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Orthognathic surgery: The patients overall subjective findings with special focus on temporomandibular joint changes
132 Journal of Cranio-Maxillofacial Surgery applied to this entity. This work seeks to review the results of surgical treatment applied according to Norman's technique (1984), with certain modifications, applied to RCD. Materials and Methods: Twelve patients, 10 female and 2 male, aged between 18-38 years with an average of 31 years participated. Previously, all of them had suffered numerous episodes, requiring hospital care on more than one occasion. All of the patients underwent clinical exploration and pre- and postoperative radiological study. Nuclear magnetic resonance (NMR) was used in combination with tomographies in the preoperative period to evaluate the state of the join. In the postoperative period, tomography was used as the radiological test to carry out regular follow-ups. Glenotemporal oblique osteotomy with interposition of an autologous bone graft was performed in all of them, 20 joints in total. The graft was taken from the iliac crest in 6 patients and from cranial vault in the remaining 6. Elements used in osteosynthesis were either wire, screws or nothing. Results: The patients were followed for between 2 months and 4 years. None of these patients presented any episode of RCD in the postoperative period. Oral opening ranged between 28-35 mm in the postoperative period. Only one of these patients still suffered articular pain in this function. In the postoperative period, radiology revealed different degrees of bone resorption in the cases of iliac crest bone grafts, yet did not affect the clinical result of the operation.
relief of the inflammatory response at the surgicallycreated bone defects, but it did anticipate the initial phase of repair.
Standard Therapeutic Plan in the Therapy of Oromaxillo-Facial Dismorphysms
D'Andrea F., Corvo G., Tartaro G. Instituto di Chirurgica Maxillo Facciale, Seconda Univerita di Napolg Napoli, Italy In our experience, we have found that the improvement of the occlusion with orthodontic therapy, and the correction of skeletal dysmorphism with surgical procedures are not sufficient to establish an harmonic facial aesthetics face's soft tissues. Therefore, it is essential to perform a careful aesthetics analysis with cephalometric study and occlusal examination for a complete structural analysis of patients suffering from maxillo-facial dysmorphism. It is important to consider some protections of other schools, for example Professor Sailer's school and Dr Haers's school in Zurich. We propose the introduction of a standardized system for considering possible operations of plastic surgery for the equilibrium of soft tissue (ears, nose, cheeks, lips, etc.). We suggest the introduction of some points of orientation for a prognostic diagnosis about this particular purpose.
Effect of Calcitonin on Bone Healing
Crivello O. JR., Lara P.E, Oliveira-Filho R.M., Menecheli-Josd A.P. Surgical removal of impacted third molars involves osteotomy resulting relatively large bone cavities. The healing of such cavities is normally a long-lasting process and depends upon restorative physiological processes, in which several factors take place. This paper deals with calcitonin, wich acts by inhibition of bone reabsorption through blockade of the osteoclastic activity. Other presumable mechanisms include lowering of local concentration of PGE2 =20 and inhibition of interleukin1, a osteoclast-activating factor. Though some experiments were not able to show a relationship between osteoblast formation and calcitonin, this hyphotesis should not be ruled out. In this paper we evaluated the local inflammatory response after 10 selected cases of surgical removal of impacted mandibular third molar. No anti-inflammatory drugs were used before or after surgery. In 5 patients the surgically-created bone cavities were filled with calcitonin ( Miacalcic=AE, Sandoz). The remaining patients were followed-up in a drug-free basis and served as controls. Sequential scintigraphic studies of the site of operation were made with 99m Tc-MDP in the preoperative and the 1st, 12th, 22nd and 44th postoperative ('p.o.') days. The intensity of tracer concentration at the operative region in the corresponding scannograms was spectrophotometrically determined and taken as a mesure of the intensity of inflammatory response. Results showed that (1) the patients treated with calcitonin had a milder inflammatory response starting at the 1st p.o. day of observation, differently of what occurred in the control group, which started recovery at the 10th day p.o. and (2) thereafter, time-response plots of data revealed that the slope of the curve for controls had a decay constant essentially identical to that of calcitonintreated patients. In conclusion, the local action of calcitonin was not effective to promote any significant
Long-Term Stability of Maxillary Expansion by a Le Fort I Osteotomy with Midline Split
De Backer T., Mommaerts M. Y., Abeloos J. ES., De Clercq C.A. S., Neyt L.F. Division of Maxillo-Facial Surgery, A Z St Jan, Bruges, Belgium Current literature reports relapse rates between 30-50% after maxillary expansion by a two-partite Le Fort I osteotomy. Possible factors contributing to more stability are splinting with a heavy surgical arch bar, ligating the wafer to the upper dentition, inserting a transpalatal bar (Goshgarian), overcorrection, midline grafting with bone or hydroxyapatite blocks. With the latter we experienced healing problems. We resort now to an individually fabricated heavy arch bar, ligated to the dentition for 6 weeks, and to the insertion of a transpalatal bar for 6 months. Nine cases are documented with preoperative and immediately, 6 12 month and 4-5 years postoperative PA cephalograms, and 4-5 years postoperative models. Both dental and skeletal relapse rates were calculated with the interorbital distance as a reference on digitized copies. The models were judged for occlusal stability. Relapse was minimal when the widening at the first molar level was less than 6 mm. The importance of the transpalatal bar is stressed.
