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Le Fort Fractures

Aleksa Janovic, Petar Milovanovic, Michael Hahn, Zoran Rakocevic, Michael Amling, Bjoern Busse, Milovan Dimitrijevic, Marija Djuric
BACKGROUND/AIM: Le Fort lines have traditionally been considered as zones of weakness in the mid-facial skeleton although the structural basis of increased bone fragility at these sites has not yet been investigated. Considering recent findings of occlusal loading-related regional heterogeneity in the mid-facial bone micro-architecture, the aim of this study was to explore whether such heterogeneity in cortical and cancellous bone micro-architecture may contribute to increased fragility at Le Fort fracture sites MATERIALS AND METHODS: Twenty-five cortical and thirteen cancellous bone specimens were harvested from a dry skull and analyzed by micro-CT...
March 4, 2017: Dental Traumatology: Official Publication of International Association for Dental Traumatology
Sandeep Mehrotra, Sunil Anand
INTRODUCTION: Faciomaxillary fractures (FMF) occur in a significant proportion of trauma patients. Nearly all polytrauma patients and even those with isolated FMF are managed under general anesthesia for definitive management. We propose the use of regional nerve blocks as a safe and effective means for open reduction and fixation of isolated FMF. AIM AND OBJECTIVES: The aim is to evaluate the feasibility, effectiveness and safety of base of skull maxillomandibular and distal trigeminal nerve blocks in the management of FMF...
February 14, 2017: Annals of Plastic Surgery
H Fujii, N Kuroyanagi, T Kanazawa, S Yamamoto, H Miyachi, K Shimozato
The aim of this study was to determine whether non-linear three-dimensional finite element analysis (3D-FEA) can be applied to simulate pterygomaxillary dysjunction during Le Fort I osteotomy (LFI) not involving a curved osteotome (LFI-non-COSep), and to predict potential changes in the fracture pattern associated with extending the cutting line. Computed tomography (CT) image data (100 snapshots) after LFI were converted to 3D-CT images. 3D-FEA models were built using preoperative CT matrix data and used to simulate pterygomaxillary dysjunction...
January 12, 2017: International Journal of Oral and Maxillofacial Surgery
Krishna Prasad Regmi, JunBo Tu, SuMeng Ge, ChengQun Hou, XiaoYi Hu, ShiXian Li, JingTing Du
PURPOSE: Because of less attention to the sagittal component of maxillary fractures, these fractures are often misdiagnosed or the reduction is missed leading to maxillary transverse discrepancies. Therefore, the purpose of this study was to identify factors associated with good or adverse postoperative outcomes of maxillary sagittal fractures. MATERIALS AND METHODS: This study was a single-center retrospective cohort study. The sample was composed of cases of maxillary sagittal fractures treated at the Department of Oral and Maxillofacial Surgery, Craniomaxillofacial Trauma Unit of Xi'an Jiaotong University (Xi'an, China) from January 2008 through December 2013...
March 2017: Journal of Oral and Maxillofacial Surgery
Brandaan G R Zigterman, Maurice Y Mommaerts
CONTEXT: Slotplates were specifically designed to meet the special requirements of corrective surgeries of the facial skeleton. This design enables small readjustments of bone fragments in the midface and chin area during surgery without complete removal of plates and screws. OBJECTIVE, DESIGN, AND SETTING: The aim of this study was to compare morbidity rates of slotplates versus meshplates after Le Fort I osteotomy, genioplasty and/or zygoma 'sandwich' osteotomy performed in a tertiary care centre...
November 2, 2016: Journal of Cranio-maxillo-facial Surgery
Zhongying Wang, Peihua Wang, Yixin Zhang, Guofang Shen
Septal deviation constitutes an important component of both esthetic deformity and airway compromise in patients with cleft lip and palate (CLP). The posterior parts of the nasal septum presented greater deviation than the anterior parts in patients with complete unilateral CLP. Le Fort I down-fracture provides better access to the nasal septum than intranasal incision during rhinoplasty, especially to the posterior part. This study objectively and subjectively evaluated the nasal function after Le Fort I osteotomy combined with septoplasty in patients with complete unilateral CLP...
January 2017: Journal of Craniofacial Surgery
Clemens Klug, Julia Cede
PURPOSE: The intraoral quadrangular Le Fort II osteotomy (IQLFIIO) represents a reliable surgical method in cases of midfacial deficiency with good functional, esthetic, and stable long-term results. PATIENTS AND METHODS: In this technical note, we present 3 surgical modifications to previous reports: 1) inferior orbital rim osteotomy by angulated piezosurgical instruments, thereby avoiding the use of chisels in the orbital region; 2) osteosynthetic fixation only laterally at the zygomatic buttress with 2 L-shaped miniplates, thus avoiding paranasal osteosynthesis; and 3) advancement step camouflage in the lateral infraorbital region with a compound mass of autologous bone chips and fibrin glue with the intention to reduce bone block-associated side effects...
