Publications by authors named "Behnam Bohluli"

49 Publications

Preservation Dorsal Hump Surgery: A Changing Paradigm.

Oral Maxillofac Surg Clin North Am 2021 Feb;33(1):51-59

Department of oral and maxillofacial, University of Augusta, GA, USA.

Preservative dorsal hump surgery is an old approach that has revitalized recently. Preservation rhinoplasty aims to shape the existing structures instead of resection/reconstruction approaches. A thorough understanding of the applied anatomy of the nose is the backbone of preservative hump surgery. In preservative hump surgery keystone works as a joint, and by lowering this joint the hump is eliminated.
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http://dx.doi.org/10.1016/j.coms.2020.09.013DOI Listing
February 2021

Management of the Cephalic Positioning of the Lower Lateral Cartilage in Modern Rhinoplasty: An Algorithmic Approach.

Oral Maxillofac Surg Clin North Am 2021 Feb;33(1):131-141

private practice, No. 11, 2nd floor, sepehr build.(1425), shariati Av., Gholhak, Tehran, Iran.

Cephalic positioning of lateral cruras literally means that the cartilage does not support the nasal rim. Cephalic positioning is a relatively common anatomic variant of lower lateral cartilages that shows an extremely vulnerable rhinoplasty patient. In these patients, any reductive technique, such as cephalic trimming without compensation, worsens the situation and may lead to esthetic failures and airway compromise. True cephalic malpositioning needs to be diagnosed from pseudomalpositions preoperatively. The presence of the pseudomalposition does not mean that it can be ignored. Either malposition or pseudomalposition is best diagnosed and considered in the treatment plan.
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http://dx.doi.org/10.1016/j.coms.2020.09.008DOI Listing
February 2021

New Concepts in Dorsal Nasal Augmentation.

Oral Maxillofac Surg Clin North Am 2021 Feb 5;33(1):39-50. Epub 2020 Nov 5.

Department of Oral and Maxillofacial surgery, Istanbul Aydin university, Beşyol Mahallesi, İnönü Caddesi & Akasya Sk. No:6, 34295 Küçükçekmece/İstanbul, Turkey.

Dorsal augmentation is commonly indicated in many primary and secondary aesthetic nose surgeries. Throughout the history, various synthetic and autogenous materials have been used for dorsal augmentation. In this article, we give an overview of basic concepts of cartilage grafting, review new concepts of dorsal augmentation, and discuss some emerging engineering modalities.
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http://dx.doi.org/10.1016/j.coms.2020.09.007DOI Listing
February 2021

Modern Rhinoplasty and the Management of Its Complications.

Oral Maxillofac Surg Clin North Am 2021 02 4;33(1):xiii-xiv. Epub 2020 Nov 4.

Department of Oral and Maxillofacial Surgery, University of Toronto, 124 Edward Street, Toronto ON M5G 1G6, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.coms.2020.09.009DOI Listing
February 2021

The effect of the tongue in groove technique on the nasolabial angle and nasal tip projection.

Maxillofac Plast Reconstr Surg 2020 Dec 8;42(1):19. Epub 2020 Jun 8.

Department of Oral and Maxillofacial Surgery, Bu Ali Hospital, Islamic Azad University, Tehran, Iran.

Background: The tongue in groove technique (TIG) is a useful technique for the correction of the nasal tip projection and the nasolabial angle. The purpose of this study was to determine the utility of this technique for nasal tip rotation and projection correction in the Iranian society.

Methods: This is a retrospective clinical trial study of 20 patients undergoing open septo-rhinoplasty using TIG technique from January 2017 to August 2019 at the oral and maxillofacial unit of Bu Ali Hospital and private sector. Preoperative and postoperative profile view photographs were compared to assess the changes in tip projection and rotation.

Results: Fifteen patients (75%) had normal angular size, and 5 of them (25%) were not within the normal range after the surgery. The Fisher exact test showed that this success was statistically significant ( = 0.006). Ten patients (50%) had normal projection size, postoperatively. The Fisher exact test showed that this effect was statistically significant ( < 0.01).

