Pub Date : 2024-03-01Epub Date: 2023-02-13DOI: 10.1177/19433875231157454
Karla C Maita, Francisco R Avila, Ricardo A Torres-Guzman, Rachel Sarabia-Estrada, Abba C Zubair, Alfredo Quinones-Hinojosa, Antonio J Forte
Study design: Human bone marrow stem cells (hBMSCs) and human adipose-derived stem cells (hADSCs) have demonstrated the capability to regenerate bone once they have differentiated into osteoblasts.
Objective: This systematic review aimed to evaluate the in vitro osteogenic differentiation potential of these cells when seeded in a poly (lactic-co-glycolic) acid (PLGA) scaffold.
Methods: A literature search of 4 databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted in January 2021 for studies evaluating the osteogenic differentiation potential of hBMSCs and hADSCs seeded in a PLGA scaffold. Only in vitro models were included. Studies in languages other than English were excluded.
Results: A total of 257 studies were identified after the removal of duplicates. Seven articles fulfilled our inclusion and exclusion criteria. Four of these reviews used hADSCs and three used hBMSCs in the scaffold. Upregulation in osteogenic gene expression was seen in all the cells seeded in a 3-dimensional scaffold compared with 2-dimensional films. High angiogenic gene expression was found in hADSCs. Addition of inorganic material to the scaffold material affected cell performance.
Conclusions: Viability, proliferation, and differentiation of cells strongly depend on the environment where they grow. There are several factors that can enhance the differentiation capacity of stem cells. A PLGA scaffold proved to be a biocompatible material capable of boosting the osteogenic differentiation potential and mineralization capacity in hBMSCs and hADSCs.
{"title":"In Vitro Enhanced Osteogenic Potential of Human Mesenchymal Stem Cells Seeded in a Poly (Lactic-<i>co</i>-Glycolic) Acid Scaffold: A Systematic Review.","authors":"Karla C Maita, Francisco R Avila, Ricardo A Torres-Guzman, Rachel Sarabia-Estrada, Abba C Zubair, Alfredo Quinones-Hinojosa, Antonio J Forte","doi":"10.1177/19433875231157454","DOIUrl":"10.1177/19433875231157454","url":null,"abstract":"<p><strong>Study design: </strong>Human bone marrow stem cells (hBMSCs) and human adipose-derived stem cells (hADSCs) have demonstrated the capability to regenerate bone once they have differentiated into osteoblasts.</p><p><strong>Objective: </strong>This systematic review aimed to evaluate the in vitro osteogenic differentiation potential of these cells when seeded in a poly (lactic-<i>co</i>-glycolic) acid (PLGA) scaffold.</p><p><strong>Methods: </strong>A literature search of 4 databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted in January 2021 for studies evaluating the osteogenic differentiation potential of hBMSCs and hADSCs seeded in a PLGA scaffold. Only in vitro models were included. Studies in languages other than English were excluded.</p><p><strong>Results: </strong>A total of 257 studies were identified after the removal of duplicates. Seven articles fulfilled our inclusion and exclusion criteria. Four of these reviews used hADSCs and three used hBMSCs in the scaffold. Upregulation in osteogenic gene expression was seen in all the cells seeded in a 3-dimensional scaffold compared with 2-dimensional films. High angiogenic gene expression was found in hADSCs. Addition of inorganic material to the scaffold material affected cell performance.</p><p><strong>Conclusions: </strong>Viability, proliferation, and differentiation of cells strongly depend on the environment where they grow. There are several factors that can enhance the differentiation capacity of stem cells. A PLGA scaffold proved to be a biocompatible material capable of boosting the osteogenic differentiation potential and mineralization capacity in hBMSCs and hADSCs.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78329499","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}
Pub Date : 2024-03-01Epub Date: 2022-12-13DOI: 10.1177/19433875221143852
Manoj Kumar, Sathyanarayanan Ramanujam, Raghu Kumaravelu, Raja Sethupathy Cheeman, Raymond Joseph Periera, Sarah Titus
Study design: Retrospective Observational Study.
Objective: Mandibular condyle fractures are distinctive among maxillofacial injuries in which they disrupt mandibular function in a way that other traumatic injuries do not. Condylar fractures can be treated using either the conservative (closed reduction and immobilisation) or surgical (open reduction and internal fixation) approaches. Both of these modalities of treatment have advantages and disadvantages, as well as indications and contraindications. The purpose of this study is to compile and compare our experience in the management of condylar fractures through open and closed reduction.
Methods: The present retrospective analysis included a total 100 patients of condylar fractures in patients > 18 years of age who were randomly divided into nonsurgical and surgical group based on Edward Ellies criteria. In the present study, the outcomes of conservative vs surgical management of condylar fractures were discussed in terms of seven parameters, including the maximal inter-incisal mouth opening, protrusive and lateral excursive movements of the mandible, status of occlusion, deviation of mandible during mouth opening, temporo-mandibular disorders and facial nerve paralysis which were measured and evaluated pre- and post-operatively at different intervals of time. Follow-up period was for 6 months.
Results: It was noted that the main cause of condylar fracture was trauma with a male predilection with an average age of 32.6 ± 1.2 years. Subcondylar fracture was the commonest type of condylar fracture that we encountered. 33.3% of the patients had restricted mouth opening and 57% of the patients had deranged occlusion. 37% of the patients were treated surgically and 48.6% of these fractures were approached using peri-angular approach. More patients had an increased mouth opening and a stable occlusion at the 6 months follow-up when compared to that of the 2 month follow up.
