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Archives of Otolaryngology--head & Neck... Aug 2011To outline a contemporary review of defect classification and reconstructive options. (Review)
Review
OBJECTIVE
To outline a contemporary review of defect classification and reconstructive options.
DESIGN
Review article.
SETTING
Tertiary care referral centers.
RESULTS
Although prosthetic rehabilitation remains the standard of care in many institutions, the discomfort of wearing, removing, and cleaning a prosthesis; the inability to retain a prosthesis in large defects; and the frequent need for readjustments often limit the value of this cost-effective and successful method of restoring speech and mastication. However, flap reconstruction offers an option for many, although there is no agreement as to which techniques should be used for optimal reconstruction. Flap reconstruction also involves a longer recovery time with increased risk of surgical complications, has higher costs associated with the procedure, and requires access to a highly experienced surgeon.
CONCLUSION
The surgeon and reconstructive team must make individualized decisions based on the extent of the maxillectomy defect (eg, the resection of the infraorbital rim, the extent of palate excision, skin compromise) and the need for radiation therapy.
Topics: Humans; Maxilla; Prosthesis Implantation; Plastic Surgery Procedures; Surgical Flaps
PubMed: 21844415
DOI: 10.1001/archoto.2011.132 -
The Angle Orthodontist Jan 2022To evaluate whether the amount of rapid maxillary expansion differentially affects the skeletal and dentoalveolar changes that occur. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To evaluate whether the amount of rapid maxillary expansion differentially affects the skeletal and dentoalveolar changes that occur.
MATERIALS AND METHODS
This randomized controlled trial included 23 patients who had rapid maxillary expansion (RME). Subjects were randomly assigned to a conventional expansion control group (n = 12) or an overexpansion group (n = 11), who started treatment at 13.2 ± 1.5 and 13.8 ± 1 years of age, respectively. Cone beam computed tomography scans (11 cm) were obtained prior to rapid maxillary expander (RME) delivery and approximately 3.7 months later. Initial hand-wrist radiographs were used to determine the participants' skeletal maturity.
RESULTS
The RME screws were activated 5.6 ± 1.2 mm and 10.1 ± 0.6 mm in the conventional and overexpansion groups, respectively. Overexpansion produced significantly greater expansion of the nasal cavity (2.1X-2.5X), maxillary base (2.3X), buccal alveolar crest (1.4X), and greater palatine foramina (1.9X). Significantly greater intermolar width increases (1.8X) and molar inclination (2.8X) changes were also produced. The nasal cavity and maxillary base expanded 23%-32% as much as the screws were activated. Skeletal expansion was positively correlated with RME screw activation (R = 0.61 to 0.70) and negatively correlated (R = -0.56 to -0.64) with the patients' skeletal maturation indicators (SMIs). Together, screw activation and the patients' SMI scores explained 48%-66% of the variation in skeletal expansion.
CONCLUSIONS
This pilot study shows that overexpansion produces greater changes than conventional expansion, with greater skeletal effects among less mature patients.
Topics: Cone-Beam Computed Tomography; Humans; Maxilla; Molar; Palatal Expansion Technique; Pilot Projects
PubMed: 34388256
DOI: 10.2319/032921-243.1 -
Nature Communications Dec 2015Neanderthals had large and projecting (prognathic) faces similar to those of their putative ancestors from Sima de los Huesos (SH) and different from the retracted...
Neanderthals had large and projecting (prognathic) faces similar to those of their putative ancestors from Sima de los Huesos (SH) and different from the retracted modern human face. When such differences arose during development and the morphogenetic modifications involved are unknown. We show that maxillary growth remodelling (bone formation and resorption) of the Devil's Tower (Gibraltar 2) and La Quina 18 Neanderthals and four SH hominins, all sub-adults, show extensive bone deposition, whereas in modern humans extensive osteoclastic bone resorption is found in the same regions. This morphogenetic difference is evident by ∼5 years of age. Modern human faces are distinct from those of the Neanderthal and SH fossils in part because their postnatal growth processes differ markedly. The growth remodelling identified in these fossil hominins is shared with Australopithecus and early Homo but not with modern humans suggesting that the modern human face is developmentally derived.
Topics: Animals; Child; Fossils; Hominidae; Humans; Male; Maxilla; Neanderthals
PubMed: 26639346
DOI: 10.1038/ncomms9996 -
Folia Medica Cracoviensia 2013Based on the current literature authors revised anatomical and clinical datas considering the mandible. (Review)
Review
Based on the current literature authors revised anatomical and clinical datas considering the mandible.
Topics: Humans; Mandible; Mandibular Diseases; Mandibular Nerve; Maxilla
PubMed: 25556509
DOI: No ID Found -
Oral Surgery, Oral Medicine, Oral... Mar 2022To compare the 2 surgically assisted rapid maxillary expansion (SARME) techniques, the conventional 2-segment osteotomy between maxillary central incisors and the...