Orthognathic Surgery: The Patients Overall Subjective Findings with Special Focus on TemporomandibularJoint Changes
De Ciercq C.A.S., Neyt L.F., Mommaerts M. Y.., Abeloos J. V.S. Division of Maxillo-Facial Surgery, A Z St Jan, Bruges, Belgium
Posters The patients' overall satisfaction with orthognathic surgery was evaluated retrospectively by a closed-form written questionnaire filled out by patients 1-2..5 years postoperatively. Patient satisfaction as well as the opinion of relatives on the results of the treatment were graded on a digital visual analogue scale. Included in the questionnaire were questions related to patient self-confidence and willingness to re-elect surgery. Special attention was given to subjective changes in their temporomandibular joint (TMJ) function. The responses of 238 (149 females, 89 males) osteotomy patients of the 296 consecutively operated between 1/1/93 and 31/7/94 in the Division of Maxillofacial Surgery of the AZ St Jan, Bruges, Belgium were evaluated. Cleft patients, laterognathia and isolated genioplasty cases were excluded from the study. All patients in the study received orthodontic treatment preoperatively. Of 238 patients, 87% would reelect the whole treatment again (surgery and orthodontics). On the visual analogue scale, patient satisfaction was graded excellent (the maximum score) in 22% of patients. Relatives' opinion on the treatment was graded excellent in 26%. In 77% of patients, there was a higher self-confidence in themselves. Postoperatively, there was a subjective improvement in TMJ function in 40% of patients and a worsening in 11%; the masticatory efficiency was improved in 41% of patients and was worse in 7% of the patients.
Clinical Types of Neck Chemodeetoma Duditskaya T.K., Nered S.N., Chistyakov S.S.
Cancer Research Centre of RAMS, Moscow, Russia Between 1965 and 1996, 139 patients with chemodectoma of the neck were treated in the Cancer Research Centre RAMS. 120 patients were operated on, 9 patients were assessed as inoperable. 94 (67.6%) patients had carotid body, 34 (25.1%) glomus vagale and 10 (7.3%) patients were with atypical tumour. All patients with carotid chemodectoma had no recurrences after operations and had no tendency to hormonal activity. Patients with glomus vagale had neurologic symptoms due to spreading to the skull base, technical difficulties and inoperable character. In atypical cases, there were stable recurrences and salvage surgery. In our opinion the most important prognostic factor for the patients with chemodectoma of the neck is the localization of tumour.
The Contribution of Mirault to the History of Cleft Lip Surgery Dupoirieux L., Plane L., Elle A., Gard C., Khouri M., Penneau M.
Department of Oral and Maxillofacial Surgery, Centre Hospitalier Universitaired'Angers, Angers, France Germanicus Mirault was a French surgeon born in Angers in 1796. In 1844, he described a technique for closure of the cleft lip that introduced for the first time the concept of flap transposition. Until 1930, this technique and its variants were still the most popular in the US. This poster relates the works, but also the life, of this skilful and very eclectic surgeon. He also made very important contributions to other fields of maxillofacial surgery including the first ligature of the lingual artery for a tongue carcinoma in 1835 and a method of temporary occlusion of the eye to prevent cicatricial ectropion that was awarded by the Acad6mie des Sciences in 1869.
