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Archives of Plastic Surgery Sep 2013The aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each...
BACKGROUND
The aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each side. We observed nostril base augmentation in patients with alveolar clefts after alveolar bone grafting. The purpose of this study was to evaluate the nostril base augmentation effect of secondary alveolar bone grafting in patients with unilateral alveolar cleft.
METHODS
Records of 15 children with alveolar clefts who underwent secondary alveolar bone grafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 were reviewed. Preoperative and postoperative worm's-eye view photographs and reconstructed three-dimensional computed tomography (CT) scans were used for photogrammetry. The depression of the nostril base and thickness of the philtrum on the cleft side were measured in comparison to the normal side. The depression of the cleft side pyriform aperture was measured in comparison to the normal side on reconstructed three-dimensional CT.
RESULTS
Significant changes were seen in the nostril base (P=0.005), the philtrum length (P=0.013), and the angle (P=0.006). The CT measurements showed significant changes in the pyriform aperture (P<0.001) and the angle (P<0.001).
CONCLUSIONS
An alveolar bone graft not only fills the gap in the alveolar process but also augments the nostril base after surgery. In this study, only an alveolar bone graft was performed to prevent bias from other procedures. Nostril base augmentation can be achieved by performing alveolar bone grafts in children, in whom invasive methods are not advised.
PubMed: 24086807
DOI: 10.5999/aps.2013.40.5.542 -
Dentistry Today Aug 2013
Topics: Adult; Aged; Alveoloplasty; Dental Occlusion, Balanced; Denture Bases; Denture Design; Denture Rebasing; Denture, Complete, Immediate; Denture, Complete, Upper; Female; Humans; Male; Patient Care Planning; Tooth Extraction
PubMed: 24079140
DOI: No ID Found -
The Journal of Craniofacial Surgery Sep 2013Maxillary development is often inadequate in bilateral cleft patients. The use of presurgical orthopedics (PSO) and gingivoperiosteoplasty (GPP) may promote bone...
Maxillary growth after the use of protraction head gear in conjunction with presurgical orthopedics and gingivoperiosteoplasty for complete bilateral cleft lip and alveolus patients.
INTRODUCTION
Maxillary development is often inadequate in bilateral cleft patients. The use of presurgical orthopedics (PSO) and gingivoperiosteoplasty (GPP) may promote bone formation at the alveolar cleft, but can also have detrimental effects on maxillary development. Our objective was to investigate the effect of PSO and GPP on maxillary development in bilateral cleft lip and alveolus (BCLA) patients.
SUBJECTS AND METHODS
We had 3 complete BCLA patients who had received PSO. All patients underwent cheiloplasty and GPP simultaneously. At 4 years, maxillary protraction head gear was used as part of the protocol. They were evaluated by cephalometric analysis at 4 and 8 years of age, and by CT imaging at 5 years of age.
RESULTS
At 4 years of age, patients with all BCLA had anterior crossbite of deciduous central incisors. As a result of maxillary protraction, jaw development at 8 years was good. Among all patients, only one showed bone formation at the alveolar cleft sufficient to avoid alveolar bone grafting (ABG).
DISCUSSION
All patients presented anterior crossbite in the premaxillary region, but had good maxillary growth at 8 years old as a result of maxillary protraction. The combination of PSO and GPP can potentially eliminate the need for ABG and does not significantly retard maxillary development. PSO with GPP and protraction head gear may be an option, but long-term growth is not known.
Topics: Alveoloplasty; Child, Preschool; Cleft Lip; Female; Gingivoplasty; Humans; Male; Malocclusion; Maxilla; Maxillofacial Development; Orthodontics; Plastic Surgery Procedures
PubMed: 24036752
DOI: 10.1097/SCS.0b013e31828f27c5 -
The Cleft Palate-craniofacial Journal :... Nov 2015The aim of this study is to describe the prevalence of obstructive sleep apnea (OSA) and its level of severity associated with Orticochea pharyngoplasty in patients with...
BACKGROUND AND PURPOSE
The aim of this study is to describe the prevalence of obstructive sleep apnea (OSA) and its level of severity associated with Orticochea pharyngoplasty in patients with velopharyngeal insufficiency after at least 1 year of the surgical procedure.
DESIGN
Case series prospective descriptive study.
MAIN OUTCOME MEASURES
At FISULAB, a rehabilitation center for patients with cleft palate, we studied 37 patients who were treated elsewhere with Orticochea pharyngoplasty for velopharyngeal insufficiency; these patients may or may not have had clinical symptoms related to OSA. All participants underwent a polysomnography sleep study, which was also done in different institutions. We applied the Epworth Sleepiness Scales during the clinical investigation because it is an effective instrument used to measure average daytime sleepiness. Another questionnaire to identify cases of OSA was used. Among other variables studied, the apnea/hypopnea index was the main outcome, while age and type of cleft were secondary variables.