OBJECTIVE
To compare the 2 surgically assisted rapid maxillary expansion (SARME) techniques, the conventional 2-segment osteotomy between maxillary central incisors and the 3-segment osteotomy between maxillary lateral incisors and canines bilaterally. Authors hypothesized that the 3-piece would provide better bone expansion.
STUDY DESIGN
A pilot study was conducted; 19 patients were divided into 2 groups: conventional 2-segment osteotomy (10 patients) and 3-segment osteotomy (9 patients). Dental and skeletal measurements of the preoperative and postoperative cone beam computed tomography images were analyzed. Pre- and postoperative periodontal probing was performed, patients' cosmetic perception was evaluated in a colored visual analog scale (VAS), and surgical time was measured with a regular chronometer.
RESULTS
Three-segment SARME resulted in greater bone expansion (5.12 vs 6.20 mm; P = .016), less molar inclination (7.16 vs 3.57 degrees; P = .028), better patient cosmetic perception (3.13 vs 7.68 in a VAS; P = .000), and longer surgical time (43 vs 52 minutes; P = .026). Furthermore, the 2-segment group presented necrosis of 1 central incisor.
CONCLUSIONS
Results suggest that 3-piece SARME is more effective for bone expansion of the maxilla.
Topics: Cone-Beam Computed Tomography; Humans; Maxilla; Palatal Expansion Technique; Pilot Projects; Retrospective Studies
PubMed: 34518140
DOI: 10.1016/j.oooo.2021.06.002 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Jun 2021This study aims to evaluate the short-term clinical outcomes and patient satisfaction of anterior and pterygoid implants in the rehabilitation of edentulous maxilla with...
OBJECTIVES
This study aims to evaluate the short-term clinical outcomes and patient satisfaction of anterior and pterygoid implants in the rehabilitation of edentulous maxilla with posterior atrophy.
METHODS
Given a minimum follow-up of 1 year, 25 patients with fixed maxillary rehabilitation over anterior and pterygoid implants were enrolled in this retrospective study. The implant survival rates, peri-implant soft tissue status (including probing depth, modified sulcus bleeding index, and plaque index), marginal bone loss, and patient satisfaction were measured.
RESULTS
The survival rates for anterior and pterygoid implants at 1-year follow-up were 96.5% and 97.8%, respectively (>0.05). No statistically significant difference in probing depth, modified sulcus bleeding index, and plaque index was observed between the two types of implants (>0.05). The marginal bone losses of anterior implants were 0.62 mm± 0.44 mm (mesial) and 0.61 mm± 0.40 mm (distal), and those of pterygoid implants were 0.64 mm± 0.46 mm (mesial) and 0.68 mm± 0.41 mm (distal) mm. These results showed no statistical difference in mesial and distal sites (>0.05). Patients indicated a high degree of satisfaction with the full-arch prostheses supported by anterior and pterygoid implants.
CONCLUSIONS
For the edentulous maxilla with posterior atrophy, full-arch fixed prostheses supported by anterior and pterygoid implants has an acceptable short-term clinical outcome and excellent patient satisfaction. It may be considered as a predictable and feasible method for maxillary rehabilitation.
Topics: Atrophy; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis, Implant-Supported; Follow-Up Studies; Humans; Jaw, Edentulous; Maxilla; Retrospective Studies; Treatment Outcome
PubMed: 34041877
DOI: 10.7518/hxkq.2021.03.007 -
International Journal of Implant... Jun 2023The purpose of this document is to clarify the biomechanical principles involved when zygoma implants are placed under functional loads. (Review)
Review
PURPOSE
The purpose of this document is to clarify the biomechanical principles involved when zygoma implants are placed under functional loads.
METHODS
Two independent reviewers conducted electronic search of the literature from January 2000 to February 2023 describing the biomechanical principles involved using the zygoma implant for maxillary reconstruction. Articles describing the stresses within the zygoma implant, the maxillary bone and the zygoma bone under functional loads were included.
RESULTS
The lack of maxillary boney support at the implant platform resulted in significant higher stress measured within the zygoma implant as well as the zygoma bone.
CONCLUSION
The maxilla is the primary support when zygoma implants are placed under functional loads. Quad-cortical stabilization of the zygoma implants and their cross-arch stabilization are recommended to reduce the degree of stress whenever possible.
Topics: Dental Implants; Zygoma; Dental Implantation, Endosseous; Maxilla
PubMed: 37347335
DOI: 10.1186/s40729-023-00483-1 -
Journal of Plastic, Reconstructive &... Feb 2023The use of virtual surgical planning and patient-specific saw and drill guides combined with customized osteosynthesis is becoming a gold standard in orthognathic...
PURPOSE
The use of virtual surgical planning and patient-specific saw and drill guides combined with customized osteosynthesis is becoming a gold standard in orthognathic surgery. The aim of this study is to report preliminary results of the use of virtual surgical planning and the wafer-free PSI technique in cleft patients.
MATERIALS AND METHODS
Patient-specific saw and drill guides combined with milled patient-specific 3D titanium alloy implants were used in reposition and fixation in Le Fort I osteotomy of 12 cleft patients. Surgical information was retrieved from hospital records. Pre- and post-operative lateral cephalograms were analyzed.
