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Management of frontal sinus fractures — review of cases
80 Findings: Mean distances between the orbital rim (A) and orbital process of the palatine bone (B) were 32.5 mm in females and 33.7 mm in males. Males had significantly larger bony orbits than females. Conclusions: These measurements can enable a safer and more predictable surgical approach to the orbit, which may help reduce the risk of damaging important neighbouring structures. It may also help adequately localise the posterior ledge, specifically the orbital process of the palatine bone thereby ensuring a more precise reconstruction of the orbital floor and promoting a better surgical outcome.
The use of Floseal haemostatic matrix for acute maxillofacial haemorrhage: experience from a major trauma centre in the United Kingdom
Objectives: To review our case series of patients who have had Norian bone cement used for secondary orbital reconstruction and to assess the efficacy and safety. Methods: Patients were assessed clinically for enophthalmos and diplopia and with fine cut computed tomography scan of the orbits to assess the size and position of the defect. Intraoperatively access was via a transconjunctival approach, the defect was exposed and a PDS sheet was used to retract the orbital contents. The Norian bone cement was placed into the defect and allowed to set, before removal of the PDS sheet and closure with sutures. Findings: Our case series of patients is presented. Demographics and the nature of the orbital defect were recorded. The outcomes assessed were postoperative enophthalmos, diplopia and any complications recorded. Conclusion: Norian bone cement is an effective and safe method of orbital reconstruction in secondary posttraumatic deformity. We therefore recommend its use in selected cases.
E. Gruber ∗ , J. Breeze, M.S. Dover
http://dx.doi.org/10.1016/j.ijom.2017.02.287
Queen Elizabeth Hospital, Birmingham, United Kingdom
Intraoral transmucosal rigid fixation to treat severely infected mandibular fractures
http://dx.doi.org/10.1016/j.ijom.2017.02.285
Background: Floseal haemostatic matrix (Baxter) is indicated in surgical procedures as an adjunct to haemostasis when the control of bleeding by ligature or conventional procedures is ineffective or impractical. It comprises two independent haemostatic agents: gelatin granules which swell to produce a tamponade effect and high concentrations of human thrombin which converts fibrinogen into fibrin, thereby accelerating clot formation. There are few reports of its use in the maxillofacial region. Objectives: To review our case series of patients who have had Floseal haemostatic matrix utilised in the control of acute haemorrhage and to assess the efficacy and safety. Methods: All patients who underwent maxillofacial surgery or sustained maxillofacial trauma in which Floseal haemostatic matrix was utilised in acute haemorrhage control within our Unit were identified and analysed. Findings: Our case series of patients is presented. Demographics and the nature of the bleeding were recorded. The outcomes assessed were control of the haemorrhage, need for other haemostatic measures and any complications recorded. These included postoperative bleeding following elective tracheostomy and in epistaxis resulting from midfacial fractures. Conclusion: Floseal haemostatic matrix is an effective and safe adjunctive method of controlling acute haemorrhage in the maxillofacial region. We have found this to be useful when conventional measures have been ineffective and therefore recommend its use in selected cases.
C. Guerrero ∗ , M. Gonzalez, R.R. Throndson University of Texas Medical Branch, Galveston, TX, United States Objectives: To combine incision and drainage of facial infections and treat mandibular fractures in a singular surgical stage Methods: Eight patients (aged 16–42 years, five males and three females) with severe multi-spaces facial infections after mandibular fractures secondarily to gun-shot wounds or trauma were treated by Erich arch bars to obtain an ideal occlusion and physiotherapy post surgery, bone reduction was performed either open or closed, transmucosal rigid fixation was apply to avoid internal plates colonisation. The arch bars and plating system were removed 8–12 weeks after, according to bone healing. The infections were treated by incision and drainage with drains installation and removal, either 24 or 48 h after surgery. Results: All infections were cured; the fractured bones were aligned and fixated without complications, ideal dental occlusion, aesthetics and function were obtained. Conclusions: This new method allows the combination of facial infections and fractures treatments in one surgical stage, with major economical savings and less time away from work. http://dx.doi.org/10.1016/j.ijom.2017.02.288
http://dx.doi.org/10.1016/j.ijom.2017.02.286
Management of frontal sinus fractures — review of cases
The use of Norian bone cement for secondary orbital reconstruction: a case series
A. Gupta ∗ , G. Lehl
E. Gruber ∗ , I. Sharp Queen Elizabeth Hospital, Birmingham, United Kingdom Background: Norian craniofacial repair system (CRS) calcium phosphate bone cement (Synthes) is a biocompatible putty that has been used for augmentation and restoration of the craniofacial skeleton. There is limited experience of its use in the secondary reconstruction of posttraumatic orbital defects.
