ABSTRACT
STUDY DESIGN: Free fibula flaps are nowadays the gold standard for the surgical reconstruction on large mandibular defects. Malocclusion is an important complication of this type of reconstruction and many of these patients end up requiring subsequent orthognathic corrective surgery. This is a descriptive retrospective case series study. OBJECTIVE: To describe the demographic data, operative techniques, corrective methods and postoperative results in the management of malocclusion following mandibular reconstruction with free fibula flap. METHODS: This case series study included patients who underwent free fibula flap mandibular reconstructions and who that subsequently developed malocclusion requiring orthognathic corrective surgery, from June 2010 to December 2019. Panoramic X-rays, cephalometries and/or 3-D facial reconstruction CT scans were used for surgical planning to create surgical cutting guides, templates and occlusal splints in all the patients that underwent corrective orthognathic surgery. RESULTS: There were 46 patients who underwent a free fibula flap mandibular and maxillary reconstruction at San Jose Hospital between June 2010 and December 2019 of these, 5 patients (10.9%) developed postoperative malocclusion. One case from another institution was added to this study for a total of 6 patients with malocclusion following mandibular reconstruction surgery with a fibula free flap. During the orthognathic surgery, vertical osteotomies were performed in 3 patients and bilateral sagittal split osteotomies were necessary in 2 patients and L-shape in 1 patient. Osteogenic distraction was performed in 3 patients as part of their orthognathic treatment. The fixation methods were based in miniplates for 3 of the patients and lag screws for the remaining 3 patients. With this approach, all patients had an adequate occlusion correction with a 100% consolidation at their 6-month follow up. CONCLUSION: Malocclusion is a significant complication following mandibular reconstruction surgery that must be identified and managed. In severe cases, it requires corrective orthognathic surgery in severe cases. We have developed a protocol to avoid pitfalls during the primary reconstruction and in case an orthognathic surgery is required for malocclusion correction, preoperative planning with cutting guides and occlusal splints should be assessed, to guarantee favorable results through a reproducible technique.
ABSTRACT
Background and Purpose Sphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is any relationship between various isolated or combined fractures of facial skeleton and sphenoid bone and sphenoid sinus fractures. Methods We retrospectively studied hospital charts of all patients who reported to the trauma center at Hospital de San José with facial fractures from December 2009 to August 2011. All patients were evaluated by computed tomography scan and classified into low-, medium-, and high-energy trauma fractures, according to the classification described by Manson. Design This is a retrospective descriptive study. Results The study data were collected as part of retrospective analysis. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Thirty-eight patients were excluded. A total of 212 patients had facial fractures; 33 had a combination of sphenoid sinus and sphenoid bone fractures, and facial fractures were identified within this group (15.5%). Gender predilection was seen to favor males (77.3%) more than females (22.7%). The mean age of the patients was 37 years. Orbital fractures (78.8%) and maxillary fractures (57.5%) were found more commonly associated with sphenoid sinus and sphenoid bone fractures. Conclusions High-energy trauma is more frequently associated with sphenoid fractures when compared with medium- and low-energy trauma. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures.
ABSTRACT
En permanencia, ninguna técnica para la fijación de la elevación ciliar en la frontoplastia ha demostrado de manera concluyente ser la mejor. Se han propuesto con sutura o tornillos tratando de que los resultados perduren. Se muestra la experiencia con estos dos métodos, con seguimiento a doce meses. Materiales y métodos: se practicó frontoplastia a 17 pacientes con elevación ciliar en un periodo de un año con seguimiento a tres meses en su totalidad y a doce en tres de ellos. En siete se utilizó fijación con tornillos, nueve con sutura y uno no se usó material de fijación. Método descriptivo prospectivo de serie de casos con mediciones mediante fotogrametría estandarizada. Resultados: ninguno tuvo recurrencia de la ptosis ciliar y todos refirieron satisfacción con el resultado. Conclusiones: en el seguimiento a doce meses no se evidenciaron recurrencias ni complicaciones Las características metodológicas del estudio no permiten dar recomendaciones, pero si crear la base para seguimiento a largo plazo con un mayor número de pacientes...
As related to permanency, no technique for brow lift fixation has conclusively demonstrated to be the best one. The use of sutures and screws, have been proposed, seeking results to remain. Experience with these two techniques is shown in this work through a 12-month follow-up. Materials and Methods: a frontoplasty with brow lift was practiced in 17 patients over a 1-year period conducting a 3-month follow-up to the whole group and a 12-month follow-up in 3 patients. Screw fixation was practiced in 7, suture fixation in 9 and no fixation material was used in one patient. Method: descriptive prospective case series using standardized photogrammetry measurements. Results: none had brow ptosis recurrence and all patients stated to be satisfied with the results. Conclusions: no recurrence or complications were evidenced at 12-month follow-up. Methodology characteristics of the study do not allow recommendations to be posed but allow the creation of a long-term follow-up basis including a larger number of patients...
