RESUMEN
PURPOSE: In the context of the ongoing development and expanding availability of 3-dimensional (3D) printing, there is increasing interest in designing simplified workflows that would encourage more medical practitioners to include 3D printing in their current practice. The purpose of this study is to present our experience regarding the use of 3D printing in the preoperative planning and management of acute midface trauma, an area less explored by existing studies. METHODS: We performed a retrospective case series study including admitted patients who underwent surgical repair of midface fractures, in which 3D-printed stereolithic models were used preoperatively for shaping the osteosynthesis material. We recorded standard information about the patients, imaging method used, and type of midface fracture. We also logged the details and durations of each main step in the preoperative 3D printing workflow and documented the durations and outcomes of each surgical procedure. RESULTS: We identified 29 cases of midface fractures that benefited of a preoperative stereolithic model. From the 2 main methods of obtaining the virtual model, mirroring and virtual fracture reduction, the longest duration was recorded in a case in which the later method was used. The longest stereolithic model printing time was found in a complex midface fracture case. All the prebent osteosynthesis material was used intraoperatively and fitted the reduced fracture sites, also serving as an intraoperative guide for correct fracture reduction. The particularities, benefits, as well as the possible challenges associated with the application of 3D printing in acute trauma cases are discussed. CONCLUSIONS: Our 3D printing protocol was applicable and rendered favorable outcomes in the acute midface trauma setting. Proper understanding of the steps involved in achieving the stereolithic model is key for the adaptation of 3D printing to the current management of acute midface trauma.
Asunto(s)
Fracturas Óseas , Cirugía Asistida por Computador , Fijación Interna de Fracturas , Humanos , Impresión Tridimensional , Estudios RetrospectivosRESUMEN
Due to the anatomical and functional complexity of the region, craniofacial tumor removal requires some of the most challenging surgical approaches, often complemented with advanced chemo-radiotherapy techniques. However, these modern therapies often lead to sequelae that can drastically reduce the quality of life for the surviving patients. Recent advances in the field of regenerative medicine opened new avenues for craniofacial reconstruction following head and neck cancer treatment. One of the most promising recent strategies relies on the use of autologous fat transplant. In this mini review, we briefly present some of the fat's biological properties that make it an ideal tissue for craniofacial reconstruction following cancer treatment. We then outline the recent advances that led to a better understanding of the detailed anatomy of the craniofacial fat depots. Furthermore, we provide a succinct review of the methods used for fat harvesting, processing and engrafting in the craniofacial area after head and neck tumor removal, discussing their main applications, advantages and limitations.
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Tejido Adiposo/trasplante , Neoplasias de Cabeza y Cuello/cirugía , Trasplante Autólogo/métodos , Tejido Adiposo/anatomía & histología , Tejido Adiposo/fisiología , Cara/cirugía , Humanos , Procedimientos de Cirugía Plástica/métodos , Recolección de Tejidos y Órganos/métodosRESUMEN
PURPOSE: Sialolithotomy for submandibular gland lithiasis is a common procedure often performed in the office setting, with the patient under local anesthesia. The location, size, and number of the sialoliths can greatly influence the indication owing to the difficulty of the procedure for hilar and proximal calculi. The purpose of the present study was to report our experience regarding the advantages of using preoperative cone-beam computed tomography (CBCT) to evaluate submandibular gland lithiasis in patients undergoing sialolithotomy for calculi located anywhere in the area of Wharton's duct, with special regard to hilar and proximal calculi. MATERIALS AND METHODS: We performed a retrospective study by reviewing the medical records of patients with a diagnosis of sialolithiasis of the submandibular gland using CBCT performed the day of stone removal by sialolithotomy. We have described the operative technique and the CBCT landmarks used for intraoperative orientation and control. RESULTS: Thirty-two patients with submandibular sialolithiasis were included in the present study. A total of 51 salivary stones were identified using CBCT. Proximal and hilar calculi were encountered in 14 cases. The number of calculi diagnosed using CBCT matched the number of surgically removed calculi in all cases. Transient lingual nerve hypoesthesia was encountered in 2 patients. No obstructive symptoms recurred after surgery. CONCLUSIONS: We found that preoperative CBCT allows for an optimal understanding of the individual stone configuration in relation to the patient's anatomy. It allows for easy identification of the calculi during sialolithotomy, leading to greater confidence in approaching proximal and hilar stones.
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Cálculos del Conducto Salival , Cálculos de las Glándulas Salivales , Enfermedades de la Glándula Submandibular , Tomografía Computarizada de Haz Cónico , Endoscopía , Humanos , Estudios Retrospectivos , Conductos Salivales , Cálculos de las Glándulas Salivales/diagnóstico por imagen , Cálculos de las Glándulas Salivales/cirugía , Glándula Submandibular , Enfermedades de la Glándula Submandibular/diagnóstico por imagen , Enfermedades de la Glándula Submandibular/cirugíaRESUMEN
This manuscript highlights key aspects regarding the practical use of botulinum toxin for the conservative nonsurgical treatment of a rarely encountered, but significant posttraumatic complication-the parotid salivary fistula. It adds information to the scarce existing literature on the subject. The authors outline the main differences between postoperative and trauma-related parotid injury regarding salivary fistula treatment. A total of 6 patients with trauma-related salivary fistulas have been treated by Abobotulinum toxin A injections over the course of 5 years. The technique is detailed, describing the doses used in the presence of parenchyma and duct injuries, the location and number of injection points in relation to the wound pattern. The results were favorable, leading to the healing of the salivary fistulas in all patients, with 1 injection session, without additional conservative treatment. In our experience, the use of botulinum toxin is of great benefit for treating salivary fistulas in a traumatic context.
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Inhibidores de la Liberación de Acetilcolina/uso terapéutico , Toxinas Botulínicas Tipo A/uso terapéutico , Fístula Cutánea/tratamiento farmacológico , Traumatismos Faciales/complicaciones , Enfermedades de las Parótidas/tratamiento farmacológico , Fístula de las Glándulas Salivales/tratamiento farmacológico , Inhibidores de la Liberación de Acetilcolina/administración & dosificación , Adolescente , Adulto , Toxinas Botulínicas Tipo A/administración & dosificación , Fístula Cutánea/etiología , Fístula/tratamiento farmacológico , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Enfermedades de las Parótidas/etiología , Fístula de las Glándulas Salivales/etiología , Adulto JovenRESUMEN
PURPOSE: The objective of this study was to present the authors' experience in static facial reanimation using a straightforward incisionless procedure adapted from techniques commonly used for performing minimally invasive facelifts. MATERIALS AND METHODS: Seventeen patients were treated by static suspension using barbed sutures and all resulting changes were reviewed. The technique used for suture placement is described in detail, as are the author's tips for achieving the best esthetic and functional results. All patients had preoperative indication for physiotherapy and rehabilitation procedures (local massage and mirror therapy). Facial nerve function was evaluated using the Arianna Disease Scale. RESULTS: The cosmetic outcome improved in all cases, with marked amelioration of the preoperative facial asymmetry. Oral competence was enhanced by elevating the oral commissure and reinforcing the cheek, and amelioration of symptoms related to lagophthalmos was achieved through increased support and decreased pull on the inferior eyelid. The addition of physiotherapy with specific rehabilitation exercises before the surgical intervention increased the success rate. CONCLUSION: This technique proved to be a good alternative to other static reanimation procedures because of its straightforward technique, availability, good outcomes, low complication rate, and ability to perform minor adjustments and corrections at any time.