February 2017: Journal of Oral and Maxillofacial Surgery
Atsushi Imaizumi, Kunihiro Ishida, Osamu Nishizeki
BACKGROUND: Recent advancements in computed tomography have enabled the diagnosis of naso-orbito-ethmoid (NOE) fractures to be made in much greater detail. Surgical access to the upper nasofrontal buttress in NOE fractures, however, has remained unchanged over the past decades. All approaches to these fractures using skin incisions have individual drawbacks. The transcaruncular approach is free of the drawbacks of the cutaneous approaches. We further extended the transcaruncular approach for the treatment of NOE and Le Fort II fractures...
December 2016: Journal of Cranio-maxillo-facial Surgery
Amy L Richter, K Kelly Gallagher
We describe the case of a 77-year-old immunocompetent woman with a history of chronic rhinosinusitis who presented with a pathologic Le Fort I fracture after a forceful sneeze. Imaging revealed diffuse sinus opacification and a Le Fort type I complex fracture involving the maxilla, pterygoid plates, clivus, and right nasal bridge. The patient underwent endoscopic debridement of her sinuses, which revealed mucosal dehiscence and otherwise normal healthy bleeding tissue. Anatomic pathology identified necrotic bone with invasive fungal hyphae...
September 2016: Ear, Nose, & Throat Journal
Tetsuya Yumoto, Tatsushi Matsumura, Kohei Tsukahara, Keiji Sato, Toyomu Ugawa, Yoshihito Ujike
INTRODUCTION: Cricothyroidotomy is an emergency procedure that can be used to secure the airway in situations in which intubation and ventilation are not possible. PRESENTATION OF CASE: We describe a case of 79-year-old male presenting with facial trauma combined with massive upper airway bleeding and swelling in which cricothyroidotomy was required to open the airway in an elderly male patient taking antiplatelet agents who suffered a simple ground-level fall. DISCUSSION: Although emergency airway management is often required in patients with Le Fort fractures, mandibular condyle fractures exhibit a significant relationship with ground-level falls, which are not usually associated with emergency airway management...
2016: International Journal of Surgery Case Reports
Sagar Dahiya, Prasad Chitra, Vikrant, Narahari Kalyana Srinivas Aravind, Sukhvinder Bindra
Mid palatal fractures are usually present in conjunction with Le Fort I maxillary fractures. Literature on isolated mid palatal fractures as seen in this case is relatively rare. A novel approach for the management of this case was undertaken. A rapid maxillary expander was used to separate palatal segments which healed well. The patient's crossbite and open bite was corrected with elastic use. The protocol of management of malunion of isolated mid palatal fractures is simple with reduced costs, morbidity and higher rates of acceptance...
May 2016: Journal of Clinical and Diagnostic Research: JCDR
Shao-Fu Huang, Lun-Jou Lo, Chun-Li Lin
This study investigates the biomechanical interaction of different mini-plate fixation types (shapes/sizes and patterns) with segmental advancement levels on the Le Fort I osteotomy using the non-linear finite element (FE) approach. Nine models were generated under a standard 1-piece LeFort I osteotomy for advancement with 3, 6 and 9 mm distances and four mini-plates with three fixation patterns including LL, LI, and II patterns placed on the maxillae models by integrating computed tomography images and computer-aided design system...
December 2016: Computer Methods in Biomechanics and Biomedical Engineering
Shinji Kobayashi, Toshihiko Fukawa, Takashi Hirakawa, Toshihiko Satake, Jiro Maegawa
The Le Fort II osteotomy is a relatively rare operation. The posterior wall osteotomy of the maxillary sinus (MS) is often difficult for Le Fort III. We developed the transmaxillary sinus approach (TSA) for the Le Fort II osteotomy that cuts the posterior wall of the MS directly. This report illustrates this easy-to-use procedure for the Le Fort II osteotomy in syndromic craniosynostosis. This procedure was performed in an 18-year-old patient with Apert syndrome and a 15-year-old patient with Pfeiffer syndrome...
