1
|
Mendes BM, Bortoli ÉS, Zaleski CB, Martinelli MPD, Pascoal VF, Oliveira SD. Detection of multidrug-resistant bacteria in the nasal cavities and evaluation of sinus disorders in patients undergoing Le Fort I osteotomy. BMC Oral Health 2024; 24:533. [PMID: 38704542 DOI: 10.1186/s12903-024-04295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Orthognathic surgery can lead to sinus alterations, including sinusitis, attributed to the exposure of maxillary sinuses during Le Fort I osteotomy. Furthermore, being a hospital-based procedure, there is potential risk of complications arising from bacteria prevalent in such environments. This study evaluated maxillary sinusitis occurrence and the presence of multidrug-resistant bacteria in the nasal cavity before and after orthognathic surgery. METHODS Ten patients with dentofacial deformities underwent Le Fort I osteotomy. Clinical evaluations using SNOT-22 questionnaire were performed, and nasal cavity samples were collected pre-surgery and 3-6 months post-surgery to quantify total mesophilic bacteria and detect Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Cone Beam Computed Tomography (CBCT) was performed pre- and post-operatively, and the results were evaluated using the Lund-Mackay system. This study was registered and approved by the Research Ethics Committee of PUCRS (No. 4.683.066). RESULTS The evaluation of SNOT-22 revealed that five patients showed an improvement in symptoms, while two remained in the same range of interpretation. One patient developed post-operative maxillary sinusitis, which was not detected at the time of evaluation by SNOT-22 or CBCT. CBCT showed a worsening sinus condition in three patients, two of whom had a significant increase in total bacteria count in their nasal cavities. The Brodsky scale was used to assess hypertrophy in palatine tonsils, where 60% of the subjects had grade 1 tonsils, 20% had grade 2 and 20% had grade 3. None of the patients had grade 4 tonsils, which would indicate more than 75% obstruction. Two patients harboured S. aureus and K. pneumoniae in their nasal cavities. Notably, K. pneumoniae, which was multidrug-resistant, was present in the nasal cavity of patients even before surgery, but this did not result in maxillary sinusitis, likely due to the patients' young and healthy condition. CONCLUSION There was an improvement in signs and symptoms of maxillary sinusitis and quality of life in most patients after orthognathic surgery. However, some patients may still harbour multidrug-resistant bacteria, even if they are asymptomatic. Therefore, a thorough pre-operative assessment is essential to avoid difficult-to-treat post-operative complications.
Collapse
Affiliation(s)
- Bárbara M Mendes
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
- Programa de Pós-graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil
| | - Évelin S Bortoli
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Catherine B Zaleski
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Maila P D Martinelli
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Vanessa F Pascoal
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Sílvia D Oliveira
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil.
- Programa de Pós-graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil.
| |
Collapse
|
2
|
Suzen M, Temiz M, Cesur K, Uckan S. Safe Limits of Lateral Nasal Wall Osteotomy at Le Fort I Surgery. ORL J Otorhinolaryngol Relat Spec 2023; 85:97-103. [PMID: 36657407 DOI: 10.1159/000528512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/22/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The aim of this study was to define the difference between lateral nasal wall anatomy and variations as linear and angular in patients with class II and class III dentofacial deformities and to determine a surgical margin for safe entry by establishing an ideal osteotomy line for lateral nasal wall osteotomy during Le Fort I surgery. MATERIALS AND METHODS Eighty-five patients with dentofacial deformities, who were admitted to Medipol Mega University Hospital between September 2018 and February 2021, and 170 regions, including the right and left, were evaluated. In the axial image taken from coronal sections 5 mm above the deepest point of the nasal floor, lateral nasal wall angulations and linear and angular distances to the descending palatine canal were measured. Class II and class III patients were evaluated according to the right and left regions and gender. RESULTS The angled right distance values to the descending palatine artery of class III patients are higher than the values of the angled left distance to the descending palatine canal (p = 0.034). The right second angulation levels of class II female patients are higher than those of class II male patients (p = 0.037). Class III male patients have a significantly higher right linear distance to the descending palatine canal and right second angulation levels compared to class III female patients (p1 = 0.009; p2 = 0.003). The right second angulation levels of class II male patients are significantly lower than those of class III male patients (p = 0.003). CONCLUSION This study described the mean angulations and linear distances between anatomic structures of the lateral nasal wall in patients with class II and class III dentofacial deformities for the purpose of a safe osteotomy. The location of the descending palatine canal and the morphology of the lateral nasal wall are not significantly associated with dentofacial deformity.
Collapse
Affiliation(s)
- Muazzez Suzen
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Medipol University, Istanbul, Turkey
| | - Mustafa Temiz
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Medipol University, Istanbul, Turkey
| | - Kadir Cesur
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Medipol University, Istanbul, Turkey
| | - Sina Uckan
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Medipol University, Istanbul, Turkey
| |
Collapse
|
3
|
Joshi RJ, AlOtaibi N, Naudi K, Henderson N, Benington P, Ayoub A. Pattern of pterygomaxillary disarticulation associated with Le Fort I maxillary osteotomy. Br J Oral Maxillofac Surg 2022; 60:1411-1416. [PMID: 36175216 DOI: 10.1016/j.bjoms.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/20/2022] [Accepted: 08/17/2022] [Indexed: 12/31/2022]
Abstract
Pterygomaxillary disarticulation (PMD) contributes to surgical complications of Le Fort 1 osteotomy and is associated with undesirable fractures of the pterygoid plates. The aim of this paper was to investigate the patterns of PMD in Le Fort I osteotomies using Rowe's disimpaction forceps, and to evaluate correlations with age and anatomical measurements. Cone-beam computed tomography (CBCT) scans of 70 consecutive orthognathic patients were retrospectively evaluated to study four patterns of PMD: Type 1 - PMD at, or anterior to, the pterygomaxillary junction (PMJ); Type 2 - PMD posterior to the PMJ; Type 3 - PMJ separation with comminuted fracture of the pterygoid plates; Type 4 - disarticulation of the maxilla involving the pterygoid plates above the level of the osteotomy line. The preoperative anteroposterior and mediolateral thicknesses of the PMJ and the length of the medial and lateral pterygoid plates were assessed. Satisfactory PMD was achieved in all cases and no severe complications were reported, including vascular, dental, mucosal, or neural damage. The most common PMD was Type 1 (54.3%), followed by Type 2 (40%). Comminuted fracture of the pterygoid plates was limited to 5.7% of cases, and no Type 4 was detected. A weak correlation was detected between PMJ thickness and PMD pattern (p = 0.04). No statistically significant correlation was detected between patients' age and type of PMD. PMD of Le Fort I maxillary osteotomy using a Smith spreader and Rowe's disimpaction forceps proved safe, with minimal damage to the pterygoid plates.
