Journal of Cranio-Maxillofacial Surgery - Articles in Press

3D powder printed calcium phosphate implants for reconstruction of cranial and maxillofacial defects - Corrected Proof

2010-03-08

Summary: Background: The aim of this study was to investigate the processing and the possible use of 3D powder printed calcium phosphate implants for the reconstruction of cranial and maxillofacial defects.Materials: The fabrication of the implants was carried out with a commercial 3D powder printing system. Diluted phosphoric acid was printed onto tricalcium phosphate powder, leading to the formation of dicalcium phosphate dihydrate (Brushite). Hydrothermal conversion of the brushite matrices led to the formation of dicalcium phosphate anhydrous (Monetite).Method: Bony defects were generated using a human cadaver skull. The implants were computer-aided designed (CAD) using a mirror imaging procedure following computed tomography of the skull. Specific implants were manufactured by the 3D powder printing rapid prototyping technique.Result: The processing chain from data acquisition to printing of the implants proved to be practical and uncomplicated. The individual implants showed a high degree of accuracy of fit. Mechanical and physical investigations revealed suitable characteristics.Conclusion: 3D powder printing of calcium phosphate cement material provides a promising new method for the manufacturing of biodegradable synthetic patient-specific craniofacial implants.

Symptomatic plate removal after treatment of facial fractures - Corrected Proof

2010-03-03

Summary: Aims: To identify the rates and reasons for plate removal (PR) among patients treated for facial fractures.Materials and methods: A retrospective review of files of 238 patients.Results: Forty-eight patients (20.2%) had plates removed. The reason for removal was objective in 33.3% and subjective in 29.2%. The most common subjective reason was cold sensitivity, and the most common objective reason was wound dehiscence/infection. Women had PR for subjective reasons more often than men (p=0.018). Removal was performed more often for subjective reasons after zygomatico-orbital fractures than after mandibular fractures (p=0.002). Plates inserted in the mandible from an intraoral approach were removed more frequently than extraorally inserted mandibular plates, intraorally inserted maxillary plates, and extraorally inserted plates in other locations (p<0.001). Orbital rim plates had a higher risk of being removed than maxillary or frontal bone plates (p=0.02).Conclusions: Subjective discomfort is a notable reason for PR among Finnish patients, suggesting that the cold climate has an influence on the need for removal. Patients receiving mandibular osteosynthesis with miniplates from an intraoral approach are at risk of hardware removal because of wound dehiscence/infection and loose/broken hardware, reminding us that more rigid fixation devices should not be forgotten despite the widespread use of miniplates.

Haemangiopericytoma of the mandible - Corrected Proof

2010-03-03

Summary: Haemangiopericytomas (HPCs) found in bony structures are rare sarcomas of vascular origin. Here, we report the case of a 41-year-old female with a HPC originating in the right ramus of the mandible. After tumour staging and biopsy for histological reference the tumour was surgically removed. The surgical technique is described and therapy options of these rare cases are discussed and compared with these cases already documented. To the best of our knowledge, this is the 6th case of mandibular HPC reported in the literature.

Bone formation and degradation of a highly porous biphasic calcium phosphate ceramic in presence of BMP-7, VEGF and mesenchymal stem cells in an ectopic mouse model - Corrected Proof

2010-03-02

Summary: Introduction: Angiogenesis and mesenchymal stem cells (MSCs) promote osteogenesis. The aim of the present study was to evaluate whether bone morphogenetic protein (BMP-7) promoted osteoinduction could be enhanced by combining it with vascular endothelial growth factor (VEGF) or MSCs in highly porous biphasic calcium phosphate (BCP) ceramics.Materials and methods: BCP ceramic blocks were implanted in an ectopic site in 24 mice (BMP-7 vs. BMP-7/VEGF; BMP-7 vs. BMP-7/MSCs and BMP-7 vs. Control; each group n=8). Specimens were analysed 12 weeks after surgery by environmental scanning electron microscopy (ESEM) and Giemsa staining.Results: In all implanted scaffolds, newly formed bone was observed, even in the control site. No statistical differences in the amount of new bone were found in the presence of BMP-7 compared to BMP-7/VEGF (p=1.0) or BMP-7/MSCs (p=0.786). ESEM revealed a degradation of the scaffolds. A higher degradation was observed in areas where no bone-implant contact was present compared to areas where the ceramic was integrated in newly formed bone.Conclusions: Neither VEGF nor MSCs enhanced BMP-7 induced bone formation under the selected conditions. The present ceramic seemed to be osteoinductive and degradable, making this material suitable for bone tissue engineering.

Quantifying migration and polarization of murine mesenchymal stem cells on different bone substitutes by confocal laser scanning microscopy - Corrected Proof

2010-03-02

Summary: Introduction: Cell migration is preceded by cell polarization. The aim of the present study was to evaluate the impact of the geometry of different bone substitutes on cell morphology and chemical responses in vitro.Materials and methods: Cell polarization and migration were monitored temporally by using confocal laser scanning microscopy (CLSM) to follow green fluorescent protein (GFP)±mesenchymal stem cells (MSCs) on anorganic cancellous bovine bone (Bio-Oss®), β-tricalcium phosphate (β-TCP) (chronOS®) and highly porous calcium phosphate ceramics (Friedrich-Baur-Research-Institute for Biomaterials, Germany). Differentiation GFP±MSCs was observed using pro-angiogenic and pro-osteogenic biomarkers.Results: At the third day of culture polarized vs. non-polarized cellular sub-populations were clearly established. Biomaterials that showed more than 40% of polarized cells at the 3rd day of culture, subsequently showed an enhanced cell migration compared to biomaterials, where non-polarized cells predominated (p<0.003). This trend continued untill the 7th day of culture (p<0.003). The expression of vascular endothelial growth factor was enhanced in biomaterials where cell polarization predominated at the 7th day of culture (p=0.001).Conclusions: This model opens an interesting approach to understand osteoconductivity at a cellular level. MSCs are promising in bone tissue engineering considering the strong angiogenic effect before differentiation occurs.

Erratum to “Publication bias in oral and maxillofacial surgery journals: An observation on published controlled trials” [Journal of Cranio-Maxillofacial Surgery (2010) 38, 4–10] - Corrected Proof

2010-03-02

To the Editor – We would like to draw your attention to the abstract on p. 4 of our article: the section relating to Author queries was published in error and does not form part of our finished article.

