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Semirigid mandibular fixation in orthognathic surgery: Stability after 18 months
72 Journal of Cranio-Maxillofacial Surgery mandibular region. A ramus mandibulae was created by transplantation and ensuring distraction patients aged 14-20 years were treated. Stretching the mandible ranged from 45-80 ram, in average 58 mm. The rate of distraction was 1.5-2.5 mm/day. The time of adhesion of osseous fragments was 3 4 weeks. In patients with postradial defects of soft tissues, a simultaneous increase of their volume was obtained.
Markwardt J., Hlawitschka M., Piissler L.
Semirigid Mandibular Fixation in Orthognathic Surgery: Stability after 18 Months
Ten-year experience in the treatment of patients with oral precancers gained in special consultations held for patients with diseases of the oral mucosa allows comparisons of the results of the applied therapeutic methods. In addition to excision, leukoplakias and erythroplakias and their mixed forms were treated with cryotherapy and CO2-1asertherapy.
Marchetti C, Gentile L., Cocchi R., Bianchi A. Division of Maxillo-Facial Surgery, Bellaria Hospital, Bologna, Italy The authors have evaluated the stability of osteosynthesis with the use of semirigid mandibular fixation for the correction of class III malocclusion. The semirigid fixation is an original osteosynthesis which was proposed by Paulus in 1992. It uses two adaptive 0.7 mm diameter bicortical screws applied to the upper border of the mandible, above the neurovascular bundle. The characteristics reported by Paulus are as follows: good condylar fit, effective postoperative stability and minor neurovascular damage. In our research the osteosynthesis method reported was used on a sample of 20 patients operated on 1993-94, with a minimum follow-up of at least 18 months. Fifteen of these patients were subjected to a bimaxillary operation during which a rigid fixation was applied to the maxillary level with the use of 4 miniplates and screws. The remaining 5 patients were subjected only to sagittal split osteotomy of the mandibular ramus. All of the patients were submitted to cephalometric controls before the operation (T1), after the operation (T2) and at least 18 months, mean 21 (18-27) months, after the operation (T3). In the cases where only mandibular set-back were done, the results were substantially more stable:
SNB SNPo McNamara/Po
T1
T2
T3
86 °, 1 87 °, 1 - 0.5 mm
80 °, 6 82 °, 4 + 2.3 mm
81 ° 82 ° + 2.4 mm
Instead of in bimaxillary surgery we observed a mean mandibular relapse of 2.56 mm associated with a further forward movement of the maxilla (A point) of 0.47 mm. There was also a substantially correct dental relationship:
SNB SNPo McNamara/Po SNA McNamara/A
T1
T2
T3
81 °, 89 82°,86 - 3.17mm 79°,06 - 2.36mm
79 °, 36 80°,68 - 0.81lnm 80°,66 + 0.53mm
80 °, 88 82°,31 - 3.37mm 82°,30 + l mm
In conclusion, the stability of the mandibular fragments in this sample (patient population) depends on if the upper maxillary was operated on or not. In addition, neither clinical damage to the temporomandibular was noticeable nor lesions to the neurovascular bundle were detected.
Application of COz-Lasertherapy and Cryotherapy to Precancers of the Oral Mucosa
Department of Maxillo Facial Surgery, Universityof Dresden, Dresden, Germany
Materials and Methods: To determine the extent of dysplasia, a biopsy was carried out prior to cryoapplication or CO2-1aser beam application. We investigated whether changes in the extent of dysplasia occur in recurrences of precancers after application of cryotherapy or CO 2lasertherapy and whether there are differences between both therapeutic methods in this regard. In the period of 1984-1995, 192 patients with leukoplakia were registered and treated. After cryosurgical treatment of 74 patients with leukoplakia, there was a recurrence in 23 cases and an increase in the extent of dysplasia in 5. In contrast, recurrence was seen in 9 patients and an increase in the extent of dysplasia in 4 after 68 leukoplakias had been ablated with CO 2 laser. We discuss the differences in the clinical findings and the results of histologic examinations including incidence of recurrence of precancers between the two therapeutic methods.
Clinical and Radiologic Features of Maxillofacial Vascular Malformations
Martin-Granizo R. 1, Ramos M. 2, Monje F, 1, Caniego J.L, 2, Goizueta C.1, Mu~oz M. t, Gil-Diez J.L. 1, Herrera J.A. ~ Departments of 1Oral and Maxillofacial Surgery and 2Radiodiagnosis ( Vascular Section), University Hospital de la Princesa, Madrid, Spain Introduction: Vascular anomalies (VA) have an extremely colom'ful history rife with misconceptions and confusing terminology. Different classifications have been used throughout the years. 1,2Nevertheless this fact seems to be the highest obstacle for the correct understanding and management of these lesions. Several modalities of treatment have been advocated, including steroid injections, alpha 2-interferon, 5 embolization with different substances (ethanol, coils,3 ethibloc4), pressure, laser resection, etc. Purpose: The aim of this presentation is to show our experience in classifying and treating VA in the maxillofacial area. Thus, we use the innovate and simple classification precognized by Mulliken and Glowacki in 1982.1,2 They divide VA into hemangiomas - that ingrowth spontaneously with age - and vascular malformations (VM) which are subdivided in high- (HFVM) or low-flow (LFVM), and enlarge with time. Materials and Methods: Forty patients were retrospectively evaluated in a period of 6 years (1990-1996), 19 males and 21 females. The median age was 30.6 years. Clinical charts and radiological test features were analysed and, thus, are shown. They included, 18 magnetic resonance imaging (T1 and T2), 18 selective angiograms and 9 patients computed tomography.
