Aim of study The aim of this clinical retrospective study is to evaluate the clinical outcomes of patients with transverse maxillary hypoplasia who underwent surgical assisted maxillary expansion (SARME) using a bone borne distractor in 2 different surgical centers. Patients and Methods This is a clinical retrospective cross‐sectional study of adult patients diagnosed with maxillary transverse hypoplasia and having had transpalatal distraction by SARME done in two surgical centers (Oral and Maxillofacial Surgery, The University of Hong Kong, Hong Kong and The Baruch Padeh Medical Center, Poriya, Israel) from January 2004 to December 2011. A total of 37 patients were identified. The mean age was 27.1. Each patient underwent a standard Le Fort I osteotomy with midline split with no mobilization under general anesthesia. A bone‐borne palatal distractor was fitted on the hard palate. The distractor was activated at a rate of 0.6mm per day following 5 ‐ 7 days of latency until the amount of expansion was reached according to plan. Occlusal radiographs and lateral cephalographs were obtained at pre‐expansion phase and regular postoperative intervals during the activation and consolidation period. Among the 37 patients, only 15 patients could be contacted by phone, mail or e‐mail and has agreed to participate in the cross‐sectional analysis. Clinical examination was performed and included the following: tooth vitality, tooth mobility, periodontal status and occlusion. Questionnaire was also given to patients to grade their experiences toward the treatment outcome. Results The mean transverse expansion achieved was 9.58mm. The TPD was removed from the patients in the ranged of 2 months to the longest 8 months (mean: 5.2 months). The distraction gap was gradually ossified by bone and then the teeth were aligned into the space achieving stable dental occlusion. No intra‐operative complications were recorded. Post‐operatively, 2 patients had to be re‐operated due to failure to activate the distractor. Others post‐operative complications encountered were pain, fixation screw loosening, insufficient distractor length, infection, asymmetric expansion and tooth migration into the distraction gap. These complications were well managed accordingly. Majority of the patients were satisfied with the treatment and will recommend it to others. Conclusions Correction of maxillary transverse hypoplasia using a transpalatal distractor can reliably achieve large bony expansion of the maxillary arch with few postoperative complications. / published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

Thesis (PhD (Surgical Sciences))—University of Stellenbosch, 2007. / Aims: The goal of this study was to identify arterial variations by cadaveric dissection, in the forehead, in order to validate the practicality and implementation of planned forehead flaps and to increase the safety of forehead flaps in plastic and reconstructive surgery. Hypothesis tested: Unique frontal forehead flaps can be safely based on anatomical dissection and on the presence of the central vein and the anastomosing branches of the frontal ramifications of the angular artery (AA). Materials & methods: The study had two strategic components: an anatomical cadaveric study and a clinical study, based on the newly described forehead vasculature. The anatomical study consisted of a) dissection of 30 latex infused cadavers and 20 non-latexed cadavers; b) histological assessment of forehead vasculature of 20 cadavers. The clinical applicability study consisted of a cohort of 12 plastic and reconstructive surgery cases, undergoing nasal rhinoplasty, based on the cadaveric study and anatomical vasculature. The research was conducted within an ethical protocol and all patients gave informed consent. The follow-up period is 2 years. Results: In the cadaveric dissection, the following vessels, relevant to forehead flaps and nasal reconstruction, were consistently identified: DNA, FBSTA, STrA, TFA, AA, CA, CV, PCA, SOA and OV. Side branch analysis of STrA (N = 43) showed: MCB (60%), LCB (23%), SPA (26%), OB (19%), single VB (47%), medial and lateral VB (53%). Side branches of the supra-orbital artery (SOA) were: LRB (91%), OB (91%), VB (100%), MB (44%), BB (5%) and SVB (9%). Side branch profile of the angular artery (AA) was: DNA (96%), CB (67%) and PCA (47%). In 71% of cases the origin of the PCA was from the angular artery (AA). Individual artery side branches of the forehead were as follows: STrA (9), SOA (6), FBSTA (4), DNA (4), AA (3/4), CA (2) and PCA (2). Average diameter of the small arteries