RESUMEN
BACKGROUND AND OBJECTIVES: Reconstruction of the nonstress-bearing portions of the craniofacial skeleton has recently utilized several alloplastic compounds. One such recent compound is hydroxyapatite cement (HAC)--a calcium-phosphate-based product. Its chemical structure consists primarily of calcium phosphate, as does human bone, and this similarity in the mineral structure renders it biocompatible. METHODS AND MATERIALS: Based on clinical indications for HAC, the authors have classified acquired craniofacial defects into four types. This article presents 5 clinical cases with craniofacial fractures, sustained in various accidents, in which hydroxyapatite cement was used to prevent cranial deformities or to reinstate contour. RESULTS AND/OR CONCLUSIONS: Complications were encountered in some of these cases, but all patients healed without any secondary complications. While the short-term experience using hydroxyapatite cement in craniofacial trauma surgery has been favorable, long-term studies in humans are required to validate the safety and efficacy of this product.
Asunto(s)
Cementos para Huesos/uso terapéutico , Sustitutos de Huesos/uso terapéutico , Durapatita/uso terapéutico , Huesos Faciales/lesiones , Fracturas Craneales/cirugía , Adolescente , Adulto , Cementos para Huesos/química , Sustitutos de Huesos/química , Trasplante Óseo , Niño , Durapatita/química , Huesos Faciales/cirugía , Femenino , Estudios de Seguimiento , Hueso Frontal/lesiones , Hueso Frontal/cirugía , Seno Frontal/lesiones , Seno Frontal/cirugía , Humanos , Hidroxiapatitas , Masculino , Fracturas Maxilares/cirugía , Persona de Mediana Edad , Deformidades Adquiridas Nasales/cirugía , Fracturas Orbitales/cirugía , Osteonecrosis/etiología , Procedimientos de Cirugía Plástica , Infección de la Herida Quirúrgica/etiología , Heridas por Arma de Fuego/cirugía , Fracturas Cigomáticas/cirugíaRESUMEN
The objective in treating patients with injuries sustained in craniofacial trauma is to reinstate preinjury facial projection and function. The capability of providing spatially related facial reconstruction is predicated on basic craniofacial surgical principles, generally accepted as the standard of care. These principles include early surgical intervention, immediate bone grafting, and the use of internal rigid fixation. The introduction of osseointegrated dental implants has significantly improved the overall reconstruction of patients with cranio-maxillofacial injuries, including soft tissue repair and cosmetic surgery. The purpose of this article is to review the utilization of dental implants in the context of maxillofacial trauma, using three cases to document the clinical procedure.
Asunto(s)
Implantes Dentales , Traumatismos Maxilofaciales/cirugía , Prótesis e Implantes , Adolescente , Adulto , Trasplante Óseo , Implantación Dental Endoósea , Huesos Faciales/lesiones , Traumatismos Faciales/cirugía , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Nariz , Oseointegración , Diseño de Prótesis , Procedimientos de Cirugía Plástica , Fracturas Craneales/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Heridas por Arma de Fuego/cirugíaRESUMEN
Frontal sinus fractures have been reported in 2 to 12 percent of all cranial fractures and, according to one study, in 8 percent of all facial fractures. Although immediate frontal bone reconstruction is not universally accepted, it is rapidly becoming the standard of care in treating cranial facial fractures, even in the face of gross contamination. This article presents a historical overview of fracture management, a review of the relevant anatomy, and a discussion of appropriate management principles. Three case studies are presented to demonstrate appropriate techniques for the management of frontal sinus fractures.
Asunto(s)
Seno Frontal/lesiones , Fracturas Craneales/cirugía , Tejido Adiposo/trasplante , Adulto , Placas Óseas , Tornillos Óseos , Trasplante Óseo , Legrado , Estudios de Seguimiento , Fijación Interna de Fracturas , Fracturas Conminutas/cirugía , Hueso Frontal/lesiones , Seno Frontal/anatomía & histología , Humanos , Masculino , Persona de Mediana Edad , Osteotomía , Fracturas Craneales/clasificaciónRESUMEN
A technique for total reconstruction of the temporomandibular joint using cryopreserved cartilage and freeze-dried dura is described. The rationale, indications, and surgical technique are discussed. The technique has been used in nine joints in seven patients, followed between 3 and 27 months. There was one total failure of the graft, with the remainder maintaining good, asymptomatic joint function.
Asunto(s)
Cartílago Articular/trasplante , Duramadre/trasplante , Cóndilo Mandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Criopreservación , Estudios de Seguimiento , Liofilización , Humanos , Cóndilo Mandibular/patología , Métodos , Trastornos de la Articulación Temporomandibular/patologíaRESUMEN
Personnel in the VA dental facilities were screened for the detection of viral hepatitis and identification of factors implicating infectivity. A total of 963 personnel from 126 dental facilities throughout the United States voluntarily participated in the study. The rate of seroconversion for any hepatitis B markers was approximately 1% per year. Serial positive tests for antibody to hepatitis B core antigen or antibody to hepatitis B surface antigen (or both) were present in 16.2% of dentists and 13.0% of dental auxiliary personnel. Oral and maxillofacial surgeons composed the highest prevalence occupation (24.0%), and clinical personnel composed the lowest prevalence occupation (8.9%). There was a significant association between years in dental environment and serological positivity for viral B infection. The dentists and dental auxiliary personnel had significant linear trends of increasing serological positivity with years in the dental environment. Although a majority of personnel reported wearing gloves while treating high-risk patients or performing invasive procedures, inadequate prophylactic measures were exercised for most patients undergoing a variety of less invasive procedures. The results of the study show the need for an active immunization program against type B viral infection for dental and dental auxiliary personnel, preferably before the initial exposure to the professional environment.
