Journal of Cranio-Maxillo-Facial Surgery - Articles in Press

Comparative study of tramadol combined with dexamethasone and diclofenac sodium in third-molar surgery - Corrected Proof

2012-02-02

Abstract: The aim of this randomized, double-blind clinical trial was to investigate the effect of preemptive analgesia with a combination of tramadol+dexamethasone or tramadol+diclofenac sodium. The study included 30 patients (age range: 16–30years), who were randomly assigned to 2 groups by the split-mouth method. Postoperative pain was assessed with a visual analogue scale at 4, 6, 12, 24, and 48h postoperatively (p.o.h.). Swelling was measured at 48p.o.h. Maximal interincisor distance was measured at 48p.o.h. and 7 postoperative days (p.o.d.). Significant differences in postoperative pain intensity were detected between the drug combinations at 4, 6, and 12p.o.h., suggesting the importance of preemptive analgesia. Patients treated with tramadol+dexamethasone showed lower pain scores compared to the tramadol+diclofenac sodium combination, larger postoperative mouth opening, and less swelling. The tramadol+dexamethasone combination also was more effective than tramadol+diclofenac sodium at reducing inflammation.

Current trends and future perspectives of bone substitute materials – From space holders to innovative biomaterials - Corrected Proof

2012-02-01

Abstract: An autologous bone graft is still the ideal material for the repair of craniofacial defects, but its availability is limited and harvesting can be associated with complications. Bone replacement materials as an alternative have a long history of success. With increasing technological advances the spectrum of grafting materials has broadened to allografts, xenografts, and synthetic materials, providing material specific advantages. A large number of bone-graft substitutes are available including allograft bone preparations such as demineralized bone matrix and calcium-based materials. More and more replacement materials consist of one or more components: an osteoconductive matrix, which supports the ingrowth of new bone; and osteoinductive proteins, which sustain mitogenesis of undifferentiated cells; and osteogenic cells (osteoblasts or osteoblast precursors), which are capable of forming bone in the proper environment. All substitutes can either replace autologous bone or expand an existing amount of autologous bone graft.Because an understanding of the properties of each material enables individual treatment concepts this review presents an overview of the principles of bone replacement, the types of graft materials available, and considers future perspectives. Bone substitutes are undergoing a change from a simple replacement material to an individually created composite biomaterial with osteoinductive properties to enable enhanced defect bridging.

Management of penetrating medial and retro-bulbar orbital shrapnel/bullet injuries - Corrected Proof

Sabri T. Shuker — 2012-01-30

Abstract: The presence of shrapnel or a bullet lying in the medial orbital and retrobulbar area is rare. A review of the literature revealed only a few reports. Recently eye/orbital penetrating trauma has increased dramatically, mainly due to IEDs or conventional weaponry in civilian and military casualties. Our experience in the management of these types of injuries prompted this report.Practical techniques for correctly determining the location of retained projectiles in the orbit are described. Surgical techniques for treatment are presented, based on safe and successful practices used in the missile retrievals.Six shrapnel and three bullet injuries, mostly in the medial orbital region, were removed without increasing morbidity and with limited orbital tissue injury.

3D CT based rating of unilateral impacted canines - Corrected Proof

Sebastian Hanke, Ursula Hirschfelder, Thomas Keller, Elisabeth Hofmann — 2012-01-27

Abstract: Objective: The aim of this study was to develop a reference system for multislice computed tomography (MSCT) images to determine of the location of impacted teeth in metric terms.Study design: The CT data of 17 patients with unilateral impacted maxillary canines were selected retrospectively from existing MSCT data sets. In a reference coordinate system, defined by anterior nasal spine (ANS), posterior nasal spine (PNS), and A-point, the axis length and the inclination of the canines were determined and impacted and non-impacted canines were compared.Results: There were significant differences between the impacted and non-impacted canines (p≤0.0003) for all inclinations and the lengths in the x- and z-axes. The measurement of the inclination and sections of the impacted and non-impacted canine tooth axes showed sufficient repeatability and reproducibility.Conclusion: The coordinate system proved to be suitable for the exact metric localization of impacted teeth.

The use of image guidance in avoiding vascular injury during trans-sphenoidal access and decompression of recurrent pituitary adenomas - Corrected Proof

Sunil V. Furtado, Sumit Thakar, Alangar S. Hegde — 2012-01-25

Abstract: Repeat trans-sphenoidal surgery for pituitary adenomas is fraught with the risk of injury to the internal carotid artery that can occur either while incising scar tissue in the sphenoid sinus/sella or during tumour decompression. The ensuing complications can be devastating and difficult to manage within the limited confines of the bony sella and sphenoid sinus, and more so when the local anatomy is distorted by previous surgery. This article highlights complications involved in repeat trans-sphenoidal pituitary surgery and outlines the role of image-guided surgery in avoiding them. With the use of modalities like Doppler sonography and neuronavigation, the position of the ICA can be determined accurately in all cases.

Letter to the Editor in re: Chen M-J, Yang C, Zhang X-H, Qiu Y-T: Synovial chondromatosis originally arising in the lower compartment of the temporomandibular joint: a case report and literature review. J Craniomaxillofac Surg 39: 459–462, 2011 - Corrected Proof

John E deB Norman — 2012-01-24

In re: Chen M-J, Yang C, Zhang X-H, Qiu Y-T: Synovial chondromatosis originally arising in the lower compartment of the temporomandibular joint: a case report and literature review. J Craniomaxillofac Surg 39: 459–462, 2011.

Infant ectopic cervical thymus one case report: Diagnostic and management difficulties - Corrected Proof

2012-01-24

Abstract: Cervical ectopic thymus (CET), an embryological anomaly detected incidentally at autopsy, is rarely described in clinical patients. Furthermore, aberrant cervical thymic tissue is an infrequently reported cause of neck masses, and especially for pediatric patients. However, according to clinical work, it should be included in the differential diagnosis of neck masses, particularly for children patients. Thymic tissue rests can be found all along the route of thymic descent from the neck into the anterior mediastinum. In routine practice, the preoperative diagnosis of ectopic cervical thymus is seldom considered and it is often misdiagnosed as a possible tumor or as a lymph node, which leads to biopsy or surgical removal. Here, a case of ectopic thymic tissue was presented in the neck misdiagnosed as cystic hydroma (one type of lymphatic malformation). Our misdiagnosis was introduced, the literature about diagnosis and management controversy were reviewed in recent years.

Tessier 3 cleft with bilateral anophthalmia: Case report and surgical treatment - Corrected Proof

Enrico Sesenna, Marilena L. Anghinoni, Alessandra C. Modugno, Alice S. Magri — 2012-01-24

Abstract: Tessier clefts type 3 and 4 are rare. In this paper the authors report on the management of a wide Tessier 3 cleft. There is no standardized protocol or timing of the surgical procedures in this rare disfiguring condition. Generally speaking, the aim is to preserve the function of important anatomical structures (e.g., a seeing eye.) and reconstruct, as best as possible, harmonic facial features. The authors present a “step by step” solution of the malformation pointing out the limitations of the surgical procedures they used and the goals they wanted to obtain.Despite of the uniqueness and the complexity of the pathology, the authors think they obtained reasonable results both in term of function and aesthetics, permitting the patient to be accepted in the social environment.

The oculo-auriculo-fronto-nasal syndrome (OAFNS) – Description of a rare and complex craniofacial deformity and its interdisciplinary management before school age - Corrected Proof

2012-01-16

Abstract: Craniofacial clefts are certainly among the most challenging congenital malformations with respect to functional, aesthetic and psychosocial consequences. The aetiology is still under discussion, recent molecular genetic findings suggest defects in the ciliary function of neural crest cells during facial development. The severity of craniofacial clefting is known to be extremely variable. Different classifications have been proposed however nomenclature is not uniform. If vertical, median craniofacial clefting of fronto-naso-maxillary structures is accompanied by auriculo-mandibular malformations the term oculo-auriculo-fronto-nasal syndrome (OAFNS) has been proposed. Extreme craniofacial abnormalities have to be expected in this rare disorder. Adequate correction is a surgical challenge and interventions have to be adapted individually to patient's needs with respect to general condition, age and growth. This case report describes both the underlying pathology as well as the interdisciplinary management of a female patient from birth to 6years of age affected by this rare combination of vertical craniofacial clefting and bilateral auriculo-mandibular dysplasia.

