BackgroundThe goal of cranioplasty is to achieve a lifelong, stable and structural reconstruction of the cranium covered by a healthy skin and scalp flap. We present two cases of large frontal bone defect following a accident.CasesWe describe the utilization of autogenous local split calvarial graft and titanium mesh for the reconstruction of the post trauma frontal bone defect.ConclusionCranioplasty using split calvarial bone grafting for restoring large cranial defects resulting from a trauma is a useful technique, and allows the surgeon to reconstruct a moderate to large cranial defect without rifting the inner cortical plate.

Introduction: The alar cinch techniques are used in order to control the alar base widening following Le Fort I surgeries. Three main alar cinch techniques include classic, Shams-Kalantar and modified techniques. There is scarcity of scientific literature regarding the modified technique therefore, this review was conducted to assess the photographic changes in the alar base width following Lefort I osteotomy using the modified Cinch technique. Methods: Literature search was performed using the “Modified”, “alar base”, “Lefort I osteotomy” keywords in the Web od Science, PubMed and Scopus databases. Articles published between 2010 till Jun 2019 were included in the study. Identified articles were screened based on inclusion and exclusion criteria by two researchers independently and the identified articles were discussed afterwards. Results: The search yielded 7 articles in English language. The findings of all the included studies revealed that the modified technique was as effective as the classic and Shams-Kalantar techniques. Furthermore, it was reported that the modified technique was more effective in controlling the alar base width in case of alar base flaring. Conclusion: The findings of this review revealed that the modified cinch technique was more effective compared to other techniques. In conclusion, the advantages of the modified technique including better control of the alar base width and improved patient satisfaction following orthognathic surgery out power its disadvantages.

Background: The surgical guide enabled the surgeon to accurately perform osteotomy, mini- mize iatrogenic injury to vital structure in vicinity to osteotomy and moving the bony segments to desired position exactly as planned during computer simulation. The purpose of this study is assess the role of computer assisted designed and manufactured surgical guide in minimizing inferior alveolar nerve injury during sagittal split ramus osteotomy (SSRO). Materials and Methods: A prospective double blind, randomized controlled, clinical trial is designed to assess role of computer assisted designed and manufactured surgical guide in min- imizing inferior alveolar nerve injury during sagittal split ramus osteotomy (SSRO). We had two study group, the side of mandibular ramus that were treated by conventional SSRO (can be right or left) and the side that was treated using the computer designed and manufactured surgical guideof same patient (can be right or left side). For every patient the side of mandibular and osteotomy technique was selected by simple random sampling technique (double coin tossing). The statistical analyses were performed using SPSS version 25 (statistics package for social sciences, Chicago. IL). Statistical significance threshold was set to 0.05 (p-value<0.05). Result: The study population consisted of 10 subjects undergoing SSRO (Sagittal split ramus osteotomy). Seven (70%) were female and three were male. Their mean (±SD) age was 22.4±3024 yrs., range 16 to 27. The mean (±SD) duration of osteotomy on surgical guide assisted SSRO side was 37.2±4.83 and for conventional SSRO side it was 28.2±4.10 and the difference is statistically significant. Conclusion: Using CAD/CAM surgical guide for SSRO has no significant difference with con- ventional osteotomy technique regarding minimizing the incidence of inferior alveolar nerve inju- ries that occurs intraoperatively.