• Title/Summary/Keyword: Osteotomy level

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An in vitro comparison between two different designs of sagittal split ramus osteotomy

  • Andrade, Valdir Cabral;Luthi, Leonardo Flores;Sato, Fabio Loureiro;Pozzer, Leandro;Olate, Sergio;Albergaria-Barbosa, Jose Ricardo
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.41 no.3
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    • pp.133-138
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    • 2015
  • Objectives: To evaluate the influence of the type of osteotomy in the inferior aspect of the mandible on the mechanical performance. Materials and Methods: The study was performed on 20 polyurethane hemimandibles. A sagittal split ramus osteotomy (SSRO) was designed in 10 hemimandibles (group 1) with a vertical osteotomy in the buccal side (second molar level) and final osteotomy was performed horizontally on the lingual aspect, while the mandible body osteotomy was finalized as a straight osteotomy in the basilar area, perpendicular to the body. For group 2, the same osteotomy technique was used, but an oblique osteotomy was done in the basilar aspect of the mandibular body, forming continuity with the sagittal cut in the basilar area. Using a surgical guide, osteosynthesis was performed with bicortical screws using an inverted L scheme. In both groups vertical compression tests were performed with a linear load of 1 mm/min on the central fossa of the first molar and tests were done with models made from photoelastic resin. Data were analyzed using Student's t-test, establishing a statistical significance when P<0.05. Results: A statistical difference was not observed in the maximum displacements obtained in the two osteotomies (P<0.05). In the extensiometric analysis, statistically significant differences were identified only in the middle screw of the fixation. The photoelastic resin models showed force dissipation towards the inferior aspect of the mandible in both SSRO models. Conclusion: We found that osteotomy of the inferior aspect did not influence the mechanical performance for osteosynthesis with an inverted L system.

IMMEDIATE RECONSTRUCTION USING VERTICAL RAMUS OSTEOTOMY AND BONE SLIDNG AFTER CONDYLECTOMY DUE TO OSTEOCHONDROMA: A CASE REPORT (골연골종으로 인한 과두절제 후 하악지 수직 골절단술 및 bone sliding을 통한 즉시 재건: 증례보고)

  • Jang, Ji-Young;Oh, Jae-Kyung;Cha, Du-Won;Baek, Sang-Heum
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.29 no.3
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    • pp.233-240
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    • 2007
  • Osteochondroma is a common benign tumor of the axial skeleton, especially the distal metaphysis of the femur and proximal metaphysis of the tibia. However, it occurred rarely on the facial skeleton. The coronoid and condylar processes have been considered to be the most common sites of occurrence for osteochondroma of the facial skeleton. The first treatment of osteochondroma is condylectomy, whereas extirpation was done by excision with condyle salvage. Condylectomy presents decrease of vertical dimension, jaw deviation, malocclusion. So, reconstruction is need. Methods of reconstruction are as follows: no reconstruction, condyloplasty, discectomy, costochondral graft, discplication or coronoidectomy, eminoplasty, alloplastic spacer placement, Le Fort I level maxillary osteotomy, extraoral and intraoral vertical ramus osteotomy. This is a case report of a 28-year old woman who had facial asymmetry, malocclusion and temporomandibular joint pain. We obtained moderate functional and cosmetic results with surgical removal of the osteochondroma by condylectomy and concomitant reconstruction of condyle by vertical ramus osteotomy with sliding technique.

The Incidence and Management of Dural Tears and Cerebrospinal Fluid Leakage during Corrective Osteotomy for Ankylosing Spondylitis with Kyphotic Deformity

  • Jo, Dae-Jean;Kim, Ki-Tack;Lee, Sang-Hun;Cho, Myung-Guk;Seo, Eun-Min
    • Journal of Korean Neurosurgical Society
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    • v.58 no.1
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    • pp.60-64
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    • 2015
  • Objective : To present the incidence and management of dural tears and cerebrospinal fluid leakage during corrective osteotomy [Pedicle Subtraction Osteotomy (PSO) or Smith-Petersen Osteotomy (SPO)] for ankylosing spondylitis with kyphotic deformity. Methods : A retrospective study was performed for ankylosing spondylitis patients with fixed sagittal imbalance, who had undergone corrective osteotomy (PSO or SPO) at lumbar level. 87 patients were included in this study. 55 patients underwent PSO, 32 patients underwent SPO. The mean age of the patients at the time of surgery was 41.7 years (21-70 years). Of the 87 patients, 15 patients had intraoperative dural tears. Results : The overall incidence of dural tears was 17.2%. The incidence of dural tears during PSO was 20.0%, SPO was 12.5%. There was significant difference in the incidence of dural tears based on surgical procedures ( PSO vs. SPO) (p<0.05). The dural tears ranged in size from 12 to $221mm^2$. A nine of 15 patients had the relatively small dural tears, underwent direct repair via watertight closure. The remaining 6 patients had the large dural tears, consequently direct repair was impossible. The large dural tears were repaired with an on-lay graft of muscle, fascia or fat harvested from the adjacent operation site. All patients had a successful repair with no patient requiring reoperation for the cerebrospinal fluid leak. Conclusion : The overall incidence of dural tears during PSO or SPO for ankylosing spondylitis with kyphotic deformity was 17.2%. The risk factor of dural tears was complexity of surgery. All dural tears were repaired primarily using direct suture, muscle, fascia or fat graft.