Repeated sodium hyaluronate injections following multiple arthrocenteses in the treatment of early stage reducing disc displacement of the temporomandibular joint: A preliminary report - Corrected Proof

Umut Tuncel — 2012-01-16

Abstract: Purpose: The aim of this study was to assess the safety and clinical utility of intraarticular injection of sodium hyaluronate for the treatment of symptoms associated with internal derangement of the temporomandibular joint (TMJ).Patients and methods: Twenty patients, who have early stage temporomandibular dysfunction (TMD), were treated with intraarticular sodium hyaluronate injection and arthrocentesis. The patients received sodium hyaluronate (15 mg/ml) (1 ml) injections two times a week first following arthrocentesis with 200 ml Ringer’s Lactate and the second without. The procedure was repeated for three times at weekly intervals for 3 weeks. Pre- and postinjection pain intensity, the presence of joint sounds, and interincisial distance were recorded. These data were evaluated by visual analog scale (VAS).Results: The follow-up period was 6 months. There was a statistically significant reduction of pain intensity (p < 0.001) and joint sound (p < 0.001) in all patients. Initial measurement of maximal mouth opening (MMO) was 33.40 ± 3.75 mm. At the end of the follow-up period, the same measurements were repeated and interincisal distance was 49.3 ± 3.74 mm. The difference between these measurements was statistically significant (p < 0.001).Conclusion: We suggest that repeated sodium hyaluronate injections following multiple arthrocenteses with Ringer’s Lactate is an effective and safe method for the treatment of early stage reducing disc displacement of TMJ.

The pattern of the maxillofacial fractures – A multicentre retrospective study - Corrected Proof

2012-01-04

Abstract: Aim of the present study was to report on the survey of fractures, frequency of presentation, sex and age distributions, aetiology, site distributions, associated injuries & modalities of treatment rendered at muticentres treated by the division of oral and maxillofacial surgery between 2000 and 2005 in Karnataka state of India. Study revealed that the common cause for the facial fractures was found to be traffic accidents (72.7%) with a male preponderance and peak incidence during 20–30years of age. Isolated mandibular fractures were most frequent [1035 patients (41.7%)] followed by isolated mid face fractures [526 patients (21.2%)]. Among mid face fractures, zygomatic bone and arch were most frequently involved. Open reduction and internal fixation and closed method were used in almost the same frequency. Traffic accidents are the leading cause of the maxillofacial fractures from the observation made from the study. Legislations preventive measures to be enforced and abided by every citizen.

Comparative study of skeletal stability between bicortical resorbable and titanium screw fixation after sagittal split ramus osteotomy for mandibular prognathism - Corrected Proof

Jun-Young Paeng, Jongrak Hong, Chang-Soo Kim, Myung-Jin Kim — 2011-12-30

Abstract: Introduction: Resorbable screw fixation for orthognathic surgery is widely used in oral and maxillofacial surgery and has several advantages. However, surgeons are concerned about using resorbable screws in orthognathic surgery because of possible postoperative complications such as relapse, screw fracture, and infection. The purpose of this study was to evaluate the skeletal stability of bicortical resorbable screw fixation after sagittal split ramus osteotomies for mandibular prognathism.Materials and methods: This study included 25 patients who underwent mandibular setback surgery fixed with resorbable screws after sagittal split osteotomy at the Department of Oral and Maxillofacial Surgery at Seoul National University Dental Hospital. Five resorbable screws (Inion CPS®, Inion Ltd., Finland) were applied bicortically at each osteotomy site via a transbuccal approach. No rigid intermaxillary fixation was applied on the first postoperative day. Passive mouth opening exercises were allowed, using two light, rubber elastics for guidance. The control group was 25 patients fixed with four titanium screws. The follow-up period was 12–22months (mean 17.8months). Postoperative skeletal changes on lateral cephalometric radiographs were analyzed and compared between the two groups preoperatively, immediately postoperatively, and 6months postoperatively.Results: The average setback was 6.9mm and no major intraoperative complications occurred. One patient experienced infection immediately after surgery that was controlled uneventfully. The data did not demonstrate any significant difference in postoperative skeletal stability between the two groups. Differences between the immediate postoperative state and 6months after surgery were not significant. In earlier cases, especially for patients with severe mandibular prognathism, immediate postoperative elastic traction was needed for stable occlusal guidance.Conclusions: The results of this study indicate that bicortical resorbable screws offer a clinically stable outcome for the fixation of mandibular sagittal split osteotomies in mandibular prognathism. However the resorbable screws showed less stable results vertically than the titanium screws.

Endoscopic abdominoplasty providing a perforator fat flap for treatment of hemi-facial microsomia - Corrected Proof

Fred Podmelle, Hans Robert Metelmann, Peter Waite — 2011-12-30

Abstract: A patient with a history of an extended unilateral hemifacial cleft desired the restoration of the buccal fat on the hollow cheeked side and also wished to reduce an abdominal bulge at the same time. The amount of tissue volume needed exceeded the possibilities of free autologous fat grafting, lipofilling and allogenic implants. Therefore a free fat flap with microvascular anastomoses harvested as part of a minimal invasive abdominoplastic procedure using an incision well hidden within the bikini zone was the most attractive surgical option. This is the first case reported, where the standard free deep inferior epigastric artery (DIEA) perforator flap was utilised.

Preliminary report of Ki-67 reactivity in synovial chondromatosis of the temporomandibular joint: An immunohistochemical study - Corrected Proof

Hiroaki Yoshida, Kaname Tsuji, Nobuyoshi Oshiro, Masahiro Wato, Shosuke Morita — 2011-12-23

Abstract: Background: Synovial chondromatosis (SC) is rare benign condition characterized by the formation of metaplastic cartilaginous nodules in the synovial membrane and joint space. Cartilaginous nodules from and may become pedunculated and detached from the synovial membrane, so becoming loose bodies within the joint space.Purpose: The aim of this study was to determine the proliferative activity of loose body and synovial membrane of SC in temporomandibular joint by using Ki-67 antibody.Material and methods: We obtained 4 specimens (4 female) of released loose body and 2 specimens of synovial membrane with attached loose bodies by surgical operation. The specimens were fixed in 10% formalin solution, and embedded in paraffin. The immunohistochemical study was carried out using an anti-human Ki-67 monoclonal antibody. The sections were visualized by 3, 3′-diaminobenzidine-tetrahydrochloride (DAB).Results: The expression of Ki-67 was scarcely detected in all cases of loose bodies. In second phase cases, the mild expression of Ki-67 was detected at both cases of synovial membrane which were attached loose bodies.Conclusion: These results suggested that released loose bodies into the joint compartment did not have independent proliferating activity. However, the synovial membrane may play a very important role in the proliferation of the loose bodies.

