Surgical protocols and outcome for the treatment of maxillofacial fractures in children: 9 years' experience

Trauma and facial fractures in a population of children have been analysed in several studies mainly regarding their incidence and much less their treatment modalities. Aim: The aim of this study was to retrospectively analyse the treatment methods and outcome of facial fractures in children and young adolescents during the last decade and to discuss findings and propose treatment protocols. Patients and methods: Patients of the Paediatric Maxillofacial department, treated for fractures of the facial skeleton were included in the study. Open reduction and osteosynthesis plate fixation (titanium and resorbable material) was the main treatment method with conservative treatment saved for selected cases. Titanium plates were removed after bone healing. Intermaxillary fixation (IMF) was not used regularly in mandibular fractures, with the exception of condylar fractures. Results: 156 children and young adolescents with 208 fracture sites in total were treated. 139 fracture sites (66.8%) were treated with open reduction and 69 conservatively. The mandible was affected in 49.0% of the cases, the maxilla in 21.2% (both with the alveolar process fractures included), the zygomatic complex in 10.1%, the orbital walls in 9.6%. There were 38 alveolar process fractures. Conclusion: The results of the fracture treatment verified the usefulness of open reduction and plate fixation in children. There was no need for wire suspension and only occasional need for IMF. Closed reduction was selectively applied in condylar fractures and dento-alveolar trauma. © 2010 European Association for Cranio-Maxillo- Facial Surgery

Lymphatic malformations in children and adolescents

This article aimed to present a series of surgically treated lymphatic malformations of the cervicofacial region in a population of children and adolescents during a 13-year period. Methods: The medical records of all children and adolescents with cervicofacial lymphatic malformations, treated surgically at our department from 1998 to 2011, were reviewed retrospectively. Results: Eighteen patients with 20 lymphatic malformations located within the soft tissues of the cervicofacial region were identified. All patients were submitted to surgical treatment (excision or resection with conventional scalpel or radiosurgery) to address complications (ulceration, bleeding, impaired mastication and feeding, airway obstruction) and/or aesthetic issues. Recurrence was noted in 2 of our patients. Conclusions: Accurate diagnosis based on history, clinical examination, and adequate imaging techniques is the key to the optimal treatment of cervicofacial lymphatic malformations; surgical intervention remains the treatment of choice for these lesions. Copyright © 2012 Mutaz B. Habal, MD

Oro-facial tumours and tumour-like lesions in Greek children and adolescents: An 11-year retrospective study

Objective: To determine the epidemiology, histological diagnosis and treatment outcome of oro-facial tumours and tumour-like lesions in Greek children and adolescents. Material and methods: The medical records of patients with oro-facial lesions who presented at the Department of Oral and Maxillofacial Surgery at "A. & P. Kyriakou" Children's Hospital from 2000 to 2010 were reviewed. Data was analyzed in relation to age, gender, location, histology, treatment choice and outcome. Results: Two hundred and eleven oro-facial lesions were identified. Age ranged from 14 days to 15 years (mean 8 years); the male-to-female ratio was 1.09: 1; 90.05% of the lesions were benign and 9.95% malignant. Vascular anomalies were the most common benign lesion (22.1%) and rhabdomyosarcoma was the most prevalent malignancy (28.57%). One hundred and ten lesions (52.1%) involved soft tissue, most commonly the tongue and 96 cases (45.5%), involved hard tissue, most frequently the mandible; 5 lesions (2.4%) involved both hard and soft tissue. Surgery was performed under general anaesthesia in 198 cases (93.84%). Some malignant lesions were treated with chemotherapy and/or radiotherapy. Conclusions: Oro-facial tumours and tumour-like lesions are not uncommon in the Greek paediatric population; although most frequently benign, these may cause considerable morbidity. As such early diagnosis and treatment are imperative. © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved

Treatment of macroglossia in a child with Weaver syndrome

Weaver syndrome is a rare disorder, characterized by accelerated growth, advanced osseous maturation and distinct craniofacial features. Macroglossia and hypothyroidism are seldom mentioned in the literature as clinical findings associated with the syndrome. This paper describes a patient with Weaver syndrome, referred for consultation and treatment of macroglossia, who also suffered from congenital hypothyroidism. This is the first reported case of Weaver syndrome treated with partial glossectomy (tongue reduction). The paper describes the clinical findings of the syndrome, emphasizing the difficulty in identifying it, the indications for partial glossectomy and the authors' recommended operative technique. © 2008 International Association of Oral and Maxillofacial Surgeons

Comparison of lateral thermal injury and healing of porcine skin incisions performed by CO2-laser, monopolar electrosurgery and radiosurgery: A preliminary study based on histological and immunohistochemical results