Treatment of Hallux Valgus with Modified McBride Procedure and Proximal Metatarsal Crescentic Osteotomy (McBride씨 변형 술식과 근위 중족골 반월형 절골술을 이용한 무지 외반증의 치료)

  • Lee, Ju-Hong;Park, Jong-Hyuk
    • Journal of Korean Foot and Ankle Society
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    • v.9 no.1
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    • pp.81-86
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    • 2005
  • Propose: This study was retrospectively to review the surgical results for moderate to severe hallux valgus corrected with a modified McBride procedure and proximal metatarsal crescentic osteotomy. Materials and Methods: Between August 1997 and August 2001, 15 patients with 22 bunion underwent surgical correction and were followed for an average 29.3 months (range, 18 to 53 months). Clinical results were evaluated with AOFAS clinical rating system for hallux and radiological measurements were done preoperatively and at a minimum of 12 months postoperatively. Results: The average AOFAS clinical rating score improved from 47.5 to 86.0. Union of the osteotomy site occurred at 9.5 weeks except one delayed union. The hallux valgus angle improved an from $36.5^{\circ}$ to $15.7^{\circ}$ and the intermetatarsal angle improved from $17.4^{\circ}$ to $8.6^{\circ}$ on average. Dorsiflexion of the first metatarsal at the osteotomy site was present in three (13.6%) with average $4^{\circ}$. Complications were two recurred deformity, one hallux varus and one painful transfer lesion. There was a high level of satisfaction with clinical results in 11 patients (73.3%) with 17 feets and cosmesis in 18 feets (81.8%). Conclusion: Modified McBride procedure and proximal metatarsal crescentic osteotomy based on careful patient selection and meticulous technique showed satisfactory outcome for moderate to severe hallux valgus.

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Analgesic Effect of Electroacupuncture after Femoral Head Osteotomy in Dogs (개에서 대퇴골두 제거술 후 전침 자극이 통증완화에 미치는 영향)

  • Choi In-young;Cheong Jongtae;Shin Taekyun;Lee Joo-myoung
    • Journal of Veterinary Clinics
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    • v.21 no.4
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    • pp.374-397
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    • 2004
  • This experiment was designed to investigate the analgesic effect of non-invasive electroacupuncture treatment on femoral head osteotomy in dogs. Twelve dogs were divided into 3 groups in this experiment. Electroacupuncture group was non-invasively electrostimulated in Huan Tiao (GB-30) acupoint for 10 minutes by 4.5V, 5Hz for 10 days. Medication group was treated with carprofen (4mg/kg, P.O.) for 10 days. Control group was not treated. Each group was pre-operatively and post-operatively scored by using VAS (Visual Analogue Scale), SDS (Simple Descriptive Scale), NRS (Numerical Rating Scale), and measured serum cortisol levels. The results of VAS, SDS and NRS in electroacupuncture and medication groups were better than those of control group. And, the results of electroacupuncture group were better than those of medication group since 6th day after osteotomy in pain management(p<0.05). But, there were no significances in serum cortisol level among 3 groups. In conclusion, non-invasive electroacupuncture treatment showed sufficient analgesic effect on postoperative pain management after femoral head osteotomy, and VAS, SDS, and NRS scoring system would be adapted in evaluation of pain management.

Protecting the tracheal tube cuff: a novel solution

  • Abel, Adam;Behrman, David A.;Samuels, Jon D.
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.21 no.2
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    • pp.167-171
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    • 2021
  • We describe the successful insertion of a nasotracheal tube following repeated cuff rupture. The patient was a 55-year-old woman with a history of nasal trauma and multiple rhinoplasties, who underwent elective Lefort I osteotomy and bilateral sagittal split osteotomy for correction of skeletal facial deformity. During fiberoptic bronchoscope-guided nasal intubation after the induction of general anesthesia, the tracheal tube repeatedly ruptured in both nares, despite extensive preparation of the nasal airways. We covered the cuff with a one-inch tape, intubated to the level of the oropharynx, pulled the tracheal tube out through the mouth, and removed the tape. The tracheal tube was then backed out to the level of the uvula, and was successfully advanced.

