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14 Symposia

f injury is not confined to the paediatricge group.

oi:10.1016/j.ijom.2009.03.066

L13.2anagement strategy for

aso-orbito-ethmoidal fractures. Gabrielli

Oral and Maxillofacial Division, Dentalchool at Araraquara, São Paulo Stateniversity, Brazil

aso-orbito-ethmoidal fractures, whethersolated or as a component of complexacial fractures, are always some of theost challenging skeletal facial injuries to

reat.Traumatic telecanthus is usually the

ominant feature and associated injurieso the frontal sinus are frequent. Possibleunctional and aesthetic sequelae includeelecanthus; impairment or obstructionf lacrimal drainage; nasal deviation orbstruction; enophthalmos, vertical ocu-ar dystopia, limitation of eye movements,iplopia; and sinus pathology amongthers.

Early open treatment is indicated forislocated fractures. Traumatic telecan-hus correction will demand the use ofransnasal wires and canthopexies, and theurgeon has to be familiar with techniquesf orbital and nasal reconstruction, as wells with the management of acute trauma tohe frontal sinus.

This presentation will discuss the cur-ent management of naso-orbito-ethmoidalractures.

oi:10.1016/j.ijom.2009.03.067

L13.3natomic orbital reconstructionnd late correction ofost-traumatic enophthalmos. Zhang

Department of Oral and Maxillofacialurgery, Peking University School andospital of Stomatology, Beijing, China

ackground and Objectives: Correction ofomputer-aided individual shaped-adaptedabricated titanium mesh to mirroring-econstruct orbit is reported to be a promiseethod in correcting posttraumatic enoph-

halmos (En). This presentation is to

emonstrate the application of this tech-ique and evaluate the treatment outcomes.ethods: Twenty one patients withn resulting from the delayed unilat-ral impure orbital fracture are included

in series. Computed tomography-basedmirrored orbit image is prepared foreach to fabricate anatomically adap-tive Ti-mesh by means of computer-aided design/computer-aided manufactur-ing (CAD/CAM) technique. The internalorbit is reconstructed by following surgi-cal procedures: reduction of orbital rimalong with surrounding bones, exposure oforbital defects, reduction of herniated softtissue and insertion of available Ti-meshwith deep extension of mean 29.33 mm.The measurements are performed to assessthe change of En and orbital volume beforeand after surgery. Paired samples t test andPearson’s correlation coefficient were usedfor statistical analysis.Results: The follow-up results demon-strate that En degree decreased to lessthan 2 mm in 11 patients and 2–4 mmin 9 patients. One patient remained Enlarge than 7 mm. Statistical analysisshowed that posttraumatic En in this serieswas 4.05 ± 2.02 mm, which associatedwith orbital volume increment (OVI) of6.61 ± 3.63 cm3 with a regress formulaEn = 0.446 × OVI + 2.406. Orbital recon-struction produced the orbital volumedecrease (OVD) of 4.24 ± 2.41 cm3 andEn correction of 2.01 ± 1.46 mm, regressformula being En = 0.586 × OVD + 0.508.After surgery, 2.03 ± 1.52 mm En wasunresolved and 2.23 ± 2.86 cm3 orbitalvolume expansion (OVE) remained,regress formula being expressed asEn = 0.494 × OVE + 1.415.Conclusions: From the results above it isconcluded that orbital anatomical recon-struction is only expected to reduce thetrauma-induced orbital volume incrementby 65%, and corresponding, correct 50%of severe late En. Additional augmenta-tion of orbital contents is recommended.Four patients in this series received sec-ondary operation and achieved expectedoutcomes.

doi:10.1016/j.ijom.2009.03.068

SL13.4Endoscopic fixation ofsubcondylar fracturesR. GutwaldDepartment of Oral and MaxillofacialSurgery, University Freiburg, Germany

The open treatment of condylar fracturesvia the preauricular, retromandibular and

submandibular approach is routinely per-formed. The disadvantage of the extraoralapproach is possible damage of the facialnerve, the creation of visible scars and sali-vary fistulas.

