S4B-06 SESSION 4B: ORTHOGNATHIC / TREACHER-COLLINS THE UTILITY OF ORTHOGNATHIC SURGERY IN CRANIOFACIAL SYNDROMES. IMPROVING FUNCTIONAL AND AESTHETICS SHORTCOMINGS.

Abstract

Introduction: Patients with craniofacial syndromes needs orthognathic procedures and the end of their growing age to achieve sufficient aesthetic and functional results to develop a normal life.Craniofacial syndromes correct management requires a multidisciplinary team approach, wide variety of surgical procedures for the soft tissues and skeletal abnormalities and for the important functional issues associated to the syndrome, particularly airway obstruction resulting in obstructive sleep apnea.The orthodontic preparation and planning of these cases is more difficult than the conventional patients and the use of conventional cephalometrics is also difficult due to severe anatomical alterations and the consequent low utility of the normal reference lines.The modern techniques of virtual planning, computer assisted surgery and the use of customized implants are indispensable tools for the correct execution of the orthognathic procedure in these complex cases. Methods: We present our retrospective series about 23 cases of craniofacial syndromes treated by orthognathic procedures during the period 2012 to 2019.6 Crouzon´s, 3 Apert´s, 8 hemifacial microsomia, 2 oro-facial-digital´s, 2 Treacher Collins; 1 ectodermal dysplasia and 1 Hadju-Cheney´s.TMJ reconstruction in the affected side with customized TMJ Prosthesis and two jaw surgery at the same time was our protocol in hemifacial microsomia cases. Results: The medium age of the patients was 21 y. old (15–27 y.old); 21 bimaxillary procedures and 1 monomaxillary. One case of the pseudoarthrosis was documented and treated through reoperation and autologous bone grafting.No major complications were reported. The improvement of the previously narrow airway associated to these patients has decreased the incidence of obstructive sleep apnea. Conclusion: Craniofacial syndromes have severe anatomical and functional anomalies and need multiple and complex treatments during growth.Orthognathic surgery is reliable and stable tool in the protocol of treatment for these patients.Virtual planning with computer assisted surgery to perform two jaw surgery is our best treatment protocol to correct the severe malocclusion present in Syndromic Craniosynostosis.TMJ reconstruction in combination with counterclockwise rotation two jaw surgery is the gold standard to obtain long term stability in the correction of the occlusal anomalies in hemifacial macrosomia.