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Amadi JU, Plutino F, Scozzafava E, Delitala F, Liberatore G, Brevi BC. Maxilla management in "phase II" skeletal surgery for obstructive sleep apnea. J Craniomaxillofac Surg 2024:S1010-5182(24)00068-4. [PMID: 39261240 DOI: 10.1016/j.jcms.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/11/2024] [Indexed: 09/13/2024] Open
Abstract
This study investigates the management of patients with obstructive sleep apnea (OSA) who have previously undergone palatal surgery and subsequently undergo maxillomandibular advancement (MMA). The research entails a retrospective analysis of phase II MMA cases from 2017 to 2022. Data encompassing demographics, clinical profiles, pre- and post-operative polysomnographic and radiological findings, surgical techniques, and complications were collected. Out of the 14 patients studied, conservative vestibular approaches were applied universally, with four cases necessitating the sectioning of descending palatine arteries. Results indicate an average maxillary sagittal advancement of 10.07 mm, a mean counterclockwise rotation of the maxillary occlusal plane at 9.35°, and a decline in apnea-hypopnea index from 45.5 to 4.5 events per hour. Surgical success and cure rates were 93.3% and 40%, respectively, with no major complications observed throughout the 45-month follow-up. This study underscores the safe and efficacious application of MMA in OSA patients with prior palatal surgery, offering valuable insights into their management.
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Affiliation(s)
- Jude Ugochukwu Amadi
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Francesco Plutino
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Department of Maxillofacial Surgery, University of Siena, Siena, Italy
| | - Emanuele Scozzafava
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Filippo Delitala
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gianmauro Liberatore
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Bruno Carlo Brevi
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Yun Y, Kurasawa S, Morita M, Kawachi R, Murata H, Sawada S, Kojima Y, Yagi M, Asako M, Iwai H. Postoperative hemorrhage after Le Fort I osteotomy hemostasis with angiographic embolization: report of two cases. J Surg Case Rep 2023; 2023:rjad663. [PMID: 38111488 PMCID: PMC10725792 DOI: 10.1093/jscr/rjad663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
This study reported two cases of acute life-threatening hemorrhage after Le Fort I osteotomy. In both cases, computed tomography and angiography revealed damage to the descending palatine artery, which was successfully treated by angiographic embolization. Although massive hemorrhage after Le Fort I osteotomy is rare, acute hemorrhage from the postoperative area may occur. Angiographic embolization is useful in cases of such hemorrhage from the posterior nasal cavity where endoscopic hemostasis is not possible.
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Affiliation(s)
- Yasutaka Yun
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shiro Kurasawa
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mizuki Morita
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Risaki Kawachi
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hideyuki Murata
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shunsuke Sawada
- Department of Oral and Maxillofacial Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yuka Kojima
- Department of Oral and Maxillofacial Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masao Yagi
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mikiya Asako
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hiroshi Iwai
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
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Pyramidal and posterior osseous release for maxillary superior/posterior mobilization using an ultrasonic bone-cutting device after Le Fort I osteotomy. J Craniomaxillofac Surg 2020; 48:170-175. [PMID: 32005513 DOI: 10.1016/j.jcms.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/13/2019] [Accepted: 01/06/2020] [Indexed: 11/21/2022] Open
Abstract
AIM The purpose of this study was to evaluate the efficiency of pyramidal and posterior osseous release (PPOR) for maxillary impaction using an ultrasonic bone-cutting device after Le Fort I (LFI) osteotomy. MATERIALS AND METHODS In total, 31 Japanese adults with jaw deformities, diagnosed as having maxillary excess with mandibular prognathism or deficiency, underwent LFI osteotomy and bilateral sagittal split osteotomy. The patients were divided into two groups: a trimming group (15 patients, four men and 11 women; mean age 24.8 years) and a PPOR group (16 patients, seven men and nine women; mean age 22.8 years). In the trimming group, osseous interference around the descending palatine artery (DPA) was removed using forceps, rounding bur, and reciprocating rasp. The PPOR technique was used to remove osseous fragments created by V-shaped osteotomy around the DPA following vertical osteotomy behind the DPA using an ultrasonic bone-cutting device (Variosurg 3; NSK, Tochigi, Japan). The operative times for maxillary osteotomy, total operative times (including bilateral sagittal split osteotomy), and total blood loss were assessed. RESULTS The mean planned amounts of maxillary impaction were 4.37 ± 1.27 mm in the trimming group and 4.38 ± 1.36 mm in the PPOR group (p = 0.98). The mean maxillary operative time for the PPOR group was significantly shorter, by 25.5% (p < 0.001). Total operative time for the PPOR group was also significantly shorter, by 24.3% (p < 0.001). Mean blood loss was significantly lower in the PPOR group than in the trimming group (p = 0.003). CONCLUSION The PPOR technique for maxillary impaction after LFI osteotomy shortened the operative time and enabled secure reduction of the maxilla in patients who required the treatment of maxillary impaction with preservation of the DPA bundle.
