A comparative evaluation of rhytidectomy versus retromandibular approach for Open Reduction and Internal Fixation (ORIF) of mandibular condylar fractures

Objective  This clinical study was carried out on thirty patients who underwent open reduction and internal fixation for condylar fractures via rhytidectomy/retromandibular approach were evaluated. Methods  Group I (rhytidectomy approach) were compared and evaluated clinically and radiologically with Group II (retromandibular approach) for the following parameters like surgical access, duration of surgery, anatomic reduction assessment with relevant radiographs, occlusal discrepancies, need for post operative IMF, facial nerve morbidity, other post operative complications and scarring. Results  There was a statistically significant difference between the two groups in the duration of surgery which was found to be significantly lesser for group II than group I. Access was better in group I. Scar was well camouflaged in patients of Group I when compared to group II. Conclusion  The rhytidectomy (Face-lift) incision which we have used in our study has all the advantages of the retromandibular approach with an added advantage of a less conspicuous scar and a wider exposure of the fracture site. The only disadvantage is the added time required for the closure which is not a concern as the aesthetic outcome of this technique is superior to the other approaches.     

A Comparative Prospective Study of Two Different Treatment Sequences i.e. Bottom Up–Inside Out and Topdown–Outside in,in the Treatment of Panfacial Fractures

Purpose

To compare the sequence bottom-up inside-out with top-down outside-in, in the treatment of pan facial fractures and to evaluate the outcome of these approaches.

Patients and Methods

The data from 11 patients with panfacial fracture are prospectively analysed. Five cases are treated with bottom-up approach and six patients with top-down approach.

Results

There were 11 male patients (six in top-down approach and five in bottom-up approach), ranging in age from 24 to 50 years. All injuries were result of RTA (n = 11, 100 %). Final treatment outcome was excellent in 3 (50 %), 1 (16 %) good and 2 (32 %) cases were fair in topdown approach, 3 (60 %) excellent and 2 (40 %) fair in bottom up approach with contingency coefficient value (P < .632) which was insignificant. There was no significant deviation from the two groups in the final treatment outcome.

Conclusion

Within the limitation of low sample size we found that both bottom-up inside-out and top-down outside-in approaches have similar clinical outcomes. Hence it could be suggestive to start fixation of least disrupted (more stable) facial half as a guide for reconstruction of the remaining. Choice of the bottom-up inside-out or top-down outside-in sequence should be according to the pattern of fractures and preference of the surgeon. However, further controlled clinical trials, comparative studies with a larger sample size would be better to evaluate the final clinical outcome of individual techniques.     

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??The aesthetic retreatment of maxillary anterior teeth and the related treatment have been widely concerned in clinical practice. Such kind of treatment often inevitably involves problems like compromised esthetic prosthesis??irritation of normal periodontal structures caused by excessive tooth preparation??and occlusal problems??which then lead to esthetic deficiency of anterior region. These cases full of challenge usually need interdisciplinary approach. The purpose of this article is to provide experience in the clinical application of interdisciplinary approach to dealing with aesthetic problems of anterior teeth??by presenting and analyzing a case with 5 years follow-up.     

Rehabilitation following spinal cord injury

It is estimated that up to 2500 people are injured or diagnosed with a spinal cord injury (SCI) within the UK every year (this was previously thought to be 1000 new cases each year). This corresponds to 35 newly diagnosed patients per week. These injuries can vary in ability to recover from complete to incomplete primarily depending on the location and level of the injury producing tetraplegia, hemiplegia or paraplegia. There is no known cure or effective treatment to reverse the damage that occurred to the spinal cord at the time of injury. The aim of rehabilitation following a SCI is to provide patients with the skill set, confidence and equipment to return to as full and independent a life as possible. This can only be achieved through a multidisciplinary holistic approach and a close collaboration between the patient, family and clinical teams.     

