Prediction of surface area size in orbital floor and medial orbital wall fractures based on topographical subregions.

Objective: This retrospective study evaluates the occurrence and frequency of different fracture patterns in a series of computed tomography (CT) scans in terms of the AOCMF Trauma Classification (TC) orbit module and correlates the assigned defects with measurements of the fracture area in order to get an approximate guideline for fracture size predictions on the basis of the classification.

Material And Methods: CT scans of patients with orbital floor fractures were evaluated using the AOCMFTC to determine the topographical subregions. The coding consisted of: W = orbital wall, 1 = anterior orbit, 2 = midorbit, i = inferior, m = medial.

Prefabricated fibular flaps for reconstruction of defects of the maxillofacial skeleton: planning, technique, and long-term experience.

Reconstruction of complex defects involving the maxilla or mandible often requires transfer of free vascularized tissue. In the conventional approach, a flap is transferred to provide vital tissue, and subsequent shaping and debulking are required. The authors present their experience with prefabrication of vascularized fibular flaps.

Classification of orbital morphology for decompression surgery in Graves' orbitopathy: two-dimensional versus three-dimensional orbital parameters.

Aim: Three-dimensional (3D) CT reconstruction of the bony orbit for accurate measurement and classification of the complex orbital morphology may not be suitable for daily practice. We present an easily measurable two-dimensional (2D) reference dataset of the bony orbit for study of individual orbital morphology prior to decompression surgery in Graves' orbitopathy.

Methods: CT images of 70 European adults (140 orbits) with unaffected orbits were included.

Anatomical background for the development of preformed cranioplasty implants.

Preformed cranioplasty implants form a new concept of implants to repair relatively large-sized calvarial defects. They could offer an alternative treatment to manually molded cranioplasty, and to flat or patient specific implants, while still achieving a satisfactory clinical result.We report on 3D statistical modeling and analysis performed in 80 clinical CT data of adult European Whites with unaffected calvarial bones to establish an anatomical background for the development of preformed alloplastic cranioplasty implants.

Importance of patient-specific intraoperative guides in complex maxillofacial reconstruction.

Background: Conventional maxillofacial reconstruction often leads to suboptimal results due to inaccurate planning or surgical difficulties in adjusting a free flap and osteosynthesis plates into a three-dimensional defect.

Objectives: To justify the importance of patient-specific intraoperative guides in complex maxillofacial reconstruction. CLINICAL EXAMPLE: A 40-year old patient underwent a left hemimaxillectomy for an adenoid cystic carcinoma of the palate.

Anatomy-based surgical concepts for individualized orbital decompression surgery in graves orbitopathy. II. Orbital rim position and angulation.

Purpose: To detect anatomical conditions that may benefit from an orbital rim advancement procedure in patients suffering from Graves orbitopathy.

Methods: In postprocessed 70 clinical CTs from adults of white European ethnicity with unaffected orbits, the authors assessed the intra- and interindividual variability of the orbital rim angulation and orbital rim position relative to their medial rim parts. This included morphometrical analysis and computer model visualization using Amira software (version 5.

An evaluation of face-bow transfer for the planning of orthognathic surgery.

Purpose: The purpose of this study was to evaluate the error magnitude in the clinical application of face-bow devices. Technical and methodologic inaccuracies, as well as deviations from reference planes, were determined.

Materials And Methods: The presented method is part of a 3-dimensional virtual planning procedure for orthognathic surgery and included 15 patients with dentoskeletal deformities.

How predictable is exophthalmos reduction in Graves' orbitopathy? A review of the literature.

Aim: To give an overview on the currently performed decompression techniques in Graves' orbitopathy, its indications, outcome, complications and predictability.

Methods: A review of the literature was conducted (PubMed 1993-2010). Case series with a minimum of 10 patients, with a detailed description of surgical methods and available patient data, were included.

In vitro biomechanical comparison of the effect of pattern, inclination, and size of positional screws on load resistance for bilateral sagittal split osteotomy.

