Rehabilitation of atrophic posterior partial edentulous maxilla with TTPHIL ALL TILT® technique: 3 year follow-up case report / Reabilitação de maxila atrófica posterior parcialmente desdentada com técnica TTPHIL ALL TILT®: relato de caso de acompanhamento de 3 anos

Maxillary sinus pneumatisation pose a grave clinical challenge for implant fixed rehabilitation in posterior maxilla owing to diminished bone volume. This necessitates sinus lift and grafting which increase the duration and cost and possible surgical complications. Pterygoid implant has a greater short term osseointegration and is a proven treatment method for rehabilitation of highly resorbed posterior maxilla. To overcome the limitations of sinus grafting techniques, the current case report describes the use of flapless, tilted and pterygoid implant for restoration of partially edentulous atrophic maxilla eliminating grafting (AU).

A pneumatização do seio maxilar representa um grande desafio clínico para a reabilitação fixa por implante na região posterior da maxila devido ao volume ósseo diminuído. Isso requer elevação do seio e enxerto, fatores que aumentam a duração, o custo e as possíveis complicações cirúrgicas. O implante pterigóide tem uma osseointegração maior em curto prazo e é um método de tratamento comprovado para reabilitação de maxila posterior altamente reabsorvida. Para superar as limitações das técnicas de enxerto de seio, o relato de caso atual descreve o uso de implante sem retalho, inclinado e pterigóide para restauração de maxila atrófica parcialmente edêntula eliminando o enxerto.(AU)

Impact of mandibular distraction osteogenesis on the oropharyngeal airway in adult patients with obstructive sleep apnea secondary to retroglossal airway obstruction.

AIM: To evaluate the impact of mandibular advancement by distraction osteogenesis on the oropharyngeal airway in adult patients with retroglossal airway obstruction using two different techniques of mandibular distraction. MATERIALS AND METHODS: 13 adult patients with mandibular hypoplasia secondary to TMJ ankylosis with OSAS and radiographic, CT and polysomnographic evidence of OSAS were included in the study. MDO was performed (corpus distraction in 8 cases and morphometric distraction in 5 patients). Post-operatively the patients were followed up by radiographs, CT and polysomnography after 1 month and 6 months. RESULTS: There was an increase in the linear dimension of mandible by 11.07 mm, the volume by 19.3% and a decrease in AHI from 44.8 to 13.2. CONCLUSION: Mandibular distraction (corpus and orthomorphic-equivocal results) is an effective method of relieving the retroglossal airway obstruction in adult patients with OSAS.

Catheter-based donor site analgesia after rib grafting: a prospective, randomized, double-blinded clinical trial comparing ropivacaine and bupivacaine.

PURPOSE: Although ribs provide the best source of cartilage for reconstruction, its harvesting is associated with significant postoperative pain and sometimes incapacitating functional deficit. The lack of studies in the maxillofacial literature on regional analgesia for rib harvests stimulated this study design. This study compared ropivacaine with bupivacaine in providing postoperative analgesia after rib harvest. PATIENTS AND METHODS: Patients who needed rib grafting for maxillofacial reconstructive procedures were enrolled in this prospective, randomized, double-blinded clinical trial. Patients were randomly allocated to 1 of 2 groups with different modalities of anesthesia against a control group. A catheter was embedded in the rib donor site in all patients. Patients in group A received 0.75% ropivacaine, those in group B received 0.5% bupivacaine, and those in croup C patients received normal saline and served as the controls. The outcome variables were the subjective and objective pain scores, the duration of action, and the efficacy of the drugs after rib harvest. Dependent variables were the need for a rescue analgesic by the patient and the duration of hospital stay. The subjective intensity of pain at rest was calculated using the visual analog scale. The objective pain scores at function were evaluated by comparing preoperative with postoperative values of incentive spirometry, breath-holding test, maximal chest expansion, and match-blowing test. The t test and paired samples test were used to the analyze data, and a P value less than .05 was considered significant. RESULTS: Forty-two patients were enrolled in this study. Patients in groups A and B showed significant pain relief compared with group C. Patients in group A showed significantly less pain at rest (2.8±0.894) compared with those in group B (3.7±0.875; P<.05). Patients in group A also showed significantly less in pain at function (3.8±0.894) compared with those in group B (4.7±0.923; P<.05). Patients in group A showed a minimal need for a rescue bolus compared with those in group B. The duration of action for ropivacaine was longer by a mean difference of 11 hours. No noteworthy difference was seen for the duration of stay in the hospital. CONCLUSIONS: The use of catheter-based analgesia after rib harvesting provides excellent postoperative comfort, with ropivacaine providing an earlier return to normal function compared with bupivacaine. The duration of action of ropivacaine was significantly longer and, hence, decreased the need for rescue analgesics.

Incidence and consequences of bur breakage in orthognathic surgery: a retrospective study with discussion of 2 interesting clinical situations.

PURPOSE: To determine the incidence of bur breakage in routine orthognathic surgery, as well as its postsurgical sequela, and to illustrate 2 cases with more than 6 months' follow-up. PATIENTS AND METHODS: We performed a retrospective evaluation of case records of 76 consecutive orthognathic surgical procedures performed by a team of 2 surgeons over a period of 16 months, between January 2009 and July 2010, at a single center. RESULTS: Surgical bur breakage was reported in 5 patients in the series. Of these, 3 were retrieved whereas 2 were not, 1 of which caused a foreign body reaction in the patient, which persisted for a duration of almost 1 year. CONCLUSION: Instrument breakage may be a relatively common occurrence with the use of surgical burs in orthognathic surgery but its incidence is seldom recorded or reported. This study gives insight into the probability of postoperative sequela of these instruments when left in situ and a protocol for management of broken instruments.