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PubMed2002

Preshaped hydroxyapatite tricalcium-phosphate implant using three-dimensional computed tomography in the reconstruction of bone deformities of craniomaxillofacial region.

We prepared solid life-sized models and templates of implants based on three-dimensional computed tomography data in six cases with a bone deformity of the craniomaxillofacial region. After simulation surgery using these models and templates, the preshaped hydroxyapatite-tricalcium phosphate (HAP-TCP) implants were prepared to fill in the facial bone defects, and implantation was performed. Consequently, implants fitted the individual bone defects, and satisfactory facial contouring was obtained in five cases. In one case with severe cutaneous scarring in the grafted site, it was necessary to reduce the volume of the preshaped HAP-TCP implant during surgery. In conclusion, the three-dimensional, solid, life-sized model and template are useful for preoperative detailed simulation, and the use of preshaped HAP-TCP implants based on the template probably contributes to successful reconstruction of complex facial bone deformities and to the reduction of surgical invasion, resulting in achievement of better results.

Adult↗
PubMed2003

Role of routine nonenhanced head computed tomography scan in excluding orbital, maxillary, or zygomatic fractures secondary to blunt head trauma.

The purpose of this paper is to determine the necessity of a dedicated facial bone/orbital computed tomography (CT) scan for fracture surveillance in patients who have suffered blunt head trauma and whose routine nonenhanced head CT scan is negative. It is based on a retrospective review of 115 patients presenting to the Emergency Department at a level I trauma center after blunt head trauma. Included patients underwent both a nonenhanced head CT scan and a dedicated facial bone or orbit CT. Standard nonenhanced head CT protocol was followed for each patient as per department protocol. A positive head CT scan is defined to include either an air-fluid level within the paranasal sinuses or fracture of the maxillary, orbital, or zygomatic osseous structures. A negative scan demonstrates none of these findings. Intracranial/parenchymal pathology was not evaluated in this study. Sixty-five of the 115 patients had a negative head CT scan as defined above. Of these 65 patients, none subsequently had a positive facial bone or orbit CT scan. The sensitivity and negative predictive values of a negative routine nonenhanced head CT scan for fracture surveillance are both 100%. In the setting of blunt trauma, a negative nonenhanced head CT scan precludes the need for a dedicated facial bone or orbital CT scan in the evaluation for orbital, maxillary, or zygomatic fractures. This saves the patient unnecessary radiation exposure, health care costs, and time spent in the emergency radiology department.

Adult↗
PubMed1979

Temporal bone trauma and facial paralysis.

Temporal bone trauma includes a wide range of injuries of greater and lesser severity, most of which require the immediate attention of an otolaryngologist. The most common temporal bone injuries encountered in an emergency room setting include longitudinal and transverse fractures of the temporal bone with and without facial paralysis, labyrinthine concussion, foreign bodies in the external canal, penetrating injuries via the external auditory canal, and pressure injuries, including otitic barotrauma, water skiing accidents, blows or slaps to the ear or side of the head, and severe impact noise. A brief but inclusive examination can be performed within the limitations necessarily imposed by an emergency room setting. Cranial nerve screening, balance testing, hearing, and vestibular evaluation can be accomplished with a considerable degree of accuracy. To a large extent, the long term result reflects the quality of the initial examination.

Barotrauma↗
PubMed1993

Retention designs for bone-anchored facial prostheses.

A facial prosthesis can be retained by bone-anchored implants and by a retentive bar. Because tissue response is critical around the abutments, the retentive bar should be constructed so that it is comfortable, conveniently hygienic, and designed without compromising the contours of the prosthesis.

Ear, External↗
PubMed1982

[CT analysis of facial skull fracture].

Computer tomography of the facial bones provides the maxillo-facial surgeon with valuable information regarding the type and extent of typical mid-facial fractures (le Fort fractures I to III, fractures of the malar bone, orbital fractures, fractures of the skull base close to the facial bones). The procedure takes little extra time. The patient is saved additional investigations, requiring changes in position which may, at times, be hazardous. Our experience extends to 59 examinations, which is used for an analysis of mid-facial fractures. Some typical examples are given.

Facial Bones↗
PubMed1997

Malignant fibrous histiocytoma degeneration in a patient with facial fibrous dysplasia.

Seventy-two patients with craniofacial fibrous dysplasia were treated during a period of 18 years. Only 1 patient (1.4%) developed malignant degeneration into malignant fibrous histiocytoma. Total excision including the gross mass and adjacent facial bone was performed at that time, however the patient refused an orbital exenteration and postoperative adjuvant therapy. Tumor recurrence developed 2 years later and the patient died. To our knowledge this is the first report describing malignant fibrous histiocytoma degeneration from a fibrous dysplasia localized to the facial bones. Although complete curative treatment could not be undertaken in this case, some conclusions can be drawn regarding the clinical course of this uncommon entity.