Clinical aspects of a 2.0-mm locking plate system for mandibular fracture surgery - Corrected Proof

2010-02-16

Summary: Purpose: The use of a 2.0-mm locking plate system was evaluated in mandibular surgery.Patients and methods: 53 patients (42 male, 11 female) with a total of 56 mandibular fractures were treated with a 2.0-mm mini-locking-plate system and retrospectively examined. Gender, age, cause of fracture, surgical access, classification of fractures, osteosynthesis, postsurgical findings and complications were evaluated.Results: Assault in male patients (mean age 31) was the most common aetiological factor. Fractures in women (mean age 43 years) mostly occurred due to falls. Mandibular angle fractures were the most common and this anatomical site also presented the highest complication rate. Only 6% of patients had minor occlusal disturbance postoperatively, and minor complications (infections and dehiscence) occurred in 14% of patients in this study. Major complications only occurred in one patient included in the study (1.9%). Risk factors for the development of complications in this series were a history of alcohol or tobacco use, mandibular angle fractures, associated facial fractures, presurgical occlusal disturbance and concomitant dental infections. Surgical access to the fracture and the interval from injury to surgery was not associated with the development of complications.Conclusions: The use of a 2.0-mm locking plate system with its advantages of improved handling characteristics, increased stability, shorter surgical time and the preservation of bony perfusion is a viable alternative to conventional miniplates in the management of mandibular fractures.

Structure and remodelling of the human parietal bone: An age and gender histomorphometric study - Corrected Proof

2010-01-29

Summary: Objective: Despite its clinical usefulness, the internal structure and remodelling of parietal bone remained poorly documented. The aim of this study was to gain reliable information on parietal bone remodelling in living humans.Materials and methods: This study provided a site-specific analysis of static indices of turnover in relation to gender and age by using leftovers of parietal bone sampled in 100 patients (78 females; 22 males, aged 16–79 years).Results: The bone architecture, cortical thickness, trabecular volume and cortical volume (C.Th, BV/TV, BV/CV) did not vary with gender. The number of osteoclasts (N.Oc/BPm) and the resorption surface (Oc.S/BS) were higher in females (p<0.05) when osteoclast resorbing activity did not vary with gender. Bone formation, osteoid surface (OS/BS) and surface covered by alkaline phosphatase-positive osteogenic cells (ALPS/BS) were higher in females (p<0.05 and p<0.01 respectively). All these parameters remained stable with aging. The osteocytic parameters, number of osteocytes (Ot.N/B.Ar) and number of osteocyte lacunae (T.L.N/B.Ar) were higher in females (p<0.05) and decreased with age in both genders (p<0.01).Conclusion: This study highlights the low and stable remodelling in the parietal bone. It appears to be higher in women. This stability probably reflects the low mechanical strains applied to the skull, particularly to the parietal bone.

Simultaneous management of the enophthalmos and sinus pathology in silent sinus syndrome: A report of three cases - Corrected Proof

Enrico Sesenna, Gabriele Oretti, Marilena Laura Anghinoni, Andrea Ferri — 2010-01-22

Summary: Silent sinus syndrome is a rare disorder affecting the maxillary sinus unilaterally, characterized by ipsilateral enophthalmos and hypoglobus. The treatment is surgical: the endoscopic approach represents the gold standard for the restoration of normal sinus aeration, but there is no consensus in the management of the enophthalmos. Most authors suggest a two stage procedure consisting of endoscopic sinus surgery initially and a delayed secondary operation for the restoration of the orbital floor. We present our experience with three cases treated with a single-stage procedure, focusing on the advantages of this one-step approach.

The figure-of-eight radix nasi flap for medial canthal defects - Corrected Proof

Tamer Seyhan — 2010-01-15

Summary: Basal cell carcinomas commonly involve the medial canthal region and reconstruction of medial canthal defects is a challenging problem in reconstructive surgery. A new axial pattern flap raised from radix nasi region has been succesfully used for the medial canthal defects in eight patients in figure-of-eight manner. One of the ellipses of the figure of eight is the defect, the other is the radix nasi flap. The radix nasi flap with a dimension up to 25mm is transposed to the defect based either on ipsilateral anastomosis of the dorsal nasal artery with angular artery (AA) or with the connection of its source artery (i.e. ophthalmic artery) if the AA is damaged. All flaps survived and no tumour recurrence was observed. The donor sites were closed primarily and hidden at the radix nasi crease in all cases. The radix nasi flap in figure-of-eight fashion is good alternative for defects of the medial canthal area in terms of attaining a suitable colour and texture and minimal surgical scars.

Contouring the forehead and rhinoplasty in the feminization of the face in male-to-female transsexuals - Corrected Proof

Rupert Dempf, Alexander W. Eckert — 2009-12-28

Summary: Transsexualism is a gender identity disorder in which there is a strong and ongoing desire to live and be accepted as a member of the opposite sex. In male-to-female transsexuals with strong masculine facial features facial feminization surgery can be performed as part of gender reassignment. The male forehead has extensive supraorbital bossing, and above this there is often a flat area before the convex curvature of the upper forehead begins. In the female, the supraorbital bossing is considerably less, often nonexistent, and above this the flattening is usually less marked and more of a continuous mild curvature. The female nose is relatively smaller than the male nose. The glabellar and the nasolabial angle are less acute. The female nose is regarded as attractive if it shows a straight or mildly concave dorsum and an accented tip. We present a case of treatment of a 26-year-old male-to-female transsexual to demonstrate that contouring the forehead combined with a rhinoplasty can lead to significant feminization of the face. The procedures described seem to be safe and reliable.

Bilateral carcinoma of the temporal bone: Case report and literature review - Corrected Proof

Theodore Vamvakidis, John Sengas, John Xenellis — 2009-12-25

Summary: Introduction: Squamous cell carcinoma of the temporal bone is a rare entity. Only a few cases have been reported in the literature and even fewer describe bilateral tumours. Because its clinical presentation resembles chronic otitis media or otitis externa, diagnosis could be delayed.Case Report: A case is presented of bilateral squamous cell carcinoma of the temporal bone in a 66 year old woman. The patient underwent a left subtotal petrosectomy followed by a right subtotal petrosectomy a month later.Conclusions: Early diagnosis is directly related to patient prognosis. However, prognosis remains poor and the surgical treatment is a challenge for the experienced skull base surgeon.

“Mandibular distraction osteogenesis for severe airway obstruction in Robin Sequence. Case report” - Corrected Proof

Ioannis Iatrou, Nadia Theologie-Lygidakis, Ourania Schoinohoriti — 2009-12-11

Summary: Mandibular distraction osteogenesis (MDO) has been increasingly gaining interest over the last decade as a treatment alternative for the challenging airway management in infants with the Robin Sequence (RS).This paper is a case report of a male child diagnosed with RS, suffering from life-threatening airway obstruction and feeding difficulties, treated with tracheostomy and gastrostomy since infancy. After evaluation of the patient by a multidisciplinary team of specialists, MDO performed as soon as possible, was considered the optimal treatment, not only to address the severe micrognathia but also to allow early tracheal decannulation.As the lack of space intraorally contraindicated the use of internal distractors, they were placed externally bilaterally. The patient was successfully decannulated 3 weeks postoperatively and the gastrostomy was removed 1 month postoperatively. The mandibular expansion exceeded 20mm bilaterally and the maxilla-mandible discrepancy was fully corrected. There were no complications related to device placement, activation or removal.Follow-up clinical and radiographic examinations of the patient 1 year after the removal of the distractors revealed improved mandibular projection and continued mandibular growth. No significant scarring occurred at the surgical site and the patient has normal respiratory and feeding function.

