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Say MA. Subperichondrial Hematoma of Alar Cartilage: A Case Report. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2023; 35:231-233. [PMID: 37497163 PMCID: PMC10368167 DOI: 10.22038/ijorl.2023.71166.3417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/20/2023] [Indexed: 07/28/2023]
Abstract
Introduction Cartilage deformation may develop due to congenital and trauma-related hematomas. Early diagnosis and treatment are imperative to prevent aesthetic and functional complications related to alar cartilage hematomas. Case Report An 8-year-old male presented with a major alar cartilage hematoma with a nasal fracture as a result of trauma. The patient underwent surgery on the 1st day of trauma for alar cartilage hematoma drainage and nasal bone reduction. No functional or cosmetic complications were observed in the patient's postoperative 1st month. Conclusion Subperichondral hematomas of the alar cartilage are rarely observed after nasal trauma and early diagnosis and treatment are important to prevent possible complications.
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Affiliation(s)
- Mehmet Ali Say
- Department of Otolaryngology, Cerkezköy State Hospital, Tekirdağ, Turkey
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Fuchs A, Bartolf-Kopp M, Böhm H, Straub A, Kübler AC, Linz C, Gbureck U. Composite grafts made of polycaprolactone fiber mats and oil-based calcium phosphate cement pastes for the reconstruction of cranial and maxillofacial defects. Clin Oral Investig 2023; 27:3199-3209. [PMID: 36864278 PMCID: PMC10264493 DOI: 10.1007/s00784-023-04932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES Synthetic bone substitutes which can be adapted preoperatively and patient specific may be helpful in various bony defects in the field of oral- and maxillofacial surgery. For this purpose, composite grafts made of self-setting and oil-based calcium phosphate cement (CPC) pastes, which were reinforced with 3D-printed polycaprolactone (PCL) fiber mats were manufactured. MATERIALS AND METHODS Bone defect models were acquired using patient data from real defect situations of patients from our clinic. Using a mirror imaging technique, templates of the defect situation were fabricated via a commercially available 3D-printing system. The composite grafts were assembled layer by layer, aligned on top of these templates and fitted into the defect situation. Besides, PCL-reinforced CPC samples were evaluated regarding their structural and mechanical properties via X-ray diffraction (XRD), infrared (IR) spectroscopy, scanning electron microscopy (SEM), and 3-point-bending testing. RESULTS The process sequence including data acquisition, template fabrication, and manufacturing of patient specific implants proved to be accurate and uncomplicated. The individual implants consisting mainly of hydroxyapatite and tetracalcium phosphate displayed good processability and a high precision of fit. The mechanical properties of the CPC cements in terms of maximum force and stress load to material fatigue were not negatively affected by the PCL fiber reinforcement, whereas clinical handling properties increased remarkably. CONCLUSION PCL fiber reinforcement of CPC cements enables the production of very freely modelable three-dimensional implants with adequate chemical and mechanical properties for bone replacement applications. CLINICAL RELEVANCE The complex bone morphology in the region of the facial skull often poses a great challenge for a sufficient reconstruction of bony defects. A full-fledged bone replacement here often requires the replication of filigree three-dimensional structures partly without support from the surrounding tissue. With regard to this problem, the combination of smooth 3D-printed fiber mats and oil-based CPC pastes represents a promising method for fabricating patient specific degradable implants for the treatment of various craniofacial bone defects.
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Affiliation(s)
- Andreas Fuchs
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany.
| | - Michael Bartolf-Kopp
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Hartmut Böhm
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Anton Straub
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Alexander C Kübler
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Christian Linz
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
- Department of Oral and Maxillofacial Plastic Surgery, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
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Risk Factors for Maxillary Sinus Pathology after Surgery for Midfacial Fracture: A Multivariate Analysis. J Clin Med 2022; 11:jcm11216299. [DOI: 10.3390/jcm11216299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to determine the incidence of maxillary sinus pathology in patients with a midfacial fracture who underwent osteosynthesis surgery and evaluate the associated risk factors. We conducted a retrospective case-control analysis of patients with midfacial fractures involving a maxillary sinus wall who were treated with open reduction and internal fixation (ORIF) between January 2015 and December 2020. Fracture reduction, the number of screws implanted in the maxillary sinus, and the number of screws penetrating the maxillary sinus, etc., were examined as potential risk factors. Maxillary sinus pathology on postoperative CT was considered the primary outcome for case-control analysis. Binary logistic regression was used to identify variables associated with postoperative maxillary sinus pathology. Thereafter, propensity score matching (PSM) was used to extract confounding factors. A total of 262 patients (totaling 372 maxillary sinuses) were included for analysis. PSM yielded 178, 246, and 70 matched sinuses, respectively, depending on the potential risk factors. Postoperative maxillary sinus pathology was visualized in 218 of the 372 maxillary sinuses (58.60%). The risk factors for postoperative maxillary sinus pathology included the number of screws penetrating the maxillary sinus (odds ratio (OR), 1.124; p = 0.007), an imperfect maxillary sinus wall fracture reduction (OR, 2.901; p = 0.021), and the number of sinus walls involved (OR, 1.383; p = 0.011). After PSM, postoperative maxillary sinus pathology was still more prevalent in sinuses with multiple maxillary sinus wall fractures (64.04% vs. 48.31%, p = 0.034), sinuses with more screws penetrating the maxillary sinus (64.23% vs. 50.41%, p = 0.028), and sinuses with an imperfect reduction (80% vs. 51.43%, p = 0.012). In conclusion, maxillary sinus pathology is common after the ORIF of midfacial fractures. Patients with a fracture of multiple maxillary sinus walls require a close follow-up. Screw penetration of the maxillary sinus should be avoided to prevent maxillary sinus pathology after a midfacial fracture ORIF.
