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1.
Plast Reconstr Surg ; 146(5): 599e-606e, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33136957

RESUMO

BACKGROUND: One of the arguments against early intervention for micrognathia in Pierre Robin sequence is the concept that the growth of the mandible will eventually "catch up." Long-term growth of the mandible and occlusal relationships of conservatively managed Pierre Robin sequence patients remain unknown. In this study, the authors evaluated the orthognathic surgery requirements for Pierre Robin sequence patients at skeletal maturity. METHODS: Orthognathic surgical requirements of conservatively managed Pierre Robin sequence and isolated cleft patients (aged ≥13 years) at two institutions were reviewed and analyzed using t test, chi-square test, and Fisher's exact test. Values of p < 0.05 were considered statistically significant. RESULTS: Of the Pierre Robin sequence patients (n = 64; mean age ± SD, 17.9 ± 2.9 years), 65.6 percent were syndromic (primarily Stickler and velocardiofacial syndrome), 96.9 percent had a cleft palate, and 39.1 percent required orthognathic surgery at skeletal maturity. Nonsyndromic and syndromic Pierre Robin sequence patients demonstrated no differences in occlusal relationships or mandibular surgery frequency. The majority of Pierre Robin sequence patients requiring mandibular advancement had a class II occlusion. Comparison of Pierre Robin sequence patients to isolated cleft palate patients (n = 17) revealed a comparable frequency of orthognathic surgery between the two; however, Pierre Robin sequence patients did require mandibular advancement surgery at a greater frequency than cleft palate patients (p = 0.006). CONCLUSIONS: The present study found that 39.1 percent of conservatively managed Pierre Robin sequence patients required orthognathic surgery at skeletal maturity, of which the vast majority required mandibular advancement for class II malocclusion. These data suggest that mandibular micrognathia in conservatively managed Pierre Robin sequence patients may not resolve over time and may require surgical intervention. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Fissura Palatina/cirurgia , Tratamento Conservador/efeitos adversos , Má Oclusão de Angle Classe II/epidemiologia , Procedimentos Cirúrgicos Ortognáticos/estatística & dados numéricos , Síndrome de Pierre Robin/terapia , Adolescente , Cefalometria/estatística & dados numéricos , Fissura Palatina/complicações , Tratamento Conservador/métodos , Feminino , Seguimentos , Humanos , Masculino , Má Oclusão de Angle Classe II/diagnóstico , Má Oclusão de Angle Classe II/prevenção & controle , Má Oclusão de Angle Classe II/cirurgia , Mandíbula/anatomia & histologia , Mandíbula/crescimento & desenvolvimento , Mandíbula/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Síndrome de Pierre Robin/complicações , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
Plast Reconstr Surg ; 146(5): 622e-629e, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33136961

RESUMO

BACKGROUND: Cleft lip affects one in 700 children globally, and the prevalence far surpasses capacity to deliver cleft care in underresourced and endemic regions. A hands-on educational presence is needed to promote overseas surgical autonomy, build overseas capacity, and ensure a sustained clinical and educational infrastructure. The goal of this study was to build and assess an augmented reality educational platform that allows a remote yet virtual interactive presence to transfer cleft surgery knowledge/skills to overseas colleagues. METHODS: A prospective study assessing a 13-month overseas augmented reality-based cleft surgery curriculum was conducted. Three semiannual site visits engaged two Peruvian surgeons in evidence-based didactics, on-site cleft surgery, and familiarization with the augmented reality platform. During 10 remote augmented reality visits, a surgeon stationed in United States guided the same Peruvian surgeons through cleft surgery. Quarterly assessments of the Peruvian surgeons were performed using visual analogue scale questionnaires. RESULTS: Visual analogue scale scores by both the remote and overseas surgeons demonstrated significant, progressive improvement in all facets of cleft lip repair throughout the curriculum. Site visits preferentially built capacity for cleft diagnosis and preoperative counseling (p < 0.001), principles of repair (p < 0.001), repair technique (p < 0.02) and intraoperative decision-making (p < 0.001). Remote sessions preferentially developed understanding of cleft operative design/anthropometry (p < 0.04), cleft anatomy (p < 0.01), and operative efficiency (p < 0.001). At 30-month follow-up, no children with cleft lip required transfer to tertiary care centers. CONCLUSION: A curriculum that combines on-site training and augmented reality-based hands-on remote teaching can build sustained capacity of comprehensive cleft care in underresourced areas.


