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PubMed1991

Standing surgery and procedures of the head.

Although most surgical procedures of the head are technically easier to perform with the horse under general anesthesia, other factors will influence whether a surgical procedure is performed with the horse standing or recumbent under the influence of general anesthesia. The accessibility of the head lends itself to many standing surgical procedures if the proper combination of analgesia and physical and chemical restraint is used. Traumatic injuries of the head (lacerations, facial bone fractures, and oral fractures) may involve vital structures, and a thorough examination is indicated. Failure to treat a traumatic injury may result in facial deformity, bony sequestra, paranasal sinusitis, salivary-cutaneous fistula, cutaneous fistulas into a nasal passage or paranasal sinus, nasal septal deformities, and ocular dysfunction. Proper management of these injuries typically results in a cosmetic outcome because of the head's abundant blood supply. Other surgical procedures that can be performed in the standing horse include centesis and trephination of the paranasal sinuses, certain dental procedures, alar fold stabilization, and extirpation of epidermal inclusion cysts of the nasal diverticulum.

Analgesia↗
PubMed2006

Analysis of incidences and types of complications in mandibular angle ostectomy in Koreans.

A prominent mandibular angle is considered to be unattractive in Asians because it gives the face a square, coarse, and muscular appearance. Asian women desire to have an ovoid, reduced, and slender face by aesthetic mandibular angle resection. Mandibular angle ostectomy has been known to be effective and to satisfy both surgeons and patients. Especially in Korea, it has become as popular as facial bone contouring surgery, which reduces lower facial width. However, a narrow surgical field hinders direct view of the site, making a procedure that is rather difficult to perform. Despite thorough presurgical planning and attention, there can be many complications and unfavorable results. The purpose of this study is to find out the cause of these complications of mandibular angle ostectomy and to develop methods that could prevent these complications from occurring. A questionnaire consisting of 30 questions regarding mandibular angle ostectomy was sent to 40 Korean plastic surgeons. Data from 33 surgeons were analyzed. The total number of operations was 1251, and among them complications appeared in 124 operations, a complication rate of 9.9%. In regards to severe complications, there were 8 cases of subcondyle fracture of the mandible and 6 cases of severe bleeding. Transient facial nerve injury, infection, trismus, asymmetry, undercorrection, overcorrection, secondary angle formation, and entrapped bony segment were also noted as complications. We will report the cause and the prevention methods for each complication.

Asian People↗
PubMed2006

Pattern of paediatric maxillofacial fractures in Lagos, Nigeria.

BACKGROUND: Maxillofacial fractures in children are rare when compared to those occurring in adults. To establish the incidence, pattern, and aetiology of maxillofacial fractures in children aged 15 years and below in Lagos, Nigeria. DESIGN: A review of patients with maxillofacial fractures aged 15 years and below seen and treated at the Lagos University Teaching Hospital, Lagos, Nigeria between January 1997 and December 2004 was conducted. RESULTS: Of the 225 patients with maxillofacial fractures seen within the study period, 37 (16.4%) were children aged 15 years and below, with a male-to-female ratio of 1.5 : 1. The highest incidence recorded was found within the age group 12-15 years (41%), with the lowest incidence occurring in the age group 0-5 years (27%). Multiple fractures were commoner in older patients (P > 0.05), and in boys (P > 0.05). There were no statistically significant relationships between the age of the patients, gender distribution, and mechanisms of injury. Road traffic crashes were the most common aetiological factor (64.9%), with the mandible being the most involved facial bone (63.8%). Majority of the mandibular fractures (33.3%) were located in parasymphyseal region. Zygomatic complex fractures were the most common in the mid-facial region. Most of the fractures (81.1%) were immobilized by simple methods (arch bars, eyelet wires, acrylic splint with circum-mandibular wiring) with or without intermaxillary fixation. Of the cases, 18.9% were managed conservatively. CONCLUSION: The incidence of facial fractures in this study was found to be higher than previously reported in Nigeria and worldwide, with almost two-thirds of cases a result of road traffic crashes. There is a need to enforce legislation aimed at preventing road traffic crashes to reduce maxillofacial injuries in children.

