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2.
J Dent Child (Chic) ; 87(1): 48-52, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32151311

RESUMO

Infants diagnosed with Pierre Robin sequence frequently have airway obstruction. In severe cases of obstruction, mandibular distraction osteogenesis (MDO) can alleviate the airway blockage through elongation of the mandible and subsequent anterior placement of the tongue. However, there are several complications associated with MDO in the very young child. Among those are injuries to teeth that develop in the area of the MDO osteotomies. Such injuries include distalization and/or morphologic anomalies of primary and permanent molars. We describe a case of an unusual macrodontia of the primary mandibular left second molar in a six-year-old male who underwent MDO as an infant. We believe that the mesial-distal elongation of the crown of the primary second molar occurred through distraction histogenesis of the tooth structures during the distraction of the mandible. We discuss the importance of preoperative planning to minimize such damages to the developing dentition.


Assuntos
Osteogênese por Distração , Síndrome de Pierre Robin , Criança , Humanos , Lactente , Masculino , Mandíbula , Estudos Retrospectivos , Resultado do Tratamento
3.
Instr Course Lect ; 69: 417-432, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017743

RESUMO

Bone defects may occur after trauma, infection, or oncologic resection. A critical sized defect is any defect that is unable to spontaneously heal and will require secondary procedure(s) to obtain union. Autologous grafting is widely used, but may be insufficient to obtain union in these situations. Other options include the induced membrane technique, bone transport through distraction osteogenesis, or free vascularized bone transfer. This chapter will review options for obtaining graft, and the aforementioned special techniques for managing these challenging problems.


Assuntos
Anormalidades Musculoesqueléticas/terapia , Osteogênese por Distração , Transplante Ósseo , Humanos , Cicatrização
4.
PLoS One ; 15(1): e0227975, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31968005

RESUMO

OBJECTIVES: Knee joint distraction (KJD) has been evaluated as a joint-preserving treatment to postpone total knee arthroplasty in knee osteoarthritis patients in three clinical trials. Since 2014 the treatment is used in regular care in some hospitals, which might lead to a deviation from the original indication and decreased treatment outcome. In this study, baseline characteristics, complications and clinical benefit are compared between patients treated in regular care and in clinical trials. METHODS: In our hospital, 84 patients were treated in regular care for 6 weeks with KJD. Surgical details, complications, and range of motion were assessed from patient hospital charts. Patient-reported outcome measures were evaluated in regular care before and one year after treatment. Trial patients (n = 62) were treated and followed as described in literature. RESULTS: Patient characteristics were not significantly different between groups, except for distraction duration (regular care 45.3±4.3; clinical trials 48.1±8.1 days; p = 0.019). Pin tract infections were the most occurring complication (70% regular care; 66% clinical trials), but there was no significant difference in treatment complications between groups (p>0.1). The range of motion was recovered within a year after treatment for both groups. WOMAC questionnaires showed statistically and clinically significant improvement for both groups (both p<0.001 and >15 points in all subscales) and no significant differences between groups (all differences p>0.05). After one year, 70% of patients were responders (regular care 61%, trial 75%; p = 0.120). Neither regular care compared to clinical trial, nor any other characteristic could predict clinical response. CONCLUSIONS: KJD as joint-preserving treatment in clinical practice, to postpone arthroplasty for end-stage knee osteoarthritis patient below the age of 65, results in an outcome similar to that thus far demonstrated in clinical trials. Longer follow-up in regular care is needed to test whether also long-term results remain beneficial and comparable to trial data.


Assuntos
Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Osteogênese por Distração/métodos , Osteogênese por Distração/normas , Adulto , Antibacterianos/administração & dosagem , Artroplastia do Joelho , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/fisiopatologia , Cartilagem Articular/cirurgia , Ensaios Clínicos como Assunto/normas , Fixadores Externos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/normas , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
5.
Oral Maxillofac Surg Clin North Am ; 32(1): 83-88, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31685346

RESUMO

Patients and orthodontists seek to reduce treatment time in braces. Rapid canine retraction through dentoalveolar distraction osteogenesis is one of several treatment approaches to reduce treatment in braces. This article provides an overview of technique of dentoalveolar distraction osteogenesis to accomplish rapid canine retraction and associated outcomes. When this treatment protocol is implemented well, rapid canine retraction is achieved predictably with minimal side effects. Although current evidence suggests that adverse sequelae, such as root resorptions and pulp devitalization, are rare, prospective clinical studies that are adequately powered and documenting long-term follow-up of these outcomes are lacking.


