Maxillary le fort I and III by intraoral distraction osteogenesis

Int. J. Oral Maxillofac. Surg. 2005; 34 (Supplement 1): $ 1 - $ 1 8 1

90 when nutritional intervention should take place is unknown. Therefore in this study specification of malnutrition and nutrition related problems are documented and analysed. A prospective observational study (2003) was performed to measure outcome of treatment and pinpoint the moment to prevent malnutrition (defined as loss of weight ~>5% in 1 month or ~>10% in 6 months) in patients with OOH admitted at the department of Head and Neck oncology. Nutritional and anthropometrical assessments were conducted. The EORTC QLQ-H&N35 and -C30 were applied to assess the nutrition related problems and quality of life six times during and at last six month after treatment. Patients (=68) included in this study were treated with Radiotherapy (n=25), Chemo/Radiotherapy (n =10), Surgery (n = 19) or Surgery/Radiotherapy (n = 14). Twentyfour patients (35%) reported substantial loss of weight on their first visit according to the malnutrition criteria. Substantial loss of weight (6.5-10.5%) occurred in 26 patients at completion of treatment with radiotherapy alone or combined with another treatment modality. Loss of weight in patients undergoing surgery was less prominent (4/19). Mann Whitney U test showed a higher loss of weight (p=0.002) in patients treated with radiotherapy or combined with another treatment modality. Patients admitted to the outpatient clinic were already underfed. Their nutritional status declined progressively during treatment, especially in radiotherapy patients. Screening malnutrition in patients should be compulsory and should preferably be repeated before, during and six month after treatment. Nutritional assessment has to be done on a weekly basis during treatment with radiotherapy with a standard food questionnaire and should result in prompt intervention. [-0--4"-~ PEG INSERTION AT THE TIME OF DEFINITIVE SURG ERY FOR ORAL MALIGNANCY R. Molloy, S. Akhtar. Department of Maxillofacial Surgery, Royal Preston Hospital England, Preston, England A retrospective analysis of the outcome of PEG insertion by one surgeon. To examine factors such as cost-effectiveness, ease of treatment and complication rate associated with PEG placement by the Maxillofacial Team. Case-note review of over 50 patients who underwent operation for Oral Carcinoma and had PEG placement by Maxillofacial Team at the same operation. Our results show that PEG placement by the Maxillofacial Team is a safe, cost-effective procedure with a low complication rate. The patient is not subjected to a further operation, feeding is commenced on the first post-operative day and complications of NG insertion are avoided. We advocate the placement of PEG feeding tubes by the Maxillofacial Team at the time of definitive operation.

ability to control the movement of nasomaxillary complex according to patients' preference and the final occlusal relationship. Simultaneous distraction of maxilla and mandible is an effective procedure for patient with midfacial hypoplasia ~-~]

C. Guerrero. Oral and Maxillofacial Surgery Center, Caracas, Venezuela A new internal miniaturized maxillary distractor was used to offer maxillary progressive advancement, stability and early return to regular life activities. 10 patients (6 females and 4 males, 12 to 35 y.o. average 18.4) with maxillary deficiency were treated by intraoral distraction osteogenesis to lengthen and/or augment vertically. Complete radiographs and photographs were obtained. Those patients requiring a Le Fort I (7/10) underwent a conventional incision and osteotomy, and two distractors were anchored bilaterally to the base of the zygoma, and fixed to the maxilla above the level of the teeth. For the second group (Le Fort III) (3/10) an additional coronal and trans-conjunctival approach were utilized and the classic osteotomies designs were performed. The distraction protocol consisted: 7 day latency period, activation phase at a rate of 1 mm per day until desired movement was obtained, followed by 5 to 7 months consolidation period. Lateral cephalometric radiographs were used to evaluate the maxillary advancement. Pre-surgical (T1), immediate post-surgery (T2), 3 (T3) and 6 months after surgery, when most of the appliances were removed (T4) and after orthodontic braces removal (T5). Particular fixation screws were utilized as bone markers; they were left in the surgical site to evaluate the stability. The maxilla was advanced 8 to 14 mm (average 10.5), augmented vertically 4 to 6 mm (average 4.8). All patients obtained Class I dental occlusions, and were markedly improved psychologically. Several surgical complications were seen in the Le Fort III group: unexpected zygomatic fractures (2/6) that required extra rigid fixation; two patients developed mild open bites that were treated by elastics and orthodontics, one patient had unilateral intropion, requiring wound revision, infraorbital nerve dysesthesia (3/6) that resolved spontaneously within 6 months after surgery. Distraction Osteogenesis by intraoral devices allows maxillary bi-dimensional corrections at different Le Fort levels, avoiding extraoral appliances, bone grafts, heavy rigid fixation and facial scars. It requires a meticulous surgical-orthodontics planning, adequate surgical timing and individual osteotomy design, a sound vector and careful 3D planning. [-0--~~

