The Comprehensive AOCMF Classification: Skull Base and Cranial Vault Fractures - Level 2 and 3 Tutorial.

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial classification system with increasing level of complexity and details. The highest level 1 system distinguish four major anatomical units, including the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). This tutorial presents the level 2 and more detailed level 3 systems for the skull base and cranial vault units.

A comprehensive classification of mandibular fractures: a preliminary agreement validation study.

This study evaluates a comprehensive classification system for mandibular fractures based on imaging analysis. The AO/ASIF scheme, defining three fracture types (A, B, C), three groups within each type (e.g.

Endoscopic management of frontal sinus fractures.

Endoscopes have had a profound effect on nearly every surgical specialty over the past 20 years. Using endoscopic approaches, excellent visualization of the surgical site can be achieved while avoiding extensive external incisions, thus, dramatically reducing morbidity compared with traditional surgical approaches. This article outlines the state of the art with regard to the use of endoscopes for managing frontal sinus fractures, which are one of the most common fractures treated with endoscopic techniques.

Endoscopic management of frontal sinus fractures.

Endoscopes have had a profound effect on nearly every surgical specialty over the past 20 years. Using endoscopic approaches, excellent visualization of the surgical site can be achieved while avoiding extensive external incisions, thus, dramatically reducing morbidity compared with traditional surgical approaches. This article outlines the state of the art with regard to the use of endoscopes for managing frontal sinus fractures, which are one of the most common fractures treated with endoscopic techniques.

Improvements in forehead flap design for nasal reconstruction.

Joseph Carpue introduced us to the use of the forehead flap for nasal reconstruction in 1814 after he read an account of its use in India. The forehead flap was the first pedicled flap to be described in European literature and it set off an immediate search for similar flaps elsewhere on the body. In fact, this initial use of the forehead flap was so inspirational that it has been given credit for the rise of plastic surgery as a specialty.

Endoscopic management of facial fractures.

Endoscopic management of facial fractures has lagged behind endoscopic surgery in other areas of the body but is rapidly gaining credibility. With the subsequent development of improved instrumentation for fracture reduction and stabilization, it is foreseeable that wide-incision exposures of the facial skeleton will be reserved for only the most complicated cases.

Early perioperative use of polytef suspension for the management of facial paralysis after extirpative skull base surgery.

Background: The satisfactory management of facial paralysis after extirpative skull base surgery has been notoriously difficult. To optimize physical and psychological recovery, early perioperative use of polytef (polytetrafluoroethylene [PTFE]) facial suspension has been used in patients with either profound electrophysiological or anatomical disruption of the facial nerve.

Objective: To review the efficacy of this clinical algorithm.

Nasal reconstruction in the elderly patient. The case for not letting age determine method.

Objectives: To review a series of nasal reconstructive procedures in elderly patients, and to discuss management issues related to reconstructing nasal defects in patients 80 years and older.

Design: Retrospective review identifying patients 80 years and older undergoing significant nasal reconstructive surgery.

Setting: University and private practice settings.

Modification of the subunit principle for reconstruction of nasal tip and dorsum defects.

This article reports our observations on, and modification of, the subunit principle with regard to reconstruction of nasal tip and dorsum defects. Forty-two patients who underwent reconstruction of a nasal tip and/or dorsum defect with a forehead flap were reviewed. These patients were categorized by how the subunit principle was used in their reconstruction and graded on the aesthetic outcome of the reconstruction.

Management of the orbital rim and floor in zygoma and midface fractures: criteria for selective exploration.

The management of zygomaticomaxillary and midface fractures has been revolutionized in the past decade as a result of improved surgical access, rigid plating systems, and high-resolution computed tomography. Previously, virtually all midface fractures underwent mandatory orbital exploration to aid in reduction and stabilization. This article emphasizes the importance of reducing and fixating the facial buttresses involved in zygomatic complex fractures, and recommends orbital exploration on a selective basis.

Compression of the upper cervical spinal cord causing symptoms of brainstem compromise. A case report.

Study Design: A case is reported in which a flexion-induced compression of the upper cervical spinal cord caused symptoms of brainstem compromise in the absence of radiographic evidence of osseous instability.

