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To summarize, direct comparisons between vertebroplasty and kyphoplasty are difficult because of a paucity of data. Assessment of stability of the cervical spine in blunt trauma patients: review of the literature, with presentation and preliminary results of a modified traction test protocol. Checkpoints are positions in the cell cycle where progress can be arrested to prevent formation of abnormal daughter cells (see M, G1, and G2 arrests). A finger placed on the palatal side of the maxilla and posterior to the maxillary tuberosity will help verify complete separation of the maxilla from the pterygoid plates while avoiding trauma to the palatal vascular pedicle. Autonomic dysreflexia in acute spinal cord injury: an under-recognized clinical entity. Results There is no consensus on which instruments to use when measuring nonmortality trauma outcomes in general. Anoscopy, which involves stretching of the anal sphincters, was a more potent stimulus for autonomic dysreflexia. With a good light source and suction for visualization, the nasal cavity should be examined to reveal whether a bleeding site is arterial or venous in nature. Subaxial Cervical Facet Dislocation Acute cervical facet dislocation is commonly accompanied by devastating neurological deficits from spinal cord injury. Neurological Damage About 40% of all cervical spine injuries result in neurological damage. Intra- and inter-rater reliability of the anterior atlantodental interval measurement from conventional lateral view flexion/extension radiographs. Good visualization and ease of mobilization are the major advantages of this approach. The forehead and brow area must be entirely evaluated for a wide range of interlacing diagnoses. In an assessment of the reliability of five measures for kyphosis after thoracolumbar burst fractures, Kuklo et al26 found that the Cobb angle was the most reliable and least variable. On the other hand, the positive predictive value of utilizing these findings to assess neurological risk was 0. The periosteum is elevated to expose the lateral cortex, with care taken around the mental nerve, as well as leaving some attachment at the inferior border of the symphysis for the soft tissue chin. Systemically administered interleukin-10 reduces tumor necrosis factor-alpha production and significantly improves functional recovery following traumatic spinal cord injury in rats. This is largely because whiplash injury is determined by several factors, namely, energy of the trauma, direction of force, biomechanics, preparedness for the injury, social awareness, psychosocial attributes, and medicolegal aspects. Prospective evaluation of multislice computed tomography versus plain radiographic cervical spine clearance in trauma patients. Neurosurg Focus 2005;18:e4 37 Nonoperative and Surgical Management of Thoracolumbar Burst Fractures: A Systematic Review Lali H. Chronic neurological sequelae of acute trauma to the spine and spinal cord, V: the syndrome of acute central cervical spinal-cord injury followed by chronic anterior cervical-cord injury (or compression) syndrome. This is an interrupted strip technique in which the lateral crura are divided lateral to the tip-defining points. Patients need to be prepared to wear the external head frame device for at least 3 to 4 months, and approximately 6 months of reverse-pull headgear in the postoperative period. Fortunately, the use of screws and plates does improve the chance of obtaining a satisfactory result, in light of an unexpected fracture, with minimum further morbidity to the patient. However, there is some research and intuitive evidence that rigid internal fixation that permits mandibular movement soon after surgery may result in a more rapid return to preoperative mandibular movement without active physiotherapy. However, consultation with a surgeon before micropigmentation is important because placement of a permanent brow tattoo in a more elevated position may create problems if the patient desires a surgical brow lift later. Hair may return after an average 4- to 8-month dormancy period of the hair follicle. Surgical Options and Postoperative Management with Level of Evidence Determination Overview the need for surgical management of subaxial cervical distraction injuries depends on the extent of mechanical instability and neurological compromise.

