Segmental surgery of the jaws
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
Vertical incisions are made in the mucoperiosteum of the interdental area and these are joined up by a vestibular incision that is carried out into the buccal vestibule (Figure 71.19). After subperiosteal dissection, the whole buccal side of the chin is exposed and the flap pulled downwards with a chin retractor as described for the genioplasty. Vertical bone cuts are made in the areas designated and they are connected by a horizontal bone cut. These bone cuts are made with a tapered fissure burr and, if possible, carried just through the lingual cortex. The horizontal bone cut should be at least 5 mm away from the apices of the roots of the anterior teeth. A 4 mm osteotome may be used to finish the osteotomy. If the segment is to be brought down, a strip of bone should be removed so as to allow the segment to fit the new position. A prefabricated acrylic splint helps to position the segment correctly in the desired position.
Pierre Robin sequence
Prem Puri in Newborn Surgery, 2017
The first described functional therapy for micrognathia was the use of the orthodontic palatal plate to achieve growth stimulation of the mandible. It was not clear until today whether the growth potential of the mandible after this stimulation is sufficient to achieve the normal dimensions. However, it has been shown, based on physical examinations until age 5, that the mandible can barely regain its growth in relation to a normal population.29 A retrospective longitudinal study by cephalograms and lateral photographs of American patients with PRS and cleft of the soft palate showed that the mandible achieved only partial catch-up growth and, in adults, a smaller maxilla, mandible, and a narrow respiratory airway space persisted.30 Studies in the Finnish population showed the same result.31 An increased mandibular growth was seen during the first 2 years of life, but normal craniofacial dimensions were never achieved. At the young adult stage, even if the patient’s profile appeared less retrognathic due to masking by the overlying soft tissues or the patient’s teeth showed neutral occlusion, cephalograms revealed retrognathia and caudal–dorsal rotation of the mandible. Thus, it seems in accordance with today’s knowledge that the microgenia in PRS can be balanced only partially by growth processes. Frequently, orthodontic therapy is necessary in childhood. In severe cases, surgical advancement of the mandible combined with a genioplasty can be beneficial, as well.
Pre-Operative Assessment for Rhinoplasty
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Lip–chin relationship: The horizontal distance from the surface of the upper lip to that of lower lip is normally around 2 mm. The anterior surface of the upper and lower lips rest on the nasomental line in an aesthetic face (Figure 81.7).34 When the chin lies posterior to this line, it is described as retrognathic; when it lies anterior to this line, it is described as prognathic. A retrognathic chin can give the illusion of an overprojected nose and the reverse applies to a prognathic chin. Genioplasty or chin implant procedures are therefore often used in conjunction with rhinoplasty.35
Obstructive sleep apnea: personalizing CPAP alternative therapies to individual physiology
Published in Expert Review of Respiratory Medicine, 2022
Brandon Nokes, Jessica Cooper, Michelle Cao
Skeletal surgery includes 1) hyoid advancement 2) genioplasty/genioglossus advancement 3) maxillary expansion 4) maxillomandibular advancement 5) mandibular distraction and 6) maxillomandibular expansion. The two most common are maxillomandibular advancement (MMA) and genioglossus advancement (GGA), which are often described as tongue base surgery [91]. Predictors of success for skeletal surgery are complete concentric collapse (CCC) and lateral pharyngeal wall collapse (LPW) on DISE, or congenital dentofacial deformity on physical exam [91]. Previously, MMA was used as a salvage surgical therapy for OSA, but now has more predictable clinical outcomes through visualizing the pattern of collapse at the velum during DISE [91]. The OSA cure rate for MMA is approximately 38%, but again can be optimized through careful patient selection [92].
Condylectomy as a treatment approach to condylar hyperplasia
Published in Orthodontic Waves, 2021
Sarah Abu Arqub, Carlos Villegas, Flavio Uribe
The term low (proportional) condylectomy refers to the removal of the active portion of the condyle in cases of TMJ tumours and additionally resecting some of the bone on the affected side to match the unaffected side, thus correcting the mandibular height. When low condylectomy is used for the removal of osteochondroma, the healthy side is used as a reference to level the occlusal plane [53–55]. On the other hand, the term high condylectomy refers to the removal of the most superior aspect of the mandibular condyle (5 mm), which is considered the most active growth region of the condylar head [45]. The presence of condylar activity is a very important parameter for this therapeutic approach. It has been suggested that condylectomy stops the condylar overgrowth and eliminates the future asymmetry [10]. Contouring, osteotomies, grafts and genioplasty might be done if needed to improve facial symmetry [56,57].
Soft tissues cephalometric norms for a sample of Sudanese adults. Part I: Legan and Burstone analysis
Published in Orthodontic Waves, 2020
Marwa M. Hamid, Amal H. Abuaffan
The lower face-throat angle is essential in planning surgical correction of anteroposterior facial dysplasia. Moreover, surgical procedures to reduce chin prominence in patients with obtuse angle or class III must be avoided. However, in class III patients with short throats alternative procedures to chin reduction must be considered such as maxillary advancement, mandibular subapical set back with or without advancement genioplasty or even compromised tooth positions [9].
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