[FRACTURES OF THE MIDDLE THIRD OF THE FACIAL SKELETON].
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Facial Bones↗
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Rationale for osteotome selection in rhinoplasty.
Proper selection of an osteotome for nasal osteotomy is important for minimizing soft tissue trauma. Radiographic analysis of the facial bony lateral wall thickness was performed to suggest a guideline for an appropriate osteotome size for Asians. Facial bone computed tomography (CT) of 100 patients (50 male, 50 female) were studied. The thickness of the facial bony lateral wall at three points along the track of a lateral osteotomy, and two points along the track of a medial osteotomy and intermediate osteotomy were measured. The average bony thickness along the track of a lateral osteotomy was 2.61 +/- 0.66 mm at the low level, 2.75 +/- 0.76 mm at the middle level, and 2.72 +/- 0.53 mm at the high level in subjects. The average bony thickness along the track of an intermediate osteotomy were 1.26 +/- 0.34 mm at the low level, and 1.31 +/- 0.32 mm at the high level in the subjects. The average bony thickness along the track of the medial osteotomy were 2.54 +/- 0.31 mm at the low level, and 2.77 +/- 0.30 mm at the high level in subjects. These results may provide a guideline for choosing an osteotome of appropriate size for the Asian population.
Adult↗
High resolution CT scan of temporal bone fractures: association of facial nerve paralysis with temporal bone fractures.
This radiologic study analyzed high resolution computed tomographic (CT) scans of 22 patients with temporal bone fractures. There were 19 males and three females. Fifteen of 22 had clinical evidence of facial nerve injury ranging from mild paresis to complete paralysis. The high resolution CT scan analysis identified a characteristic fracture of the temporal bone in every patient with facial nerve injury. A high percentage of these fractures (68%) could be classified as mixed and did not fall into a longitudinal or transverse fracture category. The characteristic fracture extends from the petrotympanic fissure at the glenoid fossa to the anterior inferior aspect of the medial bony external auditory canal. It resumes at the superior aspect of the external auditory canal (scutum) extending laterally along the external canal wall. If the vector force of the fracture is projected medially, it will cross the facial nerve in its horizontal portion. Often, the evaluation of trauma patients with routine CT scans for central nervous system (CNS) (brain) evaluation is inadequate for evaluation of temporal bone fractures. A high resolution CT scan should be performed when clinical criteria warrant its use. It is recognized that the incidence of facial nerve injury may be higher in this select population.
Adolescent↗
Application of bone morphogenetic proteins in the treatment of clinical oral and maxillofacial osseous defects.
BACKGROUND: Commonly occurring extensive osseous defects in the oral and maxillofacial area are seen following complete or partial resection of the mandible and other facial bones in oncologic surgery or following traumatic injury. Autogenous osseous grafts have been used to restore these defects. Additionally, bone graft substitute materials and autogenous osseous grafts are applied to congenital defects such as cleft palate, facial clefts, and facial asymmetry. We have simulated these types of defects in appropriately aged Macaca fascicularis and Macaca mulatta monkeys to study the efficacy of using bone morphogenetic protein (BMP) as an osseous inductor. The objective of these studies was to obtain information on the feasibility of employing bone inductors to regenerate large continuity critical-sized maxillofacial defects without using bone grafts. METHODS AND RESULTS: In one study, involving eight animals, the body of the mandible was removed, simulating hemi-mandibulectomy defects following traumatic bone loss or oncologic surgery. Recombinant human (rh) BMP-2 (Genetics Institute, Cambridge, Massachusetts) in a collagen carrier (Colla-Tec Inc., Plainsboro, New Jersey) then was placed in the hemi-mandibulectomy defect with use of titanium orthopaedic mesh fixation (Sofamor Danek-Medtronic, Memphis, Tennessee). Entire bone regeneration of the defect was observed 5 and 6 months postoperatively. In another group of subhuman primates, the restored area was functionally stimulated at the 5-month post-BMP implantation level by placement of intraoral titanium implants. The animals were allowed to function for 8 months with these titanium implants. Microscopic results showed increased density, bone volume, and thickness of the trabecular bone pattern. The bone cortex in the restored defect also increased in thickness compared with the nonsurgical areas. To evaluate the effect of rhBMP-2 in aging individuals, a group of six Macaca animals over 20 years of age received the same type of mandibular resection followed by BMP grafting with functional stimulation by mastication on root form implants placed at 5 months after BMP implantation. The entire mandible