Secondary Correction of Post-traumatic Craniofacial Deformities

Mokal, Nitin; Desai, Mahinoor Feroze

doi:10.1097/scs.0000000000001138

Cited by 6 publications

(11 citation statements)

References 9 publications

(12 reference statements)

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“…Despite advances in technology and principles in craniomaxillofacial trauma management, postsurgical complications are still inevitable and patients present with deformities even after dedicated attempts of primary fracture management. 9 To return a traumatic deformity to an exact preinjury state still remains a challenge for craniofacial trauma surgeons. 10 Malocclusion as a complication of surgical management of facial trauma is well documented in the literature and is reported to be around 5% to 20%.…”

Section: Discussionmentioning

confidence: 99%

Application of Orthognathic Surgery Principles and Techniques in the Management of Craniomaxillofacial Trauma

Bhandari¹,

Ho²,

Liao³

2023

Ann Plast Surg

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Background: Posttraumatic secondary deformities of facial skeleton may occur because of nonmanagement or ill management of primary injuries, whereas some unexpectedly occur even after dedicated management attempts. Orthognathic surgery (OGS) principles and techniques can be used as an efficient tool to correct posttraumatic craniomaxillofacial deformities or skeletal developmental deformities during trauma management. Aim and Objectives: The aims of this study were to describe the different types of posttraumatic secondary deformity and address how to use the principles of orthognathic techniques to correct them. Materials and Methods: Patients with orthognathic surgical osteotomies during primary or secondary management of facial trauma (referred to as trauma-OGS) during the period of 2010 to 2018 were retrospectively reviewed. Variables pertaining to patients and surgery were collected, including trauma diagnosis, etiology, duration between trauma/primary surgery and secondary presentation, suggested reason for secondary deformity, intervention undertaken to address, and the surgical outcome. Results: Twenty-seven patients were eligible and extensively reviewed. Etiological categorization of trauma-OGS could be done into posttraumatic deformities (18) and developmental deformities (9). The former group was further categorized as OGS done as primary procedure (8) that included immobile Le Fort fractures and delayed initial treatment, and OGS done as secondary procedure (10) that included complex fractures and condylar fractures. The developmental deformity group was categorized into OGS done simultaneously during trauma management (5) or done as a secondary procedure after trauma management (4). Conclusions: Application of principles and techniques of OGS in indicated primary or secondary management of facial trauma patients should always be considered. The categorization of scenarios presented in this article relating facial trauma and OGS may further help to understand the application.

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Section: Discussionmentioning

confidence: 99%

Application of Orthognathic Surgery Principles and Techniques in the Management of Craniomaxillofacial Trauma

Bhandari¹,

Ho²,

Liao³

2023

Ann Plast Surg

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“…Thus, the complexity of the injury and the time of intervention can be considered major factors in surgical outcome. Mokal and Desai added the time elapsed till secondary reconstruction 33…”

Section: Discussionmentioning

confidence: 99%

“…Facial injuries and deformities were usually classified according to the anatomic location,9 fractures pattern,10 severity,111213141516 or mechanism of injury 17181920212223242526272829303132. Mokal and Desai stated that no classification system is entirely satisfactory in taking into account the mix of soft and bony tissue deficits and the resulting functional and aesthetic deformities 33…”

mentioning

confidence: 99%

“…[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Mokal and Desai stated that no classification system is entirely satisfactory in taking into account the mix of soft and bony tissue deficits and the resulting functional and aesthetic deformities. 33 The primary repair of bones and soft tissues requires thorough examination, imaging, and the awareness that low clinical suspicion for a fracture may not exclude significant soft tissue injury. 8,34 Multidisciplinary work may be required in severe cases due to the proximity of the vital structures in the craniofacial and skull-base region.…”

mentioning

confidence: 99%

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Periorbital Trauma: A New Classification

