Is there a difference in surgical accuracy following bimaxillary surgery between cleft and non-cleft patients?

OBJECTIVES

To assess the surgical accuracy of 3D virtually planned orthognathic surgery among patients with and without cleft.

MATERIALS AND METHODS

This retrospective cohort study included cleft and non-cleft patients with class III malocclusion who underwent bimaxillary surgery. CBCT scans were acquired before and immediately after surgery. 3D virtual surgical planning (VSP) was performed using CBCT and digitalized dentition data. All orthognathic surgeries were performed by the same surgeons using interocclusal splints. The primary outcome variable was surgical accuracy, defined as the difference between the planned and surgically achieved maxillary movements, quantified in six degrees of freedom. Analysis of covariance was used to test for intergroup differences in surgical accuracy after correcting for differences in the magnitude of planned surgical maxillary movements.

RESULTS

Twenty-eight cleft and 33 non-cleft patients were enrolled, with mean ages of 18.5 and 25.4 years, respectively (P=0.01). No significant gender difference was present between the groups (P=0.10). After adjustment for small differences in surgical movements, no significant differences in surgical accuracy were observed between cleft and non-cleft patients.

CONCLUSION

The present study demonstrates that high surgical accuracy in maxillary movements can be achieved in both cleft and non-cleft patients using VSP and interocclusal splints.

CLINICAL RELEVANCE

Orthognathic cases with cleft can be performed with 3D VSP to obtain a satisfactory surgical accuracy.

Simultaneous thyroglossal duct cyst with parathyroid cyst: A case report

BACKGROUND

Thyroglossal duct cysts (TDC) are common congenital deformities. Most of them are cysts formed by the thyroglossal ducts that do not disappear and degenerate in the early embryonic stage. TDC exists alone and is rarely complicated by other congenital embryonic malformations. Only a few reports of TDC with branchial cleft cysts, thyroid cancer, thyroid hematoma, and epidermoid cysts have been reported. Therefore, we report a patient with TDC and parathyroid cyst (PC), a rare disease that has never been reported.

CASE SUMMARY

A 47-year-old woman presented to clinic in April 2021 with a neck tumor which she had noticed 5 d earlier. We perfected the relevant examinations, such as ultrasound and computed tomography, and resected the tumor. After surgical treatment, the pathology revealed a cervical thyroglossal duct cyst and a left lobe parathyroid cyst. The patient was followed up for 1 year without significant recurrence.

CONCLUSION

We report a patient with a simultaneous TDC and a PC to explore the correlation between the two congenital anomalies.

Plantar approach for treatment of brachymetatarsia: A novel approach with an aesthetic consideration

In the past, open osteotomy was always performed through a dorsal approach in the surgical treatment of brachymetatarsia, which created scar formation on the dorsal skin, subsequently resulting in dissatisfaction with cosmetic results. In this study, we provided a plantar approach to avoid forming scars on the dorsal side. A retrospective review was conducted in nine patients (13 feet) with brachymetatarsia treated with an open osteotomy and gradual bone lengthening through a plantar approach. Visual analogue scale (VAS) was used to evaluate the satisfaction of foot appearance, and we designed a questionnaire called appearance index (AI) to assess the influence of foot appearance on quality of life after surgery. The complications were also recorded during the follow-up. The patients were followed up for 34.8 ± 23.7 months. All cases were healed with a time of 64.4 ± 7.1 days and a healing index of 44.1 ± 7.8 d/cm. Satisfaction VAS for foot appearance improved from a preoperative score of 1.7 ± 1.3 points to a postoperative score of 9.3 ± 0.5 points. The AI improved from a preoperative score of 9.2 ± 0.8 points to a postoperative score of 0.6 ± 0.7 points. Complications were observed in three feet (23.1%), but none was related to the plantar approach. In conclusion, the plantar approach for metatarsal osteotomy and pins fixation was a safe and efficient technique with a satisfactory cosmetic result for the patients. No complications related to the novel approach, such as neurovascular injury, were reported.

Bilateral Congenital Absence of Femur: A Rare Case Report

INTRODUCTION

Bilateral congenital absence of femur is a rare congenital anomaly.

CASE REPORT

We report a 2-year-old Indonesian female child, the third of the birth of diabetic mother. There is no congenital abnormality among her siblings. She has a normal mentality and normal upper limbs. She was brought to us with a complaint of the short lower limb. Examination revealed short lower limb with an absence of thigh, a full range of motion of the hip and ankle and left club foot. A detailed history was obtained and she was radiologically examined. The X-ray of the pelvis and lower limb shows shallow of the acetabulum, absence of bilateral femur, and uncommon form of tibia fibula. She was diagnosed with bilateral congenital absence of femur.

CONCLUSION

We report this case because it does not meet the existing classification criteria for congenital femur deficiency. Proper evaluation and management of this case can help the patient and the parents to accept her condition and be able to live a good social and economically productive life.

[Osteotomies of the distal tibia]

OBJECTIVE

Restoration of physiological alignment of the distal tibia and thereby restoration of physiological loading of the ankle joint; joint preservation in asymmetric degenerative arthritis of the ankle.