Collapse
Affiliation(s)
- Riddhi J Joshi
- Glasgow University Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, United Kingdom
| | - Noura AlOtaibi
- Glasgow University Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, United Kingdom
| | - Kurt Naudi
- Glasgow University Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, United Kingdom
| | - Neil Henderson
- Glasgow University Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, United Kingdom
| | - Philip Benington
- Glasgow University Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, United Kingdom
| | - Ashraf Ayoub
- Glasgow University Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, United Kingdom.
| |
Collapse
|
4
|
Girard A, Lopez CD, Chen J, Perrault D, Desai N, Bruckman KC, Bartlett SP, Yang R. Epistaxis After Orthognathic Surgery: Literature Review and Three Case Studies. Craniomaxillofac Trauma Reconstr 2022; 15:147-163. [PMID: 35633764 DOI: 10.1177/19433875211008086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Study Design This is a literature review with 3 case studies. Objective Intraoperative and postoperative bleeding are the most common complications of orthognathic surgery and have the potential to become life-threatening. The rarity of severe postoperative epistaxis has resulted in limited characterization of these cases in the literature. The purpose of this study is to 1) differentiate various presentations of epistaxis following orthognathic surgery in the literature, 2) identify management approaches, and 3) to synthesize a treatment algorithm to guide future management of postoperative epistaxis. Methods A literature search of PubMed was conducted and 28 cases from 17 studies were assessed. Results Bleeding within the first week may indicate isolated epistaxis, often resolved with local tamponade. Half of cases were attributed to pseudoaneurysm rupture (n = 14), with epistaxis onset ranging from postoperative day 6 to week 9. Angiography was used in most cases (n = 17), often as the primary imaging modality (n = 11). Nasal endoscopy is a less invasive and effective alternative to angiography with embolization. Proximal vessel ligation was used in 3 cases but is not preferred because collaterals may reconstitute flow through the defect and cause rebleeding. Repeat maxillary down-fracture with surgical exploration was described in 4 cases. Conclusions As outlined in our management algorithm, nasal packing and tamponade should be followed by either local electrocautery or vascular imaging. Angiography with embolization is the preferred approach to diagnosis and management, whereas surgical intervention is reserved for cases of embolization failure or unavailability.
Collapse
Affiliation(s)
- Alisa Girard
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Plastic Surgery, Rutgers - Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Christopher D Lopez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonlin Chen
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Perrault
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Nikhil Desai
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Karl C Bruckman
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott P Bartlett
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
5
|
Santagata M, Sgaramella N, Chirico F, D’Amato S, Ferrieri I, Corvo G, Corvo C, Tartaro G. W-Shaped Osteotomy to Avoid Paranasal Deformity After Standard Le Fort I in Orthognathic Surgery. Plast Surg (Oakv) 2022; 30:45-48. [PMID: 35096692 PMCID: PMC8793756 DOI: 10.1177/2292550320969655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
When occlusal alterations are not accompanied by paranasal deficiencies, mobilization of the maxilla via Le Fort I osteotomy should be made with a different design. In this preliminary report, a W-shaped osteotomy that doesn't change the position of the maxillary bone surrounding the pyriform aperture was presented for the first time. Advantages and indications of this new procedure are discussed.
Collapse
Affiliation(s)
- Mario Santagata
- Multidisciplinary Department of Medical and Dental Specialities, Oral and Maxillofacial Department, University of Campania “Luigi Vanvitelli,” Piazza Miraglia, Naples, Italy
| | - Nicola Sgaramella
- Multidisciplinary Department of Medical and Dental Specialities, Oral and Maxillofacial Department, University of Campania “Luigi Vanvitelli,” Piazza Miraglia, Naples, Italy
| | - Fabrizio Chirico
- Multidisciplinary Department of Medical and Dental Specialities, Oral and Maxillofacial Department, University of Campania “Luigi Vanvitelli,” Piazza Miraglia, Naples, Italy,Fabrizio Chirico, Multidisciplinary Department of Medical and Dental Specialities, Oral and Maxillofacial Department, University of Campania “Luigi Vanvitelli,” Piazza Miraglia, 80138 Naples, Italy.
