Evolución hacia la era digital de la cirugía ortognática: experiencia en un centro universitario / Evolution towards the digital era of orthognatic surgery: experience in a university center

Resumen Introducción: La incorporación de tecnologías en la práctica quirúrgica, ha cambiado la forma de enfrentar el proceso quirúrgico. Objetivo: Describir la experiencia de los últimos 9 años, en cirugía ortognática, con la incorporación de la cefalometría 3D. Materiales y Método: Se realizó una revisión retrospectiva de pacientes operados de cirugía ortognática durante el período enero de 2011 a agosto de 2018. Se registraron datos demográficos, quirúrgicos, tipo de planificación quirúrgica, complicaciones y resultados a largo plazo. Resultados: 21 pacientes requirieron cirugías ortognáticas. Se realizaron 16 cirugías bimaxilares (76%), 3 cirugías de avance maxilar superior (14%) y 2 cirugías de osteotomía sagital de rama (10%). Las principales etiologías fueron: 67% maloclusión clase III (n = 14), 28% maloclusión clase II (n = 6) y 5% desviación mandibular (n = 1). La planificación prequirúrgica virtual fue utilizada en 11 pacientes (52%). La tasa de complicaciones Clavien-Dindo > III fue 4,8% (n = 1). Conclusiones: En nuestra experiencia, las técnicas de cirugía ortognática son seguras. Las complicaciones de la serie fueron escasas y bien toleradas por los pacientes. Durante los últimos años y, de acuerdo a los avances tecnológicos, la incorporación de la planificación quirúrgica virtual 3D favoreció el desarrollo de la cirugía ortognática en nuestro centro.

Introduction: Technological advances have been incorporated into cranio-maxillo-facial surgery changing the clinical practice of surgeons. Aim: The aim of this article is to describe our experience in orthognatic surgery in the last 9-years, with the incorporation of 3D cephalometry. Materials and Method: A retrospective chart review was performed from January 2011 to August 2018 on patients undergoing Orthognatic Surgery. Demographic and surgical data, type of surgical planning, complications and long-term results were recorded. Results: A total of 21 patients underwent orthognatic surgery. Average age was 28 years (DE 8.1), 11 men (52.3%) and 10 women (47.61%). The principal surgeries performed were: 16 (76%) bimaxillary, 3 maxillary advancement surgery 3 (14%) and bilateral sagital split osteotomy 2 (10%). Ethiologies were: 14 patients (this 67%) with malocclusion class III, 6 patients (28%) with malocussion class II, and 1 patient (5%) with mandibular deviation. Virtual 3D presurgical planning was used in 11 patients (52%). The total of complications Clavien-Dindo > III was 4.8% (n = 1). None patient required reoperation. Satisfaction rate with the procedure was high. Conclusions: Based on our experience, orthognatic surgery techniques are safe. The complication rate was lower and well tolerated by patients. The introduction of virtual planning provided a better scenario to develop maxillo-facial surgery.

Upper Body Lift: serie de casos en un hospital clínico universitario entre los años 2013-2016: descripción de la técnica quirúrgica / Upper Body Lift: cases series from a clinical hospital between years 2013-2016, and description of the surgical technique

Introducción: En pacientes obesos la pérdida masiva de peso presenta efectos beneficiosos para la salud, sin embargo, suelen cursar con un excedente cutáneo que genera problemas físicos, afectando la calidad de vida. En casos severos las técnicas convencionales de contorno corporal, no permiten dar solución a grandes alteraciones, siendo necesario utilizar procedimientos más extensos. El Upper Body Lift es una técnica que ofrece un manejo integral del tronco superior. Objetivos: Describir una serie de casos de pacientes sometidos a Upper Body Lift y presentar la técnica quirúrgica. Material y Método: Serie de casos prospectiva entre enero del 2013 y junio de 2016, en un hospital clínico universitario. Se excluyó a pacientes con información incompleta u operados en otro centro. Se utilizó estadística descriptiva. Resultados: 8 pacientes manejados mediante Upper Body Lift, con edad 39,75 ± 9,37 años, 6 (75%) mujeres. Con pérdida de peso de 36,75 ± 9,11 Kg, alcanzando un IMC de 25,97 ± 2,35 Kg/m2. En hombres la región pectoral se manejó con liposucción y posterior injerto de pezón, en mujeres se realizó mastopexia sin implantes en 5 (83,33%). No se observó complicación mayor y en 4 casos (50%) se presentó complicación menor durante posoperatorio. Discusión: Esta serie presenta resultados similares a lo descrito por otros autores. Conclusiones: El Upper Body Lift es un procedimiento que ofrece un manejo integral y con buenos resultados, en pacientes con gran excedente cutáneo en tronco superior.

