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Yang C, Limthanakul I, Chou PY, Chen YR. Synergistic benefits of hyperbaric oxygen therapy for postoperative palatal oro-nasal fistula following segmental Le Fort 1 osteotomy. JPRAS Open 2024; 41:225-229. [PMID: 39070883 PMCID: PMC11279687 DOI: 10.1016/j.jpra.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/19/2024] [Indexed: 07/30/2024] Open
Abstract
Segmental maxillary osteotomy, a surgical technique used in orthognathic surgery, involves the risk of palatal mucosa tearing, which can lead to severe complications. Herein, we report the case of a woman with Angle class II malocclusion who underwent multiple elective segmental maxillary osteotomy and augmentation genioplasty procedures for the correction of her malocclusion and the enhancement of her facial profile. A week after surgery, the patient developed a palatal ulcer. We adopted a comprehensive treatment approach involving 14-day hyperbaric oxygen therapy and conventional modalities; this approach resulted in favorable outcomes. Our case underscores the importance of immediate intervention and the synergistic potential of the comprehensive approach against oronasal fistula formation. Our findings indicate that hyperbaric oxygen therapy promotes wound healing, particularly in patients with complications arising from maxillofacial surgery.
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Affiliation(s)
- Cristhiam Yang
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Isara Limthanakul
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 333, Taiwan
| | - Yu-Ray Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
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Surgical Correction of Maxillofacial Skeletal Deformities. J Oral Maxillofac Surg 2023; 81:E95-E119. [PMID: 37833031 DOI: 10.1016/j.joms.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Chou PY, Denadai R, Yao CF, Chen YA, Chang CS, Lin CCH, Liao YF, Liou EJW, Ko EWC, Lo LJ, Huang CS, Chen YR. History and Evolution of Orthognathic Surgery at Chang Gung Craniofacial Center. Ann Plast Surg 2020; 84:S60-S68. [PMID: 31833889 DOI: 10.1097/sap.0000000000002179] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Kang M, Jee YJ, Lee DW, Jung SP, Kim SW, Yang S, Ryu DM. Midfacial degloving approach for management of the maxillary fibrous dysplasia: a case report. Maxillofac Plast Reconstr Surg 2018; 40:38. [PMID: 30588475 PMCID: PMC6281586 DOI: 10.1186/s40902-018-0177-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/23/2018] [Indexed: 11/24/2022] Open
Abstract
Background Fibrous dysplasia (FD) is a benign bone lesion characterized by the progressive replacement of normal bone with fibro-osseous connective tissue. The maxilla is the most commonly affected area of facial bone, resulting in facial asymmetry and functional disorders. Surgery is an effective management option and involves removing the diseased bone via an intraoral approach: conservative bone shaving or radical excision and reconstruction. Case presentation This case report describes a monostotic fibrous dysplasia in which the patient’s right midface had a prominent appearance. The asymmetric maxillary area was surgically recontoured via the midfacial degloving approach under general anesthesia. Follow-up photography and radiographic imaging after surgery showed the structures were in a stable state without recurrence of the FD lesion. Furthermore, there were no visible scars or functional disability, and the patient reported no postoperative discomfort. Conclusions In conclusion, the midfacial degloving approach for treatment of maxillary fibrous dysplasia is a reliable and successful treatment option. Without visible scars and virtually free of postoperative functional disability, this approach offers good exposure of the middle third of the face for treatment of maxillary fibrous dysplasia with excellent cosmetic outcomes.
