World Journal of Plastic Surgery
Volume:12 Issue: 1, Jan 2023

Maxillofacial fractures are a common type of injury that can result in significant morbidity and mortality. We aimed to systematically review the literature on the prevalence and causes of maxillofacial fractures in Iran to estimate the overall prevalence of maxillofacial fractures and the most common causes.

A systematic search of PubMed, Cochrane Library, Web of Science (WS) and Google Scholar (GS) electronic databases was conducted to identify relevant articles published up to January 2023. Studies reporting the prevalence and causes of maxillofacial fractures in Iran were included in the analysis. MOOSE guidelines were adopted for the current systematic review. No data or language restriction were applied. Risk of bias across the articles was assessed.

A total of 32 studies comprising 35,720 patients were included in the analysis. The most common cause of maxillofacial fractures was road traffic accidents (RTAs), accounting for 68.97% of all cases, followed by falls (12.62%) and interpersonal violence (9.03%). The prevalence of maxillofacial fractures was higher in males (81.04%) and in the age group of 21-30 years (43.23%). Risk of bias across studies was considered low.

Maxillofacial fractures are a significant public health problem in Iran, with a high prevalence and RTAs being the leading cause. These results highlight the need for increased efforts to prevent maxillofacial fractures in Iran, especially through measures to reduce the incidence of RTAs.

Rhinoplasty as the most common aesthetic surgical operations aims to correct deformities of the different structures of the nose with each case its own challenges. We aimed to highlight the importance of self-assessment for rhino surgeons.

This retrospective descriptive study was done on 192 patients in Ordibehesht Hospital, Isfahan, Iran from April 2017 to Jun 2021. candidate for secondary rhinoplasty, with mandatory aesthetic and optional functional purposes, having previously undergone rhinoplasty with the same or another surgeon. Patients with initial rhinoplasty by the first author were assigned to group 1 (n=102) and the patients who were operated by the other surgeons were in the group 2 (n=90). Data were collected using an author made checklist divided into three parts: overall demographic questions, questions about the patients’ aesthetic and functional complaints and objective evaluation by the surgeon.

The most frequent reported complaints led to their current rhinoplasty were about the nasal tip with 161 cases (83.9%), upper nasal part with 98 cases (51%) and mid-nose (middle nose) with 81 cases (42.2%). Besides, respiratory problem was observed in 58 patients (30.2%). Surgeon's skill was significantly associated with occurrence of these two complaints; so that these two complaints were more common in group2 than group1 (P value <0.05).

Such assessments resulted to improve the surgical outcomes due to finding the more prevalent problems in own patients than the other surgeons’ patients and determining the reasons that leads to change the techniques with regard to the researches and consulting with the colleagues.

Reconstruction of soft tissue defects overlying the Achilles tendon has always been a challenge. Various modalities of reconstruction have been described to resurface such defects. We aimed to assess the functional and cosmetic outcomes of all patients who had undergone reconstruction of small and medium sized soft tissue defects of the Achilles region using local fasciocutaneous island flaps.

This retrospective study was conducted from January 2020 to June 2022. 15 patients with small (≤ 30 cm2) and medium (30-90 cm2) sized soft tissue defects of the tendo-Achilles region, underwent reconstruction with local fasciocutaneous island flaps and had complete medical records, were included.

Thirteen patients were male (86.7%). The mean age was 53.2 years. 5 cases (33.3%) had post-traumatic open AT injuries with skin avulsion, while ten patients (66.7%) had suture line complications after open repair of spontaneous Achilles tendon rupture. Defect sizes ranged from 12 to 63 cm2. Reverse sural flap was used in 5 patients (33.3%) and medial plantar flap in 10 patients (66.7%). All flaps survived completely. Complications were detected in 3 patients (20%); 1 distal superficial necrosis in a sural flap and 2 marginal minimal graft loss. Functional outcome was good in 12 patients (80%), excellent in 1 patient (6.7%) and fair in 2 patients (13.3%). 13 patients (86.7%) were satisfied with the cosmetic results.

Local fasciocutenous island flaps are reliable and simple solutions for covering small to moderate soft tissue defects overlying the Achilles Tendon, with acceptable functional and cosmetic outcomes.

Hand traumas are common in young men and their complications can have negative effects on their occupation and economic activities. On the other hand, most of the hand injuries are related to occupation accidents and thus necessitates preventive measures. The goal of a clinical registry is assisting epidemiologic surveys, quality improvement preventions.

This article explains the first phase of implementing a registry for upper extremity trauma. This phase includes recording of demographic data of patients. A questionnaire was designed. Contents include patients’ characteristics, pattern of injury and past medical history in a minimal data set checklist. This questionnaire was filled in the emergency room by general practitioners. For 2 months the data were collected in paper based manner, then problems and obstacles were evaluated and corrected. During this period a web based software was designed. The registry was then ran for another 4 months using web based software.

From 6.11.2019 to 5.3.2020, 1675 patients were recorded in the registry. Random check of recorded data suggests that accuracy of records was about 95.5%. Most of the missing data was related to associated injuries and job experience. Some mechanisms of injury seems to be related to Iran community and thus warrants special attention for preventive activities.

