An Orthodontic Index assessment and its relationship with total treatment time in surgery first orthognathic approach: an observational study.

BACKGROUND: The aim of this study was to highlight the connection between orthodontic difficulty before surgical treatment and in the transient malocclusion as evaluated by the mean of the of Complexity, Outcome, and Need (ICON) Score and total treatment time in surgery-first approach (SFA). METHODS: For each patient, the ICON Score was evaluated preoperatively and on the 3rd postoperative day in order to assess the orthodontic difficulty of presurgical occlusion and the transient malocclusion. RESULTS: Our group of patients at the preoperative stage showed score values between hard and very hard with only one patient scored as "easy" and nine "medium" patients. All scores lowered after surgical treatment. This confirms that the surgery first approach can change a malocclusion from not orthodontically treatable to an orthodontically treatable one. In our study, this was objectified by improvements in the ICON Score. CONCLUSIONS: In the conventional three-phase approach of orthognathic surgery the total treatment time found in literature is around 18-36 months. In our study, even the most difficult cases do not have a duration of more than 15 months This demonstrates that the surgery-first approach can reduce the total treatment time even in more severe cases.

Patient First: Surgery First and More.

INTRODUCTION: The success of surgery first approach has been defined by the number of advantages offered and is definitively determined by the satisfaction of the patients themselves. The strength of this protocol resides in its philosophy that puts the patient at the center of the whole diagnostic-therapeutic process. The compliance of the patient, its happiness and comfort are the best guarantee of a good final results. While pursuing this philosophy we have wondered whether there was way to increase the comfort of surgery first approach even more and to make it even more appealing for the patients. For these reasons, we have decided to work on a preliminary protocol in order to reduce or even eliminate the use of orthodontic braces and wires during perioperative stages. Materials and Methods: No orthodontic braces or wires are bonded on the teeth before surgery. Intraoperatory intermaxillary fixation (IMF) is carried out with the use of IMF screws which are positioned at the beginning of the operation on the edge between keratinized and nonkeratinized gingiva. Once the osteotomies are performed IMF with IMF screws is carried out on the planned occlusion with the use of surgical splints.Discussion and Conclusions: In selected cases the postsurgical orthodontic treatment can be carried out with the use of clear aligners, completely eliminating the need of braces and wires with an additional level of comfort.

OSAS surgery and postoperative discomfort: phase I surgery versus phase II surgery.

INTRODUCTION: This study aims to investigate the reasons that discourage the patients affected by OSAS to undergo orthognathic surgery and compares the postoperative discomfort of phase I (soft tissue surgery) and phase II (orthognathic surgery) procedures for treatment of OSAS. MATERIAL AND METHODS: A pool of 46 patients affected by OSAS was divided into two groups: "surgery patients" who accepted surgical treatments of their condition and "no surgery patients" who refused surgical procedures. The "surgery patients" group was further subdivided into two arms: patients who accepted phase I procedures (IP) and those who accepted phase II (IIP). To better understand the motivations behind the refusal of II phase procedures, we asked the patients belonging to both the IP group and "no surgery" group to indicate the main reason that influenced their decision to avoid II phase procedures. We also monitored and compared five parameters of postoperative discomfort: pain, painkiller assumption, length of hospitalization, foreign body sensation, and diet assumption following IP and IIP procedures. RESULTS: The main reason to avoid IIP procedures was the concern of a more severe postoperative discomfort. Comparison of the postoperative discomfort following IP versus IIP procedures showed that the former scored worse in 4 out of 5 parameters analyzed. CONCLUSION: IIP procedures produce less postoperative discomfort. IIP procedures, namely, orthognathic surgery, should be the first choice intervention in patients affected by OSAS and dentoskeletal malformation.

Anterior retrograde approach to the myofascial temporalis muscle for orbital reconstruction: series of 9 consecutive cases.

