Osteotomía subcondílea en el tratamiento de las deformidades mandibulares / S.rbeondylar osteotomy in the treatment of mandibular deformites

La corrección quirúrgica del prognatismo mediante intervenciones en las ramas ascendentes de la mandíbula, fue la opción que sustituyó a las técnicas de ostectomíasquereducían el volumen mandibularo más exactamente la longitud del cuerpo bilateralmente. Se realizan osteotomías subcondíleas oblícuas por encima de la espina de Spix, preservando el paquete vásculo-nervioso que, partiendo de la escotadura sgmoidea, llegan al borde posterior de la mandíbula. Desde el año 1974 hemos empleado la técnica subcondílea oblicua (OSO) por vía intraoral en 367 casos para la corrección del prognatismo (AU)

25 Aniversario de la Especialidad de Cirugía Oral y Maxilofacial / 25th Aniversary of the speciality of oral and maxilofacial surgery

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Morphometric and morphological changes in the temporomandibular joint after orthognathic surgery: a magnetic resonance imaging and computed tomography prospective study.

The possible morphological and morphometric changes in the different components of the temporomandibular joint (TMJ) after orthognathic surgery were analysed using computed tomography (CT) transverse scans and sagittal and coronal magnetic resonance imaging (MRI) images. Twenty-four patients with class III dentofacial deformity were studied. Nine had isolated maxillary osteotomies and 15 had combined maxillary and mandibular subcondylar osteotomies (MSO). Ten patients were studied as a control group. The patients were studied clinically, radiographically and with CT and MRI in four different phases in order to locate the position of the mandibular condyle in relation to the glenoid fossa. No statistically significant differences were found in the group of patients who had had isolated maxillary osteotomies throughout the four phases of the study. Patients treated by bimaxillary surgery showed different condylar movements after surgery. Intra-articular effusion was evident during the early postoperative period in patients treated by bimaxillary surgery. Although different changes in the position of the bony components of the TMJ occurred after MSO, these seemed to be transient, with no major alterations in the final outcome in the patients.

Changes in the temporomandibular joint caused by the vertical facial pattern. Study on an experimental model.

An experimental model reproducing open bite or verticalized facial pattern was used to study its effect on the temporomandibular joints. 140 Wistar rats were used, divided into 3 groups: bilateral resection of the masseteric muscle, simulated muscular resection and control group. A series of radiological, morphological and histological tests were analyzed. The posterior rotation of the jaw caused by muscular resection although not producing a degenerative effect, did produce specific articular changes in the temporomandibular joint components.

Primary mandibular reconstruction with bridging plates.

25 cases in which the mandible was resected and reconstructed using a reconstruction plate (AO titanium reconstruction system and Leibinger titanium reconstruction system) are presented. 16 patients suffered from oral carcinoma, 7 presented with odontogenic tumours and 2 had chronic osteomyelitis of the mandible. The mean age was 54.2 years, the male to female ratio was 2.6:1. 3 patients had a reconstruction plate for mandibular resection without continuity defect (marginal resection), in all the other patients the reconstruction plate bridged a mandibular resection with a continuity defect: 13 were located in the body, body-angle or ascending ramus with preservation of the mandibular condyle; 4 hemimandibulectomies with disarticulation of the TMJ; and 5 involved the anterior arch, crossing the midline. 12 patients received radiotherapy (3 pre-operatively). Only 3 patients with significant local side effects needed the treatment to be stopped for a period of time. There was no perioperative mortality. Only one plate was removed. Although minor complications were noted in 11 patients, the general improvement in the functional and cosmetic balance of the patients when compared with patients in whom no plate was used, justifies the use of this reconstruction system, in our opinion.

The temporalis muscle flap: an evaluation and review of 38 cases.

This article analyzes the authors' experience with the temporal myofascial flap in orbital, maxillary, floor of the mouth, tongue, retromolar trigone, and buccal mucosa reconstruction after oncologic surgery. Thirty-eight patients were treated and evaluated after using this technique. Four of the patients received the flap to restore orbital defects; the other 34 flaps were used in oral reconstruction. The flap remained viable in all instances. Most of the patients experienced no perioperative complications. Ten patients (29.4%) with flaps transposed to the oral cavity showed partial wound dehiscence. Two patients experienced temporomandibular joint dysfunction, two severe reduction in the oral aperture, 22 had mild depression of the temporal fossa, and four had mild to severe alteration in the facial aesthetics secondary to bone resection. All flaps transposed to the oral cavity showed good epithelialization and adaptation to the recipient site.

Changes in temporomandibular joint after mandibular subcondylar osteotomy: an experimental study in rats.

The objective of this study was to analyze the changes in the different components of the temporomandibular joint and their relation with age after subcondylar osteotomy. For this purpose 149 Wistar rats were divided into three groups: osteotomy, sham operation, and control. Two experimental ages (30 and 70 days) and radiologic, morphometric, macroscopic, and histologic methods of analysis were used. Different changes were observed in young and adult animals. Subcondylar mandibular osteotomy in growing rats caused anteroinferior displacement of the temporal and mandibular component of the joint. At the end of the experimental period only condylar displacement was maintained. Other changes were flattening of the mandibular condyle, which was transient, and lateral thickening of the articular disc. Subcondylar mandibular osteotomy in adult rats caused slight anterior displacement of the joint components at the end of the experimental period. At this age, although changes similar to those in growing animals were observed in some cases, in other cases the presence of pathologic findings, such as deformation of the condylar cartilage, thickening of the disc, intra-articular adherences, and osteolysis of the temporal fossa, were observed. Changes in the joint components were more marked in growing rats than in adults. In growing rats they affected the form of the condylar process to a greater extent, but the majority of these changes were transient. In adult rats, alterations in the joints were less pronounced, but they affected a greater number of joint components and were permanent.

Carbon dioxide laser vermilionectomy for actinic cheilitis.

Actinic cheilitis is a premalignant condition of the lower lip that requires treatment. Several methods have been advocated to manage this disease. In this study, 19 cases of actinic cheilitis were treated by carbon dioxide (CO2) laser vermilionectomy with good results. Because it has the advantages of both scalpel vermilionectomy and laser vaporization of the vermilion, CO2 laser vermilionectomy is proposed as a good method of treating actinic cheilitis.

Sarcomas of the head and neck.

Fourteen cases of sarcomas involving the head and neck over a period of 15 years were reviewed. The male to female ratio was 3.5:1. Mean age of occurrence was 33.4 years, with a range of 5-84 years. Soft tissue was the site of origin in three cases, maxilla in four and mandible in seven patients. Radical surgery with resection of adequate disease-free margins was the most effective mode of treatment. Radiotherapy and chemotherapy was used in selected cases. Recurrence occurred in 42.9% of patients, and was the main cause of death. Three patients (21.4%) developed distant metastases. The actuarial 2-year and 5-year survivals of the 14 patients assessed were 64% and 56% respectively.

[Cranio-orbital neurofibrosarcoma]. / Neurofibrosarcome cranio-orbitaire.

We present a type 1 neurofibromatosis case with sarcomatous degeneration of a cranio-orbital neurofibroma, its surgical evolution and the cytogenetics and cellular proliferative potential features (CMF, Ki-67 antibody).

Mandibular lesion as the first evidence of multiple myeloma. Case report.

Plasma cell dyscrasias affect the jaws relatively infrequently, and on rare occasions this is the first sign of the disease. This article describes the case of a patient aged 53 who presented with a lytic lesion in the right mandible which was initially diagnosed as an ameloblastoma. The diagnosis was made histopathologically and further investigation showed that the patient had multiple myelomatosis.