RESUMO
The aim of this study was to evaluate the spine by video rasterstereography before and after orthognathic surgery. Twenty-nine patients (17 patients with a skeletal class III, 7 patients with a skeletal class II, and 5 patients with mandibular asymmetry) were evaluated preoperatively and 1 year postoperatively. Video rasterstereography is a method of back surface measurement and shape analysis using the moire topography. Orthognathic surgery in cases of class III and asymmetry did not lead to significant changes in body posture. In class II patients it led to some changes in body posture, but without orthopaedic consequences. It is concluded that orthognathic surgery causes minimal or no change in body posture.
Assuntos
Processamento de Imagem Assistida por Computador/métodos , Cifose/complicações , Má Oclusão/complicações , Ortodontia Corretiva , Postura , Coluna Vertebral/anatomia & histologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Má Oclusão/cirurgia , Fotogrametria/métodos , Estudos Prospectivos , Resultado do Tratamento , Gravação em VídeoRESUMO
AIM: The authors present the 1-year results of combined use of arthroscopic lysis and lavage procedure, capsular stretch and holmium:yttrium-aluminium-garnet (Ho:YAG) laser techniques for the treatment of chronic closed lock of the temporomandibular joint. METHODS: Twelve joints were treated in 10 patients (9 females and 1 male) affected by anterior disk displacement without reduction not responsive to conservative treatment. All the patients were studied with preoperative magnetic resonance immaging (MRI). Surgical procedures included lysis and lavage, capsular stretch and Ho:YAG laser techniques with anterior release, posterior scarification and debridment of cartilage surface. The individual outcome was evaluated with the clinical examination, a visual analogue scale (VAS) for pain and a questionnaire concerning mandibular functional impairment. Patients were followed-up for 1 year. RESULTS: One-year results show that 9 patients (success rate 90%) achieved improvement of mandibular function and reduction of pain. The clinical recordings at the 1-year follow-up indicated good outcomes. Nine patients could masticate a regular diet at 1-year follow-up. CONCLUSIONS: These findings seem to justify the use of Ho:YAG laser techniques together with the lysis and lavage procedure and capsular stretch for the treatment of chronic closed lock of the temporomandibular joint. These arthroscopic procedures represent the first choice and an effective approach in the surgical treatment of this condition.
Assuntos
Artroscopia , Terapia a Laser/métodos , Transtornos da Articulação Temporomandibular/cirurgia , Seguimentos , HumanosRESUMO
Computer-aided surgical navigation technology is commonly used in craniomaxillofacial surgery. It offers substantial improvement regarding esthetic and functional aspects in a range of surgical procedures. Based on augmented reality principles, where the real operative site is merged with computer generated graphic information, computer-aided navigation systems were employed, among other procedures, in dental implantology, arthroscopy of the temporomandibular joint, osteotomies, distraction osteogenesis, image guided biopsies and removals of foreign bodies. The decision to perform a procedure with or without computer-aided intraoperative navigation depends on the expected benefit to the procedure as well as on the technical expenditure necessary to achieve that goal. This paper comprises the experience gained in 12 years of research, development and routine clinical application. One hundred and fifty-eight operations with successful application of surgical navigation technology--divided into five groups--are evaluated regarding the criteria "medical benefit" and "technical expenditure" necessary to perform these procedures. Our results indicate that the medical benefit is likely to outweight the expenditure of technology with few exceptions (calvaria transplant, resection of the temporal bone, reconstruction of the orbital floor). Especially in dental implantology, specialized software reduces time and additional costs necessary to plan and perform procedures with computer-aided surgical navigation.
Assuntos
Procedimentos Cirúrgicos Bucais/métodos , Cirurgia Assistida por Computador , Gráficos por Computador , Pesquisa em Odontologia , Humanos , Imageamento Tridimensional , Tecnologia de Alto Custo , Interface Usuário-ComputadorRESUMO
OBJECTIVE: To determine the clinical characteristics of carotid body tumors to define better a standardized proceeding in the management of carotid body tumors. DESIGN: Retrospective survey. Duration of postoperative follow-up was 4 months to 16 years (median, 57 months). SETTING: Institutional, tertiary care medical center. PATIENTS: Consecutive sample of 24 patients (10 men and 14 women) with 28 carotid body tumors treated in the University of Vienna (Austria) General Hospital in 35 years. INTERVENTIONS: Surgical resection, preoperative embolization. MAIN OUTCOME MEASURES: Initial signs, duration of symptoms, extension of the tumors, methods of investigations, and treatment modality, with special respect to the operative technique. RESULTS: Doppler color flow imaging and angiography provided essential mainstays for definite diagnosis. Computed tomography and magnetic resonance imaging contributed additional information about tumor extension. Nineteen patients (79%) underwent surgical resection of 22 tumors, 8 (42%) after preoperative embolization. There were no perioperative deaths. Hemiplegia occurred in 1 patient, and cranial nerve palsy occurred in 5 patients. Tumor recurrence was observed in 3 patients. Five patients refused surgery or tumors were unresectable. CONCLUSIONS: Our standard diagnostic procedure consists of establishing diagnosis by Doppler color flow sonography, angiography for detailing the vascularization of the tumor, and selective embolization to enable safer surgery with less bleeding. Early surgery is recommended to minimize major risks.
