M-shaped Genioplasty: New Findings after 10 Years of Experience.

This study aimed to evaluate changes of the M-shaped genioplasty in sagittal and vertical planes in a group of 34 patients and describe other indications, such as the increase of the mentolabial angle, decrease in the depth of the mentolabial fold, and the centering of the chin. Methods: A retrospective analysis was performed on 34 patients between 2010 and 2019. All studies were conducted at T0 (preoperative), T1 (a month after surgery), and T2 (1 year after surgery). The position of the bone pogonion (Pg) was measured vertically and horizontally at T0, T1, and T2; the mentolabial angle and the depth of the mentolabial fold were measured at T0 and T2. Results: The average sagittal advancement at T1 was 6.6 mm and at T2 was 6.4 mm. The inferior movement was an average of 5.6 mm at T1 and T2, showing both movements excellent stability. The mentolabial angle increased at T2 an average of 28.2 degrees (5 degrees per each millimeter of inferior movement), whereas the depth of the mentolabial fold decreased an average of 2.8 mm (decreased 49% from the initial depth and decreased 0.56 mm per each mm of inferior movement). The average increase of the lower third of the face was 5 mm. No complications were observed in any patient. Conclusions: M-shaped genioplasty is an anterior osteotomy of the mandible, which allows the chin to move forward and downward. Additionally, it allows an increase of the mentolabial angle and decreases the mentolabial fold.

Cleft Lip and Palate Midfacial Hypoplasia: Criteria to Choose the Treatment.

ABSTRACT: A series of skeletal and dentoalveolar/occlusal criteria were proposed for choosing the treatment modality for the management of midface hypoplasia in cleft lip/palate patients, focusing on functional improvement, aesthetics, and minimizing the risk of recurrence and secondary alterations. For which, 42 patients with nonsyndromic cleft lip/palate, all with previous primary lip/palate surgeries and without previous osteotomies, were analyzed. Orthognathic surgery (OS) (n = 24) and maxillary distraction osteogenesis (n = 18) with anterior segmental osteotomies (segmental distraction osteogenesis [SD]), alveolar transport disc (TD), and midface total distraction osteogenesis (TDO) by modified Le Fort III osteotomy was done.The average of maxillary advancement for OS was 5.58 ±â€Š0.83 mm, for SD 9.4 ±â€Š0.89 mm, for TD 8.00 ±â€Š1.00 mm, and for TDO was 8.13 ±â€Š1.55 mm.In the presence of infraorbital and/or zygomatic hypoplasia, TDO was performed using skeletal anchorage, with the requirement of occlusal stability in dental cast in occlusion. In short maxillary arch without dental cast feasibility in occlusion, hypodontia/agenesis or absence of premaxilla, TD and SD was performed. There was only 1 mm of recurrence in 1 patient of each group. Changes in speech were detected in 2 patients in the OS group (8.3%). Orthognathic surgery can be indicated for advancements ≤7 mm not requiring orbito-zygomatic advancement, whereas distraction osteogenesis can be indicated for advances >8 mm with or without the need for orbito-zygomatic advancement, in addition with other dentoalveolar factors and velopharyngeal function.

Delayed Bleeding of Sphenopalatine Artery as a Complication in Le Fort I Osteotomy.

ABSTRACT: Rates of severe complications in orthognathic surgery are low, but when they occur they can be fatal. This article reports a case of laceration of the junction of the posterior lateral nasal artery and the sphenopalatine artery, resulting in severe delayed bleeding. Patient undergoes a multiple segment Le Fort I osteotomy with no intraoperative or immediate postoperative complications. On the fourth postoperative day, he presents with epistaxis and intractable postnasal discharge, is admitted to emergency with signs of shock, and bleeding is detected endoscopically originating from the right sphenopalatine artery, which is treated with diathermocoagulation. The advantage of endoscopy in difficult areas is that bleeding complications can be solved with low morbidity.

Alveolar Cleft Reconstruction Using Morphogenetic Protein (rhBMP-2): A Systematic Review and Meta-Analysis.

