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O.392 Orthognathic surgery: a retrospective study of operation time
S98
Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
Abstracts, EACMFS XIX Congress
O.389 Nasal morphology and function following maxillary surgery
O.391 Orthognathic surgery-asymmetries-treatment of the axial pain
G. Ramieri, A. Dellacqua, A. Nasi, L. Verz`e’. University of Turin, Turin, Italy
A. Corbacelli, S. Scarsella, T. Cutilli. University of L’Aquila, L’Aquila, Italy
Objectives: To prospectively investigate on 30 adult patients the modifications of nasal shape and function following maxillary advancement/impaction, by use of facial 3D morphometry and rhinomanometry. Methods: At surgery, the nasal septum was trimmed and sutured to the anterior nasal spine, the piriform aperture was contoured as original, and flaring of the nasal base was controlled with a modified cinch suture. Laser-scanned facial surface data, lateral cephalograms, rhinomanometric data and rinoscopic evaluation were obtained for all patients before (T0) and one year (T1) after surgery. Results: The mean forward and upward movements of the maxilla were 5.7 and 2.2 mm. Cutaneous changes were observed in the paranasal regions, cheeks and upper lip, in the range of 1−4 mm. A small advancement of the nasal tip and augment of the nasolabial angle were demonstrated. There was no significant enlargement of the interalar width or increase of the nasal base angle. Nasal resistance decreased from a preoperative 3.40 and 4.81 cm H2O/L/s (left/right side) to postoperative values of 1.18 and 1.34. Rhinological investigation documented reduction of turbinate hypertrophy and septal bowing and no septal perforation. Conclusions: The technique illustrated is able to prevent to a great extent the unfavourable nasal deformities associated with maxillary advancement, maintaining or even improving nasal functionality.
Objective: Our previous studies of integrated biomechanics of the maxillo-atlo-axio-cervico-dorsalis structures that started more than 10 years ago (EACMFS Congress, Helsinky 1998) have highlighted the functional neuro-myo-skeletal unity of the system. The normo-structured component is extremely important for the stability of the morpho-functional and structural equilibrium, broken in case of simple or bimaxillary asymmetric dysmorphias. Alterations of the skull base, occipito-atlo-epistrophic joint and axial system derangement are steadly associated with maxillofacial dysmorphias. We have highlighted cranio-cervico-brachialis pain syndromes, sometimes very serious, in 85% of the patients. The purpose of this research is to demonstrate the extremely important effects of the orthognathic surgery on the axial pain. Method: Pre and postoperative studies have been carried out with the more advanced imaging devices (CT, 3DCT, MR) and electrophysiologic analysis in 180 pre-selected cases of asymmetric dysmorphias (excluding concomitant articular pathologies of TMJ). Results: We had positive results in the 95% of the cases. Indeed the pain syndromes disappeared at the immediate postoperative time in the 55% and over of the cases. The disappearance of the pain was substantially permanent during the 5 years follow up. Conclusions: The orthognathic surgery, thanks to the morphofunctional and structural re-equilibrum of the maxillofacial asymmetrical dysmorphias and associed cranio-maxillo-atlo-axial system, represents the treatment of choice for these serious algic pathologies.
O.390 Novel treatment for asymmetric prognathism
O.392 Orthognathic surgery: a retrospective study of operation time
J.P. Bradley, H.K. Kawamoto, H.V. Katchikian, R. Jarrahy. UCLA Plastic and Reconstructive Surgery Objective: Mild asymmetric prognathism is not uncommon but the etiology is poorly understood. Traditional treatment involves a two-jaw orthognathic correction using a bilateral sagittal-split mandibular osteotomy. We investigated the etiology using cranial base analysis and compared the traditional treatment to a novel treatment with two-jaw orthognathic correction but with a unilateral sagittal-split mandibular osteotomy and final splint only. Methods: Part I: We used preoperative New Tom scans, 3D photographic images, and measurements of neck mobility to assess for unrecognized torticollis in patients with aysmetric prognathsim (n = 30). Part II: Group 1 Novel Unilateral Split patients were compared to Group 2 Traditional Bilateral Split using preoperative and postoperative exams and cephalometric measurements in order to assess the stability of correction (n = 60). Results: Part I: 31% of all non-cleft Class III maloclusion patients had asymmetric prognathism and were diagnosed with previously unrecognized torticollis. These patients had deviation of the mandibular midline and chin point to the contralateral side of the torticollis. 3D CT scans revealed an asymmetic cranial base in 85% of patients with anteriomedial displacement of the glenoid fossa ipsilateral to the torticollis. Part II: Group 1: Operative time was decreased by 15%. No patients complained of trismus, TMJ clicking/popping, or lateral deviation with incisal opening. Complications for both groups were similar and include: infection (2−3%), bleeding (2%), hardware failure (1%), and need for revision (2%). Patients maintained a stable correction (F/up >1 year). Conclusions: Unilateral sagittal split provides successful correction for patients with asymmetric prognathism and unrecognized torticollis without compromising function while decreasing morbidity.
