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Modabber A.,Maxillofacial and Plastic Facial surgery | Ayoub N.,Maxillofacial and Plastic Facial surgery | Mohlhenrich S.C.,Maxillofacial and Plastic Facial surgery | Goloborodko E.,Maxillofacial and Plastic Facial surgery | And 5 more authors.
Medical Devices: Evidence and Research | Year: 2014

Background: The intention of mandibular reconstruction is to restore the complex anatomy with maximum possible functionality and high accuracy. The aim of this study was to evaluate the accuracy of computer-assisted surgery in primary mandibular reconstruction with an iliac crest bone fap compared with an osteomyocutaneous fbula fap. Materials and methods: Preoperative computed tomography data of the mandible and the iliac crest or fbula donor site were imported into a specifc surgical planning software program. Surgical guides were manufactured using a rapid prototyping technique for translating the virtual plan, including information on the transplant dimensions and shape, into real-time surgery. Using postoperative computed tomography scans and an automatic surface-comparison algorithm, the actual postoperative situation was compared with the preoperative virtual simulation. Results: The actual fap position showed a mean difference from the virtual plan of 2.43 mm (standard deviation [SD] ±1.26) and a surface deviation of 39%,2 mm and 15%,1 mm for the iliac crest bone fap, and a mean difference of 2.18 mm (SD ±1.93) and a surface deviation of 60%,2 mm and 37%,1 mm for the osteomyocutaneous fbula fap. The position of the neomandible reconstructed with an osteomyocutaneous fbula fap indicated a mean difference from the virtual plan of 1.25 mm (SD ±1.31) and a surface deviation of 82%,2 mm and 57%,1 mm, in contrast to a mean difference of 1.68 mm (SD ±1.25) and a surface deviation of 63%,2 mm and 38%,1 mm for the neomandible after reconstruction with an iliac crest bone fap. For shape analysis, a similarly high accuracy could be calculated for both faps. Conclusion: Virtual surgical planning is an effective method for mandibular reconstruction with vascularized bone faps, and can help to restore the anatomy of the mandible with high accuracy in position and shape. It seems that primary mandibular reconstruction with the osteomyocutane-ous fbula fap is more accurate compared with the vascularized iliac crest bone fap. © 2014 Modabber et al.


Ghassemi A.,RWTH Aachen | Riediger D.,RWTH Aachen | Holzle F.,RWTH Aachen | Gerressen M.,Maxillofacial and Plastic Facial Surgery
Aesthetic Plastic Surgery | Year: 2013

Lateral osteotomy is one of the most traumatic but critical steps in rhinoplasty and can dictate the aesthetic and functional outcomes. Many techniques and instruments to perform it have been suggested, with the objectives of increasing predictability, reliability, and easiness of this invasive approach. We used a 1.5-mm diamond burr via an intraoral approach to thin out the base of the nasal wall along the nasofacial crease in 24 patients. This technique was performed in patients seeking primary rhinoplasty (n = 6), correction of cleft nose deformities (n = 4), deformities due to trauma (n = 9), and secondary nose correction (n = 5). A high mucosal incision paranasally allowed easy access to the osteotomy line. The digital in-fracturing could be performed with light pressure and without extensive manipulation at any time during the rhinoplasty. The osteotomy took on average of 14.5 min (range = 11.00-19.80) and endoscopic examination showed no mucosal tearing. Postoperative swelling and hematoma were comparable to those of other techniques. Using a diamond burr via an intraoral approach is an easy, safe, and reliable method leading to predictable outcomes. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266. © 2013 Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.


Ghassemi A.,RWTH Aachen | Shamsinejad M.,Maxillofacial and Plastic Facial Surgery | Gerressen M.,Maxillofacial and Plastic Facial Surgery | Talebzadeh M.,RWTH Aachen | And 2 more authors.
Journal of Oral and Maxillofacial Surgery | Year: 2013

Purpose: Large defects in the face resulting from the excision of malignant tumors, trauma, and congenital malformation pose a significant challenge to reconstructive surgeons. Achieving good esthetic and functional outcomes is often very demanding. Patients and Methods: A facelift technique was used in 47 patients (25 female, 22 male; age range, 17.5 to 82.3 years; mean age, 49.3 years) to replace lost tissue of the face from 2009 through 2012. The minimum defect size was 2 cm in diameter and the maximum was 8 cm. To achieve tension-free coverage with a reliable blood supply, a deep-plane dissection, including the skin and superficial musculoaponeurotic system (SMAS), was performed. The deep sub-SMAS dissection was extended into the neck and the contralateral part, as needed. A thick flap was created and composite lifting was performed. Results: No significant deformity concerning the lower eyelids, nose, and lip was registered. Most scars could be placed in hidden regions and became undetectable after a year. The facial nerve function remained intact in all patients. Conclusion: Using these facelift techniques, including the incision, sub-SMAS dissection for volumetric positioning of the skin, and the SMAS flap, the closure of extensive facial defects with excellent functional and esthetic results is conceivable. © 2013 American Association of Oral and Maxillofacial Surgeons.


Ghassemi A.,RWTH Aachen | Prescher A.,RWTH Aachen | Riediger D.,RWTH Aachen | Knobe M.,RWTH Aachen | And 2 more authors.
Clinical Anatomy | Year: 2013

The iliac bone crest is one of the most valuable regions for harvesting bone grafts, both vascularized and nonvascularized. Since the first commendable description of this region as a possible source for vascularized bone flaps by Taylor, little relevant information concerning the variations of the deep circumflex iliac vessels and their relationship to the neighboring structures has been published. The purpose of the current study was to examine this region clinically and anatomically, taking into consideration the former description by Taylor. We gathered all our findings on 216 iliac regions and proposed a new classification. In addition we measured the relationships between the deep circumflex iliac artery and important surgical landmarks. A comparison of our finding with other studies showed similarities and differences but was far more complete. Generally (92%) the deep circumflex iliac artery (DCIA) originated from external iliac artery (EIA) behind the inguinal ligament (IL) and passed cranio-laterally toward the anterior superior iliac spine, where it divided into two important branches. Four variations were observed of the DCIA. The deep circumflex iliac vein (DCIV) ran over (82.5%) or under (17.5%) the EIA. The superficial circumflex iliac vein (SCIV) was observed draining into the DCIV in some dissections. Three different variations of the superficial circumflex iliac artery (SCIA) were observed. The anatomical knowledge of these variations and their correlation to important surgical landmarks can help in harvesting the DCIA flap more safely and thus increasing the success rate while reducing donor site morbidity. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc. Copyright © 2013 Wiley Periodicals, Inc.

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