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Experimental palatal mucoperiosteal tissue expansion
Free oral communications 119 flap interposition seems to be a good possibility of treatment to functional rehabilitation of TMJ after disk destruction. Further examinations have to be done to explore the function of interponates in a long-term study.
The Lips: Reconstructive Surgery after Oncological Resections
Urtial E., lanes E., Streian F., Urtila R.
mouth, the resulting scarring frequently produces limitation of mobility of the tongue. Following the treatment of carcinoma of the mandible, the tongue is generally fixed with the cheek and the prosthetic dental rehabilitation is difficult. In all these cases we have performed a secondary liberation of the tongue, with a full-thickness skin graft covered by an expander for 8 days. The mucosa is sutured over the skin graft and the expander which is then filled with a saline solution. This technique has been used in 6 cases and gives good results in mobility of the tongue, and allows a prosthetic dental rehabilitation.
Department of Oral and Maxillofacial Surgery, Municipal Hospital, Timisoara, Romania Tumours of the Submandibular Gland The lips are often the site of tumours more or less extensive, which require large resection, followed by defects of the whole lips or even exceeding them. The authors presents the experience of over 30 years of activity in this field, a period in which it has been used various surgical techniques. Surgical modifications for classic procedures are also presented, as well as original methods of lips plasty. The surgical technique aspect is accompanied by a vascular modifications study within various flaps, establishing on this basis the most ,propitious moment for corrective interventions.
Aesthetic Surgery of the Nose: Between Caprice and Necessity
Urtila E., Streian F., Pricop M., Bratu E. Department of Oral and Maxillofacial Surgery, Municipal Hospital, Timisoara, Romania The nose, anatomic element of great physiognomical value, is often the site of structural modifications, inborn or gained, which modify the general aspect of the face. For this reason, the aesthetic surgery of the nose is more frequently solicited. Patient requests are always accompanied by arguments which differ for every person. In most cases, these requests are objective and entirely justified. However, in some situations these are caprices, but for patients represent obsessive concerns. The authors present the evaluation of more then 1000 cases, accompanied by images, illustrating particular,situations, as well as surgical techniques for nasal plasty.
Use of Expanders in Functional Rehabilitation after Oral Malignancy Excision
Vacher C., Loncle T., Lezy J-P. Department of Maxillofacial Surgery, Hospital Beaujon Clichy, Clichy, France The authors present two techniques of rehabilitation after intraoral malignancy excision using expanders. 1. Following the treatment of carcinoma of the antrum by removal of the maxilla, we describe the use of an expander for 2 months after surgery, to prevent facial skin retraction. The expander, filled with air, is placed in the operative cavity between the cheek laterally, and a smooth temporary prosthesis which close the oro-antral defect. This technique has been used in 3 cases. In our experience it seems to give good results to prevent retraction of the cheek, if the expander is well tolerated during the period of radiotherapy. 2. Following the treatment of carcinoma of the floor of the
Valldosera M.A., Pamias J., Gonzalez J., Raspail G. Servicio de CirugIa Maxilofacial, Hospital General Universitario Vall d'Hebr6, Barcelona, Spain A retrospective study on survival of patients affected by tumours of the submandibular salivary gland was undertaken. The medical records of those patients were reviewed and the following data were compiled: age, sex, clinical staging, regional or distant metastasis, histologic diagnosis, surgical margins, therapy and disease status after last examination. A total number of 42 tumours could be identified, 13 being malignant. No sex differences were observed. All the cases of benign tumours were pleomorphic adenomas and one of them was a recurrent case. The most frequent malignant tumour was the adenoid cystic carcinoma followed by undifferentiated carcinoma. Our experience with those malignancies indicate that the main prognostic factors were pathology, clinical staging, and the state of surgical margins.
