Journal of Maxillofacial and Oral Surgery

Retraction of Orbital Soft Tissue During Orbital Surgery: A Technical Note Abstract Introduction Orbital fractures may be either isolated or part of midface fractures. These injuries may cause disruption of the orbital walls and herniation or entrapment of orbital contents resulting in enophthalmos or diplopia. Methods Surgical exploration of the orbit is the definitive mode of management of such injuries. A common problem encountered during such exploration is the prolapse of orbital soft tissues which hamper the visualization of the defects. Conclusion Here, we suggest an adjunct to the orbital retractors in control prolapsing soft tissues.

Long-Term Dislocation of the Mandible: Is there an Algorithm to Success? Intraoperative Decision and Review of Literature Abstract Purpose Long-term TMJ dislocation is a rare condition. It occurs when an acute luxation remains untreated in time. Methods A 52-year-old man presented with a long-term TMJ luxation in the context of Steinert’s disease. A discectomy together with condylectomy and eminectomy was performed, obtaining an adequate reduction of the luxated condyle and disc. Results Twelve months after the operation, the condition has not recurred at all. A stable and centred occlusion was checked; his MIO was over 30 mm. Conclusion The combination of these three techniques could be a good option in cases of Steinert’s myotonia, where the condyle luxation becomes chronic and irreducible due to the altered neuromuscular condition. There is still no consensus regarding the treatment for long-term TMJ dislocations. New and more solid studies may be needed in order to find adequate treatment protocols for this condition.

Intraoperative Image-Guided Retrieval of Foreign Body from Infratemporal Fossa: A Rare Case Report Abstract Entrapped foreign bodies in the head and neck region pose a challenge for surgeons, especially when present in areas like infratemporal space. In this case report, a bomb splinter entered through skin below the right infraorbital rim, traversed the maxillary antrum and got entrapped in the infratemporal fossa of the patient, which was initially localized using preoperative two-dimensional and three-dimensional radiographs. The foreign body was exposed via Alkayat Bramley approach and finally retrieved with the help of intraoperative C-arm fluoroscopy.

Maxillofacial Gossypiboma: Case Report, Review of the Literature, and Diagnosis Algorithm Abstract Gossypiboma is a retained surgical sponge and represents a rare complication with an uncertain incidence probably due to medical–legal implications. It is an iatrogenic condition solely due to human factors. While the medical literature has previously described cases of this entity after orthopedic, abdominal, otorhinolaryngology, and plastic surgery procedures, gossypibomas in oral and maxillofacial region are uncommon. It can mimic neoplasms or other injuries, which may promote a delayed diagnosis; thus, the differential diagnosis should be based on clinical history in each particular case. Although there are no pathognomonic features of gossypiboma in oral and maxillofacial region, the most common symptoms suggestive of persistent inflammation include pain, fever, swelling, surgical wounds that do not heal, and purulent drainage. The aim of this study was to report a maxillofacial gossypiboma misdiagnosed as third molar surgery-related odontogenic infection and a diagnosis algorithm.

A Rare Case of Hyoid Bone Fracture Concomitant with a Comminuted Mandibular Fracture Abstract The hyoid bone fracture secondary to trauma other than strangulation is a rare event, regarding the literature. Hereby, we presented a rare and interesting case of hyoid bone fracture associated with comminuted mandibular fracture following falling-down in a 13-year-old girl. The importance of timely diagnosis and proper treatment plan would be discussed, as well. The maxillofacial surgeon should be aware of the possibility of a hyoid bone fracture in patients who have suffered maxillofacial trauma. Potentially fatal respiratory complications can develop rapidly unless proper care is given to such injuries.

