Showing papers in "Journal of Cranio-maxillofacial Surgery in 1997"
TL;DR: Detailed knowledge about location, morphology and height of antral septa is clinically relevant to reduce the rate of complications when maxillary sinus surgery, i.e. sinus floor elevation, is carried out.
Abstract: This study was carried out to examine the incidence, morphology and clinical implication of antral septa. Out of 265 maxillary sinuses, 65 sinuses in atrophic maxillae were examined clinically during sinus floor elevation and 200 sinuses examined radiographically (CT), the latter being further subdivided into non-atrophic/dentate and atrophic/edentulous maxillary segments. Eighteen (27.7%) out of 65 clinically-examined maxillae and 32 (16%) out of the 200 non-preselected CT-examined maxillary sinuses showed antral septa. CT-topogram subclassification revealed 21 septa (13.2%) in 159 non-atrophic and 11 septa (26.8%) in 41 atrophic maxillary segments (P < 0.01). Morphologically, CT examination yielded one complete septum (0.5%), 21 incomplete septa on the sinus floor and 10 incomplete septa on the anterior antral wall (5%). CT revealed a significantly greater dimension of antral septa in non-atrophic maxillary segments than in atrophic ones (P < 0.01). In atrophic maxillary sinuses, the incidence (27.7% vs 26.8%), morphology (all septa located on sinus floor) and height (8.1 +/- 2.5 mm vs 6.8 +/- 1.6 mm) did not differ between the clinical and the CT examinations. Detailed knowledge about location, morphology and height of antral septa is clinically relevant to reduce the rate of complications when maxillary sinus surgery, i.e. sinus floor elevation, is carried out.
142 citations
TL;DR: In a prospective randomized study, 31 consecutive patients were treated with 2.0 mm (mini) plates and no significant differences in postoperative short- or long-term complications were found between the two groups.
Abstract: Standard treatment of mandibular angle fractures with miniplates, according to the recommendations of Champy et al. (1976), consists of fixation with one plate at the superior border of the mandible ventral to the external oblique line. In certain constellations, a second miniplate at the lower mandibular margin may provide additional stability. In contrast, extremely high complication rates following two-plate fixation of mandibular angle fractures were reported by Ellis and Walker (1994). In a prospective randomized study, 31 consecutive patients were treated with 2.0 mm (mini) plates (Synthes Co., Switzerland). One group was treated with one plate, the other one with two plates. In none of the patients was intermaxillary immobilization used. Follow-up was performed 6 months postoperatively, consisting of clinical and radiographic examination. No significant differences (P = 0.74 for infection, and P = 1.0 for occlusal and postoperative sensory disturbance) in postoperative short- or long-term complications were found between the two groups. The results are compared with our experimental investigations presented at the annual congress of the Germany Society of Oral and Maxillofacial Surgery, 1995. Two-plate fixation may not offer advantages over single-plate fixation in general. However, individual fracture constellations may benefit from variation in plate(s) localization. Factors contributing to complications in mandibular angle fractures are discussed.
133 citations
TL;DR: Augmented reality technology was used in 5 patients for secondary reconstruction of post-traumatic unilateral deformities of the zygomaticomaxillary complex and the results have been satisfactory in all 5 patients.
Abstract: Augmented reality technology was used in 5 patients for secondary reconstruction of post-traumatic unilateral deformities of the zygomaticomaxillary complex. Three electromagnetic sensors interfaced to a computer-aided navigation system (ARTMA Biomedical Inc.) were utilized. The computer navigation procedure was planned by drawing graphic lines on the CT scan at the level of the zygomatic arch, representing the outer surface of the zygoma. The desired position of the displaced zygoma was planned by mirroring from the healthy side, using a virtual mid-sagittal plane. These virtual graphics were presented intraoperatively on a TV monitor and also on the surgeon's see-through head-mounted display. Correct reduction was assumed when the virtual line representing the position of the zygoma before the osteotomy reached the virtual line defined preoperatively as the desired position. The advantages of the technique presented are that a complete exposure of the zygomatic bone is no longer necessary, and coronal and subciliary incisions may be avoided unless enophthalmos correction has to be carried out, which was in fact necessary in 2 patients. The results of zygomatic reconstruction have been satisfactory in all 5 patients.