regenerated as in the younger group of animals; therefore, age did not appear to be a factor in the reparative process. Thus, the number of stem cells supposedly reduced with increasing age did not appear to affect the overall result of BMP-induced bone regeneration. Additionally, in applying the inductor material to younger monkeys (1-1 1/2 years of age), the rhBMP-2 was placed in simulated bilateral cleft palate defects. On one side, the rhBMP-2 was placed with use of the collagen sponge carrier. The autogenous graft most frequently used at present for regeneration of the osseous defects of maxillary clefts is iliac crest particulate cancellous bone. As a control graft on the contralateral side, therefore, autogenous particulate bone and marrow was placed. At the end of 3 months, the cleft side receiving the BMP-2 showed complete osseous restoration of the simulated cleft. The autogenously grafted side exhibited bone repair but incomplete regeneration of the bone defect at the early (3-months postoperative) stage of healing. CONCLUSIONS AND CLINICAL RELEVANCE: The results of these three subhuman primate defect studies--(a) mandibular resection defects in middle-aged Macaca fascicularis animals, (b) mandibular resection defects in Macaca fascicularis animals over 20 years of age, and (c) simulated bilateral clefts in Macaca mulatta animals 1 1/2 years of age (comparable with a 5-year-old child)--were very encouraging. Histomorphometric analysis in all of these investigations indicated that the use of rhBMP-2 in bone repair without the use of bone grafting materials will offer a new method of osseous reconstruction in clinical facial bone defects.
Aging↗
Head trauma.
The equine head is especially prone to trauma from kicks, collisions, entrapments, and falls. The specialized structures of the equine head are important in both function and appearance. When injury causes either loss of function or cosmesis, timely treatment is paramount. This article discusses the occurrence and therapy of trauma to the equine head, including fractures of the mandible and premaxilla, facial bone, hyoid apparatus, and skull base.
Animals↗
Skeletal alterations as a basis for facial rejuvenation.
A slight decrease in overall facial bone bulk coupled with the increased soft-tissue expansion associated with aging produce effects that should be reversed in both the bone and soft tissue where possible. The changes are best done at the ledge areas: the supraorbital-temporal ridge areas, malar-midface, and chin mandible. However, the overall bone bulk may be increased in addition in the temporal fossae, in the infraorbital rim, at the lateral canthus, in the paranasal area, and at the alveolar ridges and dental areas. A combination of autogenous and synthetic materials is currently best, with synthetic materials most useful in the malar-midface, posterior mandibular, infraorbital, and paranasal areas. In the supraorbital ridge-temporal areas, it is a near equal choice between autogenous and synthetic materials. In the chin, the preferred method is by osteotomy using autogenous augmentation. The concept of increasing bone mass and decreasing expanded soft-tissue mass has application within the judgment of the surgeon coupled with the patient's desires. Subtle increases of bone mass to compensate for soft-tissue thinning as well as bone shrinkage, at the same time taking up lax soft tissue, can be done in conjunction with one another, effectively producing a three-layer face lift. The subperiosteal face lift is in reality an extended brow lift and can be used to enhance the brow-forehead area and the temporal, zygomatic, and paranasal areas. At the same time, the perioral, jowl, and submandibular regions must be treated by a combination of standard face lifting procedures and augmentation of the bone structures of the face.
Aging↗
Zygomatic bone fracture.
OBJECTIVE: To find out the number and etiology of fractures of zygomatic bone. DESIGN: Observational study. PLACE AND DURATION OF STUDY: This study was carried out at the Department of Oral and Maxillofacial Surgery, Mayo Hospital, Lahore from January 2001 to December 2002. PATIENTS AND METHODS: A total of 209 cases were treated during a period of two years. A detailed history and examination was done and findings were confirmed radiologically. RESULTS: There were 184 (88.04%) male and 25 (11.96%) female patients. In 117 (56 %) cases only the zygomatic bone was involved while in the rest of the 92 (44 %) cases, fracture occurred in combination with fracture of other facial bones. The youngest patient in the series was 9 years of age and the oldest of 80 years. Most of the patients were in the third decade of life (35%). Most common etiology was road traffic accidents, followed by interpersonal violence. In half of the road traffic accidents, motorcyclists were involved. CONCLUSION: Most common etiology of the fractured zygomatic bone was road traffic accidents. Measures, like various awareness campaigns, raising the traffic sense in public, wearing helmets while driving the motorcycle, can minimize number of these cases.