L. Cascarini, D. Tsarouchi. King’s College Hospital, London, UK Introduction: Most orthognathic surgeons agree that operation time and inpatient stay have both reduced significantly over the last ten years. However there is virtually nothing in the literature to support this. Most published accounts of operation time relate to surgical morbidity, there are no large scale studies of operation time or inpatient stay in orthognathic surgery. Methods: Seven centres were recruited to form a South of England group and data was collected retrospectively to avoid introducing any bias. The operation time (excluding anaesthetic time) was collected as was inpatient stay, type of care on first postoperative day and which measures if any were used to minimise blood loss. Results: Fifty-five percent of cases were bimaxillary osteotomies, 31% bilateral sagittal split osteotomies and the remaining 14% Le Fort 1 level osteotomies. The average operative time for all procedures was 170 minutes. The average inpatient stay was 1.87 days. Seventy-seven percent had some degree of hypotensive anaesthesia, 55% some head up tilt and 37% tranexamic acid. Conclusion: This is the largest study of its kind. It shows that modern orthognathic surgery takes between an hour for a sagittal split to about three hours for a bimaxillary procedure. Many patients go home the following day (36%) and most go home within two days O.393 Orthognathic surgery: pitfalls and complications M. Fadda, F. Filiaci, V. Mitro, E. Riccardi, M. Della Monaca, G. Iannetti. Universit`a Roma “Sapienza”, Rome, Italy Introduction: This study was conducted to determine the general complications related to orthognathic surgery and evaluate the
Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
Abstracts, EACMFS XIX Congress
O.389 Nasal morphology and function following maxillary surgery
O.391 Orthognathic surgery-asymmetries-treatment of the axial pain
G. Ramieri, A. Dellacqua, A. Nasi, L. Verz`e’. University of Turin, Turin, Italy
A. Corbacelli, S. Scarsella, T. Cutilli. University of L’Aquila, L’Aquila, Italy
Objectives: To prospectively investigate on 30 adult patients the modifications of nasal shape and function following maxillary advancement/impaction, by use of facial 3D morphometry and rhinomanometry. Methods: At surgery, the nasal septum was trimmed and sutured to the anterior nasal spine, the piriform aperture was contoured as original, and flaring of the nasal base was controlled with a modified cinch suture. Laser-scanned facial surface data, lateral cephalograms, rhinomanometric data and rinoscopic evaluation were obtained for all patients before (T0) and one year (T1) after surgery. Results: The mean forward and upward movements of the maxilla were 5.7 and 2.2 mm. Cutaneous changes were observed in the paranasal regions, cheeks and upper lip, in the range of 1−4 mm. A small advancement of the nasal tip and augment of the nasolabial angle were demonstrated. There was no significant enlargement of the interalar width or increase of the nasal base angle. Nasal resistance decreased from a preoperative 3.40 and 4.81 cm H2O/L/s (left/right side) to postoperative values of 1.18 and 1.34. Rhinological investigation documented reduction of turbinate hypertrophy and septal bowing and no septal perforation. Conclusions: The technique illustrated is able to prevent to a great extent the unfavourable nasal deformities associated with maxillary advancement, maintaining or even improving nasal functionality.
