Publications by authors named "Likith Reddy"

26 Publications

  • Page 1 of 1

Maxillofacial Bony Considerations in Facial Transplantation.

Facial Plast Surg 2021 Apr 20. Epub 2021 Apr 20.

Department of Oral and Maxillofacial Surgery, Texas A&M Health Science Center, Dallas, Texas.

Alloplastic facial transplantation has become a new rung on the proverbial reconstructive ladder for severe facial wounds in the past couple of decades. Since the first transfer including bony components in 2006, numerous facial allotransplantations across many countries have been successfully performed, many incorporating multiple bony elements of the face. There are many unique considerations to facial transplantation of bone, however, beyond the considerations of simple soft tissue transfer. Herein, we review the current literature and considerations specific to bony facial transplantation focusing on the pertinent surgical anatomy, preoperative planning needs, intraoperative harvest and inset considerations, and postoperative protocols.
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http://dx.doi.org/10.1055/s-0041-1726443DOI Listing
April 2021

Combined bone- and mucosa-supported 3D-printed guide for sinus slot preparation and prosthetically driven zygomatic implant placement.

J Prosthet Dent 2021 Mar 29. Epub 2021 Mar 29.

Private practice, Fayetteville, Ark.

The use of zygomatic implants to rehabilitate the severely atrophic maxilla has been well documented since first being introduced by Brånemark. Placement of zygomatic implants is technically complex, with catastrophic complications and numerous prosthetic challenges resulting from imprecise placement. The purpose of this report was to demonstrate a technique that allows transfer of the preoperatively planned sinus slot position to the surgical field by using cone beam computed tomography (CBCT) and an implant planning software program to fabricate a combined bone- and mucosa-supported 3D-printed surgical guide. This facilitates optimal zygomatic implant positioning and promotes favorable biomechanics with a predictable prosthetic outcome.
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http://dx.doi.org/10.1016/j.prosdent.2021.02.024DOI Listing
March 2021

Lip Augmentation.

Oral Maxillofac Surg Clin North Am 2021 May 6;33(2):185-195. Epub 2021 Mar 6.

Texas A&M Oral and Maxillofacial Surgery, 3000 Gaston Avenue Dallas, TX 75226 USA.

A heightened cultural emphasis on youth and beauty has resulted in an increase in cosmetic surgery in the Western world. Lip augmentation is one of the most popular cosmetic procedures done because full lips are considered youthful and voluptuous. With reliable and improved techniques, it is possible to change the appearance of the lips utilizing injectable materials and surgical techniques. This article focuses on popular materials and techniques utilized to augment the size and volume of the lips-the most common are dermal fillers. Lip augmentation requires a thorough understanding of anatomy and managing patient expectations, available materials, and techniques.
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http://dx.doi.org/10.1016/j.coms.2021.01.004DOI Listing
May 2021

Secondary Reconstruction of the Zygomaticomaxillary Complex.

Semin Plast Surg 2020 Nov 24;34(4):254-259. Epub 2020 Dec 24.

Department of Oral and Maxillofacial, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas.

Zygomaticomaxillary (ZMC) fractures are the second most common facial fractures after nasal bone fractures. The zygoma, with its location and multiple points of articulations, lends itself to both facial structure and esthetics. Secondary ZMC deformities are complications of inadequate primary correction, delayed repair, or lack of repair. Secondary revisions of ZMC aim to correct ZMC displacement and projection and to address orbital discrepancies. Extensive correction involving significant orbital and malar defects requires zygomatic repositioning osteotomies and would greatly benefit from the utilization of virtual surgical planning, intraoperative navigation, and imaging. Minor corrections in malar projection can be corrected by onlay grafting and soft tissue augmentation and resuspension. Isolated or minor orbital corrections can be managed by autogenous or alloplastic material to restore lost orbital volume and anatomy.
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http://dx.doi.org/10.1055/s-0040-1721761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759427PMC
November 2020

Facial Transplantation: Complications, Outcomes, and Long-Term Management Strategies.

