Minimally invasive genioplasty: an observational study.

PURPOSE: This study aimed to determine the feasibility of a minimal invasive genioplasty (MIG) technique combining a limited vertical incision, endoscopy, and a piezotome. METHODS: A total of thirteen patients who underwent primary genioplasty procedures under general anesthesia were evaluated. The feasibility of the method was reported in terms of total surgery time, the total amount of intra-operative blood loss, neurosensory dysfunction, pain sensation, infection, and patient satisfaction using the FACE-Q Chin scale. RESULTS: We observed the mean surgery time of 46.08 ± 5.33 min with a statistically significant p-value of 0.157. The ANOVA test value for mean neurosensory testing score (NST) was calculated as 5.95 (p = 0.006) for the right side and 7.64 (p = 0.017) for the left side. The paired t-test value of the mean pain score was 117.98 (p < 0.001) and showed no significant pain after 1 week. The quality of the osteotomy was deemed good in 12 patients with less intra-operative blood (ranged from 7.7 to 46.2%). CONCLUSION: Based on these results, this minimally invasive technique for genioplasty is a promising approach to perform a chin osteotomy and should be an alternative to the conventional genioplasty technique.

Does Intraoperative Computed Tomography Scanning in Maxillofacial Trauma Surgery Affect the Revision Rate?

PURPOSE: The purpose of this study was to determine how intraoperative computed tomography affects the intraoperative revision rate and consequently the post-operative, secondary corrective surgery in maxillofacial trauma surgeries. PATIENTS AND METHODS: A retrospective study composed of patients with facial fractures was conducted in Prince Sultan Military Medical City in Riyadh, Saudi Arabia. The predictor variables were age, gender, site of facial fracture, type of treatment, number of scans per patient, and discharge time. The primary outcome variable was immediate intraoperative revision rate. Secondary outcome variable was total scanning time (recorded from the moment surgery was halted until it was resumed after image acquisition). Descriptive statistics were used; numerical data presented as mean ± SD and categorical variables as frequency (%). RESULTS: A total of 22 patients underwent 25 intraoperative scans while undergoing different maxillofacial surgeries. Eleven (50%) required intraoperative revisions after the scans, and 3 (13.6%) cases had another intraoperative scan after revision. Eighteen were men and 4 were women. The mean age was 30 years and age range was 19 to 76. Cases were categorized by fracture location and treatment preformed. The mean scanning time was 18.9 ± 4.6 minutes. The highest rate of revisions was seen in zygomaticomaxillary complex fractures (63.6%), they were also the only cases that required a second intraoperative scan after revision to confirm final reduction. No complications were seen postoperatively, and all patients recovered uneventfully. None of the patients required a secondary corrective surgery. All patients were discharged on the following day, except 1 case which was admitted under another service. CONCLUSIONS: The use of intraoperative computed tomography imaging in treating maxillofacial fractures results in a higher rate of intraoperative revisions, which in turn leads to more accurate fracture reduction and consequently reduces the possibility of a postoperative, secondary corrective surgery.

Patient-specific implants for maxillofacial defects: challenges and solutions.

BACKGROUND: Reconstructing maxillofacial defects is quite challenging for most surgeons due to the region's complex anatomy and cosmetic and functional effects on patients. The use of pre-made alloplastic implants and autogenous grafts is often associated with resorption, infection, and displacement. Recent technological advances have led to the use of custom computer-designed patient-specific implants (PSIs) in reconstructive surgery. This study describes our experience with PSI, details the complications we faced, how to overcome them, and finally, evaluates patient satisfaction. CASE PRESENTATION: Six patients underwent reconstruction of various maxillofacial defects arising due to different etiologies using PSI. A combined total of 10 implants was used. PEEK was used to fabricate 8, while titanium was used to fabricate 2. No complications were seen in any patient both immediately post-op and in subsequent follow-ups. All patients reported a high level of satisfaction with the final result both functionally and cosmetically. CONCLUSION: The use of computer-designed PSI enables a more accurate reconstruction of maxillofacial defects, eliminating the usual complications seen in preformed implants and resulting in higher patient satisfaction. Its main drawback is its high cost.