Experimental Palatal Mueoperiosteal Tissue Expansion
Van Damme P.A. 1, Freihofer H.P.M. 1, Maltha J. C.~, Kuijpers-Jagtman A.M. ~, van't HOF M.A. 3 Departments oflOral and Maxillofacial Surgery, 2Orthodontics and Oral Biology and 3Medical Statistics, University of Nijmegen, Nijmegen, The Netherlands The effects of experimental palatal mucoperiosteal soft tissue expansion were studied in 75 growing cats, with and without palatal scars, by means of two-dimensional cephalometric, three-dimensional morphometric, and histological analysis of data. The results indicate that significant soft tissue gain can be achieved by the tissue expansion technique. Surface-area increase was quantified in relation to the base surface and base diameter of the tissue expander. After 8 weeks of expansion, 85% surface area, 36% transverse, and 32% sagittal increments were reached. During active expansion, side effects were primarily anteroposterior and transverse growth retardation at the level of the bony palate and dentoalveolar structures, and accelerated vertical growth of the anterior naso-maxillary height. In the 8 week period after removal of the tissue expanders, significantly accelerated growth was found in scarred tissue expansion cases, with initial correction of the abnormal growth at the cranial base and/or palatal level. Histological evaluation showed marked thinning of the epithelial layers, thinning and alteration of the architecture of the connective tissue layers, development of a fibrous capsule surrounding the tissue expander, and resorption/depression of the palatal bone. The constitution of the capsule is likely to
120 Journal of Cranio-MaxillofacialSurgery be related to palatal soft tissue contraction and retraction. Osteoplastic resorption of the palatal bone may have compromised the palatal and vomero-septal growth centres. In time, after removal of the expander, normalization of epithelial, connective and bony tissues takes place and the capsular tissue dissolves. From this study it may be concluded that palatal mucoperiosteal tissue expansion is feasible, with relevant soft tissue gain and with mainly temporary impairment of maxillofacial growth and development.
Reduction of Fractures of the Zygomatic Complex under Local Anaesthesia Van Cool A. E, Van Beek G.£
Department of Oral and Maxillofacial Surgery, Sophia Ziekenhuis, Zwolle, The Netherlands In 40-50% of all facial bone fractures, the zygoma is involved (Schnetler 1990, van Beek 1992); 30-40% are isolated zygomatic fractures. In the past decades much has been published in the literature about the therapy. The surgery always takes place under general anaesthesia. In two articles only is local anaesthesia mentioned. Schnetler (1990) uses local anaesthesia in combination with intravenous sedation for the reduction of zygomatic fractures. Richter (1985) uses local anaesthesia only for intraoral reduction of isolated arch fractures. In the past 25 years more then 1000 isolated zygomatic fractures were diagnosed in our department in Zwolle. From 1982 till 1994, 60 fractures of the zygomatic complex were reduced under local anaesthesia by means of a percutaneous hook; 40% of these fractures were treated in the last 2 years. Seventy-fve per cent of the operations were performed on the same day the trauma occurred; 90% within 3 days. The reduction of 53 fractures was anatomic, 6 times the result was acceptable. Only once it was necessary to continue the surgery under general anaesthesia. Among other things indication and technique will be further discussed.
References
1. Richter, W.Ch. Die isolierten Frakturen des Arcus Zygomaticus. Laryngogce Rhino-l-Otol 64 (1985) 548-549 2. Schnetler, JF. C. A technique for reducing fractures of the zygomatic complex under local anaesthesia. Br J Oral. Max. fac. Surg. 28 (1990) 168-171 3. Van Beek, G.J. Veranderingen in het patroon van fracturen van het maxillofaciale skelet. Nijmegen: Thesis, (1992)
2. The different treatment strategies are shown as well as their indications and shortcomings. We will discuss in detail our philosophy on the advancement osteotomies in the treatment of sleep apnoea. 3. Discussion of a clinical case: The patient is a young truck driver with a severe degree of apnoea (more than 60 apnoea/h). He has already been treated with an uvelo-velopharyngoplasty with little or no amelioration of his symptoms. Afterwards his condition even deteriorated and a breathing oxygen mask support became necessary. At this stage the patient was sent to our unit. In conjunction with the sleep disorder coordinator and our orthodontist, a treatment plan was set up. We decided that a bimaxillary advancement osteotomy was the only way to cure this patient's problem. An additional sagittal mandibular advancement was also required. Postoperatively his condition improved remarkable. He has relieved from his oxygen mask and his number of apnea episodes diminished tremendously. This case will be illustrated with the relevant X-rays and clinical slides. In conclusion, we can confirm the important role of maxillofacial surgery in the treatment of sleep apnoea syndrome.
The Implant Set-Up Procedure for the Atrophic Maxilla with Compressed Posterior Iliac Bonegraft Vanassche B., Defrancq J., van der Dussen N., Vercruysse H.