Accidents, Traffic↗
PubMed2004

Intraoperative 3D imaging of the facial skeleton using the SIREMOBIL Iso-C3D.

OBJECTIVES: With respect to high-contrast structures, cone beam computed tomography (CBCT) offers an alternative imaging modality to computed tomography (CT), requiring less radiation exposure. The C-arm system SIREMOBIL Iso-C3D for three-dimensional (3D) reconstruction has made this modality available for intraoperative use. This paper presents the first intraoperative images of the facial skeleton using the SIREMOBIL Iso-C3D. METHODS: Cases of a zygomaticomaxillary complex fracture, a mandibular angle fracture and a bimaxillary repositioning osteotomy are described to demonstrate the application possibilities of this system in maxillofacial surgery. RESULTS: In addition to the uncomplicated handling of the SIREMOBIL Iso-C3D, generally important was the low level of metal artefacts in its primary and secondary reconstructions, even in close proximity to the material. However, it has to be kept in mind that while soft tissues are visualized using CBCT, information about soft tissue quality cannot be obtained. CONCLUSION: The SIREMOBIL Iso-C3D generates intraoperative data sets suitable for the visualization of the facial bones after open reduction of fractures.

Adolescent↗
PubMed1988

Evaluation in cats of a new material for cranioplasty: a composite of plaster of Paris and hydroxylapatite.

The materials ordinarily used to reconstruct bone defects in the calvaria and facial bones either are difficult to shape, are partially resorbed by the body, or are likely to become infected if used near a contaminated area such as the frontal sinus. Calcium sulfate hemihydrate (plaster of Paris) has been known for years to have excellent reparative qualities in bone defects, but ordinarily it is quickly resorbed. Consequently, a new material, a composite of a dense form of plaster of Paris and hydroxylapatite, was devised to provide nonabsorbable hydroxylapatite particles for bone to form around and within during the phase of plaster absorption. Two types of this material were evaluated in cranial defects in cats. Each of the plaster of Paris/hydroxylapatite mixtures was placed into a surgically unroofed frontal sinus and into a contralateral parietal trephine hole in a group of 32 cats. Two cats in each group succumbed to anesthesia, leaving two sets of 30 cats. During the entire follow-up period there was only one other death, with no evidence of wound infection, wound dehiscence, implant rejection, or cerebral dysfunction among the survivors. The cats in each group were sacrificed at 1, 2, 3, 5, 7, 8, 9, 10, or 12 months after operation. Following sacrifice, both the frontal and parietal defects were exposed and examined visually, histologically, and with histomorphometric analysis for new bone formation. New bone formation was present as early as 1 month after operation and continued to increase during the 12 months of the study. Based upon these osteogenic qualities, the ease of shaping the composite, and the lack of infection in the frontal sinus region, it is concluded that this substance could be a valuable new material for human cranioplasty.

Animals↗
PubMed1989

Osteoma of the tongue.

Osteomas are benign bony neoplasms commonly found in long bones and in the skull and facial bones. Osseous growths within soft tissue structures of the head and neck are rare. Review of the English literature reveals only 31 cases of osteomas within the soft tissues of the tongue and 2 in the buccal mucosa. We report on a patient with a bony hard asymptomatic mass at the base of the tongue, which was found to be an osteoma by biopsy. Complete removal was declined by the patient. There was no progression during a six-month period of follow-up.

Adult↗
PubMed2001

[A classical form of actinomycoses involving the mouth, face bones, orbit and base of the cranium in an African patient].

Osteitis due to actinomycosis is now an uncommon clinical entity in industrialized countries. This report describes a classic case of imported actinomycosis involving the buccal cavity, facial bones, orbit and skull base. For two years after the onset, various diagnoses followed by different medical as well as surgical treatments were unsuccessfully attempted first in Senegal then in Italy. Proper diagnosis was finally established in Marseille, France, on the basis of histological findings after extensive surgical biopsy. The patient was treated with high-dose intravenous penicillin G for four weeks followed by daily oral administration of amoxicillin for one year. Surgical reconstruction could not be carried out before the patient's return to Senegal. The pitfalls of diagnosis and treatment of actinomycosis are discussed.

