ABSTRACT
SUMMARY: Based on the new concepts of the modified Le Fort III osteotomy (MLFIIIO), Three variations of this technique are implemented: (A) the modified osteotomy Le Fort III Champy (1980) technique to be described with the use of surgical guides, and subciliary approach or an transconjunctival approach. Excellent technique for horizontal advancement no further to 6 mm, without requiring any type of graft.. (B) The modified Le Fort III osteotomy in "Z": to solve horizontal (posterior anterior) problems of more than 6 mm without bone grafting. It is itself a modification of the technique described by Champy. (C) The modified Le Fort III osteotomy ascending: modified the original technique described by Bell and Epker with interpositional grafts, was modified by the called ascendant, making it higher in cases where the patient has an acceptable nasal bridge, but exorbitism the lateral wall of the orbit. Le Fort III osteotomy combined with a Le Fort I osteotomy and a front implant. METHOD: As pointed out in Part I for the modified oblique Le Fort III osteotomy, methods for the design of the osteotomy Le Fort III property will depend on the requirements of individual patients, and this has led us to design specific techniques for the deformity. RESULTS: Patients have a right projection of the middle third, and protection of the eyeball. CONCLUSIONS: The techniques presented for the advancement of the middle third have excellent results with the ability to be tailored to each patient deformity.
ABSTRACT
INTRODUCTION: The purpose of this study is to demonstrate the surgical technique for the correction of midfacial deformities; vertical excess and posteroanterior hypoplasia. This situation obligates the need to move the whole osseous structure in an oblique posteroanterior movement that should correct both midfacial deformities. This should also correct the lip incompetence while improving the malar projection on a profile view of the patient. We also present a mathematical formula that gives the angulation needed for moving the midface complex in a simultaneous vertical and posteroanterior direction. Once given the correct angulation for the desired oblique movement, the surgeon can reproduce this angulation with custom made surgical guides over the stereolithographic model, that can then be used during surgery to achieve the desired movement accurately. This technique exemplified on this paper will give maxillofacial surgeons a new and affordable tool for the correction of midfacial deformities in an accurate and easily reproducible manner and amplifying the surgical repertoire. MATERIALS AND METHODS: Patients seen in the specialty hospital "Dr. Bernardo Sepulveda" National Medical Center XXI Century, IMSS, during the period from February 2013 to November 2014 with Modified Oblique Le Fort III osteotomies, with the application of two trigonometric formulas for the accuracy of the technique. CONCLUSIONS: The application of the formulas give accurate results as well as the enlargement of the upper airway and esthetic results.
ABSTRACT
INTRODUCTION: The temporomandibular joint (TMJ) is anatomically complex; with its close proximity to neurovascular structures, including the facial nerve that gives a high degree of difficulty during surgical exposure. When the first description on TMJ surgery by Orlow in 1913 was published it gave an account describing the basic retroauricular, preauricular, endoaural and submandibular approaches, on treatment of articular pathologies as used today. The proposed study of the 'Bat Wing' approach, first described in 1993 by Garcia y Sanchez J.M. as a surgical alternative, offers great advantages is that it avoids the section of the ear canal and provides a wide surgical field. The management of the proposed technique has wide application with multiple joints addressed, achieving major objectives such as avoiding facial nerve damage, as well as avoiding the section of the external auditory canal with an optimum visibility of the operative field. MATERIAL AND METHODS: The Department of Maxillofacial Surgery National Medical Center XXI Century records over a period of approximately 18 months have completed twenty TMJ surgeries using the 'Bat Wing', approach. CONCLUSIONS: The bat wing approach is a surgical alternative that offers broad exposure of the surgical field in TMJ, it is effective and meets the goal of exposing the area to intervene safely, good visibility and access to the site to intervene. It perfectly fulfills the above described.
