Late sequelae after high midface trauma.

The upper midface area comprises mainly the naso-orbito-ethmoidal (NOE) region which plays a paramount role in facial expression. Fractures of this area often result in neglected bony defects in the fragile periorbital region with major secondary impairments such as traumatic telecanthus, orbital dystopia, and/or enophthalmos. Permanent cranial nerve deficits also can occur as the result of post-traumatic/post-operative sequelae. Seventy-one patients (age range 7-78 years) with severe high midface trauma, treated from January 1989 to December 1996, were reviewed with a minimum follow-up of 2 years. The patient population has been distributed according to the fracture type in three groups: Group 1 (n = 35): Isolated NOE with/without associated central midface injury; Group 2 (n = 22): NOE associated with craniofacial injury and Group 3 (n = 14): NOE associated with orbital displacement. The estimated post-surgical parameters included qualitative and quantitative data from the long-term clinical evaluation. Persistent headache and/or concentration difficulties were mainly noted in Group 1. Smell reduction or anosmia was reported mainly in Group 2. Deficits of the trigeminal and/or the facial nerve were found in Group 3. Enophthalmos and/or telecanthus were predominantly seen with injuries associated with orbital displacement.

Frontal sinus fractures: computed tomography evaluation of sinus obliteration with lyophilized cartilage.

Allogenic lyophilized cartilage has been proven clinically to be a reliable material for obliteration of the frontal sinus without the limitations of donor site morbidity and the prolongation of the operation time produced by autogenic grafting. The long-term behaviour of the implanted material is of paramount importance for the success of the obliterative technique. This survey included 51 trauma patients on whom obliteration of the frontal sinus with lyophilized cartilage was performed. The fate of the lyophilized cartilage graft was evaluated from computed tomography imaging of the obliterated frontal sinus. No radiological sign of mucocele formation or inflammatory disease was noted. Bone density measurement of the obliterated sinus and the adjacent trabecular bone was calculated. The patient population was distributed into four groups (0-2, 2-4, 4-6, > 6 years) according the postobliterative time. The bone density of the implanted lyophilized cartilage was accentuated from group 1 to group 4 when compared with the bone density of the trabecular bone. This shows the long-term tendency of lyophilized cartilage graft to osseous substitution.

Frontal sinus fractures: principles of treatment and long-term results after sinus obliteration with the use of lyophilized cartilage.

The most commonly used techniques for frontal sinus obliteration involve the implantation of an autogenous tissue graft: either fat, muscle or bone. Lyophilized allogenic cartilage due to its unique properties, such as the tendency to ossification and resistance to volume reduction, can be used as the material of choice for sinus obliteration. A clinical and radiological study of 66 patients operated on for frontal sinus fractures, between January 1 1988 through December 31 1995 was undertaken. Variables recorded included the aetiological factors, the clinical and radiological fracture features with the corresponding treatment modality, the association of frontal sinus fractures with intracranial involvement, the early and late postsurgical complications and the correlation between pre- and postoperative radiological findings. Obliteration of the frontal sinus with lyophilized cartilage chips was performed in 51 (77.3%) patients. The postsurgical evaluation showed no major complications. Revision of the frontal sinus was only required in one patient. The radiological findings verified the progressive calcification of the obliterated sinus. Allogenic lyophilized cartilage implantation offers distinct advantages in cases of severe frontal sinus trauma: 1. There is nearly unlimited availability of the material. 2. There is no need for a second operation field with the associated potential donor site morbidity. 3. The operation time is reduced due to the avoidance of a second operation on the donor site.

[Obliteration of the frontal sinus with lyophilized cartilage in frontal fractures]. / Obliteration der Stirnhöhle mit lyophilisiertem Knorpel bei frontalen Frakturen.

Obliteration of the frontal sinus is frequently necessary in the appropriate treatment of major craniofacial trauma of the upper third of the face. Successful frontal sinus obliteration requires (1) meticulous removal of the frontal sinus mucosa, (2) permanent occlusion of the nasofrontal duct and (3) obliteration of the denuded cavity. The current techniques include implantation of autologous fat, bone or muscle. These techniques are effective when the appropriate guidelines are respected, but the problems of donor site morbidity, which has been as high as 5%, recipient site morbidity due to the shrinkage of the free graft, and the increase in the operative time must be pointed out. The unique characteristics of lyophilized cartilage, i.e. the low resorption rate and tendency to undergo osseous substitution, justify its use for obliteration of the frontal sinus. The present study reviews 51 patients with obliteration of the frontal sinus due to craniofacial trauma. In none of the patients were there clinical or radiological signs of postoperative mucocele formation. Progressive ossification of the implanted cartilage was verified in most of the patient population.

[Obliteration of the frontal sinus with lyophilized cartilage in frontal fractures]. / Obliteration der Stirnhöhle mit lyophilisiertem Knorpel bei frontalen Frakturen.

Obliteration of the frontal sinus is frequently necessary in the appropriate treatment of major craniofacial trauma of the upper third of the face. Successful frontal sinus obliteration requires (1) meticulous removal of the frontal sinus mucosa, (2) permanent occlusion of the nasofrontal duct and (3) obliteration of the denuded cavity. The current techniques include implantation of autologous fat, bone or muscle. These techniques are effective when the appropriate guidelines are respected, but the problems of donor site morbidity, which has been as high as 5%, recipient site morbidity due to the shrinkage of the free graft, and the increase in the operative time must be pointed out. The unique characteristics of lyophilized cartilage, i.e. the low resorption rate and tendency to undergo osseous substitution, justify its use for obliteration of the frontal sinus. The present study reviews 51 patients with obliteration of the frontal sinus due to craniofacial trauma. In none of the patients were there clinical or radiological signs of postoperative mucocele formation. Progressive ossification of the implanted cartilage was verified in most of the patient population.

Correlation of imaging and clinical features in the assessment of mandibular invasion of oral carcinomas.

The detection in the mandible of early local spreading of adjacent primary malignancies poses a difficult problem. A survey of 60 patients suspected of carcinomatous mandibular infiltration was undertaken, and the most important clinical and imaging data were studied. Tumor localization and bone scintigraphy proved to offer the most important predictive power. A decision tree and a logistic regression model which determines a score function combining these characteristics were designed. This decision tree improves the sensitivity and specificity of the preoperative assessment and provides the surgeon with an algorithm for the accurate estimation of early mandibular invasion.

[Surgical correction of a patient with Goldenhar syndrome]. / Cheirourgike antimetopise periptoses syndromou goldenhar.

The syndrome has been described at first in 1952 by Goldenhar. Today, after the completion by Gorlin in 1963, the Goldenhar anomaly and the hemifacial microsomia are considered variants of a single dysmorphogenetic entity. The main characteristics of the syndrome are: 1. Epibulbar dermoids, 2. auricular appendages or fistulae, 3. vertebral anomalies. More recently, other malformations have been documented in association with the Goldenhar complex including CNS, cardiac, pulmonary and renal anomalies. We present the surgical correction of a patient with Goldenhar syndrome, with a combination of maxillofacial and plastic procedures. A review of the literature concerning the pathogenetic mechanisms and the surgical intervention is also presented.