Brett A. Miles

Fractures of the mandible: A technical perspective

Summary: The purpose of this article is to describe the treatment of mandibular fractures using principles of functionally stable or rigid internal fixation techniques. The fixation requirements for various fractures of the mandible, excluding those of the condylar process (which are discussed in another article), are described using mandibular biomechanics as a basis for the recommendations.

Experience with cranial implant-based prosthetic reconstruction.

Reconstruction of acquired or congenitally absent facial structures is a challenging task for the reconstructive surgeon. Often inadequate soft tissue, cartilaginous, or osseous support exists for a reconstruction which is functional, aesthetic, and achieved with a reasonable effort on the part of the surgeon and patient. Prosthetic reconstruction of these structures utilizing cranial implants is a viable option which offers several advantages when compared to traditional reconstructive techniques. We present our experience with 114 cranial implants in 32 patients for craniofacial reconstruction. One hundred fourteen cranial implants were placed in a total of 32 patients for reconstruction of facial structures. Indications for cranial implants with prosthetic reconstruction were lack of adequate tissue for reconstruction, failed reconstructive attempts, and selection of the technique by the patient. Seventy-two implants were placed in the mastoid region, 31 within the orbit, 7 within the nasal cavity, with four additional implants for the reconstruction of eyebrows. Cranial implants were followed by clinical and radiographic examination at intervals ranging from 3-46 months (mean 15.3 months). Patient records were retrospectively reviewed for surgical complications, soft tissue reactions, infections, and implant failures. The total success rate of cranial implantation in the study group was 92.9% (106/114). Surgical complications occurred in three of the 32 patients (9.3%). All cranial implants were successfully reconstructed after integration. Seven percent of the implants failed after initial integration was successful. The rate of significant soft tissue reactions or frank infection observed among the implanted patients was 6.1%. Titanium cranial implants coupled with custom prosthetic reconstruction offer an excellent alternative to traditional surgical techniques in the reconstruction of acquired or congenitally absent facial structures. Predictability, prosthetic adaptability, as well as superior aesthetics are major advantages to this technique when compared to traditional surgical reconstructive techniques.

Anatomical variation of the nasal septum: Analysis of 57 cadaver specimens

Objectives The purpose of this study was to examine the anatomical variation of the osseous and cartilaginous components of the nasal septum. Study Design Fifty-seven cadaver specimens were digitally scanned and analyzed utilizing Bersoft Image software. Anatomical data were statistically analyzed utilizing SPSS 13.0. Evaluation of the area of the osseous/cartilaginous nasal septum as well as an estimation of the available cartilage for grafting was performed. Results Septal specimens revealed males had greater variation in cartilaginous area compared to female specimens. The intranasal/extranasal cartilage contributes about 45%/55% of the total cartilage, respectively. The data indicate that the mean area of cartilage available for grafting is around 420 mm2. Conclusions Significant variability in the cartilaginous elements of the nose is the rule rather than the exception. Key differences exist in the anatomic location of the graft material between males and females. This has important surgical implications given the critical attention required during graft harvesting in order to maintain support of the nose.

Extending the traditional resection limits of squamous cell carcinoma of the anterior skull base

Objective Preliminary report to evaluate the efficacy of resection of squamous cell carcinomas that demonstrate intracra-nial invasion. Methods A retrospective review of all cases of extracranial squamous cell carcinomas that extend intracranially treated by a single surgeon. Results A total of 21 cases were reviewed. In 6 cases, there was noted to be overt brain invasion. Complete resection of the intracranial disease was achieved in each of the remaining 15 cases. There were no instances of CSF leak, meningitis, brain abscess, stroke, or other intracranial complication noted either acutely or secondarily. In follow-ups that ranged from 10 months (single patient died of disease at 10 months) to 6 years (average, 3.8 years), there were no instances of intracranial recurrence. There was a disease-free control rate of 67.7% at an average follow-up of 4.1 years. Conclusions Extending the resection of squamous cell carcinoma into the intracranial vault judiciously as outlined appears to be associated with acceptable outcomes in the treatment of advanced squamous cell carcinoma of the skull base.