Description

The Journal of Cranio-Maxillofacial Surgery covers all aspects of surgery of the head, face and jaw. A wide range of topics are covered, with section editors representing the following subject areas: aesthetic and cosmetic surgery; research, development and new horizons; oncology and reconstructive surgery; orthognathic surgery; traumatology and temporomandibular joint surgery; implantology, preprosthetic and oral surgery; craniofacial surgery including clefts of lip, alveolus and palate. Contents include: original research papers, invited editorials, case reports, new instruments/technical innovation, book reviews and forthcoming events.

Publisher details

Elsevier

Publications in this journal

• The sequential hypothesis of impaction of maxillary canine - A hypothesis based on clinical and radiographic findings

  Authors: Anand K Sajnani, Nigel M King

  Journal of Cranio-Maxillofacial Surgery.

  The aetiology of impacted maxillary canines remains obscure. Numerous researchers have focused on identifying specific and non-specific aetiological factors responsible for canine displacement.The aetiology of impacted maxillary canines remains obscure. Numerous researchers have focused on identifying specific and non-specific aetiological factors responsible for canine displacement. Currently, the two most popular hypotheses that have gained consensus worldwide are the guidance theory and the genetic theory. However, no single hypotheses, can completely explain the aetiology of impaction of maxillary canines. This retrospective study was used to develop and postulate the aetiology of both buccally and palatally impacted maxillary canines. The study was conducted on a sample of 533 patients for whom the pattern and distribution of the impacted maxillary canines, sex differences, the dental age of the patients, dental anomalies and various geometric measurements which were made on the panoramic radiographs were recorded. Based on these findings, the sequential hypothesis of impaction of the maxillary canine was postulated. The hypothesis states that both buccally and palatally impacted canines have similar aetiological factors leading to their impaction. It is suggested that genetic mechanisms strongly influence the potential of the maxillary canine to be impacted and the guidance from the lateral incisor and the stage of development plays a vital role in determining the ultimate position of the impacted canine.

• Post-laryngectomy stomal cancer recurrences, re-treatment decisions and outcomes: Case series.

  Authors: Federico Ampil, Ghali Ghali, Gloria Caldito, Roxana Baluna

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  OBJECTIVE: Post-laryngectomy stomal cancer recurrences pose management problems because aggressive therapeutic interventions have already often been employed. The purpose of this study is to describeOBJECTIVE: Post-laryngectomy stomal cancer recurrences pose management problems because aggressive therapeutic interventions have already often been employed. The purpose of this study is to describe the extent of peristomal cancer relapses, treatment decisions and patient outcomes. METHODS: Of the 429 individuals who underwent total laryngectomy for laryngeal cancer between 1985 and 2005, 11 patients developed recurrent tumour in the tracheal stoma. RESULTS: Using Sisson's disease classification, the lesions were assigned as type I [5 patients], II [2 patients], III [1 patient] or IV [3 patients]. Combined therapy or re-irradiation alone was administered more often to individuals with early stage disease than to patients with type III or IV recurrences. Complete resolution with local control of tumour occurred in two patients. The overall 2-year survival rate was 10%, and the median survival with and without repeated treatment was 11 months and 7 months, respectively. CONCLUSION: Re-treatment deserves consideration in individuals with post-laryngectomy stomal cancer recurrences because salvage therapy could truly rescue patients, and progressive tracheostomal obstruction or massive hemorrhage invariably develops if the tumours are left untreated.

• Superficial inferior epigastric artery adiposal flap for facial contour reconstruction: Report of two cases.

  Authors: Bernardo Bianchi, Andrea Ferri, Silvano Ferrari, Chiara Copelli, Enrico Sesenna

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  Reconstruction of facial contour represents a real surgical challenge. Several free flaps have been proposed for these defects: fasciocutaneous free flaps such as groin, deltopectoral, anterolateralReconstruction of facial contour represents a real surgical challenge. Several free flaps have been proposed for these defects: fasciocutaneous free flaps such as groin, deltopectoral, anterolateral thigh, or parascapular and deep inferior epigastric. The authors report their experience with the superficial inferior epigastric artery (SIEA) adiposal flap in two cases of facial contour reconstruction. This technique presents several advantages. In particular, harvest of this flap provides a plenty of fatty tissue and reduced donor site morbidity, with optimal aesthetic results both in the face and at the donor site. For these reasons, the SIEA flap can be considered as the first option for facial contour reconstruction.

