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Extraoral implantology and prosthetics in craniofacial rehabilitation
Free oral communications 27 als such a silicon, vitalium, ivory, silver, polyethylene and alternative autogenous materials were used to reconstruct the nose The alloplastic materials have been abandoned due to the high incidence of complications. Iliac and rib bone have shown unpredictable resorption. Calvarial bone grafting was popularized by Tessier and presented for nasal reconstruction by Jackson. This study reviews 218 cranial bone graft nasal reconstructions performed in 4 centres over the past 14 years. The bone was harvested from temporoparietal skull according to the method described by Jackson. The grafts were inserted through coronal (50%o), glabellar (29%), or old incisions. The reasons for surgery were trauma (32%), congenital malformations (30%) and postrhinoplastic deformities (24%). Screw fixation (56%) and wire fixation (22%) were used for stabilization of the bone grafts to the nasal bones. In most cases the grafts were split thickness. The mean followup period is 52 months ranging from 3 months to 14 years. Donor site complications were found to be 3% while nasal complications were 12% requiring secondary surgery. Calvarial bone grafts provide satisfactory nasal reconstruction and show little evidence of resorption.
Extraoral Implantology and Prosthetics in Craniofacial Rehabilitation
Cervelli V..,Migliano E., Grimaldi M., Cervelli G., Giudiceandrea 17. Department of Plastic Surgery, University of Rome Tor Vergata, Rome, Italy The clinical application of extraoral osseointegrated implants is going to be successful in the prosthetic management of complex craniofacial defects. Extraoral osseointegration concepts and techniques are essentially the same as in intraoral implantology. Three-dimensional reconstructions of computed tomography (3-D CT) have been used for a better clinical and therapeutic planning of complex craniofacial reconstructions in order to obtain a comprehensive evaluation of the skeletal and the soft tissue alterations. Accurate surgical preoperative planning makes also prosthetic treatment easier. The authors report the longterm follow-up of the osteointegrated facial rehabilitation. Radiological and scintigraphical (SPECT Tc99m-MDP) findings demonstrate that the osteointegration process of the fixtures and the bone healing are the same as that in intraoral implantology.
Quantitative Volume Replacement in the Correction of Posttraumatic Enophthalmos
Chan C-H., McGurk M.
Department of Oral and Maxillofaeial Surgery, Guy's Hospital' London, UK Enophthalmos is due to volumetric enlargement of the bony orbit usually due to displacement of the orbital floor and/or medial wall. The logical approach to treatment is to quantify the volume change and replace it accordingly with a customized graft. This study describes the result of such an approach in 15 patients. Methods: Fifteen patients were entered into the study. Preoperative assessment consisted of computed tomography evaluation of orbital volume using the non-traumatized orbit for comparison (mean difference between the right and left orbit is 1.2 cc, 2 SD). Binocular singular vision was
assessed with a Hess chart and enophthalmos measured by exophthalmometer. A bone press was designed with a variable central chamber to produce custom made graft of the appropriate volume. The graft consisted of cancellous bone united with fibrin glue (Biocol). At 3 months post-operative, the assessments were repeated and compared to preoperative values. Results: Clinically enophthalmos was reliably reduced using this technique. However, measurement of enophthalmos using exophthalmometer did not always correlate with changes in orbital volume due to the subjective nature of measuring enophthalmos by exophthalmometry. Conclusions: A reliable method of treating enophthalmos is described. The results will be further improved when nonabsorbable implant material (Biolgass) is used in conjunction with bone. An accurate method of measuring globe position using a structured light system is being investigated to improve objective assessment of enophthalmos.
Comparison of Immediate Implantation with Secondary Implantation after Vascularized Fibular Bone Graft in Oromandibular Reconstruction
Chang Y.M., Shen Y-F., Chan C-P., Wei F-C., Chen H-C.
Oral and Maxillofacial Surgery Department, Chang-Gung Memorial Hospital, Taipei, Taiwan Six patients, aged 1%53 years old, suffering from ameloblastoma in the mandible are considered. Three cases involved the region from canine-premolar area to the condyle neck at the same side and the other 3 involved total mandibular body-lymphysis-body region. After the tumour was completely resected, there was insufficient soft tissue in the oral cavity. We used vascularized fibular bone graft for oromandibular reconstruction. In 3 cases, 8 dental implants were immediately placed during reconstruction procedure. In the other 3 cases, 10 dental implants were implanted 4 months postoperatively. Placement of healing abutment and palatal mucosal graft at the surrounding area were performed at the same stage. Six months later, oral functional rehabilitation was performed. After 1 year follow-up examination, the results are: (i) no recurrence of ameloblastoma was found in any case, (ii) no infection or loss of implant was noted, all are in function (these results meet with the criteria of successful osseointegration), (iii) the soft tissue problem was solved by using palatal mucosal graft with custom stent and (iv) determination of long axis and functional loading position of dental implant in immediate implantation is more challenging than secondary implantation.