Accidents, Traffic↗
FRACTURES OF THE MIDDLE FACIAL SKELETON.
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Facial Bones↗
Value of magnetic resonance imaging in assessing bone destruction in head and neck lesions.
We utilized low-field magnetic resonance imaging (MRI) to evaluate 12 patients with head and neck lesions and suspected skull base or facial bone destruction. All except one had high resolution computed tomography (CT). MRI was performed on a 0.15 tesla (low-field) resistive unit, with routinely good resolution due mainly to the use of specially designed rf receiver coils (surface coils). T1 and T2 weighted spin echo images were performed in all cases. In three instances axial, coronal, and sagittal images were done. All CTs were done with high resolution techniques on state-of-the-art equipment. Comparison of the CT and MR images (at low-field strength) showed that MRI's main strength lies in its freedom to perform images in any plane and to visualize intracranial lesions with early brain involvement. Otherwise, the two modalities are comparable. Bone destruction seen on CT was always detectable on MRI, although CT is clearly superior in resolving bone detail. MRI is recommended when direct coronal CT scans are not obtainable to evaluate superiad tumor extension. The improved visualization of nasopharyngeal soft tissue and cavernous sinus region is likely to make MRI the examination of first choice in evaluating lesions of the nasopharynx, skull base, and cavernous sinus.
Adult↗
Maxillofacial injuries in women.
Although maxillofacial injuries account for a large number of hospital admissions, there appear to be only a few reports detailing the etiology and pattern of facial injuries in women. To delineate this problem, we performed a retrospective chart review of all women admitted to University of California, Davis Medical Center with traumatic facial injuries from July 1, 1990, to June 30, 1992. Motor vehicle accidents were the primary etiology, followed by assaults. The mandible was the most commonly injured facial bone. In a closer evaluation of female patients injured by assault, we found inadequate documentation describing the circumstances surrounding their facial injuries. This indicates that domestic violence and other forms of assaults against women may be severely underreported and has important implications for health care professionals who must always suspect physical abuse in any woman who presents with maxillofacial injuries without an obvious, known etiology.
Accidents, Traffic↗
[TRAUMA OF THE NASOMAXILLARY REGION (WITH SPECIAL REFERENCE TO THE EVALUATION OF THE ESTHETIC DAMAGE)].
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Accidents↗
[Vascularized outer-table calvarial bone flaps to repair depressed disfigurement of face].
Utilizing the superficial temporal artery as the pedical, seven vascularized outer-table calvarial bone flaps have been raised for the reconstruction of a variety of craniofacial deformities. Satisfactory results were obtained. The advantages of the flap include: 1. proximity to the operative field; 2. it is a membranous bone similar to that of the facial bone; 3. it is more or less malleable, so that it can be formed into different shapes, in different sizes and thickness; 4. donor-site scar is inconspicuous; 5. no postoperative pain; 6. no resorption.
Adolescent↗
A mild case of frontonasal dysplasia: the rhinologic perspective.
Frontonasal dysplasia (FND) is a congenital malformation characterized by hypertelorism, broad nasion with a midline cleft in the bony dorsum, midline defect of the frontal bone, absence of the nasal tip, and deformities in the nasal alar region. The clinician should be aware of the mild forms of FND. We presented absence of crista galli in a mild case of FND. Computed tomography scanning should assess the facial bones, nose, and paranasal structures. If a surgical correction is planned, this complete work-up prevents unexpected complications and complements the evaluation of paranasal deformities.
Abnormalities, Multiple↗
Hydroxyapatite cement to repair skull base defects: radiologic appearance.
PURPOSE: To describe the radiologic appearance of hydroxyapatite cement (HAC), which, when mixed with liquid, forms a paste that can be contoured to osseous defects and, over time, becomes "osseointegrated" (native bone grows into the pores of the HAC and forms a strong chemical bond with the substance). METHODS: Between March 1992 and June 1993, 24 adults (16 men, eight women) underwent skull base surgery that included reconstruction or closure with HAC. Fourteen patients had HAC placed in the paranasal sinuses or facial bones, and 10 had HAC placed in the mastoid cavity. RESULTS: HAC is homogeneously radiopaque on CT scans and plain radiographs. Large amounts (ablating a frontal sinus or mastoid air cells) are readily seen; small amounts are inconspicuous. On MR images, HAC is a signal void. Infected HAC in one patient was surrounded be enhancing soft tissue on MR images, separated from native bone by an irregular radiolucent cleft on CT scans. CONCLUSIONS: HAC is a valuable addition to the surgical armamentarium for the repair of skull base defects. More experience will determine the time course for normal osseointegration, as well as the typical appearance of infection.