OBJECTIVE: This study aimed to review the existing evidence regarding reconstruction of the alveolar cleft using recombinant human bone morphogenetic protein-2 (rhBMP-2) in terms of bone volume and bone height. DESIGN: Systematic review and meta-analysis. PATIENTS­PARTICIPANTS: A systematic search was done. Randomized and nonrandomized clinical trials, where rhBMP-2 was used in the reconstruction of human alveolar cleft were included. INTERVENTIONS: Reconstruction of alveolar cleft with rhBMP-2. MAIN OUTCOME MEASURES: Average bone volume formation and average bone height formation in the alveolar cleft. Mean difference was calculated and pooled by meta-analysis. RESULTS: Of 709 identified articles, 5 studies met the inclusion criteria. The average bone volume formation was higher in the rhBMP-2 group than in the control group (61.11% vs 59.12%). The average bone height formation was higher in the control group compared to the rhBMP-2 group (75.4% vs 61.5%). The risk of bias in the selected articles was high. The meta-analysis showed that rhBMP-2 treatment may benefit bone formation compared to iliac crest graft (low certainty evidence; mean difference: -208.76; 95% confidence interval: -253.59 to -163.93; -I2 = 0%). CONCLUSIONS: The results obtained in primary articles are promising but have a high risk of bias and have low quality of evidence; therefore, it is necessary to conduct controlled clinical trials with a greater number of patients to recommend the use of rhBMP-2 in the treatment of the alveolar cleft. PROSPERO registration number: CRD42018077741.

Relationship Between Nostril, Nasal Valve and Minimal Cross-Sectional Area in Functional Upper Airway.

PURPOSE: To propose a three-dimensional cephalometric analysis of upper airway (UA) related to its functionality, defining normal reference values in healthy individuals and the relationship between nostril, nasal valve, and minimal cross-sectional area (MCS) in functional upper airway. MATERIALS AND METHODS: The UAs of 20 Class I patients were analyzed with CBCT using Nemoceph 3D-OS and HOROS software, determining linear distances, volumes and cross-sectional areas, including MCS. RESULTS: MCS was mostly located in the middle-upper oropharynx and high hypopharynx. MCS showed moderate correlation with the area of both nares (BNA) (r = 0.60, P = 0.004) and high correlation with the area of both internal nasal valves (BNV) (r = 0.66, P = 0.0016). BNA and BNV showed a moderate correlation (r = 0.445, P = 0.049). A total upper airway (TUA) and functional upper airway (FUA) volumes were established. TUA and FUA showed the strongest statistical correlation (r = 0.82, P = 0.00). A paired samples t test compared the measurement as absolute values of MCS with BNA (t = 0.781, P = 0.44), with BNV (t = -0.12, P = 0.90); and BNA with BNV (t = -0.76, P = 0.45), showed no significant differences. CONCLUSIONS: A functional cephalometric analysis of the UA with stable parameters in cervical spine and normal reference values has been proposed. BNA and BNV could be used as reference to establish the MCS compatible with respiratory health.

Characterization of bone substitute beta946; -TCP block for maxillofacial reconstruction / Caracterización del bloque beta946; -TCP de sustitución ósea para la reconstrucción maxilofacial

SUMMARY: The aim of this study was to characterize a commercial beta tricalcium phosphate (β-TCP) block allograft for use in maxillofacial reconstruction, evaluating its homogeneity, porosity and mineralization. Two commercial 5 x 5 x10 mm chronOS Vivify β-TCP blocks were used, which were evaluated by a STEM SU-3500 variable pressure scanning electron microscope (SEM-STEM) (Hitachi, Japan). For the semi-quantitative microanalysis of elements, the QUANTAX 100 energy dispersive x-ray spectrometer detector (EDX) (Bruker, Germany) was used. The homogeneity of the structural morphology, macropore and micropore size and component homogeneity were evaluated. The microscopic analysis showed micropores of 164.92 mm (± 35.032 mm) in diameter in the outer area and micropores in the inner area of 54.44 mm (± 17.676 mm). The formation of porosities and irregularities present in the block was heterogeneous between the outer and inner surfaces. The mineral content of the blocks presented homogeneity with the presence of carbon (2.02 %), oxygen (44.33 %), phosphate (16.62 %) and calcium (37.87 %). The β-TCP block can be used in bone reconstruction but the presence of reduced macropore and micropore sizes could limit efficiency in the substitution and bone regeneration phase.

