The Journal of craniofacial surgery
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Microvascular free tissue transfer (FTT) is an increasingly used method of reconstruction for traumatic defects of the head and neck. We describe the immediate management, FTT reconstruction techniques, and outcomes of 6 individuals who sustained maxillofacial gunshot trauma and were treated at a single tertiary-care level I trauma center. All 6 patients were white men with a mean age of 33 years. ⋯ Oral incompetence and poor cosmesis from undesirable scarring patterns were the most common long-term complications. In summary, successful reconstruction of head and neck defects caused by gunshot trauma begins with airway stabilization, wound management, and bony fracture reduction and fixation. Definitive microvascular FTT is a useful method of repairing traumatic head and neck defects, although long-term functional and cosmetic complications may still occur.
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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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Case Reports
Paradoxical herniation in wartime penetrating brain injury with concomitant skull-base trauma.
A case of the syndrome of the trephined progressing to paradoxical herniation is presented in a patient with a penetrating brain injury, postdecompressive craniectomy, and a delayed cerebral spinal fluid leak from a skull base defect. The patient had a penetrating head trauma from a high-velocity ballistic projectile during military wartime operations. The patient's clinical course, which demonstrates a rare presentation of central sleep apnea syndrome or Ondine's curse, is reviewed. ⋯ Medical management was directed at increasing the intracranial pressures (ICPs) by placing the patient into Trendelenburg position and increasing hydration. Surgical intervention involved correction of the skull base defect by intranasal endoscopic repair. A literature review of paradoxical herniation and delayed neurologic decline in postcraniectomy patients is conducted, and the surgical and neurocritical care management is discussed.
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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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Defects on the craniofacial complex may result in aesthetic defects, functional damage, and psychologic consequences. Previously, surgeons showed no interest in reconstructing the operated area, but in the treatment of the problem, leaving bone contour is a secondary issue. Nowadays, area reconstruction with post-reestablishment of contour and local shape has become one of the surgeon's priorities. ⋯ Polyether ether ketone (PEEK) is a potential candidate because it is a linear polyaromatic semicrystalline polymer that combines strength, stiffness, durability, and resistance. Polyether ether ketone biocompatibility has been supported in literature, and subsequent medical applications of the material have been observed. The aim of this study was to describe a case of frontal bone defect reconstruction in which the PEEK was used as polymer material in a specific implant for the Synthes (PEEK-PSI) patient.