Semin Plast Surg 2020 Nov 24;34(4):245-253. Epub 2020 Dec 24.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for patients with extensive facial disfigurements. As it has expanded the frontiers of microsurgical reconstructive techniques, facial transplantation has come to garner widespread interest within both the medical community and the general public. The procedure has established itself as an amalgamation of the forefronts of reconstructive microsurgery, immunology, and transplantation science. Therein too lies its complexity as multifaceted scientific developments are met with ethical and social issues. Both patients and physicians are faced with the everlasting challenges of immunosuppression regimens and their inherent complications, long-term aesthetic and functional considerations, the role of revision procedures, and the inevitable psychosocial implications. This article reflects on the medical and surgical advancements in facial transplantation surgery and highlights anticipated future challenges. It aims to encourage discussion regarding anticipated barriers to current practice and suggest future directions as we transition into the next phase of facial allograft transplantation.
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http://dx.doi.org/10.1055/s-0040-1721760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759434PMC
November 2020

Necrotizing fasciitis of the scalp stemming from odontogenic infection.

Proc (Bayl Univ Med Cent) 2020 Jan 1;33(1):110-112. Epub 2019 Nov 1.

Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas.

Necrotizing fasciitis is a severe, rapidly progressive infectious process characterized by rapid spread and extensive tissue destruction. This condition stems from a variety of sources, may affect any area of the body, and requires rapid diagnosis and aggressive intervention. We present a rare case of odontogenic infection progressing to acute cervicofacial necrotizing fasciitis of the scalp and neck.
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http://dx.doi.org/10.1080/08998280.2019.1675419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988694PMC
January 2020

A 3D-Printed Guide to Assist in Sinus Slot Preparation for the Optimization of Zygomatic Implant Axis Trajectory.

J Prosthodont 2020 Feb 11;29(2):179-184. Epub 2020 Jan 11.

Private Practice, Fayetteville, AR.

Zygomatic implants have become a predictable treatment modality for the rehabilitation of the severely atrophic maxilla. Due to differing anatomic variations, proximity to vital anatomic structures and limited intraoperative visibility, the placement of zygomatic implants can be a difficult task; compromised implant positioning may ultimately lead to postoperative surgical and prosthetic complications. The purpose of this report is to demonstrate a technique that allows for the transfer of the sinus slot position. Ultimately, this optimizes zygomatic implant axis trajectory from preoperative prosthetic planning by using cone beam computed tomography (CBCT) and 3-dimensional (3D) planning software to fabricate a stereolithographic 3D-printed surgical guide.
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http://dx.doi.org/10.1111/jopr.13139DOI Listing
February 2020

Secondary Management of Midface Fractures.

Facial Plast Surg 2019 Dec 29;35(6):640-644. Epub 2019 Nov 29.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Secondary reconstruction of posttraumatic facial deformities has been consistently described as one of the most challenging procedures performed. Ideal primary reconstruction cannot always be achieved, and often it is complicated by severe comminution or inadequate surgical management. It also can arise because of a lack of definitive surgical repair or excessive delay of initial treatment. Complications leading to secondary deformities can occur even when craniofacial injuries are treated by experienced surgeons. Following proper surgical principles, meticulous perioperative planning, and anticipation of potential functional and aesthetic sequelae limit many of those complications. Herein, we discuss secondary procedures in traumatic midface injuries.
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http://dx.doi.org/10.1055/s-0039-3399494DOI Listing
December 2019

Secondary Management of Mandible Fractures.

Facial Plast Surg 2019 Dec 29;35(6):627-632. Epub 2019 Nov 29.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Mandibular fractures are the most common facial fractures that need surgical intervention. If untreated, these fractures affect a patient's occlusion, degree of mouth opening, and facial symmetry, and could cause infection with significant pain. The goal of any surgical intervention is to restore the preinjury occlusion, even if the preinjury occlusion is abnormal. Initial therapies, whether surgical or conservative, are not always successful, however, and revision or delayed surgical intervention can be challenging. Herein, we review common causes of failure of primary surgical management of mandibular fractures and provide tips to successful secondary intervention.
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http://dx.doi.org/10.1055/s-0039-1700887DOI Listing
December 2019

Dental Injuries and Management.

