RESUMO
Rigid external distraction is currently performed to correct cases of severe maxillary hypoplasia. As an improvement of this technique, we propose the use of an intranasal bone-borne traction hook. This study is a retrospective chart review of the intranasal bone-borne traction hooks used in the treatment of severe maxillary hypoplasia. There were 110 patients treated with the hooks from 2005 to 2017. The maximum traction force was 7.75 kg, and there were few complications encountered during distraction. There were 76 patients who had the hooks removed under local anaesthesia. A cephalometric analysis was conducted in 56 patients. The average advancement of A-point was 9.9 ± 4.2 mm, 8.4 ± 2.5 mm, 11.0 ± 3.7 mm, 17.9 ± 4.4 mm for the trans-sutural distraction osteogenesis (DO), maxillary anterior segment DO, Le Fort I osteotomy DO and Le Fort III/II osteotomy DO, respectively. The average changes of sella-nasion-point A (SNA) were 8.89 ± 4.30 degrees, 8.21 ± 3.17 degrees, 10.49 ± 3.26 degrees, and 15.10 ± 4.00 degrees, respectively. The A point-nasion-B point (ANB) also showed increases in all procedures with P < 0.001. In conclusion, this technique sufficiently advances the midface and ensures the scars are concealed in the nasal base. The traction hook can bear a large traction force, causes minimal complications and is easily removed.
Assuntos
Anormalidades Maxilofaciais/cirurgia , Osteogênese por Distração/métodos , Osteotomia de Le Fort/métodos , Instrumentos Cirúrgicos , Tração/instrumentação , Adolescente , Adulto , Anestesia Local/métodos , Osso e Ossos , Cefalometria/métodos , Criança , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Feminino , Humanos , Masculino , Anormalidades Maxilofaciais/diagnóstico , Nariz , Osteogênese por Distração/instrumentação , Osteotomia de Le Fort/efeitos adversos , Osteotomia de Le Fort/instrumentação , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: The aim of this study was to evaluate the relative effectiveness of stellate ganglion blockade (SGB) versus xenon light irradiation (XLI) for the treatment of neurosensory deficits resulting from orthognathic surgery as determined by a comparison of prospective measurements of electrical current perception thresholds (CPTs) and ranged CPTs (R-CPTs). MATERIALS AND METHODS: CPT and R-CPT in the mental foramen area were measured during electrical stimulation at 98 different sites on the body in patients who had undergone orthognathic surgery. After surgery, patients were assigned to the SGB group or the XLI group. CPT and R-CPT of the 2 groups were measured at stimulation frequencies of 2,000, 250, and 5 Hz before surgery, 1 week after surgery, and after 10 treatment sessions. Furthermore, the influence of surgical factors, such as genioplasty and a surgically exposed inferior alveolar nerve (IAN), was examined in the 2 groups. RESULTS: Patients' CPT and R-CPT values indicated a considerable amount of sensory disturbance in most cases after surgery. The change in magnitude of all CPT and R-CPT values for the SGB group decreased considerably compared with that for the XLI group after treatment. There was no correlation between CPT or R-CPT values and surgical factors (eg, genioplasty and exposure of the IAN). CONCLUSION: SGB of the IAN could be an effective method for treating neurosensory deficits after orthognathic surgery on the IAN.
Assuntos
Lasers de Gás/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Bloqueio Nervoso/métodos , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Complicações Pós-Operatórias/terapia , Distúrbios Somatossensoriais/terapia , Gânglio Estrelado/efeitos dos fármacos , Adolescente , Adulto , Anestésicos Locais/administração & dosagem , Estimulação Elétrica/métodos , Feminino , Seguimentos , Mentoplastia/efeitos adversos , Humanos , Masculino , Nervo Mandibular/efeitos dos fármacos , Nervo Mandibular/fisiopatologia , Nervo Mandibular/efeitos da radiação , Maxila/cirurgia , Mepivacaína/administração & dosagem , Pessoa de Meia-Idade , Fibras Nervosas Mielinizadas/efeitos dos fármacos , Fibras Nervosas Mielinizadas/fisiologia , Fibras Nervosas Mielinizadas/efeitos da radiação , Osteotomia de Le Fort/efeitos adversos , Osteotomia Sagital do Ramo Mandibular/efeitos adversos , Complicações Pós-Operatórias/radioterapia , Estudos Prospectivos , Limiar Sensorial/fisiologia , Distúrbios Somatossensoriais/radioterapia , Adulto JovemRESUMO
We present the reconstruction of near total aseptic necrosis of the maxillary alveolus that occurred after a Le Fort I osteotomy eight years previously.
Assuntos
Doenças Maxilares/cirurgia , Osteonecrose/cirurgia , Osteotomia de Le Fort/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Transplante Ósseo , Implantação Dentária Endóssea , Prótese Dentária Fixada por Implante , Prótese Parcial Fixa , Feminino , Humanos , Oxigenoterapia Hiperbárica , Doenças Maxilares/etiologia , Osteonecrose/etiologia , Perda de Dente/etiologiaRESUMO
Excessive blood loss is one of the major complications of orthognathic surgery. Numerous strategies, including hypotensive anesthetic techniques and blood transfusion, have been developed to deal with the blood loss. Blood for transfusions can be obtained from banked blood or from autologous donation. In this study, the authors looked at 2 groups of patients who had bimaxillary orthognathic surgery. One group included patients who had autodonated blood (group 1) and who were operated on between 1991 and 1993, and the other patients did not autodonate and were operated on between 1998 and 2000 (group 2). It was found that fewer than 50% of patients in group 1 were transfused, and none of the group 2 patients were. A protocol to lessen blood loss that should obviate the need for blood transfusion is proposed. It is concluded that blood transfusion should no longer be a consideration during routine bimaxillary orthognathic surgery.