Background
Severe microretrognathia with the absence of ascending mandibular ramus is a challenging deformity and treatment must aim to avoid tracheostomy or remove it as soon as possible. Although ...it is not often reported, mandibular distraction osteogenesis represents a valid treatment option in infants affected by hypoplastic mandible Pruzansky-Kaban type IIb and III.
Case presentation
The authors describe 3 cases of infants affected by severe respiratory insufficiency due to congenital mandibular hypoplasia, with follow up ranging from 4 to 8 years. Clinical and technical considerations on treatment choices and outcomes are discussed starting from review of the literature and direct clinical experience.
Conclusion
Early mandibular distraction, specifically bidirectional distraction, is an effective and repeatable technique that leads to mandible lengthening with counterclockwise rotation, pogonion projection increase, anteropositioning of the tongue base, and expansion of oropharyngeal volume with positive effect on the respiratory problems of the infant. Even in Treacher Collins patients, known to have a low decannulation rate, all of these elements are essential for effective speech and swallowing therapy and for a subsequent attempt of decannulation.
Navigation in oral surgery: a systematic review Oillic, Alexis; Varazzani, Andrea; Fitouchi, Benjamin ...
Journal of oral medicine and oral surgery,
2023, Volume:
29, Issue:
4
Journal Article
Peer reviewed
Open access
Introduction:
Dynamic navigation is a fast-growing technology in the field of head and neck surgery, which is now taking its place in oral surgery. The aim of this review was to present and describe ...all the uses of navigation in oral surgery.
Materials and methods:
A systematic review was conducted using all clinical trial/cases reports (Embase/PubMed) in which navigation is used during oral surgery, published over the last 5 yr. A total of 32 clinical trial/cases reports were analyzed.
Results:
Dynamic navigation was used in 7 different indications: implantology (55%), foreign body removal (15%), dental avulsion (12%), bone augmentation (9%), cellulitis (3%), benign tumour (3%), pre-prosthetic surgery (3%). A total of 335 patients were treated, 631 implants, 8 foreign bodies, 1 benign tumour, 24 dental avulsions, 3 bone augmentations, 1 cellulitis, and 1 pre-prosthetic surgery were found. In implantology, there were 500 standard implants, 75 zygomatic implants, 31 pterygoid implants, 1 short implant and 24 angulated implants.
Conclusion:
This review showed the recent development of dynamic navigation in oral surgery. The most common indication is dental implantology and few others indications seemed promising. This technique broadened its scope and might become an indispensable tool that can be used in many situations, increasing safety and predictability of a lot of procedure.
Our study aimed to compare the biomechanical behaviour of mandibles with or without titanium miniplates when subjected to an impact after bone healing using a finite element model (FEM) of the human ...mandible. We simulated mandibular trauma on an FEM of a human mandible carrying or not two parasymphyseal miniplates and applying a concentrated force of 2000 N to four different areas, including the insertion area, the area straddling the edge of the miniplates and the adjacent bone, at a distance from the miniplates on the symphysis, and on the basilar border of the mandible below the miniplates. Then, we compared the Von Mises stress distributions between the two models. In the case of an impact on the miniplates, the maximum Von Mises stress occurred in two specific areas, on the cortical bone at the posterior border of the two miniplates at a distance from the impact, while in the model without miniplates, the Von Mises stresses were homogenously distributed in the impact area. The presence of titanium miniplates in the case of trauma affects the biomechanical behaviour of the mandible and could cause more complex fractures. We recommend informing patients of this potential risk.
Summary Purpose Gracilis muscle reinnervated by the contralateral facial nerve via cross-graft technique is nowadays considered to be a first-line procedure for facial animation in unilateral ...palsies. Despite the wide number of papers published analyzing technical aspects, refinements, functional results, and cosmetic outcomes, only a few authors have focused their publications on the patient’s perspective and impact on QOL of these procedures. Material and Methods Changes in quality of life in 42 patients treated with gracilis muscle transplant reinnervated via cross-face graft were analyzed through a comparison of preoperative and postoperative items on the Facial Disability Index questionnaire. Statistical evaluation with a paired t-test was performed concerning overall results and specific items modifications. Results Overall improvement of QOL was found to be highly significant (p = 0.001). Mouth and eye functions were the most improved (p = 0.001), whereas isolation (p = 0.004) and feeling calm and peaceful (p = 0.001) were the most improved among the social functions. Conclusions Facial animation with gracilis neuromuscular transplantation reinnervated with contralateral healthy facial nerve via a cross-graft procedure has been demonstrated to be a safe and reliable procedure in the treatment of congenital or established facial palsies. Our results on quality of life impact support that these operations are not only reliable and safe but also of primary relevance to patients’ every-day lives.