Assuntos
Realidade Aumentada , Treinamento com Simulação de Alta Fidelidade/métodos , Cooperação Internacional , Procedimentos Cirúrgicos Ortognáticos/educação , Realidade Virtual , Fenda Labial/epidemiologia , Fenda Labial/cirurgia , Fissura Palatina/epidemiologia , Fissura Palatina/cirurgia , Competência Clínica , Currículo , Carga Global da Doença , Humanos , Lactente , Período Intraoperatório , Procedimentos Cirúrgicos Ortognáticos/métodos , Projetos Piloto , Estudo de Prova de Conceito , Estudos Prospectivos , Reprodutibilidade dos Testes , Desenvolvimento Sustentável
3.
Sci Rep ; 10(1): 16235, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004872

RESUMO

Facial photographs of the subjects are often used in the diagnosis process of orthognathic surgery. The aim of this study was to determine whether convolutional neural networks (CNNs) can judge soft tissue profiles requiring orthognathic surgery using facial photographs alone. 822 subjects with dentofacial dysmorphosis and / or malocclusion were included. Facial photographs of front and right side were taken from all patients. Subjects who did not need orthognathic surgery were classified as Group I (411 subjects). Group II (411 subjects) was set up for cases requiring surgery. CNNs of VGG19 was used for machine learning. 366 of the total 410 data were correctly classified, yielding 89.3% accuracy. The values of accuracy, precision, recall, and F1 scores were 0.893, 0.912, 0.867, and 0.889, respectively. As a result of this study, it was found that CNNs can judge soft tissue profiles requiring orthognathic surgery relatively accurately with the photographs alone.


Assuntos
Aprendizado Profundo , Face/anatomia & histologia , Procedimentos Cirúrgicos Ortognáticos , Fotografia Dentária , Adulto , Deformidades Dentofaciais/diagnóstico , Deformidades Dentofaciais/patologia , Deformidades Dentofaciais/cirurgia , Face/patologia , Feminino , Humanos , Masculino , Má Oclusão/diagnóstico , Má Oclusão/patologia , Má Oclusão/cirurgia , Redes Neurais de Computação , Procedimentos Cirúrgicos Ortognáticos/métodos , Reprodutibilidade dos Testes , Adulto Jovem
4.
Sci Rep ; 10(1): 15853, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32985539

RESUMO

Perioperative anaemia increases postoperative morbidity and mortality, and iron deficiency is anaemia's most common cause in surgical patients. Preoperative intravenous iron increases postoperative haemoglobin; however, data regarding intraoperative intravenous iron's effectiveness are inadequate. This study examined intraoperative intravenous iron's effects on postoperative haemoglobin levels in adults. Fifty-seven healthy subjects (aged 19-40 years) scheduled for bimaxillary orthognathic surgery were assigned randomly to the iron (n = 28) or control (n = 29) groups. The iron group received intravenous ferric derisomaltose (1,000 mg) after anaesthetic induction. The control group received an identical volume of intravenous normal saline. The primary outcome was postoperative haemoglobin level. Secondary outcomes included other postoperative haematologic and iron parameters. Laboratory data were obtained preoperatively and at 1 day, 2 weeks, and 4 weeks postoperatively. Haemoglobin was higher in the iron group 2 weeks postoperatively (12.9 g/dL vs. 12.2 g/dL), but the between-group difference was not significant after adjustment for multiple testing. However, the reticulocyte production index was significantly higher in the iron group 2 weeks postoperatively. Intraoperative intravenous iron maintains postoperative haemoglobin values in patients undergoing bimaxillary orthognathic surgery by increasing haematopoietic function and iron bioavailability and therefore appears to be a useful strategy for blood management.


