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1.
Int. j. morphol ; 38(4): 947-955, Aug. 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1124881

RESUMEN

Trans-sutural distraction is a biological process that induces the formation of new bone and changes the position of bone by pulling on growing suture under the action of external forces. Currently, therapy to midfacial hypoplasia treated by trans-sutural distraction has been applied. In this study, Beagle dogs were selected as experimental animals, and a traction device designed by ourselves was applied to Beagle dogs to simulate the treatment process of trans-sutural distraction in human face, so as to provide a basis for the subsequent research on the related mechanism of trans-sutural distraction. The objective is that the animal model can provide the basis for the follow-up study of transsutural distraction. 45 month beagle dogs were randomly divided into two groups 3 in experiment group and 3 in control group. Implant nails were implanted as the bone marker in the bilateral zygomatic temporal suture, zygomandibular maxillary suture and palatine transverse suture in experimental group. The traction of the maxilla was carried out by the external cranial traction frame with canine fossa as bearing point, 800g force each side, elastic traction for 15 days. The control group only implanted the implant nail as the bone marker on both sides of the bone suture. The distance between two implant nails was measured by vernier calipers and X-ray examination, compared with preoperative and postoperative changes. X-ray and cephalometric measurements were used to measure change in the cranial basal angle. HE staining was used to observe the width of the bone seams, the morphology and structure of the cells and the tissue of the new bone under the phase contrast microscope. Then descriptive statistical analysis and t-test between two independent samples are carried out for the measurement data. The experimental group had a good retention of the beagle traction frame. In the experimental group, the maxillaries of dogs were protrudent in the process of traction gradually and the occlusal relationship changed to type II malocclusion. When the traction is 15 days, the coverage distance is about 8~9 mm. Before and after the traction, the distance between landmark points indicated that the spacing between the transverse palatine suture was the largest (experimental group: 5.52±0.19 mm control group 1.31±0.06 mm P<0.05), and zygomaticotemporal suture was the second (experimental group: 3.12±0.15 mm, control group 0.73±0.04 mm, P<0.05), and zygomaticomaxillary suture was less (experimental group: 2.60±0.34 mm, control group 0.53±0.05 mm, P<0.05). The cranial basal angle was no change before and after operation (controlgroup: 32.3±1.3°, experimental group: 33.2±1.1° P>0.05. Histology showed that the collagenous fibers in the suture of the control group were denser and the osteoblasts were visible on the edge of the suture, showing osteogenic activity. The experimental group significantly widened suture (experimental group: 1209.388±42.714 µm, control group 248.276±22.864 µm, P<0.05), the number of fibroblasts increased significantly with loose collagen fiber. The direction of cell and fiber arrangement were parallel to the traction force. There were many small blood vessels and marrow cavities, and the bone trabecula around the bone suture was thin (experimental group: 23.684±3.774 mm, control group: 86.810±9.219 mm, P < 0.05), showing active osteogenic activity. The growing beagle dog can be used to establish a suture traction animal model for experimental study. In the experiment, Kirschner wire was used to penetrate the bottom plane of the piriform hole of the maxilla (about the position of the canine fossa at the back) and the traction direction was basically the same as the growth direction, and the maxilla was basically parallel and moved forward.


La distracción trans-sutural es un proceso biológico que induce la formación de hueso nuevo y cambia la posición del éste al tirar de la sutura en crecimiento bajo la acción de fuerzas externas. Actualmente, se ha aplicado la terapia para la hipoplasia de la cara media tratada por distracción trans-sutural. En este estudio, fueron seleccionados perros Beagle como animales experimentales, y un dispositivo de tracción fue instalado a los perros para simular el proceso de tratamiento de la distracción trans-sutural en el rostro humano. El objetivo fue proporcionar una base para la investigación posterior sobre mecanismos relacionados con la distracción trans-sutural. El modelo animal puede proporcionar la base para este tipo de estudio de seguimiento de la distracción trans-sutural. Perros Beagle de 45 meses de edad se dividieron aleatoriamente en dos grupos: 3 en el grupo experimental y 3 en el grupo control. Los clavos de implante se usaron como marcadores óseos en la sutura temporal cigomática bilateral, la sutura maxilar cigomandibular y en la sutura transversal palatina en el grupo experimental. La tracción del maxilar se realizó mediante el marco de tracción craneal externo con fosa canina como punto de apoyo, 800 g de fuerza a cada lado, tracción elástica durante 15 días. En el grupo control solo se implantó el clavo del implante como marcador óseo en ambos lados de la sutura. La distancia entre dos clavos de implante se midió mediante calibradores de vernier y examen de rayos X, en comparación con los cambios preoperatorios y postoperatorios. Se utilizaron mediciones cefalométricas y de rayos X para medir el cambio en el ángulo basal craneal. La tinción con HE se usó para observar el ancho de las suturas óseas, la morfología y la estructura de las células y el tejido del hueso nuevo bajo el microscopio de contraste de fase. Luego se realizó un análisis estadístico descriptivo y una prueba t entre dos muestras independientes para los datos de medición. El grupo experimental tuvo una buena retención del cuadro de tracción del Beagle. En el grupo experimental, los maxilares de los perros sobresalieron gradualmente en el proceso de tracción y la relación oclusal cambió a maloclusión tipo II. Cuando la tracción era de 15 días, la distancia de cobertura fue de aproximadamente 8 ~ 9 mm. Antes y después de la tracción, la distancia entre los puntos de referencia indicaba que el espacio entre la sutura palatina transversal era más grande (grupo experimental: 5,52 ± 0,19 mm, grupo de control 1,31 ± 0,06 mm, P <0,05), y la sutura cigomáticotemporal fue la segunda. (Grupo experimental: 3,12 ± 0,15 mm, grupo control 0,73 ± 0,04 mm, P <0,05), y la sutura cigomaticomaxilar fue menor (grupo experimental, 2,60 ± 0,34 mm, grupo control 0,53 ± 0,05 mm, P <0,05). El ángulo basal craneal no cambió antes ni después de la operación (grupo control 32,3 ± 1,3, grupo experimental, 33,2 ± 1,1 ° , P> 0,05). La histología mostró que las fibras colágenas en la sutura del grupo control eran más densas y los osteoblastos se observaron en el margen de la sutura, mostrando actividad osteogénica. En el grupo experimental se amplió significativamente la sutura (1209,388 ± 42,714 µm, grupo control 248,276 ± 22,864 µm, P <0,05), el número de fibroblastos aumentó significativamente con fibras colágenas dispersas. La dirección de la disposición de la celda y las fibras era paralela a la fuerza de tracción. Se observó gran cantidad de vasos sanguíneos pequeños, cavidades medulares, y trabéculas óseas alrededor de la sutura ósea (grupo experimental: 23,684 ± 3,774 mm, grupo control: 86,810 ± 9,219 mm, P <0,05), que mostró actividad osteogénica activa. El perro Beagle en crecimiento se puede utilizar para estudios experimentales y así establecer un modelo animal de tracción de sutura. En el proceso, se usó alambre de Kirschner para penetrar en el plano inferior del foramen piriforme del maxilar (aproximadamente en la posición de la fosa canina en la parte posterior) y la dirección de tracción fue básicamente la misma que en el crecimiento.


