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1.
J Craniomaxillofac Surg ; 47(12): 1868-1874, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31812310

RESUMO

BACKGROUND: Maxillary advancement may affect speech in cleft patients. AIMS: To evaluate whether the amount of maxillary advancement in Le Fort I osteotomy affects velopharyngeal function (VPF) in cleft patients. METHODS: Ninety-three non-syndromic cleft patients (51 females, 42 males) were evaluated retrospectively. All patients had undergone a Le Fort I or bimaxillary (n = 24) osteotomy at Helsinki Cleft Palate and Craniofacial Center. Preoperative and postoperative lateral cephalometric radiographs were digitized to measure the amount of maxillary advancement. Pre- and postoperative speech was assessed perceptually and instrumentally by experienced speech therapists. Student's t-test and Mann-Whitney's U-test were used in the statistical analyses. Kappa statistics were calculated to assess reliability. RESULTS: The mean advancement of A point was 4.0 mm horizontally (range: -2.8-11.3) and 3.9 mm vertically (range -14.2-3.9). Although there was a negative change in VPF, the amount of maxillary horizontal or vertical movement did not significantly influence the VPF. There was no difference between the patients with maxillary and bimaxillary osteotomy. CONCLUSIONS: The amount of maxillary advancement does not affect the velopharyngeal function in cleft patients.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Osteotomia Maxilar/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteotomia de Le Fort/métodos , Fala/fisiologia , Insuficiência Velofaríngea/fisiopatologia , Adolescente , Adulto , Cefalometria/métodos , Fenda Labial/fisiopatologia , Fissura Palatina/fisiopatologia , Feminino , Finlândia , Humanos , Masculino , Avanço Mandibular/métodos , Maxila/anormalidades , Maxila/cirurgia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Distúrbios da Fala/fisiopatologia , Distúrbios da Fala/cirurgia , Resultado do Tratamento , Insuficiência Velofaríngea/cirurgia , Adulto Jovem
2.
Plast Reconstr Surg ; 144(6): 1010e-1013e, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764642

RESUMO

The occlusal plane angle is an important factor in lateral facial aesthetics. Low occlusal plane facial profiles appear planar and long-faced, whereas high occlusal plane facial profiles are considered more attractive, especially in Asian regions. Clockwise rotation of the occlusal plane for truly aesthetic purposes can be accomplished with double jaw surgery, without need for orthodontic treatments. Patients with normal occlusion who desired to improve their lateral facial aesthetics were included in this study. A conventional Le Fort I osteotomy was followed by a sagittal split ramus osteotomy under general anesthesia. The movement of the maxillomandibular complex was determined in accord with a preoperative analysis. From 2015 to 2017, 43 patients with normal occlusion underwent double jaw surgery without orthodontic treatment. Whereas all patients were subjectively satisfied with the surgery, two underwent orthodontic treatment to correct mild occlusal discrepancies noticed after surgery. There were no delayed occlusal problems or relapses reported during the study. For patients who desired to improve their lateral facial aesthetics but had normal occlusion, orthognathic surgery without orthodontic treatment can be effective. Clockwise rotation of the occlusal plane by double jaw surgery without orthodontic treatment resulted in satisfactory aesthetic outcomes with stable and reliable long-term results. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Oclusão Dentária , Estética , Mandíbula/cirurgia , Maxila/cirurgia , Osteotomia de Le Fort/métodos , Adulto , Feminino , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Maxila/diagnóstico por imagem , Satisfação do Paciente , Ritidoplastia/métodos , Rotação , Resultado do Tratamento , Adulto Jovem
4.
Plast Reconstr Surg ; 144(5): 1125-1134, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31385890

