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2.
Artículo en Inglés | MEDLINE | ID: mdl-33031774

RESUMEN

PURPOSE: To evaluate whether the distance between the mandibular occlusal plane and mandibular foramen predicts inferior alveolar nerve (IAN) position after the sagittal split osteotomy (SSO) when using a low medial horizontal osteotomy (Posnick's modification). METHODS: This was a retrospective cohort study of patients undergoing bilateral SSOs with the medial osteotomy placed at the level of the mandibular occlusal plane. The primary predictor variable was the vertical distance between the mandibular foramen and mandibular occlusal plane. The primary outcome was IAN position after SSO: contained within the proximal segment or freely entering the distal segment. Secondary predictor variables were age, gender, primary diagnosis, and type of surgery. Descriptive, bivariate, and regression statistics were computed. RESULTS: Thirty-one patients underwent 62 SSOs using a low medial cut; the sample's mean age was 19.6 ± 3.0 years, and 16 subjects were female. Twenty-three subjects had a primary diagnosis of craniofacial anomaly, and 26 subjects underwent bimaxillary surgery. The IAN was contained within the proximal segment in 28 SSOs (45.2%). The distance between the mandibular occlusal plane and mandibular foramen was greater in SSOs where the nerve was contained within the proximal segment (6.9 ± 2.5 mm) versus freely entering the distal segment (4.5 ± 2.7 mm, P < .001). A receiver-operator characteristic curve identified a threshold distance of greater than 5 mm as predictive of the IAN being contained within the proximal segment (sensitivity, 0.89; specificity, 0.85; area under the curve, 0.84; P < .001). When the mandibular foramen was greater than 5 mm above the mandibular occlusal plane, there was an increased odds of the IAN being contained within the proximal segment (odds ratio, 48.3; 95% confidence interval, 10.5, 222.8; P < .001). CONCLUSIONS: The distance between the mandibular occlusal plane and mandibular foramen predicts the position of the IAN after SSO when using a low medial horizontal osteotomy.

3.
Plast Reconstr Surg ; 146(2): 248e-250e, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32740631
4.
J Craniofac Surg ; 31(7): 2012-2014, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32657980

RESUMEN

Primary intraosseous meningiomas (PIMs) are an infrequent variant of meningiomas characterized by hyperostosis and brain compression. En bloc surgical resection of giant PIMs involving critical structures such as venous sinuses or cranial nerves could be associated with significant morbidity. The objective of this report is to demonstrate the safety and feasibility of piecemeal resection of PIMs involving the superior sagittal sinus and frontal sinus. A 54-year-old female with a large 5 cm thick bifrontal primary intra-osseous meningioma encasing the anterior segment of the superior sagittal sinus and frontal sinus underwent a bifrontal craniotomy with piecemeal microsurgical resection of the lesion, complete frontal sinus exoneration, and a synthetic cranioplasty. Clinical outcome was measured by extent of resection, preservation of cortical draining veins and postoperative course. A Simpson grade I resection of the lesion was achieved following piecemeal resection of the giant PIM without clinical or radiographic evidence of venous infarct or injury. The postoperative course was uncomplicated, and the patient was discharged home 3 days after cranioplasty. A complete resection of a giant bifrontal PIM with superior sagittal sinus encasement and frontal sinus involvement can be achieved safely via a piecemeal approach without significant intra-operative morbidity.

6.
World Neurosurg ; 143: 108-113, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32711139

RESUMEN

BACKGROUND: The aim of this study was to evaluate surgical outcomes for patients with sagittal craniosynostosis undergoing open cranial vault remodeling with a modified pi procedure comparing subgaleal versus subperiosteal dissection. METHODS: A retrospective chart review was performed for children between the ages of 3 and 7 months with sagittal craniosynostosis undergoing open cranial vault expansion at Seattle Children's Hospital. Patient demographics, operative variables, and postoperative outcomes including the surface area of bony cranial defects at 2-year follow-up were evaluated. RESULTS: Over a 3-year period, 35 patients between the ages of 3 and 7 months underwent surgical correction of sagittal craniosynostosis using our institutional adaptation of the modified pi technique. Twenty-five patients underwent exposure via a subgaleal (SG) approach, 10 patients had a subpericranial (SP) exposure. Compared with the SP group, the SG group had significant lower estimated blood loss and a shorter operating time (P < 0.05). There were no significant differences with regard to hospital length of stay or postoperative complications (P ≥ 0.48). At 2 years postoperatively, there were no significant differences in the size of the largest cranial defects (SG: 1.1 ± 0.1 cm2 versus 3.7 ± 0.1 cm2, P = 0.40); no patients required a secondary cranioplasty. CONCLUSIONS: Open posterior and middle cranial vault expansion is a safe and efficient method of open cranial vault expansion in sagittal craniosynostosis regardless of the plane of dissection. Elevation of the scalp flaps in the SG plane is a minor technical modification that can reduce blood loss and operative times.

