Reconstruction of infra orbital rim with rib cartilage

Maxillo Mandibular injuries are most common through road traffic accident. The defects and deformities are usually prominent in case of facial injuries. The ultimate aim of recontouring and reconstruction of the facial defect is to achieve the maximum functional as well as esthetic part of the face. Here we present a case of fracture in to multiple fragment of the infra orbital rim, reconstructed with rib graft.

Autogenic Rib Graft for Atlantoaxial and Occipitocervical Fixation in Pediatric Patients

STUDY DESIGN: Retrospective case series. PURPOSE: To evaluate surgical outcomes and effectiveness of an autogenic rib graft for upper cervical fixation in pediatric patients. OVERVIEW OF LITERATURE: Autogenic bone grafts have long been considered the ‘gold standard’ bone source for posterior cervical fusion in pediatric patients. However, there are some unsolved problems associated with donor-site morbidity and amount of bone grafting. METHODS: We studied five consecutive pediatric patients who underwent atlantoaxial fixation or occipitocervical fixation (OCF) using an autogenic rib graft with at least 2 years of follow-up (mean age, 9.8 years; mean follow-up period, 73.0 months). Two patients underwent OCF without screw-rod constructs and three patients with screw-rod constructs. Autogenic rib grafts were used in all patients. We evaluated the surgical outcomes including radiographic parameter, bony union, and perioperative complications. RESULTS: The atlantoaxial interval (ADI) was corrected from 11.6 to 6.0 mm, and the C1–2 angle was corrected −14.8° to 7.8°. The C2–7 angle was reduced from 31° to 9° spontaneously. Two patients with OCF required revision surgery due to loss of correction. Patients did not experience any complication associated with the donor sites (rib bone grafts). Six months postoperation X-rays clearly showed regeneration of the rib at the donor sites. Bony fusion was achieved in all patients; however, bony fusion occurred more slowly in patients without screw-rod constructs compared with patients with screw-rod constructs. Bone regeneration of the rib was observed in all patients with no complications at the donor site. CONCLUSIONS: Autogenic rib grafts have advantages of potential bone regeneration, high fusion rate, and low donor-site morbidity. In addition, a screw-rod construct provides better bony fusion in pediatric patients with OCF and atlantoaxial fixation.

Variation in the repair of a rib graft used for mandibular reconstruction after 20 years / Variación en la reparación de un injerto costal utilizado para reconstrucción mandibular después de 20 años

Mandibular reconstruction has been used in the last 100 years as a safe, effective and stable technique. Various types of grafts have been used, including the autogenous rib graft; the normal repair of this type of graft has been defined in some studies although some observations have been made indicating low predictability of the growth of this bone. The aim of this study was to report the case of a patient with a rib graft for mandibular reconstruction where after 20 years cartilaginous tissue was observed exclusively in the absence of bone tissue. A 61-year-old female patient presented in the Oral and Maxillofacial Surgery Service for dental implants. The patient had a history of 4 previous mandibular reconstructions; imaging showed no alterations to the normal evolution of a graft. However, the intraoral access contained softer tissue than the normal bone, and thus the implant installation was abandoned. Histopathological analysis revealed the formation of collagenous tissue and cartilage, chondrocytes island conditions characteristic of cartilaginous tissue in the absence of mineralization and cancellous bone. This led to the conclusion that repair conditions can vary based on specific and general factors as yet under discussion.

La reconstrucción mandibular ha sido utilizada en los últimos 100 años como una técnica segura, eficaz y estable. Diversos tipos de injertos se han utilizado siendo el auto trasplante de hueso costal uno de ellos; la normal reparación de este tipo de injertos ha sido definida en algunas investigaciones aunque se han realizado otras observaciones indicando baja predictibilidad del crecimiento de este hueso; el objetivo de esta investigación es reportar un caso de una paciente portadora de injerto costal para reconstrucción de mandíbula donde después de 20 años se observó exclusivamente tejido cartilaginoso en ausencia de tejido óseo. Una paciente del sexo femenino, 61 años se presentó al Servicio de Cirugía Oral y Maxilofacial para ser tratada con implantes dentales; la paciente presentaba historia de 4 reconstrucciones mandibulares previas; los estudios de imagen se presentaban sin alteraciones a la condición normal de la evolución. Sin embargo, al acceso intraoral se observó un tejido más blando que el hueso normal, abortándose la instalación del implante. El análisis histopatológico reveló la formación de tejido colágeno y cartílago, condrocitos en lagunas y condiciones características de tejido cartilaginoso en ausencia de mineralización y trabeculado óseo.Se concluye que las condiciones de reparación pueden variar en base a factores específicos y generales aun en discusión.

