Analysis of the implementation of a circuit for intra-operative superposition and comparison of the surgical outcomes using ICBCT in maxillofacial surgery.

PURPOSE: This paper describes a novel circuit for intraoperative analysis with ICBCT in maxillofacial surgery. The aim is to establish guidelines, define indications, and conduct an analysis of the implementation of the circuit for intraoperative comparison of surgical outcomes in relation to 3D virtual planning in maxillofacial surgery. METHODS: The study included 150 maxillofacial surgical procedures. Intraoperative actions involved fluoroscopy localization, intraoperative CBCT acquisition, segmentation, and superimposition, among other steps. Surgical times due to intraoperative superposition were measured, including time required for ICBCT positioning and acquisition, image segmentation, and comparison of 3D surfaces from the surgical planning. RESULTS: Successful intraoperative comparison was achieved in all 150 cases, enabling surgeons to detect and address modifications before concluding the surgery. Out of the total, 26 patients (17.33%) required intraoperative revisions, with 11 cases (7.33%) needing major surgical revisions. On average, the additional surgical time with this circuit implementation was 10.66 ± 3.03 min (n = 22). CONCLUSION: The results of our research demonstrate the potential for performing intraoperative surgical revision, allowing for immediate evaluation, enhancing surgical outcomes, and reducing the need for re-interventions.

Consensus Report and Recommendations on the Management of Late-stage Internal Derangement of the Temporomandibular Joint.

Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.

On the feasibility of minimally invasive Le Fort I with patient-specific implants: Proof of concept.

A novel approach to Le Fort I osteotomy is presented, integrating patient-specific implants (PSIs), osteosynthesis and cutting guides within a minimally invasive surgical framework, and the accuracy of the procedure is assessed through 3D voxel-based superimposition. The technique was applied in 5 cases. Differences between the surgical plan and final outcome were evaluated as follows: a 2-mm color scale was established to assess the anterior surfaces of the maxilla, mandible and chin, as well as the condylar surfaces. Measurements were made at 8 specific landmarks, and all of them showed a mean difference of less than 1 mm. In conclusion, the described protocol allows for minimally invasive Le Fort I osteotomy using PSIs. Besides, although the accuracy of the results may be limited by the small sample size, the findings are consistent with those reported in the literature. A prospective comparative study is needed to obtain statistically significant results and draw meaningful conclusions.

Effectiveness of virtual reality in relieving anxiety and controlling hemodynamics during oral surgery under local anesthesia: A prospective randomized comparative study.

It was the aim of the study to evaluate the contribution of a relaxing immersive experience with virtual reality (VR) goggles in reducing patient anxiety related to wisdom tooth extraction under local anesthesia. A prospective randomized comparative study in consecutive patients scheduled for bilateral wisdom tooth extraction under local anesthesia was carried out between March and December 2022. Both sides were operated upon in the same surgery, but on one side VR goggles were applied (VR), while on the other they were not (noVR). Anxiety was evaluated both subjectively (State-Trait Anxiety Inventory [STAI] and visual analogue scale [VAS]) and objectively (measuring heart rate, blood pressure [BP] and blood oxygen saturation) before (T1) and after each surgical step (T2VR and T2noVR). The study sample consisted of 27 patients: 9 men and 18 women, with an average age of 25.8 ± 6.5 years (range: 18-43). Anxiety as assessed by the STAI and VAS decreased from T1 to T2 (p < 0.001 and p < 0.001, respectively), although to a similar degree regardless of whether VR was used or not. Heart rate showed significant differences influenced by RV exposure (p = 0.013): it increased +2.5 ± 8.8 bpm in the control group and decreased -2.22 ± 7.55 bpm with VR (p = 0.013). Both minimum and maximum BP after surgery were significantly higher in the noVR group (p = 0.002 and p = 0.040, respectively). Regarding minimum BP, VR proved more effective among male patients (p = 0.057) and on starting the procedure using VR (p = 0.055). The results provided evidence of meaningful control of the hemodynamic variables, but less predictable performance in the subjective evaluation of anxiety.

