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Archibald LK, Gupta R, Shahwan KT, Swick M, Bakker C, Mattox AR, Alam M, Maher IA. Periorbital reconstructive techniques following Mohs micrographic surgery or excisions: a systematic review. Arch Dermatol Res 2023; 315:1853-1861. [PMID: 36646921 DOI: 10.1007/s00403-022-02523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/19/2022] [Accepted: 12/27/2022] [Indexed: 01/18/2023]
Abstract
There are many articles in the literature on periorbital reconstruction after Mohs micrographic surgery (MMS) or surgical excision, however, the literature lacks a comprehensive systematic review of these reports. We performed a systematic review of published data on periorbital defect reconstruction to identify trends in the literature. A comprehensive search of eight databases was performed. To be included in the study, articles had to be published in English between 2005 and 2020 and contain repair data for MMS or excision defects in the periorbital region. Studies with less than four patients, literature or systematic reviews, and abstract-only publications were excluded. Data extracted from eligible articles included the authors' medical specialties, study design, subject number and demographics, defect characteristics, procedure type, reconstructive methods, complications, outcome measures, and method of outcome assessment. 53 studies met the inclusion criteria. The first and last authors' specialties were ophthalmology (47%), plastic and reconstructive surgery (23%), dermatology (13%), otolaryngology (4%), or were multi-specialty collaborations (13%). Only 5 of the studies were prospective. Defects were located on the lower eyelid (55%), medial canthus (31%), upper eyelid (8%), lateral canthus (4%), or a combination of these sites (2%). Reconstructive methods were reported for 3678 cases and included linear repair (18%), advancement flap (8%), rotation flap (5%), transposition flap (3%), island pedicle flap (1%), unspecified local skin flap (21%), skin graft (23%), secondary intention (4%), tarsoconjunctival flap (3%), and combined reconstruction techniques (13%). Thirty-three of 53 articles specified the periorbital subunit for each reconstructive technique that was employed. Among these 33 articles which allowed for correlation between defect location and reconstructive technique, the most utilized repair method for lower eyelid defects was local skin flap. Defects on the upper eyelid or medial canthus were most frequently repaired with a skin graft. Forty articles commented on cosmetic outcomes, however, only 3 of these articles utilized a defined grading system, objective measurements, or independent reviewers to assess the cosmetic outcomes. The methods of reconstruction in this review were diverse, however, local skin flaps and grafts were the most utilized techniques. In future reports, increased reporting of reconstructive technique by defect location as well as increased use of standardized assessments of aesthetic outcomes can help strengthen this body of literature.
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Affiliation(s)
- Laura K Archibald
- Department of Dermatology, University of Minnesota, Phillips-Wangensteen Building, 516 Delaware Street SE, Suite 1-400, Mail Code 98, Minneapolis, MN, 55455, USA.
| | - Rachit Gupta
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - Kathryn T Shahwan
- Altru Health System/University of North Dakota Medical School, Grand Forks, ND, USA
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Marki Swick
- Department of Dermatology, University of Minnesota, Phillips-Wangensteen Building, 516 Delaware Street SE, Suite 1-400, Mail Code 98, Minneapolis, MN, 55455, USA
| | | | - Adam R Mattox
- Department of Dermatology, University of Minnesota, Phillips-Wangensteen Building, 516 Delaware Street SE, Suite 1-400, Mail Code 98, Minneapolis, MN, 55455, USA
| | - Murad Alam
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Phillips-Wangensteen Building, 516 Delaware Street SE, Suite 1-400, Mail Code 98, Minneapolis, MN, 55455, USA
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McCrary HC, Seim NB, Old MO. History, Innovation, Pearls, and Pitfalls in Complex Midface Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00067-1. [PMID: 37230926 DOI: 10.1016/j.otc.2023.04.010] [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: 05/27/2023]
Abstract
Midface reconstruction in head and neck cancer or individuals with extensive trauma to the face has evolved significantly over the past few decades with the introduction of free flap reconstruction and virtual surgical planning enabling surgeons to obtain optimal cosmetic and functional outcomes. Traditional methods such as the use of obturators or local flaps still have a role in select situations, but complex defects have been replaced by the advent of microvascular free tissue transfer and virtual planning, which can commonly provide a single-stage reconstruction of the midface with excellent aesthetic and functional results. This article provides an overview of the history and evolution of midface reconstruction, a discussion of how to integrate virtual surgical planning into a surgical practice, an example of a complex midface reconstruction case, and pearls and pitfalls that have been experienced by an experienced reconstructive team.