Introduction: Obese patients gets beneficial health effects with the massive weight loss, however they develop excessive redundant skin and become physical problems affecting their quality of life. In severe cases, the conventional body contouring techniques are not able to solve this large alterations, being necessary to use more extensive procedures. The Upper Body Lift is a technique that offers integral management of the upper trunk. Objectives: To describe a case series of patients submitted to Upper Body Lift and present the surgical technique. Materials and Methods: Prospective case series of patients with Upper Body Lift between January 2013 and June 2016 in a clinical hospital. Patients with incomplete information or operated in another center were excluded. Descriptive statistics was used. Results: 8 patients were included, age 39.75 ± 9.37 years, 6 (75%) women. Prior to the contouring surgery they lose 36.75 ± 9.11 kg, reaching a BMI of 25.97 ± 2.35 kg/m2. In men the chest region was managed with liposuction and subsequent nipple graft, in women mastopexy without implants was performed in 5. No major complications was observed, 4 had minor complications during the postoperative period. Discussion: This series presents similar results to those described by other authors. Conclusions: The Upper Body Lift offers comprehensive and successful management in patients with large upper body disturbance.

Cirugía de contorno corporal en pacientes con pérdida masiva de peso en un hospital universitario: estudio de frecuencias / Body contouring surgery in patients with massive weight loss in a university hospital: study of frequencies

Resumen Introducción La pérdida masiva de peso en obesos, presenta efectos beneficiosos para la salud, sin embargo esto pacientes suelen cursar exceso de adiposidad y piel redundante, generando problemas físicos y psicológicos. La cirugía de contorno corporal busca modificar el contorno del cuerpo para lograr una armonía estética. Existen pocos estudios a nivel nacional que aborden la epidemiología de la cirugía de contorno corporal en pacientes con baja masiva de peso. Objetivos Describir una serie de pacientes con baja masiva de peso sometidos a cirugía de contorno corporal y sus complicaciones. Materiales Métodos Serie de casos prospectiva, de pacientes sometidos a cirugía de contorno corporal con antecedente de baja masiva de peso, entre enero de 2013 y junio de 2016, en un hospital universitario. Se excluyó a pacientes con información incompleta u operados en otro Centro. Utilizando estadística descriptiva. Resultados 120 pacientes con cirugía de contorno corporal y baja masiva de peso, con edad de 38,4 ± 10,4 años, 105 (87,5%) mujeres. La pérdida de peso fue en 110 (91.67%) con cirugía bariátrica. Alcanzando un IMC de 26,56 ± 3,26 Kg/m2, con una pérdida de peso 39,06 ± 14,1 7 Kg. Las cirugías más frecuentes fueron la abdominoplastía estándar 79 (65,83%) y la mastopexia con implantes 21 (17,5%). Uno (0,83%) presentó complicación mayor y 33 (27,5%) alguna complicación menor durante posoperatorio. Discusión Esta serie presenta resultados similares a lo descrito por otros autores, observándose una menor tasa de complicaciones en posoperatorio. Conclusiones La cirugía de contorno corporal en este grupo de pacientes es un procedimiento seguro, que ofrece solución a las secuelas corporales pospérdida masiva de peso según nuestra experiencia.

Introduction Massive weight loss in obese, has beneficial health effects, however patients usually presents excessive adiposity and redundant skin, that generates physical and psychological problems. The body contouring surgery helps to modify the contour of the body to achieve aesthetic harmony. There are few national studies that describe the epidemiology of body contour surgery in patients with massive weight loss. Objectives Describes a series of patients with massive weight loss with body contour surgery and its complications. Materials and Methods A prospective series of patients with body contouring surgery with a history of low body mass, between January 2013 and June 2016, in a university hospital. Patients with incomplete information or operated at another center were excluded. Descriptive statistics was used. Results 120 patients with body contouring surgery and low weight mass were included. Age of 38.4 ± 10.4 years, 105 (87.5%) were women. 110 (91.67%) were bariatric patients. BMI of 26.56 ± 3.26 kg/m2 and a weight loss of 39.06 ± 14.17 Kg were reached previous the contouring surgery. The most frequent surgery was the standard abdominoplasty 79 (65.83%), followed by mastopexy with implants 21 (17.5%). 1 (0.83%) presented major complication and 33 (27.5%) had a minor complication during the postoperative period. Discussion This series presents results similar to other authors, with a lower rate of postoperative complications. Conclusion The Body contouring surgery are safe procedures, which provides a solution to the bodily sequels after massive weight loss according to our experience.

Investigation of Gender Difference of Physiological Response in Gonadectomy in Sprague-Dawley (SD) Rats.

