The Journal of craniofacial surgery
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Comparative Study
Orbital stress analysis, Part IV: Use of a "stiffness-graded" biodegradable implants to repair orbital blow-out fracture.
The purpose of this study was to develop a finite element model (FEM) of a human orbit, of 1 patient, who had an orbital blow-out fracture, to study the effect of using a "stiffness-graded" (SG) biodegradable implant on the biomechanics of bone-fracture repair. ⋯ The use of SG implants induced significant changes in the stress patterns at the fracture interface and at the bone-implant interface. Stiffness-graded biodegradable implants offered less stress shielding to the bone, providing higher compressive stress at the fractured surface, to induce accelerated bone healing, as well as higher tensile stress in the intact portion of the bone. It seems that this is the first reported study, in the literature, on the use of SG biodegradable implants to repair and promote bone healing at the fracture site of the inferior orbital wall bone defect.
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Comparative Study
Controversies in the management of neonatal micrognathia: to distract or not to distract, that is the question.
Symptomatic micrognathia, as seen in syndromic and isolated presentations of the Robin sequence (RS), can pose immediate an ongoing threats to the well-being of neonates. Upper airway obstruction can manifest as acute respiratory insufficiency requiring postpartum intubation and mechanical ventilation or as a mild irregularity in the oropharyngeal airflow that can be managed by positioning the newborn in a prone or decubitus position. Clinically significant micrognathia is often accompanied by some degree of feeding difficulty, obstructive sleep apnea, and gastroesophageal reflux disease, all of which should be evaluated by a multidisciplinary team of specialists before a definitive treatment plan is formulated. ⋯ Rather than serve as a panacea, however, the practice of neonatal mandibular distraction for infants with upper airway obstruction has probably given rise to more questions than it has answered. The debate over its most appropriate indication in the micrognathia patient is quite current. In this article, we consider some of the controversies surrounding the use of distraction compared with other techniques in the management of the neonatal airway.
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Diabetes mellitus can cause various diseases, including loss of bone mineral density as a characteristic manifestation of osteoporosis. In this condition, bone is more vulnerable to pathologic fractures that can be treated by implantation of biomaterial grafts. The aim of this study was to evaluate the osteogenic capacity of hydroxyapatite implanted into bone defects in the skull of nonobese diabetic mice. ⋯ The quantity of newly formed bone was significantly higher (P < 0.05) than that observed in the diabetic groups. The recipient area of diabetic groups contained a larger amount of connective tissue as demonstrated by radiographic analyses. In conclusion, the osteogenesis guided by the properties of hydroxyapatite may even occur in bone suffering from the effects of diabetes, but the quantity of newly formed bone is lower, and the process is slower.
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Treatment of microstomia, whether congenital or acquired, has long challenged the ingenuity of surgeons. In all instances, the challenge remains the ability to preserve function and provide and maintain reasonable aesthetics. The following case report presents 2 different cases of surgical correction of microstomia, resulting from flap reconstructions after perioral tumor surgery. ⋯ Results have shown that, with the use of our fishtail design, we can restore the unique architecture of the oral commissure with the postoperative intercommissural distance improved by more than 10 mm and the interincisal width enlarged by approximately 5 mm. Our solution was functional and aesthetically acceptable, as well as simpler and cheaper, in comparison with the traditional surgical methods that are usually expensive, complex, and less practical. We believe that, in cases in which either the contracture is mild or a commissurotomy can be expected to increase the width and the general size of the oral aperture, this relatively conservative technique, if judiciously used, can be performed with ease and safety with good results.
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Case Reports
Life-threatening complication of recurrent laryngeal nerve monitoring with EMG reinforced silicone ETT.
We present 2 cases with complication of herniation of a specially designed endotracheal tube (ETT) cuff used for laryngeal nerve monitoring during thyroid surgery. Abrupt and total blockage of ventilation has occurred at 35th and 40th minutes of general anesthesia. ⋯ In patients intubated with electromyographic reinforced ETT, any event suggesting sudden ventilation blockage should be managed initially by prompt deflation of the cuff. The cuff should be inflated at the minimal necessary volume, and operating room staff should pay maximum attention to the stability of endotracheal and breathing tubes.