Soft-Tissue Simulation for Computational Planning of Orthognathic Surgery.

Simulation technologies offer interesting opportunities for computer planning of orthognathic surgery. However, the methods used to date require tedious set up of simulation meshes based on patient imaging data, and they rely on complex simulation models that require long computations. In this work, we propose a modeling and simulation methodology that addresses model set up and runtime simulation in a holistic manner. We pay special attention to modeling the coupling of rigid-bone and soft-tissue components of the facial model, such that the resulting model is computationally simple yet accurate. The proposed simulation methodology has been evaluated on a cohort of 10 patients of orthognathic surgery, comparing quantitatively simulation results to post-operative scans. The results suggest that the proposed simulation methods admit the use of coarse simulation meshes, with planning computation times of less than 10 seconds in most cases, and with clinically viable accuracy.

Derivación de pacientes con síndrome de disfunción temporomandibular desde Atención Primaria / Referral of patients with temporomandibular joint dysfunction from Primary Care

Introducción: El síndrome de disfunción temporomandibular (SDTM) engloba un amplio abanico de síntomas que van desde molestias a la palpación de la musculatura masticadora hasta episodios de imposibilidad para la apertura o el cierre oral e incluso degeneración articular irreversible. El manejo de los pacientes con sintomatología propia de esta enfermedad es controvertido; generalmente los episodios inflamatorios agudos son susceptibles de tratamiento conservador y no precisan, en principio, valoración por un especialista. Como centro de referencia de la Comunidad de Madrid nuestra impresión es que la derivación de esta dolencia desde Atención Primaria es masiva y poco orientada, lo que, de ser cierto, ocasionaría un aumento de los costes sanitarios directos e indirectos, así como una saturación de las consultas de especialidad. Material y métodos: En este trabajo realizamos un análisis prospectivo de la derivación de los pacientes con SDTM desde Atención Primaria al Hospital Universitario La Paz en un período de 6 meses mediante un sistema de cuestionarios anónimos cumplimentados por el especialista y el paciente. Resultados: La muestra del estudio la constituyen 101 pacientes. El 35,6% de los pacientes derivados presentan una evolución crónica (mayor de 6 meses) de la enfermedad, con una sintomatología leve y en el 65,3% de los casos no se había instaurado ningún tipo de tratamiento por un médico/dentista antes de acudir a nuestra consulta. El gasto extra total anual provocado por la incorrecta derivación desde Atención Primaria asciende a 54.309,024 euros anuales. Conclusiones: Por su elevada prevalencia, el SDTM constituye un foco interesante de acción a la hora de optimizar los tratamientos y minimizar el gasto dentro de las entidades maxilofaciales. Este trabajo pone de manifiesto la situación actual y alerta sobre la necesidad de elaborar protocolos de derivación en consenso con Atención Primaria

Introduction: Temporomandibular joint syndrome (TMJS) includes a wide range of signs and symptoms that vary from mild pain in masticatory muscles to inability to open and close the mouth, and even irreversible joint derangement. Management is controversial, with the more acute inflammatory episodes being good candidates for conservative treatment. These patients do not need, at least initially, to be evaluated by a maxillofacial surgeon. As a maxillofacial referral centre in the Madrid area, it seems that patients affected by this syndrome are referred to our centre from Primary Care on a large scale, and are completely uninformed about their disorder. If this is the case, unnecessary direct and indirect health care costs would be increased, as well as contribute to medical consultation overload. Material and methods: A prospective analysis was performed on TMJS patient referral from Primary care to the Hospital Universitario La Paz during a 6 months period. A self-report anonymous questionnaire was also completed by the professional and the patient in order to collect data. Results: Of the101 patients evaluated, 35.6% had chronic onset (more than 6 months) and with mild symptoms. Almost two-thirds (65.3%) of patients had not received any kind of treatment before coming to the centre. Annual additional costs due to incorrect patient referral were 54,309.024 euros. Conclusions: Due to its high prevalence, TMJS is an interesting focus for action when it comes to controlling extra costs and medical consultation overload. This report shows the present situation, and stressed the need for a consensus referral protocol in Primary Care

Orthodontically guided bone transport in the treatment of alveolar cleft: A case report.

INTRODUCTION: Conventional treatments are sometimes not possible in certain alveolar cleft cases due to the severity of the gap which separates the fragments. Various management strategies have been proposed, including sequential surgical interventions or delaying treatment until adulthood to then carry out maxillary osteotomies. A further alternative approach has also been proposed, involving the application of bone transport techniques to mobilise the osseous fragments and thereby reduce the gap between lateral fragments and the premaxilla. CASE REPORT: We introduce the case of a 10-year-old patient who presented with a bilateral alveolar cleft and a severe gap. Stable occlusion between the premaxilla and the mandible was achieved following orthodontic treatment, making it inadvisable to perform a retrusive osteotomy of the premaxilla in order to close the alveolar clefts. Faced with this situation, it was decided we would employ a bone transport technique under orthodontic guidance using a dental splint. This would enable an osseous disc to be displaced towards the medial area and reduce the interfragmentary distance. During a second surgical intervention, closure of the soft tissues was performed and the gap was filled in using autogenous bone. CONCLUSIONS: The use of bone transport techniques in selected cases allows closure of the osseous defect, whilst also preserving soft tissues and reducing the amount of bone autograft required. In our case, we were able to respect the position of the premaxilla and, at the same time, generate new tissues at both an alveolar bone and soft tissue level with results which have remained stable over the course of time. KEY WORDS: Alveolar cleft, bone transport, graft.

¿Cuál es su diagnóstico? / What would your diagnosis be

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