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At least 289 records · Page 16Linked to original sources
PubMed2005

Bilateral mandibular distraction for patients with compromised airway analyzed by three-dimensional CT.

The purpose of this study was to present the method of mandibular distraction osteogenesis in order to improve airway to respiratory distressed patients due to significant mandibular deficiency, and to present the quantitative volumetric evaluation of mandible and upper airway using three-dimensional-CT (3D-CT) before and after distraction. This study involved 12 patients aged 12 months to seven years with various complaints of Obstructive Sleep Apnea (OSA) such as noisy breathing during sleep, waking episodes, pauses in respiration and daytime somnolence. Some of them were considered tracheostomy candidates. All the patients underwent bilateral mandibular distraction under general anesthesia. 3D-CT of face and neck was performed before and after distraction and a quantitative volumetric evaluation of mandibular volume and airway volume was performed. The results reveal successful mandibular advancement with increase of mandibular volume by an average of 28.24% and increase of upper airway volume with a mean of 71.92%. Moreover, there were improved apnea index and oxygen saturation and elimination of OSA symptoms. In conclusion, the results demonstrate that following distraction osteogenesis of hypoplastic mandible the volume of the mandible and upper airway increases, eliminating symptoms of OSA and preventing tracheostomy.

Child↗
PubMed2005

Pharyngeal narrowing as a common feature in pycnodysostosis--a cephalometric study.

We report on pycnodysostosis presenting as severe snoring caused by pharyngeal narrowing in two siblings. Cephalograms showed pharyngeal narrowing at the level of the soft palate and the base of the tongue caused by the long soft palate and mandibular hypoplasia. From the literature review and our results, we suggest that respiratory insufficiency such as snoring or obstructed sleep apnea are common and under-appreciated symptoms of pycnodysostosis.

Aged↗
PubMed2005

Surgically assisted rapid maxillary expansion (SARME): a review of the literature.

Transverse maxillary hypoplasia, in adolescents and adults, is frequently seen in non-syndromal and syndromal patients including cleft patients. In skeletally matured patients, the uni- or bilateral transverse hypoplasia can be corrected by means of a surgically assisted rapid maxillary expansion. The treatment is a combination of orthodontics and surgical procedures and provides dental arch space for alignment of teeth. The procedure also causes a substantial enlargement of the maxillary apical base and of the palatal vault, providing space for the tongue for correct swallowing and thus preventing relapse. In addition, a distinct subjective improvement in nasal breathing associated with enlargement of the nasal valve towards normal values is seen with an increase of nasal volume in all compartments. In this article we give a review on surgically assisted rapid maxillary expansion. We conclude that there is no consensus in the searched literature regarding either the surgical technique, the type of distractor used (tooth-borne or bone-borne), the existence, cause and amount of relapse and whether or not overcorrection is necessary. A proposal for a prospective randomized patient study in order to find answers to the lacunas in knowledge regarding this treatment is done.

Adolescent↗
PubMed2006

Intraoral distraction osteogenesis for the correction of facial deformities following temporomandibular joint ankylosis: a modified technique.

The aim of this study was to evaluate the feasibility of transoral bimaxillary distraction osteogenesis before releasing temporomandibular joint (TMJ) ankylosis using intraoral mandibular distractors. Nine patients (5 males, 4 females) aged 14-35 (mean 19) years were included. A bilateral Le Fort I osteotomy was performed together with a mandibular osteotomy on the affected side(s). An intraoral distractor(s) was inserted in the lower jaw, followed by an intermaxillary fixation (IMF) to maintain preoperative dental occlusion. The distractor was activated, after a latency period of 5-7 days, 2 times daily by 0.5 mm. There followed a consolidation period of 6-8 weeks. TMJ ankylosis was then released via a peri-auricular incision, a gap arthroplasty was performed, and mandibular movement was established after removal of the IMF and distractor. Optimal results were achieved clinically and radiologically with minimal relapse and complications. Apart from minor complaints, the distraction process was smooth and tolerable in all cases. Total mandibular elongation ranged from 17 to 25 mm (20.7 mm). Occlusal canting decreased to 0 degrees in 7 patients and to 1 degree in 2 patients (mean 0.2 degrees). After a mean follow-up period of 17 months, a mean postoperative mouth opening of 34.7 mm was achieved (0.6 mm preoperatively) and no re-ankylosis was detected. Intraoral distraction of a deformed mandible and maxilla before releasing TMJ ankylosis is a feasible and perhaps advantageous technique.

Adolescent↗
PubMed2004

The role of simultaneous gap arthroplasty and distraction osteogenesis in the management of temporo-mandibular joint ankylosis with mandibular deformity in children.

