The International Association of Oral and Maxillofacial Surgeons (IAOMS) is pleased to collaborate with the Asociación Latinoamericana de Cirugía y Traumatología Bucomaxilofacial (ALACIBU) for the IAOMS/ALACIBU NextGen Online Conference.
The abstracts published here are the accepted abstracts, as selected by the conference Scientific Committee, from among submissions in four topic categories: TMJ, Trauma, and Orthognathic Surgery.
Click on the quick link below to view the title and authors of all accepted abstracts.
Primary Author: Bianca Pulino
Coauthor(s): Daniel Nastri de Luca, Henry Garcia Guevara, Robert Alexander Sader, Florian Thieringer, Beat Hammer, Raphael Guerra
Surgical excision can be performed with conventional methods such as scalpel blade, electrocautery, or laser. Scalpels have been the instrument of choice because of their ease of use, precise cutting ability, and favorable wound healing, but disadvantages include lack of hemostasis of the surgical field and increased postoperative pain and edema. Intra-articular management with Diode Laser promotes less bleeding, cleaner and more adequate operative field, significant reduction in postoperative edema associated with direct pain reduction, and better tissue repair. The Diode Laser can be applied in muscle and capsular incision, hemostasis, muscle dissection, tissue ablation of the retrodiscal zone, and elimination of synovitis. The aim of this study is to report a technique using diode laser to perform pre-auricular approach. After skin incision the muscle planes were dissected with Thera Lase Surgery (DMC – São Carlos; Brazil) 980nm surgical diode laser (infrared light) with 600 micrometers in power ranging from 3 to 4 W. Myotomy of the lateral pterygoid muscle was performed using the laser (3W pulsed) until the necessary mobilisation for the correct disc repositioning over the condylar head. After this, the discopexy was performed with anchor and the joint function was checked manually. The use of diode laser to make incisions is an appropriate device due to the suitable biological outcomes for the TMJ tissues. Thus, it can be included in the surgical arsenal as alternative to surgical approaches as well as the bilaminar zone ablation.
Primary Author: Rachel Uppgaard
Coauthor(s): Annika Johnson
A case of a 71 year old man with an 8 week history of malocclusion that developed immediately after eating is reviewed. He sought care from multiple providers prior to obtaining appropriate imaging and definitive diagnosis. Methods: Retrospective chart review reveals a patient with a significant history of tobacco use who presented with occlusion only on his left posterior dentition. A panoramic radiograph revealed a comminuted left mandibular subcondylar fracture with a moth-eaten radiolucency associated on the posterior aspect of the sigmoid notch of the left mandible. A CT scan revealed evidence of cortical expansion and perforation. Labs and chest radiographs were unremarkable. A biopsy was performed via preauricular approach and the occlusion was stabilized via maxillomandibular fixation with hybrid arch bars. Results: The histopathologic result of biopsy included features consistent with a poorly differentiated carcinoma with neuroendocrine features, most likely metastatic small cell carcinoma from the lung. A PET CT following the biopsy revealed lung carcinoma with metastases to bone, brain, and liver. Between initial presentation and definitive diagnosis, he developed symptoms of brain metastases and chemotherapy was initiated for palliation until he succumbed 4.5 months later. Conclusions: This case highlights the importance of thorough radiologic examination with new onset malocclusion. This patient was seen by multiple providers before receiving imaging or referral for definitive diagnosis while his carcinoma metastasized rapidly. When the clinical presentation does not match the history it is vital to consider a systemic approach and obtain the necessary imaging and referrals.
Primary Author:Shivya Chopra
Coauthor(s): Pushkar Waknis
Condylar hyperplasia is a rare disorder characterized by excessive bone growth that almost always presents unilaterally, resulting in facial asymmetry. METHOD A 51 yr old male reported to us with a chief complaint of pain with growing asymmetry on the right side of the face since 2 years. Patient was apparently alright 2 years back when he started experiencing pain with clicking noise on right side of the face while opening the jaw. Pain was mild, dull and continuous in nature which aggravated on chewing and talking. Patient also noticed deviation of lower jaw on the left side on opening the jaw. There was no history of trauma, any systemic diseases, infection or surgery of face or jaw. Clinical and radiologic findings were suggestive of right unilateral condylar hyperplasia. Patient was planned for right condylectomy under general anaesthesia. RESULTS Postoperatively, patient was kept on elastics and was recommended to have soft diet .Histopathology report of patient didn’t mimic any neoplastic change for the lesion of this size which was unusual. Patient was satisfied with the outcome both functionally and aesthetically. CONCLUSION There are several debated methods of treatment of condylar hyperplasia. Clinically and radiological similar representation of condylar hyperplasia and condylar osteochondroma can alter the prognosis tremendously. One can not predict the lesion’s neoplastic behaviour by its clinical and radiographic representation itself and should manage condylar pathologies the same way.
Primary Author: Alexandar Stamatoski
Surprisingly malar bone fractures are some of the most frequently encountered facial fractures. However, the relationships between the trauma etiology, the zygomatic fracture patterns, and patient ages are point of interest. A 10-year (2003-2013) retrospective evaluation of midface fractures was performed in patients diagnosed and treated in a Clinic of Maxillofacial Surgery Skopje. Nominal data were expressed as frequency and percentage. Comparative statistical analyses were conducted and value of p < 0.025 was considered statistically significant In total 284 patients 248 (87%) were males and 36 (13%) females. There was a male predominance, with a male: female ratio of 6.88:1 and mean age was 36.86 years. The highest incidence was in the age group of 21–30 years. Major etiology of injuries was interpersonal violence (41%) followed by road traffic accidents (31%) and accidental falls (21%). Anatomic site-wise distribution of zygomatic bone fractures shows that most common fractured anatomical region was in the zygomatico-frontal suture (41%) and orbital rim (29%). Depending on the type of associated maxillofacial fractures including the zygoma, most of which was nasal bones (4.58%), mandible (4.22%) and maxillary bone (3.88%) fractures of the face. The treatment of zygomatic fractures was: closed reduction (56%); open reduction with internal rigid fixation (31%) and conservative (10%). Only five patients (2%) refused to be treated. Further statistical analysis is needed to obtain more specific data for head and neck traumatic injuries, with or without cranial bone fractures in Covid19 pandemic area to portray the institutional experience from our clinic.
Primary Author: Daniel Prada
Coauthors: Edgar Luque Acuna, Liset Rodriguez
Objective: To characterize the behavior and severity of maxillofacial trauma in patients treated at the Maxillofacial Surgery emergency service of the "General Calixto García" University Hospital, 2018-2021. Material and method: Cross-sectional descriptive observational study carried out in patients who attended the Maxillofacial Surgery emergency department of the "General Calixto García" University Hospital, between September 2018 and March 2021. Universe made up of 57 patients. Facial Injury Severity Scale was applied to determine the severity of the maxillofacial trauma. Variables analyzed: age, sex, etiology, ingestion of alcoholic beverages, diagnoses, complementary tests, severity of maxillofacial trauma, immediate therapeutic procedures. Results: Most represented age groups, 19 to 30 years old and 31 to 40 years old, (64.9%); standing out the male sex (86.0%). Most frequent etiology: interpersonal violence (29.8%). Mandibular fracture prevailed as diagnosis (66.7%). Mild severity of maxillofacial trauma prevailed (71.9%). The extraction of foreign bodies from the airway, lingual traction, oropharyngeal cannula insertion, orotracheal intubation (5.3%), suture (64.9%), were the most used immediate therapeutic procedures. Conclusions: The most affected patients were male and from the age groups of 19 to 30 years and 31 to 40 years. Interpersonal violence was the most frequent etiology. Mandibular fracture prevailed as diagnosis. The most used complementary tests were computed tomography, complete blood count and coagulogram. Mild severity of maxillofacial trauma prevailed. The most used immediate therapeutic procedures were extraction of foreign bodies from the airway, lingual traction, oropharyngeal cannula insertion, orotracheal intubation, suture. Keywords: maxillofacial trauma; Facial Injury Severity Scale; severity of facial trauma
Primary Author:Bamidele Famurewa
Purpose: Contemporary maxillofacial osteosynthesis has become the standard of care in Nigeria. However, there is dearth of literature on the fate of implanted hardware in our nation. Therefore, we sought to examine the rate and indications for the removal of titanium plates following osteosynthesis in maxillofacial trauma patients. Methods: All trauma patients, with maxillofacial fractures who had plates placed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria between January 2013 and January 2022 were included in this study. Patients’ demographics, number and location of plates, duration of implants placement and indications for removal were retrieved and entered into Microsoft Excel spreadsheet. Results: One hundred and nine patients of 381 patients who sustained facial fractures during the study period underwent open reduction and internal fixation using titanium implants. Osteosynthesis hardware were removed in three patients (2.8%) all of who were males. Indications for removal were plate migration and infection (n=1) and asymptomatic removal (n=2; patient’s request and growth concern in a child). Nine plates and 38 screws were removed from the mandible (7 plates and 30 screws) and maxilla (2 plates and 8 screws). Osteosynthesis hardware were removed within fifth month (plate migration and infection), sixth month (growth concern) and two years of placement (patient’s request). Conclusions: Hardware removal rate in our centre is lower than the previously reported rates elsewhere. Indications for removal were plate migration and infection, prophylactic removal in paediatric patient and patient’s wish.
