Is the pure and impure distinction of orbital fractures clinically relevant with respect to ocular and periocular injuries? A retrospective study of 473 patients.

OBJECTIVE: To determine the association of "pure" orbital fractures (POF) and "impure" orbital fractures (IOF) with ocular and periocular injuries. MATERIALS AND METHODS: A retrospective study of patients with orbital fractures was designed. The predictor variable was the orbital's fracture configuration (pure versus impure). The primary outcome variables were ocular and periocular injuries classified as mild, moderate, and severe. The secondary outcome was the need for surgical repair. Standard statistics for patient characteristics, the Fisher exact test for categorical variables, and the Mann-Whitney U test for continuous variables were computed to compare fractures. RESULTS: The sample was composed of 473 patients (220 POF and 253 IOF). No significant association between the two groups with regard to ocular and periocular injuries was found. Combined medial wall and floor fractures and naso-orbito-ethmoidal (NOE) fractures had the highest incidence of severe injury (34.5%, p = 0.02). Le Fort fractures were associated with moderate ocular and periocular injuries (36.4%, p = 0.01). Impure orbital fractures were more frequently associated with the need for surgical treatment (p = 0.04) than were POF. CONCLUSION: The present study has demonstrated that the pure and impure distinction of orbital fractures was not clinically relevant with respect to ocular and periocular injuries. However, our findings seem to suggest that other parameters such as the direction of the impact and/or its magnitude, rather than merely the pure or impure configuration, could be involved in determining the risk of developing concomitant ocular and periocular injuries.

[Applications of maxillo-facial computer assisted surgery]. / Applications de la chirurgie maxillo-faciale assistée par ordinateur.

During the last two decades, computer-assisted surgery (CAS) has drastically changed the strategy for craniofacial reconstructive surgery, especially with respect to the prediction of preoperative virtual and ideal bone repositioning for correction of developmental or post-traumatic malformations. Intraoperative navigation and computer-aided design and modeling techniques (CAD/CAM) allow for the transfer of the virtual planned reconstruction to the operating room by guaranteeing a real time assistance during the realization of the surgical task and respectively by using patient-specific implants, surgical cutting and drilling guides. This approach has thus significantly contributed to improve the clinical accuracy, predictability and patient outcome, compared to traditional techniques.

Au cours des deux dernières décennies, la chirurgie assistée par ordinateur (CAO) a drastiquement changé la stratégie de prise en charge des patients en chirurgie reconstructrice crâniofaciale complexe, notamment pour la correction des malformations congénitales ou post-traumatiques. La navigation peropératoire et la conception et fabrication assistées par ordinateur (CFAO) permettent un transfert de la reconstruction planifiée virtuellement, directement au bloc opératoire via une assistance en temps réel pendant l'intervention chirurgicale et en utilisant des implants, des guides de coupe et de forage spécifiques au patient. Par rapport aux techniques conventionnelles, cette méthode a contribué de façon non négligeable à améliorer la précision, la prédictibilité clinique des résultats et la satisfaction des patients.

Periorbital Necrotizing Fasciitis Induced by Streptococcus pyogenes: A Case Report and Clarification.

Periorbital necrotizing fasciitis (PONF) is a rare condition of the face. PONF can lead to blindness, functional and esthetic sequelae, multiple-organ failure, and death. The aim of this report is to raise the awareness of this severe condition in maxillofacial surgeons. This report describes the case of a 30-year-old woman who presented with a bilateral palpebral edema and pain 3 days after a jugal wound was sutured. Necrosis of the skin of the left palpebral unit was extending rapidly. The patient had signs of sepsis. Surgical debridement was performed promptly and intravenous broad-spectrum empiric antibiotics were administered. The patient recovered slowly with no complication other than a residual skin defect of the 2 eyelids that was later corrected by full-thickness skin grafting. Special attention should be paid to signs of preseptal cellulitis because it can, in some cases, rapidly develop into PONF. Early diagnosis and treatment are the keys to a favorable outcome.

Mandibular Sagittal Split Osteotomy for Removal of Impacted Mandibular Teeth: Indications, Surgical Pitfalls, and Final Outcome.

PURPOSE: The purpose of this study was to determine the indications for mandibular sagittal split osteotomy (MSSO) for the removal of impacted mandibular teeth and to evaluate the surgical pitfalls and final outcomes. PATIENTS AND METHODS: In this retrospective case-series study, radiologic and clinical data of all patients who underwent MSSO for the removal of impacted mandibular teeth between 2008 and 2015 at the University Hospitals of Geneva were reviewed. The primary outcome variables were 1) the indication for the removal of impacted mandibular teeth by MSSO, 2) complications, and 3) surgical pitfalls. Other variables included age, gender, teeth involved, indication for tooth removal, concomitant lesions such as cysts and/or tumors, and radiologic features. RESULTS: In 18 consecutive patients, 21 impacted mandibular teeth (18 third molars, 2 second molars, and 1 first molar) were extracted by MSSO. In all patients the indication for the MSSO approach included deeply impacted teeth associated with an intimate relationship between the inferior alveolar nerve and the dental roots as shown on computed tomography or cone-beam computed tomography scan images. A non-disabling hypoesthesia of the inferior alveolar nerve developed in 6 patients (33.3%). Major complications occurred in 3 patients (16.6%), including 2 cases of infection (11.1%) and 1 case of a "bad split" (5.5%). CONCLUSIONS: This study showed that the MSSO approach is a valuable method for removing deeply impacted teeth in proximity to the mandibular canal. Local factors, such as bone remodeling, concomitant large lesions (cysts and/or tumors), and the mandibular canal within the buccal cortex, represent pitfalls that might increase the risk of complications developing.

