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Conservative condylectomy in mandibular asymmetry caused by osteochondroma of mandibular condyle: a report of 5 cases
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E-Poster Presentation
The changes of nasal area after posterior repositioning Le Fort I osteotomy in 2-jaw surgery Y.H. Son 1 , Y.H. Kim 1,2 , J.C. Park 1,2,∗ , M.S. Kang 1,2 , H.G. Kim 1,2 , J.Y. Yoon 2 , Y.D. Kim 1,2 1
Pusan National University, Department of Oral and Maxillofacial Surgery, Pusan, South Korea 2 Pusan National University, Department of Dental Anesthesia & Pain Medicine, Pusan, South Korea Background: The surgical goal in repositioning the maxilla is to establish a harmonious maxillomandibular dentoskeletel relationship and to achieve aesthetic soft-tissue changes. The identification of aesthetic factors and the prediction of the final facial soft tissue profile play an important role in planning the orthognathic surgery. Many studies have been performed to predict the changes in the tissue caused by the movement of the facial bones and many studies have been reported for soft tissue changes after Le Fort I osteotomy of the maxilla. However, most of previous studies on soft tissue changes associated with the movement of the maxilla were about anterior and superior movement and there are few studies about posterior movement. Objectives: The aim of this study was to evaluate the changes of nasal area after Le Fort I maxillary posterior movement. Methods: This study was performed based upon radiographic measurements of nasal tip position, nasolabial angle, the relationship between nasal tip and upper incisor in 49 patients treated with maxillary posterior movement and had pre-op and post-op 2,6 month ccephalometric radiograph operated with Le Fort I osteotomy at the department of Oral and maxillofacial surgery of Pusan National University from December 2012 to February 2014. Conclusions: In our study, the posterior repositioning Le Fort I osteotomy seems to increase the nasolabial angle and increase subnasale distance and decrease nasal length. A significant correlations were found between palatal plane angle and nasal tip distance, and palatal plane angle and subnasale distance. http://dx.doi.org/10.1016/j.ijom.2015.08.276 Evaluation of postoperative stability of mandibular setback surgery after intersegmental rigid fixation with intentional counter-clockwise rotation of the proximal segment using 3D CT and lateral cephalograms J. Park ∗ , S. Hwang Seoul National University Dental Hospital, Seoul, South Korea Background: Postoperative relapse in orthognatic surgery results from multifactorial factors and recent studies have presented that the major relapse factor after mandibular setback surgery is the intraoperative clockwise rotation (CWR) of the proximal segment during rigid fixation. Objectives: In this study, we evaluated the relapse after intraoperative intentional counterclockwise rotation (CCWR) of proximal segment (PS) during rigid fixation in comparison with no rotational change of proximal segment using 3D CT and lateral cephalograms. Methods: The subjects consisted of 30 patients. All subjects were divided in 2 groups according to the difference in rotational movement of PS. Patients who had not changed in position of PS or amount of changes less than 1 degree belonged to Group I. Group II included the patients with CCWR of PS greater than 1◦ in both sides. To measure the amounts of rotation of PS on the right
and left side, three dimensional CT was taken, prior to surgery (T0), Immediately post operative (T1). For the measurement of the surgical change and the evaluation of the long term postoperative stability, lateral cephalograms were obtained T0, T1, six weeks after surgery (T2) and more than six months after surgery (T3). Each cephalogram was traced and analysis was performed according to the superimposition technique. The horizontal and vertical changes in the point A, point B, pogonion, menton and the angula changes in SNA, SNB, SnArGo were determined. Findings and conclusions: In comparison between two groups, Group II has shown statistically less relapse than Group I. The relapse did not significantly increase with the increased amount of setback, but it decreased significantly with the intraoperative CCWR of PS. This study suggests that postoperative relapse may be reduced when PS is fixed with intentional CCWR, independent on the magnitude of the setback. http://dx.doi.org/10.1016/j.ijom.2015.08.277 Conservative condylectomy in mandibular asymmetry caused by osteochondroma of mandibular condyle: a report of 5 cases J.B. Park ∗ , D.S. Kim, J.Y. Kim, K.H. Park, J.K. Huh Yonsei University College of Dentistry, Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Seoul, South Korea Background: Osteochondroma is the most common tumour of skeletal bones. However, it is relatively uncommon in the jaw bones, especially at the condyle or the tip of the coronoid process. This benign cartilage-capped growth is usually discovered incidentally on radiographic examination or on palpation of a protruding mass in the affected area. Malocclusion and progressive facial asymmetry are common findings in most cases of condylar osteochondroma. Wolford et al. presented a conservative condylectomy technique (condylectomy performed below the condylar head but high in the condylar neck) and articular disc repositioning as the surgical treatment approach for management of osteochondroma of the condylar head. Objectives: To report stabilities and favourable surgical outcomes treated by conservative condylectomy, intermaxillary traction and orthodontic procedure in the patients of facial asymmetry caused by osteochondroma at mandibular condyle. Methods: Five out of 10 patients who were treated at our clinic from March 2004 to April 2014 and pathologically proven as osteochondroma of mandibular condyle were included. We analyzed pre- and post-operative X-ray images and clinical photographs. We also measured the amount of pre- and post-operative mouth opening, and the follow-up period. Findings: There were no recurrences to dates. In addition to removing the tumours, facial asymmetry and malocclusion were also improved. Conclusions: In this case report, satisfactory results were obtained without any other additional operation. Thus conservative condylectomy can be suggested as an acceptable option for treatment of facial asymmetry caused by osteochondromas of the mandibular condyle. http://dx.doi.org/10.1016/j.ijom.2015.08.278