Assuntos
Procedimentos Cirúrgicos Bucais/métodos , Procedimentos de Ancoragem Ortodôntica , Desenho de Aparelho Ortodôntico , Osteogênese por Distração/métodos , Osteotomia/métodos , Técnicas de Movimentação Dentária/métodos , Humanos , Maxila , Procedimentos de Ancoragem Ortodôntica/efeitos adversos , Procedimentos de Ancoragem Ortodôntica/instrumentação , Aparelhos Ortodônticos , Procedimentos Cirúrgicos Ortognáticos , Estudos Prospectivos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(49): e18290, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804373

RESUMO

INTRODUCTION: A resected mandibular edentulous ridge resulting from an ameloblastoma and marginal mandibulectomy is a restorative challenge. To maintain oral hygiene, recurrent examinations, and for long-term maintenance, a removable dental prosthesis is preferred to an implant-supported fixed dental prosthesis. PATIENT CONCERNS: A 28-year-old Asian man was referred for evaluation of a radiolucent area on the right side of the mandible. The right mandibular area had increasingly enlarged over a period of ≥5 months. Marginal resection and inferior alveolar nerve repositioning of the mandible were performed by oral surgeons, followed by reconstruction of the resected mandible with distraction osteogenesis. After 6 years, the patient presented with swelling of the same area. DIAGNOSIS: Histopathological examination revealed recurrence of benign ameloblastoma in the mandible. After mass excision of the recurrent benign tumor, dental implants were installed. To aid with recurrent examinations and oral hygiene maintenance, a treatment plan using implant-assisted removable dental prosthesis, instead of a fixed prosthesis, was formulated. INTERVENTIONS: The edentulous area was rehabilitated with a tooth- and implant-assisted removable partial denture. Due to the insufficient intermaxillary clearance, the removable prosthesis was designed in such a manner that retention, support, and stability could be ensured by separate components. OUTCOMES: The tooth- and implant-assisted removable partial denture showed satisfactory function and esthetics. No complications were observed in the dental prosthesis and supporting tissues during the 3-year follow-up period. CONCLUSION: In recurrent ameloblastoma cases, a removable dental prosthesis may be an effective treatment option for oral rehabilitation. The type of denture design used in this study is novel for implant-assisted removable partial denture rehabilitation.


Assuntos
Ameloblastoma/cirurgia , Prótese Dentária Fixada por Implante , Neoplasias Mandibulares/cirurgia , Osteogênese por Distração , Adulto , Humanos , Masculino , Reconstrução Mandibular , Recidiva Local de Neoplasia
7.
Am J Orthod Dentofacial Orthop ; 156(6): 779-790, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31784011

RESUMO

INTRODUCTION: LeFort III distraction osteogenesis may be indicated in the treatment of syndromic craniosynostosis with severe midface retrusion. This study investigates long-term changes in patients undergoing distraction as children, and compares outcomes to an unaffected, untreated control. METHODS: Fifteen patients (9 males, 6 females) with syndromic craniosynostosis treated by LeFort III distraction at an average age of 4.9 ± 1.5 years were identified. Lateral cephalograms at predistraction, immediate, 1-, 5-, and 10-year postdistraction were superimposed using the best-fit of cranial base details. An untreated, unaffected matched control was obtained from the American Association of Orthodontists Foundation Legacy Collection. Differences in landmark location and cephalometric relationships were assessed between time points and between treatment and control groups. RESULTS: LeFort III distraction produced an average advancement of 14.86 ± 5.14 mm at A-point and 10.54 ± 3.78 mm at orbitale. This advancement produced overcorrection of anteroposterior occlusal relationships and phenotypic correction of midface position. Surgical stability over a 10-year follow-up was excellent. Posttreatment growth was characterized by absent anteroposterior maxillary growth, preservation of dentoalveolar development and maxillary remodeling, and delayed mandibular growth. Subsequent growth resulted in a long-term phenotypic relapse of pretreatment Class III maxillomandibular relationship and negative overjet. CONCLUSIONS: LeFort III distraction osteogenesis produces stable advancement of the midface. Overcorrection is required for long-term phenotypic stability because of deficient postdistraction sagittal midface growth. Late mandibular growth contributes to underestimation of the amount of distraction required to produce long-term phenotypic correction.


