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Stability following surgical correction of mandibular prognathism: vertical subsigmoid osteotomy versus sagittal split osteotomy
226
British
Journal
of Oral
Preliminary experience Morton, S. Chadwick, Blackburn, UK.
and Maxillojacial
of intraoral distraction J. C. Lowry. Blackburn
Surgery osteogenesis. M. E. Royal Infirmary,
The Ilizarov method of callus distraction’ has been applied to mandibular lengthening using extra oral devices2 More recently, intraoral devices have become available. In this paper, the authors will present their experience with one type of commercially available intraoral distractor in 5 clinical cases: The planning procedures, technical problems and complications will be discussed, particularly with reference to extending this procedure from the wider craniofacial field to the management of Class II Division I malocclusions.
References Ilizarov G A. The principles of the Ilizarov method. Bull Hosp Joint Dis Orthop Inst 1988; 48: l-1 1. McCarthy J G, Schreiber J, Karp N, Thorne C H, Grayson B H. Lengthening of the human mandible by gradual distraction. Plast Reconstr Surg 1992; 89: l-8.
Stability following vertical subsigmoid Ayoub, D. Millett, West of Scotland Hospital, Bearsden,
surgical correction of mandibular prognathism: osteotomy versus sagittal split osteotomy. A. S. Hasan, K. Moos, University of Glasgow & Regional Maxillofacial Unit, Canniesburn Glasgow, UK.
The aim of this study was to investigate stability following mandibular set-back osteotomy. This investigation was conducted on 31 patients who had ramus osteotomy for correction of their mandibular prognathism. In 15 cases (group l), the sagittal split osteotomy (SSO) technique was utilized for mandibular set-back. In the other 16 cases (group 2) the vertical sub-sigmoid osteotomy (VSS) was carried out for correction of mandibular prognathism. Lateral cephalographs taken immediately before surgery, within the first week following surgery, and at least one year postoperative intervals, were used in the assessment. The cases were matched in both groups. No statistically significant differences were detected between the two groups regarding the extent of preoperative surgical deformities or the magnitude of mandibular set-back. There were statistically significant differences in mandibular stability between the two groups (Student t-test P = 0.0034) at the one-year postoperative follow-up interval. Cases treated by SSO showed significant mandibular relapse of about 50% of the achieved surgical change. The mandible relapsed in a forward direction with minimal vertical changes. In group 2, the mandible was quite stable and changes detected at one year postoperative interval were not significant. The VSS is more stable than SSO for mandibular set-back.
Gender-confuming facial surgery. A. G Becking, J J Hage, T&zing. Department of Oral and Maxillofacial Surgery Plastic and Reconstructive Surgery, Free University Hospital, Box 7057 1007, MB Amsterdam, The Netherlands.
D. B. and P.O.
To facilitate passing in public as a member of the opposite sex, gender-confirming facial surgery is incidentally carried out in male-tofemale transsexuals. From anthropologic and forensic studies, several cross-gender differences can be noted for the facial skeleton, the subcutaneous tissues and the skin. With use of anthropometric data, several significant and surgically correctable differences can be identified. In the period 1992-1996, 46 male-to-female transsexuals were referred for possible bony facial corrections as gender-confirming procedures of the face. In 11 cases, patients’ expectations and surgical possibilities did not match. In the remaining 35 patients, 45 surgical facial procedures were performed. Of the 35 patients, 29 patients had undergone genital reassignment while in 5 this was scheduled. Several techniques were used for feminizing a male face. Mandibular angle reduction (n = 23) is carried out to reduce the
lower facial width. Chin reduction procedures (n = 14) are performed to 3-dimensionally reduce the masculine, prominent bony chin. Zygoma onlay or zygoma osteotomies (n = 3) increase the mid-facial width. Bimaxillary osteotomies (n = 3) with dorsal impaction and clockwise rotation of the bimaxillary complex decrease the projection of both the chin and the mandibular angle region. Reduction of the supraorbital prominence (n = 2) leads to less frontal bossing and a more obtuse naso-frontal angle, which are considered feminine. The latter technique can easily be combined with a browlift procedure and thus feminize the curvature and position of the eyebrows. Rhinoplasty was performed separately in 21 patients with nasal osteotomies and tip surgery to correct the different angles of the nose toward a more feminine appearance. In selected male-to-female transsexuals, good results were obtained with gender-confirming facial surgery. Stability of the results, psychosocial aspects and improvement of quality of life need further evaluation.
