Craniomaxillofacial Research & Innovation

Motorcycle crashes in Kenya have increased over the last decade and the most common injuries include the cranio-maxillofacial regions which needs documentation. This article determines the occurrence and pattern of maxillofacial injuries in motorcycle crashes. This was a descriptive, cross-sectional prospective study conducted at two referral hospitals in Nairobi, Kenya. Data were obtained through interview and physical examination of patients. Ninety-one patients were examined, among whom 76 (83.5%) were males and 15(16.5%) females (male—female ratio, 5:1). The age range and modal age were between 3 and 62 years and 21 and 30 years, respectively (mean age = 29 years). The midface was the most common fractured site (38%). Motorcycle-related injuries were most common in males aged 21 to 40 years. Collisions and falls were the most common cause of crashes. The midface was the most common region of facial injury and the injuries were associated with the lack of helmet use.

This report describes the use of a computer-aided planning and intraoperative surgical guide for dental implants placement in the tent pole surgery. The surgical planning was established using DentalSlice program and the surgical guide for intraoperative surgical drilling and dental implants insertion was made by Bioparts. The surgical access was performed with a transcutaneous submental approach and using sequential drilling, suitable perforations and dental implants insertion were performed using the same surgical guide, without complications. The use of the proposed intraoperative surgical guide made from a computer-aided planning can minimize the matter of an improper angulation of dental implants in the tent pole technique, providing more appropriate positioning and angulation of these implants.

Facial trauma is an enormous public health problem with overwhelmingly negative physical and psychological impacts. The authors retrospectively analyzed the incidence, etiology, clinical presentations, and characteristics of facial fractures along with sociodemographic, economic, and cultural factors. They analyzed facial fractures treated from June 2010 to December 2016 at the operative unit. Maxillofacial Adult Surgery Unit, Spedali Civili Brescia, Italy, with particular attention to the associations among age, etiology, fracture site, and clinical management.

In this paper, the authors present two case reports with patients who presented at different institutions for traumatic aneurysmal dilation of temporal vessels. The first case is a 18-year-old male who presented to plastic surgery following attempted excision by an outside provider after a fist fight. The second case is a 22-year-old male who presented to plastic surgery while inpatient after gunshot wound to the face. The differences in the cases are highlighted by the different approaches to the management of the lesions with direct incision and embolization respectively.

ProPlan CMF (Depuy Synthes, Solothurn, Switzerland, and Materialise, Leuven, Belgium) is a computer-aided surgical virtual planning service using an online meeting with professional medical engineers and transfers patient-specific surgical guide to the virtual plan. Moreover, prebent reconstruction plates or patient-specific computer-aided manufacturing-fabricated reconstruction can also be used. This service started in 2011. Currently, it is widely used in Europe. Current status of mandibular reconstruction with ProPlan CMF vertical planning service with the surgical guide was reviewed. The accuracy was excellent in terms of contact of the osteotomized parts and the contact to the remaining skeleton. The authors found that currently, a small number of reports regarding the mandibular reconstruction with virtual planning service and surgical guides are available. These reports also have a small number of cases and short-term follow-up results. In this situation, this review revealed that (1) mainly the resection guides, cutting guides, and patient-specific mandible reconstruction plates were adequately well fitted to the surgical site intraoperatively, (2) the ischemic time might be more reduced than that of the conventional surgery (3) the accuracy of computer-assisted surgery in the mandibular reconstruction was clinically acceptable, and (4) condyle positions after the computer-assisted surgery was mainly normal. The higher additional cost than that of the conventional technique is presently an issue. Large-scale clinical studies and long-term follow-up studies are demanded.

Domestic violence, a grave violation of basic human rights, remains one of the most challenging problems of our society. Though commonly involving the facial region, these injuries are difficult to characterize and treat due to varied and unique presentations. Cases of violent weapon injuries can often be a challenge for the treating surgeon due to nonbiomechanical pattern of the presentation. The purpose of this report is to discuss the presentation and management of a brutal case of domestic violence with a rare “chop” injury pattern caused by an “axe.” Only two previous reports of sharp weapon injury resulting in horizontal fracture of mandible have been found in literature, of which only one was caused by an axe. The important social issue of significance of health care personnel, who are in a unique position and can contribute toward raising the awareness to the plight of silent sufferers of domestic violence for whom home is often the most dangerous place, is also raised.

