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Khattak YR, Ghaffar N, Gulzar MA, Rahim S, Rafique F, Jan Z, Iqbal S, Ahmad I. Can growing patients with end-stage TMJ pathology be successfully treated with alloplastic temporomandibular joint reconstruction? - A systematic review. Oral Maxillofac Surg 2024; 28:529-537. [PMID: 37733214 DOI: 10.1007/s10006-023-01180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION The use of alloplastic total temporomandibular joint reconstruction (TMJR) in growing patients is controversial, mainly due to immature elements of the craniomaxillofacial skeleton. The aim of this systematic review was to evaluate the use of alloplastic TMJR in growing patients, focusing on the patient's clinical presentation, surgical and medical history and efficacy of alloplastic TMJR implantation. MATERIALS AND METHODS The literature search strategy was based on the Population, Intervention, Comparator, Outcomes and Study type (PICOS) framework. We searched Pubmed, Google Scholar, Dimension, Web of Science, X-mol, Semantic Scholar and Embase to January 2023, without any restriction on the type of publication reporting alloplastic TMJR in growing patients (age ≤ 18 years for boys and age ≤ 15 years for girls). RESULTS A total of 15 studies (case reports: 09, case series: 02, cohort studies: 04) met the inclusion criteria, documenting 73 patients of growing age from 07 countries. Thirty-eight (~ 52%) cases were female. The mean ± SD (range) age and follow-up of patients in all studies was 13.1 ± 3.2 (0-17) years and 34.3 ± 21.5 (7-96) months, respectively. A total of 22 (30%) patients were implanted with bilateral alloplastic TMJR. Over half of the studies (n = 10) were published in the last 3 years. All patients underwent multiple surgeries prior to implantation of alloplastic TMJR. In extreme cases, patients underwent a total of 17 surgeries. Different types of studies reporting inconsistent variables restricted our ability to perform quality assessment measures for evidence building. CONCLUSIONS Clinical experience with alloplastic TMJR in growing patients is limited to cases showing poor prognosis with other types of reconstruction. Nevertheless, studies show promising results for the use of alloplastic TMJR in growing patients, highlighting the need for well-controlled prospective studies with long-term follow-up.
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Affiliation(s)
| | | | | | - Sundas Rahim
- Peshawar Medical and Dental College, Peshawar, Pakistan
| | | | - Zainab Jan
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan
| | - Shaheen Iqbal
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan.
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Koenig ZA, Lokant BT, Weaver S, Brooke SM, Uygur HS. Surgical Guide Splint Fabrication via Virtual Surgical Planning for Complex Mandible Fractures in the Trauma Setting. J Craniofac Surg 2023:00001665-990000000-01199. [PMID: 37973056 DOI: 10.1097/scs.0000000000009898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION In cases of significantly displaced or comminuted mandible fractures, surgical guide splints can be developed to create the normal preinjury occlusion rather than placing patients in maxillomandibular fixation. Standard fracture fixation involves bending of plates intraoperatively based on surgeon-constructed dental splints which is prone to error. METHODS A 38-year-old male experienced a gunshot wound to the face that resulted in mandibular angle fractures bilaterally causing severely deranged occlusion and free-floating anterior mandible segment. Virtual surgical planning (VSP) software was used to recreate the injury-induced anatomy and anticipated postoperative anatomy. It also provided a surgical guide splint and a framework to preoperatively bend reconstruction plates to assist in achieving proper occlusion. RESULTS He underwent open reduction internal fixation of comminuted mandible fractures with lingual guide splint placement 10 days after injury. Following lingual splint application, the reconstruction plate was applied from angle to angle. The lingual splint was maintained for 3 weeks postoperatively to support the stabilization, and he was able to tolerate a regular diet and showed no evidence of wound breakdown. DISCUSSION Virtual surgical planning has had important implications in craniofacial surgery, orthognathic surgery, maxillomandibular reconstruction, and orbital reconstruction after tumor resection, temporomandibular joint surgery, and others. However, there have only been isolated reports describing the role of VSP in the facial trauma setting. In this technical study, the authors demonstrate the benefits of VSP and surgical guide splinting in trauma settings.
