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1.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541954

RESUMEN

Cavernous sinus thrombosis is a rare but fatal condition arising due to various infectious and noninfectious causes. Although its incidence is very low in the setting of head and neck surgery, including radical neck dissection, a high index of suspicion with prompt treatment is the key to a successful outcome. We report a case of a 50-year-old woman with a chondrosarcoma of left lower alveolobuccal complex who underwent en bloc tumour resection with infratemporal fossa clearance and left modified radical neck dissection. Subsequently, she developed cavernous sinus thrombosis, which was successfully managed with a multidisciplinary approach. This case highlights the importance of high clinical suspicion in the postoperative setting to diagnose this potentially lethal complication.


Asunto(s)
Trombosis del Seno Cavernoso/diagnóstico , Condrosarcoma/complicaciones , Neoplasias de Cabeza y Cuello/complicaciones , Osteotomía Mandibular , Mioepitelioma , Disección del Cuello/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias , Tomografía Computarizada por Rayos X
2.
Am J Orthod Dentofacial Orthop ; 158(6): 878-888, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33129633

RESUMEN

The demand for fast and invisible treatment options for adults has grown. Treatment protocols involving clear aligners in association with alveolar corticotomy have been developed in response to this demand. Alveolar corticotomy surgery can accelerate orthodontic tooth movement, but good clinical follow-up is crucial and can become cumbersome as the frequency of aligner changes accelerates. Clinical monitoring with patient-managed software can be of assistance in such cases. We present the ortho-surgical treatment of a healthy 21-year-old woman with Class III malocclusion who was treated with corticotomy-accelerated presurgical decompensation and clear aligners, followed by mandibular sagittal split osteotomy. Alveolar corticotomy surgery was performed and the aligners were changed every 4 days. Clinical follow-up of aligner-mediated tooth movement was managed with a patient-managed smartphone application, allowing early interception and correction of minute orthodontic movement errors. Such errors would have been difficult to detect considering the rapidity of aligner change when accelerated by alveolar corticotomy. Clinical follow-up with a patient-managed smartphone application could thus allow for better and easier management of corticotomy-accelerated clear aligner orthodontic treatment.


Asunto(s)
Maloclusión de Angle Clase III , Aparatos Ortodóncicos Removibles , Adulto , Femenino , Estudios de Seguimiento , Humanos , Osteotomía Mandibular , Técnicas de Movimiento Dental , Adulto Joven
3.
Shanghai Kou Qiang Yi Xue ; 29(3): 237-241, 2020 Jun.
Artículo en Chino | MEDLINE | ID: mdl-33043338

RESUMEN

PURPOSE: The aim of this study was to compare the stress distribution of microtitanium plate and bioresorbable plates in fixation of mandibulotomy. METHODS: Three dimensional models of different internal fixation systems in mandibular resection were established, and three dimensional finite element analysis was carried out to compare the displacement changes of fracture segments and stress distribution of titanium plates under the same stress conditions. RESULTS: The maximum stress value of titanium plate was 49.8 MPa, and that of absorbable plate was 4.42 MPa. The maximum stress value of titanium plate was far greater than that of absorbable plate. However, all the stresses were less than their yield limits. It can be seen from the relative displacement comparison that when the mini-titanium plate was fixed on the mandible, the maximum displacement value was 0.1 mm; when absorbable plate was used for fixation, the maximum displacement value was 0.2 mm, and the relative displacement of both plates was small. CONCLUSIONS: These results suggest that the stiffness and internal strength of bioabsorbable fixation system are sufficient to support bone healing at the mandible site.


