A systematic review and meta-analysis of the surgical outcomes in patients with osteochondroma of mandibular condyle.

Many options exist in the diagnosis and management of condylar osteochondroma. The purpose of this study was to provide a congregate information concerning treatment of the osteochondroma involving the mandibular condyle. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane database until February 2022. Twenty-seven studies were included for the final review. The review included 439 patients who underwent surgical management for mandibular condylar osteochondroma. The position of osteochondroma was mentioned in 13 studies. Preauricular, retromandibular, endaural, submandibular, transzygomatic, and intraoral approaches were used for approaching the tumor. Surgical techniques included resection, conservative condylectomy, and total condylectomy. Concomitant orthognathic surgery was performed along with tumor resection in 19 studies. In the entire review, the recurrence rate was 0.22% (1/439). The results of the meta-analysis showed that 2 studies reported significant malocclusion events after surgical therapy. Total joint replacement after tumor resection has a higher improvement in maximal mouth opening (8 mm) compared with vertical ramus osteotomy and no reconstruction groups, which have similar improvements (6 mm). The mainstay of treatment of osteochondroma is surgical excision either as condylectomy or conservative condylectomy. Among the various reconstruction modalities, total joint replacement showed better improvement in mouth opening. Adjunct procedures like orthodontic and orthognathic surgery have an important role in holistic management of severe cases. The treating surgeon must choose the surgical procedures in a pragmatic way.

Using an expanded scalp flap without fascial flap harvest or skin grafting for total auricular reconstruction in hemifacial microsomia with low hairline.

BACKGROUND: Total auricular reconstruction for hemifacial microsomia patients with extremely low hairline is a tough challenge in plastic surgery. In this work, a brand new technique using a singer expanded scalp flap without skin graft and combined with intense pulse light treatments (IPLT) for ear reconstruction is described in this special population. METHODS: From January 2015 to April 2019, 41 hemifacial macrosomia (HFM) patients with 70-100% low hairline were enrolled in our study. Operative treatment was performed in 3 stages: 1. Expander insertion and inflation; 2. Expander removal, costal cartilage framework fabrication and auricular reconstruction; 3. Tragus reconstruction and reconstructed auricle refinement. Several IPLTs were performed every 45 days until local area become hairless during the whole course. The first IPLT could be executed either before all the operations or during the expansion period. The flap was treated with M22 system using a filter of 695-1200 nm. Follow up ranged from 10 months to 4 years. RESULTS: During follow-up, 90.2% patients were surveyed as satisfied with the outcome, especially in the aspects of minimal scars, natural matched color and clear contour of the reconstructed ear. No serious complications happened. Patients starting the IPLT during the expansion period required less treatment times of depilation (p < 0.05). CONCLUSION: Auricular reconstruction using a single expanded scalp flap combined with intense pulse light depilation is a safe, effective and less invasive technique for hemifacial microsomia with extremely low hairline, and providing highly satisfying results. Initialing the IPLD during the expansion period is recommended. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Influencia del patrón morfogenético en el crecimiento y desarrollo / Influence of morphogenetic pattern on growth and development

Se plantean dos situaciones clínicas de pacientes adultos, hermanos, que presentan la misma maloclusión (Clase III con desviación mandibular hacia la izquierda), distinto sexo y biotipos faciales diferentes. En ellos queda de manifiesto en qué manera el patrón facial de cada individuo es determinante en la génesis de una maloclusión, teniendo una influencia directa en el pronóstico y plan de tratamiento. Uno de los casos se resolvió ortodóncicamente, con un tratamiento de compensación y extracción asimétrica del elemento 44, al tiempo que en el otro se efectuó un tratamiento ortodóncico-quirúrgico.

One-stage treatment to osteochondroma of the coronoid process and secondary facial asymmetry with coronoidectomy and reduction malarplasty: a case report and literature review.

