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Zeng X, Li Y, Sun H, Li Y, Kikkawa DO, Lu W. Comparison of the biomechanical properties of internal fixation materials for zygomaticomaxillary complex fractures, A finite element analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023:101534. [PMID: 37321538 DOI: 10.1016/j.jormas.2023.101534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 04/10/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023]
Abstract
Regarding the three distinct types of zygomaticomaxillary complex (ZMC) fractures, this study developed finite element models (FEMs) of absorbable material and titanium material for repair and fixation, respectively. By applying a force of 120 N to the model to simulate the masseter muscle strength, the maximum stress and displacement of the repair materials and the fracture ends were measured. In discussing various models, the maximum stress values of absorbable and titanium materials are less than their yield strength, and the maximum displacement values of the titanium material and fracture end were less than 0.1 mm and 0.2 mm. The maximum displacement values of absorbable material and fracture end in incomplete zygomatic fracture and dislocation were less than 0.1 mm and 0.2 mm. While in the zygomatic complex complete fractures and dislocation, the maximum displacement values of the absorbable material and the fracture end exceeded 0.1 mm and 0.2 mm. Consequently, the distinction between the maximum displacement values of the two materials was 0.08 mm, and the distinction between the maximum displacement values of the fracture ends was 0.22 mm, despite the fact that the absorbable material can withstand the fracture end's strength, it is not as stable as the titanium material.
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Affiliation(s)
- Xueying Zeng
- Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yang Li
- Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Hetian Sun
- Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yan Li
- Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Don O Kikkawa
- Shiley Eye Institute, 9415 Campus Point Drive La Jolla, CA California, USA
| | - Wei Lu
- Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
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Chu YY, Yang JR, Lai BR, Liao HT. Preliminary outcomes of the surgical navigation system combined with intraoperative three-dimensional C-arm computed tomography for zygomatico-orbital fracture reconstruction. Sci Rep 2022; 12:7893. [PMID: 35550552 PMCID: PMC9098405 DOI: 10.1038/s41598-022-11659-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 04/27/2022] [Indexed: 11/09/2022] Open
Abstract
This study analyzed the outcomes of zygomatico-orbital fracture reconstruction using the real-time navigation system with intraoperative three-dimensional (3D) C-arm computed tomography (CT). Fifteen patients with zygomatico-orbital or isolated orbital/zygoma fractures were enrolled in this prospective cohort. For zygoma reduction, the displacement at five key sutures and the differences between preoperative and intraoperative CT images were compared. For orbital reconstruction, the bilateral orbital volume differences in the anterior, middle, and posterior angles over the medial transitional buttress were measured. Two patients required implant adjustment once after the intraoperative 3D C-arm assessment. On comparing the preoperative and postoperative findings for the zygoma, the average sum of displacement was 19.48 (range, 5.1–34.65) vs. 1.96 (0–3.95) mm (P < 0.001) and the deviation index was 13.56 (10–24.35) vs. 2.44 (0.6–4.85) (P < 0.001). For the orbit, the mean preoperative to postoperative bilateral orbital volume difference was 3.93 (0.35–10.95) vs. 1.05 (0.12–3.61) mm3 (P < 0.001). The mean difference in the bilateral angles at the transition buttress was significantly decreased postoperatively at the middle and posterior one-third. There was no significant difference in orbital volume, angle of the transition zone, and the sum of five zygoma distances between post operative results and preoperative virtual planning. The surgical navigation system with the intraoperative 3D C-arm can effectively improve the accuracy of zygomatico-orbital fracture reconstruction and decrease implant adjustment times.
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Affiliation(s)
- Yu-Ying Chu
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fuxing Street, Taoyuan, 333, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Jia-Ruei Yang
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fuxing Street, Taoyuan, 333, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Bo-Ru Lai
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fuxing Street, Taoyuan, 333, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Han-Tsung Liao
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fuxing Street, Taoyuan, 333, Taiwan. .,Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan. .,Department of Plastic Surgery, Xiamen Chang Gung Hospital, Xiamen, 361000, China.
