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Four male monkeys were utilized to determine whether alveolar dehiscences of fenestrations could be produced by facial tipping of mandibular incisor teeth. Two experimental teeth and two controls were chosen in each monkey. The experimental incisors were moved facially from 2.1 to 5.0 mm over a period of 36 to 95 days. Following movement, the teeth were placed in retention and the monkeys were sacrificed at 0, 30, 60, and 120 days. Clinical measurements were made prior or orthodontic movement by laying a mucoperiosteal flap and measuring the height of the alveolar crest. Measurements were also taken at the time of sacrifice and experimental and control tooth in each animal was used for histological examination. The results were as follows: 1. There was no significant difference in bone loss between the control and experimental teeth. 2. No dehiscences or fenestrations developed with the facial movement of the experimental teeth.
The classic facial fracture patterns have gradually been changing toward more severe comminutions. This necessitates an early and accurate anatomical reduction and a fixation in this position until the fragments have united. Stable fixation favors early mineralization in the fracture gap. The mechanical function of the implants is thus only needed for a short term. Similar considerations are true for the incorporation of grafts. Mechanics of fixation of facial bones is influenced by the structural properties as well.
Selected facial bone locations were impacted to simulate clinical trauma conditions. Locations selected included the nose, zygoma, mandible, maxilla, and frontal bone. The experiment clearly delineate tolerance bands for the facial bones for both sexes. These data should permit the improved design of injury producing structures.
Bone infarction in the sickle cell syndromes (sickle cell anemia, sickle beta thalassemia, and sickle C disease) is common in the long bones, but the facial bones, particularly the orbits, are infrequently involved. In a review of the literature, only 13 cases of facial bone infarcts in sickle cell syndromes were found. Seven episodes of facial bone infarcts--four orbital, two mandibular, and one in the zygomatic arch--in six patients encountered at the authors' institution are reported. Five patients had hemoglobin SS, and one had hemoglobin SC. Bone marrow scans were positive for infarction in five of the six episodes during which they were obtained, which highlights the usefulness of this technique in the diagnosis of facial bone infarction.
Some features of facial anatomy have been identified on 99mTc polyphosphate bone scans by a comparison of scans, radiographs, and photographs. 99mTc polyphosphate bone scans are used clinically to show bone injury and increased osteoblastic activity; the primary use is to identify malignancy and other diseases involving bone. A knowledge of normal anatomy is of the utmost importance in the accurate interpretation of bone scans of the face.
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Facial trauma is frequent and mainly caused by motor vehicle accidents. Due to this main etiologic factor, trauma to the facial skeleton is often associated with serious injuries, commonly involving the brain, chest or abdomen. As a consequence, the initial clinical management of these patients includes control of hemorrhage and immediate assessment of life-threatening injuries, including the maintenance of the airways. Patients presenting with facial trauma are initially evaluated with a systematic clinical examination because many fractures can be accurately diagnosed by inspection and palpation alone. In these cases plain film radiographs serve only for confirmation and documentation of the diagnosis. In many other cases accompanying and extensive soft tissue swelling may clinically obscure fractures. A complete and accurate evaluation of these patients requires additional radiological imaging methods. A series of plain films may be generally sufficient but in most of the cases they can be regarded as initial screening methods for more thorough diagnosis with computed tomography (CT). In trauma patients CT is the imaging method of choice because it shows more fracture lines and displaced fragments than any other imaging modality. CT delineates soft tissue and bony structures and can localize and even characterize foreign bodies. A complete and accurate characterization of the fracture type and potentially associated complications in mandatory for the appropriate treatment and can only be achieved by careful radiological (CT) evaluation.
Facial bone wound healing has practical importance not only in acute fracture repair, but also in head and neck surgery. Fundamental principles of fracture fixation are now understood, and the benefit of acute bone grafting has emerged. In the future, bone healing may be augmented with growth factors and implants incorporating cells grown in tissue culture.