With a special registry personnel and supervision of plastic surgery faculties, an accurate record of data of upper extremity trauma is possible. The patterns of injury were remarkable and can be used for investigations and policy making for prevention.

Previously, absorbable screw and plate systems were widely used in craniosynostosis surgery in Iran, but now, due to the establishment of economic sanctions, the importation of these tools into the country has become difficult. In this study, we compared the short-term complications of cranioplasty surgery in craniosynostosis using absorbable plate screws with absorbable sutures.

In this cross-sectional study, 47 patients with a history of craniosynostosis who underwent cranioplasty at Tehran Mofid Hospital, Tehran, Iran from 2018 to 2021 were divided into two groups. For first group (31 patients) we used absorbable plate and screws, and for the second group (16 patients) absorbable sutures (PDS). All operations in both groups were performed by the identical surgical team. Patients followed up for consecutive post-operative examinations in the first and second weeks and 1, 3, and 6 months. Data were analyzed using SPSS software version 25.

The results did not show any short-term or medium-term complications in either group. No recurrences were observed. In Whittaker classification, 63.8% were Class I, 29.8% were Class II, 6.4% were Class III, and 0% were Class IV. There was no statistically significant relationship between the type of treatment (screw and plate or absorbable suture) and higher Whitaker. There was also no statistically significant relationship between type of craniosynostosis and higher Whittaker.

The absorbable sutures can be considered as valuable and cost-effective tools in the fixation of bone fragments in craniosynostosis surgeries by surgeons.

The provision of sufficient stability after maxillofacial surgery is essential for the reduction of complications and disease recurrence. The stabilization of osteotomized pieces results in rapid restoration of normal masticatory function, reduction of skeletal relapse, and uneventful healing at the osteotomy site. We aimed to compare qualitatively stress distribution patterns over a virtual mandible model after bilateral sagittal split osteotomy (BSSO) bridged with three different intraoral fixation techniques.

This study was conducted in the Oral and Maxillofacial Surgery Department of Mashhad School of Dentistry, Mashhad, Iran, from March 2021-March 2022.  The mandible computed tomography scan of a healthy adult was used to generate a 3D model; thereafter, BSSO with a 3mm setback was simulated. The three following fixation techniques were applied to the model: 1) two bicortical screws, 2) three bicortical screws, and 3) a miniplate. The bilateral second premolars and first molars were placed under mechanical loads of 75, 135, and 600N in order to simulate symmetric occlusal forces. Finite element analysis (FEA) was carried out in Ansys software, and the mechanical strain, stress, and displacement calculations were recorded.

The FEA contours revealed that stress was mainly concentrated in the fixation units. Although bicortical screws presented better rigidity than miniplates, they were associated with higher stress and displacement readings.

Miniplate fixation demonstrated the most favorable biomechanical performance, followed by fixation with two and three bicortical screws, respectively. Intraoral fixation with miniplates in combination with monocortical screws can serve as an appropriate fixation arrangement and treatment option for skeletal stabilization after BSSO setback surgery.

Supralevator fistula stays a challenge in general surgery. We present a case with supralevator anorectal fistula and subsequent retroperitoneal necrotizing fasciitis in which autologous platelet-rich plasma and platelet-rich fibrin glue were used for fistula closure. A 59-year-old man was admitted with pelvic pain and fever. Abdominopelvic sonography and CT scan reported a deep horseshoe-shaped anorectal abscess with extension to the pelvic floor, supralevator, psoas, retroperitoneal muscles, and kidneys. He was managed with antibiotics, abscess drainage, repeated radical surgical debridement, and necrosectomy. After 30 days, he was discharged, but he returned to the office with the complaint of purulent discharge from the hypogastric region and a diagnosis of fistula formation. Platelet-rich plasma was injected around the fistula into the tissue, and platelet-rich fibrin glue was introduced to the fistula tract. At the 11-month follow-up, the patient did not have voiding dysfunction, constipation, diarrhea, or fistula tract infection. Autologous platelet-rich plasma injection and platelet-rich fibrin glue insertion suggest a secure and effective approach for treating supralevator anorectal fistula.

Degloving is a type of avulsion injury that leads to the separation of the skin from its underlying tissues. It is usually caused by industrial machinery through smashing or traction mechanisms, where the patient typically tries to avoid severe trauma by pulling their hand off, resulting in this particular injury. Although free flaps have now become the standard of treatment in many institutions, the lack of this possibility makes pedicled flaps a good reconstructive option, with advantages such as low donor-site morbidity, low procedure costs, and relatively easy dissection of the flap. Since the description of the pedicled groin flap technique by McGregor and Jackson, this reconstructive option has become a versatile flap for the coverage of wounds on the hand and distal forearm. This axial-patterned cutaneous flap is based on the superficial circumflex arteriovenous system, which can provide soft-tissue coverage for moderate-to-severe injuries, especially those caused by work accidents. This article aims to describe our experience in treating five different cases of traumatic degloving hand injuries using a groin flap for coverage, with excellent aesthetic and functional results. Two of these cases resulted from degloving after a traction accident, one from a firework explosion, one from a gunshot, and finally, one as a result of an electric wound.

