- Email: [email protected]
Maxillary and mandibular advancement osteotomies as a curative treatment in severe obstructive sleep apnoea syndrome
224
British
Journal
of Oral and Maxillofacial
Surgery
Conclusions: There is a significant (P < 0.0033) increased risk of having an infectious complication after bimaxillary orthognathic surgery without antibiotic prophylaxis. No significant difference in incidence of infectious complications was found in patients receiving antibiotic prophylaxis with either cefuroxim or amoxicillin-clavulanic acid.
Stereolithographic models of 3-D sonographic soft-tissue data for preoperative surgical simulation. R. Sad&, B. Kirst2, H. F. Zeilhofer’, G. Kadegge2, M. HaunschiU, B. Nuber’, U Kliegi9. ‘Department of Oral and Maxillofacial Surgery/University of Technology Munich; ZDepartment of Mechanical Engineering/Technical College Munich; ‘KL-Technik Co; Yiewpoint Co; 3Nordcom Medical Systems Co. Three-dimensional (3-D) stereolithographic skull models rank high in operation planning of complex osseous deformities. A similar procedure for evaluating soft tissues does not exist. A new technique of model building was developed using 3-D ultrasound data. First aim was the automated model building of the nose for preoperative surgical simulation. For data acquisition, diving goggles were modified by replacing the glass with a silicone membrane. A 13 mhz transducer was used connected with a transducer-independent 3-D ultrasound PC workstation. The sonographically presented soft-tissue structures were segmentated using semi-automated algorithms. Here, the nasal surface, the cartilages and the bone could be segmentated separately. The 3-D system exports the segmentated data as STL tiles to a stereolithographic machine. Then, the soft tissues were built in the known transparent technique, and the cartilage and the bone were built in different colours using special polymerization patterns. Up to now, we have rebuilt 9 noses of patients with a cleft lip deformity. In preoperative planning the nasal correction, considering the alar cartilage, these models were very useful, especially in prediction of a needed cartilaginous transplant. This procedure led to a high patient acceptance, the aesthetical and functional results were excellent. The use as well as the limitations of this new technique will be presented.
Maxillary and mandibular advancement osteotomies as a curative treatment in severe obstructive sleep apnoea syndrome. A. De Clercq’, D. Pevernagie=, C. De Clercq’, H. Schautteetl. ‘Department of Oral and Maxillofacial Surgery; *Centre for Sleep Disorders, State University of Ghent, Belgium. Obstructive sleep apnoea syndrome (OSAS) is characterized by a disruption of the normal sleep pattern due to a pathological amount of apnoea and hypopneoa during sleep. This results in morning headaches, daytime somnolence, loss of concentration and pulmonary hypertension with cardiac failure in severe cases. Clinical findings are confirmed with polysomnography (PSG) evaluation. Nasal continuous positive airway pressure (nCPAP) during sleep is the treatment of choice but has limitations such as lifetime dependence and intolerance in 5510% of cases. Seven consecutive cases of severe OSAS, intolerant to nCPAP, were treated with major maxillary and mandibular advancement osteotomies (ranging from IO-17 mm). All cases were assessed with PSG pre- and 6-29 months postoperatively. Cephalometric changes in posterior airway space, stability and aesthetic considerations in major advancements are addressed. Very promising clinical findings and PSG results were achieved in that six out of seven patients were cured. This perspective places maxillofacial surgery as a first-line surgical treatment for severe OSAS and the maxillofacial surgeon as a crucial part of the multidisciplinary team in the treatment of OSAS.
Short-term effect of a modified activator device in the treatment of obstructive sleep apnoea syndrome. Heinrich Strobl, E: Tracik2, R. Emshoff IDepartment of Oral and Maxillofacial Surgery; ZDepartment of Neurology (Laboratory of Sleep-related Disorders, University of Innsbruck, Innsbruck, Austria.
In the treatment of the obstructive sleep apnoea syndrome (OSAS), multiple surgical procedures designed to increase the posterior airway space have been devised. Several authors have described dental appliances to be quite effective in patients with OSAS. However, the question of how these appliances work and why they may be effective in some patients but not in others remains a point of controversy. The purpose of this study was to evaluate the short-term effect of a modified activator device (MAD) on signs and symptoms of OSAS. With OSAS defined as a sleep-related breathing disorder (SRBD) characterized by five at least 10 second long apnoeas per hour of sleep (respiratory disturbance index > 5), the study consisted of 41 patients showing mild-to-severe OSAS with a respiratory disturbance index (RDI) between 5 and 59. Each patient received an individual MAD designed to increase vertical dimension and protrude the mandible. Polysomnography performed at the Laboratory of Sleep-related Disorders was used to compute RDI before treatment and at 3-month follow-up. MAD treatment resulted in a significant decrease of the pretreatment RDIs (P C 0.01). In patients with pretreatment RDIs ranging from 40 to 59 the respective decrease was more significant than in those showing values from 20 to 40. Nine patients showed no change of the respective pretreatment RDIs, while 5 patients were unable to tolerate the activator treatment. The results suggest application of MADs as a cost-effective and rational approach for patients with OSAS. Further clinical trials are warranted to assess the clinical efftcacy and the long-term effect of the presented treatment modality.
