Displaying publications 1 - 20 of 35 in total

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  1. Burezq H, Bang RL, George A, Mukhtar A
    J Craniofac Surg, 2007 Jul;18(4):971-4.
    PMID: 17667698
    Prominent premaxilla is one of the problems encountered when dealing with bilateral complete cleft lip and palate patients. Secondary alveolar bone grafting with these patients would achieve filling of the osseous defect, supports the alar base, eliminate the oro-nasal fistula and enhance the maxillary instability. This article describes the management of a bilateral cleft lip and palate patient with an extremely protruding premaxilla done in one stage surgery. To our knowledge, this is the first report of such degree of severity in the English literature.
  2. Arshad AR, Selvapragasam T
    J Craniofac Surg, 2008 Jan;19(1):175-83.
    PMID: 18216685 DOI: 10.1097/scs.0b013e3181534a77
    This is a study on 124 patients who were treated by the authors over a 19-year period. There were 48 male and 76 female patients. The age range of these patients at the time of treatment was between 4 months and 32 years. There was no family history of similar deformity. All of these patients come from a socially low-income group. Fourteen patients had accompanying congenital amputation of fingers, toes, or limbs. Two had oral cleft lip and palate. The surgical treatment was medial orbital wall osteotomy and excision of encephalocele. There were two mortalities and five patients who had complications that needed secondary surgical intervention. Thirty-eight patients are still under follow up without any complaints.
  3. Ramli R, Abdul Rahman R, Abdul Rahman N, Abdul Karim F, Krsna Rajandram R, Mohamad MS, et al.
    J Craniofac Surg, 2008 Mar;19(2):316-21.
    PMID: 18362705 DOI: 10.1097/SCS.0b013e318163f94d
    Motorcycle casualties represent significant number in road traffic accidents in Malaysia, and among all the injuries, facial injuries pose many significant problems physiologically, functionally, and aesthetically. The aim of this study was to analyze the pattern of maxillofacial as well as other injuries in motorcyclists who were seen at Hospital Universiti Kebangsaan Malaysia.Patients' records from January 2004 to December 2005 were reviewed. Data related to demographics, vehicle/object involved in collision, involvement as a rider or pillion, whether a helmet was worn or not, location of injuries on the face/facial bones, and other associated injuries were collected.A total of 113 cases of motorcycle accidents were recorded; 106 males and 7 females were involved. Mean age was 25.8 years. Among all the races, Malay had the highest involvement (72.3%), followed by Chinese (14.3%), Indians (8.9%), and others (5.4%). The types of collision were either a single-vehicle collision (i.e., skidded) or with another vehicle/s or object (e.g., tree, stone, or lamppost). The injuries were mainly seen on the lower face (46.9%) followed by midface (25.7%) and a combination of the midface and lower face (15%) and others (12.4%). The most frequent other associated injuries recorded were orthopedic and head injuries.
  4. Hariri F, Rahman ZA, Mahdah S, Mathaneswaran V, Ganesan D
    J Craniofac Surg, 2015 Nov;26(8):e740-4.
    PMID: 26594993 DOI: 10.1097/SCS.0000000000002174
    Rigid external distraction device is often indicated for superior midfacial advancement in pediatric syndromic craniosynostosis patients. Even though the technique is proven reliable to treat the functional issues related to the craniofacial deformity, major complications associated with its fixation, such as intracranial pin perforation and migration have been reported. We report a novel technique of using a customized headgear to prevent intracranial pin perforation over a very thin temporal bone region in an 8-month-old infant with Crouzon syndrome who underwent monobloc Le Fort III distraction osteogenesis using a combination of bilateral internal and a rigid external distraction device. The customized headgear provides a protective platform at the temporal region thus preventing intracranial pin perforation and allows stable fixation during the early phase of consolidation period to prevent central component relapse. The headgear can be used short term when rigid external distractor is indicated in infant patient but requires close monitoring because of risks of skin necrosis and temporal region indentation.
  5. Ibrahim N, Nazimi AJ, Ajura AJ, Nordin R, Latiff ZA, Ramli R
    J Craniofac Surg, 2016 Jul;27(5):1361-6.
    PMID: 27391504 DOI: 10.1097/SCS.0000000000002792
    The aim of this study was to describe the clinical features and expression of bcl-2, cyclin D1, p53, and proliferating cell nuclear antigen (PCNA) antibodies in syndromic (nevoid basal cell carcinoma syndrome [NBCCS]) and nonsyndromic patients diagnosed with keratocystic odontogenic tumor (KCOT).

