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How to plan and implement mandibular callus distraction
Free oral communications different methods. The work was based on the assumption that an effective and useful clinical technique is one which is associated with the lowest number of complications, is relatively straightforward technically and ensures a good final result to treatment. As a basis for the assessment, use was made of the number and type of complications found in 656 patients treated by three different methods. An analysis of clinical material and its statistical analysis allowed for the choice of such a method which is the most effective in mandibular fractures.
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ate postoperative orthodontic treatment, a relapse seems to be inevitable, so a certain amount of overcorrection is necessary.
Covering Defects of the Oral Cavity using Microsurgical Reanastomized Arterialized Venous Flaps Klein C., Kovdcs A., Stuckensen T.
Department of Maxillofacial Surgery, Medical School, Frankfurt University, Frankfurt~Main, Germany The Reconstruction of Alveolar Bone Deficiencies with a Unique Lag Screw System for Monocortical Bone Block Fixation in Combination with Membrane Techniques A Five Year Clinical Report Kitsch A., Ackermann K-L., Kitsch C., Hutmacher D.
Private Practice, Filderstadt, Germany Monocortical bone transplants from the chin region in combination with membrane techniques have significantly enhanced the biomechanic and esthetic results of reconstructions of partially extreme atrophied alveolar ridges. Newly developed mini-lag-screws of the Corticofix®Systems stabilize the autogenous monocortical bonegraft. The necessary padding and contouring is carried out with porous HA-granules and autogenous spongy bone. The GBR-membranes, both resorbable and non resorbable are stabilized using a titanium minipin system. In combination with appropriate suturing techniques, resorption of the onlay graft can be totally prevented. Later implant installation is carried out using a specifically developed trephine set that allows simultaneous harvesting of biopsies. The harvesting technique of the monocortical block of the chin, its fixation, the membrane technique, the histological evaluation of approximately 50 cases and the prosthetic rehabilitation will be demonstrated.
In search for thin and pliable free flaps to cover acral defects, composite grafts nourished through their venous system were designed in animal models. The arterialization of the venous system showed the best results compared to flaps with only venous blood supply. Clinical experience was reported by several authors applying these flaps to areas of the extremities. In 25 patients we covered defects caused by resection of oral squamous cell carcinoma using arterialized venous flaps. In all cases, an epifascial lipocutaneous composite graft crossed by a superficial vein was harvested from the flexor side of the right forearm. After suturing the flap into the oral defect the formerly distal part of the vein was connected to a cervical artery and the proximal part to a cervical vein. Forty-eight per cent of the flaps showed uneventful healing, Twenty-four per cent showed superficial or marginal necrosis and 28% were lost. In case of partial or total demarcation it developed slowly and led to stable granulation tissue. The donor site defect was either closed primary (n = 18) or covered by a sPlit thickness skin graft (n = 7), no patient showed functional limitations. Though their mechanism of survival is not yet completely understood and further research seems to be essential, venous flaps do present a new possibility in the repertoire of the maxillofacial surgeon.
How to Plan and Implement Mandibular Callus Distraction
Optical Three-Dimensional Coordinate Measurements and Imaging of Human Condyles
Klein C.
Kleinheinz ,/.1, Friese C.l, Dirksen D.2, Saulin E 2, Weingart D. 1, Joos U.1
Department of Maxillofacial Surgery, Medical School, Frankfurt University, Frankfurt~Main, Germany In the correction of developmental disturbances of the facial skeleton, Ilizarov's gradual callus distraction seems to become an established method worldwide. In our department, more than 30 children with congenital or acquired hypoplasias of the mandible have been operated on using this new technique since 1992. After gaining our first experiences with an unidirectional device, we developed a unit construction system together with the Normed company for an individual mandibular bone lengthening. Depending on the degree of the hypoplasia and the age of the patient, we perform a uni-, bi- or multidirectional lengthening procedure after one or two osteotomies on each affected side. So we hope to reach our goal of an, as accurately as possible, anatomical reconstruction. In a survey of our cases we show technique, potentials and limitations of the mandibular callus distraction taking our follow-up results into account. Essentially we saw no complications The analysis and evaluation of 20 pre- and postlengthening computed tomography (CT) scans show that after a fixation phase of about 8 weeks the ossification of the new bony field was almost complete in young children and finished up to 90% in elder children. Nevertheless, in case of missing immedi-
Departments of ~Oral and Cranio-Maxillo-Facial Surgery and :Prosthetic Dentistry B, University of Miinster, Miinster, Germany In order to develop a functional and anatomical endoprothesis for the human condyle, it is necessary to collect data about the surface morphology. The aim of this study was to collect and compare the constant and variable forms, diameters and curvatures of human cadaver condyles using a computer-aided optical three-dimensional (3-D)-coordinate measurement system. A total of 34 human cadaver condyles (19 male, 15 female, age between 25-60 years) were examined using the optical 3-D scanner. The condyles were all fixed on a plate according to the same reference level. A pattern of light and dark fringes was projected onto the object's surface and the deformation of this pattern was recorded by two CCD cameras under different angles. The digitized images were then evaluated by a program calculating the height for each pixel value. A 3-D reconstruction of the whole condyle was achieved by the combination of measurements from different perspectives. Depending on the size of the images, the precision of this technique is better than 0.1 mm. This technique seems to be of extreme value in the assessment of irregular biological surfaces, like the
63
ate postoperative orthodontic treatment, a relapse seems to be inevitable, so a certain amount of overcorrection is necessary.
