John Paul Stella

Predictability of upper lip soft tissue changes with maxillary advancement

To improve predictability of the esthetic (soft tissue) results after maxillary advancement surgery, a better understanding of the relationships between the dental osseous movement and overlying soft tissue response is essential. Twenty-one adult patients who underwent isolated maxillary advancement via LeFort I osteotomies without adjunctive nasal soft tissue procedures and/or V-Y closure of the vestibular incision were studied. Homogeneity of the patient population was ensured by selecting cases with less than 2 mm vertical change. The mean maxillary advancement and mean change in Sn was calculated for these 21 patients. Additionally, the 21 patients were subdivided into two groups based on lip thickness: group 1 (lips between 10 and 17 mm thick) and group 2 (greater than 17 mm thick). In each patient group a linear regression (LR) was determined on the magnitude of maxillary advancement (MMA) to the change in soft tissue subnasale (Sn) and on the ratio of Sn change to bone move. The results using mean data showed that the relationships produce significantly high standard deviations; thus, a general correlation between change in soft tissue position to bony advancement cannot be made. Individuals with thin lips (12 to 17 mm) had a good correlation between the magnitude of bony move and amount of soft tissue change. However, increased lip thickness (greater than 17 mm) produced a less predictable correlation between soft and hard tissue changes. All lips thinned around 2 mm when compared with preoperative values. Lip thickness stabilized at approximately 6 months postoperatively.

Vascular transformation in cherubism

Cherubism is a well-known disease entity that was first described by Jones in 1933. A case is presented in which the usual course of the lesion changed dramatically during treatment. The lesion demonstrated unilateral growth with a vascular proliferation after surgical recontouring. Vascular transformation and surgical activation of cherubism, as well as treatment considerations, are discussed.

Reconstruction of frontal and frontal-nasal deformities with prefabricated custom implants

The use of prefabricated custom silicone rubber implants for frontal and nasofrontal deformities produces predictable esthetic results with minimal operative and postoperative morbidity and/or complications in selected patients. Over the past 8 years, 15 custom silicone rubber implants have been placed with good to excellent results. Only one implant was removed due to postoperative infection. This implant was successfully replaced upon resolution of the infection.

Cephalometric profile evaluations in patients with cleft lip and palate

This study was done to determine those abnormal cephalometric features found in adult cleft lip and palate patients. The sample population consisted of 30 randomly selected white patients with cleft lip and palate who were treated by the same team that had been accredited by the American Cleft Palate-Craniofacial Association. Twenty patients had unilateral complete clefts, and 10 had bilateral complete clefts. Thirteen different cephalometric parameters were measured and compared with normal. The results from this study showed that there were few statistically significant differences between the unilateral and bilateral cleft palate patient populations. There were only three measurements that had statistically significant differences between the unilateral cleft patients and the bilateral cleft patients: subnasale-stomion, subnasale-stomion: stomion-soft-tissue menton, and subnasale-lower lip vermillion: lower lip vermillion-soft tissue menton. However, 10 of the 13 measurements had statistically significant variations from normal. These measurements included subnasale=stomion; stomion=soft tissue menton, subnasale=lower lip vermillion; lower lip vermillion=soft tissue menton, interlabial distance, subnasale-perpendicular to upper lip, subnasale-perpendicular to lower lip, subnasale-perpendicular to chin, angle formed between sella turcica=nasion and nasion=A=point, maxillary depth angle, A-point to nasion-pogonion, and angle formed between A=point=nasion and nasion=B=point. The data indicated that a multiplicity of vertical and horizontal abnormalities exist in the person with cleft lip and palate in addition to the well-known transverse deficiencies, and that cephalometric abnormalities are not limited to anteroposterior maxillary deficiency.

The modified superiorly based pharyngeal flap. Part IV: Position of the base of the flap

The modified superiorly based pharyngeal flap surgical technique developed by Epker et al. was performed on 13 patients with moderate to severe hypernasality. The flap base was attached close to the level of the palatal plane and was found to maintain a consistent longitudinal relationship to the level of the atlas. This technique corrected hypernasality in a range of patients with velopharyngeal incompetence, as predicted.

