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O.093 Distraction osteogenesis in treating Pierre Robin sequence
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Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
is manufactured and has to be sustained for 23 h/day over some months. Results: Head-ortheses show a satisfying fit after manufacture by 3D-Phography. Even stigmatizing head deformity of non-synostotic kind can be normalized properly. Severe head deformity infrequently normalizes without an orthotic therapy. Children with non-synostotic head deformities show typical diagnostical characteristics and interesting auxiliary findings. Conclusion: It is essential to treat severe deformational head deformity not only by physiotherapeutical, but also by orthotic means to normalize infant head form properly. Differential Diagnosis between synostotic and non-synostotic deformity is an important capability for craniomaxillofacial surgeons. Standardized measurements are needed to objectify deformity and make results repeatable and independent of examiner.
Abstracts, EACMFS XIX Congress exclude skeletal buccal cross bite. Unmatching of the middle axis of the face (SS plane) were found in all 25 patients. 12 patients had narrow maxilla, 4 patients had wider maxilla and 9 patients had narrow face. The ramus height (Go-Cd) were increased (from 3−22 mm) in 5 patients on the right side and in 6 patients (from 1−13 mm) on the left side. The length of the mandibular body (Go-Gn) were increased in 11 patients on the right side and in 3 patients on the left side. Conclusion: The most patients (80%), were with increased craniofacial-transversal angle which indicate skeletal-lingual cross bite and undeveloped maxilla in transversal plane. The presented analysis enable proper preoperative planning of skeletal osteotomy and correction of facial asymmetry.
O.095 Genioplasty with piezosurgery O.093 Distraction osteogenesis in treating Pierre Robin sequence I. Iatrou1 , N. Theologie-Lygidakis2 . 1 Children’s Hospital, University Department of OMFS, Athens, Greece; 2 University Department of OMFS in Children’s Hospital “A. & P. Kyriakou”, Dental School, Athens, Greece Objectives: To present the early treatment of severe micrognathia, using distraction osteogenesis in a case of a 9 months infant with Pierre Robin sequence, which is characterized by the clinical triad of micrognathia, glossoptosis and cleft palate. Material and Method: The infant, a twin brother of a healthy child, was first seen in the age of 3 months, having already a tracheostomy for breathing and being underweighed due to malnutrition although he had undergone a nestidostomy. When the infant reached the weight of 5100 kilograms, in the age of 9 months, was operated for improvement of his micrognathia. Via an extraoral approach, osteotomies were performed and small distraction osteogenesis appliances were fixed in the body of his mandible bilaterally. Appliances, 4 days post operatively, were activated for 1 month to gain 2 cm at each side, were maintained for another 1 month and then were removed. Results: Impressive improvement was achieved with the mandible reaching an acceptable size and enabling the proper positioning of the tongue. Both tracheostomy and nestidostomy were removed as breathing and feeding of the infant were possible. Conclusion: Distraction osteogenesis had a definitely positive contribution in a case of severe micrognathia with life-threatening implications. Further follow-up and surgical intervention for the cleft will be required. O.094 Face asymmetry and postero-anterior cephalometric radiographs M. Buric, M. Janosevic, N. Buric. Clinic of Stomatology, Nis, Serbia Aim: To present results of measured postero-anterior cephalometric radiographs according to Ricketts and Dahan in identification of skeletal medio-lateral face asymmetry joined with dental malocclusion. Material and Methods: 25 consecutive patients of both sexes, with age range from 12 to 32 yrs, affected with facial asymmetry have been underwent to Rickett’s and Dahn’s analysis in preoperative treatment. Rickett’s analysis included: transversal relations of the jaws – angles Z−AG−J and A−AG−ZA; angle ANS and Me; bizygomatic plane ZA−AZ; main medial vertical plain SS; maxillary, mandibular and facial proportions; and Dahn’s analysis included: ramus height and mandibular corpus length. Results: In 15 patients the there was greater angle Z-AG-J in the range 14−31.5º (mean 21.26º) on right side; on the left side in 10 patients there was greater angle 14−38º (mean 22.06º) indicating skeletal lingual cross bite. Lower angle of 12º wasn’t found which