BACKGROUND: Among the reconstructive options after orbital exenteration, the temporalis myofascial flap (TMF) has been widely recognized as the one of the best available solutions. We think that the hemicoronal approach to harvest the TMF represents a disadvantage so we adopted a modified approach that we named the anterior retrograde approach to the TMF. METHODS: Nine patients with malignant orbital tumors underwent orbital exenteration and primary reconstruction with TMF harvested with the anterior retrograde approach. The temporalis muscle was widely exposed through the anterior incision used to perform the orbital exenteration. The harvested flap was then rotated and insetted to fill the orbital cavity. RESULTS: Neither cases of total/partial flap failure nor local/regional recurrence of tumor were recorded. The technique showed a significant reduction of morbidity, surgical time, and blood loss compared with the traditional technique. CONCLUSIONS: We think that the anterior retrograde approach should be considered as a valid alternative to the traditional hemicoronal approach.

Autologous fat transplantation for the temporalis muscle flap donor site: our experience with 45 cases.

BACKGROUND: Temporal depression after temporalis muscle flap transposition is characterized by a concavity of the soft tissue and associated with the relief of the orbital rim and zygomatic arch. The purpose of this study was to describe the use of autologous fat grafting for the treatment of postsurgical temporal contour deformities. METHODS: Between March 2008 and April 2011, 45 patients were treated with lipofilling. A virtual 3-dimensional preoperative assessment was used to objectively quantify the loss of volume of the affected side. Two different methods were used to evaluate the surgical outcomes. RESULTS: A noticeable soft tissue augmentation of the temporal region was noted in all cases. In 35 patients, a second procedure was required and in 1 patient, a third procedure was required. The final result was assessed as fully satisfactory by 39 patients (86.6%), as satisfactory by 5 patients (11.1%), and as unsatisfactory by 1 patient (2.2%). CONCLUSION: We believe that structural fat grafting at the temporalis muscle flap donor site is an effective technique that provides a high satisfaction rate and only a few complications.

Giant neglected desmoplastic ameloblastoma: reconstruction with free fibula flap.

The desmoplastic ameloblastoma (DA) is a rare variant of the conventional ameloblastoma. It accounts for only 4% to 13% of all ameloblastomas. In this article, we describe the case of a young child affected by a giant neglected DA of the jaw. Preoperative biopsy demonstrated the extremely rare osteoplastic variant of DA. The patient was submitted to segmental mandibulectomy and immediate reconstruction with a free fibula osseous flap. The postoperative period was uneventful. The patient was very satisfied with the functional and aesthetic results of the procedure. In case of such rare variants of ameloblastoma, it is mandatory to preoperatively recognize them to allow the adequate treatment modality to be provided.

Three-dimensional analysis and treatment planning of hemimandibular hyperplasia.

INTRODUCTION: The advent of computed tomography (CT) provided a useful instrument for diagnosis and surgical treatment of patients with craniofacial malformations. The development of software for three-dimensional graphic simulation applied to CT scan has made possible the three-dimensional computerized analysis, surgical planning, and simulation. This kind of analysis is particularly useful in case of complex facial malformations, making reliable a surgical treatment in 1 step. The purpose of this report was to present the diagnosis and treatment planning on a patient with hemimandibular hyperplasia by three-dimensional cephalometric analysis. METHODS: A 20-year-old young woman who presented with hemimandibular hyperplasia was investigated with CT scan and plaster cast mounted on an articulator; a two-dimensional manual and computerized cephalometric analysis was also developed on frontal and lateral cephalograms. Images in DICOM format were processed on a PC by means of commercial software, thus obtaining the three-dimensional reconstruction of the skeletal structures. RESULTS: Three-dimensional CT permits to program skeletal corrections and to foresee surgical outcomes with adequate realism. Surgical planning based on three-dimensional CT makes it easy and reliable to achieve the correction of the malformation in a single surgical intervention. CONCLUSIONS: The virtual three-dimensional CT model, a versatile diagnostic aid, has proven to be effective in the exact reproduction of bone and soft tissue anatomy, thus helping in the diagnosis, surgical planning, and simulations. Three-dimensional analysis is particularly indicated in case of complex asymmetric malformations, in which the more accurate reproduction of the individual anatomy can be very useful in implementing surgical results.