Pedicled Tragal Chondral Flap for Interpositional Gap Arthroplasty in a TMJ Ankyloses.

Interpositional gap arthroplasty has shown good results; however, these techniques could be improved by taking into account the biological bases of the tissue used. Therefore, we suggest the pedicled tragal chondral flap as a safe, simple, and low-morbidity alternative.

Open Reduction of Condylar Fracture Through a Modified Endaural Approach.

Throughout history, several authors have extensively modified approaches to temporomandibular joint surgery to improve access, improve aesthetics, and decrease the risk of nerve damage. In this report, we propose the reduction of a medial condylar fracture through the modified endaural approach, being a safe approach for the facial nerve, effective, aesthetic, and simple to perform.

A Novel Method for Lengthening Iliac Crest Grafts for Mandibular Reconstruction.

The objective of this article is to propose a technique for mandibular reconstructions of up to 17 cm, in order to obtain anterior iliac crest grafts smaller than those required, and then lengthen them using corticotomies. This technique has been performed in 5 patients with an indication for reconstruction after partial mandibulectomy due to pathology. Reconstruction of the body of the mandible, including the angle in some cases, was performed using nonvascularized anterior iliac crest grafts. These were elongated using corticotomies and fixed to cover the defect using reconstruction plates and screws (2.4 system). The wedge spaces that were formed by lengthening the bone block were grafted with autologous medullary bone and platelet-rich plasma. There was no loss of any of the grafts and there was no need for second surgical times to place more grafts. All cases were able to be rehabilitated with removable prostheses or dental implants. This method optimizes the amount of graft obtained, favors revascularization of the graft, reduces hypoxia times and allows the placement of osteoconductive and/or osteoinductive grafts directly on the exposed medullary areas, with the aim of promoting integration and reducing the resorption rate in large grafts.

Management of Bilateral Condylar Fractures in an Edentulous Patient with Atrophic Mandible Using CADCAM Technology.

Purpose: The objective of this article is to report the case of an edentulous patient with a diagnosis of bilateral condylar fracture, who was treated using virtual planning. Methods: CAD/CAM technology was used for the design and manufacture of a Gunning splint, which was employed for open reduction of the right fracture and closed management of the left side. Results: The reduction of the right condylar fracture projected in the planning was achieved, as well as the return of the vertical dimension and the restoration of function, after 28 months of observation. Conclusion: In the case of total edentulism, the lack of occlusal guidance and bone atrophy are important variables to consider; however, tools such as CAD/CAM technology can be used to take more predictable treatment decisions and facilitate the execution of the procedures.

Potential role of active decompression with distraction sugosteogenesis for the management of odontogenic cystic lesions: a retrospective review of 10 cases.

PURPOSE: The aim of this paper is to describe active decompression and distraction sugosteogenesis as an alternative for the management of odontogenic cystic lesions. The technique, demographics, success rate, and complications will be presented. PATIENTS AND METHODS: A retrospective case series study design was implemented. This included patients found in our database from 2015 to 2018 with a diagnosis of any odontogenic cyst, in whom active decompression with distraction sugosteogenesis was implemented. The patient's medical history, demographics, radiographic characteristics of the cyst, technique/device employed, complications, and rate of success were recorded. RESULTS: The sample consisted of 10 patients, with a mean age of 19.6 years (range 14-34). Sixty percent of all cases occurred in male patients and 40% in females. Forty percent of cases were consistent with odontogenic keratocysts with all cysts presenting in the mandible. No maxillary cases were documented. Seventy percent of such lesions were unilocular and 30% multilocular. Cortical fenestration/perforation was documented in 30% of cases and 1 pathologic fracture was seen. Active decompression was performed for an average of 37 days (range 30-50 days). With this system, radiographic resolution occurred in 1-3 months in 50% of cases, 6-12 months in 30% of cases, and 12 months in 20% of cases. Mean follow-up was 24.3 months. No recurrence was documented. Complications included fistula development (2 cases), flap dehiscence (1 case), and the size of the intraoral unit. CONCLUSIONS: This investigation reviewed the authors' 5-year experience employing active decompression with distraction sugosteogenesis for the management of odontogenic cystic lesions and showed that this is a reliable alternative for the management of odontogenic cysts.

Correlation between MRI-diagnosed joint effusion and demographic, clinical, imaging, and arthroscopic findings of the temporomandibular joint.

