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Poster 064: Bilateral Sagittal Split Osteotomies Versus Mandibular Distraction Osteogenesis: Which Is Better?
Scientific Poster Session
POSTER 063 The Correction of Mandibular Asymmetry Using Angled Titanium Mesh Carlos M. Moretta DDS, Loma Linda University, 11092 Anderson Ave, Loma Linda, CA, 92354 (Stringer D; Brown B) Purpose: Our goal was to evaluate and present a technique of correcting facial asymmetry involving the mandible using angled titanium mesh. Patients and Methods: From 1990 to 2006, 5 patients had augmentation of the mandibular angle with titanium mesh done in conjunction with orthognathic surgery. The angle mesh was placed to correct a lower-third facial asymmetry that was due to unilateral mandibular asymmetry. The mesh was placed in subperiosteal fashion and fixated with monocortical screws. The facial asymmetry was a result of congenital defects and trauma. A combination of clinical and radiographic examination, photographs and occlusal records were used to evaluate treatment outcome. Results: All five patients were treated successfully using the titanium mesh to augment the mandibular angle in conjunction with orthognathic surgery. There were no incidences of implant infection, migration or exposure. The esthetic outcome was deemed satisfactory by both the patients and clinicians. Conclusion: Facial asymmetries that involve the mandible can be corrected by placement of an angled titanium mesh in conjunction with orthognathic surgery.
POSTER 064 Bilateral Sagittal Split Osteotomies Versus Mandibular Distraction Osteogenesis: Which Is Better? Andrew T. Ow, BDS, MDS, FRACDS, University of Hong Kong, 2/F Oral and Maxillofacial Surgery, 34, Hospital road, Hong Kong, China (Cheung LK) Statement of the problem: Bilateral sagittal split osteotomies (BSSO) and mandibular distraction osteogenesis (MDO) have both been applied in the surgical treatment of Class II mandibular hypoplasia. BSSO have reported predictable stability for advancements of 6mm and less while MDO has been shown to produce good stability for advancements of 10mm or more. For advancements between 6-10mm, there has yet to be any comparison of which method is more stable. BSSO have also been associated with a high incidence of neurosensory disturbance of the inferior alveolar nerve (IAN). This randomized controlled trial aims to compare the stability and morbidities of both techniques for mandibular advancements between 6-10mm. Materials and Methods: 17 Class II mandibular hypoplasia patients requiring mandibular advancement of 6-10mm AAOMS • 2008
were randomized into 2 groups for either BSSO or MDO. Conventional BSSO were performed and fixed in the preplanned position using titanium mini-plates. For MDO, bilateral body osteotomies were performed distal to the last molar teeth. Fixation was achieved using intra-oral bone borne unidirectional distractors. Serial lateral cephalographs were taken at post-operative periods 2 weeks (T1), 6 weeks (T2), 12 weeks (T3), 6 months (T4) and 12 months (T5). Skeletal stability using specific cephalometric landmarks was assessed at the respective post-operative periods. Objective and subjective neurosensory evaluation were performed and any intra-operative or post-operative complications were recorded. The paired t-test was used to analyze stability and neurosensory scores with statistical significance set at p⬍0.05. Results: The mean mandibular advancement for the BSSO and MDO group was 7.4mm and 7.1mm, respectively. There was no significant difference (p⬎0.05) in horizontal skeletal stability between the two groups at all post-operative time periods. Objective neurosensory evaluation showed no significant differences (p⬎0.05) in light touch (LT), 2-point discrimination (2PD) and pin-prick pain threshold (PPPT) scores at all time periods between the 2 groups although the MDO group reported slightly lower LT and 2PD scores in the early post-operative period. Postoperative complications included posterior open bite (BSSO ⫽2, MDO⫽2), wound infection (BSSO⫽1, MDO⫽6) and condylar resorption (BSSO⫽1, MDO⫽1). Conclusions: Skeletal stability and post-operative complications seem to be comparable between BSSO and MDO for advancements between 6-10 mm. MDO appears to report lower LT and 2PD scores in the early post-operative period. A greater sample size is required to ascertain which technique is better. References Borstlap, WA, Stoelinga, PJ, Hoppenreijs, TJ, et al. Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with two-year follow-up. Part II. Radiographic parameters. Int J Oral Maxillofac Surg 33: 535, 2004 Van Strijen, PJ, Breuning, KH, Becking, AG, et al. Stability after distraction osteogenesis to lengthen the mandible: results in 50 patients. J Oral Maxillofac Surg 62: 304, 2004
POSTER 065 Analysis of the Porcine Maxillary Distraction Wound With Light and Fluorescence Microscopy Maria E. Papadaki, MD, DMD, Oral and Maxillofacial Surgery Department, Massachusetts General Hospital, Warren 1201, Boston, MA 02114 (Tayebaty F; Abulikamu M; Kaban L; Troulis M) Purpose: Distraction osteogenesis (DO) is a minimally invasive surgical technique to achieve skeletal expan105
POSTER 063 The Correction of Mandibular Asymmetry Using Angled Titanium Mesh Carlos M. Moretta DDS, Loma Linda University, 11092 Anderson Ave, Loma Linda, CA, 92354 (Stringer D; Brown B) Purpose: Our goal was to evaluate and present a technique of correcting facial asymmetry involving the mandible using angled titanium mesh. Patients and Methods: From 1990 to 2006, 5 patients had augmentation of the mandibular angle with titanium mesh done in conjunction with orthognathic surgery. The angle mesh was placed to correct a lower-third facial asymmetry that was due to unilateral mandibular asymmetry. The mesh was placed in subperiosteal fashion and fixated with monocortical screws. The facial asymmetry was a result of congenital defects and trauma. A combination of clinical and radiographic examination, photographs and occlusal records were used to evaluate treatment outcome. Results: All five patients were treated successfully using the titanium mesh to augment the mandibular angle in conjunction with orthognathic surgery. There were no incidences of implant infection, migration or exposure. The esthetic outcome was deemed satisfactory by both the patients and clinicians. Conclusion: Facial asymmetries that involve the mandible can be corrected by placement of an angled titanium mesh in conjunction with orthognathic surgery.