• Huge teratoma of the face.

  Authors: Pascal Paulus, Hervé Crêvecoeur, Etienne Piette, Patrice Lejuste, Jean Hustin

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  BACKGROUND: A case of facial teratoma is reported which was composed of the three germinal layers of the embryo. Teratomas form tissues foreign to the body part in which they arise. These are mostBACKGROUND: A case of facial teratoma is reported which was composed of the three germinal layers of the embryo. Teratomas form tissues foreign to the body part in which they arise. These are most common in the sacrococcygeal region and in the gonads, but can also be present in extragonadal sites. They remain rare in the head and neck area. Facial teratoma is a very rare tumour, generally benign. Less than 5% of those appearing in the head and neck of children are estimated to be malignant. PATIENT: We describe the case of a female neonate with a very large facial mass, deforming the orbit, the zygomatic arch and the jaws, without any intracranial extension. The tumour was removed at the age of 4 months because of rapid growth. An extended laterofacial approach was used, with superficial parotidectomy and complete facial nerve dissection. The postoperative course was unevenful. The diagnosis was mature teratoma. CONCLUSION: Clinical outcome of teratomas depends on their histological grade, localization and quality of surgical treatment.

• Contour refinements of free flaps for optimal outcome in oral reconstruction: combination of modified liposuction technique and w-plasty in one-stage procedure.

  Authors: Shu-Hung Huang, Sheng-Hua Wu, Kao-Ping Chang, Wen-Her Wang, Ching-Hung Lai, I-Feng Sun, Sin-Daw Lin, Chung-Sheng Lai

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  BACKGROUND: Bulkiness and unsightly scarring are the major complaints after oral cancer reconstruction with free flap transfer. Some debulking procedures, such as blunt-tipped cannula liposuction orBACKGROUND: Bulkiness and unsightly scarring are the major complaints after oral cancer reconstruction with free flap transfer. Some debulking procedures, such as blunt-tipped cannula liposuction or staged excision, can result in some improvement, but these methods do not provide a one-stage procedure for flap thinning and scar revision due to the concern of flap ischemic change. All suction lipectomy methods were applied on flap resurfacing cases; no through-and-through defect case was used. The author used a nonstandard open-tip cannula for liposuction and w-plasty for scar revision in a one-stage operation in oral through-and-through defect cases. This method achieved excellent aesthetic results without complications. MATERIAL AND METHODS: From January of 2004 to October of 2006, secondary debulking procedures were performed on 22 patients who had undergone reconstruction with free anterolateral thigh flaps. All flaps were on the cheek for oral cancer through-and-through defect reconstruction. Suction lipectomy with nonstandard open-tip cannula and w-plasty were performed. RESULTS: All flaps survived well without any partial skin necrosis. Over 85% of patients were satisfied with the outcome. CONCLUSIONS: This method can provide a one-stage debulking procedure for the cheek through-and-through defect after free flap reconstruction, and it achieves good aesthetic outcomes.

• Prevalence of the pneumatized articular eminence in the temporal bone.

  Authors: Muhammed Selim Yavuz, Mutan Hamdi Aras, Hasan Güngör, Mustafa Cemil Büyükkurt

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  OBJECTIVES: The pneumatized articular eminence (PAT) of the temporal bone has been identified as an asymptomatic radiolucent appearance defect in the temporal bone. Although it occurs very rarely,OBJECTIVES: The pneumatized articular eminence (PAT) of the temporal bone has been identified as an asymptomatic radiolucent appearance defect in the temporal bone. Although it occurs very rarely, when present, it may represent the potential for complications following surgical manipulation of the temporomandibular joint. MATERIALS AND METHODS: The record of 8107 patients who presented to our Oral and Maxillofacial Surgery services, between January 1998 and February 2008 was reviewed. Observations were made on the side and radiographic appearance of the PAT; and sex and age of patients. RESULTS: Eighty-three of 8107 (1.03%) individuals had PAT with 41 females and 42 males. PATs were located on the right side in 60 individuals and in the left side in 50 individuals. PATs were unilateral in 56 cases and bilateral in 27 (totally 110 PAT). Forty-four of the PATs were unilocular type, and 66 of the PATs were multilocular type. CONCLUSIONS: Treatment of PAT is unnecessary. However if a surgeon who is planning to perform eminoplasty or eminectomy on a patient who has PAT, he/she should be aware of the details of PAT. Moreover, fractures of the temporal bone with PAT can occur easier than temporal bone without PAT.