Vascular Delay Soft Tissue Technique in Oral/Maxillary Bone Reconstructive Surgery: A Technical Note.

PURPOSE: The present study describes a new presurgical soft tissue technique in oral/maxillary bone reconstructive surgery for reducing the risk of soft tissue dehiscence and its related complications. MATERIALS AND METHODS: Ten consecutive patients with Cawood and Howell type V atrophy were scheduled for CAD/CAM titanium mesh bone reconstructive surgery after applying the vascular delay technique 21 days before regenerative surgery. The surgical and healing complications were clinically assessed at nine time points, ranging from the time of bone regenerative surgery to 9 months after surgery. Surgical complications included flap damage and neurologic and vascular complications. Healing complications were subdivided into four classes. These classes comprised Class I: small membrane exposure (≤ 3 mm) without purulent exudate; Class II: large membrane exposure (> 3 mm) without purulent exudate; Class III: membrane exposure with purulent exudate; and Class IV: abscess formation without membrane. RESULTS: The study sample included seven men and three women (mean age: 48.2 ± 3.5 years) with seven mandibular cases and three maxillary cases. The defect length ranged from three to six teeth, with a mean mesiodistal distance of 29.9 ± 8.5 mm and a mean volume augmentation of 2.03 ± 0.9 cm3. There were no surgical complications. One patient presented a Class I healing complication that did not affect the regeneration outcome. CONCLUSIONS: The vascular delay technique appears to reduce the risk of soft tissue dehiscence and exposure in bone regenerative surgery, though randomized studies involving larger samples and longer follow-up periods are needed in order to draw firm conclusions.

Ultrasound-Guided Suprazygomatic Maxillary Nerve Block Is Effective in Reducing Postoperative Opioid Use Following Bimaxillary Osteotomy.

BACKGROUND: Ultrasound-guided maxillary nerve block has recently been described, though its impact upon bimaxillary osteotomy has not been formally investigated. PURPOSE: The present study was carried out to determine whether the addition of ultrasound-guided maxillary nerve block in subjects undergoing bimaxillary osteotomy reduces opioid use. STUDY DESIGN, SETTING, SAMPLE: A randomized clinical trial was carried out in adults undergoing bimaxillary osteotomy between April 2019 and January 2020 at Teknon Medical Center (Barcelona, Spain). PREDICTOR VARIABLE: The predictor variable was the treatment technique used (maxillary nerve block or no block). The subjects were randomized to either receive (test group) or not receive (control group) bilateral ultrasound-guided suprazygomatic maxillary nerve block (5 ml of 0.37% ropivacaine) before surgery. MAIN OUTCOME VARIABLE(S): The primary outcome variable was the intravenous methadone requirements in the first two postoperative hours. The secondary outcome variables were postoperative pain, rescue subcutaneous methadone, intravenous remifentanil used intraoperatively, the incidence of postoperative nausea-vomiting, and complications derived from maxillary nerve block. COVARIATES: Subject age, sex, weight, height, and anesthetic risk, and the duration of surgery were recorded. ANALYSES: Descriptive and inferential analyses were performed using the χ2 test and Mann-Whitney U test. Statistical significance was considered for P < .05. RESULTS: The baseline sample consisted of 68 subjects scheduled for bimaxillary osteotomy. The follow-up sample comprised 60 subjects: 30 in the control group (10 females and 20 males, aged 34.0 ± 10.2 years) and 30 in the test group (13 females and 17 males, aged 29.8 ± 10.8 years). The subjects who received maxillary nerve block showed less intravenous methadone use in the first 2 hours postsurgery (median 2.0 mg control group vs 0 mg test group; P < .001), lower pain levels at any time during the first 18 hours postsurgery (median visual analog score 4 control group vs 2 test group; P < .001), and a lesser percentage required methadone (33.3% control group vs 0% test group; P < .01) at 4-18 hours postsurgery. CONCLUSION AND RELEVANCE: The results obtained suggest that ultrasound-guided maxillary nerve block is a promising anesthetic technique capable of reducing intraoperative and postoperative opioid use, with greater patient comfort in bimaxillary osteotomy.