应用多学科联合治疗解决前牙美学区复杂病例（附1例5年随访结果）

上前牙美学区的二次修复及相关治疗在日常诊疗过程中备受关注,此类病例常涉及既往修复体形态不佳、基牙医源性过度预备导致侵犯牙周正常解剖结构以及咬合关系紊乱等问题,进而产生前牙区美学缺陷,给再治疗带来挑战,往往需要多学科联合治疗。文章通过展示1例前牙美学区病例的诊疗全过程,包括病情分析、多学科参与治疗设计、具体实施步骤和修复后效果等,以期为临床多学科联合治疗上前牙复杂病例提供经验。     

Surgical approaches for primary total hip replacement

Excellent exposure is an essential requirement for successful hip surgery. The surgical approach selected should provide appropriate exposure of the acetabulum together with safe mobilization and exposure of the proximal femur. The approach should be versatile, allowing adequate release and exposure in the various circumstances in which primary hip arthroplasty is indicated. It should be extensile, allowing intraoperative flexibility, safe, avoiding significant risk to adjacent neurovascular structures and limit soft tissue damage and blood loss. This review article describes the common surgical approaches used for primary total hip replacement, reviewing those in common use and discussing reduced access variations on those approaches. Newer trends, such as the direct anterior approach and the direct superior approaches will be described. The strengths, limitations and clinical evidence related to each option will be discussed.     

‘Y’ Modification of the Transconjunctival Approach for Management of Zygomatic Complex Fractures: A Prospective Analysis

Purpose

The purpose of this study was to clinically and radiologically evaluate reduction and fixation of isolated zygomatic complex (ZMC) fractures treated by Y modification of the transconjunctival approach.

Patients and Methods

A prospective evaluation of ten patients was undertaken for a period of 6 months using this modified approach from Jan 2012 to Jun 2013. Patients were examined preoperatively and post operatively at the end of 6 months for symmetry discrepancies involving A–P globe projection, lateral canthal level, malar projection and diplopia in direct and extreme gazes. Cosmetic outcomes were assessed by clinical assessment and examination of photographs. Quality of reduction and stability of fixation was assessed by examination of postoperative images.

Results

All patients underwent a three point fixation of ZMC with reconstruction of the orbital floor using titanium mesh. Patients were post surgically followed up at regular intervals of 1, 3 and 6 months. Immediate complications noted were chemosis, lid edema and lower lid retraction. Late complications included minor scleral show in two cases. All patients experienced significant improvement with excellent esthetic appearance and function.

Conclusions

Y modification of transconjunctival approach provides excellent surgical exposure for ZMC fractures potentially avoiding the use of a second incision in the area of ZF suture. Although this technique provides good exposure and excellent esthetics, it requires more operating time and detailed knowledge of the anatomy of the lateral canthal region.

     

双重睑切口在颧额缝骨折内固定入路的临床应用

目的　探讨双重睑切口在颧额缝骨折内固定入路的临床应用效果。方法　选取12例颧骨复合体骨折、骨折段移位明显、伴有面部塌陷或张口受限等功能障碍患者,行局部小切口切开复位内固定术,其中颧额缝采用双重睑切口入路,术后评价骨折复位固定、功能和畸形改善、术后瘢痕等情况。结果　所有骨折复位固定方便,患者颧面部外形满意,功能改善明显,术后瘢痕隐蔽。结论　双重睑切口作为颧骨复合体骨折复位内固定其中的手术入路,既能达到骨折复位,又能减少创伤,具有一定的临床使用价值。     

动态导航技术在牙髓治疗中的应用

随着动态导航技术的不断发展，这项技术已逐步应用于牙髓治疗中，如根尖手术、钙化根管定位、建立髓腔入路等。动态导航技术可使临床操作更加直观、精确、微创。文章就近年来动态导航技术在牙髓治疗中的应用做一介绍。     

