hirjak ∗ , M. Beno, V. Machon, B. Galis Department of Oral and Maxillofacial Surgery, Comenius University University Hospital Ruzinov, Bratislava, Slovakia Background: There is a general understanding that condylar trauma results in both hard and soft tissue injuries. Plain films and computed tomography (CT) are standard for radiographic evaluation of facial bone fractures. The bony elements have historically been the focus of the diagnosis and treatment. Magnetic resonance imaging (MRI) can detect both bone and soft tissue pathology. We have used perioperative arthroscopic evaluation of upper joint compartment during open surgery in cases with condylar head fracture. Methods: Arthroscopy of upper compartment was performed in 24 patients with dislocated condylar head fractures. We have evaluated disc position, disc perforation, cartilage damage, haemorrhagic clots, hypervascularity and synovitis. Patients were divided to two groups, depending on the period from trauma, less than five days and more than five days. Results: In majority of the cases the disc was dislocated anteromedially following fragment dislocation. We have had no case with disc perforation or disc rupture. Hyperemia, haemorrhagic clots and cartilage erosions were the most frequent changes. Conclusions: Information from this study is useful in furthering the understanding of intraarticular damage occurring in acute trauma. Presence of haematoma after acute joint trauma and its evacuation and early movement may prevent later pathology. http://dx.doi.org/10.1016/j.ijom.2017.02.293 Planes of reference for orbital fractures: computed tomographic assessment of orbital fractures made easy J. Hung ∗ , E.Z. Cai, L.S.F. Chan, X.T. Chong, W.L. Ong, J.Y. Goh, E.C.H. Hing, W.K. Leow, Y.H. Chan, H.J. Lee, V. Nallathamby, Y.L. Yap, W.C. Ong, J. Lim, S. Gangadhara, T.C. Lim Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore Background: The posterior ledge (PL) is the portion of the orbital floor left after a fracture. It is important for implant placement during orbital reconstruction. Correct placement involves resting its posterior aspect on PL. Without knowledge of its location, dissection to PL is challenging. Inaccurate placement leads to postoperative complications. We developed a novel technique (Planes of Reference for Orbital Fractures [PROF]) to determine the most common location of PL from infraorbital margin (IM). Methods: This retrospective study evaluates 104 consecutive patients with unilateral orbital floor fractures who underwent orbital floor reconstruction from 2008 to 2013. Of 104 cases, 52 had intact IM and 52 had fractured IM. We excluded patients with
pre-existing orbital pathologies. Facial computed tomography ® (CT) scans were analysed using Osirix Lite Digital Imaging and Communications in Medicine (DICOM) Viewer v7.0.1 (Geneva, Switzerland). The skull was positioned upright according to the Frankfurt and midsagittal planes. Measurements were taken on the sagittal view corresponding to the midorbital line (MOL) bisecting the fractured orbit. Without intact IM, MOL of the nonfractured orbit was reflected and superimposed onto the fractured orbit. The location of PL is determined from the reflected intact IM. Results: Orbits with intact IM, PL were located 15.0 mm to 25.0 mm from IM (mean, 22.1 mm; 95% CI, 21.2–23.0 mm). Fractured IM, PL located 15.0 mm to 25.0 mm from IM (mean, 21.1 mm; 95% CI, 20.2–21.9 mm). Conclusion: PROF is an efficient technique in locating PL, avoiding insufficient or overaggressive dissections during orbital reconstructions. The mean distance of PL from IM is 22.1 mm and 21.1 mm for intact and fractured IM, respectively. http://dx.doi.org/10.1016/j.ijom.2017.02.294 Comparison of titanium mesh versus polycaprolactone-tricalcium phosphate implant in orbital fracture reconstruction J. Hung ∗ , A.C. Han, E. Cai, L.T. Chye Division of Plastic, Reconstructive and Aesthetic Surgery, National University Health Systems, Singapore Background: Controversy exists regarding the choice of implant material for orbital floor reconstructions. This study aims to compare the effectiveness of titanium mesh and polycaprolactonetricalcium phosphate (PCL/TCP) implant for repairing traumatic orbital fractures. Methods: A total of 19 patients with orbital floor reconstructions operated at the National University Health System, Singapore were included in this prospective study between November 2010 and June 2013. Titanium mesh was used in 10 patients, while PCL/TCP implant was used in the other nine patients. Patients were evaluated for the worsening of visual acuity, presence or absence of infraorbital nerve paraesthesia, extraocular muscle function, enophthalmos and diplopia. Postoperative complications such as infection, early resorption, extrusion and persistent pain were also recorded. Results: Restoration of orbital wall continuity was successful in all patients. Follow-up duration was at least one year. There was no statistically significant difference in worsening of visual acuity, presence or absence of infraorbital nerve paraesthesia, extraocular muscle function and enophthalmos. Even though there was no statistically significant difference in diplopia between the two treatment groups preoperatively, there were more patients who had diplopia following titanium mesh postoperatively (P < 0.05). One patient had persistent diplopia, enopthalmos and lateral rectus muscle dysfunction postoperatively, but declined further corrective surgery. There was no infection, early resorption, extrusion or persistent pain. Conclusions: Both groups showed satisfactory results. PCL/TCP composite can be used to fabricate biodegradable fixators for the reconstruction of orbital wall fractures. http://dx.doi.org/10.1016/j.ijom.2017.02.295