| | - Salvatore D’Amato
- Multidisciplinary Department of Medical and Dental Specialities, Oral and Maxillofacial Department, University of Campania “Luigi Vanvitelli,” Piazza Miraglia, Naples, Italy
| | - Ivo Ferrieri
- Multidisciplinary Department of Medical and Dental Specialities, Oral and Maxillofacial Department, University of Campania “Luigi Vanvitelli,” Piazza Miraglia, Naples, Italy
| | - Giovanni Corvo
- Multidisciplinary Department of Medical and Dental Specialities, Oral and Maxillofacial Department, University of Campania “Luigi Vanvitelli,” Piazza Miraglia, Naples, Italy
| | - Camilla Corvo
- Multidisciplinary Department of Medical and Dental Specialities, Oral and Maxillofacial Department, University of Campania “Luigi Vanvitelli,” Piazza Miraglia, Naples, Italy
| | - Gianpaolo Tartaro
- Multidisciplinary Department of Medical and Dental Specialities, Oral and Maxillofacial Department, University of Campania “Luigi Vanvitelli,” Piazza Miraglia, Naples, Italy
| |
Collapse
|
6
|
Yılmaz HN, Acar YB, Onem Ozbilen E. Scleral exposure changes after Le Fort I maxillary advancement with vertical component in individuals with skeletal Class III malocclusion-A stereophotogrammetric image study. Orthod Craniofac Res 2021; 25:502-508. [PMID: 34964257 DOI: 10.1111/ocr.12562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/01/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This retrospective study aimed to evaluate inferior scleral exposure changes in Class III patients that underwent orthognathic surgery with Le Fort I osteotomy with and without vertical displacement. MATERIALS AND METHODS Preoperative and 6-months postoperative cephalograms and stereophotogrammetric images of 45 subjects (mean age:21.66±2.97 years) that underwent orthognathic surgery for Class III correction were retrieved. Subjects were divided into 3 groups: maxillary advancement-only (AO); maxillary advancement+impaction (AI), maxillary advancement+downfracture (AD). Exclusion criteria were mandibular-only surgery, occlusal canting, facial asymmetry, orbital surgery, and craniofacial syndrome. One investigator measured inferior scleral exposure on both sides using following landmarks: upper eyelid margin (A), inferior limbus (B) and lower eyelid margin (C). Distance between A and C was recorded as overall eye height (E), distance between B and C was recorded as inferior sclera exposure (S). S:E ratio in percentage was calculated to standardize sclera exposure relative to overall eye height. Wilcoxon signed-rank and Kruskal Wallis tests were used for statistical analysis (p<0.05). RESULTS Mean value of maxillary movements were: 4.21±1.82mm advancement in AO; 5.08±2.18mm advancement and 2.33±0.99mm impaction in AI; 3.95±1.45mm advancement and 3.1±0.71mm downfracture in AD. Change in reduction of scleral exposure was significant in all groups (p<0.05). AI group bilaterally and AO group right side had highest differences (-4.96±4.86, -6.09±4.21, -4.99±3.23, respectively). There was no significant difference between groups in S:E ratio changes (p>0.05). CONCLUSION Intergroup comparisons showed no statistically significant difference, revealing similar reduction in all three groups despite the differences in the vertical movement variable.
Collapse
Affiliation(s)
- Hanife Nuray Yılmaz
- Department of Orthodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Yasemin Bahar Acar
- Department of Orthodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Elvan Onem Ozbilen
- Department of Orthodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| |
Collapse
|
7
|
Valls-Ontañón A, Hernández-Margarit P, Mazarro-Campos A, Hernández-Alfaro F. Transmucosal posterior segmentation in the context of minimally invasive Le Fort I osteotomy: Technical note. J Stomatol Oral Maxillofac Surg 2021; 123:e82-e84. [PMID: 34339878 DOI: 10.1016/j.jormas.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
In patients in which posterior segmentation of the maxilla is planned in the context of a minimally invasive Le Fort I osteotomy, accessing the posterior segmentation may tear the soft tissues, causing the minimally invasive approach to become lost, and tissue vascularization may be jeopardized. A technical note is presented for maintaining the original incision length when posterior osteotomies are required in the context of a minimally invasive Le Fort I osteotomy. Two vertical incisions are performed at the level of the premolars, a subperiosteal tunnel is made to access the bone with the piezoelectric device, and then an osteotome is used to complete the osteotomy. It thus may be concluded that this simple and safe additional limited approach can be reproduced in all cases where reaching an anatomical structure in the posterior maxillary region is required in the context of a minimally invasive Le Fort I osteotomy. The described technique offers easy and direct access to the posterior region of the maxilla while maintaining the initial incision length and preserving vascularization through the buccal corridors.
Collapse
Affiliation(s)
- A Valls-Ontañón
- Institute of Maxillofacial Surgery, Teknon Medical Center, Barcelona 08022, Spain; Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
| | - P Hernández-Margarit
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - A Mazarro-Campos
- Institute of Maxillofacial Surgery, Teknon Medical Center, Barcelona 08022, Spain
| | - F Hernández-Alfaro
- Institute of Maxillofacial Surgery, Teknon Medical Center, Barcelona 08022, Spain; Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| |
Collapse
|
8
|
Quast A, Santander P, Kahlmeier T, Moser N, Schliephake H, Meyer-Marcotty P. Predictability of maxillary positioning: a 3D comparison of virtual and conventional orthognathic surgery planning. Head Face Med 2021; 17:27. [PMID: 34256775 PMCID: PMC8276391 DOI: 10.1186/s13005-021-00279-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background Virtual surgery planning (VSP) is believed to reduce inaccuracies in maxillary positioning compared to conventional surgery planning (CSP) due to the elimination of face-bow transfer and laboratory steps. However, there is still a lack of comparative studies for the accuracy of splint-based maxillary positioning in CSP versus VSP. Therefore, the objective of this retrospective, observational study was to compare if splints produced by VSP and CSP reach postoperative outcomes within clinically acceptable limits. Methods The planned and actual postoperative results of 52 patients (VSP: n = 26; CSP: n = 26) with a mean age of 24.4 ± 6.2 years were investigated by three-dimensional (3D) alignment with planning software. The conventional treatment plan was digitized, so that the evaluation of both methods was performed in the same manner using the same coordinate system. Inaccuracies were measured by sagittal, vertical and transversal deviations of the upper central incisors and the inclination of the maxillary occlusal plane between the planned and achieved maxillary positions. Results Both methods demonstrated significant differences between the planned and actual outcome. The highest inaccuracies were observed in vertical impaction and midline correction. No significant differences between CSP and VSP were observed in any dimension. Errors in vertical and sagittal dimension intensified each other. Conclusions In conclusion, splint-based surgeries reached similar results regardless of the applied planning method and splint production.
Collapse
Affiliation(s)
- Anja Quast
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Petra Santander
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Timon Kahlmeier
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Norman Moser
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| |
Collapse
|
9
|
Abstract
Distraction osteogenesis is a viable treatment option for patients with a cleft associated with severe maxillary retrusion. A rigid external distraction device and a hybrid internal maxillary distractor have been used to advance the maxilla allowing for predictable and stable results. These techniques can be applied by itself or as an adjunct to traditional orthognathic procedures. The technical aspects are presented. These procedures tend to be simpler and demonstrate great stability compared to traditional surgical methods. The reasons for stability are discussed.