RESUMO

BACKGROUND: The choice between internal and external distraction osteogenesis for midface advancement in patients with syndromic craniosynostosis is based primarily on surgeon preference and expertise. However, differences in outcomes between the two techniques have been sparingly compared. In this work, the authors performed a systematic review to compare outcomes between internal versus external midface distraction. METHODS: A systematic review was performed of studies published between 1998 and 2018 (61 studies included; n = 689 patients). Operative characteristics, early reoperations, complications, and relapse rates were extracted. Bias evaluation was performed using the Newcastle-Ottawa instrument. Statistical analyses were performed with independent samples t tests and linear regression analyses (p < 0.05 considered significant). RESULTS: The authors found that external distraction was associated with more Le Fort III osteotomies and hardware adjustments (p = 0.023), whereas internal distraction was associated with more monobloc osteotomies and longer consolidation times (p = 0.008). No significant differences in the distance of midface advancement, reoperations, complications, or relapse rates were noted between internal versus external distraction, although external distraction trended toward a slightly higher relapse rate. Regardless of distraction protocol, consolidation time was found to be a strong negative predictor for relapse (beta = -0.792; p = 0.02). CONCLUSIONS: No significant differences were demonstrated in advancement distance, reoperative rates, complication rates, or relapse rates for internal versus external distraction for midface advancement. Regardless of distraction type, consolidation time was strongly inversely associated with relapse rates. The trend toward higher relapse in external distraction is potentially explained by the significantly lower consolidation times.


Assuntos
Craniossinostoses/cirurgia , Ossos Faciais/cirurgia , Osteogênese por Distração/métodos , Osteotomia de Le Fort/métodos , Adolescente , Criança , Craniossinostoses/diagnóstico por imagem , Feminino , Humanos , Masculino , Osteogênese por Distração/efeitos adversos , Prognóstico , Recuperação de Função Fisiológica/fisiologia , Recidiva , Reoperação/métodos , Medição de Risco , Fatores de Tempo
5.
Niger J Clin Pract ; 22(7): 891-896, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31293251

RESUMO

Background: Pterygomaxillary separation is the most critical step of Le Fort I osteotomy. Nonideal separation of pterygomaxillary junction could be associated with many complications. The purpose of this study was to evaluate the anatomic basis of proper pterygoid osteotome in Le Fort I surgery. Materials and Methods: The cone beam computed tomography image of 177 patients were evaluated retrospectively. To design an ideal osteotomy, the angle and the length of the posterior curvature of the maxillary sinus wall were measured. For the classification of the posterior angle as low, medium, and high, the category was based on upper and lower groups consisting of 27%, where the measurement and representability are at the maximum level. Results: The mean posterior length of three angle groups was as follows: low group: 7.81 mm, medium group: 7.54 mm, and high group: 7.41 mm. The differences were not statistically significant (P > 0.05). In addition, the posterior angle and length were evaluated according to the gender and the sides, and no statistically significant difference was found. (P > 0.05). Conclusion: Ideal osteotomy technique for pterygomaxillary disjunction and the avoidance of related complications could be achieved by selecting patient-specific osteotome using radiographic assessment.


Assuntos
Maxila/diagnóstico por imagem , Maxila/cirurgia , Osteotomia de Le Fort/métodos , Osso Esfenoide/cirurgia , Adulto , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Masculino , Maxila/anatomia & histologia , Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Osso Esfenoide/diagnóstico por imagem , Turquia , Adulto Jovem
6.
Plast Reconstr Surg ; 144(2): 246e-251e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348355

RESUMO

Orthognathic surgery is a powerful tool for correction of facial asymmetry and malocclusion. The goal is to achieve good dental function and facial aesthetics. Three-dimensional simulation is used for surgical planning, and bone gaps could be created to achieve facial balance. In this study, customized "spacers" were made using computer-aided design and three-dimensional printing for guides for use during surgery. With the final three-dimensional plan, the skull images were exported to 3-Matic software, where spacers were designed according to the bone gaps. Three-dimensionally-printed spacers were made and used to facilitate positioning and fixation. Consecutive patients with facial asymmetry were recruited in this prospective study. The postoperative outcome was assessed using a visual analogue scale and the three-dimensional facial surface area discrepancy index for subjective and objective evaluation. There were 12 patients and a total of 19 spacers for the Le Fort I and mandibular ramus segments. The spacers worked nicely during the bone fixation process. Mean preoperative and postoperative visual analogue scale scores were 4.83 and 7.14, with a statistically significant improvement for facial symmetry (p = 0.018). Mean preoperative and postoperative facial surface area discrepancy index was 0.95 and 0.98, and the correction of asymmetry was significant (p = 0.009). There were no related surgical complications. All patients were satisfied with the correction of facial asymmetry and malocclusion. The custom-made, three-dimensionally-printed spacers help to achieve surgical precision to correct and prevent facial asymmetry in orthognathic surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Assimetria Facial/cirurgia , Má Oclusão/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteotomia de Le Fort/métodos , Medicina de Precisão/métodos , Impressão Tridimensional , Adulto , Estudos de Coortes , Desenho Assistido por Computador , Estética , Assimetria Facial/diagnóstico por imagem , Feminino , Humanos , Masculino , Má Oclusão/diagnóstico por imagem , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/terapia , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Cirurgia Assistida por Computador/métodos , Taiwan , Resultado do Tratamento , Adulto Jovem
7.
Clin Ter ; 170(3): e174-e176, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31173045