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A Three-dimensionally Printed Acrylonitrile Butadiene Styrene Model for the Reduction of Nasomaxillary Fracture. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3877. [PMID: 34671544 PMCID: PMC8522875 DOI: 10.1097/gox.0000000000003877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
The successful reduction of a nasomaxillary fracture was performed using a three-dimensional printed model. A 16-year-old boy was struck in the left orbit by a baseball; subsequently, he was diagnosed with the nasal bone fracture at a hospital, and was referred to the authors' department. A left nasomaxillary fracture and nasal bone fracture were diagnosed by computed tomography. Standard triangulated language data for the mirror image of the frontal process of the right maxilla were obtained from digital imaging and communications in medicine data for preparing a three-dimensional printed acrylonitrile butadiene styrene model. On postinjury day 13, the frontal process fracture was reduced via transconjunctival and intraoral approaches. After the reduction of the fracture, an absorbable plate fitting to the shape of three-dimensional printed acrylonitrile butadiene styrene model was molded, and the maxillary frontal process and infraorbital rim were reduced and fixed with an absorbable plate and screws. Postoperative computed tomography demonstrated a favorable reduction. The intraoperative use of the 3D printed acrylonitrile butadiene styrene model was helpful in the nasomaxillary fracture reduction and fixation.
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Chu YY, Yang JR, Pek CH, Liao HT. Application of real-time surgical navigation for zygomatic fracture reduction and fixation. J Plast Reconstr Aesthet Surg 2021; 75:424-432. [PMID: 34257033 DOI: 10.1016/j.bjps.2021.05.052] [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: 01/29/2020] [Revised: 04/18/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inappropriate treatment of zygomatic fractures can reduce esthetic and functional outcomes. The aim of this study was to answer the research question: "Among patients with a unilateral zygomatic fracture, is the use of computer-assisted real-time navigation system during fracture reduction precise and accurate to create postoperative facial symmetry?" METHODS Using a retrospective cohort study design, we enrolled a cohort of unilateral zygomatic fractures undergoing open reduction and internal fixation (ORIF) with the aid of the computer-based navigation system at Chang Gung Memorial Hospital, Taiwan, during January 2015 and March 2018. The predictor variable was the comparison before and after surgery. The main outcome variables included (1) two-dimensional (2D) reduction of the displacement at five anatomical landmarks: zygomaticofrontal, inferior orbital rim, zygomaticosphenoidal, zygomaticomaxillary, and zygomaticotemporal lines/buttresses and (2) three-dimensional (3D) differences on distances between zygomatic surface to the porion plane and the midpoint of zygomatic arch (ZA) to the mid-porion (MP) plane. The Wilcoxon signed-rank test was computed to compare between pre- and postoperative data, and a p-value less than 0.05 was considered statistically significant. RESULTS The cohort comprised 24 subjects (50% females, 75% left-sided) with a mean age of 30.5 +/- 13.8 years. On 2D analysis, the significant fracture reduction was found: 4.78 vs. 1.22 mm, 1.78 vs. 0.40 mm, 3.50 vs. 0.07 mm, 3.06 vs. 0.55 mm, and 2.55 vs. 0.50 mm at zygomaticomaxillary, zygomaticofrontal, inferior orbital rim, zygomaticosphenoidal, and zygomaticotemporal landmarks. The 3D evaluations revealed the significant reduction of the differences between the left and right zygomatic surface to the porion plane (4.09 ± 2.12 vs. 0.46 ± 0.35 mm) and between the left and right ZA midpoints to the MP plane (4.89 ± 2.59 vs. 0.71 ± 0.44 mm) (p<0.001 for both 2D and 3D analyses). CONCLUSIONS The results of this study suggest that the real-time surgical navigation system can effectively guide the ORIF of zygomatic fractures. Future research studies should focus on the learning curve and cost-effectiveness analysis of this technique.
