Luis G. Vega

Alveolar distraction osteogenesis for dental implant preparation: an update.

Alveolar distraction is a constantly evolving technique. A review of the literature within the past 14 years reveals that there are clear indications for its use, with outcomes similar to and sometimes even more predictable than traditional bone grafting techniques in preparation for implant placement. Although complications exist with alveolar distraction, it seems that most are minor and easy to manage. Appropriate patient selection and a better understanding of the technique are paramount to successful bone regeneration with alveolar distraction osteogenesis. This article discusses newer research and provides clinical advice on the practice of alveolar distraction osteogenesis for dental implant preparation.

Reoperative mandibular trauma: management of posttraumatic mandibular deformities.

Mandibular fractures are one the most common maxillofacial injuries. Diagnostic errors, poor surgical technique, healing disorders, or complications may lead to the establishment of posttraumatic mandibular deformities. Nonunion, malunion/malocclusion, or facial asymmetry can be found early during the healing process or as long-term sequelae after the initial mandibular fracture repair. Although occasionally these problems can be solved in a nonsurgical manner, reoperations play an important role in the management of these untoward outcomes. This article discusses the reoperative techniques used for the management of these deformities.

Reconstruction of acquired temporomandibular joint defects.

Various conditions are responsible for the development of acquired temporomandibular joint (TMJ) defects, the reconstruction of which represents a unique challenge, as the TMJ plays an important role in the functioning of the jaw including mastication, deglutition, and phonation. Autogenous reconstructions such as costochondral or sternoclavicular joint graft continue to be the best option in children, owing to their ability to transfer a growth center. In adults, alloplastic reconstructions are a safe and predictable option. Vascularized tissue transfers have also become a popular and reliable way to restore these defects.

Zygoma Implant Reconstruction of Acquired Maxillary Bony Defects

The reconstruction of acquired maxillary bony defects after pathologic ablation, infectious debridement, avulsive trauma, or previously failed reconstructions with zygoma implants represents a treatment alternative that is safe, predictable, and cost-effective. Still the single most important factor for treatment success of these complex reconstructions is the implementation of a team approach between the surgeon and the restorative dentist. The focus of this article is to review the surgical and prosthetic nuances to successfully reconstruct acquired maxillary defects with zygoma implants.

Reoperative Temporomandibular Joint Surgery

TMJ surgeries are not always successful. Many potential pitfalls can occur during any phase of the treatment and can lead to complications, less than desirable results, and short- or long-term failures. Unsatisfactory results can occur for multiple reasons, including misdiagnosis of the original pathologic condition, incorrect selection of surgical technique, technical failures, complications, systemic disease, and unrealistic expectations. This article focuses on the reoperation of the TMJ primarily in cases of internal derangement and discusses TMJ arthrocentesis, arthroscopy, modified condylotomy, and open joint procedures.

Preface. Reoperative oral and maxillofacial surgery.

We are very pleased to be guest editors for this Oral and Maxillofacial Surgery Clinics dedicated to “Reoperative Oral and Maxillofacial Surgery.” Whether we are seasoned surgeons or recent graduates, we are all faced with patients needing reoperative interventions. The term “reoperative surgery” is often perceived negatively due to its connotation of complication andblame. As a result, surgeons are often reluctant to discuss their experiences, forgoing opportunities for shared learning. Reoperative surgery has different meanings for different surgeons. It may encompass touchup procedures for cleft lip and palate patients, redoing a facelift due to continued aging and its sequelae, multistage maxillofacial reconstructive procedures, correction of an unsatisfactory orthognathic result, complications from bone grafts for dental implants, or a reoperation due to a positive margin or recurrence of initial disease. Reoperative maxillofacial surgery is often more difficult than the initial surgery due to the inherent scarring and altered anatomy. Equally, the surgeon must dedicate significant time to planning to minimize the need for yet another intervention in the future. We have sought to recruit leaders in our specialty to contribute their collective experiences in dealing with these difficult processes. We hope