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At least 541 records · Page 30Linked to original sources
PubMed2006

Bone graft necrosis of facial translocation: comparison of 3 different techniques.

OBJECTIVE: To compare the viability of translocated facial bone grafts among 3 different techniques of facial translocation: free bone graft (FBG), attached bone graft (ABG), and modified facial translocation (MFT). STUDY DESIGN: A total of 107 patients were divided into 3 groups: FBG group without reconstruction (N = 33), ABG group (N = 14), and FBG group with reconstruction using a flap (FBG[R+] and MFT) (N = 60). Data evaluated included the respective incidence of bone graft necrosis (BGN) and the impact of radiotherapy. RESULTS: The incidence of BGN significantly varied among the three different groups (P = 0.00003): FBG[R-] (11/33[33.3%]), ABG (1/14[7.1%]) and FBG[R+] and MFT (1/60[1.67%]). Soft tissue reconstruction significantly decreased the incidence of BGN (P = 0.00003), even in patients with radiation therapy (P = 0.00001). CONCLUSIONS: MFT significantly increases the viability of translocated facial bone grafts, which provides a good surgical approach to the anterior skull base.

Adolescent↗
PubMed1999

The clinical application of computerized three-dimensional mimic operation for maxillofacial bone tumor.

Facial bone, as the frame to support maxillofacial region and with several sinuses and cavities, is structurally complicated and the maxillofacial tumors, benign or malignant, in this region usually grows into the deep tissues, sinus-cavities and orbit and destroys the bone. In this study, the maxillofacial tumors were subjected to a mimic operation on a computer following CT scanning and 3-dimensional reconstruction. The data similar to those of real operation were obtained, which could be used for developing operative plans. As compared with data on the basis of conditions in the real operation, computerized mimic operation reflected the real conditions during operation. Computerized mimic operation is valuable for the preoperative planning and the prediction of probable intraoperative events.

Bone Neoplasms↗
PubMedDate not supplied

Use of a surgical positioner for bone-anchored facial prostheses.

The use of osseointegrated implants to retain facial prostheses in craniofacial rehabilitation is a reliable procedure. Proper location of the implants is critical for fabrication of a prosthesis with ideal shape and contour. The use of a positioner at time of surgery can guide placement of the implants to achieve an optimum result. The positioner is also useful as a guide to the shape of the retentive element and as a quick method for obtaining a wax pattern for the prosthesis. This article describes-the fabrication and applications of a positioner.

Ear, External↗
PubMed2003

Effect of unilateral partial facial paralysis on periosteal growth at the muscle-bone interface of facial muscles and facial bones.

In a previous study, the influence of the midfacial musculature upon growth and development of the maxilla and mandible was established macroscopically. Dry skull measurements revealed a reduced premaxillary, maxillary, mandibular, and anterior corpus length with a simultaneous increase in mandibular ramal height on the paralyzed side. It was demonstrated that these reduced premaxillary and maxillary lengths were among others the result of reduced nasofrontal growth, whereas the increased ramal height was accompanied by condylar growth alterations. This study investigated whether the growth alterations at the mandibular corpus region could be explained by altered periosteal growth at the muscle-bone interface of the zygomatico-auricular muscle and the mandibular corpus, caused by altered muscle activity acting upon the periosteal sleeve. Fifty-six 12-day-old New Zealand White rabbits were randomly assigned to either a control or an experimental group. In the experimental group, left-sided partial facial paralysis was induced surgically when the animals were 12 days old. To study the muscle-bone interface, seven follow-up time intervals were defined between 3.5 and 60 days following the surgery. At these time intervals, four randomly selected control animals and four randomly selected experimental animals were killed. The anterior mandibular corpus region with the muscle-bone interface of the left control hemimandible and the left and right experimental hemimandibles was processed for undecalcified tissue preparation. Quantitative analysis of the total bone area at the muscle-bone interface revealed no significant differences between the left control hemimandible and the left and right experimental hemimandibles. Also, qualitative study of the histologic sections showed no major changes in the appearance or development of the trabecular pattern between the groups. However, slight differences in the distribution pattern of osteoblasts and osteoclasts along the bony surface were found between the left control hemimandible and the left and right experimental hemimandibles, which seemed to explain the alterations in mandibular corpus shape between these groups. It was suggested that these changes in the distribution pattern of osteoblasts and osteoclasts were the result of changes in the loading distribution pattern acting upon the mandible, caused by an altered neuromuscular recruitment pattern of the remaining functionally intact, mandibularly attached muscles. The latter was probably the result of adaptive mandibular positioning in response to an altered occlusal relationship, which was induced by the abnormal maxillary growth as a result of the unilateral partial facial paralysis.

