Altan Varol

The role of controlled hypotension upon transfusion requirement during maxillary downfracture in double-jaw surgery

INTRODUCTION To evaluate the role of induced hypotension during maxillary downfracture osteotomy on the requirement for blood transfusion, duration of operation and induced anaemia in bimaxillary surgery. MATERIAL AND METHODS 45 young orthognathic patients were operated under hypotensive anaesthesia between 2004 and 2006. Operations were LeFort I osteotomies (n=45), bilateral sagittal split osteotomies (BSSO) (n=42), segmental osteotomies (n=3), tongue reduction (n=1), genioplasties (n=15), digastric myotomies (n=2), and bone grafts were the supplementary procedures. Pre-postoperative haemograms, intraoperative blood loss, and duration of operations were the studied parameters. Statistical analysis was performed using SPSS 11.5 for Windows. RESULTS None of the patients received a blood transfusion. Mean blood loss was 377+/-111.2mL with the range of 180mL to the maximum of 625mL. Mean duration was 267.1+/-61.2min with minimum of 180min and maximum of 400min. Mean preop Hb level was 14+/-1.9g/dL with the range from 10.3g/dL to a maximum of 17.2g/dL. Mean postop Hb level was 11.8+/-2g/dL with a range of 8.2-16.2g/dL levels. Preop erythrocyte counts were 435.3+/-18.2 and 416.4+/-16.1 (x104/mcL) on the first postop day. CONCLUSION Transfusion in bimaxillary orthognathic surgery could be prevented by induction of hypotension during maxillary downfracture.

Extraction of a deeply impacted lower third molar by sagittal split osteotomy.

Extraction of deeply impacted wisdom molars from the lower jaw with the bone osteotomy may necessitate removal of extra bone and complicate the procedure with damage to the inferior alveolar nerve and iatrogenic fractures of the mandible. In such cases, the sagittal split osteotomy offers excellent exposure to the operative field and minimizes bone loss at the mandibular ramus. The presented case includes removal of a deeply impacted lower third molar presenting mild infection from the mid-ramus using the sagittal split of the mandible. The sagittal split osteotomy, which appears to be a reliable technique, should be the method of preference when lower molars are deeply positioned between buccal and lingual cortices.

The role of computer‐aided 3D surgery and stereolithographic modelling for vector orientation in premaxillary and trans‐sinusoidal maxillary distraction osteogenesis

Maxillary distraction osteogenesis is a challenging procedure when it is performed with internal submerged distractors due to obligation of setting accurate distraction vectors.

Actinomycosis: report of a case with a persistent extraoral sinus tract

Cervicofacial actinomycosis is a chronic suppurative and granulomatous infection that may reside for years and recur with sudden onset. It is the second most common type of actinomycosis and could be caused by trauma or infection. We report a draining actinomycotic sinus tract with extraordinary thickness that occurred owing to a long-standing chronic periapical infection of an extracted upper left second premolar 3 years before.

Complications related to surgically assisted rapid palatal expansion.

OBJECTIVE The goals of this retrospective clinical study were to identify surgically assisted rapid palatal expansion (SARPE) complications and assess their incidence, with the aim of informing surgeons and orthodontists of the risks of this widely used procedure before they recommend it to patients. STUDY DESIGN Between June 2008 and July 2010, 60 patients (23 women and 37 men) underwent SARPE according to a defined multidisciplinary protocol at the University of Marmara, Istanbul, Turkey. RESULTS Twelve patients (20%) suffered from nasal bleeding. Of these 12, 2 patients suffered late-onset bleeding beginning on postoperative day 8, and in the other 10, nasal bleeding was insignificant. Three patients reported excessive lacrimation postoperatively. Minor problems related to pain and numbness were all temporary. CONCLUSIONS SARPE procedures have traditionally been reported to be associated with low morbidity, especially in comparison with other orthognathic surgical procedures. However, many complications have been reported.

