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Schopper H, Krane NA, Sykes KJ, Yu K, Kriet JD, Humphrey CD. Trends in Maxillomandibular Fixation Technique at a Single Academic Institution. Craniomaxillofac Trauma Reconstr 2024; 17:119-123. [PMID: 38779397 PMCID: PMC11107819 DOI: 10.1177/19433875231176339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Study Design Retrospective chart review. Objective Restoration of premorbid occlusion is a key goal in the treatment of mandibular fractures. Placement of the patient in maxillomandibular fixation (MMF) is performed during mandibular fracture repair to help establish occlusion. A number of techniques are available to achieve MMF. We sought to examine trends in MMF technique at our institution. Methods A retrospective chart review was conducted to evaluate patients who underwent surgical treatment of mandibular fractures between January 1, 2011 and March 31, 2021. Data including fracture characteristics, mechanism of injury, patient demographics, complication rates, and MMF technique utilized were collected. Results One hundred sixty-three patients underwent MMF (132 males). The most common etiology of fracture was assault (34%). There was an increasing preference for rapid MMF techniques over time, as opposed to standard Erich arch bars. No significant difference in obtaining adequate fracture reduction as determined by postoperative imaging or complications were noted between those who underwent MMF with newer rapid techniques vs traditional MMF techniques. Conclusions Our institution has demonstrated changing trends in the technique utilized for establishing occlusion intraoperatively, more recently favoring rapid MMF techniques, with similar rates of complications and ability to adequately reduce fractures.
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Affiliation(s)
- Heather Schopper
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Natalie A. Krane
- Department of Otolaryngology, Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Kevin J. Sykes
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Katherine Yu
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - J. David Kriet
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Clinton D. Humphrey
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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Kostares E, Kostare G, Kostares M, Kantzanou M. Prevalence of surgical site infections after open reduction and internal fixation for mandibular fractures: a systematic review and meta-analysis. Sci Rep 2023; 13:11174. [PMID: 37430033 DOI: 10.1038/s41598-023-37652-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023] Open
Abstract
Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to determine the effect of potential moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. The pooled prevalence with 95% confidence intervals was estimated. Quality assessment as well as outlier and influential analysis were performed. Additionally, subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, seventy-five eligible studies (comprising a sum of 5825 participants) were included in this meta-analysis. The overall prevalence of SSI following ORIF for mandibular fractures was estimated as high as 4.2% (95% CI 3.0-5.6%) with significant heterogeneity between studies. One study was identified to be critically influential. In the subgroup analysis, the prevalence was 4.2% (95% CI 2.2-6.6%) among studies conducted in Europe, 4.3% (95% CI 3.1-5.6%) among studies conducted in Asia and higher among those conducted in America (7.3%) (95% CI 4.7-10.3%). It is important for healthcare professionals to be aware of the etiology of these infections, despite the relatively low rate of SSI in these procedures. However, further, well-designed prospective and retrospective studies need to be conducted in order this issue to be fully clarified.
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Affiliation(s)
- Evangelos Kostares
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece.
| | - Georgia Kostare
- National and Kapodistrian University of Athens Faculty of Medicine: Ethniko kai Kapodistriako Panepistemio Athenon Iatrike Schole, 115 27, Athens, Greece
| | - Michael Kostares
- National and Kapodistrian University of Athens Faculty of Medicine: Ethniko kai Kapodistriako Panepistemio Athenon Iatrike Schole, 115 27, Athens, Greece
| | - Maria Kantzanou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
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Kaur T, Dhawan A, Bhullar RS, Kapila S, Gupta S, Resham R. Are Embrasure Wires Effective and Reliable Method for Intraoperative Maxillomandibular Fixation in Mandibular Fractures? J Maxillofac Oral Surg 2022; 21:433-441. [DOI: 10.1007/s12663-021-01528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 02/03/2021] [Indexed: 11/28/2022] Open
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Singh AK, Dahal S, Singh S, Krishna KC, Chaulagain R. Is manual reduction adequate for intraoperative control of occlusion during fixation of mandibular fractures? A systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 60:271-278. [PMID: 35248408 DOI: 10.1016/j.bjoms.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022]
Abstract
The aim of this systematic review was to find out if manual intraoperative control of occlusion is adequate for the reduction of mandibular fractures in comparison with intermaxillary fixation (IMF). We searched PubMed, Embase, the Cochrane Library and Clinical Trials Registry, and the references of included trials. Our primary outcomes of interest were the reduction of fracture anatomically and radiographically, occlusal disturbances, and the incidence of revision procedures due to poor occlusion or reduction. Our secondary outcomes of interest were operating time and infective complications. Of the 257 studies retrieved (manual reduction = 136, IMF = 121), four were included. The studies had an unclear risk of bias. Nevertheless, the overall effect was statistically significant and in favour of manual reduction, with a lower number of adverse events in the manual reduction group (n = 43) than in the IMF group (n = 78), odds ratio 0.42 (95% CI 0.27 to 0.64). An absolute reduction in adverse events was seen in occlusion disturbances (120 fewer/1000), revision procedures (164 fewer/1000), and infective complications (178 fewer/1000). The evidence to support manual reduction over IMF for the intraoperative control of fracture fragments and occlusion was derived from few studies with an unclear risk of bias, and the quality was low. The results were not different when condylar fractures were present. The overall certainty of evidence was moderate. Clinicians should select the appropriate technique based on the injury pattern, and the treating surgeon's experience and available resources.
