Combining single- and double-tooth osteotomies with traditional orthognathic surgery

Synergistic benefits of hyperbaric oxygen therapy for postoperative palatal oro-nasal fistula following segmental Le Fort 1 osteotomy

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.

Midfacial degloving approach for management of the maxillary fibrous dysplasia: a case report

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.

Orthognathic surgery for patients with fibrous dysplasia involved with dentition

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.

Surgical treatment of craniomaxillofacial fibrous dysplasia: functionally or aesthetically?

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.

Fibrous dysplasia of the zygomaticomaxillary region: outcomes of surgical intervention

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.

Generalized idiopathic root resorption: a case report

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.

Infantile fibrous dysplasia of the mandible

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.

Treatment of Fibrous Dysplasia of the Mandible with Radical Excision and Immediate Reconstruction: Case Report

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.