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Vallefuoco R, Bird F, Gordo I, Brissot H, Fina C. Titanium mesh osteosynthesis for the treatment of severely comminuted maxillofacial fractures in four dogs. J Small Anim Pract 2021; 62:903-910. [PMID: 34101195 DOI: 10.1111/jsap.13390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/10/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Major goals in maxillofacial fracture treatment include to restore the dental occlusion, stabilise the major skeletal supports, restore the contour of the face and achieve proper function and appearance of the face. Titanium is considered an optimal material for maxillofacial reconstruction due to its biocompatibility, high strength, minimal inflammatory reaction and minimal imaging artefact. OBJECTIVES To describe the clinical details, surgical technique, pre- and postoperative imaging and short- and long-term follow-up of severely comminuted maxillofacial fractures treated with titanium mesh and titanium screws in dogs. MATERIALS AND METHODS Retrospective short case series included four client-owned dogs with maxillofacial fractures. After appropriate medical stabilisation, preoperative CT examination of the head was obtained in all patients for evaluation of fracture configuration and surgical planning. The maxillofacial fractures were stabilised by titanium mesh osteosynthesis. Short- and long-term clinical and radiographic follow-ups were available for all dogs. RESULTS Proper dental occlusion and reconstruction of the anatomic buttresses was achieved in all cases. All dogs recovered uneventfully from the surgery and no complications were recorded on the long-term follow-up up to 43 months. Occlusion was maintained in all dogs, as well as excellent cosmesis of the midface. CLINICAL SIGNIFICANCE Titanium mesh osteosynthesis can achieve sufficient rigidity and lead to uncomplicated healing of severely comminuted maxillofacial fractures. This internal fixation method can be considered a valuable option to treat maxillofacial fractures in particular in cases of large bone defect and midface reconstruction.
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Affiliation(s)
- R Vallefuoco
- Small Animal Surgical Department, Pride Veterinary Centre, Derby, DE24 8HX, UK
| | - F Bird
- Small Animal Surgical Department, Pride Veterinary Centre, Derby, DE24 8HX, UK
| | - I Gordo
- Small Animal Surgical Department, UCD School of Veterinary Medicine, Dublin, Ireland
| | - H Brissot
- Small Animal Surgical Department, AzurVet, St-Laurent du Var, France
| | - C Fina
- Small Animal Diagnostic Imaging Department, Pride Veterinary Centre, Derby, DE24 8HX, UK
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Sun Q, Soh HY, Zhang WB, Yu Y, Wang Y, Mao C, Guo CB, Yu GY, Peng X. Long-term Effect of Individualized Titanium Mesh in Orbital Floor Reconstruction After Maxillectomy. Laryngoscope 2021; 131:2231-2237. [PMID: 33847391 DOI: 10.1002/lary.29569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/05/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of this study was to determine the clinical outcomes and long-term stability of individualized titanium mesh combined with free flap for orbital floor reconstruction after maxillectomy and to identify the risk factors for titanium mesh exposure. MATERIAL AND METHODS The data of 66 patients who underwent maxillectomy and orbital floor defect reconstruction by individualized titanium mesh in Peking University School and Hospital of Stomatology between 2011 and 2019 were retrospectively reviewed. Postoperative ophthalmic function and success of aesthetic restoration were assessed. Titanium mesh exposure was recorded and the risk factors were identified. RESULTS Mean follow-up was for 24.8 months (range, 6-92 months). Ophthalmic function was successfully restored in 63/66 patients. Aesthetic restoration was not considered satisfactory by 10 patients. Titanium mesh exposure occurred in six patients (exposure rate, 9.1%). Preoperative radiotherapy was identified as an independent risk factor for mesh exposure (OR = 28.8, P = 0.006). Previous surgery, postoperative radiotherapy, pathological type of the primary lesion, the type of tissue flap applied, and the use of intraoperative navigation were not significant risk factors. Six patients with titanium mesh exposure underwent second surgery, but mesh exposure recurred in two patients due to insufficient soft tissue coverage. CONCLUSION Individualized titanium mesh with free flap can effectively restore maxilla-orbital defects. Preoperative radiotherapy is an independent predictor of postoperative titanium mesh exposure. Adequate soft tissue coverage of the mesh may reduce the risk of mesh exposure. LEVEL OF EVIDENCE Level 4 (case-control study) Laryngoscope, 2021.