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Psillas G, Dimas GG, Papaioannou D, Savopoulos C, Constantinidis J. Epistaxis in dental and maxillofacial practice: a comprehensive review. J Korean Assoc Oral Maxillofac Surg 2022; 48:13-20. [PMID: 35221303 PMCID: PMC8890961 DOI: 10.5125/jkaoms.2022.48.1.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/05/2021] [Accepted: 04/20/2021] [Indexed: 11/07/2022] Open
Abstract
The lifetime incidence of epistaxis in dental and maxillofacial practice has been reported to be as high as 60% and can be caused by dental implant placement, Le Fort I osteotomy, intranasal supernumerary tooth, odontogenic tumors, blood disorders and maxillofacial trauma. Most epistaxis cases are minor and easily managed with direct compression on the nares for 10 minutes. For more significant or recurrent epistaxis, other techniques might include electrocautery, anterior or posterior nasal packing, or Foley catheter balloon. For patients with refractory epistaxis, cauterization of the sphenopalatine artery under endonasal endoscopy or embolization of the internal maxillary artery should be performed. Epistaxis control is required in patients diagnosed with inherited or acquired bleeding disorders or with drug-induced coagulopathies during dental procedures. In these cases, hemostatic system adjustment and hemostasis achieved by local and adjunctive methods are required. Dentists and maxillofacial surgeons must be aware that the nasal cavity is a potential source of perioperative hemorrhage. Depending on the invasiveness of the dental intervention, preoperative involvement of the hematologist and cardiologist is usually necessary to reverse anticoagulation or to cease anticoagulant therapy.
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Affiliation(s)
- George Psillas
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Grigorios Georgios Dimas
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Despoina Papaioannou
- School of Dentistry, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Jiannis Constantinidis
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Abstract
Orbital fractures are common in facial trauma and can be a challenge to treat. Understanding anatomy of the orbit, the clinical evaluation, indications for surgery, surgical approaches, complications, and postoperative are essential in providing appropriate treatment for patients who have sustained orbital fractures. In this article, the authors review the diagnostic evaluation, acute management, treatment options, and common complications of orbital fractures, as well as recent advancements in orbital fracture repairs.
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Affiliation(s)
- Peiran Zhou
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
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Kühnel TS, Hosemann WG, Weber R. [Postoperative treatment following paranasal sinus surgery]. HNO 2021; 69:517-528. [PMID: 33942126 DOI: 10.1007/s00106-021-01057-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Postoperative care is a crucial aspect for the success of paranasal sinus interventions. Basic procedures include saline nasal wash, which should be started on the first postoperative day, topical steroids, and antibiotics in cases of infection. Medical treatment involves aspiration of secretion in the inferior meatus during the first week. Removal of scabs in the surgical field should be carried out under endoscopic control beginning at the second week. Intervals are scheduled individually. Occlusion of the nose for the time of epithelium regeneration provides a moist space in the ethmoid, which improves wound healing.
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Affiliation(s)
- Thomas S Kühnel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Werner G Hosemann
- Fachbereich HNO, Helios Hanseklinikum Stralsund, Große Parower Straße 47, 18435, Stralsund, Deutschland
| | - Rainer Weber
- HNO-Klinik, Städtisches Klinikum Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Deutschland
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Abstract
Surgical management of lacrimal duct obstruction beyond the canaliculi proves to be a promising endeavor in most cases. To realize the full potential of endonasal dacryocystorhinostomy, some aspects of diagnosis and differential indication setting should be considered in order to avoid errors and problems during patient selection, execution of the technical procedure, and communication with ophthalmologists. These issues are described according to the clinical management of patients; current literature is cited.