Invasive Cervical Resorption: Clinical Management in the Anterior Zone

According to the high number of articles published on invasive cervical resorption (ICR), this pathology, as commonly believed, is a more frequent form of cervical resorption. ICR is often misdiagnosed as internal resorption or caries, which leads to inappropriate treatment and even unnecessary tooth loss. Despite a correct diagnosis, the treatment of this type of hyperplastic invasive external resorption poses a challenge for the clinician. The Heithersay classification and the use of cone-beam computed tomographic imaging have increased our knowledge of the pathology and helped improve its prognosis. Nevertheless, there is no standard protocol for the treatment of this type of lesion. This article proposes a treatment protocol for ICR based on the pattern and location of resorption. Three treatment approaches (internal access, external access, and intentional replantation) are presented through 3 clinical cases.     

Intraoral versus transcervical approaches in mandibular reconstruction with free flaps: A retrospective study

This study aims to investigate the clinical and functional differences between intraoral and transcervical approaches for segmental mandible resection and reconstruction with free flaps. Patients diagnosed as benign and low-grade mandibular malignant tumors without neck dissections were retrospectively reviewed and divided into intraoral and transcervical groups. Patients of intraoral group underwent intraoral mandibulectomy and vascular anastomosis was performed through a 2-cm submandibular incision, while traditional submandibular approach was used in transcervical group. Clinical characteristics of two groups were assessed including body mass index (BMI), defect types and number of fibular segments, as well as perioperative variables such as operation time, blood loss, drainage volume. The score of appearance, swallowing and speech using the University of Washington Quality of Life Questionnaire (UW-QOL) was recorded and analyzed 6-month postoperatively.A total of 14 patients in intraoral group and 21 patients in transcervical group was collected, respectively. In intraoral group, intraoperative blood loss and postoperative drainage volume were significantly reduced in comparison with transcervical group (p = 0.0146, p = 0.0017; respectively). The score of appearance was 87.50 ± 12.97 in intraoral group, which was significantly higher than 64.29 ± 12.68 in transcervical group (p < 0.0001). Similar results were found in patients of subtype Class II mandibular defect between two groups. However, patients of intraoral group had a significant increase in operative time and a comparable amount of intraoperative blood loss (p = 0.0472, p = 0.1434; respectively).Within the limitations of the study it seems that an intraoral approach combined with a 2-cm submandibular incision should be preferred over a transcervical approach for segmental mandibulectomy and free flap reconstruction whenever appropriate.     

Anthropometric changes in the morphology of the lower eyelid after using three different approaches in patients with orbital fractures

PurposeThe aim of this prospective study was to address the anthropometric changes in the morphology of the lower eyelid and esthetic outcomes after performing subciliary, subtarsal, and transconjunctival approaches in patients with orbital and periorbital fractures.Patients and methodsA prospective randomized controlled clinical study was undertaken on patients with orbital floor and infraorbital rim fractures. These were equally divided into three groups: in group 1, the fractures were approached via a stepped subciliary approach; in group 2, they were approached via a subtarsal approach; in group 3, a retroseptal transconjunctival approach was performed. The patients were assessed for anthropometric changes in the morphology of the lower eyelid, esthetic outcomes, and postoperative lower eyelid complications (LLCs). A one-way ANOVA test was used to analyze differences between the operated and non-operated sides and the effect of the surgical approach on anthropometric measurements.ResultsA total of 45 patients were included in the study. All the surgical approaches provided adequate surgical exposure of the infraorbital rim and orbital floor. The subtarsal approach allowed rapid access to the field (10.5 ± 1.9 min). All incisions resulted in adequate postoperative esthetic outcomes. Anthropometric analysis revealed that there were no significant differences between the three approaches, except for measurements of the eye fissure index (EFI) and lower iris coverage (LIC). Mean EFI measurements increased on all operated sides. The subciliary approach showed the highest percentage of increased measurements of this variable (34.5 ± 4.6), followed by the subtarsal approach (32 ± 2.1), and then the transconjunctival approach (31.1 ± 3.7), with p = 0.046. Furthermore, the subciliary approach significantly decreased the measurements of LIC. This change was also bigger with the subciliary approach (1.09 ± 2.3) than with the subtarsal approach (2.1 ± 2.4) or transconjunctival approach (3.4 ± 2.6), with p = 0.048.ConclusionBased on the results of this study, the subtarsal approach is a minimally invasive incision that provides an adequate and direct approach to orbital floor and infraorbital rim fractures, with a favorable periorbital architecture and the lowest incidence of LLCs. Therefore, the subtarsal technique should be preferred over subciliary and transconjunctival approaches.     

