21st ICOMS 2013—Abstracts: Oral Papers 1211

Patients and method: The objective of the study was to com-pare the fronto-orbital advancement, airway and occlusion ofpatients treated by these two surgical techniques. The measureswere taken pre and postoperative in 6 children operated by bonedistraction and 3 by fronto-orbital advancement on a single time.

Results: The three children treated by fronto-orbital advance-ment are awaiting new surgery of the third half because of themaxila hypoplasia with recurrence of the proptosis since theadvance was less than using bone distraction. In the intervenedgroup through distraction three of them are waiting new surgerybecause the recurrence of the malocclusion in class III in any casethere was significant ostoperative complications.

Conclusions: The multidisciplinary management of thesepatients is important to make a proper diagnosis, planning of eachcase each time with more sophisticated radio-diagnostic tech-niques. It is essential to determine the ideal timing for surgery,the surgical technique (increasingly more distraction), vector ofdistraction and finally not to forget the alteration of the growthof these children who very likely require further surgery in mostcases.

http://dx.doi.org/10.1016/j.ijom.2013.07.141

T6.OR011

Modified Le Fort III osteotomy for maxillomandibular dis-traction on a patient with progressive facial hemiatrophysyndrome

D. Cortes 3,∗, R. Torrealba 2, R. Farina 1, L. Canto 4

1 Hospital del Salvador, Santiago, Chile2 Hospital de Carabineros de Chile, Santiago, Chile3 Hospital Base, Puerto Montt, Chile4 Universidad de Chile, Santiago, Chile

Background and objectives: Progressive Facial HemiatrophySyndrome (PFH) is characterized by a slow progressive atrophythat appears in early stages of life, affecting the subcutaneoustissue and subjacent fat and, in most serious cases comprises themaxillofacial skeleton on 1 side of the face. Numerous techniqueshave been described to improve facial contour, however, there isno consensus in the literature concerning treatment. The aim ofthis work is to present an alternative for treatment of the skeletalasymmetry in a patient with PFH based on a maxillomandibulardistraction using a modified Le Fort III osteotomy.

Patient and method: A 15-year-old male patient with a severePFH was admitted to the oral and maxillofacial surgery departmentof the Exequiel Gonzalez Cortes Children Hospital, Santiago,Chile. A modified Le Fort III osteotomy was done on the leftside via an intraoral and a transconjunctival approach with lateralcanthotomy and a Le Fort I osteotomy on the right side. A hori-zontal mandibular osteotomy on the left side was performed fixingat the same time a bone distractor. Then, with maxillomandibularfixation, the distrator was activated until the maxillae reached aright position. This allowed to achieve a mid and low facial bonedistraction in the vertical and sagittal plane.

Results: The outcome of this treatment was an optimal bonecontour of the facial skeleton after 20 mm bone distraction and fiveweeks of contention period. The horizontalization of the occlusalplane, an equal position of mandibular angles in the vertical planeand pogonion sagittal projection was achieved.

Conclusions: The mid and low facial bone distraction witha modified Le fort III osteotomy combined with a mandibulardistraction is a good alternative to correct skeletal atrophy in severecases of PFH.

Key words: modified Le Fort III; Parry–Romberg syndrome;maxillomandibular distraction

http://dx.doi.org/10.1016/j.ijom.2013.07.142

T6.OR012

Long term assessment of craniofacial morphology aftermaxillo-mandibular rotation in long face syndrome associatedwith skeletal class II patients

J. Cortés 1,∗, M. Pizarro 1, C. Collao 2, L. Córdova 3

1 Department of oral and maxillofacial surgery, Universidad deChile, Santiago, Chile2 Maxillofacial Surgery Unit, San Borja-Arriarán Clinical Hospi-tal, Santiago, Chile3 Service de Stomatología et Chirurgie Maxillofaciale, CentreHospitalier Universitaire Hotel-Dieu, Nantes, France

Background: The long face syndrome is considered a particu-lar dentofacial deformity characterized by an increase of anteriorfacial height generally associated to retrognathia. This conditioninvolves a severe functional compromise and constitutes a greatchallenge for the treatment. Its pathogenesis is poorly understoodand there are few long-term reports of this particular entity. Theanalyze of clinical and morphological features seems to be anessential step in order to refine the indication of surgical tech-niques.