Assuntos
Anemia Ferropriva/prevenção & controle , Cuidados Intraoperatórios/métodos , Ferro/uso terapêutico , Adulto , Feminino , Ferritinas/sangue , Hemoglobinas/análise , Humanos , Infusões Intravenosas , Ferro/administração & dosagem , Ferro/sangue , Masculino , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Procedimentos Cirúrgicos Ortognáticos/métodos , Contagem de Reticulócitos , Adulto Jovem
5.
PLoS One ; 15(9): e0238494, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32886686

RESUMO

The purposes of this study were to investigate the influence of the orthodontics-first approach (OFA) and surgery-first approach (SFA) on changes in the signs and symptoms of temporomandibular joint disorders (TMDs) and to compare pre- and postoperative orthodontic treatment duration and total treatment duration between the two approaches. This retrospective study recruited 182 adult patients with malocclusions treated with OFA and SFA and recorded variables such as age, gender, skeletal classification, and signs and symptoms of TMD (clicking and pain disorders) before the start of the surgical-orthodontic treatment and after surgery. Changes in the signs and symptoms of TMD and treatment duration were evaluated within each approach and compared between two approaches. A binary logistic regression was performed to assess the influence of the variables on the postoperative signs and symptoms of TMD. There were no significant postoperative changes in temporomandibular joint (TMJ) pain for OFA and SFA, whereas a significant reduction was found in TMJ clicking after surgery for both approaches. According to binary logistic regression, the type of surgical-orthodontic treatment (OFA or SFA) was not a significant risk factor for postoperative TMJ clicking and pain, and the risk of postoperative TMJ clicking and pain was significant only when TMJ clicking (OR = 10.774, p < 0.001) and pain (OR = 26.876, p = 0.008) existed before the start of the entire treatment, respectively. With regard to the treatment duration, SFA (21.1 ± 10.3 months) exhibited significantly shorter total treatment duration than OFA (34.4 ± 11.9 months) (p < 0.001). The results of this study suggest that surgical-orthodontic treatment using SFA can be a feasible option of treatment for dentofacial deformities based on the equivalent effect on TMD and shorter overall treatment period compared to conventional surgical-orthodontic treatment using OFA.


Assuntos
Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Procedimentos Cirúrgicos Ortognáticos/métodos , Articulação Temporomandibular/cirurgia , Adulto , Ossos Faciais , Feminino , Humanos , Masculino , Ortodontia , Cirurgia Ortognática , Dor/complicações , Estudos Retrospectivos , Transtornos Somatoformes/complicações , Transtornos da Articulação Temporomandibular/terapia
7.
Sci Rep ; 10(1): 12015, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32694715

RESUMO

Surgical site infections (SSI) occur in 1.4% to 33.4% of cases after orthognathic surgery. This type of complication is a major concern to surgical teams, but there is no consensus for the prevention and treatment of SSI in orthognathic surgery. The purpose of this descriptive study was to evaluate the severity and the consequences of postoperative infections. The charts of all the patients operated on by the orthognathic surgery team between January 2015 and July 2017 were collected. All types of orthognathic procedures (Le Fort I maxillary osteotomy, bilateral sagittal split mandibular osteotomy, and genioplasty) were screened, and patients diagnosed with SSI were included. Demographic data, timing and severity of the infection, as well as long-term complications were recorded. Five hundred and twelve patients were screened. Forty-one patients (8%) presenting with SSI were included. There were 18 men and 23 women. The site of the infection was mandibular for 38 patients (92.7%) and maxillary for 3 patients (7.3%). The average time between surgery and infection was 31.5 days. Twenty-four patients received isolated oral antibiotics for inflammatory cellulitic reaction (58.8%), 15 patients had a localized collection treated by incision and drainage under local anesthesia (36.6%), and 2 patients had an extensive collection requiring surgical drainage under general anesthesia (4.9%). Five patients (12.2%) needed hardware removal for plate loosening, and 2 patients (4.9%) developed chronic osteomyelitis. Infection following orthognathic surgery is easily treated most of the time with no long-term complications. In cases of patients with potential risk factors for severe infection, antibiotics may be given with curative intents.


