Volume 03 Issue 05-2023
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(ISSN
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ABSTRACT
The introduction of digital technologies and improvement of reconstruction methods, diagnostics of combined
traumas of the maxillofacial region should be aimed at improving the quality of life and aesthetic parameters of
patients, reducing traumatization, reconstructing anatomical areas, reducing the duration of the postoperative
period.
KEYWORDS
Maxillofacial surgery, orbital floor, reconstruction, trauma, face.
INTRODUCTION
Orbital reconstruction is the first and most predictable
step in the surgical treatment of orbital fractures.
Orbital reconstruction is *keyhole* surgery performed
in an enclosed space. The technology-supported
workflow, called computer-assisted surgery (CAS), has
become the standard for complex orbital trauma
surgery in many hospitals. CAS technology has become
the catalyst for the implementation of personalized
medicine in orbital reconstruction. The complete
workflow consists of diagnosis, planning, surgery, and
Research Article
MODERN COMPREHENSIVE TREATMENT OF FACIAL INJURIES
Submission Date:
May 05, 2023,
Accepted Date:
May 10, 2023,
Published Date:
May 15, 2023
Crossref doi:
https://doi.org/10.37547/ajbspi/Volume03Issue05-02
Shamov Vladislav
Students Dental Istitute Of Tashkent, Uzbekistan
Kholikov Azizbek Alimurodovich
Students Dental Istitute Of Tashkent, Uzbekistan
Fattayeva Dilorom Rustamovna
Students Dental Istitute Of Tashkent, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ajbspi
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
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evaluation. Advanced diagnostics and virtual surgical
planning are methods used in the preoperative phase
to optimally prepare for surgery and adapt treatment
to the patient. Further personalization of treatment is
possible if the reconstruction is performed using an
implant that is customized for the patient, and several
design options are available to adapt the implant to the
individual needs. During surgery, visual assessment is
used to evaluate the resulting position of the implant.
Surgical navigation, intraoperative imaging, and
special PSI design options can improve feedback in the
CAS workflow. Assessment of surgical outcome can be
done both qualitatively and quantitatively. The
concepts of CAS and personalized medicine are
intertwined throughout the workflow. A combination
of methods can be used to achieve the most optimal
clinical outcome.
The position of the globe after trauma may be
displaced, for example, with inward displacement
(enophthalmos)
or
downward
displacement
(hypoglobus). The soft tissues of the orbit may also be
affected by trauma. The structural integrity and
functionality of the connective tissue or extraocular
muscles may be compromised, resulting in impaired
eye movement and double vision (diplopia). The
location and type of impact, combined with the
amount of energy delivered to the bony structures of
the orbit and the soft tissues of the orbit, cause a
heterogeneous clinical picture.
There is an ongoing debate about the indications for
surgical reconstruction, and systematic reviews have
failed to provide evidence-based recommendations.
Some advocate a radical approach to prevent clinical
symptoms, others opt for a more conservative
approach with delayed surgery if clinical symptoms
develop. The indication for reconstruction in most
cases remains a subjective decision, depending on the
surgeon and the characteristics of the patient. Surgical
treatment of orbital fractures focuses on repositioning
the contents of the orbit and globe and restoring
structural support to restore ocular function. Orbital
reconstruction is the first and most predictable step in
the surgical treatment of orbital fractures.
Titanium mesh implants have now become the
preferred
biomaterial
for
surgical
orbital
reconstruction. Titanium implants can be divided into
flat implants, pre-formed implants, and patient-specific
implants (PSIs). Flat implants are shaped and trimmed
by hand by the surgeon. A generic or custom (mirror)
orbital model can assist in the shaping process.
Prefabricated implants have a predetermined shape
based on the mid orbital model . Patient Specific
Implants (PSIs) are designed individually for the
patient and are subsequently manufactured using
additive manufacturing.
The complex soft tissue architecture and proximity to
vital structures create surgical challenges in orbital
reconstruction. Orbital reconstruction is a keyhole
surgery performed in a limited space. This contributes
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to limited visualization, which is further enhanced by
the protruding fat. The margin for error is small: an
improperly placed implant can have significant
implications for the clinical outcome and quality of life
of the patient, and the literature considers this to be
grounds for revision surgery. Medical technology has
been incorporated into the clinical workflow of orbital
reconstructions to reduce the risk of incorrect
positioning of the implant .
