IntroductionVertical discrepancy between the fibula flap and the native mandible results in difficult prosthetic rehabilitation. The aim of this study was to evaluate the outcomes of 3D reconstruction of the mandible in oncologic patients using three different techniques through virtual surgical planning (VSP), cutting guides, customized titanium mesh and plates with CAD/CAM technology, STL models and intraoperative dynamic navigation for implant placement. Material and methodsMaterial and MethodsThree different techniques for mandibular reconstruction and implant rehabilitation were performed in 14 oncologic patients. Five patients (36%) underwent VSP, cutting guides, STL models and a customized double-barrel titanium plate with a double-barrel flap and immediate implants. In six patients (43%), VSP, STL models and a custom-made titanium mesh (CAD/CAM) for 3D reconstruction with iliac crest graft over a fibula flap with deferred dental implants were performed. Three patients (21%) underwent VSP with cutting guides and customized titanium plates for mandibular reconstruction and implant rehabilitation using intraoperative dynamic navigation was accomplished. Vertical bone reconstruction, peri-implant bone resorption, implant success rate, effects of radiotherapy in vertical reconstruction, bone resorption and implant failure, mastication, aesthetic result and dysphagia were evaluated.ResultsSignificant differences in bone growth between the double-barrel technique and iliac crest graft with titanium mesh technique were found (p<0.002). Regarding bone resorption, there were no significant differences between the techniques (p=0.11). 60 implants were placed with an osseointegration rate of 91.49%. Five implants were lost during the osseointegration period (8%). Peri-implant bone resorption was measured with a mean of 1.27 mm. There was no significant difference between the vertical gain technique used and implant survival (p>0.385). Implant survival rates were higher in non-irradiated patients (p<0.017). All patients were rehabilitated with a fixed implant-supported prosthesis reporting a regular diet (80%), normal swallowing (85.7%) and excellent aesthetic results.ConclusionsMulti-stage implementation of VSP, STL models and cutting guides, CAD/CAM technology, customized plates and in-house dynamic implant navigation for mandibular defects increases bone-to-bone contact, resolves vertical discrepancy and improves operative efficiency with reduced complication rates and minimal bone resorption. It provides accurate reconstruction that optimizes implant placement, thereby improving facial symmetry, aesthetics and function.
The aim of this study is to determine changes that occur in the nasolabial angle (ANL) in patients who received Le Fort I advancement surgeries with or without maxillary impaction. Methods: A cephalometric evaluation of McNamara was performed in 16 healthy Chilean patients after orthognathic surgeries. Only patients with pre-and postsurgery teleradiography were included in this study. The radiographs were standardised in head posture position, with olives and first tooth contact. Pre-and postsurgery images were on the same scale (1:1). A comparison was made between two types of surgeries: (1) forehead and maxillary impaction (eight patients); (2) pure maxillary advancement (eight patients). The efficiency of the ANL change in degrees was demonstrated. Cephalometric analysis was measured with Nemoceph 11 software, by a calibrated operator, between 2 and 4 weeks after surgery. Findings: Maxillary movement showed that maxillary impaction and maxillary impaction surgery produced an average increase of 15.125 • , while pure advancement determined an average increase of 8.625 • . Thus, it was established that the maxillary impaction and advancement surgery is more efficient in the change of nasolabial angulation.
Conclusion:The objective of this study was to determine the most efficient maxillary movement to achieve changes in ANL. This is of paramount importance in surgical planning, because when considering these results, the clinician will be able to predict what kind of movement is convenient and how much the patient's soft profile may change after one or the other type of maxillary movement.
The appearance of cervical adenopathies can occur in many pathologies in a non-specific manner; Erdheim–Chester disease (ECD) is characterized by xanthogranulomatous and xanthomatous infiltration of different tissues with numerous foamy histiocytes. Bone lesions are frequent and radiological features are pathognomonic for diagnosis, but lymph node involvement is exceptional and is not a form of presentation reported in the literature. Recurrent BRAFV600E mutation and others have been discovered in recent years. Since then, several treatments targeting the BRAF and MEK pathways have been developed with high success rates; even so, interferon-α continues to be one of the most widely used treatments. The best imaging test for the study and monitoring of the disease is PET-CT. The prognosis of ECD is relatively poor, with a survival of 43% of patients after 32 months follow-up. Higher survival rates have been reported in patients treated with interferon. The authors present an exceptional case of ECD with cervical adenopathies as a debut, highlighting the need for the knowledge of the disease for differential diagnosis, early treatment, and the importance of communication between the clinician and the pathologist. The main features of the disease and a brief discussion of current diagnosis and treatment are reviewed.
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