- Email: [email protected]
Advancement le fort I osteotomy in cleft patients
10
025A - Orthognathic, cleft lip~palate and craniofacial surgery
create profound aesthetic and functional problems. However a combination of obturation of the palatal cleft with a temporalis muscle flap, and a segmental osteotomy of the displaced premaxilla, achieves closure of the oro-nasal defect and repair of the alveolar ridge in one operation. Whilst temporalis muscle is a convenient source of vascularised tissue, the thickness of the pedicle may interfere with masticatory function if the flap is passed across the alveolar ridge. For repairing palatal defects, the alternative technique of muscle transfer through openings in the maxillary sinus walls allows obturation of clefts from a superior direction and avoids any occlusal trauma or disturbance to oral function. Osteotomy and repositioning of the displaced premaxilla, originally carried out as a second stage, is now performed concurrently; allowing simultaneous repair of all defects in one operation. By transferring readily available vascularised tissue, these procedures have low morbidity and are a simple, predictably successful, and cost-effective technique for treating adult clefts in the Indian subcontinent.
9. Autogenous Bone Grafting of the Cleft Maxilla
Byun, J., Pyo, S., Hwang, 19., Sung, L, Jin, S., Kim, J., Chung, L Department of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University, Pusan, Korea Bone grafting to repair the cleft maxilla has long been a part of the accepted treatment regimen for the cleft palate patients. Timing of bone grafting is generally described as "primary" and "secondary". The "primary" bone grafting is performed before eruption of the primary dentition or before 2 years of age and the "secondary" bone grafting after development of the permanent dentition. However, there are no universal agreements on the desirability of the procedure. Seventy-six cases of "secondary" bone grafting utilizing autogenous iliac bone were observed at our department for 7 years (1991-1997). Among them, 64 patients were unilateral (Rt: Lt=24:40) and 12 were bilateral. The mean time of bone graft was 13years old (range 7-25 years) and the follow up period was an average of 2.1 years. The overall success rate determined by bridging was 96.6% (unilateral 96.9%, bilateral 91.7%) and contour of the reconstructed alveolar ridge was measured. Secondary alveolar bone grafting is a practical and efficient method to restore the function and structure of the maxillary arch at the cleft sites.
10. Advancement Le Fort I Osteotomy in Cleft Patients
Kim, J., Hwang, D., Cha, M., Byun, J., Pyo, S. Department of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University, Pusan, Korea Generally, the congenital cleft lip and palate (CLP) patient shows maxillary hypoplasia due to early cheiloplasty, palatoplasty and hypofunction of adjacent tissues. But most of CLP patients have normal or somewhat prognathic mandibles so resultantly they show class III malocclusion. In these cases, orthodontic and surgical treatment to solve the esthetic and functional problems and bone grafting is also done on cleft maxilla to give postoperative stability and tooth arrangement: But it is not easy to do this in CLP patients for lack of soft tissue elasticity, scar band on upper lip, cleft maxilla and poor postoperative occlusion. We analyzed our 9 cleft patients who underwent advancement Le Fort I osteotomy from May 1993 to June 1997. The age of patients at the time of operation ranged from 15 to 27 (mean 21.3) and 8 patients were male and 7 were unilateral. Mean period of preoperative orthodontic treatment was 2.1 years. Five patients showed VPI but none of them deteriorated after operation. The range of advancement was 3 tO~12 mm and mean amount was 6.7 ram. Eight patients received bone grafting at the cleft maxilla and 6 at the pterygomaxillary junction. Estimated relapse at minimally 12 months after operation was 0.5 to 4 mm (mean 2.1 mm).
