RESUMEN
PURPOSE: Traditionally, patients with hemifacial microsomia (HFM) and significant ipsilateral hypoplasia or absence of the condyle and ramus undergo reconstruction on the ipsilateral side with autogenous tissues such as rib grafts, often with compromised results. This study analyzed the surgical treatment outcomes of nongrowing patients with HFM and reconstruction of the ipsilateral temporomandibular joint (TMJ) and advancement of the mandible with a patient-fitted TMJ total joint prosthesis (TMJ Concepts, Inc, Ventura, CA), a contralateral mandibular ramus sagittal split osteotomy, and maxillary osteotomies performed in 1 operation. PATIENTS AND METHODS: All nongrowing patients with HFM treated with this surgical protocol from 1997 to 2010 in a single private practice were included in this study and subjectively evaluated before surgery and at the longest postsurgical follow-up for pain, diet, jaw function, and disability using a visual numerical scale (0 to 10). Surgical changes and postsurgical stability were analyzed using lateral cephalograms before surgery, immediately after surgery, and at the longest follow-up. RESULTS: Six patients (4 female and 2 male) were included in this study, with an average age at surgery of 23.5 years (range, 14 to 39 yrs) and an average follow-up of 6 years 3 months (range, 1 yr to 11 yrs 4 mo). For all subjective parameters, all patients improved or remained the same. Incisal opening improved or remained the same in 4 of the 6 patients, with 2 patients having decreased opening. Excursive movements decreased. The maxillomandibular complex was surgically rotated counterclockwise, advanced, and transversely leveled, with the anterior maxillary reference points (anterior nasal spine, point A) undergoing relative small movements. The mandibular incisor tips (lower incisor tips) advanced a mean of 8.9 mm, point B 14.8 mm, pogonion 18.6 mm, menton 17.5 mm and the occlusal plane angle decreased -12.3°. Postsurgical long-term stability indicated that the anterior maxillary references changed a significant amount, whereas all horizontal and vertical anterior mandibular measurements (lower incisor tip, point B, pogonion, menton) and the occlusal plane showed no significant changes. CONCLUSIONS: The TMJ Concepts total joint prosthesis in conjunction with orthognathic surgery for TMJ and jaw reconstruction in nongrowing patients with HFM is highly predictable for skeletal and occlusal stability, comfort, TMJ function, and improved facial balance.
Asunto(s)
Asimetría Facial/cirugía , Prótesis Articulares , Procedimientos Quirúrgicos Ortognáticos/métodos , Procedimientos de Cirugía Plástica/métodos , Articulación Temporomandibular/cirugía , Adolescente , Adulto , Cefalometría/métodos , Mentón/patología , Oclusión Dental , Dieta , Femenino , Estudios de Seguimiento , Humanos , Incisivo/patología , Masculino , Mandíbula/patología , Avance Mandibular/métodos , Maxilar/patología , Osteotomía Maxilar/métodos , Hueso Nasal/patología , Osteotomía Sagital de Rama Mandibular/métodos , Planificación de Atención al Paciente , Satisfacción del Paciente , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Postsurgical patient management is a critical factor for high-quality patient treatment and predictable outcomes in orthognathic and temporomandibular joint (TMJ) surgery. Lack of understanding of proper patient management on the part of the surgeon and orthodontist can result in compromised or even disastrous results. Surgeons and orthodontists must have the knowledge and ability to implement postsurgical management protocols and strategies to provide the best care and outcomes possible for their orthognathic and TMJ surgery patients. Information is presented here in reference to postsurgical orthodontics, healing process, dietary considerations, activities, and potential complications to aid the clinician in understanding the postsurgical processes that patients will encounter.
Asunto(s)
Procedimientos Quirúrgicos Ortognáticos/métodos , Articulación Temporomandibular/cirugía , Actividades Cotidianas , Bruxismo/prevención & control , Oclusión Dental , Dieta , Epistaxis/etiología , Humanos , Hipoestesia/etiología , Ferulas Oclusales , Diseño de Aparato Ortodóncico , Retenedores Ortodóncicos , Ortodoncia Correctiva/instrumentación , Osteogénesis/fisiología , Dolor Postoperatorio/etiología , Cuidados Posoperatorios , Complicaciones Posoperatorias , Hemorragia Posoperatoria/etiología , Rango del Movimiento Articular/fisiología , Férulas (Fijadores) , Infección de la Herida Quirúrgica/etiología , Trastornos de la Articulación Temporomandibular/etiología , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
A distalização de molares superiores consiste numa excelente estratégia de tratamento para a correção das más oclusões de Classe II de natureza dentoalveolar ou para a compensação das más oclusões de Classe II de natureza esquelética moderada, reduzindo o número de indicações de extrações de pré-molares superiores. Esta abordagem vem sendo cada vez mais utilizada por meio de dispositivos que não dependem da colaboração do paciente, com o intuito de tornar os tratamentos mais previsíveis. Os dispositivos intra-bucais convencionais de ancoragem não são capazes de oferecer total eficiência, resultando em movimentações dentárias indesejadas, que podem comprometer o resultado final ou aumentar o tempo total de tratamento. Com a utilização dos microparafusos como unidade de ancoragem, as distalizações são executadas eficientemente, sem efeitos colaterias indesejados. Este artigo tem como objetivo apresentar uma forma de tratamento da Classe II com distalização de molares, utilizando um cursor associado à ancoragem esquelética por meio de microparafusos ortodônticos.