Assuntos
Tumor do Corpo Carotídeo/diagnóstico , Tumor do Corpo Carotídeo/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos RetrospectivosRESUMO
A new technique of manufacturing dual-colour stereolithographic models of hard and soft tissues of the temporomandibular joint (TMJ) is presented. Sagittal T1/PD weighted magnetic resonance (MR) images of joints with and without disc displacement were obtained in the closed and open mouth positions. Individual interactive contour identification of bony structures and the articular disc followed by binary interpolation provided the data for the generation of acrylic TMJ models. Three dimensional in vivo visualization of the articular disc in relation to bony structures in the closed and open mouth positions allows a new perception of normal and pathological TMJ anatomy.
Assuntos
Desenho Assistido por Computador , Imageamento por Ressonância Magnética , Modelos Anatômicos , Articulação Temporomandibular/patologia , Resinas Acrílicas , Remodelação Óssea , Humanos , Luxações Articulares/patologia , Côndilo Mandibular/patologia , Amplitude de Movimento Articular , Osso Temporal/patologia , Disco da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/patologiaRESUMO
According to our experience in five patients, the calvarial bone flap pedicled on the temporalis muscle in combination with a galeal-pericranial flap can be recommended for one-stage reconstruction of the anterior skull base following tumor resection. It gives good support to the brain, prevents CSF leakage and ascending infection, and can be used for closure of defects exceeding the midline.
Assuntos
Condrossarcoma/cirurgia , Neoplasias Faciais/cirurgia , Neoplasias Nasais/cirurgia , Neoplasias Cranianas/cirurgia , Retalhos Cirúrgicos/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Acute mandibular dislocations caused by extrapyramidal syndromes under neuroleptic therapy have often been reported in the literature. However, the success of surgical therapy for recurrent mandibular dislocation in patients under long-term neuroleptic therapy has been discussed controversially. In our opinion, modifications in drug therapy--including the administration of so-called atypical neuroleptics--should be considered before advocating surgery. If the revised therapeutic approach proves to be unsuccessful because of psychotic relapse or persistence of extrapyramidal symptoms, good operative results may be achieved by bilateral eminectomy as reported on three psychiatric patients in this paper. In order to avoid postoperative subluxation and internal derangement due to increased muscular tension under chronic neuroleptic therapy, as much bone as possible should be removed when performing eminectomy.
Assuntos
Antipsicóticos/efeitos adversos , Doenças dos Gânglios da Base/induzido quimicamente , Luxações Articulares/etiologia , Doenças Mandibulares/etiologia , Osso Temporal/cirurgia , Transtornos da Articulação Temporomandibular/etiologia , Adulto , Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Doenças dos Gânglios da Base/complicações , Discinesia Induzida por Medicamentos/etiologia , Distonia/induzido quimicamente , Feminino , Humanos , Luxações Articulares/cirurgia , Instabilidade Articular/complicações , Masculino , Doenças Mandibulares/cirurgia , Contração Muscular , Osteotomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/fisiopatologia , Recidiva , Transtornos da Articulação Temporomandibular/cirurgiaRESUMO
High-precision anatomical facsimile models of the patients' skulls, individually produced by colour stereolithography, were used in the preoperative planning for seven patients with complex maxillofacial tumours. Selectively coloured models facilitated the management of ablative surgery and reconstructive procedures as well. The indicators for preoperative colour stereolithographic model planning concerning maxillofacial tumour surgery are discussed.
