Maxillary and mandibular osteotomy for maxillary and mandibular protrusion.
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Mandible↗
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Transoral approach using the mandibular osteotomy for atlantoaxial vertical subluxation in juvenile rheumatoid arthritis associated with mandibular micrognathia.
We report a case of atlantoaxial vertical subluxation with mandibular micrognathia associated with juvenile rheumatoid arthritis. The patient was treated by odontoidectomy via the transoral approach and required a sagittal split mandibular osteotomy because of the mandibular micrognathia. The clinical outcome was excellent.
Adult↗
Condylar changes after contralateral mandibular osteotomy in the rabbit.
Following orthognathic surgery undesirable changes in the temporomandibular joints (TMJs) are noted sometimes. Altered stress on the condyle and surrounding tissue frequently causes morphological changes in the TMJ. The purpose of the present study was to assess these morphologic changes in a rabbit following mandibular osteotomy and the resulting mandibular body rotation. Adult male Japanese white rabbits (3 kg, 12-16 weeks old) were applied in this study. An experimental mandibular osteotomy was performed on the right side of the body of the mandible. The surgery includes vertical mandibular body osteotomy 5 mm in width after masseter muscle reflection. Then the anterior and posterior osseous segments were fixed with wire at previously made holes. As a result, the condylar medio-lateral width on the contralateral (left) side was significantly larger than that of the ipsilateral side 2 weeks postoperatively (p < 0.05). There were significant differences in the angle between the right and the left condylar heads 4 weeks postoperatively (p < 0.05). The present experimental study demonstrated morphological changes in the contralateral TMJ caused by unilateral mandibular osteotomy. Postoperative morphological changes implied that there is a process of biological adaptation in the rabbit TMJ.
Adaptation, Physiological↗
Hemorrhage following mandibular osteotomies: a report of 21 cases.
Hemorrhage associated with mandibular osteotomies, especially to the extent that it becomes life threatening, is a rare occurrence and its risk is less than that following maxillary orthognathic surgery. Twenty-one cases of significant bleeding following mandibular sagittal split ramus osteotomies, vertical and oblique ramus osteotomies, and genioplasties are presented. Life-threatening hemorrhage associated with mandibular osteotomies is primarily an intraoperative problem and the incidence of major postoperative and recurrent hemorrhage is not as great as following maxillary osteotomies. Suggestions for the avoidance and treatment of these bleeding complications are discussed.
Adolescent↗
What is the best possible design of temporary anterior mandibular osteotomy? A histomorphological animal study.
When squamous cell carcinomas in the oral cavity have advanced to the size of T2 to T3 or when they start to encroach on the middle, occasionally it is necessary to divide the mandible at the parasymphysis and swing the hemimandible away from the midline for intraoral exposure of tumor resection. The osteotomy is usually performed in either a straight vertical cut, in a step-cut fashion, or in a dove-tail geometric configuration. The design of the geometric pattern of the osteotomy determines whether or not the postoperative period is prolonged. The authors analyzed the best possible design of temporary anterior mandibular osteotomy. In an animal study of 12 Goettingen minipigs (GMPs) the authors investigated the best possible design of geometric pattern of mandibular osteotomy and the fragment healing process. Their primary interest was directed at the histomorphological bone-healing process after straight vertical bone cut, step-cut fashion, and dove-tail osteotomy of the mandible, and rigid fixation with an osteosynthesis plate. From this study it can be concluded that the dove-tail osteotomy of the mandible is the best possible design of temporary anterior mandibular osteotomy in preventing pseudoarthrosis due to the mainly primary bone contact and gap healing process.
Animals↗
[The profile surgery. Mandibular osteotomies].
During the years 1987-1994, 31 mandibular osteotomies have been performed in 25 patients, 15 had mandibular alteration alone, 10 of them with prognatism, 2 with microretrognatia and 3 with chin hipoplasia. The other 10 had a combined maxillary-mandibular alteration with hipoplasia and maxillary retrussion. The preoperative work-up included cephalometric and dental study, and a cast model was done to asses the theoretical benefic of the osteotomy. All these patients underwent orthodontic treatment before and after surgery. The results have been good or very good in 96% of the cases. The ortognatic surgery offers significant aesthetic and functional improvement to these patients.