Blindness following severe midfacial trauma – Case report and review - Corrected Proof

Johannes Roth, Volker Hingst, Jan-Hendrik Lenz — 2011-12-23

Abstract: Purpose: Severe trauma of the viscerocranium or neurocranium may result in impaired visual acuity or even blindness. Case based epidemiology, pathomechanism and actual strategies in midfacial trauma for initial therapy and prevention of posttraumatic blindness are discussed.Case and review: A 58-year old patient was treated at our Department of Oral and Maxillofacial Plastic Surgery after his central midface had been hit by a swinging steel girder. Initially he was blind on both eyes. Initial treatment started by applying 24 mg of dexamethasone and omeprazole. During the following 2 weeks, amaurosis persisted on the left eye. On the right eye complete visual acuity was regained. On the basis of data from our Department of Oral and Maxillofacial Plastic Surgery an Odds Ratio of 0.12 was calculated for the combination of blindness and midfacial trauma. Today cortisol therapy is still used. However, hypothermia, anti-Trendelenburg position, and application of mannitol seem to be more effective therapeutic strategies. Erythropoetine and progesterone are promising drugs with neuroprotective, anti-inflammatory as well as anti-oedematous effects.Conclusion: The risk of blindness is higher than expected. Latest findings regarding the neuroprotective effects of erythropoetine or/and progesterone seem to promise a more successful treatment.

Oculoauriculovertebral spectrum with a full range of severe clinical manifestations – Case report - Corrected Proof

Elżbieta Gawrych, Joanna Janiszewska-Olszowska, Hanna Chojnacka — 2011-12-12

Abstract: Oculoauriculovertebral spectrum (OAVS) is a rare congenital malformation consisting of epibulbar dermoids, lid colobomas, auricular deformities, hypoplasia of the soft and bony tissues of the face, associated oral deformities and vertebral anomalies. This report presents a child with a choroid of the right eye, coloboma of the upper eyelid, epibulbar dermoid of the left eye, mandibular hypoplasia, facial asymmetry, bilateral complete cleft lip and palate, hypoplasia of the left alar cartilage, appendage of the left nose, butterfly vertebral defects of Th-1, Th-2 and abnormality of rib XI. Widened sulci of frontal and parietal lobes, bilateral white matter density decrease and calcifications of falx cerebelli were noted. Axial hypotony and delayed psycho-motor development were apparent. This rare case presents a range of severe clinical manifestations of oculoauriculovertebral spectrum. Despite a normal cervical vertebral column, tracheostenosis was present. It caused difficulties in tracheal intubation, creating the need for a tracheostomy, and death after a failed attempt at decannulation. This case indicates that in patients with clinical manifestations including cerebral anomalies, a risk of respiratory insufficiency should be always taken under consideration, when planning surgery.

Particulate vs. block bone grafts: Three-dimensional changes in graft volume after reconstruction of the atrophic maxilla, a 2-year radiographic follow-up - Corrected Proof

Amir Dasmah, Andreas Thor, Annika Ekestubbe, Lars Sennerby, Lars Rasmusson — 2011-12-05

Abstract: Background: Extensive alveolar bone resorption in the maxilla limits the possibility of successful placement and osseointegration of endosseous implants for future prosthetic rehabilitation. Autogenous bone from the iliac crest may be used as lateral onlays in the atrophic maxilla, both as block and particulate bone. To our knowledge, there is no three-dimensional 2-year follow-up study measuring the volumetric reduction of the augmented areas comparing particulate and block bone grafts.Purpose: The aim of this study was to conduct a radiographic 2-year follow-up study, using computed tomographic (CT) images in order to evaluate and compare the extent of bone graft resorption in the frontal maxillae augmented by particulate (test) and block bone (control).Material and methods: Eleven patients treated with iliac bone grafts and oral implants in the maxilla were followed with CT examinations directly post grafting and after 2years.Result: The volumetric changes after 6months were extensive. Additionally, the changes in particulate bone tended to be larger after 2years compared to block bone, using this protocol. However, the difference was not statistically significant.Conclusion: The present follow-up study showed that there is radiographically complete integration and embedding of implants installed in grafted bone despite extensive initial graft resorption. There was no significant difference in the amount of volumetric reduction between particulate bone and block bone grafts.

Anatomical aspects in the transsphenoidal–transethmoidal approach to the optic canal: An anatomic–cadaveric study - Corrected Proof

Selcuk Yilmazlar, Ozlem Saraydaroglu, Ender Korfali — 2011-11-30

Abstract: Background: Determining anatomic landmarks during a transsphenoidal–transethmoidal approach to the optic canal region is of critical importance.Methods: Sella–parasella sphenoid bone blocks were extracted from adult cadavers. Anatomic dissections were performed in the optic canal region using a surgical microscope in 30 samples. Quantitative measurements were done using photographic techniques. For histological evaluation, coronal and longitudinal cross-sections were taken from the bilateral optic canal in seven decalcified samples.Results: Optic protuberance (OP), carotid protuberance (CP), medial opticocarotid recess (MOCR) and lateral opticocarotid recess (LOCR) were defined as lateral landmarks determining the width of the opening in the extended transsphenoidal–transethmoidal approach. Among all anatomic markers, LOCR was the most determinant lateral marker with tubercular recess the most prominent central marker. OPs showing the optic canal direction and inter-recessal sulci had similar distinguishing rates in the sphenoid sinus base. Inter-recessal sulci formed by OPs and CPs were observed between MOCR and LOCR in most samples. In histologic sections, the dural sheath was thicker inferolaterally to the optic nerve compared to superiorly and medially; collagen arrangement was dense and irregular.Conclusion: Although LOCRs and tubercular recesses are safe and prominent markers in extended transsphenoidal–transethmoidal approaches, other anatomic markers should also be taken into consideration to perform an efficient optic canal approach and optic canal decompression. Other factors for safe dissection are the length of the optic canal, bone thickness, adherence of dural structures and the course of the intradural ophthalmic artery.

Incidence of maxillary sinusitis and oro-antral fistulae in bisphosphonate-related osteonecrosis of the jaw - Corrected Proof

2011-11-28

Abstract: Objective: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious side-effect of bisphosphonate therapy. In the majority of cases BRONJ occurs in the mandible. As a consequence a detailed investigation of BRONJ of the maxilla and in particular of involvement of the maxillary sinus has largely so far been neglected. The aim of this study was to analyse the frequency of maxillary sinusitis and oro-antral fistulae in BRONJ of the maxilla.Subjects and methods: A retrospective multicentre analysis was carried out in three Departments of Oral and Maxillofacial Surgery focussing on patients suffering from BRONJ in the maxilla. The role of involvement of the maxillary sinus, in particular sinusitis and oro-antral fistula, was analysed.Results: Out of a total of 170 patients suffering from BRONJ 53 cases (31.2%) with involvement of the maxilla were identified. At least one sign of maxillary sinusitis was present in 43.6% (23/53) and an oro-antral fistula in the course of the disease was detected in 35.8% (19/53) of those patients. The mean length of time of bisphosphonate intake was 36.16±16.32 months. Zoledronate was most frequently associated (60.4%) with symptoms, followed by the combination of Zoledronate/Ibandronate (13.2%), and Zoledronate/Pamidronate or Pamidronate alone (both 7.5%).Conclusion: Maxillary sinusitis and oro-antral fistulae are associated with a BRONJ manifestation in the upper jaw in approximately 44%. The involvement of the maxillary sinus should be given special attention and three-dimensional imaging modalities might be necessary, not only to evaluate the extent of necrosis, but also to exclude involvement of the maxillary sinus.

German animal terms for oral cleft deformity: A Leipzig survey - Corrected Proof

2011-11-28

Abstract: Background: German animal terms have been used to name oral cleft deformity for centuries. However, their contemporary use and influence on cleft patients remain unstudied.Objective: The main aim of this study was to evaluate the current use of German animal terms for oral cleft and their influence on the perception of cleft patients.Methods: We used a cross-sectional study design and the study sample consisted of German adult cleft and noncleft subjects in Leipzig, Germany. The study was conducted during May and December 2008, using two questionnaires and two cleft photographs (one unilateral and one bilateral). The predictor variables were medical background and presence of oral cleft. The primary outcome variable was the terminology used for the deformity by noncleft subjects. The secondary outcome variables were self-perception of the cleft patients and their idea about the use of the animal terms. Other study variables included age, gender and specialty/future career of the noncleft participants. Appropriate descriptive, uni- and bivariate statistics were computed, and a P-value of <0.05 was considered to be statistically significant.Results: The study sample was composed of 261 noncleft (146 females [55.9%]) and 71 cleft subjects (33 females [46.5%]) with a mean age of 24.2±6.4 and 24.9±7.2 years, respectively. Noncleft subjects without medical background who used animal terms to name oral cleft deformity were more than those with medical background (P<0.0001). Over half of cleft patients (60.6%) rejected public use of the animal terms, which was still common in their daily life (P<0.0001).Conclusions: The study results suggest that animal terms have been used until now, especially by those without medical background. The cleft patients become insulted by these negative descriptions. This strikes the importance of public education to replace these animal terms with inoffensive words.

