Polymethyl Methacrylate Custom-Made Prosthesis: A Novel Three-Dimension Printing-Aided Fabrication Technique for Cranial and/or Orbital Reconstruction

Background: Over the years, many materials have been used in orbital reconstruction and cranioplasty. Among the materials in current use, polymethyl methacrylate (PMMA) offers a high degree of compatibility with human tissue. Objective: This work describes a new, custom-made, 3D printing-aided, prosthetic fabrication process for orbital and/or cranial reconstruction using PMMA. Methods: On the basis of information obtained from computerized tomography scanning processed in Digital Imaging and Communication in Medicine format and exported to treatment planning software, a 3D prosthesis master model was designed and digitally printed. This was then used to create an injection mold from which the prosthesis was cast in PMMA and implanted in the patient. Five patients with cranial and/or orbital defects of tumoral or traumatic etiology were treated by this method. After 5 to 7 years follow-up, no complications occurred to cause the removal of the prostheses. Conclusion: This novel method makes it possible to produce customized PMMA prostheses to treat orbital and/or cranial defects that are cost-effective and individualized to each case. Address correspondence and reprint requests to Dr Pedro Martinez-Seijas, MD, PhD, Department of Oral and Maxillofacial Surgery, Donostia University Hospital, Paseo Dr Beguiristain s/n San Sebastián, Guipuzkoa, Spain; E-mail: pedromartinezseijas@gmail.com. Received 24 December, 2017 Accepted 15 January, 2018 The authors report no conflict of interest. © 2018 by Mutaz B. Habal, MD.

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Facial Surgery in Antiquity

No abstract available

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Facial Defect Reconstruction Using the True Scarless Pre-Expanded Forehead Flap

Objective: This clinical study describes a reconstructive method for facial soft-tissue defects that uses the pre-expanded forehead flap and minimizes donor site morbidities. Methods: The surgery was subdivided into 3 stages. First stage, an appropriately sized expander was buried underneath the forehead. Second stage, after adequate inflation of the expander, a forehead flap based on the frontal branches of the superficial temporal artery was raised, and the distal portion of the flap was used to reconstruct the facial defect. The cutaneous pedicle of the flap was designed near the frontal hairline. Third stage, 3 weeks later, the flap pedicle was divided, and the forehead incisional scar was melted into the neoreconstructed hairline. Results: Between July 2010 and December 2016, 16 patients underwent facial defect reconstruction. Etiologies included postburn scar (31%), melanocytic nevus (56%), and hemangioma (13%). The mean size of the defects was 8.78 × 5.06 cm (range, 3 × 2.5 to 15 × 7 cm). The average dimension of the forehead flap was 21.63 × 7.38 cm (range, 12 × 4 to 28 × 10 cm). Fifteen flaps survived without any perfusion-related complications. Venous congestion occurred in 1 flap and gradually subsided without any flap loss. Patients were followed after surgery, ranging from 4 to 48 months. Patients and/or their family members were satisfied with the final aesthetic outcomes. Conclusion: Facial defect reconstruction using a pre-expanded forehead flap, with the donor-site incisional scar designed along the hairline, can not only provide sufficient tissue for defect reconstruction, but also maximally reduce donor-site morbidities. Address correspondence and reprint requests to Yuanbo Liu, MD, Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing 100144, China; E-mail: ybpumc@sina.com Received 23 November, 2017 Accepted 15 January, 2018 This study was approved by the Ethical Committee of Plastic Surgery Hospital. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Antral Wall Approach for Reconstruction of Orbital Floor Fractures Using Anterior Maxillary Sinus Bone Grafts