Adolescent↗
Mandibular osteotomy fixed with biodegradable plates and screws: an animal study.
The objective of the study was to evaluate the use of a totally biodegradable fixation device in the fixation of mandibular osteotomy in sheep. Mandibular unilateral body osteotomies were fixed with biodegradable self-reinforced poly-L-lactide (SR-PLLA) multi-layer plates and screws in nine sheep. The unoperated sides acted as control. The follow-up times were 6, 12 and 24 weeks, after which radiological, mechanical and histological studies were carried out. An analysis of the implanted material was also carried out. The results showed that the SR-PLLA plates and screws were strong enough to fix the osteotomy and that the osteotomies healed mainly with callus formation. Therefore we conclude that SR-PLLA multi-layer plates and screws can be used together successfully in the fixation of mandibular osteotomies without maxillomandibular fixation. However, before they can be used in humans, the size of the plate and screws should be decreased.
Animals↗
Mandibular osteotomies for tumor extirpation: the advantages of rigid fixation.
Adequate exposure of intraoral tumors occupying the posterior oral cavity, base of tongue, tonsil, and superior hypopharynx for wide-field primary surgical resection is critical to precise tumor ablation. The exposure resulting from a mandibular osteotomy has greatly assisted the tumor ablation of these areas. This procedure has also been beneficial in providing exposure to the anterior skull base, pterygomaxillary, and infratemporal space, clivus, and nasopharynx. In evaluating various osteotomy sites and methods of fixation, we reviewed 26 patients treated for benign or malignant neoplasia of the head and neck requiring mandibulotomy. The osteotomy complication rate was 2 (29%) of 7 for wire osteosynthesis and 1 (5.3%) of 19 for plate osteosynthesis. All patients with osteotomy complications had received preoperative radiation therapy. The one complication in the plated group was associated with a lateral stairstep osteotomy and two screws on either side of the osteotomy. This study suggests advantages of absolute rigid internal fixation of mandibular osteotomies used for tumor ablation. It is also concluded that a midline osteotomy reapproximated with rigid internal fixation has the benefits of 1. primary bone healing by means of plating counteracting the balanced forces acting on the symphysis; 2. improved reapproximation with minimal bony loss, improving occlusion; 3. decreased incidence of osteoradionecrosis as the symphysis lies outside the usual radiation ports; 4. preservation of the neurovascular bundle; and 5. maintenance of osteotomy-site immobility in an infected field. This review helped identify surgical techniques that decrease the complications that are commonly associated with mandibular osteotomies for precise tumor ablation.
Adult↗
The effect of mandibular nerve block on opioid consumption, nausea and vomiting in bilateral mandibular osteotomies.
UNLABELLED: The purpose of this study was to compare the efficacy of a mandibular nerve block to placebo, in patients undergoing mandibular osteotomy surgery, regarding opioid consumption and adverse opioid induced side effects. Forty healthy individuals with a mean age of 19.7 years participated in the study. All subjects received lidocaïn 2% + adrenaline 1/80,000 versus placebo for mandibular nerve block in a randomized double-blind manner. Opioid consumption and opioid related side effect such as postoperative nausea and vomiting (PONV), and respiratory depression were assessed. RESULTS: The placebo group received significantly more sufentanil during the surgical procedure than the lidocaïngroup. There were no significant differences in adverse opioid induced side effects. In the postoperative phase there was no difference in additional pain intervention between the two groups. CONCLUSION: The mandibular block during mandibular osteotomy reduces intra-operative opioid consumption but does not alternate the opioid related side-effects in the postoperative phase.
Adult↗
Inferior alveolar nerve function after mandibular osteotomies.
A total of 1034 patients who had undergone orthognathic surgery were examined after 2 years; 818 had been treated with varying types of mandibular osteotomy such as vertical ramus osteotomy, sagittal split ramus osteotomy, and genioplasty. Neurosensory function in the mental nerve region was assessed by evaluating light touch perception. The incidence of neurosensory deficiency was 216/548 (39%) after sagittal split ramus osteotomy, 26/140 (19%) after extraoral vertical ramus osteotomy, 9/78 (12%) after genioplasty and 60/650 (9%) after intraoral vertical ramus osteotomy. Additional genioplasty increased both the incidence and severity of neurosensory disturbance after intraoral vertical ramus osteotomy but did not significantly influence the neurosensory function after sagittal split ramus osteotomy. The incidences of neurosensory disturbance after mandibular osteotomies in this report correspond well with those previously reported, but the incidence of almost 40% after sagittal split ramus osteotomy must be considered a disquieting drawback of the procedure.
