The WhatsApp Application as a Teledentistry Tool in Oral and Maxillofacial Surgery in Cameroon

Introduction: Technological advances have greatly influenced the healthcare sector. The ability to transmit information and deliver services using telecommunication tools continues to transform the way healthcare is delivered around the world. The aim of this study was to highlight the epidemiological, clinical and therapeutic profile of oral and maxillofacial surgery patients consulted using the WhatsApp application. Methodology: This was a three-year descriptive study with a retrospective data collection, from 2021 to 2023, of WhatsApp communications between our team and oral and maxillofacial surgeons in Cameroon. In this study, the type/content of messages received, the epidemiological data of practitioners and patients, the various pathologies diagnosed and the procedures performed were evaluated. Results: 319 communications were received for a total of 146 cases. Written messages associated with images (photographs and/or X-rays) were the most frequently received, at 85.62%. Hospitals in urban areas were the most represented at 93.84%. Oral health professionals in the private sector sent more messages (65.75%). In terms of diagnoses, tumour and cystic pathologies were the most common (28.08%), followed by impacted/retained teeth (22.6%). Patients were referred to our hospital for treatment in 62.33% of cases. Conclusion: The WhatsApp application is an easy-to-use telecommunications tool. It facilitates exchanges between practitioners and improves patient care in oral and maxillofacial surgery.

Management of Mandibular Fractures in Children in Ivory Coast: Experience of the Stomatology and Maxillofacial Surgery Department at the University Hospital of Cocody from 2000 to 2019

Introduction: Mandibular fractures in children are becoming increasingly common. Treatment of these fractures is difficult due to their anatomical and physiological complexity. Therefore, there is a need for well-codified management. Our main aim was to develop a decision algorithm for the management of mandibular fractures in children based on our experience. Materials and Methods: This was a retrospective descriptive study carried out in the Department of Stomatology and Maxillofacial Surgery at the University Hospital of Cocody over a period of 20 years (2000-2019). Results: We enrolled 58 patients. The mean age of the patients was 9.35 ± 2.3 years with a sex ratio of 2.22. Traffic accidents were the main cause of mandibular fractures (60.35%). Condylar fractures were the most common (46.87%). Treatment was orthopedic in 45.76% of cases, mixed (orthopedic and surgical) in 24.14% and surgical in 5.17%. Patients were followed up weekly for 1 month, then monthly for 6 months and annually for 3 years, with panoramic radiographs of the maxilla starting at 21 days. We observed 2 cases of complications: temporomandibular ankylosis and gingival stomatitis. Conclusion: Mandibular fractures are common in children. Management is difficult due to anatomical and physiological peculiarities. The choice of treatment depends on several criteria.

Management of Maxillofacial Gunshot Trauma in the Stomatology and Maxillofacial Surgery Departments of Ouagadougou

Introduction: Maxillofacial ballistic trauma is a serious injury that is difficult to manage, with significant complications and after-effects. The authors report their experience in managing this type of trauma in the context of insecurity linked to terrorism. Patients and Methods: This was a descriptive cross-sectional study with retrospective data collection covering the period from January 1, 2018 to December 31, 2022 in the stomatology and maxillofacial surgery departments of the university hospitals of Ouagadougou. Results: In 5 years, 52 patients were collected, i.e. 10.4 cases per year. The mean age of the patients was 31.46 ± 15.41 years, and the sex ratio was 3. In 67.31% of patients, these injuries were the result of shootings during terrorist attacks. The jugal (36.54%) and chin (32.69%) regions were the most affected. The mandible (36.54%) and zygomatic bones (28.85%) were the most injured bones in these traumas. All patients underwent surgical treatment, and 25% suffered secondary complications. All patients retained at least one sequela. Conclusion: Maxillofacial injuries caused by ballistic trauma are true emergencies that can be life-threatening and functionally disabling. Their management is delicate and the outcome is uncertain, hence, the prevention is important.