穿腮腺入路治疗髁颈及髁突基底部骨折

目的：探讨穿腮腺入路治疗髁颈及髁突基底部的安全性及有效性。方法：对15例（21侧）髁颈及髁突基底部骨折患者选择穿腮腺入路切开复位内固定术。结果：15例患者,21例侧髁突骨折行手术治疗。19例侧髁突骨折选择2块接骨板固定,2例侧选择1块接骨板固定。所有患者伤口均一期愈合,术后复查全口曲面断层片或三维CT示骨折断端对位良好。除1例患侧后牙暂时性轻度开外,所有患者咬合关系恢复良好。术后1个月复查,张口度32～45mm（平均38mm）。3例侧出现面神经损伤症状,术后3个月内均恢复正常,无1例出现永久性面瘫。所有患者均未出现涎瘘、感染等并发症。结论：相对于髁突骨折的颌后及颌下入路,穿腮腺入路行髁突骨折切开复位内固定术,容易暴露,可直视下完成骨折复位固定,是治疗髁颈和髁突基底部骨折安全有效的手术入路。     

Midcheek mass: 10 year of clinical experience

This is a literature review and retrospective chart review of ten years experience on the treatment of midcheek masses in our department. The purpose of this study is to provide the reader with an overview of the pathology of this complex anatomic area focusing the attention on the differential diagnosis and the recent surgical strategies.From May 2002 to December 2012 we enrolled 22 consecutive patients studied for masses located in the midcheek area. Only four studies were found in the literature describing the experience of individual centres reporting few cases of midcheek masses. Combined with the previously reported 37 cases, we describe 22 lesions for a total of 59 cases. Patients were evaluated with a head and neck clinical and instrumental examination. Apart from 4 cases treated with intramuscular infiltration of botulinum toxin for masseter hypertrophy, surgical approach to the lesions was varied: 10 patients received an external approach (standard parotidectomy approach or face-lift-type approach); 6 patients had the lesion removed through an intraoral approach; in 2 cases a direct skin incision was performed. In our series we found a significant rate (55.5%) of temporary complications in all the procedures performed (external, intraoral, direct skin approach). This study aims to emphasize the role of endoscope assisted surgery as a possible alternative to the traditional approaches for the management of well selected benign midcheek masses.It would be advisable to increase the study of the endoscopic anatomy of the midcheek area in order to standardize the procedure and better define the surgical indications.     

脱套入路在鼻眶筛区骨折治疗中的应用

目的:探讨面中部脱套入路治疗鼻眶筛区骨折的疗效。方法:选取佛山中医院口腔医疗中心鼻眶筛骨折患者11例,均为单侧一类骨折,其中眶区骨折6例,鼻区骨折5例。所有患者采用面中部脱套入路行骨折复位内固定术或隆鼻术。结果:11例患者术后随访3～12个月,伤口均一期愈合,所有患者均有鼻腔结痂和出血现象,创伤性溢泪1例,眶下区麻木4例,鼻部歪斜1例。结论:面中部脱套入路治疗鼻眶筛区骨折操作安全,术野暴露充分,面部不留瘢痕,无鼻前庭狭窄等并发症发生,值得临床推广应用。     

