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1.
Stomatologiia (Mosk) ; 99(4): 33-42, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32692517

RESUMEN

One of the most common abnormalities in the development of the jaw is the narrowing of the alveolar process of the maxilla. In childhood, the elimination of such a deformation is quite common. But with age, the only effective option is the inclusion of a surgical procedure in the rehabilitation plan. The medial and parasagittal osteotomy of the maxilla for the purpose of its expansion by a distraction device has a number of important nuances which can significantly affect the result. These include: localization of sagittal osteotomy of the palate and alveolar process; the direction of cutting the walls of the maxillary sinus; type of fixation of the device (dental-borne or bone-borne). The article summarizes the experience of 74 surgical-associated expansions of the jaws with asymmetric deformations performed over 2 years. A retrospective analysis according to cone beam computed tomography is given. of complex treatment with the inclusion of sparing osteotomy of the maxilla in the rehabilitation plan and a differentiated approach to performing surgical manipulation allow to achieve optimal aesthetic and functional results and to correct the asymmetry to the greatest extent.


Asunto(s)
Osteogénesis por Distracción , Técnica de Expansión Palatina , Proceso Alveolar , Maxilar , Osteotomía Le Fort , Estudios Retrospectivos
2.
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
3.
Codas ; 32(4): e20190152, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32401996

RESUMEN

Purpose This study investigated the influence of the cleft type on the appearance of hypernasality after surgical maxillary advancement (MA). Methods Nasality was determined by measurement of nasalance (acoustic correlate of nasality) by nasometry. The study involved analysis of the nasalance scores of 17 individuals with isolated cleft palate (CP), 118 with unilateral cleft lip and palate (UCLP) and 69 with bilateral cleft lip and palate (BCLP), of both sexes, aged 18 to 28 years, after MA. Only individuals with normal nasalance scores indicating balanced resonance before MA were included in this study. Nasometry was performed 3 days before and 15 months after MA, on average. The proportion of patients who presented nasalance scores indicating hypernasality after surgery was calculated by the ANOVA test, and comparison among the different cleft types was evaluated by the chi-square test (p < 0.05). Results No significant difference was found in the proportions of individuals with hypernasality among the cleft types. Conclusion Nasometry showed that the appearance of hypernasality after MA in individuals with cleft palate with or without cleft lip occurred in similar proportions, regardless of the cleft type.


Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Procedimientos Quirúrgicos Ortognáticos/efectos adversos , Trastornos del Habla/etiología , Habla/fisiología , Insuficiencia Velofaríngea/etiología , Adolescente , Adulto , Labio Leporino/fisiopatología , Fisura del Paladar/fisiopatología , Femenino , Humanos , Masculino , Maxilar/cirugía , Osteotomía Le Fort/efectos adversos , Estudios Retrospectivos , Trastornos del Habla/fisiopatología , Medición de la Producción del Habla , Insuficiencia Velofaríngea/fisiopatología , Adulto Joven
4.
Plast Reconstr Surg ; 145(5): 963e-974e, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32332545

RESUMEN

BACKGROUND: The aim of this study was to evaluate the effects of the use of computer-aided design and manufacturing cutting and drilling guides with prebent titanium plates for the correction of skeletal class III malocclusion. METHODS: In this prospective, randomized, controlled clinical trial, 46 patients with skeletal class III malocclusion were randomly assigned into two groups. The patients underwent bimaxillary surgery with computer-aided design and manufacturing cutting and drilling guides with prebent titanium plates (experimental group) or computer-aided design and manufacturing splints (control group). Preoperative and postoperative imaging data were collected and then analyzed using Mimics Research 19.0, Geomagic Studio, and IBM SPSS Version 21.0. RESULTS: Deformity evaluation and posttreatment assessment were performed for all patients. The experimental group had fewer postoperative complications. Comparison of the linear and angular differences to facial reference planes revealed more accurate repositioning of the mandible and condyles in the experimental group, although the position of several landmarks still requires small adjustments. CONCLUSION: Computer-aided design and manufacturing cutting and drilling guides with prebent titanium plates effectively corrected skeletal class III malocclusion, providing positional control of segments with reasonable surgical accuracy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Asunto(s)
Diseño Asistido por Computadora , Maloclusión de Angle Clase III/cirugía , Procedimientos Quirúrgicos Ortognáticos/instrumentación , Osteotomía Le Fort/instrumentación , Cirugía Asistida por Computador/instrumentación , Adulto , Puntos Anatómicos de Referencia , Placas Óseas , Cefalometría/métodos , Femenino , Humanos , Imagenología Tridimensional , Masculino , Mandíbula/anatomía & histología , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Maxilar/anatomía & histología , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteotomía Le Fort/métodos , Estudios Prospectivos , Férulas (Fijadores) , Cirugía Asistida por Computador/métodos , Titanio , Tomografía Computarizada Espiral , Resultado del Tratamiento , Adulto Joven
5.
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
6.
J Craniomaxillofac Surg ; 48(2): 170-175, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32005513

