[Corrections on the bone following facial injuries].
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Humans↗
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E.N.T. manifestations of Von Recklinghausen's disease.
Von Recklinghausen's Disease (VRD) is a neurocutaneous, systemic disease characterized by CNS tumors and disorders, cafe-au-lait spots, generalized cutaneous neurofibromata, skeletal deformities, and somatic and endocrine abnormalities. It is an autosomal dominant, hereditary disorder found in approximately 1:2500 to 3300 births. There are many manifestations of this disease in the head and neck region of interest to the otolaryngologist. Case reports of three patients with multiple ENT involvements are detailed. A review of the literature is presented with a brief discussion of diagnosis and treatment. The most common intracranial tumor in the adult is the acoustic neuroma, usually bilateral, while in the child it is the astrocytoma. A defect in the sphenoid bone is common and may produce temporal lobe herniation into the orbit causing pulsatile exophthalmos. Involvement of the facial bones usually causes radiolucent defects secondary to neurofibromata within nerve pathways, and a variety of asymmetrical changes, especially within the mandible. "Elephantiasis" of the face is a hypertrophy of the soft tissues overlying a neurofibroma, often quite extensive and disfiguring. Laryngeal and neck involvement may compromise the airway and early and repeated surgical intervention is required. The over-all malignancy rate approaches 30%, indicating that the patient with VRD may be predisposed to developing a malignancy. There appears to be an increased surgical risk in these patients, with some demonstrating abnormal responses to neuromuscular blockade.
Adult↗
Coral, a new biomedical material. Experimental and first clinical investigations on Madreporaria.
The coral or Madreporaria skeleton is morphologically and chemically very close to mineral bone. In 1979 we began to experiment with the implantation of selected pieces of coral in the cranial or facial bones of dogs, pigs and monkeys. With the wide porous varieties we obtained a true reossification. With the other varieties we had a very stable implant and very good tolerance. For the past three years we have used Madreporaria in human surgery. The cases included the stabilization of facial osteotomies, bone apposition near the pyriform aperture, and the treatment of periodontal lesions.
Adult↗
Multicentric leiomyosarcoma in a young male horse.
A 2-year-old male Thoroughbred was evaluated for multiple firm, raised nodules of the maxilla and mandible that had been present since 6 months of age. The horse was evaluated as a yearling with a final histologic diagnosis of fibrosarcoma. As a 2-year-old, the colt made a loud upper airway sound and was agitated after strenuous exercise. Results of upper airway endoscopy indicated severe narrowing of the nasal passages and pharynx with normal resting function. Radiography revealed multiple circular bony lesions in the mandible, maxilla, multiple long bones, and cervical vertebrae. Biopsy specimens of the left mandible and right facial bone were obtained. A diagnosis of leiomyosarcoma with extensive metastatic bone formation was made on the basis of histologic features and the immunohistochemical staining properties of the biopsy specimens. Because of the diffuse distribution of the lesions, prognosis was guarded; 4 years after diagnosis, the horse had not pursued an athletic career.
Animals↗
Bilateral proptosis: an unusual presentation of fibrous dysplasia.
Fibrous dysplasia is a benign, developmental bone disorder of unknown aetiology. With involvement of the facial bones, indications for surgical intervention include cosmetic deformity and/or progressive neurological dysfunction. We present the case of a 36-year-old female with bilateral orbital lesions whose initial presentation was that of progressive proptosis and visual loss. She underwent bilateral pterional craniotomies with gross total resection of her tumours. Review of the literature reveals several cases of unilateral orbital fibrous dysplasia. This appears to be the first reported case of distinct, bilateral orbital fibrous dysplasia.
Adult↗
Facial injuries in automobile crashes.
In automobile accidents, the facial area is the most frequently injured body region in passenger car occupants. Laboratory studies have indicated that the tolerance of facial bones to impact is relatively low. Most of these facial injuries are rated as minor. The windshield, steering wheel, and instrument panel are the major points of contact. Restraints, lap belts, and lap-shoulder belts reduce the frequency of facial injuries at all levels of severity and also reduce the more severe and serious injuries to other body regions.
Accidents, Traffic↗
Aneurysmal bone cyst of the ethmoid.
Although nearly 500 cases of aneurysmal bone cyst have been recorded in the English literature, involvement of the facial bone is uncommon. To our knowledge, this is the first case of extragnathic, facial aneurysmal bone cyst to be reported in the English literature. A left ethmoid aneurysmal bone cyst was found in a 20-year-old pregnant woman who had a 5-month history of progressive left periorbital swelling, left cystic nasal mass, progressive nasal obstruction, blurred vision, and occasional diplopia. The diagnostic evaluation included a sinus series, facial lamiograms, and an EMI scan. Needle aspirates taken frequently from the intranasal cyst consisted of a dark bloody fluid. The surgical procedure, using external rhinotomy approaches, pathologic findings, and a literature review are presented.
Adult↗
Bone-anchored reconstruction of the irradiated head and neck cancer patient.
