Academic literature on the topic 'Mandible – Abnormalities ; Mouth – Surgery ; Osteotomy'

Introduction: Masseter muscle enlargement accompanied by hypertrophy of Mandibular angle can significantly affect the appearance and quality of life. The treatment methods can be varied, and, in the present study, osteotomy of Mandibular angle and treatment of Masseter muscle with Botulinum toxin was carried out. Observation: In this case study, a 19-year-old female patient was admitted with inadequate mouth opening for three years. Clinical examination and Cone-Beam Computed Tomography scan revealed bilateral well-developed Masseter muscles and hypertrophy of mandibular angle on both sides. Osteotomy of mandibular angle was performed. Additionally, 25 units of Botulinum toxin were administered. This improved the aesthetic appearance and increased the mouth opening from 21 mm to 38 mm in one year after surgery. Conclusion: Oral and maxillofacial surgeons should consider Masticatory muscle tendon-aponeurosis hyperplasia as a differential diagnosis when the patient's chief complaint is inadequate mouth-opening with a square mandible. Osteotomy of mandibular angle in conjunction with, Botulinum toxin is efficient in cases of Masseter muscle hypertrophy and an enlargement of the Mandibular angle.

Purpose The purpose of this paper is to develop a workflow for design and fabrication of customized surgical guides (CSGs) for placement of the bidirectional extraoral distraction instruments (EDIs) in bilateral mandibular distraction osteogenesis (MDO) surgery to treat the bilateral temporomandibular joint ankylosis with zero mouth opening. Design/methodology/approach The comprehensive workflow consists of six steps: medical imaging; virtual surgical planning (VSP); computer aided design; rapid prototyping (RP); functional testing of CSGs and mock surgery; and clinical application. Fused deposition modeling, an RP process was used to fabricate CSGs in acrylonitrile butadiene styrene material. Finally, mandibular reconstruction with MDO was performed successfully using RP-assisted CSGs. Findings Design and development of CSGs prior to the actual MDO surgery improves accuracy, reduces operation time and decreases patient morbidity, hence improving the quality of surgery. Manufacturing of CSG is easy using RP to transfer VSP into the actual surgery. Originality/value This study describes an RP-assisted CSGs fabrication for exact finding of both; osteotomy site and drilling location to fix EDI’s pins accurately in the mandible; for accurate osteotomy and placement of the bidirectional EDIs in MDO surgery to achieve accurate distraction.

Abstract Difficulties with airway management are often caused by anatomic abnormalities due to previous oral surgery. We performed general anesthesia for a patient who had undergone several operations such as hemisection of the mandible and reconstructive surgery with a deltopectoralis flap, resulting in severe maxillofacial deformation. This made it impossible to ventilate with a face mask and to intubate in the normal way. An attempt at oral awake intubation using fiberoptic bronchoscopy was unsuccessful because of severe anatomical abnormality of the neck. We therefore decided to perform retrograde intubation and selected the cuffed oropharyngeal airway (COPA) for airway management. We inserted the COPA, not through the patient's mouth but through the abnormal oropharyngeal space. Retrograde nasal intubation was accomplished with controlled ventilation through the COPA, which proved to be very useful for this difficult airway management during tracheal intubation even though the method was unusual.

SummaryObjective: To describe the clinical features and results of treatment of true ankylosis and pseudoankylosis of the temporomandibular joint in dogs.Methods: This study was a retrospective case series. Ten client-owned dogs that were presented for inability to open the mouth or a severely decreased range of motion of the temporomandibular joint were included. Information on the surgical procedures performed and the perioperative complications were documented. Three-dimensional printing of the skull was performed in four dogs.Results: Two dogs were diagnosed with temporomandibular joint ankylosis and seven dogs with pseudoankylosis. One dog had evidence of combined temporomandibular joint ankylosis and pseudoankylosis. Of the seven dogs with pseudoankylosis, six had an osseous fusion involving the zygomatic arch and mandible. Surgical treatment was performed in nine dogs and a revision surgery was needed in one dog. Follow-up ranged from five months to eight years (mean: 48.6 months). Eight out of nine dogs that were treated surgically regained the ability to open their mouth, but six dogs never regained a fully normal temporomandibular joint range of motion.Clinical significance: Temporomandibular joint ankylosis and pseudoankylosis are uncommon in the dog. Surgical treatment for temporomandibular joint ankylosis or pseudoankylosis in dogs is a successful option and carries a prognosis dependent on patient-specific abnormalities. Computed tomography complemented with three- dimensional printing is valuable for understanding the extent of abnormalities and for preoperative planning.Supplementary material for this paper is available online at http://dx.doi.org/10.3415/VCOT-15-11-0189.