Animals↗
PubMed1984

Variations of rat skull bone robusticity evoked by malnutrition.

Weanling Holtzman rats of both sexes were fed a control (25% protein), a 10% protein, and a 2% protein semisynthetic diet. Protein deficit (PD) and protein calorie malnutrition (PCM) were estimated from comparisons between control and 10% protein, and control and 2% protein-fed animals, respectively. Animals were killed when they were 56 days old and their skulls cleaned and disarticulated. Individual bones and incisors were ovendried to constant weight. Total weight (TW), maximal projected length (MPL), and robusticity index (RI) were determined on each bone and incisor. It was found that all the bones and incisors did not behave uniformly. They followed two main patterns: (1) Proportional variation. RI values were not affected by nutritional deficiencies. All basicranial bones and 4 of 10 facial bones followed this pattern. (2) Non-proportional variation. RI values were affected by nutritional deficiencies. This pattern was subdivided into two trends: (2a) PD-diminished RI values. Both upper and lower incisors and 1 of 10 facial bones followed this trend. (2b) PCM, but not PD, decreased RI values. All vault bones and the remaining five facial bones followed this trend. It was concluded that there was a differential robusticity response among cranial base, calvaria, and incisors. This response may be connected with the differences in both histogenetic characteristics of those components and the functional roles they have to perform. The nonvault intramembranous bones showed a nonspecific behavior. This fact precluded the classification of the facial region in some of the previously defined patterns.

Analysis of Variance↗
PubMed2001

Surgical repair of skull fractures in four horses using cuttable bone plates.

Three horses with severely comminuted, open facial bone fractures and one horse with a comminuted, open orbital rim fracture were referred for treatment. Severe facial bone asymmetry and epistaxis were apparent in all cases and subcutaneous emphysema was present in two, however physical and neurological examinations were otherwise normal. Radiography and endoscopy were of some use in assessing the degree of damage, although the true extent of the damage was more apparent at surgery. Surgical reduction of the fractures was recommended to maximise cosmetic and functional outcome. After surgical debridement and reduction of the fractures the bone fragments remained unstable and were not amenable to stabilisation with interfragmentary wires alone, so 2 mm cuttable bone plates were used to maintain fracture alignment. Screw migration occurred in three horses and in one of these horses the plate had to be removed. Other complications were minor and in all horses the fractures healed with good cosmetic and functional outcome. The use of cuttable bone plates should be considered as a reasonable alternative to inter-fragmentary wiring for unstable, comminuted fractures of the facial bones, even where fractures are open.

Animals↗
PubMed1984

Athletic facial injuries.

Most facial injuries that occur during athletic activities are of a minor nature, consisting of lacerations, contusions, and abrasions. These are usually treated by a team physician or an emergency department physician. However, minor injuries must be differentiated from the more significant injuries, especially those involving facial bone fractures. Significant facial trauma must be diagnosed accurately and treated with precision to avoid permanent facial deformity. Soft-tissue trauma as well as fractures are included in this review, and evaluation of the injured athlete is emphasized. A systematic approach is developed for diagnosing and treating common facial injuries in athletes.