Asunto(s)
Animales , Perros , Anomalías Craneofaciales/cirugía , Osteogénesis por Distracción/métodos , Huesos Faciales/cirugía , Suturas , Tracción , Modelos Animales de Enfermedad , Maloclusión/cirugía
2.
PLoS One ; 15(7): e0236425, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32726330

RESUMEN

Craniofacial asymmetry, mandibular condylar modeling and temporomandibular joint disorders are common comorbidities of skeletally disproportionate malocclusions, but etiology of occurrence together is poorly understood. We compared asymmetry, condyle modeling stability and temporomandibular health in a cohort of 128 patients having orthodontics and orthognathic surgery to correct dentofacial deformity malocclusions. We also compared ACTN3 and ENPP1 genotypes for association to clinical conditions. Pre-surgical posterior-anterior cephalometric and panometric radiographic analyses; jaw pain and function questionnaire and clinical examination of TMD; and SNP-genotype analysis from saliva samples were compared to assess interrelationships. Almost half had asymmetries in need of surgical correction, which could be subdivided into four distinct morphological patterns. Asymmetric condyle modeling between sides was significantly greater in craniofacial asymmetry, but most commonly had an unanticipated pattern. Often, longer or larger condyles occurred on the shorter mandibular ramus side. Subjects with longer ramus but dimensionally smaller condyles were more likely to have self-reported TMD symptoms (p = 0.023) and significantly greater clinical diagnosis of TMD (p = 0 .000001), with masticatory myalgia most prominent. Genotyping found two significant genotype associations for ACTN3 rs1671064 (Q523R missense) p = 0.02; rs678397 (intronic SNP) p = 0.04 and one significant allele association rs1815739 (R577X nonsense) p = 0.00. Skeletal asymmetry, unusual condyle modeling and TMD are common and interrelated components of many dentofacial deformities. Imbalanced musculoskeletal functional adaptations and genetic or epigenetic influences contribute to the etiology, and require further investigation.


Asunto(s)
Actinina/genética , Deformidades Dentofaciales/genética , Predisposición Genética a la Enfermedad , Hidrolasas Diéster Fosfóricas/genética , Pirofosfatasas/genética , Trastornos de la Articulación Temporomandibular/genética , Adulto , Mentón/diagnóstico por imagen , Modelos Dentales , Deformidades Dentofaciales/diagnóstico por imagen , Deformidades Dentofaciales/patología , Deformidades Dentofaciales/cirugía , Cara/diagnóstico por imagen , Femenino , Estudios de Asociación Genética , Humanos , Maxilares/diagnóstico por imagen , Masculino , Maloclusión/diagnóstico por imagen , Maloclusión/genética , Maloclusión/patología , Maloclusión/cirugía , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Procedimientos Quirúrgicos Ortognáticos , Polimorfismo de Nucleótido Simple/genética , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/cirugía
3.
Plast Reconstr Surg ; 145(6): 1067e-1072e, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32459778

