Maxillofacial Deformities Research Articles

The Precise Repositioning Instrument for Genioplasty and a Three-Dimensional Printing Technique for Treatment of Complex Facial Asymmetry.

Facial asymmetry is very common in maxillofacial deformities. It is difficult to achieve accurate reconstruction. With the help of 3D printing models and surgical templates, the osteotomy line and the amount of bone grinding can be accurate. Also, by means of the precise repositioning instrument, the repositioning of genioplasty can be accurate and quick. In this study, we present a three-dimensional printing technique and the precise repositioning instrument to guide the osteotomy and repositioning, and illustrate their feasibility and validity. Eight patients with complex facial asymmetries were studied. A precise 3D printing model was obtained. We made the preoperative design and surgical templates according to it. The surgical templates and precise repositioning instrument were used to obtain an accurate osteotomy and repositioning during the operation. Postoperative measurements were made based on computed tomographic data, including chin point deviation as well as the symmetry of the mandible evaluated by 3D curve functions. All patients obtained satisfactory esthetic results, and no recurrences occurred during follow-up. The results showed that we achieved clinically acceptable precision for the mandible and chin. The mean and SD of ICC between R-Post and L-Post were 0.973±0.007. The mean and SD of chin point deviation 6months after the operation were 0.63±0.19mm. The results of this study suggest that the three-dimensional printing technique and the precise repositioning instrument could aid in making better operation designs and more accurate manipulation in orthognathic surgery for complex facial asymmetry. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Preliminary evaluation of cone beam computed tomography in three-dimensional cephalometry for clinical application.

The present study was conducted to evaluate the three-dimensional (3D) cephalometry accuracy of cone-beam computed tomography (CBCT). A total of 40 newly diagnosed orthodontic patients (including 18 males and 22 females; age range, 12-18 years) were subjected to CBCT scanning and X-ray imaging in order to obtain lateral cephalograms. The 3D CBCT cephalograms were reconstructed and measured with in vivo 5.1 software, and compared with the results from the conventional 2D lateral cephalograms. Measurements in the two images were performed twice using the Steiner and Tweed standards and a single analyzer paired t-test was used to analyze the differences between the two cephalometric methods. The results indicated that the two methods showed significant differences in all 12 angle and 5 linear measurements (P<0.05). These findings indicated that CBCT is a more accurate technique compared with the conventional 2D method. In conclusion, CBCT may provide diagnostic and treatment information for maxillofacial deformities by using fast computer-aided analysis platform.

Treatment of Micrognathia by Intraoral Distraction Osteogenesis: A Prospective Study.

Purpose:Maxillofacial deformities are always psychologically and physically distressing to the patients and is also challenging to the treating surgeons. The term Micrognathia means a “small jaw”. True micrognathia, where the maxilla or the mandibular skeleton does not grow to the full size can be congenital or acquired. Distraction osteogenesis also called as callus distraction or callostasis or osteodistraction or distraction histogenesis is a biological process of regenerating newly formed bone and adjacent soft tissue by a gradual and controlled traction of surgically separated bone segments. The purpose of this prospective study was to assess the versatility of distraction osteogenesis in the treatment of micrognathia.Materials and Methods:Four patients (three males and one female) with micrognathia of mandible were included in this prospective study. The patients were between the age group of 10-20 years. Facial asymmetry was the chief complaint of all the patients. In all the patients following treatment protocol was carried out, Osteotomy and placement of intraoral distraction device under general anaesthesia, latency phase (5-7 days), activation period-rate 1.5 mm per day, consolidation period of 8 weeks, removal of distraction device under local anaesthesia. The parameters assessed were ramus height, body length, hyo mental distance, posterior pharyngeal airway space, chin projection, facial symmetry occlusion, mid line shift pre and post operatively.Results:The mean increase in ramus height achieved was 9.2 + 2.17 mm and the mandibular body length achieved was 10.4+1.67 mm. There was an average increase in hyo-mental distance of 2.75 cm +0.9 cm postoperatively showing a definitive improvement in the airway. The posterior pharyngeal space measured from the lateral cephalogram preoperatively ranged from 3-6 mm and post operatively from 6-9 mm.Intraorally there was a shift in occlusion to class I molar relation in three patients and there was posterior open bite in one patient. Marked correction of facial asymmetry was noticed in all cases both clinically and in PA cephalogram. There was a restoration of dental as well as lip midline and improved lip competence. There was a significant improvement in chin projection and occlusal cant however further chin correction was needed in one case by means of advancement genioplasty.Conclusion:A definite improvement in all parameters such as body length,ramus height,chin projection,occlusal cant was observed in all patients. Moreover the patients were subjectively satisfied with the outcome of the results. Distraction Osteogenesis is definitely a boon to the oral and maxillofacial surgeons in treating large deficiencies of mandible in terms of stability

Impact of interprofessional education module on attitudes of health-care providers involved in maxillofacial rehabilitation: A cross-sectional study.