Primary Author: Alvaro Ranz Colio
Coauthor(s): Anna Maria Simon Flores, Alberto Haddad Riesgo, Eduardo Alpanes, Julio Acero Sanz
INTRODUCTION. The surgical management of orbital fractures is usually a challenge. One of the main objectives is to obtain an adequate orbit volume through a correct positioning of the orbital mesh. The main objective of this study is to describe the changes in orbital volumes obtained with the intraoperative navigation (ION) combined with intraoperative CT (IOCT). MATERIAL AND METHODS. A retrospective study including 27 patients with a unilateral orbit fracture from September of 2017 to September of 2021 was performed. A prior virtual surgical planning with BRAINLAB 2.0 system, ION and IOCT were performed. We have measured and analyzed the volumes of the healthy, fractured and repaired orbits to compare them with each other. The t student test for paired samples was used. RESULTS. 27 patients were included, 20 men and 7 women. The median age was 43 years. Most frequent etiologies were aggressions (33%) and falls (29.6%). We used a preformed mesh in 20 cases (74%). 4 patients required replacement of the mesh after IOCT. Preoperative and postoperative orbital volumes of the fractured orbit were compared obtaining a mean difference of 2.821 cm3 (p<0.0003). Comparing the volume of the healthy orbits with the postoperative orbit volume, the mean difference obtained is -0.402 cm3 (p 0.051). CONCLUSIONS. Orbital repairing using ION combined with IOCT provides a significant improvement in postsurgical orbit volume with a great accuracy placing the orbit implant. Intraoperative CT allows a real-time control of the proper placement of the orbit mesh with a low dose of radiation.
Primary Author: Kurdi Salah
Management of complex soft tissue injuries of facial in Libya Salah Eddin M. Kurdi BDS, SOMF, PHDS Dental Faculty- University Of Tripoli Oral & Maxillofacial Surgery Department Abu Slim Trauma Center – TRIPOLI - LIBYA Aim--- To assess the treatment of severe soft tissue injuries in maxillofacial region operated in the department of OMF Surgery, Abu Slim Trauma Center . Materials and methods--- A total study group of 181 patients with severe soft tissue injuries were admitted & operated during the last year. The following parameters were recorded: Type and site of trauma, Age, Gender, Type of management & outcome. Results--- Out of 181 patients, 122 were males and 59 females. Road traffic accidents (RTA) has been the most common etiology of sever soft tissue injuries in 154 patients. The region of the sever soft tissue trauma in 69 patients is frontal area, 41 patients with severe soft tissue trauma in infraorbital region, 22 patients with severe soft tissue trauma cheek region, 13 patients with external ear trauma, 8 patients with severe soft tissue trauma in nasal area, 10 patients with skin defect in maxillofacial area, and 18 patients with severe multiple facial soft tissue trauma. Conclusion--- Most of the patients with severe soft tissue trauma often requires individual treatment plan (91%). In civilian life, severe soft tissue trauma is often associated with RTA and subsequent injury is usually severe and consists of multiple damage (85%). Most of the patients with severe soft tissue injuries require definite soft tissue rehabilitation with a combined multidisciplinary approach.
Primary Author: Alice Soares Goncalves
Coauthor(s):Wanderson Ferreira da Silva Junior, Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral, Alice Soares
Purpose: Penetrating facial trauma may be associated with the presence of organic and/or inorganic foreign bodies and presents several clinical challenges, specially when involving the orbital area. Its etiology includes interpersonal violence, accidents and self-harm. The present study aims to describe a case series of five patients inflicted by large foreign bodies penetrating its orbital structures. Methods: Five patients were referred to the emergency unit of João XXIII Hospital, a level 1 trauma center, requiring emergency surgical procedures due to large penetrating orbital trauma by impacted foreign bodies. Results: The majority of patients (60%) were victims of interpersonal violence with knives, all from the male gender, except a woman victim of a feminicide attempt by her abusive ex-husband. The mean age was 28.6 and only two patients presented visual acuity of both ocular globes preserved, showing no visual sequelae associated. Nevertheless, one of them died 7 days after trauma, which was a car accident, due to the severity of the multiple traumas in his body. Despite this, all cases were treated successfully, with uneventful postoperative periods. None of the patients had enophthalmos after treatment, showing a satisfactory aesthetic and functional outcome. Furthermore, no secondary surgical interventions were performed due to lack of need or to the patient's choice. Conclusions: The main complications of impaled foreign bodies into the orbits is complete or partial blindness and poor ocular movements. The challenging treatment requires a thorough initial assessment and planning by an experienced team to minimize its sequelaes.
Primary Author: Kishore Kumar
Coauthors: Sivanagendra Yaratha
AIM: Persistent oronasal fistulas after midfacial trauma are rarely reported in the literature. The aim of the study was designed to evaluate results of persistent palatal fistula closure using Bardach’s palatoplasty technique but raising the flap on one side only to close the defect MATERIALS and METHODS: A study was conducted from January 2019 to December 2021. A total 11 cases (all male patients) were included and managed by Bardach’s palatoplasty technique. The technique consists of endotracheal intubation under general anesthesia, the fistula was isolated and granulation tissue was removed. oral and nasal layers are separated .single flap was raised as per the technique of Bardach,from the nonfracured side of palate .palatal flap transposition done medially to close the fistula without any tension and followed by closure of nasal and oral layers. RESULTS AND DISCUSSION- In all the cases the results were very good without any recurrence of fistula or problems associated with flap. The palatal fistulas of post traumatic origin (midline/paramidline) are usually longitudinal in nature. . The main advantage in trauma patients is that usually patients are adult with well-developed palate and mucoperiosteum and defects are usually more anteroposterior than transverse. There is a natural tendency for retraction of flaps in clefts, which is absent in trauma patients. CONCLUSION: The results are encouraging with promising results. Newer procedures like bone morphogenic proteins, acellular dermal matrices, human amniotic membrane, and distraction osteogenesis may be useful in future for treating oronasal communication.