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Affiliation(s)
- Miju Kang
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Yu-Jin Jee
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea.,2Department of Oral and Maxillofacial Surgery, College of Dentistry, School of Dentistry, Kyung-Hee University, 7-13, Kyungheedae-ro 6-gil, Dongdaemun-gu, Seoul, 02453 Republic of Korea
| | - Deok Won Lee
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea.,2Department of Oral and Maxillofacial Surgery, College of Dentistry, School of Dentistry, Kyung-Hee University, 7-13, Kyungheedae-ro 6-gil, Dongdaemun-gu, Seoul, 02453 Republic of Korea
| | - Sang-Pil Jung
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Se-Won Kim
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Sunin Yang
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Dong-Mok Ryu
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea.,2Department of Oral and Maxillofacial Surgery, College of Dentistry, School of Dentistry, Kyung-Hee University, 7-13, Kyungheedae-ro 6-gil, Dongdaemun-gu, Seoul, 02453 Republic of Korea
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Udayakumar SIV, Paeng JY, Choi SY, Shin HI, Lee ST, Kwon TG. Orthognathic surgery for patients with fibrous dysplasia involved with dentition. Maxillofac Plast Reconstr Surg 2018; 40:37. [PMID: 30581810 PMCID: PMC6275155 DOI: 10.1186/s40902-018-0176-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022] Open
Abstract
Background Fibrous dysplasia (FD) is characterized by the replacement of normal bone by abnormal fibro-osseous connective tissue and typically treated with surgical contouring of the dysplastic bone. When dysplastic lesions involve occlusion, not only is surgical debulking needed, orthognathic surgery for correction of dentofacial deformity is mandatory. However, the long-term stability of osteotomized, dysplastic bone segments is a major concern because of insufficient screw-to-bone engagement during surgery and the risk of FD lesion re-growth. Case presentation This case report reviewed two patients with non-syndromic FD that presented with maxillary occlusal canting and facial asymmetry. Le Fort I osteotomy with recontouring of the dysplastic zygomaticomaxillary region had been performed. The stability of osseous segments were favorable. However, dysplastic, newly formed bone covered the previous plate fixation site and mild bony expansion was observed, which did not influence the facial profile. Including the current cases, 15 cases of orthognathic surgery for FD with dentition have been reported in the literature. Conclusion The results showed that osteotomy did not appear to significantly reduce the long-term stability of the initial fixation insufficiency of the screw to the dysplastic bone. However, based on our results and those of the others, long-term follow-up and monitoring are needed, even in cases where the osteotomized segment shows stable results.
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Affiliation(s)
- Santhiya Iswarya Vinothini Udayakumar
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| | - Jun-Young Paeng
- 2Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So-Young Choi
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| | - Hong-In Shin
- 3Department of Oral Pathology, School of Dentistry, Institute for Hard Tissue and Bio-tooth Regeneration, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| | - Sung-Tak Lee
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| | - Tae-Geon Kwon
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
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Cottrell DA, Farrell B, Ferrer-Nuin L, Ratner S. Surgical Correction of Maxillofacial Skeletal Deformities. J Oral Maxillofac Surg 2017; 75:e94-e125. [DOI: 10.1016/j.joms.2017.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Surgical treatment of craniomaxillofacial fibrous dysplasia: functionally or aesthetically? J Craniofac Surg 2015; 24:758-62. [PMID: 23714874 DOI: 10.1097/scs.0b013e3182869674] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fibrous dysplasia (FD) is a tumor-like growth that consists of replacement of the medullary bone with fibrous tissue, causing the expansion and weakening of the areas of bone involved. The most commonly affected bones are facial bones, causing a number of facial cosmetic and functional problems. METHODS From December 2008 to July 2012, 10 patients with craniomaxillofacial fibrous dysplasia were treated by conservative resection and local recontouring. The patients were followed up yearly, with an average of 3 years; the longest follow-up period was 5 years. RESULTS All the 10 patients received appropriate treatment and histopathological examinations were performed to confirm the diagnosis of FD. Four patients with zygoma involved had received partial zygoma osteoectomy and 2 patients received mandibular partial osteoectomy. Average time of follow-up was 3 years, with a range from 1 to 5 years, and all patients obtained satisfactory aesthetic and functional results. CONCLUSION In most patients, a conservative surgery will achieve good functional and aesthetic results. For patients with mild symptoms, the aesthetic effect should be given priority while for the heavier patients the restoration of function and aesthetic effects should all be taken into account.
