Frontal cranial modeling using endocranial resorbable plate fixation in 27 consecutive plagiocephaly and trigonocephaly patients.

INTRODUCTION: Premature ossification of coronal and metopic sutures is treated by fronto-orbital remodeling. Such operations require stable fixation of the reshaped cranial bones. Currently, biodegradable plating systems are used to provide sufficient stability over the time that takes for the osteotomies to ossify. Plates that are placed traditionally on the outer surface of the cranium are often palpable and even visible through the thin overlying skin, compromising the cosmetic results of these operations. Improved aesthetics could be achieved by placing the plates endocranially. PURPOSE: This study aimed to evaluate endocranial resorbable plate fixation and its clinical and radiographic results in frontal remodeling cranioplasty for plagiocephaly and trigonocephaly patients with follow-up sufficiently long for the plates to have been completely resorbed. METHODS: A poly(lactide-co-glycolide) (PLGA) resorbable plating system was used on the inner aspect of frontal bone in 27 patients treated for coronal and metopic craniosynostoses. The outcome was evaluated at follow-up visits. The mean follow-up was 79.2 months. RESULTS: Three patients had complications that required reoperations. None of these complications were related to the endocranial location of the plates. There were no problems with ossification of the osteotomy sites. All but one patient's outcome was judged as good or excellent. CONCLUSION: Placement of resorbable fixation on the endocranial surface of the calvarial bones is safe, stable, and results in satisfactory aesthetics without interfering with the ossification of the cranial bones.

Short-term postoperative changes in temporomandibular joints and masticatory muscles of Angle class II patients after mandibular advancement surgery: Clinical findings.

BACKGROUND AND OBJECTIVE: The aim of the study was to detect postoperative changes in the temporomandibular joints (TMJs) and masticatory muscles of Angle class II malocclusion patients who underwent mandibular advancement surgery. MATERIAL AND METHODS: Twenty-three patients were selected for mandibular advancement by bilateral sagittal split ramus osteotomy (BSSO). Cephalograms and clinical evaluation were performed before the surgery as well as fourteen days and six months after surgery. Clinical examination included measurement of overjet, overbite and of the amplitude of mandibular movements, registration of deviation on mouth opening, of TMJ pain and pathological sounds and of tenderness of masticatory muscles on palpation. Mandibular position was determined by cephalometric analysis. Statistical analyses were performed using a mixed-level longitudinal random intercept model with a confidence level of 95% and a P-value of 0.05 to reveal significant differences. RESULTS: Statistical results showed a mean mandibular advancement of 4 mm (3.1-5.0). Cephalometric measurements, overjet and overbite remained stable six months after surgery. Postoperative amplitude of mandibular movements was limited and did not completely recover 6 months later. Mouth opening was the most affected, showing an average reduction of 7.5 mm six months after surgery. Deviation on mouth opening, pathological TMJ sounds, TMJ pain and masticatory muscle tenderness did not show significant changes. CONCLUSIONS: Moderate mandibular advancement surgery offers stable results, yet the amplitudes of mandibular movements, were significant smaller after surgery and did not completely recovered 6 months following surgery. TMJ and masticatory muscles symptoms did not change after the surgery, suggesting that mandibular advancement surgery does not change the course of TMD.