• Congenital maxillomandibular syngnathia: Case report.

  Authors: Grace E Parkins, Matthew O Boamah

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  INTRODUCTION: Congenital maxillomandibular fusion is a very rare condition with few cases reported. Cases of combinations of bony or soft tissue adhesions between the mandible and maxilla with cleftINTRODUCTION: Congenital maxillomandibular fusion is a very rare condition with few cases reported. Cases of combinations of bony or soft tissue adhesions between the mandible and maxilla with cleft of the lip or palate, aglossia, popliteal pterygium and van der Woude syndrome have been reported. CASE REPORT: The aim of this paper is to report a case of fibrous maxillomandibular fusion of the jaws, with synechiae of buccal mucosa and the gingivae, which was referred to the Oral and Maxillofacial team of the Korle-Bu Teaching Hospital, Accra, Ghana soon after delivery. Separation of the fusion was done under nitrous oxide/oxygen sedation. Cleft of the hard palate was discovered during surgery. CONCLUSION: Maxillomandibular syngnathia is considered rare and synechiae with other maxillofacial abnormalities without syngnathia could exist and should not be ruled out. This report adds more information to the literature, by reporting a baby with synechiae and a cleft of the palate. Prompt, definitive diagnosis and management of other abnormalities in the baby could only be done under deep sedation. This was necessary to avoid deformity and early death.

• Report of rare bilateral nasolabial cysts.

  Authors: Marius P Marcoviceanu, Marc C Metzger, Herbert Deppe, Nikolaus Freudenberg, Ahmad Kassem, Christoph Pautke, Bettina Hohlweg-Majert

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  PURPOSE: Nasolabial cysts are usually unilateral and are quite rare, while bilateral cysts are even rarer. PATIENT AND METHOD: Our report concerns a 48-year-old female with bilateral nasolabialPURPOSE: Nasolabial cysts are usually unilateral and are quite rare, while bilateral cysts are even rarer. PATIENT AND METHOD: Our report concerns a 48-year-old female with bilateral nasolabial cysts. After many years of misdiagnosis she was finally referred to our clinic with a subnasal swelling of unknown origin. RESULT: Evaluation of the patient's medical history, clinical examination and of a previous CT scan led to the diagnosis of a nasolabial cyst, which was later confirmed by histological examination. Treatment involved the surgical excision. CONCLUSION: A complete surgical excision is recommended using a sublabial approach as the treatment of choice, although transnasal endoscopic marsupialization seems to be a simple and effective alternative. It has been shown that after successful marsupialization, the nasolabial cyst is converted to an air-containing paranasal sinus.

• Double venous anastomosis for the radial artery forearm flap. Improving success and minimising morbidity.

  Authors: Mark Jürgen Alan Turner, William P Smith

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  INTRODUCTION: We present a retrospective analysis of 106 radial forearm free flaps (RFFFs) using double venous anastomoses as performed at Northampton General Hospital over an 11-year period. The aimINTRODUCTION: We present a retrospective analysis of 106 radial forearm free flaps (RFFFs) using double venous anastomoses as performed at Northampton General Hospital over an 11-year period. The aim was to assess the failure rate and salvage rate for venous thrombosis of these flaps. METHODS: RFFFs were raised with the cephalic vein where possible. The cephalic vein and 1 venae commitantes or 2 venae commitantes (VC) were anastomosed using microscope assistance. The veins were anastomosed end to side on to the internal jugular vein (IJV). Data was collected from patient notes using a proforma and entered onto an Accesstrade mark database. RESULTS: Of the 106 RFFFs there was 1 (0.94%) failure at day 9, a presumed arterial failure. None of the 106 RFFFs were returned to theatre for salvage for venous thrombosis. CONCLUSION: Our results compare favourably with similar published data. Comparable studies gave a mean failure rate of 4% (range of 0-10%) and 7% (range 3-12.5%). We believe our results are due to: 1 - Double venous anastomosis, 2 - end to side anastomosis to the IJV using deep and superficial systems, 3 - initial anastomosis of the cephalic vein low in the neck to shorten ischaemic time. 4 - overnight sedation and ventilation of the patient on the intensive care unit.

