Distraction osteogenesis in maxillofacial surgery

With distraction osteogenesis (DOG) formation of new bone is initiated by gradual separation of osteotomized bone fragments. Both external and internal distraction devices are available. Since its first application in craniomaxillofacial surgery in the early nineties, developments in distraction osteogenesis have been tremendous. Important advantages of this technique are: lack of a donorsite and its associated morbidity; increase of the volume of the soft tissue envelop; less surgical trauma compared to conventional craniomaxillofacial procedures; and the usability of the technique in growing individuals. Disadvantages of DOG are: the sofar limited experience and follow-up in craniomaxillofacial surgery; and the unknown influences on growth. The technique will gradually find its niche and the general dentist will therefore be increasingly confronted with its specific indications. In this paper the general principles of DOG and a number of indications in craniomaxillofacial surgery are discussed.     

Localized sarcoidosis of the maxillofacial region

Three cases of localized sarcoidosis in the maxillofacial region are reported. The location of two lesions in proximity to tattoos supports the idea that local sarcoid reactions can develop in response to a foreign body.     

Vascular anomalies of the maxillofacial region

A biologic classification based on clinical behavior and endothelial cell characteristics is used to divide vascular birthmarks into two groups: hemangiomas and vascular malformations. This system is applied to vascular anomalies of the maxillofacial region and is demonstrated with illustrative cases. The distinction between hemangioma and vascular malformation is important for maxillofacial surgeons because hemangiomas rarely affect bone, whereas malformations affect bone in 35% of cases.     

Hydatid cyst in the maxillofacial region

Two cases of hydatid cyst, one in the mandibular body and the other in the infratemporal fossa, are reported. Treatment by excision was successful in both patients.     

Penetrating injuries to the maxillofacial region

The cases of 37 patients who had incurred penetrating injuries to the maxillofacial region, with retention of foreign bodies, are described. Primary surgery was performed when possible. In some cases the foreign bodies were removed several years after the injuries, and in others the objects were never removed. Methods for locating and removing foreign bodies lodged within the maxillofacial region are discussed.     

Chain saw injury of the maxillofacial region

A case of facial chain saw injury has been presented, along with a review of the literature and a discussion of the preoperative and postoperative management. The mechanism of injury and recommendations to reduce the incidence of maxillofacial injuries are also discussed.     

Penetrating arrow injuries of the maxillofacial region

We operated on four civilian patients who had unusual penetrating maxillofacial injuries that resulted from assault with arrows. The patients were fully conscious at the time of presentation. Recovery was uneventful in three, but one died.     

Fractures of the maxillofacial region in children.

83 children with maxillofacial fractures have been analyzed according to, aetiology, age, sex, type, and site of fractures. The results showed a high male to female ratio. Mandibular fractures were the commonest, in the condylar region in particular. The commonest causes in descending order were falls, bicycle accidents and at play.