11. A Cephalometric Study on Changes in Pharyngeal Airway Space, Tongue and Hyoid Bone Positions Following the Surgical Correction of Mandibular Prognathism
Park, B., Kim, J. Department of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University, Pusan, Korea Purpose This study was aimed at measOring the changes in the hyoid bone position, tongue position, and pharyngeal airway space in subjects with mandibular setback osteotomies. Methods Twenty patients were evaluated retrospectively for their changes in pharyngeal airway space, tongue and hyoid bone positions. All patients underwent surgical mandibular setback using bilateral sagittal split osteotomies. The cephalometric analysis was performed preoperatively, and 1 week, 3-6 months, and 1 year postoperatively. Results The hyoid hone moved inferiorly and posteriorly immediately after surgery, and it returned to the preoperative position during follow-up period. The nasopharyngeal airway space was not significantly Changed after surgery. A considerable decrease in the oropharyngeal and hypopharyngeal
025A - Orthognathic, cleft lip~palate and craniofacial surgery
create profound aesthetic and functional problems. However a combination of obturation of the palatal cleft with a temporalis muscle flap, and a segmental osteotomy of the displaced premaxilla, achieves closure of the oro-nasal defect and repair of the alveolar ridge in one operation. Whilst temporalis muscle is a convenient source of vascularised tissue, the thickness of the pedicle may interfere with masticatory function if the flap is passed across the alveolar ridge. For repairing palatal defects, the alternative technique of muscle transfer through openings in the maxillary sinus walls allows obturation of clefts from a superior direction and avoids any occlusal trauma or disturbance to oral function. Osteotomy and repositioning of the displaced premaxilla, originally carried out as a second stage, is now performed concurrently; allowing simultaneous repair of all defects in one operation. By transferring readily available vascularised tissue, these procedures have low morbidity and are a simple, predictably successful, and cost-effective technique for treating adult clefts in the Indian subcontinent.
9. Autogenous Bone Grafting of the Cleft Maxilla
Byun, J., Pyo, S., Hwang, 19., Sung, L, Jin, S., Kim, J., Chung, L Department of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University, Pusan, Korea Bone grafting to repair the cleft maxilla has long been a part of the accepted treatment regimen for the cleft palate patients. Timing of bone grafting is generally described as "primary" and "secondary". The "primary" bone grafting is performed before eruption of the primary dentition or before 2 years of age and the "secondary" bone grafting after development of the permanent dentition. However, there are no universal agreements on the desirability of the procedure. Seventy-six cases of "secondary" bone grafting utilizing autogenous iliac bone were observed at our department for 7 years (1991-1997). Among them, 64 patients were unilateral (Rt: Lt=24:40) and 12 were bilateral. The mean time of bone graft was 13years old (range 7-25 years) and the follow up period was an average of 2.1 years. The overall success rate determined by bridging was 96.6% (unilateral 96.9%, bilateral 91.7%) and contour of the reconstructed alveolar ridge was measured. Secondary alveolar bone grafting is a practical and efficient method to restore the function and structure of the maxillary arch at the cleft sites.
10. Advancement Le Fort I Osteotomy in Cleft Patients
Kim, J., Hwang, D., Cha, M., Byun, J., Pyo, S. Department of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University, Pusan, Korea Generally, the congenital cleft lip and palate (CLP) patient shows maxillary hypoplasia due to early cheiloplasty, palatoplasty and hypofunction of adjacent tissues. But most of CLP patients have normal or somewhat prognathic mandibles so resultantly they show class III malocclusion. In these cases, orthodontic and surgical treatment to solve the esthetic and functional problems and bone grafting is also done on cleft maxilla to give postoperative stability and tooth arrangement: But it is not easy to do this in CLP patients for lack of soft tissue elasticity, scar band on upper lip, cleft maxilla and poor postoperative occlusion. We analyzed our 9 cleft patients who underwent advancement Le Fort I osteotomy from May 1993 to June 1997. The age of patients at the time of operation ranged from 15 to 27 (mean 21.3) and 8 patients were male and 7 were unilateral. Mean period of preoperative orthodontic treatment was 2.1 years. Five patients showed VPI but none of them deteriorated after operation. The range of advancement was 3 tO~12 mm and mean amount was 6.7 ram. Eight patients received bone grafting at the cleft maxilla and 6 at the pterygomaxillary junction. Estimated relapse at minimally 12 months after operation was 0.5 to 4 mm (mean 2.1 mm).
11. A Cephalometric Study on Changes in Pharyngeal Airway Space, Tongue and Hyoid Bone Positions Following the Surgical Correction of Mandibular Prognathism
Park, B., Kim, J. Department of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University, Pusan, Korea Purpose This study was aimed at measOring the changes in the hyoid bone position, tongue position, and pharyngeal airway space in subjects with mandibular setback osteotomies. Methods Twenty patients were evaluated retrospectively for their changes in pharyngeal airway space, tongue and hyoid bone positions. All patients underwent surgical mandibular setback using bilateral sagittal split osteotomies. The cephalometric analysis was performed preoperatively, and 1 week, 3-6 months, and 1 year postoperatively. Results The hyoid hone moved inferiorly and posteriorly immediately after surgery, and it returned to the preoperative position during follow-up period. The nasopharyngeal airway space was not significantly Changed after surgery. A considerable decrease in the oropharyngeal and hypopharyngeal