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Long-term follow-up of early cleft maxillary distraction.

Young Wook PARK ; Kwang Jun KWON ; Min Keun KIM

Maxillofacial Plastic and Reconstructive Surgery.2016;38(4):20-. doi:10.1186/s40902-016-0069-x

BACKGROUND: Most of cleft lip and palate patients have the esthetic and functional problems of midfacial deficiencies due to innate developmental tendency and scar tissues from repeated operations. In these cases, maxillary protraction is required for the harmonious facial esthetics and functional occlusion. CASE PRESENTATION: A 7-year old boy had been diagnosed as severe maxillary constriction due to unilateral complete cleft lip and palate. The author tried to correct the secondary deformity by early distraction osteogenesis with the aim of avoiding marked psychological impact from peers of elementary school. From 1999 to 2006, repeated treatments, which consisted of Le Fort I osteotomy and face mask distraction, and complementary maxillary protraction using miniplates were performed including orthodontics. But, final facial profile was not satisfactory, which needs compromising surgery. CONCLUSIONS: The result of this study suggests that if early distraction treatment is performed before facial skeletal growth is completed, an orthognathic surgery or additional distraction may be needed later. Maxillofacial plastic and reconstructive surgeons should notify this point when they plan early distraction treatment for cleft maxillary deformity.
Cicatrix ; Cleft Lip ; Congenital Abnormalities ; Constriction ; Esthetics ; Follow-Up Studies* ; Humans ; Male ; Masks ; Orthodontics ; Orthognathic Surgery ; Osteogenesis, Distraction ; Osteotomy ; Palate ; Plastics ; Surgeons

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Effectiveness of Computed Tomography for Blow-out Fracture.

Seung Hyun RHEE ; Tae Seup KIM ; Jae Min SONG ; Sang Hoon SHIN ; Jae Yeol LEE

Maxillofacial Plastic and Reconstructive Surgery.2014;36(6):273-279.

PURPOSE: This study assessed the association between eye symptoms (enophthalmos or diplopia) and site of damage, volume, deviated inferior rectus muscle (IRM) and type of fracture with computed tomography (CT). The intent is to anticipate the prognosis of orbital trauma at initial diagnosis. METHODS: Forty-five patients were diagnosed with fractures of the inferior wall of one orbit. Fracture area, volume of displaced tissue, deviated IRM, and type of fracture were evaluated from coronal CT by one investigator. The association of those variables with the occurrence of eye symptoms (diplopia and enophthalmos) was assessed. RESULTS: Of 45 patients, 27 were symptom-free (Group A) and 18 had symptoms (Group B) of enophthalmos and/or diplopia. In Group B, 12 had diplopia, one was enophthalmos, and five had both. By CT measurement, group A mean area was 192.6 mm2 and the mean volume was 673.2 mm3. Group B area was 316.2 mm2 and volume was 1,710.6 mm3. The volume was more influential on symptom occurrence. Each patient was categorized into four grades depending on the location of IRM. Symptom occurrence and higher grade were associated. Twenty-six patients had trap-door fracture (one side, attached to the fracture), and 19 had punched-out fracture (both sides detached). The punched-out fracture was more strongly associated with symptoms and had statistically significantly higher area and volume. CONCLUSION: In orbital trauma, measurement of fracture area and volume, evaluation of the deviated IRM and classification of the fracture type by coronal CT can effectively predict prognosis and surgical indication.
Classification ; Diagnosis ; Diplopia ; Enophthalmos ; Humans ; Orbit ; Orbital Fractures* ; Prognosis ; Research Personnel

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The Retrospective Study of Closed Reduction of Nasal Bone Fracture.

Han Kyul PARK ; Jae Yeol LEE ; Jae Min SONG ; Tae Seup KIM ; Sang Hun SHIN

Maxillofacial Plastic and Reconstructive Surgery.2014;36(6):266-272.