Adult↗
PubMed1993

Use of homologous bone in maxillofacial surgery.

Homologous bone grafts were used in 135 maxillofacial surgical procedures, including acute midfacial fracture repair (n = 77), elective osteotomies of the facial bones (n = 35), secondary correction of traumatic deformities (n = 6), mandibular reconstruction (n = 10), facial bone augmentation (n = 5), and reconstruction of maxillary tumor defects (n = 2). Postsurgical complications occurred in five of the patients. This article reviews the rationale for using homologous bone grafts, their immune response, how they heal, and the risk of transmission of disease.

Adolescent↗
PubMed1988

The role of three-dimensional computed tomography in the management of maxillofacial trauma.

Open reduction and internal fixation of facial fractures demand a detailed understanding of the three-dimensional pattern of injury. This is difficult if not impossible to obtain with present radiographic methods. The purpose of this study was to define the role of three-dimensional computerized tomography (3DCT) in surgical management of facial fractures. The two-part investigation: 1) compared the diagnostic accuracy of 3DCT with conventional CT and plain film studies; and 2) examined the clinical usefulness of 3DCT to surgeons. Twenty-four acute trauma patients suspected of having facial fractures were examined radiographically with analysis of every facial bone and specific facial regions. Particular attention was directed to the course of the fracture lines and the number, size, and displacement of fracture fragments. The surgeons were then asked to conceptualize the reported and the personally observed radiographic information and document their impressions on preprinted diagrams of the facial skeleton. They also completed questionnaires designed to indicate whether patient management would be influenced by the 3DCT. The radiographic findings were correlated with intraoperative observations. The 3DCT provided superior definition of fracture lines (especially horizontal) and the extent of comminution was better appreciated. This additional information improved the surgeons' ability to plan placement of interfragmentary wires and/or plates. Surgeons were also able to more accurately predict those patients requiring immediate bone grafting. Large, life-size 3D images of the facial skeleton made intraoperative conceptualization of the injury pattern easier. The accuracy of the 3DCT images corroborated the intraoperative findings in all cases. The following conclusions are offered: 1) The diagnosis of most mandibular fractures can be made equally well with conventional and 3DCT techniques. 2) Improved diagnosis of fracture lines and the specific patterns of comminution in midface fractures is made possible with 3DCT. 3) If open reduction and internal fixation is the mode of treatment, 3DCT is desirable because the added information makes preoperative planning more accurate and thereby facilitates surgical intervention.

Facial Injuries↗
PubMed1998

Facial trauma in children and adolescents.

Most studies on facial trauma in the pediatric age group focus on special subgroups. This investigation encompasses all traumatic facial injuries, minor and major, of children and adolescents. Epidemiological data of the type and pattern of injury of trauma patients less than 19 years of age, treated during a 3-year-period in a large metropolitan trauma centre were reevaluated. Of the 1385 patients, 68% had soft tissue injuries, 24% had dental trauma, and 8% fractures of facial bones. More than 90% suffered from minimal or minor trauma. The leading cause of injury was a fall, predominantly at the toddler stage. In adolescents an adult mechanism of trauma prevailed: over 60% of injuries were sequelae of an assault or altercation. The male sex predominated through all age groups and for all types of injuries. The bulk of soft tissue injuries are located within a small falling zone, extending from the nose to the mental area. There was a rising incidence of fractures of facial bones towards older age groups, mandibular fractures being the most common. Condylar fractures, with their potential impact on further growth of the mandible, are seen frequently in children and adolescents, making up 80% of the fractures of the lower jaw.

Adolescent↗
PubMed1985

Exencephaly and axial skeletal dysmorphogenesis induced by acute doses of ethanol in mouse fetuses.

Administration of single doses (0.02 ml and 0.03 ml/g body wt.) of a solution of absolute alcohol (25%, v/v) in saline to MF1 mice on day 8 of gestation resulted in significant fetal mortality, growth retardation and gross malformations of the fetuses at term. The malformations included cranioschisis with exencephaly, maxillary hypoplasia, exophthalmia and various digital anomalies. The exencephalic fetuses, cleared in KOH and stained with alizarin red revealed the absence of the skull vault and hypoplasia of the facial bones. The skull base indicated under ossification and overcrowding of the constituent bones resulting in severe reduction in the cranial volume and asymmetry of cranial base. These cranial skeletal malformations were accompanied by abnormalities of the vertebral bodies, arches, ribs and sternum. It is concluded that acute doses of alcohol during critical stages of neural tube development is deleterious to both the central nervous system (CNS) and axial skeleton in the mouse.