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Affiliation(s)
- Qian Sun
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Hui-Yuh Soh
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wen-Bo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yao Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yang Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chi Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chuan-Bin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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Wagner MEH, Rotsch C, Hanus S, Essig H, Grunert R, Gellrich NC, Lichtenstein J. Feasibility of implants with superelastic behaviour for midface reconstruction. J Biomater Appl 2020; 34:1449-1457. [PMID: 32183582 DOI: 10.1177/0885328220911585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maximilian E H Wagner
- Department of Craniomaxillofacial Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Christian Rotsch
- Fraunhofer-Institut für Werkzeugmaschinen und Umformtechnik Institutsteil Dresden, Dresden, Germany
| | - Sibylle Hanus
- Sächsisches Textilforschungsinstitut eV, Chemnitz, Germany
| | - Harald Essig
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Ronny Grunert
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Craniomaxillofacial Surgery, University Hospital Schleswig Holstein Campus Kiel, Kiel, Germany
| | - Jürgen Lichtenstein
- Department of Craniomaxillofacial Surgery, University Hospital Schleswig Holstein Campus Kiel, Kiel, Germany
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Dent B, Wavreille VA, Selmic LE. Use of a temporalis fascia transposition flap for ventral orbital stabilization after ventral orbitectomy in a dog. Vet Surg 2019; 48:1058-1063. [PMID: 30677160 DOI: 10.1111/vsu.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/26/2018] [Accepted: 12/15/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe a novel surgical technique for ventral orbital reconstruction after ventral orbitectomy by using a temporalis fascia transposition flap. STUDY DESIGN Case report. METHODS A 7-year-old, spayed female Boston terrier was treated for multilobular osteochondrosarcoma arising from the cranial aspect of the left zygomatic arch, causing asymmetry of the face and mild exophthalmos of the left eye. A ventral orbitectomy with a wide surgical excision (including the cranial aspect of the zygomatic bone, the medial aspect of the lacrimal bone, and the dorsal aspect of the maxilla) was performed with preservation of the left eye. To support and maintain the left eye in a normal position, a temporalis fascia transposition flap was elevated and used. No complications occurred during the procedure. RESULTS Thirteen days after surgery, the referring veterinarian reported no complications. Complete excision was confirmed on histopathology. Eighty-three days after surgery, the dog remained asymptomatic with only mild epiphora of the left eye. Follow-up information from the owner 11 months after surgery indicated that the dog was asymptomatic with minimal ventral globe deviation. CONCLUSION Additional ventral support of the globe after ventral orbitectomy via a temporalis fascia transposition flap resulted in an excellent functional and cosmetic outcome. CLINICAL SIGNIFICANCE A temporalis fascia transposition flap can be used to reconstruct the ventral aspect of the orbit in dogs.
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Affiliation(s)
- Brian Dent
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Vincent A Wavreille
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
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Extra-ocular movement restriction and diplopia following orbital fracture repair. Am J Otolaryngol 2018; 39:34-36. [PMID: 28969869 DOI: 10.1016/j.amjoto.2017.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To report a series of patients with extra-ocular movement restriction and diplopia after orbital fracture repair, and determine the effect of timing of repair and the type of implant used. METHODS A chart review was conducted identifying all patients >18years of age at our institution between June 2005 and June 2008 who underwent orbital fracture repair, and presented with clinically significant diplopia and extra-ocular movement restriction persisting longer than one month after repair. Data collected included timing of repair, implant used within the orbit, and need for revision. RESULTS Ten patients were identified with a mean time to primary orbital fracture repair at 9days (range 1-48). Seven patients underwent revision of their orbital fracture repair with removal of the previously placed implant and replacement with non-porous 0.4mm Supramid Foil, whereas one patient underwent lateral and inferior rectus recessions without revision of primary fracture repair. Titanium mesh was the intra-orbital implant found in all patients requiring revision of orbital fracture repair. All revisions resulted in resolution of clinically significant diplopia. CONCLUSIONS Clinically significant diplopia and extra-ocular movement restriction is not an uncommon complication after orbital fracture repair. In our series, there was a strong association between these complications and the use of porous titanium mesh implants. Revision of fractures significantly improved diplopia in all but one patient. This suggests that meticulous fracture repair and the use of non-porous implants primarily or secondarily may preclude the need for strabismus surgery after orbital trauma.
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[Bone cement implant as an alternative for orbital floor reconstruction: A case report]. CIR CIR 2017; 85 Suppl 1:13-18. [PMID: 28038736 DOI: 10.1016/j.circir.2016.10.034] [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: 03/03/2016] [Accepted: 10/17/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The management of orbitary fractures is one of the most challenging in facial trauma; the variety of reconstruction materials for its treatment is broad and is constantly improving, but despite this there is no consensus for its use or literature that sustains it. OBJECTIVE To present the use and design of a preformed bone implant as an alternative for the reconstruction of orbital floor fractures in the pediatric age group. CLINICAL CASE A 7-year old male who suffered a right hemifacial contusion trauma with clinical and tomographic diagnosis of right pure blowout type orbital floor fracture with inferior rectus muscle entrapment and right post-traumatic palpebral ptosis. Successful surgical reconstruction was performed 7 days later with a pre-constructed bone cement implant. Eight weeks after surgery the patient presented with mild residual palpebral ptosis, no ocular movement limitations and no diplopia. CONCLUSIONS The use of a bone cement implant can be considered appropriate for the reconstruction of these fractures, as another alternative to be used by the ophthalmologist among the variety of all the other materials used for this purpose. We consider that our optimism based on the results obtained in this case obligates us to increase the number of patients treated in order to gather more evidence and do larger follow up.