Assuntos
Craniossinostoses , Osteogênese por Distração , Osteotomia de Le Fort , Cefalometria , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Mandíbula , Maxila , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(51): e18339, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860988

RESUMO

Mandibular distraction osteogenesis (MDO) is an effective treatment for tongue-based airway obstruction in infants with severe Pierre Robin sequence (PRS). Most infants receiving MDO require postoperative mechanical ventilation (MV) to assist breathing. Optimal MV time for each individual patient and factors influencing the time must be identified to guide clinical decision-making.A retrospective analysis was performed on 75 infants with PRS receiving MDO from November 2016 to August 2018. Twenty-six were females and 47 were males. Data extracted from the hospital information system included sex, age, weight, history of preterm labor, preoperative pulmonary infection, laryngomalacia/tracheomalacia, laryngoscope exposure classification, anesthesia duration, operation duration, postoperative treatment site, situation of distraction, postoperative complications and MV duration. Statistical analyses were conducted to investigate the potential associations of these factors with MV time.Seventy-three PRS syndrome patients received anesthesia for MDO device procedures were considered eligible for study. Patient sex, history of preterm labor, preoperative pulmonary infection, laryngomalacia/tracheomalacia, laryngoscopy exposure difficulty, postoperative treatment site (neonatal or pediatric intensive care unit), ventilator-associated pneumonia, age, weight, anesthesia duration, and operation duration had no significant influence on postsurgical MV time (P > .05). Amount of distraction at the time of extubation had statistically significant influence on postoperative MV time (P < .05). In addition, scatter plots revealed linear relationships between postoperative MV time and amount of distraction at extubation.According to this analysis, amount of distraction was associated with MV time following MDO for severe PRS and roughly 6 days post-surgery is a generally safe extubation time.


Assuntos
Obstrução das Vias Respiratórias/terapia , Mandíbula , Osteogênese por Distração , Síndrome de Pierre Robin/complicações , Respiração Artificial , Extubação , Obstrução das Vias Respiratórias/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Tempo
9.
PLoS One ; 14(12): e0226839, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860680

RESUMO

Previous studies have suggested that treatment plans for segmental bone defects (SBDs) are affected by the bone defect sizes. If the selected treatment was not the most appropriate, it would not contribute to bone healing, but increase complications. The induced membrane technique (IM) and distraction osteogenesis (DO) have been proved to be effective in treating SBDs. However, the differences between the two in therapeutic effects on SBDs with different sizes are still unclear. Thus, we aimed to observe the effects of IM and DO on different sizes of SBDs and to further determine what method is more appropriate for what defect size. Rat models of 4-, 6-and 8-mm mid-diaphyseal defects using IM and DO techniques were established. X-rays, micro-CT, histological and immunohistochemical examinations were performed to assess bone repair. Faster bone formation rate, shorter treatment duration, higher expressions of OPN and OCN and higher parameters of bone properties including bone mineral density (BMD), bone volume/total tissue volume (BV/TV), mineral apposition rate (MAR) and mineral surface/bone surface (MS/BS) were found in 4-mm SBDs treated with DO than in those with IM treatment. However, the results were reversed and IM outperformed DO in bone repair capacity for 8-mm SBDs, while no significant difference emerges in the case of 6-mm SBDs. This study suggests that the therapeutic effects of IM and DO may be subjected to sizes of bone defects and the best treatment size of defects is different between the two. For small-sized SBDs, DO may be more suitable and efficient than IM, but IM has advantages over DO for over-sized SBDs, while DO and IM show similar bone repair capability in moderate-sized SBDs, which would offer a new insight into how to choose DO and IM for SBDs in clinical practice and provide references for further clinical research.


