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Zeidan T, Kassouf E, Ahmadieh N, Nassar A, Jabbour G, Sleilati F. The Different Surgical Approaches to Maxillofacial Reconstruction after Ballistic Trauma. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6066. [PMID: 39139837 PMCID: PMC11321747 DOI: 10.1097/gox.0000000000006066] [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: 11/16/2023] [Accepted: 06/21/2024] [Indexed: 08/15/2024]
Abstract
Background Ballistic trauma to the face is a challenge, combining complex bone injury with severe soft tissue loss. The various surgical methods available are influenced by the extent of injuries. This study compares different operative modalities and their outcomes with different variables, aiming to define the ideal therapeutic approach. Methods We retrospectively compared reconstructive modalities used to treat facial ballistic trauma cases at Hôtel-Dieu de France Hospital, Beirut, Lebanon, for a 12-year span. Statistical analysis was used to determine correlation between several factors and satisfactory results. Results Eighteen patients were included, with varying degrees of bone and soft tissue loss. After conservative debridement, fractures were treated by different modalities: open reduction and internal fixation, maxillomandibular fixation, and osteosynthesis with a reconstruction plate. Although primary closure was sufficient in 10 cases, severe loss of tissues was reconstructed with a fibular free flap in five cases, radial free forearm flap in two cases, and free parascapular flap in one case. Two others received an iliac bone graft as secondary reconstruction. The average follow-up was 2.45 years. Most cases achieved good aesthetic and functional results after several secondary operations, with few late complications. Early reconstruction and younger patients were associated with better outcomes. Conclusions We favor early debridement and reconstruction. Free flaps were ideal for extensive tissue loss. Bone grafting was needed secondarily. A single surgical procedure seldom led to satisfactory functional and aesthetic outcomes, and secondary operations were inevitable.
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Affiliation(s)
- Toufic Zeidan
- From the Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Elia Kassouf
- From the Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Nizar Ahmadieh
- From the Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Aref Nassar
- From the Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Georges Jabbour
- From the Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fadi Sleilati
- From the Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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2
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Singh S. Delayed Surgical Intervention in Cranio-Maxillofacial Splinter Injury: Report of a Case and A Literature Review. J Maxillofac Oral Surg 2024; 23:394-401. [PMID: 38601233 PMCID: PMC11001846 DOI: 10.1007/s12663-023-02061-9] [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: 10/04/2022] [Accepted: 11/07/2023] [Indexed: 04/12/2024] Open
Abstract
Introduction In the context of Indian combat scenario, maxillofacial injuries from gunshots are uncommon. Methods The first section of this study is a case report of a rare instance of metal foreign bodies that were lodged in the parapharyngeal space, deeper to the deep lobe of the parotid right next to the carotid space in the neck. The second section focusses on the unique treatment for blast injuries as well as the variety of imaging procedures that are readily available to assist with surgery, such as plain film, CT, angiography, and occasionally MR imaging. Result and Conclusion According to the study, understanding the pertinent anatomy, precise imaging of the penetrating object in relation to vital structures, meticulously planned and conducted surgical removal of the foreign body, and repair of damaged structures are the key elements of a successful treatment.