at point of entry ranged from 1 – 2mm (CA < 1mm, PCA < 1mm). The central vein was a constant finding in all dissections and an important landmark. Other constant veins detected included the nasofrontal, ophthalmic, angular, supra-trochlear and facial veins. Twelve prospective randomized patients met inclusion criteria for nasal flap reconstruction, based on the cadaveric vascular study. Race profile was white (6), mixed (4) and black (2). There were 8 males and 4 females. Disease demographics included cancer (6; melanoma 2, basal cell cancer 5), trauma (3), infections (1) and congenital (1). Post-operative grading was as follows: defects corrected (12/12), subjective improvement (12/12), objective improvement (12/12), partial flap necrosis (1/12) and secondary interventions (debulking or revision 2/12). Doppler assessment for pedicle vasculature showed identification of the following arteries: TFA (85%), STrA (65%), PCA (20%) and AA (25%). Doppler studies further indicated the following small side branches: TFA (49%), STrA (30%), PCA (9%), AA (12%). The central vein was identified in 9/12 (75%) by macroscopic examination. In one female with a basal cell carcinoma (BCC), modest dermal stock loss was demonstrated by the application of high frequency dermal ultrasound (Dermascan®). The results of the cadaveric anatomy study show the existence of various important subtle arterial variations in the forehead that are not described in the literature. Many arterial side branches not clearly named and others not described before, were highlighted in this anatomical study. Other observations regarding the anatomical relationships of the forehead nerves were of practical surgical value, the most important being to reduce sensory neuropraxia. The histological study endorsed the cadaver dissection observations and showed the importance of the flap vasculature at the proximal level of the pedicle. The clinical study with follow-up period of 24 months, illustrates an evolving refinement in surgical technique based on the findings of the anatomic vasculature study. A new method of planning a “2500-year-old operation” was confidently developed based on the anatomical vasculature observations detected during the cadaver study. The Doppler study suggests that crude arterial variations of the central forehead, in the region of the intended flap pedicle, can not be diagnosed and highlighted accurately pre-operatively. The macroscopic anatomy of the central vein (clinical landmark) is an accurate predictor of underlying arterial variations and may be more valuable clinically than the hand-held Doppler examination. Conclusion: Comprehensive vascular anatomical detail of the forehead was not described accurately or completely by clinical anatomists in the past and does not appear in classic text books of anatomy and morphology. This has led to one-dimensional (arterial) application of the midline forehead flap planning and eventually the introduction of the para-median forehead flap, which has become the modern “work horse” of forehead flaps for nasal reconstruction. Now that in a definitive cadaveric study of the forehead blood supply has been demonstrated, the results show that surgeons will once again be able to embrace the midline forehead flap, only this time there will be possibly no inconsistent descriptions of unnamed blood vessels or ill-defined landmarks for flap planning. New flaps and reconstructive options in or around the forehead will be hopefully planned and executed more effectively and safer based on a more comprehensive understanding of the forehead anatomy and vasculature. The subjective and objective end-point analysis of the clinical study show favourable measured outcomes in the interim follow-up period (24 months) and benefit to the patients, in the presence of a low percentage of flap loss (1/12; 8.3%). The use of pre-operative Doppler assessment helped with flap planning. In one patient, the application of high frequency ultrasound facilitated long term follow-up regarding recurrent tumour formation and enhancement of dermal consistency with anti-aging creams, vitamin A derivations and sunscreens. Recommendations: The classic anatomy text books and clinical plastic surgery works with their inconsistent descriptions of the central forehead blood supply (arterial and venous) need to be updated. The evolution of the midline forehead flap method is far from complete. The refinement of the one-stage midline forehead flap method without an island is in progress and can clinically be implemented, based on a sound anatomical dissection study.