    METHODS: This descriptive study comprised 5 patients of KCOT associated with NBCCS and 8 patients of nonsyndromic type treated in the Department of Oral Maxillofacial Surgery, Universiti Kebangsaan Malaysia Medical Centre between years 1998 and 2011. The clinical features (site, size, treatment, and recurrence), demographic characteristics, and immunohistochemistry results using antibodies of bcl-2, cyclin D1, p53, and PCNA were examined. The association of the antibody expression and the type of KCOT was analyzed using Fisher exact test.

    RESULTS: Altogether there were 13 patients, 5 with syndromic KCOT (1 patient met 3 major criteria of NBCCS) and 8 with sporadic KCOT. The age range for syndromic KCT was 11 to 21 years (mean 16.00 years, SD 4.36) and 10 to 54 years (median 24.50 years, interquartile range 19.00) for the nonsyndromic KCOT. Tumor recurrence occurred in 3 patients (7.7%); 1 patient from the syndromic and 2 patients from the nonsyndromic. The most positive expression was observed in PCNA for both the syndromic and nonsyndromic samples and the least positive expression involved the p53.

    CONCLUSION: PCNA, bcl-2 protein, and cyclin D1 expressions could be useful in evaluating the proliferative activity of the tumor and the aggressiveness of the clinical presentation; however, the authors would propose for larger sample size research for more definitive results.

  6. Singh J, Rahman RA, Rajion ZA, Abdullah J, Mohamad I
    J Craniofac Surg, 2017 Jan;28(1):e64-e70.
    PMID: 27922969 DOI: 10.1097/SCS.0000000000003218
    INTRODUCTION: The human orbit is a complex anatomic region, which plays predominant role in the evaluation of craniofacial complex. A thorough understanding of the relationship of the distance from orbital rim to the important vital structures of the orbital apex is required for the surgeon to perform safe and effective surgery.

    OBJECTIVES: To evaluate and compare the depth and distances from various points of the orbital rim to the fissures and foramina of the orbital apex between genders in the local population.

    METHODOLOGY: Linear measurements were conducted on 60 orbits from 30 patients who had undergone head computed tomography scan. These measurements were done utilizing the multiplanar reconstruction modes on computed tomography images with minimum slice thickness of 1 mm.

    RESULTS: Males have statistically significant larger orbits than females with higher mean measurements in all parameters, except for the distance from posterior ethmoidal foramen to the optic canal which was the same. However, there were no significant differences in all parameters between the right and left orbits.

    CONCLUSION: This study provides the absolute limit of safe internal orbital dissection in respect to the local population. Despite males having larger orbits than females, it is clinically negligible.