RESUMEN: El objetivo de este estudio fue caracterizar un aloinjerto de bloqueo de fosfato tricálcico (β-TCP) comercial para su uso en la reconstrucción maxilofacial, evaluando su homogeneidad, porosidad y mineralización. Se utilizaron dos bloques comerciales de 5 x 5 x 10 mm de vivify β-TCP de chronOS, que se evaluaron mediante un microscopio electrónico de barrido de presión variable STEM SU-3500 (SEM-STEM) (Hitachi, Japón). Para el microanálisis de elementos semicuantitativo, se utilizó el detector de espectrómetro de rayos X de dispersión de energía QUANTAX 100 (EDX) (Bruker, Alemania). Se evaluó la homogeneidad de la morfología estructural, el tamaño del macroporo y microporo y la homogeneidad de los componentes. El análisis microscópico mostró microporos de 164,92 mm (± 35,032 mm) de diámetro en el área externa y microporos en el área interna de 54,44 mm (± 17,676 mm). La formación de porosidades e irregularidades presentes en el bloque fue heterogénea entre las superficies externas e internas. El contenido mineral de los bloques presentó homogeneidad con la presencia de carbono (2,02 %), oxígeno (44,33 %), fosfato (16,62 %) y calcio (37,87 %). El bloque β-TCP se puede utilizar en la reconstrucción ósea, pero la presencia de macroporos y tamaños de microporos reducidos podría limitar la eficacia en la fase de sustitución y regeneración ósea.

Modified Le Fort III osteotomy: A simple solution to severe midfacial hypoplasia.

PURPOSE: There are multiple conditions that may affect the development of the middle third of the face and with varying degrees of severity. The surgical treatment alternatives for major midfacial sagittal deficiencies consist in Le Fort I, II, or III with conventional osteotomies or with distraction osteogenesis (DO). Both techniques have advantages and disadvantages that should be evaluated specifically in each case. The aim of this report is to present a group of patients with severe hypoplasia of the middle third of the face, with different origins, and their treatment with a Modified Le Fort III osteotomy and distraction osteogenesis, using a minimally invasive surgical approach. MATERIALS AND METHODS: The surgical technique was performed in a group of patients with severe hypoplasia of the middle third of the face, through a transconjunctival approach with lateral canthotomy and a trans-oral approach. The osteotomy consisted of a Le Fort III without the nasofrontal component. A rigid external distractor (RED) type II or internal distractor was installed. The amount of distraction, surgical time, blood loss, and complications were evaluated. RESULTS: A total of 7 patients underwent operation, 5 men and 2 women with an average age of 20.8 (range 11-41) years; 3 patients with Crouzon syndrome, 2 with Pfeiffer syndrome, 1 patient with cleft lip and palate sequel, and 1 with a severe non-syndromic class III. The average follow-up was 3.14 years. All patients achieved stable occlusion without postoperative changes, positive overbite and overjet, without relapse in the skeletal position. The average advancement was 14.7 (±4.07) mm, in 1.1 incisors, and 15.2 (±3.19) in point A. The average time of surgery was 2.78 (±0.64) hours, with an average blood loss of 240 (±48.6) ml. Four patients required a rhinoplasty in a secondary surgery. CONCLUSION: This technique shows a surgical approach with low morbidity, short surgery time, and low blood loss. It allows optimal resolution of severe hypoplasia of the middle third of the face with long-term stability. It avoids the use of grafts and osteosynthesis material. By not including the nasal pyramid in the osteotomy design, the size, position, and nasofrontal angle in patients with adequate facial balance is maintained. If nasal correction is necessary, a second surgery may be done. In cases of asymmetrical hypoplasia of the middle third, this osteotomy shows great versatility and can be done unilaterally and/or simultaneously combined with other distractions.

Temporomandibular Joint Ankylosis: Algorithm of Treatment.

