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Rubio-Palau J, Ayats-Soler M, Albert-Cazalla A, Martìnez-Padilla I, Prieto-Gundin A, Prieto-Peronnet N, Ramìrez-Fernández MP, Mareque-Bueno J. Accuracy of Virtually Planned Maxillary Distraction in Cleft Patients - An Evaluative Study. Ann Maxillofac Surg 2021; 11:49-57. [PMID: 34522654 PMCID: PMC8407633 DOI: 10.4103/ams.ams_331_20] [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: 08/01/2020] [Revised: 09/07/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Maxillary distraction may be used to treat severe maxillary hypoplasia in cleft lip and palate (CLP) patients. Three-dimensional (3D) planning has been shown to increase the accuracy of distraction and reduce operative time and complications. The aim of the study was to measure the accuracy of internal maxillary distraction after 3D planning in CLP patients, to add evidence to validate the virtual osteotomy and distraction procedure. Materials and Methods: Eleven CLP patients with severe maxillary hypoplasia underwent maxillary distraction using internal distractors. Virtual planning was used to design the osteotomies, the distractor position, and the distraction vector. Cutting and positioning guides transferred this information to the surgical procedure. Four to six month postoperative computed tomography-scan was done before distractor removal; anatomical reference points were compared to the virtual planning to determine accuracy. Results: A high accuracy (point dislocation <1.5 mm) was found in 90% of the points of the surface of the maxilla; the majority of the zygomatic screws were placed within a distance of 0.8–1 mm from their planned position. Discussion: The high accuracy achieved through virtual planning promotes optimal distractor placement; a customized distraction vector has a direct effect on the final position of the maxilla.
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Affiliation(s)
- Josep Rubio-Palau
- Department of Pediatric Surgery, Division of Maxillofacial Surgery, Hospital Sant Joan De Déu, Barcelona, Spain.,Department of Innovation (3D4H, 3D for Health), Hospital Sant Joan De Déu, Barcelona, Spain
| | - Marta Ayats-Soler
- Department of Innovation (3D4H, 3D for Health), Hospital Sant Joan De Déu, Barcelona, Spain
| | | | - Irene Martìnez-Padilla
- Department of Pediatric Surgery, Division of Maxillofacial Surgery, Hospital Sant Joan De Déu, Barcelona, Spain
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Gibreel W, Wlodarczyk JR, Wolfswinkel EM, Yen S, Urata MM, Hammoudeh JA. Cleft Lip and Palate: Le Fort I Distraction Using an Internal Device. Clin Plast Surg 2021; 48:407-417. [PMID: 34051894 DOI: 10.1016/j.cps.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Maxillary hypoplasia is a commonly seen dentofacial anomaly in patients with cleft lip and palate after surgical repair of the cleft anomaly. To facilitate large horizontal movements of the maxilla, distraction osteogenesis is used to slowly stretch the soft tissue envelope with the skeletal advancement preventing tissue recoil and skeletal relapse. Internal distraction devices have the advantage of reducing the amount of physical and psychological stress placed on patients, families, and caregivers. The technique has been successful in producing stable results for large advancements of the facial skeleton when compared with conventional Le Fort I advancement and fixation of the maxilla.
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Affiliation(s)
- Waleed Gibreel
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA
| | - Jordan R Wlodarczyk
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA; Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
| | - Erik M Wolfswinkel
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA
| | - Stephen Yen
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA; Division of Dentistry and Orthodontics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Mark M Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA; Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA; Division of Dentistry and Orthodontics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey A Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA; Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA; Division of Dentistry and Orthodontics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA.
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Sommerfeld R, Bergamaschi IP, Scariot R, da Costa DJ. Evaluation of Tissue Tensions in Segmental Maxillary Osteotomies by Finite Element Analysis. J Oral Maxillofac Surg 2020; 78:2298.e1-2298.e9. [DOI: 10.1016/j.joms.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/17/2022]
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Recapitulation of Unilateral Cleft Lip Nasal Deformity on Normal Nasal Structure: A Finite Element Model Analysis. J Craniofac Surg 2019; 29:2220-2225. [PMID: 30339602 DOI: 10.1097/scs.0000000000005024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cleft lip nasal deformity has been challenging to plastic surgeons. A better understanding of the biomechanical aspect of the cleft nose would contribute to a better correction. In this study, finite element model of a normal nose was constructed and loaded with forces to recapitulate the unilateral cleft lip nasal deformity. Tether at the alar base was simulated by a laterally directed force at the lateral crus, and tether at the columella base by a posteriorly directed force at the medial crus. The equivalent von-Mises stress and the total deformation consequent to different patterns of loading were captured. In accordance with clinical observations, unilaterally loaded forces caused deformation on both sides of the nose. A correlation between the patterns of loading and different cleft lip nasal deformities was documented in detail. When set at the same force magnitude, tether at the columella base led to more extensive changes in the nasal morphology and higher level of stress than at the alar base. Clear identification of major pathological tethers in the nasolabial region might lead to more accurate and stable correction of cleft lip nasal deformities.