Facial Plast Surg 2019 Dec 29;35(6):607-613. Epub 2019 Nov 29.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Traumatic dental injuries affect 1 to 3% of the population, and disproportionately affect children and adolescents. The management of these injuries incorporates the age of patients, as children between 6 and 13 years of age have a mixed dentition. This helps to preserve the vitality of teeth that may be salvaged after a traumatic event. The clinical examination of these cases involves a thorough examination of the maxilla and mandible for associated fractures and any lodged debris and dislodged teeth or tooth fragments. The objective is to rule out any accidental aspiration or displacement into the nose, sinuses, or soft tissue. After ruling out any complications, the focus is on determining the type of injury to the tooth or teeth involved. These include clinical examination for any color change in the teeth, mobility testing, and testing for pulp vitality. Radiographic evaluation using periapical, occlusal, panoramic radiographs, and cone beam computed tomography is performed to view the effect of trauma on the tooth, root, periodontal ligament, and adjoining bone. The most commonly used classification system for dental trauma is Andreasen's classification and is applied to both deciduous and permanent teeth. Managing dental trauma is based on the type of injury, such as hard tissue and pulp injuries, injuries to periodontal tissue, injuries of the supporting bone, and injuries of the gingiva and oral mucosa. Hard-tissue injuries without the involvement of the pulp typically require restoration only. Any pulp involvement may require endodontic treatment. Fractures involving the alveolar bone or luxation of the tooth require stabilization which is typically achieved with flexible splints. The most common procedures employed in managing dental injuries include root canal/endodontics, surgical tooth repositioning, and flexible splinting. Recognition and treatment of these injuries are necessary to facilitate proper healing and salvage of a patient's natural dentition, reducing future complications to patients.
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http://dx.doi.org/10.1055/s-0039-1700877DOI Listing
December 2019

Radiographic manifestations of fibroblastic osteosarcoma: A diagnostic challenge.

Imaging Sci Dent 2019 Sep 24;49(3):235-240. Epub 2019 Sep 24.

Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Dallas, TX, USA.

Osteosarcoma is the most common primary bone tumor after plasma cell neoplasms. Osteosarcoma has diverse histological features and is characterized by the presence of malignant spindle cells and pluripotent neoplastic mesenchymal cells that produce immature bone, cartilage, and fibrous tissue. Osteosarcoma most frequently develops in the extremities of long bones, but can occur in the jaw in rare cases. The clinical and biological behavior of osteosarcoma of the jaw slightly differs from that of long-bone osteosarcoma. The incidence of jaw osteosarcoma is greater in the third to fourth decades of life, whereas long-bone osteosarcoma mostly occurs in the second decade of life. Osteosarcoma of the jaw has a lower tendency to metastasize and a better prognosis than long-bone osteosarcoma. Radiographically, osteosarcoma can present as a poorly-defined lytic, sclerotic, or mixed-density lesion with periosteal bone reaction response. Multi-detector computed tomography is useful for identifying the extent of bone destruction, as well as soft tissue involvement of the lesion. The current case report presents a fibroblastic osteosarcoma involving the left hemimandible with very unusual radiographic features.
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http://dx.doi.org/10.5624/isd.2019.49.3.235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761061PMC
September 2019

Craniofacial Injuries Seen With the Introduction of Bicycle-Share Electric Scooters in an Urban Setting.

J Oral Maxillofac Surg 2019 Nov 1;77(11):2292-2297. Epub 2019 Aug 1.

Clinical Professor, Department of Oral and Maxillofacial Surgery, and Director, Residency Program, Texas A&M College of Dentistry; and Surgeon, Department of Oral and Maxillofacial Surgery, Baylor University Medical Center, Dallas, TX.

Purpose: Standing electric scooters (e-scooters) are rapidly becoming popular modes of transportation in many urban areas across the United States. However, this increase in popularity has resulted in an increase in traumatic injuries associated with these modes of expedient travel. The purpose of the present study was to determine the types of craniofacial trauma directly related to e-scooter use in a major urban center (Dallas, TX).

Materials And Methods: We performed a retrospective case series and examined the medical records of the patients who had presented to the emergency department (ED) for trauma related to e-scooter use. Descriptive statistics were calculated for all variables on patient presentation, including incident notes and patient interviews, demographic information, diagnostic tests, trauma (ie, location, type, severity), treatment (ie, type, admission, outpatient referral, follow-up data), and contributing factors (ie, reported or detected alcohol use, use of protective equipment).

Results: A total of 90 patients (56 males, 34 females; mean age, 31.8 years) had presented with scooter-related trauma to the ED during the first 7 months of scooters after their introduction to the metropolitan area. A total of 52 admissions (58% of all admissions) involved injuries of the head and face. The patients had presented with a myriad of craniofacial trauma, ranging from abrasions, lacerations, and concussions to intracranial hemorrhage and Le Fort II and III fractures. Of the 52 craniofacial injuries, 30 (58%) were considered severe (ie, fracture, internal hemorrhage, concussion, loss of consciousness), and 22 (42%) were considered minor (ie, lacerations, contusion, abrasion, dental). Alcohol use had been involved in 18% of all scooter-related trauma admissions, and no rider had reported wearing a helmet.

