Emil Dediol

European Maxillofacial Trauma (EURMAT) project: A multicentre and prospective study

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries.

Brown class III maxillectomy defects reconstruction with prefabricated titanium mesh and soft tissue free flap.

BackgroundMidface reconstruction is one of the most challenging tasks for the reconstructive surgeon. We present a technique for the reconstruction of the midface after total maxillectomy with preservation of orbital contents. MethodsSkeletal reconstruction is achieved with a preoperatively bent titanium sheet mesh on a universal skeletal model. The alveolar ridge, the anterior wall of the maxillary sinus, the zygomatic prominence, the lower orbital rim, and the orbital floor are reconstructed with a titanium mesh. A soft tissue free flap, preferably anterolateral thigh free flap, is harvested as well. A part of the flap is deepithelized and put in front of the mesh to prevent exposure, and the other part is used for palatal reconstruction. ResultsFour male and 1 female patients were reconstructed with titanium mesh. Four free flaps were raised: 3 anterolateral thigh and 1 latissimus dorsi. All free flaps survived. All patients received postoperative irradiation with 64 Gy. Median follow-up was 12 months; no major complications occurred. Mesh was exposed in only 1 case, which was managed successfully with resuspension of the heavy latissimus dorsi myocutaneous flap. Midface projection and height, globe position, ocular movements, and vision where satisfactory in all cases. ConclusionsMidface reconstruction with titanium mesh and soft tissue free flap is a reliable and safe method for functional and aesthetic reconstruction after maxillectomy.

European Maxillofacial Trauma (EURMAT) in children: A multicenter and prospective study

OBJECTIVE The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year. STUDY DESIGN The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years. RESULTS The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures. CONCLUSIONS Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.

Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration

OBJECTIVE The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study. STUDY DESIGN Demographic and injury data were recorded for each patient who was a victim of an assault. RESULTS Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures. CONCLUSIONS Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.

Modifikacija klizno-rotirajućeg režnja napravljenog 1950. godine

The early techniques of cleft lip repair involved the straight-line technique, the triangular flap technique or some kind of geometric line (triangular, quadrangular closure). A turning point in cleft lip surgery was in 1955 when doctor. Millard presented his method: the rotation-advancement technique or flap, at the First International Congress of Plastic Surgery in Stockholm. Today, the technique, with or without some modifications, is used by more than 85% of cleft surgeons around the world. We are presenting a patient with complete unilateral cleft lip and palate who underwent surgery sixty-five years ago. The scar on his lip was similar to rotation advancement line. Cheiloplasty was performed by Professor Šercer in 1950, five years before Millards publication. Professor Ante Šercer was an internationally recognized Croatian scholar in the area of ear, nose and throat diseases. He also gave a significant contribution to surgical management of velopharyngeal insufficiency and plastic surgery of the nose and ear.

Comparative study between lag screw and miniplate fixation for straight midline mandibular osteotomy

The mandibular swing approach is a surgical approach for the resection of malignant lesions localized in the posterior oral cavity and oropharynx. We analyzed 15 years of experience with fixation of the straight midline mandibulotomy and compared two fixation methods: lag screws and miniplates. A total of 117 patients underwent a straight midline mandibulotomy during the study period; 85 had fixation with two lag screws and 32 with two miniplates. The overall complication rate was low and there was no significant difference in complication rate regarding the fixation method (9% for miniplates vs. 7% for lag screws). The most serious complication over the whole study period was non union, which occurred in only two patients, followed by orocutaneous fistula and infection. Radiotherapy did not cause serious complications and is not regarded as hazardous in midline mandibulotomy patients. We conclude that lag screw fixation is at least as safe as miniplate fixation, but because of better fragment compression, offers faster bone healing.

Underestimated value of communicating vein between deep and superficial venous system of radial forearm free flap.

