Stability between single and segmental maxillary osteotomies in bimaxillary surgery for cleft-associated class III deformity: a CBCT study.

OBJECTIVE: Segmental Le Fort I osteotomy through the cleft is a common strategy to narrow the alveolar cleft in adults. This study compared skeletal stability between single and segmental Le Fort I osteotomies in patients with unilateral cleft lip and palate (UCLP). MATERIALS AND METHODS: This retrospective analysis examined 45 adults with complete UCLP-associated class III deformities who underwent bimaxillary surgery with either single (n = 30) or segmental (n = 15) Le Fort I advancement. Cone beam computed tomography (CBCT) scans of the facial skeleton were acquired before surgery, 1-week postsurgery, and at follow-up. Measures of landmarks from the CBCT images for the two treatment groups were compared for translation (left/right, posterior/anterior, superior/inferior) and rotation (yaw, roll, pitch). RESULTS: Postsurgery, the downward movement of the maxilla was larger in the segmental group than the single group. At follow-up, the maxilla moved backward in both groups, and upward in the segmental group. The mandible moved forward and upward and rotated upward in both groups. The amount of upward movement and rotation was larger in the segmental group than the single group. CONCLUSIONS: Two years after bimaxillary surgery in patients with UCLP-associated class III deformity, greater relapse was found after segmental Le Fort I osteotomies in vertical translation of the maxilla and mandible, and pitch rotation of the mandible compared with single Le Fort I osteotomies. CLINICAL RELEVANCE: The vertical relapse of the maxilla was larger after segmental Le Fort I advancement compared with single Le Fort I advancement in clefts.

Comparison of Skeletal Stability after Le Fort I Osteotomy With Bone Fixation Using Biodegradable and Titanium Systems: A Retrospective Study.

The titanium osteosynthesis system used for fixing bone segments after maxillary osteotomy provides reliable outcomes owing to its biocompatibility and adequate strength. In addition, several studies have evaluated the skeletal stability after maxillary osteotomy with fixation using a biodegradable system. However, the indications for applying a biodegradable system after maxillary osteotomy remain controversial. Therefore, this study aimed to compare the long-term skeletal stability of bone segments after maxillary osteotomy with bone fixation using biodegradable and titanium osteosynthesis systems and to assess the usefulness of a biodegradable osteosynthesis system. Patients who underwent Le Fort I osteotomy of the maxilla to correct jaw deformities between April 2008 and March 2021 were included in this study. A total of 45 patients were included, with 28 in the biodegradable osteosynthesis system group and 17 in the titanium group. Cephalometric and computed tomography analyses were performed to evaluate the skeletal stability of the bone segments after maxillary osteotomy with bone fixation using biodegradable or titanium osteosynthesis systems. The maxillary segment was repositioned anteriorly with a clockwise rotation. Skeletal stability was similar between the biodegradable and titanium osteosynthesis systems. Segmental changes occurred mainly in the first 6 months after surgery, and the segment was completely stable between 6 and 12 months after surgery. This study revealed no significant differences in skeletal stability after maxillary osteotomy between the biodegradable and titanium osteosynthesis systems. However, the findings in this study should be interpreted with caution owing to the small sample size and small amount of maxillary-segment movement.

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.

Scalpel Versus Diathermy in Wound Healing After Mucosal Incisions: A Split-Mouth Study.

PURPOSE: The aim of this study was to analyze and compare the healing of scalpel and diathermy incision wounds in the oral mucosa. MATERIALS AND METHODS: This is a prospective split-mouth study conducted from January 2015 to April 2017 among patients undergoing either Le Fort I or anterior maxillary osteotomy (or both). The study groups were classified based on the different techniques used to make the incision (group A, incision made by a scalpel; group B, incision made by diathermy). Wound healing was assessed on the first, third, seventh, and tenth postoperative days using the Southampton scoring system. Data were statistically analyzed using the Student t test for continuous variables and the χ2 test for categorical variables, and P < .05 was considered significant. RESULTS: Among the 113 participants included in the study, the age range was 16 to 35 years and male patients comprised 50.4%. The rates of postoperative complications of wound healing were 68.1% (n = 77) in group A and 77% (n = 87) in group B. Wound healing showed a statistically significant difference between the techniques (P < .001). CONCLUSIONS: The findings of this study suggest that wounds caused by scalpel incisions healed better than those caused by diathermy incisions in the oral mucosa.