Fiberoptic endotracheal intubation in oral and maxillofacial surgery

Abstract The advent of a fiberoptic endoscope has made endotracheal intubation feasible in a wide variety of patients who were previously considered for tracheostomy. Patients who pose increased anesthetic risks due to hypomobility of the mandible can be induced and successfully intubated by a skilled operator without incident by any one of the currently accepted fiberoptic techniques.1–8 Various devices have been designed to facilitate the use of fiberoptic endotracheal intubation.6,8,9 Many reports have discussed fiberoptic endotracheal intubation, using case reports to exemplify the technique employed,10–13 but to date none has addressed the specific needs of the oral and maxillofacial surgeon. This article presents 1) the indications for fiberoptic endotracheal intubation in patients undergoing various types of oral and maxillofacial surgery, 2) the intubation technique used with the fiberoptic bronchoscope, and 3) our results in 42 consecutive patients.

Transoral submental lipectomy: An adjunct to orthognathic surgery

Individuals undergoing the surgical correction of dentofacial deformities are becoming both older and more discriminating. Consequently, they often request specific esthetic improvements. To meet the desires of such patients, adjunctive surgical procedures to the planned orthognathic surgery are becoming more commonplace. One of the more frequent procedures performed is the transoral submental lipectomy. This article discusses the evaluation of the submental region, the indications for transoral submental lipectomy, and the surgical technique. Several case indications illustrate the results of this procedure.

Anthropometric profile evaluation of the midface in patients with cleft lip and palate

This study was done to determine those profile anthropometric measurements that are abnormal in the midface profile in patients with cleft lip and palate. The sample population consisted of 30 randomly selected skeletally mature white patients with cleft lip and palate who had been treated by the same team who were accredited by the American Cleft Palate-Craniofacial Association. Twenty patients had unilateral and 10 had bilateral complete clefts. None of these patients had previously undergone orthognathic surgery or definitive rhinoplasty surgery. Fifteen facial anthropometric features were measured on each persons face. The result from this study showed that in patients with cleft lip and palate right versus left side differences did not exist and only four statistically significant differences existed between the unilateral and bilateral cases. However, in all patients, four of these esthetic facial features were consistently and significantly abnormal: obtuse nasofrontal angle: obtuse nasomental angle; a posteriorly positioned infraorbitale relative to globe; and an obtuse general facial angle. Several other features were abnormal in a high percentage of persons in this study. These were lack of supratip break, flat to concave paranasal contour, increased subnasale-alargroove:subnasale-pronasale ratio, decreased nasal protrusion:nasal length ratio, decreased nasolabial angle ratio, decreased maxillary length ratio, increased nasal bridge projection:nasal protrusion ratio, and deficient cheek contour. This data indicates that the major deformity in persons with adult cleft lip and palate exist in the nose and secondarily in other components of the midface.

The modified superior based pharyngeal flap: Part III. A retrospective study

A retrospective study of 31 patients who had diagnosed velopharyngeal incompetence and were surgically managed with the modified superior based pharyngeal flap was completed. The following were analyzed: age at time of operation, gender, physical status, diagnostic protocol, length of operation (length of total surgery) and length of superior based pharyngeal flap, length of postoperative hospital stay, length of total hospital stay, length of follow-up, speech results, complications, patient care, and medication. The result showed that the optimal timing for correction of velopharyngeal incompetence was between 3 and 6 years of age. The mean length of total hospital stay was 2.7 days, postoperative complications were minimal, and speech results were generally good.

Algorithm for the Differential Diagnosis of Posterior Open Bites: Two Illustrative Cases

PURPOSE Posterior open bites can result from several causes: trauma, degenerative changes, tongue thrust habits, single-tooth ankylosis, multiple-tooth ankylosis, and/or condylar hyperplasia. Occasionally, posterior open bites are secondary to a combination of condylar hyperplasia and dental ankylosis, which can be difficult to diagnose and treat because of the large array of causative problems. MATERIALS AND METHODS This article presents 2 unusual cases of posterior open bite secondary to multiple etiologies in adolescent male patients. A useful method of algorithmic diagnosis, treatment, and protocol is presented that was used for these cases. RESULTS The 2 cases were successfully diagnosed and treated using the formulated algorithm for posterior open bites. CONCLUSIONS The algorithms presented facilitate the differential diagnosis of posterior open bites with ambiguous etiology.