The temporalis flap is a common flap used in head and neck reconstruction. In this article, the authors present a new modification of the use of the temporalis muscle flap for orbital skull base reconstruction with the use of a sphenoid keyhole. This technique confers multiple advantages in reducing the arc of rotation and providing a tension-free reconstruction of the orbital skull base.

Foreign body migration in the deep spaces of the neck is particularly concerning due to the increased risk of damage to the great vessels and nerves. In addition, migration often cannot be easily predicted as objects may travel outside the confines of anatomic fascial planes. Although patients may be asymptomatic for years prior to presentation, timely removal of foreign bodies is ideal to preclude injury to important vascular and neurological structures as well as to prevent the development of recurrent infections and foreign body reactions. The authors report two cases of removal of migrated foreign bodies that presented at their institution. In one case, they report the use of intraoperative computed tomography (CT) imaging to help locate the position of a migrating dental needle. In another, they report the retrieval of a bullet fragment six months after the initial trauma. The classic method for retrieval of foreign bodies within the craniomaxillofacial complex centered around review of static radiographic imaging and a “blind,” broad exposure of the site in an attempt to localize and retrieve the material. This often resulted in iatrogenic injuries to surrounding structures or migration of the foreign body to a location, which may cause the patient additional harm. The utilization of intraoperative CT technology and computer navigation affords the craniomaxillofacial surgeon an additional tool for retrieval of these foreign bodies, often in a manner that affords minimally invasive surgical approaches, identification of vital structures within the operative field, and decrease in overall operative time for removal. Referral to institutions, which have this technology, should be considered early in the operative care of patients who encounter retained foreign bodies in the craniomaxillofacial region.

Disability is defined as a physical or mental condition that limits a person's movements, senses, or activities. Disability can be congenital or acquired. Modern medicine can only help such an individual with a better lifestyle, but can never cure the condition as a whole. As a result, one is forced to live with it through one's lifetime. Blindness/loss of vision is one such condition which is not only taxing physically but also psychologically especially in a young child. The authors present one such case of complete globe avulsion in maxillofacial trauma due to road traffic accident in a 13-year-old young boy. This case report discusses in detail about the etiology, biomechanics associated with orbital fractures, anophthalmic surgeries, and the various implantation options. The authors would also like to stress the importance of decision making regarding preservation of the globe or enucleation in an emergency situation such as this one, where the patient reports with a “popped out” eyeball. An ophthalmologist along with an oral and maxillofacial surgeon plays a significant role in primary management, restoration, and replacement influencing the final treatment outcome.

There are multiple etiologies for facial subcutaneous emphysema, including facial trauma, dissection of air along facial planes from a pneumomediastinum, infection, and entry of air through defects in teeth due to decay, trauma, or dental procedure. In addition, air can be forced through lacerations of the oral or pharyngeal mucosa by increased intraoral pressure. An infrequently reported cause of subcutaneous emphysema is autoinsufflation of the parotid duct with extravasation of air into the surrounding tissue. In this report, the authors present a 14-year-old patient treated at the Department of Oral and Maxillofacial Surgery of the Hospital Escuela Universitario due to an increase in size in the buccal region and left masseterine space of 2 months of evolution. Presenting with a sudden evolution, without any possible explanation, which caused displacement of adjacent structures without damage to the bone or surrounding tissues. After a series of echographic and tomographic studies, it showed that inside the submandibular gland there was a hypodense image with gas density (-1100 UH) expanding the gland and its respective excretory duct.

