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Metal osteosynthesis of the facial skeletal bones
116 Journal of Cranio-Maxillofacial Surgery emphysema and wound contamination, compromising local healing and the microvascular anastomosis. We report our experience with 20 cases. The advantages and limitations of the technique will be discussed. Reference
1. Ciaglia P. et al, Elective percutaneous dilatational tracheostomy. Chest 87 (1985) 715-719 Complete Rehabilitation of the Lower Jaw after Segmental Resection: A New Method if-/.
Department of Oral and Maxillofacial Surgery, University of Hong Kong, Hong Kong Oral tumour resection results in serious aesthetic and functional disorder of the face and mouth. When the resection includes part of the jaw, the aim of reconstruction should encompass not only the restoration of facial aesthetics, speech and swallowing, but also the recreation of an alveolar ridge suitable for prosthetic rehabilitation of the occlusion. This enables masticatory function to regain its contribution to the well-being of the patient. Reconstruction after segmental mandibulectomy is feasible by a variety of methods including free autogenous or allogenic bone grafting and vascularized composite flaps with microvascular anastomosis. We present a method of treatment utilizing an individually designed titanium mesh tray with a removable lid containing tightly packed autogenous corticocancellous bone chips for the restoration of facial contour and alveolar ridge dimensions. Advantages include applicability to part or whole mandible defects, excellent symmetry of reconstruction, planned interarch relationship and implant positions, and endosseous implant insertion into the preplanned position. The method will be illustrated by case examples demonstrating the planning process. Metal Osteosynthesis of the Facial Skeletal Bones
Timofeyey A., Peredkov K. Ukrainian Maxillo-Facial Surgery Centre, Kyiv, Ukraine The results of various methods for osteosynthesis of the facial skeletal bones in 256 patients with maxillofacial traumas are analyzed. Osteosynthesis was performed using metal wire (tantalum, steel), on-bone plates (stainless steel, titanium, bioceramics-coated titanium). Routinely used were general clinical examination methods, radiography, computer tomography, ultrasonic examination; organism reactivity was studied as well. The advantage of osteosynthesis with titanium and bioceramic-coated titanium onbone plates over other methods was shown. It can be applied to the patients with both normal and lowered reactiveness, i.e. in the presence of accompanying diseases (diabetes mellitus, anaemia, old age, etc.). The use of the titanium or bioceramic-coated titanium for osteosynthesis reduced the number of postoperative complications more than tenfold. Any contraindications to this method of treatment were not revealed. Long-Term Results after Surgical Correction of Fibrous Dysplasia of the Visceral Cranium
Tkotz T., Weingart D., Joos U.
Department of Oral and Cranio-Maxillo-Facial Surgery, University Clinics of Miinster, MOnster, Germany
The fibrous dysplasia in the region of the visceral cranium causes troubles to the concerned patients, particularly for the reason of unesthetic disfiguring. From this point of view, a clinical study was carried out in a total of 10 patients followed up from 1982 to 1995. The patients underwent surgical treatment consisting of removal of the tumourous alterations to improve facial aesthetics. Pre- and postoperative photographs, X-rays and clinical findings were compared with regard to surgical improvement of the patient's profile. Further, it was tried to establish a correlation between the serum concentration using alkaline phosphatase and the incidence of local relapse. The results of this study indicate that, especially with regard to facial aesthetics, often only a very slight long-term improvement could be achieved. The high relapse rate (10-60%) reported in the literature could be confirmed. From the surgical point of view, the major problem is the predictability of growth reaction of this osseous change. The alkaline phosphatase of the serum, which is reported in the literature as a sign of the incidence of local relapse, did not prove to be a reliable parameter in this study. Additionally observed reactive bone regeneration following modelling osteotomy did impair the aesthetic outcome. The results of this study show that with regard to facial aesthetics the long-term results are not satisfactory. Surgical intervention in treatment of fibrous dysplasia is therefore indicated in carefully selected cases only.
Maxillary Advancement by Gradual Distraction
Triaca A., Van Waes H., Miiller P.
Pyramide Klinik am See, Ziirieh, Switzerland Application of distraction osteogenesis to the human craniofacial skeleton in properly selected cases represents a major advance in the treatment of craniofacial deformities. We report our initial clinical experience with an intraoral distraction device that permits a maxillary distraction. The device consists of a distracter fixed by self-tapping screws to the posterior maxilla and a bone plate fixed to the zygoma. Beginning 1 week postoperatively, the maxilla was gradually distracted and advanced 0.5 mm every day until normal sagittal relation was achieved. Final orthodontic treatment was necessary for a perfect occlusion. Indications, results and stability of all patients treated to date are presented.
The Surgical Procedure of Tumours of Minor Salivary Glands
Triantafillidou K., Lazaridis N., Dimitrakopoulos I., Letsis L
Aristotle University, Thessaloniki, Greece The tumours of minor salivary glands can be divided into those that are benign, those that are locally aggressive and those that are malignant with the potential to metastasize. Depending on the type of the tumour the surgical procedure consisted of local enucleation, wide local excision and partial or total maxillectomy. In this paper we present benign and malignant types of these tumours of patients at our clinic in the last 10 years. The benign tumours include the monomorphic and pleomorphic adenoma. The malignant tumours include the adenoid carcinoma, mucoepidermoid carcinoma and the malignant pleomorphie adenoma. Furthermore two cases of acinic cell carcinoma and one case of clear cell carcinoma are presented, which are rare
1. Ciaglia P. et al, Elective percutaneous dilatational tracheostomy. Chest 87 (1985) 715-719 Complete Rehabilitation of the Lower Jaw after Segmental Resection: A New Method if-/.