Long-Term Stability of Pre-Orthodontic Orthognathic Bimaxillary Surgery Using Intraoral Vertical Ramus Osteotomy Versus Conventional Surgery.

PURPOSE: The aim of the present study was to compare the long-term stability of bimaxillary surgery using an intraoral vertical ramus osteotomy (IVRO) with and without presurgical orthodontic treatment. MATERIALS AND METHODS: The present retrospective study included 31 consecutive patients with skeletal Class III malocclusions who had undergone bimaxillary surgery (Le Fort I osteotomy and bilateral IVRO). Patients were divided into 2 groups based on treatment type: pre-orthodontic orthognathic surgery (POGS; n = 17) and conventional surgery with presurgical orthodontic treatment (CS; n = 14). Lateral cephalograms were obtained before surgery, 1 day after surgery, 1 month after surgery, 1 year after surgery, and 2 years after surgery to evaluate skeletal and soft tissue changes between the 2 groups. Data were analyzed using χ2 tests, Mann-Whitney U tests, repeated-measures analyses of variance, and independent t tests. RESULTS: There was no significant difference in skeletal or soft tissue measurements-with the exception of the angle between the sella-and-nasion plane and the occlusal plane (SN-OP; P < .001)-between the CS and POGS groups at 2 years after IVRO. The SN-OP had increased in the CS group but decreased in the POGS group at 2 years after surgery. CONCLUSIONS: These findings suggest that POGS and CS have similar long-term stability in patients with skeletal Class III malocclusion.

Effects of Pterygomaxillary Separation on Skeletal and Dental Changes After Surgically Assisted Rapid Maxillary Expansion: A Single-Center, Double-Blind, Randomized Clinical Trial.

PURPOSE: Surgically assisted rapid maxillary expansion (SARME) is a procedure routinely performed to correct transverse maxillary deformities and can be performed with or without pterygomaxillary disjunction (PD). The aim of the present study was to measure the effect of the amount of expansion and stability of SARME with or without PD. PATIENTS AND METHODS: We designed and implemented a double-blind, randomized clinical trial. The patients were randomly assigned to 2 groups: group 1, SARME without PD; and group 2, SARME with PD. Cone-beam computed tomography scans were performed at 3 points: baseline (T0), after maxillary expansion (T1), and at the end of the retention period (T2). Dental and bone expansion and dental inclination at the maxillary canine and first molar regions were assessed. Two-way repeated measures analysis of variance was used to evaluate the differences between the 2 groups at the 3 evaluation periods (T0, T1, and T2), using a level of significance of P < .05. RESULTS: A total of 24 patients underwent maxillary surgical expansion (group 1, n = 12; and group 2, n = 12). Both techniques promoted a significant transverse dental expansion in the first molar at T2 (with PD, 5.4 mm; vs without PD, 6.4 mm; change, -6.18 mm to 1.48 mm). However, no statistically significant differences were observed between the 2 groups. The tipping molars at T2 remained at a higher level in the SARME, no PD group than in the SARME, PD group (with PD, 2.3°; vs no PD, 4.6° for 3 teeth; change, -12.72° to 5.57°; and with PD, 1.6° vs without PD, 3.6° for 14 teeth; change, -9.96° to 9.83°). CONCLUSIONS: SARME with and without PD is a reliable method for obtaining maxillary expansion, with slight differences in the patterns of skeletal and dental alterations.

The U-Shaped Maxillary Osteotomy: A Novel Resource for the Treatment of the Middle Third Facial Hypoplasia.