Asunto(s)
Implantes Absorbibles , Osteotomía Mandibular , Placas Óseas , Análisis de Elementos Finitos , Fijación Interna de Fracturas
4.
Medicine (Baltimore) ; 99(33): e21756, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32872069

RESUMEN

RATIONALE: Medication-related osteonecrosis of the jaw decreases quality of life of patients with cancer. The debate about it continues regarding the risk factors, etiology, and treatment methods, and so on. Also, spontaneous regeneration of the mandible is clinically rare. PATIENT CONCERNS: A 67-year-old woman presented to the authors' department complaining of pain, swelling, and pus discharge from a fistula. She previously had breast cancer bone metastases and had received antiresorptive intravenous bisphosphonate. DIAGNOSIS: The patient was diagnosed with medication-related osteonecrosis of the jaw. INTERVENTIONS: She received conservative therapy with antibiotics and surgical therapy as sequestrectomy under general anesthesia; however, the lesion did not heal. Thirty months after the MRONJ diagnosis, when she was 70 years' old, she underwent a left hemimandibulectomy without reconstruction under general anesthesia. OUTCOMES: Spontaneous regeneration of the mandible was observed by follow-up imaging examinations. The patient has no current subjective or objective symptoms. LESSONS: This is the first case report of the spontaneous mandibular regeneration after surgery for medication-related osteonecrosis of the jaw. Additionally, this case was the oldest patient among the published mandibular regeneration cases.


Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/cirugía , Regeneración Ósea , Mandíbula , Osteotomía Mandibular , Anciano , Femenino , Humanos , Radiografía Panorámica
5.
Int J Oral Maxillofac Surg ; 49(11): 1421-1429, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32921555

RESUMEN

The purpose of this study was to assess the pre- and postoperative position and dimensions of the inferior alveolar canal (IAC) following sagittal split osteotomy (SSO) and identify any association with postoperative neurosensory deficit (NSD) at 1 year. This retrospective cohort study enrolled consecutive patients who had SSO performed to correct skeletal malocclusion. The pre- and postoperative cone beam computed tomography data were superimposed to visualize differences in IAC position and dimensions. Subjective and objective neurosensory tests were used to determine NSD in the inferior alveolar nerve distribution. A total of 20 subjects were included. The preoperative distance from the lateral cortex of the IAC to the inner aspect of the lateral cortex of the mandible was significantly greater in sides with NSD when compared to sides without NSD (P = 0.01). A significantly greater reduction in the postoperative distance measurement was seen in sides with NSD when compared to sides without NSD (P = 0.01). The magnitude of mandibular movement was significantly increased in sides with NSD (P = 0.02). The preoperative location of the IAC, as well as certain changes in the mediolateral and vertical positions as a result of SSO, are risk factors for postoperative NSD.


Asunto(s)
Osteotomía Mandibular , Traumatismos del Nervio Trigémino , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Nervio Mandibular/diagnóstico por imagen , Osteotomía Sagital de Rama Mandibular , Estudios Retrospectivos , Traumatismos del Nervio Trigémino/etiología
6.
J Oral Maxillofac Surg ; 78(11): 2080-2089, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32640210

RESUMEN

PURPOSE: Historically, synthetic polymers, such as polyamide, have been the predominate material used for patient-specific cutting guides in 3-dimensionally guided craniomaxillofacial surgery. The physical properties of polyamide result in guides that are bulky and difficult to place within the confines of the facial soft tissue envelope, requiring larger incisions with resultant morbidity. Despite their utility, we found the need for wider exposure simply for guide placement was unacceptable. The purpose of the present study was to evaluate our experience with the newly marketed titanium alloy cutting guides. MATERIALS AND METHODS: We conducted a retrospective cohort study of patients who had undergone either segmental mandibulectomy or maxillectomy using patient-specific titanium alloy cutting guides from May to December 2019. The primary outcome variable was the need for an extended-access cervical incision or a transfacial incision for either maxillectomy or segmental mandibulectomy in patients with benign disorders. The secondary outcome variables included the need for a transfacial incision in patients with malignant pathology requiring either maxillectomy or composite oromandibular resection and the final histopathologic bone margin status. RESULTS: Of the 21 included patients, 11 had undergone maxillectomy (1 of 2) or segmental mandibulectomy (9 of 9) for benign disorders, with 91% (10 of 11) having undergone titanium alloy guide placement and resection entirely transorally without the need for an extended cervical or a transfacial incision. For 10 of the 11 patients undergoing immediate reconstruction with vascularized bone flaps, transcervical access was limited to small 1.5- to 2.5-cm incisions for target vessel access and microvascular anastomosis. None of the 10 patients with a malignant disorder requiring either maxillectomy or composite oromandibular resection required a transfacial incision. The bone margins, as determined by histopathologic analysis, were negative for 100% of the patients. CONCLUSIONS: Patient-specific titanium alloy cutting guides represent a viable alternative to traditional synthetic polymer guides. Their superior properties permit easier intraoral placement, decreasing the need for cutaneous incisions and excessive periosteal stripping.