RESUMEN

BACKGROUND: Midface hypoplasia dramatically affects the normative facial cascade. Simultaneous Le Fort III and Le Fort I procedures (Le Fort III/I) provide a powerful tool for achieving significant midface advancement. This study presents the authors' approach for addressing midface hypoplasia in the setting of class III malocclusion using Le Fort III/I advancement. METHODS: This was an institutional review board-approved retrospective review of patients who underwent Le Fort III/I advancement at the authors' institution from 2009 to 2019. Demographic, surgical, and postoperative data were recorded. The authors' operative technique and surgical pearls are described. RESULTS: Twenty-five patients met inclusion criteria, 15 male patients (60 percent) and 10 female patients (40 percent). Patient age ranged from 14.9 to 21.6 years. Diagnoses included Crouzon syndrome, nonsyndromic developmental skeletal dysplasia, cleft lip/palate, Klippel-Feil syndrome, Apert syndrome, Van den Ende-Gupta syndrome, and Pfeiffer syndrome. Le Fort III advancements averaged 6.18 ± 1.38 mm and Le Fort I advancements averaged 6.70 ± 2.48 mm. Thirteen patients underwent simultaneous bilateral sagittal split osteotomy with average movement of 5.85 ± 1.21 mm. Average follow-up was 1.3 ± 1.0 years. One patient experienced intraoperative cerebrospinal fluid leak that resolved with expectant management. Three patients experienced major complications (12 percent) postoperatively necessitating repeated orthognathic operations. Ten patients experienced minor complications (40 percent). Average length of stay was 10 days, with all patients achieving improvement of their facial profile. CONCLUSIONS: The authors' experience reaffirms the relative safety of simultaneous Le Fort III/I advancement. This technique should be considered in select patients with global midface retrusion and class III malocclusion. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Asunto(s)
Anomalías Craneofaciales/cirugía , Maloclusión/cirugía , Maxilar/cirugía , Osteotomía Le Fort/métodos , Complicaciones Posoperatorias/epidemiología , Adolescente , Tratamiento Conservador , Estudios de Factibilidad , Femenino , Humanos , Incidencia , Masculino , Osteotomía Le Fort/efectos adversos , Selección de Paciente , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
4.
Ann R Coll Surg Engl ; 102(6): e125, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32233880

RESUMEN

A postoperative radiograph demonstrated a folded radio-opaque structure in the nasopharynx, resembling a retained throat pack, despite her not having any respiratory symptoms. Retention of a throat pack is a never event.


Asunto(s)
Artefactos , Hallazgos Incidentales , Procedimientos Quirúrgicos Ortognáticos/instrumentación , Osteotomía/instrumentación , Faringe/diagnóstico por imagen , Adulto , Diagnóstico Diferencial , Femenino , Cuerpos Extraños/diagnóstico , Humanos , Maloclusión/cirugía , Periodo Posoperatorio , Radiografía , Tapones Quirúrgicos de Gaza
5.
Oral Maxillofac Surg Clin North Am ; 32(1): 53-69, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31699580

RESUMEN

The transverse dimension is a critical component of comprehensive treatment in orthognathic surgery. Several treatment approaches exist and the team must consider the patient's needs, desires, and limitations when working to correct the malocclusion. Treatment approaches may include only orthodontic expansion or rapid palatal orthodontic expansion; however, in adults, the orthodontist may require surgical assistance to expand the bony maxilla. Segmental maxillary expansion may be indicated in severe transverse deficiencies of the maxillary arch or dentofacial deformity patients also requiring vertical and sagittal corrections. The various treatment options, advantages, and disadvantages, and indications for each surgical approach are discussed.


Asunto(s)
Maloclusión/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Técnica de Expansión Palatina , Adulto , Humanos , Maxilar
6.
Oral Maxillofac Surg Clin North Am ; 32(1): 39-51, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31699583

RESUMEN

Although all dentofacial deformities involve deviation of skeletal and dental units that require correction, the timing and method of treatment can vary considerably. Growth is a key consideration when managing dentofacial deformities, because it has a direct impact on the timing and method of management. Some deformities may be intercepted and managed during growth, whereas others can only be definitively managed after cessation of growth. This article focuses on clinical considerations of growth in managing dentofacial deformities, and discusses methods of growth evaluation and interceptive orthodontic management strategies in different types of dentofacial deformities.


Asunto(s)
Deformidades Dentofaciales/cirugía , Maloclusión/cirugía , Ortodoncia Interceptiva , Procedimientos Quirúrgicos Ortognáticos , Ortopedia , Humanos , Maloclusión/diagnóstico , Planificación de Atención al Paciente
7.
J Craniomaxillofac Surg ; 47(12): 1855-1860, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31813754

RESUMEN

PURPOSE: To identify the most prevalent types of complications associated with orthognathic surgery and its possible risk factors. METHODS: This study was a retrospective investigation of records of 485 patients who underwent orthognathic surgery between 2008 and 2014 at the Oral and Maxillofacial Surgery Service at the Federal University of Paraná, Curitiba, Brazil. Types of complications were recorded. Independent variables such as sex, age, duration of surgery and hospitalization, number of surgeries, surgical site, and types of osteotomy performed were evaluated. Complications were also evaluated based on the treatment according to the Clavien-Dindo Classification. Data were submitted to statistical analysis with a significance level of 0.05. RESULTS: A total of 93 complications were reported (19.2%), including postoperative malocclusion, hemorrhage, inferior alveolar nerve injury, bad split, and infection. Complications were more common in men (p = 0.029). The number of complications was higher in surgeries that took more time to perform (p < 0.05) when the entire sample was taken into consideration. The prevalence of complications was related to a higher number of procedures per surgery (p = 0.019). Complications were more frequent in mandibular procedures (p = 0.010), particularly in bilateral sagittal split osteotomies (p < 0.001). Related to treatment, Clavien-Dindo grade I complications were the most frequent (72.04%). There was no association between sex, age, surgery duration, length of hospitalization, or surgical site with complication grades according to the Clavien-Dindo classification (p ≥ 0.05). CONCLUSION: Postoperative malocclusion, hemorrhage, inferior alveolar nerve injury, bad split and infection are the most prevalent complication in orthognathic surgery. They seem to be related to sex, duration of surgery, number of surgeries, surgical site, and the type of osteotomy performed. With these in mind, it is possible to explain to the patient the different levels of severity of complications related to the surgery.