Assuntos
Cirurgia Ortognática/métodos , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Procedimentos Cirúrgicos Ortognáticos/métodos , Índice de Gravidade de Doença , Infecção da Ferida Cirúrgica/etiologia , Adolescente , Adulto , Antibacterianos/administração & dosagem , Drenagem/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
8.
J Plast Reconstr Aesthet Surg ; 73(9): 1717-1722, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32446569

RESUMO

PURPOSE: To demonstrate a maneuver for achieving optimal force balance of reconstructed orbicularis oris during primary unilateral incomplete cleft lip reconstruction. METHODS: The surgical maneuver was performed as follows: the length of the orbicularis oris on the noncleft side is first isolated and adjusted to be equal to the length of the muscle on the cleft side. The remaining muscle from the noncleft side near the midline is used to fill in the vermilion tubercle, and finally, the two orbicularis oris muscles are sutured at the midline. Finite element analysis was utilized to model the biomechanics of our novel surgical method. RESULTS: Finite element analysis showed that when the lengths of two orbicularis oris muscles were the same after primary cleft lip repair, the stress on this muscle system was minimized under different lip conformations. Seventeen cleft lip patients were enrolled to receive reconstruction with this new maneuver. Significant differences were found in (1) noncleft/cleft alar base width, nasal dorsum angle, columella length relationship between two sides, and columella angle under the comparison between preoperative and postoperative; (2) noncleft/cleft alar base width, nasal dorsum angle, and columella angle under the comparison between preoperative and follow-up; and (3) columella length relationship between two sides under the comparison between postoperative and follow-up. CONCLUSION: Force balance of the orbicularis oris muscles is important during unilateral incomplete cleft lip repair. This surgical maneuver for achieving force balance of the orbicularis oris and the muscle system of the lips is easy to perform and can help avoid relapses.


Assuntos
Fenda Labial/cirurgia , Músculos Faciais/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Fotogrametria , Cirurgia Assistida por Computador
9.
Tunis Med ; 98(3): 246-253, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32395819

RESUMO

INTRODUCTION: By means of orthopedics, orthognathic surgery or orthodontics, the management of the maxillary transverse defisciency is a key element of the orthodontic treatment plan, and the guarantee of its stability. the following work aims to support, through a clinical case, the management and the progression of the treatment of the maxillary transverse deficiency associated to a class III skeletal anomaly. OBSERVATION: The authors report the case of a 15-year-old patient with a severe class III    malocclusion, with severe maxillary transverse deficiency. The objectives of the treatment were, first, to solve the transverse disharmony by surgically assisted rapid maxillary expansion (SARME), then, secondly, to remove the dentoalveolar compensations and a bimaxillary orthognathic surgery, was carried out to correct the sagittal and vertical disharmony. CONCLUSION: Surgically assisted rapid maxillary expansion (SARME) appears to be advantageous, both functionally and aesthetically to overcome transverse maxillary deficiency. The agreement between the orthodontist, the maxillofacial surgeon and / or the plastic surgeon, both in the schedule and in the choice of surgical interventions, remains decisive concerning ortho-surgical treatments.


Assuntos
Má Oclusão de Angle Classe III/cirurgia , Maxila/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Técnica de Expansão Palatina , Adolescente , Humanos , Má Oclusão de Angle Classe III/patologia , Maxila/patologia , Índice de Gravidade de Doença
11.
Plast Reconstr Surg ; 145(5): 963e-974e, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332545

RESUMO

BACKGROUND: The aim of this study was to evaluate the effects of the use of computer-aided design and manufacturing cutting and drilling guides with prebent titanium plates for the correction of skeletal class III malocclusion. METHODS: In this prospective, randomized, controlled clinical trial, 46 patients with skeletal class III malocclusion were randomly assigned into two groups. The patients underwent bimaxillary surgery with computer-aided design and manufacturing cutting and drilling guides with prebent titanium plates (experimental group) or computer-aided design and manufacturing splints (control group). Preoperative and postoperative imaging data were collected and then analyzed using Mimics Research 19.0, Geomagic Studio, and IBM SPSS Version 21.0. RESULTS: Deformity evaluation and posttreatment assessment were performed for all patients. The experimental group had fewer postoperative complications. Comparison of the linear and angular differences to facial reference planes revealed more accurate repositioning of the mandible and condyles in the experimental group, although the position of several landmarks still requires small adjustments. CONCLUSION: Computer-aided design and manufacturing cutting and drilling guides with prebent titanium plates effectively corrected skeletal class III malocclusion, providing positional control of segments with reasonable surgical accuracy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Desenho Assistido por Computador , Má Oclusão de Angle Classe III/cirurgia , Procedimentos Cirúrgicos Ortognáticos/instrumentação , Osteotomia de Le Fort/instrumentação , Cirurgia Assistida por Computador/instrumentação , Adulto , Pontos de Referência Anatômicos , Placas Ósseas , Cefalometria/métodos , Feminino , Humanos , Imageamento Tridimensional , Masculino , Mandíbula/anatomia & histologia , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Maxila/anatomia & histologia , Maxila/diagnóstico por imagem , Maxila/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteotomia de Le Fort/métodos , Estudos Prospectivos , Contenções , Cirurgia Assistida por Computador/métodos , Titânio , Tomografia Computadorizada Espiral , Resultado do Tratamento , Adulto Jovem
12.
Int. j interdiscip. dent. (Print) ; 13(1): 44-46, abr. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1114893

