Favorable and unfavorable maxillofacial comminuted fractures

Many maxillofacial injuries were reported with the most common ones being nasal bone injuries. In another context, injuries occurring to the mandible followed by the malar bone and axilla are the most common injuries that require surgical interventions. However, favorable outcomes regarding the management of these injuries are associated with many factors. Such factors include the severity of the fracture and the presence of associated morbidities and other fractures, which might lead to unwanted complications and complex management plans. In this study, we aim to discuss the most reported maxillofacial fractures, elaborating when favorable and unfavorable events can be detected. Moreover, this literature review discusses some challenges that might be present in some cases, requiring the integration of certain management skills and techniques. Providing adequate examination is essential to conduct better management. Caring for the associated fractures with the main event is also important, and should be considered to intervene against the development of any adverse events.

Three-Dimensional Radiographic Evaluation of the Malar Bone Engagement Available for Ideal Zygomatic Implant Placement

Zygomatic implant rehabilitation is a challenging procedure that requires an accurate prosthetic and implant plan. The aim of this study was to evaluate the malar bone available for three-dimensional zygomatic implant placement on the possible trajectories exhibiting optimal occlusal emergence. After a preliminary analysis on 30 computed tomography (CT) scans of dentate patients to identify the ideal implant emergencies, we used 80 CT scans of edentulous patients to create two sagittal planes representing the possible trajectories of the anterior and posterior zygomatic implants. These planes were rotated clockwise on the ideal emergence points and three different hypothetical implant trajectories per zygoma were drawn for each slice. Then, the engageable malar bone and intra- and extra-sinus paths were measured. It was possible to identify the ideal implant emergences via anatomical landmarks with a high predictability. Significant differences were evident between males and females, between implants featuring anterior and those featuring posterior emergences, and between the different trajectories. The use of internal trajectories provided better bone engagement but required a higher intra-sinus path. A significant association was found between higher intra-sinus paths and lower crestal bone heights.

Incidence of Maxillofacial Trauma Associated with Complications of Airway

Summary: Objective: To determine the incidence of the maxillofacial traumaand its relationship with airway complications in a third level institution of Santiago de Cali.Materials and Methods: In this cross sectional study, a convenience sample was taken from clinicalrecords of patients older than15 years with clinical diagnosis of maxillofacial trauma, from January1st to December 31st, 2005. A total of 331 clinical histories were reviewed. After selectioncriteria were applied, a total of 199 clinical histories were selected. Results: A greaterproportion of men (81.4 %) were affected by maxillofacial trauma. The major cause of trauma wastraffic accident (89 %). Malar bone was the most affected by fracture (29 cases). Thirteen of 199cases required airway management, due to neurological compromise or active hemorrhages, as well asobstruction of airway caused by foreign bodies. Conclusions: Major maxillofacial traumas areassociated with airway compromise and its clearance becomes difficult by the disruption of faceanatomy. Key words: Airway management. Maxillofacial trauma. Airway obstruction.

Subclavicular Pectoralis Major Myocutaneous Flap for Optimal Reconstruction of Large Orbitozygomatic Defects: A Case Report

Since the introduction of microvascular free flaps, the pectoralis major myocutaneous flap (PMMF) has been relegated to background for most reconstructive surgeons. The objective of this article is to show the advantages of cervicofacial defects reconstruction with PMMF using the subclavicular plane route in a challenging clinical case. An 83-year-old man presented with cutaneous temporomalar lesion with orbital spread. Tumor resection was performed, including 12 × 11 cm skin and subcutaneous tissue, overlying zygomatic and malar bone, and orbital exenteration. Radical parotidectomy and functional neck dissection were performed. PMMF was chosen as reconstructive option routing the pedicle to the subclavicular plane. The length of the pedicle was 31 cm. The subclavicular route for PMMF increases the flap's length and arc of rotation compared with the conventional supraclavicular one. This procedure decreases the bulk of the PMMF pedicle which makes it functionally and cosmetically favorable. By using this modification, we may widen the “safe” reconstructive possibilities.