Asunto(s)
Deformidades Dentofaciales/cirugía , Maloclusión/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Infección de la Herida Quirúrgica/epidemiología , Adulto , Brasil/epidemiología , Deformidades Dentofaciales/epidemiología , Femenino , Humanos , Masculino , Nervio Mandibular , Persona de Mediana Edad , Cirugía Ortognática , Hemorragia Posoperatoria , Estudios Retrospectivos
8.
J Craniofac Surg ; 30(8): 2479-2482, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31689730

RESUMEN

OBJECTIVES: To retrospectively assess malocclusions, skeletal relationships and the functional needs of orthognathic patients treated in a University teaching hospital. SUBJECTS AND METHODS: This study used clinical records of 100 consecutive patients [51 female, 49 males, mean (SD) age =21.5 (2.71) years] who had orthognathic surgery in a Shahid Beheshti University of Medical Sciences affiliated hospital (9/2014-7/2017). Malocclusion type (incisor classification), sagittal skeletal pattern (ANB angle), index of orthognathic functional treatment need (IOFTN) score, and osteotomy type were recorded. RESULTS: Overall, 66%, 31%, and 3% had Class III, II, and Class I malocclusions, respectively. Similarly, 68% and 32% had Class III and II sagittal skeletal relationships, respectively. Overall, 95% of patients scored IOFTN 4 or 5. The most prevalent IOFTN score were 4.3 (37%), 5.3 (16%), 5.4 (16%), and 4.2 (10%). There were no gender differences (P >0.05) for the distribution of malocclusions, sagittal skeletal relationships, different IOFTN scores, or when IOFTN scores were re-grouped (5, 4, and ≤3). When IOFTN scores were re-grouped (5, 4, and ≤3), they were equally distributed among patients with Class II or III skeletal relationships (P >0.05), but when the authors looked at different malocclusions, there were significant differences in IOFTN score distribution (P = 0.006). The use of genioplasty (4%) or distraction osteogenesis (2%) was limited. Single jaw surgery of either maxilla or mandible was used in 15% and 22% of patients, respectively. About 63% had undergone double-jaw surgery. CONCLUSION: Retrospective assessment using IOFTN identified 95% of patients as having great and very great functional needs, but prospective studies using IOFTN is needed to assess the need for orthognathic surgery. Class III malocclusions and Class III sagittal skeletal relationships were more common in this sample.


Asunto(s)
Maloclusión/cirugía , Adulto , Femenino , Humanos , Masculino , Mandíbula/cirugía , Maxilar/cirugía , Procedimientos Ortopédicos , Estudios Retrospectivos , Adulto Joven
9.
J Craniofac Surg ; 30(7): 2111-2114, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31568159

RESUMEN

INTRODUCTION: Despite there being several clinical studies reporting promising outcomes of resorbable plates for fixation of pediatric mandible fractures, the literature is devoid of large studies or comprehensive reviews assessing safety rates, complications and long-term outcomes. The purpose of the current review is to obtain a global consensus, shed light on efficacy and complications, and provide the reader with evidence-based data to help guide clinical management. METHODS: A systematic review of clinical studies assessing outcomes for resorbable plates in pediatric mandibular fractures was carried out. The main outcomes included infection, hardware failure, hardware exposure, malocclusion, reoperation and nonunion. Overall rates were pooled and stratified by fracture and implant type. RESULTS: Ten studies were included yielding 232 patients with 269 fractures. The mean age at surgery was 8.24 years with a mean follow up of 1.03 years. The overall complication rate was 5.2% (n = 12). Complications included infection (n = 4, 1.7%), hardware exposure (n = 3, 1.29%), wound dehiscence (n = 2, .86%) and intra-oral fistula formation (n = 2, .86%). One patient (0.43%) had malocclusion and none (0%) had hardware failure, nonunion or revision surgery. Patients with multiple fractures (≥ 2) had higher complication rates compared to isolated fractures (12.5% versus 1.7%). CONCLUSION: The use of resorbable plates for pediatric mandibular fractures is a viable option with similar rates of post-operative complications and outcomes compared to standard metallic counterparts. In the absence of large studies or systematic reviews, this study provides craniofacial surgeons with an evidence-based reference to guide decision making and improve informed consent.