RESUMEN

AIM: The purpose of this study was to evaluate the efficiency of pyramidal and posterior osseous release (PPOR) for maxillary impaction using an ultrasonic bone-cutting device after Le Fort I (LFI) osteotomy. MATERIALS AND METHODS: In total, 31 Japanese adults with jaw deformities, diagnosed as having maxillary excess with mandibular prognathism or deficiency, underwent LFI osteotomy and bilateral sagittal split osteotomy. The patients were divided into two groups: a trimming group (15 patients, four men and 11 women; mean age 24.8 years) and a PPOR group (16 patients, seven men and nine women; mean age 22.8 years). In the trimming group, osseous interference around the descending palatine artery (DPA) was removed using forceps, rounding bur, and reciprocating rasp. The PPOR technique was used to remove osseous fragments created by V-shaped osteotomy around the DPA following vertical osteotomy behind the DPA using an ultrasonic bone-cutting device (Variosurg 3; NSK, Tochigi, Japan). The operative times for maxillary osteotomy, total operative times (including bilateral sagittal split osteotomy), and total blood loss were assessed. RESULTS: The mean planned amounts of maxillary impaction were 4.37 ± 1.27 mm in the trimming group and 4.38 ± 1.36 mm in the PPOR group (p = 0.98). The mean maxillary operative time for the PPOR group was significantly shorter, by 25.5% (p < 0.001). Total operative time for the PPOR group was also significantly shorter, by 24.3% (p < 0.001). Mean blood loss was significantly lower in the PPOR group than in the trimming group (p = 0.003). CONCLUSION: The PPOR technique for maxillary impaction after LFI osteotomy shortened the operative time and enabled secure reduction of the maxilla in patients who required the treatment of maxillary impaction with preservation of the DPA bundle.


Asunto(s)
Maloclusión de Angle Clase III/cirugía , Maxilar/cirugía , Osteotomía Le Fort , Ultrasonido , Adulto , Cefalometría , Femenino , Humanos , Masculino , Adulto Joven
7.
Clin Oral Investig ; 24(4): 1509-1516, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32100114

RESUMEN

OBJECTIVES: To determine if patient outcome variables differ between conventional and virtual surgical planning of orthognathic surgery for class III asymmetry. MATERIAL AND METHODS: This retrospective case-control study examined 95 patients with class III asymmetry who had been consecutively treated with at least a Le Fort I osteotomy and a bilateral sagittal split osteotomy with a surgery-first approach. Two groups were examined: 51 patients treated with conventional surgical planning and 44 with virtual surgical planning. After treatment, quantitative assessment was determined with measurements of midline symmetry, contour symmetry, and overall facial symmetry using standardized frontal photographs. Subject assessments were analyzed with questionnaires regarding self-perception of overall appearance, satisfaction with appearance, and quality of life. RESULTS: Conventional and virtual surgical planning resulted in significant improvements in outcomes for all patients. However, facial midline and overall facial symmetry were significantly greater for the virtual compared with the conventional group. There were no significant differences in subjective measures of appearance, satisfaction with appearance, and quality of life for patients treated with conventional or virtual surgical planning; measures were high for both groups. CONCLUSIONS: Conventional and virtual surgical planning of surgery-first bimaxillary orthognathic surgery resulted in quantitative and qualitative improvements in facial symmetry. Although patient satisfaction was similar for both approaches, virtual surgical planning was superior to conventional surgical planning for the improvement of midline and overall asymmetry. CLINICAL RELEVANCE: Improvements with virtual surgical planning in facial midline, facial contour, and overall facial symmetry are as good as or better than conventional surgical planning.