RESULTS
In 10 of 12 cases, the implants fitted as planned to predesigned drill holes and bone contours with high precision. In one patient, the mobilization of the maxilla was too demanding for virtually planned advancement, and the implants could not be used. In another patient, PSI fitting was impaired due to an insufficient mobilization of maxilla and tension on PSI fixation with screws. After the surgery, the mean advancement of the anterior maxilla (point A) of all patients was 5.8 mm horizontally (range 2.7-10.1) and -3.1 mm vertically (range -9.2 to 3.4). Skeletal relationships of the maxilla and mandible could be corrected successfully in all patients except for the one whose PSI could not be used.
CONCLUSIONS
Virtual surgical planning combined with PSI is a possible useful clinical adjunct for the correction of maxillary hypoplasia in cleft patients. Large maxillary advancements and scarring may be cause problems for desired advancement and for the use of implants.
Topics: Humans; Cleft Lip; Cleft Palate; Osteotomy, Le Fort; Maxilla; Cephalometry
PubMed: 36563638
DOI: 10.1016/j.bjps.2022.10.051 -
Plastic and Reconstructive Surgery Nov 2021The maxilla position is essential for the aesthetic and functional outcomes of orthognathic surgery. Previous studies demonstrated the advantages of patient-specific... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
The maxilla position is essential for the aesthetic and functional outcomes of orthognathic surgery. Previous studies demonstrated the advantages of patient-specific implants in orthognathic surgery. However, more data are needed to confirm the superiority of patient-specific implants over surgical splints created with computer-aided design/computer-aided manufacturing (CAD/CAM). This randomized controlled trial aimed to compare the accuracy of patient-specific implants and CAD/CAM splints for maxilla repositioning in orthognathic surgery.
METHODS
Patients (n = 64) who required orthognathic surgery were randomly assigned to use either patient-specific implants (patient-specific implant group) or CAD/CAM surgical splints (splint group) to reposition the maxilla. The outcome evaluation was completed by comparing virtual plans with actual results. The primary outcome was the discrepancies of the centroid position of the maxilla. Other translation and orientation discrepancies of the maxilla were also assessed.
RESULTS
The authors analyzed 27 patients in the patient-specific implant group and 31 in the splint group. The maxilla position discrepancy was 1.41 ± 0.58 mm in the patient-specific implant group and 2.20 ± 0.94 mm in the splint group; the between-group difference was significant (p < 0.001). For the patient-specific implant group, the largest translation discrepancy was 1.02 ± 0.66 mm in the anteroposterior direction, and the largest orientation discrepancy was 1.85 ± 1.42 degrees in pitch. For the splint group, the largest translation discrepancy was 1.23 ± 0.93 mm in the mediolateral direction, and the largest orientation discrepancy was 1.72 ± 1.56 degrees in pitch.
CONCLUSION
The result showed that using patient-specific implants in orthognathic surgery resulted in a more accurate maxilla position than CAD/CAM surgical splints.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, I.
Topics: Adult; Computer-Aided Design; Equipment Design; Female; Humans; Imaging, Three-Dimensional; Male; Malocclusion; Maxilla; Orthognathic Surgical Procedures; Patient Care Planning; Splints; Treatment Outcome; Young Adult
PubMed: 34705785
DOI: 10.1097/PRS.0000000000008427 -
Journal of Plastic, Reconstructive &... Feb 2022The aim of this study was to describe the 3D planning process used in our two composite face transplantations and to analyze the accuracy of a virtual transplantation in...
BACKGROUND
The aim of this study was to describe the 3D planning process used in our two composite face transplantations and to analyze the accuracy of a virtual transplantation in predicting the end-result of face transplantation.
METHODS
The study material consists of two bimaxillary composite face transplantations performed in the Helsinki University Hospital in 2016 and 2018. Computed tomography (CT) scans of the recipient and donor were used to define the osteotomy lines and perform the virtual face transplantation and to 3D print customized osteotomy guides for recipient and donor. Differences between cephalometric linear and angular measurements of the virtually simulated and the actual postoperative face transplantation were calculated.
RESULTS
No changes to the planned osteotomy lines were needed during surgery. The differences in skeletal linear and angular measurements of the virtually simulated predictions and the actual postoperative face transplantations of the two patients varied between 0.1-5.6 mm and 0.7°-4°. The postoperative skeletal relationship between maxilla and mandible in both patients were almost identical in comparison to the predictions.
CONCLUSIONS
3D planning is feasible and provides close to accurate bone reconstruction in face transplantation. Preoperative virtual transplantation assists planning and improves the outcome in bimaxillary face transplantation.
Topics: Cephalometry; Facial Transplantation; Humans; Imaging, Three-Dimensional; Mandible; Maxilla; Orthognathic Surgical Procedures; Surgery, Computer-Assisted
PubMed: 34794919
DOI: 10.1016/j.bjps.2021.09.061