• Multi-directional Le Fort III midfacial distraction using an individual prefabricated device.

  Authors: Uwe Klammert, Hartmut Böhm, Tilmann Schweitzer, Kristian Würzler, Uwe Gbureck, Jürgen Reuther, Alexander Kübler

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  BACKGROUND: Midfacial distraction following Le Fort III osteotomy has become an established procedure for midfacial advancement of syndromic craniosynostosis patients. A frequent difficulty is theBACKGROUND: Midfacial distraction following Le Fort III osteotomy has become an established procedure for midfacial advancement of syndromic craniosynostosis patients. A frequent difficulty is the precise three dimensional (3D) alignment of the distracted midface and the proper fixation of the distraction device in the midfacial area. In this study we present an individual modification method for commercial distraction devices comprising the establishment of prefabricated fixation plates and parallel connecting pins. MATERIAL: Individual prefabricated fixation plates for the zygomatic buttress were combined with two commercial distraction devices. METHOD: The fixation plates were made by a casting technique using individual cranial models as templates. The latter were fabricated by the rapid prototyping technique of 3D powder printing. For precise realization of the distraction vector, two commercial devices were combined and attached rigidly to the fixation plates by two parallel pins. RESULT: In the clinical routine, the 3D powder printing technique enables the simple fabrication of precise individual cranial models, which are required for manufacturing individual fixation plates. The combination of two commercial distraction devices facilitates the appropriate transfer of complex distraction vectors into the midfacial area. CONCLUSION: The technique presented should be useful for a precise multi-directional midfacial distraction following Le Fort III osteotomy.

• Letter to the Editor.

  Authors: Wilfred A Borstlap, P J Stoelinga

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

• Method selection in craniofacial measurements: Advantages and disadvantages of 3D digitization method.

  Authors: Umut Ozsoy, Bahadir Murat Demirel, Fatos B Yildirim, Ozgur Tosun, Levent Sarikcioglu

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  AIM: Treatment of the craniofacial malformations is a primary goal of cranio-maxillo-facial surgeons. Surgical treatment of these malformations requires accurate data. Accuracy of measurement shouldAIM: Treatment of the craniofacial malformations is a primary goal of cranio-maxillo-facial surgeons. Surgical treatment of these malformations requires accurate data. Accuracy of measurement should be a priority of scientists to prevent statistical errors and therefore to promote the comparison of the results obtained from various research groups. In the present study, we aimed to compare three different measurement techniques, which were used frequently in craniofacial measurements. METHODS: A total number of 35 female and 35 male volunteer adults were included to the study. Two-dimensional (2D) photogrammetry, three-dimensional (3D) digitization and manual anthropometry methods were used for the present study. Measurements were obtained from the ear, eye, nose and face. RESULTS: By comparing three methods, our findings revealed that 3D digitization method is an easy, robust, and sensitive method to obtain the data. CONCLUSIONS: We think that 3D digitization method is accurate, and it can be applied to both clinical practice and research. Advantages and disadvantages of three methods are discussed with the relevant literature.

• Accuracy of combined maxillary and mandibular repositioning and of soft tissue prediction in relation to maxillary antero-superior repositioning combined with mandibular set back A computerized cephalometric evaluation of the immediate postsurgical outcome using the TIOPS planning system.

  Authors: Ole Donatsky, Jens Bjørn-Jørgensen, Niels Ulrich Hermund, Henrik Nielsen, Michael Holmqvist-Larsen, Paul Henrik Nerder