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Affiliation(s)
- Yu-Ying Chu
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan
| | - Jia-Ruei Yang
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan
| | - Chong-Han Pek
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Taoyuan, Taiwan
| | - Han-Tsung Liao
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan; Department of Plastic Surgery, Xiamen Chang Gung Memorial Hospital, China.
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da Silva BCL, Souto-Souza D, de Souza GM, Magesty RA, de Cassia Ávila B, Galvão EL, Falci SGM. Comparison between resorbable plates vs. titanium plates for treatment of zygomatic fractures: a systematic review with meta-analysis. Oral Maxillofac Surg 2021; 25:289-301. [PMID: 33398647 DOI: 10.1007/s10006-020-00937-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare resorbable plates with titanium plates for the fixation of zygomatic fractures, taking into account postoperative complications. METHODS This systematic review followed the guidelines of PRISMA and the recommendations of the Cochrane Handbook and was registered in PROSPERO. The electronic search was performed in the Web of Science, PubMed, Virtual Health Library, and Cochrane Library databases and in the gray literature. The study selection and the data extraction were performed by three calibrated and independent researchers. The assessment of the risk of bias in the studies was performed using the Cochrane Risk of Bias Tool for clinical trials. Meta-analyses were performed using Review Manager Software version 5.3, using the Peto's Odds Ratios (PORs), and when I2 > 30, the random effect model was used. The evaluation of the quality of the evidence was carried out through GRADE. RESULTS A total of 2651 studies were screened and only nine were included; 7 of which were used for quantitative assessment. The follow-up time for patients ranged from 6 months to 5 years. All studies showed a low risk of bias in the "incomplete outcome data" domain. The need for plate removal (POR: 0.11, 95% CI: 0.02 to 0.81, I2 = 0%) and dehiscence (POR 0.12, 95% CI 0.02 to 0.63, I2 = not applied) was lower for the group of patients who used resorbable plates than for titanium plates. CONCLUSION There was no difference in the occurrence of infection, diplopia, or paresthesia between the fixation methods. Resorbable plates showed better postoperative clinical performance.
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Affiliation(s)
- Bianca Cristina Lopes da Silva
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Debora Souto-Souza
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Glaciele Maria de Souza
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Rafael Alvim Magesty
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Bruna de Cassia Ávila
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Endi Lanza Galvão
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Saulo Gabriel Moreira Falci
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil.
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Shamanaeva L, Diachkova E, Petruk P, Polyakov K, Cherkesov I, Ivanov S. Titanium Nickelide in Midface Fractures Treatment. J Funct Biomater 2020; 11:jfb11030052. [PMID: 32726970 PMCID: PMC7564408 DOI: 10.3390/jfb11030052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/23/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The question of reconstruction of human tissues and organs with the use of medical materials is still open, because of the accurate requirements for their biological and physical features. The aim of this study was to prove the efficiency of titanium nickelide constructors in treatment of isolated orbital floor fractures or combination with zygomatico-orbital complex fractures. Methods: Patients with a fracture of zygomatico-orbital complex and/or low orbital floor (n = 44) carried out different treatments: in the first group, osteosynthesis and endoprosthesis with titanium nickelide structures; in the second group, titan mini-plates osteosynthesis; in the third group (‘blow-out’), endoprosthesis with a titanium nickelide mesh; and in the fourth group (‘blow-out’), conservative treatment and monitoring (archive data) (p > 0.05). The paraesthesia, diplopia, enophthalmos and exophthalmos degree were measured in points. Results: In one year, the first and second groups had no differences in level of paraesthesia (p > 0.05). The absence of exophthalmos and differences between first and second groups, and between the third and the fourth groups with positive dynamics inside the groups were proved (p < 0.05). In the first and third groups, enophthalmos was absent, and it increased in the second and fourth groups (p < 0.01, p < 0.11). Diplopia in the first and third groups was absent, and it increased in the second and fourth groups (p < 0.05, p < 0.01). Conclusion: The elasticity and biocompatibility of titanium nickelide make the implant insertion and restoration of the lower orbital wall anatomy easier, with good postoperative clinical results.