RESUMO

AIMS: The aim of this retrospective work on 30 patients affected by dento-skeletal III class and Infantile Swallowing (I.S.), treated between 2006 and 2014, is to analyze the causes of eventual surgical relapses and to underline the consequences of untreated Infantile Swallowing. Infantile Swallowing can be correlated with a relapse in the surgical treatment and therefore requires investigation and treatment beforehand any surgical approach. METHODS: Between the 2006 and 2014 a number of 30 patients affected by III dento-skeletal class and I.S. were treated with a pre-surgery protocol, surgery and a post-surgery protocol. The surgical protocol consisted of: Le Fort I and Bilateral Sagittal Split Osteotomy (BSSO). Out of the 30 patients 3 received previous surgical treatment in another locality without going through pre- and post-surgery protocols for I.S., and they presented themselves about 14 months post-surgery to the first examination having a relapse of the dento-skeletal III class. RESULTS: No skeletal relapse has ever been recorded today in the 30 patients treated with pre and post-surgery protocols and Le Fort I and BSSO osteotomy. CONCLUSIONS: Relapses are commonly attributed to surgical errors or inappropriate surgical program only; in our analysis we observed that the 100% of relapses were due to an untreated or undiagnosed I.S. that caused derangement of bicortical screw and incorrect bony formation and consequently a sort of an improper "distraction osteogenesis".


Assuntos
Transtornos de Deglutição/cirurgia , Deglutição , Osteotomia de Le Fort/métodos , Adolescente , Adulto , Parafusos Ósseos , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Estudos Retrospectivos , Adulto Jovem
8.
J Craniofac Surg ; 30(7): e639-e643, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31232989

RESUMO

Rigid external distraction device (RED) is an efficient and reliable technique for syndromic craniosynostosis patient's postoperative midface distraction. But the instability of the RED is still a major complication. In this case, the authors reported a novel and simple method to solve the RED movement after Le Fort III osteotomy by using W-shaped steel wire suspension system in a child with Apert syndrome whose bilateral temporal bone is extremely thin. The system resisted the rotational force produced by traction force and effectively restricted the RED rotation down, improving the stability of the RED. The authors think this technique has the advantages of being cheap, easy to accomplish and comfortable to wear. Although may cause extra trauma, it is an available technique to improve the postoperative stability of RED especially for patients with thin temporal bones.


Assuntos
Acrocefalossindactilia/cirurgia , Fios Ortopédicos , Osteogênese por Distração/instrumentação , Criança , Craniossinostoses/cirurgia , Craniotomia , Face/cirurgia , Ossos Faciais/cirurgia , Feminino , Humanos , Movimento , Osteotomia de Le Fort/métodos , Período Pós-Operatório , Aço , Osso Temporal/cirurgia
9.
Plast Reconstr Surg ; 143(6): 1255e-1265e, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31136492