Bilateral sagittal split osteotomy with or without concomitant removal of third molars: a retrospective cohort study of related complications and bone healing.

PURPOSE: To carry out a comparative evaluation of the intra- and postoperative complications, and bone healing, following bilateral sagittal split osteotomy (BSSO) with or without concomitant removal of third molars. MATERIAL AND METHODS: A retrospective analysis was performed of two cohorts subjected to BSSO with the intraoperative removal of third molars (test group) versus the removal of third molars at least 6 months prior to BSSO (control group), comprising at least 1 year of clinical and radiographic follow-up. Partially or completely erupted third molars were extracted immediately before completing the osteotomy, whereas impacted third molars were removed after the osteotomy had been performed. Hardware reinforcement was performed in bimaxillary cases where concomitant molar extraction impeded placement of the retromolar bicortical screw of the hybrid technique. RESULTS: A total of 80 surgical sites were included (40 in each group). Concomitant extraction of the molar represented a mean increase in surgery time of 3.7 min (p < 0.001). No additional complications occurred in the test group (p = 0.476). The gain in bone density was preserved in both groups (p = 0.002), and the increase was of the same magnitude in both (p = 0.342), despite the fact that the immediate and final postoperative bone densities were significantly higher in the control group (p = 0.020). CONCLUSION: The results obtained support concomitant molar extraction with BSSO as a feasible option.

Does Aesthetic Osseous Genioplasty Impact Upper Airway Volume?

BACKGROUND: Although maxillomandibular advancement is the treatment of choice for obstructive sleep apnea syndrome (OSAS) in the presence of underlying maxillomandibular complex hypoplasia, there is still a gap in the literature regarding the impact of genioplasty upon upper airway volume (UAV). OBJECTIVES: The aim of this study was to evaluate the impact of isolated osseous genioplasty upon UAV. METHODS: A retrospective analysis of all patients subjected to isolated osseous genioplasty between July 2015 and July 2022 was conducted. Cone-beam computed tomography was performed preoperatively and postoperatively to assess the chin and hyoid 3-dimensional (3D) spatial position and UAV changes after surgery. RESULTS: A total of 44 patients were included in the study. Regarding surgical movements of the chin, almost all patients received a sagittal movement (n = 42; 39 forward and 3 backward), while in 8 patients a vertical movement (5 upward and 3 downward) was applied, and in 6 patients the chin was centered. Statistically significant increases in total UAV (P = .014) and at the level of the oropharynx (P = .004) were observed. Specifically, chin centering, upward and forward movements enlarged the oropharynx volume (P = .006, .043 and .065, respectively). Chin advancement enlarged the hypopharynx volume (P = .032), as did upward movement of the hyoid bone (P < .001). CONCLUSIONS: Results of the study suggest that aesthetic osseous genioplasty impacts the UAV: each 3D spatial chin movement differently impacts the upper airway by enlarging or narrowing it. However, further studies addressing the apnea-hypopnea index are required to assess its effectiveness in treating OSAS.

Patient's perception of recovery following surgical removal of mandibular third molars. A prospective european multi-center study.