The purpose of orthognathic surgery procedures is to manipulate the elements of the facial skeleton to reestablish normal anatomy and function. These elements could be repositioned with the technique known as Le Fort I osteotomy. This technique can be modified to be adapted on each patient, depending on the anomaly presented and the planned objective. The versatility, offered by the modifications of the Le Fort I osteotomy, has taken us to design one that allows the capability to correct the malar region hypoplasia in the same surgical procedure. A total of 9 patients were included with malocclusion as indication for orthognathic surgery who also presented with malar hypoplasia diagnosed clinically and cephalometrically. A modified technique, the "U"-shaped maxillary osteotomy, was performed with excellent functional and aesthetics results, and none of the patients presented complications associated directly to the maxillary osteotomy. Some patients with maxillary zygomatic deficiency combined with malocclusion continue to present a special challenge to clinicians treating these deformities. This technique is useful in improving zygomatic projection in bloc with the Le Fort I advancement without the need to place a bone graft and the advantage of rigid fixation along with the one used in the Le Fort I osteotomy. The U-shaped maxillary osteotomy is a safe, trustworthy, and reproducible technique that allows the resolution of the maxillomalar hypoplasia in a single surgical time, providing satisfactory aesthetic results. Any surgeon with adequate training in orthognathic or craniofacial surgery could perform it and incorporate it to his technical armamentarium.

Melanotic Neuroectodermal Tumor of Infancy in the Maxilla.

Melanotic neuroectodermal tumor of infancy is uncommon and has rapid expansile growth. Melanotic neuroectodermal tumor of infancy is a very rare and benign but locally aggressive neoplasm that originates from neural crest and is composed of relatively primitive pigment-producing cells. The lesion commonly affects the maxilla of infants during the first year of life. Common treatment methods include surgical excision and resection of the tumor. The aim of this article is to present the diagnosis and treatment of a patient with melanotic neuroectodermal tumor that occurred in the anterior maxilla of a 6-month-old male baby.

Horizontal Maxillary Osteotomy Stability Using Mandibular Outer Cortex Bone Grafts in Patients With Cleft Lip and Palate.

OBJECTIVE: To investigate horizontal maxillary osteotomy stability after using bone grafts for the treatment of patients with unilateral cleft lip and palate (UCLP). DESIGN: Retrospective cohort study. SETTING: Plastic surgery hospital. PATIENTS: Fifty-eight patients with UCLP and maxillary hypoplasia requiring a maxillary Le Fort I advancement of 6 to 9 mm. INTERVENTIONS: The test group (TG) was comprised of 28 patients who underwent mandibular outer cortex bone grafting in the gaps created by a modified Le Fort I osteotomy. The control group (CG) was comprised of 30 patients who underwent a Le Fort I osteotomy without bone grafts. MAIN OUTCOME MEASURES: Maxillary horizontal advancement (recorded during the operation using a Vernier caliper) and horizontal relapse at 12 months after surgery (based on a manual cephalometric analysis of pre- and postoperative lateral teleradiographs). RESULTS: In the TG, the mean maxillary horizontal advancement was 7.13 ±â€Š0.7 mm (range: 6.01-8.23 mm), and the mean postoperative horizontal relapse was 25.07 ±â€Š6.64%. In the CG, the mean maxillary horizontal advancement was 6.90 ±â€Š0.55 mm (range: 6.05-7.39 mm), and the mean postoperative horizontal relapse was 24.89 ±â€Š4.25%. There were no significant between-group differences in the mean horizontal relapses. CONCLUSION: The use of mandibular outer cortex bone grafts as physical barriers in patients with UCLP does not increase postoperative stability when the maxillary advancement is 6 to 9 mm.

Intra- and Postoperative Complications of Le Fort I Maxillary Osteotomy.

