Stability after Bimaxillary Orthognathic Surgery with Rigid Fixation

After bimaxillary orthognathic surgery for correction of facial deformity, the factors influencing stability of bone segment are the amount of bone segment, surgical technique, fixation technique, rotation of proximal segment. The aim of this study is to analyze the significance of the factors influencing skeletal relapse after bimaxillary orthognathic surgery. From March 1994 to march 2003, 11 patients who underwent bimaxillary procedures without genioplasty or any other orthognathic surgical procedures were included for sample. Lateral cephalograms were analyzed before surgery, 1 month and 12 months after surgery respectively. Vertical, horizontal, angular and dental measurements were obtained from each tracing using the horizontal and vertical reference lines. The mean amount of bone movement and relapse was 7.03mm, 2.44mm (35%) respectively at pogonion and 3.41mm, 0.6mm (18%) respectively at point A. After statistical analysis of collected data, the amount of skeletal movement, fixation technique were significantly related to relapse, but rotation of proximal segment, surgical procedures were not significantly related to relapse. Then we suggest that when operation is planned, 20-30% overcorrection was recommended at the time of bimaxillary surgery.

Total Tongue Reconstruction with Innervated Latissimus Dorsi Free Flap

Total tongue resection result in severe speech problem, swallowing difficulty and life threatening aspiration. When a total glossectomy is performed, the functional recovery of swallowing, articulation, and airway protection are important for maintaining life quality of the patient. To achieve good functional results, First, the donor tissue should be bulky. Second, the tissue should be pliable and capable of movement. Third, the neotongue should be innervated by anastomosis to the hypoglossal nerve. Innervated latissimus dorsi free flap satisfies the above conditions. The authors performed two immediate total tongue reconstruction using a innervated latissimus dorsi myocutaneous free flap in which the thoracodorsal nerve was anastomosed to the hypoglossal nerve. Decanulation was performed on the 15th and 20th day respectively after the operation. The oral intake of pureed diet was possible in both patients without aspiration. After 3 months, it was confirmed in videofluoroscopic study that the neotongue was able to contact with the palate effectively. And the articulation was satisfactory. Considering speech and feeding rehabilitation, innervated latissimus dorsi flap can be more valuable method of tongue reconstruction than any other methods and we recommend it for better life quality of the patient.

Congenital Lateral Sinus of the Upper Lip

Congenital sinuses of the lips are uncommon congenital malformations. Congenital lateral upper lip sinuses or pits are more rare than those that occur in the midline, and only 10 cases have been reported previously. Congenital sinus of the upper lip usually present as a pit, which is the opening of a blind sinus penetrating the orbicularis oris muscle and ending just beneath the mucosal surface of the lip, without communication with oral cavity. Most sinus tracts are lined by stratified squamous epithelium, and mucous drainage or secretion is the most common symptom. In the literature, there are several theories of pathogenesis in which the invagination theory recieves the most attention but its etiology remains controversial. Surgical resection is the tratment of choice and an elliptical excision gives the most acceptable aesthetic result. The authors present 2 rare cases of congenital lateral upper lip sinus with pits found below right vermilion border, and just above the vermilion border on the left ridge of the philtrum.