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Surgical reconstruction of maxillary defects using a computer-assisted design/computer-assisted manufacturing-produced titanium mesh supporting a free flap. J Craniomaxillofac Surg 2016; 44:1320-6. [DOI: 10.1016/j.jcms.2016.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/06/2016] [Accepted: 07/13/2016] [Indexed: 11/19/2022] Open
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Palato-maxillary reconstruction by the angular branch-based tip of scapula free flap. Eur Arch Otorhinolaryngol 2016; 274:939-945. [DOI: 10.1007/s00405-016-4266-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/13/2016] [Indexed: 10/21/2022]
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Su Y, Sun J, Fan X. Epithelial cysts associated with alloplastic implants after repair of orbital fractures: a systematic review and four new cases. Br J Oral Maxillofac Surg 2016; 54:658-63. [DOI: 10.1016/j.bjoms.2016.03.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 03/29/2016] [Indexed: 01/29/2023]
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Baumann A, Sinko K, Dorner G. Late Reconstruction of the Orbit With Patient-Specific Implants Using Computer-Aided Planning and Navigation. J Oral Maxillofac Surg 2016; 73:S101-6. [PMID: 26608137 DOI: 10.1016/j.joms.2015.06.149] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Reconstruction of orbital deformities is a challenging task. Virtual 3-dimensional (3D) planning and the use of patient-specific implants (PSIs) could improve anatomic and functional outcomes in the orbital region. MATERIALS AND METHODS A retrospective study was performed of patients who underwent late orbital reconstruction from 2009 to 2013. To be included in the study, patients had a unilateral orbital deformity by involvement of at least 2 orbital wall defects. No orbital osteotomies could be used to correct the deformity. All patients underwent 3D virtual treatment planning. The unaffected orbit was mirrored onto the affected orbit. The PSI was fabricated according to this plan. Navigation was used to check the implant position. RESULTS Six patients were included in this study. All patients had diplopia or motility limitations and enophthalmos. The ophthalmic parameters showed improvement in all patients. Enophthalmos was corrected adequately by the PSI. Four patients received a poly-ether-ether-ketone PSI. Two patients received a titanium mesh PSI. The position of the PSI was controlled by intraoperative navigation. Superimposition of the planned and postoperative positions of the PSI showed good correlation. CONCLUSION PSIs placed with intraoperative navigation facilitate late or secondary correction of orbital deformities.
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Affiliation(s)
- Arnulf Baumann
- Professor, Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Medical University of Vienna, Austria.
| | - Klaus Sinko
- Consultant, Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Medical University of Vienna, Austria
| | - Guido Dorner
- Professor, Department of Ophthalmology, Medical University of Vienna, Austria
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Dubois L, Steenen S, Gooris P, Bos R, Becking A. Controversies in orbital reconstruction—III. Biomaterials for orbital reconstruction: a review with clinical recommendations. Int J Oral Maxillofac Surg 2016; 45:41-50. [DOI: 10.1016/j.ijom.2015.06.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 06/24/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022]
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Zhang WB, Mao C, Liu XJ, Guo CB, Yu GY, Peng X. Outcomes of Orbital Floor Reconstruction After Extensive Maxillectomy Using the Computer-Assisted Fabricated Individual Titanium Mesh Technique. J Oral Maxillofac Surg 2015; 73:2065.e1-15. [PMID: 26188101 DOI: 10.1016/j.joms.2015.06.171] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/23/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Orbital floor defects after extensive maxillectomy can cause severe esthetic and functional deformities. Orbital floor reconstruction using the computer-assisted fabricated individual titanium mesh technique is a promising method. This study evaluated the application and clinical outcomes of this technique. PATIENTS AND METHODS This retrospective study included 10 patients with orbital floor defects after maxillectomy performed from 2012 through 2014. A 3-dimensional individual stereo model based on mirror images of the unaffected orbit was obtained to fabricate an anatomically adapted titanium mesh using computer-assisted design and manufacturing. The titanium mesh was inserted into the defect using computer navigation. The postoperative globe projection and orbital volume were measured and the incidence of postoperative complications was evaluated. RESULTS The average postoperative globe projection was 15.91 ± 1.80 mm on the affected side and 16.24 ± 2.24 mm on the unaffected side (P = .505), and the average postoperative orbital volume was 26.01 ± 1.28 and 25.57 ± 1.89 mL, respectively (P = .312). The mean mesh depth was 25.11 ± 2.13 mm. The mean follow-up period was 23.4 ± 7.7 months (12 to 34 months). Of the 10 patients, 9 did not develop diplopia or a decrease in visual acuity and ocular motility. Titanium mesh exposure was not observed in any patient. All patients were satisfied with their postoperative facial symmetry. CONCLUSION Orbital floor reconstruction after extensive maxillectomy with an individual titanium mesh fabricated using computer-assisted techniques can preserve globe projection and orbital volume, resulting in successful clinical outcomes.