050. Distraction Osteogenesis IV

[-0--5"-~ A NEW TECHNIQUE OF DISTRACTION OSTEOGENESIS IN THE TREATMENT OF MIDFACIAL H Y P O P L A S I A A C C O R D I N G TO PATIENT'S PREFERENCE E-H. Choung, U.-L. Lee, H. Myoung, S.-J. Hwang, B.-M. Seo, J.-'~ Choi, J.-H. Lee, M.-J. Kim. Department of Oral and Maxillofacial Sugery,

College of Dentistry, Seoul National University, Korea The purpose of this study is to examine postoperative changes of skeletal and soft tissue of patient with hypoplastic midface who underwent simultaneous distraction of maxilla and mandible. Seven patients, aged 14 to 25 years of age with maxillary and midfacial hypoplasia were treated using internal distractor (Zurich maxillary distractor, Martin) after complete Le Fort II osteotomy (n =5) and Le Fort I osteotomy (n = 1), Intraoral Verticosagittal Ramus Osteotomy (IVSRO) and intermaxillary fixation with occlusal wafer. Facial photographs and lateral cephalometric radiographs were obtained, mandibular movements, condylar position and occlusion were checked pre-operatively, and 3 and 6 months after distraction. Cephalometric analysis was performed to compare the skeletal and soft tissue morphology before and after distraction. At the end of distraction phase when patients were pleased with their profile, the average maxillary advancement was 7.2 mm. Maxillary distraction improved the profile by increasing nasal projection, normalizing nasolabial angle. The final occlusal relationship, mandibular movements and condylar position were satisfactory. The major advantage of this technique is the

M A X I L L A R Y LE FORT I AND III BY INTRAORAL DISTRACTION OSTEOGENESIS

LEFORT III OSTEOTOMY AND MIDFACIAL DISTRACTION OSTEOGENESlS IN CRANIOFACIAL MALFORMATIONS RESULTS OF 25 CASES

J. Kleinheinz 1 , C. Meyer 2, A. Wilk 2, J. Obwegeser 3, U. Joos 1 .

1Department of Cranio-Maxillofacial Surgery, University Hospital, Muenster, Germany; 2Service de Chirurgie Maxillo-Faciale, Hopitaux Universitaires, Strasbourg, France;3Departmentof Maxillofacial Surgery, University Hospital, Zuerich, Switzerland Distraction osteogenesis has become a popular treatment of congenital cranio-maxillofacial malformations. Aim of this study was to evaluate the results using a modular craniofacial distraction device. All craniofacial malformations treated with Le Fort III distraction osteogenesis in the time between 1999 and 2003 were evaluated retrospectively. Distraction was carried out using a modular subcutaneous distraction device fixed on both sides at the lateral orbital rim. The mobilized midface was pushed anteriorly using 3 little ledges placed in the osteotomy line. Rate of distraction was classical (0.5 mm to 1 mm per day) starting on day 3. A total of 25 cases could be analyzed. There were nine patients with Morbus Crouzon, eight with Apert-Syndrome, three Treacher-CollinsSyndromes, three Binder-Syndromes, and two with craniosynostosis. Distraction ranged from 9 to 21 mm, mean age at surgery was 10.3 years and mean follow-up was 14 months. Atypical osteotomies or combinations with distraction osteogenesis of the maxilla and the mandible were performed in 8 cases. Distraction was completed uneventfully in 23/25 patients. Second operations were required for two patients during the early phase: distractor failed in one requiring immediate reoperation and a second developed a device infection. Distractors were removed after 6 months. Equalized occlusion was obtained in 20/25 patients requiring only little orthodontic treatment. In 5 cases a second operation was necessary to achieve a good occlusion. Relapse was observed in three patients whose retaining phase was less than five