INDICATIONS

Congenital deformities of the distal tibia; acquired deformities of the distal tibia; asymmetric degenerative arthritis with partially preserved cartilage.

CONTRAINDICATIONS

Absolute contraindications comprise severe nicotine abuse, Charcot arthropathy, peripheral polyneuropathy, relevant peripheral arterial vessel disease, poor local soft tissue condition, acute infection and extensive cartilage damage grade 3-4 in the Outerbridge classification in the complete joint.

SURGICAL TECHNIQUE

Medial and lateral open and closed wedge osteotomies and dome osteotomies of the distal tibia are used, and shortening, lengthening and derotating osteotomies of the fibula.

POSTOPERATIVE MANAGEMENT

For 6 weeks, 15-20 kg partial weight-bearing in a below knee cast or a walker orthosis; full weight-bearing depending on osseous healing after 9-12 weeks postoperatively.

RESULTS

Between July 2012 and May 2017, 15 patients (10 men, 5 women) underwent a supramalleor osteotomy. Average age was 41.8 years (range 17-63 years) and the retrospective average follow-up was 28.7 months (range 3-47 months). Mean preoperative AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot score was 54.3 (range 26-86) and postoperatively a mean of 74.2 (44-100). Preoperatively, 9 patients had varus malalignment and 6 patients valgus malalignment; overall, 4 patients developed complications requiring surgical intervention (26.7%). Osteosynthetic material was removed in 60% of the patients.

[Congenital deformities of the hand and upper limb]

Congenital deformities of the hand and upper limb include a significant number of clinical situations. Their expression is, as in all congenital diseases, variable. Therefore, we can almost consider that each clinical situation is a bit unique. The difficulty, as any congenital disease, is the fact that the clinical cases are extremely diverse and difficult to classify. So what to do and surgical strategies are often matter of "School". This is even more true that the evaluation of results is very difficult due to low series (poor statistical value) and functional assessment to be partly due to the growth of the child. It is impossible in a few pages to describe all malformations of the hand and upper limb, summarize the indications and evaluate the results. Also, this chapter is not exhaustive and we will focus primarily on the most frequent pathologies.

The teratogenic effects of imatinib mesylate on rat fetuses

Imatinib mesylate, a selective tyrosine kinase inhibitor, is the first line treatment against chronic myelogenous leukemia and gastrointestinal stromal tumors. The aim of the present study is to investigate the effects of imatinib mesylate on the pregnant rats and their fetuses. Pregnant rats were divided into three groups; the first group served as a control group. The second and third groups were orally administered imatinib at doses of 36 mg/kg body weight or 54 mg/kg b.wt. on gestation days (SDs) 6 through 13 or SDs 13 through 19, respectively. All animals were sacrificed on the 20th day of gestation. Treatment with imatinib caused a reduction of maternal body weight gain, uterine and placental weights, increased rate of abortion and fetal resorptions. High dose of imatinib caused fetal congenital deformities represented in harelip, contraction of the fore limbs, and paralysis of the hind limbs, exencephaly, encephalocoele and distended abdominal wall, besides occurrence of wavy ribs and absence of other ribs in addition to skeletal growth retardation and lack of ossification of the most skeletal elements. The present work concluded that imatinib is teratogenic when given orally to pregnant rats at 54 mg/kg b.wt. and causes direct maternal or developmental toxicity.

Ophthalmic considerations in cleft lip and palate patients

Cleft lip and palate (CL and P) represents the second most frequently occurring congenital deformity after clubfoot deformity. CL and P could be associated with many other structural abnormalities of the adjacent vital structures of the face. In this study, an attempt was made to identify the abnormalities of the ocular structures seen in patients with isolated CL and P as well as in those with syndromic CL and P. Of the 322 patients with cleft lip and palate screened, 27 (8.3%) had ocular abnormalities. Totally 47 ocular defects were identified in 27 patients. Abnormalities of the eyelid were the commonest accounting for 22% of the total defects (11/47), which includes symblepharon, ectropion, lid colobomas, euryblepharon and ptosis. Second commonest abnormality was squint 8/47 (17%) followed by orbital defects 8/47 (17%) (Telecanthus and Hypertelorism). Abnormalities of the nasolacrimal apparatus 3/47 (6%), refractive errors 7/47 (15%), dermoids 4/47 (6%), cataract 2/47 (4%) and retinal colobomas 2/47 (4%) constituted the rest. Thus, children with cleft lip and palate should be assessed as soon as possible after birth by a multidisciplinary team involving the Pediatrician, Ophthalmologist and specialists from Maxillofacial, ENT and Plastic surgery. The medical problems in this group of children are global and therefore, should not be looked at in isolation.

Distraction Osteogenesis in Management of Mandibular Deformities

BACKGROUND

The concept of Distraction Osteogenesis is applied in Maxillofacial surgery extensively in the recent past, revolutionizing the concept of management of facial deformities specially the mandible.

METHODS

This article describes intra oral mandibular distractors in managing mandibular deformities in 9 cases.

CONCLUSION

Surgical intervention is possible in very young patients. Distraction Osteogenosis does not reduce the need for orthodontic intervention. A multifarious approach to the problem, should form the basis of treatment of mandibular deformities.