Orthognathic surgery of the edentulous: a particular form of preprosthetic surgery

It is not unusual to find patients who have lost posterior teeth or who are totally toothless, approaching our dental surgeon colleagues in cases of difficulties, and even prosthetic impossibility, nearly always associated or in relation with skeletic maxilo-mandibular imbalance. Orthognatic surgery of the toothless should thus satisfy the essential need for prosthesis but should also re-establish the unbalanced facial architecture which can be the only guarantee of a stable result. This therefore requires true pre-prosthetic surgery in which clinical analysis, cranial-facial architectural analysis and great care in making the provisional and final prosthesis, constitute the essential stages of diagnosis and therapy.     

Pedicled facial bone flap for closure of the approach in Caldwell-Luc type sinus operations. Its role in the prevention of postoperative complications]

The primary or secondary reconstruction of the facial access after Caldwell-Luc and the more selective resection of sinusal mucous membranes can be important in the therapy and prevention of postoperative complications such as neuralgic facial pain, formation of cysts and chronic sinusitis. The different osteoplastic sinus operations are described and the use of a pedicled bonelid is illustrated. The most common accepted ethiology of post-operative pain is based on the formation of scar-tissue. Postoperative pain is first being treated conservatively, while in case of persisting pain an exploration with dissection of the infra-orbital nerve and reconstruction of the facial defect can be indicated. In a retrospective study of 36 patients the results of our surgical therapy are illustrated.     

Treatment concept of facial pain]

The therapy of chronic facial pain still poses an important challenge. A therapeutical scheme in four steps has been developed. This scheme enables modification of the pain therapy depending on localisation, intensity and former treatment. It consists of the following steps: 1. Transcutaneous electrical nerve stimulation. 2. Medication 3. Extracranial glycerol blocking of the trigeminal nerve 4. Neurosurgical treatment with thermocoagulation, chemical glycerol-rhizotomy and microsurgical decompression. The different therapeutical steps have no influence on each other.