Vesicovaginal fistula resulting from a well-cared-for pessary

An 84-year-old vaginally grand multiparous woman presented with a vesicovaginal fistula (VVF) after appropriate use of a Gehrung pessary for the past 12 years for stage III pelvic organ prolapse. The patient reported strict adherence to removing her pessary nightly and replacing it in the morning for the last 12 years. One morning, she awoke and noted a sudden gush of urine through the vagina followed by continuous leakage. Given the complex nature of VVF repair with concurrent stage III pelvic organ prolapse, the patient was referred to urogynecologic care. A Latzko fistula repair and LeFort colpocleisis were performed without complication. The patient recovered well with complete resolution of her pelvic organ prolapse and VVF based on negative cystogram findings at 3 weeks postoperatively. At 12 weeks postoperatively the patient denied any urine leakage or pelvic organ prolapse.     

SEGMENTAL LEFORT I OSTEOTOMY FOR TREATMENT OF A CLASS III MALOCCLUSION WITH TEMPOROMANDIBULAR DISORDER

This article reports the case of a 19-year-old young man with Class III malocclusion and posterior crossbite with concerns about temporomandibular disorder (TMD), esthetics and functional problems. Surgical-orthodontic treatment was carried out by decompensation of the mandibular incisors and segmentation of the maxilla in 4 pieces, which allowed expansion and advancement. Remission of the signs and symptoms occurred after surgical-orthodontic intervention. The maxillary dental arch presented normal transverse dimension. Satisfactory static and functional occlusion and esthetic results were achieved and remained stable. Three years after the surgical-orthodontic treatment, no TMD sign or symptom was observed and the occlusal results had not changed. When vertical or horizontal movements of the maxilla in the presence of moderate maxillary constriction are necessary, segmental LeFort I osteotomy can be an important part of treatment planning.     

Orthognathic Surgery for Patients with Maxillofacial Deformities

Orthognathic surgery is performed to alter the shape of the jaws to improve dental occlusion stability, improve temporomandibular joint function, open the oropharyngeal airway, and improve the patient's facial proportions. Surgery must be coordinated with orthodontic treatment. The surgeon develops a plan based on the patient's measurements and performs the planned procedure on plaster models of the patient's jaw and teeth to obtain the proper jaw position. Surgical techniques include LeFort procedures and distraction osteogenesis. Possible complications of orthognathic procedures include airway compromise, numbness, and nonunion or malunion of the bones. Postoperative instructions include an emphasis on the need for the patient to consume a blended diet for six weeks after surgery.     

上颌骨ＬeFortI型截骨术式应用及并发症的探讨

目的：对全上颌骨水平向骨切开术(total horizontal maxillary osteotomy)既上颌骨ＬeFortＩ型截骨术的不同术式,对术中及术后可能出现发并发症进行探讨,方法：对５３例先天性发育、外伤等原因造成的颌骨畸形,行单颌或双颌同期上颌骨ＦeFortＩ型截骨。结果：术中无异常骨裂,牙体,牙髓损伤等并发症,上颌骨ＬeFortＩ型截骨术式可稍有改变,术前应充分计术中及术后的各种并发症,并制订相应的预防措施,以确保手术安全。     

Prosthodontic Rehabilitation Using Surgical Space Modification

Treatment using a LeFort I osteotomy and sequential prosthodontic rehabilitation is presented. This treatment combination is a viable alternative therapy for the severe extrusion of posterior maxillary dento-osseous segments.     

Zygomatic repositioning and Le Fort II distraction with intraoral devices in Apert syndrome: A case report

The aim of this case report is to describe the surgical technique and outcome using internal intraoral distraction devices in LeFort II distraction with zygomatic repositioning (LF2ZR).In Apert syndrome the midface is characterized by a complex hypoplasia, with the central part being more affected than the lateral orbito-zygomatic complex. In LF2ZR, the zygomas are repositioned and internally fixated, and the central midface is further advanced through a LeFort II distraction. In previous publications, the distraction has been performed using external halo-based devices.It seems that the LF2ZR procedure can be planned and performed with adequate accuracy using virtual surgical planning tools. Knowledge about the possibility of using internal intraoral distraction devices in LF2ZR is important, as the inconspicuous placement of intraoral devices can be advantageous for some patients.     

LeFortⅠ型截骨旋转颌平面矫治下颌前突伴偏斜畸形

目的 评估LeFortⅠ型截骨旋转上颌颌平面在治疗下颌前突伴偏斜畸形患者中的作用 。方法 回顾性分析 在广东省口腔医院颌面外科病房接受外科手术的下颌前突伴偏斜畸形患者82例,选取资料完整并于术中行上颌LeFortⅠ型截骨的42例患者作为研究对象。患者术前设计时在投影测量正位片上旋转颌平面模拟治疗下颌偏斜畸形,应用几何学原理通过上颌颌平面的旋转角度计算出颏部移动的距离,并将模拟数据应用于模型外科及正颌患者手术中。 结果 　42例患者均取得了良好的治疗效果,口内咬颌关系良好,面形改善良好,下颌颏部无明显偏斜。下颌颏部移动的距离与上颌颌平面旋转的角度大小及上下颌骨的高度有关。旋转角度越大,上下颌骨的高度越大,颏部移动的距离越大。 结论 　 LeFortⅠ型截骨旋转上颌颌平面对治疗下颌偏斜畸形有重要的作用。     

Large vesicovaginal fistula in women with pelvic organ prolapse: the role of colpocleisis revisited

Successful repair of large vesicovaginal fistulas poses a significant challenge in surgically unfit older women with pelvic organ prolapse. Two women, at ages of 85 and 93, referred for involuntary urine loss were found to have neglected pessaries resulting in large vesicovaginal fistulas. After the removal of the pessary, fistula repair and LeFort colpocleisis were done with success. At 12 months postoperatively, the patients were free of leakage and prolapse. For frail, elderly women with large vesicovaginal fistula and pelvic organ prolapse, addition of LeFort colpocleisis to the repair provides an effective treatment for both.