107 citations
TL;DR: A case in which a mandibular segmental defect, about 60 mm in length, was reconstructed by distraction osteogenesis, in a 45-year-old man who had been treated for an oral floor cancer.
Abstract: Distraction osteogenesis in the mandible is a promising method, not only for correction of mandibular hypoplasia such as hemifacial microsomia, but also for reconstruction of segmental bone defects in the mandible. The authors report a case in which a mandibular segmental defect, about 60 mm in length, was reconstructed by distraction osteogenesis. The patient was a 45-year-old man who had been treated for an oral floor cancer. After preoperative chemotherapy and irradiation therapy, the mandible had been resected from the second incisor on the right side to the first molar on the left side, and had been reconstructed with a titanium plate and a vascularized rectus-abdominis compound flap. However, an infection developed around the titanium plate and this plate had to be removed. Therefore, trifocal distraction using an original three-dimensional distractor was performed, at the rate of 1 mm per day (0.5 mm in the morning and 0.5 mm in the evening). During the distraction period, the skin flap was pushed out from the bone defect. Although small free bone transplants were needed for complete continuity, the segmental bone defect was almost filled by the regenerated bone with the lengthened gingiva. Radiographic observation showed successful new bone formation in the lengthened area.
103 citations
TL;DR: The results demonstrate that treatment with a 'Latham device' disturbs facial growth and should be abandoned, and the primary gingivoperiosteoplasty by Millard is abandoned.
Abstract: The primary gingivoperiosteoplasty by Millard consists of presurgical active orthognathic treatment ('Latham device') of the alveolar margins at the age of 3 months and of surgical closure of the alveolar cleft with local gingivoperiosteal flaps at the age of 5 months. The aim of this investigation was to analyse the facial growth following this treatment. The following material was studied: lateral head X-rays and plaster casts from 146 patients with unilateral (UCLP) and bilateral (BCLP) clefts of lip and palate from birth to 16 years of age. Ninety-one of these patients formed the control group, who received neither gingivoperiosteoplasty nor pre-surgical active orthognathic treatment. The same surgeon and orthodontist treated all 146 patients. A three-dimensional growth disturbance after gingivoperiosteoplasty was observed: 42% patients with UCLP and 40% patients with BCLP had an 'open bite' following closure of the alveolar cleft (control group 5%/10%). The length of the upper jaw in patients who underwent gingivoperiosteoplasty was shorter than in the control group. The frequency of posterior cross bite was also higher in the gingivoperiosteoplasty group. These results demonstrate that treatment with a 'Latham device' disturbs facial growth. Therefore, this treatment should be abandoned.
87 citations
TL;DR: Very satisfactory results were obtained during a follow-up period ranging from 2 to 6 years, regarding the restoration of joint function, improvement in aesthetic appearance and relief of respiratory obstruction.
Abstract: Longstanding unilateral temporomandibular joint ankylosis, which starts during the active growth period in early childhood, results in facial asymmetry. Three problems are encountered: the ankylosed joint; the asymmetric face and, occasionally, upper airway obstruction. Simultaneous surgery was performed on 27 patients to release the joint ankylosis and to correct the facial deformity. Bimaxillary surgery was done for adult patients with occlusal canting, and mandibular surgery alone for adult patients without occlusal canting and for young children. Very satisfactory results were obtained during a follow-up period ranging from 2 to 6 years, regarding the restoration of joint function, improvement in aesthetic appearance and relief of respiratory obstruction.
77 citations
TL;DR: Lengthening of the mandible by gradual intraoral distraction was obtained in nine young patients with hemifacial microsomia, one patients had a ramus hypoplasia after TMJ ankylosis and one patient had the Treacher-Collins syndrome.
