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Morandi EM, Pinggera D, Kerschbaumer J, Rauchenwald T, Winkelmann S, Thomé C, Pierer G, Wolfram D. Correction of temporal hollowing after pterional craniotomy by autologous fat grafting. A single-center experience. World Neurosurg 2022; 164:e784-e791. [PMID: 35597536 DOI: 10.1016/j.wneu.2022.05.049] [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: 03/30/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Aesthetic complications following neurosurgical procedures impact patient quality of life and self-perception. Postoperative temporal hollowing is frequently seen after temporal craniotomy, resulting mainly from atrophy of the temporal muscle. Autologous fat grafting is a tailorable method to correct such approach-related sequelae. We herein present our clinical patient series and discuss pearls and pitfalls of this method. METHODS In this retrospective single-center study, correction of postoperative temporal hollowing using autologous fat grafting was performed in 16 patients. Temporal tissue thickness ratio was measured using magnetic resonance tomography images to visualize the graft. Patients, plastic surgeons and neurosurgeons evaluated the results independently using the herein presented scale. RESULTS The mean interval between the neurosurgical procedure and fat grafting was 62 months. A mean volume of 11.5 ml autologous fat was injected in an average of 2.5 sessions after initial rigotomy. Temporal tissue thickness was significantly augmented at a mean of 2.2 years after the operation (mean 0.71 ± 0.25, range 0.43-1.1; p=0.0214) as compared to the preoperative finding (mean 0.48 ± 0.1, range 0.32-0.6). Patients were more satisfied with the results than were surgeons, reflecting the significant impact of the deformity on patient self-esteem. CONCLUSIONS Autologous fat grafting is a valuable method for correcting postoperative temporal hollowing that provides stable results, high patient and surgeon satisfaction and can be tailored to the patient's individual needs. It should not be considered a merely aesthetic operation, but an important rehabilitation step towards restoring the patient's quality of life.
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Affiliation(s)
- Evi M Morandi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Tina Rauchenwald
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Selina Winkelmann
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Shay T, Shachar T, Olshinka A, Ad-El DD, Ibelli T, Yaacobi DS. Temporal Hollowing Causes, Classifications, and Treatment Options: A Systematic Review. J Cosmet Dermatol 2022; 21:4215-4224. [PMID: 35467073 DOI: 10.1111/jocd.15021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent developments in surgical techniques and grading schemas to treat temporal hollowing necessitate critically assessing their efficacy. This systematic review presents the currently available protocols for temporal hollowing, aimed toward improving the clinical approach, for the benefit of the surgeon and patient. METHODS A search was conducted in Pubmed, Embase, and Google Scholar in September 2021 using the key words "temporal hollowing" and "temporal augmentation." Inclusion criteria were English written articles published in peer-reviewed journals that reported an outcome relating to the cause, classification, or procedure used to prevent or correct hollowing in humans. RESULTS Of the 413, 966 publications retrieved, 24 met the study inclusion criteria. Twenty-one publications discussed the etiology of temporal hollowing, 12 discussed a classification or grading system for temporal hollowing, and 19 discussed a procedure to prevent or correct temporal hollowing. The most commonly reported etiology for temporal hollowing was iatrogenic (63%). For classifying temporal hollowing severity, visual analogue scales (25%) were most commonly used. Mesh (26%) and autologous fat grafts (26%) were the most popular procedures used to prevent or correct temporal hollowing. DISCUSSION We presented the spectrum of temporal hollowing grading schemas and treatment modalities currently published in the field. The use, by a majority of publications, of a grading system based on the subjective judgement of the examiner (either alone or adjunct to imaging results) suggests the need for a more standardized measurement tool. Future studies should investigate a universally-applicable temporal hollowing classification system and its impact on treatment outcomes.
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Affiliation(s)
- Tamir Shay
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Tal Shachar
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Asaf Olshinka
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Dean D Ad-El
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Taylor Ibelli
- Sackler School of Medicine at, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Shilo Yaacobi
- Department of Plastic Surgery & Burns, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
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Correction of Temporal Hollowing Deformity Using Serratus Anterior Muscle Flap. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9523629. [PMID: 35047641 PMCID: PMC8763481 DOI: 10.1155/2022/9523629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022]
Abstract
Temporal hollowing deformity (THD) is a contour irregularity in the frontotemporal region, which results in facial asymmetry in the frontal view. Here, we present our clinical experience of correction of THD using serratus anterior (SA) muscle and fascia free flaps. Between March 2016 and December 2018, 13 patients presenting with THD were treated with SA free flap. The mean age of the patients was 47.8 years. The patients received craniectomy due to subarachnoid hemorrhage, epidural hematoma, or brain tumor. On average, correction of THD was performed 17 months after cranioplasty. The SA flap size ranged from
to
. The mean operation time was 107.3 minutes. All of the flaps survived without complications. The mean follow-up duration was 20.3 months. For correction of THD, the SA muscle and fascia flap is among the best candidates to permanently restore aesthetic form and symmetry.