Objectives
Transitioning from non-outpatient orthognathic surgery to outpatient surgery is a new challenge, and it is essential to target the eligible population as precisely as possible. Several ...authors describe series of outpatient orthognathic surgery but do not include the reasons for their success or failure. The main aim of this study was to identify the factors significantly associated with “successful” outpatient orthognathic treatment. The secondary objective was to determine the factors significantly associated with prolonged hospital stays (≥ 2 nights).
Materials and methods
A prospective cohort study including patients undergoing orthognathic surgery was conducted over a period of 1 year. We recorded the prognostic factors that contributed to successful outpatient treatment and prolonged hospital stays. These factors were evaluated by bivariate and multivariate analysis.
Results
A total of 102 patients were included, and the success rate of treatment was 65%. The variables that were isolated by multivariate analysis were: patients over the age of 22, procedures ending before 1 pm, brief operations, the absence of both postoperative vomiting and the administration of morphine.
Conclusion
Patient selection, organisation of outpatient facilities and anaesthetic protocols contribute to the development of outpatient orthognathic surgery. These initial considerations provide a framework for our practice, but the considerations that predict the failure of outpatient surgery will need to be clarified.
Clinical relevance
Orthognathic surgery can be performed on outpatient basis in selected cases. Age, the operative time, procedure end time, postoperative vomiting and the administration of morphine are associated with the success of outpatient care.
The purpose of the study was to determine whether the duration of preoperative pain affects outcomes of temporomandibular joint replacement (TMJR). Twenty-seven patients who underwent primary TMJR ...between 1 July 2020 and 31 October 2022 were retrospectively assessed for duration of preoperative pain, level of preoperative and postoperative pain on a visual analogue scale (VAS; 0, none; 10, severe), preoperative and postoperative range of motion (ROM), and net change in quality of life (much better, better, same, worse, much worse), reporting the longest available follow up for each patient. Surgical success was defined as postoperative pain of ≤4 and postoperative ROM of ≥30 mm, or net change (Δ) in ROM of ≥10 mm. Regression analyses evaluated associations between independent variables and postoperative pain and ROM. At a mean follow-up of 17.8 (SD: 6.8, range 3-32) months , pain (5.1, SD: 2.2, p < 0.001) and ROM (9.3 mm, SD: 8.0, p<0.001) significantly improved. Quality of life was much better in 16 patients, better in eight, the same in one, and worse in two. Longer duration of preoperative pain tended to be negatively associated with postoperative ROM (β = -0.27; 95% CI -0.6 to 0.0; p = 0.078) but was not associated with severity of postoperative pain. Surgical success was achieved in 23/27 patients. The successful group tended to have lower pain on VAS preoperatively (5.9, SD: 1.9) vs 7.5, SD: 1.3) and postoperatively (0.4, SD: 0.8 vs 4.8, SD: 2.6), and greater improvement in quality of life (much better: 14/23 vs 2/4). In conclusion, longer duration of preoperative pain tended to be associated with worse postoperative ROM following TMJR. Higher preoperative pain may be a predictor for unsuccessful surgery.The purpose of the study was to determine whether the duration of preoperative pain affects outcomes of temporomandibular joint replacement (TMJR). Twenty-seven patients who underwent primary TMJR between 1 July 2020 and 31 October 2022 were retrospectively assessed for duration of preoperative pain, level of preoperative and postoperative pain on a visual analogue scale (VAS; 0, none; 10, severe), preoperative and postoperative range of motion (ROM), and net change in quality of life (much better, better, same, worse, much worse), reporting the longest available follow up for each patient. Surgical success was defined as postoperative pain of ≤4 and postoperative ROM of ≥30 mm, or net change (Δ) in ROM of ≥10 mm. Regression analyses evaluated associations between independent variables and postoperative pain and ROM. At a mean follow-up of 17.8 (SD: 6.8, range 3-32) months , pain (5.1, SD: 2.2, p < 0.001) and ROM (9.3 mm, SD: 8.0, p<0.001) significantly improved. Quality of life was much better in 16 patients, better in eight, the same in one, and worse in two. Longer duration of preoperative pain tended to be negatively associated with postoperative ROM (β = -0.27; 95% CI -0.6 to 0.0; p = 0.078) but was not associated with severity of postoperative pain. Surgical success was achieved in 23/27 patients. The successful group tended to have lower pain on VAS preoperatively (5.9, SD: 1.9) vs 7.5, SD: 1.3) and postoperatively (0.4, SD: 0.8 vs 4.8, SD: 2.6), and greater improvement in quality of life (much better: 14/23 vs 2/4). In conclusion, longer duration of preoperative pain tended to be associated with worse postoperative ROM following TMJR. Higher preoperative pain may be a predictor for unsuccessful surgery.