Conclusions: Injuries to the head and face were commonly found with e-scooter admissions in this sample, and the high prevalence of extremity injuries suggested that patients were breaking their fall during the crash. Craniofacial trauma related to e-scooter use could be significantly reduced by the wearing of a protective helmet.
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http://dx.doi.org/10.1016/j.joms.2019.07.014DOI Listing
November 2019

Macroglossia secondary to lisinopril-induced acute angioedema.

Proc (Bayl Univ Med Cent) 2019 Jan 16;32(1):70-72. Epub 2019 Jan 16.

Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas.

Presented here are two cases of acute acquired macroglossia in adults caused by angioedema resulting from a reaction to angiotensin-converting enzyme inhibitors (ACEIs). Angioedema can be caused by a variety of factors, but ACEIs are the most common precipitating factor. Symptoms such as swelling of the lips, face, tongue, and throat can lead to life-threatening airway compromise. Early management of acute angioedema and macroglossia includes antihistamines, steroids, and occasionally epinephrine, yet a small percentage of patients progress toward airway obstruction and will require intubation. Edema within the lips, face, and throat usually subsides within a week, but the tongue can remain edematous for prolonged periods if biting trauma occurs. If the patient's macroglossia does not resolve in a reasonable amount of time, a partial glossectomy may be indicated.
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http://dx.doi.org/10.1080/08998280.2018.1540736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442892PMC
January 2019

Fatal deep neck infection and respiratory arrest.

Proc (Bayl Univ Med Cent) 2019 Jan 15;32(1):67-69. Epub 2019 Jan 15.

Department of Oral and Maxillofacial Surgery, Baylor University Medical Center and Texas A&M College of DentistryDallasTexas.

Despite the wide availability of antibiotics and medical care, deep neck infections requiring hospitalization are associated with significant morbidity and mortality. Thus, early recognition and aggressive treatment are key in preventing unfavorable outcomes. We present the case of a patient who rapidly progressed from nonspecific upper respiratory symptoms to obstructive airway loss and death due to a swiftly worsening deep neck infection.
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http://dx.doi.org/10.1080/08998280.2018.1533313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442906PMC
January 2019

Craniofacial Trauma Is Associated With Significant Psychosocial Morbidity 1 Year Post-Injury.

J Oral Maxillofac Surg 2018 12 20;76(12):2610.e1-2610.e8. Epub 2018 Aug 20.

Co-Director of Trauma Research Center, Director of Neuropsychology and Rehabilitation Psychology, Baylor University Medical Center, Dallas, TX.

Purpose: The face and head play critical roles in one's sense of self and body image; as such, facial, head, and scalp injuries and potential associated disfigurement can lead to particular difficulties in coping. This study examined the psychosocial outcomes of patients with craniofacial (CF) trauma 1 year after injury and compared these outcomes with those of other traumatically injured patients who did not sustain such injuries. It was hypothesized that participants in the CF injury group would have worse outcomes than those without CF trauma.

Materials And Methods: This prospective longitudinal study included patients at least 18 years of age admitted to the trauma service of a level I trauma center for at least 24 hours. Demographic and injury-related variables were collected. CF injury was determined by International Classification of Diseases, Ninth Revision codes. Outcomes were measured at baseline and at 12 months and included depression, post-traumatic stress disorder (PTSD), alcohol use, and pain severity. Paired t tests and logistic regression were used for analysis.

Results: Fifteen percent (n = 35) of the study sample (N = 230) had CF injuries. Those with CF injuries had lower income, higher injury severity, and higher intensive care unit admission rates. The CF and non-CF trauma groups did not differ in rates of depression or PTSD at either time point. However, participants with CF trauma had higher odds of risky alcohol use than those without CF trauma at baseline and lower odds of a higher pain severity score at baseline and 12 months.

Conclusions: The groups did not differ in depression and PTSD. However, rates of depression, PTSD, alcohol use, and physical pain were higher than expected for the 2 groups. Given the high rate of psychological morbidity found after CF trauma, patients with these injuries should be screened for symptoms soon after injury and provided with resources for treatment.
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http://dx.doi.org/10.1016/j.joms.2018.08.006DOI Listing
December 2018

Plating Options for Fixation of Condylar Neck and Base Fractures.