Correlation between femoral rotation and clinical results after high tibial osteotomy in primary osteoarthritis patient (퇴행성 골관절염 환자에서 시행한 근위 경골 절골술 후 대퇴골의 회전과 임상결과의 상관관계)

  • Park, Sang Eun;Mun, Sang Won
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.10 no.2
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    • pp.100-104
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    • 2011
  • The purpose of this article is to examine correlation between femoral rotational angle and subjective satisfaction of high tibial osteotomy outcome of the range of motion of knee joint. The subjects were 15 patients (6 males, 9 females) with primary osteoarthritis undergoing high tibial osteotomy from June of 2004 to August of 2008. They were CT tested on the knee joint before and after high tibial osteotomy. TEA (Fig. 1) and Akagi's line (Fig. 2) are analyzed as percentages. The Kendall's and Spearman's nonparametric correlation coefficient were used for the statistical tests with 0.5 level of significance. The result reveals that femoral rotational angle correlates with not the range of motion of knee joint but subjective satisfaction of the patients. Therefore, this will enable patients and physicians to have better clinical outcome.

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MORPHOLOGICAL EVALUATION OF MANDIBULAR RAMUS IN MANDIBULAR PROGNATHISM BY COMPUTED TOMOGRAPHY (하악전돌증에 있어서 전산화단층촬영을 이용한 하악지의 형태학적 평가)

  • Cha, Du-Won;Jang, Ji-Young;Lee, Sang-Han
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.34 no.3
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    • pp.370-375
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    • 2008
  • Sagittal split ramus osteotomy (SSRO) is widely used in treatment of dentofacial deformities. But, many complications can occur including unfavorable fractures during osteotomy. To prevent these complications, it is necessary to understand comprehensively the anatomy of the mandiular ramus. The purpose of this study was to evaluate the morphology of the madibular ramus in manibular prognathism patients by computed tomography comparing with normal control group. The study group consisted of 33 skeletal class III patients (20 males, 13 females) and the control group consisted of the 52 patients without dentofacial deformities (32 males, 20 females). The mean age of study group was 22.0-year old, and that of control group was 37.1-year. For the CT examination, following scan parameters was used: 1mm slice thickness, 0.5 second scan time, 120kV and 100mA/s. The axial scans of the head were made parallel to the mandibular occlusal plane. The anteroposterior length of the ramus, the distance from anterior border of the ramus to lingula, the relative distance from the anterior border of the ramus to lingula compared to the anteroposterior length of the ramus, the thickness of anterior and posterior cortical plate, the thickness of medial cortical plate of the ramus at lingula level, the thickness of cancellous bone of the ramus at lingula level were measured. The skeletal class III mandibular prognathism patients exhibited shorter anteroposterior length of the ramus, thicker anterior and posterior cortical plate, thinner mediolateral cancellous bone thickness. The lingula has a relative stable anteroposterior position in ramus in all groups. There was higher possibility of fusion of medial and lateral cortical plate at lingula level in the mandibular prognathism group. In conclusion, the mandibular prognathism patients have narrow rami with scanty cancellous bone, which means that careful preoperative examination including CT scan can prevent undesirable fractures during osteotomy.

Effectiveness of low-level laser therapy on recovery from neurosensory disturbance after sagittal split ramus osteotomy: a systematic review and meta-analysis

  • Firoozi, Parsa;Keyhan, Seied Omid;Kim, Seong-Gon;Fallahi, Hamid Reza
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.42
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    • pp.41.1-41.11
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    • 2020
  • Background: Orthognathic surgery such as bilateral sagittal split ramus osteotomy (BSSRO) for the treatment of mandibular deformities is one of the most common procedures in maxillofacial operations that may lead to neurosensory disturbance. In this study, we aimed to evaluate the effectiveness of low-level laser therapy (LLLT) on augmenting recovery of neurosensory disturbance of inferior alveolar nerve (IAN) in patients who underwent BSSRO surgery. Methods: A comprehensive literature search was conducted by two independent authors in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Embase, and Google Scholar electronic databases. Besides, a manual search of all textbooks and relevant articles were conducted. Searches took place in August 2020 and were limited to published and peer-reviewed articles from 2000 to 2020. All analysis was performed using the comprehensive meta-analysis (CMA) and the STATA MP (version:16) software. The weighted mean difference (WMD) using the inverse variance method and the standard mean difference (SMD) was considered for continuous variables. Results: Seventy-four papers were retrieved after removing duplicate studies and finally, eight studies were assessed for qualitative synthesis and five for meta-analysis. Totally, 94 patients were included in the meta-analysis. Based on the meta-analysis, it was shown that LLLT was not effective in a short interval (0 to 48 h) after surgery, but in a period of more than 1 month after surgery, the positive results of treatment can be observed strikingly. Also, LLLT side/group showed no significant difference in some aspects of neurosensory recovery such as thermal sensation compared to the placebo side/group. Conclusions: The meta-analysis of randomized controlled trials revealed that LLLT generally improves IAN sensory disturbance caused by BSSRO. Further high-quality clinical trials with longer follow-up periods and larger sample sizes are recommended.