Asunto(s)
Aleaciones , Titanio , Humanos , Osteotomía Mandibular , Polímeros , Estudios Retrospectivos
7.
Artículo en Inglés | MEDLINE | ID: mdl-32665207

RESUMEN

OBJECTIVE: The aim of this study was to evaluate the relationship between neurosensory disturbance (NSD) and the different types of bilateral sagittal split osteotomy (BSSO) lingual fracture created. STUDY DESIGN: The study group consisted of 45 patients with mandibular deformities (90 sides; 14 males and 31 females). Computed tomography (CT) scans were obtained preoperatively and 1 week postoperatively. All patients were divided into lingual fracture line groups on the basis of their postoperative scans. NSD was tested preoperatively and 1, 3, and 12 months postoperatively by using a sensory touch Semmes-Weinstein (SW) test and the 2-point discrimination (TPD) test. RESULTS: Patients were divided into 2 groups on the basis of their lingual fracture lines after mandibular BSSO; among the 45 patients, 39 sides (43.3%) had short-splits, and 51 sides (56.7%) had long-splits. The short-split group was less affected at all tested times, and the difference between the 2 groups was significant 1 month postoperatively on TPD test but not at other times on the both tests. CONCLUSIONS: The split type did not affect the NSD incidence at 3 and 12 months postoperatively.


Asunto(s)
Traumatismos del Nervio Trigémino , Femenino , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Nervio Mandibular/diagnóstico por imagen , Osteotomía Mandibular , Osteotomía , Osteotomía Sagital de Rama Mandibular , Traumatismos del Nervio Trigémino/etiología
8.
Oral Maxillofac Surg ; 24(4): 515-520, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32621034

RESUMEN

INTRODUCTION: Elongated mandibular coronoid process is a rare condition defined as enlargement of the coronoid process. The only useful way to treat the mouth-opening limitation is resection of the elongated coronoid process. Four-dimensional CT (4DCT; three spatial dimensions plus time axis) is a novel imaging technique. Its usefulness of for evaluation of dynamic movements such as joint motion has been reported. Here, we show the potential usefulness of 4DCT evaluation in a patient with elongated mandibular coronoid process. CASE PRESENTATION: A 59-year-old female who suffered from mouth-opening difficulty and pressure during mouth opening was referred to our department. Elongation of the right coronoid process was evident in a panoramic X-ray image. The mandibular movement and temporal muscle motility before and after coronoidectomy in this patient on 4DCT could be evaluated. CONCLUSIONS: 4DCT is useful in the diagnosis and surgical outcome of elongated coronoid process.


Asunto(s)
Tomografía Computarizada Cuatridimensional , Osteotomía Mandibular , Femenino , Humanos , Hiperplasia/patología , Mandíbula/diagnóstico por imagen , Mandíbula/patología , Mandíbula/cirugía , Persona de Mediana Edad , Radiografía Panorámica
9.
Int J Oral Maxillofac Surg ; 49(12): 1584-1588, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32586722