Atlas Oral Maxillofac Surg Clin North Am 2017 Mar;25(1):69-73

Department of Oral and Maxillofacial Surgery, Baylor University Medical Center, Texas A&M University School of Dentistry, 3302 Gaston Avenue, Dallas, TX 75246, USA. Electronic address:

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http://dx.doi.org/10.1016/j.cxom.2016.11.003DOI Listing
March 2017

A comparative study of two different techniques for complete bilateral cleft lip repair using two-dimensional photographic analysis.

Plast Reconstr Surg 2013 Sep;132(3):634-642

Saidabad, Hyderabad, India; Cologne, Germany; New Orleans, La.; Bournemouth, United Kingdom; and Nijmegen, The Netherlands From the G.S.R. Hospital, Institute of Cranio-Maxillofacial and Facial Plastic Surgery; the Department of Plastic Surgery, Clinic Cologne Merheim, University Witten-Herdecke; the Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, School of Dentistry; Nuffield Hospital; and Radboud University Nijmegen Medical Center.

Background: The aim of this study was to compare the clinical outcomes of two techniques to repair complete bilateral cleft lip by using indirect two-dimensional photographic analysis.

Methods: One hundred eight bilateral cleft patients were included in this study, 54 patients operated on with the Millard technique and 54 patients operated on with the Afroze technique. Each group of patients was further separated into two subgroups containing symmetrical and asymmetrical cleft lips. All patients were photographed preoperatively and 4 years postoperatively in frontal and submentovertical views in a reproducible way. Eight measurements were performed on the photographs. From these measurements, seven ratios were calculated to compare the two techniques.

Results: The outcomes of the interobserver and intraobserver measurements were analyzed using the Pearson correlation test. There was a statistically significant reliability in the intraobserver and interobserver ratios. Analysis of the ratios was performed using the independent samples t test (5 percent level of significance). The authors found that the Afroze technique was better than the Millard technique in six of the seven parameters for symmetrical clefts and in four of the seven parameters for asymmetrical clefts; however, there was no statistically significant difference seen between the two techniques.

Conclusions: The Afroze technique seems to have good clinical outcomes on bilateral cleft lip patients, but more research and long-term follow-up are needed to determine the full outcome of the technique in various parameters.
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http://dx.doi.org/10.1097/PRS.0b013e31829ad193DOI Listing
September 2013

Developing and standardizing a center to treat cleft and craniofacial anomalies in a developing country like India.

J Craniofac Surg 2009 Sep;20 Suppl 2:1664-7

GSR Institute of Craniofacial Surgery, Hyderabad, Andhra Pradesh, India.

The range of facial deformities is enormous. All produce some degree of disfigurement and result in the impairment of function to some degree, sometimes even to the point of incompatibility with life. Congenital facial defects in India are associated with considerable superstition, social rejection, and failure to integrate into society.In India, cleft defects occur in 1 in 500 births. Congenital facial defects are a pressing problem in India owing to the limited resources to treat such patients. Poverty is a major factor for parents of such children to get appropriate treatment.Setting up an institute to treat children with cleft and craniofacial deformities in India presents problems with financing treatment for poor patients, procuring the right infrastructure, and employing well-trained human resources.The authors have set up such an institute in Hyderabad in the southern state of Andhra Pradesh in India. The logistics of setting up such a facility in a developing country and the future of funding for cleft treatment are important factors to consider while establishing a center for patients with cleft and craniofacial anomalies.The aim of setting up such centers was to provide quality comprehensive treatment for patients from all sections of society with cleft and craniofacial anomalies.
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http://dx.doi.org/10.1097/SCS.0b013e3181b2d6c7DOI Listing
September 2009

Maxillary advancement by distraction osteogenesis.

Atlas Oral Maxillofac Surg Clin North Am 2008 Sep;16(2):237-47

Oral and Maxillofacial Surgery, University of Cincinnati Medical Center, PO Box 670558, Cincinnati, OH 45267-0558, USA.

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http://dx.doi.org/10.1016/j.cxom.2008.04.003DOI Listing
September 2008

Distractor design and options.

Atlas Oral Maxillofac Surg Clin North Am 2008 Sep;16(2):159-67

Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, KY 40536-0297, USA.

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http://dx.doi.org/10.1016/j.cxom.2008.04.002DOI Listing
September 2008

Eyelid approach to the anterior cranial base.

