Objective To study the operation design and surgical methods for terminal surgical reconstruction of severe post-midfacial fracture deformities. Methods From July 1997 to December 2002,11 cases of severe and complex post-midfacial deformities were reconstructed. There were four cases with Le Fort Ⅰ, Ⅱ and Ⅲ fractures,five with Le Fort Ⅰ and Ⅲ fractures and two with Le Fort Ⅰ and Ⅱ fractures combined with right orbital-zygomatic fractures. Typical bicoronal and subcilliary incisions and intra-oral approach were employed to expose all the fractured sites. The displaced orbito-zygomatic bone fragments were repositioned firstly in order to reconstruct the outer midfacial framework. Then, the malunited maxilla was reduced to its proper position after osteotomy of Le Fort Ⅰ fractures under the guidance of mandible through inter-maxilla fixation. The depressed naso-orbital region were reconstructed using autogeneous outer cranial table. Meanwhile, nasal framework reconstruction, medial canthal tendon reapproximation and plasty, and fractured orbital walls repairing were performed to correct the enophathalmos. Results All the cases recovered well and the post-operative facial appearance and occlusal function were improved obviously. Conclusions Complex midfacial fractures, usually involving orbital-zygomatic bone, naso-orbit and maxillary bone, can be well improved through osteotomy and reduction, internal rigid fixation with mini-plates and screws, autogenenous bone grafting and framework reconstruction.

Objective To introduce a new method for correcting square face deformity.Methods This operation consists of malar reduction (MR)and mandibular angle osteotomy (MAO),which could be done simutaneously or at different time.Results A total of 21 patients with square face deformity accepted MR and MAO in which 12 cases were done simutaneously and 9 cases at different time.After this procedure, the width of the mid face and the lower face reduced by 15.3?3.2mm and 14.2?2.5mm, respectively. A11 the cases achieved satisfactory results without complications.Conclusion This method can effectively correct square face deformity by reducing the width and protrusion of the mid face and the width of the lower face.

BACKGROUND:Titanium mesh has good clinical effect in repairing skul defects, but due to the lack of bone induction ability, the titanium mesh has a poor integration with the bone tissue. OBJECTIVE:To observe the biological properties of the gradient bioactive coating materials on the titanium surface in the skul repair. METHODS: Osteoblasts were co-cultured with the titanium mesh with or without gradient bioactive coatings for 14 days, and then cel proliferation was detected using MTT method. Seventy-one patients with skul defects were enroled, including 43 males and 28 females, aged 15-60 years, and were subjected to skul repair using the titanium mesh with (observation group, n=3) or without (control group, n=38) gradient bioactive coatings. During the postoperative folow-up of 12 months, the repairing effects and adverse reactions were observed in the two groups. RESULTS AND CONCLUSION:(1)In vitrocel culture: the cel proliferative ability was increased significantly in the observation group as compared with the control group at 8, 10, 12 and 14 days after cel culture. (2)In vivo repair: the hospital stay and wound healing time in the observation group were significantly lower than those in the control group (P< 0.05), and at the final folow-up, the postoperative recovery effect was significantly higher in the observation group than the control group (P < 0.05). The titanium meshes were fixed firmly in the two groups, with no floating, infection and exposure. These results show that the titanium mesh with gradient bioactive coating has good biocompatibility and osteoinduction capacity.