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Affiliation(s)
- Wen-Bo Zhang
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chi Mao
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiao-Jing Liu
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chuan-Bin Guo
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Guang-Yan Yu
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xin Peng
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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Yang WE, Lan MY, Lee SW, Chang JK, Huang HH. Primary human nasal epithelial cell response to titanium surface with a nanonetwork structure in nasal implant applications. NANOSCALE RESEARCH LETTERS 2015; 10:167. [PMID: 25977647 PMCID: PMC4420767 DOI: 10.1186/s11671-015-0849-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/07/2015] [Indexed: 06/04/2023]
Abstract
In nasal reconstruction applications, the response of cells to titanium (Ti) implants is largely determined by the surface characteristics of the implant. This study investigated an electrochemical anodization surface treatment intended to improve the response of primary human nasal epithelial cells (HNEpC) to Ti surfaces in nasal implant applications. We used a simple and fast electrochemical anodization treatment, i.e., applying anodic current, to produce a titanium dioxide (TiO2) nanonetwork layer on the Ti surface with average lateral pore size below 100 nm, depending on the current applied. The TiO2 nanonetwork layer exhibited enhanced hydrophilicity and protein adsorption ability compared with untreated Ti surfaces. In addition, the spreading morphology, cytoskeletal arrangement, and proliferation of HNEpC on the nanonetwork layer indicated excellent cell response characteristics. This research advances our understanding regarding the means by which a TiO2 nanonetwork layer can improve the response of HNEpC to Ti surfaces in nasal implant applications.
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Affiliation(s)
- Wei-En Yang
- />Institute of Oral Biology, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112 Taiwan
| | - Ming-Ying Lan
- />Department of Otolaryngology, Taipei Veterans General Hospital, No.201, Sec.2, Shipai Road, Taipei, 112 Taiwan
- />School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112 Taiwan
| | - Sheng-Wei Lee
- />Institute of Materials Science and Engineering, National Central University, No. 300, Jhongda Road, Taoyuan, 320 Taiwan
| | - Jeng-Kuei Chang
- />Institute of Materials Science and Engineering, National Central University, No. 300, Jhongda Road, Taoyuan, 320 Taiwan
| | - Her-Hsiung Huang
- />Institute of Oral Biology, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112 Taiwan
- />Department of Dentistry, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112 Taiwan
- />Graduate Institute of Basic Medical Science, China Medical University, No.91, Hsueh-Shih Road, Taichung, 404 Taiwan
- />Department of Medical Research, China Medical University Hospital, No.2, Yude Road, Taichung, 404 Taiwan
- />Department of Biomedical Informatics, Asia University, No.500, Lioufeng Road, Taichung, 413 Taiwan
- />Department of Stomatology, Taipei Veterans General Hospital, No.201, Sec.2, Shipai Road, Taipei, 112 Taiwan
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Shan XF, Chen HM, Liang J, Huang JW, Cai ZG. Surgical Reconstruction of Maxillary and Mandibular Defects Using a Printed Titanium Mesh. J Oral Maxillofac Surg 2015; 73:1437.e1-9. [PMID: 25971919 DOI: 10.1016/j.joms.2015.02.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 02/22/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To reconstruct maxillary and mandibular defects with printed titanium mesh using computer-assisted surgery (CAS) for the achievement of structural, esthetic, and functional goals. PATIENTS AND METHODS The authors designed and implemented this prospective study of patients with maxillary or mandibular defects who underwent reconstruction with printed titanium mesh using CAS. After surgery, the preoperative design and postoperative outcome were evaluated using Geomagic Studio software. RESULTS The sample was comprised of 2 patients with maxillary defects and 2 with mandibular defects. A satisfactory contour was achieved in all patients. The rate of concordance between the preoperative design and the postoperative outcome was higher than 81 and 94% within 3 mm for the mandibular and maxillary reconstructions, respectively. CONCLUSION The results of this study suggest that complicated maxillary and mandibular defects can be satisfactorily reconstructed with customized printed titanium meshes using CAS.