Objectives: A 41-year-old woman developed postoperative cervical instability with flexion-induced neurologic symptoms referable to the brainstem. The instability was caused by direct compression at the third cervical vertebral body, which in turn was caused by differential movements between the neuraxis and skeletal elements in the upper cervical spine.

Desmoplastic fibroma of the temporal bone.

Background: Desmoplastic fibroma is a benign, locally aggressive, intraosseous neoplasm with a propensity for local recurrence. Desmoplastic fibroma most commonly originates within the mandible (70% of cases), and long bones with rare lesions reported in the maxillary, frontal, and parietal bones. We report two patients with desmoplastic fibroma arising within the temporal bone.

Criteria for selective management of the orbital rim and floor in zygomatic complex and midface fractures.

Objective: To develop objective criteria with which to identify patients with zygomatic complex (ZMC) or midface fractures who require a surgical exploration and treatment of the orbital component of their fracture to prevent postoperative enophthalmos, diplopia, or malar depression.

Design: Nonrandomized, prospective management of facial trauma patients.

Setting: Urban, university referral center.

Temporal bone carcinoma: contemporary perspectives in the skull base surgical era.

Historically, malignant tumors that arose within the temporal bone or that intimately juxtaposed the petrous ridge portended an ominous prognosis. Perusal of the surgical literature from 1950 to 1975 strongly supports the impression that despite heroic surgical efforts many of these patients sustained significant morbidity and a high mortality rate. This report reviews data accumulated over a 10-year period study from July 1984 to June 1994 that examines the changing clinical approach to these lesions from both a diagnostic and therapeutic perspective.

The use of cancellous bone for frontal sinus obliteration and reconstruction of frontal bony defects.

Objective: The objective of this report is to review our experience and indications for the use of cancellous bone in frontal sinus obliteration and reconstruction of frontal defects. We also describe a method of minimizing iliac crest donor-site morbidity.

Design: Case series.

Phonosurgery for voice improvement and restoration.

Recent advances in laryngology have occurred simultaneously in both the diagnostic and therapeutic realms. The advent of sophisticated voice laboratories with the ability for in-depth analysis of voice disorders has provided insights into their pathophysiology necessary to develop sophisticated procedures to treat them. Experience with these procedures has likewise provided new understanding of laryngeal function.

Genetic syndromes associated with skin cancer.

Most skin cancers are amenable to cure with early diagnosis and appropriate treatment; however, skin cancers associated with genetic syndromes may give rise to some of the most relentless, deforming, and ultimately lethal skin cancers clinicians will ever encounter. This article reviews the commonly accepted genetic syndromes associated with skin cancer, details their clinical pictures and key points of recognition and diagnosis, considers associated relevant clinical concerns, and discusses therapeutic options and dangers.

Extended access/internal approaches for the management of facial trauma.

The two most significant recent developments in the treatment of facial trauma are the introduction of plating systems, which provide rigid internal fixation and the development of surgical approaches that allow wide exposure of the entire facial skeleton while minimizing external incisions. These approaches (referred to as extended access/internal approaches) are hemicoronal and coronal flaps, the sublabial approach to the midface, the transconjunctival approach to the orbital floor and orbital rim, and the intraoral management of mandibular fractures. These approaches work well, and have become standard techniques for managing facial trauma; however, each one has definite technical points that need to be adhered to to assure their success.

The anatomic basis for the design of forehead flaps in nasal reconstruction.

The detailed arterial anatomy of the medial forehead region was evaluated using roentgenographic examinations of injected cadaver heads, anatomic dissections of injected cadaver heads, and Doppler examination of normal subjects. The supratrochlear artery was seen to be the dominant artery of the medial forehead (not the supraorbital). The supratrochlear artery exited the orbit 1.

Reconstruction of the anterior skull base after craniofacial resection.

Significant controversy continues as to how best to reconstruct anterior skull base defects after craniofacial resection with a view to minimizing the postoperative morbidity. Techniques varying from simple skin grafts to local and pedicled flaps, as well as bone harvested from a variety of sources have all been proposed. Careful review of the literature combined with personal experience with 34 anterior skull base defects following tumor surgery are presented in an attempt to develop a decision-making process to determine the ideal reconstructive technique for various situations.