February 2016: Plastic and Reconstructive Surgery. Global Open
Gustavo Halak Oliveira-Campos, Leandro Lauriti, Marcos Kazuo Yamamoto, Rubens Camino Júnior, João Gualberto C Luz
PURPOSE: To assess the trends in Le Fort (maxillary) fractures in patients seen at a South American trauma care center based on the characteristics and management of these. MATERIALS AND METHODS: Of all patients with facial fractures seen at a trauma hospital during a six-year period, 50 (6.6 %) presented with Le Fort fractures. Medical charts were reviewed for characteristics presented and management performed. To improve the analyses, computed tomography and intraoperative findings were used...
March 2016: Journal of Maxillofacial and Oral Surgery
João Paulo Bonardi, Fernanda Herrera da Costa, Glaykon Alex Vitti Stabile, Cecilia Luiz Pereira-Stabile
The chemical senses of taste and smell are important to human life, because they play an important role in detecting potential environmental hazards. Humans can identify countless different flavors by the simultaneous perception of taste and smell. Reports of sensory loss after craniocerebral trauma began to appear in the medical literature in the middle 1800s. Dysgeusia associated with head injuries is rare and its reported incidence is 0.4 to 0.5%. This report describes the clinical case of a 32-year-old man with Le Fort I and III fractures treated with surgical reduction and fixation...
July 2016: Journal of Oral and Maxillofacial Surgery
Yuuki Uchida, Nobuyuki Mitsukawa, Shinsuke Akita, Takane Suzuki, Chisato Mori, Kaneshige Satoh
UNLABELLED: Carotid-cavernous sinus fistula (CCF) is a rare complication occurring after the Le Fort osteotomy. We aimed to elucidate the cause of CCF in the Le Fort osteotomy. METHODS: Eleven fresh cadavers were used. After craniotomy, a Le Fort III bipartition osteotomy was then performed. On the left side, both the lateral wall of the maxilla and the pterygomaxillary junction (PMJ) were divided, in addition to the conventional osteotomy line. On the right side, those parts were kept intact...
April 2016: Journal of Cranio-maxillo-facial Surgery
Francesco Carinci, Ilaria Zollino, Laura Arduin, Giorgio Brunelli, Francesco Pagliaro, Roberto Cenzi
The midfacial region (MR) is located in the middle-third of the face, composed of several bones and surrounded by complex anatomical structures so that MR fractures (MRFs) often involve other parts of the face. A staging system for classifying MRFs is of paramount importance in order to exchange information among trauma centers. Le Fort described three lines of fractures but still there is no scoring method to stage MRFs. In this article, a classification for MRFs is proposed. It is based on Le Fort's three lines and it defines seven facial units...
August 2008: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
M T Kiani, G Tajik, M Ajami, H Fazli, M J Kharazifard, A Mesgarzadeh
The Le Fort I osteotomy is performed under general anaesthesia and specific haemodynamic conditions, i.e. hypotensive general anaesthesia. This study assessed the incidence of the trigeminocardiac reflex (TCR) during the different stages of the Le Fort I osteotomy. Forty-seven patients requiring a Le Fort I osteotomy were included. General anaesthesia was induced. In terms of haemodynamic changes, each patient's oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), and electrocardiogram (ECG) were monitored by SADAAT Monitoring System and recorded during the different stages of osteotomy: before the induction of anaesthesia, before osteotomy cuts, after finishing the right pterygoid plate osteotomy, after finishing the left pterygoid plate osteotomy, and after performing down-fracture of the maxilla...
May 2016: International Journal of Oral and Maxillofacial Surgery
Qiqin Zhan, Xiaojun Chen
This paper proposes an interactive method of model clipping for computer-assisted surgical planning. The model is separated by a data filter that is defined by the implicit function of the clipping path. Being interactive to surgeons, the clipping path that is composed of the plane widgets can be manually repositioned along the desirable presurgical path, which means that surgeons can produce any accurate shape of the clipped model. The implicit function is acquired through a recursive algorithm based on the Boolean combinations (including Boolean union and Boolean intersection) of a series of plane widgets' implicit functions...
2016: PloS One
J J Conforte, C P Alves, M del P R Sánchez, D Ponzoni
This study assessed the impact of oral and maxillofacial trauma and surgical treatment on the quality of life of patients. The study included 66 patients (age range 18-65 years) with facial fractures; 33 required surgical treatment and 33 required conservative (non-surgical) treatment. Quality of life was evaluated by applying the Oral Health Impact Profile questionnaire (OHIP-14) immediately after diagnosis of the trauma (T1), 30 days after surgery or trauma (T2), and 90 days after surgery or trauma (T3). For the control group (conservative treatment), there was a change in quality of life at T1 and T2...
May 2016: International Journal of Oral and Maxillofacial Surgery
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