133
Biocompatibility of Solid Poly (Ortho Ester)
Ekhoim 3/1., Salo A., Syrjiinen S., Laine P., Lindqvist C., Kellomiiki M., Virtanen L, Suuronen R. Department of Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland. Poly (ortho ester)s (POE) are a group of synthetic bioerodible polymers. We studied the tissue reactions of solid POE implanted into both tibiae of 17 rabbits. One half of the rods were sterilized by gamma radiation and the other half by ethylene oxide. The follow up times were from 1-21 weeks after which the animals were killed and the bony specimens examined histologically. The connective tissue samples were examined immunohistochemically in order to study the occurrences of two extracellular matrix glycoproteins, tenascin and fibronectin. The results showed that solid POE induces a moderate inflammatory reaction for 9 weeks. Tenascin and fibronectin were present in samples from 1 week up to 4 weeks. We also found that gamma sterilized POE was resorbed at week 7 and ethylene oxide sterilized POE at week 13. We conclude that POE seems to be promising material to be used in oral and maxillofacial surgery.
Reconstruction of Facial Defects using Osseointegrated Titanium Implants Farmand M., Klaassen P-P.
Clinic of Oral and Maxillofacial Surgery, Klinikum S~id. N~irnberg, Niirnberg, Germany Reconstruction of facial defects using facial prosthesis has maintained its role in certain circumstances the major advances in reconstructive surgery. Facial prosthesis may be used as definitive reconstruction or temporary measure prior to a delayed surgical reconstruction. The use of facial prosthesis as the sole reconstructive procedure or in combination with extensive reconstructive measures is also possible. Theoretically, several options exist to secure a facial prosthesis to a defect. Recently, the fixation with the use of osseointegrated implants has gained increasing importance. In this poster a newly developed implant system (Epitecsystem) will be presented. With the help of a carrier plate, the implants can be placed everywhere in the face. This system can still be used, where enosseous implants cannot be placed optimally due to lack of bone. Thirty-one patients with different facial defects of various origins have been treated till now. The long-term results up to 5 years will be discussed. It i s demonstrated that even today a reconstruction of facial defects using facial prosthesis should have a place in the overall concept of reconstruction and rehabilitation.
Salvage Operations and Plastic Surgery after a High Dose of Radiotherapy on Oral Cancer Fedotenko S.P., Uvarov A.A.
Department of Upper Respiratory and Digestive Tract Tumours, Cancer Research Center of RAMS, Moscow, Russia For the period from 1972-1994, 130 patients received radical surgery on occasion of continued growth or relapse of the oral cavity cancer. All of them were earlier treated by
relief of the inflammatory response at the surgicallycreated bone defects, but it did anticipate the initial phase of repair.
Standard Therapeutic Plan in the Therapy of Oromaxillo-Facial Dismorphysms
D'Andrea F., Corvo G., Tartaro G. Instituto di Chirurgica Maxillo Facciale, Seconda Univerita di Napolg Napoli, Italy In our experience, we have found that the improvement of the occlusion with orthodontic therapy, and the correction of skeletal dysmorphism with surgical procedures are not sufficient to establish an harmonic facial aesthetics face's soft tissues. Therefore, it is essential to perform a careful aesthetics analysis with cephalometric study and occlusal examination for a complete structural analysis of patients suffering from maxillo-facial dysmorphism. It is important to consider some protections of other schools, for example Professor Sailer's school and Dr Haers's school in Zurich. We propose the introduction of a standardized system for considering possible operations of plastic surgery for the equilibrium of soft tissue (ears, nose, cheeks, lips, etc.). We suggest the introduction of some points of orientation for a prognostic diagnosis about this particular purpose.