Aneurysmal bone cyst of mandibular condyle: A case report and review of the literature - Corrected Proof

Yehuda Zadik, Alper Aktaş, Scott Drucker, Dorrit W. Nitzan — 2011-11-28

Abstract: An aneurysmal bone cyst (ABC) in the right mandibular condyle and ramus of a 37-year-old woman was surgically resected and immediately reconstructed with a costochondral graft. She was followed up for 5 years. A review of the 10 cases of condylar-ABC available in the literature revealed mean age of 16.8 (±7.6) years, with equal distribution between men and women. In all cases symptoms included swelling and asymmetry, while temporomandibular disorder/dysfunction symptoms were reported in 50%. Parasthesia was not reported, except for self-limited postoperative neuropathy. Curettage or resection was employed equally and recurrence rates were 60% after curettage, 20% after resection; which are higher than reported in non-condylar-ABC’s. All recurrences occurred within 12 months. Thus close post-operative follow up, for at least 12 months, is warranted.

Further experience with the free soleus perforator flaps using CT-angiography as a planning tool – A preliminary study - Corrected Proof

Klaus-D. Wolff, Florian Bauer, Martin Dobritz, Marco R. Kesting, Andreas Kolk — 2011-11-28

Abstract: Introduction: The soleus perforator flap is a soft tissue flap with minimal donor site morbidity however is not frequently utilised due to the unpredictability of the perforating vessel to serve as the vascular pedicle. We have trialed the use of CT-angiography as a planning tool to predict location, length, course, and calibre of the pedicle to make this a more reliable choice.Methods: Twenty consecutive patients with intraoral squamous cell carcinomas were assessed with CT-angiography to examine the peroneal perforators before considering soleus flap raising. If a sizeable perforator could be visualised at the upper half of the lower leg, flap raising was carried out, and the result of the CT-angiography was compared with the intra-operative findings.Results: CT-angiography allowed for visualisation of perforators measuring 1mm in diameter and could predict location, length and course of the vessel. Accordingly, eight of the 20 patients had to be excluded from flap raising due to missing, too fine or too far distally located perforators. Intra-operative findings corresponded well with the results of the CT-scans.Conclusion: CT-angiography is a useful tool for planning the soleus perforator flap and allows selection of the most suitable perforator making the use of this flap more reliable.

Oral granuloma formation after injection of cosmetic filler - Corrected Proof

2011-11-21

Abstract: The increased use of orofacial fillers in cosmetic procedures has led to new diagnostic challenges for dentists and oral pathologists. Here, we describe a case with multiple oral foreign body granulomas, which were formed after a polymethylmetacrylate injection for cosmetic purposes.

Cranio-maxillofacial non-Hodgkin’s lymphoma: Clinical and histological presentation - Corrected Proof

2011-11-18

Abstract: Non-Hodgkin’s lymphoma represents about 5% of all malignant lesions of the head and neck. In this study we retrospectively evaluated clinical presentation, histological subtype and long-term prognosis of 42 patients with non-Hodgkin’s lymphoma involving the craniofacial area. The mean age at diagnosis was 64years. More than half of the patients presented with disseminated disease at multiple sites (55%, n=23). In 62% (n=26) the first manifestation was extranodal. The most common affected region was the oral cavity (65%, n=17). Treatment consisted of local therapy, including surgical resection and radiation, as well as chemotherapy with or without local therapy. Recurrence occurred in 31% (n=13) of the treated patients. Mean survival after first diagnosis varied from 17months in patients presenting with diffuse large B-cell lymphoma (DLBCL), to 8.5years in patients with follicular lymphoma. The most common histological subtype is DLBCL. Standard treatment for DLBCL consists of chemotherapy combined with CD 20 monoclonal antibody, even after total resection of the tumour. There is high risk of systemic disease in patients presenting with non-Hodgkin’s lymphoma and high risk of post therapy recurrence.

Root trauma and tooth loss through the application of pre-drilled transgingival fixation screws - Corrected Proof

Michael Schulte-Geers, Wolfgang Kater, Robin Seeberger — 2011-11-18

Abstract: Transgingival fixation screws are used for intermaxillary fixation in different situations. The aim of this study was to evaluate the risk of root trauma and tooth loss using pre-drilled transgingival fixation screws.Material and methods: 521 patients with mean age 26.9 (SD 9.9) years who had orthognathic surgery or trauma to the maxilla or mandible were selected for the study. Postoperative orthopantomographs (OPT) taken before and after screw removal were examined. The location of the screws and dental-root “hits” were recorded.Results: 1663 screws were inserted either to the maxilla or to the mandible. 285 teeth (17.1%) showed radiologically proven contact between the dental roots and the screws or the dental roots were hit by the screw (screw inserted with more than the screws radius into the root). In three cases (0.2%) teeth were lost due to apical or periradicular inflammation, four teeth (0.2%) had to be root filled and five teeth (0.3%) were persistent painful at the follow-up examination before miniplate removal 10.3 (SD 8.1) months post-surgery.Conclusion: Dental problems occurred in 0.7% at the screw insertions sites. The use of transgingival fixation screws showed a low risk of tooth loss. Root defects healed without any incident. However surgeons must be aware of possible consequences to provide a safe treatment.

Influences of palatoplasty by the push-back procedure on craniofacial morphology and growth - Corrected Proof

Hiroshi Iwasaki, Motonori Kudo, Yuko Yamamoto — 2011-11-17

Abstract: Purpose: For patients with a cleft palate, the push-back procedure which accompanies posterior shifting of palatal flap is thought to be most effective way of. achieving adequate velopharyngeal function. In this study, we aimed to evaluate the influences of the push-back procedure on the craniofacial morphology and its growth.Material and methods: Using cephalometry we compared the craniofacial morphology and growth of three groups of Japanese children, living in the same region (Hokkaido, Japan).1) 28 children (13 girls and 15 boys) with operated submucous cleft palates at the ages of 9 and 14 respectively.2) 12 age-matched children (7 girls and 5 boys) with unoperated submucous cleft palates.3) 60 age-matched non-cleft children (30 girls and 30 boys) with normal occlusion.None of them received dentofacial orthopaedic treatment.Results: While the patients who had been operated on had significant differences in posterior upper facial height and inclination of the palatal plane when compared with non-cleft children or unoperated cleft children, they showed no statistically significant difference in anteroposterior positioning of anterior part of the maxilla, compared with the unoperated.Conclusions: The influences of palatoplasty by the push-back procedure with posterior positioning of the palatal flaps on craniofacial morphology are additional to the cleft palate, and of minor concern.