Purpose: The purpose of this in vitro investigation was to determine whether the pattern, angle of placement, or size of positional screws affected their ability to resist vertical loads resembling mastication in the bilateral sagittal split osteotomy system.

Materials And Methods: Standardized bone substitutes were secured with three 12- to 16 mm-long, 1.85-, 2.

Anatomy-based surgical concepts for individualized orbital decompression surgery in graves orbitopathy. I. Orbital size and geometry.

Purpose: To analyze orbital morphological parameters that potentially could influence the effect of decompression surgery on exophthalmos reduction in Graves orbitopathy, thus making decompression surgery more predictable.

Methods: To generate a reference database, a CT-based study was performed in 140 orbits obtained from adult patients with unaffected orbits in a European white ethnicity. The following parameters were chosen: orbital volume, globe volume, globe to orbital volume ratio, and orbital cone angle.

Graves' orbitopathy: current imaging procedures.

In patients with Graves' orbitopathy (GO), magnetic resonance imaging (MRI) is a valuable tool to distinguish the acute inflammatory active disease from fibrotic, inactive end stage disease in demonstrating interstitial oedema within the extraocular muscles on coronal TIRM-sequences. MRI is the modality of choice to identify active inflammatory changes and to assess any immunomodulatory treatment response. MRI is always required in doubtful cases, as e.

A step towards individualized, anatomy-based surgical concepts for orbital decompression in Graves' orbitopathy.

The surgical armamentarium for orbital decompression in Graves'orbitopathy (GO) includes techniques for orbital wall resection using local incisions, but also techniques for orbital rim advancement or resection of the greater sphenoid wing, which require a coronal or even transcranial approach. Up to now the choice of technique rather depends on the surgeon;s preference than on objective criteria. The goal of our CT-based research project is to define morphological orbital parameters which potentially could influence the result of a given technique for orbital decompression in thyroid eye disease.

Imaging in Graves' orbitopathy.

In patients with Graves' orbitopathy, magnetic resonance imaging (MRI) is a useful tool to distinguish the acute inflammatory active disease in demonstrating interstitial edema within the extraocular muscles on coronal TIRM-sequences from fibrotic, inactive endstage disease. MRI is the modality of choice to identify active inflammatory changes in order to decide on possible immunomodulatory treatment response. However, MRI should be considered in atypical cases as in asymmetrical orbital involvement, to exclude other orbital pathologies and to confirm the clinical suspicion of apical optic nerve compression in Graves' orbitopathy.

[The interdisciplinary fixed restoration of an edentulous maxilla with a pronounced resorption of the alveolar crest. A case report. Part I: The immediate reconstruction].

Edentulous patients wearing a conventional complete denture often request a fixed restoration for functional, esthetical and/or psychosocial reasons. For these patients implant-supported fixed dental prostheses are a prosthetic means of choice. However, after years of edentulism often a marked resorption of the alveolar crest has taken place, asking for bone augmentation before implant placement.

A method for assessing 3D shape variations of fuzzy regions and its application on human bony orbits.

In complex orbital defects, typically the eye globe is retruded in a pathological position. This is associated with severe functional and cosmetic post-traumatic conditions. Characteristically, the posterior orbital floor and the medial wall of the bony orbit (=region of interest, ROI) is fractured where adequate reconstruction is crucial for a satisfactory surgical outcome but difficult to achieve.

Manufacturing splints for orthognathic surgery using a three-dimensional printer.

Objective: A new technique for producing splints for orthognathic surgery using a 3D printer is presented.

Study Design: After 3-dimensional (3D) data acquisition by computerized tomography (CT) or cone-beam computerized tomography (CBCT) from patients with orthognathic deformations, it is possible to perform virtual repositioning of the jaws. To reduce artifacts, plaster models were scanned either simultaneously with the patient during the 3D data acquisition or separately using a surface scanner.

[The prosthetic rehabilitation of a patient after gunshot wound and initial maxillofacial surgical reconstruction. A case report].