Abnormalities, Drug-Induced↗
PubMed1986

Torque measurements of the mechanical load capacity of thin bony structures of the visceral cranium.

The stability of self-tapping screws of the Luhr (1979)-mini-plate system in thin facial bones was assessed. The maximal possible torque which can be applied to the screws before they strip the thread in the bone was measured. This end point was called the penetration torque. Only the central section of the maxillary sinus wall was unsuitable for anchorage of the screw and plate. The other sections of the osseous middle and lateral parts of the face, of the glabella and of the root of the nose have sufficient strength for bony segments to be anchored using plates.

Adult↗
PubMed2006

Prevention of facial fractures from night vision goggle impact.

Facial bone fractures in the military can result from direct loading of night vision goggles on the orbital region. Facial fracture research has shown that increasing the area over which the load is applied increases the load tolerance. The purpose of this study is to apply this concept to reducing the risk of facial bone fracture from night vision goggle impacts. The effectiveness of countermeasures in prevention of orbital fracture was evaluated using a vertical drop tower with two impact velocities of 2.6 m/s and 3.6 m/s. The countermeasure used was a rigid plastic custom face shield made from a plaster impression of each head. In addition to two human cadaver subjects, one male and one female, tests were completed on a Hybrid III 50th percentile dummy head. Three impacts to the dummy headform included no countermeasure, safety glasses, and a custom face shield. These tests yielded peak loads of 8700 N, 7500 N, and 5640 N respectively. Using the female subject, impacts were preformed successively until injury occurred. These two impacts to the subject wearing a custom face shield resulted in peak loads of 4025 N and 5158 N. The highest load corresponds to an impact velocity of 3.6 m/s and a nasal bone fracture. Two impacts to the male subject with a custom face shield resulted in peak loads of 4554 N and 5101 N with no injury. The final impact to the male subject had a peak load of 2010 N with complete orbital fracture due to the absence of a countermeasure. From these tests it is shown that facial fracture risk from night vision goggle impact can be reduced using a contoured rigid face shield.

Aged↗
PubMed1989

Fibrous dysplasia masquerading as chronic maxillary sinusitis.

Fibrous dysplasia is a rare disease of unknown cause that affects one or multiple bones. In its monostotic form, only one bone is involved. The maxilla is the most commonly affected facial bone. Facial deformity with or without pain is the most common presentation of fibrous dysplasia affecting the craniofacial bones. In certain cases the disorder can present clinically as chronic maxillary sinusitis. The clinical, radiologic, and histologic findings, as well as the differential diagnosis and treatment of this condition are reviewed.

Adult↗
PubMedDate not supplied

[Ultrasound and endoscopic image of exencephaly (acrania) in the 12th week of pregnancy].

BACKGROUND: Acrania is a rare congenital anomaly of unknown pathogenesis, in which the flat bones of the cranial vault are absent and the facial bones are normally present. MATERIALS AND METHODS: We present a case of a 4th gravida, who had already born 2 children with acrania and came for an ultrasound examination in the 12th week of gestation. RESULTS: By transvaginal ultrasonography it was possible to diagnose fetal acrania already in the 12th week. By hysteroscopy at the same time we could see, that the brain was covered by a thin membrane, the facial bone and the shape of the cranium were normal. CONCLUSIONS: By hysteroscopy it was possible to confirm the diagnosis and to detect additional malformations. This fetus showed a small omphalocele, hexadactylism on both sides and clubfeet on both sides. DISCUSSION: By hysteroscopy in this early week of pregnancy we could demonstrate, that acrania is an independent anomaly and not the first stage of an anencephaly as reported by other authors. Hysteroscopy also offers the advantage of viewing the intact fetus before pregnancy termination.

Abnormalities, Multiple↗
PubMed1990

Gallium-67 uptake in fibrous dysplasia of the bone.

In a 43-year-old woman with fibrous dysplasia of the ribs and facial bone and in a 40-year-old man with fibrous dysplasia of the facial bone, there were considerable increases in the uptake of Tc-99m methylenediphosphonate (Tc-99m MDP) and Gallium-67 citrate. Fibrous dysplasia should be added to differential diagnosis of high Gallium-67 citrate uptake in the bone lesions.

Adult↗
PubMedDate not supplied

Common facial fractures: 1. Aetiology and presentation.

UNLABELLED: Fractures of the facial bones are common and, in the West, usually occur as a result of interpersonal violence. Patients may attend dentists in the first instance as derangement of occlusion and other oral symptoms are common. CLINICAL RELEVANCE: As patients with facial bone fractures may attend their dentist in the first instance, dentists should be confident in recognizing the signs and symptoms of facial fractures.

Domestic Violence↗