Asunto(s)
Fracturas Mandibulares/cirugía , Adolescente , Placas Óseas , Niño , Preescolar , Humanos , Lactante , Maloclusión/cirugía , Complicaciones Posoperatorias , Reoperación , Resultado del Tratamiento
10.
Am J Orthod Dentofacial Orthop ; 156(2): 266-274, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31375237

RESUMEN

Adult orthodontic treatment involving maxillary transverse deficiency is a challenge for an interdisciplinary team. Surgically assisted rapid palatal expansion to segment the maxilla was once the treatment of choice, but the invasiveness, bone deficiency, and gingival recession hindered its acceptance. Corticotomy-assisted rapid maxillary arch expansion with ridge augmentation has the advantage of augmenting alveolar bony housing to accommodate and facilitate tooth movement. This approach was used to correct a severely constricted maxilla with bilateral posterior crossbite and anterior crowding in a 46-year-old man. Treatment time was 14 months. The accelerated arch expansion overcame the crossbite in 7 months, increasing intercanine distance by 5.2 mm and intermolar distance by 9.8 mm. Subsequent implant prosthesis was able to be restored in a functional normal occlusion. Satisfactory and stable clinical outcome was followed for 7 years. Corticotomy-assisted rapid maxillary arch expansion with alveolar bone augmentation is a novel and effective interdisciplinary approach for correcting adult maxillary transverse deficiency. Well controlled prospective clinical trails are warranted for further investigation.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Maloclusión/terapia , Técnica de Expansión Palatina , Técnicas de Movimiento Dental/métodos , Cefalometría , Modelos Dentales , Oclusión Dental , Estudios de Seguimiento , Humanos , Masculino , Maloclusión/diagnóstico por imagen , Maloclusión/patología , Maloclusión/cirugía , Maloclusión de Angle Clase II/diagnóstico por imagen , Maloclusión de Angle Clase II/patología , Maloclusión de Angle Clase II/cirugía , Maloclusión de Angle Clase II/terapia , Maloclusión de Angle Clase III/diagnóstico por imagen , Maloclusión de Angle Clase III/patología , Maloclusión de Angle Clase III/cirugía , Maloclusión de Angle Clase III/terapia , Maxilar/anomalías , Maxilar/patología , Maxilar/cirugía , Persona de Mediana Edad , Aparatos Ortodóncicos , Soportes Ortodóncicos , Alambres para Ortodoncia , Paladar (Hueso)/cirugía , Planificación de Atención al Paciente , Estudios Prospectivos , Resultado del Tratamiento
11.
Plast Reconstr Surg ; 144(2): 246e-251e, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31348355

RESUMEN

Orthognathic surgery is a powerful tool for correction of facial asymmetry and malocclusion. The goal is to achieve good dental function and facial aesthetics. Three-dimensional simulation is used for surgical planning, and bone gaps could be created to achieve facial balance. In this study, customized "spacers" were made using computer-aided design and three-dimensional printing for guides for use during surgery. With the final three-dimensional plan, the skull images were exported to 3-Matic software, where spacers were designed according to the bone gaps. Three-dimensionally-printed spacers were made and used to facilitate positioning and fixation. Consecutive patients with facial asymmetry were recruited in this prospective study. The postoperative outcome was assessed using a visual analogue scale and the three-dimensional facial surface area discrepancy index for subjective and objective evaluation. There were 12 patients and a total of 19 spacers for the Le Fort I and mandibular ramus segments. The spacers worked nicely during the bone fixation process. Mean preoperative and postoperative visual analogue scale scores were 4.83 and 7.14, with a statistically significant improvement for facial symmetry (p = 0.018). Mean preoperative and postoperative facial surface area discrepancy index was 0.95 and 0.98, and the correction of asymmetry was significant (p = 0.009). There were no related surgical complications. All patients were satisfied with the correction of facial asymmetry and malocclusion. The custom-made, three-dimensionally-printed spacers help to achieve surgical precision to correct and prevent facial asymmetry in orthognathic surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Asunto(s)
Asimetría Facial/cirugía , Maloclusión/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteotomía Le Fort/métodos , Medicina de Precisión/métodos , Impresión Tridimensional , Adulto , Estudios de Cohortes , Diseño Asistido por Computadora , Estética , Asimetría Facial/diagnóstico por imagen , Femenino , Humanos , Masculino , Maloclusión/diagnóstico por imagen , Dolor Postoperatorio/fisiopatología , Dolor Postoperatorio/terapia , Cuidados Preoperatorios/métodos , Estudios Prospectivos , Cirugía Asistida por Computador/métodos , Taiwán , Resultado del Tratamiento , Adulto Joven
12.
J Craniofac Surg ; 30(8): e743-e746, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31343587

RESUMEN

Mandibular hypoplasia is a common dentofacial deformity requiring a combination of orthodontic and surgical treatment. Before the introduction of distraction osteogenesis various orthognathic surgical procedures were carried out to treat mandibular hypoplasia. Orthognathic procedures like corpus lengthening by bilateral sagittal split ramus osteotomy and genioplasty are commonly practised all over the world to address the high esthetic demands and functional problems. But hardly there are any established orthognathic surgical procedures to address the deficiency of the posterior part of the mandible that is ramus and condyle. Transverse mandibular deficiency is one of the most difficult problems to be addressed surgically.With the advent of distraction osteogenesis there is a change in concept of addressing mandibular deficiency. Mandibular corpus distraction was first performed by McCarthy et al using an extraoral unidirectional distraction device. The precision of bone lengthening with extraoral distracters did not accurately match the device settings. Since then due to sustained research and design and collaboration with the manufacturers, clinicians have developed various devices to improve the results of mandibular lengthening. Distractor devices of various shape and size are developed for intraoral use in specific anatomical locations of mandible.This presentation will focus on use of intraoral distraction devices on different anatomical locations of mandible. The surgical methods of corpus, ramus, ramuscondylar unit, and symphyseal distraction osteogenesis and associated complications will be discussed in detail.