This technologically supported workflow, called
computer-assisted surgery (CAS), has become the
standard for complex orbital trauma surgery in many
hospitals. The introduction of CAS has also allowed
personalization of treatment: treatment planning is
tailored to the capabilities and needs of the patient,
and intraoperative management is adjusted to
anatomical capabilities. The main goal of this article is
to provide a comprehensive overview of the CAS
workflow for orbital reconstruction, with an in-depth
description of the methods built into the workflow and
a particular focus on personalizing treatment with
patient-specific implant design.
The
workflow
of
post-traumatic
orbital
reconstruction
The normal workflow of post-traumatic orbital
reconstruction and the possible CAS methods are
shown in
Figure 1. The individual steps are described in detail in
the following paragraphs.
Diagnosis
A thorough clinical and radiographic evaluation of the
patient is necessary to determine the optimal
treatment. The clinical evaluation should at least assess
the magnitude of ocular displacement and the degree
of double vision. The Hertel exophthalmometer is the
simplest instrument to quantify the relative
ventrodorsal position of the globe. Despite known
limitations such as asymmetry of the lateral edges of
the orbit, soft tissue compression, and lack of uniform
technique, it is currently the gold standard.
Computed tomography (CT) is the method of choice
for radiographic evaluation because of its superior
visualization of bony structures. The size and extent of
the fracture can be assessed or measured in the
coronal, sagittal, or axial plane. Given that the bone is
thin in some areas, a maximum slice thickness of 1.0
mm is essential for
evaluation. In individual cases, evaluation of soft tissue
changes may become important. It has been reported
that shape changes in the inferior rectus muscle affect
delayed or postoperative enophthalmos and may
influence treatment decisions. In addition, orbital soft
tissue herniation may be an indication for surgical
reconstruction. Magnetic resonance imaging (MRI)
provides better soft tissue contrast than CT and is more
sensitive to detect extraocular muscle or periorbital fat
entrapment . However, MRI is not part of the standard
imaging protocol for orbital trauma . This may change
in the future, given that all subsequent stages of
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treatment benefit from optimized information
gathering at the diagnostic stage.
Advanced diagnostics
Extended diagnostics seeks to maximize the
information extracted from the available image data.
For this purpose, CT scans are imported into a virtual
surgical planning software. The CT scan is divided into
voxels (three-dimensional pixels), each with a gray
value corresponding to the absorption of X-rays in a
given volume. These voxels can be segmented
(grouped) based on the type of tissue or anatomical
structure to which they belong. Anatomical structures
of interest in orbital trauma are the orbit, the orbital
cavity, and possibly the surrounding bony structures,
such as the zygomatic complex. The segmentation is
visualized as supra-.
in a multiplanar view and as a 3D model. Additional
information can be gathered Through quantification
(e.g., volume measurement) or manipulation (e.g.,
mirror image)
Segmented anatomy. The unaffected contralateral
orbit and orbital cavity in unilateral fractures can serve
as a reference for the affected orbit, giving an idea of
the extent of the fracture and the displacement of the
orbital walls or the surrounding bony structures. The
volume of the affected orbit can be compared with the
volume of the unaffected healthy side to determine
the relative change in volume, because it has been
proven that the orbits are very symmetrical. These
volume changes can be incorporated into the
treatment plan. Information can also be extracted
from several sets of images. Image Image fusion allows
multiple datasets of the same modality to be aligned
over time or sets of images from different modalities.
Image sets can be simultaneously visualized and
evaluated after image fusion. The segmentation
process can also be based on information from several
merged modalities.
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Figure 2: Extended diagnosis for two cases. I: Single orbital reconstruction (A-D). (A) Visualization of a three-
dimensional model of the bone surface. (B) Segmentation of the unaffected orbit. (C) Mirroring of the segmented
orbit on the affected, contralateral side. (D) Visualization of additional structures such as the globe and ocular muscles.
II Fracture of the zygomatic (F) Segmentation of the unaffected side. (G) Mirroring of the segmentation on the
affected, contralateral side. (H) Visualization of displacement of the zygomatic complex.
Design of a preformed titanium orbital implant. Size modifications can easily be performed by reducing the
intersection bars.
