- Email: [email protected]
Correction of bimaxillary deformities by orthognathic surgery with do
Int. J. Oral Maxillofac. Surg. 2005; 34 (Supplement 1): $ 1 - $ 1 8 1
62 [-O-'~--] METASTASIS TO THE PAROTID NODE OF ORAL CANCER H. Harada, R. Hidaka, S. Hasegawa, M. Ikuta, H. Shimamoto, A. Kaneoya, K. Omura. era/& Maxi//ofacia/ Surgery, Department of era/
Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Japan The parotid node is an uncommon site of metastasis but must be considered as a potential site in oral cancer. This study aims to clarify the prevalence and risk factors for metastases to the parotid node. We reviewed the records of 143 patients who underwent neck dissection between April 2001 and September 2004. Primary tumor site was the tongue (65), floor of mouth (14), lower gum (43), upper gum (8), and buccal mucosa (13). The histology of the tumors was squamous cell carcinoma (133), adenoid cyctic carcinoma (4), mucoepidermoid carcinoma (3), and others (3). One hundred and forty-three patients underwent 164 neck dissections; 17 suprahyoid neck dissections, 58 supraomohyoid neck dissections, 75 modified radical neck dissections, and 14 radical neck dissections. In all neck dissections, the tail of the parotid gland below the marginal branch of the facial nerve was resected. Of the 164 neck specimes, 76 specimens had 198 parotid nodes (89 extraglandular nodes, 109 intraglandular nodes). Out of these, 7 metastatic nodes (3.5%) were found in 5 patients. Four positive nodes were extraglandular nodes and 3 were intraglandular nodes. Primary tumor site was the buccal mucosa in 3 patients, lower gum and upper gum in each one patient. Four of 5 patients with parotid node involvement had nodal diseases at other levels of the neck. During the follow-up period, 143 patients had no recurennce of parotid node. Metastasis to the parotid nodes should be considered in patients with oral cancer. Resection of the tail of the parotid gland is warranted in neck dissection.
[-0-'3-'~ INCIDENCE OF BILATERAL MALIGNANCY IN PATIENTS WITH WELL DIFFERENTIATED THYROID TUMORS K. Balaraman, J. Thiruchelvam, W. Halfpenny, I. Hutchison, A. Jay, B. Djazaeri, A.A. Baskaran. Barnet and Chase Farm Hospitals NHS
Trust, Enfield, UK Barts and The Royal London Hospitals, London, United Kingdom The aim of this study was to assess the incidence of malignancy encountered in the contralateral lobe in patients with thyroid cancer found at Thyroidectomy and also assess the associated complications of the procedure. This was a retrospective study of cases with thyroid cancer treated in two different units over a five year period (1999-2004). This study included 150 patients with malignant thyroid disease who underwent Total Thyroidectomy/Completion Thyroidectomy. The presence of malignant disease in the contralateral lobe was analysed. There was a 37% (35-43%) incidence of malignancy found in the contralateral lobe. The complications included a 3% (2-5%) recurrent laryngeal nerve injury and a 12% (8-15%) incidence of hypoparathyroidism. There is a high incidence of malignancy in the contralateral lobe in patients with well differentiated thyroid tumors. In cases of malignancy identified after Iobectomy, Completion Thyroidectomy is a safe and effective procedure for diagnosis and removal of occult disease in the contralateral lobe. This procedure is also associated with low morbidity. [ - 0 - ' 3 - ' ~ THE COST EFFECTIVENESS OF INTRA-OPERATIVE INTACT PTH (PARATHYROID HORMONE) ASSAY FOR THE SURGICAL MANAGEMENT OF HYPERPARATHYROIDISM I. Hutchison, J.K. Thiruchelvam, ES.G. Hardee, L. Cheng. Barts And
The London NHS Trust, London, United Kingdom In 80% of cases hyperparathyroidism (HPTH) is caused by a single adenoma but 20% of patients may have hyperplasia of several glands. These glands may be found in ectopic sites as well as around the thyroid gland. Intra-operative frozen section (FS) is the gold standard for determining parathyroid tissue but it cannot differentiate between hyperplasia and adenoma and is not a functional assay of operative success. Parathyroid hormone (PTH) has a 1 life of 4 minutes in the circulation. There is an intra-operative intact PTH (iPTH) assay which yields physiological results within 20 minutes of gland removal. 12 consecutive patients who underwent surgical treatment for HPTH were studied. One patient was undergoing her 3rd operation for recurrent HPTH. The time taken for iPTH results and the success of this test was compared with frozen section results and the cost of both investigations estimated.
