D. Srinivasan

Correction of facial and mandibular asymmetry using a computer aided design/computer aided manufacturing prefabricated titanium implant.

AbstractPatients with significant craniofacial asymmetry may have functional problems associated with their occlusion and aesthetic concerns related to the imbalance in soft and hard tissue profiles. This report details a case of facial asymmetry secondary to left mandible angle deficiency due to undergoing previous radiotherapy. We describe the correction of the bony deformity using computer aided design/computer aided manufacturing custom-made titanium onlay using novel direct metal laser sintering. The direct metal laser sintering onlay proved a very accurate operative fit and showed a good aesthetic correction of the bony defect with no reported complications postoperatively. It is a useful low-morbidity technique, and there is no resorption or associated donor-site complications.

Normal Fusion of the Metopic Suture

AbstractThere is some uncertainty as to when normal fusion of the metopic suture occurs. Existing studies have included relatively small numbers and have not used a statistical model to represent any variation in normality. In this study, a total of 337 head computed tomographic scans performed between 2006 and 2009 were retrospectively reviewed after strict exclusion criteria were met. Only patients aged younger than 18 months were included. Assessment was performed by analyzing axial slices of the bony window of the computed tomographic scan by 2 independent investigators. Two separate probit analyses were carried out to estimate the proportion of patients in whom the fusion process would have started and completed. Of 337 patients, 204 (60.5%) were male and 133 were female (39.5%). All patients older than 15 months and 23 days had completely fused metopic sutures. The estimated median age for the start of the fusion process was 4.96 months (95% confidence interval, 3.54–6.76 months), and the estimated median age for the completion of fusion was 8.24 months (95% confidence interval, 7.37–9.22 months). The fusion process completed between 2.05 and 14.43 months of age in 95% of the normal population. The difference between sexes was not significant. In conclusion, there was wide variation in the timing of normal fusion that can complete as early as 2 months of age.

A novel approach to immediate restoration of the cosmetic deformity after regional temporalis flap reconstruction of a maxillary defect: a case report.

Restoration of large maxillary defects can be achieved by using various muscle and bone flap transfers. Free muscle and bone transfer has become the reconstruction standard because it offers a combination of bone and soft tissues, which allows primary closure of the defect and secondary placement of dental implants for a full rehabilitation approach. If free tissue transfer is not a viable option, regional flaps such as temporalis muscle offer a viable alternative. This report presents a novel approach to immediate reconstruction of temporalis defects after muscle transfer to repair a maxillary defect. A custom-made titanium onlay was constructed preoperatively using a three-dimensional model of the patient to restore the absent muscle contour. The implant was placed at the same time as the muscle transfer. A good cosmetic outcome was achieved, and no postoperative complications were reported.