Hemifacial Microsomia: A Mini-Review and Case Report

Objectives Hemifacial microsomia (HFM) is an asymmetric craniofacial malformation, which results from hypoplasia of the first and second branchial arch components and is characterized by a wide spectrum of phenotypic expressions, varying from the underdevelopment of the temporomandibular joint, mandible, facial and trigeminal nerves, masticatory muscles, ears, and hypoplastic maxillary, temporal, orbital, and zygomatic bones to conductive hearing loss due to external and middle ear deformities. Management of this developmental defect is multidisciplinary and associated with various phenotypic spectra and severities. A wide range of treatment protocols, such as surgical interventions, have been proposed, especially for mandibular hypoplasia, including rib or fibular bone grafting, distraction osteogenesis (DO), orthognathic surgery, and a combination of these procedures. Case In this study, the treatment course and 17-year follow-up of a patient with HFM were described. The treatment included autogenous costochondral grafting, followed by full-time application of an asymmetric hybrid functional appliance, fixed orthodontic therapy, orthognathic surgery, and contour modification surgery to achieve optimal facial aesthetics. Conclusion Patients can benefit from functional jaw orthopedics psychosocially and the consequent enhanced facial symmetry during childhood and adolescence is really advantageous   &nbsp

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

Custom-Made Alloplastic Prosthetic Implant to Treat Temporomandibular Joint Ankylosis in Pediatric Patients: A Case Study

Temporomandibular Joint (TMJ) ankylosis represents a fairly common condition which surgeons need to face. According to Rowe, it can be defined as a restricted functional capacity of the jaw with limited movements owing to bony or fibrous adhesions between the condyle and either glenoid fossa, disc or eminence (or both). It can become a disease which impacts patients' daily life, who suffer from limited mandibular excursion with reduced intercisal opening, anterior open bite, inability to swallow, sleep disorders, and speech problems. In children this may also result in abnormal mandibular and facial growth. In this paper, we deal with the case of a child with an important momolateral ankylosis, previously treated surgically with Costochondral Grafting arthroplasty without success and subsequently treated with a custom-made prosthesis