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Cephalometric analyses of the facial skeleton in patients with malformations of the mandible
88 Journal of Cranio-Maxillofacial Surgery controversially. In a retrospective study of TMJ function and skeletal relapse rate 1 year after bimaxillary orthognathic surgery with intraoperative fixation of centric condylar position, we performed clinical examination of neuromuscular function, axiography, radiography and evaluated individual subjective symptoms in 12 patients. We compared the results to those of 16 patients who had been operated without a condylar positioning system. We conclude that rigid fixation of the proximal segment with positioning plates in bimaxillary orthognathic surgery has no positive influence on postoperative TMJ function. Nevertheless, this method can be regarded as valuable intraoperative aid in complicated cases and in patients with preoperative TMJ symptoms.
Alveolar Osteitis and Third Molar Surgery: A Retrospective Study
Piecuch £ F., Arzadon £, Lieblich S.
Between 1985-1995, 20 patients with unilateral facial palsy subsequent to acoustic neurinom operation were treated in our clinic. The youngest patient was 45-years, the oldest 71-years with an average of 54-years. In all cases the function of the trigeminal nerve was intact. Pulling and suspension of the corner of the lip was carried out by using a frozen broad band of fascia lata sutured to the temporalis fascia or by mobilizing a part of the muscle itself. At the same time, the nasolabial fold was lifted with an S-shaped excision of the buccal skin. The results show that for an aesthetically sufficient long-term result, the overcorrection of the corner of the lip is necessary. Following the relapse, a stable and significant improvement of the facial deformity was achieved. Results stayed constant during the whole follow-up period. Based on our results we conclude that, from the functional point of view, the isolated use of fascia lata technique is not able to improve the function in the paralyzed region. The aesthetic, however, is significantly improved. However, using a combined technique with a mobilized part of the temporalis muscle and fascia lata also the function can be improved to some degree.
Department of Oral and Maxillofacial Surgery, University of Connecticut, Farmington, Connecticut, USA Records of 2 134 patients who had 6 713 third molar extractions were reviewed for incidence of alveolar osteitis. Correlation with sex of the patient, age, position of tooth, and prophylactic use of antibiotics were made. Results were analysed by X 2. Overall incidence was 2.3% (155 out of 6713), almost all occurring in the mandible (152 out of 3443; 4.4%) compared to the maxilla (3 out of 3270; 0.09%). Only those occurring in the mandible were analysed. Incidence in males was 4.6% (65 out of 1414), while in females it was also 4.6% (87 out of 1877). Incidence increased with age, 10-19 group (26 out of 1375; 1.9%); followed by the 20-29 group (65 out of 1502; 4.5%); then the 30-39 group (34 out of 343; 9.9%); and highest in the 40-49 group (19 out of 156; 12.2%); P = 0.001. The incidence according to tooth position was 3.97% erupted, 1.35% soft tissue, 3.96% partial bony, and 6.11% full bony P = 0.001. Without antibiotics the incidence was 6.6% (22/322). Systemic perioperative antibiotics reduced incidence to 5,6% (70/1242) while local application of tetracycline produced a rate of 3.0% (48/1597). Reduction in incidence attributable to local tetracycline was significant (P = 0.001). This study indicates that alveolar osteitis occurred almost exclusively in the mandible, with increasing incidence in older patients. Teeth with infection, caries or other pathology also present a higher risk for developing dry sockets. The position to the teeth influenced the incidence, which was lowest in soft tissue impaction and highest in full bony impaction. Local application of tetracycline helped reduce the incidence of mandibular alveolar osteitis.
Surgical Correction of Facial Deformity Caused by Unilateral Facial Nerve Paralysis
Piffko £, Weingart D., Ahrberg W., Joos U.
Cephalometric Analyses of the Facial Skeleton in Patients with Malformations of the Mandible
Pisulska-Otremba Aft, Kobus K.2, Michalik Aft, lwanecka.Zdunczyk 3/1.1
¢Department of Orthodontics, Silesian Medical Academy, Zabrze, Poland 2Clinicfor Plastic Surgery, Polanica, Poland The purpose of this study was to present deformations of facial skeleton in children with symptoms of microsomia who were treated pre- and postsurgically in the Orthodontic Department of the Silesian Medical Academy in Zabrze. Orthognathic surgery was performed in the Clinic for Plastic Surgery in Polanica.
Material and Methods: Thirty cephalograms in L-L and PA projection of 17 children were analysed.. Mean age for females was 10 years and for males 5.7 years. Presurgically the dental arches were aligned. After mandibular osteotomy or corticotomy at the age of 4-10-years, the distraction device was inserted and activated 1 mm per day. After the device was removed, an orthodontic functional appliance has been applied. Results: It has been stated that before surgery the mandible was significantly shorter, rotated towards the malformed side and the chin was posteriorly positioned. Gonion point was retropositioned on the damaged side and anteriorly positioned on the opposite side. Anterior facial height was insignificantly elongated but posterior facial height, especially the damaged side, was considerably reduced. After surgery, posterior facial height was within the normal range. The obtained results indicate the possibility of early surgical intervention by distraction which creates better conditions for morphological and functional development of the orofacial region in children with severe mandibular malformations,
Department of Oral and Cranio-Maxillo-Facial Surgery, University Clinic of Miinste~ Mfinster, Germany If the patient's facial palsy appears permanent, reconstruction to obviate, or at least ameliorate, the stigmata of the condition should be considered. Various plastic-reconstructive surgical procedures have been introduced to improve the appearance of facial deformity following facial nerve paralysis without direct or indirect nerve reconstruction.