The mean reduction in operative time with iPTH compared to FS was 32 minutes and we estimated that this alone resulted in a cost saving per patient of 45 pounds sterling. Furthermore, initial failure to lower iPTH resulted in 4 on-table re-explorations in cases where FS suggested operative success. Therefore iPTH saved operative failure and the need for re-operation in 33% of cases. Finally, FS was unhelpful in a further 4 patients, iPTH assay is a cost effective intraoperative assessment which improves the success rate of HPTH surgery.
032. Orthognathic Surgery III [-0-3-~
ORTHOGNATIC BIMAXlLLARY SURGERY UTILIZING THE MANDIBULAR TECHNIQUE: 6 YEAR RETROSPECTIVE STUDY
O. Reiche-Fischel. Center for Dentofacia/ Deformities, Hospita/ Rafae/ Angel Calderon Guardia Caja Costarricense de Seguro Social, San Jose, Costa Rica The purpose of this project is to evaluate an alternative surgical planning and its long-term stability vs. the traditional surgical planning sequence for the management of bi-maxillary cases. A retrospective analysis of bimaxillary cases utilizing the mandibular technique from Jan. 1997 until Jan. 2003 was performed. A sample of 50 pts (32F & 18M) was obtained with an average age of 22.7 years (R13-43). The p.o. follow-up averaged 4.2 yrs (R 1-6). A visual analogue scale was used to objectively measure masticatory function improvement and the change produced by the surgery. Three lateral cephalometric x-rays: T1 - pre-op, T2 - 1 wk. p.o., and T3 - long-term p.o. were taken to measure the surgical change (T2-T1) and its stability (T3-T2) via cephalometric analysis. Surgical Change Post-op Stability (T2-T1)mm (T3-T2)mm Point A 5.4 0.4 Point B 7.7 0.9 Pogonion 6.4 0.6 N - Me 3.4 0.5 1. The esthetic and functional changes perceived by the patients were very acceptable with an average of 9.65 on the VAS. 2. The surgical post-op stability obtained with this technique was excellent with an average relapse of 0.9 mm in this patient population during the 6 year follow-up. 3. The modified mandibular technique for the management of bimaxillary cases simplifies the surgical planning showing excellent predictability and longterm stability. References [1] Cottrell DA, Wolford LM: Altered Orthognatic Surgical Sequencing and a Modified Approach to Model Surgery, J Oral Maxillofac Surg 52: 1010, 1994. [2] Wolford LM et al: Occlusal Plane Alteration in Orthognathic Surgery, J Oral Maxillofac Surg 51: 730, 1993.
•
CORRECTION OF BIMAXILLARY DEFORMITIES BY ORTHOGNATHIC SURGERY WITH DO
D.Z. Wang, G. Chen, S.G. Liu, Z.W. Goa, J.H. Li, "~H. Zhang. Department of Oral and Maxillofacial Surgery, West China College of Stomatology, SiChuan University, Chengdu, China To correct bimaxillary deformities with combination of Orthognathic surgery and distraction osteogenesis (DO) from which the patients can benefit advantages of the both, and the better functional and aesthetic effect can be resulted in. 44 Patients were treated by combinative protocol and assigned into two groups. Group 1 of 22 maxillary narrowing with mandibular deficiency cases (Class II), and group 2 of 22 maxillary narrowing with mandibular protrusion cases (Class III). Preoperative systematic examination and diagnosis, treatment planning, model surgery and effect prognositication were processed in all the 44 patients. Group 1. The maxilla of 22 patients were wided by DO following subtotal Le Fort I osteotomy, then presurgical orthodontic treatment and advancing mandible by bilateral SSRO (genioplasty could be done if necessary)were performed, while group 2 were undergone the same procedure as group 1 on maxilla, then presurgical orthodontic treatment, but setback mandible by bilateral IORO. Postoperative following up to 5 to 8 years. Data analysis and comparison of pre-and postoperative clinical examination, cephalometric implied that satisfied functional and aesthetic results were achieved without distinct complications. The advantages and
Oral P r e s e n t a t i o n s / 0 3 2 . O r t h o g n a t h i c S u r g e r y III effects of the combinative protocol was discussed. Rational application of orthognathic surgery with DO for correction of some certain bimaxillary deformities could be an alternative surgical modality with more ideal and safer effects. Supported by National Nature Science Foundation of China, Grant no 39970797.
