Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction / 华西口腔医学杂志

OBJECTIVES@#This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction.@*METHODS@#Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction.@*RESULTS@#At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations.@*CONCLUSIONS@#The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.

Primary clinical research of orthognathic surgery simultaneous mandibular ramus reconstruction for type M3 hemifacial macrosomia / 中华整形外科杂志

Objective@#To summarize the effect of simultaneous orthognathic surgery along with mandibular ramus reconstruction using costochondral graft, for adult M3 hemifacial macrosomia.@*Methods@#From November 2015 to October 2017, 5 adults diagnosed with M3 hemifacial macrosomia were treated. There were 3 males and 2 females, aged from 19 to 26 years. Le Fort Ⅰ osteotomy and SSRO with simultaneous mandibular ramus reconstruction using contralateral sixth or seventh costochondral graft was performed to correct the facial asymmetry and occluding relation. The data of clinical examination and CTs were collected at the time point of immediately postoperative, 1, 3, 6, 12 months after surgery. The facial symmetry, joint function, occlusion and 3D measurements in CT image reconstruction were analysed to evaluate the surgery outcome.@*Results@#The length of rib and costal cartilage ranged from 47 mm to 67 mm. All the costal cartilage grafts survived, and 4 patients got primary healing. All patients were followed for 2-13 months (with the mean follow-up of 8 months). The ratio of ramus length of affected side to normal side was over 80%. The occlusion was stable. The facial structures were satisfactory after 6 months.@*Conclusions@#Orthognathic surgery with simultaneous mandibular ramus reconstruction using costochondral graft is suitable for the adult severe hemifacial macrosomia, with satisfactory cosmetic and functional results. This method is easily performed with reliable graft survival rate, aesthetic facial structure and stable occlusion.

Reconstrucción mandibular mediante planificación tridimensional en pacientes con queratoquiste odontogénico / Mandiblular reconstruction using 3D planning in odontogenic keratocyst: a review of the literature and case reports

La reconstrucción de estructuras perdidas por causas patológicas es una tarea desafiante para la cirugía maxilofacial contemporánea. En los últimos años se ha generado y masificado un gran desarrollo tecnológico, basado en la aplicación médico quirúrgica de tecnología digital para la confección de modelos estereolitográficos tridimensionales, a partir de la obtención de datos que puede proporcionar una Tomografía Axial Computada (TAC). En relación a esto último, la planificación, tiempo intraoperatorio y pronóstico de los tratamientos reconstructivos se han visto fuertemente favorecidos en casos de patología tumoral del macizo craneofacial. El Queratoquíste odontogénico representa un enigma para el profesional, aunque los avances e investigaciones de los últimos años han mejorado enormemente la comprensión de este tipo de lesiones, resultando interesante el comportamiento clínico y biológico, que incluye altas tasas de recurrencia y su potencial invasivo local. Varias alternativas se han propuesto como tratamiento para estos quistes, incluyendo el curetaje óseo, osteotomía periférica con uso de agentes químicos, eliminación de la mucosa adyacente en casos de perforación de las corticales, y la resección ósea de manera marginal o segmentaria con el posterior reemplazo de las estructuras. El presente reporte de casos describe la planificación digital y el tratamiento quirúrgico radical, con resección de rama mandibular y articulación temporomandibular unilateral, seguido del reemplazo inmediato de las estructuras mediante injerto costocondral, en dos pacientes diagnosticados histopatológicamente con Queratoquiste odontogénico mandibular.

Reconstruction of structures lost through disease is a challenge for contemporary maxillofacial surgery. In recent years we have seen great technological advances in the application of medical surgical digital technology for the making of 3D stereolithographic models using data from computerized axial tomography. Thanks to the latter, solid craniofacial tumor reconstructive treatment planning, intra operatory times and prognoses have improved. Odontogenic keratocysts constitute an enigma for the professional, although advances in research have improved the understanding of this type of lesion enormously. Its clinical and biological behavior are interesting for their local invasive potential and high recurrence rate. Several different treatments for these cysts have been proposed, including bone curettage, peripheral osteotomy using chemical agents, removal of adjacent mucosa in the case of cortical perforation and marginal or segmentary bone resection with replacement of the structures thereafter. These case reports describe digital planning and radical surgical treatment, with resection of the mandible ramus and temporomandibular joint, followed by immediate replacement of the structures using a costochondral graft in two patients with a histopathological diagnosis of mandibular odontogenic keratocyst.

Correction of Facial Asymmetry Using Costochondral Graft and Orthognathic Surgery in Hemifacial Microsomia Patient: Case Report

Fourteen Years Follow-up of Ohara Condylar Prosthesis for the Treatment of Bilateral Temporomandibular Joint Ankylosis

Temporomandibular joint(TMJ) ankylosis is a serious and disabling condition. It results in the inability of the patient to open the mouth, impairment of the speech, difficulty in mastication, poor oral hygiene, facial asymmetry, mandibular micrognathia and psychologic disability. The causes of TMJ ankylosis can be diverse, traumatic, septic, autoimmune and rarely neoplastic. Traumas and particularly mandibular condyle fracture represent the most frequent cause of TMJ ankylosis. The interposition of muscle and fascia between the bones and many other materials like cartilage, muscle and dermis, fat or fascia was suggested.1 In addition, numerous alloplastic materials have been used for partial or total reconstruction of the TMJ. The current authors report 14 years follow-up results of Ohara condylar prosthesis for the treatment of bilateral temporomandibular joint ankylosis in a 35-year-old male. The patient had a bilateral TMJ ankylosis and micrognathia resulted from rheumatoid arthritis and the TMJ reconstruction with Ohara condylar prosthesis was performed. Four years later, right Ohara prosthesis was removed due to the penetration of the prosthesis into the middle cranial fossa and right TMJ was reconstructed with vascularized calvarial bone graft and costo-chondral graft. At 13 years after the first operation, reankylosis occurred bilaterally, and gap arthroplasty with interpositional silicon block was performed. Now he is being encouraged to exercise to open the mouth and opening up to 30mm is possible.