ABSTRACT
Objetivo: presentar un caso de pseudoaneurisma de la arteria maxilar interna, complicación hemorrágica infrecuente mediata al procedimiento de osteotomía sagital mandibular. Caso clínico: El tratamiento consistió en la embolización selectiva del vaso afectado, un procedimiento menos cruento que las maniobras hemostáticas tradicionales, como la ligadura arterial a través de un abordaje cervical. Conclusión: Es posible resolver la hemorragia con un método alternativo pero seguro, que conlleva menos morbilidades asociadas a las maniobras hemostáticas clásicas.
Aim: to report a mediate rare bleeding complication tothe procedure of mandibular sagittal split osteotomy as is thepseudoaneurysm of the internal maxillary artery is.Case report: The treatment consisted of selective embolizationof the affected vessel, which turns out to be a lessinvasive procedure than traditional hemostatic maneuverssuch as arterial ligation through a cervical approach.Conclusion: It is possible to resolve the bleeding withan alternative safe method with lower morbidity than the oneassociated with classical hemostatic maneuvers.
Subject(s)
Humans , Female , Young Adult , Orthognathic Surgery/methods , Osteotomy, Sagittal Split Ramus/adverse effects , Postoperative Complications , Embolization, Therapeutic/methods , Aneurysm, False/etiology , Hemorrhage/prevention & control , Jaw Fixation Techniques/methods , Hemostatic Techniques/methodsABSTRACT
La osteotomía sagital de rama mandibular bilateral, es un procedimiento que se considera seguro, predecible y estable utilizado para corregir las anomalías dentofaciales de origen esquelético únicas o en combinación con otras osteotomías faciales. La fijación de los segmentos osteotomizados se realiza mediante el uso de material de osteosíntesis no reabsorbible de material tipo titanio, en su mayoría con tornillos bicorticales de longitudes mayores con respecto a los tornillos convencionales utilizados para fijación rígida ósea facial, sin embargo en algunos casos, la oclusión definitiva posterior a la cirugía ortognatica no es similar al planeamiento prequirúrgico planeado, debido a factores asociados a la fijación rígida con tornillos bicorticales, Se ha observado en una amplia cantidad de osteotomías sagitales bilaterales de rama mandibular durante la fijación con tornillos bicorticales, movimientos de tipo indeseado por el operador, a menudo observando máxima intercuspidacion en la zona posterior derecha y leve mordida abierta en la zona posterior izquierda; de acuerdo a la biomecánica mandibular dichos movimientos ocurren por la presencia del eje de la rosca de los tornillos bicorticales utilizados para la fijación rígida que en su mayoría están dirigidos en sentido de las agujas del reloj. El propósito de este artículo es proponer el uso de tornillos bicorticales de rosca invertida para la fijación de la osteotomía sagital mandibular contrarrestando el efecto indeseado observado en la oclusión definitiva de pacientes sometidos a osteotomías sagitales bilaterales de rama mandibular, en paciente sometidos a cirugía ortognatica monomaxilar y bimaxilar para la corrección de anomalías dentofaciales.
The bilateral sagittal ramus osteotomy is a procedure that is considered safe, predictable and stable dentofacial used to correct skeletal abnormalities unique origin or in combination with other facial osteotomies. Osteotomized fixing segments is performed using non-resorbable osteosynthesis material type titanium material, mostly bicortical screws with longer lengths compared to conventional screws used for rigid fixation facial bone, however in some cases, the subsequent final occlusion orthognathic surgery is not similar to preoperative planning planned due to factors associated with rigid fixation with bicortical screws, it has been observed in a wide number of bilateral sagittal osteotomy of ramus during fixation with bicortical screws movements unwanted by the operator type, often observing maximum intercuspation in the right posterior open bite and mild in the left rear area; according to the mandibular biomechanics such movements occur by the presence of the thread axis of the bicortical screws used for rigid fixation which mostly are directed in the direction of clockwise. It is the purpose of this review article, proposing the use of bicortical screws reverse threaded for fixing the mandibular sagittal osteotomy counteracting the undesirable effect observed in the final occlusion patients undergoing bilateral sagittal osteotomy of ramus in patients undergoing surgery monomaxilar bimaxillary orthognathic and for the correction of dentofacial anomalies.