RESUMEN

The aim of this study was to summarize the clinical outcomes of patients with stage 3 mandibular medication-related osteonecrosis of the jaw (MRONJ) treated using reconstruction plate fixation and ipsilateral submandibular gland translocation after mandibulectomy. The medical records of patients with stage 3 mandibular MRONJ treated using the above surgical method between September 2014 and July 2019 were reviewed. Of a total of 27 patients included in this study, 23 (85.2%) experienced primary wound healing. The remaining four patients developed wound dehiscence and infection within 1 week after the operation. Three of these patients recovered after the plate was removed, and one patient died of the primary cancer. The follow-up period ranged from 3 months to 5 years, with an average of 12.7 months. The 23 patients with primary wound healing had a symmetrical facial appearance, with normal mouth opening and occlusion. Plate fracture occurred in two patients at 1year and 3 years after the operation. Radioisotope scanning in 10 patients showed that the function of the translocated submandibular gland was normal at 6 months after the operation. In summary, for patients with stage 3 MRONJ involving the mandibular angle and/or body, reconstruction plate fixation and submandibular gland translocation after segmental mandibulectomy is an effective treatment method.


Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos , Glándula Submandibular , Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico por imagen , Osteonecrosis de los Maxilares Asociada a Difosfonatos/cirugía , Placas Óseas , Humanos , Mandíbula , Osteotomía Mandibular , Glándula Submandibular/diagnóstico por imagen , Glándula Submandibular/cirugía
10.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(3): 280-283, 2020 Jun 01.
Artículo en Chino | MEDLINE | ID: mdl-32573135

RESUMEN

OBJECTIVE: This study aimed to compare the influences of postoperative oral function in patients with median or paramedian mandibulotomy during the radical resection of tongue carcinoma and to provide evidence for the choice of osteotomy location for mandibulotomy. METHODS: The clinical data of 126 patients who underwent combined radical neck dissection with mandibulectomy and glossectomy followed by simultaneous reconstruction were analyzed retrospectively. The patients were divided into two groups according to the position of mandibulotomy: median mandibulotomy group (median group, n=60) and paramedian mandibulotomy group (paramedian group, n=66). The fourth edition of the University of Washington Quality of Life Questionnaire (UW-QOL) was used to compare the differences in oral functions, such as swallowing, mastication, and speech, between the two groups during regular follow-up. SPSS 24.0 software package was used for statistical analysis, and P<0.05 was considered statistically significant. RESULTS: Six months after the operation, no significant differences in swallowing, mastication, and speech functions were found between the median and paramedian groups. However, the swallowing and speech functions in the paramedian group were better than those in the median group 1 year after the operation (P<0.05), whereas no statistical difference in mastication function was observed between the two groups. CONCLUSIONS: Evaluation of the postoperative oral function results showed that paramedian mandibulotomy was a better surgical approach than median mandibulotomy. Paramedian mandibulotomy is worth prioritizing in the radical resection of tongue carcinoma.


Asunto(s)
Osteotomía Mandibular , Neoplasias de la Lengua , Glosectomía , Humanos , Calidad de Vida , Estudios Retrospectivos
11.
Medicine (Baltimore) ; 99(15): e19397, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282695

RESUMEN

A considerable number of patients with prominent mandibular angle have mandibular third molar impaction that needs surgical removal. Mandibular reduction is a popular and effective surgery to correct prominent mandibular angle, but it has been rarely performed simultaneously with impacted third molar extraction. In order to decrease the number of operations and suffering of patients, safely performing these 2 operations together is necessary and important. From January 2016 to June 2018, patients received mandibular reduction and impacted mandibular third molar extraction together were retrospectively reviewed. Forty-seven patients receiving long-curve mandibular reduction (n = 12) or simple mandibular reduction (n = 35) were included in this study. A total of 65 impacted mandibular third molars were extracted during mandibular reduction. One patient had hematoma within facial soft tissue which reabsorbed spontaneously. Seven patients who underwent long-curve mandibular reduction reported transient inferior lip numbness for several weeks. No infection or poor wound healing was reported. No immediate or delayed mandibular fracture occurred. All the patients were satisfied with both the aesthetic result of mandibular reduction and the unnecessity of receiving a secondary surgery to extract the impacted third molar. Simultaneously performing mandibular reduction and impacted mandibular third molar extraction can effectively reduce the number of operations and patients' suffering. It is also safe with adequate pre-op assessment, professional surgical knowledge, proper use of surgical instruments, meticulous surgical procedures, and correct post-op care.


