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Our experience with modified Risdon approach for subcondylar mandibular fractures and review of literature
Oral Presentation as aggressive or non-aggressive using clinical and radiographic criteria. Representative portions of each specimen were used to create a tissue microarray. Immunohistochemistry and Aperio® image analysis were used to quantify immunoreactivity (optical density) to RANK-L and osteoprotegrin (OPG, decoy receptor for RANK-L) of giant cells (GCs) and stroma within each tumor. Results: Optical density of RANK-L was higher in both GCs (p = 0.017) and stroma (p = 0.007) in aggressive MF GCTs. No difference was seen between aggressive and non-aggressive AA GCTs (GCs, p = 0.47; stroma, p = 0.37). OPG staining intensity was less than RANK-L, but did not vary by behavior (MF: GCs p = 0.10, stroma p = 0.86, AA: GCs p = 0.16, stroma p = 0.53). Conclusion: Aggressive MF GCTs have significantly higher expression of RANK-L than non-aggressive MF GCTs. This protein may be useful as a biomarker to predict behavior and response to drug therapy.
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Computer designed guides and miniplates in orthognathic surgery: a description of the planning and surgical technique B. Philippe Private Practice, Paris, France
Chawla, S., et al. (2013). Safety and efficacy of denosumab for adults and skeletally mature adolescents with GCT of bone: interim analysis of an open-label, parallel-group, phase-2 study. Lancet Oncol, 14, 901.
Introduction: In performing orthognathic surgery one of the major challenges is ensuring that the mobilised bone is fixed in the correct position in space as planned preoperatively. A number of techniques are utilised to ensure the accuracy of its placement – direct and indirect measurement, the use of dental splints as well as the use of articulated dental Casts. Each of these steps can lead to errors. A secondary challenge is to ensure that the fixation plates are correctly adapted to hold the fragment passively. Technique: The patient is assessed clinically in the conventional way. The patient then undergoes a CT (or cone beam CT) and the data is imported into Simplant O&O software package. The osteotomies are performed virtually. Then this data is sent to OBL Company and the titanium miniplates/guides are constructed utilising sintering technology. Once constructed the miniplates/guides are used in the patient. This technique will be shown for a Lefort 1 osteotomy (1 or 2 fragments), sagittal split and bimaxillary osteotomy with genioplasty, segmental osteotomy.
http://dx.doi.org/10.1016/j.ijom.2015.08.736
http://dx.doi.org/10.1016/j.ijom.2015.08.738
Our experience with modified Risdon approach for subcondylar mandibular fractures and review of literature
Computer designed guides and miniplates in orthognathic surgery: accuracy, outcomes and complications
F. Perez-Flecha ∗ , E. Sánchez-Jáuregui, D. Villegas, G. García-Serrano, K. Sagüillo, I. Page, J. Gonzalez, J.M. Eslava, J. Acero
B. Philippe
University Hospital Ramón y Cajal and University Hospital Puerta de Hierro, Madrid, Spain
Introduction: This paper presents the accuracy, outcomes, and complications of the use of computer designed guides and direct metal laser sintering titanium miniplates in orthognathic surgery. Methods: 21 cases planned and operated on by a single surgeon are presented. 8 single Lefort 1, 3 single bilateral sagittal split osteotomies, 3 bimaxillary osteotomies, 2 bimaxillary osteotomies and genioplasty, 4 Lefort 1 and genioplasty, 1 Schuchardt osteotomy, 1 single genioplasty. Aesthetic and static and dynamical occlusal results were analyzed. Due to irradiation, and because occlusion is the most relevant criterion for assessing, accuracy of CT Scan planned position measures has been analysed on the first seven Lefort 1 and on the first sagittal split osteotomy and on the first genioplasty. Results: Concerning Lefort 1, average position calculated by computer is as follows for Lefort 1 (75, 30% of maxillary volume elements between −1 and +1 mm, vertical error 1.47 mm). Concerning bilateral sagittal split, 93% of dental arch volume elements are between −1 and +1 mm. All aesthetic result are satisfactory. Concerning static and dynamical occlusion, 18 cases out of 20 cases were satisfactory but 2 sagittal split cases out of 8 were unsatisfactory. One discrete unilateral miniplate malposition and one hyper correction (Class II) has been founded in a Class III treatment. One pseudarthrosis and one discrete endonasal exposition of the miniplate among 16 Lefort I procedures has been founded.
Reference
Background: Treatment for mandibular condyle fractures is one of the most controversial issues in facial fractures, considering not only the choice of conservative or surgical reduction but also the surgical approach. Even just regarding the surgical management no consensus has been reached. The modified Risdon approach, described in 2006 by Meyer et al., is gaining popularity nowadays. This approach requires an incision along the basilar border of the mandible and the subcutaneous tissue superficial to the platysma muscle. Then the platysma muscle is incised along the same axis to expose the masseter muscle. Care is taken to avoid he marginal mandibular branch or the buccal branch of the facial nerve, running under the masseter aponeurosis. The masseter muscle in then incised to expose the mandible ramus and the fracture. Method: We present a retrospective review of 6 patients with different types of unilateral low and medium subcondylar fractures treated by the modified Risdon approach. All the patients showed some clinical symptomatology as disocclusion, lack of stability and luxation of the condyle fragment. All fractures were reduced. Elastic IMF during 2–3 weeks and opening exercises were mandatory. A postop 3D Scan was made in all patients and photographs of the scars were taken. No facial palsy was noticed. Finding and conclusions: Our conclusion is that the modified Risdon approach for low and medium subcondylar mandibular fractures should be one of the first surgical options, due to the easy technique, minimum face scar and good exposure of the fracture. http://dx.doi.org/10.1016/j.ijom.2015.08.737
Private Practice, Paris, France
http://dx.doi.org/10.1016/j.ijom.2015.08.739
e123
Computer designed guides and miniplates in orthognathic surgery: a description of the planning and surgical technique B. Philippe Private Practice, Paris, France
Chawla, S., et al. (2013). Safety and efficacy of denosumab for adults and skeletally mature adolescents with GCT of bone: interim analysis of an open-label, parallel-group, phase-2 study. Lancet Oncol, 14, 901.
