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.

Effect of Mandible and Maxilla Osteotomies on Velar, Oropharyngeal, and Hypopharyngeal Diameter.

PURPOSE: There is a lack of anatomic comparisons between maxillomandibular advancement (MMA) and other bony surgical treatments of obstructive sleep apnea (OSA). Surgical procedures were simulated in cadavers to evaluate their ability to expand the posterior airway space (PAS). MATERIALS AND METHODS: The following bony advancement surgeries were performed on each of 9 cadavers: genioglossal advancement (GGA); genioplasty with advancement of the genioglossus, geniohyoid, and anterior digastric muscles (GPA); bilateral sagittal split osteotomy; Le Fort I maxillary advancement; Le Fort I maxillary anterior impaction osteotomy (LFAI); MMA; MMA plus GPA; and MMA plus LFAI. Bony advancements were performed at increasing distances and change in PAS anteroposterior (AP) diameter was measured at the levels of the velum, oropharynx, and hypopharynx. RESULTS: Change in PAS varied in a linear fashion with advancement surgical maneuvers. GPA led to a greater increase in AP distance at the levels of the oropharynx and hypopharynx compared with GGA. LFAI showed a greater increase in AP distance at the velum compared with MMA. All maxillary movements showed greater AP expansion in the PAS at the velum compared with mandibular advancements. CONCLUSIONS: Static AP expansion of the PAS at the levels of the velum, oropharynx, and hypopharynx occurs in a roughly linear and predictable pattern with different bony surgical procedures used in OSA surgery. MMA alone and MMA plus GPA had the overall greatest effect at all airway levels. GPA had a greater effect on expansion of the oropharynx and hypopharynx compared with GGA.

E-cigarette Blast Injury: Complex Facial Fractures and Pneumocephalus.

Electronic cigarettes (also known as e-cigarettes or e-cigs) are becoming a popular method of recreational nicotine use over recent years. The growth of new brands and devices has been outpacing the FDA's ability to regulate them. As a result, some of these devices fail without warning, most likely from malfunction of the lithium-ion batteries that are in close proximity to volatile compounds within the device. Failures have occurred during both use and storage of the devices or their components. The subsequent injuries from several of these events, including full thickness burns requiring grafting and blast injuries, have been observed at Arrowhead Regional Medical Center, a regional trauma and burn center in southern California. One severe case resulted in several maxillofacial fractures, blurred vision, and pneumocephalus after a device failed catastrophically during use. The patient required close monitoring with serial imaging by neurosurgery in the intensive care unit and multiple procedures by oral maxillofacial surgery to reconstruct his facial bones and soft tissue. Ultimately, the patient recovered with minimal permanent damage, but the potential for further injury or even death was apparent. Cases such as this one are becoming more frequent. It is important to increase awareness of this growing problem for both medical professionals and the general public in order to curb this concerning new trend.