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Affiliation(s)
- Xiao-Feng Shan
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Hui-Min Chen
- Attending Physician, Department of General Dentistry 2, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jie Liang
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jin-Wei Huang
- Resident, Department of General Dentistry 2, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhi-Gang Cai
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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Dickens AJ, Salas C, Rise L, Murray-Krezan C, Taha MR, DeCoster TA, Gehlert RJ. Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation: A biomechanical study. Injury 2015; 46:1001-6. [PMID: 25769202 DOI: 10.1016/j.injury.2015.02.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/19/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We performed a simple biomechanical study to compare the fixation strength of titanium mesh with traditional tension-band augmentation, which is a standard treatment for transverse patella fractures. We hypothesised that titanium mesh augmentation is not inferior in fixation strength to the standard treatment. METHODS Twenty-four synthetic patellae were tested. Twelve were fixed with stainless steel wire and parallel cannulated screws. Twelve were fixed with parallel cannulated screws, augmented with anterior titanium mesh and four screws. A custom test fixture was developed to simulate a knee flexed to 90°. A uniaxial force was applied to the simulated extensor mechanism at this angle. A non-inferiority study design was used to evaluate ultimate force required for failure of each construct as a measure of fixation strength. Stiffness of the bone/implant construct, fracture gap immediately prior to failure, and modes of failure are also reported. RESULTS The mean difference in force at failure was -23.0 N (95% CI: -123.6 to 77.6N) between mesh and wire constructs, well within the pre-defined non-inferiority margin of -260 N. Mean stiffness of the mesh and wire constructs were 19.42 N/mm (95% CI: 18.57-20.27 N/mm) and 19.49 N/mm (95% CI: 18.64-20.35 N/mm), respectively. Mean gap distance for the mesh constructs immediately prior to failure was 2.11 mm (95% CI: 1.35-2.88 mm) and 3.87 mm (95% CI: 2.60-5.13 mm) for wire constructs. CONCLUSIONS Titanium mesh augmentation is not inferior to tension-band wire augmentation when comparing ultimate force required for failure in this simplified biomechanical model. Results also indicate that stiffness of the two constructs is similar but that the mesh maintains a smaller fracture gap prior to failure. The results of this study indicate that the use of titanium mesh plating augmentation as a low-profile alternative to tension-band wiring for fixation of transverse patella fractures warrants further investigation.
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Affiliation(s)
- Aaron J Dickens
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, MSC10 5600, 1 University of New Mexico, Albuquerque, NM 87131, United States.
| | - Christina Salas
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, MSC10 5600, 1 University of New Mexico, Albuquerque, NM 87131, United States; Center for Biomedical Engineering, The University of New Mexico Health Sciences Center, MSC01 1141, 1 University of New Mexico, Albuquerque, NM 87131, United States
| | - LeRoy Rise
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, MSC10 5600, 1 University of New Mexico, Albuquerque, NM 87131, United States
| | - Cristina Murray-Krezan
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, The University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131, United States
| | - Mahmoud Reda Taha
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, MSC10 5600, 1 University of New Mexico, Albuquerque, NM 87131, United States; Center for Biomedical Engineering, The University of New Mexico Health Sciences Center, MSC01 1141, 1 University of New Mexico, Albuquerque, NM 87131, United States
| | - Thomas A DeCoster
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, MSC10 5600, 1 University of New Mexico, Albuquerque, NM 87131, United States
| | - Rick J Gehlert
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, MSC10 5600, 1 University of New Mexico, Albuquerque, NM 87131, United States
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Niddam J, Bosc R, Suffee TM, Le Guerinel C, Wolkenstein P, Meningaud JP. Treatment of sphenoid dysplasia with a titanium-reinforced porous polyethylene implant in orbitofrontal neurofibroma: Report of three cases. J Craniomaxillofac Surg 2014; 42:1937-41. [DOI: 10.1016/j.jcms.2014.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/23/2014] [Accepted: 08/13/2014] [Indexed: 11/30/2022] Open
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An innovative technique in orbital floor reconstruction avoiding complications: Temporary use of the silicone guide. FORMOSAN JOURNAL OF SURGERY 2014. [DOI: 10.1016/j.fjs.2014.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sivagurunathan A, Boy SC, Steenkamp G. A novel technique for ventral orbital stabilization: the masseter muscle flap. Vet Ophthalmol 2013; 17:67-72. [DOI: 10.1111/vop.12058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Amilan Sivagurunathan
- Section of Surgery, Department of Companion Animal Clinical Studies, Faculty of Veterinary Science; University of Pretoria; Pretoria South Africa
| | - Sonja C. Boy
- Department of Oral Pathology and Oral Biology, School of Dentistry; University of Pretoria; Pretoria South Africa
| | - Gerhard Steenkamp
- Section of Surgery, Department of Companion Animal Clinical Studies, Faculty of Veterinary Science; University of Pretoria; Pretoria South Africa
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Gabrielli MF, Monnazzi MS, Passeri LA, Carvalho WR, Gabrielli M, Hochuli-Vieira E. Orbital wall reconstruction with titanium mesh: retrospective study of 24 patients. Craniomaxillofac Trauma Reconstr 2012; 4:151-6. [PMID: 22942944 DOI: 10.1055/s-0031-1286120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The aim of this study was to evaluate the efficacy and safety of traumatic orbital defect reconstruction with titanium mesh. A retrospective study was made. Evaluations were made after a minimum postoperative follow-up of 12 months, looking for the main complications. Twenty-four patients were included in this evaluation; 19 were male (79.1%) and 5 (20.8%) were female. The main injury etiology was vehicle accidents (50%) followed by other causes. Fourteen patients (58.3%) presented orbital floor fractures, and 10 had more than one wall fractured (41.6%). Permanent infraorbital nerve hypoesthesia was observed in two patients (8.3%), enophthalmos occurred in five patients (20.8%), and exophthalmos was found in two patients (8.3%). Four patients (16.6%) still presented evidence of residual prolapsed intraorbital content, and one of those needed further surgical correction; sinusitis occurred in one patient (4.1%). Titanium mesh is a reliable option for orbital reconstruction, despite some complications found in this sample.
