Use of Virtual Surgical Planning and Virtual Dataset With Intraoperative Navigation to Guide Revision of Complex Facial Fractures: A Case Report.

The use of intraoperative navigation has become prevalent in multiple surgical fields, including neurosurgery, orthopedic surgery, spine surgery, and head and neck surgery. In the past decade, its use also has become popular in oral and maxillofacial surgery. Previous studies have suggested the use of intraoperative navigation improves surgical precision and accuracy and decreases intraoperative risks and postsurgical morbidity. This report presents a case in which intraoperative navigation was used for revision and secondary reconstruction of multiple facial fractures. Preoperative virtual surgical planning allowed customization of osteotomies of multiple bony segments and virtual reduction of these segments to their anatomically correct position. Then, the newly reconstructed 3-dimensional virtual computed tomographic dataset was used as a template in the navigation system to guide the osteotomies and precisely reposition bony fragments during surgery. This report describes the workflow necessary to use this technology.

Emerging Biomaterials in Trauma.

Emerging technologies and research into the science of biomaterials have developed exponentially and provide facial reconstructive surgeons with a plethora of options for a multitude of varying presentations. This article presents a comprehensive discussion in the ever-evolving field of material science and emerging biomaterials. A complete understanding of the current status of such materials is necessary for the appropriate incorporation and applicability to adequate clinical situations. The rapid progress seen in biomaterials is evidenced through the forward direction of bioengineered tissues, the incorporation of growth factors in varying scenarios, and the unique characteristics of 3-D printing of patient specific scaffolds.

Immediate Versus Delayed Treatment of Mandibular Fractures: A Stratified Analysis of Complications.

PURPOSE: To analyze the rate of complication outcomes of mandibular fracture repairs across different injury-to-repair time spans. PATIENTS AND METHODS: We conducted a retrospective cohort study of patients with repaired mandibular fractures. The independent variable was the time span from injury to surgical repair. The primary outcome variable was the rate of complications measured postoperatively during the follow-up appointments. Other variables were grouped for performance of a stratified analysis: favorability of the fracture, patient compliance, substance abuse, and fracture location. Descriptive and bivariate statistics were computed. RESULTS: The final sample was composed of 505 patients, and the time span from injury to repair ranged from 0 to 90 days. The total number of patients from the sample with reported complications was 124. There was no statistical significance correlating the time spans and complication rates (P = .796). The variables for the stratified analysis also showed no significant correlations except for fracture location. Body fractures resulted in the highest rate of complications (33%; P = .041). Of the noncompliant patients (n = 144), 28.5% presented with complications (P = .352). No significance was seen in unfavorable fractures (n = 283), with a rate of complications of 28.6%. No significance could be correlated with substance abuse (n = 107, 29.9% with complications; P = .262). CONCLUSIONS: The results of this study suggest that although time from injury to repair does not affect the rate of complications, the global standard of care for the management of non-emergent mandibular fractures should consider the cost-effectiveness of delaying treatment while exercising a reasonable length of delay for the comfort of the patient.

Evaluation of reconstructive techniques for anterior and middle skull base defects following tumor ablation.

PURPOSE: Reconstruction after resection of head and neck cancer can be challenging, especially when tumors extend to the base of the skull. Vascularized flaps are the option of choice, whether free or pedicled. Free flaps have the added benefit of access to the more cephalad defects of the anterior cranial base without the constraints of the rotation arc of pedicled flaps. The authors compared various flaps used for the reconstruction of defects of the anterior or middle skull base after resection of malignant tumors. MATERIALS AND METHODS: The authors identified 12 patients in whom 14 flaps were performed. All patients had malignant neoplasms extending to the anterior or middle cranial base that were reconstructed with free or pedicled flaps. A retrospective analysis was performed to compare the characteristics of patient demographics, tumor, and surgical technique. Complications among the various flaps were compared. Patients' assessments of function and quality of life were assessed by conducting a telephone survey. RESULTS: Most patients had stage 3 or 4 squamous cell carcinoma originating in the paranasal sinuses and extending to the anterior or middle skull base, requiring orbital exenteration. The flaps used included 6 radial forearm free flaps (RFFFs), 3 anterolateral thigh flaps (ALTs), 4 thoracodorsal artery perforator free flaps (TDAPs), and 1 pedicled supraclavicular flap. There were no major complications, such as perioperative heart attack, stroke, death, or meningitis. Minor complications included 3 mesh exposures after radiation treatment, 1 wound infection, and 2 flaps with wound dehiscence after radiation. These 2 dehiscences were seen with RFFFs and were later reoperated using TDAPs. There were no cerebrospinal fluid leaks or donor-site morbidity. There were no complaints of functional deficits, such as feeding difficulties or speech impairments. Some visual disturbance was reported after orbital exenteration, although this was an expected outcome. CONCLUSIONS: Vascularized flaps provide reliable and durable reconstructive options for anterior and middle skull base defects after resection of large complex malignant neoplasms of the craniofacial region. Free flaps, such as RFFFs, ALTs, and TDAPs, are well suited for these defects. They have a low risk of complications and low donor-site morbidity and offer good functional and esthetic outcomes.