  7. Qabbani AA, Razak NHA, Kawas SA, Sheikh Abdul Hamid S, Wahbi S, Samsudin AR
    J Craniofac Surg, 2017 Jun;28(4):e318-e325.
    PMID: 28230596 DOI: 10.1097/SCS.0000000000003569
    The aim of this study was to determine the efficacy of immediate implant placement with alveolar bone augmentation on socket preservation following atraumatic tooth extraction and comparing it with a tooth alveolar socket that was allowed to heal in a conventional way.Twenty medically fit patients (8 males and 12 females aged between 18 and 40 years) who needed noncomplicated tooth extraction of mandibular premolar teeth were divided randomly and equally into 2 groups. In Group I, the empty extraction socket was left untreated and allowed to heal in a conventional way. In Group II, the immediate implant was placed and the gap between the implant and the inner buccal plate surface of the socket wall was filled with lyophilized bovine bone granules and the wound was covered with pericardium membrane. The patients were followed up clinically and radiologically for regular reviews at 1 week, 3 months, and 9 months postoperative. Cone beam computerized tomography images of the alveolar ridge and socket were analyzed to determine the structural changes of the alveolar ridge. Resonance frequency analysis was measured at 9 months for Group II to assess the degree of secondary stability of the implants by using Osstell machine.A significant difference of bone resorption of 1.49 mm (confidence interval, CI 95%, 0.63-2.35) was observed within the control group at 3 months, and 1.84 mm (P ≤ 0.05) at 9 months intervals. No significant changes of bone resorption were observed in Group II. Comparison between groups showed a highly significant difference at 3 months; 2.56 mm (CI 95% 4.22-0.90) and at 9 months intervals; 3.2 mm (CI 95%, 4.70-1.62) P ≤ 0.001 between Group I and II. High resonance frequency analysis values were observed at 9 months postoperative in Group II.In conclusion, the insertion of immediate implants in fresh extraction sockets together with grafting the circumferential gap between the bony socket wall and the implant surface with bovine bone granules was able to preserve a greater amount of alveolar ridge volume when compared with an extraction socket that was left to heal in a conventional way.
  8. Al Qabbani A, Al Kawas S, A Razak NH, Al Bayatti SW, Enezei HH, Samsudin AR, et al.
    J Craniofac Surg, 2018 Mar;29(2):e203-e209.
    PMID: 29303859 DOI: 10.1097/SCS.0000000000004263
    INTRODUCTION: Alveolar bone is critical in supporting natural teeth, dental implants as well as a removable and fixed prosthesis. Alveolar bone volume diminishes when its associated natural tooth is lost.

    OBJECTIVE: The aim of this study is to evaluate the effectiveness of bovine bone granules on alveolar bone socket augmentation for ridge preservation following atraumatic tooth extraction.

    MATERIALS AND METHODS: Twenty medically fit patients (12 males and 8 females aged between 18 and 40 years) who needed noncomplicated tooth extraction of 1 mandibular premolar tooth were divided randomly and equally into 2 groups. In control group I, the empty extraction socket was left untreated and allowed to heal in a conventional way. In group II, the empty extraction socket wound was filled with lyophilized bovine bone xenograft granules 0.25 to 1 mm of size, 1 mL/vial. A resorbable pericardium membrane was placed to cover the defect. Clinical and 3-dimensional radiological assessments were performed at day 0, 3 months, and 9 months postoperative.

    RESULTS: There were no clinical differences in general wound healing between the groups. Comparisons within the groups showed a significant difference of bone resorption of 1.49 mm (95% confidence interval, 0.63-2.35) at 3 months, and further resorption of 1.84 mm (P ≤ 0.05) at 9 months in the control group. No significant changes of bone resorption were observed in group II during the same time interval. Comparison between groups showed a significant difference of bone resorption at 3 and 9 months (2.40 and 2.88 mm, respectively).

    CONCLUSION: The use of lyophilized demineralized bovine bone granules in socket preservation to fill in the extraction socket seems essential in preserving the alveolar bone dimension as it showed excellent soft and hard tissue healing. This study concludes that the alveolar bone socket exhibited a dynamic process of resorption from the first day of tooth extraction. Evidence shows the possibility of using bovine bone granules routinely in socket volume preservation techniques following tooth extraction.

  9. Koh KL, Zain A
    J Craniofac Surg, 2018 Jun;29(4):861-867.
    PMID: 29438206 DOI: 10.1097/SCS.0000000000004347
    : Open cranial vault remodeling techniques require rigid fixation with hardware such as plates and screws; however, complications can occur. The purpose of this study was to assess the surgical outcome after open reconstruction for craniosynostosis with less rigid fixation using nonabsorbable suture.

    METHODS: Retrospective review of patients who underwent open craniofacial reconstruction for craniosynostosis at the Hospital Kuala Lumpur between January 2011 and December 2016 were performed. Demographic data, surgical complications, and postoperative aesthetic outcomes and reoperations were evaluated using Whitaker classification. Statistical analyses were performed using SPSS.