J Neurosurg 2008 Aug;109(2):341-6

Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.

Skull base approaches play a fundamental role in modern neurosurgery by reducing surgical morbidity. Increasing experience has allowed surgeons to perform minimally invasive approaches without straying from the premises of skull base surgery. The eyelid approach has evolved from the orbitopterional osteotomy into a more effective and targeted approach to disease of the anterior cranial fossa. In this technique, after an incision is made on the supratarsal fold, the orbicularis oculi muscle is incised, and a myocutaneous flap composed of the elements of the anterior lamella is elevated. Subperiosteal dissection is used to expose the superior and lateral walls of the orbit, the superior and lateral orbital rim, and the frontosphenoidal suture. A MacCarty bur hole is drilled, and a frontal osteotomy is fashioned medial to the supraorbital notch and extending through the orbital roof back toward the orbital half of the MacCarty bur hole, exposing the frontobasal brain. A conventional microsurgical technique is used to treat tumors and aneurysms of the anterior cranial fossa under the operative microscope. Five patients were treated for unruptured aneurysms of the anterior circulation (3 anterior communicating artery aneurysms, 1 ophthalmic artery aneurysm, and 1 posterior communicating artery aneurysm) using the eyelid approach. The mean aneurysm size was 5 mm, and all aneurysms were approached from the right side. Three tumors in the anterior fossa (2 suprasellar pituitary adenomas and 1 craniopharyngioma) were also excised using this approach. There was no surgical morbidity. Three months after surgery all patients presented excellent cosmetic results. The eyelid approach may be considered as an effective, cosmetically beneficial, and minimally invasive skull base approach to selected aneurysms and tumors of the anterior circulation.
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http://dx.doi.org/10.3171/JNS/2008/109/8/0341DOI Listing
August 2008

Expansile mass of the maxilla.

J Oral Maxillofac Surg 2008 Jun;66(6):1253-8

Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, Buffalo, NY 14214, USA.

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http://dx.doi.org/10.1016/j.joms.2008.02.009DOI Listing
June 2008

Choice of incision for primary repair of unilateral complete cleft lip: a comparative study of outcomes in 796 patients.

Plast Reconstr Surg 2008 Mar;121(3):932-940

Hyderabad, India; Poole, United Kingdom; and Cincinnati, Ohio From the GSR Institute of Craniofacial Surgery; the South Coast Higher Surgical Training Program in Maxillofacial Surgery; the Division of Oral and Maxillofacial Surgery, University of Cincinnati; Dorset Research and Development Support Unit, Bournemouth University; and Dorset Cleft Center.

Background: No one technique of cleft lip repair consistently produces ideal aesthetic and functional results. This study was carried out in a developing, high-volume center. It compares outcomes attained using two different designs of skin incision used for primary closure of unilateral complete cleft lip and sought to identify the most appropriate technique for clefts of varying morphology.

Methods: Seven hundred ninety-six patients were entered into the study. In each group of slightly less than 400 patients, either a modified Millard or Pfeifer wavy line incision was used, both in conjunction with functional repair of the underlying tissues as described by Delaire. Soft-tissue measurements of the lip and nose were recorded preoperatively. Analysis was based on postoperative assessment of the white roll, vermilion border, scar, Cupid's bow, lip length, and nostril symmetry and appearance of the alar dome and base.

Results: Comparison of the two cohorts using Pearson chi-square testing for association and linear trend found a Millard incision gave significantly better results for vermilion match, whereas the Pfeifer method led to a better postoperative lip length. Preconceptions that one particular technique was better suited to certain preoperative cleft anatomical forms were not proven statistically.

Conclusions: Certain preoperative anatomical features may lead the surgeon to choose one particular incision pattern in preference to another, but in this study, it was found that one technique was essentially as good as the other. This suggests that the technique for closure of the underlying tissues is probably of more importance.
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http://dx.doi.org/10.1097/01.prs.0000299282.63111.3fDOI Listing
March 2008

Reconstruction of skin cancer defects of the auricle.

J Oral Maxillofac Surg 2004 Dec;62(12):1457-71

OMS, John Peter Smith Hospital, Fort Worth, TX 76104, USA.

Purpose: This article reviews the results of reconstruction of surface defects of the auricle after removal of skin cancer, and discusses the results of the delayed reconstruction method of care and modalities of treatment.

