Ahmed Medra

Management of unilateral temporomandibular ankylosis associated with facial asymmetry

Longstanding unilateral temporomandibular joint ankylosis, which starts during the active growth period in early childhood, results in facial asymmetry. Three problems are encountered: the ankylosed joint; the asymmetric face and, occasionally, upper airway obstruction. Simultaneous surgery was performed on 27 patients to release the joint ankylosis and to correct the facial deformity. Bimaxillary surgery was done for adult patients with occlusal canting, and mandibular surgery alone for adult patients without occlusal canting and for young children. Very satisfactory results were obtained during a follow-up period ranging from 2 to 6 years, regarding the restoration of joint function, improvement in aesthetic appearance and relief of respiratory obstruction.

Bird face deformity secondary to bilateral temporomandibular joint ankylosis

This paper describes our experience in the treatment of 10 patients with bilateral longstanding temporomandibular joint ankylosis occurring during the active growth period and causing severe bird face deformity. The clinical manifestations were: (1) upper airway obstruction in the form of either severe night snoring or obstructive sleep apnoea; (2) inability to open the mouth and (3) severely convex facial profile. Surgery consists of simultaneous release of the ankylosed joints, advancement of the mandible and insertion of posterior mandibular costochondral graft struts. A Le Fort I osteotomy was performed concomitantly in marked deformities to help in the restoration of the posterior facial height. Dramatic improvement in the airway, facial profile and jaw function were obtained by this programme.

Vascular malformations of the jaw bones: Report on nine patients

Nine patients with vascular malformations of the jaw bones, 4 affecting the mandible, 2 affecting both jaws and 3 affecting the maxilla only. Four lesions were of the high flow type and 5 were of low flow type. Our experience in the management of these lesions is presented together with the possible complications.

Improvement in the airway after mandibular distraction osteogenesis surgery in children with temporomandibular joint ankylosis and mandibular hypoplasia

Temporomandibular joint (TMJ) ankylosis accompanied by mandibular micrognathia can severely obstruct a patients upper airway. The obstructive sleep apnea and hypopnea syndrome (OSAHS) resulting from TMJ ankylosis and accompanied by mandibular micrognathia, can severely influence the patients life.

The split rib bundle graft in mandibular reconstruction

This article describes a modified technique for the use of free non-vascularized split ribs (bound together in the form of a tight bundle), to reconstruct different types of mandibular defects. Experience gained over the last 4 years in treating 38 patients with different pathological lesions is presented. The procedure, carried out simultaneously with bone resection proved to be highly effective in providing mesio-distal spanning of the defect, adequate mandibular height as well as bucco-lingual thickness. This technique utilizes the different theories of osteogenesis: (a) from the periosteal cells, (b) from the transplanted living osteocytes and from (c) stimulating host mesenchymal cells to form new bone by bone induction. The surgical technique, results and conclusions are presented in this report.

Cyanoacrylate: A Handy Tissue Glue in Maxillofacial Surgery: Our Experience in Alexandria, Egypt

Cyanoacrylate tissue glue has been widely used in different surgical applications. It is easy to apply and can save considerable time and effort. Reports including series of oral and maxillofacial cases are yet to be well documented. We report our experience using cyanoacrylate tissue glue in the head and neck region in 165 patients. We have used it for indications including orbital floor graft fixation, cleft lip and palate repair, oral dressing, skin graft fixation, nasal splinting, immobilisation of traumatised teeth, management of chyle leak during neck dissection and wound closure. We have not had any complications from using cyanoacrylate. It is found to be safe and effective in different indications it is used for without undue hazards. The role of cyanoacrylate in oral and maxillofacial surgery needs further research.

Simultaneous and Differential Fronto-orbital and Midface Distraction Osteogenesis for Syndromic Craniosynostosis Using Rigid External Distractor II

Abstract In syndromic craniosynostosis, the relation between the supraorbital area and the frontal bone is not good, and it is not possible to reform this area with 1-block advancement. To avoid this problem, the frontal bone is separated from the fronto-orbital bandeau, each is reshaped and remodeled separately, and then both are reattached. The retrusion of the midface, especially in syndromic craniosynostosis, is usually greater than that of cranial bones, so the technique usually separating the midface from the cranium is Le Fort III osteotomy, which allows differential distraction of each part. In this procedure, the cranial and midfacial bones are advanced simultaneously and differentially, both to the planned extent, in a single-stage operation, using rigid external distractor II, correcting exorbitism, respiratory embarrassment, and cranial structures and avoiding eye complications in the future. This procedure was used, with a follow-up, in 10 patients with syndromic craniosynostosis from 2 to 5 years.