Etiology, Prevalence, and Management of Oral and Maxillofacial Soft Tissue Injuries in Children at the Komfo Anokye Teaching Hospital, Kumasi-Ghana

Background: Maxillofacial injury may vary from simple soft tissue lacerations to complex fractures of the orofacial region. Soft tissue injuries, whether isolated or in combination with other injuries, form part of the frequent traumatic craniofacial injuries seen at the emergency department. The force of impact and the injury type is directly related to the severity of the injury sustained. This study aimed to analyze the etiological factors, prevalence, and management of oral and maxillofacial soft tissue injuries at the Komfo Anokye Teaching Hospital. Methods: This was a prospective study that involved children presenting with oral and maxillofacial injuries at the Accident and Emergency Department and the Oral and Maxillofacial Surgery unit of the Komfo Anokye Teaching Hospital in Kumasi between the period of April to October 2020 (6 months). Patient selection was by convenience sampling targeting all children with injuries who met the inclusion criteria. Inclusion criteria were children below the age of 18 years whose parents or caregivers consent to participation. Children with maxillofacial injuries as a result of burns were excluded from the study. Results: During the study period a total of 134 children were reviewed with oral and maxillofacial injuries at KATH. Of these, 107 (78.9%) were recorded cases of orofacial soft tissue injuries. There were 63 (58.9%) males and 44 (41.1%) females and the male-to-female ratio was 1.5:1. The age range of patients studied was 8 months – 17 years, with mean age ± SD being 9.5 ± 5.3 years. Road Traffic Crash (50.5%) was the most common etiology of which Motor cycle crash constituted 24.3% and Pedestrian knockdown was 19.6%. Falls (42.1%) were the next most common etiology. The lips (19.8%) and the forehead (18.5%) were the most frequently injured sites on the face whiles the tongue (3.3%) had the most injuries intraorally. Laceration (45.7%) was the most frequent injury reviewed, followed by abrasions (35.8%). Most of the soft tissue injuries underwent primary closure (56.3%). A complication rate of 21.2% was recorded in this study and hypertrophic scarring (11.3%) was the most observed.

Minimally Invasive Maxillofacial Surgery Using Digital Work Surgery: A Case of Alveolar Ridge Reconstruction after Maxillary Cystectomy

Introduction: Iliac particulate cancellous bone and marrow (PCBM) is commonly used as a high-quality reconstruction material;however, PCBM cannot be extracted in sufficient amounts to meet demand. To determine the appropriate amount of iliac PCBM to be collected, we used digital technology to measure the volume required for jaw reconstruction before surgery. Clinical Case: The patient, a 23-year-old man, underwent surgery for a calcifying odontogenic cyst. A maxillary cyst occupied the left anterior-premolar region (tooth 21 - 25) and the deciduous canine remained;a permanent canine was included in the cyst. We planned to preserve the teeth except for the impacted canine, completely excise the maxillary cyst, and preserve the alveolar ridge morphology. Preoperative digital imaging was used to determine the amount of alveolar ridge reconstruction required and accordingly determine the amount of iliac cancellous bone to be harvested. We used a titanium mesh tray and grafts of iliac particulate cancellous bone and marrow to reconstruct the alveolar ridge. The amount of iliac cancellous bone that needed to be collected was clarified and the supply amount could be collected in just the right amount;thus, the cortical bone of the iliac inner plate could be preserved. The alveolar bone morphology was reconstructed to allow the placement of dental implants as per the preoperative digital surgery. Three years after the operation, no sign of recurrence has been observed. Conclusion: Minimally invasive surgery was performed by clarifying the amount of iliac cancellous bone graft that needs to be harvested, which improved the accuracy of surgery.

