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ABSTRACT: Distraction osteogenesis (DO) has been popular to improve hypoplastic mandible in patients with hemifacial microsomia in craniofacial surgery. However, changes in width of the lower face after DO still lack in literatures. The aim of this pilot study was to evaluate cephalometric changes in width of the lower face at different time points after DO and to give an insight into the influence on facial contour. A total of 10 patients (8 males and 2 females) with hemifacial microsomia received DO of the mandibular body measured by posteroanterior cephalograms. Five landmarks (crista galli, latero-orbitale, gonion of the unaffected side, incisor point superior of the unaffected maxilla, incisor point inferior of the unaffected side of the mandible) were chosen for cephalometric analysis. Six distances from the soft tissue contour perpendicularly to the vertical reference line (through crista galli) were calculated through the incisor point superior of the unaffected maxilla, gonion of the unaffected side, incisor point inferior of the unaffected side of the mandible. Measurements were taken preoperatively and postoperatively on the day distraction started (time 1), at the end of distraction (time 2), and at the end of the consolidation period (time 3). Calculations for statistical significance were done for all patients. Mean differences between 3 periods were measured by repeated-measures analysis with significance determined at the 0.05 level of confidence. The results suggested that the values of 6 distances at times 2 and 3 had no significant differences when compared with the values at time 1 (P>0.05). In conclusion, DO of the unilateral mandibular body in patients with hemifacial microsomia should not be beneficial to improve the width of the lower face at a short-term follow-up.
The Journal of craniofacial surgery 01/2012; 23(1):94-7. · 0.81 Impact Factor
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ABSTRACT: Reduction malarplasty with L-shaped osteotomy has been widely applied to correct malar prominence because of its simple manipulation, satisfactory outcome, and few complications in east Asians. Secondary surgery for the removal of titanium miniplates or microplates and screws is often needed because of the drawbacks of implants. To overcome the disadvantage, the authors applied absorbable plates and screws instead of titanium fixation system and evaluated the feasibility of them. A total of 47 women (mean age, 26.8 y) diagnosed with malar prominence were randomly selected and received L-shaped osteotomy for malar reduction from January 2008 to December 2009. Of these, 22 patients (group A) received absorbable plates and screws (Fixsorb-MX, Takiron, Japan) for fixation and 25 patients received titanium fixation system as control (group B). The outcomes were evaluated by photographs and x-ray films. The distance of the anterior protrusive point of the bilateral zygoma (Zv-Zv), the distance from the paries anterior of acoustic duct (P) to the anterior protrusive point of zygoma (P-Zv), and the angle formed by the nasion-Zv line and the P-Zv line (∠NZP) were analyzed through posteroanterior and lateral cephalograms preoperatively, 10 days postoperatively, and at 6 to 12 months of follow-up, respectively. In group A, 20 patients (90.9%) were satisfied with the outcomes compared with 92.0% in group B. No zygomatic nonunion and other complications occurred after surgery in both groups. In group A, the values of Zv-Zv and P-Zv were 88.4±1.6 and 68.6±6.8 mm at 10 days after surgery, which increased to 90.6±1.5 and 70.7±3.0 mm at 6 to 12 months of follow-up. The value of ∠NZP was 105.0±4.3 degrees at 10 days after surgery and 103.2±3.6 degrees at 6 to 12 months after surgery. In group B, the values of distance and degree maintained almost the same at different time points after surgery. The results had no significant difference between groups A and B (P>0.05). The findings of the study suggested that the application of absorbable plate system in reduction malarplasty with L-shaped osteotomy is feasible. The absorbable fixation system would have a wider application in craniofacial surgery.
The Journal of craniofacial surgery 03/2011; 22(2):546-50. · 0.81 Impact Factor
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ABSTRACT: Mandibular distraction is a well-established method of correcting facial asymmetry in hemifacial microsomia. However, asymmetry in lower facial width remains after distraction because of its inability to increase bone thickness. Therefore, the authors used mandibular outer cortex bone grafting to augment the lower face following distraction to restore facial symmetry.
From January of 1997 to December of 2007, 21 patients with hemifacial microsomia underwent unilateral mandibular distraction followed by mandibular augmentation using mandibular outer cortex bone graft harvested from the normal side. Age at surgery ranged from 7 to 27 years. Facial symmetry was evaluated based on medical photography and radiography with a minimum 6-month follow-up.
Mandibular height and length were expanded successfully with distraction, resulting in improvements in chin position and oral commissure level. Lower facial width was increased on the affected side and reduced on the normal side after bone grafting. Thus, three-dimensional facial symmetry was significantly improved in all patients. Long-term follow-up showed no evidence of relapse. The majority of the patients were satisfied with the reconstructive outcome.
Mandibular augmentation with bone grafts harvested from the contralateral outer cortex effectively addressed the asymmetry in lower facial width that was uncorrected by distraction alone, achieving three-dimensional restoration of facial symmetry in hemifacial microsomia.
Plastic and reconstructive surgery 01/2011; 127(5):1997-2004. · 2.74 Impact Factor
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ABSTRACT: Curved osteotomy of a prominent mandibular angle is widely used in narrowing the width of the lower face, but its influence on occlusal force has not been evaluated.
The maximum occlusal forces of five different teeth areas in 20 consecution patients with an average age of 26.5 years were studied. The examinations were performed both before the operation and 6 months afterward.
The values of maximum occlusal force had reached the preoperative levels or slightly above for the incisor teeth, bilateral premolar teeth, and bilateral molar teeth 6 months after operation. There were no significant differences between the levels before the operation and 6 months afterward (P > 0.05).
According to the study findings, curved osteotomy of the prominent mandibular angle had no long-term harmful effects on occlusal force.
Aesthetic Plastic Surgery 12/2009; 34(3):330-4. · 1.41 Impact Factor