published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

Please read the abstract in the section 00front of this document / Dissertation (MChD (Chir Max-Fac Dent))--University of Pretoria, 2006. / Maxillo-Facial and Oral Surgery / unrestricted

published_or_final_version / Dentistry / Master / Master of Dental Surgery

Objectives: To report the incidence of objective and subjective neurosensory disturbance (NSD) after orthognathic surgery in a major orthognathic centre in Hong Kong, and to investigate the risk factors that contributed to the incidence of NSD after orthognathic surgery. Materials and Methods: A retrospective cross-sectional study on NSD after orthognathic surgery in a local major orthognathic centre. Patients who had bimaxillary orthognathic surgery reviewed at post-operative 6 months, 12 months or 24 months were recruited to undergo a neurosensory test with subjective and 3 objective assessments. Possible risk factors of NSD including subjects’ age and gender, surgical procedures and surgeons’ experience were analyzed. Results: 238 patients with 476 sides each of maxillary and mandibular procedures were recruited. The incidences of subjective NSD after maxillary procedures were 16.2%, 13% and 9.8% at post-operative 6 months, 12 months and 24 months, respectively; the incidences of subjective NSD after mandibular procedures were 35.4%, 36.6% and 34.6% at post-operative 6 months, 12 months and 24 months, respectively. Objective neurosensory tests showed general reduced sensitivity in subjects with subjective NSD. Increased age was found to be a significant risk factor of NSD after orthognathic surgery at short term (at 6 months and 12 months) but not at 24 months. SSO has a significantly higher risk of NSD when compared to VSSO. SSO in combination with anterior mandibular surgery has a higher risk of NSD when compared to VSSO in combination with anterior mandibular surgery or anterior mandibular surgery alone. Gender of patients a nd surgeons’ experience were not found to be risk factors of NSD after orthognathic surgery. Conclusion: The incidence of NSD after maxillary and mandibular orthognathic procedures at post-operative 6 months, 12 months and 24 months was reported. Increased age was identified as a risk factor of short term post-operative NSD but not in long term (24 months or more). Specific mandibular procedures were related to higher incidence of NSD after orthognathic surgery. / published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-29T18:26:25Z No. of bitstreams: 1 VanessaPinto_dissert.pdf: 1025499 bytes, checksum: 00604f97506498ad8f934d2a41cc1adb (MD5) / Made available in DSpace on 2018-10-29T18:26:25Z (GMT). No. of bitstreams: 1 VanessaPinto_dissert.pdf: 1025499 bytes, checksum: 00604f97506498ad8f934d2a41cc1adb (MD5) Previous issue date: 2018-02-19 / Orthognathic surgery is the treatment of choice for the correction of severe dentofacial deformities. It is based on the surgical manipulation of the bones of the face in order to correct anatomical relations, malocclusions and treatment of Sleep Apnea and Hypopnea Syndrome - OSAHS. Objective: The objective of this study was to study the profile of orthognathic surgery of patients who were surgically treated in the otorhinolaryngology department and to analyze whether there was statistical significance by means of logistic regression between the patients' age and the orthognathic surgery profile. Methodology: The present study was based on an observational study with a longitudinal prospective model, with an evaluation of the charts of patients submitted to orthognathic surgeries with statistical and descriptive procedures, from 2002 to 2016. The number of procedures, the individual’s characteristics, characteristics of individuals, Type of malocclusion and type of surgery performed for the treatment of dentofacial deformity and / or Sleep Apnea and Obstructive Hypopnea Syndrome - OSAHS. The patients were divided into 7 groups: Maxilla (MX), Mandible (MD), Maxilla and Mandible (MX/MD); (TM), Maxilla-Mandible-Ment (MX/MD/MT); Mandible (MD/MT); (MT); Maxilla-Ment (MX/MT). The sample consisted initially of 152 patients treated in the service subdivided into two male and female groups. Both physical and electronic medical charts were evaluated and compared with data previously collected in a previous sample. Results: The present study showed that the number of orthognathic surgical treatments for the correction of deformities was significant between 2002 and 2016, and the highest incidence of surgeries occurred in the Maxilla (MX) groups, with 53.2 % of the cases, Jaw (MD), with 17.7 % of the cases and Jaw and Jaw (MX/MD), with 17.0 % of the cases, as shown qualitatively and quantitatively in table 1 and figures 3 and 4. Surgeries of maxillary advancement (MX) exclusively correspond to the largest number of the sample, representing seventy-three (74) patients, as shown in figure 4. In addition, there was a higher incidence of female surgeries with 51.0 % of the cases. In addition, there was no influence of the continuous predictor "age" and "sex" on the predictor response "orthognathic surgery", since the critical level of significance was p> 0.05. Conclusion: It was concluded that there was an increase in cases of orthognathic surgery in the last years, and with homogeneous samples between the male and female genders, and the advances in maxillary surgery were according to the greater number of surgical treatments. / A cirurgia ortognática é o tratamento de escolha para a correção de deformidades dentoesqueletais severas. Baseia-se na manipulação cirúrgica dos ossos da face com objetivo de corrigir relações anatômicas, maloclusões e tratamento da Síndrome da Apneia e Hipopnéia do Sono SAHOS. Objetivo: O presente trabalho teve como objetivo estudar o perfil de cirurgia ortognática dos pacientes que foram tratados cirurgicamente no departamento de Otorrinolaringologia e serviço de cabeça e pescoço de um hospital de ensino e analisar se houve significância estatística por meio de regressão logística entre a idade dos pacientes e o perfil de cirurgia ortognática. Metodologia: O presente trabalho baseou-se em estudo observacional com modelo prospectivo longitudinal, com avaliação dos prontuários dos pacientes submetidos a cirurgias ortognáticas com procedimentos estatísticos e descritivos, no período de 2002 a 2016. Identificou-se o número de procedimentos, características dos indivíduos, tipo de maloclusão e o tipo de cirurgia realizada para o tratamento da deformidade dentofacial e/ou Síndrome da Apneia e Hipopneia Obstrutiva do Sono - SAHOS. Os pacientes foram separados em 7 grupos: maxila (MX), mandíbula (MD), maxila e mandíbula (MX/MD); mento (MT), maxila-mandíbula-mento (MX/MD/MT); mandíbula-mento (MD/MT); mento (MT); maxila-mento (MX/MT). A amostra constituiu inicialmente com 152 pacientes tratados no serviço subdivido em dois grupos masculino e feminino. Foram avaliados tanto os prontuários físicos como os prontuários eletrônicos e comparados com dados já colhidos em amostra anterior. Resultados: O presente trabalho mostrou que o número de tratamentos cirúrgicos ortognáticos para a correção das deformidades foi significativo entre 2002 e 2016, sendo que a maior incidência de cirurgias ocorreu nos grupos Maxila (MX), com 53.2 % dos casos, Mandíbula (MD), com 17,7 % dos casos e Maxila e Mandíbula (MX/MD), com 17.0 % dos casos, conforme apresentado de maneira qualitativa e quantitativa na Tabela 1 e Figuras 3 e 4. As cirurgias de avanço de maxila (MX) exclusivamente correspondem ao maior número da amostra, congregando setenta e três (74) pacientes, como mostrado na Figura 4. Além disso, houve maior incidência de cirurgias no sexo feminino com 51,0 % dos casos. Além disso, não houve influência do preditor contínuo “idade” e “sexo” no preditor resposta “cirurgia ortognática”, haja vista que o nível crítico de significância foi p>0,05. Conclusão: Concluiu-se que houve aumento dos casos de cirurgia ortognática nos últimos anos, e com amostras homogêneas entre os gêneros masculino e feminino, sendo que os avanços de cirurgia maxilar corresponderam ao maior número dos tratamentos cirúrgicos.

