Craniofacial Surgery

The Conundrum of Human Osteoinduction: Is the Bone Induction Principle Failing Clinical Translation? No abstract available

Transoral Approach to the Giant Deep Lobe Parotid Gland Pleomorphic Adenoma Parapharyngeal space tumors are rare tumors that make up about 0.5% to 1% of all head and neck neoplasms. The majority of parapharyngeal space tumors, which are usually benign, consist of salivary gland tumors and neurogenic tumors. Although the transcervical, transparotid or transmandibular approach is generally preferred for the excision of these tumors, the transoral approach, which is more advantageous in terms of cosmetics and function, can be applied in selected cases. This article presents a case in which the giant pleomorphic adenoma originating from the deep lobe of the parotid gland is removed by transoral approach. Address correspondence and reprint requests to Omer Vural, MD, Department of Otolaryngology, Head and Neck Surgery, Baskent University, Bahcelievler Mh. Maresal Fevzi Cakmak Cad. 5. Sokak, No: 48 Cankaya/Ankara 06490, Turkey; E-mail: dromervural@gmail.com Received 1 August, 2020 Accepted 5 December, 2020 This is a case presentation study and it does not need ethical approval in our institution. Informed written consent was obtained from the patient before abscess drainage. The authors report no conflicts of interest. © 2021 by Mutaz B. Habal, MD.

Is Le Fort I Distraction Enough to Treat Severe Midface Hypoplasia? Background: In severe cases of maxillary hypoplasia, Le Fort I distraction may be required for treatment. This study describes our experience with internal distraction devices and assesses our outcomes in patients with a negative overjet on average >15 mm. Methods: A retrospective review of patients with a history of cleft lip and/or palate who underwent Le Fort I distraction at our institution from 11/2007-11/2017 was performed. Data regarding demographics, procedural details and outcomes were collected and analyzed. Results: Twenty patients, 13 (65.0%) male and 7 (30.0%) female, were included. All (100%) patients had a history of cleft lip and/or palate and 2 (10.0%) of them had associated syndromes. All 20 patients underwent internal distraction. The average age at surgery was 17.8 years (range 15.2–20.7, SD 1.6 years). The average preoperative negative overjet was 19.27 mm (range 10–30, SD 5.63 mm). The mean total distraction length was 15.3 mm (range 0–30, SD 6.72 mm). There were no intraoperative complications, however, there were a total of 4 (20.0%) postoperative complications, 2 of which required reoperation due to device malfunction or displacement. 14 (70.0%) patients had repeat procedures to complete occlusal correction or correct relapse. Conclusions: Maxillary distraction alone was insufficient for correction of maxillary discrepancies averaging >15 mm. Instead, it's utility may be in positioning the maxilla for a more viable final advancement and fixation procedure, rather than being solely responsible for achieving normal occlusion during distraction. Address correspondence and reprint requests to Jeffrey A. Hammoudeh, MD, DDS, USC Keck School of Medicine, Associate Chief, Plastic and Maxillofacial Surgery, Associate Professor of Surgery, Craniofacial Surgeon, Director, Jaw Deformities Center, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard MS#96, Los Angeles, CA 90027; E-mail: Jhammoudeh@chla.usc.edu Received 15 September, 2020 Accepted 4 December, 2020 Dr. Jeffrey A. Hammoudeh has served as a KLS Le Fort I Internal Distraction Design Consultant. Presented at: ACPA's 76th Annual Meeting in Tucson, Arizona, April 9 – 13, 2019 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2021 by Mutaz B. Habal, MD.

Auricular Arteriovenous Malformation With Macrotia Treated With Transcatheter Arterial Embolization, Polidocanol Foam Sclerotherapy and Subsequent Otoplasty Following Resection Auricular arteriovenous malformation (AVM) occasionally accompanies macrotia. Here, the authors report a case of AVM with macrotia that was treated with transcatheter arterial embolization, percutaneous sclerotherapy, and subsequent otoplasty following partial resection. A 46-year-old man presented with Schobinger stage III AVM. After transcatheter arterial embolization of the feeding arteries using n-butyl-2-cyanoacrylate, 9 sessions of sclerotherapy were performed using 3% polidocanol foam. Partial resection of the AVM nidus and subsequent otoplasty for ear reduction were performed at the age of 50 years. Two years later, the remnant nidus was resected and the protruding ear was surgically corrected. No recurrence was observed, and the enlarged ear was reduced at follow-up 6 months after the final operation. Address correspondence and reprint requests to Satoru Sasaki, MD, PhD, Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Kita 4, Nishi 7, Chuo-ku, Sapporo, Hokkaido 060-0004, Japan; E-mail: satoru-s@tonan.gr.jp Received 28 October, 2020 Accepted 4 December, 2020 The authors have no conflicts of interest to disclose. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2021 by Mutaz B. Habal, MD.