Development of a test for evaluation of taste perception after tongue reduction - Corrected Proof

2009-12-11

Summary: When performing a tongue reduction a frequently asked question is how operation will influence taste of the patient. Different kinds of taste tests are designed, most of these being non-specific ways to determine taste sensation in which high concentration of taste solutions are used to detect if a person is able to taste.To be able to judge the influence of tongue reduction on taste we wanted to develop a validated test that could be used in early childhood. No specific tasting areas were found. This test can be used to evaluate tongue reduction procedures.

Post-transfer flap expansion for management of severe post-burn contraction neck - Corrected Proof

Tarek Mahboub, Haitham Khalil — 2009-12-03

Summary: We report a case of a 35-year-old woman who presented with post-burn neck scar contracture with massive scarring of the neck and lower face. The initial step was to release the contracture with excision of the scar tissue together with coverage of the resultant defect with a latissmus dorsi musculocutaneous flap. Six months later, we implanted a round tissue expander underneath the flap with steady cautious expansion over the following 7 months to almost double the original flap dimensions to achieve an additional replacement of the scar tissue over the upper neck and lower face.

Myopericytoma of the parotid gland – A pathological conundrum - Corrected Proof

Jerzy Kuczkowski, Robert Rzepko, Edyta Szurowska — 2009-12-02

Myopericytoma (MPC) (International Classification of Diseases (ICD-O) code 8713/1) is a benign neoplasm presenting as single or multiple subcutaneous nodule, well circumscribed, blue–grey coloured and occurring mostly in the extremities or in the head and neck region. MPC usually follows a benign clinical course with occasional recurrence, but malignancy is very rare. Histopathologically it can be a solid cellular lesion and shows thin-walled blood vessels surrounded by ovoid plump spindle cells, with oval and eosinophilic cytoplasm. MPC shows differential growth patterns: haemangiopericytomatous areas, glomangiopericytoma type vessels, leiomyomatous foci and concentric perivascular whorls (). Myopericytes derive from intermediate differentiation cell stages between vascular smooth muscle cells and pericytes and share many features with myofibroblasts (). The occurrence of MPC within the parotid gland is an exceptional finding that has not been yet reported.

Iliac crest morbidity following maxillofacial bone grafting in children: A clinical and radiographic prospective study - Corrected Proof

N. Kolomvos, I. Iatrou, N. Theologie-Lygidakis, F. Tzerbos, O. Schoinohoriti — 2009-11-30

Summary: Bone harvesting from the anterior iliac crest is commonly performed for grafting of maxillofacial defects.Purpose: To evaluate the morbidity of the procedure in children and adolescents with clefts or maxillofacial defects after tumour removal.Patients and methods: Between 2001 and 2008 36 consecutive patients who underwent iliac crest bone grafting using the trap-door technique were evaluated 6 months to 7 years postoperatively. Objective and subjective findings regarding the donor site mostly but also the recipient site were assessed by a standardized physical and radiological examination and a questionnaire. The donor site scar, neurosensory and motility function were evaluated clinically and osseous healing was investigated through radiographic examination of the ilium.Results: All respondent patients (29 out of the 36) tolerated the procedure well without major complications. Minor complications (mild pain and limp) were of short duration. No growth disturbances or contour deficits at the donor site were noted. No neurosensory or functional irregularities were detected. The donor site scar was considered aesthetically acceptable and most of the patients were satisfied with the functional outcome at the recipient site.Conclusions: Bone harvesting from the anterior iliac crest was found to be a safe and reliable procedure for maxillofacial bone grafting in paediatric patients. No complications were encountered, the morbidity was minimal and the aesthetic outcome was good.

Two load sharing plates fixation in mandibular condylar fractures: Biomechanical basis - Corrected Proof

2009-11-30

Summary: Mandibular condylar fractures have a high incidence but there is no consensus regarding the best choice of osteosynthesis. From a review of the literature, it is evident that the technique used most frequently for fixation is the positioning of a single plate despite complications concerning plate fracture or screw loosening have been reported by various authors. Different studies have highlighted that the stability of osteosynthesis is correlated with the mechanical strains occurring in the condylar region, generated by the muscles of mastication. The aim of our study was, through a mandibular finite element model (FEM), to confirm this correlation and to analyse the behaviour of single and double elements of union in the fixation of mandibular subcondylar fractures. We concluded that the use of two plates provides greater stability compared with the single plate, reducing the possibility of displacement of the condylar fragment. Therefore we recommend that this technique should be adopted whenever possible.

Diagnostic value of ultrasonography in the evaluation of the temporomandibular joint anterior disc displacement - Corrected Proof

2009-11-30

Summary: The aim of the study was to evaluate the extent of agreement between the findings of ultrasonography (US) and magnetic resonance imaging (MRI) in the assessment of anterior disc displacement (ADD), with or without reduction, and to assess the sensitivity, specificity and the accuracy of the US examination in establishing diagnosis.Fifty-two temporomandibular joints (TMJ) in 52 patients with chronic TMJ pain were examined by US and MRI with respect to ADD, with, and without reduction of the TMJ. The level of agreement between US and MRI findings was evaluated. The sensitivity, specificity, and the accuracy of US were found to be respectively 91%, 16% and 82% in the assessment of ADD; 70%, 38% and 57% in ADD with reduction; 50%, 89% and 76% in ADD without reduction. The findings of both methods were in agreement with each other.US method is fairly sensitive especially in detecting ADD, and it is very reliable in determining the absence of ADD without reduction. However, it was not found to be as quite effective in demonstrating ADD whether it was with or without reduction.

Total mandibular reconstruction after resection of rare “honeycomb-like” ameloblastic carcinoma – A case report - Corrected Proof

2009-11-30

Summary: Purpose: This case report describes a rare and aggressive ameloblastic carcinoma that infiltrated the mandible in a “honeycomb” pattern.Methods: A total mandibulectomy with bilateral modified neck dissection was followed by primary reconstruction with a single free vascularised fibula flap.Results: The postoperative course was uneventful. The one year follow-up revealed no signs of recurrent tumour or metastases. Nine months later distant metastases occurred in the lung.Conclusion: Ameloblastic carcinoma is a highly malignant lesion, which requires aggressive therapy. Prognosis is poor. Further reporting of ameloblastic carcinoma is encouraged.

