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Long-term evaluation of patients with progressive condylar resorption following orthognatic surgery
Free oral communications 95 examination? We ourselves have discovered some cases, one of whom is an 80-year-old man and have consequently debated, specifically, the real risk of cephalic pain in certain types of craniosynostosis and in general the interest of surgical treatment of craniosynostosis in the adult. Scaphocephaly is the most frequently-observed type of craniosynostosis in the adult. Cases have been observed by two of our colleagues, one an endocrinologist and the other an orthopedist. None of our patients suffer from neuro-sensorial disturbances, but 3 of them suffered psychologically from their particular dysmorphism during their school years. Indeed, this affected one 22-year-old carpenter so deeply that he requested surgical repair. One young woman with very marked plagiocephaly, mother of a young plagiocephalic boy and a brachycephalic girl, presents no disturbances and held a Masters degree in Cellular Biology, despite a disquieting radiologicat check-up (osseous indications of intracranial hypertension). A case of oxycephalia in a 40 year-old-man with a rather low IQ was discovered because of a work-related accident. At the moment, he presents obstinate cephalalgia. This problem has arisen: did the work related accident provoke traumatic decompensation? A 75-year-old man has presented functional plagiocephaly, illustrating that normal cranial remodelling cannot create a symmetrical cranium but is sufficiently effective to be morphologically viable. In conclusion, we think that great caution must be exercised for the treatment of craniosynostosis discovered in the adult. Preoperative accidents or post-therapeutic sequelae are always possible and it is very difficult to justify them. Surgery should be reserved for patients who are wellinformed, and for whom morphological correction is urgent.
Immediate Function of the Temporomandibular Joint after Total Resection and Reconstruction
Richter M/, Dulguerov p.2, Becker M. 3 Departments of 1Maxillofacial Surgery, 20to-RhinoLaryngology and 3Radiodiagnosties, H6pital Cantonal Universitaire, Geneva, Switzerland Recurrence of high-grade adenocarcinomas of the parotid required en bloc subtotal petrosectomy, resection of the lateral temporal bone and of the proximal portion of the mandibular ramus. An original technique for simultaneous reconstruction of the infratemporal region, including glenoid fossa and the mandibular condyles, is described. Two cases were treated, using autologous calvarial and full thickness rib grafts rigidly fixed with miniplates and screws. Good functional and esthetic results were obtained and allowed the patients to mobilise their jaw rapidly.
A New Classification for Temporomandibular Joint Diseases
Rixecker H.1 M611er T.2 1Department of Maxillo-Facial-Surgery and 2Center of Radiology, Am Caritas-Krankenhaus, Dillingen, Germany Purpose: As we found a high rate of discrepancies between the degree of the internal derangement and the indication for operation, we evaluated a new classification based on magnetic resonance imaging (MRI) imaging. Materials and Methods: From September 1993 to January
1995, 226 patients underwent an MRI imaging examination of the temporomandibular joint (TMJ). A total of 175 patients underwent arthroscopic or open surgery, 51 patients were treated conservatively depending on the clinical and radiological findings. The result of the treatment was compared with the clinical, the radiological and the intraoperative findings. Thus a new classification was created.
Results: After staging about 100 of the patients with the new classifications the success of treatment increases from 75% to 95% with complete or nearly complete restoration of normal function and relief of pain. Within this classification, only patients with stage II, IIIa and b underwent laser surgery or open surgery. Conclusion: A new classification system for the treatment of TMJ disorders, which takes the adhesions into consideration, seems to have very good correlation to intraoperative findings and a good predictive value for expected success based on the choice of therapy modality. It allows a clear differentiation between myofunctional and arthrogenic pain.
Long-Term Evaluation of Patients with Progressive Condylar Resorption Following Orthognatic Surgery
Robben C.M.G., Stoelinga P.J.W. Department Oral and Maxillofacial Surgery, Rynstate Hospital, Arnhem, The Netherlands Between 1986 and 1995, 22 patients with progressive condylas resorption (PCR), following orthognatic surgery, were seen. Eight patients were only orthodontically compensated for the skeletal relapse. In 3 patients, the condylar resorption is still active and these patients are still wearing splints. Eleven patients were reoperated with a sagittal split advancement osteotomy to correct the resulting skeletal deformity and malocclusion. Follow-up of these patients ranged from 1 to 8 years. Six of the patients showed no to minimal relapse (< 20% in pogonion). In 5 patients considerable relapse occurred again but the occlusion became adequate because of orthodontic treatment. It can be concluded from this study that reintervention including a mandibular advancement may be considered, provided sufficient time is allowed for the condyles to remodel after the episode of severe resorption.