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Reporting Time Horizons in Randomized Controlled Trials in Plastic Surgery. Plast Reconstr Surg 2018; 142:947e-957e. [DOI: 10.1097/prs.0000000000005040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Meertens R, Casanova F, Knapp KM, Thorn C, Strain WD. Use of near-infrared systems for investigations of hemodynamics in human in vivo bone tissue: A systematic review. J Orthop Res 2018; 36:2595-2603. [PMID: 29727022 DOI: 10.1002/jor.24035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/27/2018] [Indexed: 02/04/2023]
Abstract
A range of technologies using near infrared (NIR) light have shown promise at providing real time measurements of hemodynamic markers in bone tissue in vivo, an exciting prospect given existing difficulties in measuring hemodynamics in bone tissue. This systematic review aimed to evaluate the evidence for this potential use of NIR systems, establishing their potential as a research tool in this field. Major electronic databases including MEDLINE and EMBASE were searched using pre-planned search strategies with broad scope for any in vivo use of NIR technologies in human bone tissue. Following identification of studies by title and abstract screening, full text inclusion was determined by double blind assessment using predefined criteria. Full text studies for inclusion were data extracted using a predesigned proforma and quality assessed. Narrative synthesis was appropriate given the wide heterogeneity of included studies. Eighty-eight full text studies fulfilled the inclusion criteria, 57 addressing laser Doppler flowmetry (56 intra-operatively), 21 near infrared spectroscopy, and 10 photoplethysmography. The heterogeneity of the methodologies included differing hemodynamic markers, measurement protocols, anatomical locations, and research applications, making meaningful direct comparisons impossible. Further, studies were often limited by small sample sizes with potential selection biases, detection biases, and wide variability in results between participants. Despite promising potential in the use of NIR light to interrogate bone circulation, the application of NIR systems in bone requires rigorous assessment of the reproducibility of potential hemodynamic markers and further validation of these markers against alternative physiologically relevant reference standards. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2595-2603, 2018.
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Affiliation(s)
- Robert Meertens
- Medical Imaging, University of Exeter Medical School, South Cloisters, St Luke's Campus, Heavitree Road, Exeter EX2 1LU, United Kingdom
| | - Francesco Casanova
- Diabetes and Vascular Research Centre, University of Exeter Medical School and National Institute of Health Research Exeter Clinical Research Facility, Barrack Rd, Exeter EX2 5DW, United Kingdom
| | - Karen M Knapp
- Medical Imaging, University of Exeter Medical School, South Cloisters, St Luke's Campus, Heavitree Road, Exeter EX2 1LU, United Kingdom
| | - Clare Thorn
- Diabetes and Vascular Research Centre, University of Exeter Medical School and National Institute of Health Research Exeter Clinical Research Facility, Barrack Rd, Exeter EX2 5DW, United Kingdom
| | - William David Strain
- Diabetes and Vascular Research Centre, University of Exeter Medical School and National Institute of Health Research Exeter Clinical Research Facility, Barrack Rd, Exeter EX2 5DW, United Kingdom
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Han MD, Miloro M, Markiewicz MR. Laser-Assisted Indocyanine Green Imaging for Assessment of Perioperative Maxillary Perfusion During Le Fort I Osteotomy: A Pilot Study. J Oral Maxillofac Surg 2018; 76:2630-2637. [PMID: 29957242 DOI: 10.1016/j.joms.2018.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To determine the changes in maxillary perfusion during different stages of Le Fort I osteotomies as measured by laser-assisted indocyanine green imaging (LAICGI) and to determine whether various clinical factors affect maxillary vascular perfusion. MATERIALS AND METHODS The medical records of those who had undergone Le Fort I osteotomy with LAICGI at the University of Illinois from 2016 to 2017 were reviewed retrospectively. The maxillary perfusion levels using LAICGI were measured before induction, after induction, after down fracture, after segmentalization (for segmental osteotomies), and after wound closure. The effects of clinical variables, including gender, race, American Society of Anesthesiologists physical status, type of Le Fort I osteotomy, intraoperative status of the descending palatine vessels, maxillary movements (anteroposterior, vertical, transverse), and hemodynamic data (mean arterial blood pressure, heart rate), were analyzed. RESULTS Compared with the preoperative baseline values, the indocyanine green (ICG) levels decreased after down fracture and mobilization, segmentalization, and wound closure; no statistically significant differences were found among these 3 points. Segmentalization did not affect the ICG levels compared with the nonsegmentalized cases. Male gender and the amount of maxillary impaction were significantly associated statistically with decreased ICG levels, although the difference was not clinically significant. CONCLUSIONS Compared with the baseline levels, maxillary perfusion, as measured by LAICGI, decreased from down fracture to wound closure. Segmentalization did not appear to influence maxillary perfusion, although male gender and impaction were associated with decreased perfusion. Because of its safety and convenience, LAICGI shows promise as a method of assessing maxillary perfusion in future largescale prospective studies linking perioperative perfusion to the occurrence of aseptic necrosis.
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Affiliation(s)
- Michael D Han
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, College of Dentistry, Chicago, IL.
| | - Michael Miloro
- Professor and Head, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, College of Dentistry, Chicago, IL
| | - Michael R Markiewicz
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, College of Dentistry, Chicago, IL; and Attending Physician, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; and Attending Physician, Division of Dentistry, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Stability and surgical complications in segmental Le Fort I osteotomy: a systematic review. Int J Oral Maxillofac Surg 2017; 46:1071-1087. [DOI: 10.1016/j.ijom.2017.05.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/03/2017] [Accepted: 05/17/2017] [Indexed: 11/19/2022]
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Cone beam computed tomography assessment of the pterygomaxillary region and palatine canal for Le Fort I osteotomy. Int J Oral Maxillofac Surg 2017; 46:1017-1023. [DOI: 10.1016/j.ijom.2017.03.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/17/2017] [Accepted: 03/23/2017] [Indexed: 11/19/2022]
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