Gap arthroplasty combined with distraction osteogenesis in the treatment of unilateral ankylosis of the temporomandibular joint and micrognathia

Our aim was to evaluate the efficacy of simultaneous gap arthroplasty and distraction osteogenesis (DO) in the treatment of unilateral ankylosis of the temporomandibular joint (TMJ) in patients with micrognathia. During the period January 2000-December 2006, 11 patients with unilateral ankylosis of the TMJ and micrognathia were treated with simultaneous gap arthroplasty, mandibular osteotomy, and implantation of a distractor. Mouth opening exercises were started on the first postoperative day and distraction on the fifth postoperative day. All patients had satisfactory mouth opening at follow-up, the mean (range) being 32.4 (28-37) mm in 13 to 58 months' follow-up. Mean length (range) of the mandibular body increased by DO was 12.4 (7-15) mm. Facial asymmetry was corrected and satisfactory occlusions achieved with the help of postoperative orthodontic treatment. We conclude that DO and gap arthroplasty can be used simultaneously in the treatment of patients with ankylosis of the TMJ and micrognathia.     

颏前徙成形术矫正轻中度小颌畸形10例体会

目的通过手术改善轻中度颏部发育不足及矫治颏偏斜不对称畸形,改善面下部鼻唇颏正侧面的综合形态.方法对颏部发育不足或颏部偏斜不对称患者共10例进行颏前徙成形术,患者均不伴有明显咬合紊乱及颞下颌关节紊乱症状,其中颏部垂直向发育不足者2例,前后向发育不足者3例,前后及垂直向兼有者3例,颏部偏斜者2例,其中2例为硅胶假体隆颏术后外形不满意,术前本身就为颏部前后向发育欠佳.手术纠正了患者颏部垂直向及前后向的外形,并改善了鼻唇颏的正侧面综合形态.结果所有患者术后随访3～6个月,均恢复良好,术后面下部鼻唇颏综合外形满意,无不良反应.结论颏前徙成形术对于单纯的轻中度颏发育不足及颏部偏斜不对称患者的下颌部外形有明显的改善,术后面下部鼻唇颏形态效果良好,避免了硅胶假体隆颏术后继发局部骨质吸收、假体移位等弊端.     

小颌畸形患者的围术期气道管理

小颌畸形患者因口咽腔容积小、舌体相对肥大,易出现鼾症、阻塞性睡眠呼吸暂停低通气综合征等,是困难气道高发人群。除气道结构异常外,小颌畸形患者还可合并中枢性呼吸暂停、神经系统异常以及心血管畸形等情况,因此,这类患者围术期气道管理存在巨大挑战。本文通过回顾近5年小颌畸形相关文献,以此类患者气道解剖结构特点为基础,对小颌畸形患者围手术期气道管理的研究进展进行综述。     

Roentgenologic findings of the hydrolethalus syndrome

The hydrolethalus syndrome is an autosomal recessive malformation syndrome which has been recently described in Finland. The name hydrolethalus refers to the main findings, namely polyhydramnios, hydrocephalus and lethality. The patients are either stillborn or die soon after birth. The typical roentgenologic findings are hypoplasia of the tibia associated with the anomalies of the respective bone ray, e.g. metatarsus primus varus atavisticus, hallux varus or hallux duplex varus and hydrocephalus with extreme micrognathia and a specific midline defect of the occipital bone.     

小下颌畸形患儿下颌神经管CT解剖特征

目的 探讨小下颌畸形患儿下颌神经管的CT解剖特征.方法 在36例小下颌畸形患儿下颌骨冠状位CT图像上,分区测量下颌神经管内缘与下颌骨舌侧骨壁（舌侧指数）、外缘与颊侧骨壁（颊侧指数）、下缘与下颌骨下缘（下缘指数）间的距离.结果 第2前磨牙下颌神经管舌侧、颊侧和下缘的骨壁厚度指数为（4.71±1.25）、（2.77±1.02）、（2.92±0.83）mm,第1磨牙区为（2.64±0.99）、（4.33±1.12）、（2.38±0.72）mm,第2磨牙区为（2.44±0.76）、（4.20±0.89）、（3.38±1.31） mm,以上指数左、右侧比较差异均无统计学意义.在下颌第2前磨牙区至第2磨牙区,神经管偏舌侧走行68侧（94.4％）,偏颊侧4侧（5.6％）;颏孔开口于第2前磨牙区17侧（23.7％）,开口于第1前磨牙区与第2前磨牙间55侧（76.3％）;下颌神经管分支2侧（2.8％）.结论 小下颌畸形患儿下颌神经管大体走向为起于下颌孔,偏舌侧和下颌骨下缘走行,止于颏孔;存在下颌管分支、走行偏颊侧、颏孔后移等变异,应引起手术医师注意.     

Efficacy of I- gel™ for airway management of neonates with Pierre Robin sequence undergoing glossopexy: A prospective study

This paper aims to review the utility of I- gel as a successful airway management device for infants with Pierre robin sequence (PRS) undergoing glossopexy. A prospective study was conducted on PRS neonates. The algorithm followed was putting a ‘Tongue traction stitch’ followed by the following sequence – two trials with direct laryngoscope intubation, two attempts with fiberoptic endoscope intubation followed by insertion of I-gel? to manage difficult airway during glossopexy procedure. 6 patients were intubated with direct laryngoscope, 12 patients were intubated with fibreoptic endoscope and the rest 13 patients were intubated using I-gel?. Successful management of difficult airway was achieved with this airway management protocol during glossopexy and nil postoperative complications were encountered. Within the limitations of the study it seems that, I-gel? is a relevant alternative toprovide a reliable and secure airway access to carry out glossopexy procedure in such patients.