Autogenous Mandibular Bone Graft for Maxillary Le Fort I Osteotomy Interpositional Gap in Orthognathic Surgery: A Technique Case Series.

Correction of maxillofacial skeletal dental deformities often includes surgical interventions in the maxilla and mandible. Le Fort I maxillary osteotomies are performed to correct maxillary horizontal, vertical, and transverse discrepancies. Repositioning of the maxilla creates an interpositional gap in bone that can lead to pseudoarthrosis, instability, mobility, infection, and eventual relapse. Grafting the interpositional gap with bone creates mechanical stops to prevent relapse, provides a matrix for secondary ossification, accelerates bony union, and inhibits soft tissue herniation. This can be accomplished using autogenous bone harvested from the patient. Donor sites include the calvarium, rib, and iliac crest bone. Although these donor sites have their advantages and specific indications, they require a second surgical site, which can lead to potential complications, such as infection, donor site morbidity, pneumothorax, and gait disturbances. In conjunction with the Le Fort I maxillary osteotomy, for correction of maxillary deformities, the bilateral sagittal split mandibular osteotomy is a common procedure used for mandibular advancement, setback, and correction of mandibular asymmetry with or without concurrent genioplasty. Five patients (1 man and 4 women) underwent orthognathic surgery for correction of their maxillofacial skeletal dental deformities at the Loma Linda University Hospitals (Loma Linda, CA) from 2015 through 2017. This case series describes a technique to harvest autogenous bone from the posterior aspect of the distal sagittal split osteotomy segment of the mandible, which is milled and used to graft the interpositional gap in the maxilla. Principles of guided bone regeneration are incorporated to improve surgical outcomes.

Mandibular surgery: technologic and technical improvements.

The ability of surgeons to use advanced techniques can significantly improve both surgical outcome and patient satisfaction. Surgical evolution in mandibular orthognathic surgery is no exception, because advancements have aided both surgical planning and technique. It is important for clinicians to be aware of the historical progression of improvements in this technique and appreciate the technologic advancements as they are happening. Computer-driven surgical planning is becoming increasingly popular, providing surgeons and patients with the ability to adjust to intraoperative and postoperative variations. By using these capabilities, clinicians are now able to give patients the best possible outcomes.

Intraosseous inflammatory myofibroblastic tumor in the mandible: a rare pathologic case report.

Inflammatory myofibroblastic tumor (IMT) is an extremely rare lesion found in the maxillofacial region. Its frequency diminishes further when found in the bone. Although classification has varied throughout its history, the histologic features are often diagnostic, particularly with its strong association with anaplastic lymphoma kinase-1 (ALK-1) staining. The current mode of treatment for such a lesion is surgical removal with careful followup. In this rare case report, we describe the diagnosis and treatment in a 16-year-old male. Although this rare pathology can present as-and at times mimic-more serious pathologies, it is important for the attending surgeon to initially manage the pathology conservatively.

Surgical Treatment of Jacob's Disease: A Case Report Involving an Osteochondroma of the Coronoid Process.

Although it is one of the most common benign tumors of bone in the axial skeleton, the osteochondroma is relatively rare in the maxillofacial region. Its discovery on the coronoid process is even more rare. First described by Jacob in 1899, it remains a rare entity as only a few reported cases have been described in the literature. Nevertheless, the symptomatic features remain relatively nonspecific: limited opening, tightness, and slight expansion of the affected area with or without pain. The demographic features are more established, as it affects younger males. Definitive diagnosis is made after histological analysis, post-resection of the growth. We report a 27 year-old male with a history of limited opening and tightness of the mouth. Computed Tomography (CT) imaging revealed a well corticated exophytic protuberance from the left coronoid process. Left coronoidectomy and excision of the exophytic growth was performed, and was confirmed by histologic analysis to be an osteochondroma, demonstrating Jacob's disease.

A method of treating the patient with postpubescent juvenile rheumatoid arthritis.

PURPOSE: Juvenile rheumatoid arthritis (JRA) is a perplexing and devastating disease for which establishment of a treatment protocol is difficult. The relatively low incidence and unknown cause of this disorder have made it difficult to establish when and how to intervene. Treatment protocols for the prepubescent patient (<12 years for girls and 14 years for boys), as well as for the adult, have been established. A protocol for postpubescence (ages 12 through 18 years) has yet to be established. This pilot study attempts to establish another treatment protocol for this particular subgroup of patients. PATIENTS AND METHODS: Five girls between the ages of 14 and 18 years with common facial deformities who were given a diagnosis of juvenile rheumatoid arthritis were reconstructed by orthognathic surgery and costochondral rib grafts. All underwent surgery performed by the first author and were followed for 4 to 14 years. Patients were in disease remission at the time of surgery, and all presented with the same skeletal/dental deformity and condylar destruction. RESULTS: Serial cephalograms were taken immediately presurgically (T1), immediately postsurgically (T2), and at latest recall (T3). Tracings were done by the same orthodontist with the use of Quick Ceph Image Pro software (Quick Ceph Systems, San Diego, CA). Mandibular position as it related to the success of costochondral and orthognathic surgery was assessed by gnathion position relative to nasion-basion at the cranial center, as described by Rickett's facial analysis. Patient long-term follow-up lasted from 4 to 14 years and had a mean duration of 9.6 years. The average increase in anterior/posterior direction (T1 to T2) was 22.7 mm with an average relapse (T2 to T3) of 1.5 mm. Four of 5 patients had a stable Class I occlusion on follow-up, and 1 developed a 3-mm open bite postoperatively. CONCLUSION: This pilot study offers a treatment protocol for the postpubescent juvenile patient with rheumatoid arthritis (aged 12 to 18 years) that is based on a single surgery with relative postoperative stability.