Purpose:Rehabilitation of maxillofacial deformities is a challenging task because it involves not only a lot of skills and expertise but also many disciplines working in unison for optimum outcome. However, more often than not a prosthodontist is not a member of tumor board and consulted after surgery which affects the prognosis of the rehabilitation adversely. There was a perceived need to create awareness among referring surgeons and physicians, and interprofessional education (IPE) initiatives were deemed necessary to improve this collaboration.Methodology:Four-hour IPE module was developed involving residents and faculty from three disciplines. The change in attitudes was evaluated quantitatively using Attitudes toward Health Care Teams questionnaire both before and after the module. Semi-structured interviews with selected participants provided the qualitative feedback.Results:The questionnaire consisted of 14 questions answered on 5-point Likert scale (1–5). The mean score of pretest was 44.2 and of posttest was 49.1. Difference was statistically significant (P < 0.05). Higher score indicates better attitude.Conclusion:A brief IPE program can improve interprofessional attitudes and collaborative behavior of health-care professionals involved in maxillofacial rehabilitation. It enables the professionals to understand interact and share viewpoints regarding most critical issues faced by them and find solutions to achieve best possible patient care.

An ‘accidental’ incident leading to an incidental finding of Gorlin–Goltz syndrome in a child

AbstractA 6‐year‐old boy was referred to the oral surgery department for assessment of a cyst‐like lesion in the left body of mandible. The child had previously been managed for developmental delay and a syndromic appearance by medical colleagues with no firm diagnosis. Histology of the lesion confirmed a keratocystic odontogenic tumour (KCOT) and pointed towards a diagnosis of Gorlin–Goltz syndrome (GGS) when combined with other clinical features and confirmed by genetic testing. This case highlights the importance of team work, appropriate and proportionate application of different imaging modalities to characterise intraosseous lesions in children and monitoring for interval change, as well as the conservative approach to management of such lesions in younger patients. Prognosis improves with early recognition of clinical and radiographic manifestations of GGS facilitated by multi‐disciplinary involvement. This may reduce the severity of complications including maxillofacial deformities associated with jaw KCOTs and malignant skin and brain tumours.

Use of T.M.J. Disc as a Soft Tissue Interpositional Graft Material for Functional Rehabilitation of Ankylosed T.M. Joint.

Many surgical techniques have been described for the treatment of TMJ ankylosis, but no strategy has been uniformly agreed upon underscoring the difficulty of the problem. Despite new guidelines and updated methods, treating patients with TMJ Ankylosis remains a challenge as the incidence of recurrence after treatment is soaring. This study exemplifies our experience in using an unsullied method to treat TMJ Ankylosis to restore the structure of TMJ in conjunction with convalescing secondary maxillofacial deformity. A total of 56 cases of unilateral bony TMJ ankylosis were included in the study, and postoperative results of T.M.J disc as a soft tissue interposition graft was evaluated. The operative protocol comprised of (1) resection of ankylotic mass, (2) intraoral ipsilateral coronoidectomy or contralateral coronoidectomy when needed, (4) interpositioning disc as soft tissue graft, (5) interposing and fixing sternoclavicular or costocondral graft with lag screws and (6) early mobilization, aggressive physiotherapy. The study assessed patients with regular follow-up checks for a period of 3 years. The average preoperative mouth opening was found to be 5.46mm (range 2-10mm). Mean post-operative mouth opening was 33.05mm (range 24-43mm), while 3 years post operative mouth opening (mean) was 39.75mm. No cases of reankylosis were reported during this period suggesting it as a viable and satisfactory approach. The use of TMJ disc as a soft tissue interpositional graft material is an effectual method for functional rehabilitation of ankylosis cases and serves as an effective means of preventing recurrence.

Autologous Fat Transfer for Esthetic Contouring of Face in Posttraumatic Nonfunctional Maxillofacial Deformities.