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Huang H, Li Y, Luo X, Cheng X, Shi B, Li J. Mechanical analyses of critical surgical maneuvers in the correction of cleft lip nasal deformity. PLoS One 2018; 13:e0195583. [PMID: 29652906 PMCID: PMC5898757 DOI: 10.1371/journal.pone.0195583] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/26/2018] [Indexed: 02/05/2023] Open
Abstract
The relapse of nasal deformity is a challenge for modern correction of cleft lip. A comprehensive understanding in the biomechanical perspective of both the formation and correction of the cleft lip nasal deformity would lead to improved stability of the corrective outcome. In this study, a finite element model of secondary cleft lip nasal deformity was constructed, on which two critical corrective maneuvers were mimicked in the form of force-loading. The intercrural suture was simulated by a force loaded at the intermediate crus of the alar cartilage directing anteriorly and medially, and the suture suspending the alar cartilage to the upper lateral cartilage was simulated by a force loaded at the lateral crus directing superiorly and medially. The equivalent von-mises stress and the total deformation consequent to different patterns of loading were captured. Our biomechanical analyses suggested that the intercrural suture at the nasal tip might be more effective in generating widespread morphological change than the suspension suture, but left much higher level of stress within the skin envelope if placed too high. Synergistic effect was observed between the two sutures in both the resultant deformation and stress. In addition, our simulations were partially supported by clinical photogrammetry data.
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Affiliation(s)
- Hanyao Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yeping Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiangyou Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xu Cheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jingtao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- * E-mail:
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Medeiros MAB, do Nascimento LEAG, Lau TCL, Mineiro ALBB, Pithon MM, Sant'Anna EF. Effects of laser vs ultrasound on bone healing after distraction osteogenesis: A histomorphometric analysis. Angle Orthod 2014; 85:555-61. [DOI: 10.2319/061414-431.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
Objective:
To assess the effects of low-level laser irradiation vs ultrasound irradiation on bone healing after distraction osteogenesis.
Materials and Methods:
Distraction osteogenesis was performed with rapid maxillary expansion devices (Hyrax-Morelli, Sorocaba, São Paulo Brazil) in 24 rabbits (Oryctolagus cuniculus). After a 2-day latency period, the distraction devices were activated for 10 days at a rate of 1 mm/d. Four groups of six animals were treated as follows: (1) control, (2) laser irradiation on the right side, (3) ultrasound irradiation on the right side, and (4) laser irradiation on the right side and ultrasound on the left side. Histomorphometric analysis was used to assess the bone healing area. Analysis of variance was used to perform the statistical analyses.
Results:
The influence of low-intensity laser associated with ultrasound irradiation on bone healing was statistically significant. The analyses showed the greatest amount of bone healing in the jaws of animals in group 4, which received treatment with both ultrasound and laser.
Conclusion:
This study concluded that bone healing is accelerated with the application of laser irradiation. The greatest effects were observed with combined ultrasound and laser treatment.
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Affiliation(s)
| | | | - Thiago Chon Leon Lau
- Student, Department of Orthodontics, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil; and Visiting Professor, Department of Orthodontics, Universidade Federal do Piauí, UFPI, Brazil
| | - Ana Lys Bezerra Barradas Mineiro
- Professor, Department of Clinical and Surgical Veterinary Medicine, Universidade Federal do Piauí, UFPI, Teresina, Piauí, Brazil
| | - Matheus Melo Pithon
- Professor, Orthodontics Healthy I Department, Southwest Bahia State University, UESB, Jequié, Bahia, Brazil
| | - Eduardo Franzotti Sant'Anna
- Associate Professor of Paediatric Dentistry and Orthodontics, Department of Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil
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