Assuntos
Modelos Animais de Doenças , Deformidades Congênitas das Extremidades Inferiores/cirurgia , Osteogênese por Distração/métodos , Animais , Densidade Óssea , Regeneração Óssea , Diáfises/cirurgia , Imuno-Histoquímica , Deformidades Congênitas das Extremidades Inferiores/diagnóstico por imagem , Masculino , Osteoblastos/metabolismo , Osteocalcina/imunologia , Osteocalcina/metabolismo , Osteogênese , Osteopontina/imunologia , Osteopontina/metabolismo , Ratos , Ratos Sprague-Dawley , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Microtomografia por Raio-X
10.
BMJ Case Rep ; 12(12)2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31874842

RESUMO

A 2-year-old female child with craniosynostosis was referred to our unit for definitive management. She presented with a turricephalic head, hypoplastic midface and obstructive sleep apnoea. Routine preoperative workup included radiographs, CT and polysomnography. She was provisionally planned for calvarial remodelling and midface advancement using transfacial pin fixated distractor (TPF). This involves insertion of a K-wire from one zygoma to the other, a few millimetres below the orbits, traversing across maxilla and nasal cavity. The ends of K-wire are then connected to the distractor anchored firmly to the temporal bone. During insertion, the K-wire transected the nasogastric tube. This technical disaster was circumvented by endoscopic-guided disengagement prior to recovery. The purpose of this paper is to discuss the probable causes that lead to such untoward instances and strategies to avoid and manage the same.


Assuntos
Fios Ortopédicos/efeitos adversos , Craniossinostoses/cirurgia , Ossos Faciais/cirurgia , Osteogênese por Distração/efeitos adversos , Pré-Escolar , Endoscopia/métodos , Falha de Equipamento , Feminino , Humanos , Intubação Gastrointestinal/instrumentação , Apneia Obstrutiva do Sono/cirurgia
11.
Bone Joint J ; 101-B(11): 1416-1422, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31674252

RESUMO

AIMS: In this randomized study, we aimed to compare quality of regenerate in monolateral versus circular frame fixation in 30 patients with infected nonunion of tibia. PATIENTS AND METHODS: Both groups were comparable in demographic and injury characteristics. A phantom (aluminium step wedge of increasing thickness) was designed to compare the density of regenerate on radiographs. A CT scan was performed at three and six months postoperatively to assess regenerate density. A total of 30 patients (29 male, one female; mean age 32.54 years (18 to 60)) with an infected nonunion of a tibial fracture presenting to our tertiary institute between June 2011 and April 2016 were included in the study. RESULTS: The regenerate mineralization on radiographs was comparable in both groups at two, four, six, and ten months' follow-up but the rail fixator group had statistically significant higher grades of mineralization when compared with the circular frame group at eight and 12 months' follow-up. The regenerate mineralization was also higher in the rail fixator group than in the circular frame group on CT at three and six months, although this difference was not statistically significant. CONCLUSION: Overall, the regenerate mineralization was higher in the monolateral than the circular frame group. A monolateral fixator may be preferred in patients with infected nonunion of the tibia with bone defects up to 7 cm. Cite this article: Bone Joint J 2019;101-B:1416-1422.


