Myositis ossificans of the temporalis muscle: case report and review of the literature.

Myositis ossificans, also known as traumatic myositis ossificans or myositis ossificans circumscripta, is the product of an unusual reactive process of mesenchymal stem cells within the muscle produced secondary to a traumatic insult or inflammatory process. In approximately 75% of cases, the process has a direct correlation with a single or repetitive, traumatic, penetrating, or crushing injury to the muscle. However, in up to 25% of cases, there is no recollection of a traumatic event. The most commonly accepted mechanism of traumatic etiology includes the embedment and lysis of bone fragments within the soft tissue causing subsequent exposure of bone morphogenic proteins to extraosseous cells. This environment stimulates osteoblasts to form true bone, dystrophic calcifications, or a calcified chondroid matrix. A concomitant mechanism that occurs involves the overproduction of bone morphogenic protein-4 produced by the muscle cells or the muscle fascia.

Industrial-grade silicone injections causing intermittent bilateral malar swelling: review of safety and efficacy of techniques and products available.

Silicone and other fillers have become a popular aid to increase soft tissue density, decrease static skin rhytids, and treat muscle wasting, particularly in the face. As a result, injectable silicone has become popular in patients with the human immunodeficiency virus (HIV). It has been postulated that highly active antiretroviral therapy detrimentally induces the physiologic process of fat atrophy of the temporal and buccal fat pads of the face and regional fat wasting of the arms, legs, and buttocks and that HIV protease inhibitors may induce fat atrophy by binding and inhibiting homologous human proteins that are involved in fat metabolism. The classic hollowed-out facial appearance linked to HIV positivity can have detrimental social implications in infected patients who are otherwise very functional. In consequence, facial implantation, fat transplantation, and dermal and subcutaneous fillers have been used to aid in the restoration of facial appearance. This report describes the case of a patient who underwent multiple rounds of silicone injections and complained of intermittent facial swelling and pain long after the injections. The authors report on the safety of specific medical-grade injectable fillers and techniques found to be safely effective, especially in the HIV-positive population.

Applications of Maxillomandibular Fixation, Occlusal Guidance, and Jaw Physiotherapy in the Management of Fractures of the Mandible.

The goal of mandibular fracture management is to restore form and function. Maxillomandibular fixation, elastic occlusal guidance, and postoperative physiotherapy are essential elements to optimizing outcomes. Restoration of premorbid occlusion is paramount. Thus, an expert understanding of occlusion, coupled with the application of maxillomandibular techniques to achieve bony reduction with idealized dental occlusion, is required in the proper management of mandible fractures. Postoperatively, complete recovery initially requires elastic occlusal guidance followed by jaw range of motion physiotherapy. Bone healing, an idealized occlusion, and normal jaw range of motion signal success via the restoration of form and function.

Fixation of Le Fort I osteotomies with poly-DL-lactic acid mesh and ultrasonic welding--a new technique.

PURPOSE: This report describes a technique for use of resorbable mesh (Resorb-X) and an ultrasonic sonotrode unit (SonicWeld Rx) to bond a pin (SonicPin Rx) to the mesh and underlying bone for Le Fort I osteotomy fixation, precluding the need to tap, shortening the time needed for fixation, and eliminating many disadvantages of titanium. In total, 659 cases have been performed from October 2005 through December 2010. This study examined the first 103 consecutive Le Fort osteotomies performed with this resorbable system and thus those with the longest follow-up. MATERIALS AND METHODS: One hundred three consecutive patients who had completed growth and presurgical orthodontics were operated on using the Resorb-X plating system and SonicWeld Rx. Intraoperative adverse events were monitored and a minimum 12-month postoperative follow-up for complications was completed. RESULTS: One patient (0.9%) had maxillary mobility at initial postoperative evaluation that resolved without malocclusion. Two patients (1.9%) exhibited signs of residual soreness and swelling in the maxilla, attributed to sterile abscess formation. At last follow-up, all patients demonstrated a clinically stable maxilla with correction of their malocclusion. CONCLUSION: Use of ultrasonic-aided pins in fixation of resorbable mesh plates, in Le Fort I osteotomies, is a viable technique and superior resorbable plating system because it is easy to use, results in adequate fixation strength, and shortens time of application by eliminating the need for tapping. In addition, this resorbable system eliminates many disadvantages associated with using all-titanium fixation.

