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Poster Board Number: 58: Analysis of Stability After Maxillary Inferior Repositioning by Le Fort I Osteotomy Without Interpositional Graft
Scientific Poster Session to classify these patients into groups according to these structural characteristics. Materials and Methods: Patients with facial asymmetry and with recent CT images were selected for inclusion in this study, resulting in a total of 43 patients. Several measurements were obtained including maxillary measurements (upper midline deviation, maxilla canting, and arch form discrepancy), and mandibular measurements (Menton deviation, Go to midsagittal plane, Go to FH plane, Go to coronal plane, ramus height, frontal ramal inclination, lateral ramal inclination, and body length). All measurements were statistically analyzed using SPSS (ver 12.0). Results of Investigation: Forty-three patients were classified into five groups as a result of cluster analysis. Group 1 included subjects with the largest difference between ramus height and menton deviation. Group 2 included subjects with asymmetry caused by a shift of mandibular body. Group 3 included subjects with a shift of the maxilla to the opposite side of the face as the deviation. Group 4 included subjects with severe maxillary canting, ramus height differences, and menton deviation. Finally, group 5 included subjects with atypical asymmetry, including those with reverse maxillary canting and a prominent opposite side to that of deviation. Conclusion: In this study, patients with asymmetry were classified into five groups according to their anatomical features. This kind of classification method will be helpful in creating diagnostic and treatment plans for patients with facial asymmetry. References: Hwang HS, Hwang CH, Lee KH, Kang BC: Maxillofacial 3-dimensional image analysis for the diagnosis of facial asymmetry. Am J Orthod Dentofacial Orthop 2006;130:779 Baek SH, Cho IS, Chang YI, Kim MJ: Skeletodental factors affecting chin point deviation in female patients with class III malocclusion and facial asymmetry: a three-dimensional analysis using computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104: 628
POSTER BOARD NUMBER: 57 Mandibular Condylar Hyperplasia: A Long-Term Follow-Up Study A. Rojas, C. Guerrero: Santa Rosa Maxillofacial Surgery Center, Central University of Venezuela, A. Sabogal, P. Lopez, M. Orozco Statement of the Problem: The aim of the study was to analyze the clinical outcome of patients treated by partial condylectomy and corrective surgery according to the stage of the disease development. Materials and Methods: 47 adults and 15 growing patients were evaluated to compare the traditional combined partial condylectomy and corrective surgery verAAOMS • 2010
sus performing tailored surgery when the disease was diagnosed in the growing years. The surgery was tailored according to the stage of the disease to correct the resultant 3-D facial deformity, from high condylectomy, mandibular sagittal, Maxillary Le Fort I, genioplasty osteotomies; and to balance facial width lateral cortex ostectomy for reduction, intermediate sandwich sagittal to augment or mandibular angle prosthesis, were performed. Methods of Data Analysis: All 62 patients underwent regular surgical-orthodontics records, SPECT bone scintigraphy, and postero-anterior cephalic volumetric analysis. New records were taken at one and two years after surgery; up to 9 years in the growing patients group. The patient data were analyzed using the SPSS statistics. Results of Investigation: 57/62 patients underwent high condylectomy to eliminate the diseased bone and cartilage. Five adult patients showed no nuclear activity in the SPECT bone scintigraph and had no condylectomy; however 2 of them continued growing after orthodontics appliance removal, requiring re-treatment. Those children diagnosed early require only high condylectomy; as the deformity became more complicated the tailored treatment required more complicated and sophisticated surgical interventions. Sagittal split osteotomy 49/62, Le Fort I osteotomy 37/62, Genioplasty 58/ 62. Contra-lateral reduction 20/62, ipsilateral augmentation 14/62 and mandibular angle prosthesis 7/62. 20% of the patients still complained of some mild asymmetry after completing the treatment. Conclusion: Early diagnosis and treatment allows curing the disease at the beginning before major facial deformity develops. When the diagnosis is obtained late in the course of the disease major maxilla-mandibular deformities develop with associated muscle shapes and asymmetric volumes, requiring a more complex surgicalorthodontics treatment. References: Hayward JD, Walker RV, Poulton DG, Bell WH: Asymmetric Mandibular Excess. En Bell WH, Proffit WR, White RP: Surgical Correction of Dentofacial Deformities. Philadelphia, WB Saunders, 1980, pp 947 S. C. Hodder, J. I., T. B. Oliver, P. E. Facey, A. W. Sugar. SPECT bone scintigraphy in the diagnosis and management of mandibular condylar hyperplasia: Br J Oral Maxillofac Surg. 2000 38, pp 87-93