Sadek

Elbarbary

Safe

2019

Craniomaxillofacial Trauma & Reconstruction

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Overlooked injured structures in periorbital trauma could lead to aesthetic and functional deficits. As trauma may affect superficial, middle, and deep components, meticulous survey guided by a structured periorbital trauma classification is needed for proper management. Thus, a new classification for periorbital trauma is proposed to serve this purpose. Periorbital region was defined anatomically by anthropometric landmarks. The periorbital injuries were categorized according to anatomical and clinical basis. The new classification was used to study periorbital trauma cases received at Ain Shams University Hospitals between July 2013 and July 2016 retrospectively. The study included 260 patients: 196 (75.38%) males and 64 (24.62%) females. The type and severity of injury, time of primary intervention, type of surgery performed, and patients’ visits to the outpatient clinic were evaluated. The status of the postinjury and postoperative (primary surgery) aesthetic status and functional status were evaluated. The periorbital region was identified. Anatomical categorization of periorbital injuries included periocular, frontal, temporal, and malar regions. Injuries/deficits were categorized into simple, composite, complex, and isolated bony injuries according to the depth and involved tissues. Subsequently, the classification was formulated. In the retrospective study, the incidence of extended simple injuries was the highest, while the least was the extended complex injuries. Functional deficits occurred in 24 patients (9.23%) and aesthetic deficits occurred in 55 patients (21.15%). Required secondary operations for this group included redo of fixation, correction of medial canthal ligament, repair of canalicular system, scar revisions, fat grafting, and creation of natural creases. The results of this study demonstrated that unsatisfactory aesthetic and functional results occurred when injuries of important structures were overlooked, aesthetic units were not respected, and when management was delayed. A three-dimensional, oriented, new classification of periorbital trauma based on anatomical and clinical categorization is proposed to help in identifying injured structures, stimulate the search for other injuries, structure preoperative evaluation, and recommend a surgical plan that would ultimately achieve precise primary repair with best aesthetic and functional outcome.

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“…Usually, the bone fragments are simply discarded creating bone defects that need subsequent repair. Although some workers achieve this repair in the same sitting,9 most others perform secondary cranioplasty later on 10111213. But whether the cranioplasty is done as a primary or secondary surgery, there is usually the need to make good the cranial-facial defects left after discarding the “contaminated” fracture fragments.…”

Section: Discussionmentioning

confidence: 99%

Titanium Clamps for a Simple Low-Profile Autologous Osteosynthesis in the Reconstruction of Posttraumatic Craniofacial Convexital Skeletal Disruption

Adeleye

Malomo

2017

Craniomaxillofacial Trauma & Reconstruction

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Attempts at reconstruction of posttraumatic craniofacial defects (PTCDs) can be a challenge in low-resource practice areas of the world where the needed biomaterials are logistically beyond reach. A simple low-profile technique of autologous osteosynthesis for PTCD using the titanium clamps is presented in this report. In addition, a 6-year prospective database on a consecutive cohort of patients who underwent this procedure was analyzed for clinical, functional, and aesthetic outcomes, both in-hospital and at midterm follow-up. The clinical data of 18 patients, all males, mean age 31.3 years (standard deviation, 9.7), were analyzed. Road traffic accidents (RTAs) were the cause of trauma in 14 of 18 patients (78%) and motorcycle crash, none helmeted, in 10 of the 18 patients (71% of RTAs). Out of 18 cases, 17 were open fractures; 89% suffered mild head injury, and associated brain injury on CT scan included pneumocephalus in 6 (5 of them significant); acute extradural hematoma in 4 and subdural in 2, and brain contusions in 9. The surgery was successful in all the cases: operative time <3 hours in 10 cases (56%), the in-hospital outcome was good in 95%. The median follow-up time was 24 months, in 6 of the 18 cases for ≥36 months. There was no case of surgical site infection in the perioperative or the follow-up period to date. The aesthetic outcome was also acceptable. This surgical technique for the reconstruction of PTCD appears effectual. Although its low cost makes it very attractive therein, it appears to be actually also recommendable even outside the low-resource developing countries.

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Secondary Correction of Post-traumatic Craniofacial Deformities

Cited by 6 publications

References 9 publications

Application of Orthognathic Surgery Principles and Techniques in the Management of Craniomaxillofacial Trauma

Application of Orthognathic Surgery Principles and Techniques in the Management of Craniomaxillofacial Trauma

Periorbital Trauma: A New Classification

Titanium Clamps for a Simple Low-Profile Autologous Osteosynthesis in the Reconstruction of Posttraumatic Craniofacial Convexital Skeletal Disruption

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