Background. Reconstruction of subtotal and total defects of maxillofacial region after ablative tumor surgery is a challenging task of reconstructive surgery. The “golden rule” is maintaining of radicalism of ablative surgery as well as appropriate surgical reconstruction and prosthodontic rehabilitation, that allows patient return to normal life. Wherein reconstructive procedure is focusing on restoring of mandibular continuity by the means of different flaps and grafts, while prosthodontic rehabilitation is performing after some period of time (usually around year) by the means of removable and non-removable prosthodontic devices. Non-removable device requiring dental implants insertion into grafted material followed by period of osteointegration, that is requiring some time as well. However, within this period of time one could observe significant soft tissue deformity.The objective is to improve the outcomes of surgical reconstruction of extensive defects of the mandible and to carry out rapid prosthodontic rehabilitation supported by dental implants by application of 3D preoperative planning and navigation devices.Clinical case. Forty-nine years-old female patient with recurrent ameloblastoma, that affects vertical and horizontal ramus of the mandible. Within virtual preoperative planning one performed: resection of the mandible associated with exarticulation of condylar head, virtual plate bending according to contours of the mandible (that were determined by application of “mirror” function of virtual planning software), arthroplasty of temporomandibular joint, determination of donor site on fibula bone, osteotomy of fibula free flap, positioning of dental implants, transferring of composite flap and it’s fixation by reconstructive plate. According to acquiring data one performed fabrication of patient specific navigation guides for both fibula flap segmentation and dental implants positioning. Surgical procedure included single-step tumor ablation and exarticulation of condylar head, reconstruction of defect by the means of osseo-myo-cutaneous fibula free flap, that was pre-implanted by dental implants, total joint reconstruction by titanium condylar head and polypropylene fossa, fixation of the flap and condylar head in recipient site by the means of prebended reconstructive plate, as well as insertion of non-removable bridge prosthodontic device. Postoperative result was asses clinically and radiologically. No significant postoperative complications occurred. Restoration of facial contours, mouth opening, I class occlusion, as well as adequate meal and speech were detected. Postoperative radiological investigation revealed adequate positioning of dental implants within neo-mandible, as well as positioning of artificial joint.Conclusion. In cases of extensive tumors of the jaws single-step ablative surgical procedure, reconstruction of missing anatomical structures of the jaws and simultaneous prosthodontic rehabilitation allows to prevent possible deformities of the soft tissues and due to rapid restoration of vital functions has great impact to quality of patient’s life. Adequacy of performing procedures could be reached by implementation of virtual preoperative planning and fabrication of patient-specific surgical guides.

ABSTRACT Background: oromaxillofacial surgical procedures present a unique set of problems both for the surgeon and for the anesthesist. achieving dental occlusion is one of the fundamental aims of most oromaxillofacial procedures. oral intubation precludes this surgical prerequisite of checking dental occlusion. having the tube in the field of surgery is often disturbing for the surgeon too, especially in the patient for whom skull base surgery is planned. nasotracheal intubation is usually contraindicated in the presence of nasal bone fractures seen either in isolation or as a component of le fort fractures. we utilized submental endotracheal intubation in such situations and the experience has been very satisfying.materials and methods: the technique has been used in 20 patients with maxillofacial injuries and those requiring le fort i approach with or without maxillary swing for skull base tumors. initial oral intubation is done with a flexo-metallic tube. a small 1.5 cm incision is given in the submental region and a blunt tunnel is created in the floor of the mouth staying close to the lingual surface of mandible and a small opening is made in the mucosa. the tracheal end of tube is stabilized with magil′s forceps, and the proximal end is brought out through submental incision by using a blunt hemostat taking care not to injure the pilot balloon. at the end of procedure extubation is done through submental location only.results: the technique of submental intubation was used in a series of twenty patients from january 2005 to date. there were fifteen male patients and five female patients with a mean age of twenty seven years (range 10 to 52). seven patients had le fort i osteotomy as part of the approach for skull base surgery. twelve patients had midfacial fractures at the le fort ii level, of which 8 patients in addition had naso-ethomoidal fractures and 10 patients an associated fracture mandible. twelve patients were extubated in the theatre. eight patients had delayed extubation in the post-operative ward between 1 and 3 days postoperatively.conclusion: in conclusion, the submental intubation technique has proved to be a simple solution for many a difficult problem one would encounter during oromaxillofacial surgical procedures. it provides a safe and reliable route for the endotracheal tube during intubation while staying clear of the surgical field and permitting the checking of the dental occlusion, all without causing any significant morbidity for the patient. its usefulness both in the emergency setting and for elective procedures has been proved. the simplicity of the technique with no specialized equipment or technical expertise required makes it especially advantageous. this technique therefore, when used in appropriate cases, allows both the surgeon and the anesthetist deliver a better quality of patient care.