RESUMO

AIM: Short implants are manufactured for use in atrophic regions of the jaw. Therefore, the current does not sufficiently reveal a direct correlation between the impact of implant length on implant survival. The purpose of this systematic review was to compile the evidence of short implant survival in atrophied jaws. METHODS: Electronic and manual literature searches were performed by two independent reviewers in several databases, including MEDLINE, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to September 2015 using the following terms in some combinations: "short implant", "mandible/atrophied jaws", and "implant survival/ survival rate/ survival analysis". RESULTS: The 19 included studies present in average 5.5 years (range 1.0-20.0 years) follow-up and 96.1% (range 73.4-100.0 percent) survival rate of the short implants in atrophied mandibular. CONCLUSIONS: This systematic review found evidences regarding to safety of short implant placement in atrophied jaws although stronger evidence is essential to confirm this finding.


Assuntos
Humanos , Implantes Dentários , Implantação Dentária Endo-Óssea/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Atrofia , Análise de Sobrevida , Arcada Osseodentária , Mandíbula
13.
Sci Rep ; 10(1): 4246, 2020 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-32144392

RESUMO

Patient satisfaction with the shape and appearance of their nose after orthognathic surgery-based skeletofacial reconstruction is an important, but often overlooked, outcome. We assessed the nose-related outcomes through a recently developed patient-reported outcome instrument and a widely adopted 3D computer-based objective outcome instrument, to verify any correlation in the results produced by these tools. We collected FACE-Q nose appearance reports (2 scales) and 3D nasal morphometry (10 parameters) from patients with class III skeletal pattern and congenital cleft lip palate deformity (n = 23) or developmental dentofacial deformity (n = 23) after (>12 months) skeletofacial reconstruction. The cleft and dentofacial cohorts demonstrated significantly (p < 0.001) poorer satisfaction scores with regard to the FACE-Q nostrils scale than the normal age-, gender-, and ethnicity-matched subjects (n = 107), without any significant difference in FACE-Q nose scale. The cleft cohort had significantly (p < 0.001) smaller nasal length, nasal tip projection, and columellar angle and greater nasal protrusion, alar width, and columellar-labial angle values than the dentofacial and normal cohorts; however, there were no significant differences between the dentofacial versus normal cohorts. The FACE-Q nose and nostrils scales were significantly (p < 0.001; r = -0.26-0.27) correlated to the results of the 3D morphometric analysis, with regard to nasal length, alar width, columella angle, and columellar-labial angle parameters. This study revealed differences in satisfaction with the appearance of the nose according to the type of underlying deformity, and demonstrated a significant correlation (low correlation coefficients) between the patient-reports and 3D image-based outcome measure tools, which has implications for multidisciplinary-centered research, auditing, and clinical care.


Assuntos
Nariz/cirurgia , Procedimentos Cirúrgicos Ortognáticos , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Feminino , Humanos , Imageamento Tridimensional , Masculino , Procedimentos Cirúrgicos Ortognáticos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cirurgia Assistida por Computador , Adulto Jovem
14.
J Craniofac Surg ; 31(4): 976-979, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32195835