Collapse
Affiliation(s)
- Alvaro A Figueroa
- Division of Plastic Surgery, Department of Surgery, Rush Craniofacial Center, Rush University Medical Center, 1725 West Harrison Street, Suite 425 POB 1, Chicago, IL 60612, USA.
| | - Aaron D Figueroa
- Oral and Maxillofacial Surgery, Hospital Dentistry Institute, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Richard G Burton
- Oral and Maxillofacial Surgery, Hospital Dentistry Institute, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Christina Tragos
- Division of Plastic Surgery, Department of Surgery, Rush Craniofacial Center, Rush University Medical Center, 1725 West Harrison Street, Suite 425 POB 1, Chicago, IL 60612, USA
| |
Collapse
|
10
|
Sankar SG, Prashanth B, Rajasekhar G, Prasad M, Reddy GV, Priyanka JSY. A comparison of different osteotomy techniques with and without pterygomaxillary disjunction in surgically assisted maxillary expansion utilizing modified hybrid rapid maxillary expansion device with posterior implants: A finite element study. Natl J Maxillofac Surg 2021; 12:171-180. [PMID: 34483573 PMCID: PMC8386258 DOI: 10.4103/njms.njms_28_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/18/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The study aims to evaluate the effect of osteotomies with and without Pterygomaxillary disjunction (PMD) during Surgical Assisted Rapid Maxillary Expansion on the displacement pattern and stress distribution of Dental and Skeletal structures of the Nasomaxillary (NM) complex by a modified rapid maxillary expansion (RME) Hybrid appliance. MATERIALS AND METHODS A CT scan of a 20-year-old adult with maxillary constriction and the posterior bite was utilized for the restructuring of the finite element model. Five different meshed models were created individually with varying procedures of the osteotomy. A posteriorly anchored Hybrid-Hyrax appliance was utilized for RME. Groups included Group 0 - Control group without osteotomy; Group I - Only Midpalatal osteotomy; Group II - Only Subtotal Le fort I; Group III - Both Midpalatal and Subtotal Le fort I without PMD; Group IV - Midpalatal + subtotal Le fort I with bilateral PMD. The displacement pattern and stress distribution in all three dimensions were recorded and analyzed using analysis of variance and post-hoc Tukey test. RESULTS Group IV with PMD exhibited the highest stress dissipation and displacement of the skeletal and dental structures followed by Group III osteotomies. The highest stress concentration was at midpalatal suture (292 MPa) for Group III osteotomies. There is no statistical difference between Group III and Group IV osteotomies for many of the parameters measured (P > 0.05). CONCLUSIONS Posteriorly anchored Hybrid appliance without PMD is as effective as that with of PMD.
Collapse
Affiliation(s)
- Singaraju Gowri Sankar
- Department of Orthodontics, Narayana Dental College, Nellore, Andhra Pradesh, India,Address for correspondence: Prof. Singaraju Gowri Sankar, Department of Orthodontics, Narayana Dental College, Nellore - 524 003, Andhra Pradesh, India. E-mail:
| | - Bathini Prashanth
- Department of Orthodontics, Narayana Dental College, Nellore, Andhra Pradesh, India
| | - Galli Rajasekhar
- Department of Oral and Maxillofacial Surgery, Narayana Dental College, Nellore, Andhra Pradesh, India
| | - Mandava Prasad
- Department of Orthodontics, Narayana Dental College, Nellore, Andhra Pradesh, India
| | | | | |
Collapse
|
11
|
Denadai R, Chou PY, Lin YY, Yao CF, Chen YA, Huang CS, Lo LJ, Chen YR. Type of maxillary segment mobilization affects three-dimensional nasal morphology. J Plast Reconstr Aesthet Surg 2020; 74:592-604. [PMID: 33041238 DOI: 10.1016/j.bjps.2020.08.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/24/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Surgical mobilization of the maxillary segment affects nasal morphology. This study assessed the impact of the type of maxillary mobilization on the three-dimensional (3D) nasal morphometry. METHODS Pre- and postsurgery cone beam computed tomography-derived facial image datasets of consecutive patients who underwent two-jaw orthognathic surgery were reviewed. Using preoperative 3D facial models as the positional reference of the skeletal framework, 12-month postoperative 3D facial models were classified into four types of maxillary mobilizations (advancement [n = 83], setback [n = 24], intrusion [n = 55], and extrusion [n = 52]) and four types of final maxillary positions (anterosuperior [n = 44], anteroinferior [n = 39], posterosuperior [n = 11], and posteroinferior [n = 13]). Six 3D soft tissue nasal morphometric parameters were measured, with excellent intra- and interexaminer reliability scores (ICC>0.897) for all the measurements. The 3D nasal change for each nasal parameter was computed as the difference between postoperative and preoperative measurement values. RESULTS The intrusion maxillary mobilization resulted in a significantly (all p<0.05) larger 3D nasal change in terms of alar width, alar base width, and nostril angle parameters, and a smaller change in terms of the nasal tip height parameter than the extrusion maxillary mobilization; however, no significant (all p>0.05) difference was observed between advancement and setback maxillary mobilizations. The anterosuperior and posterosuperior maxillary positions had a significantly (all p<0.05) larger 3D nasal change in terms of the alar base width and nostril angle than the anteroinferior and posteroinferior maxillary positions. CONCLUSION The type of maxillary mobilization affects the 3D nasal morphometry.
Collapse
Affiliation(s)
- Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo, Brazil
| | - Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Yi-Yu Lin
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chuan-Fong Yao
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ying-An Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chiung-Shing Huang
- Department of Craniofacial Orthodontics and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ray Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
12
|
Özel A, Yılmaz ZÇ, Sağlam R, Uçkan S. Modified high-level Le Fort I advancement without malar augmentation: assessment of effect on midfacial aesthetics. Int J Oral Maxillofac Surg 2020; 50:378-383. [PMID: 32798163 DOI: 10.1016/j.ijom.2020.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/28/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
The 'beauty arch', an aesthetic feature of the midface, is a double-S-shaped curve that extends downward from the lateral canthus. This retrospective study evaluated whether modified high Le Fort I advancement (combined with impaction or down-grafting) without malar augmentation can approximate a patient's 'ideal' beauty arch (IBA). Pre- and postoperative profile (natural head position) photographs for 36 patients with midfacial hypoplasia were aligned digitally. For each individual, standardized methods were used to identify landmarks and draw the preoperative real beauty arch (RBA), postoperative RBA, and IBA. Distances from a defined landmark to each arch were measured and means were compared. The mean advancement range was 4.2 ± 2.2 mm, and the mean pre- and postoperative RBA distances were significantly different (138.7 ± 24.1 vs 145.0 ± 25.8 pixels, respectively; P = 0.0001). In the impaction and down-grafting subgroups, there was no significant correlation between amount of maxillary movement and the difference between pre- and postoperative RBA distances (P > 0.05 for both). The postoperative RBA was satisfactorily close to the IBA in 35 cases (97.2%); one patient required later augmentation. The findings suggest that modified high Le Fort I advancement surgery without malar augmentation provides satisfactory malar projection for most patients with maxillary hypoplasia.
