Oral and Maxillofacial Surgery Cases最新文献

This case report presents a rare but significant complication of abducens nerve palsy following Maxillary Le Fort I osteotomy. The patient, who underwent the procedure for trans palatal distraction indication, experienced left-sided abducens nerve palsy, characterized by the inability to abduct the ipsilateral eye. Undesired fracture patterns can extend to neighbouring structures. The report discusses the management strategies employed and the outcome of this specific complication. By sharing this case, it aims to increase awareness of the potential risks associated with Maxillary Le Fort I osteotomy and provide insights for optimizing surgical outcomes and improving patient safety.

Implant failure in the maxilla often determine significant bone loss. Patients that had already experienced regenerative surgeries such as sinus lift and/or the placement of zygomatic implants may want to avoid further complicate rehabilitation protocols. Pterygoid implants, when feasible, offer the unique opportunity of immediate loading bypassing the maxillary sinuses an extending the anterior-posterior spread of the future prosthesis. The present case series documented the long-term success of pterygoid implants in the rehabilitation of patients who had experienced the failure of zygomatic implants and standard implants in the posterior maxilla.

The 6- piece mandibular osteotomies was described in 1988 by Obwegeser H.L.; mobilizations interested 4 segments and the continuity between the left and right bodies was preserved. This piece of work aims to present a single surgical session for treating an adult with severe developmental deficiency of the mandible. The vertical height and projection of the patient middle third of the face and the SNA angle were within normal ranges contrasting to the 65° SNB. The 5-h procedures involved, in consequence, an incisor-canine subapical setback, an extended BSSO advancement and a double-stepped augmentation genioplasty. The lower third of the face was advanced by 25 mm. Combining mandibular osteotomies may safely save time and expenses.

This technical note describes an innovation that addresses a clinical problem in iatrogenic inferior alveolar nerve (IAN) repair. The options for IAN exposure (Miloro, 1995) are less than ideal since they offer limited access and visibility and/or the exposure itself has a risk of inducing iatrogenic IAN injury. This technical note offers the option to perform IAN exposure via a unilateral sagittal split osteotomy (SSO). There are inherent risks of mild transient IAN paresthesia, malocclusion, bad splits, and the additional cost of rigid fixation hardware (Peleg et al., 2021). The significance of this technique is that it permits wide access for IAN reconstruction in cases where the IAN injury is in the posterior mandible (eg. due to mandibular third molar removal) where another option for access is limited. This technique will improve patient care by facilitating IAN exposure and repair. There should be no challenges or delays to implementing this innovation for surgeons who perform orthognathic surgery and nerve repair.

Background

Single-stage surgical correction of Crouzon syndrome aims to remodel the cranial vault to achieve a morphology approaching age-matched norms. Virtual surgical planning (VSP) and computer-aided design (CAD) technology are recently used in craniofacial surgery. We aimed to determine the value of 3D planning tools and VSP in guiding different steps of surgical correction in craniofacial deformities in patients with untreated Crouzon syndrome.

Methods

This study included three patients with delayed presentation of untreated Crouzon syndrome who underwent cranial vault remodeling preoperatively guided by VSP techniques between Jan 2021 and Feb 2023. Preoperative evaluation included all patients' physical examinations and 3D computed tomography (CT) scans. The constructed 3D files from the CT data were subsequently used for preoperative measurements. DICOM files of both preoperative and postoperative data were introduced into the medical 3D software.

Results

The patients' ages at surgery were 18, 20, and 23 years. All patients had satisfactory aesthetic and functional outcomes with no major complications. The average operative time was 8.35 ± 2.53 hours. There was an improvement regarding cephalometric analysis and orbital morphology. The Presimulation movement distance regarding the frontal and zygomatic bone advancement showed a significant increment with a degree of overcorrection, significantly different from the preplanned.

Conclusion

In conclusion, VSP is revolutionizing the surgical approach to complex craniofacial and occlusal malformations. This study successfully reports the use and applicability of VSP in untreated adult patients in a single stage. Combining the surgeon's experience and the appropriate use of computer-assisted surgery ultimately leads to successful surgery.

Background

The Le Fort I osteotomy is a commonly employed and predictable surgical technique used to treat maxillofacial deformities. While considered technically safe, orthognathic surgery can cause significant vascular complications. Presentation: This case report describes a 20-year old male who had undergone a routine Le Fort I osteotomy to treat maxillo-mandibular discrepancy, and subsequently developed an internal maxillary artery pseudoaneurysm that caused uncontrolled hemorrhage and hemodynamic instability. The patient ultimately required interventional radiology coil embolization for source control.

Discussion

Although rare, internal maxillary artery pseudoaneurysms continue to be reported as postoperative complications in Le Fort I osteotomies, wherein coil-embolization technique remains a viable option for treatment. Additionally, the presentation of temporal swelling and retrobulbar pain may be useful in diagnosing the existence of a maxillary artery pseudoaneurysm. Conclusion: Pseudoaneurysm of the internal maxillary artery is a possible sequela of orthognathic surgery, and proper monitoring and management can avoid morbid outcomes.

This case report documents a patient with a Class II skeletal malocclusion and suspected obstructive sleep apnea who underwent a combined mandibular inverted L osteotomy and total subapical osteotomy. The surgery involved a single-piece Lefort 1 osteotomy of the maxilla, bilateral inverted L osteotomies of the mandible, and a total mandibular subapical osteotomy. After the patient's pre-surgical orthodontic phase was completed, a traditional bilateral sagittal split osteotomy (BSSO) was initially planned to achieve mandibular advancement. However, the large horizontal and yaw correction required for the patient's mandibular teeth made a BSSO alone unrealistic. The virtual surgical plan (VSP) indicated that a subapical osteotomy was necessary, and due to the extension of the total subapical segment, an inverted L osteotomy was added to benefit the subapical osteotomy. The patient's surgery was successful, and the results were satisfactory.

Amyloidosis of the submandibular gland is a rare manifestation of extranodal marginal zone lymphoma (eMZL). Here, we present a case-report of a 62-year-old female patient with a history of eMZL, limited stage IIEA. The patient was initially treated with radiotherapy; however large glands remained with lack of clinical response to the radiotherapy. Consequently, a surgical excision of the submandibular glands was performed, and histology revealed massive amyloid deposits in the gland tissue next to eMZL. This case report highlights the importance of considering amyloidosis as a possible cause of submandibular gland enlargement in patients with a history of lymphoma and emphasizes the need for a histological diagnosis to direct appropriate treatment.