Patients And Methods: Fifty-four patients with 62 defects involving various locations on the auricle were treated. Management included direct closure, secondary epithelization, full thickness skin grafts, local flaps using direct advancement, and rotational advancement flaps using one or more stages.

Results: Nine defects were treated by direct closure with adjacent tissue, 12 defects healed by secondary epithelization, and 13 patients were treated with a full thickness skin graft. Twenty-eight defects were reconstructed with local flaps, which included the direct advancement, rotational flaps, transposition, and subcutaneous island flaps. No infections occurred.

Conclusion: Many options are available for reconstruction of auricular defects which yield acceptable results. Factors to consider before choosing a reconstructive format include size, location, and depth of the defect, patient medical history, smoking, and esthetic concerns. This review exposed that patients easily accept the "delayed" method of reconstruction. Delaying allows the surgeon time to research options for care and allows the patient choices of secondary epithelization and significantly reduced costs of care.
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http://dx.doi.org/10.1016/j.joms.2004.07.006DOI Listing
December 2004

Status of the internal orbit after reduction of zygomaticomaxillary complex fractures.

J Oral Maxillofac Surg 2004 Mar;62(3):275-83

Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas 75390-9109, USA.

Purpose: We sought to determine the status of the internal orbit before and after reduction of zygomaticomaxillary complex (ZMC) fractures when treated without internal orbital reconstruction.

Patients And Methods: We conducted a retrospective study of preoperative and postoperative computed tomography (CT) scans in 65 patients with unilateral ZMC fractures who were treated by reduction of the ZMC complex without internal orbital reconstruction. The size and location of the internal orbital defects, orbital soft tissue displacement, and orbital volume were assessed in the preoperative and postoperative CT scans.

Results: Reduction in the ZMC fractures was considered ideal in 58 of the 65 patients. Only minor malpositions occurred in the remaining 7 patients. The size of the internal orbital defects increased slightly with ZMC reduction but the internal orbital fractures were realigned, and few had increases in orbital volume or soft tissue sagging into the sinuses. Examination of follow-up CT scans in several patients taken weeks to months later showed that the residual defects became smaller and that none of these patients had an increase in orbital volume or soft tissue sagging.

Conclusion: The preoperative CT scan can be used to assess the amount of internal orbital disruption for purposes of developing a treatment plan in patients with ZMC fractures. When there is minimal or no soft tissue herniation and minimal disruption of the internal orbit, ZMC reduction is adequate treatment.
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http://dx.doi.org/10.1016/j.joms.2003.01.006DOI Listing
March 2004

Bond strength for orthodontic brackets contaminated by blood: composite versus resin-modified glass ionomer cements.

J Oral Maxillofac Surg 2003 Feb;61(2):206-13

Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.

Purpose: The purpose of this study was to evaluate and compare the shear bond strengths of a self-cured glass ionomer versus composite cement for bonding of stainless steel buttons with various enamel surface and setting conditions.

Materials And Methods: Stainless steel orthodontic buttons were bonded using composite material under 3 different enamel and setting conditions: 1) conditioned and dry enamel surface, 2) conditioned and precontamination of the enamel surface with blood before bonding, 3) conditioned and immediate blood contamination postbonding and were compared with 3 different enamel conditions and setting for bonding with the glass ionomer cement: 1) nonconditioned and wet enamel surfaces, 2) nonconditioned and blood contamination of enamel before bonding, and 3) nonconditioned and immediate blood contamination postbonding. The brackets were bonded to 109 recently extracted teeth and allowed to set in a moist plastic container for 24 hours. They were subsequently tested in shear mode with a universal testing machine. The maximum bond strength and the site of bond failure were recorded. In addition, the location of the bond failure was studied.

Results: Composite was capable of sustaining greater forces than the resin-modified glass ionomer materials. Hence, it took more force to debond a bracket cemented with composite than with resin-modified glass ionomer. The effect of contamination was similar in both of the materials, and the magnitude of the decrease in bond strength was nearly of the same proportion. The postcontamination values were not significantly different from the uncontaminated bond strength for either material. The type of bond failure was significantly different for the different materials, and there were significant differences among the treatment conditions.

Conclusion: Composite resin had significantly greater shear strength than resin-reinforced glass ionomer cement. Both materials showed a significant decrease in bond strength when precontaminated with blood. The postcontamination values were not significantly different from the uncontaminated bond strength for either material.
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http://dx.doi.org/10.1053/joms.2003.50039DOI Listing
February 2003