Primary Author: Jared Akers
Coauthor(s):Caleb Hardman, Arjun Kumar, Hisham Marwan
Purpose: Post-traumatic deformity of the zygomaticomaxillary complex (ZMC) fractures with orbital involvement remains a challenge to surgeons. Achieving pleasing esthetic and restoring normal function is far more complex in post-traumatic deformity than primary repair. Our goal was to evaluate the role and utilization of virtual surgical planning (VSP) in the treatment of post-traumatic deformity of the ZMC with enophthalmos. Methods: This retrospective case series included patients with established ZMC deformities with orbital involvement due to delayed treatment or inadequate initial surgical repair. All patients reported one or multiple of the following deficits: diplopia, malocclusion, asymmetry, or loss of facial projection. Virtual surgical planning was performed in conjunction with a biomedical engineer to fabricate intra-operative surgical guides and custom mid-face plates. Also, mirroring techniques of the unaffected side across the midline provided a baseline for landmarks. Preoperative and postoperative orbital volumes were measured. In addition, the symmetry of the face was compared postoperatively using the same surgical planning system to assess the adequacy of the reconstruction. Results: Successful outcomes were based on functionality and esthetics that were favorable and predictable. This case series demonstrated patient-reported improvement of vision deficits, malocclusion, and correction of cosmetic concerns of cheek projection and symmetry. Achieving symmetrical orbital volume and facial contour were confirmed using the postoperative VSP. Conclusion: VSP is a valuable adjunct in treating complicated post-traumatic ZMC in deformities. Success with VSP allows for predictable outcomes during the intraoperative judgment of projection, facial symmetry, and restoration of the orbital volume.
Primary Author: Bianca Pulino
Coauthor(s):Daniel Nastri de Luca, Henry Garcia Guevara, Raphael Guerra, Robert Alexander, Florian Thieringer, Beat Hammer
Purpose: The facial skeleton in pediatric patients can undergo several changes during development, according to their growth zones and the traumas they suffer. Facial fractures in pediatric patients are rare when compared to the adult population. Most cases of craniofacial trauma in children result in soft tissue and dentoalveolar injuries. The rate of facial fractures is approximately 15% in the child population, with school age being the peak incidence and affecting children over 5 years of age in most cases. In adolescents, the mandible is the most commonly fractured structure, while in children (0 to 11 years), orbital fractures are more common. Thus, some of these traumas can lead to multiple complications if not treated properly. The present study aims to report a clinical case of child, who suffered trauma and evolved with fractures of the facial bones. Surgical treatment was instituted to reduce and repair fractures, using the resorbable system. The patients are followed up with periodic outpatient follow-up visits and have a good evolution of the case. The use of resorbable fixation materials in facial fractures of pediatric patients is widespread, with good acceptance and great advantages over conventional titanium materials, mainly for the elimination of a second surgery to remove the materials. Thus, some of these traumas can lead to multiple complications if not treated properly. The epidemiology may vary according to everyone's social, cultural, and environmental aspects. Therefore, each case must be treated individually, and it is important to consider age-specific aspects, such as the high osteogenic potential, which leads to faster bone healing.
Primary Author: Afrah Aldelaimi
Background: Surgical treatment of pediatric maxillofacial region is a complex and challenging task to maxillofacial surgeons. Incorrect and inappropriate treatment of trauma will end with secondary deformity that is very difficult to correct. Objectives: This study discusses types of pediatric maxillofacial injuries and evaluates the management of child patients with injuries to the maxillofacial region using pyriform suspension in Anbar Province, Iraq. Materials & Methods: Twenty-eight child patients with maxillofacial trauma were seen at Maxillofacial Surgery Department at Ramadi Teaching Hospital; including 21(75%) boys and 7(25%) girls. Age, sex, etiology, associated injuries, pattern of fractures and treatments were reviewed. Results: Road traffic accident was the most common cause for pediatric facial trauma, mandibular trauma was found in 13 children while Midfacial trauma was found in 15 children. Conclusions: Significant advances have been made in the management of these injuries, decreasing the incidence of secondary deformities
Primary Author: Bianca Pulino
Coauthor(s):Daniel Nastri de Luca, Henry Garcia Guevara, Robert Alexander, Florian Thieringer, Beat Hammer, Raphael Guerra
Orbital fractures are common facial injuries that usually occur in patients diagnosed with zygomatic-orbital fractures and can be classified as pure blow-out fractures or be part of panfacial injuries. Orbital wall fractures occur through the two main mechanisms, by impact on the soft tissues and impact on the solid structures of the orbital wall. Medial orbital wall fractures usually involve the lamina papyracea of the ethmoid bone, which is the largest and thinnest component, and is responsible for the most vulnerable part of the medial wall of the orbit. This paper aims to describe a series of 3 clinical cases of orbital reconstruction, mainly roof and medial wall fractures of the orbit reconstructed using titanium mesh and to address the possible complications in this type of treatment. The ideal material for orbital wall reconstruction would be material with periorbital properties that leads to separation of the mechanical aspects of the orbital fat and carbon support structure. There are many materials for reconstruction available and it is the authors' opinion that these softer inert materials such as titanium meshes are suitable materials for the repair of orbital wall fractures and with very satisfactory results. The results of our experience and evaluation of available reports in the literature conclude that titanium mesh can provide more accurate reconstructions than bone grafting. The reason that titanium mesh has provided better results in reconstructions is due to the ease with which the mesh can be shaped to fit the intricate contours of the internal orbit.
Primary Author:Carolina Effenberger
Background: El granuloma central de células gigantes (CGCG) También conocido como Lesión central de células gogantes, es una lesión osteolítica localizada, benigna pero a veces agresiva de los maxilares caracterizada por células gigantes de tipo osteoclasto en un estroma vascular. Tenemos como objetivo realizar tratamientos lo más conservadores, mas en esta patología que puede tener una presentación agresiva e invasiva. La etiología no está clara. El 70% surgen en la mandíbula. La mayoría de los (CGCG) son asintomáticos, con una expansión lenta, asintomáticas, sin perforación del hueso afectado, y sin reabsorción dentaria. El 30% de los casos sigue un curso clínico agresivo caracterizado por dolor, reabsorción y desplazamiento dentario, perforación cortical e invasión de los tejidos perimaxilares, tendencia a la recidiva. Radiográficamente aparecen como defectos radiotransparentes, uniloculares o multiloculares. Los regímenes de tratamiento deben guiarse por la clasificación de la lesión como agresiva o no agresiva. Para una (CGCG) agresiva, la resección con márgenes histológicamente claros es generalmente un tratamiento eficaz. El riesgo de recurrencia asociado con la pérdida de dientes, daño al nervio alveolar inferior e implicaciones nasales y sinusales, ha llevado al desarrollo de tratamientos no quirúrgicos y adyuvantes. Se presenta paciente de sexo femenino de 42 años, con diagnóstico de (CGCG) agresivo en maxilar superior, con invasión de fosas nasales y seno maxilar del lado izquierdo, a la que se le realizó en primera instancia un tratamiento no quirúrgico con inyecciones de corticosteroides intralesionales, luego curtaje y enucleación de la lesión, con una evolución favorable, sin recidivas.
Primary Author:Stefania Requejo
Purpose: evaluate the different treatments for ankylosis from the coronoid process to the zygoma after trauma. Methods: a systematic review was conducted following PRISMA statement, based on a PICO question. The data bases PubMed, Embase, Sciencedirect, Cochrane, Google Scholar were consulted , and manual search in high impact journals between 1946 and 2020, publications in English or Spanish, including randomized and non-randomized clinical trials, prospective and retrospective cohort studies, case-control studies, series, and case reports were included. Results: A total of 1993 articles were obtained from 4 databases, 15 were selected. The total number of patients between the articles if 26, of which 44.11% (n = 15) belong to the male sex, 8.82% (n = 3) to the female sex, and the age range was calculated at 28.08 years with the data presented by 69.23% (n = 18) of the patients. 53.84% (n = 14) of the patients presented bone ankylosis, while 15.38% (n = 4) presented fibrous ankylosis. 26.92% of the patients underwent coronoidectomy, 19.23% coronoidectomy + osteotomy, 7.69% bilateral coronoidectomy + osteotomy, 3.84% condylectomy + osteotomy, 3.84 % coronoidectomy + zygoma bone remodeling, 3.84% osteotomy, 3.84% mandibular ramus osteotomy + interpositional silastic. Conclusions: after evaluating the different treatments described in the literature, we can determine that coronoidectomy through an intraoral approach is the most appropriate treatment for zygomatic coronoid ankylosis, accompanied by postoperative physiotherapy that must be started the day after the surgical procedure to achieve greater mouth opening without recurrences.
