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O.364 Bimaxillary transversal distraction osteogenesis: Verona experience
100 Journal of Cranio-Maxillofacial Surgery 34(2006) Suppl. S1 O.363 Planning in craniofacial DO procedures using simplant CMF software and rapid prototyping models A. Bianchi1 , E. Arnaud2 , A. Pizzigallo1 , C. Marchetti1 . 1 Oral and Maxillofacial Surgery Unit, S. Orsola Hospital, Bologna, Italy; 2 Plastic Surgery Service, Hopital Necker, Paris, France Objective: Aim of this research is to define a more accurate way of planning Distraction Osteogenesis procedures in craniofacial surgery using a new software (Simplant CMF – Materialise) and Rapid Prototyping Skeletal Models. Materials and Methods: Three pts. affected by cranio-maxillofacial abnormalities have been submitted before surgery to CT Scan. CT data have been reconstructed in a 3D way. Utilizing Simplant CMF software osteotomies have been simulated and different distraction vectors have been simulated in a 3D virtual environment. At the end of each hard tissues simulation it was possible to preview the soft tissue final result. We later printed Rapid Prototyping Models from the same CT data and preoperatively we reproduced surgery on the models and we preplated the distractor device in a proper way. Results: This planning procedure allows to choose the best aesthetic and functional surgical plan. In Crouzon patient it was decided to add bone graft in the nasal and orbital area, in the pre-prosthetic patient it was possible to precisely decide the distraction vector useful for the future dental implant position; in the micrognathia patient it was decided to increase the sagittal distraction movement more than the preliminary orthodontic plan for aesthetic issue. Final decision seemed to be more defined and time was saved during surgery for the pre-bending of the distractor fixation plate. Conclusions: Preliminary results bring us to conclude that Planning in Craniofacial DO procedures using Simplant CMF Software and Rapid Prototyping Models could improve the quality and the final surgical result.
O.364 Bimaxillary transversal distraction osteogenesis: Verona experience M. Albanese, D. Bertossi, A. Fior, P.F. Nocini. Clinic of Dentistry and Maxillo Facial Surgery, Department of Morphological and Biomedical Science, Pol. G.B. Rossi, University of Verona, Verona, Italy Introduction and Objectives: Transversal deficit and anterior teeth crowding are common defects of the mandibular arch, in particular with skeletal II class malocclusion. When dental space for dental alignment is not recovered with usual orthodontic movements, premolar tooth extraction may necessary on both jaws. Final result is a correct molar I Class relationship with an improvement in function and stability of the occlusion, but also with a possible unaesthetic flattening of the profile. The bimaxillary transversal distraction osteogenesis technique may overcome the need of tooth extraction, enlarging the bony space for dental repositioning without bone grafting. Material and Methods: Since 2001, 10 patients underwent this procedure at the Verona Department. Treatment included: orthodontic enlargement of the upper and lower dental midline, surgical positioning of the devices after the osteotomies (an incomplete Le Fort I on the maxilla and a midline fracture on the mandible), the distraction protocol (daily activation of the devices followed by a stabilization period of 4–6 months), the devices removal, and the final orthodontic dental realignment. When required, bimaxillary surgery was performed to compleate the rehabilitation protocol.
Abstracts, EACFMS XVIII Congress Results: All cases were successfully treated with no major complications. X-ray check confirmed a good bone formation within the distraction gap created of both jaws for all procedures. Histological examination revealed a good bone formation inside the gap. The bony space achieved allowed dental repositioning avoiding tooth extraction. Conclusions: Bimaxillary transversal distraction osteogenesis may be consider an interesting alternative to traditional protocols when transversal bone deficit and dental crowding are treated avoiding tooth extraction.