Our study aimed to evaluate the diagnostic accuracy of MRI in cases of joint effusion and documented its relationship with clinical and arthroscopic findings. A cross-sectional study was carried out, using the following selection criteria: clinical, radiological, and MRI-based diagnosis of joint pathology; joint pain; and indication for minimally invasive management with arthroscopy. Arthroscopic analysis, included synovitis, adhesions, chondromalacia, and disc perforations. These variables were recorded and compared with MRI findings of effusion. Data were analyzed using chi-square and Fisher's exact tests. In total, 44 temporomandibular joints were studied, of which 38 corresponded to women; 21 cases were diagnosed as Wilkes IV-V, with effusion found in all of them. The presence of effusion was significantly related to synovitis (p = 0.031) and adherences (p = 0.042). Pain was significantly related to the presence of effusion (p = 0.002), Wilkes advanced stages (p = 0.006), synovitis (p = 0.031), and adherences (p = 0.004). Regarding maximum mouth opening, there was no significant correlation with the variables studied, aside from gender and Wilkes classification. There was a significant correlation between the presence of joint effusion detected by MRI and clinical and arthroscopic findings. This suggests that effusion diagnosed by magnetic resonance has a significant value. Therefore, an adequate presurgical examination should be considered before submitting the patient to an invasive diagnostic procedure.

Postoperative neurosensory impairment perception using ultrasonic BoneScalpel and conventional rotary instruments after bilateral split sagittal osteotomy.

PURPOSE: Although bilateral sagittal split osteotomy (BSSO) is the most widely used surgical technique for the correction of mandibular dentofacial anomalies, it is associated with lesion of inferior alveolar nerve (IAN) and unwanted neurosensory disorders. The aim of this study was to document the perception of changes in sensitivity and mean recovery time after BSSO, using an ultrasonic BoneScalpel versus the conventional rotary instruments. PATIENTS AND METHODS: This retrospective observational study included all patients with diagnosis of skeletal anomaly who underwent advancement or setback BSSO of less than 10 mL, using the ultrasonic osteotome or conventional rotary instruments. The patients were operated on at the Hospital Universitario Clínica San Rafael, Bogotá Colombia, between 2017 and 2018. The primary predictor variable was the osteotomy technique. The primary outcome was the presence or absence of postoperative sensory alteration, whereas secondary outcomes were time of appearance and recovery, affected anatomical region, laterality, and disturbance in daily activities. Data were analyzed using Chi-square, Mann-Whitney U, and Fisher's exact test. RESULTS: Data of 38 patients were retrieved, of which 23 were operated with BoneScalpel and 13 with the conventional technique. Twenty patients were women and 18 were men. All patients reported experiencing at least one type of sensory disturbance immediately after the surgical procedure. There was a significant difference (p = 0.0001) in the time that the alteration was present between the two groups, in favor of the BoneScalpel group. The chin and the lower lip were the anatomical regions with the greatest alteration in sensitivity and persistence of it. CONCLUSIONS: The results of this study indicate that BoneScalpel is effective in performing BSSO. They also suggest that it may reduce the occurrence of nerve damage during BSSO, although more research on this topic is required.

The Use of Inferior Meatal Antrostomy to Decrease Sinusitis with the Placement of Zygomatic Implants.

PURPOSE: To present a case series treated by inferior meatal antrostomy as a prophylactic maneuver after the placement of zygomatic implants to decrease the risk of sinusitis. MATERIALS AND METHODS: All patients undergoing zygomatic implant placement using the lower meatal antrostomy protocol between June 2011 and March 2019 at the Department of Oral and Maxillofacial Surgery, Universidad El Bosque, were included. Patients were evaluated after 12 months of the procedure using clinical and radiologic criteria described by Kuriyama and Reiskin. RESULTS: Forty-eight patients were included, in whom 184 implants were placed. Complications were as follows: paresthesia (6.2%), orosinusal fistula (4.1%), skin infection (2.1%), and loss of the implant (1.6%). There were no cases of sinusitis. CONCLUSION: This study provides evidence that the technique is effective and should be considered because of its simplicity. The inferior meatal antrostomy has been proven to be a simple, effective, and reliable technique to decrease the risk of sinusitis associated with the placement of zygomatic implants.

The Morpho-Functional Three-Dimensional Analysis for Zygomatic Implants: A Clinical Tool With Surgical Implications.