Overlooked Piece of Wood Served as a Vector Transmitting Clostridium Perfringens: A Case Report Emphasizing the Awareness of Gas-Forming Organisms in Posttraumatic Pneumocephalus The radiological depiction of posttraumatic pneumocephalus is due to trapped air in most cases. Although rarely reported, it can also be the result of a gas-forming organism, requiring immediate treatment due to high mortality. Here, we report on an elderly patient with radiological appearance of posttraumatic intracranial pneumocephalus after a wound was closed without recognition of a retained tree branch. The piece of wood served as a vector for transmission of Clostridium perfringens causing the collection of abnormal intracranial air. Radical excision of temporal muscle tissue along with extensive evacuation of the brain abscess and targeted intravenous antibiotics resulted in minor morbidity. Although a piece of wood can easily be missed with current diagnostic imaging, it is crucial that both clinicians and radiologists are aware of the presence of air and its differential diagnosis in posttraumatic pneumocephalus, in order to allow timely treatment in this fatal disease. Address correspondence and reprint requests to PD Dr Lukas Andereggen, MD, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; E-mail: lukas.andereggen@dbmr.unibe.ch Received 15 August, 2020 Accepted 4 December, 2020 This work is original and has not been published elsewhere nor is it currently under consideration for publication elsewhere. The authors report no conflicts of interest. Informed consent was obtained from the patient. A copy of the written consent is available for review by the Editor of this journal. This study fulfills the requirements of the Ethics Commission of the canton of Bern, Switzerland, and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. © 2021 by Mutaz B. Habal, MD.

Effectiveness of Different Surgical Flap Delay Methods and Their Systemic Toxicities Objective: The surgical flap delaying has been shown to be effective in preventing partial flap loss or in preparing larger flaps. However, there is no gold standard flap delay method in the literature. In this study, the authors aimed to compare 3 types of surgical delay methods to determine which model would increase more flap survival. The authors also investigated the effect of delay methods on circulating mononuclear leukocytes as a parameter of DNA damage. Methods: Twenty-four Sprague-Dawley male rats were divided into 4 groups. All subjects had a 10 × 3 cm modified McFarlane flap. Surface area measurements, biopsies, and blood samples were taken on the day of sacrification; 7th day for the control group and 14th day for delay groups. Results: Between incisional surgery delay groups, a significant difference was found in necrosis and apoptosis in the bipedicled group, and only necrosis in the tripedicled group compared to the control. In terms of DNA damage, it was found higher in all experimental groups than in the control group. Conclusions: Both incisional surgical delay procedures' results were meaningfully effective when only incisions were made without the elevation of flaps. In conclusion, bipedicled incisional surgical delay seems to be the most effective method in McFarlane experimental flap model whereas two-staged surgeries may increase the risk of systemic toxicity. Address correspondence and reprint requests to Kemalettin Yildiz, Associate Professor, Medical Faculty, Department of Plastic Reconstructive and Aesthetic Surgery, Bezmialem Vakif University; E-mail: yildizkemalettin@gmail.com Received 9 August, 2020 Accepted 4 December, 2020 The authors report no conflicts of interest. This study was approved by the Animal Experimentation Ethics Committee of University. (Approval codes: 2013–39). All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. © 2021 by Mutaz B. Habal, MD.

Infraorbital Nerve Decompression for Chronic Post Traumatic Neuralgia: A Novel Approach and Review of the Safety and Efficacy of Piezoelectric Surgery on Soft Tissues and Nerves Chronic post traumatic infraorbital nerve (ION) hyperesthesia is a rare complication of orbital floor fractures. Surgical decompression of the ION has been reported to relieve chronic post traumatic infraorbital neuralgia. This case report describes a novel approach for ION decompression in a patient who suffered from chronic infraorbital neuralgia associated with a healed displaced orbital floor fracture. We used an intraoperative 3D image-guided navigation system to accurately localize the fracture site and employed piezoelectric surgery for nerve decompression. We further review the literature on the safety and efficacy of piezoelectric surgery on soft tissue and nerves. Address correspondence and reprint requests to Lambros K. Viennas, MD, Department of Surgery, Division of Plastic Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue 6th floor, Norfolk, VA 23507; E-mail: viennalk@evms.edu Received 28 April, 2020 Accepted 4 December, 2020 Dr. Viennas has received honoraria as educational consultant for LifeNet Health. He is on the Speaker's Bureau for Stryker Endoscopy and has never received funding, shares, financial interest, honoraria or support from Stryker. Maxwell Wagner report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2021 by Mutaz B. Habal, MD.