A morphological study of the thoracic duct at the jugulo-subclavian junction. R. J Langford’, A. T Daudia2, 7: J Malin? ‘Royal Shrewsbury Hospital, Shrewsbury; *Department of Anatomy, University of Cambridge, Cambridge; 3North Staffordshire Hospital, Stoke on Trent, UK. Chyle fistulae are uncommon but serious complications of neck surgery, occurring with an incidence of l-2% after radical neck dissection. The majority (75%92%) occur on the left side and are due to damage to the terminal segment of the thoracic duct as it drains into the great veins of the neck in the region of the venous angle. The risk of trauma to the terminal thoracic duct may be influenced by anatomical variations. A knowledge of the surgical anatomy is of obvious importance in avoiding accidental trauma to the duct and in the subsequent surgical management of chyle leaks should they occur. A cadaveric study was therefore undertaken to examine the anatomical variations in the drainage of the thoracic duct in the neck. Particular attention was paid to any factors which might predispose to iatrogenic damage to the duct during neck dissections. Twenty four cadavers were included in the study and our results are presented.
National Facial Injury Survey: facts, figures learned. P Magennis’, I. HutchisonT ‘Walton *Royal London Hospital and St Bartholomew’s,
and lots Hospital, London,
of lessons Liverpool; UK.
In September of 1997. 137 maxillofacial units participated in the first national survey of facial injuries using a specially designed proforma. In total 6114 patients presenting to 163 accident and emergency units were included in the survey. The forms were processed and information analysed within 9 weeks and some preliminary results submitted for publication in the British Journal of Oral and Maxillojacial Surgery. Further results will be discussed along with details of the Iogistics of processing a national survey to a strict timetable and lessons learned if the process is ever to be repeated.
BAOMS National Facial Injury Week: report of activity and effect. I! Magennis’, I. Hutchisot?. ‘Royal London Hospital and St Bartholomew’s, Londom2 Walton Hospital, Liverpool, UK. The second national campaign run by the Information Subcommittee of the BAOMS followed the success of Oral Cancer Awareness Week. Virtually every oral and maxillofacial unit in the UK took part in the week. Activities included: visiting schools with a professionally produced video, A&E lectures, and media activity including interviews, articles, an editorial in the British Medical Journal and the results of a national survey published in the British Journal of Oral and Maxillojacial Surgery. A summary of the national and local events is presented and measures of the impact of the campaign are detailed.
British
Journal
of Oral
Preliminary experience Morton, S. Chadwick, Blackburn, UK.
and Maxillojacial
of intraoral distraction J. C. Lowry. Blackburn
Surgery osteogenesis. M. E. Royal Infirmary,
The Ilizarov method of callus distraction’ has been applied to mandibular lengthening using extra oral devices2 More recently, intraoral devices have become available. In this paper, the authors will present their experience with one type of commercially available intraoral distractor in 5 clinical cases: The planning procedures, technical problems and complications will be discussed, particularly with reference to extending this procedure from the wider craniofacial field to the management of Class II Division I malocclusions.
References Ilizarov G A. The principles of the Ilizarov method. Bull Hosp Joint Dis Orthop Inst 1988; 48: l-1 1. McCarthy J G, Schreiber J, Karp N, Thorne C H, Grayson B H. Lengthening of the human mandible by gradual distraction. Plast Reconstr Surg 1992; 89: l-8.
Stability following vertical subsigmoid Ayoub, D. Millett, West of Scotland Hospital, Bearsden,
surgical correction of mandibular prognathism: osteotomy versus sagittal split osteotomy. A. S. Hasan, K. Moos, University of Glasgow & Regional Maxillofacial Unit, Canniesburn Glasgow, UK.
The aim of this study was to investigate stability following mandibular set-back osteotomy. This investigation was conducted on 31 patients who had ramus osteotomy for correction of their mandibular prognathism. In 15 cases (group l), the sagittal split osteotomy (SSO) technique was utilized for mandibular set-back. In the other 16 cases (group 2) the vertical sub-sigmoid osteotomy (VSS) was carried out for correction of mandibular prognathism. Lateral cephalographs taken immediately before surgery, within the first week following surgery, and at least one year postoperative intervals, were used in the assessment. The cases were matched in both groups. No statistically significant differences were detected between the two groups regarding the extent of preoperative surgical deformities or the magnitude of mandibular set-back. There were statistically significant differences in mandibular stability between the two groups (Student t-test P = 0.0034) at the one-year postoperative follow-up interval. Cases treated by SSO showed significant mandibular relapse of about 50% of the achieved surgical change. The mandible relapsed in a forward direction with minimal vertical changes. In group 2, the mandible was quite stable and changes detected at one year postoperative interval were not significant. The VSS is more stable than SSO for mandibular set-back.
