scholarly journals Tetrapod Fracture: Surgical Anatomy Revisited As A Guide For 3D Reduction Using Carroll Girard T-Bar Screw

2018 ◽  
Vol 4 (1) ◽  
pp. 82-87
Author(s):  
Prasetyanugraheni Kreshanti ◽  
Livia Faranita Gianni
Keyword(s):  
Three Dimensional ◽  
Lower Eyelid ◽  
Surgical Anatomy ◽  
Facial Skeleton ◽  
Lateral Aspect ◽  
Reference Axis ◽  
Aesthetic Appearance ◽  
Zygomaticomaxillary Complex Fracture ◽  
Vestibular Approach ◽  
Zygomaticomaxillary Complex

Background: Zygomaticomaxillary complex plays a key role in the structure, function, and aesthetic appearance of the facial skeleton. Using Carroll Girard T-bar screw allows easy manipulation of the zygomaticomaxillary complex fracture. The goal of the treatment is three dimensional (3-D) restoration of the disturbed anatomy. Methods: After exposing the fracture sites using technique such as lower eyelid, Dingman (lateral brow) or maxillary vestibular approach, the Carroll Girard T-bar screw is then attached to the lateral aspect of the malar eminence to freely move the zygoma according to the x,y, and z axis. Zygomaticosphenoid suture acts as the anatomical landmark for adequate reduction. Conclusion: Open reduction and internal fixation is the principle of management in displaced ZMC fractures, aided by the use of Carroll Girard T-bar screw which allows easy manipulation and rotation for the zygomatic bone using the reference axis x, y and z.

Contemporary Management of Zygomaticomaxillary Complex Fractures

2021 ◽  
Author(s):  
Howard D. Wang ◽  
Jasjit Dillon
Keyword(s):  
Intraoperative Imaging ◽  
Three Dimensional ◽  
Facial Fractures ◽  
Stable Fixation ◽  
Soft Tissue Management ◽  
Orbital Reconstruction ◽  
Complex Fractures ◽  
Zygomaticomaxillary Complex Fracture ◽  
Contemporary Management ◽  
Zygomaticomaxillary Complex

AbstractZygomaticomaxillary complex fracture is one of the most commonly treated facial fractures. Accurate reduction and stable fixation of the zygoma are required to restore facial symmetry and projection and avoid functional sequalae from changes in orbital volume. Achieving optimal outcome is challenging due to the complex three-dimensional anatomy and limited visualization of all affected articulations of the zygoma. This article provides an updated overview of the evaluation and management of zygomaticomaxillary complex fractures based on available evidence and clinical experience at our center. The importance of soft tissue management is emphasized, and approaches to internal orbital reconstruction are discussed. While evidence remain limited, intraoperative imaging and navigation may prove to be useful adjuncts in the treatment of zygomaticomaxillary fractures.

scholarly journals Comparison of Tooth- and Bone-Borne Appliances on the Stress Distributions and Displacement Patterns in the Facial Skeleton in Surgically Assisted Rapid Maxillary Expansion—A Finite Element Analysis (FEA) Study

Materials ◽  
2021 ◽  
Vol 14 (5) ◽  
pp. 1152
Author(s):  
Rafał Nowak ◽  
Anna Olejnik ◽  
Hanna Gerber ◽  
Roman Frątczak ◽  
Ewa Zawiślak
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Three Dimensional ◽  
Element Model ◽  
Rapid Maxillary Expansion ◽  
Stress Distributions ◽  
Maxillary Expansion ◽  
Facial Skeleton ◽  
Element Analysis ◽  
Maxillary Constriction