Background Despite the wide application of lasers and electrosurgery in dermatology, the pertinent literature provides conflicting data regarding the lateral thermal injury (LTI) associated with these instruments and its effects on wound healing. This study aims to quantitate the LTI produced by CO2-laser, monopolar electrosurgery (MES), and radiosurgery (MRS) and determine its effects on the healing process (re-epithelialization and inflammatory response) of incisional wounds. Methods Five adult swine of similar weight (22.8-25kg) were submitted to standardized full-thickness incisions on the lateral abdominal skin by the above instruments (at settings similar to those used in clinical practice) and scalpel (control group). Full-thickness specimens from the surgical site were harvested immediately afterwards and 48hours later (days 1 and 3). The animals were euthanized by intravenous administration of propofol and pentobarbital. All specimens were formalin fixed, paraffin embedded, cut, and stained with hematoxylin-eosin to quantitate the extent of LTI and inflammatory infiltration. Sections of day 3 were stained with the MIB-1 monoclonal antibody to detect Ki-67 as a marker of epithelial cell proliferation adjacently to the incisions. Results LTI was most extensive in the CO2-laser-group but did not differ significantly between MES- and MRS-groups. Immunohistochemistry ascertained significantly greater epithelial cell proliferation in the CO2-laser-group. Inflammatory infiltration was significantly greater in the CO2-laser-group, when compared with the controls but did not differ significantly between the MES/MRS and control groups. Conclusion CO2 laser incisions exhibit more extensive LTI, epithelial cell proliferation, and inflammatory response. Confirmation of these findings requires a greater sample. © 2012 The International Society of Dermatology

Surgical management of head and neck vascular anomalies in children: A retrospective analysis of 42 patients

Objective: This article aimed to present a series of surgically treated head and neck vascular anomalies during a 12-year period, highlighting the epidemiology, diagnostic approach, indications for surgery, and final clinical outcome. Study Design: The medical records of all patients with head and neck vascular anomalies, surgically treated at our department from 1998 to 2010, were reviewed retrospectively. Results: A total of 42 patients with 46 vascular anomalies were identified. Patients' diagnoses included vascular tumors, hemangiomas mainly (18 cases), and various vascular malformations (26 cases). All patients were submitted to surgical treatment (excision-resection) to resolve main clinical symptoms (ulceration, bleeding, impaired mastication and feeding, airway obstruction) and/or esthetic issues. Recurrence was noted in 3 patients. Conclusion: Accurate differential diagnosis based on history, physical examination, and imaging, is the key to optimal treatment. Surgical intervention is warranted for small to moderately extended lesions to avoid complications and/or esthetic concerns and psychosocial distress. © 2014 Elsevier Inc

Nonsurgical management of condylar fractures in children: A 15-year clinical retrospective study

Purpose To present the 15 years of experience after closed treatment of condylar fractures in children, by evaluating the short- and long-term results and propose treatment modalities. Material and methods Data were retrieved for all young patients with condylar fractures who were treated from 2000 to 2014. Gender, age of patient, date of injury, type of fracture, treatment provided, and follow-up were registered. Results A total of 84 patients (mean age: 8.9 years) with 106 condylar fracture sites were included in the study. In 80 cases (95.2%), treatment was nonsurgical, with or without intermaxillary fixation, followed by kinesiotherapy. An intraocclusal block was additionally placed in 19 cases. Open reduction was selected in 4 cases. All condylar fractures healed without functional or esthetic complications, with the exception of 2 patients (2/80, 2.5%). Therefore, in late follow-up, no subjective symptoms were recorded, and a functional well-contoured condylar process was observed in all X-rays. Slight asymptomatic mandibular deviation was recorded in wide mouth opening in 29.1% of the patients. Conclusions Conservative treatment of condylar fractures is the treatment of choice in children. However, the child's age, adequacy of function of the mandible, degree of displacement or dislocation of the condylar fragment, and need for active kinesiotherapy should be considered in all cases

Iliac crest morbidity following maxillofacial bone grafting in children: A clinical and radiographic prospective study

Bone harvesting from the anterior iliac crest is commonly performed for grafting of maxillofacial defects. Purpose: To evaluate the morbidity of the procedure in children and adolescents with clefts or maxillofacial defects after tumour removal. Patients and methods: Between 2001 and 2008 36 consecutive patients who underwent iliac crest bone grafting using the trap-door technique were evaluated 6 months to 7 years postoperatively. Objective and subjective findings regarding the donor site mostly but also the recipient site were assessed by a standardized physical and radiological examination and a questionnaire. The donor site scar, neurosensory and motility function were evaluated clinically and osseous healing was investigated through radiographic examination of the ilium. Results: All respondent patients (29 out of the 36) tolerated the procedure well without major complications. Minor complications (mild pain and limp) were of short duration. No growth disturbances or contour deficits at the donor site were noted. No neurosensory or functional irregularities were detected. The donor site scar was considered aesthetically acceptable and most of the patients were satisfied with the functional outcome at the recipient site. Conclusions: Bone harvesting from the anterior iliac crest was found to be a safe and reliable procedure for maxillofacial bone grafting in paediatric patients. No complications were encountered, the morbidity was minimal and the aesthetic outcome was good. (C) 2009 European Association for Cranio-Maxillo-Facial Surger