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Motomura H, Iguchi H. Simple maxillary reconstruction following total maxillectomy using artificial bone wrapped with vascularized tissue: five key points to ensure success. Acta Otolaryngol 2012; 132:887-92. [PMID: 22404238 DOI: 10.3109/00016489.2012.658968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Our new method for hard tissue maxillary reconstructions using artificial bone implants provides stable results during long-term follow-up. OBJECTIVE To date, vascularized bone/cartilage grafting has been the most popular method for hard tissue reconstruction after total maxillectomy; however, such three-dimensional reconstruction requires complex and lengthy invasive surgery. We have developed a simple maxillary reconstruction procedure using artificial bone. METHODS This study included six patients who had undergone hard tissue reconstructions using artificial bone (Ceratite(TM)) implants after total maxillectomies between October 2002 and October 2010. We considered the following five key points to ensure success: (1) the procedure was conducted in two stages without communicating with the nasal cavity and sinuses; (2) when constructing the artificial bone, the curvature was reduced; (3) the space for the implant was kept to a minimum; (4) the artificial bone implant was closely and accurately fixed to the stump of the zygomatic arch; and (5) the artificial bone implant was wrapped with a vascularized tissue flap. RESULTS The follow-up period ranged from 12 to 94 months. The postoperative zygomatic contour was maintained satisfactorily in all patients with no signs of late complications.
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Affiliation(s)
- Hisashi Motomura
- Department of Plastic and Reconstructive Surgery, Osaka City University Graduate School of Medicine, Japan.
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21
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Kokemüller H, von See C, Essig H, Tavassol F, Rücker M, Schramm A, Majdani O, Gellrich NC. [Reconstruction of complex midfacial defects with individualized titanium implants]. HNO 2012; 59:319-26. [PMID: 21647827 DOI: 10.1007/s00106-011-2280-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Loss of hard and soft tissue structures of the midface due to resection or trauma is associated with substancial functional and aesthetic deficits. Besides reconstruction of bony contours for preservation of orbit position and facial symmetry, reconstruction often requires simultaneous transplantation of soft tissue flaps for separation of nasal and oral cavities and refilling of soft tissue volume deficits. PATIENTS AND METHODS A well-established procedure of our institution will be demonstrated in 10 exemplary patients, in which titanium meshes are customized for individual defect situations using computer-assisted techniques in combination with soft tissue transfer if required. RESULTS According to our experience, this procedure provides satisfactory results in functional as well as in aesthetic respects. Especially in patients with loss of bony structures of the orbit and preservation of orbital contents, this procedure forms optimal preconditions for prevention of enophthalmos and diplopia by preservation of the original orbital volume. CONCLUSION Individualized titanium implants should be used more frequently in clinical routine for reconstruction of complex midfacial defects.
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Affiliation(s)
- H Kokemüller
- Klinik und Poliklinik für Mund-, Kiefer- u. Gesichtschirurgie, Medizinische Hochschule Hannover.
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Chambless LB, Mawn LA, Forbes JA, Thompson RC. Porous polyethylene implant reconstruction of the orbit after resection of spheno-orbital meningiomas: A novel technique. J Craniomaxillofac Surg 2012; 40:e28-32. [DOI: 10.1016/j.jcms.2011.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 12/14/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022] Open
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Biomaterials and implants for orbital floor repair. Acta Biomater 2011; 7:3248-66. [PMID: 21651997 DOI: 10.1016/j.actbio.2011.05.016] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 04/19/2011] [Accepted: 05/16/2011] [Indexed: 11/23/2022]
Abstract
Treatment of orbital floor fractures and defects is often a complex issue. Repair of these injuries essentially aims to restore the continuity of the orbital floor and to provide an adequate support to the orbital content. Several materials and implants have been proposed over the years for orbital floor reconstruction, in the hope of achieving the best clinical outcome for the patient. Autografts have been traditionally considered as the "gold standard" choice due to the absence of an adverse immunological response, but they are available in limited amounts and carry the need for extra surgery. In order to overcome the drawbacks related to autografts, researchers' and surgeons' attention has been progressively attracted by alloplastic materials, which can be commercially produced and easily tailored to fit a wide range of specific clinical needs. In this review the advantages and limitations of the various biomaterials proposed and tested for orbital floor repair are critically examined and discussed. Criteria and guidelines for optimal material/implant choice, as well as future research directions, are also presented, in an attempt to understand whether an ideal biomaterial already exists or a truly functional implant will eventually materialise in the next few years.