BACKGROUND: The Le Fort I maxillary osteotomy is a versatile and simple procedure, which has gained popularity nowadays, to correct a wide range of malocclusion and maxillofacial deformities. This procedure is often associated with significant but rare postoperative complications. The aim of this study was to evaluate the types and frequencies of intra- and perioperative complications related to Le Fort I osteotomies in noncleft Iranian patients. MATERIALS AND METHODS: In this prospective study, all the healthy systemic patients, (ASA I, II) with the age range of 18 to 30 years from both genders, who had the skeletal class II or III deformities and required only isolated 1-piece maxillary Le Fort I osteotomy, were included in this study. These patients had no craniofacial cleft history and were candidates for orthognathic surgery in Maxillofacial Surgery Department of Qaem Hospital of Mashhad (Iran), 2015 to 2017. All of the operations were carried out or supervised by a single surgeon and anesthesiologist using the same protocol. The patients were monitored for occurrence of intra- or postoperative complications till 6 months. The t-test, Chi-squared test, and Fisher exact test were performed for data analysis using SPSS version 16 (SPSS Inc, Chicago, IL). RESULTS: In the present study, a total of 114 consecutive patients with the average age of 22 ±â€Š5 years from October 2015 to November 2017 were recruited. About 77 (67.54%) patients were presented skeletal class III deformity and 37 (32.46%) were class II. The most prevalent maxillary movement after Le Fort I osteotomy was identified to be isolated maxillary advancement in 51 (44.75%) patients. Only 10 (8.77%) of all 114 patients confronted surgical complications. Hemorrhagic complication (arterial bleeding from descending palatine artery and epistaxis) and anatomic complications (septal deviation and bad fracture) would be the most prevalent complications with the frequency of 5.25% and 3.5% in total. Maxillary setback with impaction presented the highest rate (36.4%) of complications compared to other maxillary movement types. On balance, there was a significant association between Le Fort I surgery complications and maxillary movement types in our research (P = 0.002). CONCLUSION: The rate of intra- and postoperative complications following Le Fort I osteotomy for healthy noncleft adults in our center was low. Therefore, it can be concluded that this technique is safe and reliable. The maxillofacial surgeon should pay more attention for prevention or even management of the risk of intra- and perioperative complications in patients with anatomic irregularities (previous craniofacial cleft or trauma history) and those who required maxillary setback concomitant with impaction movements.

Assessment of the effect of the corticotomy-assisted orthodontic treatment on the maxillary periodontal tissue in patients with malocclusions with transverse maxillary deficiency: a case series.

BACKGROUND: The aim of the study was to assess the effect of corticotomy-assisted orthodontic treatment on soft tissue clinical parameters in patients with malocclusions with transverse maxillary deficiency. METHODS: The study included 20 generally healthy adult individuals with malocclusion, who underwent a corticotomy-assisted orthodontic treatment in maxilla. During the corticotomy performed after full-thickness flap elevation, only the buccal cortical plate was cut with the use of OTS-7, OTS7-4, OTS7-3 ultrasound tips of the piezosurgery device (Mectron s. p. a., Italy). A clinical examination was performed prior to the corticotomy procedure, then repeated - 3, 6, 9 and 12 months after the procedure. The following parameters were assessed: FMPI (full mouth plaque index), FMBOP (full mouth bleading on probing), PD (probing depth), CAL (clinical attachment level), GR (gingival recession height), RW (recession width), PH (papilla height), PW (papilla width), BS (bone sounding), biotype and KT. RESULTS: There was a statistically significant reduction in PD (mean difference: 0.06; 95% Cl: - 0.33, - 0.18), CAL (mean difference: 0.07; 95% Cl: - 0.33, - 0.19), PH (mean difference: 0.26; 95% Cl: - 0.47, 0.05) and BS (mean difference: 0.13; 95% Cl: - 0.41, - 0.14) after the treatment. Statistically significant changes were also noted in relation to KT (mean difference: 0.17; 95% Cl: - 0.07, 0.27) and biotype (mean difference: 0.07; 95% Cl: 0.26, 0.39), which thickness increased significantly after the treatment. No statistically significant differences were observed in GR, RW and PW. CONCLUSIONS: The corticotomy-assisted orthodontic treatment did not jeopardize the periodontal clinical status in maxilla. There is a need for further studies on a larger number of patient to compare the clinical findings with a control group as well as in patients with conventional orthodontic treatment in a longer follow-up time to find out more about the post-treatment periodontal tissue changes and stability.