We present a case of a 69-year-old woman with multiple complicating comorbidities who developed medication-related osteonecrosis of the jaw secondary to extraction of multiple teeth with a history of intravenous bisphosphonate therapy for metastatic breast cancer requiring staged management with segmental mandibulectomy with placement of external pin fixator with subsequent exchange of this device for a titanium reconstruction plate and a submental island pedicled flap for soft tissue coverage of the bridging reconstruction plate. Once the surgical sites were well-healed that patient would immediately return to a satisfactory functional outcome with ability to tolerate a soft diet. Furthermore, the patient did not have complications (ie, cardiac, pulmonary, venous thromboembolism, sepsis, surgical site infection, reoperation) during her hospitalization and has done well with her long-term recovery.

Isolated zygomatic arch fractures are common fractures of the facial skeleton. Dislocation may result in facial disharmony and/or restricted mouth opening if not treated properly. Different methods of minimally invasive treatment of depressed fractures of the zygomatic arch have been described. Most of them are based on either a direct percutaneous approach with a malar hook, a temporal approach according to Gillies, or transorally according to Keen. For these methods, general anesthesia is often preferred. In this technical note, an alternative method of a percutaneous approach for reduction of a zygomatic arch fracture under local anesthesia is presented.

Myositis Ossificans Traumatica (MOT) is a rare condition that affects soft tissues after a trauma and hardly affects the mastication muscles. The occurrence in the temporal muscle is uncommon, and trismus is the most prevalent symptom. The diagnosis of the pathology is sufficiently obtained through the collection of clinical history, physical and imaging exams. Differential diagnosis is important mainly to rule out more aggressive diseases, such as osteosarcoma. Treatment becomes more invasive as the ossification matures, and resection of structures adjacent to the tumor, such as coronoidectomy, is well indicated for promoting good results on the mouth opening amplitude. However, to maintain this amplitude, aggressive myofunctional therapy is required. Nevertheless, the literature has no well-defined protocol for this physiotherapy. Therefore, this article reports a rare case of MOT in the temporal muscle that was treated conservatively, with bilateral coronoidectomy and mouth opening physiotherapy, and obtained a satisfactory result. Consequently, it also presents a suggestion of a postoperative physiotherapy protocol.

Osteopetrosis is a disorder characterized by an increase in bone density and a reduction in spinal cord spaces. This change results in a defect in osteoclast function and consequent decrease in bone turnover. One of the possible local bone complications is osteomyelitis, which affects up to 10% of patients with this disorder. Platelet concentrates (L-PRF) have been used in cases of bone defects and areas of tissue necrosis, as it has the characteristic of releasing growth factors after activation. The aim of this paper is to present a clinical case of a patient with mandibular osteopetrosis, who underwent dental implantation and subsequent recurrent osteomyelitis and was treated by partial resection associated with L-PRF bone defect coverage. After 1 year of follow-up, the patient presented definitive soft tissue healing, no exposure of bone tissue or phlogistic signs at the site, and good bone repair on computed tomography scan. The present study demonstrated that the association of L-PRF with resection techniques can be a viable method for the management of patients with difficult to treat osteomyelitis, especially in cases of mandibular osteopetrosis.

Le Fort fractures in pediatric patients are rare, and their management has increased complexity due to the development of the maxillofacial musculoskeletal complex and dentition. The authors present a case using historic circum-zygomatic wiring with 21st century surgical planning in a 18 month old, who sustained complex Le Fort II and III fractures. Treatment involved surgical planning with dental and stereolithographic models, and the fabrication of a retention modified, occlusal splint. Closed reduction with circum-zygomatic wiring retained by the occlusal splint, for a 3 week period, prior to removal. At 12 month review, the patient had good facial symmetry, cosmesis, profile, and function. The use of circum-zygomatic wiring provided a conservative operative approach, achieving excellent functional and cosmetic results without the potential morbidity of more invasive surgery.

The treatment of mandibular condylar fractures is a controversial topic in maxillofacial surgery. Open surgery with anatomic reduction and internal rigid fixation is well established in the literature and appears to be the most common approach. Nonsurgical therapies are indicated to intracapsular fractures, medial condylar displacement, and pediatric trauma. The high capacity of tissue remodeling and articular adaptation are important factors to support nonsurgical treatment in pediatric patients. The purpose of this article is to present a case of a pediatric mandibular bilateral condylar fracture treated with closed reduction with 10 years of follow-up and a discussion based on the literature.