Visor Osteotomy Research Articles

Coronal Split Corpus Osteotomy of the Mandible: A Modified Visor Osteotomy Technique for Bone Volume Enhancement.

The bony augmentation of severely atrophied mandible is generally required for the purposes of prosthetic rehabilitations. The treatment strategies have been well defined in the literature ranging from osteotomy techniques to distraction osteogenesis. Visor osteotomy is the milestone of the reconstructive surgery for the atrophied mandible which has received some modifications. In the present study, the authors describe a new modification of visor osteotomy in which a complete coronal split osteotomy down to the inferior border at the mental region has been performed. The main advantage of this modification is to preserve the lingual cortex from the inferior border of the mandible up to the alveolar region without disturbance of the suprahyoid muscle attachments. The procedure is thought to be a "highly sensitive" one and undesired fractures may occur during splitting of the bony segments.

Rehabilitation of severely resorbed edentulous mandible using the modified visor osteotomy technique

The prosthetic rehabilitation of an atrophic mandible is usually unsatisfactory due to the lack of support tissues, mainly bone and keratinized mucosa for treatment with osseointegrated implants or even conventional prosthesis. The prosthetic instability leads to social and functional limitations and chronic physical trauma decreasing the patient's quality of life. A 53-year-old female patient sought care at our surgical service complaining of impairment of her masticatory function associated with the instability of the lower total prosthetic denture. The clinical and complementary exams revealed edentulism in both arches, while the mandibular arch presented severe reabsorption resulting in denture instability and chronic trauma to the oral mucosa. The proposed treatment plan consisted in the mandibular rehabilitation with osseointegrated implants and fixed Brånemark's protocol prosthesis after mandibular reconstruction applying the modified visor osteotomy technique. The proposed technique offered predictable results for reconstruction of the severely resorbed edentulous mandible and posterior rehabilitation with osseointegrated implants.

Subject index

Techniques for advancing the base of tongue and modifying the hypopharyngeal airway in obstructive sleep apnea have undergone various modifications since they were first described by Powell and Riley. The purpose of this article is to describe an advancement procedure for the genioglossus muscle utilizing a three-piece anterior visor osteotomy of the mandible as an adjunctive procedure for improving the hypopharyngeal airway in obstructive sleep apnea.

A novel three-piece anterior mandibular visor osteotomy for genioglossus advancement in surgery for obstructive sleep apnea

Techniques for advancing the base of tongue and modifying the hypopharyngeal airway in obstructive sleep apnea have undergone various modifications since they were first described by Powell and Riley. The purpose of this article is to describe an advancement procedure for the genioglossus muscle utilizing a three-piece anterior visor osteotomy of the mandible as an adjunctive procedure for improving the hypopharyngeal airway in obstructive sleep apnea.

The transmandibular implant

During the period from August 1976 until July 1989 the transmandibular implant was introduced in a total of 31 oral and maxillofacial surgery departments in the Netherlands and 1,466 patients were treated. This study includes 1,356 treated patients from 28 departments. The treatment course of 1,201 patients (89.6%) was uneventful. Of the 157 complications, 58 related to the anatomic contour of the mandible, 49 to the surgery, 25 to the prosthetic reconstruction, 8 to the psychosocial attitude of the patient, 8 to the use of medication, 5 to trauma, and 4 to the presence of a skin graft. Treatment of the complications included removal of the implant in 44 patients; in 106 patients the complication was treated satisfactorily. In the remaining 7 patients, hypesthesia was present. The reasons for the removal of the 44 implants were infection (11), operative error (5), premature loading of the implant (3), insufficient width of the mandible after a visor osteotomy (1), loss of osseointegration caused by the prosthesis (14), psychological problems (4), trauma (3), drug-related gingival hyperplasia (2), and inexplicable pain (1). The present survey shows a consistent success rate of 96.8%.

The transmandibular implant: A 13-year survey of its use

During the period from August 1976 until July 1989 the transmandibular implant was introduced in a total of 31 oral and maxillofacial surgery departments in the Netherlands and 1,466 patients were treated. This study includes 1,356 treated patients from 28 departments. The treatment course of 1,201 patients (89.6%) was uneventful. Of the 157 complications, 58 related to the anatomic contour of the mandible, 49 to the surgery, 25 to the prosthetic reconstruction, 8 to the psychosocial attitude of the patient, 8 to the use of medication, 5 to trauma, and 4 to the presence of a skin graft. Treatment of the complications included removal of the implant in 44 patients; in 106 patients the complication was treated satisfactorily. In the remaining 7 patients, hypesthesia was present. The reasons for the removal of the 44 implants were infection (11), operative error (5), premature loading of the implant (3), insufficient width of the mandible after a visor osteotomy (1), loss of osseointegration caused by the prosthesis (14), psychological problems (4), trauma (3), drug-related gingival hyperplasia (2), and inexplicable pain (1). The present survey shows a consistent success rate of 96.8%.

