Consensus Report and Recommendations on the Management of Late-stage Internal Derangement of the Temporomandibular Joint.

Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.

Outcomes Following Autologous Fat Grafting in Patients with Sequelae of Head and Neck Cancer Treatment.

A single-center retrospective study was designed to assess the outcomes of autologous fat grafting for improving surgery- and radiotherapy-related sequelae in 40 patients with head and neck cancer. All patients underwent surgical resection of primary tumors and radiotherapy (50-70 Gy) and were followed over 12 months after fat grafting. Eligibility for fat grafting procedures included complete remission after at least 3 years of oncological treatment. The cervical and paramandibular regions were the most frequently treated areas. Injected fat volumes ranged between 7.5 and 120 mL (mean: 23 mL). Esthetic improvement was obtained in 77.5% of patients, being significant in 17.5%, and functional improvement in 89.2%, being significant in 29.7% of patients. Minor complications occurred in three patients. There was a high degree of satisfaction regarding esthetic improvement, global satisfaction, and 92.5% of patients would recommend the procedure. This study confirms the benefits of fat grafting as a volumetric correction reconstructive strategy with successful cosmetic and functional outcomes in patients suffering from sequelae after head and neck cancer treatment.

Improving accuracy of the intermediate splint in substantial intermaxillary sagittal discrepancies using an extra anterior anchorage point: technical note / Mejora de la precisión de la férula intermedia en intermaxilares sustanciales. Discrepancias sagitales utilizando un punto de anclaje anterior adicional: nota técnica

Background: To describe a technical feature that increases the stability of the intermediate splint in patients wherebimaxillary surgery with great maxillary/mandibular advancements are planned.Material and Methods: Prospective evaluation of the intermediate splint dental vertical penetration in patientsundergoing bimaxillary surgery where great sagittal discrepancy occur in the anterior sector between the upperand lower jaws when the intermediate splint is placed by adding an extra intermaxillary fixation (IMF) screw (2x9mm) placed between the central incisors of the maxilla and fixed to the most anterior aspect of the intermediatesplint following the direction of the sagittal maxillo-mandibular discrepancy from January to September 2018.Results: The postoperative evaluation comparing the accuracy of conventional fixation versus fixation with anextra anterior anchorage point through photographic assessment and intraoral digital scanner demonstrated betterdental penetration, and therefore improved intermediate splint precision with the latter in all casesConclusions: Our results suggest that this is a simple and safe technique that can be easily reproduced and opti-mizes the outcomes by increasing the accuracy of translation of the planned surgical movements to the operatingroom.(AU)

Interpositional collagenated cancellous bone blocks for nasal dorsum augmentation: A new technique for nasomaxillary hypoplasia treatment.

Nasomaxillary hypoplasia is a rare congenital malformation involving the middle third of the face. The present paper describes a novel technique for restoring the nasal projection in a patient with nasomaxillary hypoplasia, analyses its advantages and limitations, and discusses its potential applicability in other similar contexts. After orthognathic surgery, lateral osteotomies of the nasal bones were performed integrally with a piezoelectric device using a long cutting saw tip through the intraoral approach. The nasal bones were then projected by interpositioning two triangular-shaped collagenated cancellous bone graft blocks on each side in the osteotomies between the nasal and the frontal processes of the maxillary bones. Cone-beam computed tomography (CBCT) data was used to perform a morphometric analysis at one and 12 months of follow-up through image superimposition, which revealed a stable increased projection of the nasal dorsum and an anterior nasal spine (ANS) of 5.18 mm and 5.52 mm, respectively. The results of this case suggest that the technique affords satisfactory nasal dorsum augmentation while avoiding the use of permanent foreign materials, with minimal morbidity, no unsightly and visible scars, great patient satisfaction, and adequate stability at 12 months of follow-up.

What are the Surgical Movements in Orthognathic Surgery That Most Affect the Upper Airways? A Three-Dimensional Analysis.