How to revise and utilise the cephalogram for craniofacial dysostosis—Modification of the porion and the McNamara line - Corrected Proof

2009-11-30

Summary: McNamara line analysis is often utilised in orthognathic surgery and is particularly useful in that it can easily express the extent of maxillo-mandibular deformity quantitatively. However, in craniofacial dysostosis (CFD), the location of the porion (PR) is sometimes displaced inferiorly. The McNamara line depends on the Frankfurt horizontal plane (FH plane), and hence, its deviation is often extremely distorted in CFD.The objective of this study was to enable more correct reflection of deformities of CFD patients on lateral cephalogram analysis. The lateral cephalograms of 152 Asian individuals were involved. ∠basion(BA).orbitale(Or).PR, ∠BA. nasion(NA).PR, and the distance from BA to PR on the BA-NA plane were measured and each standard range was established. Using these ranges, modified PR (mPR) is supposed to lie within a fairly small area.Second, we utilised mPR in the practice of McNamara line analysis in CFD patients. In both cases in the present study, it was confirmed that modified McNamara line analysis can express the deformities more precisely than conventinal analysis, as far as the maxillo-mandibular relationship is concerned. However, particularly in Case 2, both the cranio-maxillary and cranio-mandibular relationships were not entirely consistent with the lateral profile appearance even on modified McNamara line analysis.

A three-dimensional study of facial mimicry in healthy young adults - Corrected Proof

Chiarella Sforza, Domenico Galante, Yuri F. Shirai, Virgilio F. Ferrario — 2009-11-26

Summary: To assess sex-related characteristics in facial movements, and to define a set of reference normal values, 20 healthy young adults (10 men, 10 women) performed six standardized facial movements (maximum smile; free smile; “surprise” with closed mouth; “surprise” with open mouth; right- and left-side eye closures). The three-dimensional coordinates of 21 soft-tissue facial landmarks were recorded by an optoelectronic motion analyzer, their movements computed, and standardized for facial dimensions. Asymmetry indices were calculated. The mouth area had the largest movements. Sex-related differences were found only for the superciliare landmark (men had larger movements than women, p<0.001). Asymmetries in the eyes, mouth and nose were similar in both sexes (p>0.01), with a significant effect of movement (p<0.001): eye and mouth asymmetry was larger during the asymmetric eye closures than during the symmetric movements. The right-side asymmetric movements were somewhat larger than the left-side ones. The total facial movement did not differ between sexes; the “surprise with mouth open” movement had the largest landmark displacements (p<0.001). In conclusion, normal young adult men and women had similar standardized facial movements, except in the forehead. Some individual asymmetry was found in symmetric facial animations; some synkinesis was found even in normal adults.

The bilobed flap in skin cancer of the face: Our experience on 285 cases - Corrected Proof

2009-11-26

Summary: Background: This article describes how many of the defects caused by oncological surgery can be closed with an easily estended flap.Patient and Method: The Zitelli bilobed flap was used to treat 285 consecutive patients with basal cell carcinomas (BCCs) or squamous cell carcinomas (SCCs); 167 men (58.60%) and 118 women (41.40%) between 45 and 98 years of age. Histologically, 247 BCCs (86.6%) and 38 SCCs (13.4%) were documented. Regarding the site, 148 (51.9%) involved the nose, 51 (17.9%) the cheeks, 36 (12.6%) the preauricular region, 27 (9.5%) the perilabial region and chin and 23 (8.1%) the periorbital region. To measure long-term satisfaction patients responded to a telephone survey consisting of a single global question.Results: The size of the defect following tumour removal was between 1 and 4cm. Carcinomas up to 1cm were treated using a one step procedure with a cryostat test of the surgical margins; all others cases were treated using two step procedure after excision and histological in sano resection. Completely acceptable aesthetic and functional deficits were obtained in 275 (96.4%) patients over a 6–72-month follow-up. Ten (3.6%) patients suffered postoperative complications. Two cases of local infection; one case of completely flap necrosis and seven cases of partial revision due to flap necrosis occurred. The level of satisfaction with the surgical long-term result reported by the patients was high.Conclusion: In our experience the bilobed Zitelli flap for covering defects in the area of the face showed very few complications and good aesthetic results.

Evaluation of the difference in accuracy between implant placement by virtual planning data and surgical guide templates versus the conventional free-hand method – a combined in vivo – in vitro technique using cone-beam CT (Part II) - Corrected Proof

2009-11-26

Summary: Purpose: The purpose of this study was to assess the accuracy of implant placement after virtual planning of implant positions using cone-beam CT data and surgical guide templates, and to match the results with those achieved with the conventional free-hand method.Materials and methods: Twenty-three implants were placed in 10 patients with a Kennedy Class II with 3-dimensional (3-D) planned surgical guide template. Manual implantation was performed in anatomical casts of the same patients by a prosthodontist and a maxillofacial surgeon. Postoperative images of casts were superimposed onto the preoperative image of virtual planned ideal position of the implant.Results: The 3-D surgical guide template produced significantly smaller variation between the planned and actual implant positions at the implant shoulder (0.9mm (0–4.5)) and apex (0.6–0.9mm (0.0–3.4)) compared with the free-hand implantation (2.4–3.5mm (0.0–7.0); p=0.000 and 2.0–2.5mm (0.0–7.7); p=0.002). Accuracy of axis was also significantly improved.Conclusions: Accuracy of implant placement after virtual planning of implant position using cone-beam CT data and surgical templates is high and significantly more accurate than free-hand insertion. The demonstrated method of superimposing radiographic images of postoperative casts and virtual planning images is a useful method, which allows reduced patient radiation exposure.

An alternative method to match planned and achieved positions of implants, after virtual planning using cone-beam CT data and surgical guide templates – A method reducing patient radiation exposure (part I) - Corrected Proof

Hans-Joachim Nickenig, Stephan Eitner — 2009-11-26

Summary: Objectives: The present study describes a new method of evaluating the precision of surgically placed dental implants compared after virtual planning of implant positions using cone-beam computed tomography (CT) data and surgical guide templates. This method reduces radiation exposure for patients participating in scientific studies.Materials and methods: Twenty-three implants in 10 patients with a unilateral free-end gap in the mandible (Kennedy Class II) were evaluated. After three-dimensional planning of implant position, the implant bed was prepared with a surgical guide template and transmucosal drilling. Preoperative cone-beam CT images were matched with postoperative images of the master cast with implant replicas. Deviations between planned and achieved positions were measured in position and axis.Results: On average, the match between planned and placed implant axis was within 4.2 degrees (range, 0.0–10.0). The mean difference in distance at the implant shoulder was 0.9mm (range, 0.0–4.5). The mean difference in distance at the implant apex was 0.6mm (range, 0.0–2.7) in the lateral/medial direction and 0.9mm (range, 0.0–3.4) in the anterior/posterior direction.Conclusions: This alternative matching method provides reliable postoperative evaluation of differences in position and axis of planned and placed implants while reducing patient radiation exposure.

