Volumetric Analysis of Alveolar Bone Defect Using Three-Dimensional-Printed Models Versus Computer-Aided Engineering.

Knowing the volume of a graft is essential in repairing alveolar bone defects. This study investigates the 2 advanced preoperative volume measurement methods: three-dimensional (3D) printing and computer-aided engineering (CAE). Ten unilateral alveolar cleft patients were enrolled in this study. Their computed tomographic data were sent to 3D printing and CAE software. A simulated graft was used on the 3D-printed model, and the graft volume was measured by water displacement. The volume calculated by CAE software used mirror-reverses technique. The authors compared the actual volumes of the simulated grafts with the CAE software-derived volumes. The average volume of the simulated bone grafts by 3D-printed models was 1.52 mL, higher than the mean volume of 1.47 calculated by CAE software. The difference between the 2 volumes was from -0.18 to 0.42 mL. The paired Student t test showed no statistically significant difference between the volumes derived from the 2 methods. This study demonstrated that the mirror-reversed technique by CAE software is as accurate as the simulated operation on 3D-printed models in unilateral alveolar cleft patients. These findings further validate the use of 3D printing and CAE technique in alveolar defect repairing. (C) 2016 by Mutaz B. Habal, MD.

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Recalcitrant Invasive Skin Cancer of the Scalp: Combined Extirpation and Microsurgical Reconstruction Without Cranioplasty.

Background: Recurrent invasive skin cancer of the scalp and calvarium is a difficult problem for which universally accepted treatment protocols have not been established. The authors present their 10-year experience with treatment of this specific subset of scalp reconstruction patients and present a successful treatment algorithm that is well suited to this patient population. Methods: The authors retrospectively reviewed all patients of microsurgical scalp reconstruction performed from 2005 to 2015 that involved invasive cutaneous malignancies of the scalp and calvarium. Results: Eleven patients met inclusion criteria. There were 9 squamous cell carcinoma, 1 basal cell carcinoma, and 1 melanoma. Seven received radiation prior to resection, 2 were irradiated postoperatively, and 2 were immunosuppressed. Seven had a history of prior scalp reconstruction. The median scalp defect size was 141 cm2. All the patients underwent craniectomy and the median cranial defect size was 71 cm2. Cranioplasty was not performed in any patient. There were no intraoperative complications or flap loss. Recipient site complications included hematoma in 1, 1 seroma, 2 cerebral spinal fluid leaks, 3 partial skin graft loss. There was 1 donor site seroma in a patient who had a latissimus dorsi flap. All the patients reported satisfaction with the overall result and none were limited in activities by the existing cranial defect. Conclusions: This is the largest series published to date that focuses exclusively on management of cutaneous malignancies with intracranial invasion. Wide resection with craniectomy, and reconstruction with microvascular free tissue transfer without cranioplasty provides safe and reliable treatment of recalcitrant invasive scalp skin cancers with low morbidity and without major complications. Pre and postoperative radiation is well tolerated with this approach. The patients in this series were of advanced age and of a lifestyle for which cranioplasty is unnecessary for return to regular activities. (C) 2016 by Mutaz B. Habal, MD.

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Reconstruction of Skin Defects on the Mid and Lower Face Using Expanded Flap in the Neck.

Background: The reconstruction of major burn and other deformities resulting from significant soft tissue deficits of the face is a continuing challenge for surgeons. In the study, the authors introduce our 5-year experiences using expanded flap in the neck for reconstruction on the mid and lower face. Methods: From 2008 and 2013, 12 tissue expanders were used in 12 patients for face resurfacing. The operation consisted of 2 steps. In the first step, the expander was placed subcutaneously under the skin of the neck and they were expanded timely to create adequate superfluous skin and soft tissue. In the second step, the expanded flap was transferred to reconstruct the defects on the mid and lower face after excision of the lesions. Results: All 12 patients with lesions on the mid and lower face underwent successful facial resurfacing with the described technique in the last 5 years. The follow-up ranged from 6 to 24 months. Flaps did not shrink after the operations, and subsequent contractures did not recur. The cervicomental angle appeared normal. All flaps survived well except 2 patients developed slight necrosis at the distal edge and no other major complication was observed. Esthetic outcomes were rated to be very good in 10 patients (83.3%) and good in 2 patients (16.7%). Conclusion: The application of expanded flaps in the neck is proved to be an effective way of repairing facial defects on the mid and lower face. The technique is remarkably reliable in resurfacing the peripheral facial esthetic units. (C) 2016 by Mutaz B. Habal, MD.

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Risk Factors Predicting Nasoseptal Flap Failure in the Endoscopic Endonasal Transsphenoidal Approach.

Objective: Reconstruction of the skull base using a pedicled nasoseptal flap (NSF) seems to be advantageous after the endoscopic endonasal transsphenoidal approach (EETSA). A few reports have evaluated the cause of flap failure in EETSA using NSFs. The aim of this study was to evaluate the perioperative risk factors for NSF failure. Study Design: Patient series. Setting: Retrospective review of medical records at a tertiary referral center. Methods: The study population comprised patients who underwent EETSA with NSF elevation between February 2009 and March 2014. The authors retrospectively reviewed the all patients' medical records, including operative findings. Results: Four hundred thirteen patients (203 males and 210 females) underwent EETSA, and 315 patients underwent EETSA with NSF elevation. The mean patient age was 48.0 years. The total number of patients of NSF failure was 6 (overall rate: 1.61%, 6/315; flap elevation: 0.31%, 1/315; flap reconstruction: 15.1%, 5/33). Two patients had diabetes mellitus. One patient had cardiovascular problems. Five patients were elderly (>60 years; mean age: 70 years). Five patients had postoperative nasal infection. One patient underwent preoperative radiation therapy. Conclusion: Nasoseptal flap is a usually safe and effective technique for skull base reconstruction. However, the management of patients with diabetes mellitus, cardiovascular problems, advanced age, postoperative nasal infection, and radiation therapy may require more attention to improve NSF survival. (C) 2016 by Mutaz B. Habal, MD.

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Review of 5 Articles of "Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Patients With Positional Plagiocephaly" Articles in Neurosurgery 79: E623-E633, 2016.

No abstract available

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Wrinkle the Skin, Wrinkle the Soul.

No abstract available

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Magnet-Retained Orbital Prosthesis Using a Dental Implant.

The loss of an eye and the associated facial disharmony has major physical, psychological, and social consequences for patients undergoing orbital exenteration. A magnet-retained prosthesis with an implant has various advantages over both adhesive and spectacle-retained prostheses for reconstruction of the exenterated orbit. The author demonstrates one representative patient with our orbital reconstruction patients with magnetic implants, which will be applied to various maxillofacial prosthesis strategies in the near future. (C) 2016 by Mutaz B. Habal, MD.

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