Primary Author: Agustin Vallejo
Coauthor(s): Alejandro Alonso Moctezuma
Zygomatic implants are longer than conventional ones, this is because these implants are placed in (as their name suggests) in the zygomatic bones. They have very good results and are indicated mainly in patients whose remaining bone does not allow the placement of conventional implants. However, sometimes; For various reasons, the implant of the length required for rehabilitation is not obtained and alternatives must be sought. Objective The objective of the present work is to report the use of conventional implants instead of zygomatic implants in a patient who previously underwent a total maxillectomy. Method A 58-year-old male patient, who previously underwent a total maxillectomy for mucormycosis, in the department of oral and maxillofacial surgery of the DEPeI UNAM with 16 months of follow-up, comes for his rehabilitation; the same one that was planned with zygomatic implants, however, implants of the planned length were not available in Mexico, so four conventional implants were placed with the aim of restoring as much as possible the masticatory function and the cosmetic defect caused by surgery. Results Currently, the patient is undergoing aesthetic and functional prosthetic rehabilitation as far as possible, because two implants are without function due to the little bone remnant due to surgery. Conclusion Conventional implants can be used as zygomatic; however, as they are normally used in patients with little bone remnant, long-term stability may be compromised and rehabilitation may become somewhat more complicated.
Primary Author: Rolf Ewers
In 1892 Wolff first described the bone adaptative response to functional changes and Frost published 1960 his mechanostat hypothesis. Mueftue could show with his Finite Element Analyses the differences in implant motion in different loading situations of short and long implants. As short implants show minimal motion due to transverse crown movements, we find in our radiological evaluations remodeling phenomena and marginal bone gain. These findings confirm the theories of Wolff and Frost and are an argument to use short implants. We have published our results with our more than 11 years’ experience with SHORT® implants. In this lecture we will show the results of our statistical analyses of the radiological measurements of bone remodeling with the grey scale value (GSV) and bone gain of the Marginal Bone Level (MBL). Besides the treatment of the atrophic jaw bones, we will demonstrate our results of treating free fibula grafts with SHORT ® implants and TRINIA ® prosthesis Also, we have treated elderly patients older than 65 years with atrophic jaws we have recorded an increase of GSV, indicating a lower translucency of bone and therefore a higher degree of mineralization and marginal bone gain (MBL) which is only explainable due to functional response to adequate load of the implants in connection with the elastic splinting system of the TRINIA prosthesis. Our results confirm the postulated laws by Wolff and Frost that “bone follows function”.
Primary Author: Charudatta Naik
Coauthor(s): Sanjay Joshi
Purpose: The inner cambium layer of the human periosteum contains several progenitor cells. Placing a barrier membrane over the grafted bone to prevent fibrous ingrowth acts as a hindrance for the migration of these cells to lay down new bone. Therefore, this study is undertaken to compare bone augmentation using autologous periosteum and resorbable collagen membrane. Methods: Eight patients with ten osseous defects requiring lateral ridge augmentation for dental implant placement were enrolled in the study. Lateral ridge augmentation was done using a mixture of autogenous and alloplastic bone graft (β-TCP). In the control group, this graft was covered with Type 1 collagen bioresorbable GBR membrane (5 cases). In the experimental group, this bone graft was covered with autogenous periosteum. Postoperative Pain and swelling were assessed on day 1, 3, 7, and 21. Radiographic evaluation was done using cone-beam computed tomography (CBCT) at 3rd and 6th month. Results: The difference in pain and swelling scores was not statistically significant in the two groups on day 7 and 21. Pain scores were higher in the experimental group on day 1 and day 3 whereas swelling was higher in the control group on day 3. CBCT showed marked improvement in the grey value and Hounsfield unit at 3rd postoperative month in the experimental group which was statistically significant. Conclusion: Within the limitations of the study, we can conclude that autogenous periosteum is a better alternative to xenogeneic membrane as it results in faster bone regeneration which allows earlier placement of the implants.
Primary Author: Arnun Jukisalapong
Background: Patients who lose natural teeth will undergo to have a prosthesis for natural teeth replacement. Nowadays, there are many dental prostheses, especially dental implant treatment is the gold standard for teeth replacement. Objective: This study aimed to understand the patients in rational and emotional issues that cause patients’ decision for choosing dental implant treatment replacing natural teeth by using the motivation and behavior theory to assess the patient's decision-making. Methods: In this study, questionnaires were administered to 220 patients who lost their teeth. The researcher explained the detail of the dental implant procedure to the patients before collecting the data. The questionnaire was divided into rational issues and emotional issues for choosing dental implants replacing natural teeth by using motivation and behavior theory. The questionnaires used 5 points Likert scale to collect the data. Results: The questionnaires were collected. The rational and emotional issues scores were high and differences in no statistically significant at the 0.05 level. The prediction of a patient’s decision-making shows that motivation issues can predict the decision-making and the forecasting equation is Decision = 3.584 - 0.018 Rational + 0.112Emotional. Conclusion: Patients with losing their teeth had a higher decision-making level in emotional issues than a rational issues for choosing dental implants treatment. In dental implant procedures, many patients don’t have experience with the treatment causing the patients to use emotion about the environment, friend experience, the reputation of the dentist more than the rational issue of treatment.
Primary Author:Nicolas Solano
Coauthor(s):Ariamay Castrillo, Arianny Peraza, Ejusmar Rivera
Purpose: To describe a stepwise drilling protocol for the placement of dental implants that allow achieving ideal primary stability and subsequent prosthetic rehabilitation. Methods: A 62-year-old male patient, who came to the clinic with a chief complaint of partial maxillomandibular edentulism. A CBTC was requested, where bone densities between D3 and D4 were evidenced. Digital planning was carried out using the NemoScan program for the placement of twelve dental implants, six in the upper jaw and six in the lower jaw, using the sequence of conventional drills and the stepwise protocol, which consists of using, after the initial drill of the same length as the implant, the following drills in ascending diameters with a shorter length than the previous drill, allowing better primary stability to be achieved. Results: After the placement of the implants, torques between 50 and 60 N/cm in the mandible and 30 and 55 N/cm in the maxilla were obtained. Provisional prosthesis was installed. In the control at 4 months, a correct osseointegration was evidenced, without clinical evidence of peri-implantitis. Conclusions: When dental implants are placed in areas where low bone densities are present the success of the surgery and the survival of the implant with conventional drilling can be compromised. A good selection of the drill protocol to be used must be made and adequate planning of the case must be carried out. The stepwise drilling protocol represents a good treatment option to increase primary stability in low bone densities, with a high percentage of predictability.
Primary Author: Fernando Almeida
Coauthor(s): Alvaro Ranz Colio, Angela Bueno-deVicente, Patricia de Leyva, Julio Acero
Introduction: The maxillary sinus lift with bone graft to insert dental implants in patients with bone atrophy in posterior sectors of the maxillary, has become a standard and common procedure in oral and maxillofacial surgery. Although the use of autologous bone is considered the gold standard technique, several biomaterials are currently used that obviate the disadvantages of autologous grafts, allowing the placement and use of implants with high long-term success rates. One of the most widely used biomaterials is the deproteinized bovine bone mineral matrix in the form of granules (Bio-Oss ®).Objectives: To show our experience in the technique of maxillary sinus lift with the use of demineralized bovine bone mineral matrix for the placement of dental implants.Material and methods:We present the study of a serie of 513 patients in which we performed 628 maxillary sinus lift with open technique and lateral approach using Bio-Oss® as filling material and subsequent placement of 1194 dental implants simultaneously or in a second phase.Results: A total of 628 cases were performed (in 549 cases, the implants were placed in the same surgical act and in the remaining 78 they were placed in a second surgical act) during the period between October 2004 and February 2020. A total of 1194 implants were placed, with a final loss at 5 years of 47 implants (3.93%).Conclusions: The maxillary sinus lift to place dental implants in atrophic bone using Bio-Oss® as a filling material is a reliable technique with predictable long-term results as evidenced by our study.