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Affiliation(s)
- Hilary C McCrary
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Abstract
SUMMARY Defects involving the midface and maxilla pose unique challenges to reconstructive surgeons. The maxilla serves as the central keystone of the face and interfaces with various other facial subunits to affect form and function. Reconstructive methods range from prosthetics to free tissue transfer, and the indications for different options are reviewed here. Finally, special considerations including management of the orbit, dental rehabilitation, and future directions are discussed.
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Ikekhuamen E, Gambo A, Fomete B, Agbonifo D, Yusuf O. Buccal fat pad flap, an option for surgical reconstruction of orbital floor defect: A case report. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:95-99. [PMID: 36203927 PMCID: PMC9531734 DOI: 10.4103/jwas.jwas_89_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/30/2022] [Indexed: 11/10/2022]
Abstract
Buccal fat pad (BFP) is widely used in oral and maxillofacial surgery, with paucity of literature describing its use in orbital reconstruction. We report a case of a 23year old female who had orbital floor defect surgically reconstructed with a pedicled buccal fat pad following maxillectomy.
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Moore EJ, Price DL, Van Abel KM, Janus JR, Moore ET, Martin E, Morris JM, Alexander AE. Association of Virtual Surgical Planning With External Incisions in Complex Maxillectomy Reconstruction. JAMA Otolaryngol Head Neck Surg 2021; 147:526-531. [PMID: 33792635 DOI: 10.1001/jamaoto.2021.0251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Maxillectomy can commonly be performed through a transoral approach, but maxillectomy defect reconstruction can be difficult to precisely design, contour, and inset through this approach. Objective To evaluate whether the use of virtual surgical planning (VSP) and 3-dimensional (3-D) modeling is associated with a decrease in the requirement of lateral rhinotomy (LR) for patients undergoing total and partial maxillectomy reconstruction. Design, Setting, and Participants This retrospective cohort study was conducted among patients undergoing subtotal or total maxillectomy with microvascular free flap reconstruction with or without VSP and 3-D modeling at a single tertiary care academic medical center between January 1, 2008, and October 3, 2019. Interventions Maxillectomy and free flap reconstruction with or without VSP. Main Outcomes and Measures Necessity of LR or other external incision for contouring, placement, and fixation of reconstruction as well as surgical complications. Results Fifteen patients (12 men [80%]; mean age, 64 years) underwent maxillectomy with free flap reconstruction without VSP. Eight patients (53%) in this group underwent total maxillectomy, and 4 patients in this group (27%) underwent partial maxillectomy. Twenty-three patients (18 men [78%]; mean age, 58 years) underwent maxillectomy with free flap reconstruction and VSP and 3-D modeling. Twelve of these patients (52%) underwent total maxillectomy, and 11 (48%) underwent partial maxillectomy. Lateral rhinotomy was necessary for 1 patient (4%) in the VSP group vs 12 patients (80%; 95% CI, 54%-98%) in the pre-VSP group. There were no LR complications in the VSP group vs 6 in the pre-VSP group. Among both groups, 14 patients underwent fibula free flap, 22 patients underwent subscapular system free flap, and 2 patients underwent cutaneous or osteocutaneous radial forearm free flap. There were no flap failures in the LR group and 1 flap failure in the group without LR. Conclusions and Relevance This cohort study suggests that the use of VSP and 3-D modeling for maxillectomy reconstruction is associated the a decrease in the need for external incisions without compromising reconstructive flap utility.
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Affiliation(s)
- Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffery R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ethan T Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Eli Martin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Amy E Alexander
- Department of Anatomic Modeling, Mayo Clinic, Rochester, Minnesota
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Craniofacial Microsurgery: An Integrated Approach to Management of Cleft and Craniofacial Syndromes, Surgical Experience, and Insights. J Craniofac Surg 2021; 32:1215-1220. [PMID: 33710046 DOI: 10.1097/scs.0000000000007342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Ian Jackson and Jack Fisher published one of the earliest reports on microsurgical applications for craniofacial patients in 1989. Since that time, applications of craniofacial surgery and microsurgery have significantly expanded and become more refined. However, there remain certain specific clinical problems in cleft and craniofacial surgery in which traditional craniofacial methods provide variable success or suboptimal outcomes. The purpose of the current study is to share our experience using an integrated approach of craniofacial and microsurgical methods to provide optimal surgical solutions to this complex patient population. The authors performed a retrospective review of 17 patients that utilized craniofacial microsurgery in setting of cleft and craniofacial syndromes performed by the senior author from July 2013 to July 2020. 22 free flaps were performed for 17 patients. The patient age at time of flap reconstruction ranged from 10 to 48 years (mean 21.4 years). There were 8 females and 9 males. There was one total flap loss. Based on our collective experience, the authors present a comprehensive algorithm for the role of microsurgical reconstruction in cleft and craniofacial patients. There are several situations in craniofacial surgery which traditional reconstructive methods require numerous operative interventions to achieve suitable outcomes. Craniofacial Microsurgery techniques can bring in new tissue and may prevent the need to manipulate scarred and multiply operated tissues. The craniofacial surgery team should not hesitate to apply microsurgical solutions to these situations for optimal results.