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Orthodontics with vertical elastics can also be used to decrease or eliminate developing open bites during distraction, by a combination of molding of the bony regenerate as well as tooth extrusion. Robinson and Lytle69 stated that this osteotomy can be used for mandibular advancement, but generally this recommendation was not accepted owing to questionable stability. One way utilizes an Erickson model platform (Great Lakes Orthodontic Products, Ltd. The authors advocate normalizing the flow of cerebrospinal fluid by creating a pseudomeningomyelocele. In all five cases in which early implant failure had occurred, the initial stabilization had been anterior only. Sagittal osteotomies of the horizontal ramus have been described with either an extraoral or an intraoral approach possible. Finally, paired temporalis muscles are located in each temporal fossa, where they originate and then insert on the coronoid process of the mandible. Axonal regeneration into Schwann cell-seeded guidance channels grafted into transected adult rat spinal cord. Therefore, patients with evidence of these conditions require more extensive imaging modalities such as computed tomography and magnetic resonance imaging and low thresholds for surgical intervention if fractures are identified. Neurologic injury and recovery patterns in burst fractures at the T12 or L1 motion segment. Clinically, patients often present with preauricular noise or crepitus, limitation of mandibular motion, preauricular pain, and an anterior open bite occlusion. The influence of pre- and, intraoperative positioning of the condyle in the centre of the articular fossa on the position of the disc in orthognathic surgery. A retrospective study comparing the radiographic results between early ambulation with and without lumbar orthosis. Although not detailed in the published article, a multitude of search strings were employed in an exhaustive attempt to detect eligible articles. This very low quality study heralded the onset of future studies of surgical decompression for this patient population. Risks and benefit of each decision are discussed with the patient based on the given rules. Measurement of preoperative maxillary vertical at right canine and mesial buccal cusp tip of right first molar with a model block. Immediate postsurgical orthodontics should be approached aggressively to maximize high-quality occlusal results in the shortest time frame. Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Bohm et al28 used both segmental posterior transpedicular as well as ventrolateral instrumentation with a 3- to 5-year follow-up period of 40 patients. Experience with endoscopic interventions in diseases of the vertebral column [in Russian]. The finding of decreased airway dimension secondary to mandibular setback has been confirmed by other studies. A survey of the neurological results of 858 spinal cord injuries; a comparison of patients treated with and without laminectomy. Very little periosteum is stripped off the medial side, especially at the angle, to retain as much blood supply as possible to the proximal fragment. These structural polysaccharides form a major part of the extracellular matrix in humans. A qualitative synthesis of the published literature was planned because we hypothesized from the outset that there would not be a sufficient number of randomized, controlled trials to make a quantitative analysis worthwhile. Some surgeons believe it is better to place spreader grafts in those patients with short nasal bones so that compromise of the internal nasal valve does not occur. Increased residual deformity with laminectomy, short fusion, and by nonsurgical modality. The group additionally compared intra-arterial to intravenous administration in acute and chronic patients. Larger series, which may help answer whether the endoscopic management of thoracolumbar trauma improves early outcomes are shown in Table 50.

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Surgical correction of overbite and overjet with sagittal osteotomy of the mandibular horizontal ramus: report of case. Functional remodeling is expected to play a role in the growing process, yet overcorrection of 25% to 33% is advocated to allow for some relapse of the bony consolidate and expected lack of continued "normal" growth. The University of Miami Neuro-spinal Index was a very detailed system, but this resulted in it being a cumbersome rating system comprising 44 muscle groups and 30 dermatomes. Fracture luxation of the cervical spine in patients with ankylosing spondylitis: six cases [in French[. The aforementioned studies do not achieve a level of evidence that can guide a specific recommendation as to whether operative or nonoperative treatment is better when neurological injury is present. Inappropriate positioning of the condyles around posterior pivot points (A) will result in open bite (B) after release from maxillomandibular fixation. A deficiency of any of these vitamins negatively impacts operation of the cycle and impairs energy production. Prospective measurement of function and pain in patients with non-neoplastic compression fractures treated with vertebroplasty. Generation of induced pluripotent stem cells without Myc from mouse and human fibroblasts. The multidisciplinary team members must be sensitive to this timing when developing their communication plans. Lindsey and Zbigniew Gugala the axis is a unique second vertebra that plays a critical role in upper cervical spine motion and stability. However, the current level of evidence to support the use of these techniques compared with open techniques remains weak. Urban transport trends and policies in China and India: impacts of rapid economic growth. Mint green coverstick followed by a flesh-tone foundation will cover most bruises. The sickle cell mutation alters the primary structure and the charge by changing glutamate to valine. Late recovery following spinal cord injury: case report and review of the literature. Fusion of the craniocervical transition with "CerviFix" after survived atlanto-occipital dislocation [in German]. Together, the paired procerus muscles and corrugator are the main depressors of the medial brow and are the most common muscles treated with botulinum toxin type A to help alleviate frown lines in the glabella. Importantly, clinical exam and lateral cervical radiographs or fluoroscopy is frequently performed. A cognizant staff that is willing to educate patients and their families is an essential component of the multidisciplinary action plan. Posterior indirect decompression and fusion Conclusion Posterior distraction instrumentation can achieve 50% reduction in canal stenosis and that results will be influenced by fracture morphology. Validity of the three-column theory of thoracolumbar fractures: a biomechanic investigation. Therefore, the surgeon should attempt to maintain as much bone-to-bone contact as possible and use bone grafts at the buttress regions, when necessary. They suggested that the proximal fragment rotation affects the short-term pogonion changes, although they did not present any corroborative research. Special consideration must be given to the patient who has had previous palatal surgery or multiple segmental procedures or has a cleft palate. Altered contractile properties of the quadriceps muscle in people with spinal cord injury following functional electrical stimulated cycle training. The necessity of a formal fusion in the operative treatment of bony flexion-distraction injuries has been equally dogmatic, but this should be challenged.

