Does Training Background Influence Outcomes after Coronal Scalp Incision for Treating Craniomaxillofacial Injuries?: A German Pilot Study.

Objectives: To examine outcomes of the coronal scalp approach to craniomaxillofacial (CMF) fractures performed by oral-maxillofacial or craniofacial plastic surgery residents (OMFS/CFPS-Rs) vs. trauma surgery residents (TS-Rs), and to determine differences in treatment outcomes between both operator groups. Methods: This retrospective cohort study enrolled a sample of CMF fracture adult patients treated via the coronal approach in a German level one trauma center during a two-year interval. The predictor variable was training background (OMFS/CFPS-Rs vs. TS-Rs; each n = 5). All trainees must assist in ≥ two surgeries before self-performance. The main outcomes were length of hospital stay (LHS) and coronal flap-related complications (CFRCs). Appropriate statistics were computed at α = 95%. Results: Of the 97 patients identified during the study period; 71 of whom (19.7% females; mean age, 40.2 ± 15.2 years; 46.5% operated by TS-Rs; 38% combined upper and midfacial fractures) met the inclusion criteria. Operative time, LHS, CFRCs, readmission rates, and post-discharge emergency room visits were not significantly different between the trainee groups. 60% of CFRCs were visible/unfavorable or hypertrophic scar with/without alopecia. The number needed to treat of short LHS was 44 (95% confidence interval [CI], 3.9 to 4.8), the number needed to harm of CFRCs was 14 (95% CI, 3.6 to 7.4), i.e., the likelihood to be helped or harmed was 0.32. Conclusions: Coronal flap raising by OMFS/CFPS-Rs does not appear beneficial over that by TS-Rs in terms of LHS and CFRCs evaluated until postoperative month six. Trainees from any surgical specialties could gain partial independence from skilled surgeons in CMF trauma "sub-steps" and favorable clinical outcomes. Further studies in a larger sample cohort are required to confirm this pilot data.

Modified Temporal Incision for the Management of Zygomatic Arch fractures-A Retrospective Study for 7 Years.

Study Design: Retrospective cross-sectional study. Objective: The objective of this retrospective study was to evaluate the clinical outcomes of Modified temporal incision in the management of zygomatic arch fractures (ZAF). Patients and Methods: Records of 34 patients who underwent open reduction for zygomatic arch fractures were retrieved and included in the study between 2011 and 2018. These patients were followed up at 4 weeks, 8 weeks and 12 weeks respectively. Clinical parameters such as post-operative infection, hematoma, scarring, degree of mouth opening, palpability of plates, alopecia and weakness of temporal branch of Facial nerve recorded were analyzed for complications of modified temporal incision in the management of ZAF. Results: A thorough analysis of the clinical parameters revealed that at the end of 4 weeks scarring was present in 4 patients and temporal branch of Facial nerve weakness was present in 21 patients. None of the patients had hematoma, infection or palpability of miniplates. At the end of 8 weeks the only complication recorded was weakness of temporal branch of Facial nerve in 21 patients. By 12 weeks, all patients had complete recovery and none of the patient had weakness of temporal branch of Facial nerve. Conclusion: The results obtained proved that the Modified temporal incision can be considered as a reliable method in the management of zygomatic arch fractures. The incision can be adopted with confidence in suitable cases of zygomatic arch fractures without any permanent morbidity.

Comparison of incisions between two approaches in transaxillary breast augmentation / 中华医学美学美容杂志

Objective To compare the coronary incision with the sagittal incision in transaxillary breast augmentation.Methods A total of 60 patients who underwent transaxillary subpectoral breast augmentation with round breast implants were randomly allocated into two groups:Group A (30 patients) received coronary incision,while Group B received sagittal incision.The operative time of implant insertion,the distinction of scar and the repair rate of scar were compared between the two groups.Results The mean operative time of implant insertion in group A was (14.55±3.79)s,and that in group B was (27.38±6.79) s,with statistically significant difference (t =9.03,P＜0.05).But there was no statistical significance in the difference in the degree of scar (x2 =0.26,P＞0.05) or the repair rate of scar (x2=0.35,P＞0.05) between two groups.Conclusions As for the operative time of implant insertion,the coronary incision is better than the sagittal incision.

