Coronal approach to zygomaticomaxillary complex fractures.

OBJECTIVE: Trauma of the zygomaticomaxillary complex constitutes 45% of all midface fractures. In the author's medical unit, the proportion is 40% of all fractures of the facial skeleton. Most zygomaticomaxillary complex fractures can be treated via local incisions, however; multiple, comminuted and late fractures require wide exposure of the fragments in order to adequately reposition them and to apply rigid fixation. PATIENTS AND METHODS: Thirty-one cases of comminuted or multiple fractures of the zygomaticomaxillary complex were treated with open reduction and rigid fixation by a coronal approach and analyzed for indications and postoperative complications. Twenty three patients had a hemi coronal approach and eight had a bicoronal approach. RESULTS: Among the early complications noted were one case of hemorrhage, no infections, and two patients experienced paresthesia/ anesthesia in the supra orbital region, two patients in the temporal/parietal region, six patients experienced facial nerve weakness related to nerve retraction and moderate surgical edema was observed in three patients. Late complications included two cases of alopecia/baldness along the incision, one case of persistent paresthesia in the operative area. As far as the esthetics in relation to the incision was concerned, all patients were extremely satisfied. CONCLUSIONS: The results of this study suggest that a coronal approach will facilitate accurate reduction and fixation of fragments and will allow good cosmetic result with minimal or no complications. The coronal incisions should be the first choice in case of comminuted, multiple and late zygomaticomaxillary complex fractures. However, indications for the use of coronal incisions must be strictly applied.

Comparative evaluation of 2.3 mm locking plate system vs conventional 2.0 mm non locking plate system for mandibular condyle fracture fixation: a seven year retrospective study.

OBJECTIVE: This retrospective study evaluated the efficacy of a 2.3 mm locking plate/screw system compared with a 2.0-mm non-locking plate/screw system in fixation of isolated non comminuted mandibular condyle fractures. PATIENTS AND METHODS: Surgical records of 101 patients who received either a 2.3 mm locking plate (group A, n = 51) or 2.0 mm non locking plate (group B, n = 50) were analyzed. All patients were followed up to a minimum of 6 months postoperatively and evaluated for hardware related complications, occlusal stability, need for and duration of MMF and mandibular functional results. RESULTS: Four complications occurred in the locking group and eighteen in the non locking group with complication rates equalling 8% and 36% respectively. When comparing the overall results according to plates used, the χ2 test showed a statistically significant difference between the locking and non locking plates (p < 0.001). Fewer patients required postoperative MMF in group A. CONCLUSIONS: Mandibular condyle fractures treated with a 2.3 mm locking plate exhibited stable osteosynthesis, were associated with minimal complications and resulted in acceptable mandibular range of motion compared with a 2.0 mm non locking plate.

Clinical effectiveness of 125I-seed implantation in combination with nimotuzumab therapy for the advanced oral carcinoma: preliminary results.

OBJECTIVE: This study determines the short-term efficacy and toxicity of combined 125I-seed implantation and nimotuzumab in treating the advanced oral carcinoma. 125I-seed implantation is safe and has shown good short-term efficacy in clinical practice. Nimotuzumab is a useful biological agent for targeted therapy. Effect of 125I-seed implantation with nimotuzumab in treating oral carcinomas remains unclear. PATIENTS AND METHODS: From November 2011 to December 2012, 11 patients with advanced oral carcinoma (pathologic types: 7 cases of squamous cell carcinoma and 4 cases of poorly differentiated adenocarcinoma) were enrolled in our hospital. The patients did not receive surgery due to systemic disease or locally advanced cancer. All of them underwent 125I-seed implantation with the matched peripheral doses (MPD) ranging from 90-100 Gy. The apparent activity per seed ranged from 0.6 mCi (2.22 MBq) to 0.7 mCi (2.59 MBq). Later, all patients were given nimotuzumab (200 mg, intravenous drip, weekly, for 6 weeks). The patients were then followed up and the response rate, acute/chronic radiation-induced injury, and safety of the induction treatment were analyzed. RESULTS: Three patients achieved complete while 6 patients had partial response; yielding a response rate of 81.8%. Major adverse events included radiation-induced oral mucositis, local hemorrhage, bone marrow suppression, nausea/vomiting, and alopecia. Adverse reaction was not significantly different between the group of patients under 65 years of age and over 65 years of age (p > 0.05). Nimotuzumab enhanced the tumor sensitivity to brachytherapy without increasing AEs and improved the patients' life quality. CONCLUSIONS: 125I-seed implantation combined with nimotuzumab is effective and safe for patients with unresectable oral carcinoma.

TPS-guided interstitial Iodine-125 implantation in patients with oral cavity and maxillofacial carcinomas.

OBJECTIVE: To investigate the efficacy as well as the complications involved in the use of interstitial Iodine-125 implantation for the treatment of oral cavity and maxillofacial carcinomas. PATIENTS AND METHODS: Fifteen patients with oral cavity and maxillofacial carcinomas received treatment planning system (TPS)-guided interstitial Iodine-125 implantation. The apparent activity per particle ranged from 0.6 mCi (2.22MBq) to 0.7 mCi (2.59MBq). The matched peripheral dose delivered by radioactive seeds ranged from 90 to 120 Gy. The efficacy of the treatment and the postoperative complications were evaluated during follow-up. RESULTS: The seeds were implanted successfully in all 15 patients and median number of seeds implanted was 36.53. CT scans were performed in all patients at 1-6 months postoperatively. During follow-up at 6-27 months, seed migration occurred and a good local tumor control was achieved with an overall response of 86.7%. No severe side effects were observed. CONCLUSIONS: TPS-guided interstitial Iodine-125 implantation is an effective and safe procedure with minimal invasiveness for the treatment of oral cavity and maxillofacial carcinomas, and it effectively prevents the recurrence of cancer and short-term lymphatic metastasis.

Digital subtraction angiography (DSA) guided sequential sclerotherapy for maxillofacial vein malformation.

OBJECTIVES: Venous malformations commonly occur in the head and neck and affect the patient's appearance and also cause pain, ulcers, and bleeding. Current treatment options have many limitations and it is necessary to explore alternate methods to address these malformations. This work was aimed to explore the best method for treating patients with maxillofacial vein malformation. PATIENTS AND METHODS: Guided by digital subtraction angiography, 43 patients with maxillofacial vein malformation were treated with sequential sclerotherapy intervention. RESULTS: Patients were followed up for 7 months to 3 years. Lesions completely recessed in 7 cases. Recession rates were greater than 50% in 28 cases, 25-50% in 5 cases, and less than 25% in 3 cases. No severe complications occurred. CONCLUSIONS: Sclerotherapy with ethanol and pingyangmycin is a safe and effective method of treating maxillofacial vein malformation.