Lefort-2 osteotomy for the treatment of nasomaxillary hypoplasia: a case report

Nasomaxillary hypoplasia clinically presents as a class lll deformity with hypoplasia or retrusion of the nasal bones and maxilla, which manifests as deficient projection of the nose.Lefort 2 osteotomy though introduced in 1950s, did not get its due attention till Henderson and Jackson published their landmark article, for the correction of Nasomaxillary hypoplasia in 1973. Accomplished surgeons can achieve a lot more in this rarely performed surgery when used in appropriate cases.     

Orthodontic-surgical treatment of patients with mandibular hypoplasia

A combined orthodontic-surgical treatment strategy for patients with mandibular hypoplasia is presented. The importance of a proper diagnosis on which the treatment should be based is emphasised. The principles of the orthodontic pre and postoperative treatment and the surgery are explained. The possibility to use the curve of Spee to gain vertical chin height is emphasised. This can be achieved by levelling of this curve postoperatively. Possible unfavourable side effects are mentioned. It is concluded that highly predictable results can be achieved using the described techniques.     

Treatment of severe mandibular prognathism in combination with maxillary hypoplasia: case report.

We performed a Le Fort I osteotomy and sagittal split ramus osteotomy (Obwegeser-Dal Pont) combined with mandibular anterior segmental osteotomy without tooth extraction for a patient with severe mandibular prognathism accompanied by a hypoplastic maxilla, anterior open bite and normal anterior mandibular vertical dimension. The results of facial appearance and occlusion were excellent. This combined surgical method appears to be satisfactory for treating severe mandibular prognathism with hypoplastic maxilla.     

Computed tomography in the diagnosis and treatment of mandibular ameloblastoma: report of cases

Treatment of ameloblastoma is based on clinical manifestations and radiological features. The value of routine radiographs in determining the extent of the lesion may be limited. Four cases of mandibular ameloblastoma were studied using axial and coronal computed tomography (CT). The soft-tissue mass, destruction of cortical bone, and extension of tumor into the infratemporal fossa and adjacent structures were clearly visualized. These features demonstrate the superiority of CT over conventional radiography in delineating the extent of the lesion, which may be essential to its management.     

Severe mandibular retrognathism: orthodontic versus surgical orthodontic treatment.

1. Treatment of Class II, Division 1 malocclusions should be accomplished by normalization of the abnormal structures that are identified diagnostically. 2. In the presence of mandibular retrognathism and unfavorable growth potential (limited amount, undesirable direction), surgical mandibular lengthening should be incorporated into the treatment plan. 3. Compensation for mandibular retrognathism by conventional orthodontic and facial orthopedic treatment incurs the risk of (a) increase in nasolabial angle, (b) reduction in upper lip support, (c) increase in lower facial concavity, (d) excessive proclination of lower incisors with compromise of labial periodontal support, and (e) protracted duration of appliance therapy and accompanying detrimental periodontal and root resorption effects.     

Immediate reconstruction of mandibular defects: a retrospective report of 242 cases.

PURPOSE: This study was conducted to evaluate the effects of routine protocols in immediate mandibular reconstruction. PATIENTS AND METHODS: A total of 242 patients who underwent immediate mandibular reconstruction were reviewed retrospectively. The therapeutic evaluation was performed according to outcomes of clinical and radiographic examination. The evaluated contents included facial symmetry, degree of mouth opening, occlusal relationship, and temporomandibular joint symptoms. Statistical analysis was also carried out to compare therapeutic differences between different methods for mandibular reconstruction. SPSS 10.0 for Windows was used for statistical analysis. RESULTS: The follow-up showed satisfactory long-term outcome in 203 patients. Statistical analysis revealed no significant difference in restoration of facial contour among several groups (chi(2) 0.05(15) = 21.93; P = .109 > .05). Ten cases involved serious postoperative complications, including local infection, exposure of rigid fixation plate, and serious pain. CONCLUSIONS: Our findings indicate that autogenous bone graft is the best for reconstruction of small mandibular defects. Frozen autogenous lesional mandible plus autogenous iliac or rib graft is recommended for reconstruction of large defects in the mandible. Strict patient selection, careful surgical procedure, and appropriate preoperative and postoperative nursing care are key factors in successful transplantation.     

Hemorrhage following mandibular osteotomies: a report of 21 cases

Hemorrhage associated with mandibular osteotomies, especially to the extent that it becomes life threatening, is a rare occurrence and its risk is less than that following maxillary orthognathic surgery. Twenty-one cases of significant bleeding following mandibular sagittal split ramus osteotomies, vertical and oblique ramus osteotomies, and genioplasties are presented. Life-threatening hemorrhage associated with mandibular osteotomies is primarily an intraoperative problem and the incidence of major postoperative and recurrent hemorrhage is not as great as following maxillary osteotomies. Suggestions for the avoidance and treatment of these bleeding complications are discussed.     