Intraoperative image fusion of the preoperative (blue
outline) and intraoperative data set (orange) in coronal
view. In addition, the preoperative planning
(segmentation and mirroring) and the intra- operative
acquired was merged. The white arrow represents the
real implant position comparing with the virtual
planning one in red.
Virtual surgical planning (VSP) is a simulation of a real
surgery based on imaging data. It is based on
information gathered from previous treatment steps.
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The exact content of virtual surgical planning depends
on the type of implant. If a flat mesh plate is used,
virtual models of the mirror orbit and the affected orbit
can be exported and printed on a 3D printer to serve as
custom template(s) for bending when shaping the flat
mesh.
When
the
finished
implant
is
placed,
a
stereolithographic model (STL) of the finished implant
is imported into the planning environment to perform
a virtual reconstruction of the affected orbit. The
potential for implant placement is assessed and its
optimal position is simulated to accurately reconstruct
the pre-injured anatomy. Thus, the potential for VSP in
the pre-formed implant environment is highly
dependent
on
the
willingness
of
implant
manufacturers to provide STL files of their pre-formed
implants. In modern planning software, the implant
can be automatically aligned to another virtual model,
such as a mirrored orbit. Manual correction may be
necessary to prevent bone interference and provide
coverage of the orbital defect with adequate support
of the implant on the dorsal protrusion and the
possibility of fixation on the infraorbital rim.
The implant can be virtually trimmed to simulate a
medial or posterior implant cut. The surgery can be
simulated several times in virtual surgical planning,
with different implant types and sizes . This allows you
to compare pre-prepared implant options and make an
informed decision before surgery. The number of
attempts during virtual planning is unlimited without
consequences for the patient, unlike attempts during
actual surgery. Determining the optimal position in
virtual
planning
provides
the
surgeon
with
intraoperative feedback, which can reduce surgical
time and the amount of intra-orbital manipulation
during surgery.
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Figure 3: Virtual placement of various pre-formed implants for a single orbital fracture.
Three-dimensional models of the KLS Martin (A), Synthes (B) and Stryker (C) pre-formed implants are visualized with
potential incision lines (black lines) in the first column. Implants are virtually positioned (red outline) and the fit is
evaluated on the coronal, sagittal, and axial slices.
Adequate support (on the posterior prominence, on the medial wall, and on the
infraorbital rim) and no interference with the bone.
Patient-specific implant design
Orbital reconstruction with PSI is the final step in
individualizing orbital reconstruction. The PSI is
virtually modeled from scratch using information from
the (advanced) diagnostic stage and exported virtual
models. A prototype of the implant is created in special
design software. The prototype is imported into virtual
surgical planning and its fit is evaluated. The prototype
position is not adjusted in virtual surgical planning to
improve the fit, but the prototype design is adjusted
and the new prototype is re-imported. Although the
PSI design is not fixed in the protocols, various design
variants have been described in the literature. An
overview of the variants is given in Table 1. This
overview is not exhaustive, and new design variants
regularly appear in the literature. Structural
considerations can be categorized according to their
intended effect: stability, ease of positioning, accuracy
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of implant placement, or relief of clinical symptoms.
The size and shape of the implant depend on the
extent of the defect. The defect must be covered by
the implant, and its shape should reflect the intended
reconstruction of the affected orbital walls. Reliance
on existing bone structures is taken into account to
ensure stability of the reconstruction. Similar to pre-
formed implants, support is most often at three points
in the orbit. Fixation is recommended to ensure the
stability of the PSI. Possible screw positions can be
evaluated in virtual planning, considering the patient's
anatomy and local bone quality. Implant thickness and
the presence of an atraumatic cord around the edge
are factors that affect both implant stability and ease
of positioning during surgery. Thanks to the rigidity of
additively manufactured titanium, the implant
thickness of 0.3 mm combined with the atraumatic
cord provides a good balance between rigidity and
ease of positioning.
The accuracy of positioning of the implant can be
controlled by extending over the unaffected bone
supports. Extension of the implant over the bony
structures creates a secure fixation. Extension of the
infraorbital rim limits rotation and translation in the
anteroposterior direction. Additional flaps may be
placed on the posterior lateral wall to prevent
unwanted movement of the implant. The screw
positions from the fixation material of the previous
reconstruction can be reused in the secondary
reconstruction to provide guidance and thus increase
the accuracy of the implant positioning . Another
design option is the inclusion of navigation markers
and vectors that can improve the interpretation of
feedback from the intraoperative navigation system.