Computer Assisted Condyle Positioning during Orthognathic Surgery
Ploder 0., Wagner A., Enislidis E., Schobel G., Millesi W. Clinicfor Maxillofacial Surgery, University Hospital AKH, Vienna, Austria
Alveolar Osteitis and Third Molar Surgery: A Retrospective Study
Piecuch £ F., Arzadon £, Lieblich S.
Between 1985-1995, 20 patients with unilateral facial palsy subsequent to acoustic neurinom operation were treated in our clinic. The youngest patient was 45-years, the oldest 71-years with an average of 54-years. In all cases the function of the trigeminal nerve was intact. Pulling and suspension of the corner of the lip was carried out by using a frozen broad band of fascia lata sutured to the temporalis fascia or by mobilizing a part of the muscle itself. At the same time, the nasolabial fold was lifted with an S-shaped excision of the buccal skin. The results show that for an aesthetically sufficient long-term result, the overcorrection of the corner of the lip is necessary. Following the relapse, a stable and significant improvement of the facial deformity was achieved. Results stayed constant during the whole follow-up period. Based on our results we conclude that, from the functional point of view, the isolated use of fascia lata technique is not able to improve the function in the paralyzed region. The aesthetic, however, is significantly improved. However, using a combined technique with a mobilized part of the temporalis muscle and fascia lata also the function can be improved to some degree.
Department of Oral and Maxillofacial Surgery, University of Connecticut, Farmington, Connecticut, USA Records of 2 134 patients who had 6 713 third molar extractions were reviewed for incidence of alveolar osteitis. Correlation with sex of the patient, age, position of tooth, and prophylactic use of antibiotics were made. Results were analysed by X 2. Overall incidence was 2.3% (155 out of 6713), almost all occurring in the mandible (152 out of 3443; 4.4%) compared to the maxilla (3 out of 3270; 0.09%). Only those occurring in the mandible were analysed. Incidence in males was 4.6% (65 out of 1414), while in females it was also 4.6% (87 out of 1877). Incidence increased with age, 10-19 group (26 out of 1375; 1.9%); followed by the 20-29 group (65 out of 1502; 4.5%); then the 30-39 group (34 out of 343; 9.9%); and highest in the 40-49 group (19 out of 156; 12.2%); P = 0.001. The incidence according to tooth position was 3.97% erupted, 1.35% soft tissue, 3.96% partial bony, and 6.11% full bony P = 0.001. Without antibiotics the incidence was 6.6% (22/322). Systemic perioperative antibiotics reduced incidence to 5,6% (70/1242) while local application of tetracycline produced a rate of 3.0% (48/1597). Reduction in incidence attributable to local tetracycline was significant (P = 0.001). This study indicates that alveolar osteitis occurred almost exclusively in the mandible, with increasing incidence in older patients. Teeth with infection, caries or other pathology also present a higher risk for developing dry sockets. The position to the teeth influenced the incidence, which was lowest in soft tissue impaction and highest in full bony impaction. Local application of tetracycline helped reduce the incidence of mandibular alveolar osteitis.
Surgical Correction of Facial Deformity Caused by Unilateral Facial Nerve Paralysis
Piffko £, Weingart D., Ahrberg W., Joos U.
Cephalometric Analyses of the Facial Skeleton in Patients with Malformations of the Mandible
Pisulska-Otremba Aft, Kobus K.2, Michalik Aft, lwanecka.Zdunczyk 3/1.1
¢Department of Orthodontics, Silesian Medical Academy, Zabrze, Poland 2Clinicfor Plastic Surgery, Polanica, Poland The purpose of this study was to present deformations of facial skeleton in children with symptoms of microsomia who were treated pre- and postsurgically in the Orthodontic Department of the Silesian Medical Academy in Zabrze. Orthognathic surgery was performed in the Clinic for Plastic Surgery in Polanica.
Material and Methods: Thirty cephalograms in L-L and PA projection of 17 children were analysed.. Mean age for females was 10 years and for males 5.7 years. Presurgically the dental arches were aligned. After mandibular osteotomy or corticotomy at the age of 4-10-years, the distraction device was inserted and activated 1 mm per day. After the device was removed, an orthodontic functional appliance has been applied. Results: It has been stated that before surgery the mandible was significantly shorter, rotated towards the malformed side and the chin was posteriorly positioned. Gonion point was retropositioned on the damaged side and anteriorly positioned on the opposite side. Anterior facial height was insignificantly elongated but posterior facial height, especially the damaged side, was considerably reduced. After surgery, posterior facial height was within the normal range. The obtained results indicate the possibility of early surgical intervention by distraction which creates better conditions for morphological and functional development of the orofacial region in children with severe mandibular malformations,
Department of Oral and Cranio-Maxillo-Facial Surgery, University Clinic of Miinste~ Mfinster, Germany If the patient's facial palsy appears permanent, reconstruction to obviate, or at least ameliorate, the stigmata of the condition should be considered. Various plastic-reconstructive surgical procedures have been introduced to improve the appearance of facial deformity following facial nerve paralysis without direct or indirect nerve reconstruction.
Computer Assisted Condyle Positioning during Orthognathic Surgery
Ploder 0., Wagner A., Enislidis E., Schobel G., Millesi W. Clinicfor Maxillofacial Surgery, University Hospital AKH, Vienna, Austria