Cephalometric long-term follow-up of nasal augmentation using iliac bone graft.

INTRODUCTION: Iliac bone grafts for nasal augmentation are characterized by resorption. In this article, the relationship between graft resorption and soft tissue retrusion is examined by cephalogram-based measurements. METHODS: Ten patients with nasal deformity underwent iliac bone grafts to the nose and were monitored using cephalograms at intervals. On every image, three distances were measured; the tip height and the upper and lower lengths of the graft. RESULTS: The upper length of the grafted bone reached 90% stability after 6 months, and the lower length reached 70% stability between 1 and 2 years postoperatively. At the tip, supported by the lower part of the grafted bone, the soft tissue projection reached 90% stability after 6 months. DISCUSSION: The lower part of the iliac bone grafted onto the nasal dorsum supports the projecting soft tissue of the nasal tip. Thus subsequent resorption of the graft results in retrusion of the nasal tip. However, the degree of soft tissue retrusion was obviously less than the amount by which the supporting bone resorbed. It seems likely that the augmentation effect persists due to the formation of scar tissue.     

Factors associated with long-term patient satisfaction

Objective:To identify factors associated with patient satisfaction at least 5 years after orthodontic treatment.Materials and Methods:A total of 209 orthodontic patients were included in the study. All subjects were treated with upper and lower fixed orthodontic appliances. Dental casts (n  =  627) were examined using the Peer Assessment Rating (PAR) Index pretreatment (T1), at the end of treatment (T2) and at a long-term follow-up (mean, 8.5 years; T3). At T3, a Dental Impact on Daily Living questionnaire was used to assess the long-term effects of orthodontic treatment on daily living and satisfaction with the dentition. Multiple regression analyses were used to quantify associations between patient satisfaction and changes produced by the orthodontic treatment (PAR T2-T1), posttreatment stability (PAR T3), age at the start of treatment (T1), treatment duration (T2-T1), gender, and extraction.Results:Orthodontic treatment produced a significant improvement of 94.2% in the PAR Index (T2-T1), but this change was not associated with the level of satisfaction when the patient was questioned at least 5 years after treatment. Regression analysis showed that satisfaction was significantly associated only with the long-term posttreatment PAR index (r²  =  0.125, P < .0001). No significant association was observed with the severity of malocclusion at the beginning (PAR-T1) or end of the orthodontic treatment (PAR-T2), age at T1, the amount of time taken during orthodontic treatment, gender, or extraction.Conclusions:Over the long term, patient satisfaction is slightly associated with the stability of the orthodontic treatment regardless of the initial occlusal condition or the final result of the orthodontic treatment.     

Mandibular ridge augmentation by visor osteotomy combined with a subperiosteal rib graft

A technique is described of true rebuilding of the mandibular crest using a combination of the visor-osteotomy (H?rle, 1975) and a subperiosteal rib graft (Obwegeser, 1963 b). A preliminary report on 25 patients with a mean follow-up of 30 months leads to the following conclusions: the resorption in the anterior part ist 52% of the initial gain after 43 months. In the lateral regions 61% is lost. This compares favourably with other techniques. Impairment of sensibility, although usually acceptable, is the main drawback of the procedure.     

Comparison of conchal cartilage graft with nasal septal cartilage graft for reconstruction of orbital floor blowout fractures

Our aim was to compare autogenous nasal septal cartilage and conchal cartilage as grafts for reconstruction of orbital blowout fractures. Twenty-two patients with blowout fractures were randomly assigned to two groups for treatment with a graft of nasal septal cartilage or conchal cartilage. Patients were evaluated for the presence of enophthalmos, diplopia, dysfunction of the infraorbital nerve, and restriction of the ocular muscles. Patients with enophthalmos of more than 2 mm were included in the study, and were followed up postoperatively at 10 days, 1 month, and 3–6 months. The patients treated with a nasal septal cartilage graft had significantly better correction of enophthalmos than those treated with conchal cartilage (p = 0.02) after 10 days (p = 0.02), 1 month (p = 0.004), and 3–6 months (p = 0.001). There was significantly less residual enophthalmos in the nasal septal graft group after 1 month (0.91 compared with 1.72 mm, p = 0.02), and after 3–6 months (1.0 compared with 2.54 mm, p = 0.008). Correction of enophthalmos was considerably better in patients who were operated on within 4 weeks of injury. We think that nasal septal cartilage is a better graft than conchal cartilage for reconstruction of blowout fractures. The time to intervention (the earlier the better) is a critical point in the correction of enophthalmos.     