POSTER BOARD NUMBER: 58 Analysis of Stability After Maxillary Inferior Repositioning by Le Fort I Osteotomy Without Interpositional Graft S. Santos, M. Arau ´ jo: Sa˜o Jose´ dos Campos Dental School, R. Moreira, M. de Moraes, L. Asprino The true vertical maxillary deficiency is a characteristic of Short Face Syndrome (CFS). In these patients, the e-93
Scientific Poster Session inferior repositioning of the maxilla is indicated in order to provide a better facial esthetics and improved function. But this surgical movement has been described as the most instable movement, and interpositional autogenous bone graft usually is used to increase post-surgical stability. The objective from this study was to evaluate long term post surgical stability of the inferior repositioning of the maxilla, fixed with four 2.0mm “L” shaped miniplates, positioned at canine and zygomatic-maxillary buttresses, without any type of graft. A cephalometric study was performed, analyzing linear measures of the I, A, ANS, CMV, and PNS points until the horizontal reference line (S-N drawing 7° inferiorly) and vertical reference line (perpendicular the S-N 7° crossing S point) traced at 3 different times: immediate pre operative, immediate post operative, and a long time post operative, at least 6 months. A total sample of 10 young adult patients who underwent an inferior repositioning of the maxilla was achieved. As a result of this study, an average surgical movement of 5.13mm at I point, 5.82mm at SNA point, and 5.34mm at A point was found. A relapse of 2.36 mm (43.39%), 2.87 mm (48.44%), and 2.80 mm (51.41%) was found respectively. A strong statistical positive correlation was found between the amount of movement and amount of relapse for all points analyzed with a Pearson coefficient r⬎ 0.5000. It was concluded, in this sample, that the inferior repositioning of the maxilla using this type of internal rigid fixation without any type of graft is not stable and that one strong positive correlation exist enters the amount of inferior movement and amount relapse.
Results of Investigation: In NHP method, in addition to reproducibility, we predict that up to 96% of symmetries assessment was true. Conclusion: P.A. cephalogram with NHP technique could improve the diagnosis ability.
References:
Statement of the Problem: Is the condylotomy (neck of mandibular condyle osteotomy) as successful as the subcondylar osteotomy for the correction of horizontal mandibular excess? Materials and Methods: A retrospective analysis was performed for patients treated by two attending(DZ and NG) from the University of Tennessee, Memphis Oral and Maxillofacial Surgery Residency Training Program from the year 2000 to 2009. Six patients underwent condylotomies and seven patients underwent subcondylar osteotomies for correction of horizontal mandibular excess. All patients were evaluated clinically and radiographically with pre-surgical and immediate post-surgical panoramic and lateral cephalometric radiographs. The average amount of set back for the condylotomy group was 5.8 mm, with a minimum of 4 and a maximum of 6 mm. The average amount of set back for the subcondylar osteotomy group was 4.6 mm with a minimum of 2 and a maximum of 9 mm. Four patients from the condylotomy group and 5 patients from the subcondylar osteotomy group underwent concomitant maxillary osteotomies with rigid fixation. All patients were treated with interdental fixation for 6 weeks post-operatively. Patients were followed 6-8 weeks by the authors and 6 months to one year by their orthodontist. Patients
Costa F, Robiony M, Politi M. Stability of Le Fort I osteotomy in maxillary inferior repositioning: Review of the literature. Int J Adult Orthod Orthognath Surg. 2000; 15(3): 197-204. Proffit WR, Turvey TA, Phillips C. The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension. Head Fac Med. 2007; 3:21-31.