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Affiliation(s)
- Zachary A Koenig
- West Virginia University Division of Plastic, Reconstructive, & Hand Surgery
| | | | | | - Sebastian M Brooke
- West Virginia University Division of Plastic, Reconstructive, & Hand Surgery
| | - Halil S Uygur
- West Virginia University Division of Plastic, Reconstructive, & Hand Surgery
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Omole D, Khatib B, Patel AA, Cheng A, Salama A, Brecht LE, Hirsch DL. Reconstructing the Mandible: Jaw-In-A-Day: Where We Were, Where We Are, and the Future. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:153-164. [PMID: 37500199 DOI: 10.1016/j.cxom.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- David Omole
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine, Northwell Health, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Baber Khatib
- Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland, OR, USA; Trauma Service, Legacy Emanuel Medical Center, Portland, OR, USA; Head and Neck Institute, 1849 NW Kearney Street #300, Portland, OR 97209, USA
| | - Ashish A Patel
- Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland, OR, USA; Trauma Service, Legacy Emanuel Medical Center, Portland, OR, USA; Head and Neck Institute, 1849 NW Kearney Street #300, Portland, OR 97209, USA
| | - Allen Cheng
- Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland, OR, USA; Trauma Service, Legacy Emanuel Medical Center, Portland, OR, USA; Head and Neck Institute, 1849 NW Kearney Street #300, Portland, OR 97209, USA
| | - Andrew Salama
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine, Northwell Health, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA
| | - Lawrence E Brecht
- Department of Dental Medicine, Northwell Health, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA
| | - David L Hirsch
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine, Northwell Health, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA
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Wamkpah NS, Kimball A, Pipkorn P. Evidence-Based Medicine for Ballistic Maxillofacial Trauma. Facial Plast Surg 2023; 39:237-252. [PMID: 36929067 DOI: 10.1055/s-0043-1764347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Ballistic trauma is a serious health issue with significant costs to physical, psychosocial, economic, and societal well-being. It may be caused from firearms, explosive devices, or any other projectile forces, and is characterized by severe tissue loss and evolving tissue devitalization. This review covers mechanism, diagnosis, and management of ballistic maxillofacial trauma, specifically. Initial evaluation includes stabilization of airway, bleeding, and circulation, followed by assessment of other injuries. The overall degree of tissue damage is determined by intrinsic patient factors and extrinsic projectile factors. Management of ballistic injuries has shifted toward advocation for early operative repair with the advent of antibiotics and advanced techniques in maxillofacial reconstruction. Appropriate timing and method of reconstruction should be carefully selected on a case-by-case basis. While ballistic trauma research is limited to studies biased by institutional practices, areas for further study identified from current literature include guidelines directing timing of reconstructive surgery; thresholds for free tissue transfer; handling of retained projectiles; incidence of surgical complications; and clinical outcomes for computer-aided surgical repair of these highly destructive injuries.
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Affiliation(s)
- Nneoma S Wamkpah
- Department of Otolaryngology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Abby Kimball
- InPrint, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Patrik Pipkorn
- Department of Otolaryngology, Washington University in St Louis School of Medicine, St Louis, Missouri
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5
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Weyh A, Gomez J, Kashat K, Fernandes R, Bunnell A. Self-inflicted craniomaxillofacial gunshot wounds: management, reconstruction, and outcomes. Int J Oral Maxillofac Surg 2023; 52:334-342. [PMID: 35773056 DOI: 10.1016/j.ijom.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
Suicide by firearm remains one of the leading causes of violence-related injury death in the United States each year. The mortality rate from these injuries is high, resulting in a paucity of outcome data in the literature regarding injuries to the maxillofacial region. This has largely been attributed to a lack of funding for research in this area compared to other leading causes of mortality in the United States. The aim of this study was to detail the authors' experience and approach to complex maxillofacial reconstruction using both local reconstructive methods and microvascular free tissue transfer. A retrospective cohort study was designed, including patients who sustained self-inflicted gunshot wounds to the maxillofacial region between January 1, 2012 and May 1, 2020. Forty-one patients met the inclusion criteria. The majority of the patients were male (87.8%). Mean patient age was 44.2 ± 16.6 years. Alcohol or drugs, and a psychiatric history were present in a majority of the cases. The most involved anatomical region was the midface (75.6% of cases). Seven patients required free tissue transfer for reconstruction, with many needing multiple flaps. Self-inflicted gunshot wounds represent challenging reconstruction scenarios, often in the setting of severe psychological trauma, and require a multidisciplinary team to ensure the optimal outcome.