Stability of the non-cleft Le Fort I osteotomy: is it improved by routine bone grafting? C. J Kerawala. Department of Oral and Facial Surgery, Sunderland Royal Hospital, Sunderland, UK. Over the past few decades, the Le Fort I osteotomy has developed into a safe, reliable mode of correcting mid-face deformity. Whilst the perioperative outcome is usually assured, long-term stability can be unpredictable, particularly for certain moves. Relapse is more common in the cleft situation but still occurs in non-cleft cases despite the widespread use of direct osteosynthesis by miniplate fixation. Although bone grafting is commonly advocated in cleft osteotomies in an attempt to minimize this potential for relapse, its use is not widespread in the non-cleft patient, possibly because of the morbidity perceived to occur at the donor site. The advent of trephine bone harvests has, however, minimized the potential for hip morbidity and an argument can therefore be developed for the routine use of bone grafting at the Le Fort I site. In an attempt to quantify whether bone grafting improves the stability of the Le Fort I osteotomy in the non-cleft situation, the records of 50 consecutive patients (M:F l:l, mean age 23 years) undergoing bimaxillary osteotomy were examined. All patients had undergone osteotomy via a standard down-fracture technique with non-compression miniplate fixation across a bone grafted osteotomy site. Lateral cephalometric radiographs taken preoperatively, immediately postoperatively and at least 1 year postoperatively were compared with reference to the cranial base using a technique originally described by Houston et al in 1987. From these measurements mean surgical change, postsurgical change and percentage of relapse was derived for the population sampled. The results obtained support the premise that bone grafting improves the stability of the Le Fort I osteotomy in the non-cleft situation.
Management of field change disease with photodynamic C. Hopper, K. Fan, J Prabhakar, P Speight. S. Bown. Medical Laser Centre and the Eastman Dental Institute, UK.
therapy. National London,
The problem of synchronous and metachronous squamous cell carcinoma of the oral cavity poses a difftcult therapeutic challenge. Many patients who present with second primaries have already been subjected to multimodality treatment, usually involving surgery and radiotherapy and options for treatment are frequently limited. For the last five years we have been treating these patients with photodynamic therapy (PDT). This treatment involves a cold photochemical reaction that results in tissue necrosis that regenerates with little
British
Journal
of Oral and Maxillofacial
Surgery
Conclusions: There is a significant (P < 0.0033) increased risk of having an infectious complication after bimaxillary orthognathic surgery without antibiotic prophylaxis. No significant difference in incidence of infectious complications was found in patients receiving antibiotic prophylaxis with either cefuroxim or amoxicillin-clavulanic acid.
Stereolithographic models of 3-D sonographic soft-tissue data for preoperative surgical simulation. R. Sad&, B. Kirst2, H. F. Zeilhofer’, G. Kadegge2, M. HaunschiU, B. Nuber’, U Kliegi9. ‘Department of Oral and Maxillofacial Surgery/University of Technology Munich; ZDepartment of Mechanical Engineering/Technical College Munich; ‘KL-Technik Co; Yiewpoint Co; 3Nordcom Medical Systems Co. Three-dimensional (3-D) stereolithographic skull models rank high in operation planning of complex osseous deformities. A similar procedure for evaluating soft tissues does not exist. A new technique of model building was developed using 3-D ultrasound data. First aim was the automated model building of the nose for preoperative surgical simulation. For data acquisition, diving goggles were modified by replacing the glass with a silicone membrane. A 13 mhz transducer was used connected with a transducer-independent 3-D ultrasound PC workstation. The sonographically presented soft-tissue structures were segmentated using semi-automated algorithms. Here, the nasal surface, the cartilages and the bone could be segmentated separately. The 3-D system exports the segmentated data as STL tiles to a stereolithographic machine. Then, the soft tissues were built in the known transparent technique, and the cartilage and the bone were built in different colours using special polymerization patterns. Up to now, we have rebuilt 9 noses of patients with a cleft lip deformity. In preoperative planning the nasal correction, considering the alar cartilage, these models were very useful, especially in prediction of a needed cartilaginous transplant. This procedure led to a high patient acceptance, the aesthetical and functional results were excellent. The use as well as the limitations of this new technique will be presented.