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Affiliation(s)
- Shagun Singh
- Department of Oral and Maxillofacial Surgery, 3 Corps Dental Unit, Armed Forces, Dimapur, India
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Lee CJ, Calvo R, Rosales R, Akhter M, Sise MJ, Krzyzaniak A, Lance S. Ballistic Facial Trauma Reconstruction: Incidence and Practice Patterns in the Civilian Population. Ann Plast Surg 2023; 90:S315-S319. [PMID: 36752402 DOI: 10.1097/sap.0000000000003413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Management of nonfatal ballistic facial trauma is well described in the literature for wounds secondary to military combat. However, there is little literature describing such management in civilian practice. We aimed to describe nonmilitary patients with recent nonfatal facial injuries from ballistic trauma using the California Office of Statewide Health Planning and Development patient database. METHODS A retrospective study was performed using the California Office of Statewide Health Planning and Development Ambulatory Surgery and Inpatient datasets. All adults with the International Classification of Diseases, 10th Revision codes of severe nonfatal facial trauma from firearms requiring emergent surgery during 2016-2018 were included. Outcomes assessed include number and type of facial procedures performed, hospital length of stay, number of admissions, timing of definitive management, and lifetime hospitalization costs. RESULTS A total of 331 traceable patients were identified over this 3-year period. The average age was 35.4 years (SD, 15.2), and 87% were male. The median index admission length of stay was 8 days (interquartile range, 3-15 days). Subsequent readmission was required for 123 (37.2%) patients with 10% mortality in the index admission. Total median charges per patient for all admissions were $257,804 (interquartile range, $105,601-$531,916). A total of 215 patients (65%) had at least 1 facial repair performed. Of all 331 patients, 64.3% underwent musculoskeletal repair (n = 213), 31.4% underwent digestive system repair (n = 104), and 29.6% underwent respiratory system repair (n = 98). The average number of repairs per patient was 2.52 (SD, 3.38), with 35% not having any of the specified International Classification of Diseases, 10th Revision repair codes. A total of 27% of patients had 1 procedure performed, whereas 38% received 2 or more, for an average of 3.87 (SD, 3.5) repairs over the study duration. DISCUSSION To our knowledge, this is the first assessment of civilian characteristics of nonfatal ballistic facial trauma in California. Nonfatal facial ballistic trauma results in complex injuries to multiple body systems, requiring long admissions, costly hospital stays, and coordination of care across several surgical specialties. Many patients require a variety of procedures over multiple admissions, highlighting the overall morbidity of these injuries. Future studies will look at how care for these patients differs between various hospitals and geographic regions and whether current civilian management aligns with well-defined military reconstructive protocols for facial ballistic injuries.
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Affiliation(s)
- Clara J Lee
- From the Division of Plastic Surgery, University of California San Diego, La Jolla
| | - Richard Calvo
- Department of Trauma Surgery, Scripps Mercy Hospital, San Diego
| | - Ricardo Rosales
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Maheen Akhter
- Central Michigan University College of Medicine, Saginaw, MI
| | - Michael J Sise
- Department of Trauma Surgery, Scripps Mercy Hospital, San Diego
| | | | - Samuel Lance
- From the Division of Plastic Surgery, University of California San Diego, La Jolla
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Sommacal A, Bingisser R, Filippi A, Bethke M, Thieringer FM, Jaquiéry C, Berg BI. Dental and Maxillofacial Emergency Algorithms in Swiss Emergency Departments. J Clin Med 2023; 12:jcm12082952. [PMID: 37109288 PMCID: PMC10144593 DOI: 10.3390/jcm12082952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/28/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
This study aimed to evaluate the availability and use of dental and maxillofacial emergency algorithms in Swiss hospitals. A survey was performed among physicians at Swiss emergency departments (ED) and participants of the "36th Annual Meeting of the Society for Oral and Cranio-Maxillofacial Surgery". Eighty-nine EDs in Switzerland were questioned about the availability and use of electronic algorithms in their hospitals. Eighty-one (91%) participated in the study. In 75 (93%) of the EDs, electronic algorithms are used, mainly "medStandards". Six have no available algorithms. Fifty-two (64%) use algorithms daily. Eight (10%) Swiss EDs have maxillofacial and dental algorithms, and 73 (90%) have no access to or do not know about them. For dental algorithms, 28 (38%) of the respondents would like to have access, and 16 (22%) do not desire access. For maxillofacial algorithms, 23 (32%) want to have access and 21 (29%) do not want it. Most (74%) of the participating maxillofacial surgeons did not know about the existence of ED algorithms regarding their specialty. Our study shows that the existence of specific algorithms is often not known. Furthermore, there is a demand for dental and maxillofacial algorithms in Swiss EDs.
