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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

Photographs showing (a) patient with a ten-day-old injury, showing ptosis and enopthalmos on the right side, (b) and (c) radiographs demonstrating complex comminuted fracture of the orbital floor, maxillary wall, and zygoma (d) six-month follow-up photograph showing an improved functional and aesthetic result, with replacement of the orbital floor with calvarial bone graft
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Figure 10: Photographs showing (a) patient with a ten-day-old injury, showing ptosis and enopthalmos on the right side, (b) and (c) radiographs demonstrating complex comminuted fracture of the orbital floor, maxillary wall, and zygoma (d) six-month follow-up photograph showing an improved functional and aesthetic result, with replacement of the orbital floor with calvarial bone graft

Mentions: The incidence of donor site complications was eleven percent (n = 7). Bone graft donor site complications included pain over the donor site, contour defect, and fracture of the bone graft during harvest. Pain was most commonly associated with the ribs, iliac crest, and olecranon harvest. The contour defect was noted following the iliac crest harvest, while the graft fracture occurred during the calvarial graft harvest. Recipient-site complications included graft fracture, infection, contour abnormalities, and resorption. These were seen in eight patients. The graft fracture was noted in patients during a follow-up CT scan. Persistent infection in the recipient site in one patient required graft and hardware removal. This patient had a compound fracture of the mandibular body opening into the skin, and had presented late. The average postoperative hospital stay for frontal and parietal fractures was seven days. Fractures located in the midface required a hospital stay averaging 7 – 15 days. This was attributed to the presence of associated injuries, tracheostomy or other systemic injuries. Nearly ninety-two percent of the patients were satisfied with the results [Figures 10 and 11].


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)

Photographs showing (a) patient with a ten-day-old injury, showing ptosis and enopthalmos on the right side, (b) and (c) radiographs demonstrating complex comminuted fracture of the orbital floor, maxillary wall, and zygoma (d) six-month follow-up photograph showing an improved functional and aesthetic result, with replacement of the orbital floor with calvarial bone graft
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 10: Photographs showing (a) patient with a ten-day-old injury, showing ptosis and enopthalmos on the right side, (b) and (c) radiographs demonstrating complex comminuted fracture of the orbital floor, maxillary wall, and zygoma (d) six-month follow-up photograph showing an improved functional and aesthetic result, with replacement of the orbital floor with calvarial bone graft
Mentions: The incidence of donor site complications was eleven percent (n = 7). Bone graft donor site complications included pain over the donor site, contour defect, and fracture of the bone graft during harvest. Pain was most commonly associated with the ribs, iliac crest, and olecranon harvest. The contour defect was noted following the iliac crest harvest, while the graft fracture occurred during the calvarial graft harvest. Recipient-site complications included graft fracture, infection, contour abnormalities, and resorption. These were seen in eight patients. The graft fracture was noted in patients during a follow-up CT scan. Persistent infection in the recipient site in one patient required graft and hardware removal. This patient had a compound fracture of the mandibular body opening into the skin, and had presented late. The average postoperative hospital stay for frontal and parietal fractures was seven days. Fractures located in the midface required a hospital stay averaging 7 – 15 days. This was attributed to the presence of associated injuries, tracheostomy or other systemic injuries. Nearly ninety-two percent of the patients were satisfied with the results [Figures 10 and 11].

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