Twenty-three cases of endoscopically assisted facial bone surgery were performed over the past 3 years. Our series is consistent with 16 cases of aesthetic contouring surgery and 12 treatments of facial bone fracture, including three cases for recontouring of frontal bone, three cases for recontouring of zygoma, endoscopically assisted correction of three zygomatic and blowout fractures, four cases for rhinoplasty and septoplasty for deviated nose, and three cases for mandible contouring surgery. To accomplish this technique, a rigid 4-mm, 30-degree down-angled endoscope was used. The frontal bone or zygomatic arch was approached endoscopically through two or three small incisions on the frontal or temporoparietal scalp. All endoscopic instruments were then manipulated through these incisions. The approach for endoscopically assisted rhinoplasty is the same as with standard rhinoplasty procedures. The approach for zygoma complex and maxillary sinus needs an intraoral incision. Recontouring of zygoma, mandible, and nasal dorsum by an air-driven burr and rasp was performed with endoscopic visual assistance. A plate and screw fixation for zygomatic arch fracture requires an additional small skin incision over the plate for the trocar method. The duration of follow-up ranged from 6 months to 30 months. The postoperative course was satisfactory with a few complications. The extra time needed for the endoscopic procedures was less than 1 hour. Endoscopically assisted facial bone surgery can be performed with adequate visualization and direct manipulation of all facial bones. Complications usually associated with extensive incisions in the bicoronal approach may be avoided. Poor visualization in the conventional approach for operation of orbit, nose, maxillae, and mandible may be avoided by use of the endoscope. This technique may prove to be ideal for aesthetic surgery for facial skeleton with smaller scar and less morbidity.
Giant cell granuloma of the facial bones is a benign, reparative metabolic lesion that usually presents as a painful, expansile mass of the mandible. However, 1 of our patients had the extremely rare findings of multiple other facial bone involvement. In this series of 3 patients followed for > 6 years, the combination of biopsy and clinical presentation provided a stereotypical pattern that enabled an accurate diagnosis in all cases. Our patients were treated successfully with aggressive, but not radical, therapy, excisional curettage, and cauterization of remaining bone. Satisfactory reconstruction and stabilization of the mandible and maxilla were achieved with split rib grafts. The rib graft reconstruction and new bone formation provided excellent contour at 6 years in our adult patients and resulted in normal mandibular growth in the child we treated and followed for 12 years.
In the quest for a material other than autograft and homograft bone for use in facial augmentation and replacement, materials scientists have developed numerous inert materials, some of which have a porous structure allowing scar tissue ingrowth to aid in stabilization of the implant. This study investigates a bioactive, nonporous, transparent glass (Bioglass) in a dog model for use in facial bone augmentation. In 18 dogs studied in three groups at 1, 3, and 6 months, Bioglass implants developed a bond to bone or soft tissue in 54 of 72 instances (75% of the time). Poor bonding of mobile chin implants and the loss of three implants due to infection accounted for all but three of the 18 failures. Histologic evaluation revealed no untoward tissue response. Because of the tissue bonding ability and amenability to contouring with a diamond bur at the time of surgery, Bioglass is promising as a graft material for facial bone augmentation.
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We analyse the details of patients with facial bone fractures who visited us from 1993 to 1997, and compare past cases treated from 1978 to 1992. From 1993 to 1997, the total numbers of patients and fractures were 633 and 697, respectively. Thus, we had 127 patients and 139 fractures annually. The number of patients has increased over the years. The highest occurrence rate of facial bone fracture was in the nasal bone (half of all), followed by the malar bone, blowout fractures and the mandibular bone. The rate was the lowest in the maxillary bone. The ratio of males to females was 7:3. Facial bone fractures were most often seen in the 10-29 age group.
Six hundred and seventy-four cases of facial bone fracture in the past 10 years were studied with respect to age and sex, region, cause, classification, and treatment at our clinic. About half of the cases of the single fractures of nasal bones were caused by sports and fights. Of the other cases of facial bone fracture, about 40% were caused by traffic accidents. Reduction of facial bone fracture should be performed as soon as possible from a functional as well as cosmetic point of view. Hence precise diagnosis and refined techniques of repairing are mandatory to avoid postoperative complications.