ABSTRACT
Objective@#To summarize the effect of simultaneous orthognathic surgery along with mandibular ramus reconstruction using costochondral graft, for adult M3 hemifacial macrosomia.@*Methods@#From November 2015 to October 2017, 5 adults diagnosed with M3 hemifacial macrosomia were treated. There were 3 males and 2 females, aged from 19 to 26 years. Le Fort Ⅰ osteotomy and SSRO with simultaneous mandibular ramus reconstruction using contralateral sixth or seventh costochondral graft was performed to correct the facial asymmetry and occluding relation. The data of clinical examination and CTs were collected at the time point of immediately postoperative, 1, 3, 6, 12 months after surgery. The facial symmetry, joint function, occlusion and 3D measurements in CT image reconstruction were analysed to evaluate the surgery outcome.@*Results@#The length of rib and costal cartilage ranged from 47 mm to 67 mm. All the costal cartilage grafts survived, and 4 patients got primary healing. All patients were followed for 2-13 months (with the mean follow-up of 8 months). The ratio of ramus length of affected side to normal side was over 80%. The occlusion was stable. The facial structures were satisfactory after 6 months.@*Conclusions@#Orthognathic surgery with simultaneous mandibular ramus reconstruction using costochondral graft is suitable for the adult severe hemifacial macrosomia, with satisfactory cosmetic and functional results. This method is easily performed with reliable graft survival rate, aesthetic facial structure and stable occlusion.
ABSTRACT
<p><b>OBJECTIVE</b>This study evaluates piezosurgery for surgically assisted rapid maxillary expansion (SARME) under local anesthesia.</p><p><b>METHODS</b>SARME was performed on adults with maxillary transverse deficiency under local anesthesia with a piezosurgical device. Fourteen patients (six males and eight females) underwent lateral maxillary osteotomies, midpalatal osteotomies, and bilateral pterygomaxillary disjunction. The feelings of patients during the operation were determined through questionnaires.</p><p><b>RESULTS</b>All patients underwent SARME in the out-patient operating room. The surgical procedures were completed under local anesthesia. All patients exhibited satisfactory tolerance. Ultrasonic bone-cutting surgery was recently introduced as a feasible alternative to the conventional tools of cranio-maxillofacial surgery for its technical characteristics of precision and safety. The device used was unique in that cutting action occurred when the tool was employed on mineralized tissues, but stoped on soft tissues. The results of the questionnaires showed that eight (57.14%) patients felt a mild sensation of ultrasonic vibration, tweleve (85.7 1%) felt mild tolerable pain and tooth soreness during surgery, and eleven (78.57%) felt little fear and hardly heard the ultrasonic sound. Preoperative and postoperative six months later measurements showed an evident effect of expansion.</p><p><b>CONCLUSION</b>Piezosurgery enabled patients to undergo all the steps of SARME under local anesthesia, but more cases and longer follow-up are needed to verif ' the results.</p>
Subject(s)
Female , Humans , Male , Anesthesia, Local , Maxilla , Palatal Expansion Technique , Piezosurgery , ToothABSTRACT
BACKGROUND: Dlx gene family is highly expressed in the cranial neural crest cells, and regulates the cranial neural crest cel migration and differentiation. OBJECTIVE: To review the mechanism that the highly-expressed Dlx genes mediate the cranial neural crest cel migration and differentiation. METHODS: An online search of CNKI and Medline databases was performed for articles published before 2013 using keywords of “cranial neural crest cells, migration of cranial neural crest cells, Dlx, Dlx overexpression, Fgf, chodrogenesis, osteogenesis” in Chinese and English, respectively. Relevant articles were summarized from three aspects: the migration of cranial neural crest cells, Dlx over-expression’s impact on the migration of cranial neural crest cells, interaction between the environment and Dlx genes. A total of 63 articles were included. According to inclusion criteria, 43 articles were retained at last. RESULTS AND CONCLUSION: Dlx abnormal-expression wil lead to cel -cel adhesion. Dlx over-expression wil induce most of the cranial neural crest cells aggregate and migrate to a wrong place, and result in skeletal dysmorphology. Dlx over-expression wil also lead to ectopic chondrogenesis, and the interaction between cel factors can be the possible reason for this.