Diced cartilage for dorsal augmentation in rhinoplasty: effect on nasal projection and frontal nasal width

This research study was designed to evaluate the aesthetic consequences of different dorsal augmentation techniques using diced cartilage on dorsal width and projection in rhinoplasty. Patients were assigned to three groups based on the dorsal augmentation technique used: diced cartilage wrapped in fascia (DCIF), free diced cartilage under fascia (DCUF), and free diced cartilage without fascia (FDC). Dorsal projection and dorsal aesthetic width were measured at two levels using pre- and postoperative photographs. A total of 98 patients were included in the study. DCIF was used in 51 patients, FDC in 27 patients, and DCUF in 20 patients. There was no significant difference in nasion projection, rhinion projection, or width of the dorsal aesthetic lines at the intercanthal and keystone levels among these groups. Significantly greater nasion and rhinion projection was observed with DCIF in thin-skinned patients followed-up for 6–12 months (nasion, P = 0.028; rhinion P = 0.039) but not at>12 months. Two patients with a graft infection and one with graft malposition were encountered in the DCIF group. Experience from this study suggests that the application of FDC prevents such complications without sacrificing the dorsal augmentation and that DCIF is a better choice for more severe deformities.     

Diced cartilage grafts wrapped in AlloDerm for dorsal nasal augmentation

Dorsal nasal augmentation is commonly performed for various aesthetic deficiencies and/or reconstructive defects such as the saddle nose deformity. However, the optimal technique for volume augmentation has yet to be identified. The senior author (F.P.) has since developed a new modified technique using wrapped diced cartilage within an AlloDerm. This novel construct provides the plastic surgeon a smooth, convenient, pliable option with similar operative times as compared with other popular techniques. In summary, this technique has been proven to be successful in achieving attractive, safe, and acceptable outcomes in nasal dorsal configuration and overall patient satisfaction.     

Long-term results of mandibular ridge augmentation by visor osteotomy with bone graft

Visor osteotomies of various designs, supplemented with illiac bone grafts, were used to augment 63 cases of severely atrophic mandibles. The rate of resorption measured on lateral cephalograms was 28% after four years, with the best performance by the full visor with peripheral bone graft (PA), and the worst by the short visor with onlayed bone graft posteriorly (PO). Ridge forms were usually inverted V-shaped or inverted U-shaped, but occasionally comma-shaped, the best form for providing retentive qualities for the denture. Only 39% were free of neurosensory problems. It was concluded that indications for such a procedure should be viewed in the light of frequent nerve injuries, adverses patterns of resorption for denture retention and newer and more effective methods for ridge augmentation using hydroxylapatite.     

Atypical cyst formation following chin augmentation using a nasal osteocartilaginous graft.

The purpose of this paper is to present a case of an intraosseous mucocele that was detected 5 years after chin augmentation using a nasal osteocartilaginous graft. Although complications of this technique have been described as negligible, the surgeon must be aware of possible long-term side effects and should remove all nasal mucosa from the graft prior to implantation.     

Nasal reconstruction with double-layer tensor fascia lata-wrapped diced rib cartilage in a patient with severe dorsal collapse

For patients with large dorsal defects due to posttraumatic deformities, rib cartilage or calvarial bone is used for reconstruction. Problems such as graft contour, distortion, limited amounts, and donor morbidity continue to exist for cartilage and bone grafts. To overcome the limitations of such grafts, many authors have used diced cartilage wrapped with fascia. However, diced cartilage wrapped with fascia is not suitable for structural support in cases of dorsal nasal collapse. We describe a technique using a dorsal structural graft for a 28-year-old man who had severe dorsal nasal collapse after a traffic collision. For enhancement of strength, we harvested a thick segment of the tensor fascia lata and applied 2 layers. A large amount of rib cartilage was inserted between the thick fascia layers. The tensor fascia lata wrapped with diced cartilage graft for dorsal augmentation is fraught with structural graft, similar to bone or cartilage grafts. This semirigid technique may be another option for dorsal structural support of severe nose deformities.     

Long-term results following mandibular resection in newborns with autogeneous rib graft for reconstruction of mandibular defects

The authors report on the clinical course of two children, in whom benign tumors with destruction of the mandible were diagnosed at the age of 4 and 6 months respectively. Following mandibular continuity resection the lateral mandible was reconstructed with autogenous rib grafts. In both children craniofacial and mandibular growth was assessed during yearly clinical and radiological follow-up visits. A slight vertical overgrowth and transversal growth inhibition could be detected.     

