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Virtual planification for mandible distraction in congenital craniomaxillofacial deformities
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21st ICOMS 2013—Abstracts: Oral Papers
endocrine disorders and haematologic alterations or allergies, and no signs of coronoid hyperplasia were present in his family history. Gene examination for differential diagnosis from Jacob syndrome showed that the patient have normal karyotype. Mouth opening was equivalent to 19 mm. Computed tomography with threedimensional reconstruction was required, and an enlargement of the coronoid process was observed bilaterally. Under general anesthesia with nasotracheal intubation, the coronoid processes on both sides were removed by intraoral approach. Result: In the immediate postoperative period, an evident improvement in the buccal opening was observed with 33 mm. After one month a mucofibrotic band from mandibular posteior buccal mocosa to maxillar side was detected and cut. The last mouth opening was equivalent to 35.5 mm. Discussion and conclusion: To clarify the diagnosis, conventional imaging examinations can be used; however, because of the superimposition of the anatomic structures caused by its bidimensional image. Many theories have been described aiming at clarifying the origin of the coronoid process hyperplasia, such as temporal muscle hyperactivity, previous facial trauma, presence of hormonal alterations in puberty, family history. This also can be related to Jacob’s disease, which is characterized by elongation of the coronoid process and temporomandibular joint dysfunction. Treatment is exclusively surgical. http://dx.doi.org/10.1016/j.ijom.2013.07.144 T6.OR014 Virtual planification for mandible distraction in congenital craniomaxillofacial deformities D. Dominguez Medina ∗ , I. García Recuero, A. Romance García Hospital 12 De Octubre, Spain Background: Distraction osteogenesis (DO) as a treatment for pediatric craniomaxillofacial deformities enhances the patient’s typical restricted facial growth potential. Virtually planned tridimensional models are useful to design osteotomy’s location, vector’s direction and to chose the appropriate distraction device. Methods: Retrospective analysis of 10 cases (mean 12.7 years) treated at our service between 2011 and 2012, that underwent mandibular distraction using esterolithographic models. Preoperatively, the information obtained from high definition CT scans in DICOM format was transferred for virtual simulation with MATERIALISE and esterolithographic models were built. Internal approach was performed in 60% of the cases, external and combined were performed in 20%, respectively. External multivectorial devices were placed in 2 patients and internal in 8. The distraction rate was 0.66–1 mm/day. Certain degree of overcorrection was pursued. The consolidation period was 3.75 months. Postoperatively, cephalometric analysis was performed to assess the elongation obtained and clinical evaluation reported the occlusion type and facial symmetry improvement. The final results were compared with predicted ones by measuring their concordance. Results: The mandible elongation mean was 22.8 mm (unilateral cases 26.4 mm and in bilateral cases at least one side was distracted 20 mm), the distraction was considered satisfactory in 90% of the cases; the rate of major complications was 10%. The vector’s direction was considered adecuate in 100% of the cases. Conclusions: Surgeon’s experience, intrinsic growth restriction of these patients, effect of muscle forces, fulfillment of orthodontic treatment and technical limitations of the devices are the main factors that might influence the discrepancies between
the planification and the final results. These outcomes improve those obtained traditionally however they still do not assure the treatment success. Key words: virtual planification; distraction osteogenesis; congenital deformities http://dx.doi.org/10.1016/j.ijom.2013.07.145 T6.OR015 Early mandibular distraction osteogenesis in neonates and paediatric age M. Galie ∗ , L. Clauser Unit of Cranio-maxillo-facial Surgery, Italy Background: Distraction osteogenesis has been one of the most innovative concepts in craniomaxillofacial surgery through the last 25 years. Technology has evolved from the first application of external devices to intraoral and hybrid or semiburied techniques. After a quarter of century of extensive use Distraction Osteogenesis has today specific indications for congenital craniofacial and cleft deformities. Methods: Seven infants with craniofacial syndromes and syndromic micrognathia underwent mandibular lengthening in neonatal age or during growth: 3 Pierre Robin Sequences (PRS), 1 Cerebro-Costo-Mandibular Syndrome (CCMS), 1 Auriculo Condylar Syndrome (ACS), 1 Craniofacial Microsomia–Tessier Cleft 7 (CFM), 1 Treacher–Collins Syndrome (TCS). All patients were evaluated by a multidisciplinary team, included fibroscopic assessment. Results: Pre-distraction and post- distraction lateral CT scans demonstrated the significative improvement in the airway space. PRS babies were early decannulated after distraction. Improvement in feeding was seen following mandibular distraction and the nasogastric tube was removed. Direct visualization with flexible endoscope demonstrated the airway changes. The baby with CCMS and TMJ ankylosis still has deglutitory problem and tracheostomy for airways protection. The mean advancement of the TCS, OAS and CFM cases was 18 mm, with changes in maxillomandibular relationships and a slight overcorrection. Conclusions: Mandibular distraction osteogenesis in the neonates with PRS is an effective treatment option to safely relieve the upper airway obstruction associated with micrognathia. For selected newborns, mandibular DO will allow for avoidance of a tracheostomy and improved oral feeding. A careful evaluation of the patient’s airway and feeding must be performed and evaluated by a multidisciplinary Team approach. In syndromic micrognathia early mandibular distraction seems to be an appropriate indication. Benefits are functional, morphological, aesthetic with consistent psychological and familiar positive effects. http://dx.doi.org/10.1016/j.ijom.2013.07.146 T6.OR016 Posterior cranial vault expansion with resorbables distractors in syndromic patients Garcia Recuero ∗ , H.B. Jose, R.G. Ana, M. Maria Jesus, F.U. Maria Isabel, P. Beatriz H.U. 12 De Octubre, Madrid, Spain Introduction: Posterior vault remodelation can prevent intracranial hypertension, improve the Chiari malformation con-
