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Introduction of 3D Printing in a German Municipal Hospital-Practice Guide for CMF Surgery. 3D打印在德国市立医院CMF手术实践指南中的介绍。
IF 0.9 Pub Date : 2022-12-01 Epub Date: 2021-09-30 DOI: 10.1177/19433875211050721
H Gleissner, G Castrillon-Oberndorfer, St Gehrlich

Study design: This study aimed to introduce 3D printing in a municipal hospital to improve the treatment of craniomaxillofacial patients and optimize costs and operating time. Thus we describe the implementation of low-cost in-house 3D printing to facilitate orbital- and mandible reconstruction in CMF surgery. Moreover, we address legal requirements, safety at work, fire- and data protection. Finally, we want to share our experiences using 3D printing and point out its advantages in providing better patient care.

Methods: We outline the setup of in-house 3D printing and focus on obeying German health care regulations. We based our approach on a fused deposition modeling 3D printer and free software. As proof of concept, we treated 4 cases of severe orbital trauma and 1 case of mandibular reconstruction. We printed a 3D patient-specific model for each case and adapted a titanium mesh implant, respectively, a titanium reconstruction plate before performing the surgery.

Results: Our approach reduced costs, duration of anesthesia, operating time, recovery time, and postoperative swelling and increased the revenue. Functional outcome in orbital reconstruction like eye movement and double vision, was improved compared to the conventional technique. No severe complications like loss-of-vision or surgical revision occurred. Likewise, mandibular reconstruction showed no plate loosening or plate fracture.

Conclusion: The implementation of cost-efficient 3D printing resulted in successful patient treatment with excellent outcomes. Our practice guide offers a 3D printing workflow and could be adapted to fit the needs of other specialties like neurosurgery, orthopedic surgery as well.

研究设计:本研究旨在将3D打印引入某市立医院,改善颅颌面患者的治疗,优化成本和手术时间。因此,我们描述了实现低成本的内部3D打印,以促进眼眶和下颌骨重建在CMF手术。此外,我们还处理法律要求、工作安全、消防和数据保护。最后,我们想分享我们使用3D打印的经验,并指出它在提供更好的病人护理方面的优势。方法:我们概述了内部3D打印的设置,重点是遵守德国卫生保健法规。我们的方法基于熔融沉积建模3D打印机和免费软件。作为概念的证明,我们治疗了4例严重眶外伤和1例下颌骨重建。我们为每个病例打印了一个3D模型,并在手术前分别安装了钛网植入物和钛重建板。结果:该方法降低了成本、麻醉时间、手术时间、恢复时间和术后肿胀,增加了收入。与传统技术相比,眼眶重建的功能结果如眼球运动和复视得到改善。无严重并发症,如视力丧失或手术修复。同样,下颌骨重建未见钢板松动或骨折。结论:成本效益高的3D打印技术的实施使患者治疗成功,效果良好。我们的实践指南提供了一个3D打印工作流程,可以适应其他专业的需求,如神经外科,骨科手术以及。
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引用次数: 2
Are Facial Gunshot Wounds More Fatal When They Are Self-Inflicted or Other-Inflicted? 面部枪伤是自己造成的还是别人造成的更致命?
IF 0.9 Pub Date : 2022-12-01 Epub Date: 2021-08-17 DOI: 10.1177/19433875211039919
Kevin C Lee, Brendan W Wu, Sung-Kiang Chuang

Study design: This was a retrospective cohort study of the 2014 Nationwide Emergency Department Sample (NEDS).

Objective: Intraoral and submental projectile entry points may be less fatal than other facial entry points due to the indirect access to the intracranial structures and the protection offered by the intervening maxillofacial complex. Because intraoral and submental trajectories are almost always present in the setting of attempted suicide, this study sought to determine if intent (self-harm versus other-harm) influenced mortality in facial gunshot wound (GSW) patients.

Methods: All patients with a diagnosis of a facial fracture secondary to firearm injury were included in the study sample. The primary predictor was self-harm. Secondary predictors were derived from patient, injury, and hospitalization characteristics. The study outcome was death. Univariate time to event analyses were conducted for all study predictors. A multivariate regression model for mortality was created using all relevant predictors.