BACKGROUND: Enophthalmos deformity is the most common complication caused by orbital blow-out fractures, and others are diplopia and worsening of visual acuity. Since the therapeutic result of orbital blow-out is not satisfactory and many complications exist after operation, it is still a dispute to select implantation materials and therapeutic regimens.OBJECTIVE: To observe the therapeutic effect and assess the improvement of visual function by surgical reconstruction with porous high-density polyethylene (Medpor) for the correction of enophthalmos deformity caused by orbital blow-out fractures.DESIGN: A pre-and postoperative controlled study.SETTING: Beauty Center for Trauma Repair,Plastic Surgery Hospital,Peking Union Medical College, Chinese Academy of Medical Science .PARTICIPANTS: Totally 56 patients with orbital blow-out fractures who had enophthalmos deformity caused by fists or traffic accidents, treated at Beauty Center for Trauma Repair,Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, were selected in this study from December 1996 to March 2004. Final diagnosis were made with case history, X-ray film, two-demensional and three-dimensional CT before operation. 24 cases were accompanied with other areas fractures such as zygoma and nasal bone, 34 cases with diplopia, 35 cases with visual acuity worsening after injured.METHODS: ①Material implantation: Exposure of the orbital floor, inferior and medial walls could be performed through a 2 mm inferior subciliary incision of 3 cm long. To approach the orbital rim via a dissection plane anterior to the orbital septum, sub-periosteal dissection was then performed over the orbital rim, and along the orbital floor to the orbital apex. Mobilized the soft tissue from the bone throughout the entire area of fractures and re-position it to its proper position. Took Medpor (Type 6331) sheets as the implantation materials, trimmed Medpor sheets according to the radian and anatomic form, and 2 mm larger than the defect rim was needed.If other operations were needed during the operation, they could be done.Mannitol and dexamethasone should be used just postoperatively to decrease edema of the orbital contents and reduce inner orbital excessive pressure. ②Functional evaluation standard: Diplopia: completely disappear meant recovered, less diplopia residual meant improvement, no improvement meant inefficacy. Enophthalmos: marked improvement meant the degree of enophthalmos stabilizated at below 2 mm, less improvement meant stabilizated at above 2 mm.MAIN OUTCOME MEASURES: ①Improvement of enophthalmos; ②Improvement of diplopia ; ③Improvement of visual acuity.RESULTS: ①All 56 cases of enophthalmos deformities caused by orbital blow-out fractures improved greatly. ② Of all the 34 patients with diplopia, 27 recovered. ③ 9 patients' visual acuity of 35 improved with different degrees. No diplopia or visual acuity worsening occurred. With a follow-up ranging from 2 months to 5 years, the degree of enophthalmos stabilizated at below 2 mm, and no relapse and other complications occurred.CONCLUTION: Medpor has such advantages as better histocompatibility,fewer complications and better visual function improvement, so it is the preferred implantation material for correcting enophthalmos deformity caused by orbital blow-out fractures.

Purpose To investigate the clinicopathological characteristics,diagnosis and differential diagnosis of benign metastasizing leiomyoma (BML).Methods The clinicopathological data in 6 patients with BML were collected.All cases of BLM were investigated by HE and immunohistochemistry of EnVision method.Results All cases were female,with age of 33 -65 years,and had undergone myomectomy.5 cases had lung metastasis,including abdominal wall metastasis and spinal metastasis in each of the 1 cases,and another case had inguinal metastasis.Morphology showed that the tumor cells were spindle without obvious atypia,nuclear mitoses and necrosis,some cases were cellular.Immunohistochemical staining showed that the tumor cells were positive for SMA,SM-MHC,desmin,ER,PR,vimentin,while negative for S-100,CD117,CD34.Ki-67 label index were less than 5％.3 patients were alive with tumor and 3 patients were alive without tumor in the follow up of 18,28,40,31,36,80 months.Conclusion BML often occurs in female patients that undergone uterine myomectomy.The lung is the most common site of metastasis,often accompanied by other sites.The disease progresses slowly,and most patients have a longer survival time.

OBJECTIVEA surgical procedure was developed to improve the operative results for bilateral mandibular prominence with microgenia.

METHODSThrough an oral approach the bilateral prominent mandibular angles were resected using the technique of continuous curve-line ostectomy with the masseteric muscle intact. Meanwhile, the chin was elongated and moved forward by horizontal osteotomy. The distal part of the chin was rigid fixed with miniplates and screws, and the bone gaps were filled with autogenous bone of the resected mandibular angle.

RESULTSFrom November 1996 to August 1999, 20 cases of bilateral mandibular angle prominence with microgenia were corrected with this procedure. The postoperative appearance was improved greatly after 3-6 months. The lower face was not only narrowed but elongated, and consequently in harmony with the upper and middle face.

CONCLUSIONBilateral continuous curve-line mandibular angle ostectomy together with chin osteotomy and autogenous bone graft is a good procedure for the management of the above-mentioned deformities.

Adolescent ; Adult ; Female ; Humans ; Male ; Mandible ; abnormalities ; surgery

OBJECTIVETo study the biodegradation process of the bioabsorbable mini-plate (LactoSorb) and its influence on bone healing.

METHODS15 mature New Zealand White Rabbits were selected as the experimental animals. The bilateral zygomatic arch were fractured using a fissure bur. One side was fixed with the bioabsorbable mini-plate and the other side was fixed with Titanium mini-plate as a control. 5 animals were killed after 4, 12, and 24 weeks post operation respectively for radiographic and histologic study.

RESULTSAt 4 weeks, the absorbable plate changed from transparent to opaque and its dimensions was enlarged. The bone gaps of both groups were filled with new bone. No inflammatory cells were found in both groups. At 12 weeks, the absorbable plate broke to small pieces or particles, its dimensions reduced greatly but the outline could still been recognized. The bone continuity had been reestablished in both groups. At 24 weeks, the absorbable plate was resorbed completely. Only the residual screw could be seen in the screw hole. Complete bone healing was seen in both groups. No histological differences of bone healing were found at this stage.

CONCLUSIONThe absorbable plate demonstrates excellent biocompatibility. No adverse local inflammatory reactions were found during the plate was absorbed gradually. In the non-weight baring area, the absorbable plate provides the same fixation stability as that of the metal plate.

