RESUMEN
Oral and maxillofacial surgeons who perform orthognathic surgery face major changes in their practices, and these challenges will increase in the near future, because the extraordinary advances in technology applied to our profession are not only amazing but are becoming the standard of care as they promote improved outcomes for our patients. Orthognathic surgery is one of the favorite areas of practicing within the scope of practice of an oral and maxillofacial surgeon. Our own practice in orthognathic surgery has completed over 1,000 surgeries of this type. Success is directly related to the consistency and capability of the surgical-orthodontic team to achieve predictable, stable results, and our hypothesis is that a successful result is directly related to the way we take our records and perform diagnosis and treatment planning following basic general principles. Now that we have the opportunity to plan and treat 3-dimensional (3D) problems with 3D technology, we should enter into this new era with appropriate standards to ensure better results, instead of simply enjoying these new tools, which will clearly show not only us but everyone what we do when we perform orthognathic surgery. Appropriate principles need to be taken into account when implementing this new technology. In other words, new technology is welcome, but we do not have to reinvent the wheel. The purpose of this article is to review the current protocol that we use for orthognathic surgery and compare it with published protocols that incorporate new 3D and virtual technology. This report also describes our approach to this new technology.
Asunto(s)
Cefalometría/métodos , Protocolos Clínicos , Imagenología Tridimensional/métodos , Anomalías Maxilofaciales/diagnóstico por imagen , Modelos Anatómicos , Procedimientos Quirúrgicos Ortognáticos/métodos , Cirugía Asistida por Computador/métodos , Relación Céntrica , Cefalometría/instrumentación , Tomografía Computarizada de Haz Cónico , Articuladores Dentales , Humanos , Registro de la Relación Maxilomandibular , Anomalías Maxilofaciales/cirugía , Procedimientos Quirúrgicos Ortognáticos/normas , Planificación de Atención al Paciente , Nivel de Atención , Articulación Temporomandibular/diagnóstico por imagen , Interfaz Usuario-ComputadorRESUMEN
INTRODUCTION: Osteochondral rib grafts are most commonly used for mandibular condylar replacements. However, when used in growing patients, unpredictable growth of the constructed condyle/ramus is a common complication. Clinically two types of overgrowth, linear or exuberant, have been described. PURPOSE: In order to investigate growth disorders associated with osteochondral rib grafts in children, overgrown grafts were examined histologically. PATIENTS AND METHODS: The material consisted of seven samples (six patients) of osteochondral rib grafts, that had been removed due to overgrowth. RESULTS: Examination revealed that the clinical type of overgrowth was not related to any specific microarchitecture, which in itself, showed considerable variation. In three of the samples, a typical endochondral ossification zone was seen and in two others, signs of metaplasia, i.e. a gradual transformation of the cartilage cells into osteocytes, were noted. CONCLUSIONS: The study reveals that the clinical type of overgrowth, linear or exuberant, cannot be related to any typical histological finding. Furthermore, the findings suggest that local factors, such as mandibular movements and loading of the reconstructed condyle may have an effect on the structure of the osteochondral rib graft, and eventually on its growth.