[Clinical analysis of 12 cases of orthognathic surgery with digital computer-assisted technique].

PURPOSE: This study was to investigate the effect of the digital computer-assisted technique in orthognathic surgery. METHODS: Twelve patients from January 2008 to December 2011 with jaw malformation were treated in our department. With the help of CT and three-dimensional reconstruction technique, 12 patients underwent surgical treatment and the results were evaluated after surgery. RESULTS: Digital computer-assisted technique could clearly show the status of the jaw deformity and assist virtual surgery. After surgery all patients were satisfied with the results. CONCLUSIONS: Digital orthognathic surgery can improve the predictability of the surgical procedure, and to facilitate patients' communication, shorten operative time, and reduce patients' pain.

[Application of computer-aided surgery in fibrous dysplasia of cranio-maxillofacial bone].

PURPOSE: To evaluate the effect of computer-aided surgical techniques in surgical treatment of cranio-maxillofacial fibrous dysplasia. METHODS: Twenty-two patients from January 1999 to December 2012 with cranio-maxillofacial fibrous dysplasia were treated in our department. According to the patients' specific conditions, surgeons designed surgical programs, and used computer-assisted surgical techniques to produce skull model and navigation template individually. The effects after surgery were evaluated. RESULTS: Twenty-two patients with resection of the bone lesions restored facial symmetry partially. The patients were followed up for 3 to 36 months, and the treatment effects were satisfactory. CONCLUSIONS: With preoperative planning, intraoperative navigation and postoperative prediction, computer-aided surgery shows its great value in improving the accuracy of cranio-maxillofacial surgery, shortening operating time and restoring facial symmetry. It is regarded as a valuable and safe surgical technique in cranio-maxillofacial surgery. Supported by Beijing Natural Science Foundation (7112124).

Recurrent Pleomorphic Adenoma of the Parotid Gland: Intraoperative Facial Nerve Monitoring during Parotidectomy.

OBJECTIVE: To determine the benefit to postoperative facial function of intraoperative facial nerve monitoring (IFNM) during recurrent pleomorphic adenoma (RPA) parotid surgery. STUDY DESIGN: Cohort study with planned data collection. SETTING: Chinese PLA General Hospital. SUBJECTS AND METHODS: Fifty-eight RPA parotidectomies were performed between 2004 and 2012. Recurrence was confirmed by histopathologic examination. None of the patients had preoperative facial palsy. Electromyography-based IFNM was used in 28 patients; 30 patients were unmonitored. The durations of surgery and the severity of postoperative facial nerve palsy were compared between the 2 groups. RESULTS: There were no significant differences between the 2 groups in the incidence of immediate or permanent facial paralysis after RPA parotidectomy (P = .95 and P = .36, respectively). However, the differences in the average duration of surgery and the severity of postoperative facial nerve palsy after total parotidectomy or wide resection were significant (P < .01 and P = .01, respectively). In contrast, these differences were not significant after superficial parotidectomies (P = .43 and P = .49, respectively). The average recovery time of temporary facial nerve paralysis was significantly shorter in the monitored group compared with the unmonitored group, independent of surgical technique (P < .01). CONCLUSION: The use of IFNM during total or wide resection RPA parotidectomy reduced the duration of surgery and the incidence of postoperative facial paralysis and enhanced recovery. However, there was little impact on facial nerve outcomes when IFNM was used during superficial RPA parotidectomy.

Clinical and radiological outcomes after treatment of sagittal fracture of mandibular condyle (SFMC) by using occlusal splint in children.

This study was designed to investigate the effects of occlusal splints in the treatment of sagittal fractures of the mandibular condyle in children. From January 1995 to December 2011, 37 sagittal fractures of the mandibular condyle in 30 patients aged 4-8 years old were included in this study. All the patients were treated with 1-2mm occlusal splints in the molar region. The mouths of the patients were kept slightly open by the occlusal splints for 3-6 months, and we reviewed the clinical and radiological remodelling of the affected condyles after treatment. Excellent (n=20) and good (n=10) clinical outcomes were achieved with full radiological remodelling seen in 19 and partial remodelling in 11. Treatment with occlusal splints is effective in delivering good results and function with minimal morbidity in children with sagittal fractures of the condyle, while permitting ongoing remodelling and growth in the short term.

[Comparative efficacies of non-surgical treatment for pediatric and adult sagittal fractures of mandibular condyle].

OBJECTIVE: To compare the efficacies of non-surgical treatment for pediatric and adult sagittal fractures of mandibular condyle. METHODS: From January 1985 to December 2010, our department treated 67 cases (82 sides) sagittal fractures of mandibular condyle with occlusal splint at a height of 1-2 mm in molar region for six months or other non-surgical treatment. Their clinical and radiological remodeling of affected condyles after treatment were reviewed at six mouths, one year and each year after treatment. They were divided into 2 groups according to age. There were 28 patients (34 sides) aged over 12 years and 39 patients (48 sides) under 12 years. During a follow-up period of 2-25 years, mandibular activity, mouth opening and parallel CT scan of condylar morphological alterations were examined. RESULTS: Under 12-year-old group:good mandibular function was observed in 39 patients. Maximal mouth opening over 35 mm was achieved at 6 months.Only 11 of 39 patients had deviation on mouth opening at 6 months.Radiological studies showed that 32 condyles were complete remodeling and 16 condyles were partial remodeling. Poor remodeling was not observed. Over 12-year-old group:Ankylosis occurred in 4 joints. And 15 of 28 patients had deviation on mouth opening at 6 months.Radiological studies showed the remodeling of condyles was complete (n = 6), partial (n = 16) and poor (n = 12) respectively. CONCLUSION: Mandibular functional recovery and condylar remodeling are better in children with more powerful healing and reconstructing capacities.