PURPOSE: This study summarizes the literature concerning osteochondroma of the mandibular coronoid process and presents a case of 1-stage treatment for this condition and concomitant facial asymmetry. MATERIALS AND METHODS: A 20-year-old man presented with osteochondroma of the mandibular coronoid process. Radiologic images showed a mushroom-shaped coronoid growth inside the zygomatic arch with outward expansion. Coronoidectomy and reduction malarplasty were performed in 1 stage. The literature on osteochondroma of the mandibular coronoid process since 1943 was reviewed concerning etiology, pathogenesis, clinical characteristics, diagnosis, and treatment. RESULTS: At 20-month follow-up, the patient achieved markedly improved joint function and a symmetric facial appearance after excision of the osteochondroma. CONCLUSION: Coronoidectomy combined with simultaneous reduction malarplasty could be an alternative and promising method to treat osteochondroma of the coronoid process with secondary facial asymmetry.

Lasers and optical technologies in facial plastic surgery.

Lasers and optical technologies play a significant role in aesthetic and reconstructive surgery. The unique ability of optical technologies to target specific structures and layers in tissues to effect chemical, mechanical, or thermal changes makes them a powerful tool in cutaneous rejuvenation, hair removal, fat removal, and treatment of vascular lesions such as port-wine stains, among many other procedures. With the development of adjunct techniques such as epidermal cooling, lasers and optical technologies have become more versatile and safe. The constant improvement of existing applications and the emergence of novel applications such as photodynamic therapy, nanoparticles, spectroscopy, and noninvasive imaging continue to revolutionize aesthetic medicine by offering a minimally invasive alternative to traditional surgery. In the future, therapies will be based on individualized, maximum, safe radiant exposure to deliver optimal dosimetry. Lasers and optical technologies are headed toward safer, easier, more quantifiable, and more individualized therapy.

Transient femoral neuropathy after harvest of bone from the iliac crest.

A 31-year-old woman had bone harvested from the left anterior iliac crest as a graft for an augmentation genioplasty. For postoperative analgesia, she was given a bupivacaine infusion into the iliac wound. She developed a temporary left femoral mononeuropathy from which she recovered completely.

Cambios en el esqueleto facial y en las relacionés maxilares en distracción osteogénica mandibular / Facial skeletal and maxilary relations changes, following distraction osteogenesis of the medible

La Distracción Osteogénica (DO), es el método más innovador, simple y racional, para el tratamiento de la microsomía hemifacial, la segunda en frecuencia de todas las malformaciones craneofaciales; compromete diversas estructuras y órganos que afectan la calidad de vida del paciente. Presentamos la primera parte de un estudio descriptivo prospectivo, realizado en el Hospital Universitario de Cartagena, en Abril del 2001, con un grupo de siete pacientes, seis en edad escolar y uno en edad adulta, a quienes se les colocó un distractor mandibular para corregir los defectos óseos y oclusales, y ofrecerles así un tratamiento integral hasta su rehabilitación, tratando de identificar objetivamente los cambios adaptativos esqueléticos y oclusales inducidos por la distracción osteogénica. El análisis de los resultados según mediciones de Schwartz, mostró una elongación ósea de entre 5 - 31 mm, con resultados estéticos excelentes o muy buenos en la mayoría de los casos. sólo un paciente presentó resultado estético regular. En el análisis de crecimiento del cuerpo mandibular se observó un crecimiento fisiológico de 1 a 2 mm./año y un crecimiento anteroposterior armónico del maxilar y de la mandíbula en los pacientes en edad escolar.se observó una mordida abierta lateral posterior en la paciente de edad adulta y una mordida abierta anterior en un paciente en edad escolar relacionado con hábitos linguales. Evaluados los pacientes y sus modelos dentales en el período pre y post distracción, se observó compresión maxilomandibular con apiñamiento y desviación de los dientes en la línea media hacia el lado elongado en todos los casos, corregido mediante la aplicación de aparatología miofuncional tipo Frankel con resultados muy satisfactorios. Este estudio demuestra que los cambios adaptativos en el esqueleto facial y en las relaciones oclusales inducidos por la DO, pueden ser identificados y medidos objetivamente a través de técnicas radiológicas para mayor precisión en la evaluación y optimización de los resultados, cuyos efectos tienen claras repercusiones en el comportamiento y adaptación de los tejidos blandos, lo cual es el reto a seguir en futuras investigaciones (AU)

Treatment of condylar hypoplasia with distraction osteogenesis: a case report.