The transfer of autologous fat has been performed since the 1890s; however, its popularity has increased owing to better understanding of fat harvesting and processing techniques. In this article, fat grafting procedure has been used to correct posttraumatic facial deformities in 25 cases. As healing of grafted fat is unpredictable, we have used longer follow-up of 2 years. Evaluation was performed using facial photographs and MRI scans. Scientific literature describes an absorption rate ranging from 20 to 90%. High fat graft resorption rates have been attributed to traumatic handling of the graft during harvest, processing, and injection. Various processing techniques have been suggested. The goal of these techniques is to obtain greater adipocyte cell survival and, consequently, more reliable clinical results. In our study, we have used syringe aspiration and low-speed centrifuge for processing of fat which has resulted in good clinical outcomes.

Management of difficult recipient vessel preparation in microsurgical reconstruction for oral and maxillofacial defects with free flaps

Objective To investigate the management of difficult recipient vessel preparation in microsurgical reconstruction for oral and maxillofacial defects with free flaps and to assess the clinical outcome. Methods A total number of 739 patients with oral and maxillofacial defects underwent consecutive free flap reconstruction with 761 free flaps from May, 2012 to May, 2015. There were 37 patients who could not find or lack of proper recipient vessels for microvascular anastomosis during operation. Among them, 22 were recurrent oral cancer after tumor ablation, 10 of them undrewent post-operative radiotherapy; 5 were second primary oral cancer, 7 diagnosed with osteoradionecrosis, and 3 suffered from oral and maxillofacial defect and deformity caused by trauma or inflammation. Forty free flaps including 23 anterolateral thigh flaps. (ALT) , 10 fibular flaps and 7 radial forearm flaps were harvested. Methods and techniques used during the operation, instant patency rate after anastomosis, the overall survival rate of free flaps, and post-operative complications were recorded. Results Ninety-one anastomoses were performed between 87 pairs of vessels in 37 patients. Fifty recepient vessels were located on ipsilateral side of neck, and the most frequently used recipient vessels were those preserved or not being damaged in former operation and radiation, former transferred free flap vascular pedicles and residual ends of the ligated vessels. Thirty-seven recepient vessels were found on the contralateral side of neck. Thirty-one cases of long-pedicle flap harvesting, 2 cases of vein and artery grafting, 4 cases of vessel transposition, 5 cases of phleboplasties, 9 cases of end-to-side anastomoses, and 1 case of flow-through technique were applied in recipient vessels preparation alone or in combination. The patency rate of anastomosis during operation was 100% and the overall survival rate of free flaps was 97.5%. Conclusion Recurrent oral cancer after tumor ablation, second primary oral cancer, osteoradionecrosis and deformity caused by trauma and inflammation are the main reasons of unsuitable recipient vessel conditions in microsurgical reconstruction for oral and maxillofacial defects. Methods including long-pedicle flap harvesting, venous grafting, vessel transposition, phleboplasty, end-to-side anastomosis and flow-through technique applied alone or in combination are still reliable choices for management of neck difficult recipient vessel preparation and anastomosis. Key words: Maxillofacial defects; Surgical flaps; Recipient vessels; Microsurgery

Virtual skeletal complex model- and landmark-guided orthognathic surgery system

In this study, correction of the maxillofacial deformities was performed by repositioning bone segments to an appropriate location according to the preoperative planning in orthognathic surgery. The surgery was planned using the patient's virtual skeletal models fused with optically scanned three-dimensional dentition. The virtual maxillomandibular complex (MMC) model of the patient's final occlusal relationship was generated by fusion of the maxillary and mandibular models with scanned occlusion. The final position of the MMC was simulated preoperatively by planning and was used as a goal model for guidance. During surgery, the intraoperative registration was finished immediately using only software processing. For accurate repositioning, the intraoperative MMC model was visualized on the monitor with respect to the simulated MMC model, and the intraoperative positions of multiple landmarks were also visualized on the MMC surface model. The deviation errors between the intraoperative and the final positions of each landmark were visualized quantitatively. As a result, the surgeon could easily recognize the three-dimensional deviation of the intraoperative MMC state from the final goal model without manually applying a pointing tool, and could also quickly determine the amount and direction of further MMC movements needed to reach the goal position. The surgeon could also perform various osteotomies and remove bone interference conveniently, as the maxillary tracking tool could be separated from the MMC. The root mean square (RMS) difference between the preoperative planning and the intraoperative guidance was 1.16±0.34mm immediately after repositioning. After surgery, the RMS differences between the planning and the postoperative computed tomographic model were 1.31±0.28mm and 1.74±0.73mm for the maxillary and mandibular landmarks, respectively. Our method provides accurate and flexible guidance for bimaxillary orthognathic surgery based on intraoperative visualization and quantification of deviations for simulated postoperative MMC and landmarks. The guidance using simulated skeletal models and landmarks can complement and improve conventional navigational surgery for bone repositioning in the craniomaxillofacial area.