Conclusions: From the above study we can conclude that the treatment plan should be patient specific and follow the algorithm for a particular type of fracture. We endorse the same based on our experience in treating condylar fractures over the last 5 years. The art of decision making solely depends on the surgeon's expertise in managing condylar fractures.
{"title":"Open vs Closed Management of Condylar Fracture Our Experience of 100 Cases in a Suburban Tertiary Care Hospital.","authors":"Manoj Kumar, Sathyanarayanan Ramanujam, Raghu Kumaravelu, Raja Sethupathy Cheeman, Raymond Joseph Periera, Sarah Titus","doi":"10.1177/19433875221143852","DOIUrl":"10.1177/19433875221143852","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Observational Study.</p><p><strong>Objective: </strong>Mandibular condyle fractures are distinctive among maxillofacial injuries in which they disrupt mandibular function in a way that other traumatic injuries do not. Condylar fractures can be treated using either the conservative (closed reduction and immobilisation) or surgical (open reduction and internal fixation) approaches. Both of these modalities of treatment have advantages and disadvantages, as well as indications and contraindications. The purpose of this study is to compile and compare our experience in the management of condylar fractures through open and closed reduction.</p><p><strong>Methods: </strong>The present retrospective analysis included a total 100 patients of condylar fractures in patients > 18 years of age who were randomly divided into nonsurgical and surgical group based on Edward Ellies criteria. In the present study, the outcomes of conservative vs surgical management of condylar fractures were discussed in terms of seven parameters, including the maximal inter-incisal mouth opening, protrusive and lateral excursive movements of the mandible, status of occlusion, deviation of mandible during mouth opening, temporo-mandibular disorders and facial nerve paralysis which were measured and evaluated pre- and post-operatively at different intervals of time. Follow-up period was for 6 months.</p><p><strong>Results: </strong>It was noted that the main cause of condylar fracture was trauma with a male predilection with an average age of 32.6 ± 1.2 years. Subcondylar fracture was the commonest type of condylar fracture that we encountered. 33.3% of the patients had restricted mouth opening and 57% of the patients had deranged occlusion. 37% of the patients were treated surgically and 48.6% of these fractures were approached using peri-angular approach. More patients had an increased mouth opening and a stable occlusion at the 6 months follow-up when compared to that of the 2 month follow up.</p><p><strong>Conclusions: </strong>From the above study we can conclude that the treatment plan should be patient specific and follow the algorithm for a particular type of fracture. We endorse the same based on our experience in treating condylar fractures over the last 5 years. The art of decision making solely depends on the surgeon's expertise in managing condylar fractures.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83418809","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}
Pub Date : 2024-03-01Epub Date: 2023-01-25DOI: 10.1177/19433875231152947
Thomaz Fleury Curado, Ahmed El Abany, Sam P Most
Study Design: Technical note. Objective: The lower nasal architecture is dependent on caudal septal integrity. Deviations of the caudal septum can compromise nasal airflow. The presence of anterior nasal spine deviations contributes to septal and medial crural shifting with ipsilateral encroachment. It is essential to identify nasal spine deviation during surgery in order to reconstruct the septum in a midline position at its base. This allows an appropriate management plan that creates a better functional and aesthetically pleasing outcome. A stable midline anterior nasal spine is warranted to support the newly reconstructed straight caudal strut, which can be effectively corrected by anterior septal reconstruction. Methods: The proposed method intends to combine anterior nasal spine centralization with correcting caudal septal deviation and nasal obstruction through a modified extracorporeal septoplasty technique. We describe a novel technique to centralize the deviated anterior nasal spine using the piezoelectric device by performing a contralateral adjacent ostectomy and en-bloc relocation and fixation of the anterior nasal spine with microplates and screws. Results: This surgical approach creates a stable caudal septum and a centrally positioned anterior nasal spine, which improves nasal airflow and ensures a stable repair. Conclusion: Sliding spine relocation surgery with anterior septal reconstruction repositions a deviated anterior nasal spine and corrects caudal septum deviation, that can impair the nasal airway.
{"title":"Sliding Spine Relocation Surgery with Anterior Septal Reconstruction.","authors":"Thomaz Fleury Curado, Ahmed El Abany, Sam P Most","doi":"10.1177/19433875231152947","DOIUrl":"10.1177/19433875231152947","url":null,"abstract":"<p><p><b>Study Design:</b> Technical note. <b>Objective:</b> The lower nasal architecture is dependent on caudal septal integrity. Deviations of the caudal septum can compromise nasal airflow. The presence of anterior nasal spine deviations contributes to septal and medial crural shifting with ipsilateral encroachment. It is essential to identify nasal spine deviation during surgery in order to reconstruct the septum in a midline position at its base. This allows an appropriate management plan that creates a better functional and aesthetically pleasing outcome. A stable midline anterior nasal spine is warranted to support the newly reconstructed straight caudal strut, which can be effectively corrected by anterior septal reconstruction. <b>Methods:</b> The proposed method intends to combine anterior nasal spine centralization with correcting caudal septal deviation and nasal obstruction through a modified extracorporeal septoplasty technique. We describe a novel technique to centralize the deviated anterior nasal spine using the piezoelectric device by performing a contralateral adjacent ostectomy and en-bloc relocation and fixation of the anterior nasal spine with microplates and screws. <b>Results:</b> This surgical approach creates a stable caudal septum and a centrally positioned anterior nasal spine, which improves nasal airflow and ensures a stable repair. <b>Conclusion:</b> Sliding spine relocation surgery with anterior septal reconstruction repositions a deviated anterior nasal spine and corrects caudal septum deviation, that can impair the nasal airway.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87312305","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}
Pub Date : 2024-03-01Epub Date: 2023-02-24DOI: 10.1177/19433875231160346
Camilo Mosquera, Marina Morante Silva, Ashleigh M Weyh, Michael A Malik, Rui Fernandes
Study design: Retrospective cohort study.