    RESULTS: Thirty-four (n = 34) cases were included in this review consisting of 16 males and 18 females (ratio 1:1.25). Sixteen patients were syndromic with multiple suture synostoses: Apert syndrome (n = 8), Crouzon syndrome (n = 6), and Muenke's syndrome (n = 2). Eighteen patients were nonsyndromic: isolated single-suture craniosynostosis (n = 12) and multiple suture involvement (n = 6). Mean age of presentation was 17.4 months (4-16 months) with mean age of surgery of 23.8 months (6-68 months). Mean length of surgery was 6.1 hours (range 3-10 hours) and mean length of hospital stay was 10 days (mean 7-20 days). Mean duration of follow-up was 2.2 years (6 month-4 years). There were a total of 9 complications postoperatively: massive blood loss (n = 4), seroma (n = 2), exposure keratitis (n = 1), hand extravasation (n = 1), and occipital sore (n = 1). Analysis showed multiple suture craniosynostoses were associated with longer operative times (4.3 hours vs 6.5 hours, P = 0.0082 24 months of age, P = 0.00059). Patients were categorized as 88.2% (n = 30) Whitaker I and II and 11.8% (n = 4) Whitaker III and IV. Reoperation rates were 2.9% (n = 1). Whitaker III and IV class were higher among patients with syndromic synostosis, unicoronal and multiple suture synostoses.

    CONCLUSIONS: Our technique of open cranial reconstruction with nonabsorbable suture nylon 2/0 as sole method of fixation has resulted in good aesthetic outcome with low reoperations and complications rate. Longer follow-up is needed to ascertain our long-term results.
  10. Nayak SB
    J Craniofac Surg, 2019 1 15;30(2):e168-e169.
    PMID: 30640853 DOI: 10.1097/SCS.0000000000005102
    Facial artery is known to show variations in its origin, course, termination, and branching pattern. One of its reported variant branch is called premasseteric branch. During our dissection classes, it was observed that an elderly male cadaver had 3 premasseteic branches arising from the facial artery. The first and second premasseteric branches passed deep to masseter under its anterior border, whereas the third premasseteric branch terminated by anastomosing with the infraorbital artery. This case could be of importance to maxillofacial surgeons, craniofacial surgeons, and plastic surgeons.
  11. Narayanan V, Jayapalan RR, Singh Sidhu A, Koh KMR
    J Craniofac Surg, 2019 2 27;30(3):841-842.
    PMID: 30807473 DOI: 10.1097/SCS.0000000000005185
    Exophytic lesions involving the face present with an undesirable esthetic deformity and usually necessitate surgical excision. Conventional open excision techniques may lead to scar formation or pigmentation issues postoperatively. Minimally invasive endoscope-assisted surgery will be able to overcome these problems. However, this technique is not widely used because of the limited optical cavity working space, which hinders good visualization. We describe a technique to improve the optical cavity workspace to enable adequate endoscope-assisted surgical excision of forehead lesions in 2 cases. Foley's catheter and ribbon gauze were used in both cases to gain optical cavity workspace. The surgical technique is described in detail. One case had a frontal osteoma, whereas other was a nodular fasciitis of the forehead, confirmed by histology. Postoperative follow-up showed good outcomes at 1 year with no recurrences. Both patients were satisfied with the surgical and cosmetic outcomes. Endoscopic excision of a forehead lesion using the described technique is both safe and reliable. It is an excellent method for excising benign growths over the forehead while being cosmetically acceptable.
  12. Raveendran M
    J Craniofac Surg, 2019 Mar 19.
    PMID: 30896517 DOI: 10.1097/SCS.0000000000005444
    Facial anthropometric data has significant ethnic variation. East Asia, comprised of fourteen countries, represents a significant proportion of the global population. This systematic review presents the facial anthropometric data collected from these countries. The systematic review was conducted in accordance with PRISMA guidelines. An electronic search of the MEDLINE database returned 3054 articles. Twenty articles were considered eligible for inclusion. Nine studies were conducted in China, 1 in Indonesia, 2 in Japan,3 in Korea, 4 in Malaysia, and 1 was a multicentre study conducted in China, Japan, Thailand, and Vietnam. Qualitative and quantitative parameters were extracted from the20 studies. No data was found for the other East Asian countries. There is a paucity of facial anthropometric data for East Asian countries despite their high burden of craniofacial anomalies and a strong demand for cosmetic facial surgery, both of which would benefit from the collection of robust craniofacial norms. It is in the interest of both the craniofacial surgeon and the East Asian patient to collect baseline facial anthropometric data for this population.
  13. Tan SK, Tang ATH, Leung WK, Zwahlen RA
    J Craniofac Surg, 2019 Mar 28.
    PMID: 30946225 DOI: 10.1097/SCS.0000000000005351
    PURPOSE: To investigate short- and long-term three-dimensional changes of pharyngeal airway morphology and hyoid bone position in dento-skeletal class III deformity patients after 2-jaw orthognathic surgery with segmentation.