バイザー骨切り術にか粒状ＨＡＰ填入を併用した歯槽堤形成術の１例

バイザー骨切り術にか粒状ＨＡＰ填入を併用した歯槽堤形成術の１例

Long-term results of mandibular ridge augmentation by visor osteotomy with bone graft.

Visor osteotomies of various designs, supplemented with illiac bone grafts, were used to augment 63 cases of severely atrophic mandibles. The rate of resorption measured on lateral cephalograms was 28% after four years, with the best performance by the full visor with peripheral bone graft (PA), and the worst by the short visor with onlayed bone graft posteriorly (PO). Ridge forms were usually inverted V-shaped or inverted U-shaped, but occasionally comma-shaped, the best form for providing retentive qualities for the denture. Only 39% were free of neurosensory problems. It was concluded that indications for such a procedure should be viewed in the light of frequent nerve injuries, adverses patterns of resorption for denture retention and newer and more effective methods for ridge augmentation using hydroxylapatite.

Visor osteotomy augmentation of the mandible with posterior onlay bone graft or with hydroxylapatite: A comparative study

A frequent and severe ridge atrophy, the anterior spheroid basal bone with posterior bilateral concavities of the mandible, has been defined. Two groups of sixteen patients who had residual ridge augmentation of the mandible with two different techniques were studied. The visor osteotomy with posterior hydroxylapatite was superior to the visor with posterior onlay bone graft in terms of ridge form, bone resorption, patient satisfaction, and neurosensory disturbances. Nevertheless, there remained some problems of anterior resorption and backward rotation of the visor segment for both techniques and of posterior resorption with the partial onlay bone graft.

Mandibular ridge augmentation by visor osteotomy combined with a subperiosteal rib graft

A technique is described of true rebuilding of the mandibular crest using a combination of the visor-osteotomy (Härle, 1975) and a subperiosteal rib graft (Obwegeser, 1963 b). A preliminary report on 25 patients with a mean follow-up of 30 months leads to the following conclusions: the resorption in the anterior part ist 52% of the initial gain after 43 months. In the lateral regions 61% is lost. This compares favourably with other techniques. Impairment of sensibility, although usually acceptable, is the main drawback of the procedure.

高度な上下がく歯そう堤い縮症例の１経験

Surgical augmentation for atrophic redidual ridge is one of the ultimate preprosthetic procedures facilitating an “ideal” denture construction.In this paper, we present a 50-year-old female treated with surgical ridge augmentation of both jaws, who worried about excessive denture mobility. We apllied Le Fort I osteotomy with interpositional bone grafting and vestibuloplasty to maxilla. During 2 years following the operation minimal positional change of bone segment and alveolar resorption occured. In mandible, modified Harle's visor osteotomy and inferior (submental) border bone grafting in combination with vestibuloplasty using skin graft were adopted. The results were very stable the first 6 months after augmentation, but from 6 months to 2 years posterior alveolar ridges improved by visor osteotomy relapsed to pre-operative level and anterior vertical height increased by inferior border bone graft was reduced to 62 percent. Now the patient is almost satisfied with acceptable dentures without any surgical complications such as TMJ problems or neural damage.

Alveolar ridge augmentation using nonresorbable hydroxylapatite with or without autogenous cancellous bone