Influence of Lateral-Medial Sinus Width on No-Grafting Inlay Osteotome Sinus Augmentation Outcomes.

PURPOSE: Intrasinus new bone formation (BF) has been observed after no-grafting osteotome sinus augmentation, and it is hypothesized to be influenced by the dimensions of the maxillary sinus. The aim of this clinical trial is to evaluate the influence of lateral-medial sinus width (SW) on no-grafting osteotome sinus augmentation outcomes using cone-beam computed tomography. PATIENTS AND METHODS: All patients recruited for this prospective study were treated with no-grafting osteotome sinus augmentation with simultaneous implant placement. Cone-beam computed tomography was obtained before, immediately after, and 6 months after the surgical procedure to use for measurements. Descriptive statistics were calculated and univariate, bivariate, and multivariate analysis were conducted to evaluate the influence of average SW and other relevant factors on procedure outcomes, including new BF, residual bone resorption (BR), and change of peri-implant bone height (CPBH). RESULTS: A total of 48 implants placed in 32 elevated sinuses of 29 patients were included. The average SW was 11.3 ± 1.8 mm. Intrasinus BF measured 1.7 ± 0.9 mm at 6 months after surgery. The amount of BR was 0.3 ± 0.9 mm, and CPBH was calculated as 1.3 ± 1.3 mm. Multivariate analysis showed a negative correlation between SW and BF (r = -0.469, P = .001), as well as between SW and CPBH (r = -0.562, P = .001). A positive correlation was discovered between SW and BR (r = 0.311, P = .027) in general. CONCLUSIONS: The lateral-medial SW was observed to have a negative correlation with new BF and CPBH after no-grafting osteotome sinus augmentation.

Split-Overlapping Genioplasty: Surgical Technique, Morphological and Radiological Long-Term Outcomes.

BACKGROUND: The overlapping bone flap genioplasty, described by Tessier, was developed to treat major retrognathia or long and retruded chins. For 15 years, we have used a modified version of this technique to avoid its drawbacks. The aim of this article is to describe our modification and evaluate the long-term morphologic and radiologic outcomes. PATIENTS AND METHOD: The authors included every split-overlapping genioplasty performed in our department between 2004 and 2014. Demographics, surgical data, and complications were recorded. Radiologic bone resorption was evaluated comparing preoperative, day-1 postoperative, and year-1 postoperative cephalometric x-rays. Morphologic outcomes were evaluated on standardized pre- and postoperative views using an analogic Likert scale. SURGICAL TECHNIQUE: The main modification of the procedure consists in separating the posterior cortex of the transplant using a reciprocating saw. After overlapping the reduced transplant onto the mandible, the posterior cortex is used as an apposition graft to soften the labiomental crease. RESULTS: Forty-seven patients were analyzed during this period. In 44 patients, the procedure was combined with mandibular and/or maxillary osteotomy. The average reduction of symphysis height was 5 mm, and the average pogonion advancement was 4.3 mm. After 1 year, we recorded 7% average bone resorption. No major complications (nerve injury, hematoma, among others) were reported. Morphologic outcomes were deemed satisfactory or very satisfactory in the vast majority of cases. CONCLUSION: Split-overlapping genioplasty is a safe and reliable procedure with stable, long-lasting outcomes. This versatile technique is particularly useful for the correction of a massive symphysis or high and retruded chins.

Frontal Changes in the Lower Face After Clockwise Rotation of the Maxillomandibular Complex Without Perisurgical Orthodontic Treatment in Angle Class I and Skeletal Class III Women.

