Mandibular remodeling after bilateral sagittal split osteotomy for prognathism of the mandible.

PURPOSE: To describe the postoperative remodeling changes in the mandible after bilateral sagittal split osteotomy to correct mandibular prognathism. PATIENTS AND METHODS: Twenty patients who underwent bilateral sagittal split osteotomy for the correction of mandibular prognathism were studied for postoperative remodeling changes within the mandible. The 6-week, 1-year, and long-term postoperative cephalometric mandibular tracings of 12 patients were superimposed using the fixation wires as the stable reference points to demonstrate the specific locations of the intrabony remodeling. RESULTS: There was a general direction of remodeling at the condylion and gonion anteriorly and superiorly, while the B point and pogonion did not show much change in remodeling. At the condylion, 60% and 40% of the cases showed significant horizontal and vertical remodeling, respectively. At the gonion, 50% and 55% of the cases showed significant horizontal and vertical remodeling, respectively. No correlation was found between the remodeling changes at condylion and gonion and the surgical movement or relapse at B point and pogonion. There was a significant correlation between the observed horizontal relapse at gonion and the horizontal remodeling changes at this point showing that the postoperative displacement of this point is a result of both positional translocation and remodeling changes. CONCLUSION: The results of this study show that there are intrabony remodeling changes that occur in the mandible after sagittal split osteotomy and that these continue for a long period of time in some patients. This remodeling occurred more in the condylar and gonial areas, while the chin remained relatively stable.

Bilateral sagittal split osteotomy for correction of mandibular prognathism: long-term results.

PURPOSE: To identify the long-term maxillomandibular changes after surgical correction of mandibular prognathism using bilateral sagittal split osteotomy (BSSO). PATIENTS AND METHODS: Twenty patients who underwent BSSO to setback the mandible and had cephalometric radiographs taken preoperatively and postoperatively at 6 weeks, 1 year, and long-term follow-up (mean, 28 months). The cephalograms were traced and measured to determine the operative and postoperative changes. Correlation analyses were performed to see the relationship between the magnitude of setback and the amount of long-term postsurgical change at B point and pogonion. RESULTS: The mean surgical setback was 8.2 mm at B point and 8.8 mm at pogonion. The mean long-term horizontal relapse was 2.3 mm (28.0%) at B point and 3.0 mm (34.1%) at pogonion. Out of 20 patients, 12 (60.0%) relapsed horizontally greater than 2 mm at B point and 13 (65.0%) at pogonion. The mean vertical surgical changes showed downward displacement of B point (2.3 mm) and pogonion (2.0 mm). The mean long-term vertical relapse was 1.6 mm (69.6%) at B point and 1.7 mm (85.0%) at pogonion. CONCLUSION: There was no correlation between the magnitude of setback and the amount of relapse at B point and pogonion. However, there was significant correlation between the magnitude of vertical, downward surgical displacement and the amount of vertical relapse at B point and pogonion. The majority of the maxillofacial changes occurred within 1 year postoperatively.

Outcome for traumatic optic neuropathy--surgical versus nonsurgical treatment.

This study was performed to identify factors that can affect the final outcome and to recognize the proper management for patients with traumatic optic neuropathy (TON). This retrospective study included 42 consecutive patients with TON after maxillofacial trauma. Megadose methylprednisolone was administered to all patients during the first 3 days after diagnosis. Twenty-four patients received treatment with megadose steroids combined with optic nerve decompression and the remaining 18 with megadose methylprednisolone alone. Initial visual acuity (IVA) was the statistically significant factor affecting the outcome of TON (P = 0.006 for improvement rate). Patients treated within 7 days after injury had a better improvement degree, P = 0.056. Patients in a surgical group with an IVA of no light perception (NLP) had a better improvement rate and degree (31.3%; 59.34 +/- 22.18%) than those in nonsurgical group (0%, 0%; P = 0.272). Initial visual acuity is the critical factor that affects the outcome of TON. Surgical optic nerve decompression is considerable in maxillofacial trauma patients with an IVA of NLP.

Programmed database system at the Chang Gung Craniofacial Center: part II--digitizing photographs.

BACKGROUND: The archival tools used for digital images in advertising are not to fulfill the clinic requisition and are just beginning to develop. The storage of a large amount of conventional photographic slides needs a lot of space and special conditions. In spite of special precautions, degradation of the slides still occurs. The most common degradation is the appearance of fungus flecks. With the recent advances in digital technology, it is now possible to store voluminous numbers of photographs on a computer hard drive and keep them for a long time. METHODS: A self-programmed interface has been developed to integrate database and image browser system that can build and locate needed files archive in a matter of seconds with the click of a button. This system requires hardware and software were market provided. RESULTS: There are 25,200 patients recorded in the database that involve 24,331 procedures. In the image files, there are 6,384 patients with 88,366 digital pictures files. From 1999 through 2002, NT400,000 dollars have been saved using the new system. CONCLUSION: Photographs can be managed with the integrating Database and Browse software for database archiving. This allows labeling of the individual photographs with demographic information and browsing. Digitized images are not only more efficient and economical than the conventional slide images, but they also facilitate clinical studies.

Spontaneous bone regeneration of the mandible in an elderly patient: a case report and review of the literature.

Spontaneous bone regeneration is an unexpected phenomenon that may take place in large mandibular defects secondary to trauma and tumor resection. One explanation for this unusual healing course is that it may be derived from the mechanism of fracture healing. A review of the literature presents several factors that may influence this process, such as the presence of periosteum and bony fragments, mandibular stabilization, soft tissue protection, the presence of infection, and a young age. Previous reports of spontaneous mandibular regeneration have all taken place in relatively young patients (5-35 years old). This paper reports a case of spontaneous bone regeneration in a 58-year-old woman who sustained an injury to her mandible from an explosive blast, and presents some explanations on how such an event could take place.

Osseous regeneration after embolization of mandibular arteriovenous malformation.

A mandibular arteriovenous malformation (AVM) is rare, and unawareness of this condition can lead to catastrophic complications. Embolization is an effective means to treat these lesions. The osseous changes and long-term outcomes among the pediatric patients after embolization treatment remain unclear. We present a 6-year-old patient with mandibular arteriovenous malformation who had sustained hemorrhagic shock after a tooth extraction. She was referred to us after stabilization of the hemodynamic condition. The patient received transarterial and direct intralesional embolization. Local infection occurred 3 months after embolization, but was well controlled. Serial computed tomography and panoramic radiographs were performed during follow-up examinations. The imaging studies showed gradual obliteration of the vascular space followed by normal bone regeneration and remodeling. The processes were complete during a period of 2 years. There was no recurrence of the vascular malformation and no abnormal growth of the right side of the mandible after 4 years and 4 months of observation.