Conclusion: The study demonstrated the benefit of TIG on the correction of nasal tip projection and rotation.
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http://dx.doi.org/10.1186/s40902-020-00261-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280400PMC
December 2020

Oral Surgeons as Cosmetic Surgeons and Their Scope of Practice.

Plast Reconstr Surg 2020 01;145(1):218e

Northside Hospital and, Augusta University Georgia Oral and Facial Reconstructive Surgery, Atlanta, Ga.

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http://dx.doi.org/10.1097/PRS.0000000000006357DOI Listing
January 2020

Treatment of mandibular angle fracture: Revision of the basic principles.

Chin J Traumatol 2019 Apr 1;22(2):117-119. Epub 2019 Mar 1.

Department of Oral and Maxillofacial Surgery, Aydin University, Istanbul, Turkey. Electronic address:

Biodynamics of mandibular angle fractures has been extensively discussed in the literature in search for the best way to fixate and expedite recovery of trauma patients. Pioneers like Michelet and Champy had the greatest impact on evolving of osteosynthesis in maxillofacial traumatology; they introduced their basic principles frequently used to describe the biomechanics of mandibular fixation. Their concept states when a physiologic load is applied on mandibular teeth a negative tension will be created at superior border and a positive pressure will appear at inferior border. These simple definitions are the basis for the advent of fixation modalities in mandibular angle fracture. This article sought to reassess these principals based on load location via finite elements method.
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http://dx.doi.org/10.1016/j.cjtee.2019.01.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488520PMC
April 2019

Esthetic Rhinoplasty in the Multiply Operated Nose.

Authors:
Behnam Bohluli

J Oral Maxillofac Surg 2019 Jul 8;77(7):1466.e1-1466.e13. Epub 2019 Mar 8.

Visiting Professor, Department of Oral and Maxillofacial Surgery, University of Toronto, Toronto, ON, Canada. Electronic address:

Purpose: The present study assessed the most common deformities in often-revised noses and their predictable surgical treatments.

Patients And Methods: This retrospective case series was designed to review different aspects of patients with rhinoplasty who had more than 2 failed previous rhinoplasties. The main requests of patients, number of operations, and final surgical plan for management of these deformities were reviewed and analyzed.

Results: This study included 38 patients (27 women, and 11 men) who underwent multiple (2 to 10) unsuccessful rhinoplasties before being operated on by the author from 2011 to 2016. Pinch deformity (14 patients), breathing problems (13 patients), and irregularities were the most common complaints. The conchal cartilage (31 patients) and fascia (19 cases) were the most common graft donor sites in definitive treatments.

Conclusion: The present study shows that multiple failed rhinoplasties can be properly corrected. Effective management of these patients is best started after a comprehensive preoperative assessment. Then, a conservative predictable approach can be used to overcome the flaws of previous surgeries.
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http://dx.doi.org/10.1016/j.joms.2019.02.042DOI Listing
July 2019

Nasal Framework Osteotomy: An Innovative Approach to Manage an Extremely Long Nose With Meningoencephalocele.

J Oral Maxillofac Surg 2019 Jun 12;77(6):1276.e1-1276.e6. Epub 2019 Feb 12.

Associate Professor, Buali Hospital, Department of Neurosurgery, Islamic Azad University, Tehran, Iran.

Meningoencephlocele is a relatively rare deformity, usually characterized by penetration of brain or meningeal tissues through a defect in skull. This protruding tissue may affect facial structure and subtle to severe facial deformities may appear. Surgical treatments of these deformities are usually done by a team including a neurosurgeon and craniofacial surgeon. The conventional treatments includes several complicated operations to relocate herniating tissues, then correcting malformed facial structure. The nasal framework osteotomy, is an innovative approach that uses transfacial incisions to gain access to herniating tissue. Then, by completing the osteotomy around the nose, the entire nasal structure is lifted and transposed to it is original position. The authors believe that this technique may considerably reduce the complexity and risks of conventional approaches, while aesthetic demands are readily achieved at the same stage.
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http://dx.doi.org/10.1016/j.joms.2019.02.003DOI Listing
June 2019

Fat Grafting: Challenges and Debates.