Clinical application of the modified scalp coronal incision in the treatment of zygomatic complex fractures / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the application of the modified scalp coronal incision in the treatment of zygomatic and zygomatic arch fracture, and analyze its prognosis. METHODS A retrospective analysis of 236 cases with zygomatic and zygomatic arch fracture from 2008 to 2016 was performed. They were treated with zygomatic and zygomatic arch fracture open reduction and firm fixation by the modified scalp coronal incision and postoperative mouse rehabilitation. After 3-6 months, the infection of incision, facial paralysis, occlusal, degree of mouth opening, facial deformity and subjective satisfaction index were followed up. The prognosis and recovery were evaluated. RESULTS 1. All of the patients had no postoperative incision infection, subcutaneous hematoma, temporal region sag, bald, and permanent facial paralysis. They all got satisfied face recovery. 2. All patients with occlusal disorders and limited mouth opening obtained functional occlusal and ideal degrees of mouth opening. Satisfaction was 97％. CONCLUSION The modified coronal scalp incision in the reconstruction of 3 d structure of zygomatic and zygomatic arch, has the advantages of a clear operation field and accurateresetting, good restoration of face, concealed scar. It contributes to the protection of the facial nerve and vascular structureand reduces the incidence of surgical complications.

Analysis on clinical effect of supratemporalis approach scalp coronal incision for treating craniomaxillofacial fracture / 重庆医学

Objective To investigate the effect of supratemporalis approach scalp coronal incision for treating craniomaxillofacial fracture.Methods Fifty-two cases of traditional coronal scalp approach were retrospectively analyzed for understanding the facial nerve damage situation.Then 30 cases a.dopted the supratemporalis approach scalp coronal incision and the facial nerve damage situation was recorded.The follow-up observation lasted for 6-24 months.Results The facial contour,mouth opening and occlusion function recovered well after the operation in all 82 cases.Eight cases of temporary facial nerve injury were observed in the traditional approach group.No case of facial nerve injury occurred in the supratemporalis approach group(P＜0.05).Conclusion The supratemporalis approach scalp coronal incision can effectively avoid the facial nerve injuries.

[Complications of supratemporalis approach with scalp coronal incision for orbital-zygomatic fracture].

OBJECTIVE: This study aimed to examine the complications of supratemporalis approach with scalp coronal incision for the treatment of orbital-zygomatic fractures. METHODS: A total of 206 patients with orbital-zygomatic fractures were treated with scalp coronal incision through the supratemporalis approach. The effects and complications of the treatment were analyzed. RESULTS: The degree of fracture of the 206 patients was successfully reduced. The facial morphologies and functions were improved. No facial nerve injury was observed in all of the cases. However, the following complications were noted: fossa introcession in 1 case, forehead scalp pain or paresthesia in 11 cases, incision infection in 1 case, subcutaneous hematoma in 1 case, incision scar in 5 cases, and alopecia in 3 cases. CONCLUSIONS: The supratemporalis approach prevents facial nerve injury and does not increase the frequency of other complications. Therefore, this approach can be applied as a routine and safe procedure in clinical settings. 
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Complications of supratemporalis approach with scalp coronal incision for orbital-zygomatic fracture / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aimed to examine the complications of supratemporalis approach with scalp coronal incision for the treatment of orbital-zygomatic fractures.</p><p><b>METHODS</b>A total of 206 patients with orbital-zygomatic fractures were treated with scalp coronal incision through the supratemporalis approach. The effects and complications of the treatment were analyzed.</p><p><b>RESULTS</b>The degree of fracture of the 206 patients was successfully reduced. The facial morphologies and functions were improved. No facial nerve injury was observed in all of the cases. However, the following complications were noted: fossa introcession in 1 case, forehead scalp pain or paresthesia in 11 cases, incision infection in 1 case, subcutaneous hematoma in 1 case, incision scar in 5 cases, and alopecia in 3 cases.</p><p><b>CONCLUSIONS</b>The supratemporalis approach prevents facial nerve injury and does not increase the frequency of other complications. Therefore, this approach can be applied as a routine and safe procedure in clinical settings. 
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Minimizing complications associated with coronal approach by application of various modifications in surgical technique for treating facial trauma: A prospective study.

