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Segment tilting associated with surgically assisted rapid maxillary expansion
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21st ICOMS 2013 - Abstracts: Oral Papers T26.OR011
T26.OR009 Managing complications in intraoral vertico-sagittal ramus osteotomy C.E. Chrzanowski Pereira de Chiodi Bim
Souza ∗ ,
J. Nazareno Gil, V. Lousan do Nascimento Poubel, A. Luis
Segment tilting associated with surgically assisted rapid maxillary expansion E. Daif Faculty of Oral and Dental Medicine, Cairo University, Egypt
Federal University of Santa Catarina, Brazil Intraoral vertico-sagittal ramus osteotomy is a suitable osteotomy for correction of mandibular prognathism and small retrognathism, associated with predictable results. Although few complications have been described when this technique is used, the Oral and Maxillofacial Surgeon must be prepared to manage them when they occur. The purpose of this presentation is to point the most common problems and the decisions we have been taking in our 15 years experience doing this osteotomy. http://dx.doi.org/10.1016/j.ijom.2013.07.535 T26.OR010 Inferior Alveolar Nerve recovery after Bilateral Sagittal Split Osteotomy of the mandible: preliminary report E. Cordero 1,2,∗ , C. Pacheco 1 , S. Correa 1 , R. Carrasco 1 , R. Pantoja 1,2
Objectives: This study aimed to evaluate, via a computed tomography, the direction and magnitude of the segmental tilting that may occur after SARME in patients having transverse maxillary deficiency. Patients and methods: Thirty adult patients having transverse maxillary deficiency greater than 5 mm were treated by surgically assisted rapid maxillary expansion (SARME). The procedures consisted of bilateral zygomatic buttress and midpalatal osteotomies combined with the use of a toothborne orthopedic device postoperatively. Axial and coronal images were made before and 6 months after SARME to evaluate the segment tilting. Results: The greatest expansion has occurred in the most inferior (5.4 ± 1.13 mm) and anterior (4.0 ± 1.26 mm) regions of the maxilla. The expanded segment tilted outward inferiorly and anteriorly in coronal and axial images, respectively. The segment tilting was 2.03 mm (2.27%) inferiorly and 3.07 mm (12.81%) anteriorly. Conclusions: It can be concluded that, an outward tilting occurs in the most inferior and anterior portions of maxilla during the SARME procedures. So, the direction and magnitude of such segmental tilting must be considered preoperatively when determining the surgical objectives.
1 Departamento de Cirugía y Traumatología Maxilofacial, Facultad de Odontología, Universidad de
Chile, Santiago, Chile 2 Servicio de Cirugía y Traumatología Maxilofacial, Hospital San Borja Arriarán, Santiago, Chile Background and objectives: Many reports have described neurosensory disturbances on Inferior Alveolar Nerve (IAN) after mandibular Bilateral Sagittal Split Osteotomy (BSSO). Paresthesia after BSSO has been reported between 12.5% and 100%. Our aim is to determine the percentage of the sensorial recovery of the area innervated by NAI after BSSO until the first year post surgery. This study is part of an investigation that is being performed since June of 2012 at Dental School of the Universidad de Chile with Hospital San Borja Arriaran, both located in Santiago, Chile. This study will have a sample of 30 patients. This is a preliminary report of the evolution of 15 patients who have completed 6 months post surgery. Methods: Were included 15 patients with dentofacial deformities Classes II and III diagnosis who underwent orthognathic surgery with BSSO technique. The patients were controlled at 1st, 3rd and 6th month post surgery. The zone of study included a rectangular area of chin (gridded in 8 equal parts) limited superiorly by a line from labial commissure prolonged to 1 cm to distal of each side and the lower limit is the basilar edge. The squares were stimulated just one time each, using a von Frey calibrated monofilament. Patient reported the sensation using a hypoesthesia scale (previously explicated to him). Results: At 1 month after surgery was registered a 26.2% of sensitivity in the study area, in the third month was registered a 41.8% meanwhile at the sixth post surgery month was registered a 55% of sensitivity. Conclusion: The sensorial recovery is progressive and shows a rising pattern until 6th month after surgery where the patient is able to discriminate the stimulated points. In this preliminary report is not possible to determine a concentric/eccentric pattern of sensorial recovery at 6th month post surgery. Key words: osteotomy; hypoesthesia; neuropraxia http://dx.doi.org/10.1016/j.ijom.2013.07.536
