Toshikatsu Horiuchi

Mandibular reconstruction using custom-made titanium mesh tray and particulate cancellous bone and marrow harvested from bilateral posterior ilia

Abstract The objective of this study is to evaluate usefulness of mandibular reconstructions using a custom-made titanium mesh (Ti-mesh) tray and particulate cancellous bone and marrow (PCBM). A consecutive nine patients who underwent mandibular reconstruction were enrolled in this study. They were five men and four women (mean age: 53.9 years). Virtual reality simulation was performed using computer software based on the pre-operative computed tomography data. A 3-dimensional (3-D) skull model was constructed using a 3-D printer. A tray was custom-made from a Ti-mesh sheet bent to adapt to the model. After PCBM harvesting from bilateral posterior ilia, the tray was fixed to the host bone. New bone formation and configuration of the reconstructed mandible were assessed radiologically. Complications were recorded in each patient during the follow-up period. Patients, satisfaction with post-operative facial contour was evaluated using a visual analogue scale (VAS score, range = 0–100). In six of nine patients, excellent new bone formation was recognised and expected results were radiologically achieved. Complications occurred in four patients. These complications included Ti-mesh fracture, Ti-mesh exposure in the oral cavity, and delayed infection. Mean VAS score on patient satisfaction was 77.6. Although the data are preliminary, the results suggest that this method is clinically useful.

The changes of joint effusion on MRI and arthroscopic findings after visually guided TMJ irrigation correlated to the clinical outcome

OBJECTIVE This study aimed to investigate the changes of joint effusion (JE) on the MRI and arthroscopically observed pathology after visually guided TMJ irrigation (VGIR) in patients with chronic closed lock. The correlation of these findings to the clinical outcome was also studied. STUDY DESIGN Forty patients with unilateral chronic closed lock who underwent 2-time VGIR, were divided into either the good outcome (g-) group (n = 29) or poor outcome (p-) group (n = 11) after the first VGIR. Before each VGIR, the each severity of JE, osteoarthritis, synovitis, and fibrous adhesion were assessed. They were compared between the g- and p-groups, or between the first and second VGIR. RESULTS The severity of JE at the first VGIR was significantly worse in the p-group. In both groups, JE significantly improved after the first VGIR. In the g-group, synovitis significantly improved after the first VGIR, but fibrous adhesion significantly became worse. CONCLUSIONS JE may be predictive for the clinical outcome of TMJ irrigation in chronic closed lock patients. Moreover, the severity of JE and arthroscopically observed synovitis could reflect the clinical state to some degree.

Two-stage orthognathic treatment of severe class III malocclusion:report of a case

We report a two-stage orthognathic operation for a 16-year-old boy with a repaired isolated cleft palate. He had a severe class III malocclusion with an overjet of 20.4 mm. In the first stage, we did an anterior subapical segmental osteotomy with symphyseal ostectomy to reposition the mandibular anterior segment posteriorly and to reduce the transverse width of the mandible. During the second stage, we did a maxillary advancement by Le Fort I osteotomy, mandibular set-back by sagittal split osteotomy, reduction genioplasty, and shortening of the tongue. This unique two-stage surgical and orthodontic treatment considerably improved his overall facial aesthetics and occlusion.

Vestibuloplasty after secondary alveolar bone grafting.

OBJECTIVE This paper introduces a surgical technique for vestibuloplasty after secondary alveolar bone grafting of patients with cleft lip and palate (CLP). This paper also reports on the patients who underwent this modified vestibuloplasty. SURGICAL PROCEDURE The vestibuloplasty technique described in this paper consists of: (1) reduction of submucosal scar tissue of the upper lip, (2) V-Y plasty of the superficial mucosa, (3) placement of horizontal mattress sutures between nostril floor skin and freed marginal mucosa, (4) application of artificial skin to cover the exposed periosteal surface, and (5) use of a removable retention splint. CONCLUSION This surgical procedure appears to be very useful for patients with CLP. The technique enables the surgeon to obtain an adequate sulcus depth around the graft area. In addition, this technique releases the mucosal scar contraction and improves the shape and mobility of the upper lip.

Accuracy of Maxillary Positioning During Orthognathic Surgery: Comparison of 2 External Reference Points

Abstract Objectives: The surgical accuracy of 2 external reference points when repositioning the osteotomised maxilla was analysed. Patients and Methods: In 31 patients undergoing Le Fort I osteotomy during orthognathic surgery, the intermediate splint and unoperated mandible was used to provide a horizontal maxillary position. In 14 patients, an external reference point marked on the forehead was taken to determine the maxillary vertical dimension (group I). In 17 patients, a miniplate screw placed into the frontal bone was used as an external reference point (group II). Preoperative lateral cephalograms were traced and superimposed onto the postoperative cephalograms to compare the preoperative, postoperative, and predicted position of the maxillary central incisor and the posterior nasal spine of each patient. The differences between predicted and actual changes in the maxillary central incisor and posterior nasal spine were calculated using the Frankfort horizontal plane as a reference. Results: Statistical analysis showed that an external reference pointplaced into the bone was a more reliable method of positioning the maxilla in the vertical dimension than a point marked on the skin ( p Conclusion: To improve surgical accuracy, surgeons must strive to reduce positional variance by careful treatment planning and precise surgery.