Piotr Arkuszewski

Clinical application of 3D pre-bent titanium implants for orbital floor fractures

INTRODUCTION Orbital structures are affected in approximately 40% of all cases of craniofacial trauma. Changes in the bony orbital dimensions can alter the function of intraorbital contents and lead to serious complications. The unique anatomy of the orbit and the resulting surgical approaches make the process of fitting and aligning implants difficult, time consuming and operator dependent. It is now possible to make relatively inexpensive anatomical models on the basis of computed tomography images, using rapid prototyping. Such models can be used as templates to form titanium mesh implants, which are then used in the reconstruction of orbital floor defects. MATERIAL AND METHODS Six patients with facial trauma were included in this study. First, 3D virtual models and then physical models were created. These were used as templates to shape the titanium mesh and then intraoperatively as guides to aid correct implant placement in the orbit. RESULTS Significant improvement resulted in three cases and total recovery in three cases. CONCLUSION It is financially viable to build anatomical models, on the basis of CT studies, that can be used in the repair of orbital floor fractures.

Characteristics and epidemiology of zygomaticomaxillary complex fractures.

Objectives: The aim of this study was to analyze the characteristics, namely, cause, type, site of fracture, and epidemiology data, of zygomaticomaxillary complex (ZMC) fractures. Materials and Methods: Hospital records and computed tomographic scans of 468 patients, treated for ZMC fractures at the Department of Craniomaxillofacial and Oncological Surgery between January 1990 and December 1995 and between January 2000 and December 2007, were selected and analyzed according to several factors including age, sex, cause, type, site of fracture, alcohol use before injury treatment modalities, complications, and mean treatment delay. Results: A total of 468 patients (400 males and 68 females; male-to-female ratio, 5.88:1) were included in this study. Their ages ranged from 15 to 85 years (mean ± SD age, 37.1 ± 14.83 y). Type B, by Zingg classification, was the most common type of ZMC fractures and accounted for 73.1% of cases. Assaults (64.5%), traffic accidents (13.9%), falls (13.0%), sports accidents (5.8%), and work accidents (2.8%) were noted. More than one-third of all the patients experienced injury after alcohol consumption. Of these patients, 96.6% were treated surgically. The most favored technique was miniplate osteosynthesis. The complication rate associated with the inaccurate reduction of the fractures was the most common. In this group of complications, minor asymmetry was the most common and occurred in 35 patients. Mean treatment delay was 42.7 hours. It ranged from 0.25 to 1080 hours, and the lowest value was observed in work accidents (2.7 hours). Conclusions: Facial trauma can result in fractures limited to 1 component of the tetrapod structure but more commonly results in a tetrapod fracture involving all 4 buttresses. Males are the most common victims of ZMC fractures, and assault remains the major cause of ZMC injuries in Poland, like in most developed countries. Alcohol involvement among trauma patients is high, especially in case of assaults and falls. Each patient with ZMC fracture should be evaluated individually.

Treatment strategy in Goldenhar syndrome.

AbstractGoldenhar syndrome is a rare congenital defect characterized by ocular symptoms including (epibulbar dermoids, microphthalmia, anophthalmia, eyes asymmetry/dysmorphy, cleft eyelid, exophthalmia, strabismus), auricular symptoms (dacryocystitis), preauricular appendages, preauricular fistulas, ear asymmetry, microtia, atresia of the external auditory canal), craniofacial deformities (cleft face, cleft lip, cleft palate, macrostomia, bifid tongue, hypoplasia of the mandible, hypoplasia of the maxilla, asymmetry of the mandible and maxilla, malocclusion, tooth discrepancies, agenesis of third molars and second premolars, supernumerary teeth, enamel and dentin malformations, delay in tooth development), and skeletal abnormalities (cleft spine, microcephaly, dolichocephaly, plagiocephaly, vertebral defects) or abnormalities of internal organs. The degree of abnormalities vary from severe to mild. In this article, we present a long-term observation of a patient with Goldenhar syndrome. During the patient’s life, the intensification of anomalies varied. We describe preoperative and postoperative orthodontic treatment and surgical correction procedures of maxillofacial deformation.

Noise in subtraction images made from pairs of intraoral radiographs: a comparison between four methods of geometric alignment.