RESUMO

PURPOSE: The purpose of this study was to assess the clinical interventions and the accuracy of maxillary reposition using a computer-aided design/computer-aided manufacturing (CAD/CAM) splint derived via surgical simulation. MATERIALS AND METHODS: The retrospective study comprised 24 patients who underwent bimaxillary surgery. The patients were assigned to 1 of 2 groups by a way of maxillary repositioning. One group received conventional intermediate wafers and the other CAD/CAM wafers during Le Fort I osteotomy. We recorded operation time, blood loss, the operative accuracy. Accuracy was analyzed by 3-dimensional computed tomography images before and immediately after the operation. The evaluation points were the right maxillary first incisor (U1), the right maxillary second molar (M2-right), and the left maxillary second molar (M2-left). RESULTS: The 2 groups did not differ significantly in operation time and blood losses. The vertical axis of U1 data differed significantly between the 2 groups (P = 0.008). None of the horizontal, vertical, or anteroposterior axis of M2-right data differed significantly, and anteroposterior axis of M2-left data differed significantly (P = 0.0296). The CAD/CAM group 3-dimensional distance errors were less than those of the conventional group for all points. CONCLUSION: Placement of CAD/CAM splint allowed highly accurate repositioning; the accuracy exceeded that afforded by conventional model surgery using a facebow and articulator.


Assuntos
Doenças Maxilares/diagnóstico por imagem , Doenças Maxilares/cirurgia , Procedimentos Cirúrgicos Ortognáticos , Contenções , Adolescente , Adulto , Feminino , Humanos , Imageamento Tridimensional/métodos , Masculino , Placas Oclusais , Procedimentos Cirúrgicos Ortognáticos/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
15.
World J Surg Oncol ; 18(1): 46, 2020 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-32113474

RESUMO

BACKGROUND: A vascularized fibular osteomyocutaneous flap with severe vascular crisis often results in serious consequences. This study aims to examine the clinical effect of non-vascularized fibular graft on patients with severe vascular crisis after reconstruction of the defect jaw with vascularized fibular osteomyocutaneous flap. MATERIALS AND METHODS: From December 2007 to December 2018, a total of 104 patients with jaw neoplasms that underwent reconstruction with free vascularized fibular flap were retrospectively analyzed; seven of these cases had postoperative vascular crisis during mandibular reconstruction. RESULTS: Of the seven cases with postoperative vascular crisis, the vascularized fibular flaps in three patients survived completely, thanks to early detection; two cases were completely necrotic and removed in the end, and the remaining two cases had severe vascular crisis after the removal of the soft tissue attached to the fibular flap. The non-vascular fibular grafts were retained regardless of the severe absorption after follow-ups for 25 and 69 months, respectively. CONCLUSIONS: If vascular crisis occurs following jaw reconstruction with a vascularized fibular osteomyocutaneous flap, early re-surgical exploration effectively improves the salvage rate. In addition, when a severe vascular crisis occurs, the vascularized fibular flap can be changed to a non-vascular fibular graft to reconstruct the mandibular defect, thus avoiding the serious consequences resulting from the complete failure of fibular graft.


Assuntos
Procedimentos Cirúrgicos Ortognáticos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Adulto , Feminino , Fíbula , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
16.
Rev. esp. cir. oral maxilofac ; 42(1): 12-19, ene.-mar. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-195293

RESUMO

OBJETIVO: Describir la eficacia del abordaje transconjuntival para el tratamiento de fracturas orbitarias con compromiso del suelo de la órbita y las posibles complicaciones asociadas a este abordaje. Material y MÉTODO: Es un estudio retrospectivo descriptivo en base a 98 pacientes con fractura de órbita donde se utilizó el abordaje transconjuntival, en el Servicio de Cirugía Maxilofacial del Hospital Clínico Mutual de Seguridad de Santiago de Chile, entre enero del 2012 y abril del 2017. Se determinó la tasa de éxito de dicha técnica y las variables con mayor predisposición a producir complicaciones. Los criterios de inclusión fueron pacientes con fracturas del complejo maxilofacial con compromiso de una o más paredes orbitarias. Se utilizó el test de Fisher para el análisis de datos, siendo significativo un p value < 0,05. RESULTADOS: Los resultados obtenidos con el abordaje transconjuntival utilizado para el tratamiento de fracturas del complejo orbitomalar demuestran una alta tasa de éxito (94 %) en relación con las escasas complicaciones (6 %). Usando el test Fisher, las complicaciones estuvieron asociadas a fracturas maxilofaciales complejas por accidentes de alta energía, que traen como consecuencia gran destrucción del complejo orbitario, afectándose frecuentemente el aparato lagrimal, en reintervenciones usando el mismo acceso del abordaje, y en variaciones de la técnica en que se utilizó el abordaje transconjuntival con cantotomía lateral y/o retrocaruncular. CONCLUSIONES: El abordaje transconjuntival es una excelente alternativa en fracturas del complejo orbitomaxilo malar, especialmente para acceder al suelo de la órbita y al reborde infraorbitario, por sus mínimas complicaciones, pronóstico favorable y técnica de baja complejidad