PURPOSE: This study was conducted in order to investigate the therapeutic effect of closed reduction according to a classification in patients with nasal bone fracture. METHODS: The study was conducted retrospectively on 186 patients with a mean age of 38 years (range: 7 to 80 years). All patients were diagnosed by clinical and radiologic examination, and then classified according to Hwang's classification by computed tomography. The patients were further classified by their age, gender, causes of fracture, operation timing after fracture, concurrent facial bone fracture, and complications. All patients underwent the same reduction and treatment protocol and were then followed up regularly for at least three months. RESULTS: The cause of the fracture was slip down, and the highest prevalence was shown in the 20s. The mean operation timing after fracture was 4.1 days (range: 1 to 14 days), and it tended to be longer in the case of defected septal bone or more severe fracture. The most common concurrent facial bone fracture was orbital blow-out fracture, and zygomaticomaxillary complex and maxillary fracture occured frequently. The largest number of complications occurred in class III and IIBs patients, and the main complication was postoperative pain. CONCLUSION: Results of nasal bone closed reduction on the 186 patients showed that serious complications rarely occurred. Closed reduction is generally an effective treatment for nasal bone fracture. However, in the case of severe concurrent septal bone fracture or comminuted fracture with depression, open reduction should be considered. Further study with a larger number of patients and further classification is required.
Classification ; Clinical Protocols ; Depression ; Facial Bones ; Fractures, Bone ; Fractures, Comminuted ; Humans ; Maxillary Fractures ; Nasal Bone* ; Orbit ; Orbital Fractures ; Orthopedics ; Pain, Postoperative ; Prevalence ; Retrospective Studies*

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Anatomical and Functional Recovery of Intracapsular Fractures of the Mandibular Condyle: Analysis of 124 Cases after Closed Treatment.

Jong Sung LEE ; Eun Gyu JEON ; Guk Jin SEOL ; So Young CHOI ; Jin Wook KIM ; Tae Geon KWON ; Jun Young PAENG

Maxillofacial Plastic and Reconstructive Surgery.2014;36(6):259-265.

PURPOSE: The purpose of this study is to evaluate the influence of intracapsular fracture lines of the mandibular condyle on the anatomical and functional recovery after non-surgical closed treatment. METHODS: Clinical and radiological follow-up of 124 patients with intracapsular fractures of the mandibular condyle was performed after closed treatment between 2005 and 2012. The intracapsular fractures were classified into three categories: type A (medial condylar pole fracture), type B (lateral condylar pole fracture with loss of vertical height) and type M (multiple fragments or comminuted fracture). RESULTS: By radiological finding, fracture types B and M lost up to 24% vertical height of the mandibular condyle compared to the height on the opposite side. In Type M, moderate to severe dysfunction was observed in 33% of the cases. Bilateral fractures were significantly associated with the risk of temporomandibular joint (TMJ) dysfunction in fracture types A and B. Bilateral fracture and TMJ dysfunction were not statistically significantly associated in type M fractures. CONCLUSION: Most of the mandibular intracapsular condylar fractures recovered acceptably after conservative non-surgical treatment with functional rehabilitation, even with some anatomical shortening of the condylar height. The poor functional recovery encountered in type M fractures, especially in cases with additional fracture sites and bilateral fractures, points up the limitation of closed treatment in such cases.
Follow-Up Studies ; Humans ; Mandibular Condyle* ; Mandibular Fractures ; Rehabilitation ; Temporomandibular Joint ; Temporomandibular Joint Disorders

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Extraction socket sealing using palatal gingival grafts and resorbable collagen membranes.

Sang Yun KIM ; Young Kyun KIM ; Hyun Suk KIM ; Pil Young YUN ; Su Gwan KIM ; Yong Hun CHOI

Maxillofacial Plastic and Reconstructive Surgery.2017;39(12):39-. doi:10.1186/s40902-017-0137-x

BACKGROUND: Socket sealing surgery is performed for the preservation of the form and volume of the soft tissue by covering the resulting socket with autogenous soft tissue graft or membrane barriers. This procedure is usually necessary to improve the esthetic results of the maxillary anterior or premolar areas. METHODS: This study retrospectively investigated cases involving the open membrane technique or socket sealing surgery with a palatal gingival graft or collagen membrane where implant placement and bone grafting were performed immediately after tooth extraction. From January 2005 to December 2008, socket sealing surgery was performed in 24 patients, and 25 implants were placed. RESULTS: All implants were successful in the follow-up period. In the palatal gingival graft group, the mean marginal bone loss was 1.17 mm during the mean follow-up period of 81.0 months. In the collagen membrane group, the mean marginal bone loss was 1.23 mm during the mean follow-up period of 76.9 months. There was no significant difference between the two groups. CONCLUSIONS: Consequently, socket sealing surgery is effective at minimizing the loss of soft tissue and alveolar bone.
Bicuspid ; Bone Transplantation ; Collagen* ; Follow-Up Studies ; Humans ; Membranes* ; Retrospective Studies ; Tooth Extraction ; Transplants*

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Conservative management (marsupialization) of unicystic ameloblastoma: literature review and a case report.