A Modified Approach to Le Fort II Osteotomy
Cheung L-K., Samman N., Tideman 11.
Department of Oral and Maxillofacial Surgery, University of Hong Kong, Hong Kong Surgical access to the Le Fort II osteotomy usually necessitates either nasal or orbital skin incision, ultimately resulting in an external scar. The facial skin incision aims to facilitate joining the maxillary osteotomy with the orbitonasal osteotomy, and is utilised by many surgeons in conjunction with a bicoronal flap. This presentation describes a modified approach to Le Fort II osteotomy and
Extraoral Implantology and Prosthetics in Craniofacial Rehabilitation
Cervelli V..,Migliano E., Grimaldi M., Cervelli G., Giudiceandrea 17. Department of Plastic Surgery, University of Rome Tor Vergata, Rome, Italy The clinical application of extraoral osseointegrated implants is going to be successful in the prosthetic management of complex craniofacial defects. Extraoral osseointegration concepts and techniques are essentially the same as in intraoral implantology. Three-dimensional reconstructions of computed tomography (3-D CT) have been used for a better clinical and therapeutic planning of complex craniofacial reconstructions in order to obtain a comprehensive evaluation of the skeletal and the soft tissue alterations. Accurate surgical preoperative planning makes also prosthetic treatment easier. The authors report the longterm follow-up of the osteointegrated facial rehabilitation. Radiological and scintigraphical (SPECT Tc99m-MDP) findings demonstrate that the osteointegration process of the fixtures and the bone healing are the same as that in intraoral implantology.
Quantitative Volume Replacement in the Correction of Posttraumatic Enophthalmos
Chan C-H., McGurk M.
Department of Oral and Maxillofaeial Surgery, Guy's Hospital' London, UK Enophthalmos is due to volumetric enlargement of the bony orbit usually due to displacement of the orbital floor and/or medial wall. The logical approach to treatment is to quantify the volume change and replace it accordingly with a customized graft. This study describes the result of such an approach in 15 patients. Methods: Fifteen patients were entered into the study. Preoperative assessment consisted of computed tomography evaluation of orbital volume using the non-traumatized orbit for comparison (mean difference between the right and left orbit is 1.2 cc, 2 SD). Binocular singular vision was
assessed with a Hess chart and enophthalmos measured by exophthalmometer. A bone press was designed with a variable central chamber to produce custom made graft of the appropriate volume. The graft consisted of cancellous bone united with fibrin glue (Biocol). At 3 months post-operative, the assessments were repeated and compared to preoperative values. Results: Clinically enophthalmos was reliably reduced using this technique. However, measurement of enophthalmos using exophthalmometer did not always correlate with changes in orbital volume due to the subjective nature of measuring enophthalmos by exophthalmometry. Conclusions: A reliable method of treating enophthalmos is described. The results will be further improved when nonabsorbable implant material (Biolgass) is used in conjunction with bone. An accurate method of measuring globe position using a structured light system is being investigated to improve objective assessment of enophthalmos.
Comparison of Immediate Implantation with Secondary Implantation after Vascularized Fibular Bone Graft in Oromandibular Reconstruction
Chang Y.M., Shen Y-F., Chan C-P., Wei F-C., Chen H-C.
Oral and Maxillofacial Surgery Department, Chang-Gung Memorial Hospital, Taipei, Taiwan Six patients, aged 1%53 years old, suffering from ameloblastoma in the mandible are considered. Three cases involved the region from canine-premolar area to the condyle neck at the same side and the other 3 involved total mandibular body-lymphysis-body region. After the tumour was completely resected, there was insufficient soft tissue in the oral cavity. We used vascularized fibular bone graft for oromandibular reconstruction. In 3 cases, 8 dental implants were immediately placed during reconstruction procedure. In the other 3 cases, 10 dental implants were implanted 4 months postoperatively. Placement of healing abutment and palatal mucosal graft at the surrounding area were performed at the same stage. Six months later, oral functional rehabilitation was performed. After 1 year follow-up examination, the results are: (i) no recurrence of ameloblastoma was found in any case, (ii) no infection or loss of implant was noted, all are in function (these results meet with the criteria of successful osseointegration), (iii) the soft tissue problem was solved by using palatal mucosal graft with custom stent and (iv) determination of long axis and functional loading position of dental implant in immediate implantation is more challenging than secondary implantation.
A Modified Approach to Le Fort II Osteotomy
Cheung L-K., Samman N., Tideman 11.
Department of Oral and Maxillofacial Surgery, University of Hong Kong, Hong Kong Surgical access to the Le Fort II osteotomy usually necessitates either nasal or orbital skin incision, ultimately resulting in an external scar. The facial skin incision aims to facilitate joining the maxillary osteotomy with the orbitonasal osteotomy, and is utilised by many surgeons in conjunction with a bicoronal flap. This presentation describes a modified approach to Le Fort II osteotomy and