Abstract: The authors report a new technique for mandibular distraction. Lengthening of the mandible by gradual intraoral distraction was obtained in nine young patients. An intraoral device was used in order to avoid external scars. Seven patients had hemifacial microsomia, one patient had a ramus hypoplasia after TMJ ankylosis and one patient had the Treacher-Collins syndrome. The amount of mandibular lengthening ranged from 12 to 28 mm depending on the duration of expansion. Retention after expansion, to allow ossification to take place, lasted for 3 weeks on average. The follow-up period ranged from a minimum of 5 months to a maximum of 44 months.
77 citations
TL;DR: A biodegradable sheet is used for bridging of the bony defects in patients with extensive fractures of the orbital floor and appears to be superior to conventional methods because it offers reproducible results without the need for secondary interventions.
Abstract: In a series of five patients with extensive fractures of the orbital floor, we used a biodegradable sheet for bridging of the bony defects. To achieve optimal support of the orbital contents in their anatomically correct position, we fixed the sheet with at least two resorbable screws to the infraorbital rim. This new technique appears to be superior to conventional methods because it offers reproducible results without the need for secondary interventions.
75 citations
TL;DR: Treating coronoid process hyperplasia by intraoral coronoidotomy, when combined with prolonged postoperative physiotherapy, gives satisfactory and stable long-term results in the correction of coronoid-malar interference.
Abstract: Summary The aim of this study was to evaluate long-term results of treatment by intraoral coronoidotomy and prolonged physiotherapy in five patients with mandibular coronoid process hyperplasia. Five consecutive cases of coronoid process hyperplasia were studied (two unilateral and three bilateral) at the Department of Maxillo-Facial Surgery of the University of Turin during the period 1985–1990. All patients were treated by intraoral coronoidotomy and given physiotherapy from the third postoperative day. This continued for an entire year. A clinical and radiological follow-up (average 39.4 months), in three cases over a 5-year period, was completed. Three months after the operation, all patients had achieved satisfactory improvement in mandibular interincisal opening. The mean value for mouth opening at the end of follow-up was 42 mm. Radiographic follow-up showed the presence of a coronoid process almost the size of the original, apparently united with the mandibular ascending ramus, with moderate dislocation and inclination posterior to the body of the zygomatic bone. The results of this study indicate that treatment of coronoid process hyperplasia by intraoral coronoidotomy, when combined with prolonged postoperative physiotherapy, gives satisfactory and stable long-term results in the correction of coronoid-malar interference.
73 citations
TL;DR: Results seem to indicate that Ki67 immunostaining can be useful in the evaluation of the biological behaviour of these tumours, as well as the presence of a high proliferative index of aneuploid cells and the Presence of distant metastases.
Abstract: Nine cases of salivary duct carcinoma were reviewed clinically, histologically and immunohistochemically, with special evaluation of biomarkers with prognostic significance (p53, Ki67, c-erbB-2 and DNA content). Eight tumours occurred in the parotid gland and one in the submandibular gland. The average age of the patients (8 males and 1 female) was 62.8 years (range = 47-74 years). Tumour size ranged from 1 to 6 cm (mean = 3.46 cm). Recurrences were found in 33.3% (3 patients), regional metastases in 44.4% (4 patients) and systemic metastases in 33.3% (3 patients). Three patients died of their disease (median survival = 12.3 months), one is alive with the disease (follow-up of 222 months) and 5 are alive without evidence of disease (mean follow-up of 75 months). p53 protein nuclear immunostaining was positive in 66.6% and c-erbB-2 overexpression was observed in 100% of the tumours. Ki 67 positivity ranged from 6.75% to 47.5% of tumour cells (mean = 21.3%). DNA aneuploidy was found in 4 tumours (44.4%) and DNA diploidy in 5 (55.5%). Our results seem to indicate that Ki67 immunostaining can be useful in the evaluation of the biological behaviour of these tumours, as well as the presence of a high proliferative index of aneuploid cells and the presence of distant metastases.
59 citations
TL;DR: A new standard to detect separately the inherent deviations of navigation systems from the deviations caused by acquisition of CT data sets, is introduced in order to prevent intraoperative failure caused by insufficient potentiometers, infrared transmitters or receivers.