Assuntos
Neoplasias Faciais/cirurgia , Neoplasias Maxilomandibulares/cirurgia , Modelos Anatômicos , Procedimentos Cirúrgicos Bucais/métodos , Planejamento de Assistência ao Paciente , Cor , HumanosRESUMO
Fourteen patients underwent eminectomy for recurrent mandibular dislocation. The clinical follow-up period ranged from 7 months to 5 years. The function of the temporomandibular joint before and after eminectomy was analysed clinically and by computer-aided axiography. There was no significant decrease in the condylar path angle postoperatively, though the articular eminence had been removed up to its most medial portion. Translatory border movements showed significant limitation six months after surgery and normal range of motion in the first and second year after the operation. Postoperative hypermobility of the condyle was not observed.
Assuntos
Luxações Articulares/cirurgia , Instabilidade Articular/cirurgia , Mandíbula/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Registro da Relação Maxilomandibular , Masculino , Mandíbula/fisiopatologia , Côndilo Mandibular/fisiopatologia , Pessoa de Meia-Idade , Cirurgia Bucal/métodos , Resultado do TratamentoRESUMO
Resection of the mandibular condyle inevitably leads to functional impairment even in cases of reconstruction with prosthesis or autogenous bone graft. Loss of function is caused by the loss of action of the lateral pterygoid muscle. Therefore, preservation and fixation of this muscle to a transplant should be performed whenever possible. A case of osteoblastoma of the condylar head and neck with functional reconstruction after ablative surgery is presented.
Assuntos
Transplante Ósseo/métodos , Côndilo Mandibular/cirurgia , Neoplasias Mandibulares/cirurgia , Osteoblastoma/cirurgia , Adulto , Cartilagem/transplante , Eletromiografia , Humanos , Registro da Relação Maxilomandibular , Masculino , Côndilo Mandibular/fisiopatologia , Contração Muscular , Osteotomia/métodos , Músculos Pterigoides/fisiopatologia , Músculos Pterigoides/cirurgiaRESUMO
Controversies still exist about the preferred treatment of condylar head and neck fractures. Newly developed access techniques in combination with new methods to fix the fragments, lead to satisfactory results. This study deals with a refinement of surgical treatment of intracapsular fractures.
Assuntos
Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Articulação Temporomandibular/lesões , Adolescente , Adulto , Parafusos Ósseos , Fixação Interna de Fraturas , Humanos , Registro da Relação Maxilomandibular , Cápsula Articular/lesões , Cápsula Articular/cirurgia , Côndilo Mandibular/cirurgia , Radiografia Panorâmica , Amplitude de Movimento Articular , Articulação Temporomandibular/cirurgiaRESUMO
The use of a modified myocutaneous platysma flap is presented for a patient with a large ameloblastoma of the mandible. The possible advantages and limitations of the technique are discussed.
Assuntos
Mandíbula/cirurgia , Músculos do Pescoço/transplante , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Adulto , Ameloblastoma/cirurgia , Humanos , Masculino , Neoplasias Mandibulares/cirurgia , Técnicas de SuturaRESUMO
Although cartilaginous exostosis is considered to be the most common tumor of the skeleton, it is relatively uncommon in the jaws. The pathogenesis of the lesion is unclear. Three cases are presented and the development of the tumors from embryonic cartilage is discussed.
Assuntos
Neoplasias Mandibulares/patologia , Osteocondroma/patologia , Adolescente , Adulto , Idoso , Cartilagem/embriologia , Cartilagem/patologia , Seguimentos , Humanos , Hialina , Masculino , Ossificação Heterotópica/patologia , Osteocondroma/embriologiaRESUMO
Nine patients with recurrent mandibular dislocation, who underwent the blocking procedure of Leclerc and Girard, as modified by Gosserez and Dautrey, are presented. The follow-up period range from 2.5 to 5 years. An axiographic study revealed significant postoperative limitation of translation of the condyle when opening, while maximal mouth opening as measured between the incisors, as well as translation of the condyle in protrusion and mediotrusion, showed no significant limitation. Long-term evaluation showed a high incidence of clicking and pain, not evident prior to surgery. The causes for recurrence in three cases were analysed.
Assuntos
Luxações Articulares/cirurgia , Instabilidade Articular/cirurgia , Côndilo Mandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/cirurgia , Articulação Temporomandibular/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Registro da Relação Maxilomandibular , Masculino , Mandíbula/fisiopatologia , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Recidiva , Procedimentos Cirúrgicos Operatórios/métodos , Falha de Tratamento , Zigoma/cirurgiaRESUMO
A patient is presented with posterior ischemic optic neuropathy (PION) after bilateral radical neck dissection, probably caused by hemodynamic hypotension, combined with other factors. A postmortem histologic study of the optic nerve was performed to analyze the pathogenic mechanism of blindness. To prevent this complication, one should favor a two-stage procedure, avoiding drug-induced hypotension, overtransfusion, and anemia. During the postoperative period, visual acuity should be monitored regularly, and proper positioning of the patient's head is necessary.