Orthodontic and Surgical Considerations for Treating Impacted Teeth.

Impacted teeth occur in a significant number of patients. Their management requires coordinated efforts of orthodontists and oral and maxillofacial surgeons. Specifically, optimal results require a prompt orthodontic diagnosis and treatment plan with execution of either closed or open exposure of impacted teeth by the oral and maxillofacial surgeon. Failure to consider orthodontic mechanics and proper surgical technique can lead to suboptimal results. Thus, orthodontist/oral and maxillofacial surgeon communication is essential for success and patient education and shared decision-making is mandatory before initiating treatment.

Controversies in Maxillofacial Trauma.

Craniomaxillofacial trauma management has continued to improve and evolve as a result of advances in technology and scientific inquiry. Controversies exist where there is little evidence-based literature to guide treatment in frontal sinus management, rigid versus absorbable fixation, open versus closed treatment of mandibular condyle fractures, extraction of teeth in the line of fracture, optimal timing for repair of mandible fractures, antibiotic use for facial wounds and fractures, and reconstructive materials in orbital fracture reconstruction. This article reviews current literature to resolve some of the controversies, to improve patient care by reducing variability and uncertainty in the optimal management of facial trauma patients.

Simulation in craniomaxillofacial training.

PURPOSE OF REVIEW: Simulation in healthcare is no longer a novel idea. Simulation continues to rapidly permeate and transform both clinical practice and medical education. Craniomaxillofacial surgery is comprised of multiple surgical disciplines, including neurosurgery, plastic surgery, otolaryngology, ophthalmology, and oral and maxillofacial surgery. All of these specialties are performing surgery in an era of evolving technology, cost containment, reduced resident work hours, and a focus on patient safety. As a result, the purpose of this manuscript is to review the most recent literature and trends in craniomaxillofacial surgery simulation as it pertains to advances in: teaching methodology, technology for training, and professional development, including lifelong learning and certificate maintenance. RECENT FINDINGS: The Halstedian model of education is no longer valid in isolation as simulation continues to evolve. Advances are occurring in craniomaxillofacial simulation fidelity, via technology, validation, and implementation, though significant opportunity still exists toward total integration into training, as procedural models are limited. SUMMARY: Simulation in craniomaxillofacial training is not fully pervasive or integrated, but evidence exists that simulation is rapidly evolving via improvements in innovation, fidelity, teaching methodology, and ultimately, commitment to simulation as a means to improve surgical education as well as patient safety and quality.

Idiopathic bone cavities of the mandible: an update on recurrence rates and case report.

Idiopathic bone cavities (IBCs) are usually an incidental finding, often found in long bones but also in the craniofacial skeleton. Typically solitary, IBCs can present at multiple sites. Surgical exploration alone has proved effective, although recurrence does occur, particularly in cases with multiple lesions. The average time necessary to observe either recurrence or complete healing has been reported to be more than 3 years. Previously reported low recurrence rates for IBCs in the craniofacial skeleton may have been artificially low because of insufficient long-term follow-up. Providers should be prepared for long-term follow-up and care of these patients. The case of the patient presented here supports the need for long-term follow-up.

Acquired defects of the nose and naso-orbitoethmoid (NOE) region.

Nasal injuries coupled with midface fractures of the orbit and ethmoids constitute a nasoorbitoethmoid (NOE) fracture pattern, which is typically the most challenging facial fracture to repair. Hard and soft tissue defects of this region may require advanced reconstruction techniques, including local rotational flaps, free tissue transfer, and even prosthetics. The restoration of form and function dictates treatment, and the success of primary repair is paramount, because secondary correction is challenging in this area of the midface. Because of the complex nature of this region, this discussion is divided into hard tissue defects, with a focus on trauma, and soft tissue defects, with a focus on oncology.

Sinonasal disease and orbital cellulitis in children.

Sinonasal disease is common in the pediatric population because of anatomic, environmental, and physiologic factors. Once paranasal sinusitis develops, orbital cellulitis is a concerning sequela that can result in loss of visual acuity and even intracranial disease. Thus, a clear history and physical examination in conjunction with radiographic studies are critical to a correct diagnosis and timely institution of treatment that may include hospitalization, serial ophthalmologic examinations, intravenous antibiotics, and surgery. The serious nature of orbital cellulitis in children cannot be overestimated; but, if prompt and appropriate treatment is initiated, the prognosis is excellent and long-term sequelae should be limited.