[•]
CASE REPORT OF SIMULTANEOUSLY SURGICALLY ASSISTED RAPID PALATAL EXPANSION AND MANDIBULAR SYMPHYSIS TRANSVERSE WIDENING
S.-K. Min, M.G. Choi. Department of Oral and maxillofacial Surgery,
School of Dentistry, Wonkwang Univ. Iksan, Chon-Buk, Republic of Korea Our department performed simultaneously surgicallly assisted rapid palatal expansion and mandibular symphysis transverse widening in 10 patients, so we report indication, complication and effects of this technique, we studied 10 patient recived Surgically assisted rapid palatal expansion (SARPE). this paient had "V" shaped palatal vault, unilateral and/or bilateral posterior crossbite, and non-extraction case in patients who has brachyfacial pattern. We only experienced masitcatory discomfort coming from malocclusion during expansion and TMJ problem during expansion. Effects of this procedure on the amount of movement is such that: increase in intercanine width in maxilla was 3.362 mm and in mandible was 3.728mm and increase in intermolar width in maxilla was 4.720 mm and in mandible was 4.366 mm. simultaneously surgicallly assisted rapid palatal expansion and mandibular symphysis transverse widening is helpful to get the rapid tooth movement and the enough amount of movement that was impossible only by orthodontic movememt and could be done under local anesthesia in the dental office without significant complications.
63 ~-~--~
THE ROTTERDAM PALATAL DISTRACTOR FOR WIDENING THE NARROW MAXILLA: AN ANALYSIS OF THE FIRST 30 CASES
E. Wolvius, M. Koudstaal, K. van der Wal. Department of Oral & Maxillofacial Surgery and Craniofacial Centre, Erasmus Medical Centre Rotterdam, The Netherlands Transverse maxillary hypoplasia (TMH) is frequently seen in syndromal and non-syndromal patients. The TMH can be corrected by means of a surgically assisted rapid maxillary expansion. The distractors can be tooth- or bone-borne. The purpose of this study is to evaluate the usage of the Rotterdam Palatal Distractor (RPD), a bone-borne device, based on the principle of a car-jack. Between September 2003 and January 2005, 30 patients with TMH were treated with the RPD. Fourteen syndromal patients (6 patients with Apert, 1 patient with Pfeiffer, 2 patients with frontonasal dysplasia and midline cleft, 2 patients with Osteopathia Striata and 3 cleft patients) and 16 non-syndromal patients were included. The RPD was positioned with the plates on the bone over the roots of the first or second premolars. Distraction was started according to protocol until the desired distance was reached. The distractor was removed after a 3 month consolidation period. In all 25 patients the distractor did function successfully and the desired expansion was achieved. In one cleft patient with an extreme low palate the distractor lost stability after reaching the expansion and had to be removed. With an orthodontic transpalatal bar the expansion was consolidated. In 8 patients the activation rod moved out of the midline without clinical consequences. The bone-borne RPD is easily placed, activated and removed. No screw fixation with possible damage to the (pre-)molar roots is necessary. Especially in syndromal patients with totally collapsed maxillary segments and no space for tooth-borne appliances or other bone-borne distractors the RPD seems very helpful. ~-~-]
MAXILLARY EXPANSION SURGICALLY ASSISTED: COMPARISON OF TWO SURGICAL TECHNIQUES
L.C. Mariani, EB. Pagotto, L.E. Manganello-Souza, L.C. Colucci, A.R. Sanches. Associa##o Brasileira de Odontologia Sec##o S#o [-0-'~'-~ SURGICALLY ASSISTED MAXILLARY EXPANSION UTILIZING A MINIMALLY INVASIVE APPROACH WITH AN ENDOSCOPE O. Ploder, H. Winsauer. Department of Oral and Maxillofacial Surgery