Assuntos
Esvaziamento Cervical/efeitos adversos , Neuropatia Óptica Isquêmica/etiologia , Anemia/complicações , Axônios/patologia , Cegueira/etiologia , Carcinoma de Células Escamosas/cirurgia , Terapia Combinada , Evolução Fatal , Humanos , Hipotensão/complicações , Hipotensão/prevenção & controle , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/cirurgia , Nervo Óptico/patologia , Neuropatia Óptica Isquêmica/patologia , Cuidados Pós-Operatórios , Reação Transfusional , Acuidade VisualRESUMO
OBJECTIVE: In a retrospective study, we reviewed a series of 55 consecutive patients with 57 fractures of the condylar neck that were treated with transoral miniplate osteosynthesis. STUDY DESIGN: Forty-one patients were included in a clinical follow-up study; the median length of study was 26.5 months (minimum, 7 months; maximum, 79 months). In a radiographic study, the positions of the condyle before open reduction, after open reduction, and more than 6 months postoperatively were evaluated in 3 radiographic planes. A statistical analysis was performed to determine factors that lead to secondary instability of the reduced condyle and to correlate the actual position of the condyle with clinical parameters collected in follow-up examinations. RESULTS: At the time of the follow-up examination, the median measurement of the mandibular openings was 48.3 +/- 8.0 mm (minimum, 32 mm; maximum, 66 mm). A deviation of 2 mm to the operated side when opening was observed in 7 patients. The median range of laterotrusion was 10.0 mm to the fracture side and 9. 0 mm to the opposite side. In 7 patients, radiographic follow-up more than 6 months postoperatively revealed a medial tilt of the proximal fragment of 15 to 40 degrees despite a good immediate postoperative position of the condyle. This may be attributed to bone resorption in the fracture gap, together with a bending instability observed when titanium miniplates with a thickness of 0. 9 mm were used. The position of the condyle at the follow-up examination did not correlate with clinical parameters. CONCLUSIONS: Transoral approach miniplate osteosynthesis of dislocated condylar neck fractures is indicated when visible scars in the head and neck region, which are encountered with other fixation techniques, must be avoided.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Cicatriz/prevenção & controle , Falha de Equipamento , Feminino , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Fraturas Mal-Unidas/etiologia , Humanos , Registro da Relação Maxilomandibular , Modelos Lineares , Masculino , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/diagnóstico por imagem , Pessoa de Meia-Idade , Parestesia/etiologia , Radiografia , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Estatísticas não ParamétricasRESUMO
OBJECTIVE: Dental magnetic resonance imaging (dMRI) with administration of contrast material is one method of assessing pulpal perfusion. The purpose of this study was to evaluate the level of contrast enhancement displayed by means of dMRI after transplantation of teeth and to compare these findings with the results of tooth mobility, pocket depth, cold, and electrical tests. STUDY DESIGN: Twenty-three teeth with either complete root formation or incomplete root formation (IRF) were investigated by using dMRI and were clinically examined at intervals of 2, 4, 8, and 12 weeks, as well as 6 months and 12 months after transplantation. RESULTS: An analysis of the enhancement in the dental images revealed a significant difference between teeth with IRF and teeth with complete root formation. In addition, the time to occurrence of a positive reaction to the cold test was significantly longer for teeth with IRF. CONCLUSIONS: The findings of this study indicate that transplanted IRF teeth are associated with reperfusion seen by means of dMRI as well as with delayed occurrence of a positive cold test.