Comparison of gene expression of tissue inhibitor of matrix metalloproteinase-1 between continuous and intermittent distraction osteogenesis: A quantitative study on rabbits - Corrected Proof

Xi Ling Liu, Lim Kwong Cheung, Hua Xiang Zhang, Jun Yuan Li, Li Ma, Li Wu Zheng — 2011-11-17

Abstract: Background: Distraction osteogenesis is a controlled surgical procedure that initiates a regenerative process and uses mechanical strain to enhance the biological responses of the injured tissues to create new bone. To explore the effect of high-frequency mechanical traction on the expression of tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), we compared the gene expression of TIMP-1 between continuous and intermittent distraction osteogenesis using a rabbit model of mandibular lengthening.Materials and methods: Forty adult New Zealand white rabbits were randomly assigned to the intermittent and continuous distraction groups. A unilateral mandibular osteotomy was performed and a custom-designed manual-driven or auto-driven distractor was bridged over the osteotomy segments. Animals were sacrificed at day-6, day-10, day-14 and day-21 after osteotomy. Samples were examined with real-time polymerase chain reaction (PCR).Results: Real-time PCR examination showed significantly higher mRNA levels of TIMP-1 under continuous distraction than that under intermittent distraction at day-6 and day-10. No significant differences were found at day-14 and day-21.Conclusion: High-frequency traction provides a good mechanical environment for accelerating bone formation by up-regulating TIMP-1.

Ocular and periocular injuries associated with an isolated orbital fracture depending on a blunt cranial trauma: Anatomical and surgical aspects - Corrected Proof

2011-11-17

Abstract: The anatomical location of fractures following blunt cranio-orbital trauma is important for neurosurgeons and maxillofacial surgeons. In this study, 588 cranio-orbital fractures following blunt trauma were evaluated retrospectively with regard to the anatomical site and surgical treatment. Orbital cranial nerve injuries and the outcomes of the medical and/or surgical treatment are described.Distribution of the zygomatic complex and orbital fractures were as follows: zygomatic complex fractures (n:304), isolated orbital fractures (n:58), complex comminuted fractures (n:226).In 58 cases, 69 orbit fractures were found (11 bilateral and 47 unilateral fractures). The lateral wall was the most frequent fracture (n:63). The least frequent fracture was the roof of the orbit (n:11). The accompanying lesions were as follows: 89.65% of cases were associated with periorbital haematoma (n:52), 13.79% of cases with retrobulbar haemorrhage (n:8), 96.55% cases with periorbital soft tissue oedema (n:56), 53.45% cases with pneumocephalus (n:31), 8.62% cases with intra-parenchymal contusion (n:5), 6.89% cases with enophthalmia (n:4), 5.17% of cases with rhinorrhoea (n: 3), 5.17% cases with optic bulb injury and adnexial trauma (n:3), 32.76% cases with intra-orbital emphysema (n:19), and 20.69% with vision dysfunctions (n:12), of whom 2 had no optic nerve injury.

Clinical, therapeutic and prognostic features of osteosarcoma of the jaws – Experience of 36 cases - Corrected Proof

2011-11-15

Abstract: Introduction: Osteosarcoma of the jaws (OSJ) differs from osteosarcoma of other skeletal regions due to later development, a high mortality associated with the local disease, fewer incidences of metastases and its extreme rarity. In regard to clinical and pathological parameters as well as therapeutic approaches and prognosis, OSJ has not been specifically examined to date. In order to achieve a better understanding of this special malignancy, an evaluation of incidence, treatment and prognosis of patients with OSJ in our department over the past 38years was conducted.Materials and methods: A retrospective analysis of patients with OSJ between 1972 and 2010 was performed. Information regarding patient characteristics, site of the lesion, main presenting symptoms, latency of initial diagnosis, treatment, histology, local recurrence, development of metastatic disease, duration of follow up and survival was obtained. The data were compared to the literature.Results: Thirty-six patients (2–81years, mean: 33.9, standard deviation: 21.3) were diagnosed and treated for OSJ (maxillar:mandibular nearly 1:2). Initial symptoms were local swelling (81%) and pain (47%). The latency period between fist symptoms and clinical presentation was 3.7months (1–24). A radical resection alone was conducted in 15 patients. In nine patients, resection and radiotherapy was used. Resection with chemotherapy was the treatment of choice in seven patients. Five patients received a triple combination of resection, chemo- and radiation therapy. The osteoblastic subtype of osteosarcoma was most frequent (42%). In 15 cases (42%) local recurrences, in two cases (5%) metastasis were seen. Of these patients, 13 died within the observation period. One other patient (3%) died as a result of progressive pulmonary metastasis. A mean total survival rate of 61% could be seen whereas the highest survival rate (80%) was found in patients who were treated with neoadjuvant chemotherapy, radical resection and adjuvant radiation. Positive prognostic factors were a younger age and tumour-free resection margins.Discussion: OSJ is a highly lethal tumour entity. According to the data at hand, therapy should possibly include chemotherapy, radical resection and irradiation. Nevertheless, due to the rarity of OSJ, information remains limited and the treatment of choice should be within the focus of clinical multi-centre studies.

Mucormycosis of the head and neck: Report of five cases with different presentations - Corrected Proof

2011-11-15

Abstract: Mucormycosis is a lethal fungal disease with a general poor prognosis. Rhinocerebral presentation is the more frequent form. The purpose of this study was to review and show our experience in the management of 5 cases of mucormycosis of the head and neck with different clinical presentations. The high suspicion led us a prompt diagnosis and aggressive surgical treatment that allowed a good outcome in our series.

The cytotoxic effects of three different bisphosphonates in-vitro on human gingival fibroblasts, osteoblasts and osteogenic sarcoma cells - Corrected Proof

2011-11-15

Abstract: Introduction: Osteonecrosis of the jaw (ONJ) is an emerging condition in patients undergoing long-term administration of bisphosphonates (BP) for the treatment of osteoporosis and hypercalcaemia associated with malignancy, multiple myeloma, and metastatic breast and prostate cancers. This is a follow-up study, its purpose was to examine the effects in-vitro of intravenous zoledronic acid (ZOL) and pamidronate (PAM) and oral alendronate (FOS) on the human oral cavity using gingival fibroblasts and osteoblasts cells and, in addition, osteogenic sarcoma cells (SaOS-2-cells).Materials and methods: Human gingival fibroblasts, osteoblasts and SaOS-2-cells were seeded on multiple 6-well plates at a density of 5×105cells in a 4-week cell culture. Four different concentrations (1, 5, 10, 20μM) of each BP (ZOL, PAM, FOS) and pyrophosphate were used in this study.Results: All BP decreased collagen production and lowered cell proliferation in-vitro. ZOL was the component with most inhibitory effect.Conclusion: The findings in this study suggest that ZOL, PAM and FOS generally diminish cell proliferation and collagen production of human gingival fibroblasts, osteoblasts and SaOS-2-cells. The present follow-up study shows that not only ZOL and PAM but also FOS have a strong inhibitory effect on collagen production and cell survival in-vitro.

Point-to-point registration with mandibulo-maxillary splint in open and closed jaw position. Evaluation of registration accuracy for computer-aided surgery of the mandible - Corrected Proof

2011-11-14

Abstract: Introduction: Computer navigation plays an increasingly important role in craniomaxillofacial surgery. The difficulties in computer navigation at the craniomaxillofacial site lie in the accurate transmission of the dataset to the operating room. This study investigates the accuracy of the dental-splint registration method for the skull, midface, and mandible.Material and methods: A synthetic human skull model was prepared with landmarks and scanned with cone beam computer tomography (CBCT). Two registration splints fixed the mandible against the viscerocranium in two different positions (closed vs. open). The target registration error was computed in all 278 landmarks spread over the entire skull and mandible in 10 repeated measurements using the VectorVision2 (BrainLAB Inc., Feldkirchen, Germany) navigation system.Results: If registered in the closed position an average precision of 2.07mm with a standard deviation (SD) of 0.78mm was computed for all landmarks distributed over the whole skull. Registration in the open position resulted in an average precision of 1.53mm (SD=0.55mm). For single landmarks the precision decreases linearly with distance from the reference markers. The longer the three-dimensional distance between the registration points, the more precise the computer navigation is, mainly in the most posterior area of the cranium.Conclusion: Our findings in the cranium are comparable with those of other studies. Artificial fixation of the lower jaw via splint seems to introduce no additional error. The registration points should be as far apart from each other as possible during navigation with the splint.