M. Turra, D. Bertossi, G. Bissolotti, A. Anesi, L. Chiarini, P.-F. Nocini. University of Verona, Policlinico “GB Rossi”, Verona, Italy Aims: The chin is the most prominent and median sector of the lower third of the face giving harmony to nose and lips. We present the application of piezoelectric bone cutting device for the correction of different chin deformities. The distinctive characteristics of this device allows us to avoid or reduce the immediate genioplasty complications. Methods: 25 cases of defective chin have been treated from January 2006 to April 2007. Intraoral chinplasty was performed during the correction of dentofacial dysmorphisms or associated to nasal surgery. We used a piezoelectric cutting device to perform different osteotomies and if necessary, different kind of interpositional grafts were used to stabilize bony segments. Results: We observed a more precise and thin osteotomies (100% of cases), a reduced intraoperative bleeding (92%) with light degree of postoperative hematoma, no nervous injuries (100%, slight paresthesia 36%) and patients’ satisfaction (96%). Discussion: Chinplasty represent one of the most common ancillary procedures and may be associated with corrective surgery of skeletal bases in dentofacial dysmorphisms. Mental nerve injuries, asymmetries, intraoperative bleeding are the main immediate complications of genioplasty. Distinctive characteristics of ultrasonic piezoelectric osteotomy are selective cutting of only mineralized structure with less risk of vascular and nervous damage (microvibrations), intraoperative precision (thin cutting scalpel and no macrovibrations), blood free site (cavitation effect). In our experience, piezoelectric cutting device, compared to saw and drill, enables us to reduce or avoid immediate complications of chin surgery, helping the surgeon to reach patients’ satisfaction. O.096 Hemimandibular elongation: evaluation of a therapy protocol A. Zimmermann, Y. Deleurant, T. Peltomaeki. Zahn- und Kieferklinik Seestrasse, Zurich, Switzerland Objectives: The aim of this retrospective study was to evaluate the feasibility of our protocol for the correction of hemimandibular elongation (HE), consisting of a two step approach combining orthodontics and maxillofacial surgery. Methods: Seven out of 47 individuals diagnosed with severe mandibular asymmetry were included in the study. All patients were treated in the same private practice. Inclusion criteria were: Diagnosis of HE based on clinical and radiological features and SPECT bone scintigraphy, availability of good quality orthopantomograms (OPT) at six time points, two-stage surgery with first high condylectomy (HC), orthodontic decompensation and at least 6 months later orthognathic surgery. Height of the mandibular ramus and length of the mandibular corpus were traced and measured on OPTs at six time points; ra-
Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
is manufactured and has to be sustained for 23 h/day over some months. Results: Head-ortheses show a satisfying fit after manufacture by 3D-Phography. Even stigmatizing head deformity of non-synostotic kind can be normalized properly. Severe head deformity infrequently normalizes without an orthotic therapy. Children with non-synostotic head deformities show typical diagnostical characteristics and interesting auxiliary findings. Conclusion: It is essential to treat severe deformational head deformity not only by physiotherapeutical, but also by orthotic means to normalize infant head form properly. Differential Diagnosis between synostotic and non-synostotic deformity is an important capability for craniomaxillofacial surgeons. Standardized measurements are needed to objectify deformity and make results repeatable and independent of examiner.
Abstracts, EACMFS XIX Congress exclude skeletal buccal cross bite. Unmatching of the middle axis of the face (SS plane) were found in all 25 patients. 12 patients had narrow maxilla, 4 patients had wider maxilla and 9 patients had narrow face. The ramus height (Go-Cd) were increased (from 3−22 mm) in 5 patients on the right side and in 6 patients (from 1−13 mm) on the left side. The length of the mandibular body (Go-Gn) were increased in 11 patients on the right side and in 3 patients on the left side. Conclusion: The most patients (80%), were with increased craniofacial-transversal angle which indicate skeletal-lingual cross bite and undeveloped maxilla in transversal plane. The presented analysis enable proper preoperative planning of skeletal osteotomy and correction of facial asymmetry.
