George A. Wessberg

Mechanisms of early skeletal relapse following surgical advancement of the mandible

Despite recent innovative technical and biological advances, surgical advancement of the mandible does not demonstrate uniform skeletal stability. In fact, the results of recent investigations have shown that considerable skeletal relapse occurs quite early in the post-surgical period. This article reviews current literature to implicate the factors primarily responsible for early skeletal relapse following surgical advancement of the mandible via the modified sagittal split ramus osteotomy. Three specific mechanisms which commonly predispose this orthognathic procedure to skeletal relapse are delineated. Prolonged skeletal stabilisation with control of the proximal segment of the mandible is advocated to insure predictably stable results.

Experiences with microsurgical reconstruction of the inferior alveolar nerve

Abstract In select cases, immediate or delayed inferior alveolar nerve reconstruction is indicated. The current state of the art indicates that when nerve reconstruction is to be undertaken, optimal results are achieved via microsurgical instrumentation. Specific technical and biologic considerations that have been found to be relevant in microsurgical reconstruction of the inferior alveolar nerve are discussed.

Transcutaneous electrical stimulation as an adjunct in the management of myofascial pain-dysfunction syndrome.

Twenty-one patients, 14 women and seven men, presenting with symptoms of the MPD syndrome, were treated with a regimen based on a neuromuscular theory of occlusion involving TES. Evaluation of treatment results shows 95% success immediately after therapy and an 86% success 1 year after therapy. No effort was made to establish a personality profile on the patients nor to incorporate active psychotherapy in treatment.

Simultaneous inferior alveolar nerve graft and osseous reconstruction of the mandible

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Surgical inferior repositioning of the maxilla: Treatment considerations and comprehensive management

Surgical inferior repositioning of the hypoplastic or vertically deficient maxilla is discussed with respect to various relevant treatment considerations, and a specific regimen for comprehensive management is recommended. Treatment considerations for persons with true vertical maxillary deficiency include esthetic, functional, and neuromuscular factors. Primary among these factors are the relationship between the maxillary incisor and the upper lip, the physiologic interocclusal space, and the masticatory bite force. A regimen for the comprehensive management of these factors is recommended to ensure skeletal stability. These measures include a careful surgical technique, transplantation of viable autogenous bone, critical evaluation of the physiologic interocclusal space, and elimination of destructive masticatory forces to the maxilla during healing of the graft by an intraoral skeletal fixation appliance. Adherence to these fundamental biologic principles ensures predictability to the inferiorly repositioned maxilla.

Neuromuscular adaptation to surgical superior repositioning of the maxilla.

This study was designed to evaluate neuromuscular adaption to orthognathic surgery. Fifteen adults were evaluated before and three months after surgical superior repositioning of the maxilla via computerized morphometric, kinesiometric, and electromyographic instrumentation. The findings of this study suggest that immediate and complete adaptation mediated by the central nervous system is followed gradually by delayed and partial compensatory adaptation within the muscles, tendons, and bones of the stomatognathic system.

Bilateral microneurosurgical reconstruction of inferior alveolar nerves via autogenous sural nerve transplantation

Microneurosurgical operative techniques permit satisfactory restoration of sensation in many lesions of the inferior alveolar nerve. Therefore, restoration of the sensory deficit is becoming increasingly more important in the total functional rehabilitation of individuals with mandibular continuity defects involving transection of or permanent damage to the inferior alveolar nerve. This article reviews the case history of a young man who underwent bilateral osseous mandibular reconstruction and microneurosurgical reconstruction of his inferior alveolar nerves following severe maxillofacial trauma. A new technique for isolating the sural nerve is introduced to facilitate harvesting of the graft. Scanning electron microscopic examination of the resected proximal inferior alveolar nerve is recommended to determine the prognosis for regeneration across the proximal anastomosis and to decide whether secondary resection and reanastomosis of the distal anastomosis is indicated when anesthesia persists 9 to 12 months after initial transplantation of a long donor nerve.

Ophthalmologic considerations in maxillofacial trauma: Anatomy and diagnostic evaluation

The high incidence of orbital involvement in facial injuries necessitates a thorough ophthalmologic evaluation in virtually all cases. This article will provide the oral and maxillofacial surgeon with a review of the anatomy of the eye and ocular adnexa and present a systematic method of conducting and interpreting an ophthalmologic examination.

Transoral inferior alveolar neurorrhaphy via a sagittally split mandible

A surgical technique for transoral exposure and secondary repair of the inferior alveolar nerve via a sagittally split mandible is described. The use of this approach in certain individuals enables the maxillofacial surgeon to perform a minor resection and re-anastomosis or major resection and autogenous grafting. This procedure provides adequate exposure for re-anastomosis of minor inferior alveolar nerve injuries under minimal tension and without a facial scar. However, postoperative intermaxillary fixation is required for four to six weeks.

Correction of sickle cell gnathopathy by total maxillary osteotomy

Medical advances in the care of individuals with sickle cell disease have progressed to the level where elective surgical procedures can be performed. Successful management of these individuals requires understanding of the pathophysiology of the disease in conjunction with specific anaesthetic and surgical considerations. The clinical relevance of these factors are discussed as they relate to haematological, anaesthetic, and surgical management of a young black male who underwent a modified LeFort I osteotomy with segmentalization and genioplasty to correct a severe dentofacial deformity secondary to sickle cell gnathopathy.