ABSTRACT
El objetivo de esta investigación es identificar las tensiones presentes en tornillos de osteosíntesis utilizados en la fijación de la osteotomía sagital de rama mandibular (OSRM). Se utilizaron dos modelos de OSRM realizados con resina fotoelástica donde el grupo 1 presentaba una osteotomía basilar recta mientras que el grupo 2 presentaba una osteotomía basilar angulada; en ambos se utilizo el sistema de L invertido para la osteosíntesis con tornillos 2.0 de 13 mm de longitud. Posteriormente el sistema fue instalado en un pilar sobre la maquina Instrom, donde se aplico una carga vertical de 1 mm/minuto hasta conseguir el desplazamiento de 3 mm; el punto de carga estuvo en la fosa central del primer molar. La distribución de franjas mostro mayor tensión en el tornillo mas próximo de la osteotomía en ambos grupos; en el grupo 2 se produjo una diseminación de fuerzas levemente hacia la basilar y en el grupo 1 se mantuvo la diseminación a través de la línea oblicua. Se puede concluir que ambas osteotomías mandibulares son eficientes en la distribución de cargas y que no se observan diferencias cualitativas entre tornillos en términos de cantidad de diseminación de energía
The aim of this research was to analyzed the tension in osteosynthesis screw used for fixation of sagittal split ramus osteotomy (SSRS). Was used two model of SSRS made in photoelastic resin; in one of them was include a basilar osteotomy and the another one only SSRS without basilar osteotomy; for both system was used inverted L osteosynthesis with 13 mm screw of 2.0 system. Posteriorly, the hemimandible was installed in Instrom machine with a vertical load of 1 mm/min until the displacement of 3 mm; the load point was on first molar. The fringe distribution show more tension in the screw close to osteotomy in both groups; when SSRS was united to basilar osteotomy was produced a inferior distribution of force and in the SSRS without basilar osteotomy group was maintained a distribution into the oblique line. It's was conclude that both mandibular osteotomies was efficient in load distribution and was not observed important differences between screw related to distribution of load
Subject(s)
Humans , Bone Screws , Dental Stress Analysis/methods , Osteotomy, Sagittal Split Ramus/methods , Stress, Mechanical , Materials Testing , Internal Fixators , Elasticity , Models, BiologicalABSTRACT
O objetivo da presente investigação foi verificar a resistência ao deslocamento de seis formas diferentes de osteossíntese, usando uma miniplaca para a estabilização da osteotomia sagital da mandíbula. Material e Método: Foram realizadas osteomias sagitais em 30 hemimandíbulas de poliuretano. Um avanço de 4 mm do segmento ósseo distal foi executado e os grupos foram divididos de acordo com a placa utilizada para fixação: Grupo 1 -placa 4 furos regular; Grupo 2 -placa 4 furos Locking; Grupo 3 -placa 6 furos regular; Grupo 4 - placa 6 furos Locking; Grupo 5 -placa sagital 6 furos regular e, Grupo 6 -placa sagital 6 furos Locking. O teste mecânico de três pontos com força compressiva sobre o segundo molar foi realizado e a carga de força foi gerada por uma máquina universal de ensaio Instron até que 3 mm de deslocamento dos segmentos fossem verificados. Os valores obtidos em kN das forças compressivas produzidas para o deslocamento foram submetidos ao teste de Análise de Variância (P<0,01) e ao Teste estatístico de Tukey para a comparação entre grupos (P<0,05). Reultados: A placa sagital locking mostrou maior resistência ao teste biomecâncio que as placas regulares de 4 e 6 furos e não apresentou diferença para a placa sagital regular e placa locking 4 furos. Dentre os 3 Grupos de melhor resultado, 2 pertencem ao sistema locking. Conclusões: Para a fixação da osteotomia sagital de mandíbula empregando-se apenas uma miniplaca, é recomendado o uso da placa sagital 6 furos do sistema locking, da placa sagital 6 furos regular ou da placa linear 4 furos locking porque apresentam maior resistência ao deslocamento. Não foi comprovado do ponto de vista estatístico vantagem na resistência ao deslocamento das placas do sistema locking em relação ao sistema regular...
Purpose: The aim of the present study was to evaluate the efficacy of six types of osteosynthesis using one miniplate for sagittal split osteotomy in mandible. Material and Methods: The osteotomy was done in 30 polyurethane hemi-mandibles. After 4 mm advancement of the distal segment 6 different groups were create using 2.0 screw system: group 1 -4-hole regular plates; group 2 -4-hole Locking; group 3 -6-hole regular plate; group 4 -6-hole locking plates, group 5 -6-hole regular sagittal plate; group 6 -6-hole locking sagittal plate. A 3-point biomechanical test model with compression loads were applied at the second inferior molar site using the INSTRON machine until 3mm displacement was reached. The load for the displacement were gathered and compared using statistics Tukeys test (P<0.05). Results: The 6-hole sagittal locking plate group followed by the 6-hole sagittal regular plate and 4-holes locking plate are more stable than the others groups and among the 3 best results, 2 groups belong to locking system. Conclusion: It is possible to suggest to the surgeons that use only one plate to fixate the bilateral sagittal split osteotomy to choose the 6-hole locking or regular sagittal plate or 4- bole locking plate because they offer more resistance to displacement. The locking system did not show better statistical results beside the numeric results indicate it...