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Affiliation(s)
- Adelita Sommacal
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Roland Bingisser
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland
| | - Andreas Filippi
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
- Clinic of Oral Surgery and Center of Dental Traumatology, University Center for Dental Medicine UZB, University of Basel, 4058 Basel, Switzerland
| | - Mascha Bethke
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland
| | - Florian M Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
- Swiss MAM Research Group, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Claude Jaquiéry
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Britt-Isabelle Berg
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
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Wamkpah NS, Kimball A, Pipkorn P. Evidence-Based Medicine for Ballistic Maxillofacial Trauma. Facial Plast Surg 2023; 39:237-252. [PMID: 36929067 DOI: 10.1055/s-0043-1764347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Ballistic trauma is a serious health issue with significant costs to physical, psychosocial, economic, and societal well-being. It may be caused from firearms, explosive devices, or any other projectile forces, and is characterized by severe tissue loss and evolving tissue devitalization. This review covers mechanism, diagnosis, and management of ballistic maxillofacial trauma, specifically. Initial evaluation includes stabilization of airway, bleeding, and circulation, followed by assessment of other injuries. The overall degree of tissue damage is determined by intrinsic patient factors and extrinsic projectile factors. Management of ballistic injuries has shifted toward advocation for early operative repair with the advent of antibiotics and advanced techniques in maxillofacial reconstruction. Appropriate timing and method of reconstruction should be carefully selected on a case-by-case basis. While ballistic trauma research is limited to studies biased by institutional practices, areas for further study identified from current literature include guidelines directing timing of reconstructive surgery; thresholds for free tissue transfer; handling of retained projectiles; incidence of surgical complications; and clinical outcomes for computer-aided surgical repair of these highly destructive injuries.
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Affiliation(s)
- Nneoma S Wamkpah
- Department of Otolaryngology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Abby Kimball
- InPrint, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Patrik Pipkorn
- Department of Otolaryngology, Washington University in St Louis School of Medicine, St Louis, Missouri
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Brauner E, Laudoni F, Amelina G, Cantore M, Armida M, Bellizzi A, Pranno N, De Angelis F, Valentini V, Di Carlo S. Dental Management of Maxillofacial Ballistic Trauma. J Pers Med 2022; 12:jpm12060934. [PMID: 35743719 PMCID: PMC9225066 DOI: 10.3390/jpm12060934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Maxillofacial ballistic trauma represents a devastating functional and aesthetic trauma. The extensive damage to soft and hard tissue is unpredictable, and because of the diversity and the complexity of these traumas, a systematic algorithm is essential. This study attempts to define the best management of maxillofacial ballistic injuries and to describe a standardized, surgical and prosthetic rehabilitation protocol from the first emergency stage up until the complete aesthetic and functional rehabilitation. In low-velocity ballistic injuries (bullet speed <600 m/s), the wound is usually less severe and not-fatal, and the management should be based on early and definitive surgery associated with reconstruction, followed by oral rehabilitation. High-velocity ballistic injuries (bullet speed >600 m/s) are associated with an extensive hard and soft tissue disruption, and the management should be based on a three-stage reconstructive algorithm: debridement and fixation, reconstruction, and final revision. Rehabilitating a patient with ballistic trauma is a multi-step challenging treatment procedure that requires a long time and a multidisciplinary team to ensure successful results. The prosthodontic treatment outcome is one of the most important parameters by which a patient measures the restoration of aesthetic, functional, and psychological deficits. This study is a retrospective review: twenty-two patients diagnosed with outcomes of ballistic traumas were identified from the department database, and eleven patients met the inclusion criteria and were enrolled.
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Affiliation(s)
- Edoardo Brauner
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (E.B.); (F.L.); (M.C.); (M.A.); (A.B.); (N.P.); (F.D.A.); (V.V.); (S.D.C.)
- Implanto-Prosthetic Unit, Policlinico Umberto I, Viale Regina Elena 287b, 00161 Rome, Italy
| | - Federico Laudoni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (E.B.); (F.L.); (M.C.); (M.A.); (A.B.); (N.P.); (F.D.A.); (V.V.); (S.D.C.)
| | - Giulia Amelina
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (E.B.); (F.L.); (M.C.); (M.A.); (A.B.); (N.P.); (F.D.A.); (V.V.); (S.D.C.)
