ABSTRACT
When occlusal alterations are not accompanied by paranasal deficiencies, mobilization of the maxilla via Le Fort I osteotomy should be made with a different design. In this preliminary report, a W-shaped osteotomy that doesn't change the position of the maxillary bone surrounding the pyriform aperture was presented for the first time. Advantages and indications of this new procedure are discussed.
Lorsque les altérations occlusales ne sont pas accompagnées d'anomalies paranasales, la mobilisation du maxillaire par l'ostéotomie de LeFort I devrait être conçue différemment. Le présent rapport préliminaire décrit une ostéotomie en W qui ne modifie pas la position de l'os maxillaire entourant l'orifice piriforme. Les avantages et les indications de cette nouvelle intervention sont exposés.
ABSTRACT
Arthrocentesis in temporomandibular joint disorders can be associated with the intra-articular infiltration of various drugs with the objective of increase treatment efficacy. The aim of this study was to evaluate the clinical indexes variation in patients affected by temporomandibular joint disorders treated with arthrocentesis and sodium hyaluronate (SH) injections. A total of 28 patients suffering from temporomandibular joint disorders underwent one cycle of five arthrocentesis and infiltrations of sodium hyaluronate. Spontaneous mouth opening improved from 36.3 ± 7.5 mm to 45.1 ± 1.9 mm at six months follow-up. A significant reduction in the pain at rest and during mastication mean values emerged at follow-up (p < 0.0001). The mean masticatory efficiency, evaluated through a visual analogic scale, showed improvement at the follow-up period, highlighted by the increase of mean value from a baseline of 3.1 ± 1.2 to a mean value of 8.5 ± 1.2 (p < 0.0001). The mean severity of the joint damage at baseline time was 2.4 ± 0.9 and decreased to 0.4 ± 0.3 at the end of the follow-up period. The decrease in values is confirmed by statistical test (p < 0.05). Our data show how arthrocentesis integrated with sodium hyaluronate infiltrations performed under local anesthesia is a valid method of treating temporomandibular joint disorders.
ABSTRACT
BACKGROUND: A three-dimensionally favourable mandibular bone crest is desirable to be able to successfully implant placement to meet the aesthetic and functional criteria in the implant-prosthetic rehabilitation. Several surgical procedures have been advocated for bone augmentation of the atrophic mandible, and the sandwich osteotomy is one of these techniques. The aim of the present case report was to assess the suitability of segmental mandibular sandwich osteotomy combined with a tunnel technique of soft tissue. Based on our knowledge, nobody described before the sandwich osteotomy with tunnel technique to improve the healing of the wound and meet the dimensional requirements of preimplant bone augmentation in cases of a severely atrophic mandible. CASE PRESENTATION: A 59-year-old woman with a severely atrophied right mandible was treated with the sandwich osteotomy technique filled with autologous bone graft harvested by a cortical bone collector from the ramus. Clinical examination revealed that the mandible was edentulous bilaterally from the first molar to the second molar region. Radiographically, atrophy of the mandibular alveolar ridge in the same teeth site was observed. We began to treat the right side. A horizontal osteotomy of the edentulous mandibular bone was then made with a piezoelectric device after tunnel technique of the soft tissue. The segmental mandibular sandwich osteotomy (SMSO) was finished by two (mesial and distal) slightly divergent vertical osteotomies. The entire bone fragment was displaced cranially, and the desirable position was obtained. The gap was filled completely with autologous bone chips harvested from the mandibular ramus through a cortical bone collector. No barrier membranes were used to protect the grafts. The vertical incisions were closing with interruptive suturing of the flaps with a resorbable material. In this way, the suture will not fall on the osteotomy line of the jaw; the result will be a better predictability of soft and hard tissue healing. CONCLUSIONS: Segmental mandibular sandwich osteotomy is an easy and safety technique that could be performed in an atrophic posterior mandible. Future studies involving long-term follow-up are needed to evaluate the permanence of these results.
ABSTRACT
BACKGROUND: Several treatments have been described for facial wasting rehabilitation in HIV-positive patients. In this article, we compare lipofilling and a nonabsorbable filler for facial wasting rehabilitation induced by antiretroviral therapy in HIV-positive patients. METHODS: This study was conducted as a clinical prospective study. Twenty-three HIV-positive patients affected by facial wasting were treated for facial rehabilitation, between January 2007 and December 2008, at the Head and Neck Department of the II University of Naples. They were divided into 2 groups; the first group was treated with lipofilling (group A), and the second one with the injection of a nonabsorbable filler, Aquamid reconstruction (Contura International A/S, Soeborg, Denmark) (group B).All the patients were HIV-positive, they had been receiving antiretroviral therapy for several years (1.8-6.7 years, 3.2 years on average) and showed clinical signs of facial lipoatrophy. Group A was composed of 14 patients (9 men, 5 women; mean age, 43.7 years), all presenting facial wasting and lipohypertrophied areas of the body. Group B was composed of 9 male patients, 7 presenting only facial wasting, and 2 presenting lipohypertrophied areas of the body (mean age, 44.8 years). Clinical efficacy was assessed independently by the investigator and the patient, 3 months, 6 months, and 1 year after baseline. The main assessment was made by the investigator using the Global Aesthetic Improvement Scale (GAIS) 1 year after baseline; secondary assessment using the GAIS was made by the investigator and the patient 6 months after baseline. RESULTS: There were no major complications. No infections or other complications were observed. According to GAIS ratings, group A (lipofilling) obtained significantly higher ratings than did group B (nonabsorbable filler) after baseline (P < 0.05). CONCLUSIONS: We can treat HIV-related lipodistrophy more extensively with lipofilling because, after harvesting the fat graft, other body contouring procedures also can be performed; there is a better aesthetic outcome in facial rehabilitation performed with lipofilling, probably due to the possibility to fill deeper than with nonabsorbable fillers.