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Affiliation(s)
- Liudmila Shamanaeva
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (P.P.); (K.P.); (I.C.); (S.I.)
- Correspondence: ; Tel.: +7-(495)-6091400
| | - Ekaterina Diachkova
- Department of Oral Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia;
| | - Pavel Petruk
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (P.P.); (K.P.); (I.C.); (S.I.)
| | - Kirill Polyakov
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (P.P.); (K.P.); (I.C.); (S.I.)
| | - Igor Cherkesov
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (P.P.); (K.P.); (I.C.); (S.I.)
| | - Sergei Ivanov
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (P.P.); (K.P.); (I.C.); (S.I.)
- Department of Maxillofacial and Oral Surgery, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
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Gareb B, van Bakelen N, Dijkstra P, Vissink A, Bos R, van Minnen B. Biodegradable versus titanium osteosynthesis in maxillofacial traumatology: a systematic review with meta-analysis and trial sequential analysis. Int J Oral Maxillofac Surg 2020; 49:914-931. [DOI: 10.1016/j.ijom.2019.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/02/2019] [Accepted: 11/20/2019] [Indexed: 01/18/2023]
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Yan G, Zhang R, Chuo W, Gao X, Zhou Q, Yang M. Open Reduction Effects of Digitally Treating Zygomaticomaxillary Complex Fractures With Bio-Resorbable Materials. J Oral Maxillofac Surg 2020; 78:986-995. [PMID: 32006489 DOI: 10.1016/j.joms.2019.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The application of bio-resorbable plates in craniomaxillofacial surgery is increasing because of the advantage of avoiding secondary surgery. This study aimed to evaluate the effects of osteosynthesis with prebent bio-resorbable plates for treating zygomaticomaxillary complex (ZMC) fractures. MATERIALS AND METHODS We implemented a prospective case series composed of patients with ZMC fractures who underwent treatment at the School of Stomatology at China Medical University. Bio-resorbable plates were used for fracture fixation. The fractures were stabilized with bio-resorbable plates prebent on a 3-dimensionally printed skull model with the fractures reduced using virtual simulation. The primary outcome variable was the stability rate of reduced bone segments. Other study variables were mouth opening, occlusion, paresthesia or anesthesia in the infraorbital nerve region (PAIN), and diplopia. Outcome variables were determined by calculating stability rates of reduced bone segments, resolution rates of postoperative restricted mouth opening, malocclusion, PAIN, and diplopia. RESULTS The sample was composed of 11 patients recruited between November 2016 and September 2018. All surgical procedures were successful, with no severe complications. The stability rate of reduced bone segments from different mechanical buttress regions was 100%. Satisfactory postoperative stability of bio-resorbable plates was obtained in all cases. The resolution rates of postoperative restricted mouth opening and malocclusion were 75 and 100%, respectively. PAIN and diplopia symptoms resolved in 50 and 100% of cases, respectively. CONCLUSIONS The results suggest that osteosynthesis with bio-resorbable plates prebent on a 3-dimensionally printed skull model, designed by virtual simulation, works well for patients with ZMC fractures. Future studies should focus on the broader applications of these findings in the practice of oral and maxillofacial surgery.
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Affiliation(s)
- Guangqi Yan
- Associate Professor, Postgraduate, School of Stomatology, China Medical University, Shenyang, China
| | - Ran Zhang
- Resident Doctor, Postgraduate, School of Stomatology, China Medical University, Shenyang, China
| | - Wenyu Chuo
- Resident Doctor, Postgraduate, School of Stomatology, China Medical University, Shenyang, China
| | - Xiaobo Gao
- Resident Doctor, Postgraduate, Hospital Affiliated of Chifeng University, Chifeng, China
| | - Qing Zhou
- Professor, Postgraduate, School of Stomatology, China Medical University, Shenyang, China
| | - Mingliang Yang
- Associate Professor, School of Stomatology, China Medical University, Shenyang, China.