    METHODS: A retrospective analysis has been performed on patients with dento-skeletal class III deformity who had undergone orthognathic 2-jaw surgery with segmentations, presenting both pre- and post-surgical cone-beam computed tomographys. Three-dimensional skeletal movements, pharyngeal airway changes and hyoid bone position were measured and correlated.

    RESULTS: The mean short term postsurgical review period for all included 47 patients was 5.8 ± 2.2 months. Thirteen patients among them provided a mean long term period of 26.4 ± 3.4 months. The mean postsurgical maxillary movement was 2.29 ± 2.49 mm in vertical, 2.02 ± 3.45 mm in horizontal direction, respectively, while the mandibular movement was 6.49 ± 4.58 mm in vertical, and -5.85 ± 6.13 mm in horizontal direction. In short-term, the vertical length of nasopharynx was found to be reduced (P = 0.005) but increased for the oropharynx (P  0.05) detected between patients with and without genioplasty advancement.

    CONCLUSION: Two-jaw orthognathic surgery in dento-skeletal class III patients led to a statistically non-significant reduction of the post-surgical airway volume in both short- and long-term. Although the post-surgical oropharyneal minimum cross-sectional area was decreased significantly in the short term, this finding did not persist in the long term.

  14. Shaeran TAT, Samsudin AR
    J Craniofac Surg, 2019 Jun 28.
    PMID: 31261319 DOI: 10.1097/SCS.0000000000005689
    Temporomandibular joint ankylosis in children commonly lead to difficulty in feeding, poor oral hygiene, retrognathic mandible and obstructive sleep apnea. Surgical release of the ankylosis has always been the standard treatment. The authors report a 12 year old boy with unilateral temporomandibular joint ankylosis and obstructive sleep apnea underwent surgical release of the ankylosis with successful gain in mouth opening. However, he continued to suffer from obstructive sleep apnea as confirmed by post-operative polysomnography. Orthognathic surgery for mandibular advancement is not favorable due to his young age and mandibular distraction osteogenesis was not a choice. A mandibular advancement device similar to orthodontic myofunctional appliance was the preferred choice in the post-operative period while waiting for definitive retrognathia surgical treatment after skeletal maturity. Surgical release of temporomandibular joint ankylosis corrects the oral problem but does not adequately address the narrow pharyngeal airway space. Assessment of pharyngeal airway with a high suspicion of obstructive sleep apnea is mandatory in the management of TMJ ankylosis.
  15. Low PH, Abdullah JY, Abdullah AM, Yahya S, Idris Z, Mohamad D
    J Craniofac Surg, 2019 Jun 28.
    PMID: 31261343 DOI: 10.1097/SCS.0000000000005713
    PURPOSE: Decompressive craniectomy is a life-saving procedure in the setting of malignant brain swelling. Patients who survive require cranioplasty for anatomical reconstruction and cerebral protection. Autologous cranioplasty remains the commonest practice nowadays, but partial bone flap defects are frequently encountered. The authors, therefore, seek to develop a new technique of reconstruction for cranioplasty candidate with partial bone flap defect utilizing computer-assisted 3D modeling and printing.