RESUMO

BACKGROUND: The aim of this retrospective case series study was to compare three-dimensional postsurgical outcomes of patients with cleft lip and palate following maxillary advancement. METHODS: Fifty consecutive cleft lip and palate patients who underwent whole-pieced Le Fort I advancements were assigned to the major (advancement ≥ 5 mm) or minor (advancement < 5 mm) groups. Three-dimensional surgical simulation was used for presurgical evaluation and planning. Virtual triangles of the presurgical, simulated, and 6-month postoperative stages were used for comparison. Translational and angular changes of each endpoint (A-point, MxR, and MxL) on the virtual triangles and reference planes were recorded and analyzed. Relationships between possible related variables and outcome discrepancies from simulations among all subgroups were also investigated. RESULTS: Analysis of covariance and the least significant difference test revealed that the outcome discrepancy measurements were affected by different combinations of independent variables. The reliability test showed high consistency of the authors' method for three-dimensional measurements. CONCLUSIONS: The actual surgical outcomes of cleft lip and palate patients differed from the virtual simulations. The outcome discrepancies are impacted by multiple factors. The outcome discrepancies of all rotational surgical corrections (roll, yaw, and pitch) were positively correlated to the degree of planned surgical movement. Meanwhile, bilateral cleft lip and palate patients are more likely to incur outcome discrepancies in yaw correction with major maxillary advancement. However, a maxillary advancement cutoff value of 5 mm would not necessarily lead to significant translational outcome discrepancies among cleft lip and palate patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Maxila/cirurgia , Osteotomia de Le Fort/métodos , Adolescente , Feminino , Humanos , Masculino , Modelos Anatômicos , Estudos Retrospectivos , Resultado do Tratamento , Interface Usuário-Computador , Adulto Jovem
10.
Plast Reconstr Surg ; 143(5): 1053e-1059e, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033831

RESUMO

BACKGROUND: Complete reoperation is defined as undergoing reoperative/repeated jaw osteotomies, in a patient who previously underwent orthognathic surgery. The purpose of this study is to (1) describe jaw positions at three time-points (before primary and before and after reoperative surgery), (2) investigate factors necessitating reoperation, and (3) outline the technical challenges. METHODS: Repeated orthognathic surgery cases >1-year out were included. Demographic, radiologic, and perioperative data were compiled. Repeated osteotomies (Le-Fort and/or bilateral split sagittal osteotomy, with or without genioplasty), were compared to their respective primary procedures. Statistical analysis was performed using t tests and z-scores. RESULTS: Fifteen patients were included (28.1 years; 71 percent female). Reoperative/repeated surgery was most often needed to address iatrogenic bony malposition and asymmetry. Relapse was a less common indication. Time between reoperative and primary surgery was 14 months. Sagittal discrepancies (p = 0.029) were the most frequent reason for primary orthognathic surgery (e.g., mandibular hypoplasia (p = 0.023). Reoperative/repeated orthognathic was performed for asymmetry (p = 0.014). Repeated procedures used more 3-dimensional planning (p < 0.001), required all three osteotomies (p = 0.034), had longer operative times (p = 0.078), and all required hardware removal (p < 0.001). Anatomical outcomes were good with 100% patient satisfaction at long-term follow-up. CONCLUSIONS: Reoperative/repeated orthognathic surgery is challenging and underreported in the literature. Whereas primary orthognathic typically addressed sagittal discrepancies, reoperative/repeated osteotomies were needed to correct iatrogenic bone malposition and asymmetries. Challenges include: re-planning, scar burden, need to remove integrated hardware, and repeated osteotomy/fixation. Despite these difficulties, outcomes and patient acceptance were good. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Mentoplastia/estatística & dados numéricos , Doenças Maxilomandibulares/cirurgia , Osteotomia de Le Fort/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Adulto , Feminino , Seguimentos , Mentoplastia/métodos , Humanos , Imageamento Tridimensional , Doenças Maxilomandibulares/diagnóstico por imagem , Masculino , Duração da Cirurgia , Osteotomia de Le Fort/métodos , Planejamento de Assistência ao Paciente , Recidiva , Reoperação/métodos , Estudos Retrospectivos , Resultado do Tratamento
11.
Clin Plast Surg ; 46(2): 141-155, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30851747

RESUMO

Management strategies for syndromic craniosynostosis patients require multidisciplinary subspecialty teams to provide optimal care for complex reconstructive approaches. The most common craniosynostosis syndromes include Apert (FGFR2), Crouzon (FGFR2), Muenke (FGFR3), Pfeiffer (FGFR1 and FGFR2), and Saethre-Chotzen (TWIST). Bicoronal craniosynostosis (turribrachycephaly) is most commonly associated with syndromic craniosynostosis. Disease presentation varies from mild sutural involvement to severe pansynostoses, with a spectrum of extracraniofacial dysmorphic manifestations. Understanding the multifaceted syndromic presentations while appreciating the panoply of variable presentations is central to delivering necessary individualized care. Cranial vault remodeling aims to relieve restriction of cranial development and elevated intracranial pressure and restore normal morphology.