Assuntos
Fraturas não Consolidadas/cirurgia , Osteogênese por Distração/métodos , Fraturas da Tíbia/cirurgia , Infecção dos Ferimentos/cirurgia , Adolescente , Adulto , Densidade Óssea/fisiologia , Desenho de Equipamento , Fixadores Externos , Feminino , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteogênese por Distração/instrumentação , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Radiografia , Fraturas da Tíbia/diagnóstico por imagem , Infecção dos Ferimentos/diagnóstico por imagem , Adulto Jovem
12.
Indian J Dent Res ; 30(4): 625-629, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31745063

RESUMO

Severe restriction of airway volume in the orofacial region, caused by temporomandibular joint (TMJ) ankylosis, may lead to obstructive sleep apnea (OSA). If the TMJ ankylosis is progressive, rarely, the caregivers may fail to notice the problem. Such patients may have only symptoms of snoring, daytime sleepiness, fatigue, inability to concentrate, and irritability. At times, emergency tracheostomy may be needed to increase the oxygen supply. Distraction osteogenesis (DO) is a less invasive surgical technique in the management of such OSA by correcting the reduced airway space. In DO, the angulation of the distractors and the pace of activation determine the success of the neo-generation of segments of bone. The formation of a well-corticated mandibular canal (MC) in the newly generated bone is an evidence of the success of the procedure. Such bilateral formation of the MC is not reported from this part of the world. We report a case of a 4-year-old boy who was struggling with OSA due to TMJ ankylosis. He was successfully treated by bilateral mandibular DO. The formation and cortication of the MC is discussed with emphasis on the neural regeneration.


Assuntos
Anquilose , Micrognatismo , Osteogênese por Distração , Síndromes da Apneia do Sono , Pré-Escolar , Humanos , Masculino , Mandíbula , Traqueostomia
13.
J Craniofac Surg ; 30(8): 2530-2532, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31609960

RESUMO

Osteogenesis imperfecta (OI) is characterized by brittle bones, premature hearing loss, blue sclera, dental abnormalities, and short stature. Maxillofacial pathology is marked in many OI patients and includes a high incidence of class III malocclusion secondary to a retrusive maxilla relative to both the mandible and cranial base.Review of literature shows that most of the orthognathic surgeries performed in the setting of OI are double jaw surgeries, in the form of maxillary advancement and mandibular setback. However, severe maxillary hypoplasia is usually not correctable with single-stage maxillary advancement. Distraction osteogenesis (DO) is a technique that relies on the normal healing process that occurs between controlled, surgically osteotomized bone segments and it is a relatively widely used technique in modern management of craniofacial conditions.Distraction osteogenesis has been reported in only several patients with OI. There is only 1 previously documented case of maxillary distraction in the craniofacial literature. The authors present here the successful management of a patient with OI and severe class III malocclusion using LeFort I osteotomy and DO with an external rigid distractor.At 12 months follow-up, the patient had no complications and maintained stable maxillary position with normal occlusion, improvement of facial appearance, obstructive airway symptoms, speech, and chewing.This case serves to reinforce the safety and efficacy of DO in patients with OI. The authors did not significantly change our distraction protocol and did not have any complications, therefore the authors believe that DO should be the preferable treatment technique for severe malocclusion in OI patient population.


Assuntos
Osteogênese Imperfeita/cirurgia , Osteogênese por Distração , Adolescente , Humanos , Masculino , Mandíbula/patologia , Maxila/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteogênese por Distração/métodos
14.
J Craniofac Surg ; 30(8): 2650-2655, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31592842

RESUMO

BACKGROUND: This study was conducted to assess effect of bone marrow aspirate concentrate (BMAC) on enhancing biomechanical properties of distraction osteogenesis (DO). METHODS: Twelve rami of goats had distraction and were divided into test group (DO bone supplemented with BMAC) and control group. RESULTS: Assessment of bone-width showed nonsignificant (P = 0.9) increase in test group (mean = 5.3 mm, standard deviation = 1.9 mm) compared to control group (mean = 5.2 mm, standard deviation = 0.8 mm). Assessment of radiographic density showed nonsignificant (P = 0.5) increase in test group (mean = 163.4 Hounsfield Unit, standard deviation = 6.5 Hounsfield Unit) compared to control group (mean = 156.6 Hounsfield Unit, standard deviation = 21.8 Hounsfield Unit). Histomorphometry of mature-bone % showed significant (P = 0.02) increase in test group (mean = 30%, standard deviation = 9.8%) compared to control group (mean = 15.9%, standard deviation = 7.2%). Assessment of biomechanical testing (bone strength) by 3-point bending test showed nonsignificant (P = 0.7) increase in test group (mean = 511.6 Newton, standard deviation = 189.1 Newton) compared to control group (mean = 467.8 Newton, standard deviation = 201.1 Newton). CONCLUSION: The BMAC failed to improve both bone quantity and biomechanical bone strength of distracted bone.