Supernumerary mandibular premolars: report of cases

Six cases, totaling seven supernumerary mandibular premolars, were seen in a sample population of 4,000 patient records. Four were from a suburban private practice sample of 2,000, the others from a similar group randomly drawn from an urban dental school. Five of seven appeared on the left side, six of seven were impacted or erupted ectopically. Only one patient was female. Four were of Spanish or Hispanic descent, one was white and one was black. The only other supernumerary teeth seen in the population sampled were two paramolars and one mesiodens. The recommended course of treatment is extraction of the supernumerary teeth, unless they may be useful for orthodontic purposes or if the surgery would be unjustifiably hazardous to adjacent structures. Complications could result in resorption of other teeth, malocclusion, and possible cystic degeneration and ameloblastoma formation.     

Root canal treatment in mandibular canines with two roots: a report of two cases

AIM: To highlight anatomical variation in the mandibular canine. SUMMARY: Two clinical case reports are presented to illustrate anatomical variation in the human mandibular canine. Endodontic treatment may sometimes fail because morphological features of the tooth adversely affect the treatment procedures. Many investigators have reported the anatomical variations associated with mandibular canines. Mandibular canines are recognized as usually having one root and one root canal in most cases, although approximately 15% may have two canals or sometimes two roots. This paper describes two clinical cases of mandibular canines with two roots and two canals. KEY LEARNING POINTS: Failure to control infection in the root canal system has an adverse impact on outcome. Clinicians should be aware of anatomical variations in the teeth they are managing, and should never assume that canal systems are simple. The majority of mandibular canines have one root and root canal, but 15% may have two canals, and a smaller number may have two distinct roots.     

Congenital mandibular hypoplasia: analysis and classification

Mandibular hypoplasia is a frequently encountered craniofacial difference and can be classified into three groups: congenital, developmental, and acquired. The focus of this article is on the congenital group, the majority of which is associated with syndromes. There have been numerous publications on patients with syndromic congenital mandibular hypoplasia; however, there has been no investigation and differentiation of the "nonsyndromic" patients. The purpose of this study was to analyze this subgroup of patients with nonsyndromic congenital mandibular hypoplasia to determine incidence, clinical presentation, and treatment.A retrospective analysis of all children treated for congenital mandibular hypoplasia at the Children's Hospital of Philadelphia between 1975 and 2003 was performed. Two hundred sixty-six patients were identified during this 27-year period. Of these 266 patients, 148 presented with oculo-auriculo-vertebral (OAV) spectrum, 52 with mandibulofacial dysostosis, 31 with Pierre Robin sequence, and 17 with miscellaneous syndromes. The remaining 18 patients were identified as having congenital mandibular hypoplasia without any known syndrome.Of the 18 patients with nonsyndromic congenital mandibular hypoplasia, 17 had primary bilateral growth anomalies and 1 had a primary unilateral growth disturbance resulting in bilateral deformity. Seven patients were products of a complicated pregnancy, 10 patients required tracheotomy or prolonged intubations, and 7 required gastric tube feedings. Associated anomalies included temporomandibular joint ankylosis in five patients, aglossia/microglossia in three patients, and rare craniofacial clefts in three patients. The average number of procedures required to treat the mandibular deformity for each patient was six.Although mandibular hypoplasia is a common craniofacial anomaly, patients manifesting nonsyndromic congenital mandibular hypoplasia are a rare subgroup. Case reports illustrating the range of mandibular deformities are presented.     

Vascularized free fibular flap for mandibular reconstruction: a report of 26 cases.

PURPOSE: Mandibular reconstruction represents a challenge to the oral and maxillofacial surgeon and has been revolutionized by the modern microvascular techniques. Rehabilitation using techniques such as reconstruction plates frequently produce a functional and cosmetic defect. The primary objective of the current study was to evaluate the usefulness of the osteomuscular free fibular flap for this purpose. PATIENTS AND METHODS: The results of 26 vascularized free fibula flaps with or without a skin paddle that were used for mandibular reconstruction is presented. The "double barrel" technique was used in 6 cases. The donor site was closed directly in 2 cases and with an abdominal full-thickness skin graft in 24 cases. RESULTS: All flaps except 1 were viable. There was partial necrosis of the skin island in 1 patient. The average length of the fibula graft was 10.96 cm, and the number of osteotomies ranged from 0 to 3. In the donor site, the most significant problem was unsatisfactory scarring related to the use of a skin graft. There were no long-term functional complications in the lower leg. Two patients have been secondarily rehabilitated with osseointegrated implants. CONCLUSION: The fibula flap provides a successful bone graft for mandibular restoration with an acceptably low complication rate. This method meets most of the requirements for oral and mandibular replacement.