Purpose: To present the treatment of zygomaticomaxillary complex (ZMC) fractures with closed-reduction Steinmannpin fixation and to compare it to the reduction and aesthetic outcomes of open-reduction techniques (ORIF). Materials and Methods: Case series. Charts for 23 patients with ZMC fractures presenting to the Head and Neck Surgery Department at Harbor-UCLA Medical Center from 2005 to 2009 were reviewed. Pre-and post-operative computed tomography (CT) scans were analyzed. Follow up ranged from 3 to 55 months. Interviews were conducted to evaluate the patient's satisfaction. Patients were placed in two groups: those treated with ORIF and those treated with closed-reduction Steinmann-pin fixation. Results: Twelve patients had complete data for analysis. Average operative time was significantly lower for patients treated with closed-reduction as compared to open-reduction: 65.3 minutes vs. 162.5 minutes (p = 0.02). Bony realignment and aesthetic results were comparable in both groups. Additionally, only one 1cm facial incision was required with this repair system versus several incisions using traditional methods. Conclusions: Closed-reduction Steinmann-pin fixation of ZMC fractures provides adequate bony alignment and aesthetics. Our study supports this system in the repair of ZMC fractures as it requires significantly less operating time, one small incision, and excellent patient outcomes.
Imaging is a critical component of the pre-procedure evaluation and planning of endovascular aneurysm repair (EVAR). Imaging is the mainstay for proper assessment of procedural candidacy, relevant vascular anatomy, device selection, and surgical approach. Computed tomography angiography (CTA) has long been considered the preferred modality for pre-operative imaging and evaluation prior to EVAR.Recently, advances in image quality and software technology have further enhanced the proceduralist's ability to plan and perform EVAR. In this review, we highlight the current state of the art to provide interventionalists a contemporary assessment of the available tools for pre-operative imaging and evaluation prior to EVAR.
A 47-year-old female presents with a pulsatile left temporal mass, which has been slowly enlarging over the past 3 years. She sustained blunt head trauma 10 years prior from a motor vehicle collision with no subsequent reported injury. Her presenting symptoms include headache, constant audible pulsation, and paresthesias over the left temporal region. Magnetic resonance angiography and computed tomography confirmed the presence of a 5.5 cm (length) ϫ 2.3 cm (diameter) proximal superficial temporal artery aneurysm (STA) with feeding branches from the middle temporal artery (A) and (B, Cover).The operative approach included a longitudinal incision directly overlying the aneurysm extending from the preauricular region to the temporal region. The proximal STA, which was nonaneurysmal, was dissected and ligated that rendered the aneurysm nonpulsatile (C). The aneurysm was exposed and dissected along its posterior aspect to avoid injury to the temporal branches of the facial nerve, which traverse anteriorly. The additional feeding branches were ligated, and the entire aneurysm was excised. The patient demonstrated no focal deficits on postoperative cranial nerve examination and remained stable in long-term follow-up.Aneurysms of the superficial temporal are rare and are usually degenerative because of blunt or penetrating trauma to the preauricular or temporal region. 1,2 True aneurysms of the STA have also been described in isolated case reports. The anterior branch of the STA is most frequently affected. Symptoms may include headache, constant pulsatility, visual disturbances, dizziness, ear discomfort, and hemorrhage. Compression of the proximal superficial temporal artery in the preauricular region frequently diminishes pulsatility and flow. Treatment of choice is ligation of the STA and feeding branches with aneurysm excision. 3 For aneurysms of the proximal STA, temporal branches of the facial nerve are present anteriorly and may cause facial hemiparesis if injured. Although not used in this patient, intraoperative facial nerve monitoring may help avoid iatrogenic injury. REFERENCES1. Pipinos II, Dossa CD, Reddy DJ. Superficial temporal artery aneurysms. J Vasc Surg 1998;27: 374-7. 2. Cheng CA, Southwick EG, Lewis EC. Aneurysms of the superficial temporal artery: literature review and case reports. Ann Plast Surg 1998;40:668 -71. 3. Peick AL, Nichols WK, Curtis JJ, Silver D. Aneurysms and pseudoaneurysms of the superficial temporal artery caused by trauma. J Vasc Surg 1988;8:606-10.
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