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Abstract
Reconstruction of the complex anatomy and aesthetics of the midface is often a challenge. A careful understanding of this three-dimensional (3D) structure is necessary. Anticipating the extent of excision and its planning following oncological resections is critical. In the past over two decades, with the advances in microsurgical procedures, contributions toward the reconstruction of this area have generated interest. Planning using digital imaging, 3D printed models, osseointegrated implants, and low-profile plates, has favorably impacted the outcome. However, there are still controversies in the management: to use single composite tissues versus multiple tissues; implants versus autografts; vascularized versus nonvascularized bone; prosthesis versus reconstruction. This article explores the present available options in maxillary reconstruction and outlines the approach in the management garnered from past publications and experiences.
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Affiliation(s)
- Gautam Biswas
- Department of Plastic and Reconstructive Surgery, TATA Medical Center, Kolkata, West Bengal, India
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Ocular Considerations in Face Transplantation: Report of 2 Cases and Review of the Literature. Ophthalmic Plast Reconstr Surg 2020; 35:218-226. [PMID: 30550500 DOI: 10.1097/iop.0000000000001296] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Periorbital injuries are common in face transplantation (FT) candidates. It is therefore essential that the ophthalmologist play a central role in the multidisciplinary treatment of these patients. In this study, the authors perform a comprehensive review of all procedures involving periorbital components, provide an update for the ophthalmology community regarding the current state of the field, and present 2 cases. METHODS A comprehensive review of the literature for all FT procedures including periorbital components was performed. The authors also present 2 patients who received FT including periorbital components for extensive facial disfigurement. One patient sustained high-energy avulsive ballistic injury and underwent a total face, double jaw, and tongue transplant in 2012. The second patient received a total face, eyelids, ears, and skeletal subunits transplant for extensive facial burns in 2015. RESULTS Literature review demonstrated that 22 (54%) of the 41 patients undergoing FT received allografts containing periorbital components. Only 14 cases (64%) reported on the presence of ocular and periocular complications. The most common complications consisted of lower eyelid ectropion and lagophthalmos, and nearly all required revisional procedures. Both patients presented with significant periorbital scarring and demonstrated good visual acuity and aesthetic outcomes at postoperative follow up between 6 and 28 months. CONCLUSIONS Face transplantation can address extensive facial and periorbital disfigurement with satisfactory functional and aesthetic outcomes. The majority of FT performed to date have included periorbital components, and postoperative ocular and periocular complications are common. It is critical for ophthalmologists to play a central role in the care of these patients.
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Farber SJ, Latham KP, Kantar RS, Perkins JN, Rodriguez ED. Reconstructing the Face of War. Mil Med 2019; 184:e236-e246. [DOI: 10.1093/milmed/usz103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/18/2019] [Indexed: 11/14/2022] Open
Abstract
AbstractIntroductionOngoing combat operations in Iraq, Afghanistan, and other theaters have led to an increase in high energy craniomaxillofacial (CMF) wounds. These challenging injuries are typically associated with complex tissue deficiencies, evolving areas of necrosis, and bony comminution with bone and ballistic fragment sequestrum. Restoring form and function in these combat-sustained CMF injuries is challenging, and frequently requires local and distant tissue transfers. War injuries are different than the isolated trauma seen in the civilian sector. Donor sites are limited on patients with blast injuries and they may have preferences or functional reasons for the decisions to choose flaps from the available donor sites.MethodsA case series of patients who sustained severe combat-related CMF injury and were treated at Walter Reed National Military Medical Center (WRNMMC) is presented. Our study was exempt from Institutional Review Board review, and appropriate written consent was obtained from all patients included in the study for the use of representative clinical images.ResultsFour patients treated by the CMF team at Walter Reed National Military Medical Center are presented. In this study, we highlight their surgical management by the CMF team at WRNMMC, detail their postoperative course, and illustrate the outcomes achieved using representative patient clinical images. We also supplement this case series demonstrating military approaches to complex CMF injuries with CMF reconstructive algorithms utilized by the senior author (EDR) in the management of civilian complex avulsive injuries of the upper, mid, and lower face are thoroughly reviewed.ConclusionWhile the epidemiology and characteristics of military CMF injuries have been well described, their management remains poorly defined and creates an opportunity for reconstructive principles proven in the civilian sector to be applied in the care of severely wounded service members. The War on Terror marks the first time that microsurgery has been used extensively to reconstruct combat sustained wounds of the CMF region. Our manuscript reviews various options to reconstruct these devastating CMF injuries and emphasizes the need for steady communication between the civilian and military surgical communities to establish the best care for these complex patients.