Hospital, Feldkirch, Austria Surgically assisted maxillary expansion (SAME) has become a widely used and acceptable means to expand the maxilla in adolescents and adult patients. Transversal widening is achieved by using various toothor bone-borne expansion devices following osteotomy of the maxilla and the median palatine suture. The aim of the present study was to show the feasibility of a minimally invasive approach for SAME utilizing an endoscope. In three patients transversal discrepancies were treated with SAME utilizing an endoscope to visualize a Le Fort I- and a median osteotomy of the maxilla. Access to the maxilla was gained through a 1.5-cm vertical incision of the mucosa in the midline and on each side of the molar region. Subsequent to elevation of the periosteum through these incisions an osteotomy was performed on the lateral and medial wall, as well as in the midline of the maxilla. Through the incisions in the molar region the pterygoid buttress was separated on each side using a chisel. After a healing period of 5 days, maxillary expansion was performed with a tooth-borne device. Minimally invasive exposure and complete osteotomy of the maxilla was achieved in all patients. In one patient, intraoperative bleeding in the tuber region was stopped with coagulation utilizing the endoscope. Postoperative bleeding and swelling were minimal. Maxillary expansion was achieved in all patients. Endoscopic visualization allowed safe osteotomy of the maxilla to perform SAME. References [1] Bell WH, Epker BN. Surgical-orthodontic expansion of the maxilla. Am J Orthod 1976; 50; 517-528. [2] Wiltfang J, Kessler E Endoscopically assisted Le Fort I osteotomy to correct transverse and sagittal discrepancies of the maxilla. J Oral Maxillofac Surg. 2002 Oct; 60(10): 1142-5; discussion 1146. [3] Rohner D, Yeow V, Hammer B. Endoscopically assisted Le Fort I osteotomy. J Craniomaxillofac Surg. 2001 Dec; 29(6): 360-5.
Paulo - Hospital Municipal de Urg#ncias de Guarulhos, Sao Paulo, Brazil The purpose of this study was to compare and evaluate the results of two surgical techniques that can be carried through expansion to maxillary expansion surgically assisted. In a prospective study from February 2001 to November 2003, 42 surgeries had been carried through expansion to maxillary. Patients from group A (21 patients) were submitted to conservative surgical technique that consisted of bilateral osteotomies the zygomatic maxillary buttress and of midpalatal sutures. The patients from group B (21 patients) were submitted to subtotal Le Fort I osteotomy preserving the pteriogoidea suture associated with midpalatal osteotomy. All the patients (groups A and B) were submitted to the activation of 2 mm at the time of surgery. On the third postoperative day, the activation of the devices was initiated 1 mm/day shared in two times. Group A - In the 21 cases the expansion was obtained. The average of 8.5mm (variation of 6-12.5mm) of palatal expansion was reached. The mean time of activation was 7 days (5 to 18 days). We observed 3 complications in three different patients. Two cases of palatal mucosa necrosis due to Haas device compression, and one case of broken hyrax device. The changing device treated all cases. The patients were followed without any complications. Group B - In the 21 cases also the expansion was obtained as planned. The average of 7.5 mm (variation of 6 - 1 3 m m ) of palatal expansion was reached in a mean of 8 days (from 6 to 14 days). We observed one case of broken Hyrax device that was immediately changed without major complications. Comparing the results of the two groups (A and B) we can conclude that as much the conservative technique as Le Fort I "sub-total" can bring good results in the maxillary surgical expansion, although we prefer the conservative technique. The use of Hyrax must be preferred against of Haas due to the possibility of palatal necrosis. References [1] Betts, NJ, Vanarsdall, RL, Barber, HD, Barber, KH, Fonseca, RJ. Diagnoses and treatment of transverse maxillary deficiency. Int J Adult Orthodon Orthognath Surg, Lombard, v.10, p. 75-80, 1995. [2] Glassman, A.S. et al. Conservative surgical orthodontic adult rapid palatal expansion: sixteen cases. Am J Orthod, St. Louis, v.86. p.207-213, Sept, 1984.