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The goals of these strategies differ among researchers, with some aiming to produce new neurons that will integrate into functional circuits and others seeking to achieve oligodendrocyte differentiation and remyelination of demyelinated axons. Electromotive drug administration of lidocaine to anesthetize the bladder before intravesical capsaicin. In general, when large magnitude advancements of the maxilla are necessary (>8 mm), it may be difficult to preserve the palatine vessels, and they may be stretched to the point of severance, or to the point of thrombosis, so routine sacrifice may be the most prudent option. Causes of vitamin C deficiency (scurvy) include diets lacking fruits and vegetables. Without significant evidence that this is of much value, this additional surgery cannot be justified. Hypertrophic orbicularis oculi: this is a distinct and hypertrophic portion of the pretarsal component of the orbicularis oculi in the lower lid. Distraction injuries are often best treated by an approach in the direction of maximal soft tissue disruption. Position statement on percutaneous vertebral augmentation: a consensus statement developed by the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Association of Neurological Surgeons/Congress of Neurological Surgeons, and American Society of Spine Radiology. The authors reported a significant, short-term reduction in spontaneous and evoked pain. Roland-Morris disability scores were significantly better for the treatment group at both time points. In addition, the medial crura can be separated from the caudal septum to decrease projection. As an additional disclaimer, the injury list attempts to be comprehensive but could likely exclude some less common injury types. We observed no side effects in the captopril group, but flushing, tachycardia and headache were observed in 6 patients in the nifedipine group. The appearance and position of the soft palate, base of tongue, and lateral pharyngeal walls are evaluated. The information obtained from precise model surgery permits accurate surgical planning, reveals the three-dimensional changes that are planned in the surgery, and facilitates the exact positioning of the jaws. Maximum decompensation is often required with minimal clinical crowding, therefore, requiring first bicuspid extractions. The amount of velum to be excised is determined by the location of palatal competence and closure of the nasopharynx. Ten patients developed pulmonary infections, including a case of adult respiratory distress syndrome. The authors concluded that the Cobb angle provided the greatest reliability of measure. This can be caused by failure to obtain radiographs, or by making judgments on technically suboptimal films. For the patient who has adequate submalar fill, but requests solely malar augmentation, the malar shell implant configuration is convenient. Less severe cases are marked only by masculinization due to increased androgen production. Pure vertical axial load compression injuries on a straightened cervical spine are rare, and, in most cases, the spine is in slight flexion during the axial load. B: At a slightly lower level, the bronchial lumen appears obstructed and local invasion has resulted in a hilar mass (M). The highest loss of correction occurred 1 year after implant removal and averaged 6. This procedure can be done with a circumvestibular incision, or with bilateral horizontal incisions, in the caninemolar regions, and a vertical incision in the midline between the central incisors. Forty-four papers were identified wherein single-case studies and redundant publications of the same patient population were eliminated. Shanmuganathan et al (1996)60 Retrospective radiological review of 21 patients with traumatic isolation of the articular pillar Retrospective case series of 44 consecutive patients treated with posterior lateral mass plating Retrospective case series of 41 patients age greater than 65 with cervical spine fractures Very low the most common mechanisms for this injury were distractionflexion and hyperflexion-rotation. Reassurance should be given to the patient because most areas of minor skin necrosis heal without major sequelae. This has led some surgeons to recommend the use of a small flat (spatula) osteotome during the split, instead of the widesplitting osteotome, although this remains controversial.