Treatment and Sequelae of Panfacial Fractures in the Maxillofacial Surgery and Stomatology Department of the Hospital University of Treichville-Abidjan (Cote d’Ivoire)

Introduction: The treatment of panfacial fractures is complex and constitutes a challenge for the maxillofacial surgeon, who, despite therapeutic progress, frequently suffers functional and aesthetic sequelae. This study aimed to describe the treatment and evaluate the functional and aesthetic sequelae of panfacial fractures in the stomatology and maxillofacial surgery department of the Treichville University Hospital. Materials and Methods: We conducted a retrospective study over a 6 years in the stomatology and maxillofacial surgery department of Treichville University Hospital. Forty-two patients with panfacial fractures were included in the study. Results: Forty-two patients were registered. The average time to osteosynthesis was 12.4 days. Nasotracheal intubation was used most often (88%), and in the majority of cases, mixed osteosynthesis combining a screwed plate and steel wire was performed (64.29%). The “Bottom-up and Outside-in” surgical sequence was the most commonly used (64.29%). All patients had at least one functional and/or cosmetic sequela after treatment. Functional sequelae were dominated by occlusal problems and aesthetic sequelae by nasal deformities. Discussion: Panfacial fractures are characterised by their complexity, presenting maxillo-facial surgeons with a therapeutic and evolutionary challenge. The quality of the initial, often multidisciplinary, management of panfacial fractures is an essential factor in both functional and aesthetic prognosis. Conclusion: The treatment of panfacial fractures, even if well managed, is sometimes a source of sequelae, requiring often complex secondary management.

Assessment of Two Years of Free Surgical Treatment of Cleft Lip, Palate and Alveolar (CLPA) in the Maxillofacial Surgery and Stomatology Department of the Hospital University of Treichville-Abidjan

Introduction: Cleft lip, palate and alveolar (CLPA) are congenital malformations of the face due to a defect in the fusion of embryonic buds during the first weeks of embryogenesis. These malformations affect the upper lip, the alveolar bone and the palate. The incidence in Africa ranges from 1/2000 to 1/500 births. Their multidisciplinary management is long and costly. Thus, the help provided by humanitarian organisations during free care campaigns is welcome. Materials and Methods: This is a retrospective descriptive study conducted from August 2014 to July 2016 in the Maxillofacial Surgery and Stomatology Department of the Treichville University Hospital in Abidjan, Côte d’Ivoire. The objective was to describe the epidemiological, clinical and therapeutic aspects of CLPA during a humanitarian campaign for free care. Results: 51 cases of CLPA were operated on. Males were involved in 54.9% of the cases, i.e. a sex ratio of 1.2. The average age of the patients at the time of the operation was 3.44 years with extremes of 3 months and 52 years. Patients with low socioeconomic status represented 84.3% of the cases. Cleft lips (31.4%) and cleft palates (33.33%) predominated. For cleft lips, unilateral forms were the most frequent (73.5%) and the left side was most often affected (59.2%). The most common surgical techniques used were MILLARD cheiloplasty for cleft lips (79.36%) and Dorrance pushback for cleft palates (78.05%). The postoperative course was simple in the majority of cases (80.47%). Patients and/or parents were satisfied with the postoperative results in over 90% of cases. Discussion: Cleft lip and palate are common. Their management by humanitarian missions through mass campaigns allows us to receive a large number of patients affected by this pathology who are treated with a high satisfaction rate. Conclusion: The characteristics of cleft lip and palate in this study are in many respects identical to those described in the literature, but with some differences specific to Africa, notably the absence of antenatal diagnosis and the advanced age at the time of treatment.

Fatal complications in a patient with severe multi-space infections in the oral and maxillofacial head and neck regions: A case report

BACKGROUND Odontogenic infection is one of the common infectious diseases in oral and maxillofacial head and neck regions.Clinically,if early odontogenic infections such as acute periapical periodontitis,alveolar abscess,and pericoronitis of wisdom teeth are not treated timely,effectively and correctly,the infected tissue may spread up to the skull and brain,down to the thoracic cavity,abdominal cavity and other areas through the natural potential fascial space in the oral and maxillofacial head and neck.Severe multi-space infections are formed and can eventually lead to life-threatening complications(LTCs),such as intracranial infection,pleural effusion,empyema,sepsis and even death.CASE SUMMARY We report a rare case of death in a 41-year-old man with severe odontogenic multi-space infections in the oral and maxillofacial head and neck regions.One week before admission,due to pain in the right lower posterior teeth,the patient placed a cigarette butt dipped in the pesticide"Miehailin"into the"dental cavity"to relieve the pain.Within a week,the infection gradually spread bilaterally to the floor of the mouth,submandibular space,neck,chest,waist,back,temporal and other areas.The patient had difficulty breathing,swallowing and eating,and was transferred to our hospital as an emergency admission.Following admission,oral and maxillofacial surgeons immediately organized consultations with doctors in otolaryngology,thoracic surgery,general surgery,hematology,anesthesia and the intensive care unit to assist with treatment.The patient was treated with the highest level of antibiotics(vancomycin)and extensive abscess incision and drainage in the oral,maxillofacial,head and neck,chest and back regions.Unfortunately,the patient died of septic shock and multiple organ failure on the third day after admission.CONCLUSION Odontogenic infection can cause serious multi-space infections in the oral and maxillofacial head and neck regions,which can result in multiple LTCs.The management and treatment of LTCs such as multi-space infections should be multidisciplinary led by oral and maxillofacial surgeons.

