Oral and Maxillofacial Surgery Cases最新文献

Background

The indications for using zygomatic implantsinvolve cases with severe resorption of the maxillary arch resulting in inadequate bone volume. The case report aims to review the HIV virus and current protocols, perioperative management and the surgical approach of zygomatic implant placement in combination with traditional implants in an HIV-positive patient.

Case report

A 59-year-old HIV positive male patient presents with atrophic maxillary and mandibular arches. Surgical placement of two zygomatic implants, two endosseous implants in the maxillary arch, and six endosseous implants in the mandibular arch. A reduction of a large palatal tori was also performed. The patient exhibited no complications after the surgical procedure. The hybrid prostheses were inserted post surgically without any issues.

Conclusion

Zygomatic implants can be an optimal treatment option for prosthetic rehabilitation in patients with atrophic maxilla for better functionality and aesthetics. This case demonstrates the perioperative work up and placement of zygomatic implants in a medically stable HIV-positive patient with no adverse effects five months post-operation. Various surgical approaches may be utilized with excellent patient acceptance and predictable outcomes.

Obstructive sleep apnea (OSA) is characterized by recurrent upper airway collapse during sleep. Since FDA approval in 2014, INSPIRE hypoglossal nerve stimulators have been used for the treatment of moderate to severe OSA in patients who are unable to use CPAP. In this case report we discuss malfunction of a hypoglossal nerve stimulator due to rotational manipulation of the implanted device that is patient generated. This phenomenon is called Twiddler's Syndrome and has been demonstrated with other implantable medical devices. We review risk factors associated with Twiddler's syndrome, and strategies for mitigating risk of occurrence.

The epithelial-myoepithelial carcinoma (EMC) is a rare neoplasm of the salivary glands with an incidence <1% of all cancers affecting them. It commonly affects the parotid gland and less frequently the submandibular gland and minor salivary glands. EMC is a rare low-grade tumor characterized biphasic tubular structure composed by an internal layer of luminal ductal cells surrounded by clear cells of myoepithelial origin. The patient had good prognostic factors determined in previous studies, and achieved complete treatment-response. Further accumulation of cases and long-term follow-up data are needed to elucidate the pathophysiology and prognosis of epithelial-myoepithelial carcinoma.

Familial dysautonomia is a rare disease that impairs the development of sensory nerves, afferent autonomic nerves, and afferent baroreflex pathways. This ultimately results in decreased pain receptors, decreased thermal sensation, blood pressure instability, dysphagia, optic neuropathy, and gait ataxia. The authors are documenting a case of a familial dysautonomia patient who suffered a pathological fracture of the left mandible approximately 4 months after undergoing routine third molar surgery. Due to the patient's inability to perceive pain and lack proprioception, this fracture went undiagnosed until facial swelling was visible. Familial dysautonomia patients require special consideration regarding anesthesia, surgery, and postoperative follow up.

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.

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.

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.

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.

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.