Asunto(s)
Osteotomía Mandibular/métodos , Tercer Molar , Extracción Dental/métodos , Adulto , Femenino , Humanos , Estudios Retrospectivos , Adulto Joven
12.
J Oral Maxillofac Surg ; 78(8): 1436.e1-1436.e7, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32283075

RESUMEN

The anterior lateral thigh osteomyocutaneous (ALTO) free flap represents a unique reconstructive option for patients who are otherwise not good candidates for traditional free flaps to repair a through-and-through defect of the head and neck. We report the case of a patient with squamous cell carcinoma of the oral cavity who had undergone composite segmental mandibulectomy with a resultant through-and-through defect. The patient was not a candidate for fibula free flap (FFF) reconstruction owing to the presence of bilaterally dominant peroneal arteries. The patient underwent reconstruction with a single free tissue ALTO flap, with a good viable flap postoperatively. The patient did not experience any major or minor surgical complications and has been living with no evidence of disease. The ALTO free flap could be an effective flap in the reconstruction of through-and-through defects of the mandible for patients who are not candidates for FFF-based reconstruction.


Asunto(s)
Colgajos Tisulares Libres , Procedimientos Quirúrgicos Reconstructivos , Arterias , Peroné/cirugía , Humanos , Osteotomía Mandibular , Estudios Retrospectivos , Muslo/cirugía
13.
Am J Otolaryngol ; 41(3): 102436, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32144022

RESUMEN

OBJECTIVE: Fibula free tissue transfer is a common and reliable method for mandibular reconstruction. Functional outcomes from this procedure are dependent on the successful union of the osseous segments postoperatively. This study was conducted to define the maximum gap-size criteria for osseous union to occur at osteotomy sites in fibula free flap reconstruction of the mandible. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care academic center. SUBJECTS AND METHODS: A retrospective chart review of computed tomography and medical records was conducted on patients who underwent fibula free flap surgery and had imaging of the mandible at <3 months and >6 months after surgery. Distances between osteotomies were measured and evaluated for interval healing. Secondary data included subject age, sex, smoking status, diabetes, number of osteotomies, complications, and adjuvant therapy. RESULTS: Thirty-eight osteotomy sites were analyzed from thirteen subjects and a total of 190 measurements were made. The mean gap size at the first scan that demonstrated union by the second scan interval was 1.31 mm and mean gap size demonstrating non-union was 2.55 mm (p < 0.01). Complication rate, number of osetotomies, adjuvant therapy, or medical co-morbidities did not significantly affect rates of union. CONCLUSIONS: In this study, osseous union was achieved with a mean osteotomy gap size of 1.31 mm. The data suggests that distances between ossesous segments >2 .55mm have a higher risk of non-union. We believe the information from this study will help augment current and future techniques in the field of mandible reconstruction.


Asunto(s)
Trasplante Óseo/métodos , Peroné/cirugía , Colgajos Tisulares Libres , Mandíbula/cirugía , Osteotomía Mandibular/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
14.
J Craniofac Surg ; 31(4): 960-965, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32149977

RESUMEN

PURPOSE: The present study summarized selection of guiding plate combined with surgical navigation for microsurgical mandibular reconstruction. METHODS: Data from preoperative maxillofacial enhanced computed tomography (CT) scans were imported to ProPlan CMF. The authors performed virtual mandibulectomy and superimposed 3-dimensional (3D) iliac images on mandibular defects. Guiding plates including mandibular fixation device, reconstruction plate, guiding model, and occlusal splint for various mandibular hemimandibular central lateral (HCL) defects were fabricated to fix bilateral residual mandible. The model was scanned, and data were imported into ProPlan CMF and the intraoperative navigation system. Through landmark points upon the guiding plate, position of the residual mandible was determined during surgical navigation. Intraoperative navigation was used to implement the virtual plan. Sagittal, coronal, axial, and 3D reconstruction images displayed by the navigation system were used to accurately determine osteotomy sites and osteotomy trajectory during surgery. Surgical probe guidance was used to mark the osteotomy line and transfer the virtual procedure to real-time surgery. Accuracy was evaluated using chromatographic analysis. RESULTS: Different guiding plates combined with surgical navigation could be used for various mandibular defects, including mandibular fixation devices for LCL defects, reconstruction plates for LC/L/C defects, and guiding models and occlusal splints for H/L/LC defects (including mandibular ramus). In our study, average and largest shift of the mandible and osteotomy site was <5 mm. CONCLUSION: The authors summarized different ways of combining guiding plates with surgical navigation for reconstruction of various mandibular defects, which could improve clinical outcomes of this procedure with high accuracy.


