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O.425 Use of local bone grafts in orthognathic surgery
Oral Presentations O.424 Treatment of post-cleft deformations of the facial skeleton M. Jagielak, M. Zadurska, M. Socha, B. Pietrzak, K. Walerzak, M. Soltan, D. Tomasik. Warsaw Medical University, Warsaw, Poland The cleft patients require specialist treatment lasting over 30 years and often involving cooperation of the orthodontist, plastic surgeon, speech therapist and eventually maxillo-facial surgeon. In many cases during the patients growth and maturation despite the orthodontic treatment, the micrognathia, retrognathia or mandibular prognathism are developed. Objectives: The aim of this paper was to share our experience and treatment results of over 2- years follow up of surgical, orthognatic and prosthetic rehabilitation of cleft patients. These patients require correction orthognatic surgery. In our material we operated on 18 patients in whom Le Fort I and Le Fort II osteotomies with maxillary advancements were performed. In 15 cases as adjuvant procedure BSSO of the mandibular ramus (Obwegeser DalPont osteotomy) and setback were performed to achieve good facial proportions. In 5 cases open rhinoplasty as a separate procedure was performed. In 6 cases (out of 18) cleft defects were grafted by autogenous bone from the hip. In 8 cases Le Fort osteotomy was accompanied by transposition of the cleft bone segments which closed the defects. Results: In all treated patients after 20 years of treatment we achieved good and very good cosmetic and functional correction allowing our patients uneventful social and professional life. Conclusions: Modern methods of the orthodontic treatment (fixed appliances), possibilities given by stable plate osteosynthesis and bone grafting allow achieve good and stable results, shorten hospitalization and rehabilitation time. O.425 Use of local bone grafts in orthognathic surgery H. Schwartz. University of California Los Angeles (UCLA), Los Angeles, USA Introduction and Objectives: Successful correction of dentofacial deformities is in part dependent on effective stabilization and rapid union of repositioned bony segments. When there are broad areas of contact between segments, firm bony union can be anticipated. When there are few areas of contact, there can be instability, relapse, or fibrous union. In such cases, there are advocates of hydroxylapatite, banked homologous bone, xenografts, or bone morphogeneic protein. Others prefer autologous bone, such as iliac crest, or cranial bone grafts. Nevertheless, abundant autogenous bone is available locally during orthognathic surgery for grafting large spaces between segments. Methods: Local autogenous bone grafts have been used in several thousand surgical cases. Common indications for bone grafting in orthognathic surgery and common local donor sites will be described. Results: These bone grafts are easily obtained during the course of orthognathic surgery. There is no need for a second operative site. Where indicated, bone grafts increase mechanical stability and prevent ingrowth of fibrous tissue. Autogenous bone contains autogenous bone morphogeneic protein. It does not elicit an immune response. There is no significant increase in operative time and no increase in complications beyond that of the underlying procedure. Conclusions: Local bone grafts can improve the outcome in certain orthognathic surgical procedures.
Osteosyntheses and traumatology I Tuesday, 9 September 2008, 08.30–10.30
S107 Room 3
Osteosyntheses and traumatology I O.426 Algorithm for indicating repair of orbital floor fractures F. H¨olzle, M. Strahleck, M.R. Kesting, D.J. Loeffelbein, A. Kolk, K.-D. Wolff. Department of Oral and Maxillofacial Surgery, Technical University Munich, M¨unchen, Germany Purpose: Identifying those patients in whom surgical exploration of orbital floor fractures is appropriate can be difficult when there are relevant radiological findings but no clinical symptoms such as double vision or hypesthesia. It is also difficult in patients with only minor radiological findings and significant clinical symptoms. The aim of this prospective study was to identify the correlation between preoperative imaging, planning of therapy, intraoperative findings and surgical techniques. Methods: Between July 2005 and March 2007 48 patients with isolated orbital floor fractures were included in this study. Clinical and ophthalmological investigation was performed pre- and postoperatively. We developed a “three to three” coordinate system of the orbital floor defined by anatomical structures. Based on this system, the surgeon appointed dimensions of the fracture and potential herniation pre- and intraoperatively. Objective data of the same dimensions were generated by a computer programme. The surgeon had to anticipate the surgical approach and operative technique preoperatively. Both were adjusted for correlation postoperatively. Results: The highest correlation between preoperative assessment and intraoperative findings in fragment position, extent of fracture, and volume of herniation was achieved by coronal CT, followed by axial CT, MRI, and conventional x-rays. Mean orbital surface amounted 5.92±1.21 cm2 , mean surface of fracture was found with 2.23±1.31 cm2 , and mean volume of herniation was 1.05±0.91 cm3 . Insertion of orbital floor implants or grafts correlated significantly with preoperative estimation (p < 0.05). Correlation between preoperative anticipated therapy and intraoperative surgical procedures equaled 90% in coronal CT and 69% in conventional x-rays. There was no significant difference between surgeons. Conclusion: Coronal CT is a prerequisite for exact planning of therapy. Thus correct surgical approach and exact treatment can be anticipated preoperatively with high reliability. O.427 Analysis of ten year experience with panfacial fractures S. Vukelic-Markovic1 , U. M¨uller-Richter2 , T. Reuther2 , Z. Mirkovic1 , M. Kochel2 , R. Kozomara1 . 