Athletic Injuries↗
PubMed1998

Biomechanical and histologic alteration of facial recipient bone after reconstruction with autogenous bone grafts and alloplastic implants: a 1-year study.

Potential alteration of the underlying recipient bone resulting from a graft or implant has significant clinical relevance. The present study was designed to evaluate the biomechanical and histologic alteration of facial recipient bone with autogenous bone graft and alloplastic implants over a 1-year period. The bilateral arches of 15 rabbits were randomized between four groups: (1) control (n = 6), subperiosteal exposure of the zygomatic arch was made; (2) onlay (n = 12), bone graft was placed as an onlay to the zygomatic arch; (3) inlay (n = 6), bone graft was placed as an inlay within the zygomatic arch; (4) implant (n = 6), a stainless steel plate was placed as an onlay to the zygomatic arch. Animals were killed 1 year after grafting. In the onlay groups, all steel implants and half of the onlay bone grafts (n = 6) were separated from the zygomatic arch; the remaining onlay bone grafts (n = 6) were left on the zygomatic arch. Three-point breaking strength was measured through the center of the graft/implant site on the zygomatic arch, followed by histologic evaluation and histometric assessment of residual bone density. The findings demonstrated no difference in the breaking strength per unit bone area between the control zygomatic arch group and the onlay group in which the bone graft was left in place. Breaking strength of the zygomatic arch in the former two groups was significantly greater than that in either group in which the onlay bone graft or implant had been removed, and was also greater than the breaking strength in that group in which inlay bone had been placed (p < 0.05). Histologic assessment showed full-thickness conversion in architecture of the zygomatic arch from compact to woven bone beneath onlays of either autogenous bone graft or steel implant; histometric assessment demonstrated an accompanying decrease in bone density in the latter groups relative to the control zygoma (p < 0.05). We conclude that onlay autogenous bone graft and alloplastic implants to the facial skeleton induce transformation of both graft and recipient bone from compact to woven architecture, accompanied by a reduction in bone density. The biomechanical strength of recipient facial bone is significantly weakened if an onlay bone graft or implant is removed. Weakening occurs per unit area of remaining bone, and is therefore independent of any thinning that may occur within the recipient bone because of graft/implant placement. These findings may impact upon decisions to augment stress-bearing regions of the facial skeleton with bone graft or implants, particularly if the graft/implant may eventually require removal.

Animals↗
PubMed1994

Second-intention healing of exposed facial-scalp bone after Mohs surgery for skin cancer: review of ninety-one cases.

BACKGROUND: Second-intention healing over exposed bone is considered by some to be subject to the complications of pain, infection, and nonhealing. OBJECTIVE: Our purpose was to determine would healing by second intention over exposed scalp or facial bone after Mohs micrographic surgery for skin cancer. METHODS: The chart records of all patients treated between 1981 and 1992 for skin cancer that resulted in exposed bone were identified. RESULTS: There were 115 wounds in 91 patients that were managed by second-intention healing, or partial closure, or both. Three cases of soft tissue infection occurred adjacent to nasal and sinus areas. The overall complication rate was 5.4% (6 of 112 cases) and consisted of localized soft tissue infections (2.7%) and poor wound healing (2.7%). There were no cases of osteomyelitis. Second-intention wound healing was successful in 95% of the wounds. CONCLUSION: The outpatient management of exposed bone after Mohs surgery is relatively safe. Relative risk factors for development of complications include (1) a history of previous x-radiation treatment for skin cancer, (2) manipulation of the operative site, and (3) an open defect located near the nose or exposed sinus cavity.

Adult↗
PubMed1998

Computed tomography of Paget disease of the skull versus fibrous dysplasia.

