Reverse Facial-Submental Artery Osteomyocutaneous Flap, a Novel Choice for Previously Operated Huge Alveolar Clefts.

Adult previously operated alveolar cleft palate presents a pronounced challenge for optimal surgical reconstruction. This optimal reconstruction dictates the restoration of soft tissues in addition to hard tissues to achieve prime functional results. Regional flaps usually used for the reconstruction of such defects were considered as either bulky or none bone bearing flaps. Furthermore, using free flaps for reconstruction can rise the concerns of increased intraoperative complications and greater suspected donor site morbidities. Here we present three unfavorably previously operated patients with current huge alveolar cleft palates, planned for the reconstruction with reverse facial-submental artery osteomyocutaneous flap. Besides, detailed flap harvesting technique, results, prosthetic restoration post to flap surgery, and follow up are presented in this article. We found the reverse facial- submental osteomyocutaneous flap as a novel and reliable choice for functional reconstruction of challenging huge alveolar cleft palates. The reverse facial-submental flap has not been yet mentioned in the medical literature for the reconstruction of alveolar clefts.

Chronic Long-Standing Temporomandibular Joint Dislocation: Report of Three Cases and Review of Literature.

PURPOSE: To present three cases of chronic long-standing TMJ dislocation and discuss our treatment protocol with other options in the literature. PATIENTS AND METHODS: Three cases of chronic TMJ dislocation (more than 4 months) that has never been reduced previously were treated by open reduction, meniscectomy or meniscoplasty and lateral pterygoid muscle myotomy. After a short period of MMF, TMJ physiotherapy was performed. RESULTS: During 3 years of follow-up, the condition had not recurred at all and all patients were functional and symptom free. CONCLUSION: Based on other therapeutic options in the literature, our treatment protocol seems to be an effectual operation with fewer complications.

Maxillofacial fracture epidemiology and treatment plans in the Northeast of Iran: A retrospective study

Background: The epidemiology of facial injuries varies based on lifestyle, cultural background and socioeconomic status in different countries and geographic zones. This study evaluated the epidemiology of maxillofacial fractures and treatment plans in hospitalized patients in Northeast of Iran (2015-2016). Material and Methods: In this retrospective study, the medical records of 502 hospitalized patients were evaluated in the Department of Maxillofacial Surgery in Kamyab Hospital in Mashhad, Iran. The type and cause of fractures and treatment plans were recorded in a checklist. Data were analyzed with Mann-Whitney test, chi-squared test and Fisher’s exact test, using SPSS 21. Results: The majority of patients were male (80.3%). Most subjects were in 20-30-year age range (43.2%). The fractures were mostly caused by accidents, particularly motorcycle accidents (MCAs), and the most common site of involvement was the body of the mandible. There was a significant association between the type of treatment and age. In fact, the age range of 16-59 years underwent open reduction internal fixation (ORIF) more than other age ranges (P=0.001). Also, there was a significant association between gender and fractures (P=0.002). Conclusions: It was concluded that patient age and gender and trauma significantly affected the prevalence of maxillofacial traumas, fracture types and treatment plans. This information would be useful for making better health policy strategies (AU)

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How to Overcome the Challenges of Non-Detachable Connector Tubes in Submental Intubation for Panfacial Fractures.

INTRODUCTION: Armored removable connector tubes are not always available in operating rooms for routine Altemir submental intubation (SMI) technique. The present study addresses a fiber-optic glidoscopy assisted 2-tubes modification of Green & Moore sequence for submandibular intubation. METHODS: The sample was composed of 11 patients (8 males and 3 females) with panfacial fractures where neither the oral and nasal intubation techniques nor tracheostomy were feasible. The inter-operative procedure duration was recorded and a comparison was made between the present results with those obtained in similar studies. Moreover, postoperative complications were assessed over a duration of 6 months. RESULTS: The average duration of this modified procedure was 8-13 min. (Mean, 10.54 ± 1.75 min). No perioperative or postoperative complications were observed. Based on the findings in this study, it is suggested that this new technique is safe, quick and reliable for submandibular intubation. CONCLUSION: This modification establishes a secure airway for treatment of maxillofacial panfacial fractures, where traditional methods are impossible due to non-detachable connector tubes. No perioperative or postoperative complications were observed. This study suggests that this new technique is safe, quick and reliable for submandibular intubation.

Decellularized human Schneiderian membrane: electron microscopic study as a bioscaffold and preliminary cell seeding.

BACKGROUND: Perforation of maxillary sinus mucous membrane is one of the most prevalent complications during open sinus lift surgery. Moreover, such complication can usually be managed by an absorbable membrane. As far as absorbable membranes are concerned, decellularized maxillary sinus mucous membrane, which is an extracellular matrix, can be used as a biologic scaffold and an insulating membrane in sinus lifting surgery. MATERIALS AND METHODS: The decellularization process of the maxillary sinus membrane was performed by means of physical and chemical procedures (liquid nitrogen and sodium dodecyl sulfate). Then this membrane was used as a bioscaffold for culturing with adult mesenchymal stem cells, which were derived from adipose tissue. RESULTS: Histologic evaluation of the decellularized scaffold revealed that cells of the Schneiderian membrane were compatibly removed via SDS 1%. Moreover, the scan with electron microscope (S6N - Leo vp1450, Germany) of the scaffold indicated that the collagen fibers of the decellularized maxillary sinus membrane were intact. Furthermore, the culture studies carried out showed that this scaffold supported cell seeding. CONCLUSION: The decellularized human maxillary Schneiderian membrane has a 3D structure similar to that of the extracellular matrix of human normal tissues. As a matter of fact, it can be used as a bioscaffold to support cell seeding.