    METHODS: A prospective study was conducted to evaluate the outcome of a new reconstruction technique that produces patient-specific hybrid polymethyl methacrylate-autologous cranial implant. Computer-assisted 3D modeling and printing was utilized to produce patient-specific molds, which allowed real-time reconstruction of bone flap with partial defect intra-operatively.

    RESULTS: Outcome assessment for 11 patients at 6 weeks and 3 months post-operatively revealed satisfactory implant alignment with favorable cosmesis. The mean visual analog scale for cosmesis was 91. Mean implant size was 50cm, and the mean duration of intra-operative reconstruction was 30 minutes. All of them revealed improvement in quality of life following surgery as measured by the SF-36 score. Cost analysis revealed that this technique is more cost-effective compared to customized cranial prosthesis.

    CONCLUSION: This new technique and approach produce hybrid autologous-alloplastic bone flap that resulted in satisfactory implant alignment and favorable cosmetic outcome with relatively low costs.

  16. Sulong S, Alias A, Johanabas F, Yap Abdullah J, Idris B
    J Craniofac Surg, 2019 8 14;31(1):46-50.
    PMID: 31403510 DOI: 10.1097/SCS.0000000000005810
    BACKGROUND: Craniosynostosis is a congenital defect that causes ≥1 suture to fuse prematurely. Cranial expansion surgery which consists of cranial vault reshaping with or without fronto-orbital advancement (FOA) is done to correct the skull to a more normal shape of the head as well as to increase the intracranial volume (ICV). Therefore, it is important to evaluate the changes of ICV after the surgery and the effect of surgery both clinically and radiologically.

    OBJECTIVE: The aim of this study is to evaluate the ICV in primary craniosynostosis patients after the cranial vault reshaping with or without FOA and to compare between syndromic and nonsyndromic synostosis group, to determine factors that associated with significant changes in the ICV postoperative, and to evaluate the resolution of copper beaten sign and improvement in neurodevelopmental delay after the surgery.

    METHODS: This is a prospective observational study of all primary craniosynostosis patients who underwent operation cranial vault reshaping with or without FOA in Hospital Kuala Lumpur from January 2017 until Jun 2018. The ICV preoperative and postoperative was measured using the 3D computed tomography (CT) imaging and analyzed. The demographic data, clinical and radiological findings were identified and analyzed.

    RESULTS: A total of 14 cases (6 males and 8 females) with 28 3D CT scans were identified. The mean age of patients was 23 months. Seven patients were having syndromic synostosis (4 Crouzon syndromes and 3 Apert syndromes) and 7 nonsyndromic synostosis. The mean preoperative ICV was 880 mL (range, 641-1234 mL), whereas the mean postoperative ICV was 1081 mL (range, 811-1385 mL). The difference was 201 mL which was statistically significant (P  1.0). However, there was 100% (n = 13) improvement of this copper beaten sign. However, the neurodevelopmental delay showed no improvement which was statistically not significant (P > 1.0).

    CONCLUSION: Surgery in craniosynostosis patient increases the ICV besides it improves the shape of the head. From this study, the syndromic synostosis had better increment of ICV compared to nonsyndromic synostosis.

  17. James JG, Izam AS, Nabil S, Rahman NA, Ramli R
    J Craniofac Surg, 2019 8 27;31(1):e22-e26.
    PMID: 31449209 DOI: 10.1097/SCS.0000000000005812
    AIM: The objective of this review was to determine the different types of surgical intervention in the management of nasal bone fractures, the outcomes, and complications associated with each intervention.

    METHODS: A search was conducted using the PubMed and Cochrane Database of Systematic Review databases from January 1, 1997 until September 9, 2017. The search strategy was constructed using the Population Intervention Comparison Outcome framework with keywords related to nasal fracture and its treatment. Two sets of independent researchers performed the analysis. Qualitative analysis was performed using the Methodological Index for Non-Randomized Studies and National Institute for Clinical Excellence methodology for randomized controlled trial checklists.