Clinical and anatomical aspects of possible mylohyoid nerve injury during genioplasties

Damage to the cutaneous branch of the mylohyoid nerve (CBMN) during genioplasties is possible but rare. The aim of this cadaveric study was to demonstrate possible mechanisms of injuring the CBMN during genioplasties. Mandibulotomy access was used to carry out sublingual and lateral cervical dissections on 10 formalinized cadavers with a mean age of 65 years. The length of the mylohyoid nerve was measured at three sections on the mandible. The posterior section of the mylohyoid nerve was 8.7+/-0.5 mm; the middle section was 14.5+/-0.9 mm and the anterior section was 15.6+/-1.2 mm in length. The submental skin island of 7 specimens had unilateral innervation by the CBMN. The bilateral innervation pattern was detected in 3 of the specimens. Damage to the sensory and the motor branches of the mylohyoid nerve can occur during genioplasties by transaction of the soft tissue pedicle attached to the mental spine and inferior border of the symphis. Surgeons should pay attention during dissection and osteotomy of the chin to avoid complications of the mylohyoid nerve and its branches.

Rigid external maxillary distraction and rhinoplasty for pyknodysostosis.

Aim: This article reports the treatment of an 33-year-old female patient with pyknodysostosis by rigid external distraction II midface distraction system. Study Design: The patient with pyknodysostosis described in this report had severe midfacial hypoplasia. Correction of this by use of routine orthognathic surgery would require osteosynthesis and bone grafting. Risk of infection and/or nonunion after such a surgical procedure was considered too great, and therefore the possibility of treatment by distraction osteogenesis of the maxilla was evaluated. The rigid external distraction II midface distraction system was used to relocate the hypoplastic maxilla at anterior-inferior projection. Conclusions: Distraction osteogenesis should be considered as the primary reconstructive method for maxillofacial deformities in patients with sclerosing bone dysplasias, since this is the second reported case treated successfully with rigid external distraction.

Posterior maxillary segmental osteotomy for restoring the mandible with dental implants: A clinical report

Posterior segmental collapse causes narrowing of interarch space and prevents adequate restoration in the posterior quadrant. Posterior maxillary segmental osteotomy (PMSO) is an alternative option that enables prosthodontic restoration with an implant-supported fixed partial denture. The following clinical report describes prosthodontic rehabilitation with fixed prostheses after a posterior maxillary segmental osteotomy for a patient with a partially edentulous mandible.

Assessment of synovial vascularization by power Doppler ultrasonography in TMJ internal derangements treated arthroscopically.

Our aim was to evaluate the effect of arthroscopic lysis and lavage of the temporomandibular joint (TMJ) on synovial microvascularisation by comparing preoperative and postoperative grades measured by power Doppler ultrasonography (US). We studied 22 patients with hypomobility, clicking, and pain in the TMJ. Power Doppler US were obtained preoperatively to assess the presence of synovial microvascularisation, and arthroscopic lysis and lavage were done after conservative treatment had proved unsuccessful. The severity of synovitis was assessed arthroscopically. The postoperative power Doppler US scans were obtained 2 months later. Other arthroscopic variables were roofing, adhesions, chondromalacia, clicking, and pain. Arthroscopic synovitis with varying degrees of synovial vascularisation was detected in all patients. Pain scores decreased considerably during the postoperative period. We conclude that power Doppler US is a good technique for the assessment of synovial changes by microvascularisation. Arthroscopy of the TMJ reduces synovial vascularisation.

The Efficacy of Mylohyoid Nerve Anesthesia in Dental Implant Placement at the Edentulous Posterior Mandibular Ridge

The aim of this study is to evaluate the anesthetic efficacy of mylohyoid and buccal nerve anesthesia at the posterior edentulous mandible versus regional anesthetic block to the inferior alveolar nerve in dental implant surgery. The study was composed of 2 groups. In the first group (group A), 14 voluntary adults (7 female and 7 male) received local infiltrations of 1 mL articaine HCl 4% with epinephrine 1/200,000 to the ipsilateral mylohyoid and buccal nerves. In the second group (group B, control; 9 female and 5 male adults), the inferior alveolar and the buccal nerve blocks were performed. Visual analog scales were obtained from patients to determine the level of pain during incision, drilling, implant placement, and suturing stages of implant surgery. A combination of buccal and mylohyoid nerve block offered an acceptable level of anesthesia. Two patients from group A stopped the ongoing surgery and had extraregional anesthesia by inferior alveolar nerve block. In group B, patients were operated on successfully. Local anesthetic infiltrations of the mylohyoid and the buccal nerve may be considered alternative methods of providing a convenient anesthetic state of the posterior mandibular ridge.