The Journal of craniofacial surgery
-
Case Reports
Severe subcutaneous emphysema and pneumomediastinum associated with minor maxillofacial trauma.
In the maxillofacial region, subcutaneous emphysema, which occurs after fractures of the pneumatic paranasal sinuses, is a common finding in a maxillofacial surgeon's daily practice. Pneumomediastinum secondary to these fractures is a less frequent event, however, without thoracic or abdominal injuries. The authors report a case of severe subcutaneous emphysema and pneumomediastinum that occurred after fractures of the nasal bones and medial orbital wall. The etiology, diagnosis, and treatment modalities of mediastinal emphysema are discussed.
-
Distraction osteogenesis (DO) has become the mainstay of treatment of mandibular hypoplasias. Despite the clinical acceptance of the technique in the last decade, little is known of the biological mechanism of bone and soft tissue regeneration. The biological response of peripheral nerves to distraction has not been well documented. ⋯ Mechanical force applied to the IAN by distraction may lead to detachment of Schwann cells from their axons, leading to segmental degeneration. The resulting myelin sheath debris may serve as a trigger for higher expression of NGF and BDNF, facilitating Schwann cell proliferation and remyelination of the affected segment. Distraction of the mandible may serve as a source of subacute injury to the IAN and influence NGF and BDNF.
-
Comparative Study
Computer aided design of large-format prefabricated cranial plates.
The authors' objective in this project was to replace current state-of-the-art manual methods for preoperative production (i.e., prefabrication) of large-format (>100 cm2) cranioplasties with a system for computer-aided design and direct computer-aided manufacture of the implant's shape. This system uses standard 3D CT data, requires no specialized training, and produces an accurately fitting cranioplasty that can be recast in the physician's material of choice (e.g., polymethylmethacrylate [PMMA] or pre-bent titanium plating). The authors begin by locating the cranial defect margin on a skull surface image generated from a 3D head CT-scan. ⋯ All five computer-generated implants were better fitting and more cosmetically suitable than the manually generated skull plates received by these patients. These well-fitting implants are more likely to protect the brain from trauma and infection. Therefore, the authors conclude that their new production method provides a better result with less expense than current methods for preoperative or intraoperative fabrication of large-format cranioplasties.