Thursday, 14 September 2006, 11.00−12.30
Hall 6
Facial trauma: orbit O.365 The consequences of 342 zygoma complex fractures treatment N. Ihan Hren. Clinical Department of Maxillofacial and Oral Surgery, Clinical Center, Zaloˇska 2, 1000 Ljubljana, Slovenia Purpose: The purpose of our study was to analyse the consequences of zygoma complex fractures (ZCF) treatment in Clinical department of maxillofacial and oral surgery in Ljubljana in a 5-year period. Patients and Methods: Three hundred and fourty two patients were surgically treated because of ZCF from 1999 to 2003 by various methods. The data were obtained from the medical records retrospectively, also their pre- and post-operative images were assessed. We also made the questionare about patients feelings after their injuries. Results: Between these 342 patients men were predominant in 79%, more than 65% of these patients were of age between 20 and 50. The most common causes of ZCF were traffic accidents in 29%, assaults in 23%; sports accidents had increased in this period. The mean pre-operative time was 8 days, but the part of operated patients in 1 week after fracture had increased. The methods of surgery were different, but the treatment by reposition without osteosynthesis decreased from 50% in 1999 to 16% in 2003. Post-operative complications as bleedings and infections were rare, but between the consequences the infraorbital nerve sensibility impairment were present in different ways in almost half of the patients, but mostly in less extent as before treatment. The patients alternations of fine sensibility were even more frequent. There are no correlations in this complication and method of treatment, surgical approach and preoperative time. Other complications were very rare. Conclusions: A variety of techniques can be used to produce a satisfactory outcome, but the infraorbital nerve damage in ZCFs is still a problem. O.366 The classification and management of late post-traumatic enophthalmos Z.Y. Zhang, L. Gui, F. Niu. Department of Cranio-maxillo-facial surgery, Plastic surgery hospital of Peking Union Medical College, Bejing 100041, China Objective: To improve the results for the management of late post-traumatic enophthalmos. Methods: Acorrding to the X-ray film and CT examination, the orbital fractures were classified to two main groups: Type I – Merely orbital walls fracture, the orbital rims were intact. It was commonly seen in orbital floor fracture or medial orbital wall fracture. Type II – Both the orbital rim and walls were fractured and the bone fragment displaced and malunited. Enophthalmos
O.364 Bimaxillary transversal distraction osteogenesis: Verona experience M. Albanese, D. Bertossi, A. Fior, P.F. Nocini. Clinic of Dentistry and Maxillo Facial Surgery, Department of Morphological and Biomedical Science, Pol. G.B. Rossi, University of Verona, Verona, Italy Introduction and Objectives: Transversal deficit and anterior teeth crowding are common defects of the mandibular arch, in particular with skeletal II class malocclusion. When dental space for dental alignment is not recovered with usual orthodontic movements, premolar tooth extraction may necessary on both jaws. Final result is a correct molar I Class relationship with an improvement in function and stability of the occlusion, but also with a possible unaesthetic flattening of the profile. The bimaxillary transversal distraction osteogenesis technique may overcome the need of tooth extraction, enlarging the bony space for dental repositioning without bone grafting. Material and Methods: Since 2001, 10 patients underwent this procedure at the Verona Department. Treatment included: orthodontic enlargement of the upper and lower dental midline, surgical positioning of the devices after the osteotomies (an incomplete Le Fort I on the maxilla and a midline fracture on the mandible), the distraction protocol (daily activation of the devices followed by a stabilization period of 4–6 months), the devices removal, and the final orthodontic dental realignment. When required, bimaxillary surgery was performed to compleate the rehabilitation protocol.
Abstracts, EACFMS XVIII Congress Results: All cases were successfully treated with no major complications. X-ray check confirmed a good bone formation within the distraction gap created of both jaws for all procedures. Histological examination revealed a good bone formation inside the gap. The bony space achieved allowed dental repositioning avoiding tooth extraction. Conclusions: Bimaxillary transversal distraction osteogenesis may be consider an interesting alternative to traditional protocols when transversal bone deficit and dental crowding are treated avoiding tooth extraction.
Thursday, 14 September 2006, 11.00−12.30
Hall 6
Facial trauma: orbit O.365 The consequences of 342 zygoma complex fractures treatment N. Ihan Hren. Clinical Department of Maxillofacial and Oral Surgery, Clinical Center, Zaloˇska 2, 1000 Ljubljana, Slovenia Purpose: The purpose of our study was to analyse the consequences of zygoma complex fractures (ZCF) treatment in Clinical department of maxillofacial and oral surgery in Ljubljana in a 5-year period. Patients and Methods: Three hundred and fourty two patients were surgically treated because of ZCF from 1999 to 2003 by various methods. The data were obtained from the medical records retrospectively, also their pre- and post-operative images were assessed. We also made the questionare about patients feelings after their injuries. Results: Between these 342 patients men were predominant in 79%, more than 65% of these patients were of age between 20 and 50. The most common causes of ZCF were traffic accidents in 29%, assaults in 23%; sports accidents had increased in this period. The mean pre-operative time was 8 days, but the part of operated patients in 1 week after fracture had increased. The methods of surgery were different, but the treatment by reposition without osteosynthesis decreased from 50% in 1999 to 16% in 2003. Post-operative complications as bleedings and infections were rare, but between the consequences the infraorbital nerve sensibility impairment were present in different ways in almost half of the patients, but mostly in less extent as before treatment. The patients alternations of fine sensibility were even more frequent. There are no correlations in this complication and method of treatment, surgical approach and preoperative time. Other complications were very rare. Conclusions: A variety of techniques can be used to produce a satisfactory outcome, but the infraorbital nerve damage in ZCFs is still a problem. O.366 The classification and management of late post-traumatic enophthalmos Z.Y. Zhang, L. Gui, F. Niu. Department of Cranio-maxillo-facial surgery, Plastic surgery hospital of Peking Union Medical College, Bejing 100041, China Objective: To improve the results for the management of late post-traumatic enophthalmos. Methods: Acorrding to the X-ray film and CT examination, the orbital fractures were classified to two main groups: Type I – Merely orbital walls fracture, the orbital rims were intact. It was commonly seen in orbital floor fracture or medial orbital wall fracture. Type II – Both the orbital rim and walls were fractured and the bone fragment displaced and malunited. Enophthalmos