Assuntos
Craniossinostoses/cirurgia , Osteotomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Criança , Suturas Cranianas/anormalidades , Suturas Cranianas/diagnóstico por imagem , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/genética , Feminino , Humanos , Imageamento Tridimensional , Lactente , Masculino , Osteotomia de Le Fort/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Crânio/diagnóstico por imagem , Síndrome , Tomografia Computadorizada por Raios X
13.
Eur Arch Otorhinolaryngol ; 276(4): 1065-1073, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30643961

RESUMO

OBJECTIVES: Orthognathic surgery is a well-established procedure for skeletal deformities. Beneficial influences to the posterior airway space (PAS) have been described, but little is known about the subjective aesthetical and functional nasal aspects after orthognathic surgery. The aim of this study was to evaluate nasal airflow by anterior rhinomanometry and volumetric changes in the nasal airway space after mono- or bimaxillary surgery using cone-beam computed tomography (CBCT) and a new segmentation software. Furthermore, changes of patient's quality of life (QoL) should be assessed. METHODS: Ten patients (9 skeletal class malformation III, 1 skeletal class malformation I) were included. CBCT images, rhinological inspections and anterior rhinomanometries were performed before (T0) and after surgery (T1). All patients completed the FROI-17, the ROE and the SF-36 questionnaires. RESULTS: A significant postoperative gain for nasal airway volume compared with the baseline was shown (p < 0.014). No statistically significant differences between pre- and postoperative flow rates were found (p = 0.114). Pre- and postoperative cohorts did not differ in responses of disease-specific (ROE and FROI-17) and generic QoL questionnaires (SF-36). CONCLUSION: Maxillary relocation surgery leads to a significant increase in nasal airway space. Subjectively, orthognathic patients did not experience any functional but psychosocial aspects after bimaxillary surgery.


Assuntos
Maxila , Obstrução Nasal , Osteotomia de Le Fort , Qualidade de Vida , Adulto , Tomografia Computadorizada de Feixe Cônico/métodos , Ossos Faciais/anormalidades , Ossos Faciais/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Imageamento Tridimensional/métodos , Masculino , Maxila/diagnóstico por imagem , Maxila/cirurgia , Obstrução Nasal/diagnóstico , Obstrução Nasal/etiologia , Obstrução Nasal/psicologia , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteotomia de Le Fort/efeitos adversos , Osteotomia de Le Fort/métodos , Osteotomia Sagital do Ramo Mandibular , Período Pós-Operatório , Rinomanometria/métodos
14.
J Craniomaxillofac Surg ; 47(3): 420-430, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30642732

RESUMO

INTRODUCTION: Le Fort III distraction osteogenesis with a rigid external distraction device is a powerful procedure to correct both exorbitism and impaired airways in faciocraniosynostosis. The aim of this study was to investigate treatment effect, perioperative parameters and volumetric outcomes after Le Fort III distraction osteogenesis in patients with Crouzon syndrome in a retrospective study design and to explore potential strengths and weaknesses of this procedure. MATERIALS AND METHODS: From June 2013 to February 2015, a total of nine children with Crouzon syndrome underwent Le Fort III distraction osteogenesis with a rigid external distraction device (RED device, KLS Martin, Tuttlingen, Germany). Along with perioperative parameters, sleep study reports, traditional cephalometric analysis, three-dimensional imaging and photographs were evaluated for severity of disease and therapeutic effect and structural and functional changes of the upper airway preoperatively, after device removal and one year postoperatively. RESULTS: Surgery for Le Fort III distraction was performed at a median age of 12.5 years (SD 2.5 months) with an average weight of 43.0 kg (SD 12.9 kg). Mean estimated blood loss was 535.7 ml (SD 128.1 ml), not requiring any red blood cell transfusions. Mean duration of surgery was 240 min (SD 30.6min), average hospital stay eight days (SD 0.5 days) with a planned median ICU stay of 1.7 days (SD 0.4 days) for all patients. There were a total of five minor complications. Exorbitism and Angle class III malocclusions were corrected in all patients. No patient showed velopharyngeal problems postoperatively. The average amount of distraction was 18.4 mm (14-26 mm). Average length of the distraction period was 18.3 days (SD 0.4 days), with a total distraction plus consolidation time of three months (SD 0.25 months). In two patients, vector correction was performed during distraction. A counterclockwise movement despite vector correction, clinically resulting in an open bite, was observed in one of these two patients. Eight of the nine patients showed a frontal overbite at the end of the distraction period. Cephalometric analysis revealed a significant increase of Sella-Nasion-Point A angle (SNA) from 76.0° (+/- 2.9; T1) to 86.0° (+/- 3.4; T2) (p = 0.006) and growth-related point A-Nasion-point B angle (ANB) from -4.8° (+/-3.7) to 5.7° (+/-4.8) (p = 0.001) from preoperatively to device removal and stable results one year postoperatively. Upper airway structure and respiratory function were improved clinically after the Le Fort III DO treatment in all cases with an average posterior airway space increase from 3199 mm3 (+/- 229.6 mm3) to 8917,7 ml (+/-415.1 mm3) (T1 to T2). Surgical outcome was judged good to excellent both by patients and families and the craniofacial team. CONCLUSION: Le Fort III DO with a rigid external distraction device in patients with Crouzon syndrome is a powerful and reliable surgical procedure that reliably produces a more significant change of appearance than most other single procedures routinely performed by craniofacial surgeons. It effectively treated sleep apnea in the affected patients. In our collective, the maxilla remained stable after advancement without any relapse, but there was no subsequent anterior growth on one year follow-up. Careful vector planning was able to avoid frontal open bite in eight patients. Complication rates were acceptably low and patients' functional and esthetic outcome was high.


