scholarly journals Spheno-Orbital Meningioma Resection and Reconstruction: The Role of Piezosurgery and Premolded Titanium Mesh

2011 ◽  
Vol 4 (4) ◽  
pp. 193-200 ◽  
Author(s):  
Susana Heredero Jung ◽  
Alicia Dean Ferrer ◽  
Juan Solivera Vela ◽  
Francisco Alamillos Granados
Keyword(s):  
Soft Tissues ◽  
Treatment Options ◽  
Titanium Mesh ◽  
Calvarial Bone ◽  
Easy Method ◽  
Orbital Reconstruction ◽  
Skull Model ◽  
Orbital Wall ◽  
Orbitozygomatic Approach ◽  
Orbital Meningioma

We present the clinical case of a patient with a spheno-orbital meningioma. Literature review of the treatment options, including the application of piezoelectric or ultrasound surgery and orbital reconstruction after meningioma resection, is also presented. Complete resection was performed by means of a frontotemporal craniotomy and an orbitozygomatic approach. Piezoelectric osteotomy was used around the optic nerve canal and the superior orbital fissure to minimize the damage to soft tissues. Orbital wall reconstruction was done using a titanium mesh previously premolded using a skull model. The superior orbital rim was reconstructed with calvarial bone grafts, and the sphenotemporal bone defect was covered with a titanium mesh cranioplasty. Ultrasonic vibrations to perform osteotomies in craniofacial surgery provide an interesting tool to reduce damage to surrounding soft tissues. Reconstruction of the roof and lateral orbital wall with premolded titanium meshes with a skull model is a safe and easy method to achieve a good orbital reconstruction and to avoid secondary sequelae.

Orbital Reconstruction via Deformable Titanium Mesh Following Spheno-Orbital Meningioma Resection

2020 ◽  
Vol 36 (1) ◽  
pp. 89-93 ◽  
Author(s):  
S. Tyler Pace ◽  
Irina V. Koreen ◽  
John A. Wilson ◽  
R. Patrick Yeatts
Keyword(s):  
Titanium Mesh ◽  
Orbital Reconstruction ◽  
Orbital Meningioma

scholarly journals Treatment of Orbital Medial Wall Fractures with Titanium Mesh Plates Using Retrocaruncular Approach: Outcomes with Different Techniques

2015 ◽  
Vol 8 (4) ◽  
pp. 326-333 ◽  
Author(s):  
Giovanni Gerbino ◽  
Emanuele Zavattero ◽  
Stefano Viterbo ◽  
Guglielmo Ramieri
Keyword(s):  
Direct Vision ◽  
Medial Wall ◽  
Titanium Mesh ◽  
Orbital Reconstruction ◽  
Complex Anatomy ◽  
Orbital Wall ◽  
Group 3 ◽  
Group 2 ◽  
Medial Orbital Wall ◽  
Group 1

Surgical management of medial wall orbital fractures should be considered to avoid diplopia and posttraumatic enophthalmos. Treatment of these fractures remains a challenge for the maxillofacial surgeon because of complex anatomy and limited vision. This article aims to retrospectively evaluate the outcomes in the repair of medial orbital wall fractures using a retrocaruncular approach and titanium meshes, comparing the placement of the titanium mesh with three different techniques: (1) conventional free hand under direct vision, (2) with the assistance of an endoscope, and (c) with the assistance of a navigation system. Eighteen patients who underwent surgery for orbital medial wall fracture were enrolled in the study. On the basis of the implant placement technique, three groups were identified: group 1 (CONV), conventional free hand under direct vision; group 2 (ENDO), endoscopically assisted; group 3 (NAVI), a navigational system assisted (BrainLab, Feldkirchen, Germany). The postoperative quality of orbital reconstruction was assessed as satisfactory in 12 cases, good in 4 cases, and unsatisfactory in 2 cases. Particularly in group 1 (CONV) in four patients out of eight, the posterior ledge of the fracture was not reached by the implant and in one patient the mesh hinged toward the ethmoid. In group 3 (NAVI), in one patient out of five, the posterior ledge of the fracture was not reached. In conclusion, titanium orbital mesh plates and retrocaruncular approach are a reliable method to obtain an accurate orbital medial wall reconstruction. The use of endoscopic assistance through the surgical incisions improves accuracy of treatment allowing better visualization of the surgical field. Navigation aided surgery is a feasible technique especially for complex orbital reconstruction to improve predictability and outcomes in orbital repair.

