Claudio Rostetter

Inferior alveolar nerve function after open reduction and internal fixation of mandibular fractures

PURPOSE Mandibular fractures are amongst the most common facial fractures and are usually treated by open reduction and internal fixation (ORIF). Inferior alveolar nerve (IAN) injuries are seen frequently in mandibular fractures as well as after ORIF of these fractures due to the exposition and the close proximity of the nerve during fracture reduction. Therefore the continuity of the IAN can be disrupted. Permanent injury to the IAN can result in diminished quality of life. This retrospective study was designed to objectively analyse the incidence and the outcome of pre- and postoperative mental nerve hypoesthesia after ORIF of mandibular fractures. MATERIAL AND METHODS Patients who were consecutively treated at the Department of Cranio-Maxillofacial and Oral Surgery of the University Hospital Zurich between 2004 and 2010 with mandibular fractures who underwent ORIF were included. Follow-up period was 12 months. Demographic, pre-, peri- and postsurgical data were tabulated and statistically evaluated using the χ(2) test and the Kruskall-Wallis-Test. RESULTS 340 patients met the inclusion criteria. 27% of the study population presented with postinjury (preoperative) mental nerve hypoesthesia, 46% suffered from purely postoperative hypoesthesia and 27% showed no nerve damage. Complete recovery was seen in 70% of all cases, partial recovery in 20% of the cases and less than 10% suffered from a permanent (>12 months) IAN damage. Mandibular angle fractures were accompanied with significantly higher rates of hypoesthesia (79% vs. 68%). Recovery rate was significantly worse in older patients, when preoperative hypoesthesia was present (66% vs. 73%) and in patients with multiple fractures in proximity to the IAN (36% vs. 52%). Mandibular body fractures showed worse recovery rates than fractures that did not affect the body (44% vs. 52%). CONCLUSION The present study shows that IAN injury is seen frequently in mandibular fractures. Mental nerve hypoesthesia may influence quality of life. Nerve continuity may not be preserved due to the initial trauma or may result as a postoperative complication. Nevertheless the results of this study show a high potential for full recovery.

Use of a monopolar microneedle device in a transconjunctival, retroseptal approach

Transconjunctival approach is a standard procedure to address fractures of orbit and the infraorbital rim. Modifications such as transcaruncular or lateral canthal widening allow for extended orbital wall exposure. Especially concerning aesthetics, the transconjunctival approach shows benefits compared to the transcutaneous incisions, such as the transciliary and infraorbital access. Moreover, transconjunctival approach is favored in the literature concerning lid retraction. Monopolar devices have become popular in surgery in the past decades because of good depth control and simultaneous hemostasis with consequently improved overview. Also numerous surgeons use monopolar device in orbital surgery, their safety have never been proved. In this study monopolar microneedle device is compared with conventional access by scalpel concerning lid retraction, foreign body sensation and formation of symblepharon. In our collective complication rates were comparable between the scalpel and the microneedle group. The monopolar microneedle device shows favorable results compared with the scalpel and is easy to handle. Weather the conventional access by scalpel or the access by monopolar device is selected, is rather driven by the surgeons preferences than by statistical relevance. Nevertheless, monopolar microneedle device shows better depth control and simplifies readaptation of the conjunctival wounds margin.

Scapular Free Vascularised Bone Flaps for Mandibular Reconstruction: Are Dental Implants Possible?

ABSTRACT Objectives Free fibula flap remains the flap of choice for reconstruction of mandibular defects. If free fibula flap is not possible, the subscapular system of flaps is a valid option. In this study, we evaluated the possibility of dental implant placement in patients receiving a scapular free flap for oromandibular reconstruction. Material and Methods We retrospectively reviewed 10 patients undergoing mandible reconstruction with a subscapular system free-tissue (lateral border of the scapula) transfer at the University Hospital Zürich between January 1, 2010 and January 1, 2013. Bone density in cortical and cancellous bone was measured in Hounsfield units (HU). Changes of bone density, height and width were analysed using IBM SPSS Statistics 22. Comparisons of bone dimensions as well as bone density were performed using a chi-square test. Results Ten patients were included. Implantation was conducted in 50%. However, all patients could have received dental implants considering bone stock. Loss of bone height and width were significant (P < 0.001). There was a statistical significant increase in bone density in cortical (P < 0.001) and cancellous (P = 0.004) bone. Conclusions Dental implants are possible after scapular free flap reconstruction of oromandibular defects. Bone height and width were reduced, while bone density increased with time.

Intraoperative three-dimensional cone beam computed tomographic imaging during reconstruction of the zygoma and orbit

OBJECTIVE Fractures of the zygoma and orbit are common facial skeleton injuries. Inadequate reduction and internal fixation may result in functional and aesthetic impairment. The aim of this study was to assess the use of intraoperative 3-dimensional (3-D) cone beam computed tomography (CBCT) for determining the intraoperative revision rate and the need for additional reconstruction of the orbit. STUDY DESIGN We conducted a retrospective analysis of 48 consecutive patients (15 females, 33 males) suffering from simple or complex zygomatic fractures, seen between June 2015 and October 2016. Intraoperative 3-D CBCT (Xoran Technologies, Ann Arbor, MI) was performed, and the intraoperative image was overlaid on the preoperative image by using iPlan software (Brainlab, Feldkirchen, Germany) for quality control. Categorical variables were cross-tabulated and compared using Fishers exact test. P values and 95% confidence intervals were assessed. RESULTS In 6 of 48 patients, intraoperative revision was deemed necessary on the basis of the superimposition on the preoperative images. Five of these 6 patients had comminuted fractures (P = .001). In 7 patients, the indication for orbital reconstruction was revised after intraoperative 3-D CBCT. CONCLUSIONS Intraoperative 3-D CBCT allows for immediate revision and prevents unnecessary orbital reconstruction.