This study evaluated patient's perception of recovery following surgical removal of mandibular third molars (SRM3s) including analyze of potential risk factors associated with impaired convalescent. Patient related parameters combined with preoperative questionnaires including Modified Dental Anxiety Scale, Oral Health Impact Profile-14, and Decayed, Missing, Filled Teeth index were correlated with questionnaires assessing pain, swelling, trismus, sick leave, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, impaired sensation of the lip, chin, and tongue, one month following SRM3s. Totally, 412 patients (223 females, 189 males) with mean age of 29.4 years were included. Treatment satisfaction and willingness to undergo similar surgery were reported by 92% and 95%, although 21% reported that the surgery and postoperative period had been worse than expected. Mean days with pain, sick leave, and swelling were 3.6, 2.1, and 3.6, respectively. Preoperative symptoms, dental anxiety level, and prolonged surgical time were associated with increased pain and swelling (P < 0.05). Pell and Gregory classification (I-IIIC) were associated with impaired sensation of the lower lip and chin (P < 0.05). Consequently, results from this study improve the surgeon's ability to predict parameters that predisposed to impaired recovery and neurosensory disturbances following SRM3s.

Three-Dimensional Evaluation of the Accuracy of Zygomatic Implant Placement Through an In-House Fully Guided Approach.

Purpose: To validate guided surgery for zygomatic implants (ZIs) by analyzing the final position of the implants relative to the preoperatively planned position. Material and Methods: Five patients with fully edentulous atrophic maxillae treated with four ZIs through a fully guided implant surgical approach were evaluated. The preoperative phase included digital planning, through which the surgical guide was designed and created. Analysis of the guided surgery accuracy was carried out by superimposing the digital planning over the final position of the implants using preoperative and postoperative CBCT. The radiologic evaluation included implant angular deviation, entrance deviation, exit deviation, platform deviation, and apex apicocoronal and mesiodistal deviation. Results: All five patients (two men and three women; mean age: 61.8 ± 3 years) were each treated with four ZIs using a fully guided approach with an extrasinusal path, obtaining ideal emergence of the implants. Superimposition comparison found a mean axial angular implant deviation of 0.79 ± 0.41 degrees and a mean implant entrance deviation of 0.95 ± 0.26 degrees. The platform deviation was 0.62 ± 0.19 mm buccopalatally and 0.76 ± 0.14 mm mesiodistally, while the apical deviation was 0.42 ± 0.13 mm buccopalatally and 1.06 ± 0.37 mm mesiodistally. Conclusions: Guided surgery in zygomatic implants appears to be sufficiently accurate to make it a safe and predictable technique.

Accuracy of Orthognathic Surgical Planning using Three-dimensional Virtual Techniques compared with Conventional Two-dimensional Techniques: a Systematic Review.

Objectives: The objective was to assess the accuracy of orthognathic surgical planning using three-dimensional virtual planning compared with conventional two-dimensional planning. Material and Methods: MEDLINE (PubMed), Embase and Cochrane Library search combined with hand-search of relevant journals was conducted to identify randomized controlled trials (RCTs) published in English through August 2nd, 2022. Primary outcomes included postsurgical accuracy of hard and soft tissue. Secondary outcomes included treatment planning time, intraoperative time, intraoperative blood loss, complications, financial expenses, and patient-reported outcome measures (PROMs). Quality and risk-of-bias assessment were evaluated by Cochrane risk of bias tool and GRADE system. Results: Seven RCTs characterised by low, high, and unclear risk of bias fulfilled inclusion criteria. Included studies disclosed conflicting results regarding accuracy of hard and soft tissue as well as treatment planning time. The intraoperative time was shortened, and financial expenses were increased with three-dimensional virtual surgical planning (TVSP), while no planning-related complications were revealed. Comparable improvement in PROMs were reported with TVSP and two-dimensional planning. Conclusions: Future orthognathic surgical planning will indisputable be performed by three-dimensional virtual planning. The financial expenses, treatment planning time, and intraoperative time will therefore probably decrease due to further development of three-dimensional virtual planning techniques. The hard and soft tissue accuracy between planned position and achieved surgical outcome seems to be improved by three-dimensional virtual planning compared with two-dimensional planning, although results are inconsistent. Further development of three-dimensional virtual planning involving cutting guides and patient-specific osteosynthesis plates are therefore needed to improve the accuracy of orthognathic surgical planning.