Orientador: Fausto Viterbo de Oliveira Neto / Banca: Aristides Augusto Palhares Neto / Banca: Jayme Adriano Farina Junior / Resumo: Defeitos ósseos decorrentes de traumas, ressecções de tumores ou mesmo malformações congênitas, são encontrados com freqüência na prática médica. O tratamento destas deformidades é feito mediante reconstruções cirúrgicas, principalmente na cirurgia plástica, proporcionando aos pacientes melhor qualidade de vida. Os defeitos ósseos são corrigidos preferencialmente com enxertos ósseos autológos por não causarem rejeição, mas estes apresentam como desvantagens a morbidade das áreas doadoras e a grande porcentagem de absorção dos enxertos, com diminuição ou perda do resultado final. Outros métodos de reconstrução, como o uso de materiais aloplásticos, são utilizados mas, muitas vezes, evoluem com rejeição e extrusão ou infecção, e necessitam ser retirados. Retalhos livres, compostos de osso com músculo ou derme e subcutâneo, em casos graves, representam a melhor opção. Entretanto, este método requer preparo específico da equipe cirúrgica, maior tempo de cirurgia e, muitas vezes, apresenta trombose vascular e perda do retalho. Avaliar a viabilidade e a formação óssea em retalho gáleoperiostal preenchido com pó de osso em calota craniana de coelhos. Foram estudados 40 coelhos divididos em dois grupos, o primeiro com retalho gáleo-periostal e o segundo com o mesmo retalho, porém preenchido com pó de osso. Os resultados demonstraram neoformação óssea em ambos, mas com diferenças na estrutura e conformação óssea. O retalho gáleo-periosteal preenchido com pó de osso em calota craniana de coelhos é viável. A formação óssea ocorreu em ambos os grupos, preenchido ou não com pó de osso. A maturidade do tecido ósseo foi maior nos retalhos preenchidos com pó de osso / Abstract: Osseus defects from traumas, tumor ressections or congenital malformations are usual in medical practice. The treatment of these deformities has been made with reconstructive surgeries, specially in plastic surgery, to give the patients better quality of life. The osseus defects are usually corrected with autologous bone grafts. These grafts are used because they do not cause rejection. However, they have disadvantages like the donnor site morbidity, the high number of absorption of these grafts and the final result partial or total lost. Other reconstruction methods like alloplastic materials are used, but they have high percentage of rejection and extrusion or even infection of these materials, which need to be taken off. Flaps of bone and muscle or dermis and subcutaneous are considered the best choice in difficult cases. However, this method needs specific training of the medical group, longer surgeries and, sometimes, presents the flap necrosis after vascular thrombosis. To study the viability and bone neoformation in a vascularized galea and periosteum flap filled with bone fragments. Fourty rabbits were studied, and divided into two groups. One had a simple galea and periosteum flap done and the other had the same flap done but filled with bone fragments of the calvaria. The results demonstrated bone formation in both groups, but with differences in the bone form and structure. The galea-periosteum flap filled with bone dust at rabbit's calvaria is viable. The bone formation happened in both groups, with or without bone dust. Bone maturity was higher in the flaps filled with bone dust / Mestre

Made available in DSpace on 2014-06-11T19:22:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-12-19Bitstream added on 2014-06-13T19:49:04Z : No. of bitstreams: 1 brock_rs_me_botfm.pdf: 602525 bytes, checksum: bd2115da27f5dda49225e5afda53918e (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Defeitos ósseos decorrentes de traumas, ressecções de tumores ou mesmo malformações congênitas, são encontrados com freqüência na prática médica. O tratamento destas deformidades é feito mediante reconstruções cirúrgicas, principalmente na cirurgia plástica, proporcionando aos pacientes melhor qualidade de vida. Os defeitos ósseos são corrigidos preferencialmente com enxertos ósseos autológos por não causarem rejeição, mas estes apresentam como desvantagens a morbidade das áreas doadoras e a grande porcentagem de absorção dos enxertos, com diminuição ou perda do resultado final. Outros métodos de reconstrução, como o uso de materiais aloplásticos, são utilizados mas, muitas vezes, evoluem com rejeição e extrusão ou infecção, e necessitam ser retirados. Retalhos