Collapse
Affiliation(s)
- A Özel
- Department of Oral & Maxillofacial Surgery, Istanbul Medipol University, Istanbul, Turkey.
| | - Z Ç Yılmaz
- Department of Oral & Maxillofacial Surgery, Istanbul Medipol University, Istanbul, Turkey
| | - R Sağlam
- Department of Oral & Maxillofacial Surgery, Istanbul Medipol University, Istanbul, Turkey
| | - S Uçkan
- Department of Oral & Maxillofacial Surgery, Istanbul Medipol University, Istanbul, Turkey
| |
Collapse
|
13
|
Quast A, Santander P, Trautmann J, Moser N, Schliephake H, Meyer-Marcotty P. A new approach in three dimensions to define pre- and intraoperative condyle-fossa relationships in orthognathic surgery - is there an effect of general anaesthesia on condylar position? Int J Oral Maxillofac Surg 2020; 49:1303-1310. [PMID: 32173246 DOI: 10.1016/j.ijom.2020.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/02/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
Incorrect registration of the condylar position in orthognathic surgery is supposed to cause postoperative relapse, condylar resorption and temporomandibular disorders. The aim of this prospective study was to evaluate the influence of general anaesthesia on centric relation (CR). Therefore, CR registered preoperatively in the awake patient and CR registered intraoperatively under general anaesthesia were recorded in 30 patients (14 men, 16 women) undergoing orthognathic surgery (skeletal class I: n=3, II: n=13, III: n=14; symmetric: n=20; asymmetric: n=10). CR records were digitized and, through superimposition on the preoperative cone beam computed tomography of the patient's skull, the superior, anterior and posterior joint space and the volumetric congruence of 120 condyles were analysed. The linear measurements of joint spaces did not demonstrate any clinically relevant discrepancy between the CR measured in the awake and anaesthetized patient. In contrast, volumetric analysis revealed statistically significant differences between both states, with an intraoperative condylar sag predominantly in the posterior-inferior direction. The patient's skeletal class or symmetry had no significant influence on the intraoperative condylar displacement. Thus, the risk of fixing the condyle in an unphysiological position supports the idea of using intraoperative condylar positioning devices to achieve predictable and stable outcomes.
Collapse
Affiliation(s)
- A Quast
- Department of Orthodontics, University Medical Center Goettingen, Goettingen, Germany.
| | - P Santander
- Department of Orthodontics, University Medical Center Goettingen, Goettingen, Germany
| | - J Trautmann
- Department of Orthodontics, University Medical Center Goettingen, Goettingen, Germany
| | - N Moser
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - H Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - P Meyer-Marcotty
- Department of Orthodontics, University Medical Center Goettingen, Goettingen, Germany
| |
Collapse
|
14
|
Yamauchi K, Suzuki H, Yamaguchi Y, Saito S, Nogami S, Takahashi T. 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; 48:170-5. [PMID: 32005513 DOI: 10.1016/j.jcms.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
Collapse
|
15
|
Frid P, Resnick C, Abramowicz S, Stoustrup P, Nørholt SE. Surgical correction of dentofacial deformities in juvenile idiopathic arthritis: a systematic literature review. Int J Oral Maxillofac Surg 2019; 48:1032-1042. [PMID: 30704836 DOI: 10.1016/j.ijom.2019.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/19/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
The aim of this study was to assess current evidence for the surgical correction of dentofacial deformities in patients with temporomandibular joint (TMJ) involvement from juvenile idiopathic arthritis (JIA). A systematic literature review, according to the PRISMA guidelines, was conducted. Meta-analyses, randomized controlled trials, cohort studies, observational studies, and case reports were eligible for inclusion. Exclusion criteria were no JIA diagnosis, no clearly defined outcomes, dual publications (except meta-analyses), non peer-reviewed studies, non English language publications, and animal studies. The outcome measures assessed were TMJ function, skeletal alignment, and morbidity. The database search identified 255 citations, of which 28 met the eligibility criteria. Of these, 24 were case reports or case series with a low level of evidence that did not allow for meta-analysis. Extrapolated evidence supports orthognathic surgery in skeletally mature patients with controlled or quiescent JIA and a stable dentofacial deformity. Distraction osteogenesis was recommended for severe deformities. Some authors demonstrated unpredictable postoperative mandibular growth with costochondral grafts. Alloplastic TMJ reconstruction was efficacious, but should be used cautiously in skeletally immature patients. TMJ function and skeletal alignment was improved with reconstruction by any technique and morbidity was low. The surgical correction of arthritis-induced dentofacial deformities is indicated but the level of evidence is low. Prospective multicenter studies are needed.
Collapse
Affiliation(s)
- P Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway and Public Dental Service Competence Centre of North Norway and Department of Clinical Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway.
