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22Q11.2 deletion syndrome .correlation between platybasia and velopharyngeal insufficiency
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21st ICOMS 2013—Abstracts: Oral Papers
T6.OR007 Our experience with piezosurgery P. Cascone ∗ , V. Ramieri, G. Iannetti Cattedra Di Chirurgia Maxillo-Facciale, ‘Sapienza’ Università di Roma, Italy Background: Piezosurgery represents a promising, meticulous and soft tissue-sparing system for bone cutting, based on ultrasonic microvibrations. There are several advantages deriving from the adoption of these devices. Above all soft tissue protection represents of the main characteristic that are particularly useful in maxillofacial surgery. In addition there is optimal visibility in the surgical field and blood loss is limited. Dealing with maxillofacial peculiar issues it has to be underlined how noble structures such as nerves and artery are more easily preserved with the adoption of this device. Its original indications were oral and maxillofacial surgery, otorhinolaryngology, neurosurgery, ophthalmology, traumatology and orthopaedics. The main indications in oral surgery are sinus lift, bone graft harvesting, osteogenic distraction, ridge expansion, endodontic surgery, periodontal surgery, inferior alveolar nerve decompression, cyst removal, dental extraction and impacted tooth removal. Methods: However, in our department, we performed craniofacial pediatric malformations, orthognatic surgery, TMJ surgery and oncology. Results: What we observed is the shortening of the postoperative swelling. There is more comfort for the patients. Conclusions: Piezosurgery is a promising technical modality for different aspects of bone surgery with a rapidly increasing number of indications throughout the whole field of surgery. We report our experience with the use of piezosurgery. http://dx.doi.org/10.1016/j.ijom.2013.07.138 T6.OR008 22Q11.2 deletion syndrome .correlation between platybasia and velopharyngeal insufficiency L. Castellon 1,∗ , L. Canto 2 , P. Agurto 3 , M. Palomares 3 1 Hospital Calvo Mackenna-Universidad Mayor-Hospital Exequiel Gonzales Cortes, Chile 2 Hospital Calvo Mackenna-Universidad Mayor, Chile 3 Hospital Calvo Mackenna, Chile
Background and purpose: Patients with 22q11.2 deletion syndrome (DS) present a spectrum of functional and anatomic abnormalities that may contribute to alterations in velopharyngeal (VP) valving, including cleft palate or submucous cleft palate, palatopharyngeal hypotonia, adenoid hypoplasia, cervical spine abnormalities and platybasia. Platybasia corresponds to an anatomical abnormality of the skull base in which the anterior cranial base angle is more obtuse. This anatomical alteration may determine an altered position of the posterior wall of the pharynx, therefore it may influence the VPI. The objective of this study is to determine the relationship between the angle of the skull base and velopharyngeal insufficiency (VPI) in patients with 22q11.2 DS. This will contribute to determine the best treatment option in the management of VPI. Methods: 23 patients with 22q11.2 DS between the ages of 6 and 27 years (mean age 13.1 years), were included in the study group. Each patient was diagnosed with a 22q11.2 deletion as confirmed by fluorescence in situ hybridization analysis. Every patient
underwent cephalometric characterization by a single operator to determine alterations in the skull base. Patients with severe mental retardation and evident alveolar cleft were excluded. In these patients the presence of platybasia was determined, in addition to a speech evaluation to establish the presence of VPI with its respective severity. Results: 21 of the 23 patients (91%) had platybasia as anatomical characteristic of the cranial base. Of these patients, 85% had VPI with scores up to 5. Conclusions: There is a relationship between the presence of platybasia and VPI in patients with the 22q11.2 DS. Key words: 22q11.2 deletion syndrome; platybasia; velopharyngeal insufficiency http://dx.doi.org/10.1016/j.ijom.2013.07.139 T6.OR009 Mandibular distraction in pierre robin syndrome. indications and results in 7 cases J. Ciechomski 1,∗ , J. Acoglani 2 1 2
Hospital De Ni˜nos, Costa Rica Private Practice, United States
While mandibular distraction is an accepted method to treat respiratory disturbances due to Pierre Robin Syndrome, the indications does not remain clear at all. We present our experience in seven cases treated with unidirectional external mandibular distractors. All the patients were operated on the first week of life. There were 5 boys and 2 girls. All patients were operated under oral intubation, that was maintained until the distraction reached 5 mm and in a radiography we can see a satisfactory air shadow. We started the distraction on day 3, and carry it on until we got a contact border to border between the maxilla and mandible. Finished the distraction, the device was kept in place for 6 weeks. We had no postoperative complications but 3 patients needed tracheostomy, 2 due swallowing disorders with aspiration, 3 weeks and 1 month after distraction, and 1, during the distraction due to neurological disorders and mechanic ventilation needs. We try to establish the parameters to improve indications, and to avoid treatment failures. http://dx.doi.org/10.1016/j.ijom.2013.07.140 T6.OR010 Cranio-facial advance in craniosynostosis syndromes: distraction osteogenesis vs traditional technique M. Contreras Morillo ∗ , M.A Martínez Navarro, F. Galeas Anaya, F. Ruiz Delgado, L. Bermudo A˜nino Oral & Maxillofacial Surgery Department, Carlos Haya Hospital, Spain Introduction: The fronto-orbital advancement cranial remodeling has been the traditional treatment of children with syndromic craniostenosis to treat potential neurological and ophthalmological complications. However, this technique does not correct hypoplasia of the facial third middle and complications arising from this. Since the introduction in the craniofacial area of bone distraction, it is getting excellent results, in addition to being a procedure effective, safe and stable method to improve aesthetics and functionally craniofacial abnormalities of these children.