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Palatomaxillary reconstruction with titanium mesh and radial forearm flap. ACTA ACUST UNITED AC 2009; 108:514-9. [DOI: 10.1016/j.tripleo.2009.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 03/24/2009] [Accepted: 05/07/2009] [Indexed: 11/17/2022]
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25
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Stringer D, Brown B. Correction of Mandibular Asymmetry Using Angled Titanium Mesh. J Oral Maxillofac Surg 2009; 67:1619-27. [DOI: 10.1016/j.joms.2008.12.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 11/12/2008] [Accepted: 12/19/2008] [Indexed: 11/16/2022]
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26
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Sun J, Shen Y, Weng YQ, Li J, Zhang ZY. Lateral Lip-Splitting Approach for Total and Subtotal Maxillectomy. J Oral Maxillofac Surg 2009; 67:1197-205. [DOI: 10.1016/j.joms.2008.06.078] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 04/17/2008] [Accepted: 06/16/2008] [Indexed: 11/28/2022]
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Kokemueller H, Tavassol F, Rücker M, Ruecker M, Gellrich NC. Complex midfacial reconstruction: a combined technique of computer-assisted surgery and microvascular tissue transfer. J Oral Maxillofac Surg 2008; 66:2398-406. [PMID: 18940515 DOI: 10.1016/j.joms.2007.12.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 12/10/2007] [Indexed: 10/21/2022]
Affiliation(s)
- Horst Kokemueller
- Department of Oral and Maxillofacial Surgery, Hanover Medical School, Hanover, Germany.
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Wang S, Xiao J, Liu L, Lin Y, Li X, Tang W, Wang H, Long J, Zheng X, Tian W. Orbital floor reconstruction: a retrospective study of 21 cases. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2008; 106:324-30. [PMID: 18424122 DOI: 10.1016/j.tripleo.2007.12.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Revised: 11/24/2007] [Accepted: 12/14/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this retrospective study was to investigate the diagnostic methods, therapeutic principles, surgical approach, and materials used for orbital floor reconstruction. STUDY DESIGN This study consisted of 21 cases with orbital fractures treated at the Hospital of Stomatology, Sichuan University, China, between July 2002 and June 2006. Inclusion criteria were patients with fractures of the orbital floor with bone defects. Patients were retrospectively analyzed for gender, age, mechanism of injury, classification of fracture, and complications. RESULTS CT scans were 100% accurate in diagnosing the fractures. Shaped autogenous bone, titanium mesh, and Medpor were respectively implanted under the periosteum of the orbital floor in 5 cases, 10 cases, and 6 cases. All the patients had good results including significant improvements in appearance and function after surgery. There were no severe permanent complications. Two cases had postoperative wound infections, and 1 case had temporary blindness that resolved completely. CONCLUSIONS CT scan is the first choice of investigation for an orbital floor fractures. The objectives of treatment for an orbital floor fracture with a bony defect are reduction of the prolapsed orbital contents and reconstruction of the orbital floor with repair materials, to restore the normal orbital floor and orbital capacity. A subciliary incision was adopted in our surgery. At present, porous polyethylene and titanium mesh are considered to be the ideal orbital floor repair materials. Titanium mesh was used in fractures with large defects that were not easy to fix without obvious enophthalmos. Porous polyethylene can be used in fractures when there is a need to restore the orbital volume.
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Affiliation(s)
- Shuting Wang
- Department of Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, Sichuan, China
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Abstract
This article presents a range of synthetic implant materials for use in facial plastic surgery. The authors discuss alternatives to autogenous tissue transfer in terms of biocompatibility, technique, complications, controversies, and cautions. The reader is presented information about a range of synthetic implant materials such as silicone, polyester fiber, polyamide mesh, metal, polyethylene, polyacrylamide gel, hydroxyapatite, polylactic acid, collagen, and others.
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Affiliation(s)
- Vito C Quatela
- Quatela Center for Plastic Surgery, 973 East Avenue, Rochester, NY 14607, USA.
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Abstract
Enophthalmos is a relatively frequent and misdiagnosed clinical sign in orbital diseases. The knowledge of the different etiologies of enophthalmos and its adequate management are important, because in some cases, it could be the first sign revealing a life-threatening disease. This article provides a comprehensive review of the pathophysiology, evaluation, and management of enophthalmos. The main etiologies, such as trauma, chronic maxillary atelectasis (silent sinus syndrome), breast cancer metastasis, and orbital varix, will be discussed. Its objective is to enable the reader to recognize, assess, and treat the spectrum of disorders causing enophthalmos.