| | - C Resnick
- Harvard School of Dental Medicine and Harvard Medical School, Boston, MS, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MS, USA
| | - S Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, and Section of Dentistry/Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - P Stoustrup
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - S E Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital and Section of Oral Surgery and Oral Pathology, Aarhus University, Aarhus, Denmark
| | | |
Collapse
|
16
|
Pozzer L, Olate S, Cavalieri-Pereira L, Navarro P, de Albergaría Barbosa JR. Mechanical stability of 2-plate versus 4-plate osteosynthesis in advancement Le Fort I osteotomy. An in vitro study. J Stomatol Oral Maxillofac Surg 2017; 118:2-4. [PMID: 28330569 DOI: 10.1016/j.jormas.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/03/2015] [Accepted: 03/11/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Stability in orthognathic surgery is nowadays considered as efficient and adequate. The objective of this study was to determine and to compare the mechanical resistance to vertical load of a Le Fort I advancement osteotomy stabilized by mean of two different osteosynthesis techniques, one using two 10-hole pre-bent T-shaped plates, the other using four manually bent 4-hole L- and J-shaped plates. MATERIEL AND METHODS Standardized Le Fort I advancement osteotomies have been made on polyurethane models. The maxillary advancement was 5mm. Two groups of five models each were created. Group 1 was stabilized by mean of two 10-hole pre-bent T-shaped plates fixed by monocortical screws in the paranasal region. Group 2 was stabilized by mean of manually bent four 4-hole L-shaped plates fixed monocortical screws in the zygomatic and paranasal regions. A testing machine was used to load vertically the models at the range of 1mm/min linear displacement until peak load and system failure. Statistical analysis was realized using ANOVA and t-test, considering P as significant if <0.005. RESULTS The maximal tolerated load was 15N in group 1and 42.71N in group 2 (P=0.003). DISCUSSION The use of two T-shaped 10-holes pre-bent plates allows for less resistance in vertical loading than the use of four 4-holes manually bent L-shaped plates.
Collapse
|
17
|
Abstract
INTRODUCTION The purpose of this study was to evaluate the accuracy of Le Fort I surgery by comparing planned surgical movements with actual outcomes. MATERIALS AND METHODS A minimum number of seven consecutive cases that had undergone a Le Fort I osteotomy procedure alone or in combination with a mandibular osteotomy from six different hospital units in the East of England between 2009 and 2010 were identified. A total of 56 cases met the inclusion criteria where surgical splints were used and model surgery had been performed. Pre- and post-operative lateral cephalograms were digitised using Dolphin© imaging software (Version 10.0) and three cephalometric points were assessed to measure precision of surgical movements: A point (A-pt); Upper incisor tip (U1 tip); and Upper first molar occlusal point (U6 occ). The final position of the maxilla was compared to the planned position. RESULTS In 71% of cases surgical movements were within 2 mm and 20% of this group were within 1 mm of the predicted position. The mean accuracy was 1.39 mm (SD 0.92 mm) for the former and 0.78 mm (SD 0.58 mm) for the latter. Accuracy correlated negatively with increased surgical complexity, particularly posterior differential impactions of the maxilla. There was no statistically significant difference between centres. CONCLUSIONS Pre-operative surgical planning of Le Fort I osteotomies was generally accurate. This study demonstrates that different operators across six centres produced consistent surgical outcomes and this confirms previously reported data.
Collapse
Affiliation(s)
- Stefan Abela
- a Department of Orthodontics , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - David Tewson
- b Norfolk and Norwich University Hospital NHS Foundation Trust , Norwich , UK
| | - Sharon Prince
- b Norfolk and Norwich University Hospital NHS Foundation Trust , Norwich , UK
| | | | - Dirk Bister
- a Department of Orthodontics , Guy's and St Thomas' NHS Foundation Trust , London , UK
| |
Collapse
|
18
|
Ragaey M, Van Sickels J. A Modified Technique for Placing Prebent Plates during a Le Fort I Osteotomy: A Technical Note. Craniomaxillofac Trauma Reconstr 2016; 9:297-298. [PMID: 27833707 DOI: 10.1055/s-0036-1592092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/15/2016] [Indexed: 10/21/2022] Open
Abstract
Prebent plates have gained popularity in recent years as a fixation appliance for large maxillary advancements. They are larger than standard plates used for maxillary procedures and appear to give greater stability. Due to their size and configuration, they have the potential to be more palpable than standard plates, possibly causing discomfort following placement. With a simple "box" osteotomy of the maxilla at the site of placement and a minor modification of the plate, the plate is less palpable and better tolerated by the patient.
Collapse
Affiliation(s)
- Marwa Ragaey
- Department of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky
| | - Joseph Van Sickels
- Department of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
19
|
Ragaey M, Van Sickels JE. Prevalence of infection with the use of β-tricalcium phosphate as a bone graft substitute during Le Fort I osteotomy. Int J Oral Maxillofac Surg 2016; 46:62-66. [PMID: 27825755 DOI: 10.1016/j.ijom.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/18/2016] [Accepted: 10/06/2016] [Indexed: 12/25/2022]
Abstract
While grafting with bone substitutes has been shown to provide greater stability in maxillary advancements, infection remains a concern with any material that is placed in close proximity to the maxillary sinus. The purpose of this study was to evaluate the prevalence of infection in maxillary advancements in which a bone graft substitute (β-tricalcium phosphate; β-TCP) was placed at the time of surgery. This was a retrospective study of all maxillary osteotomies. Patients were divided into two groups: group 1 included maxillary osteotomies in which β-TCP was not used; group 2 included any maxillary osteotomy where β-TCP was used. The prevalence of infection, slow healing, and need for second surgery due to infection or non union was noted. Fisher's exact test was used to compare differences between the groups. Records were adequate for 438 patients: group 1 included 297 patients, while group 2 included 141. No infections were noted in either group. In group 2, there was one patient who had delayed union/non-union requiring a second procedure. Statically, there was no significant difference between the two groups (P=0.3219). Based on the data obtained in this study, the use of β-TCP does not increase the incidence of infection or complications when used in Le Fort I maxillary osteotomy.
Collapse
Affiliation(s)
- M Ragaey
- Division of Oral and Maxillofacial Surgery, Chandler Medical Center, University of Kentucky, Lexington, KY, USA; ESHA Oral and Cranio-maxillofacial Surgery Center, Agouza, Cairo, Egypt.
| | - J E Van Sickels
- Division of Oral and Maxillofacial Surgery, Chandler Medical Center, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
20
|
Almukhtar A, Ayoub A, Khambay B, McDonald J, Ju X. State-of-the-art three-dimensional analysis of soft tissue changes following Le Fort I maxillary advancement. Br J Oral Maxillofac Surg 2016; 54:812-7. [PMID: 27325452 DOI: 10.1016/j.bjoms.2016.05.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 05/20/2016] [Indexed: 11/29/2022]
Abstract
We describe the comprehensive 3-dimensional analysis of facial changes after Le Fort I osteotomy and introduce a new tool for anthropometric analysis of the face. We studied the cone-beam computed tomograms of 33 patients taken one month before and 6-12 months after Le Fort I maxillary advancement with or without posterior vertical impaction. Use of a generic facial mesh for dense correspondence analysis of changes in the soft tissue showed a mean (SD) anteroposterior advancement of the maxilla of 5.9 (1.7) mm, and mean (SD) minimal anterior and posterior vertical maxillary impaction of 0.1 (1.7) mm and 0.6 (1.45) mm, respectively. It also showed distinctive forward and marked lateral expansion around the upper lip and nose, and pronounced upward movement of the alar curvature and columella. The nose was widened and the nostrils advanced. There was minimal forward change at the base of the nose (subnasale and alar base) but a noticeable upward movement at the nasal tip. Changes at the cheeks were minimal. Analysis showed widening of the midface and upper lip which, to our knowledge, has not been reported before. The nostrils were compressed and widened, and the lower lip shortened. Changes at the chin and lower lip were secondary to the limited maxillary impaction.