Objective: Malnutrition has been found to have negative effects on the immune system and inflammatory responses, impairing the wound healing process. Free flap failure is a serious complication in patients undergoing microvascular reconstruction, as it increases patient morbidity, length of stay in the hospital, patient, and hospital costs, as well as causes the need for further surgical interventions1. Malnutrition is estimated to be present in 35-50% of head and neck cancer patients with higher rates in those experiencing hypo-oropharyngeal disease. This is often caused by functional and pain limitations from due to disease burden causing odynophagia and dysphagia. The Malnutrition Universal Screening Tool (MUST) is recommended for risk screening and provides three scores for risk classification: high, intermediate, and low2. We argue that the use of MUST as a preoperative assessment tool is useful to predict postoperative surgical site infection and delayed wound healing in patients that will undergo reconstruction with free flaps for head and neck defects.
Methods: A retrospective cohort study was designed to include all subjects who underwent head and neck microvascular free tissue transfer at a single institution between 2013 and 2019. Primary and secondary reconstructions were included, for benign or malignant pathology, osteonecrosis, osteomyelitis, congenital defects, and trauma. The nutritional risk was evaluated using MUST, which analyzes body mass index, weight loss, and acute disease effect, to classify patients as low, intermediate, and high risk. We further divided the subjects into two comparison groups- low-intermediate and high risk. The primary outcome was surgical site complications and delayed wound healing. Data was analyzed as frequencies and means with standard deviations, as well as Fisher's exact test and t-test. P-values <0.05 were considered statistically significant. Analyses were done utilizing IBM SPSS Statistics Version 29.
Results: 131 subjects were included for data analysis, with 54 being considered low MUST risk, 12 intermediate risk (66 low-intermediate), and 65 were high risk. The mean BMI overall was 25.5 ±5.3, and 27.2 in the low-intermediate group, and 23.7 in the high-risk group. Eighty-two subjects experienced <5-pound weight loss in the preceding 6 months to surgery, while 17 lost between 5-10 pounds, and 23 lost 10< pounds. Cancer/osteonecrosis was the etiology for 54 (82%) subjects of the low-intermediate group, and 61 (92%) of the high-risk group (P = .089). The subjects classified in High-risk group according to the MUST score had 11% more surgical site complications (P = .120) and 13.7% more delayed wound healing and dehiscence(P = .09); only 3 subjects in the study presented total flap loss and they were all in the High-risk g
研究设计回顾性队列研究:营养不良会对免疫系统和炎症反应产生负面影响,损害伤口愈合过程。游离皮瓣失败是微血管重建患者的严重并发症,因为它会增加患者的发病率、住院时间、患者和医院的费用,并导致需要进一步的手术干预1。据估计,35%-50% 的头颈部癌症患者会出现营养不良,其中口咽下部疾病患者的营养不良率更高。这通常是由于疾病负担造成的功能和疼痛限制导致的吞咽困难和吞咽困难。营养不良通用筛查工具(MUST)被推荐用于风险筛查,并提供了三个风险分类分数:高、中、低2。我们认为,使用营养不良通用筛查工具作为术前评估工具有助于预测头颈部缺损游离皮瓣重建患者术后手术部位感染和伤口延迟愈合的情况:设计了一项回顾性队列研究,纳入2013年至2019年期间在一家机构接受头颈部微血管游离组织转移的所有受试者。研究对象包括因良性或恶性病变、骨坏死、骨髓炎、先天性缺损和创伤而进行的初次和二次重建。我们使用MUST对营养风险进行了评估,MUST分析了体重指数、体重减轻和急性疾病效应,将患者分为低风险、中风险和高风险。我们进一步将受试者分为两个对比组--中低风险组和高风险组。主要结果是手术部位并发症和伤口延迟愈合。数据分析采用频率、平均值和标准差,以及费雪精确检验和 t 检验。P值结果:131 名受试者被纳入数据分析,其中 54 人被认为是低 MUST 风险,12 人为中度风险(66 人为低中度风险),65 人为高度风险。总体平均体重指数为 25.5 ±5.3,中低风险组为 27.2,高风险组为 23.7。82名受试者经历了P = .089)。根据 MUST 评分被归入高风险组的受试者,其手术部位并发症发生率高出 11% (P = .120),伤口延迟愈合和开裂发生率高出 13.7% (P = .09);研究中只有 3 名受试者出现皮瓣完全脱落的情况,他们都属于高风险组。手术部位并发症、伤口延迟愈合率、部分或全部皮瓣缺失率并没有因为任何特定的合并症或病史(如放疗或化疗)而增加:总之,MUST评分高的受试者并发症和伤口愈合不良的几率更高,而急性疾病影响导致无期超过5天的受试者皮瓣全部脱落和手术部位并发症的风险更高。
{"title":"Can the Malnutrition Universal Screening Tool (MUST) Predict Healing Complications Following Microvascular Reconstruction of the Head and Neck?","authors":"Camilo Mosquera, Marina Morante Silva, Ashleigh M Weyh, Michael A Malik, Rui Fernandes","doi":"10.1177/19433875231160346","DOIUrl":"10.1177/19433875231160346","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Malnutrition has been found to have negative effects on the immune system and inflammatory responses, impairing the wound healing process. Free flap failure is a serious complication in patients undergoing microvascular reconstruction, as it increases patient morbidity, length of stay in the hospital, patient, and hospital costs, as well as causes the need for further surgical