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Affiliation(s)
- Scott J Farber
- University of Texas Health Science Center San Antonio, Texas, Division of Plastic and Reconstructive Surgery, 7703 Floyd Curl Drive, MC 7844, San Antonio, TX
| | - Kerry P Latham
- Walter Reed National Military Medical Center Bethesda, MD, Division of Plastic Surgery, 4494 North Palmer Road, Bethesda, MD
| | - Rami S Kantar
- NYU Langone Health New York, NY, Hansjorg Wyss Department of Plastic Surgery, 307 E 33rd Street, New York, NY
| | - Jonathan N Perkins
- Walter Reed National Military Medical Center Bethesda, MD, Department of Otolaryngology-Head & Neck Surgery, 4494 North Palmer Road, Bethesda, MD
| | - Eduardo D Rodriguez
- NYU Langone Health New York, NY, Hansjorg Wyss Department of Plastic Surgery, 307 E 33rd Street, New York, NY
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Application of low-cost fused deposition modeling additive manufacturing rapid anatomic models in patients with rhino-cerebral mucormycosis treated with maxillectomy. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-018-1476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND A longstanding dictum exists to avoid surgical manipulation of the temporalis muscle out of concern for an exceedingly high rate of muscle atrophy and recurrent temporal hollowing. The authors challenge this surgical myth, considering such advice to be erroneous. The authors hypothesize that elevation of the temporalis muscle, if performed using standard muscle flap principles, will demonstrate excellent results. METHODS To assess temporalis response to surgical manipulation, the authors reviewed patients who underwent calvarial vault remodeling by the senior author for craniosynostosis between 1988 and 2011. Nonsyndromic patients with single-suture synostosis and 5 years of follow-up were eligible for inclusion. The medical record was used to measure rates of reoperation, recurrent temporal hollowing, and persistent temporalis overcorrection. RESULTS Of the cohort reviewed, 196 patients met inclusion criteria. Ten patients (5.1%) exhibited recurrent bitemporal constriction. One patient (0.5%) underwent a revision temporalis turnover flap, and 2 patients (1.0%) underwent soft tissue augmentation. The overall reoperation rate was 1.5%. Temporalis overcorrection, in an attempt to prophylactically rectify the expected atrophy after temporalis manipulation, persisted in 11 patients (5.6%). Three of these patients required treatment with steroid injections, Botox injections, or operative muscle debulking. The overall reoperation rate for temporalis overcorrection was 1.5%. CONCLUSIONS The authors' low reoperation rates for recurrent deformity, in combination with persistent temporalis overcorrection in 5.6% of patients, should dispel the myth that manipulation of the temporalis invariably results in atrophy. The muscle may be surgically manipulated, as long as plastic surgery principles are followed.
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Management of High-energy Avulsive Ballistic Facial Injury: A Review of the Literature and Algorithmic Approach. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1693. [PMID: 29707453 PMCID: PMC5908512 DOI: 10.1097/gox.0000000000001693] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/12/2018] [Indexed: 01/13/2023]
Abstract
Background: High-energy avulsive ballistic facial injuries pose one of the most significant reconstructive challenges. We conducted a systematic review of the literature to evaluate management trends and outcomes for the treatment of devastating ballistic facial trauma. Furthermore, we describe the senior author’s early and definitive staged reconstructive approach to these challenging patients. Methods: A Medline search was conducted to include studies that described timing of treatment, interventions, complications, and/or aesthetic outcomes. Results: Initial query revealed 41 articles, of which 17 articles met inclusion criteria. A single comparative study revealed that early versus delayed management resulted in a decreased incidence of soft-tissue contracture, required fewer total procedures, and resulted in shorter hospitalizations (level 3 evidence). Seven of the 9 studies (78%) that advocated delayed reconstruction were from the Middle East, whereas 5 of the 6 studies (83%) advocating immediate or early definitive reconstruction were from the United States. No study compared debridement timing directly in a head-to-head fashion, nor described flap selection based on defect characteristics. Conclusions: Existing literature suggests that early and aggressive intervention improves outcomes following avulsive ballistic injuries. Further comparative studies are needed; however, although evidence is limited, the senior author presents a 3-stage reconstructive algorithm advocating early and definitive reconstruction with aesthetic free tissue transfer in an attempt to optimize reconstructive outcomes of these complex injuries.