Velopharyngeal Configuration Changes Following Le Fort I Osteotomy With Maxillary Advancement in Patients With Cleft Lip and Palate: A Cephalometric Study.

To describe the morphological changes of velopharyngeal components in patients with cleft lip and palate after Le Fort I osteotomy with maxillary advancement and to clarify whether the velopharyngeal morphological changes are related to the distance of maxillary advancement. Retrospective case series. Hospital and Stomatology Unit of Peking University, Beijing, China. A total of 47 patients with maxillary hypoplasia secondary to cleft lip and palate. Le Fort I osteotomy combined with bilateral sagittal split ramus osteotomy and/or genioplasty for treatment of maxillofacial deformity. The lateral cephalometric radiographs with velum at rest (n = 47) and during phonation of /i/ (n = 17) were undertaken preoperatively (T1), 1 week postoperatively (T2), and at least 6 months postoperatively (T3). Some measure indices of velopharyngeal configuration were collected and analyzed. The average maxillary advancement distance was 4.08 ± 1.58 mm. The velar length, velar angle, and nasopharyngeal depth increased, but velar thickness decreased. The motion of the soft palate had no significant change, but the motion of the posterior pharyngeal wall and the Passavant's ridge increased significantly. No significant linear correlation was found between maxillary advancement distance and velopharyngeal configuration changes. Correction of maxillary hypoplasia by Le Fort I osteotomy with maxillary advancement increases the velopharyngeal cavity depth, which may impair velopharyngeal competence. The compensatory effects of the velopharyngeal soft tissue and posterior pharyngeal wall may alleviate this impairment to a certain extent.

A novel method for the management of proximal segment using computer assisted simulation surgery: correct condyle head positioning and better proximal segment placement.

Computer Assisted Simulation Surgery (CASS) is a reliable method that permits oral and maxillofacial surgeons to visualize the position of the maxilla and the mandible as observed in the patient. The purpose of this report was to introduce a newly developed strategy for proximal segment management according to Balanced Orthognathic Surgery (BOS) protocol which is a type of CASS, and to establish the clinical feasibility of the BOS protocol in the treatment of complex maxillo-facial deformities. The BOS protocol consists of the following 4 phases: 1) Planning and simulation phase, 2) Modeling phase, 3) Surgical phase, and 4) Evaluation phase. The surgical interventions in 80 consecutive patients were planned and executed by the BOS protocol. The BOS protocol ensures accuracy during surgery, thereby facilitating the completion of procedures without any complications. The BOS protocol may be a complete solution that enables an orthognatic surgeon to perform accurate surgery based on a surgical plan, making real outcomes as close to pre-planned outcomes as possible.

Planification 3D d’une distraction mandibulaire dans le cadre d’une ankylose temporo-mandibulaire sévère

When occurring in childhood, temporomandibular ankylosis joint is responsible for complex maxillofacial deformities, including mandibular growth deficiency. We present a case of temporomandibular joint ankylosis associated with severe mandibular asymmetry treated by mandibular bone distraction performed under computer assistance. A 27-year-old patient presented with a severe facial asymmetry consisting in hypoplasia of the left hemi-mandible and maxilla. Mouth opening was non-existent. The CT-scan showed a left temporomandibular ankylosis. A left mandibular distraction was decided. The distraction characteristics (choice and positioning of the distractor, axis and amount of distraction) were determined preoperatively on the 3D CT-scan. The planning has been transferred to a navigation console (Kolibri®, Brainlab®). A combined intraoral and cutaneous was performed. Navigation allowed for an appropriate placement of the osteotomy line and fixation of the distractor. Distraction was started at the 5th postoperative day at the rate of 1mm per day and lasted 25 days without complication. 3D planning allows for better indication setting, better preparation of the procedure, reducing complications and operative time. It may help as an educational tool for young surgeons and for a better understanding from the patient. Navigation is an accurate method for the transfer of the planning in the operation room.