Abstract: This investigation detects the inherent precision of four navigation systems, of different structural type, for computer-assisted surgery, ranging from 0.1 to 1.8 mm: the Viewing Wand with a mechanical arm, and three new systems, the SMN microscope and STP pointer with infrared technology and the MKM system with laser autofocus. For this purpose, a new standard to detect separately the inherent deviations of navigation systems from the deviations caused by acquisition of CT data sets, is introduced. The measurements are performed within a complete three-dimensional room, consisting of three orthogonal planes of a geometric model. The method introduced is valid for regular measurements of the inherent precision of navigation systems for quality assurance in order to prevent intraoperative failure caused by insufficient potentiometers, infrared transmitters or receivers.
TL;DR: 6 selected cases of extensive facial vascular anomalies extending to the skull base or actually involving it are presented and variable treatment modalities are suggested depending on the age of the patient and the type of lesion.
Abstract: We present 6 selected cases of extensive facial vascular anomalies extending to the skull base or actually involving it. These patients are compared with other cases in the literature. The spontaneous course of these vascular lesions is different and so variable treatment modalities are suggested depending on the age of the patient and the type of lesion. In young children, haemangiomas are common and spontaneous involution is characteristic. Conservative treatment in the sense of a wait-and-see approach is thereby favoured if there is no urgent indication such as involvement of essential structures, e.g. blockage of an orifice as demonstrated in one case or complications such as excessive bleeding. Vascular malformations most commonly appear in adults, there is no tendency to spontaneous involution and resection is usually necessary, especially in arteriovenous malformations. Nowadays, preoperative superselective embolization is recommended to minimize intraoperative blood loss. Superselective embolization is the treatment of choice in cases of a-v fistulae. Proximal ligation of the supplying arteries should be avoided because this may make embolization more difficult, and may be responsible for the common occurrence of rapid revascularization.
TL;DR: The results of this investigation suggest that, at this time, the use of SR-PLLA screws for lag screw fixation should be restricted to low stress bearing areas.
Abstract: The torsion axial-force characteristics of biodegradable screws are central to their ability to generate interfragmentary compression when used as lag screws. The purpose of this investigation was to compare the torsion-axial force characteristics of prototype self-reinforced poly-L-lactide (SR-PLLA) screws with conventional titanium screws. Axial forces developed by incremental increases in the torque applied to the individual screws were measured in a test apparatus incorporating an Instron machine. For the SR-PLLA screws, the relationship between applied torque and axial force development was non-linear with a marked relaxation throughout the test range. The axial forces reached a maximum with increasing torque, after which failure of the screws occurred. The response curve for titanium screws of the same length demonstrated a steeper slope. No failures or force relaxation were observed with the titanium screws. The results of this investigation suggest that, at this time, the use of SR-PLLA screws for lag screw fixation should be restricted to low stress bearing areas.
TL;DR: Over a period of 3 years, 18 patients with mandibular osteomyelitis were prospectively investigated by conventional radiograph, computed tomography (CT) and in 6 cases by magnetic resonance imaging (MRI).
Abstract: Over a period of 3 years, 18 patients with mandibular osteomyelitis were prospectively investigated by conventional radiograph, computed tomography (CT) and in 6 cases by magnetic resonance imaging (MRI). The diagnosis was based on histology in 17 patients operated upon.
TL;DR: Two studies (1981-1990 retrospective, and 1989-1993 prospective) were performed to determine the optimal methods in preprosthetic surgery and keratinized grafts (split-thickness skin and palatal) showed advantages.