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Affiliation(s)
- T Kühnel
- Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
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Zhang X, Han CY, Dai MJ, Chen JL, Zheng XH, Long J, Tang W, Tian WD, Liu L. Application of computer-assisted surgery techniques in the management of zygomatic complex fractures. Chin J Traumatol 2018; 21:281-286. [PMID: 30342986 PMCID: PMC6235788 DOI: 10.1016/j.cjtee.2018.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/28/2018] [Accepted: 04/05/2018] [Indexed: 02/07/2023] Open
Abstract
Patients suffering from zygomatic complex fractures always present facial deformity and dysfunctions, and thereafter develop psychological and physiological problems. It is really hard to get an ideal prognosis for the zygomatic complex fractures because of the complicated anatomical structures. Computer-assisted surgery techniques, as the new emerging auxiliary methods, can optimize the surgical protocol, predict operation outcomes, and improve the accuracy and quality of the operation. Meanwhile the postoperative complications can be reduced effectively. This review aims to provide a comprehensive overview of the application of computer-assisted surgery techniques in the management of zygomatic complex fractures.
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Affiliation(s)
- Xiao Zhang
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Chao-Ying Han
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Min-Jia Dai
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jin-Long Chen
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xiao-Hui Zheng
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jie Long
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wei Tang
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wei-Dong Tian
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Lei Liu
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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Malaviya P, Choudhary S. Zygomaticomaxillary buttress and its dilemma. J Korean Assoc Oral Maxillofac Surg 2018; 44:151-158. [PMID: 30181981 PMCID: PMC6117466 DOI: 10.5125/jkaoms.2018.44.4.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/25/2017] [Accepted: 06/05/2017] [Indexed: 11/07/2022] Open
Abstract
Zygomatic fractures are the second most common fractures of the facial skeleton, after nasal bone fractures. Due to its uniqueness, the malar bone plays a very important role in maintaining appropriate facial contours. Zygomatic fractures can cause ocular and mandibular functional impairment, along with cosmetic defects. With the help of advanced imaging techniques and various treatment options, the management of zygomatic fractures has become more sophisticated and less invasive. This article discusses zygomatic fractures in detail: their clinical and radiographic features, and the various treatment options available.
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Affiliation(s)
- Pallavi Malaviya
- Department of Oral and Maxillofacial Surgery, NIMS Dental College and Hospital, Jaipur, India
| | - Sandeep Choudhary
- Department of Oral Medicine Diagnosis and Radiology, NIMS Dental College and Hospital, Jaipur, India
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Kopacheva-Barsova G, Nikolovski N. Justification for Rhinoseptoplasty in Children - Our 10 Years Overview. Open Access Maced J Med Sci 2016; 4:397-403. [PMID: 27703562 PMCID: PMC5042622 DOI: 10.3889/oamjms.2016.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 07/17/2016] [Accepted: 07/19/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Nasal septal surgery and rhinoplasty are controversial in children. Traditionally, an attitude of restraint has been employed by most surgeons till an empirical age of 16 to 18 years. This is to avoid the possible adverse effects that the growth spurts may have on the nose and midface region. AIM: The aim of this paper was to present the results of rhinoplasty in children in order to restore the anatomy and function or to promote normal development and outgrowth of the nose. MATERIAL AND METHODS: Ninety seven children aged 6-14, with severe nose deformities and breathing problems through the nose, were admitted for septo/rhinoplasty at the University Clinic for Ear, Nose and Throat, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Republic of Macedonia. At our Clinic, they have been observed and photographed (with parent permission) in the period of 10 years (2006-2016). The most frequent cause of these deformities was the nasal trauma in early childhood which was ignored or untreated. All of them rhino/septoplasty were indicated in accordance with the above-mentioned recommendations for rhino/septoplasty in early childhood and in adolescents. RESULTS: In 51 children and adolescents septoplasty were prepared. Mostly there was a group of younger children age from 6-10 (68%) and adolescents (32%). In the other 31 children and adolescents, septorhinoplasty was prepared. Mostly there were children older than 12 years old and adolescents (70%). Only 30% were younger than 12 years, of course with severe nasal breathing problems, nasal septal deformities and deformities of the nasal pyramid. CONCLUSION: The growth centres of the nose have to be avoided if possible; long-term nasal issues will theoretically be minimised. If the surgeon replaces it, the cartilage of the nose becomes straighter but still intact.
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Affiliation(s)
- Gabriela Kopacheva-Barsova
- University Clinic for Ear, Nose and Throat, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Vodnjanska 17, Skopje, MK 1109, Republic of Macedonia
| | - Nikola Nikolovski
- University Clinic for Ear, Nose and Throat, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Vodnjanska 17, Skopje, MK 1109, Republic of Macedonia
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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