RESUMEN
The authors present the clinical results of their method of customized reconstruction of orbital wall defects using titanium mesh or sheet. High resolution computed tomography (CT) data are imported and processed to create a three-dimensional (3D) image which is used to reconstruct the orbital defect. Mirror imaging of the air in the contralateral maxillary sinus is used to overcome artefact defects in the floor. A stereolithographic model is constructed, from which titanium mesh or sheet is shaped and sized to the required contours for implantation. Twenty-two patients were treated using this technique from 2003 to 2008. Postoperatively 10 patients reported early resolution of their diplopia. Six patients noticed significant improvement of their symptoms with mild residual diplopia in one direction only and at the extremes of gaze at final review. One patient required ocular muscle surgery. Enophthalmos resolved in eight of the nine cases. No patients developed enophthalmos or diplopia as a postoperative complication. The use of titanium mesh for orbital floor reconstruction has been shown to be safe and effective. Customized titanium implants accurately reproduce orbital contours thus restoring orbital volume. This reduces operative time and improves the functional and aesthetic outcomes of post-traumatic orbital reconstruction.
Asunto(s)
Materiales Biocompatibles , Órbita/cirugía , Fracturas Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Mallas Quirúrgicas , Titanio , Adolescente , Adulto , Diseño Asistido por Computadora , Diplopía/cirugía , Enoftalmia/cirugía , Movimientos Oculares/fisiología , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Modelos Anatómicos , Músculos Oculomotores/cirugía , Diseño de Prótesis , Implantación de Prótesis/métodos , Procedimientos de Cirugía Plástica/instrumentación , Estudios Retrospectivos , Seguridad , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Interfaz Usuario-Computador , Adulto JovenRESUMEN
This study compared fixation of simple mandibular angle fractures with a single miniplate either placed from a combined transbuccal and intra-oral approach, or intra-orally alone. 140 consecutive patients were randomly allocated to the two treatment groups. Complications were noted and compared. An email questionnaire to all the participating surgeons examined their personal preferences between the two methods. 20% of plates needed to be removed during the 3 month study period in the combined transbuccal/intra-oral group compared with 36% in the intra-oral alone group (pAsunto(s)
Placas Óseas
, Fijación Interna de Fracturas/métodos
, Fracturas Mandibulares/cirugía
, Adolescente
, Adulto
, Femenino
, Fijación Interna de Fracturas/instrumentación
, Humanos
, Masculino
, Persona de Mediana Edad
, Resultado del Tratamiento
, Adulto Joven
RESUMEN
Inadequate treatment or neglect of odontogenic infections can have serious consequences. The potential for spreading through fascial planes and intracranially can cause compromise of the airway and cavernous sinus thrombosis respectively. On rare occasions this can lead to a rapidly progressing necrotising fasciitis, with destruction of soft tissue, making reconstruction difficult. Antibiotic administration without removal of the cause is inadequate and can complicate subsequent management. We report the presentation and successful management of a 13-year-old boy, who developed necrotising fasciitis in the submandibular region as a result of inadequate initial treatment of a carious, lower molar resulting in significant skin and soft tissue loss.
Asunto(s)
Fascitis Necrotizante/etiología , Infección Focal Dental/complicaciones , Absceso Periapical/complicaciones , Adolescente , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Antibacterianos/uso terapéutico , Fascitis Necrotizante/cirugía , Humanos , Masculino , Cuello , Absceso Periapical/cirugía , Infecciones Estreptocócicas/tratamiento farmacológicoRESUMEN
A case of progressive osteolysis of the mandibular condyles in a 55-year-old female patient with systemic sclerosis (SSc) is described. Orofacial involvement and radiological manifestations of SSc are discussed.
Asunto(s)
Cóndilo Mandibular/patología , Enfermedades Mandibulares/etiología , Osteólisis/etiología , Esclerodermia Sistémica/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Mordida Abierta/etiología , Trastornos de la Articulación Temporomandibular/etiologíaRESUMEN
We have designed a form to facilitate referral of injured patients between maxillofacial and ophthalmology units. This form improves communication, gives a written record of referral, and can be used for audit.