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Abstract
There is a recognized need to reconstruct and restore complex craniomaxillofacial soft tissues. The objective of this article is to focus on the role that tissue engineering/regenerative medicine can play in addressing various barriers (vascularity, tissue bulk, volitional control, and esthetics) and impediments (timing, regional applicability/dissemination, and regulation by the US Food and Drug Administration) to optimal tissue reconstruction of complex soft tissue structures. We will use the lips as an example to illustrate our points.
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Affiliation(s)
- Roderick Youngdo Kim
- Department of Oral & Maxillofacial Surgery, University of Michigan Health System, Towsley Center Rm G1114, 1515 East Medical Center Drive, Ann Arbor, MI 48109-5222, USA
| | - Sam Seoho Bae
- Department of Oral & Maxillofacial Surgery, University of Michigan Health System, Towsley Center Rm G1114, 1515 East Medical Center Drive, Ann Arbor, MI 48109-5222, USA
| | - Stephen Elliott Feinberg
- Department of Oral & Maxillofacial Surgery, University of Michigan Health System, Towsley Center Rm G1114, 1515 East Medical Center Drive, Ann Arbor, MI 48109-5222, USA.
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Prado FB, Freire AR, Cláudia Rossi A, Ledogar JA, Smith AL, Dechow PC, Strait DS, Voigt T, Ross CF. Review of In Vivo Bone Strain Studies and Finite Element Models of the Zygomatic Complex in Humans and Nonhuman Primates: Implications for Clinical Research and Practice. Anat Rec (Hoboken) 2017; 299:1753-1778. [PMID: 27870351 DOI: 10.1002/ar.23486] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/16/2016] [Accepted: 07/27/2016] [Indexed: 11/09/2022]
Abstract
The craniofacial skeleton is often described in the clinical literature as being comprised of vertical bony pillars, which transmit forces from the toothrow to the neurocranium as axial compressive stresses, reinforced transversely by buttresses. Here, we review the literature on bony microarchitecture, in vivo bone strain, and finite-element modeling of the facial skeleton of humans and nonhuman primates to address questions regarding the structural and functional existence of facial pillars and buttresses. Available bone material properties data do not support the existence of pillars and buttresses in humans or Sapajus apella. Deformation regimes in the zygomatic complex emphasize bending and shear, therefore conceptualizing the zygomatic complex of humans or nonhuman primates as a pillar obscures its patterns of stress, strain, and deformation. Human fossil relatives and chimpanzees exhibit strain regimes corroborating the existence of a canine-frontal pillar, but the notion of a zygomatic pillar has no support. The emerging consensus on patterns of strain and deformation in finite element models (FEMs) of the human facial skeleton corroborates hypotheses in the clinical literature regarding zygomatic complex function, and provide new insights into patterns of failure of titanium and resorbable plates in experimental studies. It is suggested that the "pillar and buttress" model of human craniofacial skeleton function be replaced with FEMs that more accurately and precisely represent in vivo function, and which can serve as the basis for future research into implants used in restoration of occlusal function and fracture repair. Anat Rec, 299:1753-1778, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Felippe Bevilacqua Prado
- Department of Morphology, Anatomy Area, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba, São Paulo, Brazil
| | - Alexandre Rodrigues Freire
- Department of Morphology, Anatomy Area, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba, São Paulo, Brazil
| | - Ana Cláudia Rossi
- Department of Morphology, Anatomy Area, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba, São Paulo, Brazil
| | - Justin A Ledogar
- Zoology Division, School of Environmental and Rural Science, University of New England, Armidale, NSW, Australia
| | - Amanda L Smith
- Department of Anthropology, Washington University in St. Louis, Missouri
| | - Paul C Dechow
- Department of Biomedical Sciences Texas A&M University, College of Dentistry, Dallas, Texas
| | - David S Strait
- Zoology Division, School of Environmental and Rural Science, University of New England, Armidale, NSW, Australia
| | - Tilman Voigt