interventions<sup>1</sup>. Malnutrition is estimated to be present in 35-50% of head and neck cancer patients with higher rates in those experiencing hypo-oropharyngeal disease. This is often caused by functional and pain limitations from due to disease burden causing odynophagia and dysphagia. The Malnutrition Universal Screening Tool (MUST) is recommended for risk screening and provides three scores for risk classification: high, intermediate, and low<sup>2</sup>. We argue that the use of MUST as a preoperative assessment tool is useful to predict postoperative surgical site infection and delayed wound healing in patients that will undergo reconstruction with free flaps for head and neck defects.</p><p><strong>Methods: </strong>A retrospective cohort study was designed to include all subjects who underwent head and neck microvascular free tissue transfer at a single institution between 2013 and 2019. Primary and secondary reconstructions were included, for benign or malignant pathology, osteonecrosis, osteomyelitis, congenital defects, and trauma. The nutritional risk was evaluated using MUST, which analyzes body mass index, weight loss, and acute disease effect, to classify patients as low, intermediate, and high risk. We further divided the subjects into two comparison groups- low-intermediate and high risk. The primary outcome was surgical site complications and delayed wound healing. Data was analyzed as frequencies and means with standard deviations, as well as Fisher's exact test and t-test. P-values <0.05 were considered statistically significant. Analyses were done utilizing IBM SPSS Statistics Version 29.</p><p><strong>Results: </strong>131 subjects were included for data analysis, with 54 being considered low MUST risk, 12 intermediate risk (66 low-intermediate), and 65 were high risk. The mean BMI overall was 25.5 ±5.3, and 27.2 in the low-intermediate group, and 23.7 in the high-risk group. Eighty-two subjects experienced <5-pound weight loss in the preceding 6 months to surgery, while 17 lost between 5-10 pounds, and 23 lost 10< pounds. Cancer/osteonecrosis was the etiology for 54 (82%) subjects of the low-intermediate group, and 61 (92%) of the high-risk group (<i>P</i> = .089). The subjects classified in High-risk group according to the MUST score had 11% more surgical site complications (<i>P</i> = .120) and 13.7% more delayed wound healing and dehiscence(<i>P</i> = .09); only 3 subjects in the study presented total flap loss and they were all in the High-risk g","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82711543","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}
Pub Date : 2024-03-01Epub Date: 2022-12-20DOI: 10.1177/19433875221143605
Shekhar K Gadkaree, Adeeb Derakhshan, Victor Nyabenda, Isaie Ncogoza, Gratien Tuyishimire, David A Shaye
Study design: Cadaveric investigation.
Objective: Rigid internal fixation (RIF) using plates and screws is often not feasible in low and middle-income countries due to limited resources. Interosseous wiring to achieve semi-rigid fixation is often used, but lacks biomechanical force data. Herein we aim to quantitatively compare interosseous wiring to RIF.
Methods: Cadaveric mandibles were fractured at the parasymphysis and angle. Fixation was achieved using interosseous wiring in both single wire loop and figure-of-eight formations, as well as plate and screw fixation (n = 5 for each fixation type at each fracture site). A force gauge was used to measure the number of Newtons (N) required to achieve diastasis and complete failure at the fixation site.
Results: For angle fractures, the mean force required for initial diastasis was 4.1, 5.9, and 10.9 N for single wire, figure-of-eight wiring, and plating respectively (P < .001). Complete failure was achieved with 152.9, 168.9, and 237.6 N of force for the three methods, respectively (P < .001). Complete failure was achieved for parasymphyseal fractures with 197.7, 263.0, and 262.8 N of force for single wire, figure-of-eight wiring, and plating respectively (P = .002). Forces to achieve initial diastasis for parasymphyseal fractures were not statistically significant among the three fixation methods (P = .29).
Conclusions: Figure-of-eight interosseous wiring resists comparable forces across mandibular fractures compared to the gold standard of plating. In resource-limited settings when plates and screws are not available, this technique can be considered to achieve semi-rigid fixation of mandibular fractures.
