Intraoral technique for locking reconstruction plate fixation using an implant handpiece with adapted drills.

BACKGROUND: Locking reconstruction plates are used in the treatment of jaw trauma and diseases if there is a need for surgical resection and to prevent pathologic fracture after tumor excision. Fixation is typically performed using an extraoral approach. METHODS: This article describes a technique for the intraoral fixation of locking reconstruction plates that uses prototyping to model the plate before the procedure as well as an implant handpiece with adapted drills for bone drilling and the insertion of screws into relatively inaccessible areas. CONCLUSION: Intraoral fixation not only prevents nerve damage and facial scarring but also minimizes the plate's risk of extraoral exposure and reduces surgical morbidity. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1436-1439, 2016.

Myositis Ossificans of the Temporalis Muscle.

Traumatic myositis ossificans (TMO) is a rare ossifying disease that occurs in the muscle or soft tissues. A case of TMO isolated in the temporalis muscle is reported. In the case described, calcification in the temporalis muscle was confirmed after computed tomography. Surgery, physiotherapy, and histopathological analysis were performed. One year after treatment, further ossification was present but without interference in function. The most accepted treatment for TMO in the maxillofacial region is excision followed by physiotherapy. The high rate of non-recurrence may be concealed due to the short follow-up period. TMO is a lesion that may frequently recur and long-term follow-up must be provided.

Unusual complication after genioplasty.

Facial beauty depends on shape, proportion, and harmony between the facial thirds. The chin is one of the most important components of the inferior third and has an important role on the definition of facial aesthetic and harmony in both frontal and lateral views. There are 2 principal therapeutic approaches that one can choose to treat mental deformities, alloplastic implants, and mental basilar ostectomy, also known as genioplasty. The latest is more commonly used because of great versatility in the correction of three-dimensional deformities of the chin and smaller taxes of postoperative complications. Possible transoperative and postoperative complications of genioplasty include mental nerve lesion, bleeding, damage to tooth roots, bone resorption of the mobilized segment, mandibular fracture, ptosis of the lower lip, and failure to stabilize the ostectomized segment. The study presents 2 cases of displacement of the osteotomized segment after genioplasty associated with facial trauma during postoperative orthognathic surgery followed by rare complications with no reports in the literature.

Correction of facial asymmetry resulting from hemimandibular hyperplasia: surgical steps to the esthetic result.

Hemimandibular hyperplasia is a facial deformity in which there is an increase in the condyle, neck of the condyle or ramus, and an occlusal cant. Different surgical treatments are proposed in the literature, from simple low or high condylectomy to more complex procedures combining osteotomies in different sites of the mandible. Surgical procedure is defined by the scintigraphic diagnosis of activity or inactivity in the center of condylar growth. The case report describes a 35-year-old female patient with hemimandibular hyperplasia on the left side with inactivity of condylar growth, successfully treated with bilateral sagittal split ramus osteotomy associated with a basilar osteotomy in form of "L" on the affected side. The surgical technique was easily executed, with an improvement in function, aesthetics, and patient satisfaction. Correction of facial asymmetry caused by excessive growth of the mandible using this basilar osteotomy in the form of "L" combined with bilateral sagittal split ramus osteotomy proved to be a relatively simple technique of easy execution with a low risk of nerve damage.

Implant handpiece with adapted drills in orthognathic surgery: preventing facial scars.

The attachment of bilateral sagittal-split osteotomy of the mandibular ramus with bicortical screws or the combination of miniplates and a bicortical screw is complicated through the intraoral approach because of the angle required for insertion of screws, so it is necessary to use a trocater. This article aimed to report a technique developed and used in 60 patients, wherein an implant handpiece with adapted drills was used in the intraoral attachment. The setting was performed intraorally to prevent scarring and extraoral facial nerve damage, which may be caused by extraoral and transbuccal approaches routinely performed when using the trocater. The versatility of the handpiece implant allows for the insertion of monocortical and bicortical screws and rigid internal fixation of mandibular sagittal-split osteotomy, as well as surgical time reduction, decreasing postoperative morbidity.

Pharyngeal airway changes in Class III patients treated with double jaw orthognathic surgery--maxillary advancement and mandibular setback.

