Displaying publications 21 - 35 of 35 in total

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  1. 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.
  2. Rahman RA, Ghazali NM, Rahman NA, Pohchi A, Razak NHA
    J Craniofac Surg, 2020 Jun;31(4):1056-1062.
    PMID: 32176023 DOI: 10.1097/SCS.0000000000006297
    OBJECTIVES: This study aimed to determine the pattern of fractured zygoma, different treatment modalities, and complications of the treatment in our center. It also aimed to determine the association between the treatment modalities and complication of treatment, and association between number of fixation and complication.

    METHODOLOGY: A retrospective review was conducted from January 2008 until December 2011. All patients diagnosed with zygomatic complex fractured that met the inclusion and exclusion criteria were included in the study. Zingg's Classification was used in the study.

    RESULTS: The median age was 23.5. Type A was the most common fracture type made up 26.6%. About 90.8% of the injury was caused by road traffic accident. Forty-four patients were treated with open reduction and internal fixation and 4 patients were treated with close reduction only. Fifty patients were treated conservatively. Gillies approach in combination with fixation is the most common procedure accounted for 50%. Three-point fixation at infraorbital, maxillary buttress, frontozygomatic suture, and zygomatic arch was the most common site. However, there were no significant associations between the number of fixation and the occurrence of the complication (P = 0.307). About 29.2% in the treatment group and 66% in the conservative group had complications. About 35.7% of patients in treatment group had complications, while 66% had trismus in conservative group.

    CONCLUSION: There was a significant association between types of treatment and the occurrence of complication (P = 0.001). However, there were no significant association between number of fixation and the occurrence of complications (P = 0.307).

  3. 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.
  4. 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.

  5. 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.
  6. Qabbani AA, Bayatti SWA, Hasan H, Samsudin AB, Kawas SA
    J Craniofac Surg, 2020 1 3;31(3):e233-e236.
    PMID: 31895847 DOI: 10.1097/SCS.0000000000006106
    To evaluate the ability of the maxillary sinus membrane to produce bone after internal sinus lifting and implant placement without adding exogenous bone graft, and to assess the quality of bone that has been produced 6 months postoperatively.In this retrospective study, 10 subjects who underwent maxillary sinus floor lifting and met the inclusion criteria were selected and then subdivided into: Group-A underwent internal sinus elevation and placement of implants without the use of bone graft and Group-B underwent classical internal sinus lifting and placement of bovine bone particles and then placement of the implant as a control group. Radiofrequency analysis (RFA) values for measuring the Implant Stability Quotient (ISQ) of all implants were measured by Osstell device. CBCT was performed involving linear measurements of the site of sinus lifting for both groups.High RFA values demonstrating excellent biomechanical stability were observed in Group-A compared to Group-B at 6 months postoperatively. Group-A showed a median of ISQ value;78 (8), 77(12), 79(3.5) and 77(4.50). Group-A was significantly higher in ISQ values than Group-B, which showed median and interquartile range (IQR) of ISQ value of [51(12.50), 54(14.50), 55(9), and 55(7.50)]. However, the amount of bone available in group B was significantly higher than group A; [3.5 mm (0.75) and 3.8 mm (0.69)].Internal sinus lifting without bone graft has the ability of bone formation by osteogenic potential of the sinus membrane. Nevertheless, the high quality of bone being produced is of high importance for the success of an implant without the need for an exogenous bone graft. The newly formed bone was significantly of a better quality in Group-A. Thus, it is recommended to perform internal sinus lifting, without adding bone graft material and allow the osteogenic potential of the maxillary sinus membrane to produce its own osteogenic cells.
  7. Haque S, Khamis MF, Alam MK, Ahmad WMAW
    J Craniofac Surg, 2020 May 04.
    PMID: 32371703 DOI: 10.1097/SCS.0000000000006464
    Studies have claimed that the maxillary arch dimension of unilateral cleft lip and palate (UCLP) patient is significantly smaller than normal patient. Multiple factors (both congenital and post natal treatment factors) are believed to have an impact on the treatment outcome (maxillary arch retardation) of UCLP patient. The aim of this study was to evaluate the effects of multiple factors on the treatment outcome by assessing the maxillary arch dimension of UCLP Children. Eighty-five Malaysian UCLP children were taken who received cheiloplasty and palatoplasty. Laser scanned 3D digital models of UCLP subjects were prepared before any orthodontic treatment and bone grafting at 7.69 ± 2.46 (mean± SD) years of age. Intercanine width (ICW), intermolar width (IMW), and arch depth (AD) measurements of maxillary arch were measured with Mimics software. Multiple linear regression analyses were used to evaluate the association between multiple factors (gender, UCLP type, UCLP side, family history of cleft, family history of class III malocclusion, techniques of cheiloplasty, and techniques of palatoplasty) and maxillary arch dimensions (ICW, IMW, and AD). P value was set at 5%. Significant association was found between 2 techniques of cheiloplasty and ICW (P = 0.001) and also between 2 techniques of palatoplasty and ICW (P = 0.046) of maxilla. No significant association observed in IMW and AD in relation to all other factors. Modified Millard techniques of Cheiloplasty and Bardach technique of palatoplasty had unfavorable effect on the treatment outcome by assessing the maxillary arch dimension (ICW) using laser scanned 3D digital models in Malaysian UCLP children.
  8. Ling XF, Yew CC, Mohd Nazri SB, Tew MM
    J Craniofac Surg, 2021 Oct 01;32(7):e627-e630.
    PMID: 33654041 DOI: 10.1097/SCS.0000000000007603
    BACKGROUND: Medical advances have enabled zygomatic complex (ZMC) fractures to be treated by various approaches. This study aims to analyze the demographics and treatment outcomes of unilateral ZMC fractures, treated nonsurgically or surgically.

