- Email: [email protected]
Orthognathic surgery ‘reloaded’
Abstracts presented together with strategies for managing the traditional osteotomies. http://dx.doi.org/10.1016/j.ijom.2015.08.935 Medication related osteonecrosis of the jaw: University of Michigan experience J. Helman Department of Oral and Maxillofacial Surgery, University of Michigan, Michigan, USA Significant evidence has been published on the subject of Medication Related Osteonecrosis of the jaws. The etiological factors, the biofilms and micro-organisms associated with the condition, the antibiotics used to treat it and the potential surgical approaches for management. At the University of Michigan the vast majority of the patients were treated with IV bisphosphonates due to metastatic bone lesions and the management has been mostly conservative. With the use of suppressive antibiotic therapy, minimal debridement, oral hygiene and conservative dental rehabilitation the patients were able to maintain a good quality of life while avoiding major surgical reconstructions and the associated time of hospitalization. http://dx.doi.org/10.1016/j.ijom.2015.08.936 Management of the atrophic maxilla: what have we learned? F. Hernández-Alfaro International University of Catalonia & Teknon Medical Center, Barcelona, Spain Management of the totally atrophic maxilla constitutes a challenge. Different clinical scenarios, demand tailored solutions based in scientific evidence, personal experience and skills. In our view modern preprosthetic surgery should be based in three principles: ‘Preserve, Use, and Reconstruct’. In the last few years we are witnessing a paradigm shift in the way we approach atrophic scenarios in the maxilla. We have evolved from rather aggressive treatments which included in most cases extraoral sources for bone grafting, to minimally invasive protocols which combine autogenous bone from intraoral sites, and biomaterials. The use of maxillary butresses to anchor fixations can also solve a number of complex scenarios. In our presentation we will discuss our management protocol related to the different atrophy stages. http://dx.doi.org/10.1016/j.ijom.2015.08.937 Orthognathic surgery ‘reloaded’ F. Hernández-Alfaro International University of Catalonia & Teknon Medical Center, Barcelona, Spain Contemporary management of dentofacial deformities is undergoing a profound revolution where compliance with patients’ concerns and expectations should be the main goal. Three distinct aspects are the basis of this redefinition: First, clinical diagnosis and 3D planning must merge the artistic planning of the sagittal and vertical dimensions with the accurate determination of coronal and occlusal variables. Second, the implementation of minimally invasive surgical protocols have
e7
reduced patient morbidity and allowed for the simultaneous execution of ancillary procedures and outpatient regimens. Finally, the comprehensive analysis of patient, orthodontist, and surgeon specific variables has given way to the emergence and systematization of new timing schemes. These approaches, namely Surgery First, Early, Late, Last, and Only, have specific indications, technical particularities and limitations. In conclusion, modern treatment of dento-maxillofacial deformity is dramatically evolving, and can no longer be conceived as an inflexible, constant dogma valid for all patient prototypes; it should rather be customized to each particular case and scenario. http://dx.doi.org/10.1016/j.ijom.2015.08.938 Bony reconstruction: when to use which flap J. Hoffmann University Hospital Heidelberg, Department of Oral and Maxillofacial Surgery, Germany Tumours of the mandibular bone or adjacent soft tissue often necessitate mandibular resection. Subsequent primary bone reconstruction to achieve optimal functional and aesthetic results has been made possible by microvascular surgical techniques and now represents the international gold standard. Microvascular reanastomosis of autologous bone grafts from the iliac crest or fibula is the most common procedure for reconstruction of the mandible. The localisation and extent of the expected defect, as well as a patient’s overall condition and ability to tolerate long surgical procedures must be carefully considered before deciding upon the course of treatment. Additional microvascular reanastomosis of soft tissue flaps and stereolithographic models facilitate preoperative planning and broaden the surgical spectrum. Following successful reconstruction of the bone, insertion of dental implants and prosthetic rebuilding are required to complete rehabilitation, including restoration of the patient’s ability to chew and speak. The authors recommend specialised oncologic centres for such complex surgical reconstructions. http://dx.doi.org/10.1016/j.ijom.2015.08.939 The management of frontal encephaloceles A.D. Holmes Royal Children’s Hospital, Melbourne, Australia Encephaloceles are herniations of the central nervous system beyond the normal anatomic boundaries. Frontal encephaloceles are of two types; those associated with failure of embryonic anterior neural tube closure and those associated with Tessier Clefting disorders involving faulty foetal facial placode development. The surgical management differs with each type. The commonest are neural tube related Fronto-ethmoidal encephaloceles which exit the cranium between those two bones and are then subdivided anatatomically by their tract to the surface and external appearance. These may be Nasal, Naso-frontal, Intranasal, Orbital or combinations thereof. The herniations distort the facial bones three-dimensionally causing inter-orbital hypertelorism, trigonocephaly and inferior depression of the naso-maxillary region (long nose; long midface). Our Unit has developed a procedure for removing the encephalocele and simultaneously correcting the craniofacial deformity with consistently satisfactory results.
e7
reduced patient morbidity and allowed for the simultaneous execution of ancillary procedures and outpatient regimens. Finally, the comprehensive analysis of patient, orthodontist, and surgeon specific variables has given way to the emergence and systematization of new timing schemes. These approaches, namely Surgery First, Early, Late, Last, and Only, have specific indications, technical particularities and limitations. In conclusion, modern treatment of dento-maxillofacial deformity is dramatically evolving, and can no longer be conceived as an inflexible, constant dogma valid for all patient prototypes; it should rather be customized to each particular case and scenario. http://dx.doi.org/10.1016/j.ijom.2015.08.938 Bony reconstruction: when to use which flap J. Hoffmann University Hospital Heidelberg, Department of Oral and Maxillofacial Surgery, Germany Tumours of the mandibular bone or adjacent soft tissue often necessitate mandibular resection. Subsequent primary bone reconstruction to achieve optimal functional and aesthetic results has been made possible by microvascular surgical techniques and now represents the international gold standard. Microvascular reanastomosis of autologous bone grafts from the iliac crest or fibula is the most common procedure for reconstruction of the mandible. The localisation and extent of the expected defect, as well as a patient’s overall condition and ability to tolerate long surgical procedures must be carefully considered before deciding upon the course of treatment. Additional microvascular reanastomosis of soft tissue flaps and stereolithographic models facilitate preoperative planning and broaden the surgical spectrum. Following successful reconstruction of the bone, insertion of dental implants and prosthetic rebuilding are required to complete rehabilitation, including restoration of the patient’s ability to chew and speak. The authors recommend specialised oncologic centres for such complex surgical reconstructions. http://dx.doi.org/10.1016/j.ijom.2015.08.939 The management of frontal encephaloceles A.D. Holmes Royal Children’s Hospital, Melbourne, Australia Encephaloceles are herniations of the central nervous system beyond the normal anatomic boundaries. Frontal encephaloceles are of two types; those associated with failure of embryonic anterior neural tube closure and those associated with Tessier Clefting disorders involving faulty foetal facial placode development. The surgical management differs with each type. The commonest are neural tube related Fronto-ethmoidal encephaloceles which exit the cranium between those two bones and are then subdivided anatatomically by their tract to the surface and external appearance. These may be Nasal, Naso-frontal, Intranasal, Orbital or combinations thereof. The herniations distort the facial bones three-dimensionally causing inter-orbital hypertelorism, trigonocephaly and inferior depression of the naso-maxillary region (long nose; long midface). Our Unit has developed a procedure for removing the encephalocele and simultaneously correcting the craniofacial deformity with consistently satisfactory results.