8.
J Oral Maxillofac Surg ; 78(10): 1813-1819, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32540322

RESUMEN

PURPOSE: Sagittal split osteotomy (SSO) of rami with fused cortices or minimal marrow space above the lingula can increase the risk of an unfavorable osteotomy split of the proximal ramus. To reduce the risk of a proximal segment fracture, a recent modification of the SSO places the medial horizontal osteotomy below the lingula. The purpose of the present study was to evaluate the outcomes of SSOs utilizing a low medial horizontal osteotomy in patients with atypical ramus morphologies. PATIENTS AND METHODS: The present study was a prospective series composed of patients with atypical proximal ramus anatomy undergoing SSOs. All patients had undergone bilateral SSO for correction of mandibular deformities. The horizontal ramus osteotomy had been placed at or slightly above the mandibular occlusal plane because of atypical ramus morphology (thin ramus with no appreciable marrow space at or above the lingula and/or narrow retromolar ramus width). The outcome variables were an unfavorable split of the proximal or distal segments, nerve location after SSO (proximal or distal segment), and neurosensory recovery of the inferior alveolar nerve (IAN). RESULTS: The sample included 25 patients who had undergone 50 SSOs using a low medial horizontal osteotomy. Their mean age was 19.6 ± 3.2 years; 14 patients were female. Of the 25 patients, 22 had a primary diagnosis of craniofacial anomaly; 23 had undergone bimaxillary surgery and 6 had received concomitant genioplasty. No unfavorable fractures of the proximal segment occurred. No intraoperative IAN injuries occurred. The IAN was contained within the proximal segment in 52% of the cases. All the patients achieved functional sensory recovery of the IAN bilaterally by 1 year postoperatively. The mean interval to functional sensory recovery was 116 days. CONCLUSIONS: The low medial horizontal osteotomy is an effective technique for reliable execution of SSOs in morphologically atypical mandibles.


Asunto(s)
Mandíbula , Nervio Mandibular , Adolescente , Adulto , Femenino , Mentoplastia , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Osteotomía , Osteotomía Sagital de Rama Mandibular , Estudios Prospectivos , Adulto Joven
9.
J Oral Maxillofac Surg ; 78(9): 1484-1491, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32554065

RESUMEN

PURPOSE: Oral and maxillofacial surgery (OMS) has an expansive scope, with myriad diagnoses treated by practicing surgeons. Patients and referring providers are increasingly turning to Web-based sources to find information about clinical conditions before consultations or in conjunction with ongoing care. The purpose of this study was to examine the current trends of public interest of OMS procedures as assessed by online search trends. MATERIALS AND METHODS: A cross-sectional study of Internet search data obtained via Google Trends (GT; Alphabet, Mountain View, CA) was conducted. Data were collected using GT for OMS-related search terms between January 2004 and May 2019. The search terms used in the analysis were "wisdom teeth," "TMJ," "dental implants," "jaw surgery," "jaw fracture," "facial trauma," and "facial cosmetic surgery," defined to be the core surgical aspects of OMS based on public awareness campaigns sponsored by the American Association of Oral and Maxillofacial Surgeons. Relative search volumes, trends over time, geographic trends, and seasonal trends were analyzed. For all analyses, P ≤ .05 was considered significant. RESULTS: Overall search volume trends for OMS procedures showed an increase over time, with seasonal and geographic trends. "Wisdom teeth" was the most searched term and had the greatest increase in search volume over time. "Facial trauma" was the least searched term, with no appreciable trend over time. Geographic search volume was greatest in the United States. Seasonal changes were most apparent with searches for "wisdom teeth" and "jaw surgery." CONCLUSIONS: Analysis of GT data shows substantial interest in core OMS procedures, with seasonal variations noted for certain areas of practice (third molars and jaw surgery) and consistent interest in other areas (facial cosmetic surgery, dental implant reconstruction, and temporomandibular disorders). The use of GT data may be a powerful tool for predicting demand for OMS services and for public education campaigns.