1 Clinic for Maxillofacial Surgery, Military Medical Academy, Belgrade, Serbia; 2 Clinic of Oral and Maxillofacial Plastic Surgery, University of W¨urzburg, Germany Panfacial fractures are rare type of serious trauma where almost all facial bones are multifragmentary or comminutively fractured and facial soft tissues heavily wounded, mostly associated with fractures of other bones, endocranial and intraabdominal trauma. In all cases they at first reqiure reanimation and airway restauratuion, suture of facial skin lacerations, hemodynamic and physiologic stabilisation and fast diagnosic evaluation; intensive care and skilled surgical team. The most important is the schedule of management of this three-dimensional functional and esthetic problem, according to general physical and consciousness condition. During the last ten years in both forementioned institutions isolated panfacial fractures, craniofacial and other associated polytraumatized patients appeared in less than 1% of all cases of trauma, with predomination of males between 19−30 years old. Most of them were high-energy fractures from the traffic
Osteosyntheses and traumatology I Tuesday, 9 September 2008, 08.30–10.30
S107 Room 3
Osteosyntheses and traumatology I O.426 Algorithm for indicating repair of orbital floor fractures F. H¨olzle, M. Strahleck, M.R. Kesting, D.J. Loeffelbein, A. Kolk, K.-D. Wolff. Department of Oral and Maxillofacial Surgery, Technical University Munich, M¨unchen, Germany Purpose: Identifying those patients in whom surgical exploration of orbital floor fractures is appropriate can be difficult when there are relevant radiological findings but no clinical symptoms such as double vision or hypesthesia. It is also difficult in patients with only minor radiological findings and significant clinical symptoms. The aim of this prospective study was to identify the correlation between preoperative imaging, planning of therapy, intraoperative findings and surgical techniques. Methods: Between July 2005 and March 2007 48 patients with isolated orbital floor fractures were included in this study. Clinical and ophthalmological investigation was performed pre- and postoperatively. We developed a “three to three” coordinate system of the orbital floor defined by anatomical structures. Based on this system, the surgeon appointed dimensions of the fracture and potential herniation pre- and intraoperatively. Objective data of the same dimensions were generated by a computer programme. The surgeon had to anticipate the surgical approach and operative technique preoperatively. Both were adjusted for correlation postoperatively. Results: The highest correlation between preoperative assessment and intraoperative findings in fragment position, extent of fracture, and volume of herniation was achieved by coronal CT, followed by axial CT, MRI, and conventional x-rays. Mean orbital surface amounted 5.92±1.21 cm2 , mean surface of fracture was found with 2.23±1.31 cm2 , and mean volume of herniation was 1.05±0.91 cm3 . Insertion of orbital floor implants or grafts correlated significantly with preoperative estimation (p < 0.05). Correlation between preoperative anticipated therapy and intraoperative surgical procedures equaled 90% in coronal CT and 69% in conventional x-rays. There was no significant difference between surgeons. Conclusion: Coronal CT is a prerequisite for exact planning of therapy. Thus correct surgical approach and exact treatment can be anticipated preoperatively with high reliability. O.427 Analysis of ten year experience with panfacial fractures S. Vukelic-Markovic1 , U. M¨uller-Richter2 , T. Reuther2 , Z. Mirkovic1 , M. Kochel2 , R. Kozomara1 . 1 Clinic for Maxillofacial Surgery, Military Medical Academy, Belgrade, Serbia; 2 Clinic of Oral and Maxillofacial Plastic Surgery, University of W¨urzburg, Germany Panfacial fractures are rare type of serious trauma where almost all facial bones are multifragmentary or comminutively fractured and facial soft tissues heavily wounded, mostly associated with fractures of other bones, endocranial and intraabdominal trauma. In all cases they at first reqiure reanimation and airway restauratuion, suture of facial skin lacerations, hemodynamic and physiologic stabilisation and fast diagnosic evaluation; intensive care and skilled surgical team. The most important is the schedule of management of this three-dimensional functional and esthetic problem, according to general physical and consciousness condition. During the last ten years in both forementioned institutions isolated panfacial fractures, craniofacial and other associated polytraumatized patients appeared in less than 1% of all cases of trauma, with predomination of males between 19−30 years old. Most of them were high-energy fractures from the traffic