OBJECTIVE: Radiologists are often challenged to review CT examinations of the skull without pertinent clinical information or plain radiographs. Skull lesions of fibrous dysplasia (FD) may often be confused with Paget disease (PD). The purpose of this article is to evaluate radiographic similarities and to find the signs that can differentiate PD from FD of the skull on head CT and to describe the CT imaging features of PD and FD. DESIGN AND PATIENTS: CT scans of the skull in eight cases of PD, 18 cases of FD (13 cases of skull and facial bones, five cases of only facial bones) and 10 normals were studied retrospectively. RESULTS: Ten features were found to be similar in PD and FD and 10 other features were found to be dissimilar. The frequency of the 10 differentiating features was evaluated to determine their reliability in distinguishing one disorder from the other. The differentiating features in order of significance include: (1) "groundglass" appearance, (2) symmetry, (3) involvement of the paranasal sinuses, (4) thickness of the cranial cortices, (5) involvement of the sphenoid bone, (6) orbital involvement, (7) nasal cavity involvement, (8) presence of a soft tissue mass, (9) maxillary involvement, and (10) the presence of cyst-like changes. CONCLUSION: These 10 signs improve the radiologist's skill in differentiating FD and PD.

Aged↗
PubMed1994

Improving the accuracy of orthognathic surgery.

The advent of modern techniques for the correction of facial deformity has allowed oral and maxillofacial surgeons to routinely perform facial bone osteotomies to correct facial deformities and malocclusions. As these techniques have become more commonplace there is an ever increasing need for accuracy to fulfil the expectations of patients, orthodontists, and surgeons. Attention to detail is 'the name of the game'. This paper will highlight points of detail in the preparation, planning, and execution of facial bone osteotomies to improve the outcome for patients with facial deformities.

Humans↗
PubMed1999

[Rehabilitation with bone anchored facial prostheses].

BACKGROUND: Rehabilitation of orbita defects with loss of eyelids is difficult to achieve with plastic surgery. Here defect coverage with a facial prosthesis shows good results. PATIENTS AND METHODS: 105 patients with orbita defects were treated since 1991 with bone anchored facial prostheses. Preoperatively we measured the bone availability with computed tomography. We inserted Brånemark-titanium implants (Fa. Nobel Biocare), with a two-stage procedure. After a period of at least three months we exposed implants and connected the supraconstruction. Then our anaplastologist produced the facial prosthesis, either a "soft" facial prosthesis of silicone or a "solid" prosthesis of polymethylmetacrylate (PMMA). Not later than every three months patients came to recall. RESULTS: For all patients we found enough bone for implantation. The implants were screwed into the lateral bony orbital margin. There were no intraoperative complications accompanying implant insertion. For 96 patients we chose the silicone material; for nine patients we did produce the facial prosthesis of PMMA. In about 10.5% of the implants we had to remove subcutaneous tissue in local anesthesia because of recurrent periimplantary inflammations. Three years after insertion 95.8% of the implants were still firmly anchored in the bone. CONCLUSIONS: Performed by the experienced specialist the prosthetic treatment of orbita defects with a bone anchored facial prosthesis is a cosmetically satisfactory procedure with good long-term outcome. While modern plastic materials can replace the lost tissue with deceptively natural results, the implants guarantee firm secure retention of the facial prosthesis.

Adolescent↗
PubMed2006

[A case of sudden occurrence of complete left bundle branch block during emergency surgery].

We experienced a case of sudden occurrence of complete left bundle branch block during emergency surgery. A 59-year-old man suffered from facial bone fracture and eye ball injury. Repair of facial bone and removal of eye ball surgery were scheduled. Chest X-ray, echocardiography, blood counts and laboratory data were within normal limits. Awake intubation was performed. Anesthesia was maintained with 2-3% sevoflurane in 1 l x min(-1) of oxygen and 2 l x min(-1) of nitrous oxide. After induction of anesthesia, tracheostomy was performed with combined use of local anesthesia with 6 ml of 1% lidocaine with 1/200000 epinephrine. Then removal of eye ball surgery was started and finished uneventfully. During repair of facial bone fracture, we found an unexpected complete left bundle branch block. After rapid infusion of 1000 ml acetic Ringer's solution, the complete left bundle branch block disappeared. After surgery, mannitol administration at the previous hospital was noticed. Complete left bundle branch block in this case might have been induced by hypovolemia and hyperpotassemia due to osmotic diuresis by mannitol.