Adult↗
Neurologic manifestations in Sagliker syndrome: uglifying human face appearance in severe and late secondary hyperparathyroidism in chronic renal failure patients.
Patients with chronic renal failure (CRF) often have signs and symptoms related to fluid and electrolyte disturbances, anemia, malnutrition, bone disease, and gastrointestinal problems. Vascular and neurologic impairment in particular remain an important source of morbidity and mortality in this vulnerable patient population. Sagliker syndrome is a novel syndrome that was recently described in 2004 in patients with CRF and severe and late secondary hyperparathyroidism who suffered from severe skull and facial bone changes, particularly from uglifying human face appearances and neuropsychiatric disorders. The goal of this study was to assess neuropsychiatric manifestations occurring in CRF patients with Sagliker syndrome. Four female and 8 male patients with CRF on regular dialysis at the hemodialysis units of the Internal Medicine Departments around southern Turkey participated in the study. All patients underwent a clinical neurologic examination performed by the same neurologist. Neuropsychiatric signs and symptoms were found in all cases. The results showed that the most frequent neurologic manifestations in CRF patients with Sagliker syndrome were headache, polyneuropathy, cranial neuropathy, fatigue, and psychiatric disorders.
Adolescent↗
[Clinical evaluation of transaxial bone imaging with 99mTc-phosphate compounds].
Single photon emission computed tomography using newly designed whole body imaging system which was composed of opposing dual gamma cameras, a rotating gantry and a sliding table was clinically evaluated for bone imaging. Two hundred and seventeen portions of various bone diseases were performed single photon emission computed tomography following conventional bone imaging with 99mTc-MDP (methylen diphosphonate) or -HMDP (hydroxymethylene diphosphonate) and the results were discussed. Transaxial images were sometimes superior than conventional images in the diagnosis of the tumor localization and extension of the facial bone. Combination of emission computed tomography to conventional methods also presented more exact informations for the diagnosis of the vertebral change. Separation of the overlapped radioactivities of the bone and the soft tissue is another advantage of the tomographic image, and cross-sectional images with enoughly high qualities were available in early time after administration of 99mTc-phosphate compounds. Useful diagnostic informations could be obtained by tomographic bone imaging combined with conventional imagings.
Adult↗
Reconstruction of facial deformities with alloplastic material.
The two most ideal and versatile foreign materials for reconstruction of facial bone deformities are silicone rubber and methyl methacrylate. Their biomechanical characteristics are uniquely suited to facial implantation for reconstruction of complex, irregular bony defects. The advantages and disadvantages of each are discussed, along with specific indications for their use. Surgical approaches and various methods of fabrication and fixation are presented and illustrated. The hazards and potential disappointments in the use of these and other alloplastic implants are reviewed.
Bone Cements↗
Skeletal coccidioidomycosis: imaging findings in 19 patients.
OBJECTIVE: The objective of this study was to describe the distribution and radiologic appearance of skeletal coccidioidomycosis in 19 documented cases. DESIGN AND PATIENTS: Medical records of 19 patients (17 men, 2 women; age range 17-62 years, mean age 34 years) with clinically confirmed skeletal coccidioidomycosis were retrospectively reviewed. The patients were studied with plain radiography (n = 19), skeletal scintigraphy (n = 6), computed tomography (CT) (n = 5), and magnetic resonance imaging (MRI) (n = 1). RESULTS: Multiple lesions were seen in 11 of 19 patients (58%). Of a total of 46 lesions, 27 (59%) were described as punched-out lytic, 10 (22%) as permeative/destructive, and 9 (17%) as involving a joint and/or disk space. Lesions were identified in almost every bone (with the exception of the facial bones, ulna, carpus, and fibula) and were most commonly found in the axial skeleton (20 of 46; 43%). CONCLUSION: Skeletal coccidioidomycosis is frequently multicentric and may involve almost any bone. The axial skeleton is the most common site of involvement. Lesions are usually well demarcated but may present with an ill-defined border and permeative type of bone destruction, especially in the spine. Joint involvement is not uncommon. Plain radiographs are effective in the initial evaluation of bones and joints, scintigraphic studies can identify disseminated disease, and CT and MRI are effective in determining soft tissue involvement and spinal abnormalities.
Adolescent↗