Asunto(s)
Placas Óseas , Mandíbula/cirugía , Reconstrucción Mandibular , Microcirugia , Cirugía Asistida por Computador , Adulto , Femenino , Humanos , Masculino , Osteotomía Mandibular , Reconstrucción Mandibular/métodos , Persona de Mediana Edad , Ferulas Oclusales , Osteotomía , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X , Adulto Joven
15.
J Craniomaxillofac Surg ; 48(4): 399-404, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32199717

RESUMEN

INTRODUCTION: The purpose of our study was to evaluate the benefit of bilateral inferior alveolar nerve block (BIANB) in managing postoperative pain, nausea and vomiting and opioid and antiemetic consumption in mandibular osteotomy. MATERIAL AND METHODS: 51 patients operated for bilateral sagittal split osteotomy (BSSO) were included in this prospective randomized controlled, double-blind, superiority trial. In the first group (n = 25), standard protocol was applied (general anesthesia and postoperative multimodal analgesia). The second group (n = 26) received bilateral inferior alveolar nerve block anesthesia at the start of surgery in addition to routine protocol. Postoperative monitoring was conducted every 4 h over the first 24 h and targeted the following criteria: postoperative nausea and vomiting (PONV), the visual analog scale (VAS) for pain, consumption of morphine (cumulative dose) and antiemetic agents, need for removal of guiding elastics. RESULTS: PONV was significantly lower in the BIANB group (15.4 % VS 40 %, p = 0.049), as were mean VAS scores for pain (1 VS 1.57, p = 0.045) and medians of morphine bolus (8 [6-16] VS 5.5 [1-8], p = 0.033). We found no significant difference in incidence of guiding elastic removal, and antiemetic consumption. DISCUSSION: The use of BIANB in BSSO improved postoperative patient comfort in terms of PONV and pain. Furthermore, it led to a decrease in opioid consumption. In conclusion, it is an additional therapeutic means of improving patients' postoperative comfort.


Asunto(s)
Antieméticos/uso terapéutico , Náusea y Vómito Posoperatorios , Método Doble Ciego , Humanos , Nervio Mandibular , Osteotomía Mandibular , Dolor Postoperatorio/tratamiento farmacológico , Estudios Prospectivos
16.
J Craniomaxillofac Surg ; 48(4): 349-356, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32131990

RESUMEN

PURPOSE: Unilateral posterior vertical insufficiency (PVI) is a growth defect of the mandibular condyle that results in a facial asymmetry. Various surgical procedures can be used to elongate the hypoplastic ramus. The aim of this study was to evaluate long-term aesthetic and architectural outcomes of vertical ramus osteotomy (VRO) in patients with unilateral PVI. MATERIALS AND METHODS: Patients operated on with unilateral VRO were included in this retrospective study. Aesthetic and architectural parameters were evaluated on frontal photographs as well as on frontal and lateral cephalograms preoperatively, postoperatively, at 1-year and at the end of the follow-up. RESULTS: A total of 48 patients were analyzed. The aesthetic assessment revealed significant correction of the chin deviation (CD) and of the lip commissural line tilt after VRO (p1 = 0.0038 and p2 = 0.0067, respectively) with stable results. The architectural analysis revealed significant improvement in the maxillary and mandibular occlusal planes, as well as the chin deviation (p < 0.0001). A tendency to relapse was noted for the mandibular canting and the CD during the follow-up. VRO allowed for a mean mandibular lengthening of 8.39 mm (ranging from 2.5 to 14 mm). CONCLUSION: VRO allows for immediate restoration of the symmetry of the lower third of the face in patients with unilateral PVI. A revisional procedure may be needed due to a tendency for the chin deviation to relapse.


