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Poster 051: Pain Associated With Iliac Crest Bone Grafting for Oral Reconstruction
Scientific Poster Session width. The distraction protocol included a latency period of 5 to 7 days at a distraction rate of 1 mm per day. Distraction combined with individualized planned immediate repositioning of the maxilla was continued until the predetermined goals were achieved. Method of Data Analysis: Statistical analyses were based on paired comparisons. During the eight-week consolidation period, bone healing was measured on periapical radiographs based on the incremental increasing radiodensity of the distraction regenerate zone. Patients were followed clinically and radiographically for a minimum of 12 months. The apical and crestal bone height, root injury, and resorption were compared with the pre and postoperative radiographs. Periodontal probing depths at the interincisal osteotomy sites were compared with adjacent interproximal spaces. Results: The first evidence of new bone formation in the interincisal distraction gap was radiographically discernible postoperatively between 3 to 4 weeks. Within 8 weeks after surgery new bone bridging of the distraction gap was discernible. One year postoperatively crestal alveolar bone height at the interincisal osteotomy site and adjacent interproximal sites were comparable. The mean difference between the two sites (0.02 mm) was neither statistically significant nor clinically relevant. Damage to the periodontium at the vertical interincisal osteotomy sites was minimal. The probing depths between the surgical sites and the adjacent interproximal areas of the same patients were not significantly different ⬍.05. Damage to the periodontal hard and soft tissues in the vertical interdental osteotomy sites was minimal when compared to the adjacent interproximal areas. The overall results showed minimal discernible root resorption or injury. Conclusion: With the 3-D intraoral osteodistraction technique, the maxilla can be simultaneously widened, lengthened, and either superiorly or inferiorly repositioned. The maxillary interdental osteotomy site provided a predictable site to widen the maxilla with minimal bone resorption or soft tissue injuries. References Morgan, Teresa A. and Fridrich, Kirk L. MS. Effects of the multiplepiece maxillary osteotomy on the periodontium. Int J Adult Orthognath Surg Vol 16, No.4, 2001 Pinto, LP; Bell, WH; Chu, S; and Buschang, PH. Simultaneous 3-D LeFort I/Distraction Osteogenesis Technique: Positional Changes. JOMS, in press
POSTER 051 Pain Associated With Iliac Crest Bone Grafting for Oral Reconstruction David W. Dorfman, DDS, MD, UCSF, 521 Parnassus Ave, Room C522, San Francisco, CA 94143 (Lee JS) AAOMS • 2008
Background: Autogenous bone from the iliac crest is typically used for reconstruction of bony defects in the maxilla and mandible. Congenital defects such as an alveolar cleft routinely use iliac crest bone grafts to correct the defect. To date there have been limited prospective studies of pain or functional limitations in patients after iliac crest bone grafting, particularly in children. Also, the comparison of pain at the two different sites (the iliac crest and the oral cavity) has been limited. Methods: A prospective study was performed on 16 consecutive patients who underwent iliac crest bone grafting to an oral defect in 2007. Twelve of the patients received an iliac crest bone graft for alveolar cleft repair while 2 received an iliac crest bone graft to stabilize an orthognathic procedure, and 2 received an iliac crest bone graft to reconstruct a defect due to traumatic avulsion of bone and pathologic cyst excision. The patients were age 9 – 46 (mean age: 18 years), with 3 females and 13 males. The patients were interviewed with 8 questions for each of the two sites, the iliac crest and oral sites, and asked to rate their pain intensity level with and without function, pain character (sharpness and dull/ aching) with and without function, sensitivity to touch, and limitation of function in the mouth and hip using a scale from 0 to 10. The survey had been previously validated at our institution. The questions were asked preoperatively and immediately following the operation, as well as at 1 week, 3 weeks, 1 month, 3 months, and 6 months postoperatively. Statistical analysis was performed using paired Student t-test. P values of ⬍0.05 were accepted as significant. Results: The iliac crest pain was statistically significantly worse than oral cavity pain immediately after surgery in intensity (2.5 vs. 1.36), sharpness (2.67 vs. 0.75), and dull/aching (2.83 vs. 1.67). An even greater statistically significant difference could be seen between iliac crest and oral pain in the immediate postoperative period when measuring pain with function in intensity (5.58 vs. 2.42), sharpness (4.17 vs. 1.17), and dull/aching (5.17 vs. 1.92). A statistically significant difference was also seen with the iliac crest being more painful to touch compared with the oral defect (4.75 vs. 1.83). Pain also caused a statistically significantly greater restriction to activity with the iliac crest than the oral defect (5.09 vs. 1.54). At one week, 20% of the patients reported any pain at all in the oral cavity, and 80% were still reporting pain in the iliac crest. At 2 weeks no patients (0%) reported oral pain, and 29% reported pain in the iliac crest. All the pain in the iliac crest had resolved by 3 months except one patient (6%) still reported a pain of 3 to touch beyond 6 months. Conclusion: The greatest source of postoperative pain in patients undergoing iliac crest bone grafting to an oral site is in the iliac crest. The donor site was more painful with function, more functionally limiting, and more sen97
Scientific Poster Session sitive to touch than the recipient site. All patients’ oral pain had resolved by two weeks after surgery. The iliac pain did not completely resolve until one to three months had passed and 1 patient still complained of pain to touch beyond 6 months. These data can be used to guide future management of postoperative pain after bone grafting. As pain is greater and more functionally limiting in the iliac crest than the mouth, focus can be directed on using interventions like catheter-administrated pain medications to the hip.