Actinomycosis, Cervicofacial↗
PubMed1995

[Craniofacial bone abnormalities in von Recklinghausen neurofibromatosis].

Cases of cranio-facial bone anomalies were observed in 40 cases of neurofibromatosis. The cranio-facial skeletal manifestations are numerous and varied. Radiographic investigation is important to confirm the diagnosis, when neurologic and cutaneous signs are absent. The diagnosis should be easily confirmed by a conventional radiographic study.

Adolescent↗
PubMed1991

The midline craniofacial skeleton in holoprosencephalic fetuses.

Craniofacial skeletal development in eight human holoprosencephalic fetuses from second trimester abortions were examined by radiography and histology. The whole spectrum of associated facial malformations from anophthalmia through cyclopia, ethmocephaly, cebocephaly, and median cleft lip to short philtrum was represented. Cases with the most severe facial malformations also had the most severely affected facial skeleton. In the facial skeleton, the premaxilla was most often affected; it was absent in seven cases and malformed in the one with only a short philtrum. This and other facial skeletal malformations can be explained as abnormal fusion of the facial bones because of defective development of the nasal cartilage. The occipital bones were normal, but the basicranial skeleton anterior to the spheno-occipital junction was affected in all cases. The findings support the hypothesis that the facial malformations in holoprosencephaly result from disturbance in embryonal life of the mesoderm at the rostral end of the notochord.

Facial Bones↗
PubMed2002

Taste and olfactory disturbances after upper and middle third facial fractures: a preliminary study.

To estimate smell and taste after traumatic disturbances, the authors questioned a sample of 92 patients who underwent surgical treatment for upper third and/or middle third facial fractures between January 1, 1988, and May 31, 1996, at the Department of Maxillofacial Surgery, University of Rome "La Sapienza," Italy. A total of 86 patients included in the study had a facial fracture sustained during a motor vehicle accident. Twenty-nine patients reported smell and/or taste after the traumatic disturbance. Of these 29 patients, 8 patients had hyposmia and/or anosmia without taste deficit, 10 patients had taste disturbances without smell loss, and 11 patients noted disturbance in both smell and taste. The authors encountered posttraumatic smell disturbances in 19 patients in their sample. Nasozygomatic-Le Fort fractures, fronto-orbital fractures, and pure Le Fort fractures were found to determine posttraumatic smell disturbances in these 19 patients. Nasal fractures, nasoorbital-ethmoidal fractures, ethmoidal fractures, frontal-Le Fort fractures, and nasal-Le Fort fractures did not determine any olfactory dysfunction. Posttraumatic hypogeusia and ageusia were found in 21 patients and was caused by nasozygomatic-Le Fort fractures, fronto-orbital fractures, and pure Le Fort fractures. The authors did not find any taste deficits after patients sustained other kinds of facial fractures. In the 11 patients observed, disturbances in both smell and taste were noted. Nasozygomatic-Le Fort fracture was the most common in these 11 patients. At 5 years' of follow-up, the results indicate that hypogeusia and hyposmia are connected with the etiology of fracture, the violence of the trauma, and the involvement of specific facial bone regions.

Accidents, Traffic↗
PubMedDate not supplied

[The role of 3D CT in the treatment of maxillofacial malformations].

The computed tomographic studies obtained routinely in the examination of patients with congenital defects of facial bones can be utilized as a substrate to provide an accurate three-dimensional representation of osseous abnormalities. It is a useful tool for the maxillo-facial surgeon in clinical application, in diagnosis, accurate measurements, preoperative planning and post-operative follow-up. The experience of the Division of Maxillo-Facial Surgery of Bellaria Hospital and of the Radiological Department of Instituto Rizzoli at Bologna is presented.

