Direct Integration of 3D Printing and Cryogel Scaffolds for Bone Tissue Engineering.

Cryogels, known for their biocompatibility and porous structure, lack mechanical strength, while 3D-printed scaffolds have excellent mechanical properties but limited porosity resolution. By combining a 3D-printed plastic gyroid lattice scaffold with a chitosan-gelatin cryogel scaffold, a scaffold can be created that balances the advantages of both fabrication methods. This study compared the pore diameter, swelling potential, mechanical characteristics, and cellular infiltration capability of combined scaffolds and control cryogels. The incorporation of the 3D-printed lattice demonstrated patient-specific geometry capabilities and significantly improved mechanical strength compared to the control cryogel. The combined scaffolds exhibited similar porosity and relative swelling ratio to the control cryogels. However, they had reduced elasticity, reduced absolute swelling capacity, and are potentially cytotoxic, which may affect their performance. This paper presents a novel approach to combine two scaffold types to retain the advantages of each scaffold type while mitigating their shortcomings.

A Rare Presentation of Intraosseous Sarcoidosis of the Mandible Presenting as Peri-Implantitis: A Case Report and Literature Review.

We describe a rare case of intraosseous sarcoidosis initially presenting as peri-implantitis, perform a review and analysis of 27 cases of intraosseous sarcoidosis, and provide a clinical review of this condition. We searched the literature for patients presenting with intraosseous sarcoidosis of the jaw through June 2020 using key phrases. Additional papers were included via a search of references and citing papers. Data including patient demographic characteristics and diagnostic tests were manually extracted from the cases and then qualitatively coded by the authors. Descriptive statistical analysis was performed to elucidate general themes and characteristics. A total of 27 cases, dating as early as 1943 and as recent as this case, were identified in the literature, including our case. The average age of these patients was 39 years old, with a range of 16 to 75 years. Eighteen (67%) cases were identified as female and nine (33%) as male. Fourteen cases were reported with localized mandibular involvement. Ten had maxillary disease; 3 cases were generalized to both regions. Nine cases presented anteriorly, 12 posteriorly, and 6 extended across both regions. Eight patients received surgical interventions, such as tooth extractions or lesion removal. Five patients received nonsurgical interventions, such as steroids. Ten patients received combination therapy, often involving surgical intervention and steroid therapy. Our patient had an unusual presentation of intraosseous sarcoidosis mimicking peri-implantitis. To our knowledge, no case in the English literature describes a patient with sarcoidosis presenting with peri-implantitis. Based on the literature review and analysis of our patient's experience, sarcoidosis should be considered on the differential diagnosis for patients with persistent, nonhealing bony lesions in the maxillofacial region, particularly when patients have not been exposed to osteoclast inhibitory therapy or radiation. Pathologic analysis of bone and surrounding tissue in these scenarios is essential.

An Anatomic Predisposition to Mandibular Angle Fractures.

PURPOSE: To investigate a predisposition to mandibular angle fractures, a retrospective study was performed in which fractured mandibles were compared with healthy mandibles with no history of fracture. Other investigations of angle fracture risk have exclusively studied patients with existing fractures. In addition, the risk has not been comprehensively explained in conjunction with the specific features of mandibular anatomy. We sought to characterize any anatomic variations between the jaws that had fractured and those that had never fractured. MATERIALS AND METHODS: Healthy mandibles with no history of fracture were physically measured at the William M. Bass Skeletal Collection at the University of Tennessee, Knoxville and compared with fractured mandibles from computed tomography (CT) scans at the Dartmouth Hitchcock Medical Center. A total of 52 healthy mandibles and 44 CT scans were evaluated. MATLAB machine learning algorithms (MathWorks, Natick, MA) were used to compare the study populations and isolate those anatomic features that differed between healthy and fractured mandibles. RESULTS: Machine learning classifiers were able to differentiate between male and female jaws, with the condylion-gnathion distance the most distinguishing feature. The 6 most common anatomic features that differed between healthy and fractured mandibles were the 1) retromolar space, 2) perimeter of the cross-section just proximal to the second molar, 3) breadth of the ramal cross-section, 4) thickness of the oblique ridge, 5) transgonial angle, and 6) location of the ipsilateral mental foramen. The presence of third molars was also related to fracture risk, with third molars present in 72.7% of the fractured mandibles versus 26.9% of unfractured mandibles. Of the fractured mandibles with third molars present, 87.5% had the fracture running directly through the tooth or its socket. CONCLUSIONS: The results from the present study have provided evidence that anatomic differences exist between mandibles that sustain angle fractures and those that do not. Although much of the morphology was found to be interdependent, the fracture risk could be accurately predicted using 6 anatomic features. Understanding these mandibular variations and identifying patients vulnerable to mandibular fracture could provide clinicians with additional objective information. Furthermore, using the methods demonstrated in our study, future research could focus on developing an algorithm that includes these unique anatomic features in the hope of assisting surgeons in providing tailored treatment for mandibular angle fractures according to patient-specific morphology.