Collapse
Affiliation(s)
- A Almukhtar
- Scottish Craniofacial Research Group, University of Glasgow, MVLS College, School of Medicine, Dental School, Glasgow, UK
| | - A Ayoub
- Scottish Craniofacial Research Group, University of Glasgow, MVLS College, School of Medicine, Dental School, Glasgow, UK.
| | - B Khambay
- Orthodontic Department, Dental School, University of Leeds, Leeds, UK
| | - J McDonald
- Honorary research fellow, Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - X Ju
- Medical Device Unit, Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Glasgow, UK
| |
Collapse
|
21
|
Abstract
Background The Le Fort I osteotomy is one of the most widely used and useful procedure to correct the dentofacial deformities of the midface. The changes of the maxilla position affect to overlying soft tissue including the nasal structure. Postoperative nasal septum deviation is a rare and unpredicted outcome after the surgery. There are only a few reports reporting the management of this complication. Case Presentation In our department, three cases of the postoperative nasal septum deviation after the Le Fort I osteotomy had been experienced. Via limited intraoral circumvestibular incision, anterior maxilla, the nasal floor, and the anterior aspect of the septum were exposed. The cartilaginous part of the nasal septum was resected and repositioned to the midline and the anterior nasal spine was recontoured. Alar cinch suture performed again to prevent the sides of nostrils from flaring outwards. After the procedure, nasal septum deviation was corrected and the esthetic outcomes were favorable. Conclusion Careful extubation, intraoperative management of nasal septum, and meticulous examination of pre-existing nasal septum deviation is important to avoid postoperative nasal septum deviation. If it existed after the maxillary osteotomy, septum repositioning technique of the current report can successfully correct the postoperative septal deviation.
Collapse
Affiliation(s)
- Young-Min Shin
- Department of Dentistry and Oral Surgery, Dong-San Medical Center, Keimyung University, 194, Dong-San Dong, Jung Gu, Taegu City, 700-712 South Korea
| | - Sung-Tak Lee
- Center for Orthognathic surgery, Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Samduck 2 Ga, Jung Gu, Daegu, 700-421 South Korea
| | - Tae-Geon Kwon
- Center for Orthognathic surgery, Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Samduck 2 Ga, Jung Gu, Daegu, 700-421 South Korea
| |
Collapse
|
22
|
Bonnot P, Salles F, Cheynet F, Blanc JL, Ricbourg B, Meyer C. [Recovery of maxillary tooth sensibility after Le Fort I osteotomy]. ACTA ACUST UNITED AC 2014; 115:279-86. [PMID: 25444242 DOI: 10.1016/j.revsto.2014.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 05/16/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Upper alveolar nerves, when injured during Le Fort I osteotomies, alter maxillary tooth sensitivity. We had for aim to analyze post-operative maxillary tooth sensitivity recovery. MATERIAL AND METHODS We conducted a prospective study in a series of patients having undergone Le Fort I osteotomy, with, or without mandibular osteotomy or intermaxillary disjunction (IMD). The direction and range of displacement of the maxillary bone were recorded. One tooth in each alveolar sector (incisivocanine, premolar, molar) was tested with an electric stimulator for each patient. The tests were performed before (D-1), and after surgery (D2 or day+2, D+15, M2 (or month +2), M3, and M6). RESULTS Twenty-two patients were included. Among the tested teeth, 91.9 % were sensitive at D-1. At D2, only 12.7 % of teeth were sensitive. At D15, M2, M3, and M6, the sensitivity was respectively 33.3 %, 43.1 %, 50 %, and 61.8 %. The recovery of sensitivity was faster in young patients (under 35 years of age) and for upper middle and superior alveolar nerves. There was no difference regarding the direction of maxillary movement. DISCUSSION Among the teeth that were sensitive before surgery, 87.3 % had not regained sensitivity at D2. The recovery of sensitivity increased at D15. A great displacement of the maxillary bone was an aggravating factor for loss of tooth sensitivity.
Collapse
Affiliation(s)
- P Bonnot
- Service de chirurgie maxillo-faciale et de stomatologie (Pr. C Meyer), hôpital Jean-Minjoz, centre hospitalier universitaire de Besançon, boulevard Flemming, 25030 Besançon cedex, France.