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Many studies have shown that external reference points are more predictable and reproducible than traditional scribed lines, and, similar to model surgery, the external technique (and the technique described in Chapter 56) utilize reference points that are located at a distance from the osteotomy site. After inclusion of all eligible papers, cross-referencing was used to obtain the remaining articles. As such, most authors note that traumatic spondylolisthesis of the axis (C2) is the most appropriate term to denote these injuries. Minimal access spinal technologies: state-of-the-art, indications, and techniques. Randomized, controlled, double-blind trial, 26 patients were randomized for intersphincteric anal block with 1% lidocaine or normal saline (placebo) before the procedure. Here, the new vertical measurements are obtained at the right canine and mesial buccal cusp tip of right first molar with a model block. Upright, plain radiographs should be obtained in the hard collar prior to discharge. The overriding consideration, however, is that the balance of all these factors is not clear. Because the patient is unable to cooperate or communicate the history and physical exam components of the evaluation are lost. The radiculomedullary arteries provide collateral flow between the anterior and posterior spinal arteries and certain radicular arterial branches. Cell-cell signaling: release of signal molecule, binding of signal molecule to receptor, signal transduction. For a patient who does not respond to local attempts at management, or in whom the bleeding is severe or persistent, a return to the operating room for exploration of the surgical site and direct ligation or packing is recommended. The Braden Scale compared favorably with the Norton in sensitivity, and the Norton Scale had a tendency to overpredict risk with a higher specificity, which could lead to a greater number of patients receiving unnecessary and expensive treatments using the Norton Scale. Thirty-one of 71 patients had severe cervical cord injury, 17 had milder cervical injury, and 23 had thoracolumbar injury. It is possible to close dental spaces with segmental osteotomies, and this is frequently done in residual alveolar clefts. All five returned to play, with two, however, suffering recurrent disc at an adjacent disc space, with one requiring additional surgery (Table 23. Uncovering of 50% of the superior facet of the vertebra below the lesion (the "bowtie" sign) is seen in bilateral dislocation injuries, whereas a "double-sail" sign can be seen in unilateral dislocations. Indications for surgery and stabilization techniques of the occipito-cervical junction. The radiographic failure of single segment anterior cervical plate fixation in traumatic cervical flexion distraction injuries. The elevated blood pressure can cause a pounding headache, which is a common finding. Numerous modifications of the standard face-lift incision are available, but several general principles should be followed closely. With two of these forceps, significant torque may be placed on the maxilla to achieve mobility, but significant pressure on the palatal vascular pedicle may compromise blood flow to the anterior maxilla if used inappropriately or for an extended period of time, especially during segmental maxillary surgery and their use has been discouraged as a potential cause of aseptic necrosis of the maxilla. The same deformity can also be found after inferior repositioning of the maxilla and down graft. Simple rear-end collision excludes being pushed into oncoming traffic, being hit by large truck or bus, a rollover, and hit by a high-speed vehicle. Charcot arthropathy in relation to autonomic dysreflexia in spinal cord injury: case report and review of the literature. The vertical dimension of the triangular fragment is greater than its transverse dimension. Mechanistic classification systems, as already described, classify injuries based on force vectors, with one vector dominating the injury pattern. Heavy horizontal forehead creases can be addressed with this technique by way of either midline myotomies or minor midline thinning of the frontalis.