Asunto(s)
Lesiones Oculares , Traumatismos Maxilofaciales , Registros Médicos/normas , Transferencia de Pacientes/normas , Derivación y Consulta/normas , Unidades Hospitalarias , Humanos , Auditoría Médica/normas , Derivación y Consulta/organización & administraciónRESUMEN
The over-ordering of cross-matched blood to cover operations can result in blood shortages and is costly; it can never be free of risk. Current published guidelines recommend cross-matching 2 units of blood for bimaxillary orthognathic procedures with an additional 2 units if combined with a genioplasty. We reviewed the records of 115 consecutive cases of simultaneous bimaxillary osteotomies at Morriston Hospital over a 5-year period (January 1996 to December 2000). Ordering and use of blood were investigated and the cost analysed. Blood loss was minimised using a strategy of controlled moderate hypotension and meticulous haemostasis. Nine patients were given transfusions of blood but five of these were deemed inappropriate. No predisposing factors for transfusion were identified. We recommend that the tariff for ordering blood for bimaxillary osteotomies should be revised to a "group and save" with antibody screen, providing that a 30-min indirect antibody cross-match is available.
Asunto(s)
Transfusión Sanguínea/estadística & datos numéricos , Procedimientos Quirúrgicos Orales/métodos , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Adulto , Transfusión Sanguínea/economía , Femenino , Técnicas Hemostáticas , Humanos , Hipotensión Controlada , Masculino , Osteotomía/métodos , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Escocia , Procedimientos InnecesariosAsunto(s)
Anticoagulantes/uso terapéutico , Atención Dental para Enfermos Crónicos , Extracción Dental , Warfarina/uso terapéutico , Atención Dental para Enfermos Crónicos/economía , Odontología General , Hospitalización/economía , Humanos , Relación Normalizada Internacional , Ensayos Clínicos Controlados Aleatorios como Asunto , Extracción Dental/economíaAsunto(s)
Anticoagulantes/uso terapéutico , Extracción Dental , Warfarina/uso terapéutico , Anticoagulantes/efectos adversos , Humanos , Relación Normalizada Internacional , Hemorragia Bucal/prevención & control , Hemorragia Posoperatoria/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Warfarina/efectos adversosRESUMEN
Orbital cellulitis is uncommon. It may arise as a sequel to eyelid infection, or from direct spread of infection from the paranasal sinuses; it may be of odontogenic origin and has been reported after meningitis and after nasoorbital fractures with pre-existing sinusitis. Clinically, orbital cellulitis is of great importance, as it is a severe disease with potentially disastrous consequences. It may lead to optic neuritis, optic atrophy, blindness, cavernous sinus thrombosis, superior orbital fissure syndrome, meningitis, subdural empyema, and even death. We report two cases of severe post-traumatic orbital cellulitis with subperiosteal abscesses. These were managed surgically and vision was preserved. We describe the anatomy, a classification of orbital infection, and the importance of multidisciplinary management of these cases.
Asunto(s)
Celulitis (Flemón)/etiología , Enfermedades Orbitales/etiología , Fracturas Craneales/complicaciones , Adulto , Combinación Amoxicilina-Clavulanato de Potasio/administración & dosificación , Celulitis (Flemón)/clasificación , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/cirugía , Descompresión Quirúrgica , Drenaje , Quimioterapia Combinada/administración & dosificación , Humanos , Inyecciones Intravenosas , Masculino , Órbita/anatomía & histología , Enfermedades Orbitales/tratamiento farmacológico , Enfermedades Orbitales/cirugíaAsunto(s)
Anticoagulantes/uso terapéutico , Extracción Dental , Warfarina/uso terapéutico , Procedimientos Quirúrgicos Ambulatorios , Anticoagulantes/administración & dosificación , Inglaterra , Humanos , Relación Normalizada Internacional , Hemorragia Bucal/etiología , Hemorragia Posoperatoria/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Warfarina/administración & dosificaciónRESUMEN
A randomized controlled trial was set up to investigate whether patients who were taking warfarin and had an International Normalised Ratio (INR) within the normal therapeutic range require cessation of their anticoagulation drugs before dental extractions. Of 109 patients who completed the trial, 52 were allocated to the control group (warfarin stopped 2 days before extraction) and 57 patients were allocated to the intervention group (warfarin continued). The incidence of bleeding complications in the intervention group was higher (15/57, 26%) than in the control group (7/52, 14%) but this difference was not significant. Two patients in the study required hospital review for bleeding and all other episodes of bleeding were controlled by patients at home. Continuing warfarin when the INR is < 4.1 may lead to an increase in minor post-extraction bleeding after dental extractions but we found no evidence of an increase in clinically important bleeding. As there are risks associated with stopping warfarin, the practice of routinely discontinuing it before dental extractions should be reconsidered.
