Maxillofacial war injuries during the war in former Yugoslavia.

War wounds of the maxillofacial region occur in 5-17% of casualties. In the Clinic for Maxillofacial Surgery of the Military Medical Academy, during the war in former Yugoslavia, 482 casualties with dominant wounds in the maxillofacial region were treated. The outcome of the treatment depended on the quality and speed of the first aid and general medical aid, as well as on qualified specialist treatment. Specificity of the management of the war wounds of maxillofacial region includes: minimal debridement of soft tissues, removal of only deperiosted fragments of bony tissues, valid reconstruction of bony and soft tissues defects, correct immobilization, antitetanus prophylaxis, adequate antibiotic therapy, as well as permanent and very meticulous postoperative care.

The treatment of traumatic facial bones and jaw fractures in the period 1972-1996.

During the last twenty-five years, in the period from January 1, 1972 to December 31, 1996, 1006 injured with facial and jaw fractures have been treated at the Clinic for Maxillofacial Surgery of the Military Medical Academy--91.05% of the injured were males and 67.98% belonged to the age group between 11 and 30. The most frequent etiologic factors were traffic accidents (46.42%) and fights (38.07%). Isolated fractures of mandible were found in 51.09% of the injured. In 70.57% of the treated the surgery was used for adequate reduction, osteosynthesis and stabilization of bone fragments, and 29.34% of the injured were treated conservatively, which involved the manual reduction and intermaxillar immobilization. The post-operative complications were observed in 51 (5%) of the injured.

Monocortical osteotransplant of the iliac bone in reconstruction of mandibular gunshot defects.

In the Clinic for Maxillofacial Surgery of Military Medical Academy, 134 injured with mandibular defects were treated, as well as a significantly larger number of injured from the territory of former Yugoslavia, with dominant injuries of the head and neck regions. Until June 1994, smaller defects were treated using bicortical osteotransplant of the iliac bone. Due to its only partial successfulness in reconstruction of mandibular defects, monocortical osteotransplant of the iliac bone was selected for reconstruction of the mandibular defects and the results were much better compared to the other free osteotransplants.

Vascularized fibular graft in the reconstruction of posttraumatic mandibular defects.

The results of the use of the vascularized fibular graft for the reconstruction of posttraumatic defects of the mandible are presented. Different surgical procedures were applied in reconstruction of the mandibular defects in 120 wounded. In the last four years vascularized fibular graft was used in 11 mandibular reconstructions. Taking into account the survival rate of 100%, long vascular pedicle, strength, length and the possibilities of adaptation of the bone make this graft suitable for mandibular reconstruction. The functional and esthetic results obtained by the use of this graft were satisfactory, with minimal donor site morbidity.

Implants in management of gunshot injuries of teeth, facial bones and jaws.

The use of implants in management of gunshot injuries of teeth, face and jaws presents novelty that is manifested in primary surgical treatment, reduction and fixation of bone fragments and teeth, replacement of lost parts of bone tissues as well as preparation for definitive prosthetic management. At the Clinic for Maxillofacial Surgery of the MMA 173 implants of different types and purposes have been placed in the period 1991-1997, in rehabilitation of the patients injured during the civil war. Although this number of placed implants is significant, the conclusive estimate about benefit of using implants may be obtained only after a longer period of time. Early results are satisfactory.

Facial nerve injuries and its treatment.

Twenty four patients with traumatic interruption of the conductivity of the facial nerve were treated in the period 1991-1996 at the Clinic for Maxillofacial Surgery. After topographic orientation about the site and level of the injury, the reconstruction of the nerve using nerve grafts was performed in all patients. The results were satisfactory.

Bimaxillary osteotomies in correction of dentofacial deformities.

In 342 patients with dentofacial deformities cephalometric analyses were preoperatively performed. A study of occlusion on cast models as the simulated new position of the facial soft tissues was done on the photographs. Surgical treatment using bimaxillary osteotomies for correction of dentofacial deformities was done in 38 patients: 31 with prognathism and maxillary hypoplasia, 5 with facial asymmetry and laterognathism and in 2 with otomandibular dysostosis. The LeFort I type osteotomy was used for the upper jaw and Obwegeser technique for the lower jaw. Intermaxillary and circumzygomatic immobilization were removed 8-10 weeks after the operation. After that, the patients retained the individual chin traction from 2 to 3 months. The complete relapse occurred in one patient and prolonged loss of the mandibular nerve sensibility in one.

How we have treated parotid gland tumors.

Since the Clinic was established in 1972 to the end of 1994 at the Clinic for Maxillofacial Surgery of the Military Medical Academy 782 patients with tumors of the parotid salivary glands of glandular origin were treated. This number included only patients with sufficient data for the relevant analysis. There were 659 (85.53%) benign and 123 (14.47%) malignant tumors. They are rare in the age 0-20. Their incidence increases after the third decade, reaching the maximum in the sixth decade. The most frequent tumors were of 3 cm diameter (36.24%). The average size of tumors varied from 3 to 6 cm in diameter (29.36% of cases). Tumors larger than 15 cm are extremely rare. All patients were surgically treated: subtotal parotidectomy was done in 55.23%, total in 38.61% and radical in 6.16%. Transient facial nerve injuries were recorded in 18.63% of cases (mainly at total parotidectomy). Out of 94 patients with malignant tumors of the parotid gland, 78.13% survived for 2 years and 48.89% for 5 years. Recurrence rate for benign parotid tumors was 2.38%, and for malignant 17.62% (after total parotidectomy) and 26.12% (after the radical one).