Effect of Calcitonin on Bone Healing
Crivello O. JR., Lara P.E, Oliveira-Filho R.M., Menecheli-Josd A.P. Surgical removal of impacted third molars involves osteotomy resulting relatively large bone cavities. The healing of such cavities is normally a long-lasting process and depends upon restorative physiological processes, in which several factors take place. This paper deals with calcitonin, wich acts by inhibition of bone reabsorption through blockade of the osteoclastic activity. Other presumable mechanisms include lowering of local concentration of PGE2 =20 and inhibition of interleukin1, a osteoclast-activating factor. Though some experiments were not able to show a relationship between osteoblast formation and calcitonin, this hyphotesis should not be ruled out. In this paper we evaluated the local inflammatory response after 10 selected cases of surgical removal of impacted mandibular third molar. No anti-inflammatory drugs were used before or after surgery. In 5 patients the surgically-created bone cavities were filled with calcitonin ( Miacalcic=AE, Sandoz). The remaining patients were followed-up in a drug-free basis and served as controls. Sequential scintigraphic studies of the site of operation were made with 99m Tc-MDP in the preoperative and the 1st, 12th, 22nd and 44th postoperative ('p.o.') days. The intensity of tracer concentration at the operative region in the corresponding scannograms was spectrophotometrically determined and taken as a mesure of the intensity of inflammatory response. Results showed that (1) the patients treated with calcitonin had a milder inflammatory response starting at the 1st p.o. day of observation, differently of what occurred in the control group, which started recovery at the 10th day p.o. and (2) thereafter, time-response plots of data revealed that the slope of the curve for controls had a decay constant essentially identical to that of calcitonintreated patients. In conclusion, the local action of calcitonin was not effective to promote any significant
Long-Term Stability of Maxillary Expansion by a Le Fort I Osteotomy with Midline Split
De Backer T., Mommaerts M. Y., Abeloos J. ES., De Clercq C.A. S., Neyt L.F. Division of Maxillo-Facial Surgery, A Z St Jan, Bruges, Belgium Current literature reports relapse rates between 30-50% after maxillary expansion by a two-partite Le Fort I osteotomy. Possible factors contributing to more stability are splinting with a heavy surgical arch bar, ligating the wafer to the upper dentition, inserting a transpalatal bar (Goshgarian), overcorrection, midline grafting with bone or hydroxyapatite blocks. With the latter we experienced healing problems. We resort now to an individually fabricated heavy arch bar, ligated to the dentition for 6 weeks, and to the insertion of a transpalatal bar for 6 months. Nine cases are documented with preoperative and immediately, 6 12 month and 4-5 years postoperative PA cephalograms, and 4-5 years postoperative models. Both dental and skeletal relapse rates were calculated with the interorbital distance as a reference on digitized copies. The models were judged for occlusal stability. Relapse was minimal when the widening at the first molar level was less than 6 mm. The importance of the transpalatal bar is stressed.
Orthognathic Surgery: The Patients Overall Subjective Findings with Special Focus on TemporomandibularJoint Changes
De Ciercq C.A.S., Neyt L.F., Mommaerts M. Y.., Abeloos J. V.S. Division of Maxillo-Facial Surgery, A Z St Jan, Bruges, Belgium
Posters The patients' overall satisfaction with orthognathic surgery was evaluated retrospectively by a closed-form written questionnaire filled out by patients 1-2..5 years postoperatively. Patient satisfaction as well as the opinion of relatives on the results of the treatment were graded on a digital visual analogue scale. Included in the questionnaire were questions related to patient self-confidence and willingness to re-elect surgery. Special attention was given to subjective changes in their temporomandibular joint (TMJ) function. The responses of 238 (149 females, 89 males) osteotomy patients of the 296 consecutively operated between 1/1/93 and 31/7/94 in the Division of Maxillofacial Surgery of the AZ St Jan, Bruges, Belgium were evaluated. Cleft patients, laterognathia and isolated genioplasty cases were excluded from the study. All patients in the study received orthodontic treatment preoperatively. Of 238 patients, 87% would reelect the whole treatment again (surgery and orthodontics). On the visual analogue scale, patient satisfaction was graded excellent (the maximum score) in 22% of patients. Relatives' opinion on the treatment was graded excellent in 26%. In 77% of patients, there was a higher self-confidence in themselves. Postoperatively, there was a subjective improvement in TMJ function in 40% of patients and a worsening in 11%; the masticatory efficiency was improved in 41% of patients and was worse in 7% of the patients.