Atlas Oral Maxillofac Surg Clin North Am 2018 Mar;26(1):81-84

Plastic Surgery, Emory University, The Emory Aesthetic Center, Suite 640, 3200 Downwood Circle, Atlanta, GA 30327, USA. Electronic address:

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http://dx.doi.org/10.1016/j.cxom.2017.10.006DOI Listing
March 2018

Current Techniques in Fat Grafting.

Atlas Oral Maxillofac Surg Clin North Am 2018 Mar 8;26(1):7-13. Epub 2017 Dec 8.

Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.

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http://dx.doi.org/10.1016/j.cxom.2017.11.001DOI Listing
March 2018

Fat Grafting as an Adjunct to Facial Rejuvenation Procedures.

Atlas Oral Maxillofac Surg Clin North Am 2018 Mar;26(1):51-57

Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.

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http://dx.doi.org/10.1016/j.cxom.2017.10.005DOI Listing
March 2018

Dorsal Nasal Augmentation: Is the Composite Graft Consisting of Conchal Cartilage and Retroauricular Fascia an Effective Option?

J Oral Maxillofac Surg 2015 Sep 2;73(9):1842.e1-13. Epub 2015 Jun 2.

Associate Professor, Department of Oral and Maxillofacial Surgery, Buali Hospital, Islamic Azad University, Tehran; Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Purpose: Augmentation of a deficient nasal dorsum remains a challenge in rhinoplasty. Different methods and materials have been described in the literature. The purpose of this study was to present the authors' experiences using a composite graft consisting of conchal cartilage and retroauricular fascia for dorsal augmentation.

Materials And Methods: Patients with moderate to severe dorsal deficiencies were included in this study. The postauricular sulcus was used to gain access to the auricular cartilage and the retroauricular fascia. If the dorsal deficiency was moderate, then 1 layer of conchal cartilage was used. In more severe deficiencies, the cartilage pieces were superimposed, and a multilayer conchal graft was used. To fix the cartilage segments to each other, 6-0 polydioxanone (PDS) suture was used. Then, the cartilage segment was fixed to the retroauricular fascia with 6-0 PDS suture. The nasal dorsum was undermined carefully to create adequate space for chondrofascial graft placement. After performing required maneuvers for solving the functional disorders, tip plasty, and the lateral nasal wall osteotomy, the prepared chondrofascial graft was placed in the dorsal pocket.

Results: Fourteen patients (5 men and 9 women) participated in this study. The average follow-up duration was 25.4 months (range, 16 to 42 months). The patients' age ranged from 14 to 54 years (average, 25.9 yr). Follow-up showed no cases of infection, hematoma, major graft resorption, asymmetric graft resorption, and displacement of grafts. No postoperative scars were visible at the donor sites. Mild to moderate ecchymosis occurred at the donor sites in 8 patients, which were solved after 10 days without any complications. In 3 male patients, slight graft resorption was noted. The esthetic results were not compromised in these patients, and revision surgery was not performed.

Conclusion: This small series of cases with relatively adequate follow-up showed that a composite graft consisting of conchal cartilage and retroauricular fascia is a reliable technique for nasal dorsal augmentation in patients with moderate to severe dorsal deficiency.
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http://dx.doi.org/10.1016/j.joms.2015.05.036DOI Listing
September 2015

Do the Size and Extension of the External Nasal Splint Have an Effect on the Osteotomy, Brow Lines, and Long-Term Results of Rhinoplasty: A Prospective Randomized Controlled Trial of 2 Methods.

J Oral Maxillofac Surg 2015 Sep 29;73(9):1843.e1-9. Epub 2015 May 29.

Associate Professor, Department of Oral and Maxillofacial Surgery, Craniomaxillofacial Research Center, Buali Hospital, Islamic Azad University, Tehran, Iran; Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Purpose: While performing a lateral nasal wall osteotomy during a rhinoplasty, an intentional fracture is produced and the fractured segments are medialized to narrow a wide nasal base. The purpose of this study was to investigate the effect of size, shape, and extension of the external nasal splint on the osteotomy, brow lines, and long-term results of rhinoplasty.