Bundle-Branch Block↗
PubMed2003

Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries.

INTRODUCTION: Cranio-maxillofacial trauma management requires pertinent documentation. Using a large computerized database, injury surveillance and research data describe the whole spectrum of injuries. The goal of this study was to assess the effect of the five main causes of accidents resulting in facial injury on the severity of cranio-maxillofacial trauma. PATIENTS AND METHODS: During a period of 10 years (1991-2000) 9,543 patients were admitted to the Department of Oral and Maxillofacial Surgery, University Hospital of Innsbruck with cranio-maxillofacial trauma. Data of patients were prospectively recorded including cause of injury, age and gender, type of injury, injury mechanisms, location and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures and concomitant injuries. Statistical analyses performed included descriptive analysis, chi square test, Fisher's exact test, and Mann-Whitney's U test. This was followed by logistic regression analyses for the three injury types to determine the impact of the five main causes on the type of injury at different ages in facial trauma patients. RESULTS: Five major categories/mechanisms of injury existed: in 3,613 (38%) cases it was activity of daily life, in 2991 (31%) sports, 1170 (12%) violence, in 1,116 (12%) traffic accidents, in 504 (5%) work accidents and in 149 (2%) other causes. A total of 3,578 patients (37.5%) had 7,061 facial bone fractures, 4,763 patients (49.9%) suffered from 6,237 dentoalveolar, and 5,968 patients (62.5%) from 7,769 soft tissue injuries. Gender distribution showed an overall male-to-female ratio of 2.1 to 1 and the mean age was 25.8+/-19.9 years; but both varied greatly depending on the injury mechanism (facial bone fractures: 35.4+/-19.5 years, higher risk for males; soft tissue injuries: 28.7+/-20.5, no gender preference; dentoalveolar trauma: 18+/-15.6, elevated risk for females). For patients sustaining facial trauma, logistic regression analyses revealed increased risks for facial bone fractures (225%), soft tissue lesions (58%) in patients involved in traffic accidents, and dental trauma (49%) during activities of daily life and play accidents. When compared with other causes, the probability of suffering soft tissue injuries and dental trauma, but not facial bone fractures, is higher in sports-related accidents, 12 and 16%, respectively. CONCLUSION: This study differentiated between injury mechanisms in cranio-maxillofacial trauma. The specially trained surgeons treating cranio-maxillofacial trauma are the primary source of information for the public and legislators on implementing preventive measures for high-risk activities. In facial trauma, older persons are prone to bone fractures (increase of 4.4%/year of age) and soft tissue injuries (increase of 2%/year of age) while younger persons are more susceptible to dentoalveolar trauma (decrease of 4.5%/year of age).

Accidents↗
PubMed1998

Skeletal analysis of craniofacial asymmetries in plagiocephaly (unilateral coronal synostosis).

Why do the craniofacial bones grow asymmetrically in patients with plagiocephaly (unilateral coronal synostosis)? We obtained three-dimensional skeletal replicas of two patients with the condition and analysed the deformities of the facial bones. From this analysis we deduced that the asymmetric deformation of the facial bones in these patients was caused by a combination of three rotations: rotation of the calvaria toward the affected side because of premature synostosis of the coronal and sphenofrontal sutures; rotation of the facial bones on the horizontal plane toward the unaffected side caused by anterior displacement of the TM (temporomandibular)-joint on the affected side; and downward rotation of the facial bones toward the unaffected side caused by inferior displacement of the TM-joint on the affected side.

Cephalometry↗