Aim: Sex hormones, including testosterone and estrogen, result in various pathophysiological changes in the body. To evaluate the pathophysiological changes following gonadectomy in male and female rats, we performed gonadectomy at the same age in male and female Sprague-Dawley (SD) rats. Methods: Male and female Sprague-Dawley rats castrated by bilaternal orchidectomy and ovariectomy at 6 weeks of age (six animals of each sex per group). Food intake, body weight, and clinical chemical parameters such as glucose, insulin, triglyceride and total cholesterol levels, were examined every 4 weeks from 8 to 40 weeks of age. Statistical analysis of differences between control and gonadectomized rats was performed using the F-test, followed by the Student’s t-test or Aspin-Welch’s t-test. Results: In orchidectomized (ORX) rats, food intakes and body weights were decreased, whereas in ovariectomized (OVX) rats, the body weights were significantly elevated without an obvious change in food intake. In clinical chemical analysis, hypercholesterolemia was observed in both ORX and OVX rats, but the triglyceride level was obviously decreased only in ORX rats during the observational period. In OVX rats, decrease of insulin sensitivity and significant increase of adipose tissue weights were observed. In bone metabolic analysis, bone mineral content in ORX rats and bone mineral density in OVX rats were decreased, respectively. Conclusion: Both orchidectomy and ovariectomy in rats affect glucose/lipid and bone metabolism, and especially, the glucose metabolism was deteriorated in OVX rats. Both male and female sex hormones play a key role in metabolic disease, such as diabetes, hyperlipidemia and osteoporosis.

Pathophysiological Changes by Short-term Food Restriction in Obese Diabetic Rats.

Aim: Reduced calorie intake by food restriction leads to extension of life span by exerting beneficial effects on metabolism. Zucker diabetic fatty (ZDF) rat is a type 2 diabetic model with obesity, showing the incidence of diabetes after 7 weeks of age. The present study investigated effects of 2-week food restriction on the pancreas in ZDF rats. Methods: ZDF rats were pair-fed with Zucker lean (ZL) rats from 7 to 9 weeks of age (The amount of food in ZDF rats was calculated based on the daily food consumption in ZL rats). Body weight and biochemical parameters such as serum glucose, triglyceride, total cholesterol, non-esterified fatty acid and insulin levels, were evaluated. After necropsy, islet size and insulin content in pancreas were measured. Results: The ZDF rats showed increased blood glucose, insulin and lipid levels at 7 weeks as compared with those in ZL rats. After food restriction for 2 weeks, the blood glucose, insulin, and triglyceride levels in pair-fed ZDF rats were decreased. The islet size in pair-fed ZDF rats decreased as compared with that in ad lib-fed ZDF rats, but the insulin content in pancreas of pair-fed ZDF rats increased remarkably. Conclusion: ZDF rats showed improvement of pancreatic disorders by food restriction. Caloric restriction applied at an insulin resistant pre-diabetic stage is an effective means for preventing the pancreatic disorder in diabetes with obesity.

Effect of Isolation Stress on Glucose/Lipid Metabolism in Spontaneously Diabetic Torii (SDT) Fatty Rats.

Aim: The Spontaneously Diabetic Torii (SDT) fatty rat is a novel obese type 2 diabetic model, showing hyperphagia, obesity, and diabetes mellitus from a young age. In this study, we investigated the effects of isolation stress on pathophysiology in SDT fatty rats. Methods: SDT fatty rats (4 weeks old) were housed 3 per cage for 2 weeks and separated as males or females so as each gender will be placed in a separate cage to avoid mating. After acclimatization in 6 weeks of age, the rats were exposed to isolation stress (IS) (one rat per cage, using 5 animals in each sex). In the control group, each sex of experimental rats were housed separately continuously 3 per cage (using 6 animals in each sex). Food intake, body weights, and blood chemical parameters, such as glucose, insulin, triglyceride and total cholesterol levels, of the rats from 6 to 15 weeks of age were measured at every 3 weeks. Satellite groups were prepared for pathological analyses. Necropsy of satellite group was performed at 12 weeks of age, and the pathological analyses, such as adrenal, thymus and spleen, were performed. Results: The blood glucose level in IS group in female SDT fatty rats was significantly increased at 12 weeks of age as compared with that in control group. Female SDT fatty rats showed accelerated diabetic progression, but the male rats did show the effects of IS on the glucose/lipid metabolism. In male SDT fatty rats, an increase of adrenal weight and a decrease of thymus weight were observed in IS group and the female rats in IS group showed a tendency of an increase of adrenal weight and a decrease of thymus weight. In histopathological analyses, adrenal hypertrophy and thymus atrophy were observed in IS group in both male and female rats. Conclusion: Isolation stress affected the progression of diabetes in female SDT fatty rats. Housing conditions is a factor to care for in evaluation of pathophysiology in diabetic models.