ABSTRACT: Zygomatic implants (ZIs) have been used successfully for the rehabilitation of jaws with severe atrophy for the past 2 decades. The development of computed tomography, three-dimensional (3D) analysis software, and stereolithographic models has positively impacted the development of preoperative planning. This article describes the protocol developed by the Department of Oral and Maxillofacial Surgery of El Bosque University, Bogotá, Colombia, through 10 years of experience, for the installation of ZIs, covering from the times when the implants were placed through intraoperative guidance, until now, in which drilling guides developed by computer-aided design and computer-aided manufacturing are used, without neglecting in their design multiple factors that must be considered. To date, this protocol for the treatment of patients with atrophic jaws through ZIs includes a detailed clinical examination, in which variables such as bone and dental relationship between the jaws, oral opening and dynamic interaction between soft cervicofacial tissues are considered. It also includes a 3D computed tomography planning for the design and preparation of surgical guides whose insertion patterns must be executable during surgery. Together, clinical and imaging analysis converge in what it has been called morpho-functional 3D planning.

Endoscopic Approach for Insertion of Custom-Designed Facial Implants.

ABSTRACT: The objective of this article is to describe the combination of virtual planning used to produce a custom-made facial implant, along with the minimally invasive endoscopic approach used to place it, for the reconstruction of the frontal bone. This management reduces the sequelae that occur with the traditional incisions while restoring the proper contour of facial surfaces at the same time.

Active decompression and distraction sugosteogenesis for the treatment of calcifying odontogenic cyst.

The calcifying odontogenic cyst is as a benign, rare developmental odontogenic cyst with a wide range of histologic characteristics. It may present along with other odontogenic pathologies such as odontoma, ameloblastoma, adenomatoid odontogenic tumor, ameloblastic fibroma, and ameloblastic fibro-odontoma. Clinically, it can be an either intra- or extraosseous painless swelling that can produce cortical expansion. It affects mostly the anterior area of the mandible. Radiographically, it appears as a well-circumscribed unilocular radiolucency containing flecks of indistinct radiopacities. In about one third of cases, an impacted tooth is associated. In this paper, we employ a patient with an enormous calcifying odontogenic cyst to review both the pathology and active decompression and distraction sugosteogenesis, a novel technique employed to treat odontogenic entities. This dual approach usually results in an accelerated bone healing (sugosteogenesis), partial removal of the cystic epithelium, thickening of the wall, and migration of chronic inflammatory cells which triggered epithelial modulation, ultimately causing a realignment in the biologic behavior of the lesion.

Previously Reported Approach Now Used for Temporomandibular Joint Replacement.

Over time, different techniques have been described to obtain broad access to the temporomandibular joint (TMJ), in order to allow good visibility, minimizing post-operative complications at the same time. Most of these techniques have been very useful to perform joint replacement using custom made prostheses, varying in its extension, aesthetics and functional results. The aim of this study was to present the authors' experience using the Blair approach modified by Fernández in 2015, to replace failed TMJ prostheses, when distortion of the surgical reference points has occurred.

Pedicled Tragal Chondral Flap for Irreparable Temporomandibular Joint Disc.

Several techniques have been proposed for the management of perforation of or severe damage to the temporomandibular joint disc, with a wide range of success rates reported. We describe a new method using a pedicled sliding flap of the tragal cartilage.

Is the Mandibular Growth Affected by Internal Rigid Fixation?: A Systematic Review.

PURPOSE: The purpose of this systematic review was to evaluate, in animal model-based studies, whether there are mandibular growth alterations, after open reduction and internal rigid fixation with titanium plates and screws. METHODS: A literature search was conducted using the MEDLINE, EMBASE, and LILACS databases, up to and including August 2015. Surgical reduction and internal rigid fixation (IRF) of induced fractures were compared to non-invasive procedures, in order to investigate if there were alterations in the mandibular growth patterns. RESULTS: Of a total of 624 potentially relevant papers identified through the searching process, five were eligible for inclusion. Three studies using 3-month old New Zealand white rabbits induced fractures of mandibular body or symphysis and internal fixation with titanium microplates and screws, whereas two were based on 6-month old goats with condylar fracture. None of the studies showed statistically significant difference between experimental and control groups. CONCLUSION: As literature regarding this subject is scarce, and the included studies show low level of evidence, it is not possible to conclude that open reduction and internal rigid fixation with titanium plates and screws cause significant growing alteration of the mandible.

Conversion of Aneurysmal Bone Cyst into Fibrous Dysplasia: A Rare Pediatric Case Report.

