Maxillary sinus augmentation with autogenous tibial bone graft as an in-office procedure.

This retrospective study evaluates the efficacy of maxillary sinus grafting using autologous tibial bone in an outpatient setting. Twenty-seven patients undergoing lateral proximal tibial bone graft with subsequent sinus lifts were involved in this study. All surgeries were performed by the same surgeon in a private practice setting. A total of 28 tibial bone grafts and sinus lifts were performed on 27 patients. All subjects had minimal morbidity without any major complications. At the 1-year follow-up all implants that were placed into the grafted sites maintained stability, and no implants were lost. Two patients complained of hypertrophic scars at the site of bone harvesting (7.4%). One patient complained of leg pain for 10 weeks after the procedure, which resolved completely (2.7%). Overall complication rate was 10.1%. We conclude that the surgical harvesting of proximal tibial bone is associated with a low incidence of overall complications, mild postoperative pain, relative ease of harvest, minimal operative time, immediate ambulation, and rapid recovery, which make it an ideal office procedure when a significant amount of corticocancellous bone is required for maxillary sinus grafting.

Midmaxillary internal distraction osteogenesis: ideal surgery for the mature cleft patient.

BACKGROUND: Distraction osteogenesis is a recent technique often used for maxillary advancement to correct skeletofacial deformities in cleft patients. Conventional orthognathics falls short of achieving adequate stable results. Osteodistraction with Le Fort I osteotomy may create velopharyngeal incompetence. The authors propose a new technique for distracting only the anterior maxilla to improve aesthetics and occlusion while preserving existing speech patterns, using skeletally fixated intraoral devices. METHODS: Seven patients with cleft lip and palate aged 15 years 11 months to 26 years 5 months were selected. All osteotomies included horizontal anterior maxillary osteotomies created to the first molar and vertical osteotomies created between the second premolar and the first molars. Patients were evaluated preoperatively and postoperatively by a speech pathologist by means of fiberoptic video nasoendoscopy. RESULTS: Absolute bony anteroposterior movement ranged from 8 to 18.0 mm (average, 11.29 mm). Changes in skeletal facial profile (N- A-Pg) demonstrated approximately 18.61 degrees of correction in the conversion toward convex profiles. Patients were advanced to stable class I or mild class II relationships, and open bites were closed without development of hypernasal speech. CONCLUSIONS: This novel technique permits significant anterior movements, allowing dramatic improvements in functional and facial aesthetic outcomes. Furthermore, intraoral appliances allowed greater acceptance in this age group. Disadvantages include complicated orthodontic setup and surgical procedure, as well as the cost of occasionally necessary dental implants. No postoperative relapse was seen at an average follow-up of 33 months. This approach renders comfortable yet effective patient care, yielding optimum results while circumventing shortcomings of conventional techniques.