little decrease (42.8 mm) in relation to the preoperative value (44.5 mm), but no trismus was seen. Hemorrhage (02) and bad split (02) were the most common complications. No nerve injury was observed in the 40 patients studied. Conclusions: The IVSRO is efficient, versatile, with a low complication rate, and is an option for the oral and maxillofacial surgeon to treat patients with mandibular dento-skeletal discrepancies.
References
Choung PH: A new osteotomy for the correction of mandibular prognathism: Techniques and rationale of the intraoral verticosagittal ramus osteotomy. J Craniomaxillofac Surg 20: 153, 1992 Fujimura K, Segami N, Sato J, Kanayama K, Nishimura M, Demura N: Advantages of intraoral verticosagittal ramus osteotomy in skeletofacial deformity patients with temporomandibular joint disorders. J Oral Maxillofac Surg 62:1246, 2004
References
Kessler P, Thorwarth A, Bloch-Birkholz E, Nkenke E, Neukam FW. Harvesting of bone from the iliac crest-comparison of the anterior and posterior sites. British Journal of Oral and Maxillofacial Surgery. 43: 51-56, 2005 Kolokythas A, Connelly ST, Schmidt BL. Validation of the University of California San Francisco Oral Cancer Pain Questionnaire. J Pain. 8(12):950-3, 2007
POSTER 053 POSTER 052 An Analysis of 80 Intraoral Varticosagittal Ramus Osteotomies Jose´ Nazareno Gil, PhD, Santa Catarina Federal University, Rua Tenente Silveira 293, Sala 1001, Centro, Florianopolis, Santa Catarina, 88010-301, Brazil (Lima JR SM; Granato R; Marin C; Maliska MCS) Purpose: The intraoral verticosagittal ramus osteotomy (IVSRO) was first reported by Choung et al to correct mandibular prognathism and later it was indicated to treat patients with condylar hyperplasia or high condylar process fractures and patients with dentofacial deformities associated with temporomandibular disorders. The main advantages of this procedure are the large contact area between segments, the condylotomy effect and the low incidence of injury to the inferior alveolar nerve. The present study was conducted to evaluate the movements allowed by this osteotomy, the clinical outcome and the complications associated with the IVSRO. Patients and Methods: This was a retrospective study in which the charts of forty consecutive patients that had undergone orthognathic surgery using the IVSRO in a one year period were analyzed regarding the diagnosis, the amount of mandibular movements, mouth opening, period of intermaxillary fixation, and complications. Results: Mandibular protrusion in both genders was the main preoperative diagnosis (50 osteotomies) and it was treated by two-jaw surgery mainly (36 patients). The mean follow-up was 18 months. The mean amount of movement was 2 mm for setback and advancement and 3 mm for counterclockwise and 2 mm for clockwise in rotation movements. The mean period of intermaxillary fixation was 15.2 days. The mouth opening presented a 98
Evaluation of the Posterior Airway Space Following Mandible Setback During Bimaxillary Surgery: An Analysis of 3 Different Mandibular Osteotomies Jose´ Nazareno Gil, PhD, Santa Catarina Federal University, Rua Tenente Silveira 293, Sala 1001, Centro, Florianopolis, Santa Catarina 88010-301 Brazil (Lima JR SM; Granato R; Marin C; Maliska MCS) Purpose: Bimaxillary surgery is widely used to treat the patients with a protruding mandible. Three different mandible osteotomies are available for the oral and maxillofacial surgeon who treats this condition: the bilateral sagittal split osteotomy (BSSO), the intraoral vertical ramus osteotomy (IVRO), and the intraoral verticosagittal ramus osteotomy (IVSRO). Significant changes in mandible and maxilla positions following orthognathic surgery may lead to changes in the posterior airway space, including hyoid bone and tongue positions. Although rare, these changes may play a role in developing obstructivesleep related disorders. The aim of this investigation was to compare three different osteotomies for mandible setback within the postoperative changes in the posterior airway space and the position of the hyoid bone for correction of Class III deformities during bimaxillary surgery. Patients and Methods: The sample included 24 consecutive patients who had been diagnosed with Class III skeletal deformities and had undergone surgical-orthodontic treatment using bimaxillary surgery in a sixmonth period. The patients were divided in three groups according to the mandibular osteotomy used: 10 patients were operated with BSSO, 8 patients were operated with IVRO and 6 patients were operated with IVSRO. The radiographs were scanned and superimposed using AAOMS • 2008