- Department of Organismal Biology & Anatomy, University of Chicago, Chicago, Illinois
| | - Callum F Ross
- Department of Organismal Biology & Anatomy, University of Chicago, Chicago, Illinois
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Gravvanis A, Apostolou K, Anterriotis D, Tsoutsos D. Single stage aesthetic and functional reconstruction of composite facial gunshot wound with a chimeric functioning muscle and fibular osseous flap. Case report and review of the literature. Microsurgery 2017; 37:674-679. [DOI: 10.1002/micr.30140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/12/2016] [Accepted: 12/02/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Andreas Gravvanis
- Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich”; Athens General State Hospital “G. Gennimatas”; Athens Greece
| | - Konstantinos Apostolou
- Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich”; Athens General State Hospital “G. Gennimatas”; Athens Greece
| | - Dimitrios Anterriotis
- Department of Oral and Maxillofacial Surgery; Athens General State Hospital “G. Gennimatas”; Athens Greece
| | - Dimosthenis Tsoutsos
- Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich”; Athens General State Hospital “G. Gennimatas”; Athens Greece
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A Retrospective Analysis of Secondary Revisions after Face Transplantation. Plast Reconstr Surg 2016; 138:690e-701e. [DOI: 10.1097/prs.0000000000002605] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Koshy JC, Seruya M. Reconstructive algorithms in the pediatric population. J Surg Oncol 2016; 113:940-5. [DOI: 10.1002/jso.24200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/27/2016] [Indexed: 11/08/2022]
Affiliation(s)
- John C. Koshy
- Division of Plastic Surgery; Baylor College of Medicine; Houston Texas
| | - Mitchel Seruya
- Division of Plastic and Maxillofacial Surgery; USC Keck School of Medicine, Children's Hospital Los Angeles; Los Angeles California
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Sosin M, Mundinger GS, Dorafshar AH, Iliff NT, Christensen JM, Christy MR, Bojovic B, Rodriguez ED. Optimizing Reconstruction with Periorbital Transplantation: Clinical Indications and Anatomic Considerations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e628. [PMID: 27014557 PMCID: PMC4778899 DOI: 10.1097/gox.0000000000000545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 09/21/2015] [Indexed: 11/27/2022]
Abstract
UNLABELLED Complex periorbital subunit reconstruction is challenging because the goals of effective reconstruction vary from one individual to another. The purpose of this article is to explore the indications and anatomic feasibility of periorbital transplantation by reviewing our institutional repository of facial injury. METHODS Institutional review board approval was obtained at the R Adams Cowley Shock Trauma Center for a retrospective chart review conducted on patients with periorbital defects. Patient history, facial defects, visual acuity, and periorbital function were critically reviewed to identify indications for periorbital or total face (incorporating the periorbital subunit) vascularized composite allotransplantation. Cadaveric allograft harvest was then designed and performed for specific patient defects to determine anatomic feasibility. Disease conditions not captured by our patient population warranting consideration were reviewed. RESULTS A total of 7 facial or periorbital transplant candidates representing 6 different etiologies were selected as suitable indications for periorbital transplantation. Etiologies included trauma, burn, animal attack, and tumor, whereas proposed transplants included isolated periorbital and total face transplants. Allograft recovery was successfully completed in 4 periorbital subunits and 1 full face. Dual vascular supply was achieved in 5 of 6 periorbital subunits (superficial temporal and facial vessels). CONCLUSIONS Transplantation of isolated periorbital structures or full face transplantation including periorbital structures is technically feasible. The goal of periorbital transplantation is to re-establish protective mechanisms of the eye, to prevent deterioration of visual acuity, and to optimize aesthetic outcomes. Criteria necessary for candidate selection and allograft design are identified by periorbital defect, periorbital function, ophthalmologic evaluation, and defect etiology.