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Affiliation(s)
- A Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - J Gomez
- Department of Oral and Maxillofacial Surgery, Ascension Macomb-Oakland Hospital, Detroit, MI, USA.
| | - K Kashat
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - A Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
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Moolenaar JZ, Tümer N, Checa S. Computer-assisted preoperative planning of bone fracture fixation surgery: A state-of-the-art review. Front Bioeng Biotechnol 2022; 10:1037048. [PMID: 36312550 PMCID: PMC9613932 DOI: 10.3389/fbioe.2022.1037048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Bone fracture fixation surgery is one of the most commonly performed surgical procedures in the orthopedic field. However, fracture healing complications occur frequently, and the choice of the most optimal surgical approach often remains challenging. In the last years, computational tools have been developed with the aim to assist preoperative planning procedures of bone fracture fixation surgery. Objectives: The aims of this review are 1) to provide a comprehensive overview of the state-of-the-art in computer-assisted preoperative planning of bone fracture fixation surgery, 2) to assess the clinical feasibility of the existing virtual planning approaches, and 3) to assess their clinical efficacy in terms of clinical outcomes as compared to conventional planning methods. Methods: A literature search was performed in the MEDLINE-PubMed, Ovid-EMBASE, Ovid-EMCARE, Web of Science, and Cochrane libraries to identify articles reporting on the clinical use of computer-assisted preoperative planning of bone fracture fixation. Results: 79 articles were included to provide an overview of the state-of-the art in virtual planning. While patient-specific geometrical model construction, virtual bone fracture reduction, and virtual fixation planning are routinely applied in virtual planning, biomechanical analysis is rarely included in the planning framework. 21 of the included studies were used to assess the feasibility and efficacy of computer-assisted planning methods. The reported total mean planning duration ranged from 22 to 258 min in different studies. Computer-assisted planning resulted in reduced operation time (Standardized Mean Difference (SMD): -2.19; 95% Confidence Interval (CI): -2.87, -1.50), less blood loss (SMD: -1.99; 95% CI: -2.75, -1.24), decreased frequency of fluoroscopy (SMD: -2.18; 95% CI: -2.74, -1.61), shortened fracture healing times (SMD: -0.51; 95% CI: -0.97, -0.05) and less postoperative complications (Risk Ratio (RR): 0.64, 95% CI: 0.46, 0.90). No significant differences were found in hospitalization duration. Some studies reported improvements in reduction quality and functional outcomes but these results were not pooled for meta-analysis, since the reported outcome measures were too heterogeneous. Conclusion: Current computer-assisted planning approaches are feasible to be used in clinical practice and have been shown to improve clinical outcomes. Including biomechanical analysis into the framework has the potential to further improve clinical outcome.
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Affiliation(s)
- Jet Zoë Moolenaar
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, Netherlands
| | - Nazli Tümer
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, Netherlands
- *Correspondence: Nazli Tümer, ; Sara Checa,
| | - Sara Checa
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- *Correspondence: Nazli Tümer, ; Sara Checa,
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Knudson SA, Day KM, Kelley P, Padilla P, Collier IX, Henry S, Harshbarger R, Combs P. Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review. Craniomaxillofac Trauma Reconstr 2022; 15:206-218. [PMID: 36081679 PMCID: PMC9446274 DOI: 10.1177/19433875211026432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
Study Design Retrospective case series; systematic review. Objective It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. Methods A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis. Results Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline. Conclusions Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.