    METHODS: This 5-year nonrandomized prospective study had included 65 cases of unilateral ZMC fractures from October 2014 until December 2019. Patients were treated and divided into nonsurgical and surgically treated group. Treatment outcomes in terms of step deformities, malar depression, diplopia, infraorbital hypoaesthesia, and mouth opening were evaluated up to six months post-trauma/intervention.

    RESULTS: Road traffic accident (96.9%) was the main cause, with predominant male involvement (80%) and median age of 28 years. Significant improvements (P < 0.05) were observed for step deformities and malar depression among the surgically treated group at postoperative day 1 and week 1. Throughout the six months review, infraorbital hypoesthesia and diplopia showed no significant differences between both groups, (P > 0.05). Besides, all patients showed significant mouth opening improvement (P 

  9. Cheng TC, Yahya MFN, Mohd Naffi AA, Othman O, Seng Fai T, Yong MH, et al.
    J Craniofac Surg, 2021 Oct 01;32(7):2285-2291.
    PMID: 33770023 DOI: 10.1097/SCS.0000000000007645
    BACKGROUND: To evaluate the satisfaction of surgeons and trainees with three-dimensional (3D) ophthalmic surgery during a demonstration compared to traditional surgery.

    METHODS: This validated questionnaire-based study was conducted over 1-month during which Ngenuity 3D surgery was demonstrated. All surgeons and trainees exposed were recruited to complete a questionnaire comprising visualization, physical, ease of use, teaching and learning, and overall satisfaction.

    RESULTS: All 7 surgeons and 33 postgraduate students responded. Surgeons reported no significant difference except overall (P = 0.047, paired t-test). Postgraduate trainees reported significantly better experience with 3D for illumination (P = 0.008), manoeuvrability (P = 0.01), glare (P = 0.037), eye strain (P = 0.008), neck and upper back strain (P = 0.000), lower back pain (P = 0.019), communication (P = 0.002), comfortable environment (P = 0.001), sharing of knowledge (P = 0.000), and overall (P = 0.009).

    CONCLUSIONS: During early experience, surgeons and trainees reported better satisfaction with 3D overall. Trainees had better satisfaction with 3D in various subcomponents of visualization, physical, ease of use, and education.

  10. Khoo LS, Hsiao YC, Huang JJ, Chang FC, Wang YC, Liao YF, et al.
    J Craniofac Surg, 2021 5 4;32(8):2592-2596.
    PMID: 33935145 DOI: 10.1097/SCS.0000000000007704
    BACKGROUND: The main objective of contemporary orthognathic surgery is to correct dentofacial deformities. Nonetheless, many adjunct procedures to enhance the esthetic outcome in orthognathic surgical cases have been successfully incorporated to improve patient satisfaction. The authors report our preliminary experience of performing simultaneous orthognathic surgery with Asian double eyelid suture method blepharoplasty in the same surgical setting.

    METHOD: This case series report includes all 19 consecutive cases presenting to the Chang Gung Craniofacial Center for combined orthognathic surgery with Asian double eyelid suture method blepharoplasty. The double eyelid crease height was measured as the vertical line between the upper eyelid margin (eyelid lash) and the upper eyelid crease, observed at the mid-pupillary line with the eyes in primary gaze.

    RESULTS: There were no complications or relapse reported within this time period. There was significant improvement in the left and right mid-pupillary double eyelid crease height postsurgery. There were no statistically significant differences between the left and right mid-pupillary double eyelid crease heights after surgery indicating good eyelid crease height symmetry bilaterally was obtained.

    CONCLUSIONS: Orthognathic surgery combined with suture method blepharoplasty can be safely performed in the same surgical setting without inappropriate rise in costs or operating room time. This case series demonstrates that excellent esthetic results can be obtained in simultaneous bimaxillary orthognathic surgery with suture method Asian blepharoplasty.

