Combined use of resorbable poly-L-lactic acid-polyglycolic acid implant and bone cement for treating large orbital floor fractures.

Objectives: This prospective study evaluated the accuracy of mandibular reconstruction using free fibular flaps (by comparing virtual plans to the three-dimensional postoperative results), and the extent of bone-to-bone contact after computer-assisted surgery.Methods: We included 65 patients who underwent partial-continuity mandibular resections from February 2013 to January 2017, and evaluated virtual planning, surgical techniques, and accuracy.Results: Forty-seven patients were analysed. A total of 112 fibular segments received 54 implants. We measured 227 distances between landmarks to assess the accuracy of reconstruction. Postoperative reconstruction accuracy ranged from 0.5 to 3 mm.Conclusion: Virtual surgical planning very accurately translated simulation into reality, particularly in patients requiring large, complex mandibular reconstructions using multiple fibular segments.

An osteoma is a benign, slow-growing, osteogenic neoplasm with a low recurrence rate that is typically characterized by the proliferation of a compact or cancellous bone. It can be peripheral, central, or extraskeletal. Usually asymptomatic, peripheral osteomas in the maxillofacial region commonly arise in the paranasal sinuses and mandible and rarely occur in the zygomatic arch, with only six previously documented cases in the literature. Here, we present the management of a solitary peripheral osteoma of the right zygomatic arch in a 72-year-old woman and a review of the literature.

Objectives/Hypothesis: The aim of this study was to explore whether the production of in-hospital, low-cost surgical cutting guides would be possible and to assess different cutting guide shapes to facilitate the surgery and the application with instruments. Study Design: Cohort study. Methods: Using free computer-aided design software, surgical cutting guides for the mandible and fibula were designed and used to perform virtual segmental osteotomies and fibula transplants in seven patients. Results: Fourteen virtual osteotomies were performed using the free software and the proposed workflow. Thirteen guides were then printed to transfer the virtual planning information to the operating room. Conclusions: Virtual planning and the three-dimensional (3D) printing of guides for mandibular reconstruction is reliable with the aid of an in-hospital 3D laboratory. We also demonstrated that different guides with different shapes could be produced with benefits during surgery.

Cases in which the CCF is draining posteriorly may be more challenging because of the smaller size of the SOV. Superficial collateral veins can be used to guide the dissection posteriorly. However, these blood vessels are prone to bleeding, and the importance of proper hemostasis throughout the procedure cannot be overemphasized. Alternatively, the SOV can be cannulated via a lateral orbitotomy when the anterior segment of the vein is out of reach or thrombosed.Complications are infrequent but may include orbital hemorrhage, infection, and damage to the trochlea or other orbital structures. 6,9 The inability to identify or cannulate the SOV remains a possibility. One of our patients (the second presented) developed an orbital compartment syndrome towards the end of the procedure, after the cannula was inadvertently dislodged from the SOV. The situation was quickly recognized, and the patients did not suffer from any related sequelae. CONCLUSIONIn our experience, the SOV provides a safe and effective access for endovascular embolization of indirect CCFs. Considering the inherent risks of orbital surgery, this approach should be reserved to patients in which all other options have been exhausted. The patient should also be monitored closely during the embolization process to prevent ophthalmic complications. ACKNOWLEDGMENTSWe would like to acknowledge the three patients presented in this study, who generously granted us permission to share their stories with the academic community.