The aim of this study was to prospectively evaluate the accuracy and predictability of new three-dimensionally preformed AO titanium mesh plates for posttraumatic orbital wall reconstruction.We analyzed the preoperative and postoperative clinical and radiologic data of 10 patients with isolated blow-out orbital fractures. Fracture locations were as follows: floor (N = 7; 70%), medial wall (N = 1; 1%), and floor/medial wall (N = 2; 2%). The floor fractures were exposed by a standard transconjunctival approach, whereas a combined transcaruncular transconjunctival approach was used in patients with medial wall fractures. A three-dimensional preformed AO titanium mesh plate (0.4 mm in thickness) was selected according to the size of the defect previously measured on the preoperative computed tomographic (CT) scan examination and fixed at the inferior orbital rim with 1 or 2 screws. The accuracy of plate positioning of the reconstructed orbit was assessed on the postoperative CT scan. Coronal CT scan slices were used to measure bony orbital volume using OsiriX Medical Image software. Reconstructed versus uninjured orbital volume were statistically correlated.Nine patients (90%) had a successful treatment outcome without complications. One patient (10%) developed a mechanical limitation of upward gaze with a resulting handicapping diplopia requiring hardware removal. Postoperative orbital CT scan showed an anatomic three-dimensional placement of the orbital mesh plates in all of the patients. Volume data of the reconstructed orbit fitted that of the contralateral uninjured orbit with accuracy to within 2.5 cm(3). There was no significant difference in volume between the reconstructed and uninjured orbits.This preliminary study has demonstrated that three-dimensionally preformed AO titanium mesh plates for posttraumatic orbital wall reconstruction results in (1) a high rate of success with an acceptable rate of major clinical complications (10%) and (2) an anatomic restoration of the bony orbital contour and volume that closely approximates that of the contralateral uninjured orbit.
Objectives: To evaluate the morphological condylar changes following orthognathic surgery by using a rapid and reliable computational method on panoramic radiographs. Methods: Digital panoramic radiographs of 45 patients who underwent bilateral sagittal split osteotomy (alone or associated with a Le Fort I osteotomy) between 2007 and 2010 were analysed. Calculation of the area, perimeter and height of 90 condyles was performed by using a specific computational method. Measurements were taken before surgery (m 1 ), 1 day after surgery (m 2 ) and 1 year after surgery (m 3 ). The evolution of each index was analysed using paired t-tests between measures before and 1 day after surgery (m 1 2 m 2 ) and measures before and 1 year after surgery (m 1 2 m 3 ). The changes in the condylar area, perimeter and height were examined using the Bland and Altman plotting method. Results: There were no statistically significant changes in the mean condylar area, perimeter or height between m 1 and m 2 or between m 1 and m 3 . The Bland and Altman plots for each index showed that a very limited number of condyles increased or decreased in area, perimeter and/or height outside the boundaries of the measurement error. Given the impossibility for a condyle to increase in size, these results are considered to represent the limits of the computational method used. Conclusions: This study demonstrated that there were no significant morphological condylar changes at the 1-year follow-up following surgery and that the range of normality in condylar changes could be influenced by the methodology used. Dentomaxillofacial Radiology (2013Radiology ( ) 42, 20120463. doi: 10.1259 Cite this article as: Scolozzi P, Momjian A, Courvoisier D S, Kiliaridis S. Evaluation of condylar morphology following orthognathic surgery on digital panoramic radiographs. Could methodology influence the range of "normality" in condylar changes? Dentomaxillofac Radiol 2013; 42: 20120463.
This study has demonstrated that (1) the height of the condyle can be rapidly and reliably assessed using a specific computer system directly on digital panoramic radiographs; (2) although less reliable, area and perimeter can also be acceptably evaluated; and (3) this method has the potential for being routinely used to monitor changes in clinical follow-up as well as for research purposes.
The current study demonstrated that there were no significant differences in the orbital volume restoration using either technique. In fact, both techniques allow for close reproduction of natural orbital volume and shape, and its use in posttraumatic orbital wall reconstruction was successful.
Metallic foreign bodies are rarely found in the maxillary sinus, and usually they have a dental origin.Potential complications related to foreign bodies include recurrent sinusitis, rhinolith formation, cutaneous fistula,chemical poisoning, facial neuralgic pain and even malignancies.Two main surgical approaches are currently used for the removal of foreign bodies in the maxillary sinus: the bone flap and the endoscopic sinus techniques. We are reporting two unusual cases of large high-velocity foreign bodies removed by a modified maxillary lateral antrotomy,with free bone flap repositioning and fixation with a titanium miniplate.
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