{"title":"Wire Osteosynthesis in the Treatment of Mandible Fractures in Low Resource Settings: A Force Study.","authors":"Shekhar K Gadkaree, Adeeb Derakhshan, Victor Nyabenda, Isaie Ncogoza, Gratien Tuyishimire, David A Shaye","doi":"10.1177/19433875221143605","DOIUrl":"10.1177/19433875221143605","url":null,"abstract":"<p><strong>Study design: </strong>Cadaveric investigation.</p><p><strong>Objective: </strong>Rigid internal fixation (RIF) using plates and screws is often not feasible in low and middle-income countries due to limited resources. Interosseous wiring to achieve semi-rigid fixation is often used, but lacks biomechanical force data. Herein we aim to quantitatively compare interosseous wiring to RIF.</p><p><strong>Methods: </strong>Cadaveric mandibles were fractured at the parasymphysis and angle. Fixation was achieved using interosseous wiring in both single wire loop and figure-of-eight formations, as well as plate and screw fixation (n = 5 for each fixation type at each fracture site). A force gauge was used to measure the number of Newtons (N) required to achieve diastasis and complete failure at the fixation site.</p><p><strong>Results: </strong>For angle fractures, the mean force required for initial diastasis was 4.1, 5.9, and 10.9 N for single wire, figure-of-eight wiring, and plating respectively (<i>P</i> < .001). Complete failure was achieved with 152.9, 168.9, and 237.6 N of force for the three methods, respectively (<i>P</i> < .001). Complete failure was achieved for parasymphyseal fractures with 197.7, 263.0, and 262.8 N of force for single wire, figure-of-eight wiring, and plating respectively (<i>P</i> = .002). Forces to achieve initial diastasis for parasymphyseal fractures were not statistically significant among the three fixation methods (<i>P</i> = .29).</p><p><strong>Conclusions: </strong>Figure-of-eight interosseous wiring resists comparable forces across mandibular fractures compared to the gold standard of plating. In resource-limited settings when plates and screws are not available, this technique can be considered to achieve semi-rigid fixation of mandibular fractures.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72740793","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}
Pub Date : 2024-03-01Epub Date: 2023-03-07DOI: 10.1177/19433875231161941
Sophie K M Kelly, Gary R Hoffman
The purpose of this study was to investigate the epidemiology, pattern of injury and management of facial dog bite injuries. Methods: The authors conducted a retrospective cohort study over a 5-year period of patients who sustained a facial dog bite injury. The study setting was an Oral and Maxillofacial Surgery Department at a level 1 trauma centre, servicing an estimated catchment population in excess of 950,000 people. Results: In total, 171 patients were managed in the designated period from January 2017 to January 2022. The median age was 9 years (range 11 months to 77 years), with the highest incidence of a single age 4 years. The frequency was slightly greater amongst males (n = 93) than females (n = 78). The most common responsible breed were Pitbull types (n = 26). Overall, bites most often resulted from the family dog (n = 87), in the victim's own home (n = 84) and whilst playing with the dog (n = 64). The primary sites involved were the lips (n = 70), cheek (n = 53) and nose, representing the so called 'target area'. In 53 cases, the injuries were classified as severe. 138 patients required hospital admission, and of these, 130 required surgical management under general anaesthesia. Conclusions: Facial dog bite injuries present a significant burden on the healthcare system and result in physical, functional and/or emotional distress for the patient. As the rates of dog ownership continue to rise, a consequential increase in these injuries is also likely. Further, public health intervention is essential, particularly as the most susceptible demographic remains young male children.
{"title":"The K9-Teen Pandemic: When Good Boy Goes Bad. The Epidemiology, Management and Public Health Ramifications of Facial Dog Bite Injuries: Newcastle, Australia, Experience.","authors":"Sophie K M Kelly, Gary R Hoffman","doi":"10.1177/19433875231161941","DOIUrl":"10.1177/19433875231161941","url":null,"abstract":"<p><p>The purpose of this study was to investigate the epidemiology, pattern of injury and management of facial dog bite injuries. <b>Methods:</b> The authors conducted a retrospective cohort study over a 5-year period of patients who sustained a facial dog bite injury. The study setting was an Oral and Maxillofacial Surgery Department at a level 1 trauma centre, servicing an estimated catchment population in excess of 950,000 people. <b>Results:</b> In total, 171 patients were managed in the designated period from January 2017 to January 2022. The median age was 9 years (range 11 months to 77 years), with the highest incidence of a single age 4 years. The frequency was slightly greater amongst males (n = 93) than females (n = 78). The most common responsible breed were Pitbull types (n = 26). Overall, bites most often resulted from the family dog (n = 87), in the victim's own home (n = 84) and whilst playing with the dog (n = 64). The primary sites involved were the lips (n = 70), cheek (n = 53) and nose, representing the so called 'target area'. In 53 cases, the injuries were classified as severe. 138 patients required hospital admission, and of these, 130 required surgical management under general anaesthesia. <b>Conclusions:</b> Facial dog bite injuries present a significant burden on the healthcare system and result in physical, functional and/or emotional distress for the patient. As the rates of dog ownership continue to rise, a consequential increase in these injuries is also likely. Further, public health intervention is essential, particularly as the most susceptible demographic remains young male children.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87488557","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}
Pub Date : 2024-03-01Epub Date: 2023-04-15DOI: 10.1177/19433875231170924
Ishaque Hameed, Mohammad Omer Khan, Syed Abdus Samad, Samar Mahmood, Omer Mustafa Siddiqui, Indallah Hameed, Muhammad Nashit, Ayman Iqbal, Shayan Marsia, Al Haitham Al Shetawi
Study design: Systematic review and meta-analysis.
Objective: The clinical decision to pursue harmonic scalpel (HS) method vs conventional hemostasis to treat head and neck cancers has been arguably predicated on the clinical outcomes observed. This study aims to evaluate the surgical outcomes of neck dissection between both techniques and perform an updated meta-analysis using the available literature.
Methods: We searched PubMed, Scopus, and Cochrane Library through 31st December 2021, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcome metrics included operative time and intraoperative blood loss. Secondary outcomes consisted of length of hospital stay, length of drain stay, total drain output, and postoperative complications. A meta-analysis was conducted using Review Manager Version 5.3 (RevMan) software employing the Random Effects Model.
Results: We identified 114 articles, out of which 10 randomized control trials (RCTs) analyzing a combined total of 558 patients met the inclusion criteria after title and full-text screening. Meta-analysis shows the group treated with HS had a significantly shorter operative time. [MD = -23.21, 95% CI (-34.30, -12.12) P value <.0001 I2 = 92%] but an insignificant lesser intraoperative blood loss [MD = -61.53, 95% CI (-88.61, -34.45) P < .00001 I2 = 79%].