Assuntos
Disostose Craniofacial/cirurgia , Maxila/cirurgia , Osteogênese por Distração/métodos , Osteotomia de Le Fort/métodos , Adolescente , Cefalometria , Criança , Disostose Craniofacial/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional , Masculino , Maxila/anormalidades , Osteogênese por Distração/instrumentação , Estudos Retrospectivos
15.
J Craniomaxillofac Surg ; 47(3): 431-437, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30638741

RESUMO

In this study, we aimed to measure the stresses both on the pterygoid plates and the cranial base during the down-fracture and at the time of pterygomaxillary osteotomy by using the finite element analysis method to have an idea about the possible causes of complications. Three different surgical approaches were applied to the obtained models. In the Model 1, Le Fort I cuts without pterygomaxillary separation was applied. In the Model 2, same standard Le Fort I cuts were applied with pterygomaxillary separation. Then both models were subjected to a force of 150 N over the anterior spina nasalis to simulate down-fracture. In the third model, same standard Le Fort I cuts were applied. Following this procedure, a force of 50 N was applied with a sharp osteotome to the pterygomaxillary junction to simulate osteotomy. According to the results of this experimental study, the cranial base stress values decreased during the down-fracture in the Model 2. Moreover, it was found that the force transmitted to the base of the skull is less when the height of the pterygomaxillary osteotome is limited to 1 cm as we applied in Model 3.


Assuntos
Traumatismos dos Nervos Cranianos/diagnóstico por imagem , Análise de Elementos Finitos , Imageamento Tridimensional , Maxila/lesões , Osteotomia de Le Fort/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Crânio/lesões , Traumatismos dos Nervos Cranianos/etiologia , Humanos , Processamento de Imagem Assistida por Computador , Complicações Intraoperatórias , Maxila/diagnóstico por imagem , Modelos Anatômicos , Modelos Biológicos , Osteotomia de Le Fort/métodos , Crânio/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/lesões , Estresse Mecânico
16.
J Craniofac Surg ; 30(2): 352-357, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30531274

RESUMO

INTRODUCTION: Orthognathic surgery plays an important role in restoring aesthetic facial contour, correcting dental malocclusion, and the surgical treatment of obstructive sleep apnea. However, the rate of complications following bimaxillary as compared with single-jaw orthognathic surgery remains unclear. The authors therefore sought to evaluate complication rates following bimaxillary as compared with single-jaw orthognathic surgery MATERIALS AND METHODS:: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify comparison groups. Preoperative characteristics and postoperative outcomes were compared between groups. The listed procedures have different operating times and characteristics with longer time expected in the bimaxillary osteotomies group. Regression analyses were performed to control for potential confounders. RESULTS: The 3 groups of interest included patients who underwent mandibular osteotomies (n = 126), LeFort I osteotomy (n = 194), and bimaxillary osteotomies (n = 190). These procedures have different operating times, with a longer time expected with bimaxillary osteotomies. Patients undergoing bimaxillary osteotomies had significantly higher rates of early wound complications, overall complications, longer mean operative time, and mean hospital length of stay. Performing bimaxillary osteotomies in the outpatient setting was an independent risk factor for wound complications (OR = 12.58; 95% CI: 1.66-95.20; P = 0.01), while an ASA class of 3 or more was an independent risk factor for overall complications (OR = 3.61; 95% CI: 1.02-12.75; P = 0.04) and longer hospital length of stay (ß = 4.96; 95% CI: 2.64 - 7.29; P < 0.001). CONCLUSIONS: Surgery in the outpatient setting as well as patient American Society of Anesthesiology physical status class 3 or higher were independent factors for postoperative adverse events in patients undergoing bimaxillary surgery. Our findings highlight the importance of addressing modifiable risk factors preoperatively and the need for closer postoperative monitoring in this patient population for optimal outcomes.