Assuntos
Imageamento por Ressonância Magnética/métodos , Reperfusão , Dente/transplante , Adolescente , Adulto , Temperatura Baixa , Meios de Contraste , Polpa Dentária/irrigação sanguínea , Polpa Dentária/fisiologia , Teste da Polpa Dentária , Eletrodiagnóstico , Feminino , Seguimentos , Humanos , Masculino , Odontogênese/fisiologia , Periodontite Periapical/cirurgia , Bolsa Periodontal/classificação , Estatísticas não Paramétricas , Mobilidade Dentária/classificação , Raiz Dentária/fisiologia , Dente não Erupcionado , Transplante AutólogoRESUMO
PURPOSE: This preliminary clinical study evaluated the applicability, accuracy, and benefits of computer-assisted arthroscopy of the temporomandibular joint (TMJ) with optoelectronic tracking technology. MATERIALS AND METHODS: A hybrid of reality and virtual reality is built as a composite-reality environment by extracting 3-dimensional anatomical structures through use of computed tomography, magnetic resonance imaging, radiography, and other types of imaging procedures commonly used in clinical praxis. These various independent sources of imaging data of a particular patient can be combined with and complemented by complex graphic simulations. Intraoperatively they are merged with online position data of surgical instruments inside the patient's TMJ. This hybrid model of detailed anatomical structures, guidelines, and real-time instrument positions allows the surgeon to accurately plan the arthroscopic intervention as well as to navigate effectively intraoperatively. RESULTS: In the first 10 cases of computer-assisted TMJ arthroscopy, composite reality environment technology permitted the online visualization of TMJ structures, puncture sites, instrument positions, and virtual pathways in relation to anatomical landmarks with high spatial accuracy (minimum, 0.0 mm; maximum, 2.5 mm; mean, 1.4 mm; SD, 0.6 mm) and high temporal resolution (100 ms). Past, present, and possible future instrument positions can be displayed. The application of computer-assisted arthroscopy caused little immobility for either surgeon or patient. CONCLUSION: Even experienced surgeons profit from improved precision in the handling of the arthroscope; thus this technology was found to be particularly useful in degenerative temporomandibular disorders and for triangulation procedures.
Assuntos
Artroscopia , Eletrônica Médica/instrumentação , Óptica e Fotônica/instrumentação , Articulação Temporomandibular/cirurgia , Terapia Assistida por Computador , Artroscópios , Calibragem , Gráficos por Computador , Simulação por Computador , Humanos , Aumento da Imagem , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Cuidados Intraoperatórios , Imageamento por Ressonância Magnética , Sistemas On-Line , Planejamento de Assistência ao Paciente , Punções , Terapia Assistida por Computador/instrumentação , Tomografia Computadorizada por Raios X , Interface Usuário-Computador , Gravação em VídeoRESUMO
Carotid body tumors are rare neoplasms arising from the small chemoreceptor organ in the adventitia of the common carotid bifurcation. Patients with carotid body tumours usually present with a gradually enlarging non-tender anterolateral neck mass. Differential diagnosis includes metastatic lymph nodes, carotid artery aneurysm, salivary gland tumour, branchial cleft cyst, and neurogenic or thyroid tumours. When such a lesion is suspected, a non-invasive Doppler colour flow ultrasonography enables the clinician to arrive at a definite diagnosis. Subsequent arteriography is mandatory, because the finding of an intensely blushing hypervascular mass spreading into the carotid bifurcation further supports the diagnosis and provides accurate preoperative information concerning arterial blood supply. Computed tomography scanning is appropriate to delineate the relation of the tumour to adherent structures, while magnetic resonance tomography demonstrates the relation of the tumour to the adjacent internal jugular vein and the carotid artery. Selective embolization should be performed for safe surgical removal with less bleeding. Early surgery is the treatment of choice and is recommended in order to minimize major risks. Subadventitial resection is the most established technique. Radical resection prevents local recurrence and has the best long-term results. Removal of the internal or common carotid arteries can become mandatory in selected cases of extensive disease. Surgical treatment by an experienced team is associated with considerably low mortality and morbidity.
Assuntos
Tumor do Corpo Carotídeo , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Angiografia Digital , Tumor do Corpo Carotídeo/diagnóstico , Tumor do Corpo Carotídeo/cirurgia , Diagnóstico Diferencial , Embolização Terapêutica , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Prognóstico , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em CoresRESUMO
BACKGROUND: Osteosynthesis failure rates of 11.3% with 1 miniplate, 6.7% with 2 miniplates, and 4.4% with a single Medartis condyle plate were reported in previous studies of our clinic. Current science is still focused on the osteosynthesis material. Besides clinical parameters, conventional radiographs are still the first choice to detect osteosynthesis failures. This study scrutinized several factors assessable in postoperative orthopantomographs which might elevate the risk of osteosynthesis failure. STUDY DESIGN: A total of 136 patients (22 with osteosynthesis failure, 114 without) with 151 mandibular condyle fractures were included in this study. Eight parameters were assessed in postoperative orthopantomographs. RESULTS: The best predictor of osteosynthesis failure was a simplified concept of ramus height. In cases of reduced or normal ramus height, the odds of osteosynthesis failure was significantly (P = .000001) reduced to a 10th. Isolated fractures were significantly more error prone (P = .0009). CONCLUSIONS: Postoperative orthopantomographs depict factors which increase the risk of osteosynthesis failure.