Materials And Methods: The authors designed a randomized prospective clinical trial. The study population was composed entirely of patients who were voluntarily referred to the authors' department from May 2012 to May 2013. They were randomly divided into 2 equal groups. The primary predictor variable was splint type. For group 1, the external splint was extended beyond the osteotomy lines laterally and covered the overlying skin of the frontal process of the maxillary bone. For group 2, the external splint was trimmed above the osteotomy lines. The primary outcome variables were the levels of satisfaction with the dorsal esthetic lines, brow lines, and distinct osteotomy lines at 12 months after the operation. Demographic variables were gender and age. Mann-Whitney U test, χ(2) test, and t test were used to analyze the data. Results with a P value less than .05 were considered significant.

Results: Forty healthy patients (American Society of Anesthesiologists status I and II; 18 men and 22 women; age range, 19 to 41 yr; mean, 31.4 yr) were selected. Although the level of satisfaction with the dorsal esthetic lines was higher in group 2, it was not significantly different from group 1 (P > .05). The levels of satisfaction with the brow lines and the distinct osteotomy lines were significantly higher in group 2 (P < .05).

Conclusion: The results of this study showed that when a nasal splint is extended beyond the frontal process of the maxilla rather than the base of the nasal bones, positioning of the bones and long-term results are unpredictable.
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http://dx.doi.org/10.1016/j.joms.2015.05.027DOI Listing
September 2015

Erratum to: Autologous blood injection for treatment of chronic recurrent TMJ dislocation: is it successful? Is it safe enough? A systematic review.

Oral Maxillofac Surg 2015 Sep;19(3):329-31

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran,

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http://dx.doi.org/10.1007/s10006-015-0508-3DOI Listing
September 2015

Autologous blood injection for treatment of chronic recurrent TMJ dislocation: is it successful? Is it safe enough? A systematic review.

Oral Maxillofac Surg 2015 Sep 3;19(3):243-52. Epub 2015 May 3.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran,

Purpose: The purpose of this article is to review the English literature about the efficacy and safety of autologous blood injection in treating patients suffering from chronic recurrent temporomandibular joint dislocation. In this article, we highlight the key trials and recent directions about this modality and discuss about the mechanism, advantages, and disadvantages of this approach.

Materials And Methods: A literature search was performed using PubMed, Medline, and Ovid Medline databases to identify articles reporting on the injection of autologous blood for treatment of chronic recurrent dislocation of temporomandibular joint. Other references cited in the retrieved reports, as well as the "related articles" tool in PubMed Medline, were also checked to improve the search and, if relevant, were included in the study. The search was restricted to articles published in the English language.

Results: Seven studies meeting the inclusion criteria were reviewed. The selected articles included four prospective clinical trials and three case report articles.

Conclusion: There are a few articles about the clinical use of autologous blood for treating patients with chronic recurrent temporomandibular joint dislocation. Reviewing of the literature shows that there are successful results about this modality, but there are still some concerns about it in terms of the effect of the injected blood on the articular cartilage and formation of fibrous or bony ankylosis.
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http://dx.doi.org/10.1007/s10006-015-0500-yDOI Listing
September 2015

Anesthetic efficacy of meperidine in teeth with symptomatic irreversible pulpitis.

Anesth Prog 2015 ;62(1):14-9

Assistant Professor and.

Achieving adequate pulpal anesthesia in mandibular teeth is always a challenge. Supplementary injections and using drugs in combination are some methods implemented to overcome this hurdle. In this randomized clinical trial, use of meperidine in conjunction with lidocaine in intraligamentary injection did not exhibit significant improvement in anesthesia.
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http://dx.doi.org/10.2344/0003-3006-62.1.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389551PMC
June 2015

Use of aesthetic rhinoplasty procedures in reconstructive nasal surgery.

Br J Oral Maxillofac Surg 2015 Jan 5;53(1):44-8. Epub 2014 Nov 5.

Department of Orthodontics, University Hospital of RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.