Adult↗
Speech and lingual behavior before and after mandibular osteotomy.
A procedure was applied to compare the oral behavior of five patients before and after mandibular osteotomy for correction of Class III malocclusions. It was found that observable changes in oral behavior do occur after mandibular osteotomy. Fewer errors were found in sibilant articulation, while more maladaptive lingual behaviors were found in lingual diadochokinetic tasks. Changes were also found in swallowing behaviors. Performance tasks of speech, diadochokinetics, and swallowing were recorded on audio-videotape.
Adolescent↗
Mandibular osteotomy complicated by styloid pain.
Although temporomandibular joint pain is not a rare complication of mandibular surgery, styloid pain syndrome has not been recognized heretofore as a complication of mandibular osteotomy. Usually styloid pain syndrome occurs following tonsillectomy or de novo. Most styloid syndromes involve the styloid process, the stylohyoid attachments, or the carotid artery. This article presents a case of stylohyoid pain syndrome caused by stretching of the stylomandibular ligament following mandibular osteotomy. Additional surgical intervention was required to relieve the symptoms in this case. Styloid process pain syndromes are reviewed.
Adult↗
Relationships of changes in craniofacial morphology, head posture, and nasopharyngeal airway size following mandibular osteotomy.
The aim of the present study was to illustrate a possible relationship between changes in craniofacial morphology after mandibular osteotomy and changes in head posture and nasopharyngeal airway size. The material comprised standardized profile cephalograms of 52 patients with mandibular prognathism, all of whom underwent orthodontic adjustment before mandibular osteotomy. Mean age of the patients was 24.3 years; 12 men and 40 women participated in the study. The first profile radiograph of each patient was taken 1 day before surgical treatment in the natural head (mirror) position. All patients underwent mandibular surgery with a bilateral vertical ramus osteotomy. The cephalometric investigation was repeated approximately 1 year after the surgical procedure (means = 1.12 years). Craniofacial morphology was evaluated by 12 parameters describing sagittal and vertical jaw relationship. Head posture was evaluated by the craniocervical angulation and airway as nasopharyngeal airway size. Pearson's correlation analysis was used to evaluate the relationship between morphology, posture, and airway size before surgery and changes in these parameters after surgery. Before surgical treatment statistically significant correlations were found between posture and many morphologic variables, mostly mandibular. Small correlations were observed between posture and airway size, and airway size and morphology. After the surgical procedure, changes in posture were still related to changes in mandibular morphology, while other correlations between posture and morphology had been eliminated. Changes in nasopharyngeal airway size were not correlated to any changes in morphology, apart from maxillary prognathism, nor to changes in posture. The results indicated that mandibular morphology and function play a significant role in determining head posture.
Adolescent↗
Treatment of micrognathia with edentulous maxilla by sagittal split mandibular osteotomy and a subperiosteal implant immobilized with transmaxillary screws.
Micrognathia complicated by edentulous maxilla was treated by performing sagittal-split mandibular osteotomy and immobilizing a subperiosteal implant using transmaxillary screws. The patient was a 42-year-old man who had a birdlike facial deformity caused by significant hypoplasia of the mandible. He also demonstrated significant malocclusion attributable to micrognathia and edentulous maxilla caused by resorption of the alveolar bone. These conditions impaired his mastication and articulation, making it impossible for him to eat regular food or carry out normal conversation. A subperiosteal implant was placed on the edentulous maxilla, and was rigidly immobilized to the maxilla using five transmaxillary screws. A prosthesis was then attached to the implant, and by using the implant as the point of reference and the anchor, the mandible was moved forward by sagittal-split mandibular osteotomy. Intermaxillary fixation was subsequently performed. The postoperative course has been favorable, and his facial complexion has improved significantly. One and a half years after his surgery, there has been no sign of complications or malocclusion caused by mandibular retraction. He is now able to eat regular food and speak normally.
