JAMA Facial Plastic Surgery: Facial Trauma Topic Collection

Miniplate Fixation of Fractures of the Symphyseal and Parasymphyseal Regions of the Mandible A Review of 218 Patients Miniplate Fixation of Mandible Fractures

Lee T, Sawhney R, Ducic Y. — Fri, 01 Mar 2013 00:00:00 GMT

Objective

To review our experience with miniplate fixation of fractures of the symphyseal and parasymphyseal regions of the mandible.

Methods

A retrospective review of all mandible fractures treated from July 1, 1999, through July 31, 2011, by one of us (Y.D.) was performed. Intraoral, open rigid fixation of noncomminuted symphyseal and parasymphyseal fractures was performed using a combination of 2 miniplates that were either a 4-hole or a 6-hole miniplate using monocortical screws. The miniplates were 1-mm thick with a 2-mm screw diameter.

Results

A total of 218 patients with noncomminuted symphyseal and parasymphyseal mandible fractures were included in this study. Eighteen patients (8.3%) with concurrent panfacial fractures and other indications were left in postoperative maxillomandibular fixation (MMF), whereas 200 patients (91.7%) did not require postoperative MMF. All patients in this series achieved bony union. The following complications were noted: plate exposure, 2.3%; malocclusion, 1.4%; wound infection, 1.4%; and tooth root injury, 0.9%. The use of postoperative antibiotics and either a nonlocking or locking system was not associated with significant differences in the rates of complications.

Conclusions

For noncomminuted symphyseal and parasymphyseal mandible fractures, the application of 2 miniplates with monocortical screws offers good surgical outcomes in most patients with minimal complications. The advantages of using miniplates include easy plate adaptability, no need for MMF unless indicated, small screw diameter, and provision of adequate load-sharing rigid fixation for simple, noncomminuted symphyseal and parasymphyseal mandible fractures.

Computer-Guided Orbital Reconstruction to Improve Outcomes Computer-Guided Orbital Reconstruction

Bly RA, Chang S, Cudejkova M, et al. — Fri, 01 Mar 2013 00:00:00 GMT

Objectives

(1) To describe repair of complex orbital fractures using computer planning with preoperative virtual reconstruction, mirror image overlay, endoscopy, and surgical navigation. (2) To test the hypothesis that this technique improves outcomes in complex orbital fractures.

Methods

A series of 113 consecutive severe orbital fracture cases was analyzed, 56 of which were performed with mirror image overlay guidance, and 57 of which were repaired without. Data were collected on patient characteristics, fracture severity, diplopia and globe position outcomes, complications, and need for revision surgery.

Results

The mirror image overlay group showed decreased postoperative diplopia in all fracture types (P = .003); the effectiveness was maximal for fractures that involved 3 or 4 walls or the posterior one-third of the orbital floor (P < .001). The need for revision surgery was greatly reduced in this cohort (4% vs 20%; P = .03).

Conclusions

The efficacy of mirror image overlay navigation and orbital endoscopy was studied in one of the largest series of complex orbital fractures in the literature. Based on statistically significant improved outcomes in postoperative diplopia and orbital volume, as well as the decreased need for revision surgery, we accept the hypothesis that mirror image overlay guidance improves outcomes in complex orbital reconstruction and recommend its use for complex orbital fracture repair.

A Systematic Review of the Endoscopic Management of Orbital Floor Fractures Endoscopic Management of Orbital Floor Fractures

Cheung K, Voineskos SH, Avram R, et al. — Fri, 01 Mar 2013 00:00:00 GMT

Objective

To determine the safety and efficacy of the endoscopic management of isolated orbital floor fractures.

Methods

A systematic review was performed using electronic databases. Studies investigating the reconstruction of isolated orbital floor fractures using an endoscopic approach were considered for inclusion. Two investigators independently reviewed all results. Study quality was assessed using the Methodological Index for Nonrandomized Studies scale. Primary outcomes were the resolution of diplopia and enophthalmos. Secondary outcomes were postoperative complications, including blindness, paresthesias, sinusitis, infection, conversion to external approach, and need for revision surgery.

Results

Nine studies capturing 172 patients met the inclusion criteria for systematic review. Two studies were comparative and 7 were case series. Study quality was poor, lacking prospective data and reliable assessment of outcomes. Strong reviewer agreement was observed (intraclass correlation, 84%; 95% CI, 35%-96%). Diplopia resolved in 102 of 118 patients (86%) and enophthalmos resolved in 41 of 43 (95%). No complications of blindness, sinusitis, or conversion to external approach were reported. Thirteen patients (8%) had transient cheek numbness. Two patients (1%) required revision surgery.

Conclusions

Reconstruction of isolated orbital floor fractures through an endoscopic approach appears to be safe and effective. High-level evidence prospectively comparing endoscopic and external approaches, however, is lacking.