: Temporomandibular joint ankylosis, according to age of onset, causes severe functional and morphological disorders, as well as stunted craniofacial growth and development.The primary goal of treatment is to resolve the functional and morphological disorders. METHOD: Pre- and posttreatment clinical and cephalometric registries were conducted in 15 patients with temporomandibular joint ankylosis over a 10-year period (2002-2012). All the patients underwent complete removal of the ankylotic block, gap arthroplasty, and ipsilateral coronoidectomy. Distraction osteogenesis was performed on 12 patients. RESULTS: Fifteen patients, 8 female and 7 male, ranging from 3 to 30 years of age, were included in this study. The posttreatment follow-up period ranged from 3 to 13 years.The mean preoperative maximum mouth opening was 3 ± 1.7 mm, and the mean postoperative maximum mouth opening was 36 ± 6.5 mm. The labial inclination with respect to the true horizontal decreased considerably (6.2° ± 2.3° preoperative to 1° ± 1.6° postoperative). A correction of the mandibular deviation was measured at the symphysis with respect to the facial midline (8° ± 2° preoperative to 2° postoperative). Finally, the height ratio of both mandibular rami (the healthy side and the affected side) decreased considerably (1.27 ± 0.05 preoperative to 1.07 ± 0.06 postoperative).Reankylosis only occurred in 2 patients, who were then successfully treated by means of gap arthroplasty. CONCLUSIONS: The therapeutic algorithm proposed in the present work provides favorable functional and morphological results. Early and aggressive functional physiotherapy is essential to minimize the risk of reankylosis.

Condylar Hyperplasia in a Monozygotic Twin Girl: An Argument About Etiology.

The diagnosis of unilateral condylar hyperplasia (UCH) requires a combined assessment consisting of clinical, radiological, and histopathological examination. The etiology of this condition is unknown. The purpose of this study is to report a rare case of UCH in a monozygotic twin. A 15-year-old girl was referred to our department complaining of facial asymmetry and malocclusion. Computed tomography and single-photon emission computed tomography imaging reveal enlargement of the left condyle and condylar neck, and an increased uptake that was diagnosed as active UCH. During the investigation of family and co-twin facial profile, no cases of UCH were identified. From the case reported in this study, the authors raise a hypothesis that can exist some environmental factor that is related in the development of condylar hyperplasia given the occurrence of this disease in one of twins.

Treatment of Maxillary Hypoplasia in Cleft Lip and Palate: Segmental Distraction Osteogenesis With Hyrax Device.

The objective of this work is to describe a segmental maxillary distraction osteogenesis (SDO) with segmental Lefort I with an inexpensive device.Four patients who presented severe class III and maxillary hypoplasia due to cleft lip and palate sequel were treated. A SDO was performed using a dental-anchored Hyrax device, achieving enlargement of the upper jaw without altering speech, with adequate and stable occlusion. Dental implants in a new formed bone were installed.The authors can conclude that SDO is a good treatment alternative for patients with maxillary hypoplasia. It preserves velopharyngeal function and is a stable treatment, maintaining the overjet achieved with distraction osteogenesis, without changes in posterior occlusion. The open bite generated with tooth-borne devices can be solved with temporary anchorage devices and intermaxillary elastics during consolidation phase. Modified Hyrax device allows expanding and moving forward the maxillary arch, with a low cost.

Graftless Maxillary Sinus Lift Using Lateral Window Approach: A Systematic Review.

PURPOSE: The aim was to determine the survival rate of dental implants installed in the posterior region of the maxilla after a graftless maxillary sinus lift via the lateral window approach and to identify the factors involved in the results. MATERIALS AND METHODS: A systematic search was done on MEDLINE, EMBASE, LILACS, Scopus, and Science Direct up to June 2016; additional studies were identified through an analysis of references. Primary studies in English, Spanish, Portuguese, and French were included; the selection and data extraction process was conducted by 2 investigators independently, and the methodological quality was evaluated by means of the Effective Public Health Practice Project's Quality Assessment Tool. RESULTS: The combined search identified 232 articles. After the selection process, 11 articles were identified, 9 of which were prospective and 2 were retrospective. In all of them, the graftless maxillary sinus lift was done with the immediate installation of the implant. All the studies included presented a low methodological quality. The mean survival rate of the implants was 97% with an average new intrasinus bone formation of 6.2 mm. CONCLUSION: This technique has a high implant survival although it is not possible to identify its correct indication and contraindication.