Materials and methods: This retrospective case series include35 adults, 30 females and 5 males, with a diagnosis of longfaces syndrome associated to skeletal class II who underwentorthodontic-surgical treatment between 1994 and 2011. All caseswere treated by surgical maxilla-mandibular counter clockwise-rotation and genioplasty. Lateral cephalogram of all patientsbefore and after surgery were obtained, and Delaire cephalometricanalysis was conducted for all. The indexes of craniofacial struc-tures were analyzed and compared between pre and post-surgicalprocedure.

Conclusions: Were achieved postoperative radiographicchecks in different periods, ranging from 5 to 17 years of evo-lution. Significant improvement of vertical and sagittal structuralbalance of the craniofacial complex was observed after treatment.

Key words: class II; orthognathic surgery

http://dx.doi.org/10.1016/j.ijom.2013.07.143

T6.OR013

Mandibular movement restoration through bilateral coro-noidectomy by intraoral approach

M. Dag ∗, U. Karacayli, R. Koymen

Gulhane Military Medicine Academy, Department of Oral andMaxillofacial Surgery, Turkey

Background and objective: The coronoid process hyperplasiais an uncommon finding in the literature. It is characterized by anenlargement of the coronoid process, causing a mechanical obsta-cle by interposition of this structure in the posterior portion of themaxilla or zygomatic arch, resulting in limitation of mandibularopening, pain and trismus.

Case: A 21-year old man presented to The Department ofOral and Maxillofacial Surgery, complaining of limited mouthopening. During patient assessment, the individual did not reportany alterations in his medical history, including systemic or

1212 21st ICOMS 2013—Abstracts: Oral Papers

endocrine disorders and haematologic alterations or allergies, andno signs of coronoid hyperplasia were present in his family history.Gene examination for differential diagnosis from Jacob syndromeshowed that the patient have normal karyotype. Mouth openingwas equivalent to 19 mm. Computed tomography with three-dimensional reconstruction was required, and an enlargement ofthe coronoid process was observed bilaterally. Under general anes-thesia with nasotracheal intubation, the coronoid processes on bothsides were removed by intraoral approach.

Result: In the immediate postoperative period, an evidentimprovement in the buccal opening was observed with 33 mm.After one month a mucofibrotic band from mandibular posteiorbuccal mocosa to maxillar side was detected and cut. The lastmouth opening was equivalent to 35.5 mm.

Discussion and conclusion: To clarify the diagnosis, conven-tional imaging examinations can be used; however, because ofthe superimposition of the anatomic structures caused by its bidi-mensional image. Many theories have been described aiming atclarifying the origin of the coronoid process hyperplasia, such astemporal muscle hyperactivity, previous facial trauma, presenceof hormonal alterations in puberty, family history. This also can berelated to Jacob’s disease, which is characterized by elongation ofthe coronoid process and temporomandibular joint dysfunction.Treatment is exclusively surgical.

http://dx.doi.org/10.1016/j.ijom.2013.07.144

T6.OR014

Virtual planification for mandible distraction in congenitalcraniomaxillofacial deformities

D. Dominguez Medina ∗, I. García Recuero, A. Romance García

Hospital 12 De Octubre, Spain

Background: Distraction osteogenesis (DO) as a treatment forpediatric craniomaxillofacial deformities enhances the patient’stypical restricted facial growth potential. Virtually planned tridi-mensional models are useful to design osteotomy’s location,vector’s direction and to chose the appropriate distraction device.