BACKGROUND: Coronal incision is a popular and versatile surgical approach to the anterior cranial vault and upper and middle third facial skeleton. The flap itself permits widespread exposure of the fractures in this region. The bicoronal flap was first described by Hartley and Kenyon (neurosurgeons) to gain access to the anterior cranium in 1907. It extension as an access flap to the upper and lateral aspect of the face was pioneered by Tessier (1971). Esthetically, it is pleasing as the surgical scar is hidden within the hair. AIMS: To evaluate the versatility of coronal incision using various modifications advocated in incision, exposure to fractured site, and closure of flap in treating the upper and middle third facial fractures. MATERIALS AND METHODS: A total of ten patients diagnosed with upper and middle third facial fractures requiring open reduction and internal fixation/correction of contour defect were selected after preoperative clinical and radiographic (computed tomography scan) evaluation. All the cases were operated by coronal approach to gain the access to the fracture/defect site for reduction/correction of the defect. Advantages and complication are evaluated. RESULTS: Excellent access and anatomical reduction by this approach with least number of complications; if it is performed with healthy knowledge of anatomy of the scalp and temporal region. Certain minimal complications have also been noted using various modifications used in the procedure. CONCLUSION: Despite of prolonged surgical time for the exposure, it is very advantages in treating upper and middle third facial fractures due to wide access and discreet scar (minimal).

Cosmetic face, neck, and brow lifts with local anesthesia.

The sections on the face, neck, and brow include descriptions of facelift, neck lift, and open brow lift techniques, anesthesia, treatment goals, procedural approaches, complications, management, preoperative and postoperative care, rehabilitation, recovery, and outcomes. The approach to facial rejuvenation the midface and periorbital area is detailed. These operations are often and easily performed entirely with the use of local anesthesia and mild oral sedation. There are very high satisfaction rates.

The effect of large trauma craniotomy with bilateral frontal coronal incision on the efficacy and prognosis of patients with contusion and laceration of bilateral frontal lobes / 中国医师进修杂志

ObjectiveTo explore the efficacy of large trauma craniotomy with bilateral frontal coronal incision in treating contusion and laceration of bilateral frontal lobes.MethodsThe clinical data of 68 patients with contusion and laceration of bilateral frontal lobes who were treated with bilateral decompressive craniectomy were analyzed retrospectively.There were 36 cases(observation group) treated with large trauma craniotomy with bilateral frontal coronal incision and 32 cases (control group) given bilateral decompressive craniectomy by stages.The prognosis of two groups were observed and compared.The prognosis was evaluated at 6 months after surgery by Glasgow outcome scale (GOS) score.ResultsThere were 23 cases (63.89％,23/36) who got good recovery,8 cases(22.22％,8/36) with poor prognosis and 5 dead cases (13.89％,5/36) in observation group.There were 11 cases (34.38％,11/32) who got good recovery,9 cases (28.12％,9/32) with poor prognosis and 12 dead cases (37.50％,12/32) in control group.The rate of good recovery and mortality between two groups had significant differences (P ＜ 0.05).ConclusionsThe large trauma craniotomy with bilateral frontal coronal incision can significantly relieve or ease intracranial hypertension of patients with contusion and laceration of bilateral frontal lobes.And it can improve the prognosis and decrease the mortality.