Cortical and cancellous bone in mandibular symphysis: implications in osteosynthesis and osteotomy / Hueso cortical y esponjoso en sínfisis mandibular: implicancias en osteotomía y osteosíntesis

The aim of this study was to quantify the presence of cortical and cancellous bone in the mandibular symphysis. A descriptive study was conducted using cone beam computed tomography where skeletal class I and class III subjects were included, defined according to characteristics detected on dental, clinical and dental occlusion x-rays. From the 3D reconstruction, sections were used in relation to the axial axis of the teeth of the anterior sector; the amount of buccal cortical, cortical, lingual, inferior cortical and cancellous bone as well as symphysis height were determined. The measurements were taken using routine methods and analyzed with ANOVA and Tukey's HSD test with p <0.05 for statistical significance. 20 skeletal class I subjects aged 23 years (± 4.5) and 20 class III subjects aged 22 years (± 5.2) were included. Symphysis height was significantly greater in skeletal class III subjects, exceeding by 0.8 mm the height of class I subjects; the buccal cortical bone presented on average 2 mm less at different dental levels, whereas the lingual cortical and inferior basal bones were significantly larger than the buccal cortical bone. The cancellous and cortical bones did not present any significant differences between the two groups (p=0.093). The buccal and basilar cortical bone is smaller than lingual cortical bone.

El objetivo fue determinar la presencia de hueso cortical y esponjoso en sínfisis mandibular. Se realizó un estudio descriptivo en tomografías computadorizadas cone beam donde se analizaron sujetos clase I y clase III esqueletal definidos según características dentales, clínicas y radiográficas de oclusión dental y características radiográficas. Desde la reconstrucción 3D se utilizaron cortes en relación al eje axial de los dientes del sector anterior; en ellos se determinó la cantidad de hueso cortical bucal, cortical, lingual, cortical inferior, hueso esponjoso y altura de sínfisis. Las mediciones fueron realizadas con métodos de rutina y fueron analizados con la prueba ANOVA y HDS Turkey considerando un valor de p <0.05 para considerar significancia estadística. 20 sujetos clase I esqueletal con 23 años (+ 4.5) y 20 sujetos clase III esqueletal con edad de 23 años (+ 4.5) fueron incluidos. La altura de sínfisis fue significativamente mayor en sujetos de clase III esqueletal, superando por 0.8 mm la altura de sujetos clase I; el hueso cortical bucal presento en promedio menor de 2 mm en diferentes niveles dentarios, mientras que la cortical lingual y basal inferior fueron significativamente mayor que la cortical bucal. El hueso esponjoso y hueso cortical no presentó diferencias significativas entre ambos grupos (p=0.093). La cortical bucal y basilar son menores que el hueso cortical lingual.

Proteína morfogenética ósea y su opción como tratamiento de la fisura alveolar / Bone morphogenetic protein and its option as an alveolar cleft treatment

La proteína morfogenética ósea (BMP), es una proteína endógena que ha mostrado efectos significativos en la promoción de la formación ósea. El uso de BMP ha sido descrito en la reconstrucción de defectos óseos de origen traumáticos y patológicos, incluyendo la fisura alveolar, el aumento de reborde alveolar, la elevación de seno maxilar, el injerto de alveolo post-extracción, y la cirugía perimplantaria entre otros. A pesar de las ventajas asociadas al uso de BMP y que en la actualidad se aplica en combinación con matrices de colágeno, ciertas propiedades tales como su baja resistencia mecánica y su elevada tasa de liberación inicial disminuyen su eficacia en la formación ósea. En este contexto, el desarrollo de nuevos sistemas de liberación prolongada de BMP que permitan la quimiotaxis de células mesenquimáticas y su posterior diferenciación a osteoblastos representa un desafío con alto potencial clínico para la estimulación de la formación ósea. En este trabajo, se describe el uso de BMP en la reconstrucción de fisuras alveolares y en particular se discuten las ventajas de su administración en micropartículas poliméricas comosistemas de liberación de BMP (rhBMP-2) con promisorias aplicaciones en la estimulación de la formación ósea.