Resection of cancer often involves the excision of underlying hard tissue, and some procedures in aesthetic rhinoplasty can be used in reconstructive nasal surgery to increase the margin of safety while still achieving an acceptable aesthetic and functional outcome. We have used techniques from aesthetic rhinoplasty to shape the nasal framework. Osteotomy and formation of the tip were used in 17 patients with defects (ranging from 1 to 3.5 cm in size) from the nasal root to the tip of the nose. After the underlying bony or cartilaginous framework, or both, had been removed, the resulting open roof deformity had to be corrected by osteotomy of the bony nasal wall and the tip shaped by excision and suturing, including insertion of the tip graft and columellar strut graft. After this, and narrowing of the nose, the defect was smaller and could be closed with local tissue without tension. There were no deformities in the contour, and patency of the airway was maintained. Patients were satisfied with both the aesthetic and functional results. Although the margin of safety was increased, shaping the nasal framework reduced the size of the defect, which allowed tension-free closure with a local flap. The operation requires a thorough knowledge of procedures used in aesthetic rhinoplasty.
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http://dx.doi.org/10.1016/j.bjoms.2014.09.011DOI Listing
January 2015

Immediate effects of different steps of rhinoplasty on nasolabial angle and tip projection.

J Craniofac Surg 2014 Sep;25(5):e404-6

From the *Craniomaxillofacial Research Center and Department of Oral and Maxillofacial Surgery, Azad University of Medical Sciences, Tehran, Iran; †Department of Oral and Maxillofacial Surgery, Northside Hospital, Atlanta, Georgia; and ‡Department of Oral and Maxillofacial Surgery, Gazi University, Ankara, Turkey.

Nasolabial angle (NLA) and nasal tip projection (NTP) play an important role in aesthetic nose surgery. Little deviations can determine success and failure. The goal of this study was to analyze the immediate effect of different steps of open rhinoplasty on NLA and NTP. In this prospective single-blind study, 50 consecutive rhinoplasty cases were considered. The study consisted of 38 women and 12 men. The mean age was 28 years, ranging from 17 to 37 years. A standard life-size photograph was taken in each step of a classic open rhinoplasty during surgery. Nasolabial angle and NTP were measured and analyzed. Nasolabial angle: average increase after skeletonization (2.26 degrees), strut insertion (4 degrees), and tip spanning (0.17 degrees), whereas cephalic resection caused a decrease (1.9 degrees). Nasal tip projection: average increase after skeletonization (0.1 mm), strut insertion (0.31 mm), and tip spanning (0.84 mm), whereas cephalic resection caused a decrease (0.53 mm). Whereas strut insertion caused the highest mean increase in NLA, tip spanning was the most effective regarding change of NTP. Expectably cephalic resection was associated with decrease in NLA and NTP.
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http://dx.doi.org/10.1097/SCS.0000000000000601DOI Listing
September 2014

Trigeminocardiac reflex: Some thought to the definition.

Surg Neurol Int 2014 29;5:43. Epub 2014 Mar 29.

Craniomaxillofacial Research Center, Azad University; Tehran, Iran.

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http://dx.doi.org/10.4103/2152-7806.129617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014824PMC
May 2014

Extraction bradycardia: a pilot case-crossover study.

Head Face Med 2013 Oct 17;9:29. Epub 2013 Oct 17.

Purpose: Significant vasovagal reaction is one of the untoward events in the course of simple extractions. The present study then aimed to record the patients' heart rate during the extraction procedure.

Materials And Methods: Informed consents were obtained in advance. Patients were placed in the dental chair and their heart rate was measured before /and prior to the anesthetic injection, during, and after dental extraction on a pulse oxymeter device. Data were analyzed using paired t-test.

Results: Sixty one patients were included. The mean heart rates of these patients prior, during, and after extraction were 88, 86 and 81, respectively. Two by two comparisons showed a significant decrease in the mean heart rate during extraction compared to the baseline and also after extraction compared to both before and during extraction (p < 0.05 for all three).

Conclusions: Despite the presence of sufficient local anesthesia and performing the extraction with the least trauma, a significant decrease in heart rate is evident.
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http://dx.doi.org/10.1186/1746-160X-9-29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3854007PMC
October 2013

Lateral nasal osteotomy: a comparative study between the use of osteotome and a diamond surgical burr - a cadaver study.

Head Face Med 2013 Dec 19;9:41. Epub 2013 Dec 19.

Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital RWTH-Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.

Background: The ultimate goal of rhinoplasty is to achieve a controllable, reliable and an aesthetically pleasing result. Various approaches and instruments have been introduced for the correction of the bony walls of the nose to improve predictability of the procedure and to minimize the associated trauma. We conducted a cadaveric study comparing the results of osteotomy of the nasal wall using a diamond surgical burr with those using a 2-mm osteotome.