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Affiliation(s)
- Sean A. Knudson
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
| | - Kristopher M. Day
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Patrick Kelley
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Pablo Padilla
- Department of Plastic Surgery,
University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Ian X. Collier
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Steven Henry
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Raymond Harshbarger
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Patrick Combs
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
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Khatib B, Couey M, Patel A, Cheng A, Bell RB. A "Custom" Plate in a Day-Accurate Predictive Hole Fabrication Using Point-of-Care 3-Dimensional Printing. J Oral Maxillofac Surg 2021; 80:559-568. [PMID: 34958739 DOI: 10.1016/j.joms.2021.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE In computer surgical planned (CSP) fibular reconstructions of the mandible, custom plates facilitate accurate and efficient transfer of the digital plan intraoperatively by a way of predrilled fixation holes. Stock plates are more easily accessible and are more economical but typically preclude the utilization of these predictive holes. The purpose of this article is to describe an accurate and economical alternative to custom plates, while still having the ability to create predictive holes for plate alignment and execution of a digital surgical plan. METHODS An in vitro accuracy study was performed on a point-of-care resin-printed predictive hole guide termed "prebent plate analog" (PPA). Twenty stock 2.0 reconstruction plates prebent against a 3-dimensional printed mandibular model reconstructed with a 2-piece fibula were used to fabricate 20 PPAs. The proximal and distal 4 holes of each prebent plate and corresponding PPA were assessed using a heat map overlay, measuring difference in millimeters between matching points of the predictive hole segments. The median distance from the points of reference in the PPA versus the prebent plate was calculated for each predictive hole position in addition to the average error of the PPA to the stock plate. RESULTS Eighteen PPAs were used for statistical analysis; 2 were damaged in transport. The mean error between the body (-0.265) and condylar segments (-0.116 mm) and mean difference in error between the proximal predictive holes (-0.124 mm) and distal predictive holes (-0.215 mm) on the PPA were not statistically different (P = .061, P = .314 general estimating equation regression, respectively). The mean error across the PPA predictive holes and corresponding holes of the prebent plates was -0.194 mm (P < .001, general estimating equation regression). CONCLUSIONS The PPA is a precise and accurate analog that faithfully replicates the position of proximal and distal components of a prebent stock plate, thereby allowing for predictive hole placement in lieu of a custom plate in fibula mandibular reconstruction cases.
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Affiliation(s)
- Baber Khatib
- Attending Head and Neck/ Microvascular Reconstructive Surgeon, Providence, Head and Neck Cancer Program, Providence Cancer Center, Portland, OR; Attending Maxillofacial Surgeon, Legacy Emanuel/Good Samaritan Medical Center, Portland, OR; Consultant Head and Neck Institute, Portland, OR.
| | - Marcus Couey
- Fellow in Head and Neck Oncologic and Reconstructive Microvascular Surgery/Immuno-oncology Providence, Head and Neck Cancer Program, Providence Cancer Center, Portland, OR
| | - Ashish Patel
- Attending Head and Neck/Microvascular Surgeon, Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland, OR; Director of Maxillofacial Trauma, Trauma Service, Legacy Emanuel Medical Center, Portland, Oregon Consultant Head and Neck Institute, Portland, OR
| | - Allen Cheng
- Director, Head and Neck Cancer Program, Legacy Good Samaritan Medical Center, Portland OR; Consultant, Head and Neck Institute, Portland, OR
| | - R Bryan Bell
- Physician Executive and Director, Surgical Oncology, Radiation Oncology and Clinical Programs, Medical Director, Head and Neck Cancer Program Providence Cancer Institute Member and Director of Surgical Oncology Research Earle A. Chiles Research Institute
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Correction of Traumatic Transverse Mandibular Widening With Interdental Wiring. J Craniofac Surg 2021; 33:1214-1217. [PMID: 34759250 DOI: 10.1097/scs.0000000000008332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Mandibular symphysis fractures pose several technical challenges for the craniomaxillofacial surgeon. One classic challenge is restoration of the transverse dimension when the mandible is widened secondary to splaying of the lingual cortex. Failure to diagnose or correct this problem can result in widening of the lower facial third, inadequate fracture reduction, and/or a malocclusion. Surgeons have traditionally utilized techniques such as manual pressure to the rami or lingual splint application to address transverse defects intraoperatively. However, these methods may be inadequate in situations with significant widening, such as in the case of concomitant subcondylar fractures. More recently, virtual surgical planning and custom hardware have been utilized to address mandibular widening, though this method also has various shortcomings. In this technical note, the authors present a simple technique using interdental wiring to precisely control mandibular width intraoperatively. The technique is cost effective, does not require an assistant, and can be used in conjunction with any of the above methods. The authors also present a case of secondary reconstruction in which use of this technique was necessary given a large degree of mandibular widening not amenable to reduction and fixation with manual pressure alone.