http://dx.doi.org/10.1016/j.ijom.2013.07.537 T26.OR012 Orthognathic surgery. Results of a satisfaction survey in the last 10 years O. de La Sen Corcuera ∗ , F. Falahat, E. Fernández Martín, I. Colón de Carvajal, J. Sánchez Gutiérrez, A. Berguer Hospital Clínico San Carlos, Spain Introduction: Orthognathic surgery is the surgical treatment of dentofacial anomalies. Much of the success of this surgery depends on the subjective opinion of patients. Objectives: To study the satisfaction of orthognathic surgery patients in our Department. Methods: Retrospective descriptive study that used telephone calls and evaluated the degree of patient’s satisfaction related to this parameters: inferior alveolar nerve involvement, satisfaction with cosmetic result, with occlusal result, assessment of pain in the TMJ and overall satisfaction. We used the VAS and asked about TMJ pain and occlusal function. Results: Ninety-seven patients were analyzed. Average rating of 7.89 in terms of aesthetic results. Occlusal function improved in 90.72% of patients; 39 of 42 patients improved their TMJ pain symptoms. 40.2% had some impairment of inferior alveolar nerve. The overall satisfaction average was 8.5. Discussion: It is important to consider the subjective evaluation of orthognathic patients. The inferior alveolar nerve involvement is a common complication although it usually improves. Conclusions: It is uncommon to find aesthetic and occlusal bad results if surgery is properly planned and the surgeon’s experience is adequate. TMJ pain is one of the least predictable parameters. Orthognathic surgery has a positive impact on the overall satisfaction of our patients. http://dx.doi.org/10.1016/j.ijom.2013.07.538
21st ICOMS 2013 - Abstracts: Oral Papers T26.OR011
T26.OR009 Managing complications in intraoral vertico-sagittal ramus osteotomy C.E. Chrzanowski Pereira de Chiodi Bim
Souza ∗ ,
J. Nazareno Gil, V. Lousan do Nascimento Poubel, A. Luis
Segment tilting associated with surgically assisted rapid maxillary expansion E. Daif Faculty of Oral and Dental Medicine, Cairo University, Egypt
Federal University of Santa Catarina, Brazil Intraoral vertico-sagittal ramus osteotomy is a suitable osteotomy for correction of mandibular prognathism and small retrognathism, associated with predictable results. Although few complications have been described when this technique is used, the Oral and Maxillofacial Surgeon must be prepared to manage them when they occur. The purpose of this presentation is to point the most common problems and the decisions we have been taking in our 15 years experience doing this osteotomy. http://dx.doi.org/10.1016/j.ijom.2013.07.535 T26.OR010 Inferior Alveolar Nerve recovery after Bilateral Sagittal Split Osteotomy of the mandible: preliminary report E. Cordero 1,2,∗ , C. Pacheco 1 , S. Correa 1 , R. Carrasco 1 , R. Pantoja 1,2
Objectives: This study aimed to evaluate, via a computed tomography, the direction and magnitude of the segmental tilting that may occur after SARME in patients having transverse maxillary deficiency. Patients and methods: Thirty adult patients having transverse maxillary deficiency greater than 5 mm were treated by surgically assisted rapid maxillary expansion (SARME). The procedures consisted of bilateral zygomatic buttress and midpalatal osteotomies combined with the use of a toothborne orthopedic device postoperatively. Axial and coronal images were made before and 6 months after SARME to evaluate the segment tilting. Results: The greatest expansion has occurred in the most inferior (5.4 ± 1.13 mm) and anterior (4.0 ± 1.26 mm) regions of the maxilla. The expanded segment tilted outward inferiorly and anteriorly in coronal and axial images, respectively. The segment tilting was 2.03 mm (2.27%) inferiorly and 3.07 mm (12.81%) anteriorly. Conclusions: It can be concluded that, an outward tilting occurs in the most inferior and anterior portions of maxilla during the SARME procedures. So, the direction and magnitude of such segmental tilting must be considered preoperatively when determining the surgical objectives.