Criteria for the request of preoperative tests among oral and maxillofacial surgeons - Corrected Proof

2011-11-14

Abstract: Objective: The aim of this study was to analyze the criteria employed for the requesting of preoperative tests among maxillofacial surgeons.Materials and methods: Thirty maxillofacial surgeons working in Aracaju (Brazil) received a questionnaire to fill out. The study inquired about the practice of requesting preoperative tests for healthy patients scheduled to undergo elective surgery.Results: Most of the surgeons interviewed requested tests that are not recommended for the case in question. The highest frequency of requests was a complete blood count, coagulation test, blood glucose test and chest radiograph.Conclusion: The absence of strict rules for the requesting of preoperative tests causes uncertainty and a lack of criteria regarding pre-surgical conduct. It was not possible to clearly define the criteria used by surgeons for requesting such tests, as the clinical characteristics of the hypothetical case presented suggest a smaller number of tests.

Distributions of calcitonin gene-related peptide and substance P in the human maxillary sinus of Japanese cadavers - Corrected Proof

Iwao Sato, Kosuke Imura, Yoko Miwa, Shunji Yoshida, Masataka Sunohara — 2011-11-14

Abstract: Background: Substance P (SP) and calcitonin gene-related peptide (CGRP) are released by the nociceptive sensory nerve and are involved in blood flow, pain and inflammation in the nasal mucosa. The purpose of this study was to assess the distribution of the SP and CGRP nerve fibres related to blood supply within human Schneiderian membrane of the maxillary sinus (MS).Material and methods: In this study, the MS from Japanese cadavers was examined by whole-mount immunohistochemistry. Human male cadavers (ranging in age from 80 to 90years) were used in this study.Results: SP- and CGRP-positive fibres were found around large vessels of the medialis superior alveolar branches and also within the floor region of the MS. The floor region of the MS was composed of complex branches of these fibres.Conclusion: Our results give useful information for surgical sinus floor elevation in this region of the MS. These anatomical features may assist in the execution of a successful surgical procedure.

Evaluation of surgical treatment in mandibular condyle fractures - Corrected Proof

Aleš Vesnaver, Uroš Ahčan, Janez Rozman — 2011-11-14

Abstract: Aim: In the past, fractures of the mandibular condylar process were, as a rule, treated conservatively. At the Department of Maxillofacial and Oral Surgery of the University Medical Centre Ljubljana, Slovenia, our doctrine was changed in 2002 on the basis of preliminary results and reports in the literature, and these fractures were started to be treated surgically by open reduction and internal fixation with miniplates and screws, which led to good results and a shorter rehabilitation period. The goal of this study was to determine the safety and efficiency of surgical treatment, as well as to compare long-term results of surgical and conservative treatment, as objectively as possible.Patients and methods: Two groups of patients, which had all sustained a unilateral, extra-articular mandibular condyle fracture, were compared. In the test group, there were 42 surgically treated patients, and in the control group, 20 conservatively treated patients. Clinical parameters and X-ray images were assessed in both groups and compared by the two tailed Student t test, and in case of attributive variables by the χ2 test. Within the surgically treated group, postoperative and intraoperative complications were noted: temporary facial nerve palsy, development of a parotid salivary fistula, disturbance of auricle sensibility due to injury of the greater auricular nerve, miniplate fracture, as well as intraoperative bleeding, postoperative haematoma formation, infection, reoperation due to fragment malposition and other complications. Postoperative scars were also assessed.Results: Statistically significant differences between the surgically and conservatively treated patients were found when comparing clinical parameters as well as X-ray images, the results being better in the surgically treated group. Complications of surgical treatment were also noted, the most important among them temporary paresis of facial nerve branches, which occurred in 10 patients (24%). Plate fractures occurred in five patients (12%), in four of them miniplates of sizes less than 2.0mm were used. There were no cases of significant intraoperative bleeding, two cases (5%) required drainage of postoperative haematomas, and one patient (2%) experienced a mild postoperative infection, which was easily controlled with amoxicillin with clavulanic acid. The scar was hidden best if a facelift incision was used, and a hypertrophic scar developed in only one patient (2%).Conclusion: Results of surgical treatment of condylar process fractures are superior to the results of conservative treatment, and the procedure is safe with the transparotid surgical approach and adequate surgical technique.

Congenital malignant rhabdoid tumor of the scalp - Corrected Proof

Alistair R.M. Cobb, Neil J. Sebire, John Anderson, David Dunaway — 2011-11-14

Abstract: Background: Malignant rhabdoid tumors (MRT) are rare but aggressive tumors presenting in the pediatric population. First thought a variant of Wilms’ tumor in the kidney, it is recognized as presenting at renal, central nervous system and other extra-renal primary sites. It is uniformly of very poor prognosis, however.Case report and discussion: We present a case of congenital MRT of the scalp, which we believe to be the first described at this site.The clinical and histopathological features of the tumor are discussed in light of the current literature on MRT at other sites. The bleak prognosis at this site appears to be no different from others – the child succumbed at 10months old despite surgical resection and initial excellent response to chemotherapy.Conclusion: Malignant rhabdoid tumor has a very poor prognosis and needs to be considered in the differential diagnosis of similar lesions by clinicians involved in pediatric head and neck care.

Three-dimensional analyses of facial soft tissue configuration of Japanese females with jaw deformity – A trial of polygonal view of facial soft tissue deformity in orthognathic patients - Corrected Proof

2011-11-11

Abstract: In this study, we evaluated the three-dimensional (3D) soft tissue configuration of Japanese females with/without jaw deformity in order to establish the polygonal view of facial soft tissue deformity three-dimensionally. A polygonal chart was applied to assess the outcomes of orthognathic surgery for patients with mandibular hyperplasia with/without deviation.The study included 20 Japanese females with mandibular hyperplasia with/without deviation. All patients received mandibular setback surgery, and 3D measurements were carried out pre-operation, and at 1, 3 and 6 months postoperatively using a non-contact laser scanning system. Eighteen soft tissue landmarks were set on each 3D image and used to calculate a set of selected parameters. As controls, 20 Japanese females with class I occlusion were included.A polygonal chart was constructed based on the mean and S.D. of the control group. Patients with mandibular protrusion characteristically demonstrated significant variances in the items around the lower face. In asymmetric patients, deviation in the mental area disappeared postoperatively, but a small deviation remained when compared to the controls.The method used in this study seems to be a useful index for diagnosis and as a treatment plan for patients with mandibular hyperplasia with/without deviation.

The clinical application of the dental mini C-arm for the removal of broken instruments in soft and hard tissue in the oral and maxillofacial area - Corrected Proof

2011-11-11

Abstract: Many kinds of broken instruments, such as needles, probes, scalpels and catheters, are reported to be left in patients after surgery. These parts should be removed as soon as possible to prevent further complications. However, it is not easy to identify the exact location of the instrument intraoperatively, and a risk of damage exists for neighbouring nerves or vessels during the removal.The C-arm used in orthopaedic surgery, is seen as a useful and safe way to detect metal materials intraoperatively. However, its application for removal of broken instruments in the oral and maxillofacial area is not practical because of its large size.In our experiences with the removal of eight broken instruments in the oral and maxillofacial area, the newly developed dental mini C-arm was useful in finding broken instruments in soft tissue (five cases) and in paranasal sinus (one case), because it gives real time in situ information. This is important, because the position of the broken instrument can be changed due to traction of the soft tissue or swelling. The dental mini C-arm was less helpful in finding broken instruments in soft tissues compared to hard tissues (two cases) as the position of instruments did not change.