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Affiliation(s)
- Michael Sosin
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md
| | - Gerhard S. Mundinger
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md
| | - Amir H. Dorafshar
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md
| | - Nicholas T. Iliff
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md
| | - Joani M. Christensen
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md
| | - Michael R. Christy
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md
| | - Branko Bojovic
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md
| | - Eduardo D. Rodriguez
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md
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Costello BJ, Kumta P, Sfeir CS. Regenerative Technologies for Craniomaxillofacial Surgery. J Oral Maxillofac Surg 2015; 73:S116-25. [DOI: 10.1016/j.joms.2015.04.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/25/2015] [Indexed: 10/22/2022]
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Lundgren TK, Pignatti M, Halle M, Boscaini G, Skogh ACD, Luigi C, De Santis G. Composite orbital reconstruction using the vascularized segmentalized osteo-fascio-cutaneous fibula flap. J Plast Reconstr Aesthet Surg 2015; 69:255-61. [PMID: 26687794 DOI: 10.1016/j.bjps.2015.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 11/17/2022]
Abstract
Reconstruction of composite orbital defects must address the orbit and an exposed skull base and/or maxillary region. The orbit should not only be covered but also reshaped to accommodate the orbital contents or an epithesis when warranted. This study presents a rationale for a near-anatomical reconstruction of the orbit, together with adjacent dead space obliteration, using the segmentalized osteo-fascia-cutaneous fibula flap. Before the flap transfer, a cutting template for the fibula is made according to the measures and requirements of the facial defect. The segmentalized bone is then osteosynthesized to the facial skeleton and revascularized. Thus, an orbital depth is created by the bony fibula, whereas the fascio-cutaneous part of the flap may be used for lining the orbit and obliteration of the skull base or the maxillary region, or resurface the palate and/or the nasal cavity.
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Affiliation(s)
- T Kalle Lundgren
- Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Pignatti
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Martin Halle
- Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Giulia Boscaini
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Ann-Charlotte Docherty Skogh
- Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Chiarini Luigi
- Department of Cranio-Maxillofacial Surgery, Modena University Hospital, Policlinico di Modena, Italy
| | - Giorgio De Santis
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy.
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Motiee-Langroudi M, Harirchi I, Amali A, Jafari M. Reconstruction of Midface and Orbital Wall Defects After Maxillectomy and Orbital Content Preservation With Titanium Mesh and Fascia Lata: 3-Year Follow-Up. J Oral Maxillofac Surg 2015; 73:2447.e1-5. [PMID: 26343761 DOI: 10.1016/j.joms.2015.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the authors' experience in the reconstruction of patients after total maxillectomy with preservation of orbital contents for maxillary tumors using titanium mesh and autogenous fascia lata, where no setting for free flap reconstruction is available. PATIENTS AND METHODS Twelve consecutive patients with paranasal sinus tumors underwent total maxillectomy without orbital exenterations and primary reconstruction. The defects were reconstructed by titanium mesh in combination with autogenous fascia lata in the orbital floor performed by 1 surgical team. Titanium mesh (0.2 mm thick) was contoured and fixed to reconstruct the orbital floor and obtain midface projection. Fascia lata was used to cover the titanium mesh along the orbital floor to prevent fat entrapment in the mesh holes. RESULTS The most common pathology was squamous cell carcinoma (50%). Patients' mean age was 45.66 years (33 to 74 yr). The mean follow-up period was 35.2 months (30 to 49 months). During follow-up, no infection or foreign body reaction was encountered. Extrusion of titanium mesh occurred in 4 patients who underwent postoperative radiotherapy. Two cases of mild diplopia at extreme gaze occurred early during the postoperative period that resolved after a few months. CONCLUSION Placing fascia lata between the titanium mesh surface of the orbital implant and the orbital contents was successful in preventing long-term diplopia or dystopia. Nevertheless, exposure of the titanium implant through the skin surface represented a complication of this technique in 25% of patients. Further studies are required with head-to-head comparisons of artificial materials and free flaps for reconstruction of maxillectomy defects.
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Affiliation(s)
- Maziar Motiee-Langroudi
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Otolaryngology Research Center, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Harirchi
- Professor, Department of Oncologic Surgery, Cancer Institute, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Amali
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Otolaryngology Research Center, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Jafari
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Otolaryngology Research Center, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran.
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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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Stalder MW, Wise MW, Dupin CL, St Hilaire H. Versatility of subscapular chimeric free flaps in the secondary reconstruction of composite posttraumatic defects of the upper face. Craniomaxillofac Trauma Reconstr 2015; 8:42-9. [PMID: 25709752 DOI: 10.1055/s-0034-1384739] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/26/2013] [Indexed: 10/24/2022] Open
Abstract
High energy injuries to the upper face present challenging reconstructive problems. In some cases, initial reconstructive efforts result in unfavorable outcomes that require secondary intervention. Chimeric free flaps based on the subscapular system offer the tissue components and volume needed for these complex reconstructions. This is a series of five patients who underwent secondary reconstruction of the middle and upper face following traumatic injury. Mechanism of injury, prior attempts at reconstruction, and characteristics of the tissue defects and the flaps used in their reconstruction are described. Two patients were female and three were male. Three injuries resulted from gunshot wounds, and two from motor vehicle accidents. All patients had multiple prior failed attempts at reconstruction using local/regional tissue. Defects included symptomatic oronasal or oro-orbital fistulas, enophthalmos, and forehead contour deformities. Two of the flaps used included scapular bone and latissimus muscular components, and three included scapular bone and thoracodorsal artery perforator-based skin paddle components. All free tissue transfers were successful, and no patients suffered significant complications. Chimeric free flaps based on the subscapular system offer a valuable secondary strategy for reconstruction of composite defects of the upper face when other options have been exhausted through previous efforts.