62 [-O-'~--] METASTASIS TO THE PAROTID NODE OF ORAL CANCER H. Harada, R. Hidaka, S. Hasegawa, M. Ikuta, H. Shimamoto, A. Kaneoya, K. Omura. era/& Maxi//ofacia/ Surgery, Department of era/
Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Japan The parotid node is an uncommon site of metastasis but must be considered as a potential site in oral cancer. This study aims to clarify the prevalence and risk factors for metastases to the parotid node. We reviewed the records of 143 patients who underwent neck dissection between April 2001 and September 2004. Primary tumor site was the tongue (65), floor of mouth (14), lower gum (43), upper gum (8), and buccal mucosa (13). The histology of the tumors was squamous cell carcinoma (133), adenoid cyctic carcinoma (4), mucoepidermoid carcinoma (3), and others (3). One hundred and forty-three patients underwent 164 neck dissections; 17 suprahyoid neck dissections, 58 supraomohyoid neck dissections, 75 modified radical neck dissections, and 14 radical neck dissections. In all neck dissections, the tail of the parotid gland below the marginal branch of the facial nerve was resected. Of the 164 neck specimes, 76 specimens had 198 parotid nodes (89 extraglandular nodes, 109 intraglandular nodes). Out of these, 7 metastatic nodes (3.5%) were found in 5 patients. Four positive nodes were extraglandular nodes and 3 were intraglandular nodes. Primary tumor site was the buccal mucosa in 3 patients, lower gum and upper gum in each one patient. Four of 5 patients with parotid node involvement had nodal diseases at other levels of the neck. During the follow-up period, 143 patients had no recurennce of parotid node. Metastasis to the parotid nodes should be considered in patients with oral cancer. Resection of the tail of the parotid gland is warranted in neck dissection.
[-0-'3-'~ INCIDENCE OF BILATERAL MALIGNANCY IN PATIENTS WITH WELL DIFFERENTIATED THYROID TUMORS K. Balaraman, J. Thiruchelvam, W. Halfpenny, I. Hutchison, A. Jay, B. Djazaeri, A.A. Baskaran. Barnet and Chase Farm Hospitals NHS
Trust, Enfield, UK Barts and The Royal London Hospitals, London, United Kingdom The aim of this study was to assess the incidence of malignancy encountered in the contralateral lobe in patients with thyroid cancer found at Thyroidectomy and also assess the associated complications of the procedure. This was a retrospective study of cases with thyroid cancer treated in two different units over a five year period (1999-2004). This study included 150 patients with malignant thyroid disease who underwent Total Thyroidectomy/Completion Thyroidectomy. The presence of malignant disease in the contralateral lobe was analysed. There was a 37% (35-43%) incidence of malignancy found in the contralateral lobe. The complications included a 3% (2-5%) recurrent laryngeal nerve injury and a 12% (8-15%) incidence of hypoparathyroidism. There is a high incidence of malignancy in the contralateral lobe in patients with well differentiated thyroid tumors. In cases of malignancy identified after Iobectomy, Completion Thyroidectomy is a safe and effective procedure for diagnosis and removal of occult disease in the contralateral lobe. This procedure is also associated with low morbidity. [ - 0 - ' 3 - ' ~ THE COST EFFECTIVENESS OF INTRA-OPERATIVE INTACT PTH (PARATHYROID HORMONE) ASSAY FOR THE SURGICAL MANAGEMENT OF HYPERPARATHYROIDISM I. Hutchison, J.K. Thiruchelvam, ES.G. Hardee, L. Cheng. Barts And
The London NHS Trust, London, United Kingdom In 80% of cases hyperparathyroidism (HPTH) is caused by a single adenoma but 20% of patients may have hyperplasia of several glands. These glands may be found in ectopic sites as well as around the thyroid gland. Intra-operative frozen section (FS) is the gold standard for determining parathyroid tissue but it cannot differentiate between hyperplasia and adenoma and is not a functional assay of operative success. Parathyroid hormone (PTH) has a 1 life of 4 minutes in the circulation. There is an intra-operative intact PTH (iPTH) assay which yields physiological results within 20 minutes of gland removal. 12 consecutive patients who underwent surgical treatment for HPTH were studied. One patient was undergoing her 3rd operation for recurrent HPTH. The time taken for iPTH results and the success of this test was compared with frozen section results and the cost of both investigations estimated.