scholarly journals Orbital Wall Reconstruction with Titanium Mesh: Retrospective Study of 24 Patients

2011 ◽  
Vol 4 (3) ◽  
pp. 151-156 ◽  
Author(s):  
Mario Francisco Gabrielli ◽  
Marcelo Silva Monnazzi ◽  
Luis Augusto Passeri ◽  
Waldner Ricardo Carvalho ◽  
Marisa Gabrielli ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Correction ◽  
Infraorbital Nerve ◽  
Efficacy And Safety ◽  
Titanium Mesh ◽  
Orbital Reconstruction ◽  
Vehicle Accidents ◽  
Orbital Floor Fractures ◽  
Orbital Wall

The aim of this study was to evaluate the efficacy and safety of traumatic orbital defect reconstruction with titanium mesh. A retrospective study was made. Evaluations were made after a minimum postoperative follow-up of 12 months, looking for the main complications. Twenty-four patients were included in this evaluation; 19 were male (79.1%) and 5 (20.8%) were female. The main injury etiology was vehicle accidents (50%) followed by other causes. Fourteen patients (58.3%) presented orbital floor fractures, and 10 had more than one wall fractured (41.6%). Permanent infraorbital nerve hypoesthesia was observed in two patients (8.3%), enophthalmos occurred in five patients (20.8%), and exophthalmos was found in two patients (8.3%). Four patients (16.6%) still presented evidence of residual prolapsed intraorbital content, and one of those needed further surgical correction; sinusitis occurred in one patient (4.1%). Titanium mesh is a reliable option for orbital reconstruction, despite some complications found in this sample.

scholarly journals Patterns of Orbital Fractures Needing Surgical Reconstruction in a Large Tertiary Hospital in Northern India

2021 ◽  
Vol 6 ◽  
pp. 247275122199916
Author(s):  
Sneha Gupta ◽  
Praveen Kumar Singh ◽  
Divya Mehrotra ◽  
Shadab Mohammad ◽  
Vibha Singh ◽  
...  
Keyword(s):  
Treatment Options ◽  
Lateral Wall ◽  
Tertiary Hospital ◽  
Surgical Reconstruction ◽  
Patient Specific ◽  
Orbital Fracture ◽  
Trauma Patients ◽  
Orbital Fractures ◽  
Titanium Mesh ◽  
Calvarial Bone

Study Design: This is a prospective study for 3 year duration. Objective: The aim of this study was to observe the incidence and patterns of orbital fractures and discuss their treatment options. Methods: A total 29604 trauma patients visited our emergency department within May 2017 to Oct 2019, where 1230 (4.15%) patients presented with orbital fractures, of which only 44 (3.6% of orbital fracture) patients required surgical reconstruction, and were enrolled in our study and evaluated for their fracture patterns, size of bone defect, clinical presentation, timing of surgery, reconstruction, and complications. Results: The incidence of orbital fracture was 4.15%, of which only 20.5% were pure blow out. Associated fractures included 72.7% zygomatic complex, 50% LeFort, 31.8% mandible and 20.5% pan facial fractures. The most common pattern was the 1 wall orbital defect in 38.6%, 2 wall in 27.3%, 3 wall in 29.5% and 4 wall in 4.5%. The orbital floor fracture was seen in 100%, medial wall in 27.3%, lateral wall in 61.4%, roof in 15.9%. Different reconstruction options used included calvarial bone (2.3%), ear cartilage (2.3%), medpore (36.4%), polycaprolactone sheet (6.8%), titanium mesh (52.3%), patient specific implant (6.8%) and navigation (4.5%). Conclusion: Orbital fractures are mostly impure fractures, associated with zygomatic complex fractures, hence lateral wall fractures are seen more commonly. Patient specific implants, navigation guided reconstruction, autologous calvarial bone graft and preformed titanium mesh show better results, and fulfill the objectives of orbital reconstruction by restoring the normal anatomy and volume of the orbit.