livres, compostos de osso com músculo ou derme e subcutâneo, em casos graves, representam a melhor opção. Entretanto, este método requer preparo específico da equipe cirúrgica, maior tempo de cirurgia e, muitas vezes, apresenta trombose vascular e perda do retalho. Avaliar a viabilidade e a formação óssea em retalho gáleoperiostal preenchido com pó de osso em calota craniana de coelhos. Foram estudados 40 coelhos divididos em dois grupos, o primeiro com retalho gáleo-periostal e o segundo com o mesmo retalho, porém preenchido com pó de osso. Os resultados demonstraram neoformação óssea em ambos, mas com diferenças na estrutura e conformação óssea. O retalho gáleo-periosteal preenchido com pó de osso em calota craniana de coelhos é viável. A formação óssea ocorreu em ambos os grupos, preenchido ou não com pó de osso. A maturidade do tecido ósseo foi maior nos retalhos preenchidos com pó de osso / Osseus defects from traumas, tumor ressections or congenital malformations are usual in medical practice. The treatment of these deformities has been made with reconstructive surgeries, specially in plastic surgery, to give the patients better quality of life. The osseus defects are usually corrected with autologous bone grafts. These grafts are used because they do not cause rejection. However, they have disadvantages like the donnor site morbidity, the high number of absorption of these grafts and the final result partial or total lost. Other reconstruction methods like alloplastic materials are used, but they have high percentage of rejection and extrusion or even infection of these materials, which need to be taken off. Flaps of bone and muscle or dermis and subcutaneous are considered the best choice in difficult cases. However, this method needs specific training of the medical group, longer surgeries and, sometimes, presents the flap necrosis after vascular thrombosis. To study the viability and bone neoformation in a vascularized galea and periosteum flap filled with bone fragments. Fourty rabbits were studied, and divided into two groups. One had a simple galea and periosteum flap done and the other had the same flap done but filled with bone fragments of the calvaria. The results demonstrated bone formation in both groups, but with differences in the bone form and structure. The galea-periosteum flap filled with bone dust at rabbit’s calvaria is viable. The bone formation happened in both groups, with or without bone dust. Bone maturity was higher in the flaps filled with bone dust

Background and Objectives: Vascular variations appear as morphologically distinct patterns of blood diverging from the most commonly observed vessel patterns. The facial artery is considered to be the main vessel for supplying blood to the anterior part of the face. An anatomical understanding of the facial artery, its course, its topography, and its branches is important in medical and dental practice (especially in neck and face surgery), and is also essential for radiologists to be able to interpret vascular imaging in the face following angiography of the region. A profound knowledge of the arteries in the region will aid in minimizing the risks to the patient. Materials and Methods: In our publication a narrative literature review and a case report are presented. Results: A rare case of a facial artery pattern has been described anatomically for the first time with respect to its course and branching. This variation was found on the left side of a 60-year-old male corpse during anatomical dissection. The anterior branch of the facial artery arched in the direction of the labial angle, and there divided into the inferior and superior labial arteries. At the same time, the posterior branch coursed vertically and superficially to the masseter muscle. It here gave off the premasseteric branch, and continued towards the nose, where it ran below the levator labii superioris and the levator labii superioris alaeque nasi muscles and terminated at the dorsum nasi. Conclusions: Our review of the literature and the case report add to knowledge on the facial artery with respect to its topographical anatomy and its branching and termination patterns, as well as the areas of supply. An exact knowledge of individual facial artery anatomy may play an important role in the planning of flaps or tumor excisions due to the differing vascularization and can also help to prevent artery injuries during aesthetic procedures such as filler and botulinum toxin injections.