Steroids in Maxillofacial Space Infection: A Retrospective Cohort Study

Maxillofacial space infection (MSI) is one of the most common conditions encountered in oral and maxillofacial surgery clinics. Early recognition and proper management of MSI could prevent a life-threatening event. Objectives: To report a series of MSI managed with antibiotics, surgical intervention and exogenous steroids as an adjunct, highlighting functional improvement following steroid administration. Methods: A retrospective cohort study was carried out from December 2013 to September 2016, involving 30 patients (n = 30, 22 males, 8 females) diagnosed with MSI. All patients were initially managed with intravenous empirical antibiotics, analgesics and removal of potential source of infection. A course of 3 doses of IV Dexamethasone 8 mg at an interval of 8 hours was started during the first day of hospital admission. Results: This series reports 30 patients presenting with MSI, who received prompt antibiotics and 3 doses of steroids as inpatients. Significant clinical improvement was noted in the form of amelioration of pain, rapid reduction in edema, and improved trismus, shortening hospital stay to an average of 3.5 days, and omission of surgical intervention in 50% of our cases. No adverse effects or drug reaction was noted. Conclusion: In conclusion, the value of synergistic use of corticosteroids with antibiotics in management of MSI is significant. Despite these promising findings, there is scarce evidence in the literature to fully support the use of corticosteroids in abscess management. The role of corticosteroids in treatment of MSI should be explored further.

A Systematic Approach for Making 3D-Printed Patient-Specific Implants for Craniomaxillofacial Reconstruction

Craniomaxillofacial reconstruction implants,which are extensively used in head and neck surgery,are conventionally made in standardized forms.During surgery,the implant must be bended manually to match the anatomy of the individual bones.The bending process is time-consuming,especially for inexperienced surgeons.Moreover,repetitive bending may induce undesirable internal stress concentration,resulting in fatigue under masticatory loading in v iv o and causing various complications such as implant fracture,screw loosening,and bone resorption.There have been reports on the use of patient-specific 3D-printed implants for craniomaxillofacial reconstruction,although few reports have considered implant quality.In this paper,we present a systematic approach for making 3D-printed patientspecific surgical implants for craniomaxillofacial reconstruction.The approach consists of three parts:First,an easy-to-use design module is developed using Solidworks®software,which helps surgeons to design the implants and the axillary fixtures for surgery.Design engineers can then carry out the detailed design and use finite-element modeling(FEM)to optimize the design.Second,the fabrication process is carried out in three steps:0 testing the quality of the powder;(2)setting up the appropriate process parameters and running the 3D printing process;and (3)conducting post-processing treatments(i.e.,heat and surface treatments)to ensure the quality and performance of the implant.Third,the operation begins after the final checking of the implant and sterilization.After the surgery,postoperative rehabilitation follow-up can be carried out using our patient tracking software.Following this systematic approach,we have successfully conducted a total of 41 surgical cases.3D-printed patient-specific implants have a number of advantages;in particular,their use reduces surgery time and shortens patient recovery time.Moreover,the presented approach helps to ensure implant quality.