Asunto(s)
Traumatismos Faciales , Procedimientos Quirúrgicos Orales , Cirugía Bucal , Estudios Transversales , Traumatismos Faciales/cirugía , Humanos , Internet , Cirujanos Oromaxilofaciales , Estados Unidos
11.
Plast Reconstr Surg ; 145(5): 1262-1265, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32332550

RESUMEN

The Le Fort I osteotomy is a versatile operation for correction of developmental, congenital, and posttraumatic deformities of the lower midface. One of the challenges of the osteotomy is pterygomaxillary separation, with the potential for unfavorable fractures to the orbit/skull base or vascular injury. A modified technique for pterygomaxillary disjunction is the transmucosal tuberosity osteotomy. The authors have used this technique for pterygomaxillary separation in 200 consecutive Le Fort I osteotomies over a 3-year period (2014 to 2017). There were no episodes of unfavorable propagation to the skull base or orbit, oroantral or oronasal fistulae, excessive bleeding/vessel injuries, or vascular insufficiency to the maxilla. The transmucosal tuberosity approach is a reliable and safe method of performing the pterygomaxillary separation during the Le Fort I osteotomy.


Asunto(s)
Maxilar/anomalías , Osteotomía Le Fort/métodos , Humanos , Maxilar/cirugía , Osteotomía Le Fort/efectos adversos , Osteotomía Le Fort/instrumentación , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología
12.
J Craniofac Surg ; 31(5): 1459-1463, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32282690

RESUMEN

PURPOSE: To discuss technical modifications specific to the cleft Le Fort I osteotomy that improve mobilization and demonstrate the stability of the maxilla at the Le Fort I level in a cohort of patients with cleft palate (with or without cleft lip) who underwent traditional maxillary advancement. METHODS: This was a retrospective evaluation of patients with cleft palate (+/- cleft lip) who underwent orthognathic surgery for management of skeletal malocclusions. All study subjects had a Le Fort I osteotomy +/- bilateral mandibular sagittal split osteotomies. The cleft Le Fort I osteotomy technique is modified to extensively release fibrous tissue and scar from the posterior maxilla, including around the tuberosity, along the posterior maxillary sinus wall, and circumferentially around the descending palatine canal. Maxillary position was assessed using angular and linear measurements pre-operatively (T0), immediately post-operatively (T1), and at 1-year post-operatively (T2). Descriptive and bivariate statistics were computed; a P < 0.05 was considered significant. RESULTS: Twenty-eight patients with cleft palate (with or without cleft lip) were included. The sample's mean age was 18.9 ±â€Š1.4 years and included 11 females. The majority of subjects (64.3%) underwent bimaxillary surgery; eight subjects (28.6%) had segmental maxillary surgery and 14 subjects (50%) had simultaneous maxillary interpositional bone grafting. The mean maxillary sagittal advancement was 6.1 mm (range: 0-10 mm). At 1-year post-operatively, the absolute change in SNA was 0.7 ±â€Š0.9 degrees; the absolute change in maxillary sagittal position was 0.8 ±â€Š0.6 mm. There was no association between the magnitude of advancement and the magnitude of position change (P = 0.86). Stability was not influenced by segmental surgery, bone grafting, or bimaxillary surgery (P > 0.33). CONCLUSION: Using a modified technique with extensive release of posterior scar and graduated intra-operative traction, maxillary advancement of up to 10 mm can be performed in patients with cleft palate (± cleft lip) with sagittal relapse of < 1 mm at 1-year post-operatively.


Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Osteotomía Le Fort/métodos , Adolescente , Trasplante Óseo , Cicatriz , Femenino , Humanos , Masculino , Maxilar/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
13.
J Oral Maxillofac Surg ; 78(8): 1382-1388, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32283076

RESUMEN

PURPOSE: When the inferior alveolar nerve (IAN) is contained within the proximal segment after a mandibular sagittal split osteotomy (SSO), conventional teaching is to release the nerve so that it freely enters the distal segment. However, manipulation of the IAN may cause further injury. The purpose of this study was to measure IAN neurosensory recovery in SSOs when the nerve was not freed from the proximal segment. MATERIALS AND METHODS: This was a prospective split-mouth study of patients undergoing bilateral sagittal split osteotomy (BSSO). The sample was composed of patients who underwent a BSSO in which the IAN was intact bilaterally but freely entering the distal segment on one side (IANDI) and contained within the proximal segment on the other (IANPR). The outcome of interest was time to functional sensory recovery (FSR) of the IAN, measured in days. Descriptive, bivariate, and Kaplan-Meier statistics were computed. P ≤ .05 was considered statistically significant. RESULTS: Twenty patients undergoing 40 SSOs were included as study patients. The sample's mean age was 19.0 ± 2.4 years (range, 15 to 26 years); there were 13 female patients. Of these patients, 15 underwent BSSO whereas 5 underwent BSSO plus genioplasty. The planned mean composite 3-dimensional mandibular movements for IANDI and IANPR were 6.3 ± 2.8 mm (range, 2.5 to 12.3 mm) and 6.3 ± 2.3 mm (range, 2.7 to 10.8 mm), respectively (P = .96). All patients achieved FSR in the bilateral IAN distributions within 1 year of surgery (range, 34 to 284 days). The median times to FSR were 100 days for IANDI and 101 days for IANPR (P = .64). CONCLUSIONS: In patients undergoing SSOs, maintaining the IAN within the proximal segment of the mandible may not affect neurosensory recovery.


Asunto(s)
Traumatismos del Nervio Trigémino/etiología , Adolescente , Adulto , Femenino , Humanos , Mandíbula/cirugía , Nervio Mandibular , Osteotomía , Osteotomía Sagital de Rama Mandibular , Estudios Prospectivos , Adulto Joven
14.
Plast Reconstr Surg ; 145(4): 814e-817e, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32221230

RESUMEN

BACKGROUND: The authors conducted this study to assess the impact that Drs. Joseph Gruss and Paul Manson have had on craniofacial surgery through their individual contributions and through their trainees. METHODS: This was a retrospective analysis of fellows trained by either Dr. Gruss or Dr. Manson. Demographic and bibliometric measures were recorded for each fellow. Demographic factors included years since completion of fellowship training, current practice of craniomaxillofacial surgery, academic practice, and academic leadership roles. Bibliometric measures included number of publications, number of citations, and h-index. To adjust for scholarly activity before fellowship training, only contributions published after fellowship training were included. RESULTS: Over a 39-year period, a total of 86 surgeons completed fellowship training with either of the two principal surgeons. The mean time since completion of training was 18.7 ± 11.4 years. Seventy-nine percent of surgeons had active practices in craniomaxillofacial surgery; 54 percent had academic practices. The mean number of publications was 26.4 ± 69.3, the mean number of citations was 582 ± 2406, and the average h-index was 6.7 ± 10.6. Among academic surgeons, the average h-index was 10.7 ± 13.1, 89 percent practiced in North America, 89 percent had active practices in craniomaxillofacial surgery, and nearly 50 percent had achieved a leadership role. CONCLUSIONS: Modern craniofacial reconstruction has evolved from principles used in trauma and correction of congenital differences. The extensive impact that Drs. Paul Manson and Joseph Gruss have had on the field, and plastic surgery at large, is evident through their primary contributions and the immense impact their trainees have had on the field.


Asunto(s)
Docentes Médicos/estadística & datos numéricos , Cirugía Ortognática/historia , Cirujanos/estadística & datos numéricos , Cirugía Plástica/historia , Docentes Médicos/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Internado y Residencia/historia , Internado y Residencia/estadística & datos numéricos , Liderazgo , Mentores/historia , Mentores/estadística & datos numéricos , América del Norte , Cirugía Ortognática/educación , Cirugía Ortognática/estadística & datos numéricos , Procedimientos Quirúrgicos Ortognáticos/educación , Procedimientos Quirúrgicos Ortognáticos/historia , Publicaciones/historia , Publicaciones/estadística & datos numéricos , Procedimientos Quirúrgicos Reconstructivos/educación , Procedimientos Quirúrgicos Reconstructivos/historia , Estudios Retrospectivos , Cirujanos/educación , Cirujanos/historia , Cirugía Plástica/educación , Cirugía Plástica/estadística & datos numéricos
15.
Oral Maxillofac Surg Clin North Am ; 32(2): 197-204, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32165093

RESUMEN

Nasoalveolar molding (NAM) is a powerful tool in the treatment of patients with unilateral or bilateral cleft lip and palate. The primary goal of NAM is to improve alignment of critical anatomic elements before surgical repair of the unilateral or bilateral cleft lip. Modifications of the position of the alveolar segments and their associated lip elements, the lower lateral cartilages, and the columella achieved with NAM are helpful for creating a suitable platform for tension-free lip repair.


Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Cartílago , Humanos , Lactante , Nariz , Cuidados Preoperatorios
16.
World Neurosurg ; 138: 344-348, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32217173

RESUMEN

BACKGROUND: Patients with single-suture or minor suture craniosynostosis are typically asymptomatic at early presentation; intervention is aimed at reducing the risk of elevated intracranial pressure and associated developmental sequelae. Patients may be symptomatic in cases of major multisuture syndromic synostoses or delayed diagnosis. Clinical presentation in this context may include headaches, papilledema, cognitive delay, or behavioral issues. Cranial nerve palsies are atypical symptoms of intracranial hypertension in this patient population. CASE DESCRIPTION: An 11-month-old, otherwise healthy girl presented with bilateral severe papilledema and left abducens nerve palsy owing to nonsyndromic near-complete bilateral squamosal suture synostosis with associated incomplete sagittal and right lambdoid synostoses. The patient underwent urgent open cranial expansion, with resolution of her papilledema and improvement in eye position and motility. CONCLUSIONS: Cranial nerve palsies may be presenting symptoms of intracranial hypertension in patients with craniosynostosis. Multidisciplinary evaluation and treatment is paramount for appropriate management.


Asunto(s)
Enfermedades del Nervio Abducens/etiología , Craneosinostosis/complicaciones , Craneosinostosis/cirugía , Papiledema/etiología , Procedimientos Quirúrgicos Reconstructivos/métodos , Femenino , Humanos , Lactante , Hipertensión Intracraneal/etiología , Cráneo/cirugía
17.
J Oral Maxillofac Surg ; 78(5): 771-777, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32006493

RESUMEN

PURPOSE: To address the shortcoming of reporting P values, several leading medical journals have revised their guidelines for reporting results, specifically mandating the use of confidence intervals (CIs). The purpose of the present study was to evaluate the frequency of reporting CIs in randomized clinical trials (RCTs) by academic oral and maxillofacial surgeons. MATERIALS AND METHODS: We implemented a retrospective cohort study and enrolled a sample composed of RCTs reported in 3 oral and maxillofacial surgery (OMS) journals in 2009, 2012, 2015, and 2018. We identified RCTs using a Medical Subject Headings (MeSH) search in Medline. Studies were included in the sample if they were randomized and reported a measure of association. Predictor variables included the year of publication, journal, OMS focus area (eg, dentoalveolar surgery, anesthesia/facial pain, craniomaxillofacial trauma), reported confounding factors, funding sources, conflict of interest, study region, number of institutions involved, number of authors, and academic rank of the authors. The primary outcome of interest was reporting of the CI. Descriptive and bivariate statistics were computed. A P value of ≤ .05 was considered significant. RESULTS: The sample included 102 reports. The P value was uniformly reported (100%) in all 102 publications. CIs were reported in 29 reports (28.4%; 95% CI, 19.9 to 38.2). The OMS focus area was associated with reporting CIs (P = .02). Anesthesia/facial pain studies were significantly less likely to report the CIs (12.0%) compared with studies of craniomaxillofacial deformities (100%; Bonferroni P = .02). No other significant associations were found between the predictors and CI reporting (P ≥ .08). CONCLUSIONS: CIs have been reported in a small proportion of RCTs within OMS. Given the shortcomings of reporting only the P values, a significant need exists for improving the statistical reporting standards among OMS journals.


Asunto(s)
Cirujanos Oromaxilofaciales , Edición , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto
18.
Oral Maxillofac Surg Clin North Am ; 32(2): 309-320, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32102742

RESUMEN

Subcranial and frontofacial distraction osteogenesis have emerged as powerful tools for management of hypoplasia involving the upper two-thirds of the face. The primary goal of subcranial or frontofacial distraction is to improve the orientation of the upper face and midface structures (frontal bone, orbitozygomatic complex, maxilla, nasal complex) relative to the cranial base, globes, and mandible. The various techniques used are tailored for management of specific phenotypic differences in facial position and may include segmental osteotomies, differential vectors, or synchronous maxillomandibular rotation.