Conclusions: This study confirms that that HS use in neck dissection yields a reduced operative time and intra operative blood loss relative to conventional hemostasis. Furthermore, our paper shows no superiority of HS method over conventional hemostasis where length of hospital stays, length of drain stays, and postoperative complications are concerned. Future RCTs with high-level evidence may further elucidate the relative effectiveness of HS method over conventional hemostasis in treating head and neck cancers.
研究设计系统综述和荟萃分析:在治疗头颈部癌症时,临床决定采用谐波手术刀(HS)法还是传统止血法,主要取决于观察到的临床结果。本研究旨在评估两种技术的颈部解剖手术效果,并利用现有文献进行最新的荟萃分析:根据系统综述和荟萃分析首选报告项目(PRISMA)指南,我们检索了截至 2021 年 12 月 31 日的 PubMed、Scopus 和 Cochrane 图书馆的文献。结果指标包括手术时间和术中失血量。次要结果包括住院时间、引流管留置时间、引流管总输出量和术后并发症。我们使用Review Manager Version 5.3(RevMan)软件,采用随机效应模型进行了荟萃分析:经过标题和全文筛选,我们确定了 114 篇文章,其中有 10 项随机对照试验(RCT)符合纳入标准,共分析了 558 名患者。Meta 分析显示,接受 HS 治疗的一组患者的手术时间明显更短。[MD = -23.21,95% CI (-34.30, -12.12) P 值 2 = 92%],但术中失血量明显减少[MD = -61.53,95% CI (-88.61, -34.45) P < .00001 I2 = 79%]:本研究证实,与传统止血方法相比,在颈部解剖中使用 HS 可减少手术时间和术中失血量。此外,我们的论文显示,在住院时间、引流管停留时间和术后并发症方面,HS方法没有优于传统止血方法。未来具有高水平证据的研究性临床试验可能会进一步阐明HS止血法在治疗头颈部癌症方面相对于传统止血法的有效性。
{"title":"Is Using the Harmonic Scalpel Better than Conventional Hemostasis in Neck Dissection? A Meta-Analysis.","authors":"Ishaque Hameed, Mohammad Omer Khan, Syed Abdus Samad, Samar Mahmood, Omer Mustafa Siddiqui, Indallah Hameed, Muhammad Nashit, Ayman Iqbal, Shayan Marsia, Al Haitham Al Shetawi","doi":"10.1177/19433875231170924","DOIUrl":"10.1177/19433875231170924","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>The clinical decision to pursue harmonic scalpel (HS) method vs conventional hemostasis to treat head and neck cancers has been arguably predicated on the clinical outcomes observed. This study aims to evaluate the surgical outcomes of neck dissection between both techniques and perform an updated meta-analysis using the available literature.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, and Cochrane Library through 31st December 2021, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcome metrics included operative time and intraoperative blood loss. Secondary outcomes consisted of length of hospital stay, length of drain stay, total drain output, and postoperative complications. A meta-analysis was conducted using Review Manager Version 5.3 (RevMan) software employing the Random Effects Model.</p><p><strong>Results: </strong>We identified 114 articles, out of which 10 randomized control trials (RCTs) analyzing a combined total of 558 patients met the inclusion criteria after title and full-text screening. Meta-analysis shows the group treated with HS had a significantly shorter operative time. [MD = -23.21, 95% CI (-34.30, -12.12) <i>P</i> value <.0001 I<sup>2</sup> = 92%] but an insignificant lesser intraoperative blood loss [MD = -61.53, 95% CI (-88.61, -34.45) <i>P</i> < .00001 I<sup>2</sup> = 79%].</p><p><strong>Conclusions: </strong>This study confirms that that HS use in neck dissection yields a reduced operative time and intra operative blood loss relative to conventional hemostasis. Furthermore, our paper shows no superiority of HS method over conventional hemostasis where length of hospital stays, length of drain stays, and postoperative complications are concerned. Future RCTs with high-level evidence may further elucidate the relative effectiveness of HS method over conventional hemostasis in treating head and neck cancers.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82771308","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}
Pub Date : 2024-03-01Epub Date: 2023-03-01DOI: 10.1177/19433875231161907
Damon R T McIntire, Carole S L Spake, Charles C Jehle, Marten N Basta, Joseph W Crozier, Albert S Woo
Study design: A retrospective review was conducted of all patients with mandibular fractures who were evaluated by plastic surgery at a Level I trauma center between January 1, 2017 and May 1, 2020. Data including demographic characteristics, mechanism of injury, type of presentation (e.g., primary or transfer), treatment plan, and time to intervention were recorded.
Objective: Mandibular fractures are common traumatic injuries. Because these injuries are managed by surgical specialists, these patients are often emergently transferred to tertiary care hospitals. This study aims to assess the benefits of emergent transfer in this patient group.
Methods: Variables were summarized using descriptive statistics. The relationship with initial disposition was assessed via tests of association, including Student's t-test, Fisher's exact test, or chi-square tests. Significance was set to p values less than 0.05. Multivariate regression analysis was conducted to determine predictors of presentation to outside hospital followed by transfer to our institution.