Role of CT angiography and embolisation in the management of life-threatening haemorrhage following microvascular head and neck reconstruction - Corrected Proof

Jennifer Wylie, Gregor J. Knepil, Niall Warnock — 2009-11-23

Summary: Post-operative haemorrhage in the head and neck cancer patient can have a catastrophic outcome either for the patient or the free flap if microvascular reconstruction has been performed. The life of the patient always takes priority over the flap; however the pedicle can be at risk when the patient is returned to theatre for arrest of the haemorrhage. CT angiography is a good non-invasive method of determining the source of bleeding and facilitating superselective embolisation, minimizing risk to the flap pedicle. We present a case which this treatment was successfully used with a good result and would recommend its use when similar situations occur.

Facial contour reconstruction with temporoparietal prelaminated dermal–adipose flaps - Corrected Proof

Erdem Güven, Samet Vasfi Kuvat, Hasan Utkan Aydin, Memet Yazar, Ufuk Emekli — 2009-11-23

Summary: Aim: Compared with those for free-fat grafts, resorption rates for vascularized adipose tissue transfers are very low. We analysed benefits of transfer of dermal–adipose grafts after prelamination upon the temporal fascia in reconstruction of facial contour defects.Patients and methods: Among 8 patients operated on between 2005 and 2008, facial contour anomalies had resulted from trauma in 5, while the remaining 3 had abnormalities with a congenital, postinfectious, or iatrogenic aetiology. In the first-stage operation, a dermal–adipose graft was taken from the inguinal region and prelamination upon the superior surface of the temporal fascia. After 5.5 months, the prelaminated dermal–adipose–fascial flap was raised as an island flap, passed through a subcutaneous tunnel in the temporal region, and set into the defect site.Results: Satisfactory cosmetic results were achieved in all patients. Except for a temporary frontal nerve palsy in 1 patient, no early or late complications resulted from this procedure.Conclusion: Prelamination of dermal–adipose grafts upon the temporoparietal fascia is useful in reconstruction of soft tissue defects requiring volume augmentation.

The role of controlled hypotension upon transfusion requirement during maxillary downfracture in double-jaw surgery - Corrected Proof

Altan Varol, Selçuk Basa, Salih Ozturk — 2009-11-13

Summary: Introduction: To evaluate the role of induced hypotension during maxillary downfracture osteotomy on the requirement for blood transfusion, duration of operation and induced anaemia in bimaxillary surgery.Material and methods: 45 young orthognathic patients were operated under hypotensive anaesthesia between 2004 and 2006. Operations were LeFort I osteotomies (n=45), bilateral sagittal split osteotomies (BSSO) (n=42), segmental osteotomies (n=3), tongue reduction (n=1), genioplasties (n=15), digastric myotomies (n=2), and bone grafts were the supplementary procedures. Pre-postoperative haemograms, intraoperative blood loss, and duration of operations were the studied parameters. Statistical analysis was performed using SPSS 11.5 for Windows.Results: None of the patients received a blood transfusion. Mean blood loss was 377±111.2mL with the range of 180mL to the maximum of 625mL. Mean duration was 267.1±61.2min with minimum of 180min and maximum of 400min. Mean preop Hb level was 14±1.9g/dL with the range from 10.3g/dL to a maximum of 17.2g/dL. Mean postop Hb level was 11.8±2g/dL with a range of 8.2–16.2g/dL levels. Preop erythrocyte counts were 435.3±18.2 and 416.4±16.1 (×104/mcL) on the first postop day.Conclusion: Transfusion in bimaxillary orthognathic surgery could be prevented by induction of hypotension during maxillary downfracture.

Endoscopic transnasal management of cerebrospinal fluid leaks of the sphenoid sinus - Corrected Proof

2009-11-13

Summary: The authors reviewed the medical records of patients who had undergone endoscopic management of sphenoid sinus (SS) cerebrospinal fluid (CSF) leaks in our department between 2005 and 2007. Eight patients were included in this study: 4 males and 4 females. CSF fistulae were due to trauma, surgery, and some were idiopathic. In all the patients, a multilayer skull base closure was performed. No SS obliteration was carried out. One patient required revision surgery for persistent CSF leak. Multilayer skull base closure is confirmed as the preferred option in sphenoid CSF leaks. The limited morbidity and high success rate fit well with the data in the literature and make this treatment option advisable.

A comparison of bone reconstruction following application of bone matrix gelatin and autogenous bone grafts to alveolar defects: An animal study - Corrected Proof

Mohammad Bayat, Fatemeh Momen-Heravi, Mehdi Marjani, Pouria Motahhary — 2009-11-12

Summary: The aim of this study was to compare the quantity and quality of osseous healing of bone matrix gelatin (BMG) with autogenous bone graft (ABG) in cat models. Osseous defects (5×5mm) were made through upper alveolar bone distal to the canines in the left and right quadrants (maxilla) in each of twelve Persian male cats and filled randomly with BMG and ABG. The repair response was examined on days 14, 28, and 56 after surgery (n=4 per bone substitute per time point). Qualitative histological and quantitative histometric analysis including percentage of new formed bone fill (BF) and density were done. The inter-treatment comparison of mean levels of BF at specific time points showed consistently greater levels within BMG treated defects and reached significance on days 14, 28, and 56 (P<0.05). Regarding bone density (BD), there was no significant difference between BMG and ABG on days 14 and 28 (P>0.05). On day 56, BD was significantly higher within BMG group (P<0.05). Intra-treatment evaluation of bone formation in each group showed that BD significantly increased during treatment (P<0.05), and BF in BMG group reached significance at every time point but in ABG group only increase from day 28 to 56 reached significance (P<0. 05). Our results support the use of BMG to treat bone defects. Clinicians might expect better clinical outcomes without the possibility of side effects and morbidity associated with the harvest of autogenous bone.