BACKGROUND: Orthognathic surgery has become more popular to slenderize a wide lower face and to improve facial esthetics in Asian patients with normal occlusion. Clockwise rotation (CR) of the maxillomandibular complex (MMC) steepens the mandibular plane. This study performed a quantitative analysis on the influence of CR on slenderness of the lower face from the frontal view. PATIENTS AND METHODS: This retrospective study included 36 female patients with Angle Class I occlusion and skeletal Class III pattern. The subjects underwent CR of the MMC without perioperative orthodontic treatment and change in the occlusion only for the purpose of esthetic improvement. Linear and angular variables were measured on a cephalogram and three-dimensional computed tomography (3D CT) obtained before and at least 6 months after surgery. Data were analyzed using paired t tests and Spearman correlations. Univariate regression analysis was used to predict the postoperative change according to the amount of posterior impaction. RESULTS: The mean posterior impaction was 3.81 mm. All mandibular plane angle (MPA) measurements were increased (ranged from 5.69° to 13.12°, p < 0.001), exhibiting a significant correlation with the amount of posterior impaction. Bigonial width measurements were decreased after surgery (ranged from 4.97 to 5.51 mm, p < 0.001). Among the MPAs derived from the 3D CT, the coronal projection from the frontal view exhibited a discrepancy between right and left side. CONCLUSIONS: The changes in linear and angular measurements in this study indicate that the lower face becomes narrower and more slender as the MMC rotates in a clockwise direction. Orthognathic surgery with CR has the advantage of increasing the MPAs and obtaining natural soft tissue contouring while minimizing the amount of bone resection. LEVEL OF EVIDENCE IV: 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 www.springer.com/00266c .

Hydroxyapatite/Collagen Composite Is a Reliable Material for Malar Augmentation.

PURPOSE: To evaluate the long-term results of cheekbone augmentation using porous hydroxyapatite granules mixed with microfibrillar collagen in a large group of patients. MATERIALS AND METHODS: Four hundred thirty patients who underwent zygomatic augmentation and intermaxillary osteotomy were evaluated clinically, radiologically, and histologically. RESULTS: Complications were found in 13 patients (1.56%). There were no relevant radiologic differences in prosthesis volume after 1 month (T1) or after 24 months (T2) in any patient; there were no clinically relevant differences in 110 patients after 36 months. At T1, the prosthesis had a granular structure and the granules had not migrated; at T2, the prosthesis was staunchly adhering to the underlying bone. Over time, the radiopacity of the material increased. Histologic results of 19 biopsy specimens obtained from 8 patients 2 years after the procedure showed prominent ossification with low inflammation, confirming new bone formation over time. According to the visual analog scale, the patients were generally satisfied with the aspects that were considered. CONCLUSION: Hydroxyapatite and collagen composite used during malarplasty produced a successful outcome. Its main drawback is a learning curve that is longer than for more frequently used implantable biomaterials.

Effects of Le Fort I Osteotomy on the Nasopharyngeal Airway-6-Month Follow-Up.

PURPOSE: The literature discussing the impact of a single Le Fort I osteotomy on nasopharyngeal airways is limited. This study assessed the volumetric changes in the nasopharyngeal airway after a single Le Fort I osteotomy and explored the correlation between these changes and 3-dimensional surgical movements of the upper jaw. MATERIALS AND METHODS: This retrospective study was conducted in 40 patients who had undergone a single Le Fort I (maxillary advancement with or without impaction) to correct Class III malocclusion with maxillary hypoplasia. Preoperative (T1) and 6-month postoperative (T2) cone-beam computed tomographic (CBCT) scans of these patients were used for analysis. Maxillary surgical movements and volumetric changes in the nasopharyngeal airway were measured. The reproducibility of the measurements was evaluated using paired t tests and intraclass correlation coefficients. The Wilcoxon test and Pearson correlation coefficient were applied to evaluate the volumetric changes in the nasopharyngeal airway space and assess the correlations of these changes to the maxillary surgical movements. RESULTS: Six patients were excluded from the study owing to major differences (>5°) in their head and neck posture between the T1 and T2 CBCT scans. The errors of the repeated measurements were insignificant (P > .05), with a high level of agreement (r = 0.99; P < .05) between the repeated digitization of the landmarks. There was a statistically significant impact of a Le Fort I osteotomy on the right maxillary sinus (decreased by 17.8%) and the lower retropalatal space (expanded by 17.3%; P < .05). The correlation between the change in airway volume and the magnitude of surgical maxillary movements was moderate (r = .4). Similarly, there was a moderate correlation between changes in the upper nasopharynx and those in the hypopharynx. CONCLUSION: The single Le Fort I osteotomy was found to increase the retroglossal airway volume. This could be important for the treatment of obstructive sleep apnea in patients with maxillary deficiency. A long-term follow-up assessment of a larger sample with a functional assessment of airway would be beneficial to confirm these findings.