A four-year prospective evaluation of the use of nonresorbable, particulate hydroxylapatite (HA) to augment deficient alveolar ridges was performed. The material was used alone and in combination with finely crushed autogenous cancellous bone. Implants were delivered subperiosteally by syringe injection, usually using local anesthesia for Class I to Class III ridges and general anesthesia for Class III and Class IV ridges. The improved ridge height and width were stable. Postoperative resorption with significant loss of ridge height, frequently seen with rib and iliac crest onlayed grafts, was not observed with HA augmentation. Permanent denture construction began as early as three weeks postoperatively and by four to six weeks if HA was combined with autogenous cancellous bone. It was possible to place mandibular staple implants simultaneously or following HA augmentation. Visor osteotomy techniques were improved by use of HA to produce a wider, more convex stable ridge. Although skin, mucosa, or dermal vestibuloplasties were performed as early as three months postoperatively in a small number of patients, there appeared to be a lesser need for vestibuloplasty after HA augmentation than after onlay bone grafting. In addition, prosthodontists performed fewer denture relines after HA augmentation than after onlay bone grafts. The authors believe the most significant factor accounting for these observations is the firm, nonmobile mucosal base resulting from augmentation with HA. The resultant stable, soft tissue base and improved ridge height and contour have contributed to a comfortable, retentive, stable denture for these patients. The prosthetic and surgical procedures are easier to perform and have produced superior, more permanent results than onlay bone grafts and alloplasts. Preliminary studies also point to exciting possibilities for use of HA as a bone substitute/marrow extender in maxillary and mandibular defects, cysts, and clefts and in osteotomies for orthognathic surgery.

Augmentation of the mandibular residual ridge by a modified visor osteotomy

Augmentation procedures for the atrophic mandibular residual ridge have undergone rapid and dramatic changes since Harle’ proposed in 1975 that a vital, pedicled bone flap be elevated for this purpose, in contradistinction to the now classic free onlay bone graft procedure described by Davis et al3 in 1970. Since Harle’s publication, several moditications of the operation have been proposed,4-‘3 all of which have in common a soft tissue vascular pedicle, which presumably maintains the viability of the elevated segment. The purpose of this report is to present the longer-term results of a modified visor osteotomy procedure presented in 1977,’ changes in the procedure now recommended, and problems occasionally encountered.

The mandibular orthopedic bone staple in the treatment of the atrophic mandible

Postoperative clinical findings of the mandibular orthopedic bone staple have been essentially positive, from both the dentist's and the patient's viewpoint. The mandibular bone staple is a technically feasible procedure with a minimal morbidity, an acceptable operating time, excellent stability, good retention, minimal physiological insult, and a high degree of patient acceptance. Postoperative alveolar ridge height seems to be stabilized by the technique. It should be considered in the rehabilitation of the atrophic, edentulous mandible, especially for those patients with significant systemic diseases who might not be suitable candidates for more extensive procedures such as mandibular bone graft augmentation or visor osteotomy. In addition, another attractive advantage of this technique for the nutritionally deficient patient, is that within 4 weeks of the initiation of treatment the patient can function successfully with a mandibular denture. This can be compared with a minimum 4- to 6-month waiting period described for the patient who had either mandibular bone graft augmentation or visor osteotomy.

Mandibular interpositional and onlay bone grafting for treatment of mandibular bony deficiency in the edentulous patient.

The development of interpositional and onlay bone grafting techniques for atrophic mandibles is reviewed. A further modification of the visor osteotomy is presented along with follow-up evaluation of the conditions of 16 patients. Results of radiographic measurements show the procedure to be stable, vertical resorption of the augmented mandible in the body regions being 11.2% over a mean follow-up of 8.8 months. Neurosensory evaluation showed altered sensation and dysesthesia as a significant problem in these patients. The results are presented and discussed.

Follow-up investigation of reconstruction of the alveolar process in the atrophic mandible

In this article the results are presented of the reconstruction of the alveolar process with iliac crest bone grafts in 14 patients. In all cases in a second operation a vestibuloplasty and a floor-of-mouth plasty was done. After an average follow-up period of 39 months, almost complete resorption of the bone grafts was observed. The clinical results varied. To obtain better results and avoid complications like pain at the donor and graft sites, mental nerve disturbances and other major problems associated with bone grafting, we prefer to perform the visor osteotomy in the future.

Visor osteotomy and vestibuloplasty — a one-stage procedure: A preliminary report

The visor osteotomy as described by Härle 1 gives a considerable increase of the absolute height of the atrophic mandible, between the mental foramina. After 6 weeks a total vestibuloplasty with mucosal grafting (and a lowering of the floor of the mouth) is performed. A method is described in which the visor osteotomy and the vestibuloplasty are performed in one stage.

Visor osteotomy to increase the absolute height of the atrophied mandible: A preliminary report

A method of operation is described whereby the alveolar ridge of the mandible is osteotomised and moved on the principle of a visor. The two parts are fixed together with wires, thus increasing the absolute height of the alveolar ridge of the mandible.