Bone morphogenetic protein (BMP) is an endogenous protein that has shown significant effects in the promotion of bone formation. BMP also has been described in the reconstruction of traumatic and pathological bone defects, including alveolar cleft, alveolar ridge augmentation, maxillary sinus elevation, and applications in post-extraction alveolus graft, and peri-implant surgery among others. Despite the advantages associated with the use of BMP, currently is applied in combination with collagen matrices, which has certain properties such as low mechanical resistance and a high burst initial release that diminish its effectiveness in bone formation. In this context, the development of novel systems with greater mechanical resistance and prolonged release of BMP, that lead to chemotaxis of mesenchymal cells, following by its differentiation to osteoblasts represents a major challenge that holds outstanding clinical potential for the stimulation of bone formation. In this paper, we describe the use of BMP for the reconstruction of alveolar clefts, and its advantages being administrated in polymeric microparticles as sustain release system with promising applications in the stimulation of bone formation.

Utilización de células troncales en reconstrucción cráneo-maxilo-facial en humanos / Stem cells in human cranio-maxillo-facial reconstruction

El propósito de este estudio fue evaluar la evidencia en relación al empleo de técnicas reconstructivas en el área cráneo-facial asociado el uso de células troncales en humanos. Se realizó una revisión sistemática de la literatura en las bases Medline, ScienceDirect, EMBASE, TripDatabase, LILACS entre marzo del 2004 a marzo del 2016 con criterios de elegibilidad y estrategia de búsqueda definida. La selección de artículos fue realizada por dos investigadores de forma independiente y cuando ellos presentaron discordancia, un tercer investigador realizó le selección. Se encontraron un total de 382 artículos, se realizó una selección de artículos, eliminado duplicados, estudios experimentales en animales y selección según análisis de resúmenes, se seleccionaros 14 artículos con procedimientos reconstructivos en el área cráneo-facial asociado a células troncales. Existe limitada evidencia de calidad en relación a la utilización de células troncales en reconstrucción cráneo facial en humanos. A excepción de un estudio (ensayo clínico de bajo nivel de evidencia), todos corresponden a series o reporte de casos, con lo cual no es posible recomendar su utilización en procedimientos reconstructivos. Es necesario realizar estudios de evidencia sustentable con el empleo de células troncales que permitan identificar su real rendimiento al compararlo con otras técnicas quirúrgicas.

The purpose of this study was to evaluate the evidence regarding the use of reconstructive techniques in the craniofacial area associated with the use of stem cells in humans. A systematic review of the literature was conducted in the databases Medline, ScienceDirect, EMBASE, TripDatabase, LILACS between March 2004 and March 2016 with eligibility criteria and defined search strategy. The selection of articles was done by two researchers independently and when they presented discordance, a third researcher made the selection. We found a total of 382 articles, made a selection of articles, removed duplicates, experimental studies in animals and selection according to analysis of abstracts, we selected 14 articles with reconstructive procedures in the craniofacial area associated with stem cells. There is limited quality evidence regarding the use of stem cells in the craniofacial reconstruction in humans. With the exception of one study (clinical trial of low level of evidence), all correspond to series or report of cases, with which it is not possible to recommend its use in reconstructive procedures. It is necessary to carry out studies of sustainable evidence with the use of stem cells that allow to identify its real performance when compared with other surgical techniques.

Indications of Free Grafts in Mandibular Reconstruction, after Removing Benign Tumors: Treatment Algorithm.

BACKGROUND: Mandibular reconstruction has been the subject of much debate and research in the fields of maxillofacial surgery and head and neck surgery. MATERIALS AND METHODS: A retrospective observational study was undertaken with 14 patients diagnosed with benign tumorous pathologies and who underwent immediate mandibular resection and reconstruction at the Hospital del Salvador Maxillofacial Surgery Unit and Dr. Rodrigo Fariña's private clinic between the years 2002 and 2012. We propose a treatment algorithm, which is previous teeth extractions in area that will be removed. RESULTS: Fourteen patients underwent surgery, and a total of 40 dental implants were installed in 6 men and 8 women, the mean age of 33.5 (age range, 14-58 y). Reconstruction with iliac crest bone graft, and rehabilitation following this protocol (average of reconstruction was 8.7 cm), was successful with no complications at all in 12 patients. One patient had a minor complication, and the graft was partially reabsorbed because of communication of the graft with the oral cavity. This complication did not impede rehabilitation with dental implants. Another patient suffered the total loss of the graft due to infection because of dehiscence of oral mucosa and great communication with the mouth. Another iliac crest free graft reconstruction was undertaken 6 months later. CONCLUSIONS: The scientific evidence suggests that mandibular reconstruction using free grafts following the removal of benign tumors is a biologically sustainable alternative. The critical factor to improve the prognosis of free grafts reconstruction in benign tumors is to have good quality soft tissue and avoid communication with the oral cavity. For this, it is vital to do dental extractions before removing the tumor.