Titanium implants in facial bones for retention of epitheses or dental bridges were used for reconstruction in cancer patients after tumor surgery. Even heavily irradiated bones could integrate the implants and bear the load from the epithesis. No major complications, such as wound infection, fistulation, or osteoradionecrosis, occurred after implant surgery. There was, however, an increased loss of implants with time after irradiation, especially in the orbital region. When hyperbaric oxygen was used as adjunctive treatment, implant losses were reduced.
Adolescent↗
Bone scintigraphy of facial skeleton with 99Tcm-diphosphonate.
Bone scintigraphy of the facial skeleton with 99Tcm-diphosphonate using gamma-camera was performed in 10 cases without, and in 4 cases with pathologic processes. A. p. and lateral projections were used and a converging collimator. The normal distribution of the isotope in the bones of the face seemed to be uniform with minor variations. Increased uptake varying in intensity was evident in the region of the lesion.
Adult↗
Raine dysplasia: a Brazilian case with a mild radiological involvement.
We report a preterm male infant, the first child of a young consanguineous couple, whose physical examination revealed craniofacial disproportion with microcephaly, wide fontanelles, exophthalmos, low nasal root and hypoplastic nose, long philtrum, small mouth, high arched and narrow palate, micrognathia, dysplastic, low-set and rounded ears, short neck and, arthrogryposis. Postmortem findings included hypoplastic lungs. Radiological examinations showed mild and localized increased of bone density in the cranial vault and skull base and facial bones and undermodelled in the long bones. The above findings are characteristics of Raine dysplasia but the case reported here presents a mild bone involvement with only a localized bone sclerosis and absence of prenatal fractures. We discuss the possibility that this case represents an allelic mutation of the Raine gene. The consanguinity of the parents reinforces the hypothesis of autosomal recessive inheritance for this entity.
Abnormalities, Multiple↗
Cephalometric evaluation of patients with Sagliker syndrome: uglifying human face appearance in severe and late secondary hyperparathyroidism in chronic renal failure patients.
It is well known that secondary hyperparathyroidism may be an extremely severe condition in chronic renal failure, and almost all patients with chronic kidney disease, even in the well-developed countries, encounter every kind of bone abnormalities if they are not treated properly. Although some sporadic cases have been reported of unique facial bone changes, the largest collection of this phenomenon has been reported by Sagliker et al. We also have found 6 of 9 patients who have these changes (Sagliker syndrome) to manifest class II malocclusion of the upper and lower jaws according to dental universally accepted criteria by performing cephalometric studies, x-ray plain films, tomographic procedures, and drawing technology.
Adolescent↗
Frontometaphyseal dysplasia with congenital urinary tract malformations.
A 12-year-old by with unusual face and hearing loss was diagnosed as having frontometaphyseal dysplasia. He also had congenital urinary tract malformations and chronic urinary tract infection. The cranial and facial bones of the patient were studied by roentgen cephalometric analysis.
Abnormalities, Multiple↗
[Maxillo-facial skeletal traumas in farmers in Central-Eastern region of Poland (Part II)].
In this study based on medical documentation we assessed farming associated traumas of maxillo-facial skeleton, which occurred in the years 1988-1997. 99.1% of patients had fractures of facial bone structures. Mandible fractures were the most frequent (47.4%). Upper facial skeleton was fractured in 37.2% of cases. In 14.4% of cases multi-fractures of facial skeleton were diagnosed. Injuries frequently accompanied the mandible fractures and multi-fractures of facial skeleton.
Accidents, Home↗
A simple metal bone implant for postsurgical radiographic evaluation.
A simplified method of implanting metal markers in bone enables the surgeon to make more accurate postsurgical radiographic assessments of changes in facial bones.
Dental Implantation, Endosseous↗
Maxillofacial fractures. Analysis of demographic distribution and treatment in 2901 patients (25-year experience).
INTRODUCTION: The aim of this study was to analyse retrospectively the demographic distribution, treatment modalities, and complications of maxillofacial fractures in 2901 patients treated in this department in Southeast Anatolia between 1978 and 2002. In addition, the use of internal fixation was evaluated in an effort to determine whether there were changes in using internal fixation techniques. PATIENTS AND METHODS: Two thousand nine hundred and one cases of facial trauma were assessed according to age, sex, and aetiology, in addition to the distribution of the fractures relating to facial bones and seasons. RESULTS: It was found that facial fractures were most frequent in males (77.5%) and in the 0-10 year age group; they tended to be more frequent during summer (36.3%); and traffic accidents were the most common aetiological factor (38%). 77.9% of cases were treated with conservative methods, and 22.1% with one or more internal fixation techniques. The most favoured technique was miniplate osteosynthesis; the complication rate associated with internal fixation was 5.7%. CONCLUSION: Currently there are many techniques to be used in treating maxillofacial trauma. However, the experience of the surgical team is also an important factor in achieving satisfactory functional and aesthetic results, and in minimizing complications.
Accidental Falls↗
[Use of the calvarium for bone grafting in cranio-maxillo-facial surgery].