Isolated orbital wall fractures account for 4% to 16% of all facial fractures. Even a modest change in the position of the bony walls can have a significant impact on orbital volume and globe position. Alloplastic materials or autogenous bone grafts such as the antral maxillary wall can be used to reconstruct small- to medium-size orbital fractures. The main advantage of an antral wall graft is the intraoral approach with minimal morbidity. Nine patients underwent repair of orbital floor fractures using the extraoral and the intraoral antral wall approach. The patients underwent preoperative computed tomography imaging and a minimum of 1 year follow-up. The size of the defects ranged from 0.5 to 1.4 cm. Two patients experienced minor immediate postoperative complications; infraorbital hypoesthesia. On follow-ups, none of our patients suffered from ocular movement restrictions or complications regarding the maxillary antral wall approach. The use of harvested bone grafts from the anterolateral wall of the maxillary sinus is a promising approach for the reconstruction of small- to mid-size orbital floor defects with minimal complications and excellent cosmetic and functional results. Address correspondence and reprint requests to Saleh Nseir, DMD, Rambam Health Care Campus, 8, Ha'Aliyah Street, Haifa 35254, Israel; E-mail: salehnse@yahoo.com Received 9 March, 2017 Accepted 7 January, 2018 Ethics Committee Approval no. 0167-15-RMB. Emodi Omri and Nseir Saleh have equally contributed to this work. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Anatomical Study of the Zygomaticofacial Foramen and Its Related Canal

The zygomaticofacial branch (ZFb) of the zygomatic nerve passes through the lateral wall of the orbit anterolaterally and traverses the zygomaticofacial foramen (ZFFOUT). However, in terms of intraorbital course, only a few studies have focused on the orbital opening of the ZFb (ZFFIN) and related canal. Therefore, this study aimed to locate the orbital opening and exit of the ZFb of the zygomatic nerve. Twenty sides from 10 fresh frozen cadaveric Caucasian heads were used in this study. The vertical distance between inferior margin of the orbit and ZFFIN (V-ZFFIN), the horizontal distance between the lateral margin of the orbit and ZFFIN (H-ZFFIN), diameter of the ZFFIN (D-ZFFIN), the vertical distance between the inferior margin of the orbit and ZFFOUT (V-ZFFOUT), the horizontal distance between the lateral margin of the orbit and ZFFOUT (H-ZFFOUT), and the diameter of the ZFFOUT (D-ZFFOUT) were measured, respectively. The ZFFIN were located 5.1 ± 2.0 mm superior to the inferior margin of the orbit and 4.3 ± 1.6 mm medial to the lateral margin of the orbit. The ZFFOUT was located 1.2 ± 2.9 mm inferior to the inferior margin of the orbit and 1.1 ± 3.0 mm lateral to the lateral margin of the orbit. The diameter of the ZFFOUT was significantly larger than that of the ZFFIN. Additional knowledge of the zygomatic nerve and its branches might decrease patient morbidity following invasive procedures around the inferolateral orbit. Address correspondence and reprint requests to Joe Iwanaga, DDS, PhD, Seattle Science Foundation, 550 17th Avenue, James Tower, Suite 600, Seattle, WA 98122; E-mail: joei@seattlesciencefoundation.org Received 21 August, 2017 Accepted 16 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Unilateral Hard Palate Necrosis After Ascending Palatine Artery Embolization

Embolization is a common treatment modality for refractory epistaxis. Here, the authors reported that the first patient with unilateral necrosis of the mucosa overlying the hard palate developed after embolization of ascending palatine artery. A 46-year-old man with a history of maxillofacial trauma complicated by 2 episodes of significant unilateral epistaxis. Although he did not experience any epistaxis after embolization, unilateral necrosis of the mucosa overlying the hard palate developed gradually 2 weeks after embolization. The necrotic tissue of hard palate was treated by surgical debridement and followed by antibiotic and analgesic. Address correspondence and reprint requests to Waleed Abdulhadi Alalawi, BDS, Qassim University College of Dentistry, Qassim, Saudi Arabia; E-mail: Waleed-332@hotmail.com Received 16 November, 2017 Accepted 14 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Upper First Premolar Positioning Evaluation for the Stability of the Dental Occlusion: Anatomical Considerations

The present study aimed to find the proper distorotation of the upper first premolar to achieve the therapeutic ideal advocated for the stability of the human occlusion. Normal teeth were analyzed and occlusal photocopies of upper arch were made to perform the 2 measurements. The first parameter was the angle formed by the perpendicular to the wire through the buccal cusp and a line connecting the buccal and the lingual cusps of the upper first premolar. The second one was the angle from the buccal line and the sagittal plane of the model. The amount of distorotation was calculated and a method to bond the bracket was suggested. Address correspondence and reprint requests to Professor Marco Cicciù, DDS, PhD, University of Messina, Messina, ME, Italy; E-mail: acromarco@yahoo.it; mcicciu@unime.it Received 27 December, 2017 Accepted 16 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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