Vital Tooth Whitening Techniques. A literature Review

2020 ◽  
Vol 02 ◽  
Author(s):  
Pia Chatterjee Kirk
Keyword(s):  
Soft Tissues ◽  
Treatment Time ◽  
Tooth Bleaching ◽  
Tooth Whitening ◽  
Easy Method ◽  
Tooth Structure ◽  
Dental Esthetics ◽  
Total Treatment Time ◽  
Restorative Materials ◽  
Total Treatment

Background: Vital tooth whitening has become an integral part of esthetic dentistry and remains one of the safest and most economic options today to improve dental esthetics without removing tooth structure. The tooth whitening materials have evolved into three categories: dentist-prescribed/dispensed (in office and patient home-use), and over-thecounter purchased and applied by patients. Objective: This review outlines the latest advances in dentist prescribed vital teeth whitening techniques, effects on tooth structure, soft tissues, and dental restoratives. Areas requiring additional research are also discussed. Methods: Electronic and manual literature search was conducted for key words such as tooth bleaching, and dental bleaching techniques using PubMed/MEDLINE, followed by manual selection of the studies that included whitening procedures in vital teeth. Results: The two main whitening agents are carbamide peroxide (CP) and hydrogen peroxide (HP or H2O2) whose concentration, duration of contact, and total treatment time can alter results. In addition, factors including the type of stain, and age of patient can affect results. Although whitening agents can affect tooth structure, restorative materials, and gingival tissues, the changes are temporary or can be treated using minimally invasive techniques. Conclusion: Areas requiring further research include the actual mechanism of whitening, its effect on tooth structure and restorative materials, and the development of an easy method to quantitate the degree of whitening in the dental office.

scholarly journals Should All Patients With HR-Positive HER2-Negative Metastatic Breast Cancer Receive CDK 4/6 Inhibitor As First-Line Based Therapy? A Network Meta-Analysis of Data from the PALOMA 2, MONALEESA 2, MONALEESA 7, MONARCH 3, FALCON, SWOG and FACT Trials

Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1661 ◽  
Author(s):  
Valentina Rossi ◽  
Paola Berchialla ◽  
Diana Giannarelli ◽  
Cecilia Nisticò ◽  
Gianluigi Ferretti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Soft Tissues ◽  
Meta Analysis ◽  
Treatment Options ◽  
Indirect Comparison ◽  
Metastatic Breast ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

Background: We aim to understand whether all patients with hormonal receptor (HR)-positive (+)/human epidermal growth factor receptor-2 (HER2)-negative (−) metastatic breast cancer (MBC) should receive cyclin D-dependent kinase (CDK) 4/6 inhibitor-based therapy as a first-line approach. Methods: A network meta-analysis (NMA) using the Bayesian hierarchical arm-based model, which provides the estimates for various effect sizes, were computed. Results: First-line treatment options in HR+/HER2− MBC, including CDK 4/6 inhibitors combined with aromatase inhibitors (AIs) or fulvestrant (F), showed a significantly longer progression-free survival (PFS) in comparison with AI monotherapy, with a total of 26% progression risk reduction. In the indirect comparison across the three classes of CDK 4/6 inhibitors and F endocrine-based therapies, the first strategy resulted in longer PFS, regardless of specific CDK 4/6 inhibitor (HR: 0.68; 95% CrI: 0.53–0.87 for palbociclib + AI, HR: 0.65; 95% CrI: 0.53–0.79 for ribociclib + AI, HR: 0.63; 95% CrI: 0.47–0.86 for abemaciclib + AI) and patient’s characteristics. Longer PFS was also found in patients with bone-only and soft tissues limited disease treated with CDK 4/6 inhibitors. Conclusions: CDK 4/6 inhibitors have similar efficacy when associated with an AI in the first-line treatment of HR+ MBC, and are superior to either F or AI monotherapy, regardless of any other patients or tumor characteristics.

scholarly journals Computational Modeling of Skull Bone Structures and Simulation of Skull Fractures Using the YEAHM Head Model

Biology ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 267 ◽  
Author(s):  
Alcino Barbosa ◽  
Fábio A. O. Fernandes ◽  
Ricardo J. Alves de Sousa ◽  
Mariusz Ptak ◽  
Johannes Wilhelm
Keyword(s):  
Computational Models ◽  
Soft Tissues ◽  
Constitutive Models ◽  
Human Head ◽  
Head Model ◽  
Head Impacts ◽  
Skull Model ◽  
Linear Behavior ◽  
Local Material ◽  
Direct Head