An aesthetically possible alternative approach for craniomaxillofacial trauma: the "pretrichial incision".

Frontal sinus and supraorbital rim fractures are common in facial trauma patients. Coronal incision is the standard approach for surgical management of these injuries. Nevertheless, with this incision, complications can occur as wide scars and alopecia. Because surgical repair of fronto-orbital fractures is often indicated for aesthetic reasons, surgical incision might be an "aesthetic incision." So we have adopted the pretrichial incision, already used in brow-lift and foreheadplasty but never described in craniomaxillofacial trauma surgery. Nineteen upper-third facial trauma patients were treated: five cases were approached via an existing laceration, four cases via a coronal incision, and 10 cases via a unilateral zigzag pretrichial incision. To assess the postsurgical scar, the Patient and Observer Scar Assessment Scale was used and the scar's width was measured. In all cases, a wide surgical field was obtained to perform correct fracture reduction. Unlike straight or stealth coronal incisions, with pretrichial incision no wide scar or alopecia was registered. We think that pretrichial incision is an aesthetically reasonable alternative to the standard coronal approach for craniomaxillofacial trauma patients.

A study on coronal incision for treating zygomatic complex fractures.

OBJECTIVE: To study the value of coronal incisions for treating zygomatic complex fractures and evaluate the advantages, indications and complications associated with it. METHOD: In this prospective study, 12 patients were randomly selected regardless of age, sex requiring open reduction and internal fixation of communited zygomatic complex fractures with or without other associated fractures of the midface. Patients were all treated by coronal approach for open reduction and internal fixation of fracture of the zygomatic complex. Other local incisions were used if required. RESULTS: In all cases postoperative complications were relatively minor except in one case were the temporal branch of facial nerve weakness persisted at 3 months. Whereas 5 cases reported with slight weakness of the temporal branch of the facial nerve which resolved at the end of 3 months. The time taken for exposure of the fracture site via the coronal incision had a mean of 28.7 minutes. There were no cases of flap infection and just 1 case of stitch abscess reported. The same case later reported with a hypertrophic scar formation of greater than 0.5cm at 3months. In all other cases scar formation was negligible and well hidden within the hairline. There were no reported cases of paraesthesia at the operated site or hollowing of the temporal fossa. CONCLUSION: The coronal incision provides excellent access to the zygomatic arch and zygomatic complex, aiding in good anatomical reduction and also has the added advantage of the scar hidden in the hairline. It also has disadvantages like long operating time, risk of facial nerve injury, scarring in patients with male pattern baldness, paraesthesia of operated site etc. Therefore the incision should be judiciously used and not overused and indications strictly applied.

Therapeutic effects of coronal incision on midface fracture / 第三军医大学学报

Objective To investigate the advantages of coronal incision in the repair of midface fracture. Methods The clinical data of 42 patients who applied coronal incision and other adjuvant incisions to repair midface fractures were retrospectively analysed. Results The coronal incision can provide excellent exposure and methods for camouflaging the incision in the hair, and brought less complications and functional impairment. Conclusion Coronal incision was an ideal approach in the repair of the midface fracture.