The last category, clinical symptoms, is related to the
correction of globe displacement.
overcorrection to counteract fat atrophy and
anticipated iatrogenic soft tissue loss.
The amount of overcorrection can be subjectively
determined at the time of surgery, by introducing
Orbital volume is corrected to reduce globe
displacement, but the volume can be after the equator
of the bulbus . On the other hand, hypoglobus are
additional struts, or it can be fully integrated into the
PSI structure, the posterior portion of which is the
result of caudal displacement of the infraorbital rim.
The anterior elevation, corresponding to the equator
of the bulbus . On the other hand, the hypoglobe is the
result of a caudal downward displacement of the
orbital rim, which can facilitate the hypoglobe.
Displacement of the infraorbital rim. The anterior
elevation corresponding to the amount of (Figure 4).
The PSI grid can be developed using a variety of
techniques: the use of a large downward displacement
of the orbital rim can facilitate the hypoglobe (Figure
4). A horizontal grid pattern for maximum drainage, or
a more porous arrangement of PSIs can be developed
using a variety of techniques: the use of a large
horizontal pattern for The multitude of design and
hand-design options results in a wide range of
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maximizing drainage, or a more porous arrangement.
The many possible forms of PSI
Design options and manual design result in a wide
range of possible PSI shapes
Figure 4: Examples of two patient-specific implant designs with overcorrection (red outline) in
mirrored orbital volume (yellow outline).
The first patient-specific implant is designed with an
anterior elevation on the infraorbital rim to
compensate for globe position asymmetry (A,B). The
second patient-specific implant is designed with a large
overcorrection to reconstruct the anophthalmic eye
socket (C,D).
Figure 5. Shows the different shapes of available prefabricated implants and patient-specific implants
There is a wide variety of shapes of patient-specific
implants. From left to right the rim extension
increases. From top to bottom medial wall support
increases
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The PSI design can be adapted to facilitate
reconstruction of multi-walled defects, for example, by
using multiple PSIs (Figure 6). This allows a
reconstruction that covers the entire defect, while
limiting the size of the PSI and, in turn, the required
incision [46,55]. Depending on the connection used, it
also provides an opportunity to create artificial support
and relative feedback. In cases with concomitant
fractures of the surrounding bony structures, orbital
reconstruction with PSI alone is not sufficient. In
addition to orbital reconstruction, repositioning of the
surrounding bone may be necessary. Additional design
options are available to provide PSI feedback on the
subsequent steps of reconstruction in these more
complex cases. Examples include incorporating the
desired position of the zygomatic complex into the PSI
design to facilitate proper repositioning
Figure 6. Patient-specific implant design for multivessel
cases. (A) The ridges on the orbital floor implant
provide relative feedback for positioning the lateral
wall implant. (B) Matrix-matrix connection to connect
the medial wall implant and the orbital floor. (C) The
orbital floor implant with medial wall extension is
connected to the lateral wall implant dorsally with
ridges and anteroposteriorly with a jigsaw joint. (D)
Quadruple wall reconstruction with hook-and-loop
connection for additional support of the orbital floor
implant.
Intraoperative feedback
During surgery, the surgeon strives to position the
implant as close as possible to the ideal position that
was established in the HSP. The presence of the VSP
provides intraoperative feedback, which improves the
outcome of the reconstruction [35]. There are
additional types of feedback that help with accurate
positioning of the implant (summarized in Table 2).
Design options related to implant positioning provide
static feedback through a unique and convincing PSI fit
(Figure 7). In secondary cases, reuse of screw positions
from the primary reconstruction will also help to find
the planned position.
Figure 7: Illustration of the different feedback
methods.). Markers and vectors are visualized in (A)
and (B). The convincing match of the patient-specific
implant design is indicated by red arrows (A-C)
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Segmentation of the screw holes of the previous
reconstruction is shown in red (D) and the previous
implant is shown in dark gray.