Covering Defects of the Oral Cavity using Microsurgical Reanastomized Arterialized Venous Flaps Klein C., Kovdcs A., Stuckensen T.
Department of Maxillofacial Surgery, Medical School, Frankfurt University, Frankfurt~Main, Germany The Reconstruction of Alveolar Bone Deficiencies with a Unique Lag Screw System for Monocortical Bone Block Fixation in Combination with Membrane Techniques A Five Year Clinical Report Kitsch A., Ackermann K-L., Kitsch C., Hutmacher D.
Private Practice, Filderstadt, Germany Monocortical bone transplants from the chin region in combination with membrane techniques have significantly enhanced the biomechanic and esthetic results of reconstructions of partially extreme atrophied alveolar ridges. Newly developed mini-lag-screws of the Corticofix®Systems stabilize the autogenous monocortical bonegraft. The necessary padding and contouring is carried out with porous HA-granules and autogenous spongy bone. The GBR-membranes, both resorbable and non resorbable are stabilized using a titanium minipin system. In combination with appropriate suturing techniques, resorption of the onlay graft can be totally prevented. Later implant installation is carried out using a specifically developed trephine set that allows simultaneous harvesting of biopsies. The harvesting technique of the monocortical block of the chin, its fixation, the membrane technique, the histological evaluation of approximately 50 cases and the prosthetic rehabilitation will be demonstrated.
In search for thin and pliable free flaps to cover acral defects, composite grafts nourished through their venous system were designed in animal models. The arterialization of the venous system showed the best results compared to flaps with only venous blood supply. Clinical experience was reported by several authors applying these flaps to areas of the extremities. In 25 patients we covered defects caused by resection of oral squamous cell carcinoma using arterialized venous flaps. In all cases, an epifascial lipocutaneous composite graft crossed by a superficial vein was harvested from the flexor side of the right forearm. After suturing the flap into the oral defect the formerly distal part of the vein was connected to a cervical artery and the proximal part to a cervical vein. Forty-eight per cent of the flaps showed uneventful healing, Twenty-four per cent showed superficial or marginal necrosis and 28% were lost. In case of partial or total demarcation it developed slowly and led to stable granulation tissue. The donor site defect was either closed primary (n = 18) or covered by a sPlit thickness skin graft (n = 7), no patient showed functional limitations. Though their mechanism of survival is not yet completely understood and further research seems to be essential, venous flaps do present a new possibility in the repertoire of the maxillofacial surgeon.
How to Plan and Implement Mandibular Callus Distraction
Optical Three-Dimensional Coordinate Measurements and Imaging of Human Condyles
Klein C.
Kleinheinz ,/.1, Friese C.l, Dirksen D.2, Saulin E 2, Weingart D. 1, Joos U.1
Department of Maxillofacial Surgery, Medical School, Frankfurt University, Frankfurt~Main, Germany In the correction of developmental disturbances of the facial skeleton, Ilizarov's gradual callus distraction seems to become an established method worldwide. In our department, more than 30 children with congenital or acquired hypoplasias of the mandible have been operated on using this new technique since 1992. After gaining our first experiences with an unidirectional device, we developed a unit construction system together with the Normed company for an individual mandibular bone lengthening. Depending on the degree of the hypoplasia and the age of the patient, we perform a uni-, bi- or multidirectional lengthening procedure after one or two osteotomies on each affected side. So we hope to reach our goal of an, as accurately as possible, anatomical reconstruction. In a survey of our cases we show technique, potentials and limitations of the mandibular callus distraction taking our follow-up results into account. Essentially we saw no complications The analysis and evaluation of 20 pre- and postlengthening computed tomography (CT) scans show that after a fixation phase of about 8 weeks the ossification of the new bony field was almost complete in young children and finished up to 90% in elder children. Nevertheless, in case of missing immedi-
Departments of ~Oral and Cranio-Maxillo-Facial Surgery and :Prosthetic Dentistry B, University of Miinster, Miinster, Germany In order to develop a functional and anatomical endoprothesis for the human condyle, it is necessary to collect data about the surface morphology. The aim of this study was to collect and compare the constant and variable forms, diameters and curvatures of human cadaver condyles using a computer-aided optical three-dimensional (3-D)-coordinate measurement system. A total of 34 human cadaver condyles (19 male, 15 female, age between 25-60 years) were examined using the optical 3-D scanner. The condyles were all fixed on a plate according to the same reference level. A pattern of light and dark fringes was projected onto the object's surface and the deformation of this pattern was recorded by two CCD cameras under different angles. The digitized images were then evaluated by a program calculating the height for each pixel value. A 3-D reconstruction of the whole condyle was achieved by the combination of measurements from different perspectives. Depending on the size of the images, the precision of this technique is better than 0.1 mm. This technique seems to be of extreme value in the assessment of irregular biological surfaces, like the