Swellings of the hand are commonly seen in routine clinical practuce. Ninety five percent of them are benign and most common diagnoses include ganglions, epidermoid inclusion cysts, and giant cell tumours of the tendon sheath. It is very uncommon to find true digital aneuryms in the hand. In this clinical vignette I present a case of true digital artery aneurysm, with the tell tale clinical features and the photographs which help to identify such cases in a 22 yr married female from India.

Scarring is a common post-injury outcome that can precipitate functional impairment. We present the case of a 75-year-old female who presented with diminished upper eyelid excursion in her right (only seeing) eye due to scarring associated with a facial laceration. She had a history of right eye corneal transplantation and necessitated urgent excision of the scar to release upper eyelid motion. The scar was excised, and a full-thickness skin graft (FTSG) was used, harvested from the skin of the right supraclavicular neck. Post-operative recovery was excellent, and the patient was relieved of restriction of her right upper eyelid opening.

Orthokeratinized Odontogenic Cyst (OOC) is a rare odontogenic cyst, which is important because it has a low recurrence potential, but it has a percentage of the potential for malignant changes. OOC characteristics can be different from OKC (odontogenic keratocyst), which was once classified in its category. The microscopic view of OOC cyst is the reason for its easy identification from OKC, the orthokeratinized epithelial covering and the clear granular layer, and the hyperplasia of the basal layer, and the smooth surface of this cyst. OOC cyst treatment is conservative and can be usually carried out by enucleation. In terms of gender predominance, it is often reported in men. Furthermore, OOC is more common in the 3rd and 4th decades of life.Hereby, the authors reported a rare case of OOC in the posterior mandible of a young adult 18-year-old boy and its treatment method. The clinical and diagnostic points of view and the treatment options were discussed in this article.

Schwannomas constitute only 5% of tumors of upper limb. Schwannoma of the posterior interosseous nerve is rare. A thorough search of literature revealed only three case reports of this entity. A 33-year old female presented with insidious onset swelling over extensor aspect of right forearm for one year and deficit of extension of fourth and fifth finger for a month. Magnetic Resonance Imaging and Fine Needle Aspiration Cytology were suggestive of low- grade nerve sheath tumor. The tumor was excised under tourniquet control and magnification, using microsurgical technique. Histopathology confirmed schwannoma. Result. Patient regained her full extension of fourth and fifth finger within 1.5 months. As schwannoma does not infiltrate the nerve fibers, so a complete surgical excision is the treatment of choice. We wrote this article to draw clinicians’ attention to this unusual entity.  Schwannoma of PIN is a relatively rare condition. Till date, there are only three cases reported in literature. Meticulous attention to detail is required while excising large schwannomas, as there is a risk of fascicular injury during dissection. Use of magnification and microsurgical technique prevents inadvertent nerve injury.

An oro-antral communication represents an abnormal connection between the oral cavity and the maxillary sinus. It occurs most often after tooth extractions, improper implant placement or incorrect management of the sinus lifts. Surgical repair is challenging and most practitioners usually choose the buccal advancement flap, the palatal flap and in some cases the buccal fat pad flap to close the defect. We present a 43 year-old female of a large oro-antral communication and associated chronic sinusitis which was succesfully manged by surgery. Previous interventions including 2 buccal advancement flaps, and a double layer closure using Collagen membrane and buccal advancement flap were unsuccesful. The stepwise intervention consisted on the complete cleaning of the sinus, using the Caldwell Luc technique, followed by the closure of the oro-antral communication using Bichat fat pad flap. The particular aspect was the proper integration of the buccal fat pad flap, after 3 failed attempts, without dehiscence or any other complications. The buccal fat pad flap can be succesfully used for closure of lage oro-antral communications, even when previous methods have failed and local tissue is of poor quality.

Polydactyly is a congenital anomaly with a wide range of manifestations that occurs in many forms, ranging from varying degrees of mere splitting to completely duplicated thumb. When duplication occurs alone, it is usually unilateral and sporadic. In this case report, I report left hand polydactyly with 2 more fingers on 5th finger in a 6 month old male. He subsequently underwent surgical correction, and the over number thumb was removed with associated meticulous skeletal and soft tissue reconstruction. Polydactyly is the most common congenital digital anomaly of the hand and foot. It can occur in isolation or as part of a syndrome. Surgery is necessary to create a single, functioning thumb indicated to improve cosmetics. Skin, nail, bone, ligament, and musculoskeletal elements must be combined to reconstruct an optimal digit. Treatment options of polydactyly depend on the type and the underlying features. In the literature, different surgical treatments for lateral and medial polydactyly are described.

Platelet-rich plasma (PRP) is part of the blood with a high concentration of platelets. The history of PRP application began in the field of hematology. However, it spread to other areas of medicine as well. In this essay, we briefly highlight the current applications of PRP in plastic surgery