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  AIM: The purpose of the present study was to evaluate the immediate postsurgical outcome of planned and predicted hard and soft tissue positional changes in relation to maxillary antero-superiorAIM: The purpose of the present study was to evaluate the immediate postsurgical outcome of planned and predicted hard and soft tissue positional changes in relation to maxillary antero-superior repositioning combined with mandibular set back using the computerized, cephalometric, orthognathic surgical planning system (TIOPS). MATERIAL AND METHODS: Out of 100 prospectively and consecutively treated patients, 52 patients manifested dentofacial deformities requiring bimaxillary orthognathic surgery with maxillary antero-superior repositioning combined with mandibular set back and so were included. All patients were managed with rigid internal fixation (RIF) and without intermaxillary fixation (IMF). Preoperative cephalograms were analyzed and treatment plans and prediction tracings produced by computerized surgical interactive simulation. The planned horizontal and vertical hard tissue positional changes were transferred to model surgery on a three-dimensional articulator system (SAM) and finally to surgery. Five to six weeks after surgery, the actually obtained hard and soft tissue profile changes were cephalometricly assessed. RESULTS: The mean accuracy of the planned and predicted hard and soft tissue outcome was relatively high varying from 0.0mm to 0.5mm from one cephalometric reference point to another. At the cephalometric reference points where significant differences between planned/predicted, and actually obtained hard and soft tissue positional changes were demonstrated, these significant inaccuracies were, except for the predicted horizontal position of the lower lip, relatively small, varying from 0.2mm to 1.1mm. However, the variability of the predicted hard and soft tissue individual outcome was relatively high. CONCLUSION: The current study demonstrates from a mean point of view relatively high predictability of the immediate postsurgical hard and soft tissue outcome. However, as the variability of the predicted individual outcome seems to be relatively high, caution should be taken when presenting the planned and predicted hard and soft tissue positional changes to the individual patient, preoperatively.

• Conditioning of myocutaneous flaps.

  Authors: Wolfgang Eichhorn, Felix A S Blake, Philipp Pohlenz, Gerd Gehrke, Rainer Schmelzle, Max Heiland

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  PURPOSE: The improvement of the ischaemic tolerance of myocutaneous flaps is of clinical importance and hence the subject of numerous investigations. METHODS: In an attempt to increase the ischaemicPURPOSE: The improvement of the ischaemic tolerance of myocutaneous flaps is of clinical importance and hence the subject of numerous investigations. METHODS: In an attempt to increase the ischaemic tolerance, 20 myocutaneous flaps (rectus abdominis muscle) in pigs were elevated and perfused with various, established solutions prior to the onset of ischaemia. The flaps were elevated, utilizing the superior epigastric vessels as the pedicle. Ten flaps were flushed with the University of Wisconsin solution, five with the Euro-Collins solution and the last five with a Ringer-Lactate solution, prior to the 6h long, normothermic ischaemia. On the day of operation, the first, third, fifth, seventh and tenth postoperative day clincical examinations and thermography were performed as well as biopsies. Additionally, on the tenth postoperative day, the rate of necrosis was determined morphometrically as the average of three measurements. RESULTS: Ten days after surgery, the flaps pretreated with the University of Wisconsin solution displayed a vital surface area of 89%, the Euro-Collins solution 23% and the Ringer-Lactate solution 14%. Histologically, muscle tissue proved to be more susceptible to ischaemia than skin. CONCLUSION: Regarding the rectus abdominis flap in a pig model, the University of Wisconsin solution proved superior in the prevention of ischaemic injury compared with the Euro-Collins solution and Ringer Lactate. In accordance with the literature, muscle tissue proved to be more susceptible to ischaemia than skin in our study.

• Penetrating injury of the maxilla by needlefish jaws.

  Authors: Yaniv Ebner, Daniel Golani, Dov Ophir, Yehuda Finkelstein

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  INTRODUCTION: Needlefish penetrating injuries have become a worldwide problem, inflicting critical morbidities and even mortalities. This is the first published case of needlefish injury in theINTRODUCTION: Needlefish penetrating injuries have become a worldwide problem, inflicting critical morbidities and even mortalities. This is the first published case of needlefish injury in the Mediterranean basin. CASE REPORT: A 29 year old man was admitted to Meir Medical Centre in Israel with a penetrating facial wound caused by elongated needlefish jaws. The severity of the wound contrasted greatly with the expected injury from collision with a fish inflicting a small penetration lesion. The rigid jaws penetrated the maxilla transversely and obliquely from the left canine-fossae, through the nasal cavity, and to the right maxillary sinus, with its tip reaching the right medial-inferior orbital wall. The needlefish jaws were completely removed using a combined endoscopic and external approach. The course of surgery and hospitalization was uneventful and the patient was discharged with no complications. CONCLUSIONS: Fish inflicted critical facial injuries might be dangerously underestimated prima facie. The impact might be energetic enough to penetrate deep facial and vital cranial structures, hence thorough examination and imaging are recommended. Needlefish species are now common in the tropical and subtropical regions of all oceans and therefore this phenomenon is of interest to worldwide trauma medical providers, fishermen, divers, and also to marine-biologists.

