Deep circumflex iliac artery free flap in mandible reconstruction.
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Bone Transplantation↗
Biomedical subjects
Mark Martin
Publications and source records attributed to Mark Martin.
Multiplanar distraction osteogenesis of fibula free flaps used for secondary reconstruction of traumatic maxillary defects.
Traumatic maxillary bone loss, if not treated acutely, is accompanied by contracture of the overlying soft tissue envelope and loss of facial projection in three dimensions. Reconstruction aimed at replacing the bony architecture, expanding the soft tissue envelope and establishing a platform for dental rehabilitation can be accomplished in a staged approach. We present two patients who underwent replacement of missing maxillary segments with a free fibula flap, followed by distraction of the free fibula in three dimensions and eventual dental rehabilitation with osseo-integrated implants.
Adult↗
Quantitative topographical evaluation of the orbitozygomatic complex.
BACKGROUND: The orbitozygomatic complex is a tetrapod-shaped bone of the upper midfacial skeleton of particular clinical significance. By defining the malar prominence, it provides a significant contribution to the overall facial form. Moreover, it is the second most frequently fractured bone on the craniofacial skeleton. A method for quantitative determination of the position of the orbitozygomatic complex has important applications in the fields of reconstructive and aesthetic plastic surgery. METHODS: Ten individuals were evaluated using craniofacial anthropometry techniques. The position of the orbitozygomatic complex in three planes, x, y, and z, was determined by measuring linear projective distances between complex landmarks: the maxillozygion (the most prominent landmark on the malar prominence), the orbitale (the lowest point on the inferior orbital rim), the zygion (the most lateral point on the zygomatic arch), and the cranial reference landmarks (the vertex, opisthocranion, and nasion). RESULTS AND CONCLUSIONS: Low variability between measurements within the same individual (<1.5 mm) underscores the reliability of the chosen landmarks and techniques in the determination of orbitozygomatic complex position. Second, the complex occupies a consistent position among individuals, as shown by the low intersubject variability. Third, there is no statistically significant difference in the position of the complex, in any plane of space, between the left and right sides of the face. Thus, the authors' method may be used to determine the degree of complex displacement in individuals with unilateral facial trauma or with unilateral residual postsurgical deformity, and to calculate the amount of realignment needed to produce a symmetrical facial appearance.
Adult↗
Quantitative comparison of open reduction and internal fixation versus the Gillies method in the treatment of orbitozygomatic complex fractures.
BACKGROUND: Precise repair of orbitozygomatic complex fractures is essential for proper re-establishment of facial symmetry, ocular globe position, and infraorbital nerve function. Controversy regarding the optimal treatment method remains. METHODS: To compare uniform study groups, only patients without previous craniofacial injuries or operations who had sustained moderate-energy orbitozygomatic complex fractures, based on preoperative computed tomography scans, and who were treated using the Gillies repair or open reduction and internal fixation were selected. Quantifiable end-points, including orbitozygomatic complex position, ocular globe projection, and infraorbital nerve function, were measured to objectively compare the accuracy of repair produced by the Gillies procedure and open reduction and internal fixation. Negative sequelae resulting from cutaneous access were tabulated. RESULTS: Overall, 12 patients treated using the Gillies repair and 12 treated with open reduction and internal fixation were examined. The results demonstrated that the open reduction and internal fixation technique produces superior realignment of the orbitozygomatic complex, that is, a smaller difference in the position of the orbitozygomatic complex between the injured and noninjured sides of the face. The differences in orbitozygomatic complex projection, height, and lateral position were 1.4 mm, 1.4 mm, and 1.6 mm, respectively, in the open reduction and internal fixation group and 7.5 mm, 5.6 mm, and 4.1 mm in the Gillies group. The p values were 0.0003, 0.01, and 0.06, respectively. Visible cutaneous scarring was present in four patients and lower lid shortening was seen in three patients treated using open reduction and internal fixation. CONCLUSIONS: To the authors' knowledge, this is the first study to objectively show that the open reduction and internal fixation technique results in superior positioning of the orbitozygomatic complex in moderate-energy orbitozygomatic complex fractures compared with the Gillies repair. Although negative sequelae from surgical access were substantial, recently introduced transconjunctival and upper lid blepharoplasty incisions will minimize these drawbacks.
Adult↗
Endoscopic mandibular condyle fracture repair.
Treatment of mandibular condyle fractures remains a controversial issue. Arguments center on the relative merits of open versus closed treatment. In the past decisions were largely based on philosophy, anecdotal experience, and retrospective case series with short follow-up. Well-designed studies have now begun to appear in the literature and suggest improved results after open, anatomic reduction and fixation. Many surgeons are still hesitant about liberally applying the open approach due to the resultant facial scarring and the risk of facial nerve injury. Developments in endoscopic technology have recently been applied to facial fracture repair. The endoscopic approach to mandibular condyle fracture repair reduces the risk of facial nerve injury, and dramatically reduces facial scarring, compared with standard open approaches. We feel that the reduced morbidity of the endoscopic approach may allow the benefits of anatomic reduction and rigid fixation to be offered to a larger proportion of patients with mandibular condyle fractures. Technical and technological advances are expected to aid in the dispersal of these techniques in the future.
Contraindications↗