Absorption ; Animals ; Bone Plates ; Female ; Fracture Fixation, Internal ; instrumentation ; Male ; Rabbits

OBJECTIVETo present a new method for correction of prominent malar complex by L-shaped osteotomy through an intraoral incision.

METHODSBased on the anatomical characteristics of the malar complex, we designed a new L-shaped osteotomy for malar eminence reduction. The procedure includes oblique incision of the upper part of the mala, vertical incision of the anterior part of the mala and "greenstick" fracture of the zygomatic arches. According to the severity of malar prominence, we resect part of the anterior-inferior part of the mala and lower the malar complex.

RESULTSThis method was used in 39 patients with prominent malar complex. Of them, 32 were symmetrical and 7 were unsymmetrical. All the patients obtained good results.

CONCLUSIONL-shaped osteotomy for correction of prominent malar complex is a relatively ideal surgical method with the advantages of simpler manipulation, fewer complications, better result, and ensuring the intactness of the structural characteristics of the malar complex.

Adult ; Female ; Humans ; Male ; Osteotomy ; methods ; Surgery, Plastic ; methods ; Treatment Outcome ; Zygoma ; surgery

Objective To establish a cranial bone defect model of goat and to study application in craniomaxillo-facial surgery.Methods Electron beam computed tomography (EBCT) scanner was used to scan goat'heads and faces in series and thin layers.Data of EBCT were input in workstation from digital inlet,and then to three-dimensional reconstruction with method of surface shadow.After final data were transformed to the files,the rapid prototyping machine was able to identify and establish the 3D model.Results The EBCT continuous thin-layer (1 mm) scanning data were passed to wave filter,falling coarse,distinguishing and collecting the outline,3D-reconstruction,curved surface reconstruction with CAD and the substance reconstruction.The final data were input into the laser rapid prototyping machine.Three-dimensional bionic cranium models were fabricated by machine in layer by layer manufacturing principle.Conclusions Establishment of the cranial bone defect model in the goat is very useful to the three-dimensional measurement,individualized reconstruction and basic and clinical research for the cranial bone defect.

Objective: The purpose of this study was to explore the surgery-first approach in sequential combined orthodontic-orthognathic treatment to shorten total treatment duration and improve the clinical outcome. Methods: This study included 185 patients with Angle classⅢ malocclusion. The patients were divided into 3 different types according to cephalometry analyses and facial features. ①Type Ⅰ: mandibular prognathism or asymmetry mandibular prognathism; ②Type Ⅱ: mandibular prognathism and maxillary retrusion; ③ Type Ⅲ: mild Angle′s Class Ⅲ malocclusion, cross bite in anterior teeth, or normal overlap and overbite relation with midfacial hypoplasia. All of patients received surgery first approach therapy. The surgical procedures were chosen according to different malformation types. Type Ⅰ was treated with the sagittal split ramus osteotomy (SSRO). Type Ⅱ was treated by Le Fort Ⅰmaxillary osteotomy combined with SSRO. Type Ⅲ underwent anterior subapical osteotomy combined pyriform aperture augmentation with biomaterials as well as maxillary anterior orthodontics. All patients received postoperative rapid orthodontic treatment for 6-12 month after 2 weeks of operation. Using the straight arch wire techniques and the class Ⅲ intermaxillary traction, we removed the overcrowding upper and lower teeth, the compensatory axial tilt of teeth, and the deviation of the dental arch and maintained the neutral relationship of the molar. The mandible Hawley retaining devices were used during the maintaining stage. Results: The cases in study acquired satisfactory clinical outcome, which included the shortened overall treatment duration, the significantly improved facial features, the corrected occlusion relationship, and the restored function of mastication and temporomandibular joint. There were some complications as follows: intraoperative fracture (6 cases, 3.24%), the inferior alveolar nerve bundle injury (2 cases, 1.1%), and temporary open-bite that diminished by inter-maxillary elastic distraction one month after operation (19 cases, 10%). All cases in this study accepted postoperative orthodontic treatment. Follow-up time ranged from 6 months to 5 years. The cephalometric analysis results of 126 cases who had complete image data and over 6 months of follow-up showed that hard and soft tissue indexes were restored to normal range after combined orthognathic-orthodontic treatment. The stability of the maxillary and occlusive relationship of SFA(surgery-first approach) was similar to that of the COS(conventional orthodontics-first system) [relapse ratio=(T2-T1)/(T1-T0)×100%]. Over six months of follow-up , SNB and ANB showed that the average relapse ratio were 22% and 19.8%, whereas the relapse angle are less than 2°. Conclusions The Surgery-first approach could be used to treat most patients with Angle skeletal Class Ⅲ malocclusion, but the indications and the surgical procedures should be noticed and chosen.