Subtarsal Versus Transconjunctival Approach: A Long-Term Follow-Up of Esthetic Outcomes and Complications.

PURPOSE: There is limited data that compares the long-term esthetic outcomes in patients who undergo traumatic orbital reconstruction with the subtarsal (STA) and transconjunctival approaches. The purpose of this study is to determine the long-term differences in scarring, cosmesis, and complications between the 2 approaches. MATERIALS AND METHODS: Sixty-seven patients were examined on average 39 months after surgery. Each patient was evaluated for satisfaction in surgical scarring and complications including diplopia, nerve paresthesia, lid malposition, and epiphora. Photographic images of each patient were reviewed by 3 experienced maxillofacial surgeons and 3 nonmedical personnel to determine if scarring was present and quantify it using the Manchester scar scale (MSS). Scarring was then compared using 3 different objective scales; MSS, modified Vancouver scar scale and the modified Stony Brook scar evaluation scale. Recorded data were analyzed using the χ2 test and Fisher exact test to determine statistical significance (P < .05). RESULTS: No visible scar formation was seen in 61 to 76.5% of patients who had an STA using either of the 3 scales, although the MSS proved to be significantly more accurate when assessing linear periorbital scars than the modified Vancouver scar scale and Stony Brook scar evaluation scale (P < .001). Surgeons were able to correctly identify subtarsal scars in 26.3% of patients, in comparison with the nonmedically trained people identifying just 10.6% of scars. Most of these showed only mild scar formation and are unlikely to have any significant effect on patient's quality-of-life. Overall, 93.3% of patients who had an STA were satisfied with the scar formation. CONCLUSIONS: While the transconjunctival approach is a useful technique that offers a surgical approach with no scarring, over the long-term, only a small proportion of STA scars are visible to the average person. Surgeons should consider both approaches and their clinical advantages when treating patients with traumatic orbital injuries.

A Tip for the Reconstruction of Larger Maxillary Defects in Complicated Cleft Patients.

Residual alveolar cleft deficits can be difficult to treat. This is particularly the case in older and multiply operated patients as well as those with large oronasal defects and extensive scar tissue. In large and recalcitrant defects vascularized free tissue transfer should be considered as a definitive procedure. Vascularized free tissue transfer provides a 95% success rate and provides excellent bone for placement of osseointegrated implants for dental rehabilitation (Schwabegger et al., 2004). We feel that the scapula tip has a number of important advantages. These include reduced morbidity from the donor site, good bone quality and contour for implant placement, and a longer pedicle length.

Risk Factors associated with Dental Implant Failure: A Study of 302 Implants placed in a Regional Center.

AIM: The aim of this research is to determine which risk factors are associated with dental implant failure and survival. MATERIALS AND METHODS: Data pertaining to patients who received one or more dental implants from 2011 to 2013 in a regional center were retrospectively reviewed. This included a total of 302 Biomet 3i NanoTite Tapered Certain implants placed in 177 patients. All patients were followed up until the end of 2015. RESULTS: This study found an overall success rate of 95%. Statistically significant factors that were found to affect implant survival were implant length, surgical technique, and presence of diabetes mellitus DM. Age, gender, body mass index (BMI), implant site, smoking, and variable operators were not found to have any significant implant on implant survival. CONCLUSION: This study has demonstrated that the incidence of implant failure and its complications is affected by a number of important factors that clinicians should consider when assessing patients. A follow-up study with a larger sample size, longer follow-up period, and details of the type of prosthetic rehabilitation would be beneficial in producing more definitive conclusions which may improve clinical practice. CLINICAL SIGNIFICANCE: Dental implants play an important role in modern-day dental rehabilitation. It is vital that clinicians understand the impact of variable risk factors on implant survival. This study will add to the growing literature on the subject.

Ophthalmological injuries associated with fractures of the orbitozygomaticomaxillary complex.

Our aim was to evaluate ophthalmological injuries associated with fractures of the orbitozygomaticomaxillary complex that required operative treatment, and we collected data retrospectively over a period of five years (2012-2016 inclusive). Of the 190 patients, 162 were male with a median age of 31 (IQR 25 -39) years. Assault was the most common mechanism of injury (125/190, 66%). Minor ophthalmic injuries (those unlikely to cause permanent visual disturbance) and major ophthalmic injuries (those with the potential to cause permanent visual disturbance) were recorded. The common minor ophthalmic injuries were: diplopia, enophthalmos, proptosis, subconjunctival haemorrhage, and restriction of the extraocular muscles. Commotio retinae, traumatic mydriasis, retro-orbital haemorrhage, and hyphaema were the common major ophthalmic injuries. All 13 different major ophthalmic injuries were recorded in the group who had had orbital fractures reconstructed, which suggested that more intraocular damage can be caused by this type of fracture than by others. Visual acuity was reduced in 26/190 patients with only four having persistent postoperative changes at six weeks. The odds ratio for those patients who had a major ophthalmological injury and were unable to drive was 0.07 (95% CI 0.02 to 0.21, p=0.001), which was highly significant. Ophthalmological assessment is strongly recommended for patients with fractures of the orbitozygomaticomaxillary complex.

Botulinum toxin used to treat recurrent dislocation of the temporomandibular joint in a patient with osteoporosis.

Recurrent dislocations of the temporomandibular joint (TMJ) can be debilitating. We describe a patient with osteoporosis who presented to our regional centre where we have limited resources. We injected botulinum toxin into both of her lateral pterygoid muscles, and six months later she has not required further injections and has had no issues with tolerance of the procedure. Botulinum toxin is a safe, conservative approach to recurrent dislocations of the TMJ and can be given accurately by an experienced surgeon without the use of an electromyogram.