A 3-Dimensional Evaluation of Bone Density in Alveolar Cleft Grafting Methods: Bone Substitutes Versus Autologous Bone.

INTRODUCTION: Secondary alveolar cleft repair using autologous bone graft is currently the gold standard in treating residual alveolar clefts. Despite its effectiveness, this technique is still burdened by several withdrawals, mostly related to donor site morbidity. To decrease disadvantages for patients, numerous attempts in the literature regarding bone substitutes have been described. The aim of this study is to compare the viability of bovine-based replacement bone material with respect of autologous bone graft in alveolar cleft reconstruction, through 3-dimensional alveolar cleft segmentation and bone density evaluation from preoperative and postoperative cone-beam computed tomography. PATIENTS AND METHODS: A retrospective cohort study of 10 patients who underwent surgical procedure for alveolar cleft grafting at Sant'Orsola Malpighi University Hospital of Bologna from December 2012 to December 2016 was undertaken. Five patients received autologous bone graft and 5 a bovine bone substitute graft. Preoperative and immediate postoperative orthopanoramic x-rays were recorded. Cone-beam computed tomography scans have recorded both pre and postoperatively. Volumetric evaluation on 3-dimensional cone-beam computed tomography images was performed. RESULTS: Alveolar clefts repaired using substitute bovine bone/biological membrane scaffold had a mean fill of 69.00% of total cleft volume, while this figure was of 67.07% with autologous bone grafting. The immediate postoperative course and subsequent discharge were uneventful for both groups, with a difference in timing. The cost of substitute bovine bone was offset by cost savings associated with a reduction in operative and postoperative and hospitalization time. CONCLUSIONS: Bone substitutes showed to be a promising solution in alveolar cleft grafting.

Congenital Ulcerated Lip Hemangioma Treated With a Cleft Lip Technique.

A neonate presented to our clinic for evaluation of unusual congenital cleft lip. The clinical follow-up showed at first an ulceration of the lesion and then a stable result after propanolol systemic therapy. After 18 months of clinical follow-up, surgical treatment was performed, which consisted of double unilimb Z-plasty according to Mulliken's microform cleft lip repair. Knowing the existence of these strange vascular anomalies of the lip will allow us to improve the differential diagnosis and treatment plan.

Secondary Cleft Lip Reconstruction and the Use of Pedicled, Deepithelialized Scar Tissue.

BACKGROUND: The optimal time to create symmetry in a cleft lip is during primary repair; a secondary effort later is more difficult due to potential scarring and possible tissue deficiency of the repaired cleft lip. A plethora of methods for secondary correction have been described that have the goal of constructing the philtral column, ameliorating bad scar results, and augmenting lip volume, for example. Nevertheless, there is no single procedure that yields completely satisfactory results. In addition, the appropriate timing for secondary surgical corrections of the cleft lip is still under debate. METHODS: We present a new technique for secondary lip reconstruction of unilateral and bilateral cleft patients using pedicled, de-epithelialized cleft scar tissue as an autologous graft to obtain sustainable lip volume. Our results were evaluated by physicians and patient-parent satisfaction surveys. RESULTS: The esthetic outcomes of 29 patients were assessed using a patient satisfaction questionnaire and a physician survey based on the preoperative and postoperative clinical images. The success of the procedure was evaluated using a 5-point scale. The total scores of both the physician and patient assessments were high, although no correlation was found between the scores. CONCLUSIONS: Cleft lip reconstruction using pedicled, deepithelialized scar tissue leads to excellent physician and patient satisfaction scores; this technique can be executed at any patient age and as a secondary repair for any given primary type of cleft disorder.

Facial soft tissue esthetic predictions: validation in craniomaxillofacial surgery with cone beam computed tomography data.

PURPOSE: Facial soft tissue prediction in orthognathic surgery could be a valuable aid to preview the results and determine the best surgical treatment. After many years, considerable difficulties are still present in the prediction of the clinical final aspect. The object of the present study was to validate new soft tissue simulation software (SurgiCase CMF; Materialise, Leuven, Belgium), using data acquired by cone beam computed tomography (CBCT), that makes it possible to foresee the final result. MATERIALS AND METHODS: Ten patients with craniomaxillofacial deformations underwent CBCT before surgery. Using the SurgiCase CMF software, the data were reconstructed in 3 dimensions, and various osteotomies were simulated in a 3-dimensional virtual environment by applying different surgical procedures. At 6 months after surgery, the patients underwent repeat CBCT. Thus, it was possible to superimpose the pre- and postoperative CBCT studies to evaluate the reproducibility and reliability of the software. RESULTS: CBCT simulations defined an average absolute error of 0.94 mm, a standard deviation of 0.90 mm, and a percentage of error less than 2 mm of 86.80%. CONCLUSION: The preliminary results have allowed us to conclude that simulations in orthognathic surgery for skull-maxillofacial deformities using CBCT acquisition are reliable, in addition to the low radiation exposure, and could become the reference standard to plan surgical treatment.

Maxillary expansion and stability in the orthodontic-surgical treatment of skeletal anterior open bites.

OBJECTIVES: Evaluation of the surgical/orthodontic treatment's stability using rigid internal fixation. METHODS AND MATERIALS: Seventeen patients presenting an anterior skeletal openbite, analyzed retrospectively to evaluate stability of surgical-orthodontic treatment using rigid internal fixation: mini plates and screws for maxillary fixation and bicortical screws for the mandible. The surgical procedures were Le Fort I osteotomy and bilateral sagittal split mandibular osteotomy. The patients were classified into 4 groups according to the characteristics described by Ellis (date): Group 1a (n = 4): Class II dental and skeletal malocclusions treated with one piece Le Fort I intrusion osteotomy and bilateral sagittal split mandibular advancement. Group 1 b (n = 4): Class II dental and skeletal malocclusions treated with multisegmental Le Fort I to expand surgically the maxillary width, intrusion osteotomy and bilateral sagittal split mandibular advancement. Group 2a (n = 5): Class III dental and skeletal malocclusions treated with one piece Le Fort I intrusion with/without advancement and bilateral sagittal split mandibular set-back. Group 2b (n = 4): Class III dental and skeletal malocclusions treated with multisegmental Le Fort I, expanding surgically the maxillary width, with/without advancement.