Subject(s)
Histiocytosis, Langerhans-Cell/diagnosis , Mandibular Diseases/diagnosis , Orbital Diseases/diagnosis , Temporal Bone , Adolescent , Adult , Chemotherapy, Adjuvant , Child , Child, Preschool , Combined Modality Therapy , Diagnosis, Differential , Female , Follow-Up Studies , Histiocytosis, Langerhans-Cell/drug therapy , Histiocytosis, Langerhans-Cell/pathology , Humans , Infant , Male , Mandibular Diseases/drug therapy , Mandibular Diseases/pathology , Orbital Diseases/drug therapy , Orbital Diseases/pathology , Temporal Bone/pathology , Young AdultABSTRACT
PURPOSE: The aim of this study was to test our approach based on the use of calvarial graft and extraoral approach, in treatment of severe mandibular atrophies with implant surgery and prosthetic rehabilitation. METHODS: We selected 6 patients, 4 females and 2 males, completely edentulous with a severe mandibular atrophy (class VI Cawood and Howell classification). Mean age of patients was 63 years, ranging from 60 to 67 years. Mandibles were reconstructed with a submental incision with calvarial bone graft harvested from parietal area. After a mean of 4.2 months, each patient received 4 implants, and after a mean of 4.67 months, implants were loaded. RESULTS: No complications occurred in donor site or on the mandible, and all patients recovered well. No extraoral scar occurred. A total of 25 implants were inserted, and, with exception of an early failure and successive replacement, all implants were osseointegrated at successive visits. After 1-year follow-up, our analysis showed 100% implants survival and correct fit and success of prosthetic rehabilitation. CONCLUSIONS: Results of this study showed an uneventful recovery for all patients with our approach and reduced healing time of bone graft. So extraoral approach with submental incision and calvarial graft is a reliable method in reconstruction of atrophic mandibles, and staged implant surgery is suggested.
Subject(s)
Alveolar Ridge Augmentation/methods , Bone Transplantation/methods , Chin/surgery , Dental Implantation, Endosseous/methods , Jaw, Edentulous/surgery , Mandible/surgery , Postoperative Complications/prevention & control , Aged , Atrophy , Dental Prosthesis, Implant-Supported , Female , Follow-Up Studies , Humans , Male , Mandible/pathology , Middle Aged , Postoperative Complications/etiologyABSTRACT
BACKGROUND: Frontal bossing is a malformation characterized by peculiar prominent forehead, and commonly it can be associated with cranial synostosis and endocrine disorder; however, nonsyndromic conditions are described as well.Literature controversies on proper frontal bossing surgical treatment showed evidence of 2 main surgical procedures: frontal bone reshaping and bone en bloc mobilization.A decision-making criterion between these 2 techniques has never been described in literature. METHODS: In this paper, the authors introduce their brand-new analytic method for decision-making between bur shaping and en bloc mobilization in frontal bossing treatment, and describe a successful case of a nonsyndromic frontal bossing patient, treated with their unconventional surgical technique. RESULTS: Our analytic method indicated that bur shaping was not indicated in this particular case: aggressive remodeling of excessive thin wall could lead to sinus perforation, which could turn into unsatisfied aesthetic and functional outcome.So we planned for a bilateral orbitofrontal en bloc reposition, followed by internal rigid fixation. No postoperative complications occurred. Postoperative CT scan revealed good bone repositioning and recovery. CONCLUSIONS: The authors explained their analytic method based on careful presurgical CT-scan measurements for decision-making between bur shaping and en bloc mobilization.
