Secondary autogenous and alloplastic reshaping procedures for facial asymmetry.
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Maxillo-mandibular myxomas are rare lesions and their pathogeny remains unclear. The poor clinical picture and the absence of pain makes the diagnosis difficult. Because of the long lasting course, the tumor is usually large at the time of diagnosis. Although this tumor is benign, the local aggression and the high rate of recurrence dictate a radical treatment.
Tissue reactions to active modified composite material were studied in experiments on Chinchilla rabbits. In the first series of experiments plates from composite material were implanted: polymethylmethacrylate (PMMA) plates were used in group 1, PMMA composition with hydroxyapatite (HAP) in group 2, and PMMA composition with HAP modified by polyacrylic acid in group 3. The content of HAP in each group was 30% by weight. Implantation of plates from pure PMMA induced atrophic processes with formation of connective tissue capsule at the site of implantation. In the second series of experiments the manifestations of inflammatory reactions in the bone and adjacent tissues, caused by HAP release into tissue, were observed, which were paralleled by activation of bone formation, which sometimes acquired the pattern of a hyperproductive reaction. PMMA/HAP composite modified by chemical bond proved to be the most effective: its implantation caused no manifest pathological reactions and inflammatory infiltration; no intraosseous deposition of crystals were detected. Intensive osteogenesis round the implanted plate was observed.
Lower jaw tumours in Nigeria often grow to enormous size. A high cure rate can be achieved by wide excision of the tumours and bone grafting. Of 23 patients who underwent mandibular reconstruction in Enugu, Nigeria, over a ten year period, loss of bone graft occurred in three patients (14.28%), but no recurrence of tumour was noted over a follow-up period ranging from 2-12 years. An acceptable aesthetic and functional result followed bone grafting in most cases.
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We describe our experiences with a new silicone bag-gel chin implant, developed in two phases over a 4-year period. Fifty patients received the Phase I implant, and such complications as internal and external soft tissue erosion, indentation, slippage, asymmetry, infection, andd late bone resorption (two cases) were seen. Subsequently 28 patients received the Phase II implant, and have been followed up to one year. So far, the only complication has been asymmetry in one case.
OBJECTIVE: To evaluate the feasibility of designing and fabricating customized titanium bone substitutes to restore mandibular bone defects using reverse engineering (RE) and rapid prototyping (RP) techniques. METHODS: Titanium tray for mandibular defects were designed and fabricated through multi-step procedures of reverse engineering and rapid prototyping, then in operation it was filled with cancellous bone and fixed. RESULTS: The bone substitutes fabricated by this method had been successfully put into clinical use for maxillofacial surgery in 2 patients and got a satisfactory result. CONCLUSIONS: Reverse engineering combining with rapid prototyping could accomplish the design and manufacture of implant for the restoration of mandibular bone defects.
The use of silicone implants to correct an acquired or congenital abnormality of the face involves the use of:--blocks of foam, though these retract and the volume implanted must therefore be overestimated.--compact blocks of elastomer, which tend to migrate and to produce inaesthetic bumps with disturbances in the vascularisation of the skin. The authors therefore had the idea of making "to measure" implants similar to breast implants: envelope of silicone elastomer enclosing a gel of chosen viscosity, absorbing forces applied to the envelope and therefore tending to prevent migration of the implant. The latter has dacron patches to facilitate its adherence to deep layers. This description of manufacturing methods and operative techniques, despite a short follow-up, reports encouraging results from which it is possible to determine the indications of this type of procedure.
OBJECTIVE: To study the applications of bone grafts from the cranium or mandible in the repair of posttraumatic deformities of the nose. METHODS: From 1997 to 2002, a total of 44 patients, who presented with secondary nose deformity as well as facial fractures, were reconstructed by autogeneous outer table grafts of the calvarial or mandibular bone after facial skeleton reposition. In this series, 32 cases used the calvarial bone, 12 cases used the mandible bone, which was harvested through a coronal incision and an oral approach respectively. RESULTS: The surgical incisions healed primarily in all patients with minimal scar. The facial appearance was greatly improved. No implant infection, extrusion and shift were observed in the postoperative follow-up of 6 months to 2 years. There was not obvious bone resorption, nor donor site morbidity. CONCLUSION: Autogeneous calvarial and mandibular bone was an ideal material of bone graft in reconstruction of severe posttraumatic deformities of the nose. Compared with other autogeneous and alloplastic materials, the outer table of the calvarial and mandibular bone produced less morbidity of the donor site, invisible scar, no rejection and less resorption.
Between 1988-1997 in the Department of Dental and Maxillo-facial Surgery of Medical University in Lublin there were applied three types of fixation of mandible bone fracture. Depending on the kind of fracture and teeth condition with 692 (i.e. 60%) patients there was applied preservative treatment and 530 undergone surgery (i.e. 18.1%) and undergone surgical and orthopedic treatment (i.e. 21.9%). Upon analysis of treated population it was concluded, that during period of assessment there occurred significant change of implications for the application of fixation of mandible bone fracture and the leading method became mandible osteosynthesis with intraoral approach.
Alloplastic facial contouring is now new in plastic surgery. The demand for it, however, is rapidly increasing. Plastic surgeons must therefore explore newer and better techniques. This article presents modern concepts of evaluating the facial skeleton by zonal principles of anatomy in order to utilize contemporary design premandible and malar/midface implants and achieve more accurate and individualized facial contours. Standard techniques for performing satisfactory alloplastic facial implants are presented.
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For the fixation of mandibular fractures, at the Department of Oral Surgery and Dentistry at Semmelweis University, anodically and thermically treated TiO2/Ti osteosynthesis plates are used. The corrosion studies were performed in a generally-applied 3-electrode electrochemical measurement cell, with a calomel electrode as reference electrode, and a Pt net as conducting electrode. The cyclic voltammetric measurements demonstrated that the pore-free surface TiO2 layer forms a highly protective barrier on the surface of Ti. The electrochemical impedance spectrum reflected a decrease in inhomogeneity of the sample because of a decrease in the number of pinholes. Such a change is indicative of passivation. The reported techniques appear to comprise a reliable method of study for an evaluation of the long-term corrosion behaviour of implants.
Deformations after mandibular resection can be eliminated by single stage defects replacement by reconstructive materials of different origin. Prior to microsurgical methods of jaws reconstruction the patient rehabilitation with defects of the jaws had very limited success due to a number of drawbacks of traditional techniques (transplant tendency to resorption and seizure, complexity in surrounding tissues recovery) that makes impossible the use of the dental implantation techniques. In case of interdisciplinary planning of the treatment dental implants can be successfully placed in reconstructed mandible providing the conditions for aesthetic and functional rehabilitation of patients. The article described a clinical case of carrying out microsurgical mandible reconstruction with consequent placing of 7 dental implants and rational prosthetic appliance making.
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