POSTER BOARD NUMBER: 59 Introducing a New Midsagital Plan in PA Cephalometry for Diagnosis of Craniofacial Asymmetry M. Ordobazari: Shahid Beheshti University, A. Naghavialhosseini, A. Ordobazari, M. Behnaz Statement of the Problem: Evaluation of efficiency of P.A cephalogram with NHP technique. Materials and Methods: From crista gali,parallel to true vertical line,in posteroantero cephalogram( Midsagital plane) evaluated. Methods of Data Analysis: Sixty posteroanterior cephalogram with NHP method in Class I (30 boys and 30 girls at age of 9-13 years old )without any skeletal discrepancy evaluated. e-94
References: Athanasiou E, Drosche H l, Bosch C: Data and patterns of transverse dentofacial structure of 6 to 15 years old children: A posteroanterior cephalometric study. Am J Orthod 1992;101:4,65-71 Mongini F, Schmid W, Felliso A: A computer based assessment of structural and displacement asymmetry of the mandibule. Am J Orthod 1991;100:1,19-34.
POSTER BOARD NUMBER: 60 WITHDRAWN POSTER BOARD NUMBER: 61 WITHDRAWN POSTER BOARD NUMBER: 62 Condylotomy Versus Subcondylar Osteotomy for Treatment of Horizontal Mandibular Excess C. Sharp: University of Tennessee, Memphis, N. Gerard, D. Zelig
AAOMS • 2010
POSTER BOARD NUMBER: 57 Mandibular Condylar Hyperplasia: A Long-Term Follow-Up Study A. Rojas, C. Guerrero: Santa Rosa Maxillofacial Surgery Center, Central University of Venezuela, A. Sabogal, P. Lopez, M. Orozco Statement of the Problem: The aim of the study was to analyze the clinical outcome of patients treated by partial condylectomy and corrective surgery according to the stage of the disease development. Materials and Methods: 47 adults and 15 growing patients were evaluated to compare the traditional combined partial condylectomy and corrective surgery verAAOMS • 2010
sus performing tailored surgery when the disease was diagnosed in the growing years. The surgery was tailored according to the stage of the disease to correct the resultant 3-D facial deformity, from high condylectomy, mandibular sagittal, Maxillary Le Fort I, genioplasty osteotomies; and to balance facial width lateral cortex ostectomy for reduction, intermediate sandwich sagittal to augment or mandibular angle prosthesis, were performed. Methods of Data Analysis: All 62 patients underwent regular surgical-orthodontics records, SPECT bone scintigraphy, and postero-anterior cephalic volumetric analysis. New records were taken at one and two years after surgery; up to 9 years in the growing patients group. The patient data were analyzed using the SPSS statistics. Results of Investigation: 57/62 patients underwent high condylectomy to eliminate the diseased bone and cartilage. Five adult patients showed no nuclear activity in the SPECT bone scintigraph and had no condylectomy; however 2 of them continued growing after orthodontics appliance removal, requiring re-treatment. Those children diagnosed early require only high condylectomy; as the deformity became more complicated the tailored treatment required more complicated and sophisticated surgical interventions. Sagittal split osteotomy 49/62, Le Fort I osteotomy 37/62, Genioplasty 58/ 62. Contra-lateral reduction 20/62, ipsilateral augmentation 14/62 and mandibular angle prosthesis 7/62. 20% of the patients still complained of some mild asymmetry after completing the treatment. Conclusion: Early diagnosis and treatment allows curing the disease at the beginning before major facial deformity develops. When the diagnosis is obtained late in the course of the disease major maxilla-mandibular deformities develop with associated muscle shapes and asymmetric volumes, requiring a more complex surgicalorthodontics treatment. References: Hayward JD, Walker RV, Poulton DG, Bell WH: Asymmetric Mandibular Excess. En Bell WH, Proffit WR, White RP: Surgical Correction of Dentofacial Deformities. Philadelphia, WB Saunders, 1980, pp 947 S. C. Hodder, J. I., T. B. Oliver, P. E. Facey, A. W. Sugar. SPECT bone scintigraphy in the diagnosis and management of mandibular condylar hyperplasia: Br J Oral Maxillofac Surg. 2000 38, pp 87-93
POSTER BOARD NUMBER: 58 Analysis of Stability After Maxillary Inferior Repositioning by Le Fort I Osteotomy Without Interpositional Graft S. Santos, M. Arau ´ jo: Sa˜o Jose´ dos Campos Dental School, R. Moreira, M. de Moraes, L. Asprino The true vertical maxillary deficiency is a characteristic of Short Face Syndrome (CFS). In these patients, the e-93
Scientific Poster Session inferior repositioning of the maxilla is indicated in order to provide a better facial esthetics and improved function. But this surgical movement has been described as the most instable movement, and interpositional autogenous bone graft usually is used to increase post-surgical stability. The objective from this study was to evaluate long term post surgical stability of the inferior repositioning of the maxilla, fixed with four 2.0mm “L” shaped miniplates, positioned at canine and zygomatic-maxillary buttresses, without any type of graft. A cephalometric study was performed, analyzing linear measures of the I, A, ANS, CMV, and PNS points until the horizontal reference line (S-N drawing 7° inferiorly) and vertical reference line (perpendicular the S-N 7° crossing S point) traced at 3 different times: immediate pre operative, immediate post operative, and a long time post operative, at least 6 months. A total sample of 10 young adult patients who underwent an inferior repositioning of the maxilla was achieved. As a result of this study, an average surgical movement of 5.13mm at I point, 5.82mm at SNA point, and 5.34mm at A point was found. A relapse of 2.36 mm (43.39%), 2.87 mm (48.44%), and 2.80 mm (51.41%) was found respectively. A strong statistical positive correlation was found between the amount of movement and amount of relapse for all points analyzed with a Pearson coefficient r⬎ 0.5000. It was concluded, in this sample, that the inferior repositioning of the maxilla using this type of internal rigid fixation without any type of graft is not stable and that one strong positive correlation exist enters the amount of inferior movement and amount relapse.