Which Patients With Ossifying Fibroma of the Jaws Would Be Suitable for Radical Ablative Surgery?

OBJECTIVE: The aim of authors' study was to present their 10-year experience in the treatment of giant ossifying fibroma (GOF), and to prove if GOF can be totally excised preventing recurrence. The authors' secondary goal was to study the aesthetic and functional outcomes after radical resection of GOF followed by immediate reconstruction. METHODS: Eighteen patients who underwent radical ablative surgery of GOF of the jaw followed by immediate reconstruction with vascularized fibula flap or ilium flap between May 2003 and May 2013 were taken. Recurrence rate was statistically observed and 2-year postoperative aesthetic and functional outcomes were evaluated. RESULTS: The average length of follow-up was 4.5 years. There was no residual tumor or tumor recurrence observed in any patient during the mean follow-up of 4.5 years, and good cosmesis and functional outcome was noted after ablative surgery of GOF followed by computer-assisted reconstruction. CONCLUSIONS: For giant OF, if it is mainly located in the jaws without invasion of the skull base and/or pterygoid process, radical surgical treatment should be performed for prevention of tumor recurrence. And good aesthetic and functional results can be achieved by immediate computer-assisted reconstruction and dental rehabilitation.

[Minimally invasive approach for Le Fort I osteotomy].

Orthognathic surgeries in which mobilization of the maxilla is required, are common procedures in the treatment of skeletal and developmental facial abnormalities. The Le fort I osteotomy is currently a safe, reliable and predictable procedure granting the surgeon good visualization and approach. However, these surgeries often involve substantial post operative swelling and pain, mostly due to the relatively extensive size of the mucoperiosteal approach flap. Several techniques have been previously reported in the literature, describing alternative approaches and novel instruments in an effort to reduce the intraoperative and postoperative challenges and complications of current surgical modalities. In this article we present a brief review of past and present maxillary osteotomy surgeries and describe our experience with a modified minimally invasive surgery in which approach to the maxilla is obtained through a smaller flap above the incisors, enabling sufficient osteotomy access, while limiting the extent of required surgical incisions and related post-operative complications.

Intraoperative detection of viable bone with fluorescence imaging using Visually Enhanced Lesion Scope in patients with bisphosphonate-related osteonecrosis of the jaw: clinical and pathological evaluation.

UNLABELLED: There is no standard surgical protocol of bisphosphonate-related osteonecrosis of the jaws (BRONJ), because of the impossibility to visualize this feature intraoperatively. The aim of this study was to introduce how to provide preoperative labeling of the viable bone with minocycline bone fluorescence technique (MBFT) by using VELscope® and investigate histopathologically. INTRODUCTION: The American Association of Oral and Maxillofacial Surgeons (AAOMS) and the Japanese Society of Oral and Maxillofacial Surgeons (JSOMS) now recommend a more conservative treatment strategy. There is no standard surgical protocol of bisphosphonate-related osteonecrosis of the jaws (BRONJ) because of the impossibility to visualize this feature intraoperatively. The aim of this study was to introduce a mechanism providing preoperative labeling of a viable bone using minocycline bone fluorescence technique (MBFT) with VELscope® and to histopathologically investigate. METHODS: This report describes a surgical technique used in six patients with BRONJ who underwent jawbone resection under minocycline bone fluorescence imaging using VELscope®. Subsequently, we investigated and compared the clinical findings using VELscope® and histopathological findings. RESULTS: Histopathological examinations showed that the non-fluorescent moiety was consistent with the BRONJ lesions. CONCLUSIONS: The surgical treatments that were exactly performed using MBFT with VELscope® offered successful management of BRONJ. This bone fluorescence helped to define the margins of resection, thus improving surgical therapy for extended osteonecrosis.