Craniomaxillofacial Research and Innovation

Study Design Technical Note Objective Pharyngoesophageal injury in the setting of previous anterior cervical discectomy and fusion (ACDF) is a devastating complication with no standard corrective treatment protocol. Reconstruction can thus be a complex endeavour often leading to treatment failure, recurrent pharyngoesophageal fistula and need for multiple surgical procedures. The authors present our novel approach to free tissue reconstruction of these injuries. Methods We utilized a bulk adipofascial flap to completely obliterate the retropharyngeal space and correct the pharyngoesophageal defect. Results An adipofascial flap facilitates complete separation of the injured pharyngeal/oesophageal mucosa form the cervical spine and any retained hardware. Conclusions In our hands, this technique has allowed successful repair of complex pharyngoesophageal injuries after previous ACDF procedures which includes resumption of normal oral intake.

Shreni N. Shah

Mahnoor Khan

Abhay Sharma

Tapan A. Padhya

Matthew J. Mifsud

Craniomaxillofacial Research & Innovation

A Technique for Bulk Adipofascial Free Tissue Reconstruction of a Recurrent Pharyngoesophageal Injury in the Setting of Failed Anterior Cervical Hardware

一种用于前路颈椎内固定失败情况下复发性咽食管损伤的脂肪筋膜游离组织大块重建技术

A 38 year-old female suffered an orbital blow out fracture and oculomotor palsy due to blunt orbital trauma. After surgical treatment she developed an occlusion of the superior temporal branch of the central retinal artery. At 6 month follow-up, the oculomotor palsy was resolved and visual acuity improved, but with a residual left inferior scotoma.

Vicenç J Gómez

Jose Alberto Reche-Sainz

María Mejía-Nieto

Eduardo Olavarria-Montes

Gregorio Sanchez-Aniceto

Oculomotor nerve palsy and retinal artery occlusion after an orbital blow out fracture

眼外肌神经麻痹及视网膜动脉阻塞后眼眶爆裂性骨折

Study design case report. Objective present a transcutaneous approach to treat a fracture of the anterior wall of the frontal bone with low level of comminution. Methods the fracture was studied in detail with computed tomography (CT) and the patient was treated with a closed reduction of a midfacial bone fracture with the use of transcutaneous screws. Results Optimal aesthetic result was achieved without any adverse event up. CT at 6-month follow-up demonstrated good bone alignment of the anterior wall of the fractured frontal sinus. Conclusion Closed approaches, when well indicated, can be an interesting treatment option for isolated fractures of the anterior wall of the frontal sinus with low levels of comminution.

Brunno di Azevedo Abdalla Barbosa

Patrícia Radaic Pastore

Gustavo Lopes Barreto

Lilian Santos Freitas

Gabriel Pires Pastore

Transcutaneous Approach to Treat a Fracture of the Anterior Wall of the Frontal Bone With Low Level of Comminution: A Case Report Closed Reduction of a Midfacial Bone Fracture

经皮入路治疗粉碎程度较低的额骨前壁骨折：一例中面部骨折闭合复位病例报告

Study Design Case Report. Objective To present a case of a previous complicated mandibular orthognathic surgery that aimed to setback the mandible in a female cleft lip and palate (CLP) patient, which led to bone necrosis on one side with subsequent severe mandibular deviation and facial asymmetry. We additionally reviewed the previous reports of similar complications, the pathophysiology and the factors that could lead to this dreadful result. Method A 27-year-old female patient presented with a severe dentofacial deformity secondary to a complicated bilateral sagittal split ramus osteotomy performed five years earlier, which resulted in aseptic bone necrosis on the right side. The patient had marked mandibular deviation, chin and midface retrusion and a pronounced occlusal discrepancy. Imaging demonstrated a bony defect at the right mandibular angle with a superiorly displaced proximal segment. Deviation of the mandible was corrected first by performing vertical ramus subsigmoid osteotomy (RSO) on the left side. The right bone defect was then reconstructed with a reconstruction plate and bone grafting. Maxillary and chin advancement was performed at a second stage. Results On follow-up, the patient shows a significant improvement in facial esthetics and mandibular symmetry and is currently under orthodontic management to enhance the occlusal relationship. Conclusion Bone necrosis is a rare but dreaded problem in orthognathic surgery. Minimizing the musculo-periosteal dissection and competent execution of the bone osteotomy is substantially effective in reducing the risk of bone ischemia and necrosis.