To the Editor: We read an article by Selber et al regarding the venous drainage of radial forearm free flap with great interest. The authors favor using only 1 venous system by performing anastomosis on a single vein, either cephalic vein (CV) or one of the venae comitantes (VC) (together almost 84% of the cases). In only 9 cases of 370, they performed single anastomosis using a common vein in which these 2 venous drainage systems coalesce together. This fact is interesting because practice in our Department is proportionally inverse. A small interconnecting vein between 2 venous systems of radial forearm free flap has been described by several authors and named as a profundus cubitalis vein, perforating vein, and communicating vein. We also favor performing single venous anastomosis. During harvest of radial forearm free flap, a communicating vein between deep and superficial venous system is included whenever possible. As a result of this, drainage of 2 venous systems is joined together and slow venous outflow is prevented; in fact blood outflow is even increased. After doing arterial anastomosis, observation of venous outflow on 3 free vein ends (2 VC and single CV) is performed for about a minute. The fastest draining vein end is used for anastomosis. There is no need for stopping blood flow again through the flap; the other 2 veins can be left open while doing venous anastomosis. This way ischemia time and reperfusion injury of the flap are decreased. After completion of microanastomosis, the other 2 vein ends are ligated and venous outflow is increased and redirected to the single vein that is used for venous anastomosis. By using both venous drainage systems conjoined only through single anastomosis, either a larger VC or CV, we did not experience significant problems in terms of venous congestion. In fact we believe it is a superior technique as compared with using only one venous system separately, either superficial or deep. In contrast, doing dual venous anastomosis prolongs the surgical time and could only lead to decrease in venous outflow and thrombosis. There have not been any problems in finding a communicating vein. The key is to dissect high enough in the cubital fossa. Usually it is found a bit more proximal than the level of division of brachial artery. Doing single or dual venous anastomosis has been an issue in the literature. We believe that doing single anastomosis is at least as safe as doing dual anastomosis, but with inclusion of a communicating vein in the flap it becomes more safe and reliable regarding venous congestion or thrombosis.

DEVELOPMENT OF A VALID AND RELIABLE INSTRUMENT FORTHE ASSESSMENT OF QUALITY OF LIFE IN ADOLESCENTS WITHCLEFTS - DETECTION OF POTENTIAL MENTAL HEALTH ISSUES

BACKGROUND The rehabilitation of patients with cleft deformities is very complex and unique, and managed by a team of professionals. Quality of life depends on the health, and represents an instrument that examines the disease impact and treatment modalities on the health, integrating an objective assessment of the health status and its subjective experience. Children with clefts are often teased by their peers, and that is the reason why they experience different kinds of psychological distress. Patients with non-syndromic clefts may develop depression and anxiety, hyperactivity, elevated risk of suicide and increased drug abuse in adolescence. SUBJECTS AND METHODS Experienced members of a cleft palate team developed a specific questionnaire divided into 2 parts: the first contains the clinical profile of adolescents, and the second part contains questions regarding quality of life. This questionnaire was administered to 73 patients between June 2015 and June 2016, who matched these criteria during their control examinations at the University Hospital Dubrava. RESULTS In general, the patient group showed significantly worse scores on majority of answers, specifying that their quality of life is worse compared to the control group. The principal component analysis revealed the presence of three components (factors). The interpretation of the three components was consistent with loadings indicating the component names: Component 1: The relationship with parents, success, society; Component 2: Appearance, and Component 3: Function. CONCLUSION According to our results, we created a specific instrument - The Quality of Life in Adolescents with Cleft Assessment to assess aesthetic and functional results of treatment and quality of life of the operated adolescents with clefts. The adolescents in this study have no psychiatric disorders diagnosed in their medical charts, but results indicate that some of them need help in dealing with future life. Regarding these findings, it will be possible to intervene in the process of treatment and improve the overall outcome of therapy.

A Diagnostic Conundrum: Ectopic Nasal Ossification, Submucosal Alveolar Cleft, Absent Posterior Atlantal Arch, and Corpus Callosum Lipoma

A 19-year-old woman was referred for nasal breathing and aesthetic concerns regarding her nose. A computed tomography scan revealed a massive osseous shield anterior to the piriform aperture. Furthermore, there was a submucosal median alveolar cleft, and the posterior arch of C1 was missing. The magnetic resonance imaging brain scan revealed a curvilinear lipoma of corpus callosum. The ectopic nasal bone was removed by open rhinoplast, y and nasal function and aesthetics were restored. The described features defy conventional clinical diagnosis and severity classifications and present a diagnostic conundrum somewhere between a mild form of frontonasal dysplasia, oculoauriculofrontonasal syndrome, and Pai syndrome.

Advanced atherosclerosis of the vascular pedicle of radial forearm free flap in head and neck diabetic patient.

Abstract This study reports a case of severe atherosclerosis of the radial artery encountered during raising of a radial forearm free flap in a 56-year-old head and neck diabetic patient which precluded the use of the flap. This is a condition which most reconstructive surgeons are not aware of.