    RESULTS: The 4276 titles were obtained from PubMed database alone. Exclusion was made based on the title, abstract and full-text analysis. Finally, 23 papers were included and analyzed. Of the 23 papers, 13 (56.5%) were retrospective record review, 2 (8.7%) were randomized clinical trial or a randomized study and 8 case series (34.8%). 16 (69.6%) studies addressed closed reduction, 3 studies (13%) on open reduction and 4 studies (17.4%) addressed both open and closed reduction. The main focus in the outcome in all studies was accuracy of the anatomical reduction of the nasal bones. Three studies (13.0%) reported restoration of function such as breathing comfort or release in respiratory obstruction and another 3 (13.0%) addressed both cosmetic and breathing outcomes. Residual deformity was the most described complications in the studies (30.4%). In general, most of the studies were not of high quality as they lacked in some key elements in the Methodological Index for Non-Randomized Studies checklist.

    CONCLUSION: Both closed and open reduction provided good outcomes in cosmetic and breathing. Septoplasty is recommended to be performed simultaneously with fracture reduction.

  18. Nazimi AJ, Rajaran JR, Nordin R
    J Craniofac Surg, 2019 Oct;30(7):e609-e611.
    PMID: 31503125 DOI: 10.1097/SCS.0000000000005617
    Orbital blowout fractures are common. The same goes for its surgical complications when the efficiency of the dissection of entrapped or herniated intraorbital contents into the fracture could not be completely and safely dissected out. The authors describe a modification of the commonly used Howarth periosteal elevator for dissection of intraorbital content displacement or herniation on orbital blowout fracture. The instrument was modified by marking out the instrument from the tip into 10, 20, 25, 30, and 40 mm on both of its concave and convex surfaces to allow safe orbital soft tissue dissection and distance control. From the authors' experience, these simple modifications from its original instrument design allow better intraoperative control and appreciation of any intact important intraorbital anatomical structures such as inferomedial strut and posterior ledge. At the same time of importantly getting complete orbital fracture dissection and visualization, it causes less trauma to surrounding soft tissue with the markings ensuring unnecessary orbital exploration or visualization. Dissection can be kept for optimum maneuverability at the required or intended location based on the preoperative scan or dimension of anatomical orbital implant.
  19. Nazimi AJ, Khoo SC, Nabil S, Nordin R, Lan TH, Rajandram RK, et al.
    J Craniofac Surg, 2019 Oct;30(7):2159-2162.
    PMID: 31232997 DOI: 10.1097/SCS.0000000000005667
    Orbital fractures pose specific challenge in its surgical management. One of the greatest challenges is to obtain satisfactory reconstruction by correct positioning of orbital implant. Intraoperative computed tomography (CT) scan may facilitate this procedure. The aim of this study was to describe the early use of intraoperative CT in orbital fractures repair in our center. The authors assessed the revision types and rates that have occurred with this technique. With the use of pre-surgical planning, optical intraoperative navigation, and intraoperative CT, the impact of intraoperative CT on the management of 5 cases involving a total number of 14 orbital wall fractures were described. There were 6 pure orbital blowout wall fractures reconstructed, involving both medial and inferior wall of the orbit fracturing the transition zone and 8 impure orbital wall fractures in orbitozygomaticomaxillary complex fracture. 4 patients underwent primary and 1 had delayed orbital reconstruction. Intraoperative CT resulted in intraoperative orbital implant revision, following final navigation planning position, in 40% (2/5) of patients or 14% (2/14) of the fractures. In revised cases, both implant repositioning was conducted at posterior ledge of orbit. Intraoperative CT confirmed true to original reconstruction of medial wall, inferior wall and transition zone of the orbit. Two selected cases were illustrated. In conclusion, intraoperative CT allows real-time assessment of fracture reduction and immediate orbital implant revision, especially at posterior ledge. As a result, no postoperative imaging was indicated in any of the patients. Long-term follow-ups for orbital fracture patients managed with intraoperative CT is suggested.
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