Introduction: In performing orthognathic surgery one of the major challenges is ensuring that the mobilised bone is fixed in the correct position in space as planned preoperatively. A number of techniques are utilised to ensure the accuracy of its placement – direct and indirect measurement, the use of dental splints as well as the use of articulated dental Casts. Each of these steps can lead to errors. A secondary challenge is to ensure that the fixation plates are correctly adapted to hold the fragment passively. Technique: The patient is assessed clinically in the conventional way. The patient then undergoes a CT (or cone beam CT) and the data is imported into Simplant O&O software package. The osteotomies are performed virtually. Then this data is sent to OBL Company and the titanium miniplates/guides are constructed utilising sintering technology. Once constructed the miniplates/guides are used in the patient. This technique will be shown for a Lefort 1 osteotomy (1 or 2 fragments), sagittal split and bimaxillary osteotomy with genioplasty, segmental osteotomy.
http://dx.doi.org/10.1016/j.ijom.2015.08.736
http://dx.doi.org/10.1016/j.ijom.2015.08.738
Our experience with modified Risdon approach for subcondylar mandibular fractures and review of literature
Computer designed guides and miniplates in orthognathic surgery: accuracy, outcomes and complications
F. Perez-Flecha ∗ , E. Sánchez-Jáuregui, D. Villegas, G. García-Serrano, K. Sagüillo, I. Page, J. Gonzalez, J.M. Eslava, J. Acero
B. Philippe
University Hospital Ramón y Cajal and University Hospital Puerta de Hierro, Madrid, Spain
Introduction: This paper presents the accuracy, outcomes, and complications of the use of computer designed guides and direct metal laser sintering titanium miniplates in orthognathic surgery. Methods: 21 cases planned and operated on by a single surgeon are presented. 8 single Lefort 1, 3 single bilateral sagittal split osteotomies, 3 bimaxillary osteotomies, 2 bimaxillary osteotomies and genioplasty, 4 Lefort 1 and genioplasty, 1 Schuchardt osteotomy, 1 single genioplasty. Aesthetic and static and dynamical occlusal results were analyzed. Due to irradiation, and because occlusion is the most relevant criterion for assessing, accuracy of CT Scan planned position measures has been analysed on the first seven Lefort 1 and on the first sagittal split osteotomy and on the first genioplasty. Results: Concerning Lefort 1, average position calculated by computer is as follows for Lefort 1 (75, 30% of maxillary volume elements between −1 and +1 mm, vertical error 1.47 mm). Concerning bilateral sagittal split, 93% of dental arch volume elements are between −1 and +1 mm. All aesthetic result are satisfactory. Concerning static and dynamical occlusion, 18 cases out of 20 cases were satisfactory but 2 sagittal split cases out of 8 were unsatisfactory. One discrete unilateral miniplate malposition and one hyper correction (Class II) has been founded in a Class III treatment. One pseudarthrosis and one discrete endonasal exposition of the miniplate among 16 Lefort I procedures has been founded.
Reference
Background: Treatment for mandibular condyle fractures is one of the most controversial issues in facial fractures, considering not only the choice of conservative or surgical reduction but also the surgical approach. Even just regarding the surgical management no consensus has been reached. The modified Risdon approach, described in 2006 by Meyer et al., is gaining popularity nowadays. This approach requires an incision along the basilar border of the mandible and the subcutaneous tissue superficial to the platysma muscle. Then the platysma muscle is incised along the same axis to expose the masseter muscle. Care is taken to avoid he marginal mandibular branch or the buccal branch of the facial nerve, running under the masseter aponeurosis. The masseter muscle in then incised to expose the mandible ramus and the fracture. Method: We present a retrospective review of 6 patients with different types of unilateral low and medium subcondylar fractures treated by the modified Risdon approach. All the patients showed some clinical symptomatology as disocclusion, lack of stability and luxation of the condyle fragment. All fractures were reduced. Elastic IMF during 2–3 weeks and opening exercises were mandatory. A postop 3D Scan was made in all patients and photographs of the scars were taken. No facial palsy was noticed. Finding and conclusions: Our conclusion is that the modified Risdon approach for low and medium subcondylar mandibular fractures should be one of the first surgical options, due to the easy technique, minimum face scar and good exposure of the fracture. http://dx.doi.org/10.1016/j.ijom.2015.08.737
Private Practice, Paris, France
http://dx.doi.org/10.1016/j.ijom.2015.08.739