Early Post-Operative Complications in Surgeries Pertaining Oral and Maxillofacial Region in MNH, Tanzania

The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inadequate information on occurrence of post-operative complications in oral and maxillofacial surgeries in our setting has been documented. The aim of this study was to determine the occurrence of common early post-operative complications after oral and maxillofacial surgery in relationship to the underlying systemic condition. A descriptive postoperative study was done whereby patients who underwent oral and maxillofacial surgery were included. The included patients were those who underwent surgery for different pathological conditions, trauma, developmental/congenital conditions and inflammatory conditions to mention few. Demographic data, complications developed within one week post operative, and underlying systemic comorbidities before and after surgery were documented and analysed. A total of 102 patients were included in the study. The mean age of participants was 30.00 ± 17.01 years with a range of 2 to 81 years. Majority 43.1% (n = 44) had benign tumors with a leading diagnosis of ameloblastoma. In general, the most common complications which were noted in the cases included Pain 98% (n = 100) and Post-operative Swelling 97.1% (n = 99). The presence of underlying systemic comorbid conditions has a significant role in occurrence of some severe complications. The occurrence of complications does increase the duration of stay in the hospital hence increasing cost of treatment for which bearers are both patients and the hospital.

Oral and maxillofacial pain as the first sign of metastasis of an occult primary tumour:A fifteen-year retrospective study

BACKGROUND Metastatic adenocarcinoma of the jaw(MAJ)is a rare disease that accounts for 1%-3%of all oral and maxillofacial malignant tumours.Oral and maxillofacial pain may be the first symptom of metastatic spread of an occult primary tumour.Therefore,early identification of oral and maxillofacial pain by dental professionals is critical.AIM To explore the clinical and computerized tomography(CT)features of MAJ with oral and maxillofacial pain as the first symptom.METHODS The medical records of all patients who were treated in our hospital between January 2006 and February 2020,and diagnosed with MAJ with oral and maxillofacial pain as the first symptom,were reviewed retrospectively.Clinical data were collected on age,sex,medical history,clinical manifestations,site of metastasis,and site of the primary lesion.CT features were analysed in detail,and a radiological classification scheme comprising five types:Osteolytic,osteoblastic,mixed,cystic,and alveolar bone resorption was proposed.RESULTS The primary sites of MAJ were the lungs(n=6),liver(n=4),kidneys(n=2),prostate(n=1),and gastric cardia(n=1).Five tumours were classified as the osteolytic type,all with a permeative margin(100%,P<0.05),and three were classified as the mixed type,mostly with a moth-eaten margin(80%,P<0.05).The cystic(n=3)and alveolar bone resorption(n=1)types had geographic margins,and the osteoblastic type(n=1)had sclerotic margins.Moreover,nine tumours showed periosteal reaction and five showed a localised soft tissue mass,while the occurrence of jaw expansion was relatively rare.CONCLUSION MAJ has complex clinical and CT features.Oral and maxillofacial pain may be the first sign of a primary tumour affecting other sites.

Clinical evaluation of implants in patients with maxillofacial defects

AIM: To show the efficacy of reconstruction and rehabilitation of large acquired maxillofacial defects due to tumor resections and firearm injuries. METHODS: The study group comprised of 16 patients(10 men and 6 women) who were operated on because of their maxillofacial defects under local and general anesthesia between June 2007 and June 2011. Prosthetic treatment with the aid of dental implants was performed for all of the patients. Eight patients received an implant supported fixed prosthesis; six patients received implant supported overdentures and two patients received both. Patients were followed up postoperatively for 1 to 4 years. Implant success and survival rates were recorded. Panoramic radiographs were taken preoperatively, immediately after surgery, immediately after loading and at every recall session. Peri-implant and prosthetic complications were recorded. Subjects were asked to grade their oral health satisfaction after treatment according to 100 mm visual analog scale(VAS) and the oral health related quality oflife of the patients was measured with the short-form Oral Health Impact Profile. RESULTS: Five implants(3 in the mandible, 2 in the maxilla) in five patients were lost, while the other 53 survived, which brings an overall survival rate of 91.37% on the implant basis, but 68.75% on patient basis. All the failed implants were lost before abutment connection and were therefore regarded as early failures. For all failed implants, new implants were placed after a 2 mo period and the planning was maintained. The mean marginal bone loss(MBL) was 1.4 mm on the mesial side and 1.6 mm on the distal side of the implants. Five of the implants showed MBL > 2 mm(mean MBL = 2.3 mm) but less than 1/2 of the implant bodies and therefore were regarded as not successful but surviving implants. The VAS General Comfort mean score was 85.07, the VAS Speech mean score was 75.25 and the VAS Esthetics mean score was 82.74. No patient reported low scores(score lower than 50) of satisfaction in any of the evaluated factors. The mean of OHIP-14 scores was 5.5. CONCLUSION: Although further follow up and larger case numbers will give more information about the success of dental implants as a treatment modality in maxillofacial defects patients, the actual results are encouraging and can be recommended for similar cases.