| | - F Salles
- Service de stomatologie et chirurgie maxillo-faciale (Pr. JL Blanc), hôpital La Timone, (AP-HM), centre hospitalier universitaire de Marseille, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - F Cheynet
- Service de stomatologie et chirurgie maxillo-faciale (Pr. JL Blanc), hôpital La Timone, (AP-HM), centre hospitalier universitaire de Marseille, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - J L Blanc
- Service de stomatologie et chirurgie maxillo-faciale (Pr. JL Blanc), hôpital La Timone, (AP-HM), centre hospitalier universitaire de Marseille, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - B Ricbourg
- Service de chirurgie maxillo-faciale et de stomatologie (Pr. C Meyer), hôpital Jean-Minjoz, centre hospitalier universitaire de Besançon, boulevard Flemming, 25030 Besançon cedex, France
| | - C Meyer
- Service de chirurgie maxillo-faciale et de stomatologie (Pr. C Meyer), hôpital Jean-Minjoz, centre hospitalier universitaire de Besançon, boulevard Flemming, 25030 Besançon cedex, France; Service de stomatologie et chirurgie maxillo-faciale (Pr. JL Blanc), hôpital La Timone, (AP-HM), centre hospitalier universitaire de Marseille, rue Saint-Pierre, 13385 Marseille cedex 5, France; Université de Franche-Comté-UFR SMP, place Saint-Jacques, 25030 Besançon cedex, France
| |
Collapse
|
23
|
Gokce SM, Gorgulu S, Karacayli U, Gokce HS, Battal B. Three-dimensional evaluation of nasal and pharyngeal airway after Le Fort I maxillary distraction osteogenesis. Int J Oral Maxillofac Surg 2014; 44:455-61. [PMID: 25475850 DOI: 10.1016/j.ijom.2014.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 10/24/2014] [Accepted: 10/29/2014] [Indexed: 11/25/2022]
Abstract
The aims of this study were to evaluate volumetric changes in the nasal cavity (NC) and pharyngeal airway space (PAS) after Le Fort I maxillary distraction osteogenesis (MDO) using a three-dimensional (3D) simulation program, and to determine the effects of MDO on respiratory function during sleep with polysomnography (PSG). 3D computed tomography images were obtained and analyzed before surgery (T0) and at a mean 8.2 ± 1.2 months postsurgery (T1) (SimPlant-OMS software) for 11 male patients (mean age 25.3 ± 5.9 years) with severe skeletal class III anomalies related to maxillary retrognathia. The simulation of osteotomies and placement of distractors were performed on stereolithographic 3D models. NC and PAS were segmented separately on these models for comparison of changes between T0 and T1. PSG including the apnoea-hypopnoea index (AHI), sleep efficiency, sleep stages (weakness, stages 1-4, and rapid eye movement (REM)), and mean lowest arterial O2 saturation were obtained at T0 and T1 to investigate changes in respiratory function during sleep. MDO was successful in all cases as planned on the models; the average forward movement at A point was 10.2mm. Increases in NC and PAS volume after MDO were statistically significant. These increases resulted in significant improvement in sleep quality. PSG parameters changed after MDO; AHI and sleep stages weakness, 1, and 2 decreased, whereas REM, stages 3 and 4, sleep efficiency, and mean O2 saturation increased.
Collapse
Affiliation(s)
- S M Gokce
- Department of Orthodontics, Medipol University, Mega Hospitals Complex, Bagcilar, Istanbul, Turkey.
| | - S Gorgulu
- Department of Orthodontics, Dental Sciences Centre, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - U Karacayli
- Department of Oral and Maxillofacial Surgery, Dental Sciences Centre, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - H S Gokce
- Department of Prosthodontics, Medipol University, Mega Hospitals Complex, Bagcilar, Istanbul, Turkey
| | - B Battal
- Department of Radiology, Dental Sciences Centre, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| |
Collapse
|
24
|
O'Donovan M, Khambay BS. Anterior projection of the maxillomandibular soft tissue complex after surgical correction of maxillary hypoplasia: a Scottish perspective. Br J Oral Maxillofac Surg 2014; 52:934-9. [PMID: 25241038 DOI: 10.1016/j.bjoms.2014.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 08/25/2014] [Indexed: 11/20/2022]
Abstract
After orthognathic surgery the forehead remains unchanged. To produce facial harmony, the planned projection of the maxillomandibular complex must be placed in the correct relations to the unchanged position of the forehead. We have compared the anterior soft tissue projection of the maxillomandibular complex relative to the forehead after Le Fort I advancement surgery for correction of maxillary hypoplasia with that of a local reference group chosen by lay assessors. We retrospectively studied 32 patients (16 men and 16 women) all of whom had previously been treated by Le Fort I maxillary advancement. In addition a panel of 8 lay assessors selected a reference group of 24 women and 16 men. Standard profile photographs were taken, and horizontal measurements made, of several landmarks from a true vertical line (TV) passing through glabella. Together with facial harmony values these were compared between the groups. The orthognathic group had significantly more anterior mandibular projection relative to the forehead than the female reference group (p=0.03). As a result half of the horizontal harmony values were smaller in the orthognathic group. For men the position of the mandible, particularly the chin, was acceptable even though it was positioned more anteriorly. We have provided values for maxillomandibular projection derived from lay assessors and identified areas where differences from those of a reference group were detected. The projection of the mid and lower face of the local reference group to the forehead should guide preoperative planning.
Collapse
|
25
|
Valstar MH, Baas EM, Te Rijdt JP, De Bondt BJ, Laurens E, De Lange J. Maxillary sinus recovery and nasal ventilation after Le Fort I osteotomy: a prospective clinical, endoscopic, functional and radiographic evaluation. Int J Oral Maxillofac Surg 2013; 42:1431-6. [PMID: 23809988 DOI: 10.1016/j.ijom.2013.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 05/10/2013] [Accepted: 05/16/2013] [Indexed: 11/25/2022]
Abstract
The condition of the maxillary sinus is not routinely assessed before a Le Fort I osteotomy. Performing this procedure in an infected sinus might account for a considerable proportion of the complications, such as excessive bleeding and sinusitis. The aim of this study was to evaluate the maxillary sinus and nasal ventilation after Le Fort I osteotomy. Twenty patients were evaluated before and 2 months after surgery using validated questionnaires for sinonasal complaints (RSOM-31 and VAS score), nasal endoscopy, peak nasal inspiratory flow (PNIF), and a computed tomography (CT) scan. There were no differences in complaints before and 2 months after surgery (P>0.24). Also, the PNIF did not change significantly (P=0.10). On CT evaluation before surgery, a previously unnoted sinusitis was diagnosed in two patients. Postoperatively, a thickened sinus mucosa was present in all patients near the osteotomy line, the osteosyntheses, and around sequesters. This report describes maxillary sinus evaluation after Le Fort I osteotomy in a more comprehensive way by using CT. The Le Fort I procedure did not influence already existing physical or mental complaints, and nasal ventilation was not negatively affected. However, evaluation of sinonasal pathology should be emphasized in the preoperative work-up.
Collapse
Affiliation(s)
- M H Valstar
- Department of Oral and Maxillofacial Surgery, Isala Clinics, Zwolle, The Netherlands; Department of Oral and Maxillofacial Surgery Academic Medical Centre and Academic Centre for Dentistry, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
26
|
|