Asunto(s)
Maloclusión de Angle Clase III/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Adolescente , Adulto , Estudios de Casos y Controles , Cefalometría , Asimetría Facial , Femenino , Humanos , Masculino , Osteotomía Le Fort , Calidad de Vida , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
8.
Am J Orthod Dentofacial Orthop ; 157(2): 259-268, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32005478

RESUMEN

This case report presents the unique treatment of a patient with varying asymmetries at different levels within the face. The patient was a 17-year-old male with a diagnosis of right unilateral coronal synostosis. He had frontal and superior orbital retrusion on the fused side, and bossing of the contralateral side. The middle and lower portions of his face were rotated toward the nonfused side. This unique diagnosis presented particular challenges to surgical and orthodontic correction. The treatment approach, which included a combination of Le Fort I and II osteotomies, bilateral sagittal split osteotomy, and orthodontic treatment with 4 premolar extractions, enabled simultaneous correction of nasal, midfacial, lower facial, and dental asymmetries. The orthodontist and surgeon integrated their efforts to correct dentofacial asymmetry in all 3 planes of space. Facial esthetics and dental function were significantly improved with no appreciable relapse occurring over a 2-year retention period.


Asunto(s)
Craneosinostosis , Estética Dental , Asimetría Facial , Osteotomía Le Fort , Adolescente , Craneosinostosis/complicaciones , Craneosinostosis/cirugía , Asimetría Facial/cirugía , Huesos Faciales , Humanos , Masculino
9.
Niger J Clin Pract ; 23(2): 240-245, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32031100

RESUMEN

Aims: Le Fort I (LI) osteotomy has been used for the correction of dento-facial deformities of the midface. The aim of this study was to determine the effects of advancement and impaction of the maxilla with LI osteotomy on the nasal cavity and septum. Patients and Methods: In this study, 40 adult patients, 23 females and 17 males (mean age 20.52 ± 4.4 years), who underwent single-piece LI advancement and impaction surgery combined with a bilateral sagittal split osteotomy (BSSO) were included. Posterior-anterior (PA) and lateral cephalometric radiographs taken before surgery (T0) and at least three months after surgery (T1) were evaluated. The superior and anterior movements of maxilla, changes of the nasal cavity, nasal septum and maxillo-mandibular parameter were measured on the cephalometric radiographs. Treatment changes were statistically analyzed using paired sample t-test, and Pearson correlation analysis was applied for the determination of the relationship between variables. Results: There was no statistically significant change in the deviation parameters (P > 0,05). However, a statistically significant decrease was found for left and right nasal cavity heights after LI osteotomy (P < 0.05). Furthermore, no significant correlation was found between septal deviation angle and extent of maxillary movement (P > 0.05). Positive correlation was found between nasal cavity width and amount of maxillary impaction. (P < 0.05). Conclusion: The influence of maxillary impaction with LI osteotomy on nasal septum deviation was not found significant but maxillary impaction with LI osteotomy significantly increased the nasal cavity width.


Asunto(s)
Mandíbula/cirugía , Maxilar/cirugía , Tabique Nasal/diagnóstico por imagen , Deformidades Adquiridas Nasales/etiología , Cirugía Ortognática/métodos , Osteotomía Le Fort/métodos , Complicaciones Posoperatorias , Adolescente , Femenino , Humanos , Masculino , Cavidad Nasal , Tabique Nasal/cirugía , Osteotomía Le Fort/efectos adversos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto Joven
10.
Int J Oral Maxillofac Surg ; 49(5): 587-594, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31587823

RESUMEN

The aim of this pilot study was to evaluate the accuracy and predictability of a splintless treatment protocol for edentulous patients undergoing orthognathic surgery in four consecutive cases. All operations were virtually planned, followed by computer-aided design of individual osteotomy guides and patient-specific fixation implants, which were three-dimensionally printed in titanium. In order to evaluate the discrepancy between the planned and the achieved postoperative result, the postoperative outcome was compared to the virtual treatment plan. Rotational and translational movement and discrepancies with the planned movements were quantified for the maxilla; the advancement was quantified for the mandible. For the maxilla, there was a mean translation discrepancy of 0.6mm. With regard to rotation, there was a mean discrepancy of 1.9°, 0.1°, and 0.4° for pitch, yaw, and roll, respectively. The mean discrepancy in translation of the mandible was 0.4mm. The results of this pilot study indicate that the splintless treatment protocol for orthognathic surgery in edentulous patients presented here is accurate and predictable.