Jwayoung KIM ; Eunkyung NAM ; Sukho YOON

Maxillofacial Plastic and Reconstructive Surgery.2017;39(12):38-. doi:10.1186/s40902-017-0134-0

BACKGROUND: In this study, we present a case of unicystic ameloblastoma (UA) treated by marsupialization followed by surgical enucleation as a conservative approach. UA is a rare, benign, less aggressive, and less invasive variant of ameloblastoma that is observed quite often in younger patients. Radical approaches have effects on the physical and psychological development of a growing young patient; therefore, conservative approaches are widely used for UA management in children. CASE PRESENTATION: This report described a case of an 11-year-old girl with UA of the mandibular molar–ramus area, which also involved impaction of the second and third molars. The lesion was marsupialized, and 31 months after marsupialization, surgical enucleation was performed with extraction of the impacted third molar. The second molar, which was preserved, spontaneously and completely erupted. No recurrence was observed during a 49-month follow-up. CONCLUSIONS: Conservative treatments for UA in young patients have more advantages. Our results provide evidence that marsupialization is effective in regressing the lesion size to ease complete removal, preserving mandibular growth, maintaining involved second molar, and promoting the eruption of the tooth.
Ameloblastoma* ; Child ; Female ; Follow-Up Studies ; Humans ; Molar ; Molar, Third ; Recurrence ; Tooth ; Tooth Eruption

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Hyperpigmentation of the hard palate mucosa in a patient with chronic myeloid leukaemia taking imatinib.

Gian Paolo BOMBECCARI ; Umberto GARAGIOLA ; Francesco PALLOTTI ; Margherita ROSSI ; Massimo PORRINI ; Aldo Bruno GIANNÌ ; Francesco SPADARI

Maxillofacial Plastic and Reconstructive Surgery.2017;39(12):37-. doi:10.1186/s40902-017-0136-y

BACKGROUND: Imatinib mesylate is an inhibitor of the tyrosine kinase Bcr–Abl and a first-line treatment for Philadelphia chromosome-positive chronic myeloid leukaemia (CML). Dermatological side effects include superficial oedema, pustular eruption, lichenoid reactions, erythroderma, and skin rash. Depigmentation of the skin and/or mucosa is uncommon, and hyperpigmentation is rare. CASE PRESENTATION: We present the case of a 63-year-old Caucasian male with widespread hyperpigmentation of the hard palate associated with a 9-year history of imatinib therapy to treat CML. He did not complain of any symptoms. Clinical examination did not reveal any abnormal pigmentation of the skin or other region of the oral mucosa. He did not smoke cigarettes or drink alcohol. His medication regimen was a proton pump inhibitor, a beta-blocker, cardioaspirin, atorvastatin, and imatinib 400 mg/day. Histopathologically, melanin and haemosiderin deposits were evident in the lamina propria. The lesion persisted, with no clinical change, through several follow-ups. We reviewed the literature to explore the possible relationship between oral hyperpigmentation and long-term imatinib mesylate treatment. CONCLUSIONS: We diagnosed oral pigmentation associated with imatinib intake based on the medical history and clinical features of the pigmented macules. Oral pigmentation may have a variety of causes, and differential diagnosis requires nodal analysis. Clinicians should be aware of possible oral mucosal hyperpigmentation in patients taking imatinib mesylate. Such pigmentation is benign and no treatment is needed, but surveillance is advisable.
Atorvastatin Calcium ; Dermatitis, Exfoliative ; Diagnosis, Differential ; Exanthema ; Follow-Up Studies ; Humans ; Hyperpigmentation* ; Imatinib Mesylate* ; Lichenoid Eruptions ; Male ; Melanins ; Middle Aged ; Mouth Mucosa ; Mucous Membrane* ; Palate, Hard* ; Pigmentation ; Protein-Tyrosine Kinases ; Proton Pumps ; Skin ; Smoke ; Tobacco Products

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Three-dimensional surgical simulation for facial asymmetry: soft tissue-, skeleton-, and occlusion-based planning.