Assuntos
Medula Óssea , Animais , Fenômenos Biomecânicos , Transplante de Medula Óssea , Osso e Ossos , Osteogênese , Osteogênese por Distração
15.
J Craniofac Surg ; 30(8): 2509-2511, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31567766

RESUMO

Distraction osteogenesis technique has gained popularity and has been established as a successful procedure in the management of cranio-maxillofacial deformities for more than 2 decades. Varieties of distractor designs were evolved for the procedures in the maxilla and mandible. Various distraction parameters are clinically important as planned in each case. Inspite of distraction osteogenesis as a well-accepted procedure, currently there is no single classification available for the distraction procedure in maxilla and mandible taking into consideration all the relevant parameters. A simple and user-friendly classification was designed with coding all the relevant parameters. A retrospective data collection from distracted case records were used to validate the classification. A survey from maxillofacial surgeons in a regional meeting was also carried out. The validation and the survey showed that the new classification is comprehensive, simple, easy to use and beneficial for communication, data storage, research, coding, and billing purposes.


Assuntos
Mandíbula/cirurgia , Maxila/cirurgia , Osteogênese por Distração , Humanos , Cirurgiões Bucomaxilofaciais , Osteogênese por Distração/métodos , Estudos Retrospectivos , Inquéritos e Questionários
16.
Plast Reconstr Surg ; 144(4): 932-940, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568307

RESUMO

BACKGROUND: Patients with syndromic craniosynostosis have an increased incidence of progressive hydrocephalus and Chiari malformations, with few data on the relative benefit of various surgical interventions. The authors compare the incidence and resolution of Chiari malformations and hydrocephalus between patients undergoing posterior vault distraction osteogenesis (PVDO) and patients undergoing conventional cranial vault remodeling. METHODS: Patients with syndromic craniosynostosis who underwent cranial vault surgery from 2004 to 2016 at a single academic hospital, with adequate radiographic assessments, were reviewed. Demographics, interventions, the presence of a Chiari malformation on radiographic studies and hydrocephalus requiring shunt placement were recorded. Mann-Whitney U and Fisher's exact tests were used as appropriate. RESULTS: Forty-nine patients underwent PVDO, and 23 patients underwent cranial vault remodeling during the study period. Median age at surgery (p = 0.880), sex (p = 0.123), and types of syndrome (p = 0.583) were well matched. Patients who underwent PVDO had a decreased incidence of developing Chiari malformations postoperatively compared with the cranial vault remodeling cohort (2.0 percent versus 17.4 percent; p = 0.033). Not surprisingly, no significant difference was found between the groups with regard to the incidence of postoperative hydrocephalus requiring shunt placement (PVDO, 4.1 percent; cranial vault remodeling, 4.3 percent; p = 0.999). CONCLUSIONS: As expected, PVDO did not significantly affect intracranial hydrodynamics to the extent that hydrocephalus shunting rates were different for patients with syndromic craniosynostosis. However, PVDO was associated with a reduced risk of developing a Chiari malformation; however, prospective evaluation is needed to determine causality. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Malformação de Arnold-Chiari/etiologia , Craniossinostoses/complicações , Craniossinostoses/cirurgia , Hidrocefalia/etiologia , Osteogênese por Distração/métodos , Crânio/cirurgia , Feminino , Humanos , Lactente , Masculino , Indução de Remissão , Estudos Retrospectivos , Síndrome
17.
J Craniomaxillofac Surg ; 47(11): 1699-1705, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31477439