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Fibrous dysplasia of the zygomaticomaxillary region: outcomes of surgical intervention. Plast Reconstr Surg 2013; 131:1329-1338. [PMID: 23714793 DOI: 10.1097/prs.0b013e31828bd70c] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fibrous dysplasia is the most common craniofacial tumor, presenting in both monostotic and polyostotic forms with varying degrees of severity. No consensus exists regarding the surgical management of craniofacial fibrous dysplasia, particularly in the zygomaticomaxillary region. The present study compared long-term outcomes of limited reduction burring versus radical resection of zygomaticomaxillary fibrous dysplasia. METHODS Patients with craniofacial fibrous dysplasia at the University of California, Los Angeles, Craniofacial Center from 1982 to 2008 were studied based on demographics, treatment, and follow-up data, including examinations, computed tomographic scans, photographs, physician Whitaker scoring, and patient surveys (n=97). Outcomes were compared for zygomaticomaxillary disease treated with radical resection with cranial bone graft reconstruction or limited reduction burring (n=58). RESULTS Thirty-four percent of patients had monostotic disease, 66 percent had polyostotic disease, 3 percent had McCune-Albright syndrome, and 2.1 percent had malignant degeneration into osteosarcoma. Most patients had surgical treatment (84.5 percent). Of the patients that required optic nerve decompression for vision changes (11.4 percent), most (75 percent) had vision stabilization postoperatively. Differences were recorded in zygomaticomaxillary disease treated with radical resection (63.8 percent) versus reduction burring (36.2 percent) according to age (19.6 versus 14.2 years), complications (13.5 percent versus 4.8 percent), recurrence (66.7 percent versus 24.3 percent), and number of subsequent procedures (2.8 versus 4.0). There were similarities in Whitaker outcome score (1.3±0.3 versus 1.5±0.6) and patient satisfaction (2.7±0.4 versus 2.8±0.3). CONCLUSIONS Although different approaches have been advocated to treat fibrous dysplasia, the authors' data support a more aggressive management for zygomaticomaxillary disease with radical resection and cranial bone graft reconstruction, especially for more involved disease. CLINICAL QUESTION OF EVIDENCE: Therapeutic, III.
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Cottrell DA, Edwards SP, Gotcher JE. Surgical correction of maxillofacial skeletal deformities. J Oral Maxillofac Surg 2013; 70:e107-36. [PMID: 23127998 DOI: 10.1016/j.joms.2012.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
BACKGROUND Cases of generalized idiopathic root resorption have been reported in the literature. However the majority of previously reported cases have affected adults, and it has been rare that a possible link to a medical condition has been found. CASE REPORT The subject of this case report was 11 years old when generalized root resorption was first diagnosed. This case report is unusual in that the resorption may be connected to a bone dysplasia. The possible medical diagnoses and links to tooth resorption have been discussed for this very rare case. CONCLUSION The investigation into the exact diagnosis of the patient and the treatment of tooth resorption is still ongoing and has required input from many disciplines of Medicine and Dentistry.
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Delozier JB, Egger ME, Bottomy MB. Infantile fibrous dysplasia of the mandible. J Craniofac Surg 2004; 15:1039-43. [PMID: 15547401 DOI: 10.1097/00001665-200411000-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Fibrous dysplasia of the craniofacial skeleton is an uncommon benign neoplasm. Its appearance in infancy (<1 year) is extremely rare. The authors report a case of mandibular fibrous dysplasia presenting in a patient 12 weeks of age as a painless, primarily left-sided, enlarging neoplasm of bone. Surgical contouring was successfully performed when the patient was 9 months of age. The authors anticipate recurrence, but at 6 months of follow-up no new growth has been observed.
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Chang YM, Shen YF, Lin HN, Tsai AHY, Tsai CY, Wei FC. Total Reconstruction and Rehabilitation with Vascularized Fibula Graft and Osseointegrated Teeth Implantation after Segmental Mandibulectomy for Fibrous Dysplasia. Plast Reconstr Surg 2004; 113:1205-8. [PMID: 15083021 DOI: 10.1097/01.prs.0000110218.85710.5d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Yang-Ming Chang
- Department of Oral and Maxillofacial Surgery, Chang-Gung Memorial Hospital, Taipei, Taiwan
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Zenn MR, Zuniga J. Treatment of Fibrous Dysplasia of the Mandible with Radical Excision and Immediate Reconstruction: Case Report. J Craniofac Surg 2001; 12:259-63. [PMID: 11358100 DOI: 10.1097/00001665-200105000-00012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Monostotic fibrous dysplasia of the mandible is an unusual manifestation of the disease that is usually benign, occurs in young individuals, and is managed by conservative curettage or debridement. We present a case of persistent fibrous dysplasia complicated by pain and intraoral bony exposure that was successfully managed by radical resection and reconstruction with a free fibular flap. Although mandibular fibrous dysplasia is preferentially managed conservatively, treatment of this disease has evolved to a point where total excision and immediate reconstruction may be the treatment of choice and offer the best outcome.
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Affiliation(s)
- M R Zenn
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC 27710, USA
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