Facial defect augmentation with a dermal-fat graft

The augmentation of facial soft-tissue defects can pose a difficult problem for the surgeon. Bone tends to resorb, giving unpredictable results, and alloplastic materials are firm to the touch and can migrate in the tissues. The dermal-fat graft provides a soft, natural-appearing augmentation. In the case reported here a 2-year follow-up shows excellent results obtained with the use of a dermal-fat graft to augment a soft-tissue defect over the mandible.     

Temporomandibular joint eminence augmentation by down-fracture and inter-positional cartilage graft. A new surgical technique.

A new surgical technique for the treatment of recurrent temporomandibular joint subluxation or dislocation is described. Following a horizontal osteotomy and down-fracture of the articular eminence an inter-positional bovine cartilage xenograft is inserted in order to augment the vertical height of the eminence. The procedure combines simplicity with minimal post-operative morbidity. The increase in eminence height is both predictable and stable.     

Platelet-rich plasma for bone graft enhancement in sinus floor augmentation with simultaneous implant placement: patient series study

The use of autologous platelet-rich plasma (PRP) as a source for growth factors in bone grafting is a relatively new and promising technique. Early controlled studies indicate that combining PRP with autologous bone grafts significantly enhances the rate of bone formation and maturation. The study consisted of 105 patients who required sinus augmentation with crestal bone height of less than 5 mm in the posterior maxilla. All patients received a composite bone graft that consisted of 30% to 40% autogenous bone harvested from the lateral wall of the maxilla zygomatic-maxillary buttress and the tuberosity and 60% to 70% xenograft. A total of 50 mL of blood was obtained from each patient before the surgical treatment for preparation of 10 mL of PRP. The graft-PRP mixture was activated by human thrombin. All sinus augmentations were carried out simultaneously with dental implants. At 6 months postoperatively, implants were exposed showing no clinical evidence of crestal bone loss around the implants both clinically and radiographically. All implants were clinically osseointegrated and loaded with fixed porcelain fused to metal prosthesis. The use of PRP in augmenting the severely atrophic posterior maxilla has obvious clinical benefits in terms of reducing the healing period of bone maturation, better graft handling, and accelerated soft tissue healing.     

Mandibular cystic defect: A composite approach with rhBMP-2 and rib graft

Objective  To report treatment of severe mandibular defect caused by Aneurysmal Bone Cyst (ABC) in a 6-year-old child, with off-label use of Recombinant Bone Morphogenetic Protein-2 (rhBMP-2) Study Design  Clinical Study. Method  After corrective segmental mandibulectomy, mandible was stabilized by precontoured titanium reconstruction plates spanning the entire defect. After confirming final diagnosis and a wait and watch approach, rhBMP-2 was inserted into mandibular defect along with conventional split rib graft. Result  New bone formation was identified at 3 months and was evident at radiographic examinations upto 5 months. Conclusion  Reconstruction of a large mandibular defect was facilitated by use of an osteoinductive factor (rhBMP-2) as a graft additive. Clinical Relevance  One-step salvage and reconstruction could be facilitated by use of an osteoinductive factor, as a graft additive, may be an alternative strategy for repair of large mandibular defects.     

Histologic and histomorphometric results of three bone graft substitutes after sinus augmentation in humans

The aim of this study was to compare the histological behavior of three bone graft materials placed in human. The comparison was made among Bio-Oss? (BO), Engipore? (EP), and PepGen P-15? (P-15). Five biopsies for each group of biomaterial, retrieved 6 months after sinus lift augmentation, were analyzed. The investigation was carried out using light microscope (LM), scanning electron microscope (SEM) with an energy dispersive spectrometer (EDS), and circularly polarized light microscope (CPLM). Under LM, the amount of newly formed bone was significantly higher in BO than P-15 (P < .05), while the amount of residual graft material was significantly higher in P-15 than BO (P < .05). The extension of marrow spaces was significantly higher in EP than both BO and P-15 (P < .05). SEM-EDS analysis showed a Ca/P ratio of 1.8 for BO, 2.2 for EP, and 1.5 for P-15. Under CPLM, BO showed no significant difference for transverse (18.4 ± 2.7%) and longitudinal (16.3 ± 1.8%) bone collagen fibers (P = .195); EP showed a significant difference between transverse (4 ± 0.7%) and longitudinal (7.6 ± 2.5%) bone collagen fibers (P = .015); finally, P-15 showed no significant difference for transverse (3.8 ± 1.6%) and longitudinal (4.9 ± 1.2%) bone collagen fibers (P = .279). No investigated biomaterial was completely resorbed, but all the residual particles demonstrated a close bone integration to form a hybrid tissue. BO particles appeared perfectly osseointegrated in the trabecular bone. EP showed a tendency to concentrate the bone apposition into the microporosities; P-15 particles appeared bridged by newly formed bone trabeculae.