• The 18q deletion syndrome and analysis of the critical region for orofacial cleft at 18q22.3.

  Authors: Ales Dostal, Jitka Nemeckova, Renate Gaillyova

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  INTRODUCTION: The 18q deletion syndrome (18q-) is a multiple-anomaly disorder associated with mental retardation, white matter anomalies in the brain, growth hormone deficiency, congenital auralINTRODUCTION: The 18q deletion syndrome (18q-) is a multiple-anomaly disorder associated with mental retardation, white matter anomalies in the brain, growth hormone deficiency, congenital aural atresia, orofacial cleft (OFC), and palate abnormalities. The aims of this study were to determine the frequency of different forms of OFC in 18q- individuals: cleft palate with or without cleft lip (CP/L), cleft lip (CL), and palate abnormalities. We also sought to map a potential critical region for OFC within chromosome 18q22.3 region. PATIENTS: The study presents an overview of selected 18q- individuals from 11 published reports and one presented poster. RESULTS: The frequency of CP/L and CL among 18q- individuals is about 25%; when high/arched palate cases are included, the frequency rises to about 43%. CONCLUSION: Orofacial abnormalities are characteristic features of 18q- syndrome patients and potential CP/L critical region could be assumed at 18q22.3 between markers D18S879 and D18S1141. In addition, gene deficient mouse models for Sall3 or Tshz1 genes, which are located at the 18q22.3 critical region, displayed palate abnormality phenotype.

• Bisphosphonate related osteonecrosis of the jaws treated by surgical resection and immediate osseous microvascular reconstruction.

  Authors: Thomas Mücke, Stephan Haarmann, Klaus-Dietrich Wolff, Frank Hölzle

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  INTRODUCTION: This report presents two patients who received treatment with bisphosphonates (BPs) and who subsequently developed BP related osteonecrosis of the jaws (BRONJ). The treatment ofINTRODUCTION: This report presents two patients who received treatment with bisphosphonates (BPs) and who subsequently developed BP related osteonecrosis of the jaws (BRONJ). The treatment of advanced cases with BRONJ is an area of investigation. The possibility of microvascular reconstruction in severe cases of BRONJ needs further investigation. MATERIAL AND METHODS: Two patients with advanced BRONJ of the left mandible underwent radical resection and immediate bony reconstruction with a microvascular osteocutaneous fibula or iliac crest flap. Both patients had been treated initially without success using more conservative procedures. The progressive course of the disease and refractory pain indicated the need to perform radical resection and immediate reconstruction of the mandible. RESULTS: Both patients underwent successful resection of the affected bone with immediate reconstruction by microvascular flap transfer. After reconstruction of the mandible and cover of the defects, both patients recovered well with good mandibular function. CONCLUSIONS: Radical resection followed by microvascular composite flap reconstruction is reliable in the management of patients with advanced BRONJ and can be considered as the fourth therapeutic stage.

• Clinical application of 3D pre-bent titanium implants for orbital floor fractures.

  Authors: Marcin Kozakiewicz, Marcin Elgalal, Piotr Loba, Piotr Komuński, Piotr Arkuszewski, Anna Broniarczyk-Loba, Ludomir Stefańczyk

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  INTRODUCTION: Orbital structures are affected in approximately 40% of all cases of craniofacial trauma. Changes in the bony orbital dimensions can alter the function of intraorbital contents and leadINTRODUCTION: Orbital structures are affected in approximately 40% of all cases of craniofacial trauma. Changes in the bony orbital dimensions can alter the function of intraorbital contents and lead to serious complications. The unique anatomy of the orbit and the resulting surgical approaches make the process of fitting and aligning implants difficult, time consuming and operator dependent. It is now possible to make relatively inexpensive anatomical models on the basis of computed tomography images, using rapid prototyping. Such models can be used as templates to form titanium mesh implants, which are then used in the reconstruction of orbital floor defects. MATERIAL AND METHODS: Six patients with facial trauma were included in this study. First, 3D virtual models and then physical models were created. These were used as templates to shape the titanium mesh and then intraoperatively as guides to aid correct implant placement in the orbit. RESULTS: Significant improvement resulted in three cases and total recovery in three cases. CONCLUSION: It is financially viable to build anatomical models, on the basis of CT studies, that can be used in the repair of orbital floor fractures.