Abstract: Two studies (1981-1990 retrospective, and 1989-1993 prospective) were performed to determine the optimal methods in preprosthetic surgery. The first study deals with four different types of grafts (split-thickness skin, mucosal, mesh mucosal, palatal) in combination with vestibuloplasties and lowering of the floor of the mouth. The parameters, vestibular depth, mobility and resilience of the transplants were examined. Keratinized grafts (split-thickness skin and palatal) showed advantages. On the basis of a high rate of complications at the site of harvesting of palatal mucosa and the limited amount of palatal mucosa available for grafting, we prefer a split-thickness skin graft. A second prospective study to compare the Edlan- and Kazanjian-plasty showed the disadvantages of both methods. The Edlan-plasty, in combination with implants, showed a small amount of bone resorption; the Kazanjian-plasty showed a significant loss of attached mucosa. Both methods were therefore abandoned in our clinic. For cases with insufficient width of attached mucosa, we recommend a vestibuloplasty secondarily, with keratinized grafts. If there is a deep palatal vault and the need for a large amount of graft material, a split-thickness skin graft should be harvested. In cases of limited need and flat palatal vault, the graft can be harvested from the palate.
TL;DR: From investigations, CEE/CME are promising treatment modalities which can reduce pain and speed up the healing process in burn patients and cultured epithelium banks are worth establishing for auto- and allografting of skin/mucosal defects.
Abstract: Cultured epithelium has proven to be a good grafting material for skin defects In our experience two kinds of epithelial cells, skin keratinocytes and mucosal cells, have been used to fabricate cultured epithelial sheets and autografted to the patients Traumatic scars of the face were treated by cultured epidermal epithelium (CEE) The skin graft in the oral cavity was replaced by mucosa using cultured mucosal epithelium (CME) Also, the CME was applied to the skin defects at the donor sites of split-thickness skin grafts Postsurgical follow-up showed good results As a result, CME was useful in improving the biological environment around the abutments of dental implants, and it also promoted the re-epithelialization of skin defects From our investigations, CEE/CME are promising treatment modalities which can reduce pain and speed up the healing process in burn patients Therefore, cultured epithelium banks are worth establishing for auto- and allografting of skin/mucosal defects
TL;DR: The treatment protocol for reconstruction and rehabilitation of a typical case of devastating gunshot injury to the lower face is described and a staged sequence of surgical treatment based on an 8-year experience gained in treating war casualties during the Iraq-Iran war is proposed.
Abstract: War injuries can range from the most minor to the devastating and life-threatening. Multidisciplinary care is required for successful management of survivors. In the acute phase, care may involve emergency surgeons, anaesthetists, neurosurgeons, ophthalmic surgeons, vascular surgeons and ENT specialists in addition to the oral and maxillofacial surgeon. Afterwards, definitive treatment of facial hard and soft tissue gunshot injuries depends ultimately on the abilities and skills of the oral and maxillofacial surgeon and his appreciation of such injuries. The timing and sequence of the surgical procedures used for reconstruction and rehabilitation of maxillofacial gunshot injuries are crucial to a successful outcome and aesthetic result. If incorrect, they may lead indefinitely to infection, graft rejection, wound dehiscence with consequent multiple revisional operations and complications which will prolong hospital stay, and increase treatment costs and morbidity in these patients. In this article, we describe the treatment protocol for reconstruction and rehabilitation of a typical case of devastating gunshot injury to the lower face and propose a staged sequence of surgical treatment based on an 8-year experience gained in treating war casualties during the Iraq-Iran war (1980-1988).
TL;DR: Clinical records obtained showed considerable implications for trigeminal nerve function after BSSO, and the recovery period evaluated by the SEP method was longer than that of the objective two-point discrimination thresholds.
Abstract: Trigeminal neurosensory impairment is frequently observed following orthognathic surgery. The purpose of the present study is to visualize the degree of trigeminal nerve impairment following bilateral sagittal split osteotomy (BSSO). Twenty patients who underwent BSSO were in the present study. To record the modified somatosensory evoked potentials (SEP), two electrostimulation clips were applied. One clip was placed on the mucous surface of the lower lip and the other was placed on the skin surface. Each contact surface contained a separate 2 mm diameter silver anode and cathode attached to a 5 x 15 mm basement plate. The results obtained using this method revealed that complete recovery from neural impairment was observed in 7 cases (36.8%) on the right operative side and 4 (20.0%) on the left side at 6 months postoperatively. A definite delay in latency was observed on the left operative side at all the examination periods. The recovery period evaluated by the SEP method was longer than that of the objective two-point discrimination thresholds. Clinical records obtained showed considerable implications for trigeminal nerve function after BSSO.