Reconstruction of Temporomandibular Joint With a Fibula Free Flap: A Case Report With a Histological Study.

Reconstruction of the temporomandibular joint (TMJ) for congenital or acquired deformities is a major challenge for maxillofacial surgeons. The alternatives for reconstructing the TMJ include free grafts (costochondral, iliac crest, clavicle, or metatarsus), free flaps (fibula), osteogenic distraction, and alloplastic grafts. The lack of biological knowledge of cartilaginous grafts and their reaction to the environment of the TMJ is largely responsible for the inability to predict growth. This report describes the use of a free flap for TMJ reconstruction.

New Screw Design for Securing Buried Distractors Usefulness and Ease of Removal.

There are 2 types of distraction devices for mandibular distraction: buried and external. The advantage of buried devices is the stability, but the difficulty in removing the screws is the greatest disadvantage. To resolve this problem, an osteosynthesis screw (Fariña Screw) has been designed, which greatly facilitates its removal when buried distractors are used.

Corticotomy-Assisted Le Fort I Osteotomy: An Alternative to Segmentation of the Maxilla in Orthognathic Surgery.

PURPOSE: The aim of this study was to describe a surgical technique that can be used to solve dentofacial deformities associated with narrow interradicular spaces of the anterior teeth of the maxilla and inadequate overbite/overjet seen in hand-articulated models. This is presented here as an alternative to segmentation of the maxilla in Le Fort I osteotomy. METHODS: Six patients with dentofacial deformities (classes II and III malocclusions) had Le Fort I osteotomy accompanied by buccal alveolar corticotomies of the maxilla. During the immediate postoperative period, elastic forces were applied to mobilize the anterior dentoalveolar segments until the planned overjet/overbite was observed. RESULTS: All patients reached the desired occlusion approximately 1 month after the surgical procedure. Pulp vitality of the teeth adjacent to the corticotomies was not compromised. CONCLUSIONS: The clinical results obtained confirm the technique as a safe and reliable alternative to segmentation of the maxilla in orthognathic surgery.

Orthognathic surgery in craniofacial microsomia: treatment algorithm.

Craniofacial microsomia is a broad term that covers a variety of craniofacial malformation conditions that are caused by alterations in the derivatives of the first and second pharyngeal arches. In general terms, diverse therapeutic alternatives are proposed according to the growth stage and the severity of the alteration. When craniofacial growth has concluded, conventional orthognathic surgery (Le Fort I osteotomy, bilateral sagittal split osteotomy, and genioplasty) provides good alternatives for MI and MIIA type cases. Reconstruction of the mandibular ramus and temporomandibular joint before orthognathic surgery is the indicated treatment for cases MIIB and MIII. The goal of this article is to establish a surgical treatment algorithm for orthognathic surgery on patients with craniofacial microsomia, analyzing the points that allow the ideal treatment for each patient to be chosen.

TMJ in facial class III deformity. Condyle/fossa relations.

The aim of this study was to ascertain the joint space present in the TMJ of subjects diagnosed with Class III dentofacial deformity with an indication for orthognathic surgery. Fourteen subjects were recruited from the Division of Oral and Maxillofacial Surgery at the Universidad de La Frontera, Chile. All subjects were admitted to the study after signing an informed consent and undergoing cephalometric analyses to define the severity of the deformity. Then, the joint space was analyzed, studying a cone beam CT image of the TMJ, which was evaluated in the coronal and sagittal views, defining the most anterior, median and posterior joint space (sagittal view), as well as the lateral, median and medial joint space (coronal view). The data were recorded in millimeters by an observer and data were analyzed after measuring the same parameter at three different times. A student's t-test was used for the analyses. Differences observed in both joints were not greater than 0.2 mm with spaces between 2 mm and 1.5 mm, thereby establishing the homogeneity of the sample, which presented no significant differences between the two joint spaces (right and left). It can be concluded that the joint space is symmetrical in both condyles and that no important changes are present compared to the results indicated in the international literature.