Adolescent↗
PubMed2006

Aggressive basal cell carcinoma with invasion of the parotid gland, facial nerve, and temporal bone.

Aggressive variants of basal cell carcinoma (BCC), such as infiltrating, morpheaform, and basosquamous types, are associated with invasion of underlying tissues and are often difficult to treat.1 BCCs located in embryonic fusion planes, such as the periauricular region, are thought to exhibit deep extension and, subsequently, high recurrence rates, although this theory has been challenged and remains controversial.2-4 Despite the known features of aggressive BCC, parotid gland invasion and temporal bone and facial nerve involvement are rarely reported occurrences. We describe two patients with morpheaform BCC in the periauricular region demonstrating direct invasion of the parotid gland and concomitant facial nerve involvement. These patients require complex surgical management, as highlighted in this report.

Aged↗
PubMed1988

Craniofacial osteosarcomas: plain film, CT, and MR findings in 46 cases.

Forty-six osteosarcomas of the cranial and facial bones were reviewed radiographically by using the conventional parameters for long bone tumors. There were 32 de novo osteosarcomas (11 maxillary, 13 mandibular, and eight cranial) and 14 postradiation osteosarcomas. All the maxillary tumors originated from the alveolar ridge, and the majority of mandibular lesions began in the body of the mandible. The postradiation osteosarcomas occurred in portions of bones at the borders of the radiation field; the latent period ranged from 4 years, 2 months to 50 years (mean, 14 years). The majority of de novo or postradiation craniofacial osteosarcomas were osteolytic with a long transition zone and no periosteal reaction; the exception was in the mandible, where nearly half the cases were osteoblastic and periosteal reaction was occasionally present. Tumor matrix mineralization occurred in more than 75% of the cases, and osteoid matrix calcification was most frequent, even though most tumors were chondroblastic. Soft-tissue extension of tumor was present in all cases and contained calcifications in more than half. Conventional radiographs are of limited value in evaluating head and neck osteosarcomas because of the superimposed bony structures. CT provides excellent detection of tumor calcification, cortical involvement, and, in most instances, soft-tissue and intramedullary extension. MR is even more effective in demonstrating the intramedullary and extraosseous tumor components on both T1- and T2-weighted images. However, CT and plain films are superior to MR in detecting the matrix calcifications and bone destruction or reaction.

Adolescent↗
PubMed1991

A study of facial growth in the sooty mangabey Cercocebus atys.

This study examines the pattern of facial bone growth remodelling in the sooty mangabey (Cercocebus atys) by scanning electron microscopy (SEM) of high-accuracy replicas. The efficacy of the technique is appraised by SEM interpretations of facial remodelling in the crab-eating macaque (Macaca fascicularis) and correlative histological examination. The results indicate that the distribution of depository and resorptive areas in Cercocebus closely parallels that which has been observed in Macaca. It is suggested that the different adult facial morphologies in the sooty mangabey and crab-eating macaque are the result of changes in the rates of remodelling events that may be coupled with different patterns of sutural growth (which could not be studied by SEM).

Animals↗
PubMed1997

Should patients with facial fractures be regarded as high risk for HIV?

OBJECTIVE: To determine the prevalence of HIV seropositivity in patients with facial fractures in Edinburgh, UK. DESIGN: A prospective study of 100 consecutive patients in 1994. SETTING: Department of Maxillofacial Surgery, City Hospital, Edinburgh, UK. SUBJECTS: 100 patients with facial fractures who were willing to participate in the study. MAIN OUTCOME MEASURES: Details of facial fractures. Assessment of risk factors for HIV. The seroprevalence of HIV based on unlinked anonymous testing of saliva. RESULTS: None of the participants were HIV positive on saliva testing. Nine patients were found to have one or more risk factors for HIV. Eight patients had been tested for HIV previously. CONCLUSION: Direct history taking appears to be effective in eliciting risk factors for HIV. A detailed risk factor history should be taken for all patients with facial fractures. Continuation of this study may establish whether or not there is a link between facial bone fractures and HIV seropositivity.

Adolescent↗