PURPOSE: Most studies have focused on airway changes after maxillomandibular advancement; however, airway size will change depending on the type, direction, and magnitude of each skeletal movement. The aim of this study was to assess the effect of the maxillary and/or mandibular movements on the pharyngeal airway volume and the minimum cross-sectional area using 3-dimensional cone-beam computed tomography voxel-based superimposition. PATIENTS AND METHODS: The investigators designed and implemented a retrospective cohort study composed of patients with dentofacial deformity subjected to orthognathic surgery. The predictor variables were the surgical movements performed at surgery. The primary outcome variables were the pharyngeal airway volume and minimum cross-sectional area measured preoperatively, at 1- and 12-month follow-up. Skeletal and volumetric relapse and stability were recorded as secondary outcomes at 1 and 12 months, respectively. Descriptive, bivariate and correlation analyses were computed. Significance was set at P < .05. RESULTS: The sample was composed of 103 patients grouped as follows: bimaxillary (53), maxillary (25), or isolated mandible (25). All of the surgical treatments resulted in a significant linear pattern of initial immediate increase of 33.4% (95% confidence interval [CI]: 28.2 to 38.7%; P < .001) in volumetric (nasopharynx [28.7%, CI: 22.7 34.9%; P < .001], oropharynx [36.2%, CI: 29.0 to 43.5%; P < .001], and hypopharynx [31.5%, CI: 25.7 to 37.3%; P < .001]) and minimum cross-sectional area parameters (bimaxillary = 104%, [CI: 87.1 to 122.1%; P < .001], maxillary = 39.5%, [CI: 18.4 to 60.7%; P < .05], and mandible = 65.8%, [CI: 48.1 to 83.6%; P < .05]), followed by a slight downward trend (stabilization) at 12-month follow-up. Airway increase was favored by mandibular advancement (P < .05) and mandibular occlusal plane changes by counterclockwise rotation (P < .05). CONCLUSIONS: The results of this study suggest that there is a favorable effect of orthognathic surgery in the upper airway regardless of the surgical approach, with bimaxillary advancement and mandibular occlusal plane changes by counterclockwise rotation being the most significant contributors.

Impact of surgical maxillomandibular advancement upon pharyngeal airway volume and the apnoea-hypopnoea index in the treatment of obstructive sleep apnoea: systematic review and meta-analysis.

Background: A systematic review was carried out on the effect of surgical maxillomandibular advancement (MMA) on pharyngeal airway (PA) dimensions and the apnoea-hypopnoea index (AHI) in the treatment of obstructive sleep apnoea (OSA), with the aim of determining whether increased PA in the context of MMA is the main factor conditioning the subsequent decrease in AHI. Methods: A search was made of the PubMed, Embase, Google Scholar and Cochrane databases. A total of 496 studies were identified. The inclusion criteria were a diagnosis of moderate to severe OSA, MMA success evaluated by polysomnography, reporting of the magnitude of MMA achieved, PA increase and a minimum follow-up of 6 months. Results: Following application of the eligibility criteria, eight articles were included. Metaregression analysis showed MMA to significantly increase both pharyngeal airway volume (PAV) (mean 7.35 cm3 (range 5.35-9.34)) and pharyngeal airway space (mean 4.75 mm (range 3.15-6.35)) and ensure a final AHI score below the threshold of 20 (mean 12.9 events/hour). Conclusions: Although subgroup analysis showed MMA to be effective in treating OSA, more randomised trials are needed to individualise the required magnitude and direction of surgical movements in each patient, and to standardise the measurements of linear and nonlinear PAV parameters.

Jawline Contouring Through an Intraoral Approach in the Context of Bilateral Sagittal Split Osteotomy: A Proof-of-Concept Report.