Primary Author: Felipe Afonso
Coauthor(s): Bruno Quinta Reis, Fernando Elias
Introduction: 3D virtual simulation turned possible the systematic performance of complex surgical procedures with high predictability. For this, a standardized protocol is needed and should present good reproducibility and ideal accuracy results. Purpose: The purpose of this study was to assess the accuracy of an innovative virtual planning protocol for orthognathic surgery, the Universal Protocol. This protocol presents important innovations: (1) Its greater appeal is to substitute devices and technological resources for simpler solutions, such as the positioning of the composite skull through the standardized clinical photographs sequence (2) and the superposition of the dental cast images directly to the tomography without external fiducial markers. (3) Tomography is performed with the patient’s mouth slightly open, keeping the mandibular condyles on its rotational terminal axis. The CT condylar segment is preserved, which increases the control on movement and position of the condyle during all surgical simulations. Methods: The accuracy was assessed by comparing the planned with postoperative outcomes of 35 consecutive patients. Computer-generated surgical splints were used for all patients. Differences between the planned position of the maxilla, mandible, and chin and the actual surgical changes were measured. The prediction accuracy was assessed using root mean square deviation (RMSD), surface color maps, and the Bland-Altman method. Results: The largest RMSDs were 1.32 mm, 2.18° for the maxilla and 1.66 mm and 2.18° for the mandible, and 0,97mm for the maxillary dental midline. Conclusions: Universal Protocol transfers the computerized planning with reasonable accuracy and consistency during surgery.
Primary Author: Samuel Costa
Coauthor(s): Bruna Campos Ribeiro, Guilherme Lacerda De Toledo, Marcio Bruno Figueiredo Amaral
Purpose: To compare three techniques for alar cinch sutures for nasal width maintenance on bimaxilar orthognathic surgery. Methods: A double-blind randomized clinical trial was proposed in order to compare the conventional alar cinch suture with the hybrid, that is anchored on the subcutaneous tissue and the one that is anchored on the synthesis material. All the patients were enrolled with the indication for bimaxillary orthognathic surgery. The alar base was measured at the pre-op, and at immediate post-operative time, 30, 60,90,120 and 180 days of postoperative time. Comparative statistical analysis were performed in order to address the better choice for the control of the nasal base musculature. Results: A total of 24 patients were enrolled and subdivided in their groups. The hybrid technique presented better control of the alar base region, p=0,037. In addition to that, the others techniques did not were effective in the prevention of the nasal enlargement, with an average increase of at least 2mm wide. Conclusions: To date, there still no agreement on the gold-standard technique for the management of the muscles around the piriform aperture on orthognathic surgery. This study suggest that the hybrid one, anchored on the subcutaneous tissue present the better results, avoiding the nasal width enlargement. In the other hand, There are still need for more studies, specially those comparing the hybrid alar cinch suture with the subspinal osteotomy.
Primary Author: Julie Johana Franco Rodriguez
Coauthor(s):Jose Martinez, Jose Antonio Garcia Pina
The facial deformities that remain as sequelae of syndromic and non-syndromic, traumatic, and post-surgical craniofacial defects, constitute a challenge in the treatment, physical and psychological recovery of patients. Throughout history, several invasive and non-invasive surgical techniques, with their related complications, have been reported. Camouflage surgeries consisting of rhinoplasty, mentoplasty, and management of facial contours for patients with dentofacial anomalies have been widely described, in addition, management with the injection of different substances or materials improves the aesthetic and functional appearance. The application of autologous fat grafting has been detailed in patients without defects, with favorable results, low rates of complications, and developing techniques that are easy to reproduce. However, graft retention is affected by the quality of harvested adipocytes and the amount of adipocyte necrosis secondary to damage during harvesting, processing, and transfer. The presentation of a series of cases of patients of the pediatric maxillofacial surgery service of the Hospital del Niño Morelense with the presence of craniofacial defects as a sequel to the management of the underlying pathology is made. In which complementary managements consisting of camouflage surgeries and fat graft placement are carried out to restore the facial aesthetic units and improve the psychological and aesthetic conditions that allow him to reintegrate into social life.
Primary Author: Julie Johana Franco Rodriguez
Coauthor(s): Jose Martinez
Macrostomy or Tessier 7 fissure is a malformation that represents approximately 5.5% of facial fissures, predominantly unilateral with or without other anatomical alterations. Bilateral macrostomy is not very common and is not related to other syndromic alterations. The etiology and pathophysiology are associated with alterations in the fusion of the first brachial arch and the presence of a mechanical barrier with the persistence of the amniotic band. Different surgical clinical managements for unilateral macrostomy are reported in the literature, however, there are no clear guidelines for the reconstruction and management of wide bilateral macrostomy, instead, the generalized parameters for the reconstruction of the fissure are described. The presentation of the clinical case of a male patient with a diagnosis of bilateral macrostomy wide, the persistence of the amniotic band and compromise of bone structures is made, describing the prenatal diagnosis, the examinations and previous multidisciplinary management, the early surgical management, and the follow-up at 6 months after the procedure.
Primary Author: Siamak Khabaz-Saberi
Coauthor(s): Peter Ricciardo
Background: Obstructive sleep apnoea (OSA) is a complex disease that involves collapse of the upper airway during sleep, subsequent abnormal reduction or complete cessation of airflow. OSA is one of the most common medical disorders in the general population. Adult prevalence ranges from 9% to 38%, higher in men and the older population1. Sleep disorders cost the Australian economy $45.21 billion2. OSA is underdiagnosed and undertreated in Australia. Aims: Evaluate health practitioners and general public’s knowledge of OSA risk factors, screening, clinical signs, treatment– surgical vs non-surgical including maxillomandibular advancement (MMA) compared to uvulopalatopharyngoplasty (UPPP). Secondary aims - increase knowledge of participants and stimulate referral, multidisciplinary (MD) assessment and management. Methods: This 28-question quantitative online survey evaluated the knowledge of adult and paediatric OSA amongst health professionals and members of the general public across Australia. Results: There were 420 participants, 80% (n=335) registered health practitioners 33% (n=138) involved in the assessment or treatment of OSA practitioners. 70% of dentists and dental specialists were aware of MMA. 78% of critical care physicians were aware of UPPP compared to 50% aware of MMA. Most groups performed well in sign and symptom recognition of individuals with OSA. Conclusion: Most participants are uncertain regarding surgical interventions efficacy. Critical-care and physician's favour UPPP over MMA. Less than 46% of all participants believe retrognathism is associated with OSA – either due to believing in no association or unawareness on how to diagnose retrognathism. OSA knowledge deficits exist and it continues to require MD assessment and management.
Primary Author: Michael Joachim
Coauthor(s): Yair Brosh, Murad Abdelraziq, Amir Laviv, Imad Abu El Naaj
Background and aim: Prediction of soft tissue movement in orthognathic surgery is a great challenge, with possible numerous factors affecting the degree of soft tissue movement. The aim of this study is examine whether the thickness of the preoperative soft tissue affects the degree of soft tissue movement relative to the hard tissue movement after orthognathic surgery. Materals and Methods: This is a retrospective examination of lateral cephalometric X-rays of patients who underwent orthognathic surgery in one Medical Center in a period of 5 years (2013-2018). Soft tissue thickness was measured pre-operatively and superimposed on postoperative (>6 months) cephalometric X-rays by overlapping fixed bony landmarks. Linear regression was used to examine the correlation between the various variables. Results: In the maxilla, there was a decrease in the relative movement of soft tissue with an increase in the initial thickness in surgeries performing advancements up to 5 mm (r=-0.288). In mandibular advancements, there was a decrease in soft tissue movement ratio with an increase in the initial soft tissue thickness (r=-0.418). Same correlation was found in advancement genioplasty (r=-0.411). There was no correlation in the mandibular setback and >5mm maxillary advancement. Conclusion: This research shows a general pattern of a decrease in relative movement of the soft tissue in orthognathic surgery correlated to an increase in its initial thickness.
