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Spectrum of primary bone grafting in cranio maxillofacial trauma at a tertiary care centre in India.

Singh AK, Mohapatra DP, Kumar V - Indian J Plast Surg (2011)

Bottom Line: In past several years, traumas following road traffic accidents and other causes have increased, owing to an increase in mechanization and pace of life.Patients with a history of acute trauma resulting in facial skeletal injuries with or without bone loss were included in the study.Olecranon, Iliac crest, ribs, Vascularized as well as nonvascularized outer table calvarial grafts and nonvascularized inner table calvarial grafts were used in this study.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and reconstructive surgery, Chattrapati Shahuji Maharaj Medical University, Lucknow , Uttar Pradesh, India.

ABSTRACT

Background: In past several years, traumas following road traffic accidents and other causes have increased, owing to an increase in mechanization and pace of life. These patients frequently have complicated injuries involving soft tissue and the craniofacial skeleton. Assessment of bony injuries and loss of portions of facial skeleton and their management has proved to be a challenge to the reconstructive surgeon.

Aims: Primary bone grafting of craniofacial skeletal injuries provides an opportunity for one stage correction of bony defects. The varied spectrum of primary bone grafts for management of craniomaxillofacial injuries are evaluated in this study.

Materials and methods: Patients with a history of acute trauma resulting in facial skeletal injuries with or without bone loss were included in the study. Primary bone grafting was undertaken in situations requiring contour correction, replacement of skeletal losses and for rigid fixation of fracture segments. Olecranon, Iliac crest, ribs, Vascularized as well as nonvascularized outer table calvarial grafts and nonvascularized inner table calvarial grafts were used in this study.

Results: Sixty two patients of craniomaxillofacial injury following trauma requiring primary bone grafting were considered in this study. Fifty seven percent of patients (n=32) required primary bone grafting for replacement of bone loss while bone grafting for contour correction was done in twenty three patients. The parietal calvaria overlying the non-dominant hemisphere was used as a source of bone graft in forty-nine patients. Nearly ninety-two percent of the patients were satisfied with the results of primary bone grafting.

Conclusions: Functional and aesthetic assessment of each of these patients, managed with primary bone grafting revealed a low rate of disabilities and high percentage of satisfaction in this study.

No MeSH data available.


Related in: MedlinePlus

Rigid fixation of a mandible fracture using an autologous bone plate
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Figure 4: Rigid fixation of a mandible fracture using an autologous bone plate

Mentions: A detailed preoperative assessment including a clinical examination and radiological evaluation was carried out in each patient, to ascertain the need for primary bone grafting. The patients were operated under either general or loco-regional anesthesia depending on either the severity of the injury, age of the patient, or the expected duration of surgery. The fractures involving the faciomaxillary skeleton were approached through the existing lacerations, where present, or through standard incisions like subciliary, gingivobuccal sulcus or coronal in cases of closed injuries. Bone grafts were harvested from different sites including the calvaria, olecranon process of the ulna, ribs, and iliac crest using the standard approaches. Bone grafts in the form of vascularised as well as non-vascularised outer table calvarial grafts, non-vascularised inner table calvarial grafts, bone chips, bone dust, split ribs, and partial thickness olecranon grafts, were used for skeletal correction for patients in this study [Figure 1]. The inner table of the calvarium was harvested and used as a bone graft in patients having head injuries, who required concurrent cranioplasty. The calvarial bone graft was preferred in a majority of cases due to proximity to the affected site, abundance, and ease of harvest. Ribs were used as primary grafts where the cranial loss was extensive. The olecranon bone graft was preferred for the nasal dorsum overlay. The indications for primary bone grafting were correction of skeletal contour abnormalities, replacement of bone losses, and rigid fixation of the fracture segments [Figure 2]. These grafts were either placed as an onlay graft or an inlay graft without any rigid fixation, or with an interfragmentary fixation using stainless steel wiring, or delayed absorbable synthetic braided sutures (polyglactin 910) or screws and miniplates. The inlay graft method was used for covering the frontal and maxillary sinuses where comminution and bone loss of the anterior wall had occurred. Here the edges of the bone graft were just wedged into the margins of the sinus wall. Where the sinus wall fracture had resulted in comminution of the bone without any bone loss and only a contour defect, the bone graft was placed as an onlay without any fixation. By doing this, it was ensured that the bone graft was lying snugly in the soft tissue pocket in close contact to the bone. Interfragmentary fixation of bone chips in children was performed with polyglactin sutures [Figure 3a]. This obviated the need for removal of the hardware at a later date. Some fractures were reduced and skeletal stability was achieved with the bone graft fixed with screws to the fracture segments, where the bone graft behaved as an autologous bone plate. This method was utilized for unilateral mandibular body fractures [Figure 4]. In all patients with comminuted craniofacial fractures, an attempt was made to utilize the bone fragments by fixing them either in their original places or as bone grafts in regions having more severe losses. An adequate, well-vascularised, soft tissue cover [Figure 3b] was obtained in all cases, irrespective of the location of the fractures, number of grafts used or type of fixation obtained. All external wounds and incisions were closed meticulously. Drains were placed where required. Standard postoperative care, individualized to the type of injury, was instituted for all patients. The patients were called for follow-up at regular intervals. The OPD follow-up at one week, two weeks, four weeks, three months, and one year, included postoperative photographs in standard views, review X-rays of the face, orthopantomogram (OPG) as required, radioisotope bone scanning [Figure 5a] and a follow-up CT scan [Figures 5b,c,d] when required.