Occurrence, types and severity of associated injuries of paediatric patients with fractures of the frontal skull base - Corrected Proof

2011-11-11

Abstract: Objectives: To clarify the occurrence, sites, and types of associated injuries in paediatric patients with fractures of the anterior skull base.Study design: Retrospective analysis of files of 49 patients aged up to 18years.Results: Associated injuries were observed in 91.8% of the patients. Observed most frequently were fractures of the skull vault (85.7%), brain injury (59.2%), facial fracture (42.9%), lung contusion (18.4%) and fractures of the upper extremities (14.3%). Multiple injuries were observed in 55.1% and polytrauma in 42.9%. The mortality rate was 10.2%.Conclusions: Paediatric patients with fractures of the anterior skull base frequently present with associated injuries, with many having, multiple associated injuries including polytrauma. These patients should be treated in multidisciplinary trauma units.

Maxillary alveolar ridge reconstruction with monocortical fresh-frozen bone blocks: A clinical, histological and histomorphometric study - Corrected Proof

2011-11-10

Abstract: Background: This investigation is a clinical and histological assessment of fresh-frozen bone use in the reconstruction of maxillary alveolar ridges. The study evaluates the effectiveness of this material as a bone filler prior the placement of dental implants.Patients and methods: Sixteen patients with atrophic maxillary ridges underwent maxillary reconstruction with fresh-frozen tibial human block grafts prior to implant placement. Sampling procedures were carried out 4, 6 and 9months later when a bone core was removed from the grafts for histological and histomorphometric analysis.Results: Eighteen blocks were placed, and each patient received either 1 or 2 blocks. During the sampling procedures, all of the grafts were found to be firm in consistency, well-incorporated, and vascularized. A total of 34 implants were placed into the grafts with a minimum of 40-Newton-cm torque in all cases. The follow-up period ranged from 18 to 30months. No implants were lost. The histological analysis revealed vital bone with mature and compact osseous tissue surrounded by marrow spaces.Conclusion: Bone allografts can be used successfully as graft material for the treatment of maxillary ridge defects. This type of bone graft can be used safely in the areas of implant placement as a suitable alternative to autogenous grafts.

A case of an extremely large accessory bone with unusual sutures and foramina parietalia permagna in multiple premature craniosynostoses - Corrected Proof

Sarah E. Hanninger, Anton H. Schwabegger — 2011-11-10

Abstract: Background: Within the entity of craniofacial malformations premature craniosynostoses represent the majority of cases. They originate from disturbances in the ossification process, resulting in an osseous closure of cranial sutures ahead of time. Depending on severity and number of the affected sutures, a local or general growth inhibition of the skull follows. In the rare instance of accessory bones along these affected sutures, they may interfere with diagnostics and therapy.Patient: This clinical report describes the case of a seven-month-old male infant with multiple craniosynostoses, an extraordinary large accessory median calvarial bone, two foramina parietalia permagna and a submucosal cleft palate. Chromosomal and genetic analysis did not reveal potential mutations.Results: The osseous abnormalities were diagnosed and displayed by three-dimensional computed tomography. The sequential surgical treatment consisted of occipital remodelling at seven months of age and frontoorbital advancement at fourteen months.Conclusion: This rare anatomical variation of the cranial bones – superimposed by multiple premature craniosynostoses – demonstrates the necessity of accurately conducted preoperative diagnostics for appropriate surgical planning. Knowledge, and precise medical examination of potential anatomical variations facilitate the planning and secure performance of surgery as well as its outcome.

Preoperative three-dimensional reconstruction in vascularized fibular flap transfer - Corrected Proof

W.H. Wang, J.Y. Deng, M. Li, J. Zhu, B. Xu — 2011-11-10

Abstract: Objective: The objective of this study was to investigate the added value of preoperative computerized tomographic angiography (CTA) and three-dimensional reconstruction of the lower limb in vascularized fibular flap transfer.Methods: Eighteen patients who underwent mandibular or maxillary reconstruction with a vascularized fibular flap were studied retrospectively by image analysis. The original DICOM data of preoperative CTA were analysed and applied to the reconstruction of the lower limb using SimPlant Pro software (version 11.04).Results: The course of the peroneal artery in 17 patients was the same except for one patient. The peroneal artery originates from the posterior tibial artery. The original external diameters of the peroneal artery were 2.99 ± 0.64 mm. The perpendicular lengths from fibular head to the origin of the peroneal artery and to the fibular perforator vessel were 42.88 ± 8.84 mm and 174.55 ± 25.62 mm, respectively.Conclusion: The course of peroneal artery was relatively invariable, its original external diameter was thick. Preoperative CTA and three-dimensional reconstruction of the lower limb, which are noninvasive, accurate and direct-viewing methods, play an important, preoperative role in vascularized fibular flap transfer for lower limb vascular assessment.

A longitudinal study on the osteoarthritic change of the temporomandibular joint based on 1-year follow-up computed tomography - Corrected Proof

Jeong-Yun Lee, Dae-Jung Kim, Sang-Goo Lee, Jin-Woo Chung — 2011-11-10

Abstract: This study aims to report the results of a 1-year computed tomographic (CT) follow up of 54 temporomandibular joints (TMJs) affected by osteoarthritis (OA) and to provide longitudinal information on changes in OA and its relationship with clinical signs and symptoms. TMJ OA was diagnosed by history, clinical and CT examinations. The second CT examination was done after about 1 year of conservative treatment. Joints were divided into three groups labeled as no change, improved CT, and worsened CT groups depending on the longitudinal bony change of OA observed in the CT. The sex distribution, mean age, joint noise, subjective pain, joint tenderness, masticatory muscle tenderness, and improvement of subjective symptoms were not different between the groups at the first and second examination, while maximum (p < 0.01) and painless mouth opening range (p < 0.001) at the first examination were both smaller in the worsened CT group. Although the clinical signs and symptoms of OA were improved in 40 joints, 74.1%, at 7.2 ± 4.6 months, the amount if improvement did not differ between the groups. The extent of the destructive change of the condyle was highest in the improved CT group at the first (p < 0.001) and in the worsened CT group at the second examination (p < 0.001). These results imply that the prognosis of OA changes may be independent of the clinical signs and symptoms. More specific longitudinal information as regards OA changes of the TMJ based on a larger sample and a longer follow-up period would be likely to provide a better understanding of TMJ OA.

The immediate lifesaving management of maxillofacial, life-threatening haemorrhages due to IED and/or shrapnel injuries: “When hazard is in hesitation, not in the action” - Corrected Proof

Sabri T. Shuker — 2011-11-09

Abstract: Maxillofacial/neck vascular injuries caused by improvised explosive devices IEDs or ballistics injuries are life threatening when they cause severe haemorrhage resulting in airway compromise. One should always keep in mind that the best technique used is that which saves the patient’s life and not the most expensive and/or technologically advanced. Medical professionals on the scene should have the necessary experience to handle the emergency situations of airway compromise and haemorrhage control. In this instance there is only, “one to a few minutes” to clear airway obstruction and arrest haemorrhage to prevent death.The patients in this study had life-threatening shrapnel injuries of the carotid and/or jugular vessels, and facial primary blast affect implosion of facial middle third air-containing cavities injuries.In a massive casualties arenas, where time=lifesaving, we should need to replace “non-battlefield” civilian techniques with “time driven”, combat management for IEDs injuries. In these cases, the immediate and effective compression tamponade using digital, Foley catheter tamponade, packs and/or vessels ligation for severe facial/neck haemorrhage were used successfully.

Cicatricial iatrogenic lower eyelid malposition in skin cancer surgery: results of a combined approach - Corrected Proof

2011-11-07

Abstract: Purpose: Malposition of the lower lid, including rounding of the lateral canthal angle, lower eyelid retraction with inferior scleral show, and ectropion, is a relatively frequent complication in the surgical treatment of skin cancer of the cheek and zygomatic areas. The tarsal strip technique, in association with a vertical vector cheek lift, is a reliable method for correcting lower lid malposition.Materials and patients: From January 2008 to January 2010, we treated 19 patients with lower eyelid malposition after skin cancer surgery of the cheek and zygomatic areas. To correct lower eyelid malposition, we used the tarsal strip technique and a vertical vector cheek lift in all patients.Results: Eleven patients had scleral show and eight patients had ectropion. Sixteen patients obtained satisfactory correction of the eyelid malposition in a single surgical procedure, while three patients required a second surgical step to correct the remaining scleral show. Good esthetic and functional results were achieved in all cases.Conclusions: The surgical treatment of skin cancer of the cheek and zygomatic areas has the potential for postoperative sequelae. The tarsal strip technique, in association with a vertical vector cheek lift, is a relatively simple technique for correcting scleral show and ectropion.