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10
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Secondary Correction of Midface Fractures. Atlas Oral Maxillofac Surg Clin North Am 2020; 29:139-150. [PMID: 33516535 DOI: 10.1016/j.cxom.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Goetze E, Thiem DGE, Gielisch M, Al-Nawas B, Kämmerer PW. [Digitalization and use of artificial intelligence in microvascular reconstructive facial surgery]. Chirurg 2020; 91:216-221. [PMID: 31965197 DOI: 10.1007/s00104-019-01103-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND When using digitalization and artificial intelligence (AI), large amounts of data (big data) are produced, which can be processed by computers and used in the field of microvascular-reconstructive craniomaxillofacial surgery (CMFS). OBJECTIVE The aim of this article is to summarize current applications of digitalized medicine and AI in microvascular reconstructive CMFS. MATERIAL AND METHODS Review of frequent applications of digital medicine for microvascular CMFS reconstruction, focusing on digital planning, navigation, robotics and potential applications with AI. RESULTS The broadest utilization of medical digitalization is in the virtual planning of microvascular transplants, individualized implants and template-guided reconstruction. Navigation is commonly used for ablative tumor surgery but less frequently in reconstructions. Robotics are mainly employed in the transoral approach for tumor surgery of the hypopharynx, whereas the use of AI is still limited even if possible applications would be automated virtual planning and monitoring systems. CONCLUSION The use of digitalized methods and AI are adjuncts to microvascular reconstruction. Automatization approaches and simplification of technologies will provide such applications to a broader clientele in the future; however, in CMFS, robotic-assisted resections and automated flap monitoring are not yet the standard of care.
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Affiliation(s)
- E Goetze
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie - Plastische Operationen, Universitätsmedizin Mainz, Augustusplatz 2, 55131, Mainz, Deutschland
| | - D G E Thiem
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie - Plastische Operationen, Universitätsmedizin Mainz, Augustusplatz 2, 55131, Mainz, Deutschland
| | - M Gielisch
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie - Plastische Operationen, Universitätsmedizin Mainz, Augustusplatz 2, 55131, Mainz, Deutschland
| | - B Al-Nawas
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie - Plastische Operationen, Universitätsmedizin Mainz, Augustusplatz 2, 55131, Mainz, Deutschland.,Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyong Hee University, Seoul, Korea
| | - P W Kämmerer
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie - Plastische Operationen, Universitätsmedizin Mainz, Augustusplatz 2, 55131, Mainz, Deutschland.
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Kongsong W, Sittitavornwong S. Utilization of Virtual Surgical Planning for Surgical Splint-Assisted Comminuted Maxillomandibular Fracture Reduction and/or Fixation. Craniomaxillofac Trauma Reconstr 2020; 13:334-341. [PMID: 33456705 DOI: 10.1177/1943387520948677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design This article was a technical note. Objective To demonstrate the utilization of virtual surgical planning for surgical splint (VSPSS) fabrication. The VSPSS was used as an intraoperative assisting and guiding tool for reduction and/or fixation of treatment of comminuted maxillomandibular fractures. Methods The presented technical note showed the fabrication process that began with data acquisition and presurgical planning using virtual surgical planning (VSP). The VSPSS was designed and fabricated after the fractures were reduced digitally in VSP. In the operating room, the VSPSS was seated to guide reduction and/or allow satisfactory fixation in three different situations. Results Postoperative radiographs showed an acceptable reduction of the fractures. All patients had stable and repeatable occlusion postoperatively. Conclusions The VSPSS is a feasible tool for surgeons to assist in the comminuted maxillomandibular fracture management, decrease operating time, and improve fracture stability.
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Affiliation(s)
- Wichuda Kongsong
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.,Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, Alabama, USA
| | - Somsak Sittitavornwong
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, Alabama, USA
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13
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Zhu X, Han J, Zhang S, Min X, Liu J, Zhai G. Restoring Skeletal Marker Points for Severe Maxillary and Mandibular Jaw Defects Using a Linear Regression Approach. J Oral Maxillofac Surg 2019; 77:664.e1-664.e16. [DOI: 10.1016/j.joms.2018.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 11/26/2022]
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14
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Advancements in Maxillofacial Trauma: A Historical Perspective. J Oral Maxillofac Surg 2018; 76:2256-2270. [DOI: 10.1016/j.joms.2018.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 11/20/2022]
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