THE STUDY FOR HEMODYNAMIC CHANGE ON CORONAL APPROACH TO ZYGOMATICO-MAXILLARY COMPLEX FRACTURE

BACKGROUND: The coronal incision is versatile surgical approach to upper and middle region of the facial skeletal including the zygomatic arch. The advantages of coronal approach are minimal injury of facial tissue including facial nerve and satisfactory cosmetic result by hidden scar at hair. But wide exposure of scalp, its disadvantages are operation time and massive blood loss. METHODS: Thirty patients undergoing elective surgery were divided 3 groups. Group I used only coronal approach, group II used coronal with subciliary approach and group III used coronal with subciliary and intraoral approach. And then retrospected of the preoperative, postoperative red blood cell count, hemoglobin(Hb), hematocrit, transfused red blood cell units and platelet cell units, and the amount of infused crystalloids and colloids, and postoperative hemovac count was estimated. RESULTS: 1. Red blood cell count were decreased in all groups at immediated postoperation and decreased in all group of postoperative first day and decreased in group I, II but increased group III of postoperative third day. 2. Hemoglobin and hematocrit were decreased in all group at immediated postoperation and decreased in all group of postoperative first day and decreased in group I, II., but increased group III postoperative third day. 3. Platelet was decreased in all group at immediated postoperation, and decreased in group II, III but increased in group I of postoperative first day and decreased in group I but increased group II, III of postoperative third day. 4. Mean postoperative hemovac mean drainage group I of first day is 48.63+/-21.12ml and second day is 23.92+/-19.53ml and third day is 7.82+/-5.32ml and group II of first day 60.45+/-22.65ml and second day is 22.14+/-13.21ml and third day is 7.32+/-6.25ml. III group of first day 58.16+/-10.13ml and second day is 21.27+/-11.72ml and third day is 7.13+/-4.90ml. 5. Infusion of group I is mean PRC 1.08+/-0.91 pint, FFP 1.03+/-0.75 pint, crystalloid 2562.23+/-1345.53ml and group II is mean PRC 1.05+/-0.89 pint, FFP 1.71+/-0.78, crystalloid 2650.47+/-1096.36ml and group III is mean PRC 1.79+/-1.45 pint, crystalloid 3295.43+/-1472.432ml.

The application of coronal incision in the surgical treatment of zygomatic complex fracture / 实用口腔医学杂志

Objective:To study the indications, surgical technique and complications of the coronal approach in the treatment of zygomatic complex fractures.Methods:Eighty-four patients with zygomatic complex fracture underwent coronal incisions for surgery. Micro or mini titanium bone plates were used to stabilize the fractured bones.In patients with endophthalmos orbital wall fractures were treated with hydroxyapatite.Follow-up was conducted for 3 months to 2 years.Results:All patients had no wound infection after operation. There was no permanent facial nerve motor function deficit. All of the patients with malocclusion regained their functional occlusion after treatment. The patients with restriction of mouth opening recovered after training. Eight patients had observable asymmetry characterized by widening of the face on the side of the injury. One patient sustained the postoperative endophthalmos beyond 3 mm.Conclusion:Coronal approach is feasible in the surgical treatment of zogomatic complex fracture.

Management of zygomatic complex fractures / 实用口腔医学杂志

砄bjective: To study the cause,clinical characteristics and treatment of zygomatic complex fractres(ZCF). Methods: Medical records of 79 cases with ZCF and followed up for 3 months to 2 years were reviwed and analysed. Reduction and cosmatic outcome were assessed by clinical evaluation and postoperative images. Results: Of the 79 patients, 87.3% were male, with the peak incidence in the age group from 20 to 40 years old(73.5%). 58.2% were due to traffic accidents, 15.2% to assalts. Incidence of malar asymmetry, enophthalmos, diplopia,limited mandiblar movement and malocclusion were 83.5%,24.1%,19.0%, 60.8% and 35.4% respectively. Of the nerve disturbances, 41.8% of the infraorbital and 13.9% of the facial nerve were involved. For the treatment the most freqently used approach was the coronal incision in combination with the maxillary vestibular incision(30.4%), followed by coronal incision alone(22.8%). 40.5% of the patients were treated by rigid internal fixation with titanium miniplates alone or combined with wire fixition(20.3%). All patients but five regained satisfactary facial appearance. Three patients still showed slightly post surgical enophthalmos and diplopia at a 6 month follow up. All of the patients with malocclusion regained their functional occlusion after treatment. Conclsions:A variety of techniques can be used in the treatment of ZCF. Among them the coronal incision in combination with other incisions or alone and rigid internal fixation can produce a satisfactary outcome.