This report describes the surgical-orthodontic treatment procedures of a patient with condylar hypoplasia. Condylar hypoplasia is a major factor in any facial abnormality in a growing child. This case report describes a patient with a facial anomaly with an acquired unilateral condylar hypoplasia. His asymmetry was corrected by using functional therapy for the correction of muscle tonus and distraction osteogenesis for lengthening the mandibular ramal height. Fixed orthodontic appliances were used for conventional orthodontic therapy and final occlusal adjustment.

Clinical application of injectable calcium sulfate on early bony consolidation in distraction osteogenesis for the treatment of craniofacial microsomia.

The purpose of this project was to study the effect of calcium sulfate on early bony consolidation in distraction osteogenesis. A total of eight patients with craniofacial microsomia were treated between April 2000 and February 2001. The age of the patients ranged from 2 to 40 years, and all were male. The follow-up period was 1 to 15 months. The operative procedure in adults was based on Ortiz Monasterio's simultaneous mandibular and maxillary distraction technique. In children, osteotomy of the mandible was performed for distraction. On the fifth day after the operation, distraction was performed at a rate of 1 mm/d in three adults. In children, distraction was performed at a rate of 1 mm/d in one patient and 2 mm/d in four patients without a latent period. On the day of completion of distraction, calcium sulfate was implanted into the distracted zone. Radiographs showed bony consolidation at 4 weeks in one child at a rate of 1 mm/d, at 5 to 7 weeks in four children at a rate of 2 mm/d, and at 5 weeks in three adults after implantation of the calcium sulfate. In conclusion, these findings suggest that calcium sulfate is effective for early bony consolidation in distraction osteogenesis and that it would shorten the whole treatment period.

[Necrotizing osteitis of the mandibular angle with facial asymmetry due to tooth extraction--apropos of a case]. / Ostéite nécrosante de l'angle mandibulaire avec asymétrie faciale secondaire à une extraction dentaire--à propos d'un cas.

Five years after a tooth extraction, a bone necrosis of the mandibular angle happened, without consideration to the antibiotics. Such complication is rare. Living in poor socio-cultural and economic conditions, the patient tried to find help near tradipractionners, prayers groups, without any result. The treatment consisted to an extra oral incision, helping to eliminate bone sequestra, and the liquid around after a dynamic bimaxillary linkage by resin links was settled. About aetiology, only the questioning allowed to say that extraction was traumatic, putting in front of the surgical responsibility and post surgical survey.

Recovery of congenital facial palsy in patients with hemifacial microsomia subjected to sural to facial nerve grafts is enhanced by electric field stimulation.

The effect of electric field stimulation for promoting axonal growth between sural to facial nerve grafts in cases of congenital permanent facial palsy associated with hemifacial microsomia was studied. For this purpose, a total of 17 patients with unilateral congenital permanent facial palsy associated with hemifacial microsomia were studied pre- and post-operatively. A sural to facial nerve graft was performed in all cases and long term postoperative electric field stimulation was randomly applied to half of the patients. Although improvement occurred in both groups, the results indicated that clinical and electrophysiological recovery was significantly better in patients receiving post-operative electric field stimulation. The results, therefore, suggest that electric stimulation of the grafted area induces improvements of facial palsy over and above those observed in the non-stimulated patients.

Secondary reconstruction of the mandible with an aluminum oxide prosthesis.

A case is presented where secondary mandibular reconstruction with an aluminum oxide ceramic prosthesis was performed for a patient who had had an earlier hemimandibulectomy and primary bone graft for management of an ameloblastoma. Various factors that were considered in the construction of the prosthesis and problems encountered during operation are discussed. Although the prosthesis was found to be quite useful for the restoration of facial contour, the results of a long-term follow-up are needed to obtain a final evaluation of the reconstruction.