Haider Alalawy

Ammar S. Kadhum

Hussein A. Abdulnabi

Partial Bone Necrosis Following Sagittal Split Ramus Osteotomy: Report of a Complicated Orthognathic Jaw Surgery

下颌支矢状劈开截骨术后部分骨坏死：复杂正颌手术报告

Study design The present case report demonstrated a reproducible and low-cost method to planning orbito-zygomatic reconstruction applied to a sequela of facial trauma. Aim This study aims to purpose a method to surgical planning orbito-zygomatic reconstruction and demonstrate it in a clinical report. Method An 89 years old male patient with severe sequela due to previous trauma surgery was submitted to a reconstructive surgery using cutting guides and mini-plates pre shaped using a stereolitographic printed model with mirroring healthy side. Results Computed assisted surgery (CAS) contributed to the advancement of surgical planning and reconstruction in Oral and Maxillofacial Surgery, and trauma-related injuries. Traumatic injuries at the orbito-zygomatic region and midface are challenging and satisfactory three-dimensional reconstruction is not often achieved with conventional techniques; therefore, it strongly benefits from CAS and 3D printing. However, the high costs and technical difficulties can impair the use of new technologies in the public health system of low-income countries. Conclusion Hence, the present case report demonstrated a reproducible and low-cost method to planning orbito-zygomatic reconstruction applied to a sequela of facial trauma.

Marcelo Marotta Araújo

Mário Francisco Real Gabrielli

Valfrido Antonio Pereira-Filho

Fábio Ricardo Loureiro Sato

Paulo Roberto De Alencar Bártholo

Pedro Henrique De Azambuja Carvalho

Low-Cost Method to Volumetric Computed Aided Planning of Posttraumatic Sequelae in Orbito-Zygomatic Reconstruction: A Case Report

低成本方法在眼眶-颧骨重建后创伤后遗症的容积辅助规划中的应用：病例报告

Study Design: Case report. Objective: Pleomorphic adenoma is pathologically characterized as an epithelial lesion intermixed with mesenchymal elements. It is characterized by being a slow-growing, asymptomatic, usually nodular, firm consistency lesion that can reach large dimensions, especially when it affects the parotid gland. The present study aims to report a case about an atypical presentation of pleomorphic adenoma found in frontozygomatic region. Methods: The tumor mass was removed through resection, under general anesthesia, by cutaneous approach, preserving aesthetics and noble structures as temporalis muscle, orbicularis oculi muscle and frontal branch of the facial nerve. Intra-operative macroscopic assessment showed an encapsulated tumor. After resection, the surgical specimen was sent to the pathology laboratory for histological analysis confirming the diagnosis of Pleomorphic Adenoma. Conclusions: After 1 year of follow-up the patient had an excellent evolution, without signs of disease recurrence. It demonstrates that, until now, the surgical approach constituted the resolving therapy, even for a lesion in a rare localization.

Ricardo P. Mattos

Sylvio Luiz C. De-Moraes

Raissa D. Fares

Andre Luiz S. de Mello

Jonathan Ribeiro da Silva

Pleomorphic Adenoma Arising From Frontozygomatic Region: An Ectopic Localization

额颧区多形性腺瘤：异位定位

Study Design Case report. Objective To highlight the diagnostic and treatment dilemma associated with chronic invasive fungal sinusitis (CIFS) in the immunocompetent individual. Methods The patient was initially treated for chronic bacterial sinusitis with antibiotic therapy and multiple surgical debridement with no evidence of fungal organisms. Following the completion of the left partial maxillectomy, mucormycosis was finally identified on histopathology, and the appropriate antimicrobial therapy was initiated. During this time, the patient received an interim maxillary obturator for speech and oral function. Following the resolution of CIFS, a computed tomography (CT) of the face was obtained for computer-aided surgical planning for a vascularized fibula flap reconstruction with endosseous dental implants using patient-specific surgical cutting guides and a reconstruction plate. Results Optimal esthetic and functional outcomes were achieved following the placement of the definitive dental prosthesis. The patient remained free of disease and without pain 2 years postoperatively. Conclusions Chronic invasive fungal sinusitis in the immunocompetent patient remains rare; however, delayed diagnosis can lead to inadequate treatment and extensive soft and hard tissue necrosis. Obtaining sufficient tissue sampling is essential for a definitive diagnosis of CIFS. This report demonstrates the challenge in diagnosing CIFS and the importance of the multidisciplinary approach to treat CIFS associated with extensive involvement of the maxilla.