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Affiliation(s)
- Ashutosh Kumar Singh
- Department of Oral and Maxillofacial Surgery, TU dental Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
| | - Samarika Dahal
- Department of Oral Pathology, TU dental Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Sumit Singh
- Department of Oral and Maxillofacial Surgery, Kantipur Dental College, Kathmandu, Nepal
| | - K C Krishna
- Department of Oral and Maxillofacial Surgery, TU dental Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
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Satpute AS, Mohiuddin SA, Doiphode AM, Kulkarni SS, Qureshi AA, Jadhav SB. Comparison of Erich arch bar versus embrasure wires for intraoperative intermaxillary fixation in mandibular fractures. Oral Maxillofac Surg 2018; 22:419-428. [PMID: 30302602 DOI: 10.1007/s10006-018-0723-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/26/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Intermaxillary fixation (IMF) is a fundamental principle in the management of mandibular fractures but with recent advent of open reduction and internal fixation (ORIF), use of IMF is almost limited intraoperatively. Therefore, we compared the efficacy of Erich arch bar versus embrasure wires for intraoperative IMF in mandibular fractures. METHOD This prospective study was comprised of 50 patients with mandibular fractures who required ORIF with intraoperative IMF. Patients were categorized into two groups of 25 patients each: Erich arch bar technique was used for group A and embrasure wire technique for group B. Parameters were time taken for IMF, needle stick injury, occlusal stability, iatrogenic complications, and periodontal status of patients. STATISTICAL ANALYSIS Chi-squared test and unpaired t test analyses was run on IBM SPSS 21.0 version (2015) software. RESULT Mean time for placing embrasure wire (3.48 min) was significantly less than that for Erich arch bar (48.08 min). Needle stick injury rates to the operator as well as the assistants were significantly less when using the embrasure wire than the Erich arch bar. The Erich arch bar had significantly superior postoperative occlusion stability. Iatrogenic injury was more common when placing the Erich arch bar than the embrasure wire. Postoperative oral hygiene status was good in patients that received the embrasure wire. CONCLUSION Embrasure wire technique is a quick, easy, and reliable technique for minimally or moderately displaced fractured mandible and had better clinical outcomes than did patients that underwent the Erich arch bar technique.
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Affiliation(s)
- Ashish Shrikant Satpute
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India.
| | - Syed Ahmed Mohiuddin
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Amol Madhukar Doiphode
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Sujay Sanjay Kulkarni
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Ahtesham Ahmad Qureshi
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Swapnil Bharat Jadhav
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
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Rastogi S, Ahmed T, Giri K, Dandriyal R, Indra B NP, Joshi A, Choudhury S, Mall S. Comparative Evaluation of the Embrasure Wire versus Arch Bar Maxillomandibular Fixation in the Management of Mandibular Fractures: Are Arch Bars Replaceable? Craniomaxillofac Trauma Reconstr 2018; 11:118-123. [PMID: 29892326 DOI: 10.1055/s-0037-1603453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022] Open
Abstract
The aim of this prospective study was to appraise the role of embrasure wiring in the treatment of mandibular fractures over the arch bar as adjunctive techniques of maxillomandibular fixation (MMF). This study was conducted on 40 patients who were surgically treated for mandibular fractures with accessory use of MMF (embrasure: group A vs. arch bars: group B). All patients were evaluated for demographic data, etiology, and location of fracture. Characteristically, the complications, including wire injury, infection, and malocclusion, were recorded. The data were analyzed using Student's t -test and chi-square test as appropriate. Statistical significance was set at p < 0.05). In this study, data from 40 patients were included. In group A (embrasure wiring), time required for placement of MMF was significantly less than (7.85 ± 0.81 minutes) that in group B, and also there was less incidence of wire prick to the operator in group A than in group B ( p < 0.05). However, in terms of wire prick and malocclusion, no statistically significant difference was noted in groups A and B ( p > 0.05). Patient treated with embrasure wiring intermaxillary fixation had better outcomes especially in terms of time of placement and less incidence of wire prick injury when compared with arch bar.