- Correspondence:
| | - Marco Cantore
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (E.B.); (F.L.); (M.C.); (M.A.); (A.B.); (N.P.); (F.D.A.); (V.V.); (S.D.C.)
| | - Matteo Armida
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (E.B.); (F.L.); (M.C.); (M.A.); (A.B.); (N.P.); (F.D.A.); (V.V.); (S.D.C.)
| | - Andrea Bellizzi
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (E.B.); (F.L.); (M.C.); (M.A.); (A.B.); (N.P.); (F.D.A.); (V.V.); (S.D.C.)
| | - Nicola Pranno
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (E.B.); (F.L.); (M.C.); (M.A.); (A.B.); (N.P.); (F.D.A.); (V.V.); (S.D.C.)
| | - Francesca De Angelis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (E.B.); (F.L.); (M.C.); (M.A.); (A.B.); (N.P.); (F.D.A.); (V.V.); (S.D.C.)
| | - Valentino Valentini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (E.B.); (F.L.); (M.C.); (M.A.); (A.B.); (N.P.); (F.D.A.); (V.V.); (S.D.C.)
- Oncological and Reconstructive Maxillo-Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00167 Rome, Italy
| | - Stefano Di Carlo
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (E.B.); (F.L.); (M.C.); (M.A.); (A.B.); (N.P.); (F.D.A.); (V.V.); (S.D.C.)
- Implanto-Prosthetic Unit, Policlinico Umberto I, Viale Regina Elena 287b, 00161 Rome, Italy
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Pitak-Arnnop P. An evidence-based approach to antibiotic prophylaxis for oral, craniomaxillofacial plastic/head and neck surgical procedures. J Clin Pharm Ther 2022; 47:844-850. [PMID: 35132644 DOI: 10.1111/jcpt.13618] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Innocenti M, Menichini G, Lucattelli E, Fidanza A, Innocenti A. Reconstruction after complete mandibular avulsion with double-paddle fibular free flap. A case report. Microsurgery 2021; 41:782-786. [PMID: 34554591 DOI: 10.1002/micr.30813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/12/2021] [Accepted: 09/10/2021] [Indexed: 11/07/2022]
Abstract
Reconstruction after maxillofacial trauma is extremely challenging. During the past several decades, the chimeric fibular-free flap has emerged as a leading reconstructive option for head and neck compound defects. This report describes a unique case of total mandibular reconstruction using a double-paddle osteocutaneous fibular free flap after facial traumatic injury. A 45-year-old man presented a severe maxillofacial trauma with complete mandibular avulsion. The shortest segment of a 24-cm fibular flap was used to reconstruct the symphysis while the longest segments were placed to rebuild the mandibular body. Microvascular anastomoses were performed with the external jugular vein and facial artery. The distal skin island (10 × 5 cm) was sutured to cover the endo-oral defect while the proximal one (12 × 6 cm) to restore the external tissues continuity of the facial lower third. The postoperative course was uneventful. One year after flap reconstruction, a first commissuroplasty was performed. After 3 months, secondary commissuroplasty was performed with an Estlander flap to rebuild the right lower lip. At latest follow-up, 60 months postoperatively, the patient was able to tolerate soft diet with maximal mouth opening of more than 4 cm; no impairment to mastication, deglutition, or phonation was observed. Speech was normal and the aesthetic outcome was judged good. Double-paddle fibular free flap allows reconstruction of extremely challenging defects, such in case of complete mandibular avulsion. The proximal perforator can provide extended soft-tissue coverage and greater volume than traditional osteocutaneous flaps, avoiding two flaps simultaneous harvest.
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Affiliation(s)
- Marco Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Giulio Menichini
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Anastasia Fidanza
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Alessandro Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
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Considerations for Management of Craniomaxillofacial Trauma in COVID-19 Patients. Plast Reconstr Surg 2020; 146:248e-250e. [PMID: 32740631 DOI: 10.1097/prs.0000000000007076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Gurunluoglu R, Gatherwright J. Microsurgical reconstruction of complex maxillofacial gunshot wounds: Outcomes analysis and algorithm. Microsurgery 2019; 39:384-394. [DOI: 10.1002/micr.30418] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 11/28/2018] [Accepted: 12/12/2018] [Indexed: 11/11/2022]
Affiliation(s)
| | - James Gatherwright
- Department of Plastic Surgery; MetroHealth & Veterans Affairs; Cleveland Ohio
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