OBJECTIVES To compare noise levels in subtraction images produced by four methods of geometric alignment. METHODS 50 pairs of intraoral radiographs (Digora Optime; Soredex, Tuusula, Finland) were used in this study. Two programs were used to correct geometric differences: ToothVis 1.4 (TV) and DentalStudio 2.0 (DS). Three reference points were manually positioned in both programs (methods 1 and 2); four (method 3) and ten (method 4) reference points were positioned within TV in each of the 50 pairs of images. The standard deviation (SD) of the histogram defining the distribution of grey shades in the subtraction image was used as the statistical parameter for evaluation of homogeneity, i.e. the noise in the subtracted images. RESULTS The mean and median shade of grey values were lower for images after geometric correction in TV (126.6\126.8, 126.9\126.8 and 126.1\126.7, for three- four- and ten-point alignment, respectively) than those performed with the positioning module of DS (128.7\127.5) (P<0.05). For the SD, the mean values were significantly lower with TV (4.6, 4.0 and 3.3 for three-, four- and ten-point alignment, respectively) than with DS (6.8). The range of SD values was the largest for four-point alignment with TV (0.7-15.4), smaller for three-point alignment with DS (1.5-15.4) and three-point alignment with TV (0.5-13), and the smallest with ten-point alignment in TV (0.5-8.7). CONCLUSIONS The SD of the grey-shade histogram showed that subtraction images produced with ToothVis 1.4 software were statistically less noisy than images produced with Dental Studio 2.0 software. There is a relationship between the number of reference points chosen and the noise in the subtraction images.

Zespół Eagle’a – opis rzadkiego przypadku obustronnego wydłużenia wyrostków rylcowatych

Summary Eagles syndrome associated with elongation of styloid process or mineralization of styloid complex is uncommon pathology. The etiology of this disease has not yet been known. Main symptom of Eagles syndrome is cervical, facial and pharyngeal pain. The authors present a case of man who suffered from severe bilateral cervical pain. After the diagnosis of both side elongated styloid process syndrome, surgical treatment was conducted. Extraoral resection of syloid processes resulted in complete and lasting pain relief.

Head and Neck Lymphomas - Diagnostic Difficulties

UNLABELLED Malignant lymphomas represent approximately 5% of all malignant neoplasm of the head and neck and may involve nodal or extranodal sites. The head and neck region is the second most frequent anatomical site of extranodal lymphomas (after the gastrointestinal tract). Most are non-Hodgkin lymphomas (NHL) of B-cell lineage. Hodgkins lymphoma (HL) rarely occurs in extranodal site. THE AIM OF THE STUDY was to evaluate head and neck manifestation of lymphoma (both HL and NHL) and emphasize diagnostic difficulties of these pathologies. MATERIAL AND METHODS Retrospective review of medical records of patients diagnosed for lymphomas in our department was performed. Authors analyzed demographic data as well as clinical manifestation and diagnostic trials. RESULTS 9 patients were included to the study. 7 of them suffered from extranodal NHL and 2 of them from HL (one patient--extranodal and one nodal manifestation). There were diagnostic complications in all cases and final diagnosis was made after surgical material analysis. CONCLUSIONS This data demonstrate low sensivity of fine needle aspiration for identification of lymphoma as well as clinical picture is non characteristic.

Left atrio-esophageal fistula of a possibly iatrogenic aetiology

The study presents an exceptionally rare case of an esophago-left atrial fistula, which was diagnosed during a forensic post-mortem examination. Due to complex nature of the disease and many attempts to cure the patient, the authors did not manage to identify the aetiology of the fistula. It was only implied that the fistula might have been a distant complication of intraoperative endocardial ablation or it might have appeared as a consequence of perforation of the esophageal wall or left atrial wall of the enlarged heart with the end of an intubation tube or nasogastric tube.

Diagnosis and treatment of cervical branchial cleft cysts based on the material from the Department of Cranio-Maxillofacial Surgery, Medical University in Łódź and literature review.