John Minh Le

Kirav Patel

Kyle Murdock

Michael Kase

Yedeh Paul Ying

Overcoming Delayed Diagnosis of Chronic Invasive Fungal Sinusitis in the Immunocompetent Patient: A Case Report

克服免疫功能正常患者慢性侵袭性真菌性鼻窦炎的延迟诊断：病例报告

Study Design: Descriptive study (review containing bibliometric analyses). Objective: Since the inception of three-dimensional printing (3DP), various studies have been conducted worldwide to investigate the utilization of 3DP in craniomaxillofacial (CMF) surgery. Analyzing the current state of global research in medical 3DP in CMF surgery is a crucial first step in identifying knowledge gaps and focusing research resources on pressing problems that have not yet been addressed. Therefore, the current study was designed to present a comprehensive review of scientific research data to discover trends in the last 30 years of global research on 3DP in CMF surgery. Methods: All publications from 1994 until 14 February 2023 were retrieved from the core collection of Web of Science using a defined search. Detailed bibliographic data for all retrieved publications were collected. The bibliometric analysis was performed using VOS viewer, Histcite, and Microsoft Excel. Results: A total of 1367 evaluable articles were retrieved. Results showed that although there is an exponential increase in the number of publications related to 3DP in CMF surgery, there is a substantial regionalization of research, with the U.S.A. and China being the most significant contributors to the retrieved articles. It was also observed that there is a scarcity of published literature related to bioprinting in CMF surgery. Conclusion: This is the first study that specifically analyzed the published literature concerning 3DP in CMF surgery in a structured quantitative manner. The study found a concentration of research in specific geographies and indicated a need for more diversified research in this field. The study also identified a need for public sector involvement in such research to aid in the further dissemination of knowledge.

Vikas Modgill

Bogdan Balas

Minghan Chi

Philipp Honigmann

Florian M. Thieringer

Neha Sharma

Knowledge Domain and Innovation Trends Concerning Medical 3D Printing for Craniomaxillofacial Surgery Applications: A 30-Year Bibliometric and Visualized Analysis

医学3D打印在颅颌面外科应用中的知识领域与创新趋势：一项30年文献计量与可视化分析

Study Design Descriptive cross-sectional study. Objective The mandibular canal (MC) exhibits surgically significant anatomical variations in its course and terminal segment among different ethnic groups. The aim of this study was to document a surgically relevant position of the MC, its variants, and related anatomical structures in dentate patients from a select Kenyan population. Methods 351 hemi mandibular cone-beam computed tomography (CBCT) scans from 202 patients were used to evaluate the MC and mental foramen (MF) for normal morphology, anatomical variations, and their linear relationship to various reference points. Results The most frequently encountered course of the MC was the progressive descent type seen in 241 (68.7%) scans. Accessory MC were observed in 15 (4.3%) scans. Accessory MF were observed in 29 (8.3%) scans. The mean diameter of the MC was 3.36 ± .39 mm. The orientation of the MC was more lingual towards the angle of the mandible and more buccal towards the MF. The most frequent position of the main MF in relation to the second premolar was anterior (53.3%). The average distance from the MF to the inferior border of the mandible was 12.17 ± 1.91 mm. The anterior loop of the mental nerve was observed in 18 (5.1%) scans and its mean length was 4.83 ± .89 mm. Conclusions Our study revealed significant variations in the position, size, and course of the MC and MF. This knowledge should assist oral surgeons to avoid inadvertent injury to the inferior alveolar neurovascular bundle in the local population.

Andrew Okiriamu

Fawzia Butt

Florence Opondo

Fredrick Onyango

Morphology and Variant Anatomy of the Mandibular Canal in a Kenyan Population: A Cone-Beam Computed Tomography Study

肯尼亚人群下颌管的形态学及变异解剖学：基于锥束CT的研究

Study Design Retrospective Case Series Objective This study’s objective is to identify gaps in facial trauma care by exploring 4 cases of delayed onset facial nerve palsy after temporal bone fracture. Methods A retrospective chart review was performed on 4 patients who presented to the emergency department with facial palsy after a previous trauma. Relevant physical exam findings, radiological images and follow-up was documented. Results We present a case series of young, previously healthy patients who presented to the emergency department days or weeks after traumatic temporal bone fracture with delayed onset unilateral facial nerve paralysis. None of these patients were warned of this potential complication, connected to an outpatient physician and all received a costly workup. Conclusions Patients presenting with temporal bone fracture and intact facial nerve function can develop delayed-onset facial paralysis several days after their injury. To offset costly and stressful return visits to the emergency department, patients with temporal bone fractures along the course of the facial nerve should receive education regarding the possible delayed development of facial palsy prior to discharge and otolaryngological or primary care follow-up within 2 weeks of the injury.

出版信息	出版商: SAGE Publications Ltd，出版周期: ，期刊类型: journal，开源期刊: 否
基本数据	创刊年份: 2022，原创研究文献占比: ，自引率:， Gold OA占比:

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