Total Maxillary Alveolar Osteotomy: Surgical Technique and Review of Its Efficacy.

PURPOSE: The total maxillary alveolar osteotomy (TMxAO) is not commonly used to manage maxillary skeletal deformities. This article describes the technique, reviews its stability, and discusses its advantages over the more popular Le Fort I osteotomy. MATERIALS AND METHODS: A series of 177 TMxAO patients satisfying the inclusion criteria from a cadre of 234 patients undergoing TMxAO between 1985 and 1993 were evaluated in a retrospective cohort study regarding achievement of predicted anatomic movements, stability of skeletal results, and preservation of inter-alar dimension. The patients were evaluated early postoperatively and at 11 to 14 months postoperatively, and the data were exposed to the Shapiro-Wilk test and analysis of variance and analyzed using SPSS software (version 21; IBM, Armonk, NY) at the 99% level of confidence (P ≤ .01). RESULTS: Only in 58% of patients did the designed millimetric study model changes correspond precisely to the millimetric changes disclosed in a comparison of preoperative and early postoperative cephalograms. Comparison of early and late postoperative cephalograms, with infrequent exceptions, described millimetric instabilities of less than 2 mm and angular instabilities of less than 2°. Despite 2 significant outliers, the average inter-alar instability as determined by direct measurement was 0.19 mm. CONCLUSIONS: This study suggests that the TMxAO compares favorably in stability with the Le Fort I osteotomy as recorded in the literature and, in terms of versatility, mobility of segments, avoidance of anatomic hazard, and preservation of nasal width, offers advantages in comparison.

Scleroderma and the temporomandibular joint: reconstruction in 2 variants.

PURPOSE: This article reviews the pathophysiology of scleroderma (systemic sclerosis [SSc]) and its destructive effects on the mandible in general and the temporomandibular joint (TMJ) in particular. It discusses the considerations of operating on patients with devastating chronic disease and presents 2 cases of TMJ reconstruction in patients with the diagnosis. PATIENTS AND METHODS: Two patients with different degrees of SSc involvement underwent TMJ reconstruction with costochondral grafts. The patients represent the surgical considerations pertinent to this disease and different outcomes as determined by the variance in severity of their afflictions. RESULTS: The 2 patients tolerated the surgeries well and exhibited improvement in function in the long-term. One patient thrives and continues to do well despite her SSc approximately 10 years postoperatively; the second patient died of her disease approximately 9 years after her initial surgical care. CONCLUSIONS: The experience with these 2 cases showed that patients with SSc can safely undergo TMJ reconstruction with anticipated good results, but that the overall severity of the disease remains paramount in determining the feasibility of corrective surgery under this diagnosis.

Multiple endocrine neoplasia type 2B: maxillofacial significance in 5 cases.

PURPOSE: This paper intends to review for the oral and maxillofacial surgery community the MEN abnormalities generally, to emphasize the maxillofacial abnormalities peculiar to the MEN2B variant particularly, and to demonstrate the importance of early recognition of its most important component, medullary thyroid carcinoma. PATIENTS AND METHODS: The findings in five individuals with confirmed diagnoses of MEN2B are arranged to demonstrate the various manifestations of the disorder, and together represent the largest single group in the oral and maxillofacial surgery literature to date. RESULTS: Tabulation of the patients' individual findings demonstrates the variants and severity of the disorder, discloses findings not previously emphasized in the literature, and stresses the significance of early recognition of medullary thyroid carcinoma. CONCLUSION: The evidence in this study group suggests that the oral mucosal lesions are more commonly neurofibromas than neuromas as previously reported, that the characteristic dental central diastemas may occur independent of tongue size or the presence of oral soft tissue lesions, and that the characteristic apertognathia potentially requires surgical correction.

Volunteer cleft surgery in Colombia: an 18-year perspective.

PURPOSE: To report the clinical findings and sociologic impressions of a volunteer surgical group's 18-year experience in Colombia. METHODS: Data were collected originally on hard copy and later in a customized database from the epidemiologic, anatomic, and surgical particulars of 2,410 patients with cleft undergoing 2,558 surgeries and analyzed retrospectively. RESULTS: This population exhibited an unusually high incidence of isolated soft palate compared with complete cleft palate and the highest incidence yet reported of bilateral cleft defects. Only 11 potentially life-threatening anesthesia or surgical urgencies or emergencies ensued in the 2,727 total operations, and no fatalities occurred. The sociologic and interprofessional gains of these volunteer efforts have been significant, but actual measurement of the speech, nutritional, psychological, and sociological gains of cleft surgery in this population are yet to be determined. CONCLUSION: This review shows the imperfect, but nonetheless overwhelmingly beneficial benefits that can be provided by volunteer surgical groups in developing nations.