Bone grafts's traditional donor sites in cranio-maxillo-facial surgery have been for many years and are still in some occasions the ribs, iliac crest and tibia. Bone grafts taken from the calvaria have been used by some surgeons in the past but its wide acceptance was only achieved after Paul Tessier had reported his own experience. The calvaria is composed of inner and outer tables that encloses a layer of cancellous bone called the diploe. A high degree of variability exist with respect to skull thickness. Nevertheless parietal bones is the preferable site for the harvesting of the graft. The embryonic origin of the cranium should be responsible for greater survival of the graft. Membranous bone would maintain its volume to a greater extent than endochondral bone when autografted in the cranio-facial region. However this remains controversial. Two techniques can be used for the harvesting of a calvarial bone grafts. A split thickness calvarial graft involves removal of the outer table while leaving the inner layer in place. Its main disadvantage is the relatively thinness of the bone transferred. A full thickness segment of skull involves the cranium cavity be entered. A half of the graft can be split along the diploe space and returned to fill the donor site. The other half is used for reconstruction. It is a more complicated procedure. Cranial grafts have been used in the following cases. Correction of contour defect of the forehead and zygomatic bones, orbital floor reconstruction, restoration of the nasal bridge, bone grafting of the maxilla and mandibule. The advantages are the following: the donor and recipient sites are in adjacent surgical fields, the donor site scar is hidden in the scalp, morbidity associated with removing the graft is almost inexistent. (ABSTRACT TRUNCATED AT 250 WORDS)
Craniosynostoses↗
Insulinlike growth factor 1- and 2-augmented collagen gel repair of facial osseous defects.
BACKGROUND: Defects of the facial bone structure are common problems for the facial plastic surgeon. Native type 1 collagen gels (T1CGs) have been shown to mediate repair of facial critical-size defects in rat models. OBJECTIVE: To evaluate the efficacy of T1CG augmented with insulinlike growth factor (IGF) 1, IGF-2, and a combination of IGF-1 and IGF-2 on the repair of facial critical-size defects in a rodent model. METHODS: Twenty-four retired male breeder Sprague-Dawley rats were divided into 4 groups of 6 animals. Facial critical-size defects were created by removing the nasalis bones with a bone-cutting drill. Defects were treated with 300 pg of type 1 collagen gel (T1CG), T1CG augmented with 3 microg of IGF-1, T1CG augmented with 3 microg of IGF-2, or T1CG augmented with a combination of 3 microg of IGF-1 and 3 microg of IGF-2. After 30 days the animals were examined at necropsy with precise planimetry, histological analysis of new bone growth, and radiodensitometric analysis of bone thickness. RESULTS: Radiodensitometric measurements showed that IGF-2 augmentation resulted in greatest osseous healing, with measurements being statistically significant over those of all other groups (P< or = .03). Combination IGF-1 and IGF-2 had osseous healing that was intermediate between IGF-1 augmentation and IGF-2 augmentation alone, with measurements being statistically significant over those of unaugmented gels (P<.001) and IGF-1 augmentation (P< or = .03). Augmentation with IGF-1 resulted in healing that was significant over that of unaugmented gels (P< or = .04). CONCLUSION: Collagen gels augmented with IGF significantly enhance the osteoconductive repair of nasal critical-size defects in a rodent model, with IGF-2 showing highest efficacy.
Animals↗
Distraction osteogenesis of the craniofacial skeleton.
In summary, distraction osteogenesis is a safe and effective means of achieving bone lengthening. These techniques were originally applied to the long bones of the extremities; over the past 10 years they have been effectively applied to the bones of the craniofacial skeleton. The new bone regenerate that is observed after distraction osteogenesis is stable, and relapse rates after skeletal advancement are believed to be lower than with conventional osteotomy and bone graft techniques. There is considerable variability in distraction protocols employed in clinical practice, including differences in the types of devices used and in the rate, rhythm, latency, and period of consolidation for distraction osteogenesis. The greatest application for distraction osteogenesis in the craniofacial skeleton has been with mandible lengthening, for which there is presently a 10-year clinical experience. Midfacial advancement is a newer application of distraction osteogenesis, for which clinical experience has been accrued over the past 5 years. This latter experience indicates that distraction osteogenesis is a viable treatment option for lengthening of the hypoplastic mandible and midface. These techniques have advantages over conventional means of bone graft and rigid fixation because of the quality of the bone regenerate, the decrease in the long-term relapse rate of the advanced bone segments in both the mandible and the midface, and the simultaneous soft-tissue elongation that accompanies the distraction process. Distraction osteogenesis is particularly applicable to the correction of severe deformities of the mandible and midface in children with developmental hypoplasia and syndromic craniosynostosis. However, growth is an added variable in this patient population. The amount of overcorrection in lengthening of the hypoplastic bone required to compensate for continued growth discrepancy of the adjacent facial bones is difficult to predict. Therefore, the families of these patients should be informed that many children will require repeated operations at a later age as they reach skeletal maturity.
Child↗