The Journal of craniofacial surgery
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Injury of the zygomaticotemporal nerve causes paresthesia in its distributed area, and its entrapment induces protractive pain in case of manipulation of the orbital lateral wall, a Gillies or Dingman reduction procedure for a zygomatic fracture, or an endoscopic subperiosteal facelift. The aim of this study was to elucidate the surgical anatomy of the zygomaticotemporal nerve in the orbit and temporal area. Twenty hemifaces from 10 adult Korean cadavers (10 male and 10 female) were used in the study. ⋯ It ran just superficial to the deep layer of the deep temporal fascia toward the temporal area and innervated the temporal skin. The area innervated by terminal branches of the zygomaticotemporal nerve included a circle with 30-mm diameter, with the center located 10 mm superior to the top of the auriculocephalic sulcus and 30 mm lateral to the lateral canthus. Precautions should be taken when working in the area of the vulnerable zone during the Dingman procedure involving periorbital incision in case of zygomatic fracture.
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The purpose of this study was to compare the use of molding helmet therapy in the treatment of positional brachycephaly and posterior positional plagiocephaly. Four hundred twenty-eight children with positional brachycephaly or plagiocephaly were included in this study. In this group of patients, 132 (32%) were treated with positioning alone. ⋯ Overall, the children with posterior plagiocephaly normalized their head shapes; however, the head shapes of the children with positional brachycephaly did not normalize despite statistically significant improvements in their Cephalic Index. It is concluded that molding helmet therapy is an effective treatment of position-induced head shape abnormalities. Helmet therapy is more effective in children with posterior positional plagiocephaly than in children with positional brachycephaly.
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The aim of this study is to elucidate precisely the cutaneous distribution of the infraorbital nerve. Ten hemifaces of five Korean adult cadavers (2 males and 3 females) were subjected to the dissection. The cutaneous branches of the infraorbital nerve were distributed over the infraorbital area, which bounds on superiorly the lower eyelid margin, inferiorly the horizontal line crossing the mouth corners, medially 0.5 cm to midline, and laterally 2 cm lateral to the temporal canthus of the eyes. ⋯ The mean area of the superior labial branch was 13.1 cm2 (range, 11.2-14.3 cm2) and broader than either the 7.5 cm2 (range, 6.6-8.8 cm2) of the lower palpebral branch or the 7.6 cm2 (range, 6.7-9.3 cm2) of the external nasal branch. The external nasal branch was overlapped with the lower palpebral and superior labial branch, but the last two branches do not overlap each other. The nonoverlapped branch of the infraorbital nerve exhibits a restricted anesthesia, but the overlapped branch sustains sensory perception to some extent when being damaged.
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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.
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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.