Asunto(s)
Maloclusión/cirugía , Mandíbula/cirugía , Mentoplastia , Humanos , Osteogénesis por Distracción/métodos , Osteotomía Sagital de Rama Mandibular
13.
Int Orthod ; 17(3): 425-436, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31280998

RESUMEN

PURPOSE: The aim of this study was to compare dentoskeletal effects of bone-borne expanders with those of conventional expanders in adolescent and adults having transverse maxillary deficiency. METHODS: All randomized clinical trials (RCTs) comparing the effects of bone-borne with those of tooth-borne expansion for treatment of maxillary transverse deficiency in adults and adolescents with maxillary transverse deficiency or posterior crossbite were included. The systematic search was irrespective of language and publication type. The electronic search was conducted from 1980 to January 2018. RESULTS: The electronic searches retrieved 713 references after screening for eligibility criteria. Eight studies met the inclusion criteria for this systematic review involving 289 participants. Four studies compared rapid maxillary expansion (RME) between bone-borne and tooth-borne devices and indicated effectiveness of both devices on maxillary expansion. In the first molar region, there was no significant difference between two devices in either skeletal or dental expansion. Two studies compared the effects of bone-borne and tooth-borne device following SARME and suggested no significant difference regarding amount and pattern of expansion at various levels and in molar and premolar region between two groups. Two studies compared bone-borne and tooth-bone-borne devices. CONCLUSION: Within the limit of the present evidence regarding maxillary expansion, it seems that both tooth-borne and bone-borne devices result in the same outcome in terms of the amount of maxillary expansion, dental tipping, stability and perceived pain both in RME and SARME procedure. PROSPERO registration: CRD42017061078.


Asunto(s)
Aparatos Ortodóncicos , Técnica de Expansión Palatina , Adolescente , Adulto , Bases de Datos Factuales , Arco Dental , Humanos , Maloclusión/cirugía , Maxilar/anomalías , Maxilar/cirugía , Diente Molar , Métodos de Anclaje en Ortodoncia/métodos , Diseño de Aparato Ortodóncico , Técnica de Expansión Palatina/instrumentación , Ensayos Clínicos Controlados Aleatorios como Asunto
14.
Int Orthod ; 17(3): 567-572, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31296489

RESUMEN

Corticotomies are now an integral part of the orthodontist's therapeutic arsenal in adult orthodontics. In recent years, the number of publications about different surgical techniques has increased significantly. This shows that practitioners and patients have a common interest. It is now accepted that corticotomies cause a regional acceleratory phenomenon, which enables a faster dental movement, a reduction in treatment time, as well as a reduction in the risk of root resorption. The perspective of osteogenesis induced by corticotomies has already been mentioned in literature. It could provide a real advantage in maintaining the periodontium, reducing the risk of fenestration or dehiscence and the stability of long-term treatment by increasing the dental bone envelope. Through a clinical case, treated by mini- invasive surgical technique (as described in the previous article), we highlight the potential for osteogenesis induced by alveolar corticotomies and the utility of this procedure in adults.


Asunto(s)
Imagenología Tridimensional/métodos , Maloclusión/cirugía , Ortodoncia/métodos , Osteogénesis , Pérdida de Hueso Alveolar , Tomografía Computarizada de Haz Cónico , Humanos , Maloclusión/diagnóstico por imagen , Ortodoncia Correctiva/efectos adversos , Ortodoncia Correctiva/métodos , Osteogénesis/fisiología , Osteotomía/métodos , Ligamento Periodontal , Resorción Radicular , Adulto Joven
15.
J Craniofac Surg ; 30(7): e619-e622, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31157641

RESUMEN

Anterior segmental osteotomy (ASO) is considered the treatment modality of choice in patients with the bimaxillary dentoalveolar protrusion. However, this meticulous surgical technique accompanies a number of possible disadvantages. The considerable time required before, during, and after the operation, limited movement of the segment, damage of the mental nerve, loss of tooth vitality, loss of a tooth or teeth, or indeed total loss of the anterior segments are those that affect the result of the surgery. Recently, the authors have devised a computer-aided surgical simulation programme and fabricated the customized osteotomy guides and the spider-shaped plates based on the programme. They were then applied to a 28-year-old patient with the complaint of a bimaxillary dentoalveolar protrusion. This approach helped to overcome several problems related to ASO reported earlier.