Department of Oral and Maxillofacial Surgery, University of Hong Kong, Hong Kong Oral tumour resection results in serious aesthetic and functional disorder of the face and mouth. When the resection includes part of the jaw, the aim of reconstruction should encompass not only the restoration of facial aesthetics, speech and swallowing, but also the recreation of an alveolar ridge suitable for prosthetic rehabilitation of the occlusion. This enables masticatory function to regain its contribution to the well-being of the patient. Reconstruction after segmental mandibulectomy is feasible by a variety of methods including free autogenous or allogenic bone grafting and vascularized composite flaps with microvascular anastomosis. We present a method of treatment utilizing an individually designed titanium mesh tray with a removable lid containing tightly packed autogenous corticocancellous bone chips for the restoration of facial contour and alveolar ridge dimensions. Advantages include applicability to part or whole mandible defects, excellent symmetry of reconstruction, planned interarch relationship and implant positions, and endosseous implant insertion into the preplanned position. The method will be illustrated by case examples demonstrating the planning process. Metal Osteosynthesis of the Facial Skeletal Bones
Timofeyey A., Peredkov K. Ukrainian Maxillo-Facial Surgery Centre, Kyiv, Ukraine The results of various methods for osteosynthesis of the facial skeletal bones in 256 patients with maxillofacial traumas are analyzed. Osteosynthesis was performed using metal wire (tantalum, steel), on-bone plates (stainless steel, titanium, bioceramics-coated titanium). Routinely used were general clinical examination methods, radiography, computer tomography, ultrasonic examination; organism reactivity was studied as well. The advantage of osteosynthesis with titanium and bioceramic-coated titanium onbone plates over other methods was shown. It can be applied to the patients with both normal and lowered reactiveness, i.e. in the presence of accompanying diseases (diabetes mellitus, anaemia, old age, etc.). The use of the titanium or bioceramic-coated titanium for osteosynthesis reduced the number of postoperative complications more than tenfold. Any contraindications to this method of treatment were not revealed. Long-Term Results after Surgical Correction of Fibrous Dysplasia of the Visceral Cranium
Tkotz T., Weingart D., Joos U.
Department of Oral and Cranio-Maxillo-Facial Surgery, University Clinics of Miinster, MOnster, Germany
The fibrous dysplasia in the region of the visceral cranium causes troubles to the concerned patients, particularly for the reason of unesthetic disfiguring. From this point of view, a clinical study was carried out in a total of 10 patients followed up from 1982 to 1995. The patients underwent surgical treatment consisting of removal of the tumourous alterations to improve facial aesthetics. Pre- and postoperative photographs, X-rays and clinical findings were compared with regard to surgical improvement of the patient's profile. Further, it was tried to establish a correlation between the serum concentration using alkaline phosphatase and the incidence of local relapse. The results of this study indicate that, especially with regard to facial aesthetics, often only a very slight long-term improvement could be achieved. The high relapse rate (10-60%) reported in the literature could be confirmed. From the surgical point of view, the major problem is the predictability of growth reaction of this osseous change. The alkaline phosphatase of the serum, which is reported in the literature as a sign of the incidence of local relapse, did not prove to be a reliable parameter in this study. Additionally observed reactive bone regeneration following modelling osteotomy did impair the aesthetic outcome. The results of this study show that with regard to facial aesthetics the long-term results are not satisfactory. Surgical intervention in treatment of fibrous dysplasia is therefore indicated in carefully selected cases only.
Maxillary Advancement by Gradual Distraction
Triaca A., Van Waes H., Miiller P.
Pyramide Klinik am See, Ziirieh, Switzerland Application of distraction osteogenesis to the human craniofacial skeleton in properly selected cases represents a major advance in the treatment of craniofacial deformities. We report our initial clinical experience with an intraoral distraction device that permits a maxillary distraction. The device consists of a distracter fixed by self-tapping screws to the posterior maxilla and a bone plate fixed to the zygoma. Beginning 1 week postoperatively, the maxilla was gradually distracted and advanced 0.5 mm every day until normal sagittal relation was achieved. Final orthodontic treatment was necessary for a perfect occlusion. Indications, results and stability of all patients treated to date are presented.
The Surgical Procedure of Tumours of Minor Salivary Glands
Triantafillidou K., Lazaridis N., Dimitrakopoulos I., Letsis L
Aristotle University, Thessaloniki, Greece The tumours of minor salivary glands can be divided into those that are benign, those that are locally aggressive and those that are malignant with the potential to metastasize. Depending on the type of the tumour the surgical procedure consisted of local enucleation, wide local excision and partial or total maxillectomy. In this paper we present benign and malignant types of these tumours of patients at our clinic in the last 10 years. The benign tumours include the monomorphic and pleomorphic adenoma. The malignant tumours include the adenoid carcinoma, mucoepidermoid carcinoma and the malignant pleomorphie adenoma. Furthermore two cases of acinic cell carcinoma and one case of clear cell carcinoma are presented, which are rare