Reconstructing the Nasal Tip After a Human Bite: A Challenge for the Reconstructive Surgeon Abstract Background Human facial bites are uncommon and usually cause a wound that presents major challenges for the reconstructive surgeon. Purpose The purpose of this study is to present the advantages and disadvantages of using a superiorly based interpolated nasolabial flap for reconstruction of a nasal tip defect. Methods We present a case of serious injury of the nasal tip as a result of a human bite. Early maxillofacial surgical intervention resulted in restoration of the facial anatomy and function of the structures involved. Results and Conclusion We present a serious mutilating injury of the tip of the nose in a young patient as a result of a human bite. These injuries can be rather destructive and cause a facial defect which may have a significant adverse psychological impact on the patient. Because of the proximity and the skin colour match of the melolabial fold to the nose, nasolabial flaps are a very attractive and reliable reconstructive choice for nasal tip defects. The relative advantages over other reconstructive options and the limitations of an interpolated superiorly based nasolabial flap are discussed. The elaborated use of a nasolabial peninsular pedicled skin flap may deliver a very satisfactory outcome from a functional and cosmetic point of view.

Single-Skin Paddle Anterolateral Thigh Free Flap with Ileotibial Tract for Internal Lining in Reconstruction of Full-Thickness Cheek Defect

Application of Navigation Surgery in Temporomandibular Joint Ankylosis Case and Review of Literature Abstract The aim of this article is to develop a navigation-guided oral and maxillofacial surgery including surgical planning, simulation and navigation in temporomandibular joint ankylosis case practiced in tertiary care hospital. After getting the computed tomographic angiography of head and neck, the special software of Brain lab® is used to mark the arteries and veins of the patient, which was in close approximation to the mandibular condyle. Brain lab® navigation system was used during the surgery to ascertain the middle meningeal artery location, and osteotomy cut was given. Navigation technology use in the neurosurgery is not new. But its use in the subcontinent in the field of maxillofacial surgery is quite rare. First time, it has been used scientifically in temporomandibular joint ankylosis case. Navigation technology use in the maxillofacial surgery requires a holistic imaginative/creative approach to make the surgeries more predictive and safe.

Integration of Perforator Vessels in CAD/CAM Free Fibula Graft Planning: A Clinical Feasibility Study Abstract Introduction Commercial CAD/CAM planning of free osteocutaneous microvascular fibula flap does not support integration of soft tissue structures including perforator vessel anatomy. Therefore, in a clinical trial, a method for such a combined hard- and soft tissue 3D-fibula planning was assessed. Materials and Methods In a clinical study on 24 patients needing reconstruction with osteocutaneous fibula graft, skin perforators of the respective leg were detected via Doppler sonography and documented on a measurement device. Each of the perforators’ localization was transferred to a CAD/CAM planning software and included in each planning step as well as in the surgical cutting guide. A comparison between sonography and clinical localization, damage to perforator vessels during surgery as well as a subjective evaluation of feasibility and usefulness of the procedure was carried out. Results In total, 19 skin paddles were placed orally, 2 extraorally and 3 at both sites at once. Survival rate was 92% (22/24). In addition, 3 skin paddles were lost complete and 2 partially. Anatomical sites of perforator vessels were never < 1 cm from planned positions and not damaged at all (n = 75). Planning was judged useful for skin paddle design and positioning of osteotomies. In accordance, surgical guides were always implemented successfully without the need of changing planned procedures during surgery. Conclusion Integration of skin perforators into 3D planning of microvascular fibular graft is feasible and may even decrease involuntary dissection of perforator vessels. Even so, clinical studies for comparison are needed.

Evaluation of Changes in the Alar Base Width Following Lefort 1 and AMO with Conventional Alar Cinch Suturing: A Photographic Study of 100 Cases Abstract Objective To assess the changes in alar base width in patients who underwent Lefort 1 osteotomy with anterior maxillary osteotomy (AMO), where conventional alar cinch suturing was done to control the alar base widening. Materials and Methods This study was conducted on pre-operative and post-operative photographs of 100 female patients aged between 18 and 30 years who underwent Lefort 1 osteotomy with AMO. The derived values were then compared and analysed using t test. Results The mean alar base width pre-operatively was 14.11 mm and post-operatively was 15.28 mm. The mean increase in alar base width was 1.176 mm. The result indicated a definitive change between pre-operative and post-operative alar base widths with mean increase in width of 1.176 mm (P = 0.000), which is clinically not very significant. Conclusion The effect of Lefort 1 osteotomy on the alar base can be well controlled by the conventional alar cinch suturing without any additional anchorage on the ANS with predictable results.