Results: The final sample included 668 facial GSW injuries, of which 19.3% were attributed to self-harm. Self-inflicted GSWs were more likely to involve the mandible (58.9 vs 46.0%, P < 0.01), ZMC/maxilla (47.3 vs 32.5%, P < 0.01), and intracranial cavity (48.1 vs 22.6%, P < 0.01). The overall mortality rate was 7.3%, and the mean time to death was 2.2 days. After controlling for pertinent covariates, the risk of mortality was independently decreased with mandibular injury (HR = 0.36, P = 0.03). However, mortality was increased by self-harm intent (HR = 3.94, P < 0.01) and intracranial involvement (HR = 11.24, P < 0.01).

Conclusions: Consistent with a pattern of intraoral and submental entry points, self-inflicted facial GSWs demonstrated higher rates of mandibular injury. Despite this finding, self-harm injuries still carried a higher incidence of intracranial injury and a greater independent risk of mortality. Our results refute any notion that the mechanism and trajectory of self-inflicted GSWs is less fatal.

研究设计:这是一项2014年全国急诊科样本(NEDS)的回顾性队列研究。目的:口腔内和颏下抛射点可能比其他面部入口点更致命,因为它们间接进入颅内结构,并由中间的颌面复合体提供保护。由于口内和精神下轨迹几乎总是存在于企图自杀的情况下,本研究试图确定意图(自我伤害与他人伤害)是否影响面部枪伤(GSW)患者的死亡率。方法:所有诊断为继发于火器伤的面部骨折的患者被纳入研究样本。主要的预测因素是自残。次要预测因子来自患者、损伤和住院特征。研究结果是死亡。对所有研究预测因子进行单变量时间-事件分析。使用所有相关预测因子建立了死亡率的多变量回归模型。结果:最终样本包括668例面部GSW伤,其中19.3%为自残。自我造成的GSWs更容易累及下颌骨(58.9比46.0%,P < 0.01)、ZMC/上颌(47.3比32.5%,P < 0.01)和颅内腔(48.1比22.6%,P < 0.01)。总死亡率为7.3%,平均死亡时间为2.2 d。在控制相关协变量后,下颌骨损伤的死亡风险独立降低(HR = 0.36, P = 0.03)。然而,自残意图(HR = 3.94, P < 0.01)和颅内累及(HR = 11.24, P < 0.01)会增加死亡率。结论:与口腔内和颏下进入点的模式一致,自我造成的面部GSWs显示出更高的下颌损伤率。尽管有这一发现,自残伤害仍然具有更高的颅内损伤发生率和更大的独立死亡风险。我们的研究结果驳斥了任何关于自我造成的GSWs的机制和轨迹不那么致命的观点。
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引用次数: 1
Quality: A Community Commitment. 质量:社区承诺。
IF 0.9 Pub Date : 2022-12-01 Epub Date: 2022-09-20 DOI: 10.1177/19433875221128105
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引用次数: 0
Falls From Height, Facial Injuries and Fatalities: An Institutional Review. 从高处坠落,面部伤害和死亡:一个制度回顾。
IF 0.9 Pub Date : 2022-12-01 Epub Date: 2021-11-20 DOI: 10.1177/19433875211055356
Pasquale G Mollica, Ellie C McEwen, Gary R Hoffman

Study design: Retrospective cohort review.

Objective: To investigate the relationship between falls from height and facial injuries.

Methods: This is a retrospective cohort study, conducted over a 7-year period, of the medical records of all patients who presented to hospital for a maxillofacial injury following a fall from height. Fall heights were classified as low falls (1-3 m), high falls (3-10 m) and very high falls (≥10 m).

Results: A total of 111 patients with 218 facial bone fractures were identified (78 men, 33 women and mean age 50.3 years). High falls were the most common (n = 58, 52.3%). Multiple fractures were identified in 51 (46.0%) patients. Orbital and middle third fractures were the most prevalent. Nasal, mandible, bilateral and fractures involving more than one facial third, increased as fall height increased, as did the requirement for operative fixation. The majority of patients had an associated injury (n = 100, 90.1%) and overall mortality was 6.3%.

Conclusions: Falls from height are prevalent and there is a trend towards increased severity of facial injury, surgical intervention and associated morbidity as fall height increases. Falls from height are a significant public health concern and an important facet of maxillofacial trauma to recognise, as is the requirement for an interdisciplinary approach as they present to hospital.