[Evaluation of the clinical results of non-surgical treatment for pediatric sagittal fracture of mandibular condyle].

OBJECTIVE: To investigate the clinical results of occlusal splint in the treatment of sagittal fracture of mandibular condyle (SFMC) in children. METHODS: Thirty-nine patients (48 condyles)aged 3-8 years with sagittal fracture of mandibular condyle were included in this study. All the patients were treated by occlusal splint.Slight open occlusion was maintained by occlusal splint for 3-6 months. Clinical and radiological examination was performed six mouths and every year after treatment. RESULTS: Good mandibular function was observed in 39 patients. Maximal mouth opening over 35 mm was achieved at 6 months. But 11 of the 39 patients presented with deviation on mouth opening at 6 months. The radiology showed an complete remodeling in 32 condyles (28 patients) and partial remodeling in 16 condyles (11 patients). Poor remodelling was not observed in any patients. CONCLUSIONS: Good clinical results can be obtained by using occlusal splint in the treatment of pediatric sagittal fracture of mandibular condyle.

Chitosan conduits combined with nerve growth factor microspheres repair facial nerve defects.

Microspheres containing nerve growth factor for sustained release were prepared by a compound method, and implanted into chitosan conduits to repair 10-mm defects on the right buccal branches of the facial nerve in rabbits. In addition, chitosan conduits combined with nerve growth factor or normal saline, as well as autologous nerve, were used as controls. At 90 days post-surgery, the muscular atrophy on the right upper lip was more evident in the nerve growth factor and normal sa-line groups than in the nerve growth factor-microspheres and autologous nerve groups. physiological analysis revealed that the nerve conduction velocity and amplitude were significantly higher in the nerve growth factor-microspheres and autologous nerve groups than in the nerve growth factor and normal saline groups. Moreover, histological observation illustrated that the di-ameter, number, alignment and myelin sheath thickness of myelinated nerves derived from rabbits were higher in the nerve growth factor-microspheres and autologous nerve groups than in the nerve growth factor and normal saline groups. These findings indicate that chitosan nerve conduits bined with microspheres for sustained release of nerve growth factor can significantly improve facial nerve defect repair in rabbits.

Motor fiber organization in the extratemporal trunk of the facial nerve in rats: A retrograde Fluoro-Gold study.

Understanding the microanatomy of the facial nerve is vital to functional restoration of facial nerve injury. This study aimed to locate the spatial orientation of five branches in the extratemporal trunk of the rat facial nerve (ETFN). Fifteen adult Sprague-Dawley albino rats were divided randomly into five groups corresponding to the five facial nerves. Fluoro-Gold(™) (FG) was applied to one branch in all three rats in each group. The trunk of the facial nerve was cut at three points for fluorescence detection. Staining results showed that each branch of the facial motor nerve had a topographical orientation in the distal part of the ETFN. The temporal branch was located in the medial and acroscopic quadrant of the nerve trunk. The zygomatic branch was located in the lateral and acroscopic quadrant. The buccal branch occupied the upper half of the nerve trunk, whereas the mandibular branch occupied the lower half. The cervical branch presented a square-shaped distribution in the lateral nerve trunk. In the middle part of the ETFN, the topographical orientation remained clear, but the FG-labeled zone was extended to some extent. In the stylomastoid foramen region, all branches diffused, thereby blurring the orientation. In conclusion, each branch of the facial motor nerve had a topographical orientation and distribution in the crotch and middle part of the ETFN, but the branches diffused near the stylomastoid foramen.

[Comparison of therapeutic efficacy between surgical and non-surgical treatment on mandibular condylar fractures].

PURPOSE: To compare the therapeutic efficacy between surgical and non-surgical treatment on mandibular condylar fractures. METHODS: Patients with mandibular condylar fractures who were treated in our department with complete record from January, 1987 to June, 2009 were collected in this study. We conducted a retrospective analysis on the pathogenic factor, type, treatments and therapeutic efficacy of mandibular condylar fractures to compare the therapeutic efficacy between surgical and non-surgical treatment. RESULTS: A total of 228 patients were included in this study,among which 130 patients were treated by surgical procedure and the other 98 patients were treated by non-surgical treatment. All the patients were followed up for 1.5 years at average. Postoperative opening wide in the midline, occlusal relation and radiographs were examined to evaluate the therapeutic efficacy. Both surgical and non-surgical treatment showed good result. CONCLUSIONS: Surgical and non-surgical treatment for mandibular condylar fracture can achieve good results, when indication is selected appropriately. Non-surgical treatment is acceptable for young children or preschool children, whose mandibular condylar can accommodate well because of their vigorous growth and development and reconstruction function.