Results: Records from 406 patients with isolated mandibular fractures were evaluated. 145 (36%) were transferred from an outside hospital specifically for specialty evaluation. One patient required intervention in the Emergency Department (ED). Of the 145 patients that were transferred to our facility, eight (5.5%) were admitted for operative management. Patients with open injuries and pediatric patients showed benefit from transfer.
Conclusions: Patients are frequently transferred to tertiary care facilities for specialty service evaluation and treatment. However, when isolated mandible fractures were evaluated, only one patient required intervention in the ED. Patients with grossly open fractures and pediatric patients were more frequently admitted specifically for operative management. This practice of acute interfacility transfer represents an unnecessary cost to our health system as isolated mandible fractures can be managed on an outpatient basis. We suggest that pediatric patients and patients with open fractures be transferred for urgent evaluation and management, whereas most patients would be appropriate for outpatient evaluation.
研究设计:对2017年1月1日至2020年5月1日期间在一级创伤中心接受整形外科评估的所有下颌骨骨折患者进行回顾性研究。记录的数据包括人口统计学特征、受伤机制、发病类型(如初诊或转院)、治疗方案和干预时间:下颌骨骨折是常见的外伤。目的:下颌骨骨折是一种常见的外伤,由于这些损伤需要外科专家进行处理,因此这些患者通常会被紧急转送到三级医院。本研究旨在评估紧急转院对这类患者的益处:方法:使用描述性统计对变量进行总结。通过学生 t 检验、费雪精确检验或卡方检验等关联检验来评估与初始处置的关系。显著性设定为 p 值小于 0.05。进行了多变量回归分析,以确定转院到外院的预测因素:对 406 名孤立性下颌骨骨折患者的记录进行了评估。145例(36%)患者是从外院转入本院进行专科评估的。一名患者需要在急诊科(ED)接受治疗。在转入本院的145名患者中,有8名(5.5%)患者入院接受了手术治疗。开放性损伤患者和儿童患者从转院中获益匪浅:结论:患者经常被转送到三级医疗机构接受专科评估和治疗。然而,在对孤立的下颌骨骨折进行评估时,只有一名患者需要在急诊室进行干预。严重开放性骨折患者和儿科患者则更多需要入院接受手术治疗。由于孤立性下颌骨骨折可以在门诊进行治疗,因此这种急性医院间转院的做法给我们的医疗系统带来了不必要的成本。我们建议将小儿患者和开放性骨折患者转院进行紧急评估和治疗,而大多数患者适合在门诊进行评估。
{"title":"Mandible Fractures Undergoing Transfer Rarely Require Acute Intervention.","authors":"Damon R T McIntire, Carole S L Spake, Charles C Jehle, Marten N Basta, Joseph W Crozier, Albert S Woo","doi":"10.1177/19433875231161907","DOIUrl":"10.1177/19433875231161907","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective review was conducted of all patients with mandibular fractures who were evaluated by plastic surgery at a Level I trauma center between January 1, 2017 and May 1, 2020. Data including demographic characteristics, mechanism of injury, type of presentation (e.g., primary or transfer), treatment plan, and time to intervention were recorded.</p><p><strong>Objective: </strong>Mandibular fractures are common traumatic injuries. Because these injuries are managed by surgical specialists, these patients are often emergently transferred to tertiary care hospitals. This study aims to assess the benefits of emergent transfer in this patient group.</p><p><strong>Methods: </strong>Variables were summarized using descriptive statistics. The relationship with initial disposition was assessed via tests of association, including Student's <i>t</i>-test, Fisher's exact test, or chi-square tests. Significance was set to <i>p</i> values less than 0.05. Multivariate regression analysis was conducted to determine predictors of presentation to outside hospital followed by transfer to our institution.</p><p><strong>Results: </strong>Records from 406 patients with isolated mandibular fractures were evaluated. 145 (36%) were transferred from an outside hospital specifically for specialty evaluation. One patient required intervention in the Emergency Department (ED). Of the 145 patients that were transferred to our facility, eight (5.5%) were admitted for operative management. Patients with open injuries and pediatric patients showed benefit from transfer.</p><p><strong>Conclusions: </strong>Patients are frequently transferred to tertiary care facilities for specialty service evaluation and treatment. However, when isolated mandible fractures were evaluated, only one patient required intervention in the ED. Patients with grossly open fractures and pediatric patients were more frequently admitted specifically for operative management. This practice of acute interfacility transfer represents an unnecessary cost to our health system as isolated mandible fractures can be managed on an outpatient basis. We suggest that pediatric patients and patients with open fractures be transferred for urgent evaluation and management, whereas most patients would be appropriate for outpatient evaluation.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81149402","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}
Pub Date : 2024-03-01Epub Date: 2023-02-09DOI: 10.1177/19433875231155727
Kimberly Oslin, Meryam Shikara, Joshua Yoon, Pharibe Pope, Kelly Bridgham, Suneet Waghmarae, Andrea Hebert, Fan Liang, Kalpesh Vakharia, Natalie Justicz
Study design: Case series.
Objective: This retrospective review of frontal sinus fractures aims to describe our current experience managing these fractures at an urban level I trauma center.
Methods: An institutional database of 2081 patients who presented with maxillofacial fractures on computed tomography face/sinus in 2019 was queried for all patients with traumatic frontal sinus fractures. Demographics, trauma-related history, management approach, and follow-up data were collected and analyzed.
Results: Sixty-three (7.3%) patients had at least one fracture involving the frontal sinus. The most common etiologies were assaults, falls, and motor vehicle accidents. Surgical repair was performed in 26.8% of patients with frontal sinus fractures, and the other 73.2% were observed. Fractures that were displaced, comminuted, obstructive of the frontal sinus outflow tract, or associated with a dural tear or cerebrospinal fluid leak were more likely to be operative.