Effects of osteoinduction on bone regeneration in distraction. Results of a pilot study - Corrected Proof

A. Kroczek, J. Park, T. Birkholz, F.W. Neukam, J. Wiltfang, P. Kessler — 2009-11-12

Summary: Rate and frequency of distraction as well as stimulatory effects transmitted by growth factors and local gene therapy have a decisive influence on bone regeneration.In a pilot study we tested the effect of four different morphogenetic and mitotic proteins and a genetically transferred vector system on bone healing in continuous osteodistraction in a large animal experiment on 24 Goettingen mini-pigs. For this purpose bone morphogenetic protein (BMP-2), BMP-7, TGF-β, IGF-1 and a liposome vector were instilled into the distraction gap. The animals were killed after 1–4 weeks of consolidation.Histological and radiological evaluations showed maximum bone formation after the application of BMP-2/7, whereas the application of TGF-β, IGF-1 and the liposomal vector had only a limited effect on bone regeneration. The quantitative analysis demonstrated an average amount of bone in the distraction gap of 50% and 61% after instillation of BMP-2 and 7, respectively. The BMP-2 expression, however, was maximal after induction with the non-viral vector. Only after BMP-2/7 application could physical, radiographic and histological evidence of bone union be detected.In bone distraction with a short observation period the application of morphogenetic proteins seems to enhance bone regeneration significantly. Before application in humans further studies are necessary to measure the dose-effect relationship, the mode of application and the efficacy of different inductive proteins. The combination of osteodistraction with osteoinduction, however, could shorten treatment times dramatically.

Reconstruction of the severely atrophic mandible using autologous calvarial bone graft: An “ inverted sandwich” graft technique and dental rehabilitation with fixed implant-supported prostheses - Corrected Proof

Matías Cuesta Gil, Tommaso Bucci, Blanca Duarte Ruiz, Francisco Riba García — 2009-11-12

Summary: A new technique is described for outpatient dental rehabilitation of a severely atrophic mandible.Calvarial bone graft fixed to the mandible through an extraoral approach was used to treat a 47 year-old woman with class VI mandibular atrophy. 5 months later, six endosseous dental implants were placed between the mental foramina and rehabilitation was completed using a fixed implant-supported prostheses. After 8 years, the denture remains stable on the implants and no bony changes have been noted. This technique is an efficient option for treating patients with a severe mandibular atrophy.

Bifocal transport osteogenesis for the reconstruction of adult calvarial defects: A new surgical technique - Corrected Proof

2009-11-11

Summary: Calvarial defects are common problems in craniofacial surgery. They may be explained by surgical interventions, infectious processes, cranial trauma or congenital anomalies. Calvarial defects are particularly challenging because they do not heal spontaneously in humans older than 24 months.The feasibility of using bifocal transport distraction osteogenesis to repair calvarial defects has been successfully evaluated in numerous experimental models. To our knowledge, it has not been used for the reconstruction of human skull defects.We report the first case of human calvarial defect healed by transport distraction osteogenesis.

Intra-oral calibre persistent artery - Corrected Proof

Ahmad AbdulHameed AbdulMajeed, Camile S Farah — 2009-11-11

Summary: Calibre persistent arteries (CPA) penetrate into submucosal tissue without division or reduction in calibre. Intraorally, these abnormalities have been predominantly reported in the lip. Here we report a case of CPA in the buccal vestibule. Misdiagnosis of this entity may result in profuse bleeding during surgical intervention.

Orbital hydatid cyst: Review of 10 cases - Corrected Proof

2009-11-09

Summary: Background: Echinococcosis represents one of the most common human parasitoses in some geographical areas. Orbital involvement is extremely rare.Materials and methods: In the records of our Medical University Centre between 1984 and 2006, we found 10 cases of orbital hydatid cyst.Results: Among them, 6 males and 4 females; the ages ranged from 2 to 60 years and 7 cases (70%) were less than 12 years of age. The main symptoms of orbital hydatid cyst were slowly progressive unilateral proptosis (100%) with visual loss (90%). The presumptive diagnosis was made on the images obtained from computed tomography and/or magnetic resonance imaging. Surgical removal was the main treatment; although, it is frequently complicated with cyst rupture and spillage of the contents. For this reason, we adopted the technique of cyst puncture with irrigation. A postoperative antihelminthic treatment has always been used.Conclusion: Hydatid cyst is an endemic disease in Morocco. Orbital involvement should be considered in the differential diagnosis of proptosis especially in children known to have been in affected geographical areas.

Management of odontogenic keratocysts of the jaws: A ten-year experience with 120 consecutive lesions - Corrected Proof

2009-11-09

Summary: Background: The treatment of odontogenic keratocyst (OKC) of the jaws remains controversial. The aim of this study was to report the outcome of our conservative treatment protocol for OKC.Methods: We collected data of all OKC patients treated in the Department of Maxillofacial Surgery, Pitié-Salpêtrière University Hospital from 1995 to 2004. Basal cell naevus syndrome (Gorlin's syndrome) patients were excluded. Recurrence data was analysed in relation to radiographic features, type of microscopic diagnosis, presence of cortical perforation, and site of involvement.Results: One hundred and twenty cysts in 109 patients were examined. OKCs were more frequent in the third and the fourth decades of life (range: 11–79 years, mean: 40 years) and in men (n=71). Most of the lesions were unilocular radiolucencies in the tooth-bearing area and in the posterior part of the mandible. Histologically, 80 lesions showed parakeratosis. Most of the patients underwent uneventful enucleation. Postoperatively, infection occurred in 4 patients, and there was no jaw fracture. Recurrence was found in 28 cysts (26%), of which 7 cysts (6%) had multiple recurrences. There was no significant association between recurrences and radiographic features, histological type, cortical perforation, or site of involvement (P>0.05). Recurrences were common in the first 5 years after the operation. The average follow-up was 86 months since the last operation (range: 18–151 months).Conclusions: Despite the retrospective nature, no control group and a relatively high recurrence rate, our study suggests that enucleation with the aid of computed tomography and adequate postoperative surveillance is a conservative treatment which yields clinically acceptable results. However, the patients must strictly adhere to close follow-ups because recurrences may have serious consequences. Our algorithm for managing OKCs and cyst-like lesions of the jaws is also presented.

Characteristics of maxillofacial trauma in females: A retrospective analysis of 367 patients - Corrected Proof

2009-11-06

Summary: Introduction: Epidemiological characteristics of maxillofacial injuries are typically reported for male patients, as males represent 70% of the studied population. This retrospective study analysed the aetiology and patterns of maxillofacial fractures in female patients only.Material and methods: A total of 367 female patients, examined between 2001 and 2008, were divided into three age groups (<16, 17–60, and >60 years). Data were collected on aetiology, fracture site, associated lesions, type of treatment, and length of hospital stay.Results: The typical female patient presented a mean age of 43 and 25% were over 60 years of age. Falls were the most frequent cause of maxillofacial trauma (43%), followed by motor vehicle accidents (MVAs) (38.7%), assaults (9.3%), sports accidents (6.3%), and other causes (2.7%). The middle third of the face was most frequently affected (53.9%). Associated fractures, mostly orthopaedic and secondary to MVAs, occurred in 23.2% of cases. The over-60 age group had the greatest number of non-operated fractures (27.9%) and the longest mean hospital stay (5.7 days).Conclusions: This study considered only the female population, thereby highlighting epidemiological characteristics of maxillofacial trauma not apparent in the existing literature. Clear distinctions between genders are important for better comparison of data in the future.