Adult↗
Anterior mandibular osteotomy for tumor extirpation: a critical evaluation.
BACKGROUND: Anterior mandibular osteotomy gives excellent access to the oropharynx for oncologic resections. Although rigid internal fixation has improved results in stability and bone healing, side effects and complications of the surgical procedure must be considered. METHODS: Between 1991 and 1997, 64 patients underwent a transmandibular approach for benign or malignant tumors of the head and neck. Sixty-one of them were included in a 6-month follow-up study. Final results and major and minor complications were recorded. RESULTS: Three (5%) cases of non-union and infection of the osteotomy site required plate removal, curettage, and reosteosynthesis. Occlusal disturbances and local periodontal disease occurred in 2 (3%) patients. Thirty-two (52%) patients complained of sensitivity disturbances, 18 (30%) of temporomandibular joint pain, and 44 (72%) of a limitation in opening the mouth. Six patients (10%) had a cosmetic complaint. CONCLUSION: Dental condition and periodontal care in the vicinity of the osteotomy are important factors in reducing the risk of major complications. Trismus, limitation of joint motion, and pain cannot be directly related to the technique; they depend on the extent of tumor resection and postoperative radiotherapy.
Adolescent↗
[Maxillo-mandibular osteotomy].
The authors present their experience of maxillo-mandibular osteotomies performed at the Charles Nicolle Hospital in Tunis. The objective of this paper is to describe the preliminary steps (clinical, radiographic, photographic, modelling, cephalometric) in order to obtain a precise diagnosis of the dysmorphosis. They use Burstone's cephalometric analyses which allow evaluation of the relations between soft tissues which do not correspond to the relations of bony and dental displacement. They also present several clinical cases, the pre-operative steps and, most importantly, Burstone's cephalometric analyses demonstrating that, after osteotomies, the cephalometric values for soft tissues approach normal values. Complete analysis of the naso-maxillary profile may correct the motivation for consultation in some cases. The indication for Lefort I osteotomy is sometimes more appropriate than rhinoplasty. Preoperative orthodontic preparation is often required. Functional rehabilitation is necessary to adapt the orofacial muscles to the new shapes of the dental arch and to prevent recurrence.
Adult↗
[The use of a modified vertical mandibular osteotomy for exposure of a distal cervical internal carotid artery].
We report herein the case of a 56-year-old woman who presented with repeated transient ischemic attacks (TIAs). Cerebral angiography revealed that the left redundant internal carotid artery (ICA) uncharacteristically curved medially. These findings were highly suggestive of an internal carotid artery aneurysm at the level between the first and second cervical vertebral bodies. The lesion was presumed to be difficult to access by the surgical procedure usually adopted in carotid endarterectomy. Thus, we decided to employ a modified vertical mandibular osteotomy. The operative view revealed that the lesion was atherosclerotic stenosis with ulceration, so carotid endarterectomy was indicated. This mandibular osteotomy not only provided us with wide, satisfactory exposure of the distal cervical internal carotid artery but also afforded good mandibular stability during the postoperative period.
Carotid Artery Diseases↗
The sagittal mandibular osteotomy under local anesthesia and intravenous sedation: four years of multicenter experience.
Today many surgical procedures involving head and neck areas can be performed under local anesthesia and intravenous sedation. The authors add to this list the sagittal osteotomies of the mandibular rami, thereby avoiding the need for general anesthesia and a hospital stay. The authors designed a protocol to be followed in a multicenter study (Milan and Barcelona) and applied it in 35 clinical cases with Class II malocclusion. The surgical procedure was performed with the Monitored Anesthesia Care technique, a combination of regional anesthesia and intravenous sedation. The results were good in all the clinical cases; skeletal correction of Class II was achieved in all patients and there were no intraoperative or postoperative complications. The major advantage of this technique is the functional control of the temporomandibular joint, which avoids displacements caused by gravity and the muscular relaxation commonly seen under general anesthesia. Furthermore, this protocol allows a reduction in costs, duration of surgery, and patient morbidity and convalescence. When this technique is accepted without hesitation, all Class II patients with only mandibular deficiency deformity may be treated in the most suitable way, thus providing the most satisfactory outcomes for the patient, orthodontist, and surgeon.
Adolescent↗