Evaluation of panoramic radiographs taken from 1,056 Turkish children.

Panoramic radiographs (PRs) play an important role in the diagnosis and treatment planning of a wide range of dental and maxillofacial diseases and conditions. To examine and to determine the status of oral lesions, dental anomalies and pathologies in panoramic radiographs, which were taken at the department of pediatric dentistry, Dental School, Marmara University, Istanbul, Turkey. This retrospective study consists of 1,056 randomly selected PRs of children aged from 4 to 12 years old, conducted at the department of pediatric dentistry at Dental School, Marmara University, between 5 th December 2011 and 17 th January 2012. The following information was obtained from the patients' records and PRs: Gender, age, presence or absence of oral lesions, dental anomalies and pathologies such as mesiodentes, supernumerary teeth, odontoma, radicular cyst, impacted tooth, and fusion. One thousand and fifty-six PRs from 520 girls and 536 boys were observed. The mean and standard deviation age of the patients was 8.43 ± 2.17. Among 1,056 patients, 457 (43.28%) of them had oral lesions, discovered by the PRs. The age of these 457 patients was ranged from 4 to 12 years. There were 37 (3.50%) mesiodentes, 9 (0.85%) supernumerary teeth, 4 (0.38%) odontoma, 12 (1.14%) radicular cyst, 16 (1.52%) impacted tooth, and 20 (1.89%) fusion. Oral lesions with a rate of 43.28% could be detected relatively at early age, as presented in the present study. Early treatment of these lesions, dental anomalies, and pathologies could avoid maxillofacial deformity and other complications.

Psychologic Health Status of Patients Undergoing Orthognathic Surgery

The appearance and dysfunction of deformities may cause psychologic disorders in patients. The aim of this study was to assess the psychologic health status of patients undergoing orthognathic surgery and its relationship with demographic characteristics, social activityof the individuals, and severity of maxillofacial deformity. As a tool for assessing the psychologic health status, the Symptom Checklist-90 (SCL-90) questionnaire was used on 318 patients undergoing orthognathic surgery at the Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, China from January 2006 to November 2012. t-Test was used to compare the psychologic health status between the 318 patients and 200 healthy volunteers. Variance analysis (analysis of variance) was applied for assessing the relationship between the psychologic health status and the variables of the study. The SCL-90 total score of the patients undergoing orthognathic surgery was higher than that of the healthy volunteers (P < 0.05). Results of the t-test revealed statistically significant difference (P < 0.05) in the symptom dimensions of obsessive-compulsive, interpersonal sensitivity, depression, and paranoid ideation. An association between sex and the SCL-90 total score was observed (F = 11.293; P = 0.001 and P <0.05). The patients who had regular work presented better psychological health status than did the patients who had no regular work (F = 8.008; P = 0.005 and P < 0.05). The patients who received comfort from family and relatives presented better psychological health status than did the patients who did not receive such help (F = 10.064; P = 0.002 and P < 0.05). The patients who received economic help from family and relatives presented better psychological health status than did the patients who did not receive such help (F = 9.789; P = 0.002 and P < 0.05). An association was found between severity of deformity and psychologic health (F = 6.394; P = 0.002 and P < 0.05). Patients with jaw deformity have significant psychologic problems and their psychologic health is affected by demographic characteristics, social activity of individuals, and severity of maxillofacial deformity.

Evaluation of the Mandibular Split Patterns in Sagittal Split Ramus Osteotomy

To evaluate the split patterns of the mandibular ramus in sagittal split ramus osteotomy (SSRO) using cone-beam computed tomography (CBCT) and examine the related anatomic features that may be associated with these split patterns. The authors designed and implemented a retrospective cohort study and enrolled a sample composed of consecutive patients with different maxillofacial deformities who underwent an SSRO from July 2011 through October 2012 at the Department of Orthognathic Surgery at the Tianjin Stomatological Hospital of Nankai University. The split patterns, which were selected at random at 1 side per patient, were evaluated by CBCT as the outcome variable 1 month after the operation. The predictor variable was composed of a set of heterogeneous anatomic variables that could be associated with the split patterns. Type I split was defined as a split at the lingual side near the mylohyoid sulcus. Type II split was defined as a split at the posterior border of the mandibular ramus. Appropriate bivariate and regression statistics were computed, and the level of statistical significance was set at a P value less than .05. One hundred thirty patients with different maxillofacial deformities (62 male and 68 female; mean age, 23 yr) underwent an SSRO. Two types of split patterns of the mandibular ramus were observed in SSRO: a split at the lingual side near the mylohyoid sulcus, which occurred in 75.38% of patients, and split at the posterior border region of the mandibular ramus, which occurred in 24.62% of patients. No fracture lines were observed through the mandibular canal. The thickness of the lingual cortical bone between the mandibular canal and the posterior border of the ramus was significantly associated with the split patterns (P < .05). The thickness of the cortical bone in the posterior border of the ramus, the degree of the mandibular angle, and the shapes of the mandibular ramus in the axial plane also were found to influence these split patterns. There was no meaningful association between the split patterns and a patient's age and gender. The split patterns of the mandibular ramus during SSRO were influenced by some anatomic features of the mandibular ramus. Therefore, examining the anatomy of the mandible with CBCT before surgery may play an important role in predicting the split patterns of the mandibular ramus during SSRO.