Primary Author: Luciano Engelmann Morais
Coauthor(s): Lucas Galvagni, Mauricio Demetrio
Facial asymmetry presents as a permanent surgical challenge in the treatment of dentofacial deformities. When associated with active or potential unilateral condylar growth or tumor processes in the mandibular condyle, the effort for correct diagnosis, ortho-surgical treatment and postoperative recovery increase considerably. With the evolution of diagnostic imaging methods and 3D virtual simulation, this process has improved, being available to surgeons familiar with minimally invasive surgical techniques and imaging technology. In addition, the strategy of reduced recovery time, a trend towards oral and maxillofacial surgeries, is emerging as a new reality. Two cases of condylectomy performed by intra-oral surgery approach only are presented with specially detailed descriptions of the technical goals and pitfalls which the young surgeon must have in mind. First one was a low condylectomy without coronoid process removal to remove a tumoral lesion diagnosed as Osteochondroma in an adult patient who sustained 20 years of temporomandibular joint pain and facial asymmetry. The second was a proportional guided condylectomy with coronoidectomy with the aim of balancing the two mandibular ramus of a severe facial asymmetry in a young adult patient. The sequence of pre-operative preparation, minimally invasive orthognathic surgical technique and shortened recovery time are the aim of this work. Both cases are under close follow-up with optimal esthetic and functional results.
Primary Author: Nazlie Taheri
Coauthor(s): Allen Huang
Introduction: With recognized anatomical and physiological differences between males and females, it is critical to describe outcomes of sleep surgery with respect to gender. The objective of this study is to compare surgical success of Maxillomandibular Advancement (MMA) surgery with respect to gender and age. Materials & Methods: A retrospective chart review of patients with Obstructive Sleep Apnea (OSA) undergoing MMA was completed from 1/1/2013 to 12/31/2021. Post-operative apnea hypopnea index (AHI), oxygen desaturation index (ODI), lowest oxygen saturation (LOS), and Epworth Sleepiness Scale (ESS) were analyzed. The groups were matched for age (±5 years) and pre-operative BMI. Results: 51 subjects met inclusion criteria (16 females: 35 males). Of the females 6 were post-menopausal. The average male pre-operative AHI, ODI, LOS, and ESS were 49.3± 26.4, 32.5±22.8, 81.5±10.2, and 10.2±5.8 respectively. Post-operative results were 11.5±8.9, 7.5±5.9, 86.9±4.2, and 6.1±5.2. Pre-operative values for females were, 30.5±22.2, 12.7±10.2, 87.5±7.6, and 12.8±6.9 respectively. Post-operative values were 12.7±14.3, 8.9±14.1, 88.2±5.3, and 7.0±5.0. Independent paired t test reveals average AHI reduction in males was significantly higher, 37.8± 25.1 compared to 18.3±20.8 in females (p<0.006). When matched for age, average AHI reduction for post-menopausal females was 16.3±29.5 and 49.8±30.9 in male counterparts (p<0.05). The average ESS reduction in males was 3.1±3.2 and 6.2±5.3 for females(p=0.16). Conclusions: In this cohort, post-menopausal women have lower surgical success rate (Sher’s criteria) after MMA compared to male counterparts when matched for age and BMI. Thus, surgical treatment modalities must address patient age and gender as risk factors.
Primary Author: Luciano Engelmann Morais
Coauthor(s): Mauricio Demetrio, Lucas Galvagni
Orthognathic and Orthofacial surgery with a minimally invasive approach represents today a trend with the potential to become the future standard in this area of Oral and Maxillofacial Surgery. Genioplasty bone surgery, for instance, has the need for precise tridimensional positioning of the osteotomies and the goal of achieving optimal esthetic results based on the new location of the distal bone segment. To achieve this objective, different surgical approaches are presented in this paper, including: guided surgery, guided surgery with guided bone repositioning and non-guided surgery. Every technique was done with a minimally invasive approach to undergo surgery and heal within the fast recovery protocol. Customization initiatives such as osteotomies guides and bone fixation plates adjusted specifically for each patient have been presented, seeking to faithfully simulate and reproduce the planned movement in the patient. Four different cases are presented: two with the actual state of development of osteotomy cutting and repositioning guides of our group and two cases with non-guided surgery osteotomies for genioplasty. Every case was performed with a minimally invasive approach. Future developments for affordable and reliable techniques for genioplasty are discussed.
Primary Author: Camilo Toscano
Coauthor(s): Beatriz Eugenia Mejia Florez
Background: Facial feminization is one of the pillars of gender confirming surgeries and it can improve mental health-related quality of life of transgender patients. Purpose: To review current literature on facial feminization surgery in patients with dentofacial deformities who are transitioning from male to female, and to present a case of a Class III trans woman who required orthognathic surgery and facial feminization procedures. Methods: A review of the literature was carried out, initially finding 19 articles and afterwards a reverse search was carried out through the articles of interest. Results: Orthognathic surgery is crucial to correct dentofacial deformities, and it must be carefully planned in order to achieve a more feminine appearance. In our patient, a maxillomandibular advancement and counterclockwise rotation were performed due to a hyperdivergent and leptoprosopic face. Additionally, a modified genioplasty, gonial angle reduction and malar implants were performed in the same procedure. 3D model printing of the middle third helped to select and shape porous polyethylene intraoperatively to reduce contact with the patient's soft tissues and decrease the risk of infection. Virtual surgical planning addressed the dentofacial deformity and helped to design the modification of the genioplasty for transversal reduction and advancement; and design the osteotomies for the gonial angle reduction. Conclusions: The combination of the procedures helped to get a more rounded and smoother facial appearance desirable to a trans woman. The correction of dentofacial deformities can be combined with additional feminization procedures to get better outcomes.
Primary Author: Renato Isufi
Piezosurgery positive outcomes in orthognatic surgery (Poster) Orthognathic Surgery Renato Isufi1, KSU – University Dental Clinic Keywords: Piezoosteotomy , Bimaxillary Surgery , Orthognatic Surgery Objectives Piezosurgery device was developed for atraumatic cutting of bone by ultrasonic vibrations in oral surgery , but in the last two decades from the literature was shown that piezoelectric devices are very good inidcated in Maxillofacial Surgery and Orthognatic Surgery. Materals and Methods In this presentation we will disscus 15 cases of bimaxillary surgery operated with piezosurgery. Results Compared to burs and saws , piezoosteomtomy showed a significiant intraoperative blood loss reduction but the surgical procedure duration was longer and with higer cost and special training. In bimaxillary surgery with piezosurgery was shown a lower incidence of postoperative hematoma,swelling and nerve impairment. Conclusion In bimaxillary surgery piezodevices achive better results compared to traditional osteomties instruments.Piezosurgery is less agressive and safer.
Primary Author: Armin Makki
Coauthor(s): Tina Meisami
Maxillomandibular advancement surgery (MMA) is an alternative treatment for moderate to severe OSA in patients unable or unwilling to adhere to CPAP therapy. MMA is an effective and safe treatment in resolving OSA with reported success rates of 85%. However, there remains the issue of success predictability in 15% of patients in whom MMA surgery may not prove to be effective. The purpose of this study was to assess the feasibility of using MAD and DISE pre-operatively as diagnostic tools to predict MMA success and to determine the target mandibular advancement position. Nine patients diagnosed with moderate to severe sleep apnea underwent maxillomandibular advancement surgery. Prior to MMA surgery, the therapeutic/target position of maxillomandibular advancement was determined by using temporary MAD with concurrent Home Sleep Testing (HST). Data from dynamic MAD therapy was used to assess the degree of maxillomandibular advancement required to significantly reduce AHI. All tolerant patients responded to MAD therapy, with an optimal protrusive range=55.1%±16.1% (MEAN±SD) of maximum protrusive range. Trends in data suggest that the degree of maxillomandibular advancement based on measurements from MAD therapy can be implemented in order to predict the success of MMA and to exclude potential non-responders. Pre-operative assessment and workup with MAD and HST to identify the ideal mandibular position is a feasible and safe method for determining the efficacy and success of MMA surgery. Furthermore, concurrent testing with drug induced sleep endoscopy is required to mitigate the risk of operating on potential non-responders and to optimize surgical planning.