Asunto(s)
Implantes Dentales , Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Cirugía Asistida por Computador , Humanos , Mandíbula , Maxilar , Osteotomía Le Fort , Proyectos Piloto
11.
Int J Oral Maxillofac Surg ; 49(4): 421-431, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31526673

RESUMEN

Maxillary hypoplasia in cleft lip and palate is a complex deformity. Despite surgical improvements, postoperative relapse persists. This systematic review was performed to determine the mean horizontal relapse rates for the surgical techniques used to treat maxillary hypoplasia: Le Fort I osteotomy with rigid fixation, Le Fort I distraction osteogenesis, and anterior maxillary distraction osteogenesis. This study followed the PRISMA statement. The PubMed, Embase, Science Direct, and Web of Science databases were searched through to June 2018. Studies on non-growing cleft lip and palate patients who had undergone one of the three surgical procedures and who had postoperative horizontal maxillary changes assessed at >6 months post-surgery were included. Stata SE was used to estimate pooled means, heterogeneity, and publication bias. The search strategy identified 326 citations, from which 24 studies were selected. Relapse rates following Le Fort I osteotomy with rigid fixation, Le Fort I distraction osteogenesis, and anterior maxillary distraction osteogenesis were 20%, 12%, and 12%, respectively. Relapse rates with and without bone grafting were 19% and 66%, respectively. The relapse rate following distraction osteogenesis with internal distraction was lower than that with external distraction. Study limitations were heterogeneity, which was above moderate, the low number of high-quality studies, and unidirectional assessment of postoperative maxillary movement.


Asunto(s)
Labio Leporino , Fisura del Paladar , Micrognatismo , Osteogénesis por Distracción , Cefalometría , Humanos , Maxilar , Osteotomía Le Fort , Recurrencia , Resultado del Tratamiento
12.
Int J Oral Maxillofac Surg ; 49(4): 466-470, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31495722

RESUMEN

The purpose was to assess maxillary position among patients undergoing Le Fort I maxillary advancement with internal fixation placed only at the nasomaxillary buttresses. This was a retrospective study of patients undergoing a Le Fort I osteotomy for maxillary advancement, with internal fixation placed only at the nasomaxillary buttresses. Demographic and cephalometric measures were recorded. The outcome of interest was the change in maxillary position between immediately postoperative (T1), 6 weeks postoperative (T2), and 1 year postoperative (T3). Fifty-eight patients were included as study subjects (32 male, 26 female; mean age 18.4±1.8 years). Twenty-five subjects (43.1%) had a diagnosis of cleft lip and palate. Forty-three subjects (74.1%) had bimaxillary surgery, 16 (27.6%) had bone grafts, and 18 (31.0%) had segmental maxillary osteotomies. At T3, there were no subjects with non-union, malunion, malocclusion, or relapse requiring repeat surgery. Mean linear changes between T1 and T3 were ≤1mm. Mean angular changes between T1 and T3 were <1°. There was no significant difference in stability in multi-segment maxillary osteotomies (P= 0.22) or with bone grafting (P= 0.31). In conclusion, anterior fixation alone in the Le Fort I osteotomy results in a stable maxillary position at 1 year postoperative.


Asunto(s)
Labio Leporino , Fisura del Paladar , Adolescente , Adulto , Cefalometría , Femenino , Humanos , Masculino , Maxilar , Osteotomía Maxilar , Osteotomía Le Fort , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
13.
Int J Oral Maxillofac Surg ; 49(4): 454-460, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31506186

RESUMEN

The accuracy of orthognathic surgery has improved with three-dimensional virtual planning. The translation of the planning to the surgical result is reported to vary by >2mm. The aim of this randomized controlled multi-centre trial was to determine whether the use of splintless patient-specific osteosynthesis can improve the accuracy of maxillary translation. Patients requiring a Le Fort I osteotomy were included in the trial. The intervention group was treated using patient-specific osteosynthesis and the control group with conventional osteosynthesis and splint-based positioning. Fifty-eight patients completed the study protocol, 27 in the patient-specific osteosynthesis group and 31 in the control group. The per protocol median anteroposterior deviation was found to be 1.05mm (interquartile range (IQR) 0.45-2.72mm) in the patient-specific osteosynthesis group and 1.74mm (IQR 1.02-3.02mm) in the control group. The cranial-caudal deviation was 0.87mm (IQR 0.49-1.44mm) and 0.98mm (IQR 0.28-2.10mm), respectively, whereas the left-right translation deviation was 0.46mm (IQR 0.19-0.96mm) in the patient-specific osteosynthesis group and 1.07mm (IQR 0.62-1.55mm) in the control group. The splintless patient-specific osteosynthesis method improves the accuracy of maxillary translations in orthognathic surgery and is clinically relevant for planned anteroposterior translations of more than 3.70mm.