The Osteogenic Capacity of Human Amniotic Membrane Mesenchymal Stem Cell (hAMSC) and Potential for Application in Maxillofacial Bone Reconstruction <i>in Vitro</i>Study

Amniotic membrane of human placenta is a source of abundant mesenchymal stem cell (hAMSC) which makes it a potential source of allogeneic multipotent cell for bone healing. However, much has to be explored about its isolation procedure and the osteogenic differentiation potential. The aims of this study are to establish the procurement procedure of human amniotic membrane, the isolation and culture of hAMSC, the MSC phenotypic characterization, and the in vitro osteogenic differentiation of hAMSC. Results of the study are as follows. The quality of human amniotic membrane would be best if procured from Caesarean operation under highly aseptic condition to avoid fungal and bacterial contamination on the culture. Isolation procedure using modified Soncini protocol yielded large amount of MSC with high proliferative capacity in culture medium. Characterization of hAMSC showed that the majority of the target cells exhibited specific MSC markers (CD105 and CD90) with a small number of these cells expressing CD45, the marker of hematopoeitic cells. The in vitro osteogenic differentiation of hAMSC followed by Alizarin Red staining showed that osteoblastic differentiation was detected in a significantly high number of cells. This study concludes that hAMSCs isolated from human amniotic membrane have the capacity for in vitro osteogenesis which makes them be one of the potential allogeneic stem cells for application in maxillofacial bone reconstruction.

Platelets Levels before and after Surgical Intervention in Patients with Oral and Maxillofacial Tumors at MNH, Tanzania

Background: There are documented effects of platelets on the solid tumors which need further study. The elevated platelet counts have been described for majority of cancers. There is inadequate information of effect of benign and malignant oral and maxillofacial tumors on the regulation of platelets. The aim of this study was to investigate the changes in platelet counts among patients with oral and maxillofacial benign and malignant tumors following surgical interventions. Methods: A descriptive postoperative study was done whereby patients with benign and malignant oral and maxillofacial tumors who met the inclusion criteria were included. The included patients were those who had no history of blood transfusion prior, during or after surgery, not on haemoglobin-boosting or bone marrow suppressing medications, not seropositive to human immunodeficiency virus also without clinical findings suggestive of lymphadenopathy, splenomegaly, ecchymosis and petechiae. Demographic data, Platelet counts and haemoglobin levels before and after surgery were documented and analysed by chi-square test and values were considered to be significant if p < 0.05. Results: A total of 61 patients were included in the study. The mean age of participants was 37.03 ± 16.6 years with range of 7 to 77 years. Majority 82.5% (n = 52) had benign tumors with a leading diagnosis of ameloblastoma followed by ossifying fibroma. In general there was an increase of platelet counts following surgery from the mean of 276.38 ± 109.40 K/uL to 308.51 ± 117.24 K/uL. Looking at benign and malignant separately, following surgery there was an increase of platelet counts for benign tumors (278.87 ± 106.37 to 305.96 ± 123.12) but a decrease for malignant tumors group (282.33 ± 147.03 to 232 ± 78.48). The haemoglobin level changed from the mean of 12.60 ± 1.71 g/dl before surgery to 11.69 ± 1.70 g/dl after surgery. Conclusion: The mean postoperative increase in platelet counts in benign and malignant tumors was due to healing process of the wound following surgery while the postoperative decrease in platelets counts in malignant tumors was due to effect of tumor removal which diminished the production of platelets activating factors. Malignant tumors produce platelets activating factors which are necessary for them to grow. Also, the difference in postoperative platelets counts in benign and malignant oral and maxillofacial tumors could be attributed by different biological behavior of benign and malignant tumors and hence different interactions of platelets to these tumors.