Markwardt J., Hlawitschka M., Piissler L.
Semirigid Mandibular Fixation in Orthognathic Surgery: Stability after 18 Months
Ten-year experience in the treatment of patients with oral precancers gained in special consultations held for patients with diseases of the oral mucosa allows comparisons of the results of the applied therapeutic methods. In addition to excision, leukoplakias and erythroplakias and their mixed forms were treated with cryotherapy and CO2-1asertherapy.
Marchetti C, Gentile L., Cocchi R., Bianchi A. Division of Maxillo-Facial Surgery, Bellaria Hospital, Bologna, Italy The authors have evaluated the stability of osteosynthesis with the use of semirigid mandibular fixation for the correction of class III malocclusion. The semirigid fixation is an original osteosynthesis which was proposed by Paulus in 1992. It uses two adaptive 0.7 mm diameter bicortical screws applied to the upper border of the mandible, above the neurovascular bundle. The characteristics reported by Paulus are as follows: good condylar fit, effective postoperative stability and minor neurovascular damage. In our research the osteosynthesis method reported was used on a sample of 20 patients operated on 1993-94, with a minimum follow-up of at least 18 months. Fifteen of these patients were subjected to a bimaxillary operation during which a rigid fixation was applied to the maxillary level with the use of 4 miniplates and screws. The remaining 5 patients were subjected only to sagittal split osteotomy of the mandibular ramus. All of the patients were submitted to cephalometric controls before the operation (T1), after the operation (T2) and at least 18 months, mean 21 (18-27) months, after the operation (T3). In the cases where only mandibular set-back were done, the results were substantially more stable:
SNB SNPo McNamara/Po
T1
T2
T3
86 °, 1 87 °, 1 - 0.5 mm
80 °, 6 82 °, 4 + 2.3 mm
81 ° 82 ° + 2.4 mm
Instead of in bimaxillary surgery we observed a mean mandibular relapse of 2.56 mm associated with a further forward movement of the maxilla (A point) of 0.47 mm. There was also a substantially correct dental relationship:
SNB SNPo McNamara/Po SNA McNamara/A
T1
T2
T3
81 °, 89 82°,86 - 3.17mm 79°,06 - 2.36mm
79 °, 36 80°,68 - 0.81lnm 80°,66 + 0.53mm
80 °, 88 82°,31 - 3.37mm 82°,30 + l mm
In conclusion, the stability of the mandibular fragments in this sample (patient population) depends on if the upper maxillary was operated on or not. In addition, neither clinical damage to the temporomandibular was noticeable nor lesions to the neurovascular bundle were detected.
Application of COz-Lasertherapy and Cryotherapy to Precancers of the Oral Mucosa
Department of Maxillo Facial Surgery, Universityof Dresden, Dresden, Germany
Materials and Methods: To determine the extent of dysplasia, a biopsy was carried out prior to cryoapplication or CO2-1aser beam application. We investigated whether changes in the extent of dysplasia occur in recurrences of precancers after application of cryotherapy or CO 2lasertherapy and whether there are differences between both therapeutic methods in this regard. In the period of 1984-1995, 192 patients with leukoplakia were registered and treated. After cryosurgical treatment of 74 patients with leukoplakia, there was a recurrence in 23 cases and an increase in the extent of dysplasia in 5. In contrast, recurrence was seen in 9 patients and an increase in the extent of dysplasia in 4 after 68 leukoplakias had been ablated with CO 2 laser. We discuss the differences in the clinical findings and the results of histologic examinations including incidence of recurrence of precancers between the two therapeutic methods.
Clinical and Radiologic Features of Maxillofacial Vascular Malformations
Martin-Granizo R. 1, Ramos M. 2, Monje F, 1, Caniego J.L, 2, Goizueta C.1, Mu~oz M. t, Gil-Diez J.L. 1, Herrera J.A. ~ Departments of 1Oral and Maxillofacial Surgery and 2Radiodiagnosis ( Vascular Section), University Hospital de la Princesa, Madrid, Spain Introduction: Vascular anomalies (VA) have an extremely colom'ful history rife with misconceptions and confusing terminology. Different classifications have been used throughout the years. 1,2Nevertheless this fact seems to be the highest obstacle for the correct understanding and management of these lesions. Several modalities of treatment have been advocated, including steroid injections, alpha 2-interferon, 5 embolization with different substances (ethanol, coils,3 ethibloc4), pressure, laser resection, etc. Purpose: The aim of this presentation is to show our experience in classifying and treating VA in the maxillofacial area. Thus, we use the innovate and simple classification precognized by Mulliken and Glowacki in 1982.1,2 They divide VA into hemangiomas - that ingrowth spontaneously with age - and vascular malformations (VM) which are subdivided in high- (HFVM) or low-flow (LFVM), and enlarge with time. Materials and Methods: Forty patients were retrospectively evaluated in a period of 6 years (1990-1996), 19 males and 21 females. The median age was 30.6 years. Clinical charts and radiological test features were analysed and, thus, are shown. They included, 18 magnetic resonance imaging (T1 and T2), 18 selective angiograms and 9 patients computed tomography.