Primary Author: Wanderson Ferreira da Silva Junior
Coauthor(s): Alice Soares Goncalves, Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral, Samuel Costa
Purpose: Virtual surgical planning (VSP) in orthognathic surgery increase efficiency and precision through preoperative multidimensional visualization of the movements, allowing the design of instruments to guide surgical practice. In addition to that, the time optimization allowed the virtual planning to widespread its use, among unexperienced and experienced professionals. The purpose of this study is to evaluate the influence of experience on the use of virtual planning in orthognathic surgery. Methods: Two professionals, one with ten years of experience in virtual planning and another with no experience received full data of 10 Class II woman. Photographs, tomography, facial analysis and patient wishes and expectations with orthodontic records. The virtual plannings were executed on the Dolphin Software (Dolphin Imaging and Management Solutions, Chatsworth, CA) on different dates. The performed movements were organized in a table and compared in concordance coefficient. Results: Different patterns of agreement were observed.The condyle axis and movements linked to the anteroposterior positioning of the maxilla were the ones that showed the greatest agreement between operators. The gonial positioning was considered the one with the lowest relationship among surgeons, while again the anteroposterior movements were the most corresponding for the mandible. On average, maxillary movements showed substantial agreement, 64%, while mandibular movements showed moderate values, 52%. Conclusions: Virtual surgical planning did not make the less experienced surgeon perform the same movements as the experienced surgeon. Personal experience associated with the process of facial analysis of each professional to conduct the planning plays a fundamental role for virtual planning.
Primary Author: Jorge Antunez Trevinao
Coauthor(s): Jose Martinez
Purpose: The purpose of this specific case report is to expose a patient in the Hospital del Niño Morelense (Morelos, México), who had scaphocephaly , explain the etiology of this medical condition, and present the surgical treatment protocol set by the pediatric maxillofacial & craniofacial surgery department . The outcomes and results are consistent and reproducible. Methods: We made use of medical technology aviable in the hospital to assess, diagnose and virtually plan the surgical case. The use of pediatric craniofacial specialized equipement to surgically perform the surgery, and lastly we followed a coronal wavy approach, removed premature bone sinostosis of the sagittal suture and sugically produced radiations and parietal spiral osteotomies along the cranial vault to expand the cephalic mass and decrease the intracranial pressure, thus giving the head a more harmonic and aesthetic shape in the anterior-posterior and transverse way. Results: The outcomes were as expected at the begining of the case reported, with the amplification the cranial vault bones that were in different shape according to Virchow’s Law previously, and the new head shape and the declination of the intracranial pressure. Conclusions: It is important to appropiately diagnose clinically and with images a case like this one exposed, because in that way we can treat this condition opportunely, preventing aftermaths related to the disease. It is crucial to keep in mind that the use of 3D technology can greatly help in the correct and accurate surgical outcome. Lastly, the follow-up visits will confirm the results in form and function.
Primary Author: Paolo Verona
Coauthor(s):Nicolas Solano, Ejusmar Rivera, Arianny Peraza
Purpose: To demonstrate that it is possible to perform a rhytidectomy simultaneously with orthognatic surgery through a clinical case. Methods: A 52-year-old woman presented with significant class II dentofacial deformity, mandibular hypoplasia and facial lipodystrophy. Her surgical procedure involved bilateral sagittal ramus osteotomy and genioplasty advancement with rhytidectomy simultaneously. Results: 6 months postoperatively, occlusal stability was observed, facial wounds in a healthy healing process, without evidence of keloids or hypertrophies, the patient does not have sensory or motor nerve damage and reports great satisfaction with the result. Conclusions: It should be noted that the patient decides to undergo surgery for aesthetic reasons while the surgeon proposes a surgery that improves his function. Rhytidectomy is one of the surgical procedures that can be performed simultaneously with othognatic surgery. We must always keep in mind the changes in the facial soft tissues that occur with skeletal movements and the intraoperative edema typical of the surgical act, taking into account the increase in operative time that carries out both surgeries simultaneously.
Primary Author: Hemil Rosales
Coauthor(s): Stefania Requejo, Carlos Suarez, Henry Garcia Guevara
Introduction: The subnasal lip lift (SLL) has emerged as a standard procedure for the treatment of an elongated upper lip in conjunction with little upper dental display. SLL using the bullhorn technique, or its modifications allows for shortening of upper lip height, creating a more aesthetically pleasing lip secondary to increased vermilion height and lip pout. Patient selection is critical, considering lip height, vermilion height, alar base width, skin type, upper incisal show, and maxillary height. Precise measurements, controlled excision of the planned resection, and meticulous approximation of skin provide an aesthetic result, while minimizing visible scarring. Methods: The authors conducted a case series study who underwent a SLL procedure without another nasal or lip procedure between January 2017 and December 2021. The outcome variables were lip length, tooth show, vermillion display. Preoperative and postoperative values were compared and analyzed using paired sample t-tests. Results: Overall, 10 female and 2 male patients with an average age of 45 years and a mean follow-up of 15 months were included in the study. SLL resulted in a statistically significant 24.3% reduction in lip length, 33.5% increase in the vermilion show, and a 1.75mm increase in tooth show (P < .0001). Conclusions: SLL procedure can significantly impact in facial esthetics, specifically by decreasing upper lip height, and improving maxillary teeth display.
Primary Author: Yessica Alvarado
Coauthor(s): Beatriz Eugenia Mejia Florez
Purpose: Present a case that combines maxillary pseudarthrosis and condylar hyperplasia, showing clinical, radiographic and tomographic images of its development, diagnosis and treatment. Method: Patient 39 years old, male, who underwent orthognathic surgery and upper left condylectomy 3 years ago. With progressive facial asymmetry due to progressive mandibular dextrognatism, occlusal plane inclination to the left 6mm, occlusal instability, chin deviated 5mm to the right and maxilla with mobility. Panoramic radiography and tomography presented the absence of bone formation in the maxilla and a difference in bone hyper-uptake in SPECT Bone of 16.7% on the condyle left side with respect to the condyle of right side. Findings that support the diagnosis of maxillary pseudoarthrosis and active left condylar hyperplasia. Results: Treated with 3D planning, high left condylectomy, bimaxillary orthognathic surgery and bone graft. A 6-month follow-up was performed showing restoration of occlusal stability, facial symmetry and function. Conclusions: The adequate diagnosis, the complete resection of the fibrous tissue and the segments stability are key points for the management of PM. In condylar hyperplasia it's important to ensure complete resection of the growth zone to avoid new asymmetries.
Primary Author: Santiago Abadia Delgado, Sr.