1 Departamento de Cirugía y Traumatología Maxilofacial, Facultad de Odontología, Universidad de
Chile, Santiago, Chile 2 Servicio de Cirugía y Traumatología Maxilofacial, Hospital San Borja Arriarán, Santiago, Chile Background and objectives: Many reports have described neurosensory disturbances on Inferior Alveolar Nerve (IAN) after mandibular Bilateral Sagittal Split Osteotomy (BSSO). Paresthesia after BSSO has been reported between 12.5% and 100%. Our aim is to determine the percentage of the sensorial recovery of the area innervated by NAI after BSSO until the first year post surgery. This study is part of an investigation that is being performed since June of 2012 at Dental School of the Universidad de Chile with Hospital San Borja Arriaran, both located in Santiago, Chile. This study will have a sample of 30 patients. This is a preliminary report of the evolution of 15 patients who have completed 6 months post surgery. Methods: Were included 15 patients with dentofacial deformities Classes II and III diagnosis who underwent orthognathic surgery with BSSO technique. The patients were controlled at 1st, 3rd and 6th month post surgery. The zone of study included a rectangular area of chin (gridded in 8 equal parts) limited superiorly by a line from labial commissure prolonged to 1 cm to distal of each side and the lower limit is the basilar edge. The squares were stimulated just one time each, using a von Frey calibrated monofilament. Patient reported the sensation using a hypoesthesia scale (previously explicated to him). Results: At 1 month after surgery was registered a 26.2% of sensitivity in the study area, in the third month was registered a 41.8% meanwhile at the sixth post surgery month was registered a 55% of sensitivity. Conclusion: The sensorial recovery is progressive and shows a rising pattern until 6th month after surgery where the patient is able to discriminate the stimulated points. In this preliminary report is not possible to determine a concentric/eccentric pattern of sensorial recovery at 6th month post surgery. Key words: osteotomy; hypoesthesia; neuropraxia http://dx.doi.org/10.1016/j.ijom.2013.07.536
http://dx.doi.org/10.1016/j.ijom.2013.07.537 T26.OR012 Orthognathic surgery. Results of a satisfaction survey in the last 10 years O. de La Sen Corcuera ∗ , F. Falahat, E. Fernández Martín, I. Colón de Carvajal, J. Sánchez Gutiérrez, A. Berguer Hospital Clínico San Carlos, Spain Introduction: Orthognathic surgery is the surgical treatment of dentofacial anomalies. Much of the success of this surgery depends on the subjective opinion of patients. Objectives: To study the satisfaction of orthognathic surgery patients in our Department. Methods: Retrospective descriptive study that used telephone calls and evaluated the degree of patient’s satisfaction related to this parameters: inferior alveolar nerve involvement, satisfaction with cosmetic result, with occlusal result, assessment of pain in the TMJ and overall satisfaction. We used the VAS and asked about TMJ pain and occlusal function. Results: Ninety-seven patients were analyzed. Average rating of 7.89 in terms of aesthetic results. Occlusal function improved in 90.72% of patients; 39 of 42 patients improved their TMJ pain symptoms. 40.2% had some impairment of inferior alveolar nerve. The overall satisfaction average was 8.5. Discussion: It is important to consider the subjective evaluation of orthognathic patients. The inferior alveolar nerve involvement is a common complication although it usually improves. Conclusions: It is uncommon to find aesthetic and occlusal bad results if surgery is properly planned and the surgeon’s experience is adequate. TMJ pain is one of the least predictable parameters. Orthognathic surgery has a positive impact on the overall satisfaction of our patients. http://dx.doi.org/10.1016/j.ijom.2013.07.538