The mean reduction in operative time with iPTH compared to FS was 32 minutes and we estimated that this alone resulted in a cost saving per patient of 45 pounds sterling. Furthermore, initial failure to lower iPTH resulted in 4 on-table re-explorations in cases where FS suggested operative success. Therefore iPTH saved operative failure and the need for re-operation in 33% of cases. Finally, FS was unhelpful in a further 4 patients, iPTH assay is a cost effective intraoperative assessment which improves the success rate of HPTH surgery.
032. Orthognathic Surgery III [-0-3-~
ORTHOGNATIC BIMAXlLLARY SURGERY UTILIZING THE MANDIBULAR TECHNIQUE: 6 YEAR RETROSPECTIVE STUDY
O. Reiche-Fischel. Center for Dentofacia/ Deformities, Hospita/ Rafae/ Angel Calderon Guardia Caja Costarricense de Seguro Social, San Jose, Costa Rica The purpose of this project is to evaluate an alternative surgical planning and its long-term stability vs. the traditional surgical planning sequence for the management of bi-maxillary cases. A retrospective analysis of bimaxillary cases utilizing the mandibular technique from Jan. 1997 until Jan. 2003 was performed. A sample of 50 pts (32F & 18M) was obtained with an average age of 22.7 years (R13-43). The p.o. follow-up averaged 4.2 yrs (R 1-6). A visual analogue scale was used to objectively measure masticatory function improvement and the change produced by the surgery. Three lateral cephalometric x-rays: T1 - pre-op, T2 - 1 wk. p.o., and T3 - long-term p.o. were taken to measure the surgical change (T2-T1) and its stability (T3-T2) via cephalometric analysis. Surgical Change Post-op Stability (T2-T1)mm (T3-T2)mm Point A 5.4 0.4 Point B 7.7 0.9 Pogonion 6.4 0.6 N - Me 3.4 0.5 1. The esthetic and functional changes perceived by the patients were very acceptable with an average of 9.65 on the VAS. 2. The surgical post-op stability obtained with this technique was excellent with an average relapse of 0.9 mm in this patient population during the 6 year follow-up. 3. The modified mandibular technique for the management of bimaxillary cases simplifies the surgical planning showing excellent predictability and longterm stability. References [1] Cottrell DA, Wolford LM: Altered Orthognatic Surgical Sequencing and a Modified Approach to Model Surgery, J Oral Maxillofac Surg 52: 1010, 1994. [2] Wolford LM et al: Occlusal Plane Alteration in Orthognathic Surgery, J Oral Maxillofac Surg 51: 730, 1993.
•
CORRECTION OF BIMAXILLARY DEFORMITIES BY ORTHOGNATHIC SURGERY WITH DO
D.Z. Wang, G. Chen, S.G. Liu, Z.W. Goa, J.H. Li, "~H. Zhang. Department of Oral and Maxillofacial Surgery, West China College of Stomatology, SiChuan University, Chengdu, China To correct bimaxillary deformities with combination of Orthognathic surgery and distraction osteogenesis (DO) from which the patients can benefit advantages of the both, and the better functional and aesthetic effect can be resulted in. 44 Patients were treated by combinative protocol and assigned into two groups. Group 1 of 22 maxillary narrowing with mandibular deficiency cases (Class II), and group 2 of 22 maxillary narrowing with mandibular protrusion cases (Class III). Preoperative systematic examination and diagnosis, treatment planning, model surgery and effect prognositication were processed in all the 44 patients. Group 1. The maxilla of 22 patients were wided by DO following subtotal Le Fort I osteotomy, then presurgical orthodontic treatment and advancing mandible by bilateral SSRO (genioplasty could be done if necessary)were performed, while group 2 were undergone the same procedure as group 1 on maxilla, then presurgical orthodontic treatment, but setback mandible by bilateral IORO. Postoperative following up to 5 to 8 years. Data analysis and comparison of pre-and postoperative clinical examination, cephalometric implied that satisfied functional and aesthetic results were achieved without distinct complications. The advantages and
Oral P r e s e n t a t i o n s / 0 3 2 . O r t h o g n a t h i c S u r g e r y III effects of the combinative protocol was discussed. Rational application of orthognathic surgery with DO for correction of some certain bimaxillary deformities could be an alternative surgical modality with more ideal and safer effects. Supported by National Nature Science Foundation of China, Grant no 39970797.