研究设计:回顾性队列评价。目的:探讨高空坠落与面部损伤的关系。方法:这是一项回顾性队列研究,进行了超过7年的时间,对所有因从高处坠落后颌面部损伤而入院的患者的医疗记录进行了分析。将坠落高度分为低坠落高度(1 ~ 3 m)、高坠落高度(3 ~ 10 m)和极高坠落高度(≥10 m)。结果:共鉴定出111例面部骨折218例,其中男性78例,女性33例,平均年龄50.3岁。高处跌倒是最常见的(n = 58, 52.3%)。51例(46.0%)患者发现多发骨折。眶部和中三分之一骨折最为常见。鼻、下颌骨、双侧骨折和超过三分之一的面部骨折随着坠落高度的增加而增加,手术固定的要求也随之增加。大多数患者伴有损伤(n = 100, 90.1%),总死亡率为6.3%。结论:高空坠落是常见的,随着坠落高度的增加,面部损伤的严重程度、手术干预和相关发病率都有增加的趋势。从高处坠落是一个重大的公共卫生问题,也是颌面部创伤的一个重要方面,需要认识到这一点,因为他们在医院就诊时需要采用跨学科的方法。
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引用次数: 0
Recent Advances in Nasoalveolar Molding Therapy Using 3D Technology. 应用3D技术进行鼻肺泡成型治疗的最新进展。
IF 0.9 Pub Date : 2022-12-01 Epub Date: 2021-09-03 DOI: 10.1177/19433875211044622
Sofia Ahsanuddin, Mairaj Ahmed, Leslie Slowikowski, Jenna Heitzler

Presurgical Nasoalveolar Molding (NAM) is an adjunctive treatment modality designed to reorient misaligned tissue structures and nasal cartilage in cleft lip and/or palate (CL/P) patients. Recent advances in NAM therapy focus on modifications to the intraoral molding plate or nasal stent intended to improve treatment outcomes, ease of use, compliance, and cost-effectiveness. Notably, 3D technological advancements have been employed to design NAM devices more efficiently and create objective, standardized means of measuring progressive morphological changes during therapy. These advances are designed to incorporate 3D technology in the treatment of cleft lip and/or palate to render it more precise, accurate, and time-efficient.

手术前鼻牙槽成型(NAM)是一种辅助治疗方式,旨在重新定位唇裂和/或腭裂(CL/P)患者的错位组织结构和鼻软骨。NAM治疗的最新进展集中在改良口内模塑板或鼻支架,旨在改善治疗效果、易用性、依从性和成本效益。值得注意的是,3D技术的进步已被用于更有效地设计NAM设备,并创造客观、标准化的方法来测量治疗期间的进行性形态学变化。这些进步旨在将3D技术结合到唇裂和/或腭裂的治疗中,使其更加精确,准确和省时。
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引用次数: 1
Intraoperative Use of Ultrasonography in the Reduction of Zygomatico-Maxillary Complex Fractures. 术中超声在颧上颌复合体骨折复位术中的应用。
IF 0.9 Pub Date : 2022-09-01 DOI: 10.1177/19433875211029145
Jagdish Eswari, C Ravindran, C Deepak

Study design: A single blind randomized controlled study.

Objective: The aim of this study is to evaluate the use of ultrasonography intraoperatively to assess the reduction of unilateral zygomatic complex fractures with a control group using the conventional blind digit palpation.

Methods: The study comprised of a sample size of 24 patients with 21 male and 3 female patients. Patients of all age groups diagnosed with unilateral displaced zygomatic complex fracture with or without mandible fracture were included in the study. The subjects were randomized into study and control groups based on a standard protocol with a total of 24 patients. Imaging was in the form of a preoperative and postoperative 3D computed tomography scan with reconstruction of the maxilla and mandible to interpret the diagnosis for all subjects. The inter-fracture distance of the fractured infraorbital rim were measured in 3 dimensions (antero-posterior, medio-lateral and supero-inferior) and compared pre and postoperatively. Preoperative, intraoperative and postoperative ultrasonographic examination was performed and recorded on all patients at the frontozygomatic region, infraorbital rim and zygomatic buttress to assess the proximity of the fractured margins pre reduction, post reduction and post fixation of the fracture segments.

Result: Statistical analytic results were significant in all 3 dimensions when measured postoperatively using computed tomography.