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Fahradyan A, Goel P, Williams M, Liu A, Gould DG, Urata MM. Temporal Fat Grafting in Children With Craniofacial Anomalies. Ann Plast Surg 2020; 85:505-510. [PMID: 32541538 DOI: 10.1097/sap.0000000000002431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fat grafting is a common adjunct procedure used to treat temporal fat hollowing in children with craniofacial anomalies. The goal of this study was to assess the surgical and aesthetic outcomes of this procedure. METHODS We retrospectively reviewed patients who underwent temporal fat grafting at a single tertiary pediatric craniofacial center. The surgical outcome was assessed based on intraoperativeand 30-day postoperative complication rates. The aesthetic outcome was assessed by 3 independent investigators using a 3-point grading scale for preoperative temporal hollowing severity (1 = mild, 2 = moderate, 3 = severe) and a 5-point scale for postoperative improvement (0 = no, 1 = mild, 2 = moderate, 3 = significant, and 4 = complete improvement). RESULTS Forty-three patients met inclusion criteria. Twenty-seven (63%) were male, 39 (91%) had a history of craniosynostosis, and 18 (42%) had associated syndromes. The mean age at fat grafting was 9.9 years (2.7-20.4, SD = 5.5) with an average follow-up time of 1.6 years (0-5.8, SD = 1.8). The average volume of fat grafted was 8.6 mL (0-30, SD = 5.9) to the right temporal region and 8.6 mL (0-30, SD = 5.8) to the left. There were no intraoperative or postoperative complications. The mean improvement score was 2.9 (1-4, SD = 0.7), demonstrating that most patients experienced moderate to significant improvement. Multiple linear regression analysis demonstrated that syndromic status had a negative impact on the aesthetic outcome (P < 0.001). CONCLUSIONS These findings demonstrate that fat grafting is an effective method to treat temporal hollowing in children with craniofacial anomalies with no perioperative complications.
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Affiliation(s)
| | - Pedram Goel
- Keck School of Medicine, University of Southern California
| | - Madeline Williams
- Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Alice Liu
- Keck School of Medicine, University of Southern California
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Huang RL, Xie Y, Wang W, Tan P, Li Q. Long-term Outcomes of Temporal Hollowing Augmentation by Targeted Volume Restoration of Fat Compartments in Chinese Adults. JAMA FACIAL PLAST SU 2019; 20:387-393. [PMID: 29710230 DOI: 10.1001/jamafacial.2018.0165] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Importance Previous anatomical and clinical studies have suggested that targeted restoration of the volume and distribution of fat compartments using appropriate cannula entry sites and injection planes is an excellent fat-grafting technique for facial contouring and hand rejuvenation. Objective To perform subjective and objective evaluations of the safe and effective profile of the targeted fat-grafting technique for temporal hollowing augmentation. Design, Setting, and Participations In a retrospective cohort study, a total of 96 consecutive patients with temporal hollowing were treated at the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai, China, with the targeted fat-grafting technique from January 1, 2009, to January 1, 2017. Main Outcomes and Measures The safety and efficacy profile of this technique was evaluated by the following methods: (1) a quantitative measurement of fat-graft survival and temporal augmentation rates by using 3-dimensional laser scanning, (2) a subjective assessment using a satisfaction survey and the Hollowness Severity Rating Scale (grades range from 0-3, with higher grades representing more hollowness), and (3) the complication rate. Results Of the 96 study patients, 94 (97.9%) were women and the mean (SD) age was 34.4 (7.4) years. Of the 142 autologous fat-grafting procedures performed, the mean (SD) total follow-up time was 16.3 (3.2) months, with a mean (SD) of 1.5 (0.7) procedures performed. The mean (SD) baseline volume requirement per temple for each patient was 12.8 (4.8) mL, and the total volume of the fat graft per temple was 17.8 (7.5) mL. Quantitative analysis revealed that the mean (SD) total augmentation volume per temple was 11.7 (3.0) mL, the total survival rate of the fat grafts was 65.7% (12.6%), and total augmentation rate of hollowness was 91.4% (23.4%). Subjective analysis revealed that all patients showed an improved appearance after fat grafting, and 142 temples (74.0%) exhibited clinical improvement by more than 2 grades. In all, 88 patients (91.7%) were satisfied with the outcomes, with a low complication rate reported. Conclusions and Relevance The targeted fat-grafting technique allows the transplant of fat tissue into 4 separate fat compartments in a double-plane manner through a unique cannula entry site that avoids severe neurovascular injury. The long-term results demonstrate that this technique is an effective, reproducible, and safe approach for temporal hollowing augmentation. Level of Evidence 4.