21st ICOMS 2013—Abstracts: Oral Papers
T6.OR007 Our experience with piezosurgery P. Cascone ∗ , V. Ramieri, G. Iannetti Cattedra Di Chirurgia Maxillo-Facciale, ‘Sapienza’ Università di Roma, Italy Background: Piezosurgery represents a promising, meticulous and soft tissue-sparing system for bone cutting, based on ultrasonic microvibrations. There are several advantages deriving from the adoption of these devices. Above all soft tissue protection represents of the main characteristic that are particularly useful in maxillofacial surgery. In addition there is optimal visibility in the surgical field and blood loss is limited. Dealing with maxillofacial peculiar issues it has to be underlined how noble structures such as nerves and artery are more easily preserved with the adoption of this device. Its original indications were oral and maxillofacial surgery, otorhinolaryngology, neurosurgery, ophthalmology, traumatology and orthopaedics. The main indications in oral surgery are sinus lift, bone graft harvesting, osteogenic distraction, ridge expansion, endodontic surgery, periodontal surgery, inferior alveolar nerve decompression, cyst removal, dental extraction and impacted tooth removal. Methods: However, in our department, we performed craniofacial pediatric malformations, orthognatic surgery, TMJ surgery and oncology. Results: What we observed is the shortening of the postoperative swelling. There is more comfort for the patients. Conclusions: Piezosurgery is a promising technical modality for different aspects of bone surgery with a rapidly increasing number of indications throughout the whole field of surgery. We report our experience with the use of piezosurgery. http://dx.doi.org/10.1016/j.ijom.2013.07.138 T6.OR008 22Q11.2 deletion syndrome .correlation between platybasia and velopharyngeal insufficiency L. Castellon 1,∗ , L. Canto 2 , P. Agurto 3 , M. Palomares 3 1 Hospital Calvo Mackenna-Universidad Mayor-Hospital Exequiel Gonzales Cortes, Chile 2 Hospital Calvo Mackenna-Universidad Mayor, Chile 3 Hospital Calvo Mackenna, Chile
Background and purpose: Patients with 22q11.2 deletion syndrome (DS) present a spectrum of functional and anatomic abnormalities that may contribute to alterations in velopharyngeal (VP) valving, including cleft palate or submucous cleft palate, palatopharyngeal hypotonia, adenoid hypoplasia, cervical spine abnormalities and platybasia. Platybasia corresponds to an anatomical abnormality of the skull base in which the anterior cranial base angle is more obtuse. This anatomical alteration may determine an altered position of the posterior wall of the pharynx, therefore it may influence the VPI. The objective of this study is to determine the relationship between the angle of the skull base and velopharyngeal insufficiency (VPI) in patients with 22q11.2 DS. This will contribute to determine the best treatment option in the management of VPI. Methods: 23 patients with 22q11.2 DS between the ages of 6 and 27 years (mean age 13.1 years), were included in the study group. Each patient was diagnosed with a 22q11.2 deletion as confirmed by fluorescence in situ hybridization analysis. Every patient
underwent cephalometric characterization by a single operator to determine alterations in the skull base. Patients with severe mental retardation and evident alveolar cleft were excluded. In these patients the presence of platybasia was determined, in addition to a speech evaluation to establish the presence of VPI with its respective severity. Results: 21 of the 23 patients (91%) had platybasia as anatomical characteristic of the cranial base. Of these patients, 85% had VPI with scores up to 5. Conclusions: There is a relationship between the presence of platybasia and VPI in patients with the 22q11.2 DS. Key words: 22q11.2 deletion syndrome; platybasia; velopharyngeal insufficiency http://dx.doi.org/10.1016/j.ijom.2013.07.139 T6.OR009 Mandibular distraction in pierre robin syndrome. indications and results in 7 cases J. Ciechomski 1,∗ , J. Acoglani 2 1 2
Hospital De Ni˜nos, Costa Rica Private Practice, United States
While mandibular distraction is an accepted method to treat respiratory disturbances due to Pierre Robin Syndrome, the indications does not remain clear at all. We present our experience in seven cases treated with unidirectional external mandibular distractors. All the patients were operated on the first week of life. There were 5 boys and 2 girls. All patients were operated under oral intubation, that was maintained until the distraction reached 5 mm and in a radiography we can see a satisfactory air shadow. We started the distraction on day 3, and carry it on until we got a contact border to border between the maxilla and mandible. Finished the distraction, the device was kept in place for 6 weeks. We had no postoperative complications but 3 patients needed tracheostomy, 2 due swallowing disorders with aspiration, 3 weeks and 1 month after distraction, and 1, during the distraction due to neurological disorders and mechanic ventilation needs. We try to establish the parameters to improve indications, and to avoid treatment failures. http://dx.doi.org/10.1016/j.ijom.2013.07.140 T6.OR010 Cranio-facial advance in craniosynostosis syndromes: distraction osteogenesis vs traditional technique M. Contreras Morillo ∗ , M.A Martínez Navarro, F. Galeas Anaya, F. Ruiz Delgado, L. Bermudo A˜nino Oral & Maxillofacial Surgery Department, Carlos Haya Hospital, Spain Introduction: The fronto-orbital advancement cranial remodeling has been the traditional treatment of children with syndromic craniostenosis to treat potential neurological and ophthalmological complications. However, this technique does not correct hypoplasia of the facial third middle and complications arising from this. Since the introduction in the craniofacial area of bone distraction, it is getting excellent results, in addition to being a procedure effective, safe and stable method to improve aesthetics and functionally craniofacial abnormalities of these children.