Clinical Experience with Medpor Implants in Esthetic Orthognathic Surgery
Robiony M., Costa F., Demitri E, Crimi V., Politi M. Department of Maxillo-Facial Surgery, University of Udine, Udine, Italy Purpose: The authors present their own experience with Medpor porous polyethylene implants to expand maxillarymidface region improving facial esthetic in orthognathic surgery. Medpore implants were also used in alternative to other alloimplants and autogenous bone graft to a u ~ e n t vertical dimension of the chin and maxilla. Patients and Methods: Medpor implants were placed in 26 patients over a 2 year period from 1993 to 1995. The implant's position was determined preoperatively using skeletal and anthrophometric points. Implants in the paranasal area were placed in subperiostal position and
Immediate Function of the Temporomandibular Joint after Total Resection and Reconstruction
Richter M/, Dulguerov p.2, Becker M. 3 Departments of 1Maxillofacial Surgery, 20to-RhinoLaryngology and 3Radiodiagnosties, H6pital Cantonal Universitaire, Geneva, Switzerland Recurrence of high-grade adenocarcinomas of the parotid required en bloc subtotal petrosectomy, resection of the lateral temporal bone and of the proximal portion of the mandibular ramus. An original technique for simultaneous reconstruction of the infratemporal region, including glenoid fossa and the mandibular condyles, is described. Two cases were treated, using autologous calvarial and full thickness rib grafts rigidly fixed with miniplates and screws. Good functional and esthetic results were obtained and allowed the patients to mobilise their jaw rapidly.
A New Classification for Temporomandibular Joint Diseases
Rixecker H.1 M611er T.2 1Department of Maxillo-Facial-Surgery and 2Center of Radiology, Am Caritas-Krankenhaus, Dillingen, Germany Purpose: As we found a high rate of discrepancies between the degree of the internal derangement and the indication for operation, we evaluated a new classification based on magnetic resonance imaging (MRI) imaging. Materials and Methods: From September 1993 to January
1995, 226 patients underwent an MRI imaging examination of the temporomandibular joint (TMJ). A total of 175 patients underwent arthroscopic or open surgery, 51 patients were treated conservatively depending on the clinical and radiological findings. The result of the treatment was compared with the clinical, the radiological and the intraoperative findings. Thus a new classification was created.
Results: After staging about 100 of the patients with the new classifications the success of treatment increases from 75% to 95% with complete or nearly complete restoration of normal function and relief of pain. Within this classification, only patients with stage II, IIIa and b underwent laser surgery or open surgery. Conclusion: A new classification system for the treatment of TMJ disorders, which takes the adhesions into consideration, seems to have very good correlation to intraoperative findings and a good predictive value for expected success based on the choice of therapy modality. It allows a clear differentiation between myofunctional and arthrogenic pain.
Long-Term Evaluation of Patients with Progressive Condylar Resorption Following Orthognatic Surgery
Robben C.M.G., Stoelinga P.J.W. Department Oral and Maxillofacial Surgery, Rynstate Hospital, Arnhem, The Netherlands Between 1986 and 1995, 22 patients with progressive condylas resorption (PCR), following orthognatic surgery, were seen. Eight patients were only orthodontically compensated for the skeletal relapse. In 3 patients, the condylar resorption is still active and these patients are still wearing splints. Eleven patients were reoperated with a sagittal split advancement osteotomy to correct the resulting skeletal deformity and malocclusion. Follow-up of these patients ranged from 1 to 8 years. Six of the patients showed no to minimal relapse (< 20% in pogonion). In 5 patients considerable relapse occurred again but the occlusion became adequate because of orthodontic treatment. It can be concluded from this study that reintervention including a mandibular advancement may be considered, provided sufficient time is allowed for the condyles to remodel after the episode of severe resorption.
Clinical Experience with Medpor Implants in Esthetic Orthognathic Surgery
Robiony M., Costa F., Demitri E, Crimi V., Politi M. Department of Maxillo-Facial Surgery, University of Udine, Udine, Italy Purpose: The authors present their own experience with Medpor porous polyethylene implants to expand maxillarymidface region improving facial esthetic in orthognathic surgery. Medpore implants were also used in alternative to other alloimplants and autogenous bone graft to a u ~ e n t vertical dimension of the chin and maxilla. Patients and Methods: Medpor implants were placed in 26 patients over a 2 year period from 1993 to 1995. The implant's position was determined preoperatively using skeletal and anthrophometric points. Implants in the paranasal area were placed in subperiostal position and