Spectrum of primary bone grafting in cranio maxillofacial trauma at a tertiary care centre in India.

Singh AK, Mohapatra DP, Kumar V - Indian J Plast Surg (2011)

Rigid fixation of a mandible fracture using an autologous bone plate
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111118&req=5

Figure 4: Rigid fixation of a mandible fracture using an autologous bone plate
Mentions: A detailed preoperative assessment including a clinical examination and radiological evaluation was carried out in each patient, to ascertain the need for primary bone grafting. The patients were operated under either general or loco-regional anesthesia depending on either the severity of the injury, age of the patient, or the expected duration of surgery. The fractures involving the faciomaxillary skeleton were approached through the existing lacerations, where present, or through standard incisions like subciliary, gingivobuccal sulcus or coronal in cases of closed injuries. Bone grafts were harvested from different sites including the calvaria, olecranon process of the ulna, ribs, and iliac crest using the standard approaches. Bone grafts in the form of vascularised as well as non-vascularised outer table calvarial grafts, non-vascularised inner table calvarial grafts, bone chips, bone dust, split ribs, and partial thickness olecranon grafts, were used for skeletal correction for patients in this study [Figure 1]. The inner table of the calvarium was harvested and used as a bone graft in patients having head injuries, who required concurrent cranioplasty. The calvarial bone graft was preferred in a majority of cases due to proximity to the affected site, abundance, and ease of harvest. Ribs were used as primary grafts where the cranial loss was extensive. The olecranon bone graft was preferred for the nasal dorsum overlay. The indications for primary bone grafting were correction of skeletal contour abnormalities, replacement of bone losses, and rigid fixation of the fracture segments [Figure 2]. These grafts were either placed as an onlay graft or an inlay graft without any rigid fixation, or with an interfragmentary fixation using stainless steel wiring, or delayed absorbable synthetic braided sutures (polyglactin 910) or screws and miniplates. The inlay graft method was used for covering the frontal and maxillary sinuses where comminution and bone loss of the anterior wall had occurred. Here the edges of the bone graft were just wedged into the margins of the sinus wall. Where the sinus wall fracture had resulted in comminution of the bone without any bone loss and only a contour defect, the bone graft was placed as an onlay without any fixation. By doing this, it was ensured that the bone graft was lying snugly in the soft tissue pocket in close contact to the bone. Interfragmentary fixation of bone chips in children was performed with polyglactin sutures [Figure 3a]. This obviated the need for removal of the hardware at a later date. Some fractures were reduced and skeletal stability was achieved with the bone graft fixed with screws to the fracture segments, where the bone graft behaved as an autologous bone plate. This method was utilized for unilateral mandibular body fractures [Figure 4]. In all patients with comminuted craniofacial fractures, an attempt was made to utilize the bone fragments by fixing them either in their original places or as bone grafts in regions having more severe losses. An adequate, well-vascularised, soft tissue cover [Figure 3b] was obtained in all cases, irrespective of the location of the fractures, number of grafts used or type of fixation obtained. All external wounds and incisions were closed meticulously. Drains were placed where required. Standard postoperative care, individualized to the type of injury, was instituted for all patients. The patients were called for follow-up at regular intervals. The OPD follow-up at one week, two weeks, four weeks, three months, and one year, included postoperative photographs in standard views, review X-rays of the face, orthopantomogram (OPG) as required, radioisotope bone scanning [Figure 5a] and a follow-up CT scan [Figures 5b,c,d] when required.

Bottom Line: In past several years, traumas following road traffic accidents and other causes have increased, owing to an increase in mechanization and pace of life.Patients with a history of acute trauma resulting in facial skeletal injuries with or without bone loss were included in the study.Olecranon, Iliac crest, ribs, Vascularized as well as nonvascularized outer table calvarial grafts and nonvascularized inner table calvarial grafts were used in this study.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and reconstructive surgery, Chattrapati Shahuji Maharaj Medical University, Lucknow , Uttar Pradesh, India.

ABSTRACT

Background: In past several years, traumas following road traffic accidents and other causes have increased, owing to an increase in mechanization and pace of life. These patients frequently have complicated injuries involving soft tissue and the craniofacial skeleton. Assessment of bony injuries and loss of portions of facial skeleton and their management has proved to be a challenge to the reconstructive surgeon.

Aims: Primary bone grafting of craniofacial skeletal injuries provides an opportunity for one stage correction of bony defects. The varied spectrum of primary bone grafts for management of craniomaxillofacial injuries are evaluated in this study.

Materials and methods: Patients with a history of acute trauma resulting in facial skeletal injuries with or without bone loss were included in the study. Primary bone grafting was undertaken in situations requiring contour correction, replacement of skeletal losses and for rigid fixation of fracture segments. Olecranon, Iliac crest, ribs, Vascularized as well as nonvascularized outer table calvarial grafts and nonvascularized inner table calvarial grafts were used in this study.

Results: Sixty two patients of craniomaxillofacial injury following trauma requiring primary bone grafting were considered in this study. Fifty seven percent of patients (n=32) required primary bone grafting for replacement of bone loss while bone grafting for contour correction was done in twenty three patients. The parietal calvaria overlying the non-dominant hemisphere was used as a source of bone graft in forty-nine patients. Nearly ninety-two percent of the patients were satisfied with the results of primary bone grafting.

Conclusions: Functional and aesthetic assessment of each of these patients, managed with primary bone grafting revealed a low rate of disabilities and high percentage of satisfaction in this study.

No MeSH data available.


Related in: MedlinePlus