E-Poster Presentation
The changes of nasal area after posterior repositioning Le Fort I osteotomy in 2-jaw surgery Y.H. Son 1 , Y.H. Kim 1,2 , J.C. Park 1,2,∗ , M.S. Kang 1,2 , H.G. Kim 1,2 , J.Y. Yoon 2 , Y.D. Kim 1,2 1
Pusan National University, Department of Oral and Maxillofacial Surgery, Pusan, South Korea 2 Pusan National University, Department of Dental Anesthesia & Pain Medicine, Pusan, South Korea Background: The surgical goal in repositioning the maxilla is to establish a harmonious maxillomandibular dentoskeletel relationship and to achieve aesthetic soft-tissue changes. The identification of aesthetic factors and the prediction of the final facial soft tissue profile play an important role in planning the orthognathic surgery. Many studies have been performed to predict the changes in the tissue caused by the movement of the facial bones and many studies have been reported for soft tissue changes after Le Fort I osteotomy of the maxilla. However, most of previous studies on soft tissue changes associated with the movement of the maxilla were about anterior and superior movement and there are few studies about posterior movement. Objectives: The aim of this study was to evaluate the changes of nasal area after Le Fort I maxillary posterior movement. Methods: This study was performed based upon radiographic measurements of nasal tip position, nasolabial angle, the relationship between nasal tip and upper incisor in 49 patients treated with maxillary posterior movement and had pre-op and post-op 2,6 month ccephalometric radiograph operated with Le Fort I osteotomy at the department of Oral and maxillofacial surgery of Pusan National University from December 2012 to February 2014. Conclusions: In our study, the posterior repositioning Le Fort I osteotomy seems to increase the nasolabial angle and increase subnasale distance and decrease nasal length. A significant correlations were found between palatal plane angle and nasal tip distance, and palatal plane angle and subnasale distance. http://dx.doi.org/10.1016/j.ijom.2015.08.276 Evaluation of postoperative stability of mandibular setback surgery after intersegmental rigid fixation with intentional counter-clockwise rotation of the proximal segment using 3D CT and lateral cephalograms J. Park ∗ , S. Hwang Seoul National University Dental Hospital, Seoul, South Korea Background: Postoperative relapse in orthognatic surgery results from multifactorial factors and recent studies have presented that the major relapse factor after mandibular setback surgery is the intraoperative clockwise rotation (CWR) of the proximal segment during rigid fixation. Objectives: In this study, we evaluated the relapse after intraoperative intentional counterclockwise rotation (CCWR) of proximal segment (PS) during rigid fixation in comparison with no rotational change of proximal segment using 3D CT and lateral cephalograms. Methods: The subjects consisted of 30 patients. All subjects were divided in 2 groups according to the difference in rotational movement of PS. Patients who had not changed in position of PS or amount of changes less than 1 degree belonged to Group I. Group II included the patients with CCWR of PS greater than 1◦ in both sides. To measure the amounts of rotation of PS on the right
and left side, three dimensional CT was taken, prior to surgery (T0), Immediately post operative (T1). For the measurement of the surgical change and the evaluation of the long term postoperative stability, lateral cephalograms were obtained T0, T1, six weeks after surgery (T2) and more than six months after surgery (T3). Each cephalogram was traced and analysis was performed according to the superimposition technique. The horizontal and vertical changes in the point A, point B, pogonion, menton and the angula changes in SNA, SNB, SnArGo were determined. Findings and conclusions: In comparison between two groups, Group II has shown statistically less relapse than Group I. The relapse did not significantly increase with the increased amount of setback, but it decreased significantly with the intraoperative CCWR of PS. This study suggests that postoperative relapse may be reduced when PS is fixed with intentional CCWR, independent on the magnitude of the setback. http://dx.doi.org/10.1016/j.ijom.2015.08.277 Conservative condylectomy in mandibular asymmetry caused by osteochondroma of mandibular condyle: a report of 5 cases J.B. Park ∗ , D.S. Kim, J.Y. Kim, K.H. Park, J.K. Huh Yonsei University College of Dentistry, Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Seoul, South Korea Background: Osteochondroma is the most common tumour of skeletal bones. However, it is relatively uncommon in the jaw bones, especially at the condyle or the tip of the coronoid process. This benign cartilage-capped growth is usually discovered incidentally on radiographic examination or on palpation of a protruding mass in the affected area. Malocclusion and progressive facial asymmetry are common findings in most cases of condylar osteochondroma. Wolford et al. presented a conservative condylectomy technique (condylectomy performed below the condylar head but high in the condylar neck) and articular disc repositioning as the surgical treatment approach for management of osteochondroma of the condylar head. Objectives: To report stabilities and favourable surgical outcomes treated by conservative condylectomy, intermaxillary traction and orthodontic procedure in the patients of facial asymmetry caused by osteochondroma at mandibular condyle. Methods: Five out of 10 patients who were treated at our clinic from March 2004 to April 2014 and pathologically proven as osteochondroma of mandibular condyle were included. We analyzed pre- and post-operative X-ray images and clinical photographs. We also measured the amount of pre- and post-operative mouth opening, and the follow-up period. Findings: There were no recurrences to dates. In addition to removing the tumours, facial asymmetry and malocclusion were also improved. Conclusions: In this case report, satisfactory results were obtained without any other additional operation. Thus conservative condylectomy can be suggested as an acceptable option for treatment of facial asymmetry caused by osteochondromas of the mandibular condyle. http://dx.doi.org/10.1016/j.ijom.2015.08.278