POSTER 051 Pain Associated With Iliac Crest Bone Grafting for Oral Reconstruction David W. Dorfman, DDS, MD, UCSF, 521 Parnassus Ave, Room C522, San Francisco, CA 94143 (Lee JS) AAOMS • 2008
Background: Autogenous bone from the iliac crest is typically used for reconstruction of bony defects in the maxilla and mandible. Congenital defects such as an alveolar cleft routinely use iliac crest bone grafts to correct the defect. To date there have been limited prospective studies of pain or functional limitations in patients after iliac crest bone grafting, particularly in children. Also, the comparison of pain at the two different sites (the iliac crest and the oral cavity) has been limited. Methods: A prospective study was performed on 16 consecutive patients who underwent iliac crest bone grafting to an oral defect in 2007. Twelve of the patients received an iliac crest bone graft for alveolar cleft repair while 2 received an iliac crest bone graft to stabilize an orthognathic procedure, and 2 received an iliac crest bone graft to reconstruct a defect due to traumatic avulsion of bone and pathologic cyst excision. The patients were age 9 – 46 (mean age: 18 years), with 3 females and 13 males. The patients were interviewed with 8 questions for each of the two sites, the iliac crest and oral sites, and asked to rate their pain intensity level with and without function, pain character (sharpness and dull/ aching) with and without function, sensitivity to touch, and limitation of function in the mouth and hip using a scale from 0 to 10. The survey had been previously validated at our institution. The questions were asked preoperatively and immediately following the operation, as well as at 1 week, 3 weeks, 1 month, 3 months, and 6 months postoperatively. Statistical analysis was performed using paired Student t-test. P values of ⬍0.05 were accepted as significant. Results: The iliac crest pain was statistically significantly worse than oral cavity pain immediately after surgery in intensity (2.5 vs. 1.36), sharpness (2.67 vs. 0.75), and dull/aching (2.83 vs. 1.67). An even greater statistically significant difference could be seen between iliac crest and oral pain in the immediate postoperative period when measuring pain with function in intensity (5.58 vs. 2.42), sharpness (4.17 vs. 1.17), and dull/aching (5.17 vs. 1.92). A statistically significant difference was also seen with the iliac crest being more painful to touch compared with the oral defect (4.75 vs. 1.83). Pain also caused a statistically significantly greater restriction to activity with the iliac crest than the oral defect (5.09 vs. 1.54). At one week, 20% of the patients reported any pain at all in the oral cavity, and 80% were still reporting pain in the iliac crest. At 2 weeks no patients (0%) reported oral pain, and 29% reported pain in the iliac crest. All the pain in the iliac crest had resolved by 3 months except one patient (6%) still reported a pain of 3 to touch beyond 6 months. Conclusion: The greatest source of postoperative pain in patients undergoing iliac crest bone grafting to an oral site is in the iliac crest. The donor site was more painful with function, more functionally limiting, and more sen97
Scientific Poster Session sitive to touch than the recipient site. All patients’ oral pain had resolved by two weeks after surgery. The iliac pain did not completely resolve until one to three months had passed and 1 patient still complained of pain to touch beyond 6 months. These data can be used to guide future management of postoperative pain after bone grafting. As pain is greater and more functionally limiting in the iliac crest than the mouth, focus can be directed on using interventions like catheter-administrated pain medications to the hip.
little decrease (42.8 mm) in relation to the preoperative value (44.5 mm), but no trismus was seen. Hemorrhage (02) and bad split (02) were the most common complications. No nerve injury was observed in the 40 patients studied. Conclusions: The IVSRO is efficient, versatile, with a low complication rate, and is an option for the oral and maxillofacial surgeon to treat patients with mandibular dento-skeletal discrepancies.