PURPOSE: This report describes a technique to suspend the submandibular space (SS) through an intraoral approach in the context of a bilateral sagittal split osteotomy (BSSO), thus improving the jawline contour and achieving a neck-rejuvenating effect. PATIENTS AND METHODS: A sample of 6 consecutive patients referred for orthognathic surgery who also sought neck rejuvenation and contouring surgery was selected to implement the technique. The following measurements were used to evaluate the procedure: patient satisfaction with a visual analog scale, photographic assessment, additional operative time, and complications related to the procedure. RESULTS: The average patient age was 47 years (range, 38 to 57 yr). Three patients were women and 3 were men. All patients were highly satisfied with the results achieved at the jawline. No surgical complications occurred in any case. There was an average increase of only 5 minutes in total operative time for each side. CONCLUSION: Suspension of the SS through an intraoral approach is an effective, well-tolerated, and technically straightforward method for neck contouring in patients in whom a BSSO procedure is foreseen.

[Soft tissue management to control nasal changes after Le Fort I Osteotomy]. / Ostéotomie de Le Fort 1 : gérer les tissus mous pour contrôler les modifications du nez.

INTRODUCTION: Adverse effects in the nasolabial region should be anticipated after Le Fort I osteotomy. Intraoperative factors such as the extent of surgical dissection, type of closure and perinasal soft tissue reconstruction seem to influence soft tissue response. Attempts to control these changes have been made over the years and several techniques have been proposed. MATERIALS AND METHODS: The authors present a minimally invasive alternative surgical technique to control alar base widening as well as lip shortening.

Manejo de la vía aérea en oncología de cabeza y cuello / Airway management in head and neck oncology

Introducción. El manejo de la vía aérea en cirugía de cabeza y cuello presenta varios retos tanto para el cirujano como para el anestesista. El empleo de la traqueostomía electiva es ampliamente usado pero continúan existiendo algunas controversias en la literatura al respecto. Material y métodos. Se ha realizado un estudio prospectivo analizando aspectos clínicos, indicaciones y complicaciones en 57 pacientes afectados de enfermedad oncológica de cabeza y cuello que requirieron la realización de una traqueostomía durante el período comprendido entre enero de 2011 y junio de 2012 en el servicio de cirugía oral y maxilofacial del Hospital Universitario Vall d́Hebron de Barcelona. Resultados. El grupo de pacientes que recibieron una reconstrucción microquirúgica fue el mayoritario que requirió una traqueostomía (40,35%). La tasa de complicaciones asociada con la técnica fue del 22,8%, de las cuales el 7% fueron consideradas mayores y 5,8% menores. La tasa de complicaciones asociadas con los cuidados de la cánula fue del 15,8%. Conclusiones. La traqueostomía es un método simple y efectivo para el manejo de la vía aérea difícil en pacientes oncológicos de cabeza y cuello asociada a una baja tasa de complicaciones (AU)

Background. Airway management in head and neck surgery presents several challenges to the surgeon and the anaesthesist. The use of elective tracheostomy is widely used, but there is still some controversy in the literature. Methods. A prospective study analyzing clinical aspects, indications and complications of 57 head and neck patients who underwent tracheostomy was performed from January 2011 to June 2012 in the Oral and Maxillofacial Surgery Department of Vall D́Hebron Hospital, Barcelona, Spain. Results. Microvascular reconstruction patients were the most frequent group in which tracheostomy was performed (40.35%). The complications rate associated with the technique was of 22.8%, of which only 7% were considered major, and 5.8% minor. The complication rate in relation to cannula care was 15.8%. Conclusions. We conclude that tracheostomy is a simple and effective method for airway management in head and neck patients, with a low complication rate (AU)

Locally destructive mandibular pseudotumor as a manifestation of immunoglobulin G4-related disease.

Immunoglobulin G4-related disease is a recently identified entity. The cervicofacial location is not frequent. We report the case of a patient with an inflammatory pseudotumor in the mandible, who had to undergo surgery for diagnosis. We review the clinical manifestations, diagnostic criteria, differential diagnosis, and treatment proposed by recent publications in the literature. This case report represents the first case located in the mandible and the second one with bone destruction.