Asunto(s)
Maloclusión/cirugía , Osteotomía , Adulto , Femenino , Humanos , Osteotomía/instrumentación , Osteotomía/métodos , Cirugía Asistida por Computador
16.
Av. odontoestomatol ; 35(3): 119-129, mayo-jun. 2019. ilus, tab
Artículo en Español | IBECS | ID: ibc-187646

RESUMEN

Antecedentes: La cirugía ortognática es una opción terapéutica que busca parámetros de simetría, función masticatoria, respiratoria, e indirectamente mejorar el estado emocional de pacientes con anomalías dentofaciales. El instrumento Orthognathic Quality Of Life Questionnaire (OQLQ) permite realizar una evaluación subjetiva amplia y del nivel de calidad de vida pre y postquirúrgica, por lo que es necesario realizar el proceso de traducción al español y la adaptación cultural al contexto colombiano. Métodos: Posterior a la autorización del autor original se realizaron traducciones directas, obtención de una versión preliminar, traducciones inversas y una prueba piloto con 15 pacientes colombianos, mayores de 16 años, con anomalía dentofacial que asistieron al hospital de San José. Se aplicó la metodología del grupo de calidad de la European Organization for Research and Treatment of Cancer (EORTC) para garantizar que la versión en español de la escala sea equivalente conceptualmente a la original. Resultados: Las traducciones directas fueron consistentes, sin embargo, se hicieron ajustes para obtener la versión preliminar; las traducciones inversas fueron similares a la versión original de la escala. La prueba piloto, realizada en una muestra heterogénea de 15 pacientes, llevó al ajuste de la sintaxis de un ítem. De esta manera se obtuvo la versión en español del cuestionario que en fase posterior se validará. Conclusiones: La realización de este estudio permitió la adaptación de un cuestionario entendible en el contexto colombiano, garantizando una equivalencia lingüística y conceptual entre esta versión y la versión original


Introduction: Orthognathic surgery is a therapeutic option that seeks parameters of symmetry, masticatory function, breathing, and improves the emotional state of patients with dentofacial anomalies. The questionnaire Orthognathic Quality of Life Questionnaire (OQLQ) allows to make a subjective evaluation and the level of quality of life before and after surgery, so it is necessary to perform the translation into Spanish and the cultural adaptation to the Colombian context. Methods: After the authorization of the original author, direct translations were made obtaining a preliminary version, reverse translations and a pilot test was accomplished with 15 Colombian patients over 16 years of age with a dentofacial anomaly who attended the San José hospital in Bogotá. The methodology of the quality group of the European Organization for Research and Treatment of Cancer (EORTC) was applied to ensure that the Spanish version of the scale is conceptually equivalent to the original. Results: The direct translations were consistent, however, adjustments were made to obtain the preliminary version; the inverse translations were similar to the original version of the scale. The pilot test, carried out on a heterogeneous sample of 15 patients led to the adjustment of the syntax of one item. In this way, the Spanish version of the questionnaire was obtained. Conclusion: The realization of this study allowed the adaptation of an understandable questionnaire in the Colombian context, guaranteeing a linguistic and conceptual equivalence between this version and the original versión


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Adolescente , Comparación Transcultural , Cirugía Ortognática , Calidad de Vida , Deformidades Dentofaciales/cirugía , Cirugía Bucal/métodos , Maloclusión/cirugía , Traducción , Encuestas y Cuestionarios , Colombia , Proyectos Piloto , Articulación Temporomandibular
17.
Artículo en Inglés | MEDLINE | ID: mdl-31141986

RESUMEN

Objectives: Limited information exists on orthognathic procedures and respective dentofacial deformities in Turkey. This retrospective study assessed the orthognathic surgery procedures in two universities, using the Index of Orthognathic Functional Treatment Need (IOFTN), and compared the IOFTN grades according to gender as well as sagittal and vertical skeletal relationships. Material and Methods: Records of 200 consecutive patients (120 females, 80 males, mean age = 23.4 (SD: 5.4) years) who received orthognathic treatment (2014-2018) were analyzed. Sagittal (ANB angle) and vertical skeletal type (GoGnSN angle), osteotomies, and IOFTN scores were recorded. Results: Class III, II, and I malocclusions formed 69%, 17.5%, and 13.5% of the samples, respectively. Class III skeletal relationships (69%) and high-angle cases (64%) were the most prevalent (p < 0.05). IOFTN scores were unevenly distributed among genders (p < 0.05) and the prevalent scores were 5.3 (40.5%), 4.3 (15.5%), 5.4 (13%), and 5.2 (7.5%), with 94% scoring 4 or 5 (great and very great functional need). Bimaxillary osteotomies were the most prevalent (55%), followed by LeFort I (32%), and 26% had genioplasty. Conclusion: IOFTN is a reliable tool to identify patients in need of orthognathic surgery. Class III malocclusions and Class III sagittal skeletal relationships were more common in this sample. Comparatively, a higher number of patients had genioplasty as a part of their treatment.


Asunto(s)
Deformidades Dentofaciales/epidemiología , Deformidades Dentofaciales/cirugía , Maloclusión/epidemiología , Maloclusión/cirugía , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Adulto , Femenino , Humanos , Masculino , Estudios Retrospectivos , Turquia/epidemiología , Adulto Joven
18.
Int Orthod ; 17(2): 384-394, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31029533

RESUMEN

Facial asymmetry is a common complaint in patients with facial concerns. Some patients have mandibular asymmetries that have light maxillary cant compensation due to a reduced gingival exposure. A common treatment in facial asymmetries is bimaxillary surgery treatment. However, there are no cases of non-severe occlusal plane canting (OPC) with mandibular asymmetry treated with mandibular surgery and miniscrews for the extrusion of the maxillary molars. The aim of this article is to show how to correct mandibular asymmetries combined with OPC by making a single mandibular "early surgery" combined with the extrusion of the maxilla with miniscrews to correct the occlusal plane in order to avoid a Le Fort I surgery. This type of treatment provides lower medical costs, shorter surgeries, and less postoperative discomfort and invasion for patients.