What happens between pure hydraulic and buckling mechanisms of blowout fractures? - Corrected Proof

Tomohisa Nagasao, Junpei Miyamoto, Yusuke Shimizu, Hua Jiang, Tatsuo Nakajima — 2009-11-02

Summary: Objective: The present study aims to evaluate how the ratio of the hydraulic and buckling mechanisms affects blowout fracture patterns, when these two mechanisms work simultaneously.Materials and methods: Three-dimensional computer-aided-design (CAD)models were generated simulating ten skulls. To simulate impact, 1.2J was applied on the orbital region of these models in four patterns. Pattern 1: All the energy works to cause the hydraulic effect. Pattern 2: Two-thirds of the energy works to cause the hydraulic effect; one-third of the energy works to cause the buckling effect. Pattern 3: One-third of the energy works to cause the hydraulic effect; two-thirds of the energy works to cause the buckling effect. Pattern 4: The entire energy quantum works to cause the buckling effect. Using the finite element method, the regions where fractures were theoretically expected to occur were calculated and were compared between the four patterns.Results: More fracture damage occurred for Pattern 1 than Pattern 2, and for Pattern 3 than for Pattern 4.Conclusion: The hydraulic and buckling mechanisms interact with one another. When these two mechanisms are combined, the orbital walls tend to develop serious fractures.

Head and neck lesions of Kimura's disease: Exclusion of human herpesvirus-8 and Epstein-Barr virus by in situ hybridisation and polymerase chain reaction. An immunohistochemical study - Corrected Proof

2009-09-14

Summary: Introduction: Kimura's disease (KD) is a chronic inflammatory disorder, characterised by tumour-like lesions in the head and neck region, producing salivary gland nodules and lymph node enlargement. Many authors suggest that KD is a reactive immunological disorder; however, its aetiology remains unknown.Aims: To study immunohistochemical characteristics of head and neck lesions of KD (H&N-KD) and to investigate the possible role of human herpesvirus-8 (HHV-8) and Epstein-Barr virus (EBV) in the development of H&N-KD.Patients and methods: This study enrolled five H&N-KD specimens from three patients treated between 1995 and 2005 at Pitié-Salpêtrière University Hospital, Paris, France. Immunohistochemical studies were performed on formalin-fixed, paraffin-embedded tissue. HHV-8 DNA was determined by polymerase chain reaction (PCR) analysis, whilst EBV sequences were identified by PCR and in situ hybridisation.Results: The immunohistochemical studies revealed CD20+ germinal centres with prominent staining of CD23+ dendritic reticular cells, surrounded by numerous interfollicular CD3+, and CD4+ or CD8+ T-cells. Factor VIII-related antigen, CD31 and CD34 occurred in the thin-walled blood vessels. The reactivity of CD1a, HHV-8 and EBV-associated latent membrane protein 1-EBV (LMP1-EBV) were negative, and in situ hybridisation confirmed the lack of EBV DNA. No patient recalled an external insult or chronic irritation.Conclusions: The results of this study indicate the reactive nature of H&N-KD (or a subset of H&N-KD), and it is unlikely that HHV-8 and EBV play a role in the pathogenesis of the lesion. However, the patients in this series did not have previous history of trauma or chronic irritation; thus, a neoplastic origin could not be excluded. Further multicentre studies based on more specimens are warranted.

Diagnosis and management of intraparotid facial nerve schwannoma - Corrected Proof

Qin Ma, Hong Song, Pu Zhang, Rui Hou, Xiaobing Cheng, Delin Lei — 2009-08-19

Summary: Objective: Our objective was to provide the management guidelines for facial nerve schwannomas (FNSs) presenting as a parotid mass.Study design: The study is a case report and literature review.Methods: Four clinical cases of patients with an asymptomatic parotid mass diagnosed as FNS are presented. The patient's presentation, the diagnostic algorithm and surgical rationale are discussed. A review of the literature on FNSs is presented.Conclusions: Intraparotid FNSs are an extremely rare entity and are rarely diagnosed preoperatively. Intraoperatively, conservative biopsy in a non-functional part of the lesion can be used to make the diagnosis. Most of the FNSs of patients with normal facial nerve function could be dissected off the nerve trunk without losing FN function. FNS patients with preoperatively abnormal FN function should be managed conservatively or undergo reconstruction with nerve graft after tumour resection.

Removal of a foreign body from the skull base using a customized computer-designed guide bar - Corrected Proof

Ran Wei, Liu Xiang-Zhen, Guo Bing, Shu DA-LONG, Tan ZE-MING — 2009-08-17

Summary: Background: Foreign bodies located at the base of the skull pose a surgical challenge. Here, a customized computer-designed surgical guide bar was designed to facilitate removal of a skull base foreign body.Methods: Within 24h of the patient's presentation, a guide bar and mounting platform were designed to remove a foreign body located adjacent to the transverse process of the atlas and pressing against the internal carotid artery.Results: The foreign body was successfully located and removed using the custom designed guide bar and computer operative planning. Ten months postoperatively the patient was free of complaints and lacked any complications such as restricted opening of the mouth or false aneurysm. The inferior alveolar nerve damage noted immediately postoperatively (a consequence of mandibular osteotomy) was slightly reduced at follow-up, but labial numbness persisted.Conclusions: The navigation tools described herein were successfully employed to aid foreign body removal from the skull base.

Thermochemotherapy of lower lip squamous cell carcinoma without metastases: an experience of 31 cases - Corrected Proof

2009-08-10

Summary: Introduction: The aim of this study was to evaluate the efficacy, functional and aesthetic results, and safety of a novel treatment, thermochemotherapy, for lower lip squamous cell carcinoma (LLSCC) without metastases.Patients and Methods: A combination of local hyperthermia delivered by a 915MHz microwave heating system and the chemotherapy of pingyangmycin (bleomycin A(5) hydrochloride) (PYM) and methotrexate (MTX), was administered to 31 patients of LLSCC twice per week for a period of 4.5–7.5 weeks. Patients with complete response (CR) have been followed up for a full five-year period, whereas partial response (PR) patients were excluded for further analysis. The local control of tumour, functional and cosmetic outcomes, recurrence, regional lymph node and distant metastases, and complications were assessed by clinical and imaging examination.Results: Clinical CR was observed in twenty-nine (93.55%) patients and PR in two (6.45%), the total response rate was 100%, while the adverse effects were extremely minimal and tolerable in all 31 patients including 6 elderly patients with a compromised general condition. All 29 CR, including 8 extensive lesions, achieved excellent cosmetic and functional preservation. During the follow-up period, local relapse was seen in 1 case, 1 patient died, and the remainder obtained a complete remission.Conclusion: This clinical study suggests that thermochemotherapy may be a feasible treatment for primary LLSCC without cervical metastases, especially for patients with extensive lesions and a compromised general condition.