Department of Maxillo Facial Surgery, Eeuwfeestkliniek, Antwerp, Belgium This clinical report describes 33 consecutive patients with an edentulous atrophic upper jaw who were reconstructed with an implant set-up procedure 3.5 months prior to implant placement. This surgery rebuilt the maxilla with a combination of compressed particulate cancellous bone and marrow (PCBM) and compressed cortical bone blocks harvested from the posterior iliac crest. The bone was compressed in a ratio 5:1 to enhance the cellular quantity pro volume of the surviving osteoprogenetoric cells. A total of 260 implants were placed. An average of 8 implants (15-18 mm long) are inserted pro-atrophic maxilla. Fixture survival up till now is 94%. All patients are provided with a fixed implant born prosthesis and are functioning from 1-4.5 years. Currently we use the 5 and 6 mm implant diameters (3i ®) since they became available.
Clinical Experience in the Treatment of Hemangioma with Prednisolone and their Influence on the Unspecified Cellular Immunity
Vasilevsi B. Bimaxillary Osteotomies in the Treatment of Severe Sleep Apnoea Van Look R. 1, Cleve 11.1,Raskin S. 2, Poirrier R. 3, Lahaye Th.1
Departments of 1Maxillo-Facial Surgery, :Orthodontics and 3Neurology, University of Liege, Liege, Belgium Sleep apnoea syndrome may compromise the patient's life. With this communication we would like to demonstrate the place of maxillofacial surgery in its treatment. The paper is divided into three parts. 1. An overview of the definition and diagnosis of sleep apnea will be given.
Clinic of Maxilofacial Surgery, University St Cyril and Metodius, Skopje, Macedonia The aim of this paper is to show the usefulness of the application of the Ultracorten-H (prednisolone) locally by injecting into the interstitium of hemangioma, or given orally every second day for 8 weeks. The results after the therapy showed: 35.7% of the first group (10-19 year old patients) good and 50.0% satisfactory. With patients of 1-9 years old, good results were achieved in 40% and satisfactory ones in 26.7% cases. Investigation on the unspecified cellular immunity (UCI) was done using 3 antigens: tuberculin (PP1), monilia antigen (MO) and phytohemagglutinin (PHA) before and after treatment, i.e. in 29 patients. This
The Lips: Reconstructive Surgery after Oncological Resections
Urtial E., lanes E., Streian F., Urtila R.
mouth, the resulting scarring frequently produces limitation of mobility of the tongue. Following the treatment of carcinoma of the mandible, the tongue is generally fixed with the cheek and the prosthetic dental rehabilitation is difficult. In all these cases we have performed a secondary liberation of the tongue, with a full-thickness skin graft covered by an expander for 8 days. The mucosa is sutured over the skin graft and the expander which is then filled with a saline solution. This technique has been used in 6 cases and gives good results in mobility of the tongue, and allows a prosthetic dental rehabilitation.
Department of Oral and Maxillofacial Surgery, Municipal Hospital, Timisoara, Romania Tumours of the Submandibular Gland The lips are often the site of tumours more or less extensive, which require large resection, followed by defects of the whole lips or even exceeding them. The authors presents the experience of over 30 years of activity in this field, a period in which it has been used various surgical techniques. Surgical modifications for classic procedures are also presented, as well as original methods of lips plasty. The surgical technique aspect is accompanied by a vascular modifications study within various flaps, establishing on this basis the most ,propitious moment for corrective interventions.
Aesthetic Surgery of the Nose: Between Caprice and Necessity
Urtila E., Streian F., Pricop M., Bratu E. Department of Oral and Maxillofacial Surgery, Municipal Hospital, Timisoara, Romania The nose, anatomic element of great physiognomical value, is often the site of structural modifications, inborn or gained, which modify the general aspect of the face. For this reason, the aesthetic surgery of the nose is more frequently solicited. Patient requests are always accompanied by arguments which differ for every person. In most cases, these requests are objective and entirely justified. However, in some situations these are caprices, but for patients represent obsessive concerns. The authors present the evaluation of more then 1000 cases, accompanied by images, illustrating particular,situations, as well as surgical techniques for nasal plasty.