Material And Methods: Bilateral osteotomy of the nasal wall was performed on 10 cadavers. The 20 lateral nasal osteotomies were carried out on 7 females and 3 males of an age range between 61-91 years. A 2-mm osteotome was used percutaneously to perforate the lateral nasal wall of the right side. On the left side a 2-mm diamond surgical burr was introduced via an intraoral approach to thin out the lateral nasal wall. The in-fracture of the nasal bone was accomplished by controlled finger pressure. The nasal mucosa was inspected endoscopically and also dissected to identify any perforations or lacerations. The pattern of nasal fracture and the presence of any fragmentation of the bony segments were assessed clinically.

Results: The in-fracturing of the nasal bone was accomplished by gentle pressure on the left side, but required more force on the contra lateral side. On the left side the in-fractured lateral nasal wall remained as one piece and no irregularities were seen. On the right side 3-5 bony fragments of irregular sizes and shapes were detected. There were 3-4 tears of the nasal mucosa, where the osteotome was applied. However, no mucosal tears were detected at the side, where the surgical burr was used.

Conclusion: Osteotomy of the lateral nasal wall with a diamond burr via intraoral approach is more precise and associated with fewer complications in comparison with the use of the osteotome.
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http://dx.doi.org/10.1186/1746-160X-9-41DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878258PMC
December 2013

Submental fat transfer: an approach to enhance soft tissue conditions in patients with submental lipomatosis after orthognathic surgery.

J Oral Maxillofac Surg 2014 Jan;72(1):164.e1-7

Chair, Department of Oral and Maxillofacial Surgery, Northside Hospital, Atlanta, GA; Private Practice, Georgia Oral and Facial Surgery, Marietta, GA; Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, Medical College of Georgia, Augusta, GA; Clinical Assistant, Department of Surgery, Emory University School of Medicine, Atlanta, GA.

Soft tissue changes after orthognathic surgery and their effects on the esthetic appearance of the patient can be the most challenging and sometimes undesired parts of this procedure. Although the soft tissue profile is improved in many orthognathic surgeries, suboptimal soft tissue changes may necessitate some special interventions. To overcome these problems, the authors present a technique based on transferring the submental fat (in patients with submental lipomatosis) to the lips, paranasal areas, or other sites of the face instead of discarding it. According to this technique, in patients with submental lipomatosis, submental fat can be used not only to compensate some of the unpleasant soft tissue effects of orthognathic procedures (eg, thinning of the upper lip after mandibular setback), but also to improve pre-existing soft tissue problems, which may be worse after orthognathic surgeries (eg, a poor neck and chin profile). Although submental fat liposuction is a traditional technique to improve the neck and chin profile, the present technique is based on transferring the harvested fat to other sites of the face (lips, paranasal areas, etc) instead of discarding it.
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http://dx.doi.org/10.1016/j.joms.2013.08.032DOI Listing
January 2014

The effect of endotracheal tube cuff pressure control on postextubation throat pain in orthognathic surgeries: a randomized double-blind controlled clinical trial.

Br J Oral Maxillofac Surg 2014 Feb 21;52(2):140-3. Epub 2013 Nov 21.

Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Pain in the throat after extubation is one of the most common complaints after maxillofacial operations under general anaesthesia. We have evaluated the amount of pain after extubation when we controlled the pressure in the endotracheal cuff during operation by analysing the records of 43 patients who had maxillofacial operations under general anaesthesia. In the study group (n=20) the cuff pressure of the endotracheal tube was adjusted using a pressure gauge at the beginning of intubation and every hour during operation. In the control group (n=23), an experienced anaesthetist adjusted the pressure only at the beginning of the operation by palpating the pilot balloon. Throat pain was evaluated 1, 6, and 24h postoperatively on a visual analogue scale (VAS), and the pain scores in the control and study groups postoperatively was 5.3 (1.1) compared with 3.9 (1.5) (p=0.002); 4.5 (1.3) compared with 3.1 (1.5) (p=0.002); and 1.9 (1.1) compared with 1.6 (1.2) (p=0.4), respectively. The differences between the two groups at 1h and 6h postoperatively were significant, but that at 24h was not. Control of the cuff pressure of the endotracheal tube with a gauge at the beginning of the operation, and adjustment of the pressure during operation, can reduce postoperative complications such as throat pain.
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http://dx.doi.org/10.1016/j.bjoms.2013.10.005DOI Listing
February 2014

Management of perforations of the nasal septum: can extracorporeal septoplasty be an effective option?

