A review of morbidity associated with bone harvest from the proximal tibial metaphysis.

AIM: The proximal tibia has become a well-accepted donor site for autologous bone, but there are few reports of complications with its use in maxillofacial reconstruction. Our retrospective study quantifies incidence and type of complications related to the proximal tibia bone harvest. PATIENTS AND METHOD: Sixty-three surgeries performed from March 2000 to March 2004 were reviewed; 23 male and 38 female patients underwent unilateral proximal tibia metaphysis harvest. No additives were used to increase the volume of the grafts. All patients were allowed to ambulate as tolerated on the 2nd postoperative day. RESULTS: All patients developed ecchymosis and edema on the donor limb, which resolved quickly. All patients reported minor gait disturbances. Complications were seen in 12 patients (19%) and included prolonged pain at the donor site and prolonged gait disturbances well beyond 2 weeks, seroma formation, paresthesia around the skin incision, bleeding, scar formation after wound breakdown, and knee joint perforation. CONCLUSION: Harvesting bone from the proximal tibial metaphysis is a safe procedure associated with a low incidence of overall complications. However, prolonged pain and gait disturbances are to be expected in 10% of the patients.

[Hydrodissection as an alternative method in esthetic facial surgery. Technical contribution]. / Hydrodissektion als alternative Präparationsmethode in der ästhetischen Gesichtschirurgie. Technikbeitrag.

Conventional techniques in facial esthetic surgery are based on skin and flap elevation by sharp surgical dissection. The hydrodissection technique of local anesthetic administration facilitates creation of an atraumatic field for subcutaneous flap preparation. Its application in face- and necklifting procedures is described.

Cephalometric comparison of characteristics in chronically snoring patients with and without sleep apnea syndrome.

OBJECTIVE: The purpose of this investigation is to cephalometrically study 50 snoring patients with and without sleep apnea and to determine whether cephalograms can be used as a diagnostic tool to differentiate persons who are chronic snorers from persons with sleep apnea. STUDY DESIGN: A sample of 30 sleep apnea patients was compared with a sample of 20 chronic snorers without sleep apnea as documented by polysomnography. Forty cephalometric measurements were determined to study various skeletal, soft tissue, and airway abnormalities. RESULTS: This study showed that both groups presented multiple cephalometric abnormalities. Only four measurements differed significantly between the two samples. In the sleep apnea group the maxilla was retropositioned and the hypoid bone displaced inferiorly and distally as compared to nonapneic snorers. CONCLUSIONS: Because of the overall presence of abnormal cephalometric findings in both samples and given similar age and weight ranges, a differential diagnosis between chronic snorers with and without sleep apnea cannot be reliably based on standard cephalometric evaluation alone.

Surgical correction of facial deformities in a patient with cleidocranial dysplasia.

A one-stage procedure for correction of the maxillofacial skeletal deformities associated with cleidocranial dysplasia is presented. The common bony abnormalities are discussed, and the combined surgical and orthodontic management over an 8-year period is outlined.

Treatment prediction with three-dimensional computer tomographic skull models.

Orthodontic and surgical treatment planning in the conventional articulator is compared with three-dimensional computer tomographic (3D-CT) model surgery in an individually milled skull model. After computer tomography has been completed of the patient's skull that has a bimaxillary asymmetric disharmony, the data set is transferred to generate individually milled polyurethane foam models. The imprecisely delineated dental arches of the skull model are replaced by dental casts that allow the simulation of various orthodontic and surgical treatment procedures. Expected segment displacement, the best osteotomy lines, and the resulting skeletal and dental symmetry in relation to the orthodontic set up can be evaluated. Although the technique is both time-consuming and expensive compared with the traditional treatment planning through the articulator, we have included 3D-CT model surgery in our presurgical work-up of patients with severe dentofacial disharmonies. Especially in asymmetric cases, the individually milled skulls allow a higher precision of orthodontic and surgical treatment planning.

[Simulated surgery on a 3D model. Technic and applications]. / Chirurgie simulée en modèle 3D. Technique et applications.