Use of Expanders in Functional Rehabilitation after Oral Malignancy Excision
Vacher C., Loncle T., Lezy J-P. Department of Maxillofacial Surgery, Hospital Beaujon Clichy, Clichy, France The authors present two techniques of rehabilitation after intraoral malignancy excision using expanders. 1. Following the treatment of carcinoma of the antrum by removal of the maxilla, we describe the use of an expander for 2 months after surgery, to prevent facial skin retraction. The expander, filled with air, is placed in the operative cavity between the cheek laterally, and a smooth temporary prosthesis which close the oro-antral defect. This technique has been used in 3 cases. In our experience it seems to give good results to prevent retraction of the cheek, if the expander is well tolerated during the period of radiotherapy. 2. Following the treatment of carcinoma of the floor of the
Valldosera M.A., Pamias J., Gonzalez J., Raspail G. Servicio de CirugIa Maxilofacial, Hospital General Universitario Vall d'Hebr6, Barcelona, Spain A retrospective study on survival of patients affected by tumours of the submandibular salivary gland was undertaken. The medical records of those patients were reviewed and the following data were compiled: age, sex, clinical staging, regional or distant metastasis, histologic diagnosis, surgical margins, therapy and disease status after last examination. A total number of 42 tumours could be identified, 13 being malignant. No sex differences were observed. All the cases of benign tumours were pleomorphic adenomas and one of them was a recurrent case. The most frequent malignant tumour was the adenoid cystic carcinoma followed by undifferentiated carcinoma. Our experience with those malignancies indicate that the main prognostic factors were pathology, clinical staging, and the state of surgical margins.
Experimental Palatal Mueoperiosteal Tissue Expansion
Van Damme P.A. 1, Freihofer H.P.M. 1, Maltha J. C.~, Kuijpers-Jagtman A.M. ~, van't HOF M.A. 3 Departments oflOral and Maxillofacial Surgery, 2Orthodontics and Oral Biology and 3Medical Statistics, University of Nijmegen, Nijmegen, The Netherlands The effects of experimental palatal mucoperiosteal soft tissue expansion were studied in 75 growing cats, with and without palatal scars, by means of two-dimensional cephalometric, three-dimensional morphometric, and histological analysis of data. The results indicate that significant soft tissue gain can be achieved by the tissue expansion technique. Surface-area increase was quantified in relation to the base surface and base diameter of the tissue expander. After 8 weeks of expansion, 85% surface area, 36% transverse, and 32% sagittal increments were reached. During active expansion, side effects were primarily anteroposterior and transverse growth retardation at the level of the bony palate and dentoalveolar structures, and accelerated vertical growth of the anterior naso-maxillary height. In the 8 week period after removal of the tissue expanders, significantly accelerated growth was found in scarred tissue expansion cases, with initial correction of the abnormal growth at the cranial base and/or palatal level. Histological evaluation showed marked thinning of the epithelial layers, thinning and alteration of the architecture of the connective tissue layers, development of a fibrous capsule surrounding the tissue expander, and resorption/depression of the palatal bone. The constitution of the capsule is likely to
120 Journal of Cranio-MaxillofacialSurgery be related to palatal soft tissue contraction and retraction. Osteoplastic resorption of the palatal bone may have compromised the palatal and vomero-septal growth centres. In time, after removal of the expander, normalization of epithelial, connective and bony tissues takes place and the capsular tissue dissolves. From this study it may be concluded that palatal mucoperiosteal tissue expansion is feasible, with relevant soft tissue gain and with mainly temporary impairment of maxillofacial growth and development.
Reduction of Fractures of the Zygomatic Complex under Local Anaesthesia Van Cool A. E, Van Beek G.£
Department of Oral and Maxillofacial Surgery, Sophia Ziekenhuis, Zwolle, The Netherlands In 40-50% of all facial bone fractures, the zygoma is involved (Schnetler 1990, van Beek 1992); 30-40% are isolated zygomatic fractures. In the past decades much has been published in the literature about the therapy. The surgery always takes place under general anaesthesia. In two articles only is local anaesthesia mentioned. Schnetler (1990) uses local anaesthesia in combination with intravenous sedation for the reduction of zygomatic fractures. Richter (1985) uses local anaesthesia only for intraoral reduction of isolated arch fractures. In the past 25 years more then 1000 isolated zygomatic fractures were diagnosed in our department in Zwolle. From 1982 till 1994, 60 fractures of the zygomatic complex were reduced under local anaesthesia by means of a percutaneous hook; 40% of these fractures were treated in the last 2 years. Seventy-fve per cent of the operations were performed on the same day the trauma occurred; 90% within 3 days. The reduction of 53 fractures was anatomic, 6 times the result was acceptable. Only once it was necessary to continue the surgery under general anaesthesia. Among other things indication and technique will be further discussed.