21st ICOMS 2013—Abstracts: Oral Papers
endocrine disorders and haematologic alterations or allergies, and no signs of coronoid hyperplasia were present in his family history. Gene examination for differential diagnosis from Jacob syndrome showed that the patient have normal karyotype. Mouth opening was equivalent to 19 mm. Computed tomography with threedimensional reconstruction was required, and an enlargement of the coronoid process was observed bilaterally. Under general anesthesia with nasotracheal intubation, the coronoid processes on both sides were removed by intraoral approach. Result: In the immediate postoperative period, an evident improvement in the buccal opening was observed with 33 mm. After one month a mucofibrotic band from mandibular posteior buccal mocosa to maxillar side was detected and cut. The last mouth opening was equivalent to 35.5 mm. Discussion and conclusion: To clarify the diagnosis, conventional imaging examinations can be used; however, because of the superimposition of the anatomic structures caused by its bidimensional image. Many theories have been described aiming at clarifying the origin of the coronoid process hyperplasia, such as temporal muscle hyperactivity, previous facial trauma, presence of hormonal alterations in puberty, family history. This also can be related to Jacob’s disease, which is characterized by elongation of the coronoid process and temporomandibular joint dysfunction. Treatment is exclusively surgical. http://dx.doi.org/10.1016/j.ijom.2013.07.144 T6.OR014 Virtual planification for mandible distraction in congenital craniomaxillofacial deformities D. Dominguez Medina ∗ , I. García Recuero, A. Romance García Hospital 12 De Octubre, Spain Background: Distraction osteogenesis (DO) as a treatment for pediatric craniomaxillofacial deformities enhances the patient’s typical restricted facial growth potential. Virtually planned tridimensional models are useful to design osteotomy’s location, vector’s direction and to chose the appropriate distraction device. Methods: Retrospective analysis of 10 cases (mean 12.7 years) treated at our service between 2011 and 2012, that underwent mandibular distraction using esterolithographic models. Preoperatively, the information obtained from high definition CT scans in DICOM format was transferred for virtual simulation with MATERIALISE and esterolithographic models were built. Internal approach was performed in 60% of the cases, external and combined were performed in 20%, respectively. External multivectorial devices were placed in 2 patients and internal in 8. The distraction rate was 0.66–1 mm/day. Certain degree of overcorrection was pursued. The consolidation period was 3.75 months. Postoperatively, cephalometric analysis was performed to assess the elongation obtained and clinical evaluation reported the occlusion type and facial symmetry improvement. The final results were compared with predicted ones by measuring their concordance. Results: The mandible elongation mean was 22.8 mm (unilateral cases 26.4 mm and in bilateral cases at least one side was distracted 20 mm), the distraction was considered satisfactory in 90% of the cases; the rate of major complications was 10%. The vector’s direction was considered adecuate in 100% of the cases. Conclusions: Surgeon’s experience, intrinsic growth restriction of these patients, effect of muscle forces, fulfillment of orthodontic treatment and technical limitations of the devices are the main factors that might influence the discrepancies between
the planification and the final results. These outcomes improve those obtained traditionally however they still do not assure the treatment success. Key words: virtual planification; distraction osteogenesis; congenital deformities http://dx.doi.org/10.1016/j.ijom.2013.07.145 T6.OR015 Early mandibular distraction osteogenesis in neonates and paediatric age M. Galie ∗ , L. Clauser Unit of Cranio-maxillo-facial Surgery, Italy Background: Distraction osteogenesis has been one of the most innovative concepts in craniomaxillofacial surgery through the last 25 years. Technology has evolved from the first application of external devices to intraoral and hybrid or semiburied techniques. After a quarter of century of extensive use Distraction Osteogenesis has today specific indications for congenital craniofacial and cleft deformities. Methods: Seven infants with craniofacial syndromes and syndromic micrognathia underwent mandibular lengthening in neonatal age or during growth: 3 Pierre Robin Sequences (PRS), 1 Cerebro-Costo-Mandibular Syndrome (CCMS), 1 Auriculo Condylar Syndrome (ACS), 1 Craniofacial Microsomia–Tessier Cleft 7 (CFM), 1 Treacher–Collins Syndrome (TCS). All patients were evaluated by a multidisciplinary team, included fibroscopic assessment. Results: Pre-distraction and post- distraction lateral CT scans demonstrated the significative improvement in the airway space. PRS babies were early decannulated after distraction. Improvement in feeding was seen following mandibular distraction and the nasogastric tube was removed. Direct visualization with flexible endoscope demonstrated the airway changes. The baby with CCMS and TMJ ankylosis still has deglutitory problem and tracheostomy for airways protection. The mean advancement of the TCS, OAS and CFM cases was 18 mm, with changes in maxillomandibular relationships and a slight overcorrection. Conclusions: Mandibular distraction osteogenesis in the neonates with PRS is an effective treatment option to safely relieve the upper airway obstruction associated with micrognathia. For selected newborns, mandibular DO will allow for avoidance of a tracheostomy and improved oral feeding. A careful evaluation of the patient’s airway and feeding must be performed and evaluated by a multidisciplinary Team approach. In syndromic micrognathia early mandibular distraction seems to be an appropriate indication. Benefits are functional, morphological, aesthetic with consistent psychological and familiar positive effects. http://dx.doi.org/10.1016/j.ijom.2013.07.146 T6.OR016 Posterior cranial vault expansion with resorbables distractors in syndromic patients Garcia Recuero ∗ , H.B. Jose, R.G. Ana, M. Maria Jesus, F.U. Maria Isabel, P. Beatriz H.U. 12 De Octubre, Madrid, Spain Introduction: Posterior vault remodelation can prevent intracranial hypertension, improve the Chiari malformation con-