Category: Nevin Manimala

J Craniofac Surg. 2022 Jul-Aug 01;33(5):1458-1461. doi: 10.1097/SCS.0000000000008335. Epub 2021 Oct 27.

ABSTRACT

INTRODUCTION: Prominent ear is 1 of the most common congenital deformities of the ear. Incidence is reported as approximately 5%. This deformity can classically be the result of antihelix insufficiency, overprojection of concha or combination of both. Less frequently, folded or overprojectile ear lobule can aggravate the deformity. Surgical techniques can be aimed at concha, antihelix formation, lobule positioning. In our study, postoperative results for the combination of suture otoplasty and perichondrioadipodermal flap techniques in prominent ear surgery is discussed in light of the recent literature.

METHODS: Forty-nine patients that were operated for prominent ear deformity in our clinic between 2010 and 2015 were evaluated. Anatomic structures that cause the anomaly was analyzed by photographing concha-scaphoid angle, antithetical fold absence or presence, position of the ear lobule, conchal depth, size of the auricula, and positioning Frankfort Plane parallel to the ground. The patients were photographed preoperatively, at postoperative first week and postoperative sixth month, respectively. Comparison of age, surgical technique, surgical complications, necessity for revision surgery, additional procedures, follow up time, preoperative, and postoperative helix-mastoid bone distance were evaluated.

RESULTS: Forty-nine patients have been evaluated. Thirty-one of these patients were female, whereas 18 were male. Age of these patients ranged between 6 and 37. Operations were performed in 47 right side ears, and 44 left side ears (97% bilateral and 7% unilateral otoplasty). Preoperative helix-mastoid bone distance ranged between 21 and 33 mm (mean 26.77), whereas postoperative helix-mastoid bone distance was measured between 12 and 22 mm (mean 16.26). Compared to the preoperative values, helix-mastoid distance difference was statistically significant (P < 0.05).

CONCLUSIONS: Asymmetry and recurrence are the most common late complications of prominent ear surgeries. Perichondrioadipodermal flap can be safely added to the combined surgical techniques protecting the cartilage support, therefore, reducing complication rates, with satisfying results.

PMID:36041141 | DOI:10.1097/SCS.0000000000008335

J Craniofac Surg. 2022 Jul-Aug 01;33(5):1599-1602. doi: 10.1097/SCS.0000000000008229. Epub 2021 Oct 12.

ABSTRACT

OBJECTIVE: Due to being the weakest sutural junction of the crania and relations with intracranial anatomical structures, the accurate location of the pterion is important for surgical approaches such as in pterional craniotomy. The aim of the study was to develop regression equations to estimate the person-specific accurate location of the pterion based on the cranial morphometry.

MATERIALS AND METHODS: The study was conducted on 22 pterions located 11 dry skulls belonging to Anatomy Department of the Harran University, Medical Faculty. Twelve parameters related to pterion and 23 parameters related to the skull was measured using ImageJ software. SPSS 20.0 was performed for statistical analyses such as descriptive and comparative statistics and developing regression equations.

RESULTS: Statistically significant difference wasn’t observed between right and left sides. The 12 equations, such as P8:distance between pterion and the tip of the mastoid process= 63,780 + (1,366 × K6) – (2,786 × K7) + (1,342 × K11) – (1,029 × K13) + (2,102 × K14) – (1,710 × K15) – (0,517 × 22) Adjusted R2= 0.995 and Standard Errors = 1.221 were developed to estimate the accurate location of the pterion based on the cranial morphometry.

CONCLUSIONS: In the previous studies, the mean distances of the pterion to certain landmarks on the crania were given. The authors developed formulas in order to estimate the accurate person-specific location of the pterion. The authors are convinced that the equations they have developed will help neurosurgeons in terms of surgical approaches.

PMID:36041125 | DOI:10.1097/SCS.0000000000008229

J Craniofac Surg. 2022 Jun 1;33(4):1182-1184. doi: 10.1097/SCS.0000000000008468.