Aneurysmal bone cyst (ABC) is an uncommon, non-neoplastic, expansive and erosive bone lesion. Considered as a pseudocyst due the lack of epithelial lining, the presence of giant cells and similarity to other lesions can make preoperative diagnosis difficult; biopsy findings must be co-related to complete clinical and radiological assessment. ABC's controversial etiopathogenesis and variable clinicopathological presentations have been widely described, but to date, there are just a few reports in literature describing the development of fibrous dysplasia (FD) from an ABC, and even less cases occurring in the jaws. We describe the case of an ABC in an 8 year-old male patient, affecting the body of the mandible, which showed accelerated growth associated to thinning of the buccal, lingual and lower cortical plates. The treatment consisted of repetitive surgical resection, curettage of the lesion and mandibular reinforcement with osteosynthesis reconstruction plates. A 16-month follow-up showed self-limitation of the overgrowth. The final histopathological and radiological analysis confirmed the FD diagnosis.

Inferior Meatal Antrostomy as a Prophylactic Maneuver to Prevent Sinusitis After Zygomatic Implant Placement Using the Intrasinusal Technique.

PURPOSE: To determine whether performing an inferior meatal antrostomy as a prophylactic intraoperative maneuver in patients who underwent zygomatic implant surgery significantly reduces the incidence of postoperative sinusitis. MATERIALS AND METHODS: A double-blind randomized controlled trial was implemented. The study included 44 patients seen at the Oral and Maxillofacial Surgery Department at Universidad El Bosque in Bogota, Colombia, who required zygomatic implant surgery. Patients were randomly allocated to either group 1 (without inferior meatal antrostomy) or group 2 (with inferior meatal antrostomy). Patients were evaluated clinically and radiographically 15 days and 3 months after surgery, and classified depending on whether they did or did not develop sinusitis. Results were analyzed using descriptive and bivariate statistics. The control group event rate, experimental group event rate, relative risk, relative risk reduction, absolute risk reduction, and number needed to treat values were calculated for further analysis. RESULTS: Three patients allocated to group 1 showed clinical and radiographic signs of sinusitis after zygomatic implant surgery, for an overall rate of sinusitis of 13.6%. No patient in group 2 developed clinical or radiographic signs of sinusitis. CONCLUSION: The results of this study suggest that performing an inferior meatal antrostomy as a prophylactic intraoperative maneuver in patients who require zygomatic implant surgery is an effective method to prevent postoperative sinusitis.

Modification of Blair Approach With a Modified Endaural Component to Access the Parotid Region.

OBJECTIVE: The aim of this study is to present our experience with a modification of the Blair approach to the parotid area, by means of a modified endaural component, which provides both excellent exposure and optimal functional and esthetic results, mainly over the preauricular area. PATIENTS AND METHODS: A retrospective case series study was performed. It included surgical cases of patients who were operated on the parotid region in which the mentioned approach was indicated. The information was collected from the database available at the Universidad El Bosque Oral and Maxillofacial Surgery Department in Bogota, Colombia from 2008 to 2013. RESULTS: The sample consisted of 12 patients, with ages ranging from 23 to 56 years and a mean age of 38 years. A total of 8 patients were women and 4 patients were men. Parotid pathologies included salivary gland tumor (10 patients) and cranial base tumor (2 patients). Procedures executed were: superficial lobe and total parotidectomy resection, pharynx extended and cranial base tumor resections. CONCLUSIONS: This investigation presents our experience with a modified approach to the parotid region. This approach gives an extended and safe exposure to the region with excellent cosmetic outcomes.

Mandibular Symphyseal L-Inverted Midline Osteotomy to Correct Mild Laterognathia and Malocclusion.

OBJECTIVE: The aim of this study was to present the authors' experience with a new surgical technique to correct mild laterognathia and malocclusion by means of an L-inverted midline osteotomy. PATIENT AND METHODS: The patient was a 26-year-old woman diagnosed with left laterognathia and ipsilateral posterior crossbite. She was operated by using this novel technique in November 2009 at Hogar Clínica San Rafael, Maracaibo, Venezuela. Bicortical midline symphyseal vertical osteotomy was executed, followed by block removal of the central right inferior incisor and its surrounding alveolar bone. The mandibular segmentation was completed by means of a right hemimentoplasty. After this, a 4-mm right mandibular rotation was made, and titanium plates and monocortical screws of the 2.0 system were used to achieve the rigid fixation. RESULTS: The patient showed outstanding aesthetic and functional results after 5 years. CONCLUSIONS: This technique provides a new treatment option for the correction of mild laterognathia cases associated with dental malocclusion.