Conclusion: Ultrasonography is an effective screening and intraoperative tool in the armamentarium of oral and maxillofacial surgery to assess zygomatic complex fractures, avoiding incisions in aesthetic areas of the maxillofacial region.

研究设计:单盲随机对照研究。目的:探讨术中超声对单侧颧骨复合体骨折复位效果的评价,并以常规盲指触诊为对照。方法:本研究共纳入24例患者,其中男21例,女3例。所有年龄组诊断为单侧移位颧骨复合体骨折伴或不伴下颌骨骨折的患者均被纳入研究。受试者根据标准方案随机分为研究组和对照组,共24例患者。成像采用术前和术后三维计算机断层扫描的形式,重建上颌骨和下颌骨,以解释所有受试者的诊断。测量眶下缘骨折前后、中外侧、上下三个维度的骨折间距离,比较术前和术后的差异。术前、术中、术后均对所有患者在颧额区、眶下缘、颧支撑处进行超声检查并记录,以评估骨折段复位前、复位后及固定后骨折缘的接近程度。结果:术后计算机断层扫描3个维度均有统计学意义。结论:超声检查是口腔颌面外科评估颧骨复合体骨折的有效筛查和术中工具,可避免在颌面美观区切口。
{"title":"Intraoperative Use of Ultrasonography in the Reduction of Zygomatico-Maxillary Complex Fractures.","authors":"Jagdish Eswari,&nbsp;C Ravindran,&nbsp;C Deepak","doi":"10.1177/19433875211029145","DOIUrl":"https://doi.org/10.1177/19433875211029145","url":null,"abstract":"<p><strong>Study design: </strong>A single blind randomized controlled study.</p><p><strong>Objective: </strong>The aim of this study is to evaluate the use of ultrasonography intraoperatively to assess the reduction of unilateral zygomatic complex fractures with a control group using the conventional blind digit palpation.</p><p><strong>Methods: </strong>The study comprised of a sample size of 24 patients with 21 male and 3 female patients. Patients of all age groups diagnosed with unilateral displaced zygomatic complex fracture with or without mandible fracture were included in the study. The subjects were randomized into study and control groups based on a standard protocol with a total of 24 patients. Imaging was in the form of a preoperative and postoperative 3D computed tomography scan with reconstruction of the maxilla and mandible to interpret the diagnosis for all subjects. The inter-fracture distance of the fractured infraorbital rim were measured in 3 dimensions (antero-posterior, medio-lateral and supero-inferior) and compared pre and postoperatively. Preoperative, intraoperative and postoperative ultrasonographic examination was performed and recorded on all patients at the frontozygomatic region, infraorbital rim and zygomatic buttress to assess the proximity of the fractured margins pre reduction, post reduction and post fixation of the fracture segments.</p><p><strong>Result: </strong>Statistical analytic results were significant in all 3 dimensions when measured postoperatively using computed tomography.</p><p><strong>Conclusion: </strong>Ultrasonography is an effective screening and intraoperative tool in the armamentarium of oral and maxillofacial surgery to assess zygomatic complex fractures, avoiding incisions in aesthetic areas of the maxillofacial region.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/19433875211029145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10189475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Controversies and Contemporary Management of Orbital Floor Fractures. 眶底骨折的争议与当代治疗。
IF 0.9 Pub Date : 2022-09-01 DOI: 10.1177/19433875211026430
Shivam Patel, Tom Shokri, Kasra Ziai, Jessyka G Lighthall

Substantial controversy exists regarding the timing of intervention and management of patients with orbital floor fractures. Recent advances in computer-aided technology, including the use of 3-dimensional printing, intraoperative navigational imaging, and the use of novel implants, have allowed for improvement in prospective management modalities. As such, this article aims to review the indications and timing of repair, surgical approaches, materials used for repair, and contemporary adjuncts to repair. Indications for orbital floor fracture repair remain controversial as many of these fractures heal without intervention or adverse sequelae. Intraoperative navigation and imaging, as well as endoscopic guidance, can improve visualization of defects mitigating implant positioning errors, thereby reducing the need for secondary corrective procedures. Patient-specific implants may be constructed to fit the individual patient's anatomy using the preoperative CT dataset and mirroring the contralateral unaffected side and have been shown to improve pre-operative efficiency and minimize postoperative complications. With increased data, we can hope to form evidence-based indications for using particular biomaterials and the criteria for orbital defect characteristics, which may be best addressed by a specific surgical approach.

