FACIAL - - ..........................................................TRAUMA edited by SETH R. THALLER W. SCOTT MCDONALD University of Miami School of Medicine Miami, Florida, U.S. A. MARCEL MARCELDEKKEK, INC. NEWYORK . BASEI. DEKKER Although great care has been taken to provide accurate and current information, neither the author(s) nor the publisher, nor anyone else associated with this publi- cation, shall be liable for any loss, damage, or liability directly or indirectly caused or alleged to be caused by this book. The material contained herein is not intended to provide specific advice or recommendations for any specific situation. Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress. ISBN: 0-8247-4625-2 This book is printed on acid-free paper. 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Current printing (last digit): 10 987654321 PRINTED IN THE UNITED STATES OF AMERICA Preface Optimal management of patients who have sustained facial truma requires a collaborative interdisciplinary approach that incorporates the clinical exper- tise of a number of related specialties. This book reflects the efforts and the contributions to this field from eminent practitioners intimately involved in the challenging care and management of patients who have required recon- struction of both acute and established injuries to the facial hard and soft tissue. Although the treatment of facial injuries has made dramatic advances over the last decade due to our improved knowledge of wound healing, anatomy, diagnostic testing, and biomaterials, we trace our current refine- ments to the pioneering efforts of craniofacial surgery and the work of Dr. Paul Tessier of Paris, France. This book integrates the significant contributions made by basic science into the comprehensive care of this condition as well as the most recent clinical advances in the evaluation and management of facial injuries. We give special thanks to our contributors, who willingly shared their own experience in order to expand our readers’ knowledge base and improve our colleagues’ final results in the care of their own clinical cases. This book is dedicated to my wife, Pat, and children, Cody and Lexi Lee, who allow me the time to take care of my patients and educate our residents, and to my parents, who afforded me the opportunity to become a doctor. Seth R. Thaller iii iv Preface I would like to thank all our contributors and acknowledge their advancements in the care of the trauma victim. In these most trying times for medicine it is comforting to know that these dedicated individuals have made the sacrifices to care for this world’s unfortunate. I would especially like to thank my mother, Tommie, and my late father, Thomas E. McDonald, for all of their sacrifices to help me be who I am, and I dedicate this book to them. W. Scott McDonald Introduction Despite society’s ever-increasing concern for personal safety, trauma to the facial bones and enveloping soft tissue remains a relatively common occurence. While a significant percentage of these injuries are directly related to motor vehicle accidents, in urban trauma centers assault is also a common mode of wounding. In spite of recent progress in surgical technique, technology, and available biomaterials, the fundamental principles for achieving acceptable functional and aesthetic results remain constant. This is a comparatively young surgical specialty with an elegant history. Initially developed by general surgeons with a particular interest in this field, it has been refined by dentists, oral surgeons, otolaryngologists, and plastic surgeons. The growth of tertiary trauma centers has had two important consequences: severely injured patients are now able to survive their initial physical insult and will require reconstruction of devastating facial injuries, and interdisciplinary teams can acquire greater experience with managing complex facial trauma. An additional benefit is that a dedicated craniomax- illofacial team not only improves quality of care, but can also be extremely cost-effective. Concentrated expertise and better technology have allowed us to answer previously controversial questions in this field. Arriving patients undergo