Maxillary and mandibular advancement osteotomies as a curative treatment in severe obstructive sleep apnoea syndrome. A. De Clercq’, D. Pevernagie=, C. De Clercq’, H. Schautteetl. ‘Department of Oral and Maxillofacial Surgery; *Centre for Sleep Disorders, State University of Ghent, Belgium. Obstructive sleep apnoea syndrome (OSAS) is characterized by a disruption of the normal sleep pattern due to a pathological amount of apnoea and hypopneoa during sleep. This results in morning headaches, daytime somnolence, loss of concentration and pulmonary hypertension with cardiac failure in severe cases. Clinical findings are confirmed with polysomnography (PSG) evaluation. Nasal continuous positive airway pressure (nCPAP) during sleep is the treatment of choice but has limitations such as lifetime dependence and intolerance in 5510% of cases. Seven consecutive cases of severe OSAS, intolerant to nCPAP, were treated with major maxillary and mandibular advancement osteotomies (ranging from IO-17 mm). All cases were assessed with PSG pre- and 6-29 months postoperatively. Cephalometric changes in posterior airway space, stability and aesthetic considerations in major advancements are addressed. Very promising clinical findings and PSG results were achieved in that six out of seven patients were cured. This perspective places maxillofacial surgery as a first-line surgical treatment for severe OSAS and the maxillofacial surgeon as a crucial part of the multidisciplinary team in the treatment of OSAS.
Short-term effect of a modified activator device in the treatment of obstructive sleep apnoea syndrome. Heinrich Strobl, E: Tracik2, R. Emshoff IDepartment of Oral and Maxillofacial Surgery; ZDepartment of Neurology (Laboratory of Sleep-related Disorders, University of Innsbruck, Innsbruck, Austria.
In the treatment of the obstructive sleep apnoea syndrome (OSAS), multiple surgical procedures designed to increase the posterior airway space have been devised. Several authors have described dental appliances to be quite effective in patients with OSAS. However, the question of how these appliances work and why they may be effective in some patients but not in others remains a point of controversy. The purpose of this study was to evaluate the short-term effect of a modified activator device (MAD) on signs and symptoms of OSAS. With OSAS defined as a sleep-related breathing disorder (SRBD) characterized by five at least 10 second long apnoeas per hour of sleep (respiratory disturbance index > 5), the study consisted of 41 patients showing mild-to-severe OSAS with a respiratory disturbance index (RDI) between 5 and 59. Each patient received an individual MAD designed to increase vertical dimension and protrude the mandible. Polysomnography performed at the Laboratory of Sleep-related Disorders was used to compute RDI before treatment and at 3-month follow-up. MAD treatment resulted in a significant decrease of the pretreatment RDIs (P C 0.01). In patients with pretreatment RDIs ranging from 40 to 59 the respective decrease was more significant than in those showing values from 20 to 40. Nine patients showed no change of the respective pretreatment RDIs, while 5 patients were unable to tolerate the activator treatment. The results suggest application of MADs as a cost-effective and rational approach for patients with OSAS. Further clinical trials are warranted to assess the clinical efftcacy and the long-term effect of the presented treatment modality.
Stability of the non-cleft Le Fort I osteotomy: is it improved by routine bone grafting? C. J Kerawala. Department of Oral and Facial Surgery, Sunderland Royal Hospital, Sunderland, UK. Over the past few decades, the Le Fort I osteotomy has developed into a safe, reliable mode of correcting mid-face deformity. Whilst the perioperative outcome is usually assured, long-term stability can be unpredictable, particularly for certain moves. Relapse is more common in the cleft situation but still occurs in non-cleft cases despite the widespread use of direct osteosynthesis by miniplate fixation. Although bone grafting is commonly advocated in cleft osteotomies in an attempt to minimize this potential for relapse, its use is not widespread in the non-cleft patient, possibly because of the morbidity perceived to occur at the donor site. The advent of trephine bone harvests has, however, minimized the potential for hip morbidity and an argument can therefore be developed for the routine use of bone grafting at the Le Fort I site. In an attempt to quantify whether bone grafting improves the stability of the Le Fort I osteotomy in the non-cleft situation, the records of 50 consecutive patients (M:F l:l, mean age 23 years) undergoing bimaxillary osteotomy were examined. All patients had undergone osteotomy via a standard down-fracture technique with non-compression miniplate fixation across a bone grafted osteotomy site. Lateral cephalometric radiographs taken preoperatively, immediately postoperatively and at least 1 year postoperatively were compared with reference to the cranial base using a technique originally described by Houston et al in 1987. From these measurements mean surgical change, postsurgical change and percentage of relapse was derived for the population sampled. The results obtained support the premise that bone grafting improves the stability of the Le Fort I osteotomy in the non-cleft situation.
Management of field change disease with photodynamic C. Hopper, K. Fan, J Prabhakar, P Speight. S. Bown. Medical Laser Centre and the Eastman Dental Institute, UK.
therapy. National London,
The problem of synchronous and metachronous squamous cell carcinoma of the oral cavity poses a difftcult therapeutic challenge. Many patients who present with second primaries have already been subjected to multimodality treatment, usually involving surgery and radiotherapy and options for treatment are frequently limited. For the last five years we have been treating these patients with photodynamic therapy (PDT). This treatment involves a cold photochemical reaction that results in tissue necrosis that regenerates with little