• Induction of haemarthrosis in the TMJ of rats: Validation by MR imaging (MRI) and histology.

  Authors: Kai Alons, Manon T P Naphausen, Johannes W Von den Hoff, Peter M van der Kraan, Jaap C Maltha, Andor A Veltien, Arend Heerschap, Philip A Van Damme

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

• Dimensional error of selective laser sintering, three-dimensional printing and PolyJettrade mark models in the reproduction of mandibular anatomy.

  Authors: Danilo Ibrahim, Tiago Leonardo Broilo, Claiton Heitz, Marília Gerhardt de Oliveira, Helena Willhelm de Oliveira, Stella Maris Wanderlei Nobre, José Henrique Gomes Dos Santos Filho, Daniela Nascimento Silva

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  BACKGROUND: Selective laser sintering (SLS), three-dimensional printing (3DPtrade mark) and PolyJettrade mark are rapid prototyping (RP) techniques to fabricate prototypes from virtual biomedicalBACKGROUND: Selective laser sintering (SLS), three-dimensional printing (3DPtrade mark) and PolyJettrade mark are rapid prototyping (RP) techniques to fabricate prototypes from virtual biomedical images. To be used in maxillofacial surgery, these models must accurately reproduce the craniofacial skeleton. PURPOSE: To analyze the capacity of SLS, 3DPtrade mark and PolyJettrade mark models to reproduce mandibular anatomy and their dimensional error. MATERIAL: Dry mandible, helical CT images, SLS, 3DPtrade mark and PolyJettrade mark prototypes, and digital electronic caliper. METHODS: Helical CT images were acquired from a dry mandible (criterion standard) and manipulated with the InVesalius software. Prototypes were produced using SLS, 3DPtrade mark and PolyJettrade mark techniques. Thirteen linear measurements of each prototype were made and compared with the dry mandible measurements. RESULTS: The results showed a dimensional error of 1.79%, 3.14% and 2.14% for SLS, 3DPtrade mark and PolyJettrade mark models, respectively. The models satisfactorily reproduced anatomic details and the SLS and PolyJettrade mark prototypes showed greater dimensional precision and reproduced mandibular anatomy more accurately than the 3DPtrade mark model. CONCLUSIONS: The SLS prototype had a greater dimensional accuracy than the PolyJettrade mark and 3DPtrade mark models. The PolyJettrade mark technique reproduced anatomic details of the mandible more accurately.

• Evaluation of skeletal and surgical factors related to relapse of mandibular setback surgery using the bioabsorbable plate.

  Authors: Young-Kyun Kim, Yoon-Ji Kim, Pil-Young Yun, Jong-Wan Kim

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  BACKGROUND: This study was to evaluate the stability of the bioabsorbable plate used in the orthognathic surgery for patients with prognathic mandibles and to evaluate the relapse tendency afterBACKGROUND: This study was to evaluate the stability of the bioabsorbable plate used in the orthognathic surgery for patients with prognathic mandibles and to evaluate the relapse tendency after surgery and the factors affecting the relapse. MATERIALS AND METHODS: The sample consisted of 30 subjects (14 males and 16 females) who underwent bilateral sagittal split ramus osteotomy (BSSRO) for mandibular setback using the poly-l/dl-lactide plate system (Biosorb FX((R)), Linvatec Biomaterials Ltd., Tampere, Finland). The lateral cephalometric radiographs of each subject were taken pre-operatively within 1 month (T0), post-operatively within 1 month (T1), and post-operatively between 4 and 10 months (T2) and skeletal changes were analyzed with V-Ceph (CyberMed((R)), Seoul, Korea) software. The changes between T1 and T2 were evaluated with a paired t-test to estimate the stability of the surgery. The post-operative changes of mandibular body length and ramus height were used for a K-means clustering analysis to separate subjects into either the less changed (LC), or the more changed (MC) group. The two groups were compared with T0 and the surgical changes (T1-T0) using the t-test. RESULTS: Significant relapse after surgery was shown in vertical measurements but not in the horizontal plane measurements. The MC group showed significantly more vertical operative changes than the LC group independent of horizontal measurements. CONCLUSIONS: Usage of a bioabsorbable plate in mandibular setback surgery could provide stable fixation in the horizontal dimension, but also may allow an increase of vertical relapse due to the increase in vertical dimension post-operatively.