Fat grafting in patients with cleft lip and palate: A systematic review.

This systematic review aims to compare different fat-grafting techniques for cleft lip and palate repair. A search was conducted in PubMed, Embase, Cochrane Library, gray literature and reference lists of selected articles. A total of 25 articles were included, 12 on closure of palatal fistula and 13 on cleft lip repair. The rate of complete resolution of palatal fistula ranged from 88.6% to 100% in studies with no control group, whereas in comparative studies patients receiving a fat graft showed better outcomes than those not receiving a graft. Evidence suggests that fat grafting can be indicated for the primary and secondary repair of cleft palate, with good results. The use of dermis-fat grafts in lip repair was associated with gains in surface area (11.5%), vertical height (18.5%-27.11%), and lip projection (20%). Fat infiltration was associated with increased lip volume (6.5%), vermilion show (31.68% ± 24.03%), and lip projection (46.71% ± 31.3%). The available literature suggests that fat grafting is a promising autogenous option for palate and fistula repair and for improvement of lip projection and scar aesthetics in patients with cleft. However, to develop a guideline, further studies are needed to confirm whether one technique is superior to the other.

Barcelona line. A multicentre validation study of a facial projection reference in orthognathic surgery.

The purpose of this study was to validate an already published facial anteroposterior reference: upper incisor (UI) to soft tissue plane or so-called Barcelona line (BL) to trace the most aesthetic sagittal position of the maxilla. A cross-sectional multicentre evaluation of Caucasian patients from Spain and Brazil with different anteroposterior maxillary positions was designed. Sagittal images in natural head orientation of grouped patients according to the horizontal distance from the UI to BL were ranked by healthcare professionals and non-professional Caucasian raters according to the aesthetic perception of each profile, using a digital survey. Seventy-four raters (50 laypeople, 12 orthodontists, and 12 maxillofacial surgeons) rated 40 profiles. The best-rated profile corresponded to group 3 (0-4 mm UI-BL) with 61.8% of positive evaluations, followed by group 4 (≥ 4 mm UI-BL): with 61.1%. On the other hand, group 1 (≤-4 mm UI-BL) was the worst-ranked profile with 71.8% of negative evaluations, followed by group 2 (-4-0 mm UI-BL): with 59.6% of negative evaluations. The correlation between the mean assessment score and UI-BL showed a moderately-strong association (r = 0.68, p < 0.001). The inter-rater reliability of assessment (74 evaluators) was moderate (k = 0.49, 95% CI: 0.39 to 0.59). The results suggest that protrusive middle-third facial profiles are preferable. The BL is proposed as a simple, individualised, and reproducible tool to trace an aesthetic sagittal position of the maxilla in orthognathic surgery.

Aesthetic Considerations in Orthofacial Surgery.

Currently, the wish to optimize facial esthetics-in the context of a dysfunctional occlusion or not-has become the main motivation for orthognathic surgery in many cases. In this context, considering that protrusive faces are advised more attractive and that the lack of skeletal support accelerates the aging process, orthognathic surgery will mostly involve a forward movement of the maxillamandibular complex..

Virtual surgical planning in orthognathic surgery with the use of patient-specific plates compared with conventional plates. A systematic review focusing on complications, financial expenses, professional and patient-reported outcome measures