OBJECTIVE: To describe the efficacy of the transconjunctival approach in orbital and orbital floor fractures and the possible complications associated with this approach. MATERIAL AND METHOD: This is a retrospective descriptive study based on 98 patients with orbital fractures where the transconjunctival approach was used in the Maxillofacial Surgery Service of Mutual de Seguridad Hospital, Santiago - Chile, between January 2012 and April 2017. The success rate of this technique and the variables with greater predisposition to generate complications were determined. The inclusion criteria were patients with fractures of the maxillofacial complex with involvement of one or more orbital walls. Fisher's test was used for the data analysis, p - value <0.05 being significant. RESULTS: Results obtained in our study demonstrate a high success rate (94%) in relation to the transconjunctival approach used for orbitozygomatic complex fractures treatments, with few complications observed (6%). Using the Fisher's test, complications were associated with complex maxillofacial fractures due to high energy accidents, which resulted in great destruction of the orbital complex, frequently affecting the lacrimal apparatus, in reinterventions using the same approach access and in variations of the technique in which the transconjunctival approach with lateral cantotomy and / or retrocaruncular extension was used. CONCLUSIONS: The transconjunctival approach is an excellent alternative in orbitozygomatic maxilar complex fractures, especially to access the orbital floor and the infraorbital rim, due to its minimal complications and favorable prognosis


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fraturas Orbitárias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Ortognáticos/métodos , Traumatismos Maxilofaciais/cirurgia , Complicações Pós-Operatórias/epidemiologia
17.
J Craniofac Surg ; 31(4): 1122-1124, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32068723

RESUMO

The use of customized plates in Orthognathic surgery offers precision in the repositioning of the jaws, according to the virtual planning performed, with the great advantage of avoiding the need for intermediate occlusal splints. However, the conventional customization process takes time to manufacture, present high cost and still involve legal issues with insurance companies. Moreover, a technical disadvantage is that the systems available for customized plates require large incisions, with large detachment of soft tissues for insertion of the guides and plates. The objective of this paper is to present the in-house hybrid technique for customization of guides and miniplates in orthognathic surgery using minimally invasive approaches.


Assuntos
Procedimentos Cirúrgicos Ortognáticos , Placas Ósseas , Humanos , Imageamento Tridimensional/métodos , Placas Oclusais , Procedimentos Cirúrgicos Ortognáticos/métodos , Planejamento de Assistência ao Paciente , Cirurgia Assistida por Computador/métodos
18.
Clin Oral Investig ; 24(4): 1509-1516, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32100114

RESUMO

OBJECTIVES: To determine if patient outcome variables differ between conventional and virtual surgical planning of orthognathic surgery for class III asymmetry. MATERIAL AND METHODS: This retrospective case-control study examined 95 patients with class III asymmetry who had been consecutively treated with at least a Le Fort I osteotomy and a bilateral sagittal split osteotomy with a surgery-first approach. Two groups were examined: 51 patients treated with conventional surgical planning and 44 with virtual surgical planning. After treatment, quantitative assessment was determined with measurements of midline symmetry, contour symmetry, and overall facial symmetry using standardized frontal photographs. Subject assessments were analyzed with questionnaires regarding self-perception of overall appearance, satisfaction with appearance, and quality of life. RESULTS: Conventional and virtual surgical planning resulted in significant improvements in outcomes for all patients. However, facial midline and overall facial symmetry were significantly greater for the virtual compared with the conventional group. There were no significant differences in subjective measures of appearance, satisfaction with appearance, and quality of life for patients treated with conventional or virtual surgical planning; measures were high for both groups. CONCLUSIONS: Conventional and virtual surgical planning of surgery-first bimaxillary orthognathic surgery resulted in quantitative and qualitative improvements in facial symmetry. Although patient satisfaction was similar for both approaches, virtual surgical planning was superior to conventional surgical planning for the improvement of midline and overall asymmetry. CLINICAL RELEVANCE: Improvements with virtual surgical planning in facial midline, facial contour, and overall facial symmetry are as good as or better than conventional surgical planning.