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Affiliation(s)
- Mehrad Hamedani
- Jules Gonin Eye Hospital--University of Lausanne, Lausanne, Switzerland
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Nagasao T, Hikosaka M, Morotomi T, Nagasao M, Ogawa K, Nakajima T. Analysis of the orbital floor morphology. J Craniomaxillofac Surg 2007; 35:112-9. [PMID: 17448667 DOI: 10.1016/j.jcms.2006.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Accepted: 12/20/2006] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION For the repair of large orbital floor defects due to blow-out fractures or those involved by tumours, it is necessary to understand the detailed morphology. The purpose of the present study was to elucidate how age and gender affect its three-dimensional morphology. METHODS The 3-D computer tomography data of 305 orbits of 182 patients were included in the study. Using the CT data, the orbital floor angle (the angle between the orbital floor and the horizontal plane) and the location of the most inferior point of the orbital floor were measured. Patients were classified into subgroups according to their gender and age. Data were compared among the subgroups. RESULTS The orbital floor angle was greater in males than in females, and in children than in adults. The location of the lowest point of the orbital floor moves postero-inferiorly with increasing age. CONCLUSION The present study demonstrated that gender and age affects morphology of the orbital floor. These findings should be useful for reconstruction of the orbital floor.
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Affiliation(s)
- Tomohisa Nagasao
- Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, Tokyo, Japan.
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Glauser J, Queen JR. An overview of non-cardiac cocaine toxicity. J Emerg Med 2007; 32:181-6. [PMID: 17307630 DOI: 10.1016/j.jemermed.2006.05.044] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2004] [Revised: 09/07/2005] [Accepted: 05/17/2006] [Indexed: 10/23/2022]
Abstract
Cocaine use in the United States continues to be a significant problem. Cocaine use is responsible for approximately 143,000 Emergency Department visits annually. The cardiac effects of cocaine are well known and much is written on this topic; this is beyond the scope of this article. Cocaine use is also responsible for a variety of non-cardiac, systemic complications, which it is our purpose to review. Multiple systemic effects of cocaine are seen with both acute and chronic use. These systems include: psychological and psychiatric, neurological, renal, pulmonary, gastrointestinal, obstetrical, and otolaryngological.
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Affiliation(s)
- Jonathan Glauser
- Department of Emergency Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Shilov BL. The first case of primary metacarpal V restoration with titanium mesh and cancellous bone graft. J Plast Reconstr Aesthet Surg 2006; 59:1391-3. [PMID: 17113527 DOI: 10.1016/j.bjps.2006.03.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2005] [Revised: 02/11/2006] [Accepted: 03/05/2006] [Indexed: 11/21/2022]
Abstract
Any references of use of the titanium mesh in hand reconstruction could not be found. A case of primary metacarpal reconstruction after severe hand trauma with a help of cage made of titanium mesh and cancellous iliac bone graft is presented.
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Affiliation(s)
- Boris L Shilov
- Plastic and Aesthetic Surgery, Leuchtenbergring, 10, 81677 München, Germany.
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Schön R, Metzger MC, Zizelmann C, Weyer N, Schmelzeisen R. Individually preformed titanium mesh implants for a true-to-original repair of orbital fractures. Int J Oral Maxillofac Surg 2006; 35:990-5. [PMID: 17049812 DOI: 10.1016/j.ijom.2006.06.018] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Revised: 03/21/2006] [Accepted: 06/23/2006] [Indexed: 11/19/2022]
Abstract
The purpose of this investigation is to present the results using preoperatively-formed titanium mesh implants for a true-to-original primary repair of extensive orbital floor and medial wall fractures. Individually preformed implants were used to repair extensive orbital floor injuries in 19 patients at the University Hospital, Freiburg. The form of the orbital floor and walls was analysed by preoperative diagnostic CT scan data. The form of the virtual reconstructed orbit was transformed into a model of the orbital cavity by a template machine. Postoperative imaging by or CT scan verified the exact 3D reconstruction of the orbital cavity 'true to original'. None of the patients demonstrated diplopia or enophthalmos postoperatively. Using individually preformed titanium mesh implants, the accuracy of the 3D orbital reconstruction was within a range of 1mm. The reconstruction using preformed implants proved to be less time consuming, more precise and less invasive, compared to 'free hand' efforts, for the repair of orbital injuries using titanium mesh and calvarial grafts.
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Affiliation(s)
- R Schön
- Department of Craniomaxillofacial Surgery, University Freiburg, Hugstetter Strasse 55, D-79106 Freiburg, Germany.
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Raghavan U, Jones NS. The complications of giant titanium implants in nasal reconstruction. J Plast Reconstr Aesthet Surg 2006; 59:74-9. [PMID: 16482792 DOI: 10.1016/j.bjps.2005.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present two cases where a large titanium implant has been used in nasal reconstruction without regard to the basic principles and current philosophy in reconstructive techniques. A full thickness nasal defect requires reconstruction with an inner lining, scaffolding and external skin. Autogenous grafts are preferable particularly when they are used for support or their insertion creates tension on the overlying soft tissue. We report serious complications that result from a disregard to these basic principles in two patients following the insertion of giant titanium nasal implants along with their management.
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Affiliation(s)
- Ullas Raghavan
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Nottingham NG7 2UH, UK
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