[•]
CASE REPORT OF SIMULTANEOUSLY SURGICALLY ASSISTED RAPID PALATAL EXPANSION AND MANDIBULAR SYMPHYSIS TRANSVERSE WIDENING
S.-K. Min, M.G. Choi. Department of Oral and maxillofacial Surgery,
School of Dentistry, Wonkwang Univ. Iksan, Chon-Buk, Republic of Korea Our department performed simultaneously surgicallly assisted rapid palatal expansion and mandibular symphysis transverse widening in 10 patients, so we report indication, complication and effects of this technique, we studied 10 patient recived Surgically assisted rapid palatal expansion (SARPE). this paient had "V" shaped palatal vault, unilateral and/or bilateral posterior crossbite, and non-extraction case in patients who has brachyfacial pattern. We only experienced masitcatory discomfort coming from malocclusion during expansion and TMJ problem during expansion. Effects of this procedure on the amount of movement is such that: increase in intercanine width in maxilla was 3.362 mm and in mandible was 3.728mm and increase in intermolar width in maxilla was 4.720 mm and in mandible was 4.366 mm. simultaneously surgicallly assisted rapid palatal expansion and mandibular symphysis transverse widening is helpful to get the rapid tooth movement and the enough amount of movement that was impossible only by orthodontic movememt and could be done under local anesthesia in the dental office without significant complications.
63 ~-~--~
THE ROTTERDAM PALATAL DISTRACTOR FOR WIDENING THE NARROW MAXILLA: AN ANALYSIS OF THE FIRST 30 CASES
E. Wolvius, M. Koudstaal, K. van der Wal. Department of Oral & Maxillofacial Surgery and Craniofacial Centre, Erasmus Medical Centre Rotterdam, The Netherlands Transverse maxillary hypoplasia (TMH) is frequently seen in syndromal and non-syndromal patients. The TMH can be corrected by means of a surgically assisted rapid maxillary expansion. The distractors can be tooth- or bone-borne. The purpose of this study is to evaluate the usage of the Rotterdam Palatal Distractor (RPD), a bone-borne device, based on the principle of a car-jack. Between September 2003 and January 2005, 30 patients with TMH were treated with the RPD. Fourteen syndromal patients (6 patients with Apert, 1 patient with Pfeiffer, 2 patients with frontonasal dysplasia and midline cleft, 2 patients with Osteopathia Striata and 3 cleft patients) and 16 non-syndromal patients were included. The RPD was positioned with the plates on the bone over the roots of the first or second premolars. Distraction was started according to protocol until the desired distance was reached. The distractor was removed after a 3 month consolidation period. In all 25 patients the distractor did function successfully and the desired expansion was achieved. In one cleft patient with an extreme low palate the distractor lost stability after reaching the expansion and had to be removed. With an orthodontic transpalatal bar the expansion was consolidated. In 8 patients the activation rod moved out of the midline without clinical consequences. The bone-borne RPD is easily placed, activated and removed. No screw fixation with possible damage to the (pre-)molar roots is necessary. Especially in syndromal patients with totally collapsed maxillary segments and no space for tooth-borne appliances or other bone-borne distractors the RPD seems very helpful. ~-~-]
MAXILLARY EXPANSION SURGICALLY ASSISTED: COMPARISON OF TWO SURGICAL TECHNIQUES
L.C. Mariani, EB. Pagotto, L.E. Manganello-Souza, L.C. Colucci, A.R. Sanches. Associa##o Brasileira de Odontologia Sec##o S#o [-0-'~'-~ SURGICALLY ASSISTED MAXILLARY EXPANSION UTILIZING A MINIMALLY INVASIVE APPROACH WITH AN ENDOSCOPE O. Ploder, H. Winsauer. Department of Oral and Maxillofacial Surgery