TL;DR: The view that partial resection of chondrosarcomas of the base of the skull to alleviate symptoms is an acceptable surgical treatment is supported.
Abstract: Chondrosarcomas are malignant mesenchymal tumours occurring only rarely in the bones of the cranium. Less than 5% of all chondrosarcomas are located in the head and neck area and their commonest location is the ethmoids and the sphenoid sinus. They are slow-growing tumours with low malignancy rate and unclear histopathogenesis. The prevailing hypothesis is that they arise from cartilaginous remnants in the petro-clival, spheno-occipital and fronto-nasal synchondroses. Diagnosis is only made after biopsy since clinical signs and symptoms and radiological findings are not pathognomonic. Symptomatology mainly derives from tumour encroachment and infiltration of adjacent intracranial structures. Surgery is the treatment of choice, while radiotherapy has an adjunctive role. Chemotherapy is not effective. Partial tumour excision to alleviate symptoms is an acceptable surgical technique since diagnosis is usually late, but treatment can be repeated when recurrence occurs. During the last year, two cases of chondrosarcoma of the skull base were treated in our institution. Both patients were female, aged 62 and 73, respectively. Computerized Tomography and Magnetic Resonance Imaging were inconclusive and diagnosis was established after biopsy. Treatment for both cases was surgical, with partial excision due to intracranial involvement of the internal carotid artery. In one case, a temporal approach was used, whereas the other patient was operated on via a naso-orbital approach. One patient received postoperative radiotherapy. The postoperative course was uneventful in both patients and marked clinical improvement was noted 18 months and 1 year after surgery. We support the view that partial resection of chondrosarcomas of the base of the skull to alleviate symptoms is an acceptable surgical treatment.
TL;DR: This technique can provide significant advancement of the maxilla with better stability and can be applied in any kind of maxillary deformities which need to be corrected surgically by classic osteotomy without bone grafting.
Abstract: Summary The purpose of this study was to establish a new technique for distraction osteogenesis in the maxilla, using an osseointegrated implant and intraoral device. After extraction of the premolar and molar teeth, four titanium implants were installed in the maxillary alveolar bone. Three months later, the distraction device was connected to the abutments, and osteotomy in the medial portion of maxilla between the implants was performed. Distraction was carried out at the rate of 1 mm per day to obtain a 10-mm elongation. Morphological, radiographic and histological examinations showed that successful maxillary advancement was achieved. New bone was primarily formed by intramembranous ossification and partial endochondral ossification. Titanium implants placed for anchorage of the distraction device remained stable during the course of maxillary advancement. This technique can provide significant advancement of the maxilla with better stability. The treatment system can be applied in any kind of maxillary deformities which need to be corrected surgically by classic osteotomy without bone grafting.
TL;DR: This article presents an extremely high-flow AVM of the lower jaw with exsanguinating bleeding from the socket of the exfoliated tooth, which had disappeared completely after 6 months follow-up.
Abstract: Arteriovenous malformations (AVMs) of the jaws are extremely rare lesions, which are probably hamartomas of developmental malformations. In this article we present an extremely high-flow AVM of the lower jaw with exsanguinating bleeding from the socket of the exfoliated tooth. Repeated episodic bleedings were controlled with local pressure and packing. Digital subtraction angiography revealed a high-flow, high-shunt AVM. Preoperative embolization and external carotid artery ligation, dental extraction, curettage and packing with Gelfoam were done. Postoperative bleeding stopped, bruit ceased, and it had disappeared completely after 6 months follow-up. On the second follow-up visit, 3 months later, the patient was found to have no problems.
TL;DR: The early experience of the unit with the technique of ipsilateral full thickness forearm skin grafting of the radial forearm flap donor site defect is described, and the results with that of split skin grafts used contemporaneously for the same purpose in the unit are compared.