INTRODUCTION: Temporo-mandibular joint ankylosis is a common cause of acquired deformity in children. PURPOSE: Surgical correction of the ankylosis only leaves the patient with an uncorrected mandibular deformity. This study was to evaluate the use of distraction osteogenesis for simultaneous correction of the mandibular deformity. MATERIAL: This study was done on six children with temporo-mandibular joint ankylosis and mandibular deformity. Uniaxial double pin distractors with Schanz pins were used in this study. METHODS: The patients underwent simultaneous gap arthroplasty and mandibular osteotomy (retromolar) with distractor insertion. Distraction was started on the fifth post-operative day. The patients were put on dynamic temporo-mandibular joint exercises on the first post-operative day. RESULTS: All patients had a satisfactory mouth opening on follow-up. Satisfactory cosmetic correction of the mandibular deformity was also achieved in all these patients. Some degree of malocclusion resulted from treatment due to which the patients were placed on orthodontic treatment. CONCLUSIONS: Distraction osteogenesis can be used simultaneously with gap arthroplasty in patients with temporo-mandibular ankylosis, for the correction of the mandibular deformity.

Ankylosis↗
PubMed2004

Congenital maxillomandibular fusion: a case report and review of the literature.

Congenital fusion of mandible to maxilla (syngnathia) is rare. Only 25 cases of syngnathia have been reported up to date since the first case was reported in 1936. Of these cases only six have involved fusion of the ascending rami of mandible to the maxilla and zygomatic complex. This report is an additional case of syngnathia involving bilateral bony fusion of mandibular horizontal and ascending rami to zygomatic complex and maxilla in a female neonate. Delay in treatment afforded the opportunity to observe the effects on the growth of the patient as she presented again at the age of 3 years.

Female↗
PubMed2005

A new Le Fort I internal distraction device in the treatment of severe maxillary hypoplasia.

PURPOSE: The purpose of this pilot study was to test a new Le Fort I internal distraction device. PATIENTS AND METHODS: A new internal Le Fort I distraction device designed by 1 of the authors was used in 3 patients with cleft lip and palate and severe maxillary hypoplasia who needed maxillary advancements in excess of 12 mm. Presurgical planning used CASSOS (SoftEnable Technology, Ltd, Hong Kong SAR, China) prediction tracing software and a stereolithographic model to calculate the distraction vector. The distractors were pre-bent and installed on the stereolithographic model and activated to advance the maxilla. Surgery was performed in a conventional manner, and distraction was started after a 7-day latency phase at the rate of 1 mm/day and continued until the presurgical plan was achieved. The distractor was removed after a 3-month consolidation phase. Cephalometric radiographs were taken at the completion of each phase. RESULTS: This new Le Fort I internal distraction device successfully distracted the maxillae as planned in all 3 patients. At the end of the distraction phase, the maxillary advancement was measured at 15.8 mm, 15.8 mm, and 13.5 mm, respectively. In each patient, a clockwise rotation of the maxilla was observed with a tendency to a posterior open bite. Postoperative radiographs also showed that the actual distraction vectors differed from the planned vectors. After the consolidation phase, radiographs showed a relapse of 2.6 mm, 0 mm, and 5.0 mm, respectively. There was no further relapse on 3-month follow-up radiographs. Each case showed radiographic evidence of excellent new bone formation at the osteotomy sites. CONCLUSION: The new Le Fort I internal distraction device produced the necessary advancement in all 3 patients. The study also showed that the actual distraction vector differed from the planned vector. This discrepancy was caused by a clockwise rotation of the maxilla during the distraction. Finally, the study showed a variable relapse rate not previously reported in maxillary distraction.

Adolescent↗
PubMed2006

New fixation method for maxillary distraction osteogenesis using locking attachments.

PURPOSE: The external traction hooks of the intraoral splint used in the rigid external distraction (RED) system for maxillary distraction osteogenesis interfere with the surgical procedures. The purpose of this study is to introduce an innovative splint fixation method for maxillary distraction osteogenesis with Locking Attachments and evaluate their advantages, such as reduction of operating time compared with the traditional intraoral splint method. PATIENTS AND METHODS: Retrospective comparison of operative times of maxillary Le Fort I osteotomy procedures was carried out with the traditional protocol using the intraoral splint cemented to the maxillary dentition (n = 14), and a removable intraoral splint that is inserted postsurgically (n = 14). Operative procedure times were compared and analyzed statistically using the data extracted from the surgical records. RESULTS: There were no complications inserting the removable splint postsurgically, including pain, discomfort, or time-consuming procedure. Stable and secure splint fixation was obtained before the distraction procedure and the desired treatment goals were obtained in all patients. The total operative procedure times were significantly reduced in the Locking Attachments group by 24% to 41% (approximately 65 minutes) compared with earlier operations involving the conventional splints (P < .05). CONCLUSIONS: Maxillary distraction osteogenesis with the Locking Attachments is a highly effective fixation approach to manage severe hypoplastic maxilla, eliminating lip constraints resulting from scarring and allowing for easier, more deliberate and careful dissection. The use of the Locking Attachments is reliable in craniofacial surgery and has proved to be advantageous in the reduction of the operating time and surgical risks.

Adolescent↗
PubMed2006

The use of internal maxillary distraction for maxillary hypoplasia: a preliminary report.