The human head is a complex multi-layered structure of hard and soft tissues, governed by complex materials laws and interactions. Computational models of the human head have been developed over the years, reaching high levels of detail, complexity, and precision. However, most of the attention has been devoted to the brain and other intracranial structures. The skull, despite playing a major role in direct head impacts, is often overlooked and simplified. In this work, a new skull model is developed for the authors’ head model, the YEAHM, based on the original outer geometry, but segmenting it with sutures, diploë, and cortical bone, having variable thickness across different head sections and based on medical craniometric data. These structures are modeled with constitutive models that consider the non-linear behavior of skull bones and also the nature of their failure. Several validations are performed, comparing the simulation results with experimental results available in the literature at several levels: (i) local material validation; (ii) blunt trauma from direct impact against stationary skull; (iii) three impacts at different velocities simulating falls; (iv) blunt ballistic temporoparietal head impacts. Accelerations, impact forces, and fracture patterns are used to validate the skull model.

scholarly journals Single-Step Resection of Sphenoorbital Meningiomas and Orbital Reconstruction Using Customized CAD/CAM Implants

2019 ◽  
Vol 81 (02) ◽  
pp. 142-148
Author(s):  
Lukas Goertz ◽  
Pantelis Stavrinou ◽  
George Stranjalis ◽  
Marco Timmer ◽  
Roland Goldbrunner ◽  
...  
Keyword(s):  
Computer Aided Design ◽  
Tumor Resection ◽  
Single Step ◽  
Ct Scans ◽  
Patient Specific ◽  
Orbital Decompression ◽  
Bone Resection ◽  
Orbital Reconstruction ◽  
Orbital Wall ◽  
Cad Cam

Abstract Objective Computer-aided design and manufacturing (CAD/CAM) implants are fabricated based on volumetric analysis of computed tomography (CT) scans and are routinely used for the reconstruction of orbital fractures. We present three cases of patients with sphenoorbital meningiomas that underwent tumor resection, orbital decompression, and orbital reconstruction with patient specific porous titanium or acrylic implants in a single procedure. Methods The extent of bone resection of the sphenoorbital meningiomas was planned in a virtual three-dimensional (3D) environment using preoperative thin-layer CT data. The anatomy of the orbital wall in the resection area was reconstructed by superimposing the contralateral unaffected orbit and by using the information of the neighboring bony structures. The customized implants and a corresponding craniotomy template were designed in the desired size and shape by the manufacturer. Results All patients presented with a sphenoorbital meningioma and exophthalmos. After osteoclastic craniotomy with the drilling template, orbital decompression was performed. Implant fitting was tight in two cases and could be easily fixated with miniplates and screws. In the third patient, a reoperation was necessary for additional bone resection, as well as drilling and repositioning of the implant. The postoperative CT scans showed an accurate reconstruction of the orbital wall. After surgery, exophthalmos was substantially reduced and a satisfying cosmetic result could be finally achieved in all patients. Conclusions The concept of preoperative 3D virtual treatment planning and single-step orbital reconstruction with CAD/CAM implants after tumor resection involving the orbit is well feasible and can lead to good cosmetic results.

scholarly journals Primary orbital extraskeletal osteosarcoma and review of literature

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jingwen Hui ◽  
Yun Zhao ◽  
Lei Zhang ◽  
Jinyong Lin ◽  
Hong Zhao
Keyword(s):  
Soft Tissues ◽  
Malignant Tumour ◽  
Extraskeletal Osteosarcoma ◽  
Complete Excision ◽  
Case Presentation ◽  
Left Orbit ◽  
Orbital Wall ◽  
Previous Trauma ◽  
History Of

Abstract Background Extraskeletal osteosarcoma is a malignant tumour composed of an osteoid and/or cartilaginous matrix; it arises in soft tissues without connection to the skeleton, and to our knowledge, this type of tumour is extremely rare. Case presentation The present study reports a 57-year-old man with primary orbital extraskeletal osteosarcoma who presented with a history of painful swelling in the left orbit that had occurred for 11 months. Imaging of the orbit showed an atypical, well-defined heterogeneous mass attached to the posterior globe of the left orbit. The patient underwent an anterior orbitotomy and complete excision of the tumour. The mass was originated from neither the globe nor the bony orbital wall but from the soft tissue. Histopathology demonstrated an extraskeletal osteosarcoma. After 13 months of follow-up, there was apparent recurrence of the tumour. The medical history showed no complaints of previous trauma or radiotherapy. Conclusions ESOS is a highly malignant tumour. Immunosuppression, trauma and adjuvant radiotherapy are possible predisposing factors in the development of this tumour. Prompt recognition and thorough treatment are essential for preventing orbital lesions and presence of metastasis from other organs.

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