Abstract: The early experience of our unit with the technique of ipsilateral full thickness forearm skin grafting of the radial forearm flap donor site defect is described. The technique provides the advantages of a full thickness skin graft whilst avoiding the need to harvest skin from a remote area. We have compared the results with that of split skin grafts used contemporaneously for the same purpose in our unit; the advantages and disadvantages are outlined. Continued success has encouraged us to utilize this technique routinely with certain modifications which we describe.
TL;DR: Although different changes in the position of the bony components of the TMJ occurred after MSO, these seemed to be transient, with no major alterations in the final outcome in the patients.
Abstract: The possible morphological and morphometric changes in the different components of the temporomandibular joint (TMJ) after orthognathic surgery were analysed using computed tomography (CT) transverse scans and sagittal and coronal magnetic resonance imaging (MRI) images. Twenty-four patients with class III dentofacial deformity were studied. Nine had isolated maxillary osteotomies and 15 had combined maxillary and mandibular subcondylar osteotomies (MSO). Ten patients were studied as a control group. The patients were studied clinically, radiographically and with CT and MRI in four different phases in order to locate the position of the mandibular condyle in relation to the glenoid fossa. No statistically significant differences were found in the group of patients who had had isolated maxillary osteotomies throughout the four phases of the study. Patients treated by bimaxillary surgery showed different condylar movements after surgery. Intra-articular effusion was evident during the early postoperative period in patients treated by bimaxillary surgery. Although different changes in the position of the bony components of the TMJ occurred after MSO, these seemed to be transient, with no major alterations in the final outcome in the patients.
TL;DR: Pre- and postoperative axiography is an adequate method of controlling these results and a helpful supplement to the armentarium of orthognathic surgery.
Abstract: A bimaxillary osteotomy for mandibular prognathism and maxillary retrognathia was performed on 30 patients with an Angle Class III malocclusion. The Luhr condylar positioning device was used intraoperatively to reproduce the condylar position. Pre- and postoperative condylar positions were compared by recording joint movements with axiography. Steps, jags and jumps as symptoms of pathological joint function could not be identified. Only in one case could a pathological shortening of the joint track length be measured. This suggests that the Luhr device is effective in securing condyle position and therefore temporomandibular joint (TMJ) function. Pre- and postoperative axiography is an adequate method of controlling these results and a helpful supplement to the armentarium of orthognathic surgery.
TL;DR: A unique case of transorbital penetrating head injury with a door-key is reported and the difficulties of preoperative ophthalmological assessment in the presence of a retained object are highlighted.
Abstract: We report a unique case of transorbital penetrating head injury with a door-key. The case highlights the difficulties of preoperative ophthalmological assessment in the presence of a retained object and discusses the management of this and related injuries.
TL;DR: Acoustic rhinometry is a non-invasive, instrumental assessment technique for acquiring reproducible metric data of nasal dysplasia in cleft-palate patients and provides topographic information about the individual airway profile suitable for the longitudinal investigation of nasal-airway development, as well as the preparation and follow-up of corrective rhinosurgery.
Abstract: The objective of this study was to investigate an instrumental assessment technique for acquiring reproducible, metric data on the nasal airway in cleft-palate associated nasal dysplasia. A consecutive sample of 23 unilateral, 17 bilateral CLP patients and 15 controls with subjective normal nasal patency from a cleft-palate rehabilitation centre were studied. A series of transnasal acoustic measurements (pressure wave: 55 dB for 2 ms) of nasal volume were performed before and after topical decongestion with 2 x 0.3 mg of xylometazoline. A standardized regimen of acoustic parameters of the nasal valve and the adjacent segment of the nasal cavity were calculated. The cleft side yielded a significantly (40%) lower nasal volume than the non-cleft side. Considerably lower values were recorded for the isthmus of the cleft side (0.31 cm2) compared with the non-cleft side (0.52 cm2). Decongestion capacity was higher in the posterior segment, indicating cleft-side massive mucosal hypertrophy. In bilateral CLP, the isthmus measured 0.46 cm2. By decongestion, individual side differences were reduced in unilateral CLP patients but enhanced in bilateral clefts. The prevailing pattern of the cleft-side airway profile can be described as a 'descending W'. Acoustic rhinometry is a non-invasive, instrumental assessment technique for acquiring reproducible metric data of nasal dysplasia in cleft-palate patients. By identification of the location and amount of nasal obstruction, it provides topographic information about the individual airway profile. It is suitable for the longitudinal investigation of nasal-airway development, as well as the preparation and follow-up of corrective rhinosurgery.
