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Plast Reconstr Surg ; 142(6): 1572-1581, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30188468


BACKGROUND: Le Fort I maxillary advancements affect nasal proportions. However, there are no data on the three-dimensional nasal changes that occur with differential lateral plane adjustment (clockwise and counterclockwise movements) during Le Fort I maxillary advancements. This study analyzes and compares nasolabial soft-tissue changes after Le Fort I clockwise and counterclockwise repositioning. METHODS: Single-piece Le Fort I advancements were included. A retrospective study of patients split into clockwise and counterclockwise groups was performed. Preoperative and postoperative three-dimensional photographs (VECTRA 3D) were analyzed. Nasolabial anthropometric measurements were recorded using Mirror software. Statistical analysis involved paired t test to compare preoperative and postoperative measurements. RESULTS: Twenty-four patients were evaluated (12 per group), with 22 distinct nasolabial relationships measured. Counterclockwise movement showed a statistically significant increase in alar width (3.6 mm; p < 0.001), alar base width (1.6 mm; p = 0.009), oral width (3.2 mm; p = 0.02), and lip projection (3.4 mm; p = 0.04). Clockwise movement showed no statistically significant changes, with the largest position changes noted in alar width (2.7 mm; p = 0.07) and alar base width (1.7 mm; p = 0.09). CONCLUSIONS: Clockwise and counterclockwise Le Fort I advancements have a different effect on postoperative nasolabial morphology. Counterclockwise movements exhibit significant changes, widening the alar base and width and the oral and philtral widths. The impact on the nostril morphology and columella was similar between the groups. The differential impact on nasolabial appearance is important to recognize for treatment planning and patient counseling. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Cara/anomalías , Maxilar/cirugía , Surco Nasolabial/anatomía & histología , Osteotomía Le Fort , Adolescente , Cefalometría , Tejido Conectivo/anatomía & histología , Femenino , Humanos , Masculino , Movimiento , Estudios Retrospectivos , Rotación , Adulto Joven
J Craniofac Surg ; 28(8): 1906-1910, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28906330


PURPOSE: Autologous fat grafting is a useful adjunctive procedure to orthognathic surgery and may also confer anti-inflammatory properties. The purpose of this study is to answer the clinical question: among patients undergoing orthognathic operations, what are the effects of fat grafting on facial edema (magnitude, duration, and rate of decrease)? METHODS: A retrospective cohort study was performed. Three-dimensional photos (Canfield, Fairfield, NJ) from preoperative and a series of postprocedure time-points were analyzed. The data set was divided into a fat-grafted cohort and a non-fat-grafted cohort and later analyzed using paired and unpaired t tests and linear regressions to determine significant correlations. RESULTS: One hundred sixteen pre- and postoperative three-dimensional photo data sets were included. The sample included 29 subjects. The facial volume was analyzed both overall and comparing each subgroup (orthognathic vs. orthognathic + fat grafting group). Postoperative facial volume increase averaged 23.7% for the entire cohort (FG and nFG). By week 12, the swelling decreased about 62% from baseline. In all patients, there was a statistically significant decrease in facial volume with time. In the fat-grafted group, despite adding volume, the facial volume was equal to the non-fat-grafted group at week 1, yet the rate of decrease was faster through week 12. CONCLUSION: The majority of postoperative facial edema decreases by 12 weeks following orthognathic surgery. In this cohort of patients, despite the addition of volume, concurrent fat grafting lessened postoperative edema, and led to a greater magnitude and speed of resolution.

Tejido Adiposo/trasplante , Edema/etiología , Procedimientos Quirúrgicos Ortognáticos/efectos adversos , Complicaciones Posoperatorias/etiología , Adolescente , Adulto , Cara , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Retrospectivos , Adulto Joven
J Oral Maxillofac Surg ; 75(1): 197-206, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27649463


PURPOSE: Virtual surgical planning (VSP) using computer-aided design and manufacturing (CAD-CAM) has been reported to aid in craniofacial reconstruction. The reported improvements have been related mainly to operative performance, with limited evaluations of the position and function of the temporomandibular joint (TMJ). This study analyzed the radiographic detail of postoperative outcomes related to the TMJ. MATERIALS AND METHODS: Patients who underwent mandibular reconstruction with and without VSP were analyzed. All patients underwent preoperative computed tomography (CT) of their mandible. In the VSP group, CAD-CAM planning was performed preoperatively using CT Digital Imaging and Communications in Medicine (DICOM) data. Postoperative CT images from the 2 groups were quantitatively compared to evaluate the TMJ. CT images were digitized for 2- and 3-dimensional analysis using surgical planning software (Materialise, Leuven, Belgium). Anatomic landmarks and cephalometric relations were analyzed. RESULTS: Sixteen patients who underwent traditional planning or VSP for mandibular reconstruction were compared. Two groups (n = 8 each) were compared for positioning of the mandibular condyle in the glenoid fossa. Measurements of superior, anterior, and lateral movements were comparable in the pre- and postoperative groups for the traditional and VSP groups (P < .001 by analysis of variance). Subgroup analysis evaluating ipsilateral changes in the mandibular condyle position for traditional planning versus VSP noted decreased percentages of change in superior (22 vs 10%; P < .05), anterior (32 vs 15%; P < .05), and lateral (7 vs 1%, P < .01) shifts of the condyle for left mandibular reconstructions (n = 8). Ipsilateral right mandibular reconstructions (n = 6) showed changes in superior (62 vs 15%; P < .05) and anterior (5 vs 9%; not significant) shifts. CONCLUSION: These data showed comparable pre- and postoperative positions of the TMJ for traditional and VSP mandibular reconstructions. Evaluation of condyle movements showed differences in the ipsilateral position in the pre- and postoperative groups. VSP resulted in decreased superior and lateral shifts of the ipsilateral condyle and decreased changes in the condylar and condylar neck angles. This work shows that VSP can lead to increased precision in reconstruction leading to preserved normative anatomic relations.