ABSTRACT

The aim of this study was to understand the impact of the COVID-19 pandemic on the epidemiology of maxillofacial trauma in a regional trauma center in L’Aquila, Abruzzo, Italy, during the first wave of the pandemic and comparted it to an equivalent period from 2015 to 2018. The authorshave retrospectively analyzed personal data, site of trauma, etiology, and mechanism of injury. Statistical analysis has been carried out utilizing IBM SPSS Statistics software (IBM Corp., Armonk, NY) and significance was accepted for P values of <0.05. From January 2015 to December 2020, a total of 296 were analyzed. In Pre-COVID era, 195 patients were evaluated, 130 males (66.6%) and 65 females (33.4%). Zygomatic-malar complex fractures were the most common site of trauma in both genders (53%), followed by mandibular fractures (23%) and orbital ones (15%). The highest incidences of injuries were recorded between 15 and 34 years (21%) with the most common etiology attributed to road accidents traumas (49%). In COVID19 era, the authors recorded 101 traumas, 58 males (57.4%), 43 females (42.6%). Zygomatic-malar complex fractures were confirmed as the most common ones in both genders (41%). The most common etiology was related to casual domestic accident and assaults (37% and 30%, respectively). There was no statistically significant difference in terms of incidence in the comparison of Pre-COVID19 and COVID19 periods (P > 0.05) as opposed to the etiology in which the road traffic accidents decreased in favor of domestic accidents and interpersonal assaults (P < 0.05). Our scientific study represents the first epidemiologic study related to the impact of COVID-19 on maxillo-facial trauma in the Province of L’Aquila, Abruzzo, Italy. A decrease in the number of Maxillofacial injuries related to road traffic accidents can be demonstrated as the benefit of lockdown, however, a significant increase in the number of physical assaults shows how isolation and restrictions have had a highly negative psychological impact on society.

PMID:36041111 | DOI:10.1097/SCS.0000000000008468

J Craniofac Surg. 2022 Jun 1;33(4):1166-1169. doi: 10.1097/SCS.0000000000008444. Epub 2021 Dec 16.

ABSTRACT

BACKGROUND: Maxillofacial fractures require stable fixation for uneventful bony healing and optimal remodeling. Conventional titanium plates considered the gold standard of rigid internal fixation for many years, however due to the inherent drawbacks associated with metal devices biodegradable plates have been developed.

AIM OF THE STUDY: To evaluate the efficacy of biodegradable plates as a treatment modality of rigid internal fixation for facial fractures and to assess the perioperative complications experienced with their utilization.

PATIENTS AND METHODS: This prospective clinical study included 10 Iraqi patients, met the eligibility criteria and subjected to open reduction and internal fixation with biodegradable plates system. The data were analyzed according to the age, gender, etiology of the fracture, fracture site, surgical approach, plate application time, fracture reduction, screw holes ossification, and patient’s satisfaction. The patients were radiographically followed up with either computed tomography or CBCT at 3, 24, and 48 weeks with regular follow up intervals. The statistical analysis was performed using percentages, the mean ± standard deviation, Shapiro-Wilk test and Mann-Whitney U test.

RESULTS: The age of patients ranged from 9 to 65 years with an average of 26.1 years and a standard deviation of ± 12.9. Regarding gender, males showed a higher percentage than female (80% versus 20%), respectively. There was a significant difference between the mean time of plate application in midface and mandible (53 versus 32.9 minutes), respectively. All cases end up with complete screw holes ossification.

CONCLUSIONS: This study demonstrated that biodegradable plating system was a sensitive procedure and greatly depended upon surgeon’s experience and improvement of the learning curve.

PMID:36041110 | DOI:10.1097/SCS.0000000000008444

J Craniofac Surg. 2022 Jun 1;33(4):1108-1110. doi: 10.1097/SCS.0000000000008076. Epub 2021 Aug 10.

ABSTRACT

One of the methods applied to ensure the long-term continuity of the desired result in rhinoplasty is to detect it by placing columellar strut between the medial crus. Columellar strut helps to increase tip support and projection. However, the placement of the strut between the medial crus can disrupt the divergence angle and prevent the tip rotation to be at the desired level due to the interaction of the septum with the caudal. in this study, the data obtained by fixing the columellar strut to the lateral faces of the medial crus are shared. in 51 primary rhinoplasty patients who underwent open rhinoplasty, the medial crus was dissected and released. The distance between the footplates and the new domes was measured and the length of the columellar struts was determined. Grafts obtained from cartilage septum were shaped. After symmetry was achieved between the medial crus, the prepared grafts were fixed to the lateral face of the medial crus. Preoperative and postoperative 12th month images were transferred to computer- aided program and nasolabial angles were measured. The obtained data were transferred to SPSS 22.0 (IBM Corp., Armonk, New York, USA) program and statistical comparisons were made. Fifty one patients were included in the study. Thirty eight of the patients were female and 13 were male. The mean age of the patients included in the study was 29.2 years. The mean preoperative nasolabial angle was 90.2 degrees postoperatively, and the average nasolabial angle was 104.2 degrees at 6 months. A statistically significant difference was found between preoperative and postoperative measurements (P < 0.05). Lateral columellar strut is an effective and reliable and novel method for increasing the stability of medial crus, maintaining tip support in postoperative period and increasing tip rotation.