Assuntos
Má Oclusão/cirurgia , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Estética Dentária , Feminino , Humanos , Masculino , Má Oclusão/complicações , Osteotomia Mandibular/efeitos adversos , Osteotomia Mandibular/métodos , Análise Multivariada , Duração da Cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteotomia de Le Fort/efeitos adversos , Osteotomia de Le Fort/métodos , Complicações Pós-Operatórias/epidemiologia , Análise de Regressão , Risco , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/cirurgia
17.
J Craniofac Surg ; 30(1): 50-52, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30418289

RESUMO

Le Fort II and III procedures have generally been performed for syndromic craniosynostosis with midfacial hypoplasia and skeletal class III malocclusion. However, some patients have midfacial hypoplasia without malocclusion. Perinasal osteotomy was performed with distraction osteogenesis to move the midface forward in 2 patients (a 17-year old female patient with Crouzon-like disease and a 15-year-old female patient with Antely-Bixler syndrome) with mild midface hypoplasia without malocclusion. The success of the procedure was assured by 3 features: the intermaxillary sutures were fixed by a mini metal plate to prevent separation during distraction; the distraction wires were fixed through the bone of the piriform aperture with the mini metal plates to prevent the wires from coming off; and the osteotomy line was designed in front of the palatomaxillary suture to avoid suture damage. These were expected to secure the procedure. Perinasal osteotomy with distraction osteogenesis is considered one of the recommended procedures for mild midfacial hypoplasia as seen in mild syndromic craniosynostosis without malocclusion.


Assuntos
Fenótipo de Síndrome de Antley-Bixler/cirurgia , Disostose Craniofacial/cirurgia , Craniossinostoses/cirurgia , Osteogênese por Distração/métodos , Adolescente , Fenótipo de Síndrome de Antley-Bixler/complicações , Criança , Disostose Craniofacial/complicações , Feminino , Humanos , Masculino , Má Oclusão de Angle Classe III/complicações , Má Oclusão de Angle Classe III/cirurgia , Osteotomia de Le Fort/métodos
18.
J Craniofac Surg ; 30(2): 525-528, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30358749

RESUMO

INTRODUCTION: Orthodontists and surgeons have been looking for more accurate methods to plan and predict surgical outcomes in patients with skeletal discrepancies. METHODS: The sample consisted of 20 subjects from the surgical clinic of a graduate orthodontic program who had been treated with Le Fort I maxillary movement, bisagittal split osteotomy, with or without genioplasty. All subjects had to have preoperative (T0) and at least 6 months postoperative (T1) cone-beam computed tomographies that were imported to Dolphin three-dimensional (3D) software version 11.9 in digital imaging and communications in medicine format. Three-dimensional voxel-based superimposition on the cranial base was performed for T0 and T1 to accurately measure the skeletal surgical movements. A virtual orthognathic surgery was performed on T0 to mimic the actual skeletal osteotomies using the treatment simulation tool in Dolphin 3D. A prediction 3D soft tissue image (Tp) was generated based on the Dolphin virtual skeletal planning. The differences between Tp and T1 for all patients were measured using linear and angular measurements visualized by surface mapping. RESULTS: Significant differences were found between Tp and T1 in Nasolabial angle, Soft tissue A point, and Subalar area. CONCLUSIONS: The soft tissue prediction accuracy after double jaw surgery using Dolphin 3D is limited in some areas, especially upper lip and base of the nose.