RESUMO

Various treatments, many of them considerably invasive, are currently applied to infants with Robin sequence (RS) and accompanying upper airway obstruction (UAO). We present a narrative review of our data on the Tübingen palatal plate (TPP) which show the following: a) in a randomized trial, the TPP was superior to a sham procedure in alleviating UAO; b) children treated with the TPP in infancy showed an intellectual development within the reference range; c) prone positioning is no alternative, as it is ineffective and associated with an increased risk of sudden death; d) the TPP reduces the mixed-obstructive apnea index to near-normal values, both in isolated and most (83%) syndromic RS, e) of 443 infants (129 syndromic) treated with the TPP in our center, 23 (5%) ultimately received a tracheostomy (all with syndromic RS), f) recent data suggest that the TPP may induce mandibular catch-up growth, g) the TPP may also help to reduce respiratory complications following cleft closure in RS, and h) TPP treatment is applied by various centers around the world, although it is unclear if its effectiveness is invariably controlled by endoscopy and sleep studies, although both are necessary. Given these data from peer-reviewed studies, it may be questioned whether the "First do no harm" principle is always adhered to when subjecting RS infants to more invasive procedures such as mandibular distraction osteogenesis or tongue-lip adhesion.


Assuntos
Obstrução das Vias Respiratórias/terapia , Osteogênese por Distração , Síndrome de Pierre Robin/terapia , Apneia Obstrutiva do Sono/terapia , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Criança , Humanos , Lactente , Mandíbula/crescimento & desenvolvimento , Mandíbula/patologia , Síndrome de Pierre Robin/complicações , Síndrome de Pierre Robin/diagnóstico , Síndrome de Pierre Robin/genética , Polissonografia , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Resultado do Tratamento
18.
J Pediatr Orthop ; 39(9): e698-e702, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503227

RESUMO

BACKGROUND: Implantable rib-based distraction devices have revolutionized the treatment of children with early onset scoliosis and thoracic insufficiency syndrome. Unfortunately, the need for multiple skin incisions and repeated surgeries in a fragile patient population creates considerable infection risk. In order to assess rates of infection for different incision locations and potential risk factors, we generated a prospectively collected database of patients treated with rib-based distraction devices. METHODS: We analyzed a cohort of patients with thoracic insufficiency syndrome from various etiologies that our institution treated with rib-based distraction devices from 2013 to 2016. Surgery type (implantation, expansion, revision/removal), and surgeon adjudicated surgical site infection (SSI) were collected. For this study, we developed a novel, rib-based distraction device surgical site labeling system in which incisions could be labeled as either proximal or distal surgical exposure areas. Treating surgeons documented the operative site, procedure, and SSI site in real-time. RESULTS: A total of 166 unique patients underwent 670 procedures during the study period, producing 1537 evaluable surgical sites; 1299 proximal and 238 distal. Patients were 6.81±4.0 years of age on average. Forty-seven procedures documented SSIs (7.0%), while 40 (24.1%) patients experienced an infection. Analysis showed significant variation in the rate of infection between implantation, and expansion, and revision procedures, with implantation procedures having the highest infection rate at 13.1% (P<0.01). Infections occurred more frequently at distal sites than proximal ones (P=0.02). CONCLUSIONS: Our novel, surgeon-entered, prospective quality improvement database has identified distal surgical sites as being at higher risk for SSI than proximal ones. Further, rib-based distraction device implantation procedures were identified as being at a greater risk for SSI than expansion or revision procedures. We believe this data can lead to improved prevention measures, anticipatory guidance, and patient care. LEVEL OF EVIDENCE: Level II-prognostic study.