References
1. Richter, W.Ch. Die isolierten Frakturen des Arcus Zygomaticus. Laryngogce Rhino-l-Otol 64 (1985) 548-549 2. Schnetler, JF. C. A technique for reducing fractures of the zygomatic complex under local anaesthesia. Br J Oral. Max. fac. Surg. 28 (1990) 168-171 3. Van Beek, G.J. Veranderingen in het patroon van fracturen van het maxillofaciale skelet. Nijmegen: Thesis, (1992)
2. The different treatment strategies are shown as well as their indications and shortcomings. We will discuss in detail our philosophy on the advancement osteotomies in the treatment of sleep apnoea. 3. Discussion of a clinical case: The patient is a young truck driver with a severe degree of apnoea (more than 60 apnoea/h). He has already been treated with an uvelo-velopharyngoplasty with little or no amelioration of his symptoms. Afterwards his condition even deteriorated and a breathing oxygen mask support became necessary. At this stage the patient was sent to our unit. In conjunction with the sleep disorder coordinator and our orthodontist, a treatment plan was set up. We decided that a bimaxillary advancement osteotomy was the only way to cure this patient's problem. An additional sagittal mandibular advancement was also required. Postoperatively his condition improved remarkable. He has relieved from his oxygen mask and his number of apnea episodes diminished tremendously. This case will be illustrated with the relevant X-rays and clinical slides. In conclusion, we can confirm the important role of maxillofacial surgery in the treatment of sleep apnoea syndrome.
The Implant Set-Up Procedure for the Atrophic Maxilla with Compressed Posterior Iliac Bonegraft Vanassche B., Defrancq J., van der Dussen N., Vercruysse H.
Department of Maxillo Facial Surgery, Eeuwfeestkliniek, Antwerp, Belgium This clinical report describes 33 consecutive patients with an edentulous atrophic upper jaw who were reconstructed with an implant set-up procedure 3.5 months prior to implant placement. This surgery rebuilt the maxilla with a combination of compressed particulate cancellous bone and marrow (PCBM) and compressed cortical bone blocks harvested from the posterior iliac crest. The bone was compressed in a ratio 5:1 to enhance the cellular quantity pro volume of the surviving osteoprogenetoric cells. A total of 260 implants were placed. An average of 8 implants (15-18 mm long) are inserted pro-atrophic maxilla. Fixture survival up till now is 94%. All patients are provided with a fixed implant born prosthesis and are functioning from 1-4.5 years. Currently we use the 5 and 6 mm implant diameters (3i ®) since they became available.
Clinical Experience in the Treatment of Hemangioma with Prednisolone and their Influence on the Unspecified Cellular Immunity
Vasilevsi B. Bimaxillary Osteotomies in the Treatment of Severe Sleep Apnoea Van Look R. 1, Cleve 11.1,Raskin S. 2, Poirrier R. 3, Lahaye Th.1
Departments of 1Maxillo-Facial Surgery, :Orthodontics and 3Neurology, University of Liege, Liege, Belgium Sleep apnoea syndrome may compromise the patient's life. With this communication we would like to demonstrate the place of maxillofacial surgery in its treatment. The paper is divided into three parts. 1. An overview of the definition and diagnosis of sleep apnea will be given.
Clinic of Maxilofacial Surgery, University St Cyril and Metodius, Skopje, Macedonia The aim of this paper is to show the usefulness of the application of the Ultracorten-H (prednisolone) locally by injecting into the interstitium of hemangioma, or given orally every second day for 8 weeks. The results after the therapy showed: 35.7% of the first group (10-19 year old patients) good and 50.0% satisfactory. With patients of 1-9 years old, good results were achieved in 40% and satisfactory ones in 26.7% cases. Investigation on the unspecified cellular immunity (UCI) was done using 3 antigens: tuberculin (PP1), monilia antigen (MO) and phytohemagglutinin (PHA) before and after treatment, i.e. in 29 patients. This