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Abstract
Facial anthropometric data has significant ethnic variation. East Asia, comprised of fourteen countries, represents a significant proportion of the global population. This systematic review presents the facial anthropometric data collected from these countries. The systematic review was conducted in accordance with PRISMA guidelines. An electronic search of the MEDLINE database returned 3054 articles. Twenty articles were considered eligible for inclusion. Nine studies were conducted in China, 1 in Indonesia, 2 in Japan,3 in Korea, 4 in Malaysia, and 1 was a multicentre study conducted in China, Japan, Thailand, and Vietnam. Qualitative and quantitative parameters were extracted from the20 studies. No data was found for the other East Asian countries. There is a paucity of facial anthropometric data for East Asian countries despite their high burden of craniofacial anomalies and a strong demand for cosmetic facial surgery, both of which would benefit from the collection of robust craniofacial norms. It is in the interest of both the craniofacial surgeon and the East Asian patient to collect baseline facial anthropometric data for this population.
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Chu SG, Lee JS, Lee JW, Yang JD, Chung HY, Cho BC, Choi KY. Comparisons among four types of absorbable plates used for internal fixation of zygomaticomaxillary complex fractures. J Craniomaxillofac Surg 2019; 47:383-388. [PMID: 30711471 DOI: 10.1016/j.jcms.2019.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/22/2018] [Accepted: 01/08/2019] [Indexed: 11/28/2022] Open
Abstract
IMPORTANCE Conventional plating systems include titanium plates for the fixation of facial bone fractures. However, titanium plates result in artifacts on computed tomography images and appear unstable on magnetic resonance images. Therefore, absorbable plates have been widely used for the fixation of facial bone fractures of late in Asia. OBJECTIVE To compare stability and symmetry among four different absorbable plates used for internal fixation of zygomaticomaxillary complex fractures. PARTICIPANTS The subjects were patients with zygomaticomaxillary complex fractures that were diagnosed and treated by internal fixation with absorbable plates between January 2012 and April 2018. Patients aged ≤14 years and ≥76 years were excluded. Patients with other fracture types were also excluded. All patients underwent surgery within 2 weeks of the injury. INTERVENTION Internal fixation was performed with one of four types of absorbable plates, namely Inion®, Polymax®, Osteotrans®, and Biosorb®. MAIN OUTCOME MEASURES The stability of the four plates was investigated by evaluation of the orbital height ratio (A'/A), zygoma angle (a'/a), distance (b'/b) from the midline, and gap (c) of the temporal process on three-dimensional facial computed tomography images obtained before, 3 weeks after, and 3-6 months after surgery. Any plate-associated complications were recorded. RESULTS In total, 400 patients were enrolled, and there were 100 patients in each of the four groups. There were no significant differences with regard to postoperative stability and relapse among the four plates. Moreover, facial symmetry showed no changes over time in any group. Complications such as infection and sensory disturbance were not frequent. All plates except Biosorb® were palpable for more than 6 months after surgery, with Osteotrans® remaining palpable for several years. CONCLUSIONS AND RELEVANCE Our findings suggest that all four types of absorbable plates are useful for treating isolated zygomaticomaxillary complex fractures. While Biosorb® is unsuitable for severe comminuted fractures. Polymax® and Inion® are not bendable at room temperature. It is important to select an appropriate absorbable plate according to each patient's condition and the fracture severity.
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Affiliation(s)
- Seung Gyun Chu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jeong Woo Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Byung Chae Cho
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Kang Young Choi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea.