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Affiliation(s)
- Sanjay Rastogi
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Tousif Ahmed
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Kolli Giri
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Ramakant Dandriyal
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Niranjana Prasad Indra B
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Ankur Joshi
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Shouvik Choudhury
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Sunil Mall
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
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Rothe TM, Kumar P, Shah N, Shah R, Mahajan A, Kumar A. Comparative Evaluation of Efficacy of Conventional Arch Bar, Intermaxillary Fixation Screws, and Modified Arch Bar for Intermaxillary Fixation. J Maxillofac Oral Surg 2018; 18:412-418. [PMID: 31371884 DOI: 10.1007/s12663-018-1110-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 04/16/2018] [Indexed: 11/25/2022] Open
Abstract
Aim Comparative evaluation of efficacy of conventional arch bar, intermaxillary fixation screws, and modified arch bar with respect to plaque accumulation, time required for procedure, postoperative stability after achieving the intermaxillary fixation, mucosal growth, and complication encountered for intermaxillary fixation. Materials and methods This study is a randomized clinical trial in which participants were divided into three groups of 10 each, and designated as Group A, Group B, and Group C. In Group A, intermaxillary fixation was achieved by the conventional method using Erich arch bar, fastened with 26-gauge stainless-steel wires. In Group B, intermaxillary fixation was achieved by the use of 2 mm × 8 mm 4-6 stainless-steel intermaxillary fixation screws. In Group C, intermaxillary fixation was achieved by modified screw arch bar. A conventional arch bar was modified by making perforations in the spaces between the winglets along the entire extension of the bar which was then adapted to the vestibular surface of the maxilla and mandible, close to the cervical portion of the teeth, and perforations were made in the inter-radicular spaces with a 1.1-mm bur, and after this, 1.5-mm screws were placed to fix the bar. Results In the present study, a total of 30 patients were analyzed. The average working time for Group A, Group B, and Group C were 110, 16, and 29 min respectively. Oral hygiene scores through modified Turskey Gilmore plaque index which was taken at immediate postoperative, 15, 30, and at 45 days. Maximum hygiene was maintained in intermaxillary fixation screw group followed by modified arch bar group and conventional arch bar group. Maximum stability was seen in the conventional arch bar group followed by modified arch bar group and intermaxillary fixation screw group. With respect to mucosal coverage, maximum mucosal growth was seen in intermaxillary fixation screws group. When complications were taken into consideration, maximum complications were reported in Group A followed by Group B and Group C. Conclusion This study emphasizes that the use of modified arch bar is quick and easy method than conventional arch bar with least chances of glove puncture and needle stick injury to the operator. Oral hygiene maintenance is comparatively better in patients with modified arch bar than with conventional arch bars. Modified arch bar was significantly stable when compared with IMF screws, and therefore, for the patients who require long-term intermaxillary fixation, modified arch bars can be a viable option.