Tae Geon KWON

Maxillofacial Plastic and Reconstructive Surgery.2017;39(12):36-. doi:10.1186/s40902-017-0135-z

No abstract available.
Facial Asymmetry*

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Orthognathic surgery and temporomandibular joint symptoms.

Hwi Dong JUNG ; Sang Yoon KIM ; Hyung Sik PARK ; Young Soo JUNG

Maxillofacial Plastic and Reconstructive Surgery.2015;37(5):14-. doi:10.1186/s40902-015-0014-4

The aim of this article is to review temporomandibular joint symptoms as well as the effects of orthognathic surgery(OGS) on temporomandibular joint(TMJ). The causes of temporomandibular joint disease(TMD) are multifactorial, and the symptoms of TMD manifest as a limited range of motion of mandible, pain in masticatory muscles and TMJ, Joint noise (clicking, popping, or crepitus), myofascial pain, and other functional limitations. Treatment must be started based on the proper diagnosis, and almost symptoms could be subsided by reversible options. Minimally invasive options and open arthroplasty are also available following reversible treatment when indicated. TMD manifesting in a variety of symptoms, also can apply abnormal stress to mandibular condyles and affect its growth pattern of mandible. Thus, adaptive developmental changes on mandibular condyles and post-developmental degenerative changes of mandibular condyles can create alteration on facial skeleton and occlusion. The changes of facial skeleton in DFD patients following OGS have an impact on TMJ, masticatory musculature, and surrounding soft tissues, and the changes of TMJ symptoms. Maxillofacial surgeons must remind that any surgical procedures involving mandibular osteotomy can directly affect TMJ symptoms, thus pre-existing TMJ symptoms and diagnoses should be considered prior to treatment planning and OGS.
Arthroplasty ; Diagnosis ; Humans ; Joints ; Mandible ; Mandibular Condyle ; Mandibular Osteotomy ; Masticatory Muscles ; Noise ; Orthognathic Surgery* ; Range of Motion, Articular ; Skeleton ; Temporomandibular Joint*

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Mixed-reality simulation for orthognathic surgery.

Kenji FUSHIMA ; Masaru KOBAYASHI

Maxillofacial Plastic and Reconstructive Surgery.2016;38(3):13-. doi:10.1186/s40902-016-0059-z

BACKGROUND: Mandibular motion tracking system (ManMoS) has been developed for orthognathic surgery. This article aimed to introduce the ManMoS and to examine the accuracy of this system. METHODS: Skeletal and dental models are reconstructed in a virtual space from the DICOM data of three-dimensional computed tomography (3D-CT) recording and the STL data of 3D scanning, respectively. The ManMoS uniquely integrates the virtual dento-skeletal model with the real motion of the dental cast mounted on the simulator, using the reference splint. Positional change of the dental cast is tracked by using the 3D motion tracking equipment and reflects on the jaw position of the virtual model in real time, generating the mixed-reality surgical simulation. ManMoS was applied for two clinical cases having a facial asymmetry. In order to assess the accuracy of the ManMoS, the positional change of the lower dental arch was compared between the virtual and real models. RESULTS: With the measurement data of the real lower dental cast as a reference, measurement error for the whole simulation system was less than 0.32 mm. In ManMoS, the skeletal and dental asymmetries were adequately diagnosed in three dimensions. Jaw repositioning was simulated with priority given to the skeletal correction rather than the occlusal correction. In two cases, facial asymmetry was successfully improved while a normal occlusal relationship was reconstructed. Positional change measured in the virtual model did not differ significantly from that in the real model. CONCLUSIONS: It was suggested that the accuracy of the ManMoS was good enough for a clinical use. This surgical simulation system appears to meet clinical demands well and is an important facilitator of communication between orthodontists and surgeons.
Dental Arch ; Dental Models ; Facial Asymmetry ; Jaw ; Orthognathic Surgery* ; Splints

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