Are condylar morphologic changes associated with temporomandibular disorders in patients with orthognathia?

OBJECTIVE: To determine the association between morphologic condylar changes and temporomandibular disorders (TMDs) in patients with orthognathia. STUDY DESIGN: Data from 89 patients were analyzed. TMDs were classified according to the Research Diagnostic Criteria for TMDs. TMD severity was scored according to the Helkimo indices. Calculation of the condylar area, perimeter, and height was performed by using a specific computational method including panoramic radiography. RESULTS: Sixty-five (73%) patients presented with morphologic condylar changes. Decreases in condylar perimeter and area were found to be predictors of postoperative TMDs (P = .009; odds ratio [OR] = 3.66) and disk displacement (P = .008; OR = 4.43), respectively. Condylar area and height decreases were associated with worsening of TMDs (P = .03 and 0.04). CONCLUSIONS: This study demonstrated that in orthognathic patients, postoperative condylar changes are associated with postoperative TMDs as well as with the degree of TMD severity and that preoperative TMDs are associated with such condylar changes.

Management of dentoskeletal deformity due to condylar resorption: literature review.

OBJECTIVES: The aim of this review was to examine all publicly available literature on the current treatments of the dentoskeletal deformity due to condylar resorption and their outcomes and to suggest management guidelines. STUDY DESIGN: A systematic review was performed of all literature located on the electronic PubMed database from 1970 to 2012. RESULTS: The search resulted in 21 papers and 210 cases treated from 1991 to 2012. Orthognathic surgery was the most commonly used option (42%) and was sometimes combined with open joint surgery (19%). Stability was observed, respectively, in 57% and 100% of the orthognathic surgery and open joint surgery cases. Condylectomy and reconstruction with chondrocostal graft or temporomandibular joint total joint prosthesis were used in 19% and 10% of all cases of orthognathic surgery and open joint surgery with good results (95% and 100%, respectively). Osteogenic distraction was anecdotic (1%). Nine percent of all cases received conservative treatment. CONCLUSIONS: Larger comparative studies are necessary to obtain evidence-based recommendations.

Cultured autologous keratinocytes in the treatment of large and deep burns: a retrospective study over 15 years.

AIM: The aim was to review the use and indications of cultured autologous epidermis (CAE) in extensive burns and to evaluate the efficiency of our strategy of burn treatment. MATERIALS AND METHODS: This retrospective study comprised 15 years (1997-2012). INCLUSION CRITERIA: all patients who received CAE. EXCLUSION CRITERIA: patients who died before complete healing and patients who received exclusively cultured allogeneic keratinocytes. Evaluation criteria were clinical. Time and success of wound healing after CAE graft were evaluated. RESULTS: A total of 63 patients were included with severity Baux score of 107 (from 70 to 140) and mean percentage of TBSA of 71% (from 40% to 97%). The CAE were used as Cuono method, in STSG donor sites and deep 2nd degree burns and in combination with large-meshed STSG (1:6-1:12) in extensively burned patients. Cuono method was used in 6 patients. The final take was 16% (0-30) because of the great fragility of the obtained epidermis. Nine patients with deep 2nd degree burns (mean TBSA 81%, from 60 to 97%) were successfully treated with only CAE without skin grafting. Combined technique (STSG meshed at 1:6-1:12 covered with CAE) was used in 27 patients (mean TBSA 69%, from 49% to 96%) with 85% success rate. Finally, donor sites treated with CAE in 49 patients could be harvested several times thanks to rapid epithelialization (time of wound healing was 7 days (from 5 to 10 days)). CONCLUSION: The CAE allow rapid healing of STSG donor sites and deep 2nd second degree burns in extensively burned patients.

Cultured allogenic keratinocytes for extensive burns: a retrospective study over 15 years.

UNLABELLED: The aim was to review the use and indications of cultured allogenic keratinocytes (CAlloK) in extensive burns and their efficiency. MATERIALS AND METHODS: This retrospective study comprised 15 years (1997-2012). INCLUSION CRITERIA: all patients who received CAlloK. EXCLUSION CRITERIA: patients who died before complete healing. Evaluation criteria were clinical. Time and success of wound healing after CAlloK use were evaluated. RESULTS: The CAlloK were used for 2 indications - STSG donor sites and deep 2nd degree burns in extensively burned patients. A total of 70 patients were included with severity Baux score of 99.2 (from 51 to 144) and mean percentage of TBSA of 63.49% (from 21 to 96%). Fifty nine patients received CAlloK for STSG donor sites with a mean number of applications of 4 and mean surface of 3800 cm(2) per patient. Treated donor sites were re-harvested 2.5 times. The mean time of complete epithelialization was 7 days. In 11 patients, CAlloK were used for deep 2nd degree burns. The mean percentage of burned surface was 73.7%. The mean surface of CAlloK per patient was 2545 cm(2). Complete healing was achieved in 6.4 days. CONCLUSION: The CAlloK allow rapid healing of STSG donor-sites and deep 2nd second degree burns in extensively burned patients.