O.095 Genioplasty with piezosurgery O.093 Distraction osteogenesis in treating Pierre Robin sequence I. Iatrou1 , N. Theologie-Lygidakis2 . 1 Children’s Hospital, University Department of OMFS, Athens, Greece; 2 University Department of OMFS in Children’s Hospital “A. & P. Kyriakou”, Dental School, Athens, Greece Objectives: To present the early treatment of severe micrognathia, using distraction osteogenesis in a case of a 9 months infant with Pierre Robin sequence, which is characterized by the clinical triad of micrognathia, glossoptosis and cleft palate. Material and Method: The infant, a twin brother of a healthy child, was first seen in the age of 3 months, having already a tracheostomy for breathing and being underweighed due to malnutrition although he had undergone a nestidostomy. When the infant reached the weight of 5100 kilograms, in the age of 9 months, was operated for improvement of his micrognathia. Via an extraoral approach, osteotomies were performed and small distraction osteogenesis appliances were fixed in the body of his mandible bilaterally. Appliances, 4 days post operatively, were activated for 1 month to gain 2 cm at each side, were maintained for another 1 month and then were removed. Results: Impressive improvement was achieved with the mandible reaching an acceptable size and enabling the proper positioning of the tongue. Both tracheostomy and nestidostomy were removed as breathing and feeding of the infant were possible. Conclusion: Distraction osteogenesis had a definitely positive contribution in a case of severe micrognathia with life-threatening implications. Further follow-up and surgical intervention for the cleft will be required. O.094 Face asymmetry and postero-anterior cephalometric radiographs M. Buric, M. Janosevic, N. Buric. Clinic of Stomatology, Nis, Serbia Aim: To present results of measured postero-anterior cephalometric radiographs according to Ricketts and Dahan in identification of skeletal medio-lateral face asymmetry joined with dental malocclusion. Material and Methods: 25 consecutive patients of both sexes, with age range from 12 to 32 yrs, affected with facial asymmetry have been underwent to Rickett’s and Dahn’s analysis in preoperative treatment. Rickett’s analysis included: transversal relations of the jaws – angles Z−AG−J and A−AG−ZA; angle ANS and Me; bizygomatic plane ZA−AZ; main medial vertical plain SS; maxillary, mandibular and facial proportions; and Dahn’s analysis included: ramus height and mandibular corpus length. Results: In 15 patients the there was greater angle Z-AG-J in the range 14−31.5º (mean 21.26º) on right side; on the left side in 10 patients there was greater angle 14−38º (mean 22.06º) indicating skeletal lingual cross bite. Lower angle of 12º wasn’t found which
M. Turra, D. Bertossi, G. Bissolotti, A. Anesi, L. Chiarini, P.-F. Nocini. University of Verona, Policlinico “GB Rossi”, Verona, Italy Aims: The chin is the most prominent and median sector of the lower third of the face giving harmony to nose and lips. We present the application of piezoelectric bone cutting device for the correction of different chin deformities. The distinctive characteristics of this device allows us to avoid or reduce the immediate genioplasty complications. Methods: 25 cases of defective chin have been treated from January 2006 to April 2007. Intraoral chinplasty was performed during the correction of dentofacial dysmorphisms or associated to nasal surgery. We used a piezoelectric cutting device to perform different osteotomies and if necessary, different kind of interpositional grafts were used to stabilize bony segments. Results: We observed a more precise and thin osteotomies (100% of cases), a reduced intraoperative bleeding (92%) with light degree of postoperative hematoma, no nervous injuries (100%, slight paresthesia 36%) and patients’ satisfaction (96%). Discussion: Chinplasty represent one of the most common ancillary procedures and may be associated with corrective surgery of skeletal bases in dentofacial dysmorphisms. Mental nerve injuries, asymmetries, intraoperative bleeding are the main immediate complications of genioplasty. Distinctive characteristics of ultrasonic piezoelectric osteotomy are selective cutting of only mineralized structure with less risk of vascular and nervous damage (microvibrations), intraoperative precision (thin cutting scalpel and no macrovibrations), blood free site (cavitation effect). In our experience, piezoelectric cutting device, compared to saw and drill, enables us to reduce or avoid immediate complications of chin surgery, helping the surgeon to reach patients’ satisfaction. O.096 Hemimandibular elongation: evaluation of a therapy protocol A. Zimmermann, Y. Deleurant, T. Peltomaeki. Zahn- und Kieferklinik Seestrasse, Zurich, Switzerland Objectives: The aim of this retrospective study was to evaluate the feasibility of our protocol for the correction of hemimandibular elongation (HE), consisting of a two step approach combining orthodontics and maxillofacial surgery. Methods: Seven out of 47 individuals diagnosed with severe mandibular asymmetry were included in the study. All patients were treated in the same private practice. Inclusion criteria were: Diagnosis of HE based on clinical and radiological features and SPECT bone scintigraphy, availability of good quality orthopantomograms (OPT) at six time points, two-stage surgery with first high condylectomy (HC), orthodontic decompensation and at least 6 months later orthognathic surgery. Height of the mandibular ramus and length of the mandibular corpus were traced and measured on OPTs at six time points; ra-