Application of porous hydroxyapatite blocks for maxillofacial deformities

Background In maxillofacial fields, concave deformity often requires hard tissue augmentation. Various types of materials are used for facial augmentation: Hydroxyapatite is the most ideal material because of its remarkable biocompatibility and ability to maintain the desired form for a long period. This article describes a simple surgical procedure to augment facial concavity with porous hydroxyapatite block (pHA-B) and its clinical applications and potential complications.

A New Method of Surgical Navigation for Orthognathic Surgery

In bimaxillary orthognathic surgery, the positioning of the maxilla and the mandible is typically accomplished via 2-splint technique, which may be the sources of several types of inaccuracy. To overcome the limitations of the 2-splint technique, we developed a new navigation method, which guided the surgeon to free-hand reposition the maxillomandibular complex as a whole intraoperatively, without the intermediate splint. In this preliminary study, the feasibility was demonstrated. Five patients with dental maxillofacial deformities were enrolled. Before the surgery, 3-dimensional planning was conducted and imported into a navigation system. During the operation, a tracker was connected to the osteotomized maxillomandibular complex via a splint. The navigation system tracked the movement of the complex and displayed it on the screen in real time to guide the surgeon to reposition the complex. The postoperative result was compared with the plan by analyzing the measured distances between the maxillary landmarks and reference planes, as determined from computed tomography data. The mean absolute errors of the maxillary position were clinically acceptable (<1.0 mm). Preoperative preparation time was reduced to 100 minutes on average. All patients were satisfied with the aesthetic results. This navigation method without intraoperative image registration provided a feasible means of transferring virtual planning to the real orthognathic surgery. The real-time position of the maxillomandibular complex was displayed on a monitor to visually guide the surgeon to reposition the complex. In this method, the traditional model surgery and the intermediate splint were discarded, and the preoperative preparation was simplified.

Applications of Coronoid Process as a Bone Graft in Maxillofacial Surgery

The coronoid process can be easily harvested as a donor bone by an intraoral approach during many maxillofacial surgery procedures. The purpose of this study was to evaluate the utility of autogenous coronoid process bone grafts for maxillofacial reconstructive surgery. Twelve patients, who underwent coronoid process grafts for reconstruction of maxillofacial deformities due to trauma, alveolar atrophy, or temporomandibular joint ankylosis, were included in the study. There were 3 orbital defects after extended maxillectomy, 1 blowout fracture of the orbit, 2 cases of reconstruction after temporomandibular joint ankylosis surgery, 1 case of additional chin augmentation following horizontal flip genioplasty, 1 defect of anterior wall of maxilla due to trauma, 2 mandibular defects, and 2 cases of bone augmentation for implants.We recommend the use of coronoid process of the mandible as a source for autogenous bone graft as it can provide sufficient bone in quantity and quality for selected maxillofacial reconstructions.

Evaluation of Titanium Plate after Osteotomy Associated with Maxillofacial Deformity

Evaluation of Titanium Plate after Osteotomy Associated with Maxillofacial Deformity

Parry–Romberg syndrome with rare maxillofacial deformities: A report on two cases

Parry–Romberg syndrome, also known as progressive hemifacial atrophy, is a rare developmental disorder characterized by progressing unilateral facial atrophy slowly, which may affect the skin, fat, muscle and bone. It can also be associated with different systemic manifestations and deformities. In this article, we present the two cases with Parry–Romberg syndrome. Of them, one has additional and rare facial deformity with rare facial cleft and the other has a special tongue feature.