Effects on Fat Distribution by Food Restriction in Zucker Diabetic Fatty Rats.

Aim: Zucker diabetic fatty (ZDF) rat is a type 2 diabetic model with hyperphagia, obesity, and the overt fat storage. The present study investigated effects of food restriction for 15 weeks on the fat distribution in ZDF rats. Methods: ZDF rats were pair-fed with Zucker Lean (ZL) rats from 9 to 24 weeks of age. Body weight and blood chemistry parameters, such as glucose, insulin, triglyceride, total cholesterol and non-esterified fatty acid, were measured every two weeks. The visceral and subcutaneous fat weights were measured at 24 weeks of age by computed tomography (CT) analysis, and the total fat weight and the ratio of visceral fat weight to subcutaneous fat weight (V/S ratio) were determined. Results: The ZDF rats showed obesity, hyperglycemia, hyperinsulinemia, and hyperlipidemia as compared with the ZL rats. Pair-fed ZDF rats showed a temporary decrease in body weight and a suppression of hyperglycemia, but the blood insulin and lipid levels increased. Total fat weight was about 2.4 times higher in the ZDF rats than the ZL rats. The total fat weight in Pair-fed ZDF rats was increased by 56%, but the V/S ratio was decreased by 38% at 24 weeks of age. Conclusion: The change of fat distribution by dietary restriction may be related to the improvement of glucose and lipid metabolic disorders in diabetes mellitus with obesity.

Diet-Induced Fatty Hepatic Steatosis in Male Spontaneously Diabetic Torii (SDT) Fatty Rats, A Genetic Model for Obese Type 2 Diabetes.

Aim: The Spontaneously Diabetic Torii (SDT) fatty rat is a metabolic syndrome model, showing obesity, hyperglycemia, dyslipidemia, and hypertension. Moreover, female SDT fatty rats exhibit hepatic steatosis. In this study, metabolic abnormalities, particularly in the liver, were assessed in male SDT fatty rats fed a diet containing 40% fat and 2% cholesterol (HFC-diet). Location and Duration of Study: Niigata University, CLEA Japan and JT Central Pharmaceutical Research Institute, between January and December 2014. Methodology: Male SDT fatty rats in control and HFC groups were fed a standard or HFC-diet (40% fat and 2% cholesterol, based on percentage of total calories) from 5 to 17 weeks of age, respectively. Body weight and blood chemistry parameters were periodically measured and a pathological analysis of the liver was performed at 17 weeks of age. Results: In biological analyses, the HFC group showed increases in body weight, blood insulin, and total cholesterol during the experimental period and an increase in aspartate aminotransferase (AST) at 13 weeks of age. Blood glucose levels in HFC group decreased after 13 weeks of age. In pathological examinations, an increase in liver weight and hepatic steatosis, fatty change and hypertrophy in hepatocyte, were observed in the HFC group. Hepatic steatosis was not observed in the standard-diet group. Conclusion: Male SDT fatty rats fed an HFC-diet may serve as a new nonalcoholic fatty liver disease (NAFLD) model.

Pharmacological Effect of α-Glucosidase Inhibitor Voglibose in a Novel Obese Diabetic Model.

Aim: This study was conducted to investigate the preventive or therapeutic effect of α- glucosidase inhibitor voglibose in a new model rat, Spontaneously Diabetic Torii-Leprfa (SDT fatty) rat, which is a novel type 2 diabetic rat showing obesity, hyperglycemia and hyperlipidemia from a young age. Place and Duration of Study: Niigata University and JT Central Pharmaceutical Research Institute, between January and August 2011. Methodology: The present study was designed to the preventive and therapeutic effect of voglibose by administering (0.3, 1 mg/kg) voglibose as a dietary admixture to SDT fatty rats from 5 to 11 and 14 to 20 weeks of age, respectively. Results: In the examination of preventive effect, the obtained biochemical results show that voglibose decrease glucose level significantly in dose-dependent manner within 5-11 weeks of age. In voglibose-treated rats at 11 weeks of age, the histopathological pancreatic changes, such as vacuolation and irregular boundaries in islets, were improved. On the other hand, in the examination of therapeutic effect, voglibose improved the hyperglycemia only at a dose of 1 mg/kg within 16-20 weeks of age. Conclusion: Voglibose showed both preventive and therapeutic effects for diabetes in female SDT fatty rats. The SDT fatty rat is a useful model for development of anti-diabetic agents.