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Affiliation(s)
- Ru-Lin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Xie
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjin Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pohching Tan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Park SE, Park EK, Shim KW, Kim DS. Modified Cranioplasty Technique Using 3-Dimensional Printed Implants in Preventing Temporalis Muscle Hollowing. World Neurosurg 2019; 126:e1160-e1168. [PMID: 30880206 DOI: 10.1016/j.wneu.2019.02.221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Temporalis muscle (TM) hollowing is a complication of cranioplasty which diminishes the aesthetical outcome of the surgery and results in suboptimal functional outcome. We present and compare a modified split-temporalis muscle elevated margin cranioplasty using 3-dimensional printed titanium implant with conventional 3-dimensional printed titanium implant cranioplasty to determine an effective treatment method. METHODS A modified 3-dimensional printed cranial implant was designed where the anteroinferior border of the implant was extended and elevated between the frontozygomatic suture and root of zygomatic process. Furthermore, the implant was placed in between superficial and deep layers of the temporalis muscle. Aesthetical evaluation was carried out at the outpatient clinic, and a quantitative analysis showing the percentage difference in length of the operated and nonoperated sides was performed. RESULTS For both conventional and augmented groups, there were 0% major or minor complications. Out of 10 conventional cranioplasty patients, there were 3 cases of mild and 1 case of severe TM hollowing, whereas for 10 augmented cranioplasty patients, there was only 1 patient with mild TM hollowing. When a quantitative analysis was carried out, the overall percentage difference in length at the coronal view for conventional and augmented cranioplasty was -2.17% and 0.07%, respectively. CONCLUSIONS The augmented cranioplasty leads to superior aesthetical outcome, and the quantitative analysis also supports the efficacy of augmented cranioplasty. The surgery is technically simpler than the conventional method, therefore lowering the risk of surgical complications. Therefore, we hope that the modified cranioplasty method will be considered as an effected cranioplasty method for preventing TM hollowing.
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Affiliation(s)
- Seong-Eun Park
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea
| | - Eun-Kyung Park
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea
| | - Kyu-Won Shim
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea.
| | - Dong-Seok Kim
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea
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Post-Neurosurgical Temporal Deformities: Various Techniques for Correction and Associated Complications. J Craniofac Surg 2018; 29:1723-1729. [PMID: 29863558 DOI: 10.1097/scs.0000000000004639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION An irregular craniofacial contour along the temporal fossa, known commonly as 'temporal hollowing deformity,' (THD) can arise from multiple etiologies. In fact, up to half of all patients who undergo neurosurgical pterional dissections develop some form of temporal contour deformities. Unfortunately, temporal hollowing correction remains surgically challenging with many techniques resulting in high rates of failure and/or morbidity. METHODS Herein, we describe anatomy contributing to postsurgical temporal deformity as well as time-tested prevention and surgical correction techniques. In addition, a review of 25 articles summarizing various techniques and complication profiles associated with temporal hollowing correction are presented. RESULTS Complications included infection, implant malposition, revision surgery, pain, and implant removal because of implant-related complications Augmentation with either autologous fat or dermal filler is associated with the highest number of reported complications, including catastrophic events such as stroke, pulmonary embolism, and death. No such complications were reported with use of alloplastic material, use of autologous bone, or free tissue transfer. Furthermore, careful attention to adequate temporalis muscle resuspension and position remain paramount for stable restoration of craniofacial symmetry. CONCLUSIONS Catastrophic complications were associated with injection augmentation of both fat and dermal filler in the temporal region. In contrast, use of alloplastic materials was not found to be associated with any catastrophic complications. As such, for the most severe cases of THD, we prefer to employ alloplastic reconstruction.