Asunto(s)
Estética Dental , Osteotomía Sagital de Rama Mandibular , Cefalometría , Asimetría Facial , Estudios de Seguimiento , Humanos , Mandíbula , Osteotomía Mandibular , Estudios Retrospectivos , Resultado del Tratamiento
17.
Rev. cuba. estomatol ; 57(1): e2898, ene.-mar. 2020. graf
Artículo en Español | LILACS, CUMED | ID: biblio-1126494

RESUMEN

RESUMEN Introducción: Las anomalías dentofaciales son trastornos del crecimiento dental y facial que afectan tanto a niños como a adultos. Objetivo: Presentar un caso clínico, en que en la búsqueda de armonía, por una anomalía dentofacial, se aplicaron principios del manejo multidisciplinario de cirugía ortognática y de otoplastia. Caso clínico: Paciente masculino de 18 años de edad que refiere inconformidad estética y en el que, mediante el análisis de modelos de estudio, mediciones de las telerradiografías indicadas y los hallazgos del examen físico, se llegó al diagnóstico de prognatismo mandibular con exceso vertical del mentón. Se ejecuta tratamiento ortodóncico-quirúrgico, realizándose osteotomía sagital mandibular y mentonoplastia de reducción de altura. Se emplearon como medios de fijación interna los tornillos bicorticales en la zona de ángulo mandibular y miniplacas en la región del mentón. Tres meses después se realizó otoplastia, para corregir la presencia de orejas prominentes, con el logro de un resultado funcional y estético satisfactorio. Conclusiones: Con la aplicación de los principios del manejo multidisciplinario de cirugía ortognática, combinada con la realización de una otoplastia, los resultados fueron positivos. Se alcanzó el objetivo de brindar armonía facial, con mejoría funcional y estética, y una alta satisfacción del paciente(AU)


ABSTRACT Introduction: Dentofacial anomalies are dental and facial growth disorders affecting children and adults alike. Objective: Present a clinical case of dentofacial anomaly in which principles of the multidisciplinary management of orthognathic surgery and otoplasty were applied to achieve harmony. Case report: A male 18-year-old patient reports esthetic dissatisfaction. Analysis of study models, measurements taken by teleradiography and findings of the physical examination led to the diagnosis of mandibular prognathism with a vertically extended chin. Orthodontic-surgical treatment was performed, consisting in sagittal mandibular osteotomy and height reduction mentoplasty. Bicortical screws were used for internal fixation in the mandibular angle area and miniplates in the chin region. Otoplasty was performed three months later to correct the presence of protruding ears, achieving satisfactory functional and esthetic results. Conclusions: Application of the principles of the multidisciplinary management of orthognathic surgery, combined with the conduct of otoplasty, led to positive results. The objective of achieving facial harmony was fulfilled, alongside functional and esthetic improvement and high patient satisfaction(AU)


Asunto(s)
Humanos , Masculino , Adolescente , Prognatismo/etiología , Estética , Cirugía Ortognática/métodos , Deformidades Dentofaciales/diagnóstico , Osteotomía Mandibular/métodos , Satisfacción del Paciente
18.
J Craniofac Surg ; 31(3): 668-672, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32049916