Asunto(s)
Procedimientos Quirúrgicos Ortognáticos , Cirugía Asistida por Computador , Diseño Asistido por Computadora , Humanos , Imagenología Tridimensional , Maxilar , Osteotomía Le Fort
14.
Int J Oral Maxillofac Surg ; 49(1): 69-74, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31266680

RESUMEN

The aim of this study was to evaluate the surgical accuracy of Le Fort I surgery compared to the three-dimensional (3D) virtual planning. Fifty-five patients (29 males, 26 females; age range 15-58 years) with skeletal class III malocclusion, who underwent bimaxillary surgery were included. A validated 3D accuracy assessment tool was utilized to assess the surgical accuracy of the maxillary positioning. For translational movements, the least amount of error was associated with mediolateral translation, whereas the surgical accuracy for anteroposterior and superoinferior translation showed a tendency towards a more posterior and inferior positioning of the maxilla compared to the planning. For rotational movements, the highest discrepancy was observed for pitch. Linear regression showed increased inaccuracy with increasing advancement for anteroposterior, superoinferior and pitch movements. To conclude, 3D virtual planning of maxilla was generally accurate when compared to achieved outcome for skeletal class III patients undergoing bimaxillary surgery.


Asunto(s)
Maloclusión de Angle Clase III , Maxilar , Adolescente , Adulto , Cefalometría , Femenino , Humanos , Masculino , Osteotomía Maxilar , Persona de Mediana Edad , Osteotomía Le Fort , Adulto Joven
15.
J Craniofac Surg ; 31(1): 286-288, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31369509

RESUMEN

Le Fort III distraction is indicated for the management of skeletal malocclusions, midface hypoplasia, and exorbitism and has been found to be a safe procedure with predictable results. Although variation in the placement of the lateral orbital osteotomy has been described, the classic osteotomy divides the zygomatic arch, crosses the lateral orbital rim, transverses the orbital floor, and ends in the midline. Distraction of this segment may lead to a palpable, and sometimes visible, step deformity between the lower and upper segments of the lateral orbital wall. The authors present a novel approach to the management of the lateral orbital wall step deformity following Le Fort III distraction.


Asunto(s)
Órbita/cirugía , Cigoma/cirugía , Disostosis Craneofacial/cirugía , Humanos , Masculino , Osteogénesis por Distracción , Osteotomía Le Fort , Adulto Joven
16.
Int J Oral Maxillofac Surg ; 49(7): 895-900, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31883853

RESUMEN

The purpose of this work was to evaluate the stability of maxillary position in the setting of occlusal plane rotations in bimaxillary surgery with rigid fixation of the mandible and bilateral nasomaxillary fixation at the Le Fort I level. This was a retrospective assessment of patients undergoing bimaxillary surgery for the correction of dentofacial deformities with occlusal plane alterations. Demographic measures assessed included age, sex, history of craniofacial anomaly, segmental maxillary osteotomy, and maxillary bone grafting. Cephalometric measures assessed included occlusal plane rotation (clockwise (CWR) or counterclockwise (CCWR)), angular measurements of maxillary and mandibular position (SNA, SNB, and ANB), and occlusal plane angle (occlusal plane to corrected Frankfort horizontal); these were assessed preoperatively (T0) and immediately (T1), 6 weeks (T2), and 1year postoperative (T3). Descriptive and bivariate statistics were computed; P≤0.05 was considered significant. Thirty-six patients were included as study subjects (mean age 18.6±1.8 years; 17 (47.2%) female); 27 (75%) had a primary diagnosis of craniofacial anomaly. Eleven patients (30.6%) had segmental maxillary osteotomies; 10 patients (27.8%) had simultaneous maxillary bone grafting. Twelve patients underwent CCWR; 24 patients underwent CWR. No patient required repeat surgery for malocclusion or relapse; there were no malunions or non-unions during follow-up. For CCWR patients, the mean occlusal plane change from preoperative to postoperative was 5.8±2.8°, remaining stable at 1 year postoperative (ΔT3-T1 1.6±1.0°, P>0.05). For CWR patients, the mean occlusal plane rotation was 4.5 ± 2.2°, remaining stable at 1 year postoperative (ΔT3-T1 1.1±0.9°, P>0.05). In patients undergoing bimaxillary surgery for occlusal plane rotation, two-point fixation of the Le Fort I osteotomy resulted in a stable maxillary position at 1 year postoperative.