PMID:36041106 | DOI:10.1097/SCS.0000000000008076

J Craniofac Surg. 2022 Jun 1;33(4):1147-1149. doi: 10.1097/SCS.0000000000008314. Epub 2021 Oct 27.

ABSTRACT

PURPOSE: To determine factors influencing postoperative enophthalmos after reconstruction of orbital wall fracture.

METHOD: Data of consecutive patients who were diagnosed with unilateral medial or inferior orbital wall fracture from March 2013 to February 2020 were retrospectively reviewed. Forty-three patients were included in this study (24 with medial orbital wall fracture and 19 with inferior orbital wall fracture). Their medical records including Hertel exophthalmometry, preoperative computed tomography (CT) scan, and postoperative CT scan were reviewed. The degree of enophthalmos developed was calculated by measuring exophthalmos before surgery and at 6 months after surgery. Patients were classified into 2 groups depending on whether reduction was good after surgery or not. Data (eg, age, gender, onset, fracture size, and so on) were then compared between these 2 groups.

RESULTS: A total of 43 patients were included in the study. Their mean age was 40.1 years. There were 34 (79.1%) males. The mean onset from trauma to surgery was 8.1 days. Insufficient soft tissue reduction was found in 9 patients through postoperative CT scan. Preoperative mean enophthalmos was – 1.70 mm. Postoperative mean enophthalmos was -0.45 mm after 6 months. The mean fracture size was 213.74 mm2. There was no statistically significant difference in enophthalmos at 6 months after surgery regardless whether the reduction was good or not. Enophthalmos at 6 months after surgery was associated with preoperative fracture size and onset.

CONCLUSIONS: Postoperative enophthalmos development might be associated with preoperative fracture size and onset. Delayed operation in case of large orbital wall fracture might lead to undesired result. Thus, surgeons should keep that in mind.

PMID:36041108 | DOI:10.1097/SCS.0000000000008314

J Craniofac Surg. 2022 Jun 1;33(4):1057-1062. doi: 10.1097/SCS.0000000000008440. Epub 2021 Dec 16.

ABSTRACT

The purpose of this prospective multicenter study was to analyze the epidemiology, patterns, and management of maxillofacial fractures due to road traffic accidents (RTAs) worldwide.Between Monday September 30, 2019 and Sunday October 4, 2020,1066 patients with RTAs related fractures were admitted to 14 maxillofacial surgery departments. The following data were analyzed: age, gender, mechanism of injury, alcohol or drug abuse at the time of trauma, maxillofacial fracture site, facial injury severity scale (FISS) score, associated injuries, day and month of trauma, time of treatment, type of treatment and length of hospital stay. Data were analyzed using bivaried and multivaried statistical analysis.Eight hundred seventy patients were male, and 196 were female. The most common mechanism of injury was motorcycle accidents (48%). More than half of the patients had fractures of the middle third of the maxillofacial skeleton. In total, 59% of the study sample underwent open reduction internal fixation. The median facial injury severity scale (3 points) and the medial hospital stay (3 days) were significantly lower in patients with seatbelts and helmet (P < 0.001).This first prospective, multicenter epidemiological study shows that motorcycle accidents are the leading cause of RTAs related fractures, mostly in young males. Particularly in Australia and Europe, the incidence of RTAs was significantly lower. Moreover, this study found that the severity of maxillofacial lesions was significantly higher in patients without safety devices, with consequent longer hospital stay demonstrating the efficacy of road safety policies in preventing maxillofacial injury.

PMID:36041104 | DOI:10.1097/SCS.0000000000008440

J Craniofac Surg. 2022 Jun 1;33(4):e398-e401. doi: 10.1097/SCS.0000000000008256. Epub 2021 Oct 12.

ABSTRACT

OBJECTIVE: To evaluate whether the maxillary complex would be sagittally, vertically, or mutually displaced after the transverse maxillary correction by surgically assisted rapid maxillary expansion and how the facial profile would be affected.

MATERIALS AND METHODS: The sample comprised 28 adult patients (mean age 25.8 [age range 19-39 years]; 50% women) with transverse maxillary deficiency greater than 7 mm who underwent the surgical rapid maxillary expansion. Cephalometric analysis (n = 112), intra- and extra-oral registries, and radiographic records were taken before treatment (T1), right after the end of the expansion (T2), 4 months after the expansion (T3), and 10 months after the end of the expansion (T4). Dental and skeletal cephalometric measurements were evaluated at each time-point, whereas soft tissue cephalometric analyses were determined at 2 time points (T1 and T4).

