Mandible-first sequence in bimaxillary orthognathic surgery: a systematic review.

The sequencing of bimaxillary orthognathic surgery remains controversial, although the traditional maxilla-first approach is performed routinely. The goal of this study was to present a systematic review of the mandible-first sequence in bimaxillary orthognathic surgery, to provide data that may assist in the decision as to which jaw should undergo osteotomy first in bimaxillary orthognathic surgery cases. A literature search was conducted for articles published in the English language, reporting the use of the altered sequence for bimaxillary orthognathic surgery (mandible-first), using the following descriptors: 'orthognathic' and 'double-jaw', 'orthognathic' and 'two-jaw', 'orthognathic' and 'mandible-first', 'orthognathic' and 'bimaxillary'. Eight hundred eighty-seven abstracts were initially identified and were evaluated for inclusion according to the proposed inclusion criteria. After evaluation of these abstracts and relevant references, six publications met the criteria for consideration. Performing mandible-first surgery in bimaxillary orthognathic cases dates back to the 1970s; however the decision regarding the jaw to be operated on first seems to rely on accurate preoperative planning based upon the surgeon's experience and preference. While there appear to be significant theoretical advantages to support the use of the altered orthognathic sequence (mandible-first), future prospective studies on its reliability, accuracy, and short- and long-term outcomes are required.

External humeral condylar fracture in children. A long-term review of 30 cases operated.

Follow-up ranging from 2 to 14 years (mean 6 years) was obtained for 30 fractures of the external humeral condyle in children aged from 2 to 11 years; the patients had been submitted to reduction-osteosynthesis. Twelve patients were at the end of the growth period when followed-up. All of the patients were classified as Lagrange and Rigault grades II and III. Synthesis always involved two or three Kirschner wires bent under the skin. There were 24 perfect results and 6 good ones. Valgus equal to less than 10 degrees was present in 2 cases. Deficit in flexion-extension, present in 4 cases, did not exceed 20 degrees overall. Another case showed "fish-tail" radiographic deformity (due to epiphysiodesis) which did not interfere with function. Despite the potential danger of the lesion, the authors believe that careful surgical treatment provides very satisfactory results.

The letournel lateral approach for treatment of acetabular fractures.

The authors report 9 cases of acetabular fracture, 6 recent complex and 3 inveterate, treated surgically through the lateral incision of Letournel. This approach provides excellent exposure of the acetabulum, the iliac wing, the posterior column, and the anterior column up to the iliopectineal eminence. Nevertheless, the high incidence of often serious complications makes the combined anterior-posterior approach preferable for severe inveterate fractures of the acetabulum.