References
Choung PH: A new osteotomy for the correction of mandibular prognathism: Techniques and rationale of the intraoral verticosagittal ramus osteotomy. J Craniomaxillofac Surg 20: 153, 1992 Fujimura K, Segami N, Sato J, Kanayama K, Nishimura M, Demura N: Advantages of intraoral verticosagittal ramus osteotomy in skeletofacial deformity patients with temporomandibular joint disorders. J Oral Maxillofac Surg 62:1246, 2004
References
Kessler P, Thorwarth A, Bloch-Birkholz E, Nkenke E, Neukam FW. Harvesting of bone from the iliac crest-comparison of the anterior and posterior sites. British Journal of Oral and Maxillofacial Surgery. 43: 51-56, 2005 Kolokythas A, Connelly ST, Schmidt BL. Validation of the University of California San Francisco Oral Cancer Pain Questionnaire. J Pain. 8(12):950-3, 2007
POSTER 053 POSTER 052 An Analysis of 80 Intraoral Varticosagittal Ramus Osteotomies Jose´ Nazareno Gil, PhD, Santa Catarina Federal University, Rua Tenente Silveira 293, Sala 1001, Centro, Florianopolis, Santa Catarina, 88010-301, Brazil (Lima JR SM; Granato R; Marin C; Maliska MCS) Purpose: The intraoral verticosagittal ramus osteotomy (IVSRO) was first reported by Choung et al to correct mandibular prognathism and later it was indicated to treat patients with condylar hyperplasia or high condylar process fractures and patients with dentofacial deformities associated with temporomandibular disorders. The main advantages of this procedure are the large contact area between segments, the condylotomy effect and the low incidence of injury to the inferior alveolar nerve. The present study was conducted to evaluate the movements allowed by this osteotomy, the clinical outcome and the complications associated with the IVSRO. Patients and Methods: This was a retrospective study in which the charts of forty consecutive patients that had undergone orthognathic surgery using the IVSRO in a one year period were analyzed regarding the diagnosis, the amount of mandibular movements, mouth opening, period of intermaxillary fixation, and complications. Results: Mandibular protrusion in both genders was the main preoperative diagnosis (50 osteotomies) and it was treated by two-jaw surgery mainly (36 patients). The mean follow-up was 18 months. The mean amount of movement was 2 mm for setback and advancement and 3 mm for counterclockwise and 2 mm for clockwise in rotation movements. The mean period of intermaxillary fixation was 15.2 days. The mouth opening presented a 98
Evaluation of the Posterior Airway Space Following Mandible Setback During Bimaxillary Surgery: An Analysis of 3 Different Mandibular Osteotomies Jose´ Nazareno Gil, PhD, Santa Catarina Federal University, Rua Tenente Silveira 293, Sala 1001, Centro, Florianopolis, Santa Catarina 88010-301 Brazil (Lima JR SM; Granato R; Marin C; Maliska MCS) Purpose: Bimaxillary surgery is widely used to treat the patients with a protruding mandible. Three different mandible osteotomies are available for the oral and maxillofacial surgeon who treats this condition: the bilateral sagittal split osteotomy (BSSO), the intraoral vertical ramus osteotomy (IVRO), and the intraoral verticosagittal ramus osteotomy (IVSRO). Significant changes in mandible and maxilla positions following orthognathic surgery may lead to changes in the posterior airway space, including hyoid bone and tongue positions. Although rare, these changes may play a role in developing obstructivesleep related disorders. The aim of this investigation was to compare three different osteotomies for mandible setback within the postoperative changes in the posterior airway space and the position of the hyoid bone for correction of Class III deformities during bimaxillary surgery. Patients and Methods: The sample included 24 consecutive patients who had been diagnosed with Class III skeletal deformities and had undergone surgical-orthodontic treatment using bimaxillary surgery in a sixmonth period. The patients were divided in three groups according to the mandibular osteotomy used: 10 patients were operated with BSSO, 8 patients were operated with IVRO and 6 patients were operated with IVSRO. The radiographs were scanned and superimposed using AAOMS • 2008