Medical photography is an essential tool in orthognathic surgery to facilitate diagnosis, preoperative planning, and follow-up. Photographic documentation has clinical, research, teaching and legal ...applications. An accurate diagnostic approach and surgical planning of dentofacial deformity requires the ability to work with reproducible and measurable photographic images. It must also respect certain legislative rules for its use within a health institution and the dissemination of images in the educational and scientific framework. We propose through this narrative review a standardized protocol to obtain reproducible images in the different planes of space. We also review and discuss fundamental points for setting up a photographic room dedicated to photography in orthognathic surgery.
Purpose
After maxillary osteotomy in orthognathic surgery, patients report nasal breathing discomfort in early postoperative period. Topical hyaluronic acid (HA) has been proven to have beneficial ...effects on the upper airway tract mucosa. This prospective randomized controlled study was designed to analyze the effect on nasal obstruction of nebulized HA during the recovery process after maxillary osteotomy.
Methods
Patients were randomized to control and treatment groups. The postoperative treatment differed only for additional nebulized HA provided to the treatment group. The level of nasal obstruction, and its impact on quality of life, was assessed every 3 days for the first 15 days postoperatively using a questionnaire. Demographic and other variables (maxillary osteotomy type and surgical movements) were analyzed. Differences in quantitative data were tested using Student’s
t
-test, the Mann-Whitney
U
test, and mixed repeated measures ANOVA.
Results
Twenty-four subjects were included in each group; differences in age, sex, type of maxillary osteotomy, and movements were non-statistically significative. At the beginning of treatment (T0), the two groups had comparable questionnaire scores regarding nasal breathing discomfort (
p
>0.05), whereas statistically significant differences were found at days 3, 6, 9, and 12 (
p
<0.05). A significant decrease in nasal breathing discomfort over time was observed in both groups, with trends that differed between the two, indicating faster improvement in the treatment group.
Conclusion
Nebulized HA can be a useful additional treatment in early postoperative period after orthognathic surgery. Patients reported more rapid improvement of nasal respiratory symptoms, indicating a potential role for HA in reducing recovery time and patient discomfort after maxillary surgery.
Nodular fasciitis (NF) is a benign, self-limiting, proliferative myofibroblastic lesion typically seen in subcutaneous tissues, muscles, and fascia. NF of the parotid gland is rare, frequently ...misdiagnosed as a malignant tumour, with the misdiagnosis resulting in inappropriate treatment such as wide surgical resection, radiation therapy, or chemotherapy with sometimes poor aesthetic outcomes.
We present the case of a 44-year-old woman with a 2-cm-diameter, solid, mobile nodular swelling with well-defined edges over the superior margin of the right parotid gland. She has no facial nerve palsy, and the mass was not fixed to the overlying skin. Preoperative ultrasonography, magnetic resonance imaging (MRI), and fine needle aspiration cytology (FNAC) all suggested a pleomorphic adenoma. The postoperative histopathological findings revealed NF.
Cytological diagnosis is crucial for NF diagnosis and management. Preoperative FNAC should be accompanied by immunocytochemical evaluation; if analysis is inadequate and/or suspicious, it should be repeated in a high-volume centre with experience in salivary gland lesions. Comprehensive MRI including diffusion-weighted imaging and perfusion sequences aid differential diagnosis. As NFs are benign and self-limiting, accurate preoperative diagnosis is essential to avoid unnecessary extensive treatment.