Treatment planning for the correction of dentofacial deformities includes prediction tracing and model surgery. However, these conventional methods provide only limited information concerning the planned spatial displacement of skeletal structures. In cases of severe deformities we add simulated 3D model surgery in an individually processed life size polyurethane skull to our work-up. The basic steps of the 3D model surgery are described, the advantages outlined and the method discussed.

[Orofacial injuries in skateboard accidents]. / Orofaziale Verletzungen bei Skateboard-Unfällen.

In a clinical study, 25 accidents involving injuries by a fall with a skateboard were investigated and classified in respect of epidemiology, accident mechanism and injury patterns in the facial region. Accident victims are predominantly boys between 7 and 9 years of age. A multiple trauma involving the teeth and the dental system in general and the soft parts of the face is defined as a characteristic orofacial injury pattern in skateboard accidents. The high proportion of damage to the front teeth poses problems of functional and aesthetic rehabilitation necessitating long-term treatment courses in children and adolescents. Effective prevention of facial injuries may be possible by evolving better facial protection systems and by creating areas of playgrounds where skateboarders can practise safely.

Cephalometric analysis of long-term airway space changes with maxillary osteotomies.

The cephalometric radiographs of 13 patients without sleep apnea who had undergone isolated maxillary surgery were studied. The authors found increases in both the nasopharyngeal and hypopharyngeal airway spaces 3 to 5 years after surgery. The results suggest that adaptive processes occur in both the upper and lower jaw, which contribute to an enlarged airway after surgery.

[Maxillary osteotomy: an alternative treatment concept for obstructive sleep apnea syndrome]. / Oberkieferosteotomien: ein alternatives Therapiekonzept zur Behandlung des obstruktiven Schlaf-Apnoe-Syndroms?

This study contributes to the evaluation of the question whether patients with obstructive sleep apnea syndrome might benefit from maxillary surgery. Changes in nasopharyngeal and hypopharyngeal airway spaces of 13 non-apneic patients following maxillary advancement and/or impaction osteotomies were studied retrospectively by cephalometric analysis. The data suggest a long-term increase in both nasopharyngeal airway space and unexpected, in hypopharyngeal airway space which remained stable over time. The clinical implications are discussed in view of previous studies which suggest or recommend orthognathic surgery as a treatment modality in selected patients with obstructive sleep apnea syndrome.

Long-term airway space changes after mandibular setback using bilateral sagittal split osteotomy.

Eleven patients were evaluated retrospectively for their long-term changes in hypopharyngeal airway space after surgical correction of mandibular hyperplasia. All patients had undergone mandibular setbacks by way of bilateral sagittal split osteotomies using rigid fixation. The cephalometric evaluation of hypopharyngeal airway space was based on stable craniofacial landmarks. The results of this study indicate that mandibular setback procedures create relative narrowing of the hypopharyngeal airway space, as seen on lateral cephalometric radiographs, which in isolated cases might contribute to the development of an obstructive sleep apnea syndrome. The 2-dimensional evaluation of hypopharyngeal airway space and the clinical implications of the results are discussed.

[Long-term alternations in the hypopharyngeal respiratory tract after mandibular setback]. / Langfristige Veränderungen im Bereich der hypopharyngealen Atemwege nach Unterkieferrückverlagerungen.

10 patients were evaluated retrospectively for their long-term changes in hypopharyngeal airway space after surgical correction of mandibular prognathism. All patients had undergone mandibular setbacks by way of bilateral sagittal split osteotomies with rigid fixation. The cephalometric evaluation of the hypopharyngeal airway space was based on stable craniofacial landmarks. The results of this study indicate that mandibular setbacks procedures create relative narrowing of the hypopharyngeal airway space, which in isolated cases might contribute to the development of an obstructive sleep apnea syndrome. The clinical implications of these findings are discussed.

[State of the art of oral and maxillofacial surgery in the 13th century]. / Zum Stand der Mund-Kiefer-Gesichtschirurgie im 13. Jahrhundert.

A report is given on the level of knowledge achieved in the treatment of oral and maxillofacial diseases in the 13th century under the influence of arab medicine.