关于眶底骨折患者的干预时机和治疗存在大量争议。计算机辅助技术的最新进展,包括三维打印的使用、术中导航成像和新型植入物的使用,使得前瞻性管理模式得以改善。因此,本文旨在回顾修复的适应症和时间、手术入路、修复材料和当代修复辅助材料。眶底骨折修复的适应症仍然存在争议,因为许多此类骨折在没有干预或不良后遗症的情况下愈合。术中导航和成像,以及内镜引导,可以改善缺损的可视化,减轻种植体定位错误,从而减少二次矫正手术的需要。使用术前CT数据集和镜像对侧未受影响侧,可以构建适合患者个体解剖结构的患者特异性植入物,并已证明可以提高术前效率并减少术后并发症。随着数据的增加,我们可以希望形成基于证据的适应症,用于使用特定的生物材料和眶缺损特征的标准,这可能最好通过特定的手术入路来解决。
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引用次数: 5
Current Practice for Transverse Mandibular and Maxillary Discrepancies in the Netherlands: A Web-Based Survey Among Orthodontists and Oral and Maxillofacial Surgeons. 荷兰横下颌和上颌差异的当前实践:一项基于网络的正畸医生和口腔颌面外科医生调查。
IF 0.9 Pub Date : 2022-09-01 DOI: 10.1177/19433875211027694
Atilla Gül, Stephen T H Tjoa, Jan P de Gijt, Justin T van der Tas, Hadi Sutedja, Eppo B Wolvius, Karel G H van der Wal, Maarten J Koudstaal

The main objective of this study was to provide an overview of the current practice for transverse mandibular and maxillary discrepancies in the Netherlands using a web-based survey. Orthodontists (ORTHO) and Oral and Maxillofacial Surgeons (OMFS) in the Netherlands were invited to the web-based survey via their professional association. Three cases were presented which could be treated non-surgically and surgically. Participants were asked what treatment they preferred: no treatment, orthodontic treatment with optional extractions or surgically assisted orthodontic treatment. The web-based survey ended with questions on various technical aspects and any experienced complication. Invitation was sent to all 303 members of professional association for ORTHO and to all 379 members of professional association for OMFS. Overall response number was 276 (response rate of 40.5%), including 127 incomplete responses. Generally, ORTHO prefer orthodontic treatment with optional extractions and OMFS lean towards surgically assisted orthodontic treatment. Mandibular Midline Distraction appears to be less preferred, possibly due to lack of clinical experience or knowledge by both professions despite being proven clinical stable surgical technique with stable long-term outcomes. There seems to be consensus on technical aspects by both professions, however, there are various thoughts on duration of consolidation period. Complications are mostly minor and manageable.

本研究的主要目的是通过基于网络的调查,概述目前荷兰下颌和上颌横向差异的实践。荷兰的正畸医生(ORTHO)和口腔颌面外科医生(OMFS)通过他们的专业协会被邀请参加基于网络的调查。本文介绍了非手术治疗和手术治疗的3例。参与者被问及他们喜欢什么治疗:不治疗,正畸治疗与可选的拔牙或手术辅助正畸治疗。基于网络的调查以各种技术方面的问题和任何遇到的复杂情况结束。向ORTHO专业协会的所有303名成员和OMFS专业协会的所有379名成员发出邀请。总应答数为276个(应答率为40.5%),包括127个不完整应答。一般来说,ORTHO倾向于选择性拔牙的正畸治疗,而OMFS倾向于手术辅助的正畸治疗。下颌中线牵引似乎不太受欢迎,可能是由于缺乏临床经验或专业知识,尽管临床证明稳定的手术技术和稳定的长期结果。在技术方面,两种专业人士似乎达成了共识,然而,对于盘整期的持续时间却有不同的看法。并发症大多是轻微和可控的。
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引用次数: 0
Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review. 使用虚拟手术计划的同一入院微血管颌面弹道创伤重建:一个病例系列和系统回顾。
IF 0.9 Pub Date : 2022-09-01 DOI: 10.1177/19433875211026432
Sean A Knudson, Kristopher M Day, Patrick Kelley, Pablo Padilla, Ian X Collier, Steven Henry, Raymond Harshbarger, Patrick Combs

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.