An arteriovenous fistula of the maxillary artery as a complication of Le Fort I osteotomy - Corrected Proof

2009-08-03

Summary: Introduction: The Le Fort I osteotomy, one of the most common techniques used to correct dento-midfacial deformities, is generally considered to be operatively safe. However, sometimes this procedure can lead to fatal vascular complications.Materials and methods: This article describes a fifty-year-old woman with a giant facial venous malformation. The patient underwent a Le Fort I osteotomy in order to correct an open bite. The surgery was complicated by the development of an arteriovenous fistula (AVF) between the maxillary artery and the venous malformation, the diagnosis of which was made by ultrasound doppler. Neuroradiological embolisation process of the maxillary artery was performed in order to close the AVF.Results: The total fistula obliteration and a Class I occlusion were obtained.Conclusions: The reported case suggests the necessity of a multidisciplinary process (involving both maxillofacial and neuroradiology teams) for the treatment of dento-midfacial deformities in relation to vascular malformations. This modality is the only way to guarantee minimization of morbidity (according to patient's expectations).

Bisphosphonate-related osteonecrosis of the jaws: A review of 34 cases and evaluation of risk - Corrected Proof

Marcin Kos, Joachim F. Kuebler, Klaudiusz Luczak, Werner Engelke — 2009-07-10

Summary: Introduction: The purpose of this study was to identify factors that influence bisphosphonate-related osteonecrosis of the jaws (BRONJ).Patients and methods: Patients undergoing treatment for BRONJ (n=34) were evaluated. Sex, age, underlying diagnosis, type of bisphosphonate (BP), duration and route of administration, location of osteonecrosis, clinical symptoms, Actinomyces colonisation, treatment and outcome were recorded. Symptom onset was analysed with respect to BP potency and cumulative dose.Results: Underlying diagnoses indicating BP-treatment included multiple myeloma, breast carcinoma, prostate carcinoma and osteoporosis. In 31 patients, BRONJ was preceded by tooth extraction, root apicotomy, ill-fitting dentures, cystenucleation, implant insertion or trauma; in 3 patients, the precipitating event was not identified. Actinomyces colonisation was observed in 18 patients (53%). The occurrence of BRONJ was not directly related to BP dose or potency. More women with multiple myeloma had BRONJ than did males. BRONJ was observed in osteoporotic patients treated with both corticosteroids and BPs.Conclusions: BRONJ was not primarily associated with BP potency or dose. Factors that increased the risk of osteonecrosis were female sex, oral surgery and corticosteroids plus intravenous or oral BP administration. BP deposition in the jaw bones might enhance BRONJ by promoting bacterial colonisation; however, this hypothesis requires more study.

Tessier number 4 bilateral orbito-facial cleft: A 26-year follow-up - Corrected Proof

2009-07-09

Summary: Orbito-facial number 4 clefts are the rarest craniofacial clefts and only a few cases have been reported. We report a case of a complete bilateral Tessier number 4 cleft, and our approach to surgical correction. We analyse the patient's treatment plan over a 26-year follow-up period. We comment on the age at which the first surgical procedure is commonly performed with or without a primary bone graft, as well as the use of the facial plasty technique with interdigitating Z-plasty flaps and rotation–transposition flaps. Closure of the cleft can constitute an emergency when the patient's globe is exposed.

Salvage of a free flap by cephalic suspension with Tessier's diadem - Corrected Proof

2009-06-18

Summary: The authors present a case of a patient with a large occipital meningioma, treated by embolisation and surgery, in which skin necrosis occurred overlying the craniotomy bone flap.A free Latissimus dorsi flap was used to cover the tissue loss but poor healing and flap condition occurred due to contact with the anti-sore bed system making it impossible to maintain the patient on dorsal position.A cephalic suspension was carried out by Tessier's diadem making it possible to salvage the flap and to treat the patient.

Arachnoid cyst with extraordinary extracranial extension in the skull base as a result of an iatrogenic defect of the middle cranial fossa floor: Case report and literature review - Corrected Proof

2009-06-10

Summary:: Arachnoid cysts are benign intracranial lesions that are typically diagnosed incidentally. They are divided into two types: congenital and acquired. Acquired arachnoid cysts are rare and usually arise after trauma, infection, or haemorrhage. In this report, a rare case of an iatrogenic multiloculated arachnoid cyst as an unusual complication of a skull base defect is presented. It extended extracranially into the sphenoid sinus, the ethmoid, the infratemporal fossa, the nasopharynx and the nasal cavity, as well as into the pterygomaxillary and retromaxillary space, appearing with a distinct clinical picture. We discuss the differential diagnosis and the potential causes of the lesion and provide a brief review of the literature.

Feasibility of alloplastic mandibular reconstruction in patients following removal of oral squamous cell carcinoma - Corrected Proof

2009-06-08

Summary: Introduction: Microvascular bone grafts have evolved as the preferred technique for mandibular reconstruction in irradiated tumour patients. However immediate reconstruction by bridging plates remains an option for patients whose clinical condition is not favourable for microsurgical reconstruction. This retrospective study evaluates the performance of alloplastic mandibular reconstruction in patients following removal of oral squamous cell carcinoma.Patients and methods: Three hundred and thirty-four patients with primary (biopsy proven) oral squamous cell carcinoma without distant metastasis (stages II–IV), who were all treated by segmental mandibular resection and reconstruction by means of a titanium bridging plate were included. Two hundred and seventy-two patients received preoperative treatment, consisting of concomitant radiochemotherapy (RCT) (n=228), chemotherapy (n=34) and radiotherapy (n=10). Median follow-up was 5.1 years (min 0.3, max 18.0).Results: The median 2-year-disease-specific survival rate (DSS) was 81.6%. Five-year-DSS and 10-year-DSS was 71.8% and 62.0%, respectively. One hundred and thirty-six plates were removed due to infection with intra- and/or extraoral exposure, seven plates because of fracture. Preoperative RCT (p=0.027), mandibular defects including the symphysis (p=0.016) and heavy smoking at the time of diagnosis (p=0.042) were associated with infection-related failure of the reconstruction plates.Conclusion: Reconstruction of mandibular defects with titanium bridging plates seems crucial in heavy smoking tumour patients with preoperative RCT as well as in mandibular defects including the symphysis.