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Comparative Cost Analysis of Single and Mutli-Stage Temporal Deformity Correction Following Neurosurgical Procedures. J Craniofac Surg 2018; 29:130-138. [DOI: 10.1097/scs.0000000000004107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Park IH, Kwon H, Kim SW. Cryptogenic Temporal Hollowing. Arch Craniofac Surg 2017; 17:218-221. [PMID: 28913287 PMCID: PMC5556840 DOI: 10.7181/acfs.2016.17.4.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/19/2016] [Accepted: 09/23/2016] [Indexed: 11/16/2022] Open
Abstract
Temporal hollowing is a common complication that occurs after coronal approach surgeries. However, temporal hollowing without previous nerve damage or trauma history is rare. Herein, we present a patient with cryptogenic temporal hollowing. A 22-year-old man without any history of craniofacial interventions or trauma presented with temporal hallowing. Magnetic resonance imaging revealed fatty degeneration of the left temporalis muscle. Electromyography and nerve conduction study showed no signs of neurologic abnormalities. The patient received autologous fat injection of 30 mL harvested from the left thigh using the modified Coleman technique. Temporal hollowing is commonly caused by atrophy of the superficial temporal fat pad. Its incidence is reported to be as high as 6% after coronal approach operation. Augmentation using porous hydroxyapatite or titanium mesh is a treatment option. Autologous fat graft can also be an option for mild to moderate temporal hollowing. In this case, a patient with no history of trauma, surgery, or myogenic disease developed temporal hollowing. Further study of the littleknown cryptogenic form of temporal hollowing is warranted.
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Affiliation(s)
- Ie Hyon Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul, Korea
| | - Heeyeon Kwon
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul, Korea
| | - Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul, Korea
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Postoperative CT of the Midfacial Skeleton After Trauma: Review of Normal Appearances and Common Complications. AJR Am J Roentgenol 2017; 209:W238-W248. [PMID: 28705063 DOI: 10.2214/ajr.17.17875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this article is to describe the CT appearance of the midfacial skeleton after surgical repair of posttraumatic Le Fort, nasoorbitoethmoidal (NOE), and frontal sinus fractures. Several of the more commonly encountered complications will also be described. CONCLUSION Surgery after midfacial trauma is aimed at restoring both form and function. Knowledge of the principal tenets of Le Fort, NOE, and frontal sinus fracture repair is vital for radiologists to accurately assess the adequacy of treatment on postoperative CT and provide meaningful reports for the surgeon.
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Postoperative temporal hollowing: Is there a surgical approach that prevents this complication? A systematic review and anatomic illustration. J Plast Reconstr Aesthet Surg 2016; 70:401-415. [PMID: 27894915 DOI: 10.1016/j.bjps.2016.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/26/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Temporal hollowing is a common complication following surgical dissection in the temporal region. Our objectives were to: (1) review and clarify the temporal soft tissue relationships - supplemented by cadaveric dissection - to better understand surgical approach variations and elucidate potential etiologies of postoperative hollowing; (2) identify if there is any evidence to support a surgical approach that prevents hollowing through a systematic review. METHODS Cadaveric dissection was performed on six hemi-heads. A systematic review of the literature was undertaken to identify surgical approaches with a decreased risk of postoperative hollowing. RESULTS A total of 1212 articles were reviewed; 19 of these met final inclusion criteria. Level I and II evidence supports against the use of a dissection plane beneath the superficial layer of the deep temporal fascia or through the intermediate temporal fat pad. Level II evidence supports preservation of the temporalis muscle origin - no evidence is available to support other temporalis resuspension techniques. For intracranial exposure, refraining from temporal fat pad dissection (Level I Evidence) and use of decreased access approaches such as the minipterional craniotomy (Level I Evidence) appear to minimize temporal soft tissue atrophy. CONCLUSIONS This study highlights the significance of preservation of the temporal soft tissue components to prevent hollowing. Preserving the temporalis origin and avoiding dissection between the leaflets of the deep temporal fascia or through the intermediate temporal fat pad appear to minimize this complication.