  11. Haque S, Khamis MF, Alam MK, Ahmad WMAW
    J Craniofac Surg, 2021 May 01;32(3):964-966.
    PMID: 33405460 DOI: 10.1097/SCS.0000000000007366
    ABSTRACT: The aim of this study was to evaluate the effects of multiple factors (congenital and postnatal treatment factors) on the treatment outcome by assessing the maxillary arch dimension of children with unilateral cleft lip and palate (UCLP). Eighty-five Pakistani children with UCLP were taken who received cheiloplasty and palatoplasty. Laser scanned 3D digital models of UCLP subjects were prepared before any orthodontic treatment and bone grafting at 7.69 ± 2.46 (mean ± standard deviation) years of age. Inter-canine width (ICW), inter-molar width (IMW), and arch depth (AD) measurements of maxillary arch were measured with Mimics software. Multiple linear regression analyses were used to evaluate the association between congenital factors (age, gender, UCLP side, family history of cleft) and postnatal treatment factors (techniques of cheiloplasty and techniques of palatoplasty) with maxillary arch dimensions (ICW, IMW, and AD). P value was set at 5%. The mean (standard deviation) dimensions of ICW, IMW, and AD are 26.7 (5.70) mm, 43.3 (4.66) mm, and 27.1 (5.26) mm, respectively. There is no significant association found between multiple factors and maxillary arch dimensions. This regression analysis shows no significant association between multiple factors and MAD in this sample.
  12. Ahmad WMAW, Noor NFM, Shaari R, Nawi MAA, Ghazali FMM, Aleng NA, et al.
    J Craniofac Surg, 2021 Jun 01;32(4):1500-1503.
    PMID: 33852515 DOI: 10.1097/SCS.0000000000007435
    ABSTRACT: Oral and maxillofacial fractures are the most common injuries among multiple trauma. About 5% to 10% of trauma patients having facial fractures. The objectives of this case study are to focus the most common mid-face fractures types' and to determine the relationship of the midface fracture in maxillofacial trauma among the patient who attended the outpatient clinic in a Hospital Universiti Sains Malaysia. In this research paper, an advanced statistical tool was chosen through the multilayer perceptron neural network methodology (MLPNN). Multilayer perceptron neural network methodology was applied to determine the most associated predictor important toward maxillary bone injury. Through the predictor important classification analysis, the relationship of each bone will be determined, and sorting according to their contribution. After sorting the most associated predictor important toward maxillary bone injury, the validation process will be applied through the value of training, testing, and validation. The input variables of MLPNN were zygomatic complex fracture, orbital wall fracture, nasal bone fracture, frontal bone fracture, and zygomatic arch fracture. The performance of MLPNN having high accuracy with 82.2%. As a conclusion, the zygomatic complex fracture is the most common fracture trauma among the patient, having the most important association toward maxillary bone fracture. This finding has the highest potential for further statistical modeling for education purposes and the decision-maker among the surgeon.
  13. Dalolio M, Cordier D, Al-Zahid S, Bennett WO, Prepageran N, Waran V, et al.
    J Craniofac Surg, 2021 Oct 12.
    PMID: 35050560 DOI: 10.1097/SCS.0000000000008204
    Objectives: Information about the endonasal endoscopic approach (EEA) for the management of posttraumatic tension pneumocephalus (PTTP) remains scarce. Concomitant rhinoliquorrhea and posttraumatic hydrocephalus (PTH) can complicate the clinical course.

    Methods: The authors systematically reviewed pertinent articles published between 1961 and December 2020 and identified 6 patients with PTTP treated by EEA in 5 reports. Additionally, the authors share their institutional experience including a seventh patient, where an EEA resolved a recurrent PTTP without rhinoliquorrhea.

    Results: Seven PTTP cases in which EEA was used as part of the treatment regime were included in this review. All cases presented with a defect in the anterior skull base, and 3 of them had concomitant rhinoliquorrhea. A transcranial approach was performed in 6/7 cases before EEA was considered to treat PTTP. In 4/7 cases, the PTTP resolved after the first intent; in 2/7 cases a second repair was necessary because of recurrent PTTP, 1 with and 1 without rhinoliquorrhea, and 1/7 case because of recurrent rhinoliquorrhea only. Overall, PTTP treated by EEA resolved with a mean radiological resolution time of 69 days (range 23-150 days), with no late recurrences. Only 1 patient developed a cerebrospinal fluid diversion infection probably related to a first incomplete EEA skull base defects repair. A permanent cerebrospinal fluid diversion was necessary in 3/7 cases.

    Conclusions: Endonasal endoscopic approach repair of air conduits is a safe and efficacious second-line approach after failed transcranial approaches for symptomatic PTTP. However, the strength of recommendation for EEA remains low until further evidence is presented.

  14. 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.
  15. 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.

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