Anesthetic Management of a Patient with Sick Sinus Syndrome during General Anesthesia for Maxillofacial Surgery

Sick sinus syndrome (SSS) is a generalized abnormality of cardiac impulse formation. Patients with SSS occasionally need temporary pacing during general anesthesia. The most common issue arising in the perioperative period is electromagnetic interference with device function. We report a case of a 66-year-old man who required temporary cardiac pacing during maxillary cyst extirpation using electrocautery.

Temporary Cavity Effects of High Velocity Spherical Steel Bullet Wounds in Maxillofacial Region of Dogs

Maxillofacial region wounds of dogs were inflicted by spherical steel bullets,0.7 g weight,with the muzzle velocity of 1.3 km/s.The photographs of the temporarycavity were taken with a high speed x-ray cine-camera,and local wounding conditionswere observed with the naked eye.The experimental results proved that a temporary ca-vity was formed in the maxillofacial region wound.The contusion zone of the maxillofa-cial soft tissue was smaller than that of the extremities.The contusion zone of the skinand oral mucous membrane was 1-2 mm,and that of muscle was 5-8 mm in thickness.In clinical situation,the tissues of the contusion zones should always be excised since itconsists of devitalized tissue.The temporary cavitation is an important factor in causingstructural injuries of tissues around the local wound track.

Pathological Changes of Small Blood Vessels in Maxillofacial Region Following High Velocity Missile Wound:an Experimental Study in Dogs

In order to provide an experimental foundation and pathological base for earlyreconstruction of maxillofacial tissues defects after firearms wound using microsurgicalmethods,an experiment,was made to study the microvascular pathological changesthrough light and electron microscopy observation.In the experiment we found somepathological changes of small vessels in wounded region,such as mierothrombi forma-tion,endothelial loss,internal elastic membrane break and some degenerations,necrosis within endothelial and smooth muscle cells of vessel.The nearer the woundededge was,the more evident injury was.The microvascular injurous range was 3 cm dis-tant from wounded edge,which recovered in 7 days later after wounding.The experi-ment indicated that if we used the vascularized free tissue transfer to repair defects ofmaxillofacial firearms wounds,the pedicles of flap should be anastomosed to distant re-cipient vesseles which could be chosen beyond 3 cm from wounded edge.Thereconstructive operation should be done 7 days later after wound.

An experimental study of early anastomosis of injured microvessels of maxillofacial region in dogs

This study was designed to evaluate whether the microvascularanastomosis of small arteries and veins in the wound area was possible after gun-shot wound was inflicted to the maxillofacial region of a dog.It was found thatsmall vessels could be connected with subsequent patency of their lumen if theoperation was performed on the 3rd day after the debridment of the gunshotWound,which provides a basis for microvascular anastomosis to repairmaxillofacial defect due to gunshot wound with free vascularized flap grafting.Inaddition the best time to have a defect repaired and the healing features of thewounds after vascular anastomosis are discussed.

A NEW FLAP CLINICAL EXPERIENCE OF ACROMIOTHORACIC CUTANEOUS FREE FLAP FOR REPAIR OF DEFECTS IN THE ORAL AND MAXILLOFACIAL REGION

Since December 1986, acromiothoracic cutaneous flap (with its blood supply from the cutaneous perforators of deltoid muscular branches of thoracoacromial vessels) has been used for repair of the defects in the oral and maxillofacial region on 7 cases. All falps in this group survived. This skin flap must be very promising with advantages of an unexposed donor site, soft in texture and color matching the face. Moreover, the operation is less traumatic. The design and essential points of preparing the flap are introduced. The indication of operation is also discussed.