Coauthor(s): Beatriz Eugenia, Mejia Florez
Purpose: The present work proposes a modification to the traditional technique of Le Fort I osteotomies with pterygomaxillary dysfunction by means of piezoelectric surgery added to surgery guided by virtual planning. Methods: Through an incision of 4 cm the maxillomalar complex is exposed bilaterally by means of a Molt dissector, reaching the bilateral nasal submucoperiosteal plane of the entire nose floor the nasal caudal septum it´s disinserted from the maxillary crest. Subsequently, lateral maxillary subperiosteal dissection provides access to the pterygomaxillopalatine joint in combination with an outward facing Obwegesser retractor. Sequentially, a Le Fort I osteotomy cutting guide is positioned, making a cut by ultrasonic means reaching an angulation of 45° to the axis of the guide distal to the pyramidal process and maxillary posterior wall down the base of the pterygoid process. The "down fracture" is performed by means of disjunctive Smith forceps after the passage of the nasal septum and lateral nasal walls chissels in a conventional manner preserving the vertical palatine plate. Results: This technique has been used in 200 patients during a period between 2018 and 2022 without evidence of major bleeding, damage to cranial nerves, blindness, fractures of the tuberosity or the palatine vault, preserving the indemnity of the palatine soft tissue and vascularity. Conclusions: Various techniques have been described during pterygomaxillary disjunction, varying from techniques with or without the use of osteotomes. The current technique is presented as a valid option in passive maxillary disjunctions.
Primary Author: Samuel Costa
Coauthor(s): Bruna Campos Ribeiro, Guilherme Lacerda De Toledo, Marcio Bruno Figueiredo Amaral
Purpose: To report a case of a patient with two previous surgeries and a recurrent biprotuse Class II and degenerative TMJ disease. Methods: A descriptive study was carried on a female patient on the Mater Dei Hospital, Brazil. Results: 37-years old female, recurrent skeletal Class II with complaints of a biprotuse profile after two previous orthognathic surgeries. Together with that, presented a severe resorption on the right condyle mass. It was proposed a total TMJ joint replacement, with a custom-made prosthesis, followed by bimaxillary orthognathic surgery in order to correct the deformity. A virtual surgical planning was performed in accordance with the planned by the TMJ Concepts surgeons. The planned movements were a 15mm advancement on the pogonion, with a 15mm retrusion on the anterior nasal spine. The procedure was carried without any complications in six hours On the post-operative time the patient presented no complications, being in function for more than 12 months, pleased with the facial profile and with the TMJ function. Conclusions: To date, there are still some OMFS services that does not apply the corrects concepts on the management of the Class II patient, opting for a biprotuse profile, that often does not meet the patient desire. In these cases, the large mandibular movements, with an unreliable condyle hinge point promotes TMJ suffering. For the definitive correction of these deformities, the surgeon should perform not only the orthognathic surgery, with maxillary setback and often TMJ surgery.
Primary Author: Yenisley Brito Munoz
Coauthor(s): Edgar Luque Acuna
Introduction: Dentomaxillofacial disharmonies are alterations in the position, size and shape of the jaws. Orthognathic surgery is the branch that is responsible for correcting these. Objective: To identify the main characteristics of the treatment received by patients with dentomaxillofacial disharmony treated in the Maxillofacial Surgery service of the "Comandante Manuel Fajardo" Hospital in the period from October 2017 to December 2019. Method: A cross-sectional descriptive observational study was carried out at "Comandante Manuel Fajardo" Hospital. The universe consisted of 28 patients who completed the treatment. Results: 64,3 % of the patients belonged to the female sex, to the group of 19 to 24 years old and to the white race. The most affected region was the combined one (39.3%). The type of treatment that prevailed was orthodontic-surgical (78,6 %). The most performed surgical technique was the Epker sagittal forward osteotomy (57.9%). The most used means of osteosynthesis were wires (62,5 %). Conclusions: The female sex, the age group of 19 and 24 years and the white race prevailed. The most affected region was the combined. The most used type of treatment was orthodontic-surgical. The most frequently performed surgical techniques were the LeFort I osteotomy in the maxilla, the Epker sagittal osteotomy in the mandible, and bone mentoplasty in the chin. The most used means of osteosynthesis were wires followed by miniplates and screws.
Primary Author: Carlos Suarez
Coauthor(s): Henry Garcia Guevara, Sergio Olate, Maria Viamonte
PURPOSE: To describe, through a systematic review, the treatments associated with the management of condylar resorption (CR) after orthognathic surgery. METHODS: A search was made through Pubmed, Google Scholar, Science Direct, and Cochrane databases from 1990 to 2021 using the following keywords: “orthognathic surgery” adding “condylar resorption”, “progressive condylar resorption”, “idiopathic condylar resorption”, “condylar atrophy” or “condylysis”. All articles were selected based on established inclusion and exclusion criteria. RESULTS: A total of 15,182 articles were obtained, of which 21 were selected. The total number of patients was 3,285, with a predilection for the female gender with 1,561 (47.5%) and 419 males (12.75%). The age was found in a range between 14 and 50 years, with a mean of 23.7 +/- 6 years. The follow-up period of the cases ranged from 12 to 210 months, with a mean of 111 months in the selected studies (standard deviation of +/- 99). The clinical characteristics were class II malocclusion, higher mandibular plane, loss of vertical dimension, and posterior inclination of the condylar neck. No difference was found concerning the fixation method. Only 3 standardized protocols for the post-surgical management of CR are described. CONCLUSIONS: There are few standardized treatments for the management of condylar resorption in patients treated with orthognathic surgery. The main problem of the research was represented by the existing diversity in the literature in the way of reporting the treatments carried out. Prospective standardized clinical studies are recommended to develop validated protocols for the treatment of this condition.
Primary Author: Sergio Olate
Coauthor(s): Sigua-Rodriguez Eder Alberto, Henry Garcia Guevara,Juan Pablo Alister Herdener
Orthognathic surgery and rhinoplasty show a high success rates. The aim of this research is to analyze variables used in diagnosis and treatment for simultaneous orthognathic surgery and rhinoplasty. Male and female subjects between 18 and 45 years old were included. Diagnosis related to nasal morphology (nasal tip bifid, rotate, square and others as well as the alae morphology and columella), facial deformity (sagittal and vertical deformity), type of surgery (rhinoplasty techniques and orthognathic techniques) and complications were included. The minimum follow-up of was 12 months; Chi-Square and t test were used, considering a value of p<0.05 for statistical significance. Class III facial deformity was observed in 40% of subjects and class II facial deformity was present in 43%. For the nasal deformities, the tip and nasal bridge were most prevalent; primary nasal deformity was observed in the 83% of subjects and was significant more than secondary nasal deformity (p=0.042). Bimaxillary surgery was performed in 31 cases (88%). In 10 cases was realized a change of the original plan for rhinoplasty due to the previous maxillary surgery, with no statistical differences. Revision rhinoplasty was realized in 5 cases (14%) and was not related to surgical variables; revision for orthognathic surgery was no necessary in this series. Rhinoplasty and orthognathic surgery simultaneously show low complications and predictable results. However, the revision rhinoplasty was necessary in a 14% and could be related to learning curve or the intraoperative changes. A large study could be necessary to confirm our results.
Primary Author: Margny Johnson
Coauthor(s): Beatriz Eugenia Mejia Florez
Purpose: To develop an online didactic material to study the main theorical-practical aspects in the management of patients with mandibular asymmetry in Orthognathic Surgery. Methods: 1. Explanation of the theoretical-practical aspects in the analysis of patients with Mandibular Asymmetries through the use of Virtual Planning tools. 2. Through biomodels orthognatic surgery, images and videos were acquired to show the osteotomy designs and the management of the bone segments for the surgical treatment of Mandibular Asymmetries. 3. Explanatory didactic material was developed for the theoretical component and the execution of surgical techniques in the management of Mandibular Asymmetries in Orthognathic Surgery, uploaded as a Virtual Atlas on a Moodle platform. Results: A Virtual Atlas as a pedagogical tool for the study of Osteotomies and Virtual Planning in Orthognathic Surgery for the management of Mandibular Asymmetries. Conclusions: The growing struggle for the defense of Human Rights, as well as a greater awareness of patient safety by health personnel in training, has generated a series of economic and ethical restrictions on medical education that have impact on the need to expand the tools available for adequate training of students of surgical specialties. This virtual atlas could be used as a tool, so that residents from all over the world have an approach to surgical techniques in orthognathic surgery for the management of mandibular asymmetries, in a safe space without time restrictions, to strengthen the knowledge and provide security when facing the challenge of the surgical act.