UNLABELLED Cervical branchial cleft cysts are relatively common tumors of the neck that should be distinguished from an epidermoid cyst, hygroma, hemangioma, lymphangioma, lymphadenitis, and metastatic papillary carcinoma of the thyroid gland. Infected cysts might be misdiagnosed as a recurrent abscess. The aim of the study was to present current views concerning diagnosis and treatment of cervical branchial cleft cysts. MATERIAL AND METHODS Data and histopathological results obtained from 49 patients (18 women and 31 men) admitted to the Department of Cranio-Maxillofacial Surgery, due to lateral cervical cysts during the period between 2005 and 2009 were subject to retrospective analysis. RESULTS Most patients were in their third decade of life. The clinical examination showed a painless, slowly growing tumor on the lateral surface of the neck, more often on the right side, and in 30 cases with a concomitant infection. Initial diagnosis on the basis of the clinical examination, radiology and biopsy was confirmed in 48/49 cases (98%). All patients were subject to surgical treatment. During the 3 to 7 year follow-up period recurrence was not observed. CONCLUSIONS Initial diagnosis of a cervical branchial cleft cyst on the basis of the clinical examination should always be confirmed by means of ultrasonography. In case of suspicion of a coexisting infection, fine-needle aspiration biopsy under ultrasound control is recommended. If there is concern that the lateral neck lesion is not a branchial cyst or its dimension is large, computed tomography of the neck or magnetic resonance should be performed. Complete excision of the tumor under general anesthesia is the treatment of choice, being associated with the low risk of local postoperative complications.

Goldenhar syndrome: current perspectives

BackgroundProgress in medical branches that has taken place since the first child with Goldenhare syndrome (GS) had been described in 1952 by Maurice Goldenhar, facilitated better understanding of this congenital defect. It also gave new perspectives and the opportunity to achieve satisfactory treatment results, mainly due to development of surgical techniques.Data sourcesBased on the literature and own experience, we discussed the phenotype of presentation of GS, ethiopathogenesis, genetic counselling and treatment with particular emphasis on surgery correction of hemifacial microsomia.ResultsThe spectrum of GS abnormalities ranges from mild to severe ones and include patients with barely noticeable facial asymmetry to very pronounced facial defect with more or less severe abnormalities of internal organs and/or skeleton. It is characterized most commonly by impaired development of eyes, ears, lips, tongue, palate, mandible, maxilla, zygomatic and orbital structures and deformations of the teeth structures. Ethiopathogenesis is multifactorial and dependent on genetic and environmental factors but there are still many unknowns about the syndrome which should be revealed.ConclusionsPatients with GS due to a large variety of abnormalities and different severity of symptoms pose a challenge for clinicians. All of this necessitate an individual approach to each single patient and involvement a team of specialists in treatment planning. It is a complex, long-lasting, multidisciplinary process and should be divided into stages, according to patient’s age, as well as the extent and severity of observed abnormalities. Neonatologists and pediatricians are involved in care of these patients from the onset.

True and pseudocysts of the spleen - a diagnostic and therapeutic problem.

UNLABELLED Splenic cysts are rarely diagnosed lesions. This also includes splenic pseudocysts, which usually develop as a result of a blunt abdominal cavity injury. Splenic cysts are usually diagnosed on the basis of imaging examinations, performed in case of symptomatic patients or those subject to a blunt abdominal cavity injury. MATERIAL AND METHODS The study group comprised six patients with a positive history of blunt abdominal cavity trauma, verified by means of histopathological examinations, which were subject to surgical intervention at the Department of General and Endocrinological Surgery, Medical University in Łódź, during the period between 01.01.2006 and 31.12.2010. Before or during the surgical procedure cystic lesions were diagnosed. The efficacy of the surgical intervention was determined. RESULTS Splenic pseudocysts were diagnosed in only two of the patients, although in all there was a reasonable suspicion of the above-mentioned lesion. One patient required three operations, due to recurrence of the lesion, which proved to be a primary epithelial cyst. Two of the patients required early explorative relaparotomy. Apart from the above-mentioned, treatment proved uneventful. CONCLUSIONS The diagnosis of a splenic pseudocyst is established in case of suspicion of the above-mentioned lesion. This is evidence that in some patients focal lesions of a different nature are present, being detected by means of diagnostic imaging examinations performed after abdominal cavity injuries.