Fronto-Orbital Advancement and Posterior Cranial Vault Expansion Using Distraction Osteogenesis in Patients With Multiple Craniosynostosis This study aimed to evaluate the treatment outcomes and the efficiency of techniques of fronto-orbital advancement (FOA) and posterior cranial vault expansion (PCVE) using distraction osteogenesis in patients with multiple craniosynostosis. We assessed the treatment results and outcomes of 8 patients with multiple craniosynostosis at the Kagoshima University Hospital between 2005 and 2019. Each 4 patients underwent FOA and PCVE, respectively, using distraction osteogenesis. The cranial volume and developmental quotient (DQ) were measured at the preoperative period and 1 year after surgery. The mean patient age at surgery was 22 months. The mean preoperative cranial volume was 1027 and 1071 cm3 in the FOA and PCVE groups, respectively. The mean preoperative DQ scores were 74 and 67, respectively. After 1-year of follow-up, the corresponding mean cranial volume became 1108 and 1243 cm3, respectively. The corresponding mean DQ scores also improved to 74 and 81, respectively. The postoperative follow-ups in all cases were uneventful, except for persistent epilepsy in 1 patient. Fronto-orbital advancement and PCVE using distraction osteogenesis might contribute to good outcomes in expanding cranial volume, cosmetic osteogenesis, and infantile development in patients with multiple craniosynostosis. Regarding the cranial volume expansion, especially, PCVE using distraction osteogenesis is more effective than FOA. Address correspondence and reprint requests to Tatsuki Oyoshi, MD, PhD, Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan; E-mail: tatsuki@m2.kufm.kagoshima-u.ac.jp Received 5 August, 2020 Accepted 4 December, 2020 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2021 by Mutaz B. Habal, MD.

Photobiomodulation to Treat Necrotizing Fasciitis The spread of odontogenic infections associated with comorbidities, such as diabetes mellitus, can result in a potentially lethal complication, with rapid necrosis of the superficial fascia, necrotizing fasciitis. In this case report, a female patient, 52 years old, fasting blood glucose of 303 mg/dL with necrotizing fasciitis associated with type 2 diabetes mellitus in the left cervical-thoracic region. She was treated with antibiotics, cervicotomy, abscess drainage, and underwent 10 photobiomodulation sessions with 2 weekly applications of the red wavelength laser to correct tissue loss in the left cervical region. With the development of tissue healing, the formation of granulation tissue increased, absence of necrotic areas, contraction of the edges, and total wound repair. This case emphasizes the effectiveness of photobiomodulation to optimize healing and modulate the inflammatory pattern in the treatment of necrotizing fasciitis sequelae. Address correspondence and reprint requests to Dr Abrahão Cavalcante Gomes De Souza Carvalho, Alexandre Baraúna Street, 949, Rodolfo Teófilo, ZIP code: 60430-160, Dental Clinic 05, Fortaleza, Brazil; e-mail: abrahao@ufc.br Received 14 November, 2020 Accepted 2 December, 2020 The authors report no conflicts of interest. © 2021 by Mutaz B. Habal, MD.

Time Reduction by Prebending Osteosynthesis Plates Using 3D-Printed Anatomical Models, In Patients Treated With Open Reduction and Internal Fixation Introduction: The incidence of facial bones fractures is 18 to 32 for each 100,000 inhabitants. The most affected population are young working people. Fractures are most commonly caused by assaults and motor vehicle accidents. Its cost of care reaches 1.06 billion dollars. Premodeling osteosynthesis plates with anatomical models can decrease surgical time, bleeding, and increase patient satisfaction. This study aims to evaluate the impact of premodeled osteosynthesis plates, using anatomical models in patients with facial fractures. Material and Methods: Patients with facial fractures treated by open reduction and internal fixation were included—Group A without premolding plates and Group B with premolding. The variables studied were: age, sex, etiology of the fractures, number of fractures, among other variables that reflect the quality of the results. Results: A total of 17 osteosynthesis plates were included in 6 patients. The age was 22 to 47 years; all patients were male. The maximum surgery time was 129 to 300 minutes. The average time to start work was 4.8 weeks. When comparing the variables between the groups, we found no difference between the groups for bleeding P = 0.24, the start of work P = 0.19, the time of surgery P = 0.082, or for osteosynthesis time P = 0.15. There was only a significant difference in patient satisfaction, P = 0.04. Conclusions: The evidence collected shows that premodeling the plates only improves patients' satisfaction among facial fractures treated by open reduction and internal fixation. Address correspondence and reprint requests to Marco Aurelio Rendón-Medina, MD, Hospital General "Dr. Rubén Leñero," Plan de San Luis -Salvador Díaz Mirón no number, Col. Santo Tomás, Miguel Hidalgo. ZC. México City, México; E-mail: dr.rendon1989@gmail.com, md_marm@hotmail.com Received 2 November, 2020 Accepted 2 December, 2020 All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the Hospital Ruben Leñero. The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2021 by Mutaz B. Habal, MD.

#

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Telephone consultation 11855 int 1193,