PURPOSE: The pharyngeal airway may change after skeletal movement in patients who have undergone orthognathic surgery. The aim of this study was to evaluate the skeletal and pharyngeal airway changes in subjects with a Class III facial pattern who underwent double-jaw surgery (maxillary advancement and mandibular setback). MATERIALS AND METHODS: The present retrospective study assessed preoperative (T0), 2- to 4-month postoperative (T1), and 6- to 12-month postoperative (T2) radiographs of subjects with a Class III facial pattern treated at São Lucas Hospital (Porto Alegre, Brazil) using imaging software (Dolphin Imaging 3D 11.5). Five measurements of the pharyngeal airway space (nasopharynx; upper, middle, and lower oropharynges; hypopharynx) were evaluated and correlated with the skeletal movement of the jaws (lines perpendicular to the Frankfurt horizontal plane passing through the nasion point to points A and B). The Student t test for paired samples was used to assess the presence of significant differences between the intervals, and the Spearman correlation coefficient was used to assess the significant correlation existing between the skeletal movement and the pharyngeal airway changes. The results were considered at a maximum level of significance of 5% (P < .05). RESULTS: In the sample of 58 subjects (38 female and 20 male, 18 to 48 years old), measurements of the nasopharynx, upper oropharynx, and middle oropharynx increased, whereas measurements of the lower oropharynx and hypopharynx decreased during these periods (T0 to T1, T0 to T2). Decreases from T1 to T2 in the measurements of the nasopharynx and upper oropharynx were also identified. A correlation between the jaw movements and the change in airway measurement was found between the line perpendicular to the Frankfurt horizontal plane passing through the nasion point to point A and the nasopharynx and between the line perpendicular to the Frankfurt horizontal plane passing through the nasion point to point B and the lower oropharynx for T0 to T1 and T0 to T2. CONCLUSIONS: A correlation between skeletal movements and changes in the measurements of pharyngeal airway was found between maxillary advancement and the nasopharynx, with proportions of 102.8% and 85.5% in the short and medium terms, respectively, and between mandibular setback and the low oropharynx, with proportions of 44.8% and 43.5% in the short and medium terms. A correlation for pharyngeal airway measurements was found between those located anatomically near each other, showing the importance of the pharyngeal muscles in this relation.

Impacted foreign bodies in the maxillofacial region-diagnosis and treatment.

Foreign bodies are often encountered by oral and maxillofacial surgeons and may present a diagnostic challenge to the trauma surgeon due to many factors such as the size of the object, the difficult access, and a close anatomic relationship of the foreign body to vital structures. They are usually a result of injuries or operations. Fragments of broken instruments can be left behind and entire teeth or their fragments can be displaced during extraction. The approach to this kind of injury should be sequential and multidisciplinary, beginning with the trauma unit that will provide maintenance of the airways, hemodynamic stabilization, and, but only if necessary, neurologic, ophthalmologic, and vascular evaluation. With a view to illustrating and discussing the diagnosis and treatment of this kind of injury, this study reports impacted foreign bodies in oral and maxillofacial region. The following data were collected: age, sex, race, etiology, occurrence of fracture, anatomic location of the fracture, daytime of the traumatic event, type of the object, signal and symptoms, type of imaging examination used, type of anesthesia, approach, transoperative complication, period between surgery and hospital liberation, and the occurrence of death. Foreign body injuries in the maxillofacial region can place the patient's life at risk, so a correct initial treatment performed by a multidisciplinary team increases the survival of this kind of patient.

Embolization of pseudoaneurysm of the internal maxillary artery after orthognathic surgery.

In orthognathic surgery, Le Fort I osteotomy is one of the most often used methods for the correction of dental-facial deformities and is considered technically safe. However, this procedure may lead to diverse complications, including uncommon vascular complications. A clinical case is described of late development of pseudoaneurysm in one of the branches of the maxillary artery in a 20-year-old patient who had undergone Le Fort I osteotomy, bilateral sagittal osteotomy of mandibular branch, and mentoplasty and subsequently treated with embolization. The main forms of treating vascular injuries are reviewed, and embolization is demonstrated to be a technically safe procedure with few complications.

Manejo gengival em maxilas totalmente reconstruídas por enxertos e implantes / Gingival management in totally reconstructed maxilla by grafts and implants-case report

Os tecidos moles desempenham um importante papel para o resultado das cirurgias com implantes. Várias técnicas estão reportadas na literatura para aumentar a quantidade de gengiva ceratinizada ao redor dos implantes. Este artigo apresenta uma técnica de avanço do retalho palatal realizada durante a cirurgia de reabertura dos implantes em maxilas totalmente edêntulas reconstruídas com blocos de crista ilíaca.