Assuntos
Má Oclusão de Angle Classe III/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Adolescente , Adulto , Estudos de Casos e Controles , Cefalometria , Assimetria Facial , Feminino , Humanos , Masculino , Osteotomia de Le Fort , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
Plast Reconstr Surg ; 145(3): 591e-603e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097323

RESUMO

The surgical techniques and execution of primary cleft lip and palate repair are no longer the greatest challenge to achieving successful rehabilitation for those born with facial clefting (i.e., bilateral and unilateral cleft lip and palate). Despite a surgeon's best efforts, when cleft palate repair is carried out during infancy, by the mixed dentition, a majority will demonstrate nasomaxillary deficiency. The cleft team's commitment to a family under their care is to ensure that the newborn reaches adulthood reconstructed without need for special regard to their original birth malformation. Guiding principles are provided for the accurate diagnosis and reliable reconstruction of the bilateral and unilateral cleft lip and palate adolescent/adult who presents with nasomaxillary deficiency and any residual oronasal fistula, bony defects, cleft dental gap(s), nasal obstructions, and associated facial dysmorphology. Successful orthognathic surgery provides a stable foundation on which any remaining soft-tissue cleft lip or cleft nasal deformities can be accurately assessed and then reconstructed.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Doenças Maxilares/cirurgia , Doenças Nasais/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Fenda Labial/complicações , Fissura Palatina/complicações , Feminino , Humanos , Lactente , Masculino , Doenças Maxilares/etiologia , Doenças Nasais/etiologia
20.
Biomed Res Int ; 2020: 3283080, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32083127

RESUMO

Purpose: To compare the effects of counterclockwise rotation (CCR) and clockwise rotation (CR) of the mandible on the pharyngeal airway during mandibular setback surgery. Materials and Methods. Serial cephalograms of 40 patients with mandibular prognathism, including 20 who underwent CCR and 20 who underwent CR, were taken at the following time intervals: preoperatively (T1), immediately postoperatively (T2), >1 year after surgery (T3), final surgical changes (T31), postoperative stability (T32), and immediate surgical change (T21). Changes in menton (Me) and hyoid (H) positions, soft palate width, soft palate length, soft palate angle and craniovertebral angle (C2C4-SN), and pharyngeal airway spaces (nasal pharyngeal airway (NOP), uvula pharyngeal airway (UOP), tongue pharyngeal airway (TOP), and epiglottis pharyngeal airway (EOP)) were evaluated. Results: The mean Me (T31) setback for CCR and CR was 12.56 and 13.06 mm, respectively, with 2.41 mm upward and 3.29 mm downward, respectively. The vertical Me position of CR exhibited significant downward movement compared with that of CCR. The mean H setback results for CCR and CR were 4.42 and 5.75 mm, respectively, with 1.47 mm downward and 2.97 mm downward, respectively. The C4C2-SN angles for CCR and CR increased by 2.68° and 3.65°, respectively, whereas their palatal angles increased by 2.35° and 5.25°, respectively. Pearson's correlation analysis (T31) revealed that for CCR, no pharyngeal airway spaces were significantly correlated with any measured variables. In CR, NOP was significantly correlated (r = 0.58) with the vertical Me position. Significant relapse (T32) was observed after CR in the horizontal (r = 0.58) with the vertical Me position. Significant relapse (T32) was observed after CR in the horizontal (r = 0.58) with the vertical Me position. Significant relapse (T32) was observed after CR in the horizontal (. Conclusion: Pharyngeal airway space narrowed postoperatively, and its patency was appropriately maintained through natural physiological regulation of the craniovertebral angle (C2C4-SN). Significant postoperative relapse was correlated with CR.


Assuntos
Nasofaringe/fisiologia , Nasofaringe/cirurgia , Faringe/fisiologia , Faringe/cirurgia , Adulto , Epiglote/fisiologia , Epiglote/cirurgia , Feminino , Humanos , Osso Hioide/fisiologia , Osso Hioide/cirurgia , Masculino , Mandíbula/fisiologia , Mandíbula/cirurgia , Movimento/fisiologia , Procedimentos Cirúrgicos Ortognáticos/métodos , Palato Mole/fisiologia , Palato Mole/cirurgia , Período Pós-Operatório , Rotação , Língua/fisiologia , Língua/cirurgia , Adulto Jovem
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