A Rare Case of Odontogenic Chronic Suppurative Otitis Media.

Common causes of chronic suppurative otitis media (CSOM) include persistence of acute otitis media, cholesteatoma, and eustachian tube dysfunction. We describe a patient who presented with CSOM of several years duration refractory to medical management. Ultimately, a dental abscess was found on computed tomography (CT) to be the source of concurrent ipsilateral maxillary sinusitis and mastoiditis. Extraction of the molar abscess resulted in complete resolution of her CSOM and need to be on antibiotics. To our knowledge, this is the first report of an odontogenic cause of chronic suppurative otitis media.

Utilization of tracheostomy in craniomaxillofacial trauma at a level-1 trauma center.

PURPOSE: The decision to perform a tracheostomy on patients with maxillofacial trauma is complex. There is little data exploring the role of tracheostomy in facial fracture management. We sought to profile the utilization of tracheostomy in the context of maxillofacial trauma at our institution by comparing patients who required tracheostomy with and without facial fractures versus those with facial fractures not requiring tracheostomy. MATERIALS AND METHODS: All patients admitted to the Trauma Service at Legacy Emanuel Hospital and Health Center (LEHHC), Portland, OR, from 1993 to 2003 that sustained facial fractures or underwent tracheostomy were identified and data were retrospectively reviewed using patient charts and the trauma registry. Variables such as age, gender, death, injury severity score (ISS), facial injury severity score (FISS), Glasgow coma score (GCS), intensive care days (ICU), hospital length of stay (LOS), facial fracture profile, and oral and maxillofacial surgery (OMFS) operative intervention were tabulated and analyzed. Data were divided into 3 groups for comparison: group 1 (ffxT) consisted of patients who underwent a tracheostomy procedure and repair of their facial fracture during the SAME operation by the OMFS department (N = 125); group 2 (ffxNT) were those patients who had repair of their facial fractures by OMFS and did not require a tracheostomy (N = 224); and group 3 (NffxT) were patients who did not have facial fractures but received a tracheostomy during their hospitalization (N = 259). Ten-year data were used to analyze the ffxT and 5-year data were used to analyze the ffxNT and NffxT. Analysis of variance and chi2 testing was used for statistical analysis. RESULTS: A total of 18,187 patients were admitted to the trauma LEHHC Trauma Service during the study period, of which 1,079 (5.9%) patients sustained facial fractures and 788 (4.3%) required a tracheostomy. One hundred twenty-five patients (0.69% of total; 11.6% of facial fracture) received a tracheostomy at the same time as the facial fracture repair. All patients had their facial fractures successfully managed, regardless of the type of method used to stabilize the airway. There were no known cases of tracheal stenosis, severe bleeding requiring a return to the operating room, airway obstruction, or loss of secured airway. Males were the predominate gender in all 3 groups. The NffxT group (mean, 44.9 years) was much older compared with the ffxT (mean, 36.2 years) and ffxNT (mean, 30.9 years) groups. The incidence of death was higher in the tracheostomy groups compared with 0% with the non-tracheostomy group. The ffxNT group had a statistically significant higher GCS with an average of 12.4 when compared with the tracheostomy groups (ffxT = 6.8; NffxT = 6.7). ISS was nearly the same in the tracheostomy group (ffxT = 28.45; NffxT = 30.04), but higher when compared with the ffxNT (ISS = 17.33). All 3 groups were much different in terms of LOS and ICU days, in which the NffxT group had an average hospital LOS and ICU days of 34.4 and 16.56, respectively. This was higher when compared with the ffxT (LOS = 19.71 days; ICU = 7.21 days) and ffxNT (LOS = 6.82 days; ICU = 1.33 days) groups. The FISS averaged 6.22 in the ffxT group and was higher compared with an FISS of 3.16 in the ffxNT group. Overall, the fracture profile was different between the tracheostomy and non-tracheostomy groups. There was a higher prevalence of mandibular fractures, multiple mandibular fractures, and Le Fort III fractures in the ffxT group compared with the ffxNT group. CONCLUSION: Tracheostomy is commonly performed in the context of multisystem trauma and is a safe method for airway stabilization in patients with craniomaxillofacial trauma. Multi-institutional collaboration and a prospective, randomized trial measuring outcome, resource utilization, and length of ICU stay is necessary to determine if tracheostomy is indeed of measurable benefit to patients with complex injuries.

Facial soft tissue injuries as an aid to ordering a combination head and facial computed tomography in trauma patients.