J Oral Maxillofac Surg 2014 Feb 25;72(2):391-5. Epub 2013 Oct 25.

Chair, Department of Oral and Maxillofacial Surgery, Northside Hospital, Atlanta, GA; Private Practice, Georgia Oral and Facial Surgery, Marietta, GA; Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, Medical College of Georgia, Augusta, GA; Clinical Assistant, Department of Surgery, Emory University School of Medicine, Atlanta, GA.

Purpose: Perforation of the nasal septum is a frustrating problem frequently reported in the literature. Surprisingly, in most reports, iatrogenic perforation during septoplasty and electrocautery are the leading causes of this complication. This article presents the management of septal perforations and the indications for an extracorporeal approach.

Materials And Methods: Fourteen patients with septal perforations were referred for treatment. Treatment was chosen based on defect size. Flaps, extracorporeal repair, or no treatment was used as indicated.

Results: Two of 14 perforations were small and were repaired by local flaps, 5 cases were treated by extracorporeal repair, and the 7 remaining cases required no surgical procedure.

Conclusions: The extracorporeal technique, when indicated, can be used effectively for the repair of nasal septum perforations in selected cases.
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http://dx.doi.org/10.1016/j.joms.2013.08.016DOI Listing
February 2014

Carpentering in septorhinoplasty: a novel technique to straighten the deviated nasal septum.

J Oral Maxillofac Surg 2014 Jan 24;72(1):157-63. Epub 2013 Sep 24.

Otorhinolaryngologist, Head and Neck Surgeon, Private Practice, Tehran, Iran.

Septal deviation presents a considerable challenge in septorhinoplasty because it leads to functional and esthetic problems. This deformity may displace the nasal tip, disturb nasal valve patency, and affect the final outcomes of septorhinoplasty. This report describes an innovative technique that can be used in patients with C-shaped deviation of the septum in a cephalocaudal direction. Because the procedure is similar to carpentering, it was named a "carpenter spreader graft." In this technique, the deviated dorsal cartilage is separated and displaced to a new straightened position.
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http://dx.doi.org/10.1016/j.joms.2013.07.032DOI Listing
January 2014

Alloplastic mandibular reconstruction: a systematic review and meta-analysis of the current century case series.

Plast Reconstr Surg 2013 Sep;132(3):413e-427e

Bremerhaven and Hamburg, Germany; and Tehran, Iran From the Department of Oral and Maxillofacial Surgery, Bremerhaven Hospital (Reinkenheide); the Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf; the Craniofacial Research Center and Department of Oral and Maxillofacial Surgery, Azad University of Medical Sciences; and the Department of Head and Neck Surgical Oncology and Reconstructive Surgery, The Cancer Institute, School of Medicine, and the Craniomaxillofacial Research Center, Tehran University of Medical Science.

Background: Alloplastic mandibular reconstruction remains insufficiently predictable, with no systematic reviews to assess its scope and limitations.

Methods: The PubMed, CINAHL, EMBASE, and Web of Science databases were searched for English study reports, published in the current century, of mere alloplastic surgical reconstruction of mandibular ablative defects.

Results: In 14 articles, there were 944 patients, with a median age of 58.7 years (interquartile range, 53.2 to 62 years); 58.7 percent (interquartile range, 66.7 to 78.6 percent) were male. Cases of squamous cell carcinoma per study constituted 93.5 percent (interquartile range, 81.5 to 100 percent). Defects were mostly lateral (Boyd classification) (60.5 percent; interquartile range, 56.2 to 62 percent) and received mostly conventional bridging plates (in 64.3 percent of the studies) and pedicled flaps (45.3 percent; interquartile range, 37.1 to 58.3 percent); 60.7 percent (interquartile range, 53.5 to 58.8 percent) received adjuvant therapy. At 32-month follow-up, the complication and failure rates were 40.1 percent (interquartile range, 26.7 to 58.6 percent) and 30.8 percent (interquartile range, 11.7 to 48.1 percent), respectively. The overall survival rate was 55 percent (interquartile range, 27.8 to 74 percent). Radiotherapy seemed to be a relative risk factor for complications (1.387; p = 0.014) and plate loss (1.585; p = 0.006). Crossing the midline seemed to be a relative risk factor for plate exposure (1.533; p = 0.000) and overall complications (1.385; p = 0.002).