radiological evaluation—generally CT scanning—that is aimed at precisely defining the location and magnitude of bony injury. Advances in managing severely injured patients have permitted early and definitive primary fracture treatment. Tessier’s craniofacial techniques, including wide surgical exposure through extensive subperiosteal dissection and extensive v vi Introduction primary bone grafting for replacement and reinforcement, are now com- monly employed. It is now routine for patients to return to a productive life. This book is the foundation for the comprehensive management of complex craniomaxillofacial trauma, and serves as the basis for discussing the evolution in care of the facially traumatized patient. Few areas in reconstructive surgery have undergone such a rapid transformation. Alan Livingstone, M.D. Professor & Chairman Department of Surgery University of Miami Miami, Florida, U.S.A. Contents Preface iii Introduction v Contributors ix 1. Facial Trauma: Overview of Trauma Care 1 Igor Jeroukhimov, Mark Cockburn, and Stephen Cohn 2. Microsurgical Options in Facial Trauma 19 Milton B. Armstrong 3. Synopsis of Dental Guidelines for Management of Facial Injuries 25 Kevin J. Kelly 4. The Biology of Trauma on Facial Growth: Effects and Noneffects of Personal Surgical Experimentation 55 Bernard G. Sarnat 5. Maxillofacial and Craniofacial Surgery: Our Family Tree 87 S. Anthony Wolfe 6. Fracture Healing and Bone Graft Repair 95 Samuel T. Rhee, Lawrence Tong, and Steven R. Buchman vii viii Contents 7. Optimizing Bony Repair 137 Stephen M. Warren, Tony D. Fang, Kenton D. Fong, HanJoon M. Song, and Michael T. Longaker 8. The Use of Biomaterials in Craniofacial Trauma 181 Mutaz B. Habal, Ralph E. Holmes, and Steven R. Cohen 9. Endoscopic Approaches in the Treatment of Facial Fractures 209 Mark Martin, Chen Lee, and William Y. Hoffman 10. Orbital Injuries 235 Peter J. Taub and Henry K. Kawamoto, Jr. 11. Nasal Injuries 261 Seung-Jun O and Seth R. Thaller 12. The Management of Naso-orbital-ethmoid Fractures and Avoidance of Untoward Sequelae 281 Paul Manson 13. Management of Acute Injuries to the Frontal Sinus and Management of Untoward Sequelae 289 Danny J. Enepekides and Paul J. Donald 14. Maxillary Fractures 331 David A. O’Donovan and Oleh M. Antonyshyn 15. Zygoma Fractures 361 Jose I. Garri and W. Scott McDonald 16. Mandibular Fractures 381 Anil P. Punjabi and Alan S. Herford 17. Diagnosis and Management of Facial Fractures in Children 415 Corinna E. Zimmermann, Maria J. Troulis, and Leonard B. Kaban 18. Reconstruction of Avulsive Maxillofacial Injuries 439 Robert E. Marx and Mark Stevens Index 457 Contributors Oleh M. Antonyshyn University of Toronto, Toronto, Ontario, Canada Milton B. Armstrong Department of Clinical Surgery, Division of Plastic Surgery, University of Miami, Miami, Florida, U.S.A. Steven R. Buchman Mott Children’s Hospital, Ann Arbor, Michigan, U.S.A. Mark Cockburn University of Miami, Miami, Florida, U.S.A. Stephen M. Cohn UM Department of Surgery, University of Miami, Miami, Florida, U.S.A. Steven R. Cohen Sharp Childrens’ Hospital, San Diego, California, U.S.A. Paul J. Donald Davis Medical Center, University of California, Davis Medical Center, Sacramento, California, U.S.A. Danny J. Enepekides Davis Medical Center, University of California, Davis Medical Center, Sacramento, California, U.S.A. ix x Contributors Tony D. Fang School of Medicine, Stanford University School of Medicine, Stanford, California, U.S.A. Kenton D. Fong School of Medicine, Stanford University School of Medicine, Stanford, California, U.S.A. Jose I. Garri University of Miami School of Medicine, Miami, Florida, U.S.A. Mutaz B. Habal The Tampa Bay Craniofacial Center, University of South Florida and University of Florida, Tampa, Florida, U.S.A. Alan S. Herford Loma Linda University Medical Center, Loma Linda, California, U.S.A. William Y. Hoffman University of California at San Francisco, San Francisco, California, U.S.A. Ralph E. Holmes Sharp Childrens’ Hospital, San Diego, California, U.S.A. Igor Jeroukhimov University of Miami, Miami, Florida, U.S.A. Leonard B. Kaban Massachusetts General Hospital, Boston, Massachusetts, U.S.A. Henry K. Kawamoto, Jr. UCLA School of