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Affiliation(s)
- Tushar Manohar Rothe
- Oral and Maxillofacial Surgery, K M Shah Dental College Piparia, Vadodara, Gujarat India
- Akola, India
| | - Prachur Kumar
- Oral and Maxillofacial Surgery, K M Shah Dental College Piparia, Vadodara, Gujarat India
- Vadodara, India
| | - Navin Shah
- Oral and Maxillofacial Surgery, K M Shah Dental College Piparia, Vadodara, Gujarat India
- Paldi, India
| | - Rakesh Shah
- Oral and Maxillofacial Surgery, K M Shah Dental College Piparia, Vadodara, Gujarat India
- Vadodara, India
| | - Amit Mahajan
- Oral and Maxillofacial Surgery, K M Shah Dental College Piparia, Vadodara, Gujarat India
- Vadodara, India
| | - Ananth Kumar
- Oral and Maxillofacial Surgery, K M Shah Dental College Piparia, Vadodara, Gujarat India
- Vadodara, India
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Rothe TM, Kumar P, Shah N, Shah R, Kumar A, Das D. Evaluation of efficacy of intermaxillary fixation screws versus modified arch bar for intermaxillary fixation. Natl J Maxillofac Surg 2018; 9:134-139. [PMID: 30546226 PMCID: PMC6251282 DOI: 10.4103/njms.njms_16_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: This study aimed to evaluate the efficacy of intermaxillary fixation (IMF) screws and modified arch bar. Materials and Methods: This study is a randomized clinical trial in which all participants were divided into two groups of ten in each group and designated as Group A and Group B. In Group A, IMF was achieved by the use of four to six 2×8mm stainless steel IMF screws. In Group B, IMF was achieved by modified screw arch bar. Results: In the present study, a total of twenty patients were analyzed. The average working time for Group A and Group B was 16 min and 29 min, respectively. Oral hygiene scores through modified Turesky Gilmore plaque index were calculated at immediate postoperative period and after 15 days, 30 days, and 45 days. Maximum hygiene was maintained in IMF screw group than modified arch bar group, but maximum stability was observed in the modified arch bar group than IMF screw group. Conclusion: This study emphasizes the use of IMF screws as a quick and easy method than modified arch bar. Oral hygiene maintenance was comparatively better in patients with IMF screws than those with modified arch bar. Modified arch bar was significantly stable when compared with IMF screws; therefore, for patients who require long-term IMF, modified arch bars can be a viable option, but the perforation in the original arch bar may lead to the weakening of the arch bar, and therefore the prefabricated modified arch bar would be a better option.
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Affiliation(s)
- Tushar Manohar Rothe
- Department of Oral and Maxillofacial Surgery, K.M. Shah Dental College, Vadodara, Gujarat, India
| | - Prachur Kumar
- Department of Oral and Maxillofacial Surgery, K.M. Shah Dental College, Vadodara, Gujarat, India
| | - Navin Shah
- Department of Oral and Maxillofacial Surgery, K.M. Shah Dental College, Vadodara, Gujarat, India
| | - Rakesh Shah
- Department of Oral and Maxillofacial Surgery, K.M. Shah Dental College, Vadodara, Gujarat, India
| | - Ananth Kumar
- Department of Oral and Maxillofacial Surgery, K.M. Shah Dental College, Vadodara, Gujarat, India
| | - Devika Das
- Department of Oral and Maxillofacial Surgery, K.M. Shah Dental College, Vadodara, Gujarat, India
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Value in Oral and Maxillofacial Surgery: A Systematic Review of Economic Analyses. J Oral Maxillofac Surg 2017; 75:2287-2303. [DOI: 10.1016/j.joms.2017.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/17/2023]
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Dreizin D, Nam AJ, Tirada N, Levin MD, Stein DM, Bodanapally UK, Mirvis SE, Munera F. Multidetector CT of Mandibular Fractures, Reductions, and Complications: A Clinically Relevant Primer for the Radiologist. Radiographics 2017; 36:1539-64. [PMID: 27618328 DOI: 10.1148/rg.2016150218] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
After the nasal bones, the mandible is the second most common site of facial fractures, and mandibular fractures frequently require open reduction. In the trauma injury setting, multidetector computed tomography (CT) has become the cornerstone imaging modality for determining the most appropriate treatment management, fixation method, and surgical approach. Multidetector CT is also used to assess the adequacy of the reduction and evaluate potential complications in the postoperative period. For successful restoration of the mandible's form and function, as well as management of posttraumatic and postoperative complications, reconstructive surgeons are required to have a detailed understanding of mandibular biomechanics, occlusion, and anatomy. To provide added value in the diagnosis, treatment planning, and follow-up of mandibular fractures, radiologists should be aware of these concepts. Knowledge of the techniques commonly used to achieve occlusal and anatomic reduction and of the rationale behind the range of available treatment options for different injury patterns-from isolated and nondisplaced fractures to multisite and comminuted fractures-also is essential. This article focuses on the use of multidetector CT for pre- and postoperative evaluation of mandibular fractures and outlines fundamental concepts of diagnosis and management-beginning with an explanation of common fracture patterns and their biomechanical underpinnings, and followed by a review of the common postoperative appearances of these fractures after semirigid and rigid fixation procedures. Specific considerations regarding fractures in different regions of the tooth-bearing and non-tooth-bearing mandible and the unique issues pertaining to the edentulous atrophic mandible are reviewed, and key features that distinguish major from minor complications are described. (©)RSNA, 2016.
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Affiliation(s)
- David Dreizin
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Arthur J Nam
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Nikki Tirada
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Martin D Levin
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Deborah M Stein
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Uttam K Bodanapally
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Stuart E Mirvis
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Felipe Munera
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
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