RESULTS
From 37 patients who were studied (100%), we obtained the following results: normal apnea/hypopnea index: seven patients (18.9%); mild apnea/hypopnea index: 14 patients (37.8%); moderate apnea/hypopnea index: eight patients (21.6%); and severe apnea/hypopnea index: eight patients (21.6%).
CONCLUSIONS
In this study, we found that more than three quarters (81%) of the patients who were treated for velopharyngeal insufficiency with Orticochea pharyngoplasty presented obstructive sleep apnea when analyzing the apnea/hypopnea index in the polysomnography sleep study.
Topics: Adolescent; Adult; Alveoloplasty; Cleft Palate; Female; Humans; Male; Oral Surgical Procedures; Pharynx; Polysomnography; Prevalence; Prospective Studies; Plastic Surgery Procedures; Severity of Illness Index; Sleep Apnea, Obstructive; Surveys and Questionnaires; Velopharyngeal Insufficiency
PubMed: 23952561
DOI: 10.1597/12-049 -
The Journal of Craniofacial Surgery Jul 2013The aim of the study was to determine the prevalence and bacteriology of bacteremia associated with cleft lip and palate (CLP) surgery. Three venous blood samples were...
The aim of the study was to determine the prevalence and bacteriology of bacteremia associated with cleft lip and palate (CLP) surgery. Three venous blood samples were obtained from 90 eligible subjects who presented for CLP surgery: before surgical incision, 1 minute after placement of the last suture, and 15 minutes thereafter. The samples were injected into an Oxoid Signal blood culture and transported to the laboratory for gram-positive/negative and aerobic/anaerobic bacteria analysis. Prevalence of bacteremia associated with cleft surgery was 38.1%. Prevalence rates of bacteremia in cleft lip surgery, cleft palate surgery, and alveoloplasty were 40.9%, 33.3%, and 50%, respectively. There was no significant difference in prevalence rate of positive blood culture in cleft lip surgery, cleft palate surgery, and alveoloplasty (P = 0.69). Positive blood culture was detected most frequently (47%) 1 minute after placement of the last suture. Of the 23 subjects who had positive blood culture at 1 minute, bacteremia persisted in 8 (35%) of them after 15 minutes. The most common bacteria isolated were coagulase-negative staphylococcus, Acinetobacter lwoffii, and coagulase-positive Staphylococcus aureus. Sex and age of the subjects, duration of surgery, blood loss, and type of cleft surgery were not significantly associated with positive blood culture. Bacteremia associated with CLP surgery is polymicrobial and persisted for at least 15 minutes after surgery in 35% of cases. This may reinforce the need for prophylactic antibiotics to protect at-risk patients from developing focal infection of the heart by oral flora.
Topics: Adolescent; Adult; Bacteremia; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Health Services Needs and Demand; Humans; Infant; Male; Nigeria; Prevalence; Young Adult
PubMed: 23851754
DOI: 10.1097/SCS.0b013e31828016e8 -
Oral Surgery, Oral Medicine, Oral... Sep 2013Dabigatran is a direct thrombin inhibitor approved to help prevent thrombotic events in patients with atrial fibrillation. As a rather new drug approval, information on...
Dabigatran is a direct thrombin inhibitor approved to help prevent thrombotic events in patients with atrial fibrillation. As a rather new drug approval, information on management of bleeding during dental surgery in patients taking dabigatran is sparse. In this case report, a 67-year old male with a positive history for atrial fibrillation, coronary artery disease, intermittent angina, hypertension, type 2 diabetes and normal renal function was taking dabigatran 150 mg, 2 times daily. He underwent 8 surgical extractions, alveoloplasty and tuberosity reduction. Per guidelines prescribed by van Ryn et al., the patient's dabigatran was held the night before surgery and resumed the day after. Adverse outcomes were not observed during the procedure or in the 7-month postoperative period. This case suggests that due to its short half-life, dabigatran can be temporarily discontinued 24 h prior to elective oral surgery with consent of the physician and restarted the following day resulting in minimal complications.
Topics: Aged; Antithrombins; Atrial Fibrillation; Benzimidazoles; Dabigatran; Humans; Male; Oral Surgical Procedures; beta-Alanine
PubMed: 23850368
DOI: 10.1016/j.oooo.2013.05.001 -
Atlas of the Oral and Maxillofacial... Mar 2013Reconstruction of maxillofacial composite defects is a technically demanding and time-demanding process. It also requires a prolonged treatment course, a team approach,...