• Dealing with aberrant vessels in radial forearm flaps - Report of a case and review of literature.

  Authors: Vyomesh Bhatt, Jason Green, Nicholas Grew

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  INTRODUCTION: Anomalies of the radial artery are uncommon. A brief tabulated review of the literature is presented. CASE REPORT: We report a rare anomaly of the forearm vascular anatomy weINTRODUCTION: Anomalies of the radial artery are uncommon. A brief tabulated review of the literature is presented. CASE REPORT: We report a rare anomaly of the forearm vascular anatomy we encountered when elevating a radial forearm free flap. This is a previously unreported anatomical variation. The radial artery divided into medial and lateral branches (accompanied by their respective venae commitantes) about 1.5cm below the bifurcation of the brachial artery. The skin paddle was predominantly supplied by the aberrant medial branch and was raised on this branch along with its venae commitantes up to the point of division. CONCLUSION: This case highlights the need for vigilance when raising free flaps and the techniques employed to avoid compromising both limb and skin paddle perfusion.

• Temporalis myofascial flap in maxillary reconstruction: anatomical study and clinical application.

  Authors: Iacopo Dallan, Riccardo Lenzi, Stefano Sellari-Franceschini, Manfred Tschabitscher, Luca Muscatello

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  The authors describe indications and advantages of temporalis myofascial flap in the reconstruction of surgical defects after partial maxillectomies. This flap is thin and reliable and can be used asThe authors describe indications and advantages of temporalis myofascial flap in the reconstruction of surgical defects after partial maxillectomies. This flap is thin and reliable and can be used as an alternative to free flap tissue transfer in the reconstruction of partial defects of the upper maxilla. The surgical steps to raise the flap are simple, but the dissection must be careful to avoid damages to the fronto-temporal branches of the facial nerve on the outer surface, and to the feeding vessels on the inner surface of the temporal muscle. In the present series no major surgical complications were observed. No injuries to the facial nerve branches were reported. Neither total nor partial flap losses were experienced. Post-operative aesthetic and functional results were satisfying. Temporalis muscle flap can be considered as a first-line reconstructive option for limited resection of the upper maxilla with sparing of the orbital floor and of the anterior alveolar crest.

• Oropharyngeal airway changes following bimaxillary surgery in Class III female adults.

  Authors: Gülnaz Marşan, Samet Vasfi Kuvat, Evren Oztaş, Nil Cura, Zeynep Süsal, Ufuk Emekli

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

  AIM: The aim of this study was to evaluate oropharyngeal airway changes following Le Fort I maxillary advancement and impaction with mandibular setback in Class III deformity. SUBJECTS AND METHODS:AIM: The aim of this study was to evaluate oropharyngeal airway changes following Le Fort I maxillary advancement and impaction with mandibular setback in Class III deformity. SUBJECTS AND METHODS: 53 female Class III patients (mean age: 24.9+/-0.8 years) had Le Fort I maxillary advancement with impaction, and mandibular setback osteotomies. Lateral cephalograms were taken before (T0), one week postoperatively (T1) and 1.3+/-0.2 years after (T2) bimaxillary surgery. Paired t and Pearson tests were used to evaluate the changes. RESULTS: The mandibular plane-hyoid, upper retropalatal airway space (URP) and hyoid to horizontal reference plane (HY-HOR) distances significantly increased and the third vertebra to menton, hyoid to vertical reference plane (HY-VER) distances decreased in the T0-T1 period. Relapses were found in mandibular plane to hyoid (MP-HY), URP, HY-HOR, third cervical vertebra to menton (C3-Me) and HY-VER distances in T1-T2 period. Correlations were found between the mandibular retraction and increases of the narrowest retropalatal (r: 0.29, p<0.05) and lowest retropalatal airway spaces (r: -0.30, p<0.05) and posterior movement of hyoid (r: 0.60, p<0.001). CONCLUSIONS: Bimaxillary surgery caused an increase in the URP, together with posterior and inferior movement of hyoid bone one week postoperatively. Some relapse was found in these changes over one year later.

• The European working time directive - Facts and issues.

  Authors: Maurice Mommaerts

  Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

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