RESUMEN

INTRODUCTION: This study aimed to determine the envelope of anterior segmental movement and changes in the inferior pharyngeal airway space (IPAS) and position of the hyoid bone following mandibular anterior subapical osteotomy (ASO) under local anesthesia in skeletal Class II patients with protrusion. METHODS: The subjects were 33 skeletal Class II adult patients with lip protrusion. They were treated by extraction of 4 premolars and mandibular ASO under local anesthesia. Surgical movement of mandibular anterior segment and IPAS after surgery was evaluated by mandibular superimposition using lateral cephalograms between before and immediately after surgery. The depth of osteotomy and overlapping ratio were measured. RESULTS: The mean retraction of the mandibular incisor was 4.04 mm at the tip and 4.29 mm at the root apex. The mean vertical movement of the mandibular incisor was 3.33 mm intrusion at the tip and 3.42 mm at the root apex. The axis of the mandibular incisor did not change significantly. Patients with deep curve of Spee showed significantly more intrusion of incisors, whereas the incisor axis became more proclined. The IPAS became narrower, and the hyoid bone moved downward after surgery. The decreased IPAS was positively correlated with retraction of root apex and proclination of the mandibular incisors. CONCLUSION: To establish precise surgical treatment objectives, a balance between the amount of intrusion and changes in axis should be sought after considering anatomical limitations. Mandibular ASO should be performed with caution in skeletal Class II patients vulnerable to airway-related problems.


Asunto(s)
Enfermedades Mandibulares/cirugía , Osteotomía Mandibular , Adulto , Diente Premolar , Femenino , Humanos , Hueso Hioides , Incisivo , Masculino , Osteotomía Mandibular/efectos adversos , Respiración
19.
Dent Med Probl ; 57(1): 111-116, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32083816

RESUMEN

The various abnormalities of occlusion cause significant discomfort to the patient suffering from them. Currently, the surgical treatment of malocclusion in healthy patients is a routine process. The situation is completely different when the patient has a serious disease of the respiratory or cardiovascular system - a condition which may contraindicate such treatment. A 30-year-old female patient, with a class III skeletal defect (open bite and progeny) and Eisenmenger's syndrome was chosen as a clinical case. The DDS-Pro software was selected to plan the operation. The bilateral sagittal split osteotomy of the mandible was selected as the method of surgery. At the time of the initial examination, the patient had been denied surgical treatment several times in several other clinics. Before the treatment began, the patient underwent intensive preparation in the cardiac surgery unit for 2.5 months. Using the software, a surgical intervention was planned with the production of a surgical template. The operation was then performed; the treatment period was unremarkable. The resulting occlusion and changes in the shape of the face fully met the patient's psychological and esthetic expectations. In conclusion, a complicated cardiovascular pathology does not always deprive patients with malocclusion of the possibility to undergo surgical treatment.


Asunto(s)
Complejo de Eisenmenger , Maloclusión , Adulto , Complejo de Eisenmenger/complicaciones , Complejo de Eisenmenger/cirugía , Estética Dental , Femenino , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Osteotomía Mandibular
20.
Artículo en Inglés | MEDLINE | ID: mdl-32102765

RESUMEN

OBJECTIVE: The aim of this retrospective, single-center study was to analyze long-term results after marginal and segmental mandibulectomies in patients with oral squamous cell carcinoma (OSCC). STUDY DESIGN: The study included 259 patients treated for OSCC with mandibulectomy between 1996 and 2010. Data acquisition consisted of analysis of operation reports, re-evaluation of histologic bone specimens, and collection of clinical follow-up data. RESULTS: Of the included patients, 86.5% had received segmental and 13.5% marginal mandibulectomies. Patients who received segmental mandibulectomy generally displayed a higher TNM (tumor-node-metastasis) stage; 47% of patients who received segmental mandibulectomy and 14% of those receiving marginal mandibulectomy showed bone infiltration (pT4 a). Of all patients with bone infiltration, 49% showed an invasive histologic infiltration pattern, and 35% showed an erosive histologic infiltration pattern. We found healthy residual crestal bone height in 43% of all segmental mandibulectomies. Only 8% of all patients were prosthodontically rehabilitated. With regard to prognostic parameters, there was no significant difference between patients receiving marginal mandibulectomy and those receiving segmental mandibulectomy. CONCLUSIONS: Because healthy residual crestal bone height was found in 43% of all patients who had received segmental mandibulectomies, it is conceivable that a significant number of patients would profit from marginal mandibulectomy, at least in cases of absent or erosive bone infiltration pattern, because the residual crestal bone is functionally stable.


Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de la Boca , Humanos , Mandíbula , Osteotomía Mandibular , Estudios Retrospectivos
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