Surgical navigation can be used to provide dynamic
feedback of the implant position. During registration
for surgical navigation, the patient's position in the
operating room is linked to preoperative imaging data
in virtual surgical planning. There are several methods
of registration: soft-tissue registration, bone-fixed
fiducials, and surgical splints. Splint registration
methods used to require repeated radiographs with a
fiducial splint in place, but combining intraoral
scanning data during the in-depth diagnostic phase
allows a registration splint to be fabricated without
additional radiological imaging [59]. The splint is
designed taking into account the individual features of
the patient's dentition and contains fiducials that can
be specified virtually in the planning software and
physically in the operating room.
After registration, the position of the navigation
pointer in the patient is visualized in the virtual surgical
planning on the screen of the navigation system.
Once registered, the position of the navigation pointer
in the patient is visualized in the virtual surgical
planning on the navigation system screen. This
provides the surgeon with feedback on the position of
the pointer, representing the position of the specified
location (a specific point on the implant surface). The
quality and interpretability of the feedback can be
improved with navigation markers embedded in the
design [39,52].
The markers are indicated in the EP as navigational
landmarks and are used in the operating room as a
reference point. If the surgeon places a pointer in the
navigational marker on the implant, visual and
quantitative feedback about the position of the
pointer in relation to the landmark is provided.
Figure 8: Illustration of the evaluation. (A) Three-dimensional model of the planned patient-specific implant (red)
and the realized patient-specific implant (green) from different perspectives.
(B-D) Axial, sagittal, and coronal views of the
postoperative CT scan with the planned contour of the
patient-specific implant highlighted in red.
An optimally positioned orbital implant is no guarantee
for a perfect clinical result. Restoration of the globe
position can be achieved relatively well with PSI, even
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in secondary reconstructions [22]. The treatment of
diplopia is more difficult because it involves mechanical
eye movement, combined visual perception and
processing in the visual cortex. Visual processing can
(partially) adapt over time. On discharge, the patient is
informed that double vision will be present for the first
10-14 days, possibly longer.
Ocular mobility can be improved by training the
extraocular muscles to prevent scarring and anticipate
fibrosis [61]. Instructions are given to mobilize the eye
as much as possible: monocular orthoptical exercises
six times a day for 6-12 weeks to prevent adhesions and
to stimulate the reduction of orbital soft tissue edema,
especially for the extraocular muscles. This protocol
has a positive effect on clinical improvement in both
primary and secondary cases.
Several larger comparative studies have demonstrated
a positive effect of (components of) CAS on the
accuracy of volumetric reconstruction [62], clinical
outcomes [36], and the need for revision surgery [63].
In practice, a combination of several CAS components
is often used. This leads to heterogeneity of surgical
approaches, which makes it difficult to compare results
between studies. Differences in indications, patient
and fracture characteristics, and implant materials
used further complicate the comparison [64].
Determining the effect of individual CAS techniques on
patient outcomes is difficult because of the overlap
between the techniques in the groups studied.
Individual effects of CAS techniques have been
evaluated in a one-to-one comparison on a series of
cadavers [65]. Despite the limitations of the cadaveric
model and the inability to estimate clinical outcome
parameters, a positive effect of virtual planning,
intraoperative imaging, and surgical navigation on
reconstruction accuracy was found.
The best solution to achieve an optimal result [78] and
in the future can be accurately adapted to the
individual patient, provided the above knowledge gaps
are filled. Cost, turnaround time, and logistical
requirements are disadvantages of using PSI. Pricing.
can vary depending on geography, but typically the
process costs between 1,500 and 6,000 euros. Making
the implant takes about 3-5 business days; this amount
does not include sterilization or the time required for
virtual surgery planning and design. Korn et al.
described the average communication time between
the surgeon and the PSI technician during virtual
surgical planning, which was nearly nine days for
isolated wall fractures and 16 days for multi-wall
fractures [82]. Adjustments to the original design
proposed by the technician were required in nearly
three-quarters of cases, but implants placed by
technicians trained by the company required fewer
adjustments.
Improved
communication
and
understanding are believed to be the reasons for the
increased efficiency. Complete in-house planning and
design by a dedicated technician on site can improve
planning efficiency and ultimately significantly reduce
preparation time (assuming the surgeon and
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technician are experienced and have collaborated on
previous cases). In-house design is supposed to reduce
costs because the commercial partners rely only on
production. These advantages of in-house design may
be why surgeons using in-house planning feel less of
the disadvantages of using PSI .