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Before (A) and after (B) photos following endoscopic forehead and brow lifting demonstrate good elevation of the lateral hooding but overresection of the medial depressors in the area indicated (arrow). The orbital septa of the lower and upper lids actually meet each other medially just deep to the orbicularis oculi muscle around the posterior lacrimal crest. There is disproportional loss of height in the anterior third of the disk, but the middle and posterior sections remain unchanged. Few comparative studies exist, and the majority of studies that were reviewed were of a retrospective, case series nature with a single approach applied to a heterogeneous set of injuries. These steps will minimize the amount of heat generation and decrease the chance of creating necrotic bone or root defects. In summary, improvements in overall care compared with the report by Bohlman appear to show decreasing incidence of neurological deterioration once a patient is admitted to an emergency department. Hypertrophy caused by allergy should be managed medically with antihistamines and topical corticosteroids. She had an orthodontic consultation and it was determined that orthodontic treatment alone or single-jaw surgery would be insufficient to correct her asymmetry. The latter procedure continues to be popular, with minor variations recommended by other clinicians. The duration of bracing could not be the Optimal Nonoperative Treatment for Stable Burst Fractures When assessing the literature for evidence to support the optimal nonoperative management of stable lumbar burst fractures, the 399 publications were narrowed to 15 studies that focused on the results of conservative management. When performing deep lip volumization, the needle is inserted into the middle of the lip at the level of the wet/ dry line and the filler is injected upon withdrawal. There was overlap by the other search pairs with this most broad search that brought the initial search to 126 manuscripts. The use of functional electrical stimulation for rehabilitation of spinal cord injured patients. Longitudinal growth is the result of enchondral ossification, whereas circumferential growth is due to perichondral and periosteal apposition. Cystinuria results from an autosomal recessive hereditary defect in the carrier protein that mediates reabsorption of dibasic amino acids. The helical rim should be seen just lateral to the most lateral presence of the antihelix from the frontal view. This disorder has become a huge societal problem involving millions of dollars in lost wages, medical bills, legal fees, insurance compensation, and public and private payment of disability and compensation claims. It is wise to review any and all patient instructions during the preoperative visit including medications, skin cleaning, and makeup. After anesthetic induction and patient positioning and preparation are completed, the face is widely draped to allow for visualization of the nose. Potential complications include dislodgment, disconnection, migration, catheter blockage, pump failure, infection, drug overdose, and drug withdrawal. Thickness does increase posteriorly near the occiput, but screw or bone tunnel fixation here is more challenging and is not required. The avulsion fragment remains attached to the disk, whereas the remaining portion of the vertebral body Neurological Damage Mild hyperextension injuries are notorious for producing disproportionately severe neurological complications compared with the structural damage incurred. This episode was also associated with bradycardia Five clinical reports mention the presence of hypotension in their clinical cohorts, but neurogenic shock was not investigated in a focused fashion. The teeth at greatest risk for damage are those in the mobile segment directly adjacent to the vertical osteotomies. The authors concluded that, "minimally invasive surgery with short posterior cannulated pedicle screws and balloon kyphoplasty with calcium phosphate could. Finger pressure on the freshly marked lobe, compressing it to the mastoid skin, produces a mirror image imprint forming a W-shaped (fish-tail) portion of skin to be excised. False tunnels along the temporal crest create problems when the endoscope is inserted through the parasagittal port to visualize the lateral forehead; the tunnels force the placement of the endoscope in a more superficial plane within the temporoparietal fascia, which greatly increases the chance of nerve injury.

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Schematic drawings of preoperative (A) and postoperative (B) two-jaw advancement, genial advancement, and hyoid suspension. The ophthalmic artery then gives rise to the supraorbital and supratrochlear arteries, which exit their respective foramina and supply the majority of the forehead and midscalp with blood. As proliferation continues, the edges of the neural plate fold up and eventually fuse to form the neural tube. This procedure is no longer commonly used because of problems with tip asymmetry, pinched appearance of the nasal tip, and longterm tip ptosis. Presurgical Records Dental Impressions Dental impressions are obtained with alginate at the final presurgical records appointment. Ten refused or were considering surgery and were observed with one reported death attributed to progression of his Charcot spine with nonoperative treatment. Posnick and Ewing7 showed that 24 patients without pharyngoplasty with mean maxillary advancements of 6. However, most patients do not manifest these disturbances because their ventilation during wakeful periods is sufficient to prevent these complications of chronic hypoxia. In a retrospective study, Vaccaro et al33 found that the propensity for neurological injury correlated more highly with the sagittal:transverse ratio than to the absolute area of the spinal canal. After drying the inferior fornix of the lower lid, a Schirmer strip is bent and inserted in the lateral aspect of the lower fornix. Changes in axonal physiology and morphology after chronic compressive injury of the rat thoracic spinal cord. An intraoral technique was not suggested until Ernst5 discussed his procedure approximately 25 years later. In practice, however, many surgeons feel that the collar provides feedback to the patient to avoid excessive movements while biological fusion is occurring. The indications for selection of specific treatment modality have not been identified. Traumatic atlanto-occipital dislocation; with case report of a patient who survived. Also an overall improvement of mobility in 88% of patients with no significant difference between groups. In conclusion, the strength of the final recommendation was determined according to the guidelines proposed by Guyatt et al. A biomechanical comparison of modern anterior and posterior plate fixation of the cervical spine. Compression of the posterior elements results in fractures of the articular joints and spinous processes. Based on the best available evidence, there is no clear clinical advantage of one approach over the other and as such this decision is often based on surgeon preference and should optimally incorporate injury- and patient-specific factors. Aesthetic Complications Inadequate correction of the ear deformity is the most common untoward result of otoplasty, often more obvious to the surgeon than to the patient. Caution must be taken also to avoid lateral placement because of thinness of the lateral skull and the middle meningeal arteries. Functional considerations of stem cell transplantation therapy for spinal cord repair. Albeit challenging, a well-performed temporal lift may be the ideal procedure for the right patient. Glucuronic acid reacts with bilirubin in the liver, forming conjugated (direct) bilirubin, which is water soluble. Biomechanics and biochemistry of the intervertebral disks: the need for correlation studies. After advancement with the standard surgical technique, the fragments are rigidly fixed with screws or bone plates. In a retrospective series of 54 patients, Randle and coworkers did not find that there was a difference between early (24 hours postinjury) and late (24 hours postinjury) intervention for cervical spine injuries treated with reduction and anterior stabilization in terms of neurological improvement.