Asunto(s)
Anticoagulantes/uso terapéutico , Extracción Dental , Warfarina/uso terapéutico , Acetaminofén/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos no Narcóticos/uso terapéutico , Anestésicos Locales/administración & dosificación , Anticoagulantes/administración & dosificación , Distribución de Chi-Cuadrado , Intervalos de Confianza , Femenino , Estudios de Seguimiento , Hemostasis Quirúrgica , Humanos , Relación Normalizada Internacional , Lidocaína/administración & dosificación , Masculino , Persona de Mediana Edad , Hemorragia Bucal/etiología , Hemorragia Posoperatoria/etiología , Factores de Riesgo , Estadística como Asunto , Warfarina/administración & dosificaciónAsunto(s)
Anticoagulantes/uso terapéutico , Atención Dental para Enfermos Crónicos , Prótesis Valvulares Cardíacas , Antisépticos Bucales/uso terapéutico , Ácido Tranexámico/uso terapéutico , Acenocumarol/uso terapéutico , Aprobación de Drogas/legislación & jurisprudencia , Humanos , Reino Unido , Warfarina/uso terapéuticoRESUMEN
Patients with reconstruction of craniofacial or intraoral defects experience a profound impact on their quality of life (QOL). This impact on QOL is influenced by the patients' medical conditions and the treatment interventions. Instruments to measure general QOL have been available for many years. A major criticism of QOL instruments is that too often the questions are not specific to the particular problems of a disease or condition. A search of the literature regarding QOL measurement for patients with maxillofacial implant-supported prostheses produced a short list of instruments, none of which were sufficiently developed or suited to the patients involved in reconstructive treatment. This study was designed to develop pretreatment and posttreatment questionnaires for measuring QOL for patients with reconstruction of a craniofacial defect and patients with reconstruction of loss of specific intraoral structures utilizing an implant-supported prosthesis (e.g., severe resorption of the maxilla or mandible or both). The goal was to develop brief, targeted instruments for this specific patient population. The produced instruments were sensitive and easy to administer and score, and no disruption of clinical care occurred with the administration of the questionnaires. The instruments were used with equal success both in face-to-face interviews and via mail.
Asunto(s)
Prótesis Maxilofacial/psicología , Calidad de Vida , Encuestas y Cuestionarios , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado/psicología , Humanos , Satisfacción del Paciente , Perfil de Impacto de EnfermedadRESUMEN
Isotope bone scans have been used for a number of years to assess growth activity in the mandibular condyle in patients who present with facial asymmetry. The aim is to distinguish normal bone growth within the condyle from increased activity that may be the cause of the asymmetry. Previous studies have, however, relied only on planar images. SPECT (single photon emission computed tomography) has been used with quantitative assessments of one mandibular condyle to clivus or lumbar spine, but we have compared one condyle with the other, which is more sensitive and accurate in detecting abnormal activity. A relative percentage uptake of 55% or more in the affected mandibular condyle is considered to be abnormal, and this has been validated by comparison with an age-matched control group. We have used SPECT as an aid to diagnosis and treatment in 18 patients with asymmetrical growth and have constructed a therapeutic algorithm to aid the treatment of these patients.
Asunto(s)
Cóndilo Mandibular/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Fosa Craneal Posterior/diagnóstico por imagen , Asimetría Facial/complicaciones , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/fisiopatología , Asimetría Facial/cirugía , Femenino , Estudios de Seguimiento , Humanos , Hiperplasia , Vértebras Lumbares/diagnóstico por imagen , Masculino , Maloclusión/etiología , Maloclusión/cirugía , Cóndilo Mandibular/crecimiento & desarrollo , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Osteotomía , Radiofármacos , Reproducibilidad de los Resultados , Medronato de Tecnecio Tc 99mRESUMEN
A 53-year-old woman had an orbital mass composed of a neoplastic small round cell infiltrate and no apparent extraorbital primary tumor. Although the initial diagnosis was primary orbital lymphoma, a combination of mucin histochemistry and immunohistochemical staining for cytokeratin and estrogen receptors led to the discovery of an impalpable lobular carcinoma of the breast. We discuss how detailed histopathological assessment can lead to beneficial therapy.