Asunto(s)
Auxiliares Dentales , Odontólogos , Hepatitis B/diagnóstico , Enfermedades Profesionales/diagnóstico , United States Department of Veterans Affairs , Atención Odontológica , Guantes Quirúrgicos , Hepatitis B/etiología , Hepatitis B/prevención & control , Antígenos del Núcleo de la Hepatitis B/análisis , Antígenos de Superficie de la Hepatitis B/análisis , Humanos , Máscaras , Enfermedades Profesionales/etiología , Enfermedades Profesionales/prevención & control , Riesgo , Estados UnidosRESUMEN
A prospective randomized trial comparing hyperbaric oxygen and systemic antibiotics in the prevention of osteoradionecrosis was presented. The results indicated, in a high-risk population who required tooth removal in irradiated mandibles, that up-front hyperbaric oxygen produced an incidence of osteoradionecrosis of 5.4% as compared with the antibiotic group of 29.9% (P = .005). Hyperbaric oxygen should be considered a prophylactic measure when post-irradiation dental care involving trauma to tissue is necessary.
Asunto(s)
Oxigenoterapia Hiperbárica , Enfermedades Mandibulares/prevención & control , Osteorradionecrosis/prevención & control , Penicilina G/uso terapéutico , Traumatismos por Radiación/prevención & control , Ensayos Clínicos como Asunto , Humanos , Mandíbula/efectos de la radiación , Estudios Prospectivos , Distribución Aleatoria , Riesgo , Factores de Tiempo , Extracción Dental/efectos adversos , Cicatrización de HeridasRESUMEN
Freeze-dried allogeneic bone combined with autogenous particulate cancellous bone and marrow was used for reconstruction in 56 patients. With the exception of 3 patients who had infection postoperatively, the patients had complete acceptance of the composite graft system. Histologic examination at 2, 3, 12, 18, and 24 months demonstrated early incorporation, revascularization, resorption of the freeze-dried component, and formation of a bone ossicle that continued to remodel and form mature lamellar bone. This study suggests that freeze-dried allogeneic bone can serve as a latticework along which osteocompetent cells can proliferate, that composite grafts are readily accepted and will form a satisfactory and predictable bone ossicle over a considerable defect, and that freeze-dried allogeneic bone induces the host mesenchymal cells to differentiate into mature osteoblasts and aids in the formation of a long-lasting functional bone graft.
Asunto(s)
Trasplante de Médula Ósea , Trasplante Óseo , Biopsia , Médula Ósea/patología , Regeneración Ósea , Huesos/patología , Liofilización , Supervivencia de Injerto , Humanos , Mandíbula/cirugía , Maxilar/cirugía , Factores de Tiempo , Cigoma/cirugíaAsunto(s)
Fracturas Maxilomandibulares/terapia , Férulas (Fijadores) , Humanos , Arcada Edéntula , MétodosRESUMEN
Osseous reconstruction must be predicated on the cellular mechanisms related to bone regeneration. The use of particulate bone and cancellous marrow in allogeneic cribs was developed with cellular physiology as its basis. Consequently, this form of graft system has repeatedly met the requirements for osseous reconstruction. Hyperbaric oxygen therapy, when utilized to improve local tissue physiology, offers the surgeon another modality to overcome some of the unique problems of the oncologic patient.
Asunto(s)
Huesos/cirugía , Trasplante de Médula Ósea , Regeneración Ósea , Trasplante Óseo , Tejido Conectivo/cirugía , Humanos , Oxigenoterapia Hiperbárica , Ilion/trasplante , Mandíbula/cirugía , Maxilar/cirugía , Microcirugia , Procedimientos Quirúrgicos Vasculares , Cicatrización de HeridasRESUMEN
Clinical experience with 36 cases using freeze-dried allogeneic bone is reported. Its use in a variety of surgeries, including ridge augmentation, mandibular and maxillary osteotomies, mandibular reconstruction, midfacial advancement and obliteration of cystic cavities was associated with a minimal incidence of complications and excellent host acceptance. The collection of bone under sterile conditions and the rigid criteria for the tissue banking process are shown to account for this host compatibility and low complication rate. The physiochemical and biologic properties of freeze-dried allogeneic bone are discussed. This material provides unique practical advantages leading to long-term stability.
Asunto(s)
Trasplante Óseo , Huesos Faciales/cirugía , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Adulto , Niño , Preescolar , Femenino , Liofilización , Humanos , Maxilares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Mucosa Bucal/fisiología , Radiografía , Infección de la Herida Quirúrgica/etiología , Conservación de Tejido , Trasplante Homólogo , Cicatrización de HeridasRESUMEN
The survival of human marrow cells during the placement of marrow-cancellous bone grafts was studied by three independent viability assays. Marrow cells are resistant cells able to survive the surgical harvest from the ilium. Salt solutions such as normal saline solution and 5% dextrose in water (D5W) were superior to tissue culture medium, the serum of the patients, and several other solutions in supporting the survival of the graft cells. High survival rates of marrow cells stored in normal saline solution and D5W for four hours or less established that 95% to 100% live cells can be transplanted even with long delays between harvest and placement of the graft.
Asunto(s)
Células de la Médula Ósea , Trasplante Óseo , Médula Ósea/metabolismo , Trasplante de Médula Ósea , Supervivencia Celular , Colorantes , Humanos , Ilion/trasplante , Mandíbula/cirugía , Timidina/metabolismo , Factores de Tiempo , Conservación de Tejido , Trasplante AutólogoRESUMEN
Electrodiagnostic testing can be used to determine the extent of injury to peripheral nerves. assessment of the function of the nerves after injury is essential for determination of the prognosis and for treatment.