Conclusions: The results should be generalized cautiously. Alloplastic reconstructive surgery faces a remarkable lack of evidence. Relatively high complication and failure rates are areas of further concern.
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http://dx.doi.org/10.1097/PRS.0b013e31829ad0d9DOI Listing
September 2013

Tapia syndrome after repairing a fractured zygomatic complex: a case report and review of the literature.

J Oral Maxillofac Surg 2013 Oct 11;71(10):1665-9. Epub 2013 Jul 11.

Chief Resident, Department of Oral and Maxillofacial Surgery, Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; and Department of Oral and Maxillofacial Surgery, Jundishapour University, Ahvaz, Iran. Electronic address:

Tapia syndrome is known as a rare complication of airway manipulation, which can occur after any type of surgery under endotracheal general anesthesia. This syndrome is characterized by neurologic deficits involving the hypoglossal (XII) and recurrent laryngeal branch of the vagal nerve (X) that result in the tongue muscle's unilateral paralysis associated with the vocal cord's unilateral palsy. This article describes the first case of Tapia syndrome, which occurred after repair of a fractured zygomatic complex. In this article, we discuss the diagnosis, possible causes, clinical manifestations, treatment methods, and preventive strategies as described in 10 case reports in the literature that have been attributed to manipulation of the airway.
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http://dx.doi.org/10.1016/j.joms.2013.05.019DOI Listing
October 2013

Lateral crural suspension flap: a novel technique to modify and stabilize the nasolabial angle.

J Oral Maxillofac Surg 2013 Sep 14;71(9):1572-6. Epub 2013 Jun 14.

Department of Oral and Maxillofacial Surgery, Craniomaxillofacial Research Center, Buali Hospital, Azad University, Tehran, Iran.

The proper nasolabial angle is a determinant factor in achieving a pleasant result in esthetic rhinoplasty surgery. Nasal tip position depends on various interrelated elements. Its rotation should be analyzed by assessing the nasolabial angle. An increase in this angle results in an upward tilt of the base of the nose with a concomitant decrease in nasal length. Several methods have been advocated to improve this angle; unfortunately, these techniques have considerable limitations in modifying and stabilizing nasal tip rotation. The general principles for rotating the nasal tip include removing the factors that resist the rotation of the lower lateral cartilages, creating space to accommodate them, rotating the lower lateral cartilages into the desired position, and stabilizing the cartilages in the desired position. Resection of the cephalic margin of the lateral crura fulfills these goals. This report describes a straightforward and stable method that uses cephalic portions of the lower lateral crural cartilages as 2 flaps to suspend the nasal tip to the septum to modify and stabilize the nasolabial angle.
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http://dx.doi.org/10.1016/j.joms.2013.03.024DOI Listing
September 2013

Neck hairline incision for simultaneous harvesting of temporal and mastoid fasciae: a technical note.

J Oral Maxillofac Surg 2013 Sep 22;71(9):1598-600. Epub 2013 May 22.

Craniomaxillofacial Research Center, Azad University, Tehran, Iran.

Fasciae are known reservoirs of ideal graft material. The temporalis and mastoid fasciae are 2 of the most important graft reservoirs used by plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons. The temporalis fascia is harvested predominantly by plastic surgeons, whereas otolaryngologists often prefer the mastoid fascia. In either case, graft harvesting might be accompanied by donor-site complications, such as hair loss, bleeding, hematoma, and scar formation, which can limit its application. To gain access to the temporal and mastoid fasciae simultaneously, the authors combined conventional techniques to develop a modified single-approach incision line that would minimize most donor-site complications.
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http://dx.doi.org/10.1016/j.joms.2013.04.003DOI Listing
September 2013