Augmentation rhinoplasty with rib cartilage graft

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To investigate the outcome and complications of augmentation rhinoplasty with rib cartilage grafts.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective study<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Subjects:</strong> Patients who underwent dorsal nasal augmentation with autologous rib cartilage grafts between June 2008 and October 2012.<br /><strong>RESULTS:</strong> A total of 12 patients (3 male, 9 female) were included in the study. Mean age was 29 years. Seven were cases of primary simple rhinoplasty with four cases of revision (previously using alloplastic materials) and one case of trauma. Indications for the procedure were all cosmetic. There was no incidence of infection, both in the donor and recipient sites, warping of the graft, graft extrusion, resorption, pneumothorax, chest wall deformity or prolonged edema. Post-operative pain in the donor site was relieved by oral pain medications. No revision surgery was required.<br /><strong>CONCLUSION:</strong> Costal cartilage is a good option for structural support of the nose. In our experience patients have become wary of the complication of allografts and have opted to use autografts. The surgeon's knowledge of the nasal anatomy as well as his or her experience with autologous grafts plays a major role in avoiding post-operative morbidity.</p>

Cemento - Ossifying Fibroma- A Case Report.

Mandibular resection and reconstruction was done with rib graft on right side for a boy suffering from cemento-ossifying fibroma. The defect secondary to surgical ablation of mandible have far reaching consequences like speech, respiration, mastication, deglutition and cosmetics and growth disturbances. Restoring these functions is a challenging task. However, fairly regular crop of complications do occur during these surgical reconstructions. This article reports a rare case of an 11years old boy diagnosed as cement ossifying fibroma who underwent mandibular reconstruction with rib graft and the details of the follow up of the case for 6 months.

Combined Anterior and Posterior Operation for Thoracic Tuberculous Spondylitis

OBJECTIVE : The purpose of this study is to evaluate the clinical outcome of the two-stage operation for thoracic tuberculous spondylitis. METHODS : Eleven patients (4 male, 7 female) with thoracic tuberculous spondylitis were treated with two-stage operation. First stage consisted of anterior debridement and interbody fusion using rib graft and second with posterior instrumentation with fusion. Mean age was 46 years, and mean follow-up period was 18 months. All patients were treated with 12 months of antituberculotic medication postoperatively, and evaluated before and after surgery with respect to pain level, neurological status, associated lesions, hematological parameters and change of kyphotic angle. RESULTS : The associated lesions were pulmonary tuberculosis in 4 cases. There were no recurrences of infection and bone union was obtained within 6 months of the operation in all cases. Changes in the pain severity, neurological status, and hematological parameters demonstrated significant clinical improvement in all patients. The mean kyphotic angle was corrected from 17.8degrees to 9.8degrees after surgery. The most recent follow-up of the mean kyphotic angle was 12.3degrees, with a loss of correction of 2.5degrees. The preoperative VAS averaged to be 7.18 (range, 4-10). It decreased significantly an average of 1.45 (p 0.001). CONCLUSION : These results indicate that two-stage surgical treatment for thoracic tuberculous spondylitis provid safe and satisfactory results. Spine instability and kyphosis can be also prevented by two-stage operation.

A Case of Giant Fronto-Ethmoidal Osteoma using rib and Calvarial Bone Graft

Osteoma is a slowly growing benign tumor which mainly grows on the mandible and in the paranasal sinuses of the craniofacial region. Embryological, inflammatory, and traumatic theories make up the etiological basis of osteoma, but is still unclear and yet to be studied. We can classify osteoma by morphology and pathology into eburnated, cancellous, and mixed type, of which eburnated type is relatively common. Most osteomas accompany no symptoms, so they are often discovered accidentally by a radiological examination. They never develop into a malignant form, so that periodic observation is sufficient enough for management, but when they grow and invade intraorbitally or intracranially and then compress clinically important structures, need a surgical management, because of possibility of diplopia, exophthalmos, epiphora, blindness due to optic atrophy, mucocele, brain abscess, meningitis. A 52-year-old man complaining of right eye pain, diplopia, and exophthalmos was diagnosed a 4.5x3.0x 2.0cm sized fronto-ethmoidal osteoma by means of a three dimensional computed tomography. We experienced a osteoma removal through bicoronal incision, and orbital reconstruction with both rib and calvarial bone graft, and received satisfying results after 1 year follow-up, thereby report this case with a short review of references.

Scalp Defect, Injuries of Skull and Brain Parenchyme Caused by High Voltage Electrical Burn: A Case Report

The authors describe a case of accidental eletrical injury from high voltage direct current in a young worker, who was struck by the electric shock in the left occipito-parietal region. This case is interesting due to the development of left ooccipito-parietal parenchymal brain lesion with transient anomic aphasia and visual disturbances. We believe that is first report on parenchymal brain injury due to high voltage electrical burn confirmed pathologically in Korea. The patient had full thickness scalp defect, skull necrosis, and parenchymal brain injury. We performed one stage brain and dural biopsy with split rib graft cranioplasty after removal of devitalized skull and scalp flap surgery. The clinical presentation, radiological, pathological finding, and outcome are reviewed.