An improvement of prognosis after tumour therapy as well as a rather high number of multiple traumas in the craniofacial area imply a high treatment need for craniofacial tissue defects. For a successful rehabilitation of these individuals, reconstructive oral and maxillofacial surgery and prosthodontics must collaborate closely and synergistically. Besides medical and psychological findings, functional and esthetical aspects need to be taken into account.

Possible problems of moulding the regenerate in mandibular distraction osteogenesis -- experimental aspects in a canine model.

Introduction: Moulding of the regenerate created by distraction osteogenesis has been shown clinically to be efficient and good enough so that for complex three-dimensional deformities, final adjustments by moulding the regenerate may be part of the treatment plan. This study assessed possible drawbacks of moulding a regenerate, taking into consideration compressive and tensile forces acting simultaneously on the fresh callus.

Method: Distraction osteogenesis in 15 Beagle mandibles was performed using custom made devices which allowed for lengthening as well as for angulation.

Callus mineralization following distraction osteogenesis of the mandible monitored by scanning acoustic microscopy (SAM).

Background: Scanning acoustic microscopy uses ultrasound to analyse histomorphology of tissues with microscopic resolution and delivers data about physical properties of the specimen.

Material And Methods: Bony consolidation was monitored by scanning acoustic microscopy in 12 embedded specimens of dog mandibles after distraction osteogenesis. Increasing mineralization was detected by measurements of acoustic impedance (Z).

Distraction osteogenesis of the canine mandible: the impact of acute callus manipulation on vascularization and early bone formation.

Purpose: Manipulations of the newly created regenerate, using adjustable multiplanar devices during distraction osteogenesis or as a 1-step molding procedure at the end of the distraction process, may be necessary to correct the position of the mandible. Treatment of complex deformities may require preplanned major angulation provided by adjustable devices. We sought to assess the effects of molding the fresh regenerate on vascularization and early bone formation within clinically relevant dimensions.

Reconstruction of maxillary and mandibular defects using prefabricated microvascular fibular grafts and osseointegrated dental implants -- a prospective study.

The fibular flap can be used for a variety of indications. Recently, the treatment of four patients with severely atrophied upper jaws using a method to prefabricate the vascularized fibular graft has been published. This technique consists of a two-stage operation procedure that allows simultaneous prosthodontic rehabilitation and immediate placement of dental implants.

A faster method for 3D/2D medical image registration--a simulation study.

3D/2D patient-to-computed-tomography (CT) registration is a method to determine a transformation that maps two coordinate systems by comparing a projection image rendered from CT to a real projection image. Iterative variation of the CT's position between rendering steps finally leads to exact registration. Applications include exact patient positioning in radiation therapy, calibration of surgical robots, and pose estimation in computer-aided surgery.

Maxillofacial reconstruction with prefabricated osseous free flaps: a 3-year experience with 24 patients.

Between January of 1998 and May of 2002, 25 prefabricated osseous free flaps (23 fibula and two iliac crest flaps) were transferred in 24 patients to repair maxillary (six flaps) or mandibular (eight flaps) defects after tumor resection, severe maxillary (four flaps) or mandibular (one flap) atrophy (Cawood VI), maxillary (one flap) or mandibular (three flaps) defects after gunshot injury, and maxillary (two flaps) defects after traffic accidents. Prefabrication included insertion of dental implants, positioned with a drilling template in a preplanned position, and split-thickness grafting. Drilling template construction was based on the prosthetic planning.

In vivo efficacy of bone-marrow-coated polycaprolactone scaffolds for the reconstruction of orbital defects in the pig.

Alloplastic materials offer a number of advantages over bone autografts in the reconstruction of craniofacial defects. These include: lack of donor site morbidity, unlimited quantities of available material, and the possibility to conform exactly to the defect. An ideal bioresorbable material would degrade slowly, and have osteoconductive properties to allow replacement and remodeling by osseous tissue.