Background: Orthognathic surgery is a well-known surgical procedure for correction of facial deformities. The surgical procedure is performed by the use of conventional plates and by patient-specific osteosynthesis plates (PSOPs). The aim of this study is to investigate any differences in complications, financial expenses, professional and patient-reported outcome measures (PROM) in orthognathic surgery performed by conventional plates and by PSOPs. Material and methods: A MEDLINE (PubMed), Embase, and Cochrane Library search was conducted. Human studies published in English through August 27, 2020 were included. Grey literature, unpublished literature as well as other databases like Scopus, Google Scholar, or Research Gate were also included in the search strategy of the present systematic review. Randomized and controlled clinical trials were included. Risk of bias was assessed by Cochrane risk of bias tool and Newcastle-Ottawa Scale. Results: Five studies with unclear risk of bias and moderate quality were included. Meta-analysis was not applicable due to considerable heterogeneity. There was no significant difference in intra- and postoperative complications or professional and PROM with the two treatment modalities, although higher tendencies to reoperations were observed with conventional plates. Financial expenses were significantly higher with PSOP, but treatment planning and intraoperative time were shortened by approximately one third compared with mock surgery and conventional plates. Conclusions: No significant differences were observed in complications, professional and PROM. Higher financial expenses were recorded in orthognathic surgery performed with PSOP. Treatment planning and intraoperative time were shortened with the use of conventional plates. Although further randomized trials are needed before definite conclusions can be provided about beneficial use of PSOPs in orthognathic surgery from a professional and patient perspective. (AU)

Extramaxillary Zygomatic Implant Coverage with a Pedicled Buccal Fat Pad Flap Through a Tunnel Approach: A Prospective Case Series.

PURPOSE: To describe the benefits of covering the extrasinusal length of extramaxillary zygomatic implants with a pedicled buccal fat pad flap through a tunnel approach. MATERIALS AND METHODS: Four extramaxillary zygomatic implants were placed in 10 patients and loaded immediately with an acrylic provisional fixed prosthesis. The extrasinusal length of every implant was covered with a pedicled buccal fat pad flap. Study variables were implant survival rate, peri-implant soft tissue recession (PISTR), peri-implant soft tissue condition (PISTC), modified Bleeding Index (mBI), and suppuration. The statistical analysis comprised the Brunner-Langer model of longitudinal data for each variable and the analysis of variance to assess main effects and interactions. RESULTS: All the zygomatic implants showed osseointegration, resulting in a survival rate of 100%. The PISTR was evaluated after surgery (T0) and after 12 months (T1), statistically significant differences being observed (P = .014). Recession also depended on specific implant positioning; zygomatic implants in the anterior were found to have a higher risk of recession vs implants in the posterior (P = .065). The PISTC was assessed at T0 and T1, and no statistically significant changes were observed (P = .718). Bleeding on probing was present in 10% of the implants at T0 and in 15% at T1, the difference being nonsignificant (P = .317). CONCLUSION: The use of a pedicled buccal fat pad flap to cover the extrasinusal length of extramaxillary zygomatic implants appears to reduce the risk of soft tissue recession and exposure of the implant surface to the oral cavity.

Covariates Relating to Implant Failure and Marginal Bone Loss of a Novel Triangular Neck-Implant Placed by Post-Graduate Students: A 1-Year Prospective Cohort Study.

(1) Background: Most of the clinical literature dealing with dental implants has been issued by experienced teams working either in university settings or in private practice. The purpose of this study was to identify contributing covariates to implant failure and marginal bone loss (MBL) at the 1-year follow-up of a novel triangular-neck implant design when placed by inexperienced post-graduate students. (2) Methods: A prospective cohort study was conducted on study participants eligible for implant placement at the UIC (International University of Catalonia), Barcelona, Spain. Implant failure rate and contributors to implant failure and MBL were investigated among 24 implant and patient variables. (3) Results: One hundred and twenty implants (V3, MIS) were placed and rehabilitated by the students. The mean insertion torque was 37.1 Ncm. Survival and success rates were 97.5% and 96.7%, respectively. Implants placed in patients with smoking habits displayed a tendency of higher failure risk (OR = 5.31, p = 0.17) when compared to non-smokers. The mean (SD) MBL was 0.51 (0.44) mm. Gender significantly affected the MBL (p = 0.020). Bleeding on probing (BoP) on the buccal sites proved to be a good predictor of proximal MBL (p = 0.030). (4) Conclusions: The survival and success rates of the V3 triangular-neck implant placed by inexperienced post-graduate students at the 1-year follow-up were high and similar to the ones published in the literature by experienced teams on other implants.

Minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) in adult patients.

The purpose of this study was to evaluate maxillary expansion, operative time and pain associated with a new minimally invasive surgical technique to treat maxillary hypoplasia in adult patients. Consecutive patients were included and prospectively analyzed. The technique consists in miniscrew-assisted rapid palatal expansion (MARPE), minimally invasive approach to maxillary osteotomies, latency period and activation period until the desired expansion. The parameters evaluated included operative time, treatment-related pain by the visual analog scale (VAS), and transverse maxillary expansion. The Shapiro-Wilk test was used to assess the normality of data distribution. A paired t-test was used to compare the data between T0 (preoperative) and T1 (postoperative - end of activation). The significance level was set at 5%. Eleven patients were included. Mean operative time was 24.11 min (14.4-32 min) and overall postoperative VAS score was 2.81 (0-9). A comparative analysis showed significant increases in maxillary width at the skeletal, alveolar, and dental levels (p < 0.0001 for all), with a mean range of 1.8 (SD 0.3) mm to 4.7 (SD 0.5) mm. The present minimally invasive surgical MARPE (MISMARPE) technique appears to yield good skeletal outcomes with minimal trauma. It might have potential for clinical use, but larger comparative studies are needed to confirm the clinical relevance of the approach.

Improving accuracy of the intermediate splint in substantial intermaxillary sagittal discrepancies using an extra anterior anchorage point: technical note / Mejora de la precisión de la férula intermedia en intermaxilares sustanciales. Discrepancias sagitales utilizando un punto de anclaje anterior adicional: nota técnica

Background: To describe a technical feature that increases the stability of the intermediate splint in patients wherebimaxillary surgery with great maxillary/mandibular advancements are planned.Material and Methods: Prospective evaluation of the intermediate splint dental vertical penetration in patientsundergoing bimaxillary surgery where great sagittal discrepancy occur in the anterior sector between the upperand lower jaws when the intermediate splint is placed by adding an extra intermaxillary fixation (IMF) screw (2x9mm) placed between the central incisors of the maxilla and fixed to the most anterior aspect of the intermediatesplint following the direction of the sagittal maxillo-mandibular discrepancy from January to September 2018.Results: The postoperative evaluation comparing the accuracy of conventional fixation versus fixation with anextra anterior anchorage point through photographic assessment and intraoral digital scanner demonstrated betterdental penetration, and therefore improved intermediate splint precision with the latter in all casesConclusions: Our results suggest that this is a simple and safe technique that can be easily reproduced and opti-mizes the outcomes by increasing the accuracy of translation of the planned surgical movements to the operatingroom.(AU)

Interpositional collagenated cancellous bone blocks for nasal dorsum augmentation: A new technique for nasomaxillary hypoplasia treatment.

Nasomaxillary hypoplasia is a rare congenital malformation involving the middle third of the face. The present paper describes a novel technique for restoring the nasal projection in a patient with nasomaxillary hypoplasia, analyses its advantages and limitations, and discusses its potential applicability in other similar contexts. After orthognathic surgery, lateral osteotomies of the nasal bones were performed integrally with a piezoelectric device using a long cutting saw tip through the intraoral approach. The nasal bones were then projected by interpositioning two triangular-shaped collagenated cancellous bone graft blocks on each side in the osteotomies between the nasal and the frontal processes of the maxillary bones. Cone-beam computed tomography (CBCT) data was used to perform a morphometric analysis at one and 12 months of follow-up through image superimposition, which revealed a stable increased projection of the nasal dorsum and an anterior nasal spine (ANS) of 5.18 mm and 5.52 mm, respectively. The results of this case suggest that the technique affords satisfactory nasal dorsum augmentation while avoiding the use of permanent foreign materials, with minimal morbidity, no unsightly and visible scars, great patient satisfaction, and adequate stability at 12 months of follow-up.