Surgical treatment of mandibular hypoplasia using inverted-L osteotomy of ramus and iliac creat bone grafting / 口腔疾病防治

Objective@# The present study was designed to evaluate the use of inverted-L osteotomy of ramus combined with iliac bone graft for the treatment of mandibular hypoplasia inadult patients.@*Methods@#Intraoral or extraoralinverted-L osteotomy of ramus and iliac crest bone grafting were used for the treatment of mandibular hypoplasia in 11 adult patients (aged 19 to 29 years) from 2010 to 2016. Data were collected from the patients’ records, photographs andradiographs.@*Results @#The height and width of the mandibular ramus were significantly augmented by inverted-L osteotomy and iliac crest bone grafting with minimal complications in all patients, resulting in remarkable improvements both in facial appearance and occlusion.@*Conclusions @#Our preliminary results showed that the inverted-L osteotomy of ramus and iliac crest bone grafting is safe and effective, and should be considered as a good alternative for the patients with mandibular hypoplasia.

Distracção osteogênica mandibular: experiência do INTO-RJ / Mandibular distraction osteogenesis: experience of the INTO-RJ

Introdução: O desenvolvimento das técnicas de distracção do esqueleto craniofacial representou um grande avanço na prática da cirurgia craniofacial. A distracção é uma técnica menos invasiva, mais rápida e com uma morbidade aparentemente menor comparada com as técnicas tradicionais de reconstrução craniofacial. No ano de 2013, o serviço de Cirurgia Crânio Maxilo Facial do INTO realizou uma série de casos de distracção mandibular. Este trabalho objetiva apresentar nossa experiência. Métodos: De janeiro a março de 2013, sete pacientes realizaram cirurgia de distracção mandibular. Todos os pacientes operados apresentavam hipoplasia mandibular uni ou bilateral em decorrência de anquilose de ATM ou microssomia craniofacial. Em alguns pacientes com anquilose de ATM foi realizada também a ressecção do bloco anquilótico no mesmo tempo da distracção. Resultados: No pós-operatório houve melhora de todas as funções estomatognáticas, ganho de peso, decanulação da paciente traqueostomizada e melhora na qualidade do sono. Houve melhora nos perfis faciais, as laterognatias foram amenizadas e a abertura oral aumentou na maioria dos pacientes. A abertura oral aumentou de maneira mais significativa naqueles pacientes onde a cirurgia de anquilose foi realizada em conjunto com a distracção. A complicação mais comum foi dor à ativação, relato de cinco pacientes (71%).Conclusão: A distracção osteogênica da mandíbula é uma boa alternativa para o tratamento das hipoplasias mandibulares, muitas vezes sendo a primeira indicação em algumas situações clínicas. Aparentemente tem morbidade menor do que as reconstruções clássicas de mandíbula e possui o bônus de alongar também os tecidos moles.

Introduction: The introduction of distraction of the craniofacial skeleton represented a great advancement in the practice of craniofacial surgery. Distraction is a less invasive technique that is faster and with an apparently lower morbidity than the traditional craniofacial reconstruction techniques. In 2013, the craniomaxillofacial surgery service of the Institute of Traumatology and Orthopaedics performed a series of mandibular distraction surgeries. In this article, we aim to present our experience. Methods: From January to March 2013, seven patients underwent mandibular distraction surgery. All patients exhibited unilateral or bilateral mandibular hypoplasia due to ankylosis of the temporomandibular joint (TMJ), or craniofacial microsomia. In some patients with ankylosis of the TMJ, resection of the anlylotic block was also performed concomitantly with the distraction. Results: Postoperative improvement was noted in all the stomatognathic functions: weight gain, decannulation of a tracheostomized patient, and improved quality of sleep. There was an improvement in facial profiles: the laterognathism was eased and the mouth opening increased in most patients. The mouth opening increased more significantly in patients in whom ankylosis surgery was done in conjunction with the distraction. The most common complication was pain upon distraction, reported by five patients (71%). Conclusion: Mandibular distraction osteogenesis is a good alternative for the treatment of mandibular hypoplasia, often being the first indication in some clinical situations. It apparently has a lower morbidity than the classic mandible reconstructions and has the added benefit of also lengthening the soft tissues.

A Case of Systematized Inflammatory Linear Verrucous Epidermal Nevus with Mandibular Hypoplasia / 대한피부과학회지

Inflammatory linear verrucous epidermal nevus (ILVEN) is an uncommon variant of verrucous epidermal nevus, clinically characterized by erythematous and hyperkeratotic verrucous papules with a typical linear arrangement. Most reported cases present as solitary lesions, but systematized ILVEN is rare. Epidermal nevus syndrome is a congenital disorder in which epidermal nevi are associated with abnormalities in other organ systems. However, ILVEN has been reported rarely in association with such abnormalities, including those of the skeleton. Here we report a rare case of systematized ILVEN presenting with concomitant mandibular hypoplasia.

Bilateral Rapid Distraction of Mandible

Bilateral mandibular hypoplasia is found in Treacher Collins syndrome, Pierre Robin sequence, and bilateral craniofacial microsomia. It causes many aesthetic and functional problems such as facial deformities with malocclusion and airway problems. We have corrected bilateral hypoplastic mandible with distraction osteogenesis, which is a highlighted method in mandibular lengthening. For last 3 years 8 months, We applied this method to four bilateral cases, where were Treacher Collins syndrome patients and bilateral craniofacial microsomia patient in rapid multidirectional fashion. A complete ostectomy was made at angle of the mandible and the mandible was fixed 5 days after lengthening was started serially 1mm every 12 hours. After consolidation period for one to three month, the device was removed. We have distracted the mandibles in vertical plane, left.18.8mm, right. 13.4mm, in horizontal plane, left 13.9mm, right 13.7mm on the average. We could achieve good aesthetic results, and their airway problems were improved without any complications.