Mandibular Deformity Correction by Distraction Osteogenesis

Distraction osteogenesis (DO) is a biological process of new bone formation. It could be used as an alternative treatment method for the correction of mandibular hypoplastic deformity. Modern distraction osteogenesis evolved primarily from the work of Gavriel llizarov. DO has been first applied to craniofacial region since McCarthy et al. In this case report, the patient was 17 years old male with bird face deformity due to hypoplasia of mandible resulted from bilateral TMJ ankylosis due to the fracture of both condyle at the age of 4 years. Patient’s intraincisal opening was absent 1 year back. He underwent condylectomy in both sides to release the ankylosis and to increase intraincisal opening. His mandibular length was markedly short. To increase his mandibular antero-posterior length, mandibular body distraction was done in Oral and Maxillofacial Surgery department, BSMMU. Through this procedure length of the body of mandibule was increased by 10 mm, occlusion was edge to edge and his lower facial appearance increased markedly. Mandibular body distraction osteogenesis was considerably effective when performed in a hypoplastic mandible to facilitate post-operative functional and esthetic restoration. Long term follow-up is necessary to evaluate relapse and complications. DOI: 10.3329/bsmmuj.v3i2.7061BSMMU J 2010; 3(2): 103-10

Reconstruction of the adult hemifacial microsomia patient with temporomandibular joint total joint prosthesis and orthognathic surgery

HFM patients' reconstruction has always been a challenge for maxillofacial surgeons, and numerous reconstructive techniques have been described. Surgical treatment depends on the patient's age and contemplates Temporomandibular Joint (TMJ) reconstruction in conjunction with orthognathic surgery, usually necessary following completion of growth to maximize the functional and esthetic results. Distraction osteogenesis had gained popularity as valid alternative in growing patients, but the two primary methods to reconstruct the TMJs involve the use of autogenous, using free or microvascular bone grafts, or alloplastic graft, but there is no widely accepted method

3D-printing techniques in a medical setting : a systematic literature review

Background: Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. Methods: Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. Results: 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. Conclusion: 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D- printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis

Development of a Personalised 3D Mandibular Distraction Device for the Management of Craniofacial Microsomia

Introduction: Surgical correction of the facial skeleton in deformity has evolved significantly over the recent past as techniques and technology have improved. Where there exist significant skeletal discrepancies, large skeletal changes are required and there remains a need to further improve upon our current standard to achieve these surgical goals. Distraction osteogenesis (DO) is a technique that induces bone formation without the need for bone grafting and allows for guided shape change in addition to expanding the overlying tissue envelope. Current mandibular distractors are limited as they are bulky; there are wound problems related to the external siting of the actuator; there is a limited geometry of possible distraction; the final result is unpredictable; they function in a discontinuous rather than continuous motion and they require daily winding by the patient. There exists a clear potential benefit to patients should these drawbacks be overcome. Aim: The aim of the project is to design a novel device to modify the shape of the deformed jaw to a prescribed, predetermined shape that is specific to the patient and that does not require external manipulation. Methods: The mechanical properties of helical springs constructed from a nonlinear material were tested to review their suitability for use as actuators to deliver force in a fully buried continuous distractor. A finite element model was then created to generalise the concept for use where different forces may be required. Lastly a prototype was designed and empirically tested ex-vivo to assess whether the aims of the project were fulfilled. Results: The nonlinear material was found to deliver adequate, continuous and relatively constant force over a distance in keeping with DO. The finite element model was demonstrated to accurately represent the empirical properties of the helical spring. The prototype designed was able to modify the shape of a deformed jaw to a predetermined position without requiring external manipulation in a surgical model. Discussion: This project develops and tests a prototype that is fully buried and can achieve multiplanar continuous DO without the need for patient involvement and therefore provides novel technology as a solution to improving practice

Management Of Bilateral Temporomandibular Joint Ankylosis With Micrognathia And Obstructive Sleep Apnea Syndrome Using Interpositional Arthroplasty And Distraction Osteogenesis – A Case Report

Temporomandibular joint (TMJ) Ankylosis posses many problems like inability to open the mouth, poor oral hygiene, difficulty in eating proper food, unaesthetic appearance due to growth retardation and in severe cases difficulty in breathing specially during night depending on the time of occurance of injury. If the TMJ Ankylosis occurs the early stage of life it affects both the form and function of the patient. One of the most common treatments used to treat temporomandibular joint (TMJ) ankylosis is interpositional arthroplasty (IPA). When patients come with severe mandibular dysplasia either orthognathic surgery or distraction osteogenesis (DO) can be considered. Simultaneous IPA with DO has been used by many surgeons correct TMJ ankylosis associated with facial asymmetry/micrognathia as as it enables them to simultaneously reconstruct the neocondyle and correct facial malformations eliminating the need for second surgery. Here we have narrated a case of an young male patient suffering from bilateral TMJ Ankylosis with micrognathia treated by simultaneous IPA and DO and regular follow up was done.   &nbsp

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): Guidelines for medical 3D printing and appropriateness for clinical scenarios

Este número da revista Cadernos de Estudos Sociais estava em organização quando fomos colhidos pela morte do sociólogo Ernesto Laclau. Seu falecimento em 13 de abril de 2014 surpreendeu a todos, e particularmente ao editor Joanildo Burity, que foi seu orientando de doutorado na University of Essex, Inglaterra, e que recentemente o trouxe à Fundação Joaquim Nabuco para uma palestra, permitindo que muitos pudessem dialogar com um dos grandes intelectuais latinoamericanos contemporâneos. Assim, buscamos fazer uma homenagem ao sociólogo argentino publicando uma entrevista inédita concedida durante a sua passagem pelo Recife, em 2013, encerrando essa revista com uma sessão especial sobre a sua trajetória