Clinical Types of Neck Chemodeetoma Duditskaya T.K., Nered S.N., Chistyakov S.S.
Cancer Research Centre of RAMS, Moscow, Russia Between 1965 and 1996, 139 patients with chemodectoma of the neck were treated in the Cancer Research Centre RAMS. 120 patients were operated on, 9 patients were assessed as inoperable. 94 (67.6%) patients had carotid body, 34 (25.1%) glomus vagale and 10 (7.3%) patients were with atypical tumour. All patients with carotid chemodectoma had no recurrences after operations and had no tendency to hormonal activity. Patients with glomus vagale had neurologic symptoms due to spreading to the skull base, technical difficulties and inoperable character. In atypical cases, there were stable recurrences and salvage surgery. In our opinion the most important prognostic factor for the patients with chemodectoma of the neck is the localization of tumour.
The Contribution of Mirault to the History of Cleft Lip Surgery Dupoirieux L., Plane L., Elle A., Gard C., Khouri M., Penneau M.
Department of Oral and Maxillofacial Surgery, Centre Hospitalier Universitaired'Angers, Angers, France Germanicus Mirault was a French surgeon born in Angers in 1796. In 1844, he described a technique for closure of the cleft lip that introduced for the first time the concept of flap transposition. Until 1930, this technique and its variants were still the most popular in the US. This poster relates the works, but also the life, of this skilful and very eclectic surgeon. He also made very important contributions to other fields of maxillofacial surgery including the first ligature of the lingual artery for a tongue carcinoma in 1835 and a method of temporary occlusion of the eye to prevent cicatricial ectropion that was awarded by the Acad6mie des Sciences in 1869.
133
Biocompatibility of Solid Poly (Ortho Ester)
Ekhoim 3/1., Salo A., Syrjiinen S., Laine P., Lindqvist C., Kellomiiki M., Virtanen L, Suuronen R. Department of Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland. Poly (ortho ester)s (POE) are a group of synthetic bioerodible polymers. We studied the tissue reactions of solid POE implanted into both tibiae of 17 rabbits. One half of the rods were sterilized by gamma radiation and the other half by ethylene oxide. The follow up times were from 1-21 weeks after which the animals were killed and the bony specimens examined histologically. The connective tissue samples were examined immunohistochemically in order to study the occurrences of two extracellular matrix glycoproteins, tenascin and fibronectin. The results showed that solid POE induces a moderate inflammatory reaction for 9 weeks. Tenascin and fibronectin were present in samples from 1 week up to 4 weeks. We also found that gamma sterilized POE was resorbed at week 7 and ethylene oxide sterilized POE at week 13. We conclude that POE seems to be promising material to be used in oral and maxillofacial surgery.
Reconstruction of Facial Defects using Osseointegrated Titanium Implants Farmand M., Klaassen P-P.
Clinic of Oral and Maxillofacial Surgery, Klinikum S~id. N~irnberg, Niirnberg, Germany Reconstruction of facial defects using facial prosthesis has maintained its role in certain circumstances the major advances in reconstructive surgery. Facial prosthesis may be used as definitive reconstruction or temporary measure prior to a delayed surgical reconstruction. The use of facial prosthesis as the sole reconstructive procedure or in combination with extensive reconstructive measures is also possible. Theoretically, several options exist to secure a facial prosthesis to a defect. Recently, the fixation with the use of osseointegrated implants has gained increasing importance. In this poster a newly developed implant system (Epitecsystem) will be presented. With the help of a carrier plate, the implants can be placed everywhere in the face. This system can still be used, where enosseous implants cannot be placed optimally due to lack of bone. Thirty-one patients with different facial defects of various origins have been treated till now. The long-term results up to 5 years will be discussed. It i s demonstrated that even today a reconstruction of facial defects using facial prosthesis should have a place in the overall concept of reconstruction and rehabilitation.
Salvage Operations and Plastic Surgery after a High Dose of Radiotherapy on Oral Cancer Fedotenko S.P., Uvarov A.A.
Department of Upper Respiratory and Digestive Tract Tumours, Cancer Research Center of RAMS, Moscow, Russia For the period from 1972-1994, 130 patients received radical surgery on occasion of continued growth or relapse of the oral cavity cancer. All of them were earlier treated by