研究设计:回顾性病例系列;系统的回顾。目的:目前尚不清楚使用虚拟手术计划(VSP)促进急性颌面弹道创伤(MBT)后下颌骨的同院显微外科重建是否足以实现明确的重建和功能闭塞。方法:对急性MBT术后行VSP显微外科重建的患者进行单中心回顾性分析。采用盲法筛选对PubMed/MEDLINE、Embase、ScienceDirect和Scopus数据库进行系统回顾。通过专题分析对研究进行评价。结果:5例患者均采用VSP进行下颌骨显微外科重建。我们观察到从初次就诊到重建的平均时间为16.4±9.1天,平均住院时间为51.6±17.9天,每例患者手术6.2±2.8次,游离皮瓣1.6±0.9个。共使用4种皮瓣8个,最常见的是大腿前外侧皮瓣(37.5%)。护理使皮瓣完全存活。每位患者至少有1个轻微并发症。所有患者均达到中心闭塞、口腔营养和接近其基线面部美学。随访时间为191.0±183.9周。系统评价产生了8篇符合纳入标准的文章。在实施MBT重建时,文献中对VSP的临床目标和功能的主题是一致的,但在最佳治疗时间上却存在分歧。结论:MBT术后同院显微外科重建术能安全有效地重建下颌骨形态和功能。考虑到在确定重建之前需要做准备,VSP并没有延迟重建。
{"title":"Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review.","authors":"Sean A Knudson,&nbsp;Kristopher M Day,&nbsp;Patrick Kelley,&nbsp;Pablo Padilla,&nbsp;Ian X Collier,&nbsp;Steven Henry,&nbsp;Raymond Harshbarger,&nbsp;Patrick Combs","doi":"10.1177/19433875211026432","DOIUrl":"https://doi.org/10.1177/19433875211026432","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case series; systematic review.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/19433875211026432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10189477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Staged Head and Neck Reconstruction: Heresy or a Reasoned Approach in a Select Group of Patients? 分阶段头颈部重建术:对特定患者来说是异端还是合理的方法?
IF 0.9 Pub Date : 2022-09-01 DOI: 10.1177/19433875211031361
Mark L Urken, Quinn O'Malley, Mykayla Sandler, Monica H Xing, Edward Ansari, Neil Mundi, Daniel Buchbinder, Eran Alon, Devin Okay

Study design: case series.

Objective: The restoration of defects in a single procedure with microvascular free flap reconstruction has become a mainstay of head and neck surgery. Yet in patients with complex defects and pre-existing comorbid medical conditions, a staged-reconstructive approach can enhance the safety of the procedure and improve the patient's outcome.

Methods: We present 3 representative case examples of a larger series of patients who underwent reconstruction of major defects and discuss the usefulness of a staged-reconstructive approach in the management of complex patients.

Results: All 3 patients, with an existing composite defect in the setting of prior radiation therapy, underwent successful staged-reconstructive surgery using a variety of free tissue and regional flap transfers.

Conclusions: A staged approach facilitates the reconstruction of complex composite defects, increases vessel availability, and mitigates the risk of flap failure. Although this approach commits the patient to multiple procedures and a more prolonged plan of care, it is preferable to 1 operation in specific complex situations with adverse, high-risk clinical features.

研究设计:病例系列。目的:微血管游离皮瓣单次修复头颈部缺损已成为头颈部外科的主流。然而,对于有复杂缺陷和先前存在的合并症的患者,分阶段重建方法可以提高手术的安全性并改善患者的预后。方法:我们提出了3例具有代表性的病例,这些患者接受了重大缺陷的重建,并讨论了分期重建方法在复杂患者管理中的有效性。结果:所有3例患者均存在先前放射治疗的复合缺损,均通过各种游离组织和区域皮瓣转移成功地进行了分阶段重建手术。结论:分阶段的方法有助于重建复杂的复合缺损,增加血管的可用性,并降低皮瓣失败的风险。虽然这种方法需要患者进行多次手术和更长时间的护理计划,但在具有不良和高风险临床特征的特定复杂情况下,它优于一次手术。
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引用次数: 1
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Craniomaxillofacial Trauma & Reconstruction
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