Asunto(s)
Oclusión Dental , Osteotomía Le Fort , Adolescente , Adulto , Cefalometría , Femenino , Humanos , Mandíbula , Maxilar , Estudios Retrospectivos , Adulto Joven
18.
J Craniomaxillofac Surg ; 47(12): 1868-1874, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31812310

RESUMEN

BACKGROUND: Maxillary advancement may affect speech in cleft patients. AIMS: To evaluate whether the amount of maxillary advancement in Le Fort I osteotomy affects velopharyngeal function (VPF) in cleft patients. METHODS: Ninety-three non-syndromic cleft patients (51 females, 42 males) were evaluated retrospectively. All patients had undergone a Le Fort I or bimaxillary (n = 24) osteotomy at Helsinki Cleft Palate and Craniofacial Center. Preoperative and postoperative lateral cephalometric radiographs were digitized to measure the amount of maxillary advancement. Pre- and postoperative speech was assessed perceptually and instrumentally by experienced speech therapists. Student's t-test and Mann-Whitney's U-test were used in the statistical analyses. Kappa statistics were calculated to assess reliability. RESULTS: The mean advancement of A point was 4.0 mm horizontally (range: -2.8-11.3) and 3.9 mm vertically (range -14.2-3.9). Although there was a negative change in VPF, the amount of maxillary horizontal or vertical movement did not significantly influence the VPF. There was no difference between the patients with maxillary and bimaxillary osteotomy. CONCLUSIONS: The amount of maxillary advancement does not affect the velopharyngeal function in cleft patients.


Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Osteotomía Maxilar/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteotomía Le Fort/métodos , Habla/fisiología , Insuficiencia Velofaríngea/fisiopatología , Adolescente , Adulto , Cefalometría/métodos , Labio Leporino/fisiopatología , Fisura del Paladar/fisiopatología , Femenino , Finlandia , Humanos , Masculino , Avance Mandibular/métodos , Maxilar/anomalías , Maxilar/cirugía , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Trastornos del Habla/fisiopatología , Trastornos del Habla/cirugía , Resultado del Tratamiento , Insuficiencia Velofaríngea/cirugía , Adulto Joven
19.
Am J Orthod Dentofacial Orthop ; 156(6): 779-790, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31784011

RESUMEN

INTRODUCTION: LeFort III distraction osteogenesis may be indicated in the treatment of syndromic craniosynostosis with severe midface retrusion. This study investigates long-term changes in patients undergoing distraction as children, and compares outcomes to an unaffected, untreated control. METHODS: Fifteen patients (9 males, 6 females) with syndromic craniosynostosis treated by LeFort III distraction at an average age of 4.9 ± 1.5 years were identified. Lateral cephalograms at predistraction, immediate, 1-, 5-, and 10-year postdistraction were superimposed using the best-fit of cranial base details. An untreated, unaffected matched control was obtained from the American Association of Orthodontists Foundation Legacy Collection. Differences in landmark location and cephalometric relationships were assessed between time points and between treatment and control groups. RESULTS: LeFort III distraction produced an average advancement of 14.86 ± 5.14 mm at A-point and 10.54 ± 3.78 mm at orbitale. This advancement produced overcorrection of anteroposterior occlusal relationships and phenotypic correction of midface position. Surgical stability over a 10-year follow-up was excellent. Posttreatment growth was characterized by absent anteroposterior maxillary growth, preservation of dentoalveolar development and maxillary remodeling, and delayed mandibular growth. Subsequent growth resulted in a long-term phenotypic relapse of pretreatment Class III maxillomandibular relationship and negative overjet. CONCLUSIONS: LeFort III distraction osteogenesis produces stable advancement of the midface. Overcorrection is required for long-term phenotypic stability because of deficient postdistraction sagittal midface growth. Late mandibular growth contributes to underestimation of the amount of distraction required to produce long-term phenotypic correction.


Asunto(s)
Craneosinostosis , Osteogénesis por Distracción , Osteotomía Le Fort , Cefalometría , Niño , Preescolar , Femenino , Humanos , Masculino , Mandíbula , Maxilar , Resultado del Tratamiento
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