Gender-confuming facial surgery. A. G Becking, J J Hage, T&zing. Department of Oral and Maxillofacial Surgery Plastic and Reconstructive Surgery, Free University Hospital, Box 7057 1007, MB Amsterdam, The Netherlands.
D. B. and P.O.
To facilitate passing in public as a member of the opposite sex, gender-confirming facial surgery is incidentally carried out in male-tofemale transsexuals. From anthropologic and forensic studies, several cross-gender differences can be noted for the facial skeleton, the subcutaneous tissues and the skin. With use of anthropometric data, several significant and surgically correctable differences can be identified. In the period 1992-1996, 46 male-to-female transsexuals were referred for possible bony facial corrections as gender-confirming procedures of the face. In 11 cases, patients’ expectations and surgical possibilities did not match. In the remaining 35 patients, 45 surgical facial procedures were performed. Of the 35 patients, 29 patients had undergone genital reassignment while in 5 this was scheduled. Several techniques were used for feminizing a male face. Mandibular angle reduction (n = 23) is carried out to reduce the
lower facial width. Chin reduction procedures (n = 14) are performed to 3-dimensionally reduce the masculine, prominent bony chin. Zygoma onlay or zygoma osteotomies (n = 3) increase the mid-facial width. Bimaxillary osteotomies (n = 3) with dorsal impaction and clockwise rotation of the bimaxillary complex decrease the projection of both the chin and the mandibular angle region. Reduction of the supraorbital prominence (n = 2) leads to less frontal bossing and a more obtuse naso-frontal angle, which are considered feminine. The latter technique can easily be combined with a browlift procedure and thus feminize the curvature and position of the eyebrows. Rhinoplasty was performed separately in 21 patients with nasal osteotomies and tip surgery to correct the different angles of the nose toward a more feminine appearance. In selected male-to-female transsexuals, good results were obtained with gender-confirming facial surgery. Stability of the results, psychosocial aspects and improvement of quality of life need further evaluation.
A morphological study of the thoracic duct at the jugulo-subclavian junction. R. J Langford’, A. T Daudia2, 7: J Malin? ‘Royal Shrewsbury Hospital, Shrewsbury; *Department of Anatomy, University of Cambridge, Cambridge; 3North Staffordshire Hospital, Stoke on Trent, UK. Chyle fistulae are uncommon but serious complications of neck surgery, occurring with an incidence of l-2% after radical neck dissection. The majority (75%92%) occur on the left side and are due to damage to the terminal segment of the thoracic duct as it drains into the great veins of the neck in the region of the venous angle. The risk of trauma to the terminal thoracic duct may be influenced by anatomical variations. A knowledge of the surgical anatomy is of obvious importance in avoiding accidental trauma to the duct and in the subsequent surgical management of chyle leaks should they occur. A cadaveric study was therefore undertaken to examine the anatomical variations in the drainage of the thoracic duct in the neck. Particular attention was paid to any factors which might predispose to iatrogenic damage to the duct during neck dissections. Twenty four cadavers were included in the study and our results are presented.
National Facial Injury Survey: facts, figures learned. P Magennis’, I. HutchisonT ‘Walton *Royal London Hospital and St Bartholomew’s,
and lots Hospital, London,
of lessons Liverpool; UK.
In September of 1997. 137 maxillofacial units participated in the first national survey of facial injuries using a specially designed proforma. In total 6114 patients presenting to 163 accident and emergency units were included in the survey. The forms were processed and information analysed within 9 weeks and some preliminary results submitted for publication in the British Journal of Oral and Maxillojacial Surgery. Further results will be discussed along with details of the Iogistics of processing a national survey to a strict timetable and lessons learned if the process is ever to be repeated.
BAOMS National Facial Injury Week: report of activity and effect. I! Magennis’, I. Hutchisot?. ‘Royal London Hospital and St Bartholomew’s, Londom2 Walton Hospital, Liverpool, UK. The second national campaign run by the Information Subcommittee of the BAOMS followed the success of Oral Cancer Awareness Week. Virtually every oral and maxillofacial unit in the UK took part in the week. Activities included: visiting schools with a professionally produced video, A&E lectures, and media activity including interviews, articles, an editorial in the British Medical Journal and the results of a national survey published in the British Journal of Oral and Maxillojacial Surgery. A summary of the national and local events is presented and measures of the impact of the campaign are detailed.