Asunto(s)
Oclusión Dental , Asimetría Facial/cirugía , Maloclusión/diagnóstico , Maloclusión/cirugía , Mandíbula/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Tornillos Óseos , Cefalometría , Femenino , Humanos , Masculino , Maxilar , Persona de Mediana Edad , Diente Molar , Métodos de Anclaje en Ortodoncia/métodos , Aparatos Ortodóncicos Fijos , Radiografía Dental , Técnicas de Movimiento Dental , Resultado del Tratamiento , Adulto Joven
19.
Artículo en Inglés | MEDLINE | ID: mdl-30875852

RESUMEN

(1) Background: Oculo-facio-cardio-dental (OFCD) syndrome is a rare pathological condition with an X-linked dominant trait that only occurs in females; no males are born with OFCD syndrome. This syndrome is characterized by congenital cataracts with secondary glaucoma ocular defects, ventricular and atrial septal defects, or mitral valve prolapses. Facial traits are a long narrow face and a high nasal bridge with a bifid nasal tip. Dental anomalies include radiculomegaly, oligodontia, root dilacerations, malocclusion, and delayed eruption. (2) Methods: This clinical report describes a 26-year-old girl who suffers from OFCD syndrome and who was treated with a multidisciplinary approach. The treatment plan included orthodontic treatment, orthognathic surgery, namely LeFort I and a Bilateral Sagittal Split Osteotomy, and occlusal rehabilitation with implants. (3) Discussion: Early diagnosis and multidisciplinary treatment of orthodontic, orthognathic surgery and occlusal rehabilitation with implants make it possible to maintain tooth function and improve aesthetics with good prognoses for success. In this paper, we report a case of a female patient with OFCD syndrome, who was referred for orthodontic treatment and occlusal rehabilitation and treated with a multidisciplinary approach.


Asunto(s)
Catarata/congénito , Defectos de los Tabiques Cardíacos/terapia , Maloclusión/terapia , Microftalmía/terapia , Procedimientos Quirúrgicos Ortognáticos , Adulto , Catarata/terapia , Femenino , Defectos de los Tabiques Cardíacos/cirugía , Humanos , Maloclusión/cirugía , Microftalmía/cirugía
20.
J Craniofac Surg ; 30(3): 771-776, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30807469

RESUMEN

BACKGROUND: Integrated approaches to orthognathic surgery should include accurate volumetric evaluation of the skull and soft tissues. In patients with dentofacial deformities, the most frequent aesthetic deficits are attributable to an underdevelopment of hard and soft tissues. Traditional osteotomic procedures often fail to guarantee a stability of soft tissues over time. For this reason, in selecting a surgical strategy, the surgeon should consider not only traditional osteotomies, but also soft-tissue improving procedures, such as lipofilling. Preoperative surgical planning systems, such as the Virtual surgical planning (VSP) protocol, are based mainly on skeletal movement prediction. Quantitative estimation of soft-tissue modifications is not part of common clinical practice. Most commonly, the evaluation of soft-tissue modifications after orthognathic procedures is instead performed by clinical qualitative means.The purpose of this study was to describe a novel computed tomography (CT)-based volumetric analysis process for the quantification of injected autologous adipose tissue in patients who have undergone simultaneous orthognathic and lipofilling procedures. METHODS: This was a retrospective review of consecutive patients who underwent combined orthognathic surgery and lipofilling from June 2016 to May 2017 for malocclusion with functional and aesthetic impairments. Preoperative planning included clinical evaluation and virtual osteotomy planning according to the VSP protocol. The volume of fat to be injected was estimated clinically by comparing virtual renderings with preoperative clinical photographs. The surgical technique involved Le Fort I and sagittal split mandibular osteotomies, combined with autologous fat injection in the malar and perioral regions. Postoperative evaluation was performed with a novel imaging process based on CT image segmentation to quantify the exact volume of injected fat. Skeletal stability was also evaluated at 3 months. RESULTS: Sixteen patients were enrolled in the study, all females, with a mean age of 24.5 years (range, 18-36 years). The mean difference between the fat tissue injected and that quantified postoperatively was 6.01 cm. All patients had clinically satisfactory facial convexity, with complete restoration of the cheekbone contour, at 3 months. CONCLUSION: This study introduces a novel CT-image based technique to quantitatively assess the contribution of injected fat to the postoperative soft-tissue volume increase after combined orthognathic surgery with autologous lipofilling. In the future, this CT-based volumetric analysis technique could be the gold standard for evaluating facial lipofilling outcomes, and for assessing clinical aesthetic outcomes based on the injected volume of fat.


Asunto(s)
Tejido Adiposo/trasplante , Maloclusión , Procedimientos Quirúrgicos Ortognáticos/métodos , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Femenino , Humanos , Masculino , Maloclusión/diagnóstico por imagen , Maloclusión/cirugía , Estudios Retrospectivos , Adulto Joven
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