The aim of this study was to compare the reduced stresses according to Huber’s hypothesis and the displacement pattern in the region of the facial skeleton using a tooth- or bone-borne appliance in surgically assisted rapid maxillary expansion (SARME). In the current literature, the lack of updated reports about biomechanical effects in bone-borne appliances used in SARME is noticeable. Finite element analysis (FEA) was used for this study. Six facial skeleton models were created, five with various variants of osteotomy and one without osteotomy. Two different appliances for maxillary expansion were used for each model. The three-dimensional (3D) model of the facial skeleton was created on the basis of spiral computed tomography (CT) scans of a 32-year-old patient with maxillary constriction. The finite element model was built using ANSYS 15.0 software, in which the computations were carried out. Stress distributions and displacement values along the 3D axes were found for each osteotomy variant with the expansion of the tooth- and the bone-borne devices at a level of 0.5 mm. The investigation showed that in the case of a full osteotomy of the maxilla, as described by Bell and Epker in 1976, the method of fixing the appliance for maxillary expansion had no impact on the distribution of the reduced stresses according to Huber’s hypothesis in the facial skeleton. In the case of the bone-borne appliance, the load on the teeth, which may lead to periodontal and orthodontic complications, was eliminated. In the case of a full osteotomy of the maxilla, displacements in the buccolingual direction for all the variables of the bone-borne appliance were slightly bigger than for the tooth-borne appliance.

Foundations of Advanced Neuroanatomy: Technical Guidelines for Specimen Preparation, Dissection, and 3D-Photodocumentation in a Surgical Anatomy Laboratory

2019 ◽  
Author(s):  
Luciano César PC Leonel ◽  
Lucas P. Carlstrom ◽  
Christopher S. Graffeo ◽  
Avital Perry ◽  
Carlos Diogenes Pinheiro-Neto ◽  
...  
Keyword(s):  
Oral Tradition ◽  
Dynamic Range ◽  
Tap Water ◽  
Three Dimensional ◽  
High Dynamic Range ◽  
Surgical Anatomy ◽  
Lessons Learned ◽  
Specimen Preparation ◽  
Technological Advances ◽  
Key Steps

Abstract Objective This study was aimed to provide a key update to the seminal works of Prof. Albert L. Rhoton Jr., MD, with particular attention to previously unpublished insights from the oral tradition of his fellows, recent technological advances including endoscopy, and high-dynamic range (HDR) photodocumentation, and, local improvements in technique, we have developed to optimize efficient neuroanatomic study. Methods Two formaldehyde-fixed cadaveric heads were injected with colored latex to demonstrate step-by-step specimen preparation for microscopic or endoscopic dissection. One formaldehyde-fixed brain was utilized to demonstrate optimal three-dimensional (3D) photodocumentation techniques. Results Key steps of specimen preparation include vessel cannulation and securing, serial tap water flushing, specimen drainage, vessel injection with optimized and color-augmented latex material, and storage in 70% ethanol. Optimizations for photodocumentation included the incorporation of dry black drop cloth and covering materials, an imaging-oriented approach to specimen positioning and illumination, and single-camera stereoscopic capture techniques, emphasizing the three-exposure-times-per-eye approach to generating images for HDR postprocessing. Recommended tools, materials, and technical nuances were emphasized throughout. Relative advantages and limitations of major 3D projection systems were comparatively assessed, with sensitivity to audience size and purpose specific recommendations. Conclusion We describe the first consolidated step-by-step approach to advanced neuroanatomy, including specimen preparation, dissection, and 3D photodocumentation, supplemented by previously unpublished insights from the Rhoton fellowship experience and lessons learned in our laboratories in the past years such that Prof. Rhoton's model can be realized, reproduced, and expanded upon in surgical neuroanatomy laboratories worldwide.

scholarly journals Low-Cost Customized Cranioplasty with Polymethyl Methacrylate Using 3D Printer Generated Mold: An Institutional Experience and Review of Literature