Although this paper focuses on posttraumatic orbital
reconstruction, other orbital-related applications of
PSI have also been described. In cheekbone
reconstruction after trauma, ablative surgery or
congenital deformity, PSI has been found to accurately
restore anatomy without the need for additional bone
grafts. In secondary posttraumatic reconstruction of
the orbit and zygomatic bone, PSIs allow for a one-
stage surgical procedure in which the order of
operations is reversed: if the orbit is operated on first,
the functional result of orbital reconstruction does not
depend on repositioning of the zygomatic complex
[54]. PSIs can also be used to create an artificial rim and
orbital floor to support the globe after maxillectomy
[84,85]. The most extensive orbital reconstructions
using PSI have been described after resection of a
spheno-orbital meningioma or neurofibroma . In these
cases, reconstruction of all four orbital walls with
multiple PSIs allowed predictable reconstruction of the
internal orbital structure under the same surgical
conditions as the resection. The design of PSI in the
aforementioned cases may differ significantly from
that of posttraumatic reconstruction of single orbital
fractures. Nevertheless, the point of using PSI is the
same: freedom of design to adapt PSI to the patient's
anatomy and a predictable and accurate end result.
REFERENCES
1.
Холмурадов, Ж. Р., Холиков, А. А., &
Фаттаева,
Д.
Р.
(2022).
МЕТОДЫ
ОБСЛЕДОВАНИЯ
2.
БОЛЬНЫХ С ФЛЕГМОНАМИ ЧЕЛЮСТНО
-
ЛИЦЕВОЙ ОБЛАСТИ. Central Asian
3.
Research Journal for Interdisciplinary Studies
(CARJIS), 2(12), 97-101.
4.
2 . Фаттаева, Д. Р., Ризаев, Ж. А., Рахимова, Д.
А., & Холиков, А. А. (2021). CLINICAL
5.
PICTURE OF SINUSITIS IN PATIENTS AFTER
COVID-19 WITH CHRONIC
6.
OBSTRUCTIVE
PULMONARY
DISEASE.
УЗБЕКСКИЙ МЕДИЦИНСКИЙ
7.
ЖУРНАЛ, 2(2).
8.
Fattaeva, D. R., Rizaev, J. A., & Rakhimova, D.
A. (2021). Efficiency of Different Modes of
Therapy for Higher Sinus after COVID-19 in
Chronic Obstructive Pulmonary Disease.
Annals of
9.
the Romanian Society for Cell Biology, 6378-
6383.
10.
Холиков, А., Юлдашев, А., Фаттаева, Д., &
Олимжонов, K. (2020). ПЕРЕЛОМ ЧЕЛЮСТИ
11.
ДИАГНОСТИКА И ЛЕЧЕНИЕ. Stomatologiya,
(2 (79)), 88-93.
12.
Fattayeva, D. R. (2021). ADVANTAGES OF
EARLY DETECTION AND TREATMENT OF
Volume 03 Issue 05-2023
18
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
03
ISSUE
05
Pages:
05-18
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
6.534
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
13.
ODONTOGENIC
HEMORRHOIDS
IN
PREVENTING COVID-19
14.
COMPLICATIONS. British Medical Journal,
1(1.2).
15.
Холиков, А., Юлдашев, А., Фаттаева, Д.,
Олимжанов, К., & Худойкулов, А.
(2020).
Анализ современной эпидемиологической
картины
переломов
нижней
челюсти.
Журнал вестник врача, 1(4), 103
-108.
16.
V.V. Shamov, A.A. Kholikov, D.R.Fattayeva
(2022).
17.
Improvement of treatment methods of
combined traumas of maxillofacial region.
Periodica journal.
18.
(4).
19.
Hoffmann J, Cornelius CP, Groten M, Pröbster
L, Pfannenberg C, Schwenzer N. Orbital
reconstruction with individually copy- milled
ceramic implants. Plast Reconstr Surg
1998;101(3): 604
–
612
20.
Burm JS, Chung CH, Oh SJ. Pure orbital blowout
fracture: new concepts and importance of
medial orbital blowout fracture. Plast Reconstr
Surg 1999;103(7):1839
–
1849
21.
Nolasco FP, Mathog RH. Medial orbital wall
fractures: classification and clinical profile.
Otolaryngol Head Neck Surg 1995;112(4): 549
–
556