耳前角形切口在髁突骨折切开复位内固定术中的应用

目的:探讨应用耳前角形切口在髁突骨折切开复位内固定术中的应用效果。方法:对78例100侧下颌骨髁突骨折患者采用耳前角形切口术区皮下行肿胀液注射后沿皮下翻瓣在颧弓上方2 cm切开颞深筋膜浅层并沿此层深面剥离到颧弓,分离显露骨折部位,直视下行髁突骨折解剖复位内固定术。结果:术后通过临床及影像学检查随访,效果满意,无严重并发症。结论:耳前角形切口结合皮下肿胀分离技术可为髁突骨折切开复位内固定术提供良好的视野,方便骨折复位固定,安全便捷,值得临床推广。     

耳前长角形切口在复杂颧骨复合体骨折复位内固定术中的应用

目的：探讨应用耳前长角形切口在复杂颧骨复合体骨折切开复位内固定术中的应用效果。方法：在106例复杂颧骨复合体骨折切开复位内固定术中采用耳前长角形切口,术区皮下肿胀分离后沿皮下翻瓣,在颧弓上方2cm切开颞深筋膜浅层并沿此层深面剥离到颧弓,分离显露骨折部位,直视下行骨折复位内固定术。结果：术后通过临床及影像学检查随访,效果满意,无严重并发症。结论：耳前长角形切口结合皮下肿胀分离技术不但为复杂颧骨复合体骨折复位内固定术提供良好的视野,方便骨折复位固定,而且与头皮冠状切口相比大大减少了损伤和出血,值得临床推广。     

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??Due to dental caries and severe periodontal disease??alveolar ridge resorption in posterior maxillary area and maxillary sinus pneumatization are the most common problem??and it becomes a major challenge to inserting implants in this area. To gain efficient bone??numerous maxillary sinus floor elevation procedures are used to improve the success rate of dental implant. It is always a hot issue to explore a much simple??rapid and effective technique for maxillary sinus augmentation. The crestal approach is much preferable technique for posterior maxillary implant placement. It provides a more conservative and less invasive manner. Also??it reduces the duration of surgery and the incidence of intraoperative and postoperative complications. However??minor perforation of maxillary sinus membrane is the common complication and maxillary sinusitis occasionally occurs. Thus it is of great significance to explore a much safer and more reliable sinus lift technique. This article introduced the indications??contraindications??complications and its management??and the main clinical technical points of three minimally invasive crestal sinus lift approach according to the clinical data in Department of Oral Implantology??Peking University School and Hospital of Stomatology. It may provide the reference for the clinical usage of the crestal sinus lift techniques.     

A nonsurgical approach with repeated orthoptic evaluation is justified for most blow-out fractures

ObjectiveThis study presents the results of an updated clinical protocol for orbital blow-out fractures, with a special emphasis on nonsurgical treatment and orthoptic evaluation of functional improvement.MethodsA two-centre multidisciplinary prospective cohort study was designed to monitor the results of a clinical protocol by assessing ductions, diplopia, globe position, and fracture size. Patients underwent clinical assessment and orthoptic evaluation at first presentation and then at 2 weeks and 3/6/12 months after nonsurgical or surgical treatment. Outcome parameters were field of binocular single vision (BSV), ductions, degree of enophthalmos, a diplopia quality-of-life (QoL) questionnaire, and other sequelae or surgical complications.Results46 of the 58 patients who completed the 3, 6 and/or 12-month follow-up received nonsurgical treatment. There was full recovery without diplopia or enophthalmos (>2 mm) in 45 of the 58 patients. The other 13 patients had limited diplopia, mainly in extreme upward gaze (average BSV 90). Five of those 13 patients did not experience impairment of diplopia in daily life. The average QoL score at the end of follow-up was 97. No patients developed late enophthalmos.ConclusionThis study showed that a high percentage of patients with orbital floor and/or medial wall fracture recovered spontaneously without lasting diplopia or cosmetically disfiguring enophthalmos. The conservative treatment protocol assessed here underlines the importance of orthoptic evaluation of functional parameters.