J. Michael Key

Complications of laser surgery for laryngeal papillomatosis.

Carbon dioxide laser surgery has become the treatment of choice for laryngeal papillomatosis. The purpose of this study was to determine the type, incidence, and severity of complications that occur with laser microlaryngoscopy for a disease that often requires multiple operations.

Complications, salvage, and enhancement of local flaps in facial reconstruction

Complications are part of every surgical procedure and their occurrences are inevitable if the surgeon performs enough operations during his/her lifetime. Learning how to prevent complications and how to manage them when they occur are as important as learning how to perform any given surgical procedure. This is especially true in facial reconstruction with local flaps, as complications threaten not only the functional restoration of the integrity, but also the cosmetic appearance of the patient. This article describes common complications and their underlying mechanisms seen in facial reconstruction with local flaps as well as their treatment or prevention, when possible.

Glabellar Frown Lines as a Reliable Landmark for the Supratrochlear Artery

OBJECTIVE: Preservation of the supratrochlear vascular pedicle (SVP) during use of the paramedian forehead flap can be accomplished by the aid of Doppler imaging; however, a reliable surface landmark may be invaluable in cases where Doppler examination fails. Our observations showed that the most prominent glabellar frown lines (GFLs) are very close to the SVP; however, the actual relationship of these structures remains unclear. STUDY DESIGN: The relationship between GFLs and the SVP was investigated in 19 volunteers by the aid of Doppler imaging and in 8 cadaver heads by dissection. The distance between the GFLs and the SVP was measured. SETTING: The study took place at an academic tertiary-care facility. RESULTS: The SVP was located just at the GFLs in almost 50% of the cases and an average of 3.2 mm lateral to GFLs in the remaining cases. CONCLUSION: GFLs may serve as reliable surface landmarks in the use of the paramedian forehead flap where Doppler imaging was not helpful.

The effects of molar tooth involvement in mandibular angle fractures treated with rigid fixation

Objective: To determine whether the presence of a tooth in the line of mandibular angle fracture increases the incidence of complications and whether removing these teeth has an effect on complication rates. Design: Case series with chart review. Subjects and Methods: The analysis was performed on 83 patients who underwent open reduction and internal fixation for mandibular angle fractures. Lower molar teeth involved in the fracture line were extracted if they were loose, fractured, or grossly infected or prevented satisfactory reduction. Data regarding demographics, involvement of a molar tooth, management of the involved tooth, and postoperative outcome were analyzed. Statistical analysis was performed by using likelihood ratio χ2 and logistic regression. Results: The revision surgery in fractures with molar tooth involvement was 28.9 percent, compared to 12.9 percent when no tooth was involved (P = 0.084). When a tooth was involved in the fracture, the revision surgery rate was 25 percent when it was removed and 30% when it was preserved (P = 0.734). Conclusion: Postoperative complications, especially the revision surgery rates, may not increase by involvement of lower molar teeth in the fracture line and selective removal of these teeth by using commonly accepted guidelines may not decrease complication rates in angle fractures.

Manually provided temporary maxillomandibular fixation in the treatment of selected mandibular fractures

Objective To report the occlusal outcomes of manually provided temporary intraoperative maxillomandibular fixation (MMMF) for the open repair of selected mandibular fractures. Study Design/Subjects and Methods A retrospective chart review of the patients who underwent open reduction and internal fixation of mandibular fractures with MMMF was performed. Results Twenty-six patients underwent open reduction and internal fixation with MMMF. Postoperative data were available for only 16 patients who kept their follow-up appointments. With the exception of one patient who experienced minimal cross-bite in the right molar region, all of the patients had their original normocclusion. Conclusion Preliminary results of MMMF suggest that satisfactory postoperative occlusal outcomes may be obtained without the use of wire-based maxillomandibular fixation methods in selected mandibular fractures.

Management of Pediatric Mandible Fractures

Objectives: The use of conservative measures, mandibulomaxillary fixation (MMF), and closed reduction in children with mandible fractures has been advised due to developing dentition. Open reduction and internal fixation (ORIF) of mandible fractures with non-resorbable plates has been the preferred procedure in young children at our institution. This study evaluates the outcomes of ORIF in the management of pediatric mandible fractures. Methods: A six year retrospective chart review of children, ages 18 years and younger, treated at a tertiary pediatric hospital for mandible fractures. Demographics, fracture site, mode of treatment, and complications were evaluated. Results: A total of 303 records of children evaluated for facial fractures were reviewed. Complete records of 62 patients who suffered from a mandible fracture were identified (M = 48, F = 14, mean age = 15 years (range 2-18)). The most common fracture sites were angle (37%) and parasymphyseal (35%). Assault (53%) was the most common cause. Three patients were treated conservatively, and 1 was placed in MMF only. Fifty-eight patients (93.8%) underwent ORIF, 6 of which were placed in MMF concurrently. Average follow-up was 141 days (14-800). Complications included plate removal in 11 patients (18.9%; 6 for extruded hardware), malocclusion in 8 patients (12.9%), and infection in 1 patient. Conclusions: Management of mandibular fractures in the pediatric population can be both challenging and controversial. Many authors advocate the use of MMF whenever possible secondary to the known potential complications of ORIF. This study suggests that conservative management or ORIF of selected displaced fractures, avoiding the need for MMF, has favorable outcomes.

Hardware Removal Rates for Mandibular Angle Fractures: Comparing the 8-Hole Strut and Champy’s Plates

Objective: 1) Compare the rate of removal of Champy’s plates vs 8-hole strut plates used for repair of mandible angle fracture. 2) Determine the reason for removal of these plates. Method: A retrospective chart review was conducted from 2006 to 2010 comparing the removal rate between Champy’s plates and 8-hole strut plates for internal fixation of traumatic angle mandible fractures at a large adult tertiary care hospital. The reason for removal of each plate was then determined from the clinical record. Results: A total of 104 patients with a total of 106 angle fractures met the inclusion criteria for this study. A total of 73 angle fractures were treated with the 8-hole strut and 33 angle fractures were treated with Champy’s plates. There were 6 plates removed in both groups. This resulted in 8.2% of plates removed in the 8-hole strut plate group and 18.2% in the Champy’s group (P = .133). Loose hardware was determined to be the cause of plate removal in 1 (2.7%) of the 8-hole strut plate group compared with all 6 (18.2%) of the Champy’s group (P = .005). Conclusion: In our experience, the 8-hole strut plate has a lower rate of plate removal compared to the Champy’s plate in treating mandible angle fractures. The main reason for plate removal was loose hardware. The rate of removal for loose hardware was higher and statistically significant in the Champy’s group.

Management of the Difficult Mandible

Educational objectives: To understand the difficulties involved in the management of complex mandibular trauma and to familiarize the participant with the decision making options with common difficult mandible fractures.