Assuntos
Face/anatomia & histologia , Imageamento Tridimensional , Maxila/cirurgia , Osteotomia de Le Fort , Software , Cirurgia Assistida por Computador , Adulto , Tomografia Computadorizada de Feixe Cônico , Feminino , Mentoplastia , Humanos , Imageamento Tridimensional/métodos , Lábio/anatomia & histologia , Masculino , Maxila/diagnóstico por imagem , Nariz/anatomia & histologia , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteotomia de Le Fort/métodos , Adulto Jovem
19.
J Craniofac Surg ; 30(1): 53-56, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30444777

RESUMO

INTRODUCTION: Treatment of patients with severe Pfeiffer syndrome types II and III is difficult. The purpose of this article is to present our method of overcorrecting midface advancement to improve airway problems in such patients. MATERIALS AND METHODS: One boy and two girls with types II and III Pfeiffer syndrome and who underwent Le Fort III midface advancement using our previously described corrected cephalometric analysis and distraction system were included in the study. RESULTS: The authors overcorrected by advancing the midface to make it look as similar as possible to an adult face. While the overcorrected midface advancement widened the upper airway spaces in the 3 patients, the tracheostomy that had already been placed during infancy could not be closed, probably because of an underlying tracheal abnormality or tracheomalacia. DISCUSSION: Overcorrected midface advancement cannot enable tracheostomy closure, probably because of severe tracheal anomalies, such as tracheomalacia, below the tracheostomy. However, with the possibility of gradual improvement of the tracheomalacia with age, closure of the tracheostomy can eventually be expected. Therefore, efforts to close a tracheostomy should be pursued even if the probability of its removal is low. CONCLUSION: Overcorrected midface advancement did not enable tracheostomy closure, probably because of severe tracheal anomalies such as tracheomalacia. However, the severe exophthalmos and angle III malocclusion were improved, and with the possibility of gradual improvement of the tracheomalacia with age, closure of the tracheostomy can eventually be expected. Therefore, efforts to close a tracheostomy should be pursued even if the probability of its removal is low.


Assuntos
Acrocefalossindactilia/complicações , Acrocefalossindactilia/cirurgia , Osteogênese por Distração/métodos , Osteotomia de Le Fort/métodos , Cefalometria , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Nariz/cirurgia , Tomografia Computadorizada por Raios X , Traqueostomia , Resultado do Tratamento
20.
Int J Oral Maxillofac Implants ; 34(1): 47­60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30282090

RESUMO

PURPOSE: The purpose of this systematic review was to evaluate the outcome of dental implant treatment in fully edentulous patients who underwent Le Fort I osteotomy as a preprosthetic surgical technique. MATERIALS AND METHODS: A search was conducted of the PubMed (MEDLINE), EMBASE, Scopus, and Cochrane databases to identify records published from 1995 to 2017 dealing with Le Fort I osteotomy procedures for implant placement purposes. The primary outcomes of interest were the survival and success rates. The secondary outcomes consisted of the analysis of intra- and postsurgical complications and the surgical and prosthetic loading protocols. RESULTS: Overall, 20 articles were selected for data analysis. A total of 483 patients accounting for 3,596 implants were analyzed. The cumulative survival rate was 90.22% ± 0.8% at 10 years (mean: 59.20 ± 32.31 months). The cumulative success rate was 89.07% ± 1.3% at 10 years (mean: 62.82 ± 25 months). Higher survival rates were found for implants with a rough surface (P < .001) and for implants loaded with a delayed protocol (P < .001). The fracture of the palatine bone during the downfracture procedure was the main intrasurgical drawback, while sinus pathology and graft resorption were commonly observed during the postoperative healing. Surgical and prosthetic loading protocols were heterogenous. CONCLUSION: Based on this review, Le Fort I osteotomy might be considered a viable technique to recreate favorable conditions for implant-supported rehabilitations. Caution has to be taken when using machined implants, particularly in the case of a simultaneous approach.


Assuntos
Implantação Dentária Endo-Óssea/métodos , Implantes Dentários , Boca Edêntula/reabilitação , Osteotomia de Le Fort/métodos , Aumento do Rebordo Alveolar/métodos , Transplante Ósseo/métodos , Humanos , Fraturas Maxilomandibulares/etiologia , Maxila/cirurgia , Complicações Pós-Operatórias
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