Tibial autogenous cancellous bone as an alternative donor site in maxillofacial surgery: a preliminary report.

This preliminary report reviews the use of the proximal tibial metaphysis as an alternative to other bone graft donor sites. A series of 21 cancellous grafts were procured from 20 patients using a predictable orthopedic approach. A singular finding was the overall lack of morbidity at the donor site and the apparent favorable quality and quantity of the procured bone. Data describing the use of tibial cancellous bone grafting in a wide range of maxillofacial reconstructive procedures are presented.

Naso-orbital-ethmoid injury: report of a case and review of the literature.

Trauma to the midface severe enough to cause nasal fractures will often result in fractures of the bony naso-orbital-ethmoid (NOE) complex. Extensive damage may be encountered in the interorbital area because of the fragility of the bony framework. The medial orbital walls, ethmoid sinuses, and cribriform area of the anterior cranial fossa can resist a maximum compressive force of only 30 g. NOE injuries are usually the result of either a direct blow sustained during an altercation or of a high-velocity motor vehicle accident. Quite often multiple systemic injuries serve to complicate treatment. NOE fractures present the surgeon with numerous challenges during repair. The delicate bony architecture, anatomic framework, and cosmetic expectations indicate comprehensive, thorough treatment. Damage to the eye, which is basically an extension of the brain, is of major concern. Pupillary discrepancies, retrobulbar hematoma, and damage to the optic nerve must be ruled out. Early surgical management is indicated because delayed repair or inadequate treatment prediposes the patient to defects that may be extremely difficult if not impossible to correct with secondary procedures. Numerous articles have been published describing the NOE injury. The multifaceted array of fractures seen in NOE injuries has been formulated into a comprehensive classification by Gruss.

Comparison between CO2 microsurgical laser and conventional meniscectomies in sheep: a preliminary report.

Temporomandibular discectomies were performed in sheep using a CO2 microsurgical laser as the experimental variable and conventional scissors and scalpels as the control. Histologic sections at 1, 3, 7, 14, and 30 days failed to reveal any significant difference between groups, nor was there any significant difference noted in the subjective evaluation of intraoperative bleeding. These findings suggest that when performing discectomies, the laser offers no advantage over conventional techniques.

A retrospective study of untreated orbital blow-out fractures.

A retrospective study of 27 cases of untreated orbital blow-out fractures is presented. These patients were managed non-surgically because they presented with minimal ophthalmologic symptoms, or they sustained other injuries that prevented early repair. Twelve patients returned for follow-up examination and eight were contacted by telephone. In evaluating patients for diplopia, enophthalmos, hypesthesia, and restricted ocular movement, 85% showed complete resolution of symptoms. Based on these findings, surgical intervention is recommended only in those patients who demonstrate residual diplopia in primary gaze and restricted ocular motility that persist after 10 to 14 days, the presence of enophthalmos greater than 2 mm, and gross disruption of the orbital floor as confirmed by CT or tomography.

Circulating lupus anticoagulant in a surgical temporomandibular joint patient. Report of a case.

The lupus anticoagulant is a unique inhibitor of hemostasis. Its occurrence in patients with systemic lupus erythematosus reportedly varies from 5% to 50%. The inhibitor is endogenously produced and occurs in a diverse number of clinical states. The present case report reviews an inadvertent discovery of circulating lupus anticoagulant in a patient scheduled for surgery of the temporomandibular joint.

Immediate permanent reconstruction of a mandibular continuity defect with use of a prosthesis of chromium-cobalt alloy.

A report of ten-year follow-up examinations of a patient who had a hemimandibulectomy with disarticulation because of fibrous dysplasia and immediate permanent reconstruction of the mandible with a Vitallium custom-cast prosthesis is presented. Careful preoperative planning, operative technique, and postoperative follow-up examinations are essential for successful maintenance of the prosthesis. Autogenic bone grafts are, in general, superior to alloplasts in permanent reconstruction of defects in mandibular continuity after resection. However, there are indications for alloplastic reconstruction when the condyle is disarticulated with the resection.

Primary fibrinolysis after oral surgery.

A case report of a patient with primary fibrinolysis resulting in hemorrhage after an oral surgical procedure has been presented. A comparison was made between DIC and primary fibrinolysis in patients with carcinoma of the prostate gland; etiology, clinical findings, diagnosis, and treatment were discussed.