Asunto(s)
Osteogénesis por Distracción , Osteotomía Le Fort , Humanos , Maxilar/cirugía , Nariz
19.
J Oral Maxillofac Surg ; 78(3): 358-365, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31525327

RESUMEN

PURPOSE: In response to the national opioid epidemic crisis, the purpose of this study was to measure changes in opioid and non-narcotic analgesia (NNA) prescribing practices over time after third molar (M3) removal. MATERIALS AND METHODS: A retrospective double cohort study was utilized enrolling 2 samples of patients who had M3s removed during 2 different 3-month intervals. The primary predictor variable was prescribing practice, divided into cohorts: 1) previous prescribing practice (PPP) occurring early during the evolving opioid epidemic (2014); and 2) current prescribing practice (CPP) (2018). The outcome measures were morphine milligram equivalents (MMEs), NNA prescriptions, and refill MMEs for inadequate pain control (IPC). Other variables were age, gender, payor, provider, anesthesia, procedure, and number of M3s removed. Descriptive, bivariate, and multiple linear and logistic regression models were computed. RESULTS: The sample included 330 subjects with a mean age of 23.1 ± 8.1 years; 42.4% were male. Of the 330 subjects, 147 were in the PPP cohort (44.5%) and 183 in CPP cohort (55.5%). Mean MMEs were 130.1 ± 42.4 and 68.5 ± 32.0 in the PPP and CPP cohorts, respectively (P ≤ .001). An adjusted linear regression model showed differences in MMEs prescribed persisted (P ≤ .001). The frequency of postoperative NNA prescriptions written increased from 2.7 to 71.6% (P ≤ .001). An adjusted logistic regression model also revealed that NNA prescriptions had significantly increased (odds ratio, 242.00; P ≤ .001). No difference was found in the frequency of refills for IPC (P = .13) or mean refill MME prescriptions between the cohorts (P = .48). CONCLUSIONS: Within our academic practice, fewer opioids and more NNAs are being prescribed for postoperative pain after M3 removal without an increase in IPC. Increased awareness through prescribing regulations, non-narcotic research findings, and organizational guidelines could have contributed to these changes.


Asunto(s)
Analgésicos no Narcóticos , Analgésicos Opioides/uso terapéutico , Adolescente , Adulto , Estudios de Cohortes , Prescripciones de Medicamentos , Femenino , Humanos , Masculino , Tercer Molar , Cirujanos Oromaxilofaciales , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Odontología , Pautas de la Práctica en Medicina , Estudios Retrospectivos , Adulto Joven
20.
Artículo en Inglés | MEDLINE | ID: mdl-33515505

RESUMEN

PURPOSE: Subcranial midface distraction is used to treat central midface deficiency in syndromic synostosis. Our aim was to determine which maxillary movements were associated with improvement in measures of obstructive sleep apnea. METHODS: This was a retrospective cohort study that reviewed patients with syndromic midface retrusion and documented sleep apnea who underwent subcranial midface distraction via either Le Fort 3 osteotomy or Le Fort 2 osteotomy with zygomatic repositioning. The predictor variables measured on cephalograms were the magnitude and direction of midface and mandibular movements. The primary outcome was the change in the apnea hypopnea index (AHI) from polysomnography before and after surgery. The secondary outcomes were volumes of upper airway containing bone spaces calculated from computed tomography scans. Data analysis included linear regression to estimate the effect of distraction vectors on bone space volumes and AHI changes. RESULTS: We included 18 patients primarily with Crouzon or Apert syndrome. The magnitude of distraction in a horizontal direction was the most significant factor for AHI improvement and primarily expanded the nasopharyngeal space, but with a smaller impact on the oral cavity space. Clockwise palate rotation was most influenced by a downward direction of distraction, with 24° below horizontal creating a neutral advancement. The greater the magnitude of advancement, the more likely a counterclockwise rotation was observed. CONCLUSIONS: Horizontal magnitude of advancement had the greatest impact on AHI improvement. Vertical lengthening and closure of anterior open bite deformities can be done without compromising airway results as long as total advancement is not compromised. Palate rotation is best controlled by a downward distraction vector, but counterclockwise rotation increases with greater advancement.

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