PURPOSE: Distraction osteogenesis is a useful alternative to advance the maxilla in complicated cases of maxillary hypoplasia. The purpose of this article is to review the workup, experience, and preliminary results with the use of internal distraction osteogenesis for maxillary hypoplasia at one teaching institution. PATIENTS AND MATERIALS: Over a 5-year period, more than 300 patients with craniofacial and dentofacial defects have undergone oral and maxillofacial surgery at our center to correct their skeletal discrepancies. Of these, 10 have had maxillary distraction osteogenesis done with internal distractors. Follow-up of 6 months or more was available for 8 patients. Stereolithographic models were used to bend distractors prior to surgery in 6 patients. RESULTS: Latency prior to the start of distraction was 3 to 7 days and varied with the age of the patient. Distraction occurred at approximately 1 mm per day with an average distraction length of 8.5 mm (range, 6-10 mm). Excellent occlusal results were obtained in 5 patients. Major complications including nonunion and failure to achieve acceptable occlusal results were observed in 3 patients. Minor complications including pain and loosening of the distracter devices were observed in 2 patients, but did not appear to affect the esthetic and functional results. CONCLUSIONS: Distraction osteogenesis is a useful alternative to traditional orthognathic surgery to treat maxillary hypoplasia. Internal distractions are attractive to patients, but are more difficult to place and can cause discomfort to patients when trying to achieve an ideal primary vector of distraction. Stereolithographic models can help with placement of the device. Changes in design of distractors may help with patient discomfort.

Adolescent↗
PubMed2004

IMAGe syndrome: a complex disorder affecting growth, adrenal and gonadal function, and skeletal development.

IMAGe syndrome (intrauterine growth restriction, metaphyseal dysplasia, adrenal hypoplasia congenita, genital abnormalities; MIM 300290) is a multisystem disorder with a broad phenotype, which, if unrecognized, may result in major and possibly life-threatening complications. Initial clinical features overlap with those of Russell-Silver syndrome (RSS) and isolated growth hormone (GH) deficiency, conditions from which it must be distinguished. We report an Australian male with adrenal hypoplasia congenita (AHC) in association with IMAGe syndrome. The patient had intrauterine growth restriction (IUGR) and dysmorphic features comprising small, low-set ears, micrognathia, bilateral cryptorchidism, micropenis, and skeletal abnormalities. Signs of adrenal insufficiency occurred at aged 4.6 years. Our patient differs from those previously described by the late onset of adrenal insufficiency and the presence of GH deficiency. IMAGe is a complex syndrome involving dysmorphic features; disorders of growth, gonadal, and adrenal function; and skeletal abnormalities.

Adrenal Insufficiency↗
PubMed2004

Radiologic and histological evaluation of otogenic sliced cartilage grafts at the tip of the chin of rabbits: an experimental study.

OBJECTIVES: Cartilage grafts have been commonly used in plastic and reconstructive surgery applications for many different goals, such as auricular reconstruction and rhinoplasty. The use of autologous cartilage is ideal for many reasons. An attempt was made to produce an experimental animal model to test the efficacy of otogenic Surgicel-wrapped sliced cartilage. METHODS: In this experimental study, cartilage grafts were harvested from rabbits' ears. These grafts were cut in pieces of 0.5 mm to 1 mm using a no. 11 blade. This cartilage mass was wrapped in one layer of Surgicel (oxidized regenerated cellulose) and inserted in the chin of the rabbits. MR analyses were made at 1 week and 6 months and histological analyses were made at 6 months. RESULTS: Cartilage grafts maintained approximately 80% of their dimensions in MRI. The proportion of necrosis was between 30% and 50% and the proportion of resorption was approximately 20% in the histological studies.

Animals↗
PubMed2004

Bilateral bifid mandibular condyle.

The bifid condyle is a rather uncommon condition that is diagnosed radiographically. Its etiology is unknown, although the most tenable theory is that it is of traumatic origin. The purpose of this article is to report a new case of a bilateral bifid condyle (the left one manifested a trifid appearance) and to review the relevant literature.

Adolescent↗
PubMed2004

Backward distraction osteogenesis of condylar segment in patient with mandibular ramus deficiency--report of a case.

A backward distraction osteogenesis (BDO) of the condylar segment for treatment of mandibular ramus deficiency was developed. This report describes the clinical progress of a patient with mandibular ramus deficiency in whom satisfactory occlusion was achieved and maintained by gradual posterosuperior repositioning of the displaced condyles into the glenoid fossae during intermaxillary fixation. Findings of pre- and postoperative clinical and magnetic resonance imaging indicate that the effect of BDO on the temporomandibular joint was negligible.

Cephalometry↗
PubMed2006

Unexpected breakage of mandibular midline distraction device: case report.

Management of the transverse mandibular deficiency and anterior crowding by mandibular midline distraction osteogenesis (MMDO) is an efficient and stable alternative to orthodontic mechanics with minor complications. Although the only major complication reported previously during MMDO is the nonunion of the segments, in the present case report an unexpected breakage of the distractor in MMDO during the consolidation period as a new major complication was presented.

Adolescent↗