2021 ◽  
Author(s):  
Ankit Chaudhary ◽  
Virendra Deo Sinha ◽  
Sanjeev Chopra ◽  
Jitendra Shekhawat ◽  
Gaurav Jain
Keyword(s):  
Polymethyl Methacrylate ◽  
Bone Fractures ◽  
Low Cost ◽  
Operating Time ◽  
Three Dimensional ◽  
Wound Dehiscence ◽  
3D Printer ◽  
Skull Defects ◽  
Aesthetic Appearance ◽  
The Mean

Abstract Background Cranioplasty is performed to repair skull defects and to restore normal skull anatomy. Optimal reconstruction remains a topic of debate. Autologous bone flap is the standard option but it may not be available due to traumatic bone fractures, bone infection, and resorption. The authors present their experience with prefabrication of precise and low-cost polymethyl methacrylate (PMMA) mold using three-dimensional (3D) digital printing. Methods A total of 30 patients underwent cranioplasty between March 2017 and September 2019 at Sawai Man Singh Medical College Jaipur, India. Preoperative data included diagnosis for which decompressive craniectomy was done and Glasgow coma scale score. Intraoperative data included operating time. Postoperative data included cosmetic outcome in the form of cranial contour and margins, complications such as infection, seroma, implant failure, wound dehiscence, and hematoma. Results Patient age at cranioplasty ranged from 12 to 63 years with a mean age of 36.7 years. The mean operating time was 151.6 minutes (range 130–190 minutes). The mean follow-up period was 8 months (range 6–13 months). Postoperative wound dehiscence developed in one case (3.3%). Cranial contour and approximation of the margins were excellent and aesthetic appearance improved in all patients. Conclusion Low-cost PMMA implant made by digital 3D printer mold is associated with reconstruction of the deformed skull contour giving satisfactory results to the patient and his family members, at a low cost compared with other commercially available implants. This technique could be a breakthrough in cranioplasty.

A lateral approach to the feline cerebellar fossa: case report and identification of an external landmark for the tentorium ossium

2019 ◽  
Vol 22 (4) ◽  
pp. 358-365
Author(s):  
Marc Kent ◽  
Eric N Glass ◽  
Jordan Schachar
Keyword(s):  
Flat Surface ◽  
Three Dimensional ◽  
Lateral Approach ◽  
Cranial Morphology ◽  
Lateral Aspect ◽  
Temporal Fossa ◽  
3D Reconstructions ◽  
3D Volume ◽  
External Landmark ◽  
Ct Studies

Objectives The aim of this study was to describe the use of an external landmark that defines the attachment of the tentorium ossium for planning a craniectomy to access the cerebellar fossa. The external landmark was defined by a line where the caudal aspect of the convexity of the cranium transitions to a flat surface in the caudal aspect of the temporal fossa. We also aimed to determine if this external landmark was present and readily visualized, and to establish its relationship to the nuchal crest using three-dimensional (3D) volume-rendered CT reconstructions created from cats with normal cranial morphology. Methods First, a case is presented for the description of an approach in a cat with a meningioma located dorsolateral to the cerebellum. Second, CT studies of five cats with normal cranial morphology were selected. Regions of interest (ROIs) were drawn at the attachment of the tentorium ossium to the cranium and nuchal crest. Three-dimensional reconstructions were developed with colored ROI overlays. The external landmark defined the tentorial attachment on all 3D reconstructions. Additionally, using the postoperative CT of the clinical case described herein, ROIs of the tentorial attachment and nuchal crest along with a third ROI, the craniectomy, were drawn and overlaid on the 3D reconstruction to illustrate the position of the craniectomy in relation to the tentorium ossium attachment and nuchal crest. Results The use of the external landmark provided for a craniectomy that enabled adequate visualization for excision of a meningioma. On all 3D reconstructions, the external landmark was present and readily visualized. Conclusions and relevance Between the attachment of the tentorium ossium and nuchal crest exists an area adequately sized for a craniectomy in cats. Clinicians can use an identifiable external landmark on the lateral aspect of the cranium to plan the rostral boundary for a craniectomy to access the cerebellar fossa in cats.

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