Alberto Costas López

Primary mandibular reconstruction with bridging plates

Summary 25 cases in which the mandible was resected and reconstructed using a reconstruction plate (AO titanium reconstruction system and Leibinger titanium reconstruction system) are presented. 16 patients suffered from oral carcinoma, 7 presented with odontogenic tumours and 2 had chronic osteomyelitis of the mandible. The mean age was 54.2 years, the male to female ratio was 2.6:1. 3 patients had a reconstruction plate for mandibular resection without continuity defect (marginal resection), in all the other patients the reconstruction plate bridged a mandibular resection with a continuity defect: 13 were located in the body, body-angle or ascending ramus with preservation of the mandibular condyle; 4 hemimandibulectomies with disarticulation of the TMJ; and 5 involved the anterior arch, crossing the midline. 12 patients received radiotherapy (3 pre-operatively). Only 3 patients with significant local side effects needed the treatment to be stopped for a period of time. There was no perioperative mortality. Only one plate was removed. Although minor complications were noted in 11 patients, the general improvement in the functional and cosmetic balance of the patients when compared with patients in whom no plate was used, justifies the use of this reconstruction system, in our opinion.

Transverse Maxillary Distraction in Patients With Periodontal Pathology or Insufficient Tooth Anchorage Using Custom-Made Devices

PURPOSE We present our experience using modified Hyrax devices for treating transverse deficiencies of the maxilla in adult patients with periodontal pathology or insufficient tooth anchorage. The surgical technique, clinical indications, and results are discussed. MATERIALS AND METHODS Eight adult patients (6 females, 2 males) requiring maxillary expansion were studied prospectively between July 2002 and July 2007. All the patients had periodontal pathology or insufficient tooth anchorage preventing the use of conventional Hyrax devices. Patients underwent surgically assisted rapid maxillary expansion with the use of custom-made modified Hyrax devices (bone-borne or tooth-bone-borne devices). Patients received preoperatively (T1), at the end of distraction (T2), at removal of the expansion device (T3), and 12 months after surgery (T4) lateral and posterior anterior cephalograms and study models to measure the width of the anterior and posterior dental arches with a digital sliding calliper. RESULTS Mean age was 28.5 years (range, 18-45 years). A significant widening of the anterior (6.3 +/- 1.6 mm) and posterior (7.1 +/- 1.2 mm) dental arches was demonstrated. No significant differences were found when comparing T3 with T4 measures. No significant complications were found. CONCLUSION The results indicated that maxillary expansion with custom-made devices in adults was an easy, affordable, predictable and stable technique without significant complications in patients who suffer periodontal pathology or patients without enough dental support.

Complications of temporomandibular joint arthroscopy using two-portal coblation technologies: A prospective study of 475 procedures

PURPOSE To study the complications of temporomandibular joint (TMJ) arthroscopic procedures using two-portal coblation technologies. MATERIALS AND METHODS The 397 consecutive patients (475 joints) who underwent arthroscopic surgery were prospectively analyzed. RESULTS Complications were observed in 39 (8.21%) procedures. Complications recognized during or immediately after surgery were observed in 25 cases (5.26%). Vascular injury in the points of trocar insertion was observed in seven cases. Lesions of the fibrocartilage layer of the joint secondary to introduction of instruments were observed in 12 cases. Bleeding within the superior joint space was observed in 21 cases. Extravasation of irrigation fluid appeared in five patients, affecting the oropharyngeal space in one case. In 20 patients, more than one complication at the time of surgery occurred. Delay postoperative complications were noted in 14 patients. Blood clots in the external auditory canal were found in eight cases and lacerations in two cases. One patient experienced partial hearing loss, and two patients experienced vertigo. Temporary hypoesthesia of the auriculotemporal nerve was seen in two patients. Temporary damage to the V cranial nerve was observed in four patients. Temporary paralysis of the zygomatic branch of the facial nerve was seen in one patient. CONCLUSION TMJ arthroscopy using coblation technologies is a safe surgical procedure when performed by experienced surgeons.

Subnasal modified Le Fort I osteotomy: Indications and results

PURPOSE To study the possible morphologic changes in the nose after subnasal modified Le Fort I maxillary osteotomy to correct class III dentofacial deformities in patients with considered normal nasal morphology. MATERIAL AND METHODS Fifteen patients (7 males, 8 females) requiring maxillary advancement to treat class III dentofacial deformities were studied prospectively between January 2004 and January 2011. All the patients had an adequate projection of the nasal tip preoperatively preventing a conventional Le Fort I osteotomy. Patients received preoperatively (T1), 6 months after surgery (T2), and 12 months after the initial surgical procedure (T3) lateral cephalograms, CT-3D studies and clinical nose analysis to measure different morphologic variables including: the alar/nose base width, nasal tip protrusion and nasal bridge length using a digital sliding caliper directly on the soft-tissue surface of the face. RESULTS Mean age was 26.2 years, range 20-36 years. A significant advancement of the maxilla was noted postoperatively (mean 7.5 mm). After surgery the different anthropometric variables of the nasal region analysed had not suffered any significant variation. No significant differences were found when comparing T2 with T3 measures. No significant complications were found. CONCLUSION The results indicated that maxillary advancement using a subnasal modified Le Fort I osteotomy can prevent undesirable soft tissue changes of the nose when anterior repositioning of the maxilla is indicated in patients with preoperatively normal nasal morphology.