Mandíbula/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Cirugía Asistida por Computador/métodos , Articulación Temporomandibular/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Diseño Asistido por Computadora , Femenino , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Persona de Mediana Edad , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/fisiopatología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
Plast Reconstr Surg Glob Open ; 4(8): e848, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27622116


BACKGROUND: Le Fort I osteotomy imparts significant changes to the nasolabial region. Past studies have relied on 2-dimensional data and have not delineated differences among various Le Fort I subtypes. The purpose of this study is to 3-dimensionally analyze Le Fort I-induced nasal and lip changes comparing advancement alone versus widening alone [surgically assisted maxillary expansion (SAME)] versus advancement and widening. We hypothesize that the combination of maxillary advancement with widening will result in the most profound changes. METHODS: A retrospective cohort study was performed. Included Le Fort I patients were grouped as: (1) nonsegmental straight advancement, (2) widening without advancement, and (3) segmental advancement and widening. Pre- and postoperative 3-dimensional photogrammetry (Canfield) were analyzed. Anthropometric landmarks were placed and measured by 2 independent observers. Statistics involved both paired and unpaired t tests (significance = P < 0.05). RESULTS: One hundred eight photogrammetric data sets were analyzed, including 46 single-piece, 26 SAME, and 36 segmental. Significant postoperative nasal changes were observed within each intragroup analysis. The most dramatic changes were seen after segmental Le Fort I with advancement and widening, which included alar base width, alar width, nostril width, and soft triangle angle, all P < 0.05. CONCLUSIONS: Le Fort I osteotomy results in significant alteration of the nasolabial morphology. This is the first study to 3-dimensionally analyze nasal changes that occur comparing maxillary advancement alone versus widening alone (SAME) versus advancement with widening. These objective data permit improved patient counseling and surgical planning.

J Craniofac Surg ; 27(2): e112-3, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26967093


In this video, we present a single piece Le Fort I osteotomy with bone graft in a patient with a unilateral cleft lip and palate. Maxillary osteotomies in the cleft patient can be challenging because of the presence of scar, palatal or alveolar fistulae, compromised teeth, and vascularization of the segments. The video demonstrates our current approach and technique. The authors particularly want to highlight aspects of the approach, such as the incision, exposure, osteotomies, mobilization, splints, and plating. The associated manuscript discusses the depicted video as well as the blood supply to the maxilla, and postoperative patient care.

Fisura del Paladar/cirugía , Maxilar/cirugía , Osteotomía Le Fort/métodos , Placas Óseas , Trasplante Óseo/métodos , Cicatriz/cirugía , Labio Leporino/cirugía , Craneotomía , Disección/métodos , Humanos , Técnicas de Fijación de Maxilares/instrumentación , Maxilar/irrigación sanguínea , Cavidad Nasal/cirugía , Mucosa Nasal/cirugía , Férulas (Fijadores) , Cigoma/cirugía
J Oral Maxillofac Surg ; 74(2): 292-301, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26296596


T-cell lymphomas (TCLs) account for approximately 15 to 20% of all non-Hodgkin lymphomas in the United States. The most common form of TCL is cutaneous TCL (CTCL), with Sézary syndrome and mycosis fungoides being the most prevalent subtypes. Sézary syndrome is the more aggressive form and often is referred to as a late-stage variant of mycosis fungoides. Clinically, it is characterized by diffuse erythroderma, cutaneous edema, pruritus, nonhealing cutaneous ulcers, and lymphadenopathy. Patients also can present with changes to their nails, hyperpigmentation, alopecia, palmoplantar keratoderma, ectropion, and hepatosplenomegaly. The overall prognosis for patients with Sézary syndrome is poor. The literature regarding oral manifestations of CTCL mostly report those of mycosis fungoides because it is the most common subtype of CTCL. Currently, there are only 2 reports in the scientific literature of intraoral manifestations of Sézary syndrome. This case report describes a patient with Sézary syndrome who presented with rapidly progressing erythematous lesions of the gingiva and multifocal osteonecrosis of the maxilla and mandible. This is the third reported case of an intraoral manifestation of Sézary syndrome and the first reported case of osteonecrosis in the setting of CTCL.

Antineoplásicos/uso terapéutico , Enfermedades de las Encías/etiología , Enfermedades Mandibulares/etiología , Enfermedades Maxilares/etiología , Osteonecrosis/etiología , Síndrome de Sézary/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Anciano , Pérdida de Hueso Alveolar/etiología , Pérdida de Hueso Alveolar/patología , Resultado Fatal , Estudios de Seguimiento , Enfermedades de las Encías/patología , Humanos , Masculino , Enfermedades Mandibulares/patología , Enfermedades Maxilares/patología , Invasividad Neoplásica , Osteonecrosis/patología , Síndrome de Sézary/complicaciones , Síndrome de Sézary/patología , Neoplasias Cutáneas/complicaciones