Reconstruction of a face destroyed by an explosion.

We have followed up the course of the facial reconstruction in a 12 year old boy with totally destroyed middle and lower third of the face when the fuse for initial mine activation exploded in his mouth. The boy has undergone more than 20 operations within the 7-year period and his rehabilitation has not been completed, yet.

Do prostaglandins E2, F2 alpha and D2 have a role in the development of idiopathic trigeminal neuralgia?

Idiopathic trigeminal neuralgia (ITN), resistant to the drug treatment was diagnosed in 20 patients using following parameters: clinical feature, usage of Bell-McGill questionnaire, as well as X-ray and neurophysiologic examinations. Peripheral neurectomy was performed in all of them as a palliative therapeutic procedure. In removed nerves of patients (n. infraorbitalis, n. alveolaris inferior), as well as in the same nerves of cadavers, the concentrations of prostaglandins (PGs) E2, F2 alpha and D2 were determined using commercial radioimmunoassay. Significant increase in PGE2 and PGF2 alpha concentration and simultaneous decrease in PGD2 concentration in the nerves of the patients with ITN was noticed. Results demonstrated that the increase in the concentration of hyperalgesic PGE2 and PGF2 alpha as well as the decrease in hypoalgesic PGD2 concentration had an important role in the onset of neuralgic pain in patients with ITN.

[Reconstruction of defects of the oral cavity with the myocutaneous sternocleidomastoid flap]. / Rekonstrukcija defekta usne supljine miokutanim sternokleidomastoidnim reznjem.

The sternocleidomastoid (SCM) muscle can be used for a muscular myocutaneous or osteomyocutaneous flap in the reconstruction of cancer and trauma related defects of the oral cavity. The SCM muscle has 3 principal arterial pedicles and a number of minor ones. The superior pedicle is a branch given off in about 70% of cases by the occipital artery, the middle is formed by a branch of the superior thyroid artery, and the inferior pedicle arises from the suprascapular or the transverse cervical artery. We used the SCM myocutaneous flap for the reconstruction of various defects in the middle and lower part of the face and oral cavity. Group of 28 patients was submitted to transfemoral angiography of the external carotid artery and thyreocervical trunc. The dominant vascularisation of the superior pedicle was found in 17 (60%) cases. We used the SCM myocutaneous flap only in cases with dominant vascularisation from superior pedicle and good results were obtained in all cases.

[Blood autotransfusion in head and neck surgery]. / Primena autotransfuzije krvi u hirurgiji glave i vrata.

Autotransfusion as a method of blood compensation after multilative surgical operation in cases of malignant neoplasm of the maxillofacial region, was introduced in our clinical practice in 1989, and up to now we have performed it in a group of 23 patients. It has been known that an autotransfusion depends on the patients' general health situation, hemoglobin level, hematocrit and iron concentration in serum. We exfused at least three days before operation 450 ml of blood from each patient. The blood was taken into plastic bags and kept in the refrigerator at the temperature of +4 degrees C. The decrease of serum iron concentration was approximately 54.26% in all tested patients that demanded the substitution therapy with iron together with vitamin C before and after surgery. There was neither prolongation of postoperative treatment nor complications associated with this method of post-operative blood loss compensation. Based on obtained results we could conclude that the best method of inter- and postoperative blood compensation was autotransfusion, taking care about factors which could limit the possibilities of its applications.

[Motivation in patients for surgical treatment of prognathism using bimaxillary surgery]. / Motivisanost pacijenata za hirursko lecenje progenije primenom bimaksilarne hirurgije.

A postoperative survey was conducted to evaluate the motivation of twenty three patients following surgical correction of mandibular prognathism. The operative technique of bimaxillary surgery was applied to all patients. The major reason for surgery was esthetics. Majority of patients were informed about surgery by their family dentists, and almost all of them were satisfied and stated that their expectations were fulfilled.

[Large dermoid cysts of the mouth floor]. / Velike dermoidne ciste poda usta.

Dermoid cysts of the mouth floor are very rare. The incidence of these cysts is up to 3.6% of all cysts in the oral cavity. The article presents the material from the Clinic of Maxillofacial Surgery MMA. Eleven cases of large dermoid cyst are discussed. All of them were removed completely and no recurrence developed in longer period of time postoperatively.

[Fractures of the zygomaxillary complex: indications for exploration and reconstruction of the orbital floor]. / Frakture zigomatikomaksilarnog kompleksa: indikacije za eksploraciju i rekonstrukciju poda orbite.

Within the period of 11 years 132 patients with fractures and dislocations of the zygomatic maxillary complex have been treated at the Clinic of Maxillofacial Surgery of the M.M.A. In all cases the Converse-Valentine method was used which provided good reposition and fixation of fragments in the correct anatomic position as well as insight into the state of the orbital floor. In 75 operated patients (56.81%) it was necessary to reconstruct the orbital floor by osteo or allotransplants. The results have pointed out the necessity of operative reposition and fixation of fragments on three typical sites as well as the necessity of exploration of the orbital floor in order to prevent diplopia, sensibility disorders as well as traumatic neuralgia.