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Zhong S, Huang GJ, Susarla SM, Swanson EW, Huang J, Gordon CR. Quantitative analysis of dual-purpose, patient-specific craniofacial implants for correction of temporal deformity. Neurosurgery 2015; 11 Suppl 2:220-9; discussion 229. [PMID: 25710104 DOI: 10.1227/neu.0000000000000679] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The development of computer-assisted design, virtual modeling, and computed tomography has allowed precise customization of implants for patients who undergo neurosurgical or craniofacial surgery procedures. However, such techniques and implant designs have not adequately addressed temporal asymmetry due to postoperative bone resorption, temporalis muscle malposition/foreshortening, and/or temporal fat pad atrophy. OBJECTIVE We hypothesized that an alteration in customized craniofacial implant (CCI) design with a strategic extension inferolaterally and excessive material bulking would provide simultaneous reconstruction of coexisting temporal skull defects and therefore reduce the effect of soft tissue deformities. METHODS A single-surgeon, single-institution retrospective cohort study was performed to include 10 consecutive subjects who underwent cranioplasty reconstruction with modified implants during a 3-year period. Implants were placed with the use of our previously described pericranial-onlay technique. With the use of a computed tomography-based, computer-assisted design/manufacturing methodology, novel dual-purpose implants were designed to prevent and/or correct persistent temporal hollowing. The efficacy of the new CCI shape and design for cranial restoration of temporal symmetry was analyzed in both 2 and 3 dimensions. RESULTS In 2-dimensional analyses, the modified implant provided enhanced lateral projection (21%; 1.06 cm(3)) in areas closest to the temporal arch. Three-dimensional volumetric analyses demonstrated that additional bulking totaled 24 ± 11 cm(3) (range, 9-43 cm), which essentially replaced 40 ± 13.7% (range, 26%-60%) of the absent temporal volume contributing to persistent temporal hollowing. CONCLUSION Computer-designed, dual-purpose CCIs can be safely created with unprecedented shape to prevent and/or eradicate postoperative temporal deformity.
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Affiliation(s)
- Shuting Zhong
- *The University of Illinois College of Medicine, Rockford, Illinois; ‡Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; §Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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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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Massa AF, Otero-Rivas M, Rodríguez-Prieto MÁ. Titanium mesh in the reconstruction of a malar defect: a case report. Int J Dermatol 2014; 53:1278-80. [PMID: 25039983 DOI: 10.1111/ijd.12551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Increasing rates of non-melanoma skin cancer support the use of prosthetic materials for the closure of post-surgical defects with cartilage or bone involvement. The use of allografts, especially titanium, is well established in maxillofacial procedures but is uncommon in dermatologic surgery. METHODS A 92-year-old man presented with a basal cell carcinoma measuring 2×3 cm on the right cheek. Computed tomography showed infiltration of the anterior maxillary sinus wall. The tumor was excised under general anesthesia. The final defect comprised skin, muscle, the central portion of the maxillary bone and part of the maxillary sinus mucous. The defect was closed with titanium mesh and covered with a rotation flap from the right cheek. The secondary defect created by the preauricular rotation was closed with a free skin graft from the supraclavicular area. RESULTS The use of titanium mesh enabled satisfactory esthetic and functional results to be achieved safely and quickly. CONCLUSIONS Titanium mesh facilitates the repair of large defects and avoids the second intervention and increased risk for infection associated with bone grafting. Reconstruction with titanium mesh is considered a valuable technique in post-trauma fractures and post-oncologic defects but remains underused in dermatologic surgery. The present experience supports its use as a reliable option in bone replacement.
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Affiliation(s)
- António Fernandes Massa
- Department of Dermatology, Centro Hospitalar de Vila Nova de Gaia/Espinho (Vila Nova de Gaia and Espinho Hospital Center), Vila Nova de Gaia, Portugal; Department of Dermatology, Complejo Asistencial Universitario de León (Care Complex of the University of León), León, Spain
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Rieck KL, Fillmore WJ, Ettinger KS. Late revision or correction of facial trauma-related soft-tissue deformities. Oral Maxillofac Surg Clin North Am 2013; 25:697-713. [PMID: 24183375 DOI: 10.1016/j.coms.2013.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Surgical approaches used in accessing the facial skeleton for fracture repair are often the same as or similar to those used for cosmetic enhancement of the face. Rarely does facial trauma result in injuries that do not in some way affect the facial soft-tissue envelope either directly or as sequelae of the surgical repair. Knowledge of both skeletal and facial soft-tissue anatomy is paramount to successful clinical outcomes. Facial soft-tissue deformities can arise that require specific evaluation and management for correction. This article focuses on revision and correction of these soft-tissue-related injuries secondary to facial trauma.
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Affiliation(s)
- Kevin L Rieck
- Division of Oral & Maxillofacial Surgery, Department of Surgery, Mayo College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
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Temporal Hollowing Augmentation with Titanium Mesh after Autologous Cranioplasty in Temporal Muscle Resected Case: A Case Report. Korean J Neurotrauma 2013. [DOI: 10.13004/kjnt.2013.9.2.154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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