Government Medical College Hospital, Chandigarh, India Background and Objectives: The goals in the treatment of frontal sinus injuries are to provide an aesthetic outcome, restore function, and prevent complications. However there is no consensus as how to best achieve these goals. The authors retrospectively reviewed the cases of frontal sinus injuries managed 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
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).
The use of Floseal haemostatic matrix for acute maxillofacial haemorrhage: experience from a major trauma centre in the United Kingdom
Objectives: To review our case series of patients who have had Norian bone cement used for secondary orbital reconstruction and to assess the efficacy and safety. Methods: Patients were assessed clinically for enophthalmos and diplopia and with fine cut computed tomography scan of the orbits to assess the size and position of the defect. Intraoperatively access was via a transconjunctival approach, the defect was exposed and a PDS sheet was used to retract the orbital contents. The Norian bone cement was placed into the defect and allowed to set, before removal of the PDS sheet and closure with sutures. Findings: Our case series of patients is presented. Demographics and the nature of the orbital defect were recorded. The outcomes assessed were postoperative enophthalmos, diplopia and any complications recorded. Conclusion: Norian bone cement is an effective and safe method of orbital reconstruction in secondary posttraumatic deformity. We therefore recommend its use in selected cases.
E. Gruber ∗ , J. Breeze, M.S. Dover
http://dx.doi.org/10.1016/j.ijom.2017.02.287
Queen Elizabeth Hospital, Birmingham, United Kingdom
Intraoral transmucosal rigid fixation to treat severely infected mandibular fractures
http://dx.doi.org/10.1016/j.ijom.2017.02.285
Background: Floseal haemostatic matrix (Baxter) is indicated in surgical procedures as an adjunct to haemostasis when the control of bleeding by ligature or conventional procedures is ineffective or impractical. It comprises two independent haemostatic agents: gelatin granules which swell to produce a tamponade effect and high concentrations of human thrombin which converts fibrinogen into fibrin, thereby accelerating clot formation. There are few reports of its use in the maxillofacial region. Objectives: To review our case series of patients who have had Floseal haemostatic matrix utilised in the control of acute haemorrhage and to assess the efficacy and safety. Methods: All patients who underwent maxillofacial surgery or sustained maxillofacial trauma in which Floseal haemostatic matrix was utilised in acute haemorrhage control within our Unit were identified and analysed. Findings: Our case series of patients is presented. Demographics and the nature of the bleeding were recorded. The outcomes assessed were control of the haemorrhage, need for other haemostatic measures and any complications recorded. These included postoperative bleeding following elective tracheostomy and in epistaxis resulting from midfacial fractures. Conclusion: Floseal haemostatic matrix is an effective and safe adjunctive method of controlling acute haemorrhage in the maxillofacial region. We have found this to be useful when conventional measures have been ineffective and therefore recommend its use in selected cases.
C. Guerrero ∗ , M. Gonzalez, R.R. Throndson University of Texas Medical Branch, Galveston, TX, United States Objectives: To combine incision and drainage of facial infections and treat mandibular fractures in a singular surgical stage Methods: Eight patients (aged 16–42 years, five males and three females) with severe multi-spaces facial infections after mandibular fractures secondarily to gun-shot wounds or trauma were treated by Erich arch bars to obtain an ideal occlusion and physiotherapy post surgery, bone reduction was performed either open or closed, transmucosal rigid fixation was apply to avoid internal plates colonisation. The arch bars and plating system were removed 8–12 weeks after, according to bone healing. The infections were treated by incision and drainage with drains installation and removal, either 24 or 48 h after surgery. Results: All infections were cured; the fractured bones were aligned and fixated without complications, ideal dental occlusion, aesthetics and function were obtained. Conclusions: This new method allows the combination of facial infections and fractures treatments in one surgical stage, with major economical savings and less time away from work. http://dx.doi.org/10.1016/j.ijom.2017.02.288
http://dx.doi.org/10.1016/j.ijom.2017.02.286
Management of frontal sinus fractures — review of cases
The use of Norian bone cement for secondary orbital reconstruction: a case series
A. Gupta ∗ , G. Lehl
E. Gruber ∗ , I. Sharp Queen Elizabeth Hospital, Birmingham, United Kingdom Background: Norian craniofacial repair system (CRS) calcium phosphate bone cement (Synthes) is a biocompatible putty that has been used for augmentation and restoration of the craniofacial skeleton. There is limited experience of its use in the secondary reconstruction of posttraumatic orbital defects.
Government Medical College Hospital, Chandigarh, India Background and Objectives: The goals in the treatment of frontal sinus injuries are to provide an aesthetic outcome, restore function, and prevent complications. However there is no consensus as how to best achieve these goals. The authors retrospectively reviewed the cases of frontal sinus injuries managed 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
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).