The Journal of craniofacial surgery
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We present a case of a maxillary fungus ball caused by retained foreign bodies for 25 years. The patient sustained a stab wound in the left face 25 years ago. ⋯ The fungus ball and foreign bodies were removed via an endoscopic and Caldwell-Luc approach. We suggest the need for careful inspection and radiologic studies to localize occult foreign bodies in the sinonasal cavity or facial soft tissues after facial trauma.
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Greater palatine nerve block anesthesia (GPNBA) is a local anesthetic procedure used for maxillary and nasal treatment. Investigation of the three-dimensional anatomic location of the greater palatine foramen (GPF) is important for successful local anesthesia. The study aim was to provide standards for anatomic structures in the oral cavity that can be easily referred to in GPNBA. ⋯ In adults, the measured perpendicular distance from the incisive foramen to the GPF in the coronal plane was 32.04 mm, and the perpendicular distance from the median of the line that connects both of the contact points between the maxillary tuberosity and the pterygoid plate to the GPF in the coronal plane was 5.23 mm. Three-dimensional reference values relative to the anatomic structures in the oral cavity may increase the success rate of GPNBA and reduce complications. Although the maxillary growth pattern was analyzed, a limitation of this study is that maxillary anatomic measurements were not analyzed with regard to race or ethnicity.
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Comparative Study
Comparison of the effect of 2 hypotensive anesthetic techniques on early recovery complications after orthognathic surgery.
The aim of this study was to evaluate the recovery complications following the use of 2 anesthetic protocols in orthognathic surgery, namely, propofol with remifentanil and isoflurane with remifentanil. Sixty-two patients with American Society of Anesthesiologists physical status I were selected. All underwent bimaxillary orthognathic surgery. ⋯ General anesthesia can be provided via intravenously administered medications and/or inhaled volatile anesthetics. No significant difference in early recovery time was found in patients when either isoflurane or propofol was used to maintain the anesthesia. However, the length of the operation played a major role in increasing early recovery complications.
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The most common approaches used today for the correction of sagittal synostosis involve large craniectomies and extensive cranial vault remodeling. Although these techniques ultimately yield very good cosmetic results, they have significant drawbacks. They are lengthy, expensive, associated with significant blood loss, universally require transfusions, and often result in prolonged hospitalization. ⋯ The change in cranial index from a preoperative value of 0.7 to 0.8 postoperatively was virtually stabilized 3 months after the surgical intervention. Significantly better correction rates were observed in the youngest patients. Because of its excellent attributes, minimally invasive strip craniectomy followed by postoperative helmet molding is likely to become the preferred treatment modality for the correction of sagittal synostosis.
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Case Reports
Modified Gillies approach for zygomatic arch fracture reduction in the setting of bicoronal exposure.
Zygomatic arch fractures are common injuries, occurring in isolation in 5% of all patients with facial fractures and in 10% of patients with any fracture to the zygomaticomaxillary complex. Isolated noncomminuted depressed zygomatic arch fractures are easily treated with the minimally invasive Gillies approach, which most often provides long-term stability. However, zygomatic arch fractures often occur in conjunction with zygomaticomaxillary complex, Le Fort, calvarial, and naso-orbitoethmoid fractures. ⋯ This technique exploits the advantages of the traditional Gillies approach, preserving fascial attachments, avoiding neurovascular injury, and obviating the need for rigid fixation. Moreover, this method saves time and money and decreases morbidity. Our modified Gillies approach to zygomatic arch fractures in the setting of a bicoronal incision can be applied to a wide range of cases because of the frequency with which arch fractures occur with concomitant craniomaxillofacial injuries requiring wide exposure.