Results of Investigation: In NHP method, in addition to reproducibility, we predict that up to 96% of symmetries assessment was true. Conclusion: P.A. cephalogram with NHP technique could improve the diagnosis ability.
References:
Statement of the Problem: Is the condylotomy (neck of mandibular condyle osteotomy) as successful as the subcondylar osteotomy for the correction of horizontal mandibular excess? Materials and Methods: A retrospective analysis was performed for patients treated by two attending(DZ and NG) from the University of Tennessee, Memphis Oral and Maxillofacial Surgery Residency Training Program from the year 2000 to 2009. Six patients underwent condylotomies and seven patients underwent subcondylar osteotomies for correction of horizontal mandibular excess. All patients were evaluated clinically and radiographically with pre-surgical and immediate post-surgical panoramic and lateral cephalometric radiographs. The average amount of set back for the condylotomy group was 5.8 mm, with a minimum of 4 and a maximum of 6 mm. The average amount of set back for the subcondylar osteotomy group was 4.6 mm with a minimum of 2 and a maximum of 9 mm. Four patients from the condylotomy group and 5 patients from the subcondylar osteotomy group underwent concomitant maxillary osteotomies with rigid fixation. All patients were treated with interdental fixation for 6 weeks post-operatively. Patients were followed 6-8 weeks by the authors and 6 months to one year by their orthodontist. Patients
Costa F, Robiony M, Politi M. Stability of Le Fort I osteotomy in maxillary inferior repositioning: Review of the literature. Int J Adult Orthod Orthognath Surg. 2000; 15(3): 197-204. Proffit WR, Turvey TA, Phillips C. The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension. Head Fac Med. 2007; 3:21-31.
POSTER BOARD NUMBER: 59 Introducing a New Midsagital Plan in PA Cephalometry for Diagnosis of Craniofacial Asymmetry M. Ordobazari: Shahid Beheshti University, A. Naghavialhosseini, A. Ordobazari, M. Behnaz Statement of the Problem: Evaluation of efficiency of P.A cephalogram with NHP technique. Materials and Methods: From crista gali,parallel to true vertical line,in posteroantero cephalogram( Midsagital plane) evaluated. Methods of Data Analysis: Sixty posteroanterior cephalogram with NHP method in Class I (30 boys and 30 girls at age of 9-13 years old )without any skeletal discrepancy evaluated. e-94
References: Athanasiou E, Drosche H l, Bosch C: Data and patterns of transverse dentofacial structure of 6 to 15 years old children: A posteroanterior cephalometric study. Am J Orthod 1992;101:4,65-71 Mongini F, Schmid W, Felliso A: A computer based assessment of structural and displacement asymmetry of the mandibule. Am J Orthod 1991;100:1,19-34.
POSTER BOARD NUMBER: 60 WITHDRAWN POSTER BOARD NUMBER: 61 WITHDRAWN POSTER BOARD NUMBER: 62 Condylotomy Versus Subcondylar Osteotomy for Treatment of Horizontal Mandibular Excess C. Sharp: University of Tennessee, Memphis, N. Gerard, D. Zelig
AAOMS • 2010