Methods: Retrospective analysis of 10 cases (mean 12.7 years)treated at our service between 2011 and 2012, that underwentmandibular distraction using esterolithographic models. Preoper-atively, the information obtained from high definition CT scansin DICOM format was transferred for virtual simulation withMATERIALISE and esterolithographic models were built. Inter-nal approach was performed in 60% of the cases, external andcombined were performed in 20%, respectively. External multi-vectorial devices were placed in 2 patients and internal in 8. Thedistraction rate was 0.66–1 mm/day. Certain degree of overcor-rection was pursued. The consolidation period was 3.75 months.Postoperatively, cephalometric analysis was performed to assessthe elongation obtained and clinical evaluation reported the occlu-sion type and facial symmetry improvement. The final results werecompared with predicted ones by measuring their concordance.

Results: The mandible elongation mean was 22.8 mm (unilat-eral cases 26.4 mm and in bilateral cases at least one side wasdistracted 20 mm), the distraction was considered satisfactory in90% of the cases; the rate of major complications was 10%. Thevector’s direction was considered adecuate in 100% of the cases.

Conclusions: Surgeon’s experience, intrinsic growth restric-tion of these patients, effect of muscle forces, fulfillment oforthodontic treatment and technical limitations of the devices arethe main factors that might influence the discrepancies between

the planification and the final results. These outcomes improvethose obtained traditionally however they still do not assure thetreatment success.

Key words: virtual planification; distraction osteogenesis; con-genital deformities

http://dx.doi.org/10.1016/j.ijom.2013.07.145

T6.OR015

Early mandibular distraction osteogenesis in neonates andpaediatric age

M. Galie ∗, L. Clauser

Unit of Cranio-maxillo-facial Surgery, Italy

Background: Distraction osteogenesis has been one of themost innovative concepts in craniomaxillofacial surgery throughthe last 25 years. Technology has evolved from the first appli-cation of external devices to intraoral and hybrid or semiburiedtechniques. After a quarter of century of extensive use Distrac-tion Osteogenesis has today specific indications for congenitalcraniofacial and cleft deformities.

Methods: Seven infants with craniofacial syndromes andsyndromic micrognathia underwent mandibular lengthening inneonatal age or during growth: 3 Pierre Robin Sequences (PRS),1 Cerebro-Costo-Mandibular Syndrome (CCMS), 1 AuriculoCondylar Syndrome (ACS), 1 Craniofacial Microsomia–TessierCleft 7 (CFM), 1 Treacher–Collins Syndrome (TCS). All patientswere evaluated by a multidisciplinary team, included fibroscopicassessment.

Results: Pre-distraction and post- distraction lateral CT scansdemonstrated the significative improvement in the airway space.PRS babies were early decannulated after distraction. Improve-ment in feeding was seen following mandibular distraction andthe nasogastric tube was removed. Direct visualization with flex-ible endoscope demonstrated the airway changes. The baby withCCMS and TMJ ankylosis still has deglutitory problem and tra-cheostomy for airways protection. The mean advancement of theTCS, OAS and CFM cases was 18 mm, with changes in maxillo-mandibular relationships and a slight overcorrection.

Conclusions: Mandibular distraction osteogenesis in theneonates with PRS is an effective treatment option to safely relievethe upper airway obstruction associated with micrognathia. Forselected newborns, mandibular DO will allow for avoidance of atracheostomy and improved oral feeding. A careful evaluation ofthe patient’s airway and feeding must be performed and evaluatedby a multidisciplinary Team approach. In syndromic micrognathiaearly mandibular distraction seems to be an appropriate indication.Benefits are functional, morphological, aesthetic with consistentpsychological and familiar positive effects.

http://dx.doi.org/10.1016/j.ijom.2013.07.146

T6.OR016

Posterior cranial vault expansion with resorbables distractorsin syndromic patients

Garcia Recuero ∗, H.B. Jose, R.G. Ana, M. Maria Jesus, F.U.Maria Isabel, P. Beatriz

H.U. 12 De Octubre, Madrid, Spain

Introduction: Posterior vault remodelation can preventintracranial hypertension, improve the Chiari malformation con-