Assuntos
Osteogênese por Distração/efeitos adversos , Costelas/cirurgia , Escoliose/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Humanos , Philadelphia/epidemiologia , Próteses e Implantes/efeitos adversos , Melhoria de Qualidade , Reoperação , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Doenças Torácicas/cirurgia
19.
J Pediatr Orthop ; 39(9): e703-e707, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503228

RESUMO

BACKGROUND: Despite clinical reports of improved pulmonary function and reduced spinal deformity with rib-based distraction surgery in early-onset scoliosis (EOS) patients, infection remains a common complication, reported as high as 32% in some studies. The purpose of this study was to evaluate intrawound vancomycin powder in pediatric patients managed with rib-based distraction for EOS. METHODS: This was a single institution retrospective cohort study of EOS patients treated with rib-based distraction. Patients treated with and without intrawound vancomycin were compared. Patients included were younger than 18 years of age, had undergone placement of a rib-based distraction construct, and had a minimum of 6 months' follow-up. For patients in the vancomycin group, 500 mg of vancomycin powder was placed before wound closure. Complications including infection and revision surgery were recorded. P-values and 95% confidence intervals (CIs) were reported for both unadjusted and adjusted complication rates for prevancomycin and postvancomycin powder. All P-values were calculated at a significance level of 0.05. RESULTS: In total, 118 patients were included, accounting for 1035 procedures in the nonvancomycin control group and 252 procedures in the vancomycin group. Both groups were similar with regard to age at initial implant, sex, diagnosis, ambulatory status, and bowel/bladder incontinence. There were 55 (5.3%; 95% CI, 4.1-7.6) postoperative infections in the control group and 3 (1.2%; 95% CI, 0.3-3.8) in the vancomycin group (P=0.008, unadjusted). After adjusting for surgery type and transfusions, the vancomycin group still had a significantly lower infection rate (1.4%; 95% CI, 0.3-3.7 vs. 5.5%; 95% CI, 3.04-6.5; P=0.022). We were unable to demonstrate a difference between the control (3.5%, 95% CI, 2.4-5.1) and vancomycin (1.8%, 95% CI, 0.5-5.7) groups for deep infection (P=0.27). CONCLUSIONS: Intrawound vancomycin powder significantly reduced the surgical site infection rates following rib-based distraction surgery for EOS. We therefore recommend the use of intrawound vancomycin powder as a standard of care for patients undergoing rib-based distraction surgery. LEVEL OF EVIDENCE: Pre-post intervention, retrospective cohort study-therapeutic level III.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Osteogênese por Distração/efeitos adversos , Escoliose/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Vancomicina/administração & dosagem , Administração Tópica , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pós , Próteses e Implantes/efeitos adversos , Reoperação , Estudos Retrospectivos , Costelas/cirurgia , Infecção da Ferida Cirúrgica/etiologia
20.
J Craniofac Surg ; 30(7): 2271-2274, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503124

RESUMO

INTRODUCTION: Distraction osteogenesis is an integral part in management of mandibular defects associated with hemifacial microsomia and post-ankylotic mandibular defects. The most difficult part in distraction osteogenesis is the prediction of distraction vector and risk of injury to vital structures as inferior alveolar. The present study aimed to present 3-dimensionally constructed computer-guided splints in distraction osteogenesis to get an ideal vector and minimal risk of vital structures injury. MATERIAL AND METHODS: The technical note presents cases series of 6 patients who had computer-guided distraction osteogenesis surgery using prefabricated splints. RESULTS: The distance between the virtual and physical pins and osteotomy was measured, and the deviation of the vector angle and osteotomy angle was also assessed. Average deviation in pin distance was 3 mm and in vector angle 13.5°. Average deviation in osteotomy distance was 2.6 mm and in osteotomy angle 14.4°. None of the cases had injury to vital structure. There was significant improvement (P = 0.0078) in the medial canthus-buccal commissure distance where the arithmetic mean improved from 59.6 (SD = 10.1) mm pre-distraction in the defective side to 67.1 (SD = 8) mm post-distraction. The degree of correction was 97% compared to the normal side. CONCLUSION: 3D printed surgical stents were successful in transferring the virtual treatment plan of mandibular distraction osteogenesis into the surgical theatre with an acceptable margin of error and without injury to any vital structures.


Assuntos
Osteogênese por Distração/métodos , Stents , Humanos , Interpretação de Imagem Assistida por Computador , Fixadores Internos , Mandíbula/cirurgia , Osteotomia/métodos , Impressão Tridimensional
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