PURPOSE: While the trauma computed tomography (CT) head scan is frequently ordered during resuscitation of multiply injured patients, determining when also to order facial CT in these situations can be difficult. Consequently, facial fractures are commonly missed on initial imaging evaluation. In acute trauma situations, facial soft tissue injury markers are often used to aid in this decision. A study was undertaken to identify exactly which facial soft tissue injuries correlate with facial fractures and which did not. The aim of our research was to compare the facial soft tissue injury patterns of patients receiving a combination head and facial CT who had facial fractures versus those who had no facial fractures. PATIENTS AND METHODS: A retrospective trauma registry review was performed for a 5-year period at Legacy Emanuel Hospital, a level 1 trauma center. The trauma team saw a total of 9,871 trauma patients and 49.9% required head CT as part of their initial evaluation. A total of 777 (15.7%) patients had a combination head and facial CT in which 477 (61.4%) had a facial fracture and 300 (38.6%) had no facial fracture. Statistical significance was established using Bonferroni corrected P values less than .05. RESULTS: Lacerations occurring in areas of the lips, nose, and intraorally, as well as wounds leading to periorbital contusion and subconjunctival hemorrhage, were significantly prevalent in the fracture group. Conversely, scalp lacerations and scalp contusions were significantly higher in the nonfracture group. Other injuries such as lacerations of the tongue, chin, forehead, cheek, ear, eyelid, and eyebrow were indistinguishable between both groups. CONCLUSIONS: Our data demonstrate that there are certain facial soft tissue injury zones that correlate with facial fractures in trauma patients who obtain head CT. We would like to propose that the acronym LIPS-N (Lip laceration, Intraoral laceration, Periorbital contusion, Subconjunctival hemorrhage, and Nasal laceration) be used in conjunction with a physical examination when assessing if a trauma patient who is getting head CT should also get facial CT.

Facial computed tomography use in trauma patients who require a head computed tomogram.

PURPOSE: Head-injured patients admitted to a trauma center may or may not have associated facial fractures. Most head-injured patients undergo head computed tomography (CT) scan early in their evaluation. The question of adding a facial CT at the time of the head CT can be unclear. The aims of our study are 1) to analyze how the facial CT is used in conjunction with the head CT in facial fracture trauma patients, 2) to recognize unique identifiers that would aid the surgeon's decision-making process to order a facial CT in continuity with a head CT, and 3) to examine what is characteristic of head trauma patients who receive a facial CT separately, at some point after the head CT. Materials and methods Data were retrospectively reviewed for a 5-year period at a level I trauma center in which all patients who present with craniomaxillofacial trauma are managed by the oral and maxillofacial surgery (OMFS) service. Included patients must have obtained a head CT during initial resuscitation and be diagnosed with a facial fracture during the same hospital stay. These patients were divided into 3 groups: those who had a 1) head CT only, 2) head CT and facial CT at the same time, and 3) head CT with the facial CT performed at a later time. RESULTS: A total of 9,871 patients were admitted to the trauma service during a 5-year period and 4,926 patients (49.9%) had head CT performed. Of this group, 12% had facial fractures, and the most common associated injury in this group was facial lacerations and concussions. The nasal fracture followed by the orbital fracture was the most common fracture type. Eighty-four percent of the time, the facial CT was used to help diagnose facial fractures in this patient population. The 3 different groups showed unique trends. CONCLUSION: Six points were identified in our study that can augment the physical examination in patients who require head CT. The following points can help prompt the clinician to order a combination head and facial CT: 1) 12% of trauma patients who require a head CT will have a facial fracture, whereas half of these patients will have multiple facial fractures. 2) Orbital fractures are commonly missed in this group and often require a secondary scan such as coronal views for accurate diagnosis. 3) Facial lacerations correlate with ordering a combination head and facial CT. 4) The most common facial fracture identified among patients receiving a trauma head CT is the nasal fracture. 5) The use of the facial CT in more severely injured patients tended to be delayed and was related to increased hospital and intensive care unit days. 6) Only 16% of facial fracture patients who had received an initial trauma head CT did not require further facial CT scanning.

Referral patterns for the treatment of facial trauma in teaching hospitals in the United States.

PURPOSE: The management of facial trauma is considered an integral part of the training of several specialties, including general plastic surgery, otolaryngology, and oral and maxillofacial surgery. Referral patterns of patients who have sustained facial trauma to these various specialty services, however, vary at different institutions according to physician preferences and protocols. The purpose of this project was to examine the referral patterns of facial trauma in the United States at teaching hospitals. MATERIALS AND METHODS: A questionnaire survey of physician-chiefs of emergency or trauma services at teaching hospitals was carried out. Scenarios involving a variety of facial injury patterns were presented, and a hypothetical referral was requested. In addition, questions regarding preferences and opinions regarding the various services were included. RESULTS: Most teaching hospitals had a formal protocol for the referral of patients with facial injuries. With the exception of mandible fractures, referral patterns for patients with facial injuries were relatively even across the 3 specialties. Interestingly, only 56% of respondents would seek the same referral for themselves or relatives in the same way as they would refer a patient based on their in-house protocol. In regard to timeliness, efficiency, and perceived competency in the handling of facial trauma, oral and maxillofacial surgery had statistically significant higher scores than otolarygology and plastic surgery, which were not statistically distinguishable between each other. CONCLUSIONS: All 3 specialties appear to be involved in the management of facial trauma at teaching institutions in the United States; therefore, it seems unlikely that any one specialty will be singled out as the sole provider of these services at all institutions.