POSTER 064 Bilateral Sagittal Split Osteotomies Versus Mandibular Distraction Osteogenesis: Which Is Better? Andrew T. Ow, BDS, MDS, FRACDS, University of Hong Kong, 2/F Oral and Maxillofacial Surgery, 34, Hospital road, Hong Kong, China (Cheung LK) Statement of the problem: Bilateral sagittal split osteotomies (BSSO) and mandibular distraction osteogenesis (MDO) have both been applied in the surgical treatment of Class II mandibular hypoplasia. BSSO have reported predictable stability for advancements of 6mm and less while MDO has been shown to produce good stability for advancements of 10mm or more. For advancements between 6-10mm, there has yet to be any comparison of which method is more stable. BSSO have also been associated with a high incidence of neurosensory disturbance of the inferior alveolar nerve (IAN). This randomized controlled trial aims to compare the stability and morbidities of both techniques for mandibular advancements between 6-10mm. Materials and Methods: 17 Class II mandibular hypoplasia patients requiring mandibular advancement of 6-10mm AAOMS • 2008
were randomized into 2 groups for either BSSO or MDO. Conventional BSSO were performed and fixed in the preplanned position using titanium mini-plates. For MDO, bilateral body osteotomies were performed distal to the last molar teeth. Fixation was achieved using intra-oral bone borne unidirectional distractors. Serial lateral cephalographs were taken at post-operative periods 2 weeks (T1), 6 weeks (T2), 12 weeks (T3), 6 months (T4) and 12 months (T5). Skeletal stability using specific cephalometric landmarks was assessed at the respective post-operative periods. Objective and subjective neurosensory evaluation were performed and any intra-operative or post-operative complications were recorded. The paired t-test was used to analyze stability and neurosensory scores with statistical significance set at p⬍0.05. Results: The mean mandibular advancement for the BSSO and MDO group was 7.4mm and 7.1mm, respectively. There was no significant difference (p⬎0.05) in horizontal skeletal stability between the two groups at all post-operative time periods. Objective neurosensory evaluation showed no significant differences (p⬎0.05) in light touch (LT), 2-point discrimination (2PD) and pin-prick pain threshold (PPPT) scores at all time periods between the 2 groups although the MDO group reported slightly lower LT and 2PD scores in the early post-operative period. Postoperative complications included posterior open bite (BSSO ⫽2, MDO⫽2), wound infection (BSSO⫽1, MDO⫽6) and condylar resorption (BSSO⫽1, MDO⫽1). Conclusions: Skeletal stability and post-operative complications seem to be comparable between BSSO and MDO for advancements between 6-10 mm. MDO appears to report lower LT and 2PD scores in the early post-operative period. A greater sample size is required to ascertain which technique is better. References Borstlap, WA, Stoelinga, PJ, Hoppenreijs, TJ, et al. Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with two-year follow-up. Part II. Radiographic parameters. Int J Oral Maxillofac Surg 33: 535, 2004 Van Strijen, PJ, Breuning, KH, Becking, AG, et al. Stability after distraction osteogenesis to lengthen the mandible: results in 50 patients. J Oral Maxillofac Surg 62: 304, 2004
POSTER 065 Analysis of the Porcine Maxillary Distraction Wound With Light and Fluorescence Microscopy Maria E. Papadaki, MD, DMD, Oral and Maxillofacial Surgery Department, Massachusetts General Hospital, Warren 1201, Boston, MA 02114 (Tayebaty F; Abulikamu M; Kaban L; Troulis M) Purpose: Distraction osteogenesis (DO) is a minimally invasive surgical technique to achieve skeletal expan105