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This chapter specifically addresses impaction (A1) fractures, which can be further subdivided into end plate impaction (A1. This Neck Pain Task Force conducted a systematic search and critical review of studies on neck pain and its associated disorders and from that data produced a Best Evidence Synthesis of the 552 studies accepted as scientifically admissible. All of these systems fall short of meeting the goals of a functional classification system. Data on delay in diagnosis was identified in one of the larger cohorts to amount to 76% (13 of 17 patients) using strict diagnostic criteria despite availability of all forms of imaging and utilization of a stringent trauma care algorithm. Allen et al14 developed a formal classification system (the Allen-Ferguson system) that focuses on mechanisms of injury inferred from radiographic images, and it is one of the most widely used systems today. Dressings should not be manipulated for evaluation until the first postoperative day. Vertebroplasty and kyphoplasty in osteoporotic fractures of vertebral bodies: a prospective 1-year follow-up analysis [in German]. Achieving acceptable results when decreasing projection can be difficult because nasal definition can be lost. Impaired mandibular growth and micrognathic development in children with juvenile rheumatoid arthritis. Only the anterior column is involved, rendering these injuries inherently stable and manageable by conservative methods. This chapter reviews what has been observed in the past and what technologies are currently under investigation or are on the near horizon. Anterior decompression in cervical spine trauma: does the timing of surgery affect the outcome The place of closed manipulation in the management of flexion-rotation dislocations of the cervical spine. If the mandible is set back any significant distance, a wedge of attached tissue over techniques. The patient should be instructed to limit activity and to use cold compresses over the eyes and brows. This trial will seek to randomize 30 patients to decompression within 5 days or after 6 weeks of injury. The who, what, when, and why of cosmetic surgery: do our patients need a preoperative psychiatric evaluation Inferior turbinate surgery: an adjunct to successful treatment of nasal obstruction in 408 patients. This system in addition provides the ability to identify the level of where a spinal injury occurred based on the most caudal level with normal function. Prognostic significance of the delayed plantar reflex following spinal cord injury. Characterized by slate gray cyanosis in early infancy without pulmonary or cardiac disease b. This may result in severance of the inferior alveolar nerovascular bundle on the medial aspect of the ramus from the oscillating saw used laterally on the ramus for the vertical osteotomy. Sodium: acid-base balance, osmotic pressure, muscle and nerve excitability, active transport, and membrane potential Sodium controls water movement between extracellular and intracellular fluid compartments. Deniz Olgun Pediatric spinal injuries, although rare, constitute an important cause of morbidity and mortality, not to mention the economical ramifications of healthy individuals becoming disabled. The second phase requires an assessment by different surgeons at multiple centers that allows appropriate adjustments to be made to the system so that a sufficient level of agreement may be achieved. Recognition of particular patterns of neurological deficits can help determine prognosis. When an unanticipated fracture occurs, the osteotomy must be completed along the original planned osteotomy lines. Some clinicians use dental plaster whereas others utilize a glue gun for the same purpose. The neurological 281 29 Cervical Burst Fractures the facet joints, and forward subluxation of the superior adjacent vertebral body. Reconstructive options must include free flap bone graft options (fibula) with associated soft tissue transfer, owing to the compromised blood supply in the area, which will not provide an environment conducive to support healing of a standard iliac crest corticocancellous bone graft. Although rare, airway obstruction resulting from a hematoma can occur after anterior cervical surgery.