Conclusions: The majority of frontal sinus fractures in this study were treated with observation. Despite advances in transnasal endoscopic approaches, many surgeons still rely on open approaches to repair frontal sinus fractures.
{"title":"Management of Frontal Sinus Fractures at a Level 1 Trauma Center: Retrospective Study and Review of the Literature.","authors":"Kimberly Oslin, Meryam Shikara, Joshua Yoon, Pharibe Pope, Kelly Bridgham, Suneet Waghmarae, Andrea Hebert, Fan Liang, Kalpesh Vakharia, Natalie Justicz","doi":"10.1177/19433875231155727","DOIUrl":"10.1177/19433875231155727","url":null,"abstract":"<p><strong>Study design: </strong>Case series.</p><p><strong>Objective: </strong>This retrospective review of frontal sinus fractures aims to describe our current experience managing these fractures at an urban level I trauma center.</p><p><strong>Methods: </strong>An institutional database of 2081 patients who presented with maxillofacial fractures on computed tomography face/sinus in 2019 was queried for all patients with traumatic frontal sinus fractures. Demographics, trauma-related history, management approach, and follow-up data were collected and analyzed.</p><p><strong>Results: </strong>Sixty-three (7.3%) patients had at least one fracture involving the frontal sinus. The most common etiologies were assaults, falls, and motor vehicle accidents. Surgical repair was performed in 26.8% of patients with frontal sinus fractures, and the other 73.2% were observed. Fractures that were displaced, comminuted, obstructive of the frontal sinus outflow tract, or associated with a dural tear or cerebrospinal fluid leak were more likely to be operative.</p><p><strong>Conclusions: </strong>The majority of frontal sinus fractures in this study were treated with observation. Despite advances in transnasal endoscopic approaches, many surgeons still rely on open approaches to repair frontal sinus fractures.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73095361","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}
Pub Date : 2023-12-01Epub Date: 2022-11-28DOI: 10.1177/19433875221142676
Kathryn W Brown, Shelley R Edwards, Ian C Hoppe
Study design: Retrospective observational study.
Objective: The purpose of this publication is to address the absence of literature detailing respiratory management in patients with syndromic craniosynostosis and obstructive sleep apnea during the immediate postoperative interval following LeFort III advancement with placement of distraction hardware but prior to sufficient midface advancement.
Methods: After IRB approval, the investigators retrospectively selected candidates for inclusion in this case series. The sample was composed of four patients ranging from 10 to 19 years of age undergoing LeFort III midface advancement during a one-year span at a single tertiary care center. All operations were performed by a single surgeon. Three of the selected patients suffered significant obstructive sleep apnea necessitating the operation, as determined by polysomnography. One patient experienced persistent apnea postoperatively requiring prolonged ICU level care.
Results: Three of the four patients had severe OSA diagnosed by polysomnography with a median AHI of 28.3. Two of the three patients with preoperative OSA experienced no untoward respiratory compromise in the immediate postoperative period; one required nightly oxygen tent and the other required no supplemental oxygen. Patient 1 experienced significant postoperative respiratory distress with nightly apneic episodes and desaturations requiring supplemental oxygen and frequent stimulation.
Conclusions: The present study suggests that early involvement of sleep medicine and management of patient expectations is vital. Extremely close postoperative monitoring in the ICU is necessary. Future studies are needed to protocolize perioperative management of obstructive sleep apnea in patients undergoing LeFort III osteotomy prior to initiation and completion of midface advancement.
{"title":"Perioperative Management of Obstructive Sleep Apnea in Patients With Syndromic Craniosynostosis Undergoing LeFort III Osteotomy With Distraction: A Case Series.","authors":"Kathryn W Brown, Shelley R Edwards, Ian C Hoppe","doi":"10.1177/19433875221142676","DOIUrl":"10.1177/19433875221142676","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Objective: </strong>The purpose of this publication is to address the absence of literature detailing respiratory management in patients with syndromic craniosynostosis and obstructive sleep apnea during the immediate postoperative interval following LeFort III advancement with placement of distraction hardware but prior to sufficient midface advancement.</p><p><strong>Methods: </strong>After IRB approval, the investigators retrospectively selected candidates for inclusion in this case series. The sample was composed of four patients ranging from 10 to 19 years of age undergoing LeFort III midface advancement during a one-year span at a single tertiary care center. All operations were performed by a single surgeon. Three of the selected patients suffered significant obstructive sleep apnea necessitating the operation, as determined by polysomnography. One patient experienced persistent apnea postoperatively requiring prolonged ICU level care.</p><p><strong>Results: </strong>Three of the four patients had severe OSA diagnosed by polysomnography with a median AHI of 28.3. Two of the three patients with preoperative OSA experienced no untoward respiratory compromise in the immediate postoperative period; one required nightly oxygen tent and the other required no supplemental oxygen. Patient 1 experienced significant postoperative respiratory distress with nightly apneic episodes and desaturations requiring supplemental oxygen and frequent stimulation.</p><p><strong>Conclusions: </strong>The present study suggests that early involvement of sleep medicine and management of patient expectations is vital. Extremely close postoperative monitoring in the ICU is necessary. Future studies are needed to protocolize perioperative management of obstructive sleep apnea in patients undergoing LeFort III osteotomy prior to initiation and completion of midface advancement.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78689860","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}