Objective: Our previous studies of integrated biomechanics of the maxillo-atlo-axio-cervico-dorsalis structures that started more than 10 years ago (EACMFS Congress, Helsinky 1998) have highlighted the functional neuro-myo-skeletal unity of the system. The normo-structured component is extremely important for the stability of the morpho-functional and structural equilibrium, broken in case of simple or bimaxillary asymmetric dysmorphias. Alterations of the skull base, occipito-atlo-epistrophic joint and axial system derangement are steadly associated with maxillofacial dysmorphias. We have highlighted cranio-cervico-brachialis pain syndromes, sometimes very serious, in 85% of the patients. The purpose of this research is to demonstrate the extremely important effects of the orthognathic surgery on the axial pain. Method: Pre and postoperative studies have been carried out with the more advanced imaging devices (CT, 3DCT, MR) and electrophysiologic analysis in 180 pre-selected cases of asymmetric dysmorphias (excluding concomitant articular pathologies of TMJ). Results: We had positive results in the 95% of the cases. Indeed the pain syndromes disappeared at the immediate postoperative time in the 55% and over of the cases. The disappearance of the pain was substantially permanent during the 5 years follow up. Conclusions: The orthognathic surgery, thanks to the morphofunctional and structural re-equilibrum of the maxillofacial asymmetrical dysmorphias and associed cranio-maxillo-atlo-axial system, represents the treatment of choice for these serious algic pathologies.
O.390 Novel treatment for asymmetric prognathism
O.392 Orthognathic surgery: a retrospective study of operation time
J.P. Bradley, H.K. Kawamoto, H.V. Katchikian, R. Jarrahy. UCLA Plastic and Reconstructive Surgery Objective: Mild asymmetric prognathism is not uncommon but the etiology is poorly understood. Traditional treatment involves a two-jaw orthognathic correction using a bilateral sagittal-split mandibular osteotomy. We investigated the etiology using cranial base analysis and compared the traditional treatment to a novel treatment with two-jaw orthognathic correction but with a unilateral sagittal-split mandibular osteotomy and final splint only. Methods: Part I: We used preoperative New Tom scans, 3D photographic images, and measurements of neck mobility to assess for unrecognized torticollis in patients with aysmetric prognathsim (n = 30). Part II: Group 1 Novel Unilateral Split patients were compared to Group 2 Traditional Bilateral Split using preoperative and postoperative exams and cephalometric measurements in order to assess the stability of correction (n = 60). Results: Part I: 31% of all non-cleft Class III maloclusion patients had asymmetric prognathism and were diagnosed with previously unrecognized torticollis. These patients had deviation of the mandibular midline and chin point to the contralateral side of the torticollis. 3D CT scans revealed an asymmetic cranial base in 85% of patients with anteriomedial displacement of the glenoid fossa ipsilateral to the torticollis. Part II: Group 1: Operative time was decreased by 15%. No patients complained of trismus, TMJ clicking/popping, or lateral deviation with incisal opening. Complications for both groups were similar and include: infection (2−3%), bleeding (2%), hardware failure (1%), and need for revision (2%). Patients maintained a stable correction (F/up >1 year). Conclusions: Unilateral sagittal split provides successful correction for patients with asymmetric prognathism and unrecognized torticollis without compromising function while decreasing morbidity.
L. Cascarini, D. Tsarouchi. King’s College Hospital, London, UK Introduction: Most orthognathic surgeons agree that operation time and inpatient stay have both reduced significantly over the last ten years. However there is virtually nothing in the literature to support this. Most published accounts of operation time relate to surgical morbidity, there are no large scale studies of operation time or inpatient stay in orthognathic surgery. Methods: Seven centres were recruited to form a South of England group and data was collected retrospectively to avoid introducing any bias. The operation time (excluding anaesthetic time) was collected as was inpatient stay, type of care on first postoperative day and which measures if any were used to minimise blood loss. Results: Fifty-five percent of cases were bimaxillary osteotomies, 31% bilateral sagittal split osteotomies and the remaining 14% Le Fort 1 level osteotomies. The average operative time for all procedures was 170 minutes. The average inpatient stay was 1.87 days. Seventy-seven percent had some degree of hypotensive anaesthesia, 55% some head up tilt and 37% tranexamic acid. Conclusion: This is the largest study of its kind. It shows that modern orthognathic surgery takes between an hour for a sagittal split to about three hours for a bimaxillary procedure. Many patients go home the following day (36%) and most go home within two days O.393 Orthognathic surgery: pitfalls and complications M. Fadda, F. Filiaci, V. Mitro, E. Riccardi, M. Della Monaca, G. Iannetti. Universit`a Roma “Sapienza”, Rome, Italy Introduction: This study was conducted to determine the general complications related to orthognathic surgery and evaluate the