Reconstruction of maxillofacial composite defects is a technically demanding and time-demanding process. It also requires a prolonged treatment course, a team approach, and meticulous planning that is prosthetic and esthetically driven. The use of vascularized flap reconstruction, dental implants, and computer-aided technology and advances in maxillofacial prosthetics has contributed immensely toward the goal of fully reconstructing victims of large avulsive wounds. Further advances in technology, surgical training, and maxillofacial prosthodontics will undoubtedly aid in minimizing the number of surgical interventions and maximize the final functional and esthetic results of these patients.
Topics: Alveoloplasty; Blast Injuries; Bone Transplantation; Computer-Aided Design; Dental Implantation, Endosseous; Dental Implants; Facial Bones; Facial Injuries; Graft Survival; Humans; Maxillofacial Injuries; Maxillofacial Prosthesis; Patient Care Planning; Patient Care Team; Postoperative Complications; Plastic Surgery Procedures; Soft Tissue Injuries; Surgery, Computer-Assisted; Surgical Flaps; Tomography, X-Ray Computed; Wounds, Gunshot
PubMed: 23498337
DOI: 10.1016/j.cxom.2012.12.004 -
The Cleft Palate-craniofacial Journal :... Jul 2014Synthetic octacalcium phosphate and porcine atelocollagen composites significantly enhanced bone regeneration more than β-tricalcium phosphate collagen composite and...
OBJECTIVE
Synthetic octacalcium phosphate and porcine atelocollagen composites significantly enhanced bone regeneration more than β-tricalcium phosphate collagen composite and hydroxyapatite collagen composite in a rat cranial defect model. However, the long-term stability and quality of octacalcium phosphate collagen (OCP/Col) composites-derived regenerated bone, when implanted in a canine alveolar cleft model, have yet to be elucidated. The present study investigated the longterm stability and quality of bone regenerated by OCP/Col.
DESIGN
Disks of OCP/Col or collagen were implanted in a canine alveolar-cleft model (n = 6). Then, bone regeneration in the implanted areas was investigated macroscopically, radiographically, and histologically at 10 months after implantation. In addition, three-dimensional quantitative images of regenerated bone were analyzed by microcomputed tomography.
RESULTS
Macroscopically, the OCP/Col treated alveolus was clearly augmented, and radio-opacity in the OCP/Col implanted area was comparable to that of the original alveolus bone. On histological analysis, the area was mostly filled with newly formed bone, and a few granules of implanted OCP/Col were enclosed in it. In the microcomputed tomography analysis, the regenerated bone volume in the OCP/Col group was larger than that in the collagen group. OCP/Col-derived bone consisted of outer cortical and inner cancellous structure with dense trabeculae and seemed like the original bone structure.
CONCLUSIONS
OCP/Co composites could be a useful bone regenerative material to substitute for autogenous bone because their implantation could elicit high bone regeneration and active structural reconstitution.
Topics: Alveolar Process; Alveoloplasty; Animals; Bone Regeneration; Bone Substitutes; Calcium Phosphates; Collagen; Disease Models, Animal; Dogs; Drug Combinations
PubMed: 23369014
DOI: 10.1597/12-096 -
BMJ Case Reports Jan 2013Alveolar bone exostoses (ABE), also known as a buttress bone formation, are not uncommon to the literature. Although, exostoses in response to the trauma from occlusion...
Alveolar bone exostoses (ABE), also known as a buttress bone formation, are not uncommon to the literature. Although, exostoses in response to the trauma from occlusion are a popular concept proposed more than 45 years ago, still the aetiological factors behind this development are unclear. Various risks and complications associated with orthodontic implants have been published, but buttress bone formation subsequent to this procedure has not been reported till date. This article describes a case of ABE, subsequent to the placement of orthodontic mini implants, where after careful evaluation, resective osseous surgery was performed.
Topics: Adolescent; Alveolar Process; Alveoloplasty; Bone Screws; Exostoses; Female; Humans; Jaw Diseases; Orthodontic Anchorage Procedures
PubMed: 23355580
DOI: 10.1136/bcr-2012-007951 -
Journal of Applied Oral Science :... 2012This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial...
Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP (HRAC-USP)--part 3: oral and maxillofacial surgery.
This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.
Topics: Alveoloplasty; Brazil; Cleft Lip; Cleft Palate; Hospitals, University; Humans; Ilium; Tooth Socket; Treatment Outcome
PubMed: 23329251
DOI: 10.1590/s1678-77572012000600014