Anatomical variation and morphology in the position of the palatine foramina in adult human skulls from Greece - Corrected Proof

2011-11-04

Abstract: Objective: To investigate the anatomical variability of the palatine structures in Greek population.Material and methods: 71 Greek adult dry human skulls were examined to detect the position of the greater palatine (GPF) and lesser palatine foramina (LPF) related to adjacent anatomical landmarks.Results: The perpendicular distance of the GPF to the midline sagittal suture was 1.53cm and 0.3cm from the inner border of the alveolar ridge. The mean distance from the posterior palatal border was consistent 0.46cm on the right and 0.47cm on the left side of the skulls. In the greater majority of the skulls (76.2%), the GPF were between proximal–distal surfaces of the 3rd maxillary molar. A single LPF was observed in 53.45% of the skulls, two LPF were observed in 31% of the skulls bilaterally and five LPF were rare (2.1%). The commonest position of LPF was at the junction of the palatine bone and the inner lamella of the pterygoid plate (71.9%).Conclusion: Our results can help clinicians localize the palatine foramina in patients with and without maxillary molars and to predict the depth of a needle to anaesthetise the maxillary nerve with greater success when performing surgical procedures in the hard and soft palate.

Effect of bone quality and position of the inferior alveolar nerve canal in continuous, long-term, neurosensory disturbance after sagittal split ramus osteotomy - Corrected Proof

2011-10-17

Abstract: Objectives: To examine the relationship between the anatomical position and the bone quality of the inferior alveolar nerve (IFAN) canal and long-term neurosensory disturbance (NSD) of the IFAN after a sagittal split ramus osteotomy (SSRO).Material and methods: CT images were taken of patients with mandibular prognathism. The location of the IFAN and the bone density around the IFAN were measured on CT images. Whether NSD at 6 months and 1 year after SSRO was related to the position and bone quality of the IFAN canal was analyzed.Results: Significant correlations were found between the anatomical position and the bone quality of the IFAN canal and the period to the resolution of NSD of the IFAN from 3 months to 1 year after SSRO. If the HU values around the IFAN were greater than 300 HU and/or the distance from the buccal aspect of the IFAN canal to the outer buccal cortical margin was less than 6 mm, NSD of the IFAN at 1 year after SSRO was significantly increased.Conclusion: It is important to pay particular attention to the anatomical position of the IFAN and the bone quality around the IFAN to predict long-term NSD of the IFAN after SSRO.

Virtual reality surgical anatomy of the sphenoid sinus and adjacent structures by the transnasal approach - Corrected Proof

Shou-Sen Wang, Liang Xue, Jun-Jie Jing, Ru-Mi Wang — 2011-10-13

Abstract: Objective: To examine the three-dimensional virtual anatomical features of the sphenoid sinus and adjacent structures during virtual surgery and explore their relevance to actual transsphenoidal surgery.Methods: CT images of the sphenoid sinus and surrounding structures from 28 Chinese adult patients were measured using a 16-slice helical CT scanner. Image analysis was performed using the volume-rendering method. Two experienced neurosurgeons wearing stereoscopic glasses performed virtual transsphenoidal surgery by the transnasal approach.Results: The virtual anatomical features of the sphenoid sinus and the adjacent structures during virtual surgery were described. The distance from the sphenopalatine foramen to the left and right sphenoid ostium was 10.1 ± 2.7 mm and 10.5 ± 3.2 mm, respectively, to the left and right sphenoidal crest 12.9 ± 2.0 mm and 12.8 ± 2.2 mm, respectively, and to the left and right uncinate process 24.0 ± 1.9 mm and 23.9 ± 2.0 mm, respectively. The distance from the uncinate process to the medial and lateral edge of the most prominent part of the anterior bend of the cavernous internal carotid artery (ICA) was 33.7 ± 3.7 mm and 34.8 ± 3.7 mm, respectively, and the angle between the two lines was 9.7 ± 1.9°.Conclusion: The study provides virtual anatomical information about the sphenoid sinus and important surrounding structures that is essential for successful real life transsphenoidal surgery.

Immunohistochemical study of NF-E2-related factor 2 (Nrf2) in an end-to-end anastomosis of the rat carotid artery - Corrected Proof

Lin Zhu, Xiao-liang Wang, Han-Dong Wang, Hao Pan, Ke Ding — 2011-10-13

Abstract: Introduction: The detailed process and underlying mechanism of stenosis following microvascular anastomoses remains unclear. NF-E2-related factor 2 (Nrf2), is a pleiotropic regulator of cell survival and plays a crucial role in modulating acute inflammatory response. An animal experiment was employed to obtain new information on the histomorphological changes and distribution of Nrf2 in anastomoses.Methods: An end-to-end anastomotic model in rat carotid arteries was carried out. The stoma was examined by H&E staining and immunostaining to evaluate histomorphological change as well as the intensity of anti-Nrf2 and а-SMA staining.Results: Compression, dehiscence and inflammatory cells infiltration were often seen following vessel anastomoses. Inflammatory cells infiltrate was reduced and the granulation tissue fibrosis and endothelium reforming become apparent with times. Marked tunica media hyperplasia consisting of a packed layer of neogenetic smooth muscle cell was present around the anastomosis. Nrf2 expression was upregulated after the operation and was mainly distributed in the neogenetic smooth muscle cells.Conclusion: Stenosis following the micro-artery anastomoses may be mainly due to the progressive myointimal hyperplasia in the media of the arteries. Nrf2 was involved in the pro-inflammatory stress during the vascular morphogenesis/angiogenesis and can be a valuable tool for studying the process of wound healing.

A comparative clinical evaluation of the outcome of patients treated for bilateral fracture of the mandibular condyles - Corrected Proof

Virendra Singh, Amrish Bhagol, Rahul Dhingra — 2011-10-05

Abstract: Aim: To compare open reduction and internal fixation (ORIF) with closed treatment and maxillomandibular fixation (CRMMF) for management of bilateral subcondylar fractures of the mandible.Patients and methods: This study involved a retrospective analysis of bilateral subcondylar fractures of the mandible treated at Government Dental College, Rohtak from 2007 to 2010. Data were collected by a review of pertinent inpatient and outpatient clinic records, and radiographic results. Patients were followed up weekly for 4 weeks and then at 2, 3 and 6 months after surgery. At these visits, careful attention was paid to clinical parameters included mouth opening, protrusion, laterotrusion, deviation on mouth opening and occlusion.Results: The patient sample ranged in age from 19 to 55 years, with an average age of 28.2 years. In total, 44 patients with 88 mandibular subcondylar fractures were included in the study. Out of these, 20 patients were managed by closed treatment and 24 by ORIF of the subcondylar fractures (19 unilateral and 5 bilateral).Regarding mouth opening/lateral excursion/protrusion, significant (p=0.00) differences were observed between both groups (open 37.6/11.5/5.9mm versus closed 31.5/7.8/3.1mm). The visual analogue scoring revealed significant (p=0.00) difference with less pain in the operative treatment group (1.3 open versus 7.2 closed). Statistically significant difference was found between two groups for occlusion (p=0.00).Conclusion: The current retrospective study shows that operative treatment was superior in all objective and subjective functional parameters. It is concluded that if either of the condyles is displaced ORIF is the most satisfactory method of treatment.