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Affiliation(s)
- Mark Winston Stalder
- Division of Plastic and Reconstructive Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana
| | - Matthew Whitten Wise
- Division of Plastic and Reconstructive Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana
| | - Charles L Dupin
- Division of Plastic and Reconstructive Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana
| | - Hugo St Hilaire
- Division of Plastic and Reconstructive Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana
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Wolff J, Sándor GKB, Pyysalo M, Miettinen A, Koivumäki AV, Kainulainen VT. Late reconstruction of orbital and naso-orbital deformities. Oral Maxillofac Surg Clin North Am 2013; 25:683-95. [PMID: 24021624 DOI: 10.1016/j.coms.2013.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute orbital fractures and naso-orbital ethmoid fractures can result in chronic orbital and naso-orbital deformities. Understanding the acute injury is the first step in reconstructing the established late deformity. The best management strategy for reconstruction of orbital hypertelorism is to avoid late complications by repairing these deformities early near the time of the original fractures. New technologies from computer-guided surgical planning and additive manufacturing technology produce passive fitting implants tailored for patient-specific needs.
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Affiliation(s)
- Jan Wolff
- Tissue Engineering, Regea-BioMediTech, University of Tampere, Biokatu 12 Krs 6, Tampere FIN-33520, Finland; Oral and Maxillofacial Unit, Department of Otorhinolaryngology, Tampere University Hospital, PO Box 2000, Tampere FIN-33521, Finland
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Shen Y, Sun J, Li J, Li MM, Huang W, Ow A. Special considerations in virtual surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap. J Plast Reconstr Aesthet Surg 2012; 65:893-902. [DOI: 10.1016/j.bjps.2011.12.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 12/22/2011] [Accepted: 12/24/2011] [Indexed: 10/14/2022]
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28
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Ross CF, Berthaume MA, Dechow PC, Iriarte-Diaz J, Porro LB, Richmond BG, Spencer M, Strait D. In vivo bone strain and finite-element modeling of the craniofacial haft in catarrhine primates. J Anat 2010; 218:112-41. [PMID: 21105871 DOI: 10.1111/j.1469-7580.2010.01322.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Hypotheses regarding patterns of stress, strain and deformation in the craniofacial skeleton are central to adaptive explanations for the evolution of primate craniofacial form. The complexity of craniofacial skeletal morphology makes it difficult to evaluate these hypotheses with in vivo bone strain data. In this paper, new in vivo bone strain data from the intraorbital surfaces of the supraorbital torus, postorbital bar and postorbital septum, the anterior surface of the postorbital bar, and the anterior root of the zygoma are combined with published data from the supraorbital region and zygomatic arch to evaluate the validity of a finite-element model (FEM) of a macaque cranium during mastication. The behavior of this model is then used to test hypotheses regarding the overall deformation regime in the craniofacial haft of macaques. This FEM constitutes a hypothesis regarding deformation of the facial skeleton during mastication. A simplified verbal description of the deformation regime in the macaque FEM is as follows. Inferior bending and twisting of the zygomatic arches about a rostrocaudal axis exerts inferolaterally directed tensile forces on the lateral orbital wall, bending the wall and the supraorbital torus in frontal planes and bending and shearing the infraorbital region and anterior zygoma root in frontal planes. Similar deformation regimes also characterize the crania of Homo and Gorilla under in vitro loading conditions and may be shared among extant catarrhines. Relatively high strain magnitudes in the anterior root of the zygoma suggest that the morphology of this region may be important for resisting forces generated during feeding.
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Affiliation(s)
- Callum F Ross
- Organismal Biology & Anatomy, University of Chicago, Chicago, IL, USA.
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Current Opinion in Otolaryngology & Head and Neck Surgery. Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:326-31. [PMID: 19602933 DOI: 10.1097/moo.0b013e32832fa68b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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