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Raveendran M. The South Asian facial anthropometric profile: A systematic review. J Craniomaxillofac Surg 2018; 47:263-272. [PMID: 30573375 DOI: 10.1016/j.jcms.2018.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/26/2018] [Accepted: 11/26/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Craniofacial anatomy, as measured by facial anthropometric data, varies significantly between races. South Asia, comprised of eight countries, represents a large proportion of the global population and is the fastest-growing region of the world. This systematic review presents the facial anthropometric data collected for populations from this region. MATERIALS AND METHODS This systematic review was conducted in accordance with PRISMA guidelines. A systematic review of the literature was conducted by an electronic search of the MEDLINE and Cochran databases, returning 1675 articles. Bibliographies of accepted articles were screened to identify further eligible studies. RESULTS A total of 12 articles were considered eligible for the systematic review. Two studies were conducted in Bangladesh, 7 in India, and 3 in Nepal. No facial anthropometric data were found for populations from Afghanistan, Bhutan, Maldives, Pakistan, or Sri Lanka. Qualitative and quantitative parameters from the 12 studies were extracted. CONCLUSION There is a paucity of facial anthropometric data for South Asian populations. As South Asia has a significant prevalence of craniofacial anomalies and a burgeoning cosmetic facial surgery market, it is in the interest of both the craniofacial surgeon and the South Asian patient to collect baseline facial anthropometric data for this population.
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Affiliation(s)
- Maria Raveendran
- University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1AB, Canada.
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12
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Evaluation of Postoperative Stability After Open Reduction and Internal Fixation of Zygomaticomaxillary Complex Fractures Using Cone Beam Computed Tomography Analysis. J Craniofac Surg 2018; 29:980-984. [DOI: 10.1097/scs.0000000000004355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bioabsorbable plating in the treatment of pediatric clavicle fractures: A biomechanical and clinical analysis. Clin Biomech (Bristol, Avon) 2018; 55:94-99. [PMID: 29727767 DOI: 10.1016/j.clinbiomech.2018.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/20/2018] [Accepted: 04/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Classic implants for operative intervention of mid-shaft clavicle fractures in adolescents can become symptomatic, requiring removal. This study compares 1) biomechanical properties and 2) clinical outcomes in adolescents of mid-shaft clavicle fracture fixation with bioabsorbable versus metal implants. METHODS Six synthetic clavicles with mid-shaft fractures underwent bioabsorbable plating. A testing frame applied 10 non-destructive torsion and 10 axial compression cycles, followed by cantilever bending to failure. Stiffness was calculated; maximum failure load and failure mode were recorded. Results were compared to previous data for locked metal constructs. Retrospective review of surgically treated clavicle fractures over three years included functional and radiographic outcomes. FINDINGS Bioabsorbable plates had lower torsional stiffness (P < 0.001) and maximum cantilever load (P < 0.0001) than locked metal plates. There was no significant difference in compression stiffness (P = 0.2) or cantilever bending stiffness (P = 0.4). Primary failure of metal plates was screw pull-out compared to plate bending in bioabsorbable constructs. Seven patients with bioabsorbable implants were included. All patients with bioabsorbable constructs achieved radiographic union, but 71% lost reduction. Despite fracture angulation, all achieved normal shoulder function after one year determined by QuickDASH evaluation. None required a second surgery. INTERPRETATION Bioabsorbable implants had lower torsional stiffness and cantilever failure load, but comparable compression stiffness to metal implants. Bioabsorbable implants failed via gradual bending versus the catastrophic failure seen in metal implants. The clinical review allows understanding of the sequelae of this lower failure load of bioabsorbable plates where their use allowed in fracture displacement, yet achievement of ultimate radiographic union and acceptable functional outcomes.
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Chandra SR, Zemplenyi KS. Issues in Pediatric Craniofacial Trauma. Facial Plast Surg Clin North Am 2017; 25:581-591. [DOI: 10.1016/j.fsc.2017.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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