The article presents data on the treatment of patients with TMJ and concomitant deformities. The most important connection between the dental system and the musculoskeletal system is the temporomandibular joint, which in the presence of dental anomalies and in the period of temporary occlusion undergoes increased loads, which leads to its dysfunction. The concept of the interaction of posture and occlusion was first put forward in the early 20th century, which noted that children with glossoptosis have X-shaped legs, crooked posture and typical signs of distal occlusion. It has been theorized that occlusal disorders can alter posture in the frontal and sagittal planes and ultimately alter body weight distribution. Postural curvature causes a violation of the position of the head of the temporomandibular joint, which in turn leads to pain and joint dysfunction. Any postural disorders lead to compensatory changes throughout the body, not excluding the maxillofacial area. This is especially true for the formation of mesial occlusion (III class according to Angle). Mesial occlusion in the structure of dental anomalies is determined in 12% of cases, but the severity of the anomaly and aesthetic disorders that occur often force orthodontists to use a combination. Therefore, further improvement of methods of diagnosis and treatment of occlusions of occlusion of the third class according to Angle will allow most patients to get a positive treatment result and the opportunity to adapt in society. An example of coordination of specialists in the planning and implementation of treatment is the clinical case of patient K. 16 years old, who went to the clinic where on the basis of examination and special research methods diagnosed: Angle class III (skeletal form) true progeny, macroglossia. Also at inspection of a posture sharp curvature of a backbone, with signs of scoliosis is defined. From the back there is a clear asymmetry of the shoulders within 4 centimeters. Asymmetrical location of the shoulder blade and even significant hypertrophy of the right shoulder blade (in this direction the patient is determined by the displacement of the mandible). Asymmetry was noted in the general study of the face. Displacement of the chin to the right was noted. The asymmetry of facial structures begins with the upper third. Asymmetry of superciliary arches, orbits, wings of the nose, nostrils, and corners of the mouth was also observed. Deepened nasolabial folds were noted. The lower lip overlaps the upper one. But the profile of the face remains almost straight. Based on the data obtained, the patient was offered the following treatment plan: consultation with an orthopedist traumatologist about scoliosis, consultation with a dentist surgeon about skeletal surgery, consultation with a speech therapist. Orthodontic treatment is concerned with a brace system. The patient’s brace system was fixed on the upper jaw (“straight arch” technique was used). 38 and 48 teeth were removed. Bilateral planar osteotomy of the mandible and resection of the tip of the tongue were performed. The lower jaw brace system was fixed using oblique intermaxillary traction, which the patient used for 6 months. A course of therapy with a speech therapist was conducted to restore speech function. The total duration of the active treatment period contained 4 years. After creating the maximum occlusal contact, the patient regained chewing function. Thus, the treatment of mesial occlusion and its prognosis largely depends on etiological factors and the possibility of their elimination, as well as the severity of morphological and functional disorders, the difficulty of eliminating them during permanent occlusion. Therefore, the sacred rule of medicine "better to prevent than to cure" in relation to skeletal forms of mesial occlusion is the most relevant.

Abstract Gorlin Syndrome (GS) is a rare condition with multisystemic manifestations. Known features include basal cell carcinomas, odontogenic keratocysts (OKCs), and skeletal abnormalities. Multidisciplinary involvement is paramount with surgical intervention as a common treatment modality. Multiple OKCs with recurrence is common in GS. However, limited up-to-date guidelines are available on the appropriate radiographic monitoring of such lesions, in the form of orthopantomogram, in these patients. This is a case of a 12-year-old girl with GS and multiple episodes of OKCs. She is monitored regularly with the Oral and Maxillofacial team since the age of 3, after her dentist referred her due to her condition and its association with OKCs. A multidisciplinary approach with Dermatology, Pediatrics, Ophthalmology, Ear Nose and Throat, and Orthodontics and Restorative Dentistry within the dental specialty is undertaken to manage her condition. Yearly clinical reviews of her mouth and radiographs biannually were done, with her first episode of OKCs presenting at 10 years old. Orthopantomogram and magnetic resonance imaging revealed 6 OKCs – 2 in the maxilla, 4 in the mandible. These were surgically enucleated with liquid nitrogen cryotherapy adjunct, alongside extractions of associated deciduous teeth. Eighteen months following this, her OPG showed 2 new OKCs – 1 in the maxilla, 1 in the mandible. These were removed successfully in a similar fashion and active monitoring is ongoing. This case underscores the importance of regular clinical and radiographic follow-ups due to the frequency of multiple OKCs with recurrence in GS. Long-term multidisciplinary approach in this multisystemic syndrome is also paramount.

This study investigates the intraoral inverted 'L' osteotomy for mandibular advancement. The stability of the intraoral inverted 'L' osteotomy is assessed by cephalometric analysis over the short, medium and long term and this is compared to the stability of the bilateral sagittal split osteotomy and the extraoral inverted 'L' osteotomy. The thesis investigates also the incidence of neurosensory disturbance following inverted 'L' osteotomy and comparedit to bilatteral saggittal split osteotomy.
Thesis (M.D.S.) -- University of Adelaide, Dept. of Dentistry, 1997.