TL;DR: The conclusion is reached that the implantation of porous hydroxyapatite and fibrin glue leads to the formation of long-lasting bone whose hardness is equal to, or greater than, that of normal bone.
Abstract: Summary The bone tissue formed in orthotopic or heterotopic implants of granular, porous hydroxyapatite and fibrin glue was examined several (2½–8) years after implantation. The results showed distinct ossification in all cases and the functional situation and external appearance were also satisfactory. The reconstituted spongy and compact bone underwent a remodelling process similar to that of normal bone. Most of the hydroxyapatite granules were embedded in the bone tissue; a few were very close to the fibrillar connective tissue of the intertrabecular spaces and were either covered by osteoid-like collagenous borders or were in contact with osteoclast-like giant cells. Even if the results refer only to a few patients, and were obtained from a cross-sectional study, they allow the conclusion to be reached that the implantation of porous hydroxyapatite and fibrin glue leads to the formation of long-lasting bone whose hardness is equal to, or greater than, that of normal bone.
TL;DR: A postoperative jaw exercise programme has proved important as a means of maintaining or increasing mouth-opening capacity and is an important part of maxillofacial reconstructive surgery.
Abstract: A total of 20 patients with varying degrees of facial asymmetry were followed clinically and radiographically for at least 18 months after undergoing surgical correction. In 12 of the patients, the cause of asymmetry was hemifacial microsomia of varying severity. Infection of the TMJ in early childhood and irradiation damage were other causes of facial growth disturbance. Bimaxillary osteotomy was carried out in all cases and was often combined with resection of the coronoid process in order to lengthen the ramus. A postoperative jaw exercise programme has proved important as a means of maintaining or increasing mouth-opening capacity. The facial asymmetry cases are not easy to correct and are not always in line with expectations. However, they are an important part of maxillofacial reconstructive surgery.
TL;DR: It is demonstrated that there is on difference in the eruption curve of the permanent premolars in the four groups and that bone transplantation has no inhibitory effect on eruption and crown development of the underlying permanent premolar but that Bio-Oss does not have the same resorbable or integrating capability as autogenous bone grafts.
Abstract: S U M M A R Y . The effect of implanting autogenous and xenogenous (Bio-Oss) bone transplants into metabolically active sites within beagle dog mandibles during permanent premolar tooth eruption was examined. Ten 14-weekold beagles were used. Before commencing the radiographic experiments, metal bone markers were placed in the caudal margin of the mandible at the age of 10 weeks. The deciduous first and third molar teeth were extracted and their sockets over the permanent second and fourth premolars were implanted with autogenous particulate enchondral iliac crest bone, autogenous particulate membraneous mandibular body bone, xenogenous bovine anorganic bone mineral spongiosa granules (1 -2 mm3) (Bio-Oss, Geistlich Pharma, Switzerland) or left empty. The third premolar served as a control site. Standardized oblique lateral radiographs were taken once a week. A number of coordinates of defined points and structures were determined by means of a coordinate digitizing system. Animals were killed 4, 10 and 16 weeks after bone transplantation for histological examination of the transplan tation sites. All premolars showed no delay in eruption or disruption of crown and root development. On histology, the Bio-Oss particles were not resorbed or integrated in the alveolar bone but were pushed forward into the gingiva. We have demonstrated that there is no difference in the eruption curve of the permanent premolars in the four groups (ANOVA ^ > 0 .5 ) and that bone transplantation has no inhibitory effect on eruption (ANO VA P > 0 .3 ) and crown development of the underlying permanent premolar but that Bio-Oss does not have the same resorbable or integrating capability as autogenous bone grafts.