RESULTS: The results indicated that no sagittal, vertical, skeletal, or soft tissue variation was found after the surgical expansion. However, statistically significant dental changes (P < 0.05) were observed in dental angles (1.NA/1.SN/1.PoOR/1.PP) throughout the different time-points. The authors found statistically relevant posterior inclination of the incisors from T2 to T3 based on multiple comparisons.

CONCLUSIONS: Surgically assisted rapid maxillary expansion does not promote anterior and vertical displacement of the maxilla. Notwithstanding, the surgical intervention causes upper incisor palatal inclination.

PMID:36041096 | DOI:10.1097/SCS.0000000000008256

J Craniofac Surg. 2022 Jun 1;33(4):e382-e384. doi: 10.1097/SCS.0000000000008210. Epub 2021 Sep 21.

ABSTRACT

Facial trauma is now considered an epidemic due to its high incidence. This type of injury represents an impact on the social, psychological and professional life of the victim. It may be associated with poor protection and exposure of this region of the body, as well as with the attempt to disfigure the face of victims of aggression, to affect their identity and self-image. This study aims to carry out an epidemiological survey on the profile of facial trauma related to violence at the First Aid Hospital of Porto Alegre from November 2015 to July 2016. In this retrospective descriptive cross-sectional study, data such as age and sex of the patient, type of trauma, anatomical region, etiology, and reasons for the aggression of patients’ records were analyzed using the Chi-Square test in Paws Statistics 18 software, evaluating P < 0.05. During the period evaluated, 1224 cases were recorded. The most prevalent sex was male. The age group with the most injuries varied from 21 to 40. The most affected type of lesion was soft tissue injury. Scalp regions (parietal, occipital, temporal) and multiple regions were the most affected in males, differing from females, where the frontal and nasal regions were the most predominant. Violence is a major risk factor for facial trauma in adult patients and it is from epidemiological studies like this that we have the possibility to know the magnitude and severity of the results of violence, allowing the definition of public policies for coping.

PMID:36041094 | DOI:10.1097/SCS.0000000000008210

J Craniofac Surg. 2022 Jun 1;33(4):e376-e382. doi: 10.1097/SCS.0000000000008174. Epub 2021 Oct 26.

ABSTRACT

OBJECTIVE: To evaluate the accuracy of intentional change of the frontal ramal inclination (FRI) from virtual to actual orthognathic surgery.

MATERIALS AND METHODS: A total of 16 patients who underwent orthognathic surgery for correction of facial asymmetry and took cone-beam computed tomography 2 to 3 weeks before surgery (T0) and 3 days after surgery (T1A) were selected. After reorientation of cone-beam computed tomography, the digital imaging and communications in medicine data was converted to StereoLithography format for the merging with dental cast scan using R2GATE software (MegaGen Implant, Daegu, Republic of Korea). During virtual surgery using Geomagic Freeform Plus software (3D Systems, Rock Hill, SC), bilateral FRI discrepancy was corrected (T1V) and 3D-printed surgical wafers and customized metal plates were manufactured using 3D printer (Meg-printer II, MegaGen Implant, Daegu, Republic of Korea) and computer numerical control milling machine (ARDEN, TPS Korea Ltd., Gwangju, Republic of Korea) accordingly. During surgery, FRI correction was done using surgical guide and customized plates. The difference between preoperative and virtually corrected FRI (Δ T1V – T0) and the difference between preoperative and actually surgically corrected FRI (Δ T1A – T0) were measured, and the achieved FRI correction in percentage ([Δ T1A – T0]/[Δ T1V – T0] × 100) was calculated.

RESULTS: The mean absolute value of virtual FRI correction (Δ T1V – T0) and actual FRI correction (Δ T1A – T0) were 3.0° and 2.9°, respectively (n = 32). In the increased (medial rotation) FRI group, mean virtual and actual correction amount were 3.2° and 2.8° (n = 17), whereas in the decreased (lateral rotation) group, mean virtual and actual correction amount were -2.7° and -3.1°, respectively (n = 15). No statistically significant difference between virtual and actual measurements were present in either group. The mean achievement rate was 102.8%. Tendency of undercorrection (91.2%) in the increased FRI group and overcorrection (116.0%) in the decreased FRI group were noted.

DISCUSSION: With virtual planning and computer-aided design and computer-aided manufacturing-made customized plates, it is possible to correct FRI during orthognathic surgery of patients with facial asymmetry.

PMID:36041093 | DOI:10.1097/SCS.0000000000008174