Hospital, Feldkirch, Austria Surgically assisted maxillary expansion (SAME) has become a widely used and acceptable means to expand the maxilla in adolescents and adult patients. Transversal widening is achieved by using various toothor bone-borne expansion devices following osteotomy of the maxilla and the median palatine suture. The aim of the present study was to show the feasibility of a minimally invasive approach for SAME utilizing an endoscope. In three patients transversal discrepancies were treated with SAME utilizing an endoscope to visualize a Le Fort I- and a median osteotomy of the maxilla. Access to the maxilla was gained through a 1.5-cm vertical incision of the mucosa in the midline and on each side of the molar region. Subsequent to elevation of the periosteum through these incisions an osteotomy was performed on the lateral and medial wall, as well as in the midline of the maxilla. Through the incisions in the molar region the pterygoid buttress was separated on each side using a chisel. After a healing period of 5 days, maxillary expansion was performed with a tooth-borne device. Minimally invasive exposure and complete osteotomy of the maxilla was achieved in all patients. In one patient, intraoperative bleeding in the tuber region was stopped with coagulation utilizing the endoscope. Postoperative bleeding and swelling were minimal. Maxillary expansion was achieved in all patients. Endoscopic visualization allowed safe osteotomy of the maxilla to perform SAME. References [1] Bell WH, Epker BN. Surgical-orthodontic expansion of the maxilla. Am J Orthod 1976; 50; 517-528. [2] Wiltfang J, Kessler E Endoscopically assisted Le Fort I osteotomy to correct transverse and sagittal discrepancies of the maxilla. J Oral Maxillofac Surg. 2002 Oct; 60(10): 1142-5; discussion 1146. [3] Rohner D, Yeow V, Hammer B. Endoscopically assisted Le Fort I osteotomy. J Craniomaxillofac Surg. 2001 Dec; 29(6): 360-5.
Paulo - Hospital Municipal de Urg#ncias de Guarulhos, Sao Paulo, Brazil The purpose of this study was to compare and evaluate the results of two surgical techniques that can be carried through expansion to maxillary expansion surgically assisted. In a prospective study from February 2001 to November 2003, 42 surgeries had been carried through expansion to maxillary. Patients from group A (21 patients) were submitted to conservative surgical technique that consisted of bilateral osteotomies the zygomatic maxillary buttress and of midpalatal sutures. The patients from group B (21 patients) were submitted to subtotal Le Fort I osteotomy preserving the pteriogoidea suture associated with midpalatal osteotomy. All the patients (groups A and B) were submitted to the activation of 2 mm at the time of surgery. On the third postoperative day, the activation of the devices was initiated 1 mm/day shared in two times. Group A - In the 21 cases the expansion was obtained. The average of 8.5mm (variation of 6-12.5mm) of palatal expansion was reached. The mean time of activation was 7 days (5 to 18 days). We observed 3 complications in three different patients. Two cases of palatal mucosa necrosis due to Haas device compression, and one case of broken hyrax device. The changing device treated all cases. The patients were followed without any complications. Group B - In the 21 cases also the expansion was obtained as planned. The average of 7.5 mm (variation of 6 - 1 3 m m ) of palatal expansion was reached in a mean of 8 days (from 6 to 14 days). We observed one case of broken Hyrax device that was immediately changed without major complications. Comparing the results of the two groups (A and B) we can conclude that as much the conservative technique as Le Fort I "sub-total" can bring good results in the maxillary surgical expansion, although we prefer the conservative technique. The use of Hyrax must be preferred against of Haas due to the possibility of palatal necrosis. References [1] Betts, NJ, Vanarsdall, RL, Barber, HD, Barber, KH, Fonseca, RJ. Diagnoses and treatment of transverse maxillary deficiency. Int J Adult Orthodon Orthognath Surg, Lombard, v.10, p. 75-80, 1995. [2] Glassman, A.S. et al. Conservative surgical orthodontic adult rapid palatal expansion: sixteen cases. Am J Orthod, St. Louis, v.86. p.207-213, Sept, 1984.