Using the endoscope superior visibil-ity in areas of limited exposure can beachieved by limited incisions in inconspic-uous areas. Therefore the risk of facialnerve damage is reduced. In our treatmentprotocol the endoscopic-assisted treatmentby transoral approach is the treatment ofchoice. However, in severely dislocatedfractures the extraoral approach is advan-tageous for the reduction of displacedcondylar fractures and especially in caseswith medial override.

Endoscopic techniques are more timeconsuming, however due to a steep learningcurve when using endoscopic instrumentsroutinely this disadvantage can be sig-nificantly reduced. The transoral use ofendoscopes for the control after fracturereduction in areas of limited vision suchas the posterior aspect of the ascendingramus provides further information aboutthe quality of fracture reduction.

The critical evaluation of the resultsafter fracture reduction may help inimproving surgical results and for teachingreasons.

The results after endoscopic-assistedtreatment of more than 100 patients withcondylar fractures have demonstrated theadvantage of the use of endoscopes fortreatment of condylar fractures. The trans-oral endoscopic assisted treatment ofcondylar fractures became a routineprocedure in our clinic.

Refinements of the minimal inva-sive techniques and further developmentof instruments are made in the endo-scopic training laboratories in Davos andFreiburg.

doi:10.1016/j.ijom.2009.03.069

Symposium 14: OrthognathicSurgery 1

SL14.1Planning: why don’t we get itright every time?P. Ward-BoothDepartment of Oral and MaxillofacialSurgery, Queen Victoria Hospital, EastGrinstead, West Sussex, United Kingdom

The evolution of orthognathic surgerysince the pioneers in the 20’s, have cen-tred on achieving a normal occlusion withexcellent inter-digitation. It has evolvedinto a precise surgical procedure, in which

extraordinary accuracy is achieved at thedental/occlusal level.

This is laudable and essential if thesurgery is to be justified, as a functionalexercise in correcting moderate to severe

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alocclusions. It is however well recog-ised that such bony movements producehanges in the soft tissue, and it is in thisrea that planned outcome may not be seens the same predictable satisfactory resulteen at the dental level.

For most patients this is not a prob-em, but for a small number of patients andany surgeons, they rightly feel “could do

etter” would be a fair comment.I hope to show that this important area

an be improved, without over complicat-ng the planning/surgery.

Careful combined orthodontic and sur-gical planning◦ This requires close integration of the

two specialties at the beginning andthroughout the orthodontics.

Being aware of the need to address softtissue problems at the time of the bonesurgery◦ This requires the surgeon to appreci-

ate when adverse soft tissue changesmay occur and how to prevent, butnot make futile attempts to mask thechanges.

oi:10.1016/j.ijom.2009.03.070

L14.2ecent advances in the diagnosisnd management of facialeformities.F. Ayoub

Department of Oral and Maxillofacialurgery, Glasgow University Dentalospital and School, Glasgow, Scotland,nited Kingdom

his presentation will illustrate the com-lexity of dentofacial deformities and theeed for a multidisciplinary approach forhe proper diagnosis and management ofhese cases.

The support obtained from a clinicalsychologist in the assessment and theostsurgical management of facial malfor-ations will be highlighted.

The limitations of the existing methodsf face bow recording and the use of semidjustable articulators will be explained;he advantages and design of a newly devel-ped orthognathic face bow and articulatorill be demonstrated.

The limitations of two-dimensional pre-iction planning using profile photographsnd lateral cephalograph will be presented.

The applications of three-dimensionalmaging to overcome these limitations and

o improve the diagnosis and planningf the surgical correction of craniofacialnomalies will be presented.

oi:10.1016/j.ijom.2009.03.071

Canada). The required osteotomy and

SL14.3Simultaneous orthognathic andnasal surgery: is there a place?E. Ellis IIIDivision of Oral and MaxillofacialSurgery, University of Texas SouthwesternMedical Center, Dallas, Texas, UnitedStates

Facial balance involves components of theupper, middle and lower face. Orthog-nathic surgery can have a dramatic effecton facial aesthetics. Similarly, rhinoplastycan cause a major change in facialappearance. Can, or should simultaneousrhinoplasty and orthognathic surgery beperformed?

There are several advantages to simul-taneous nasal/orthognathic surgery. Bothnasal and jaw problems can be solved inone surgery, making it more convenientfor the patient and reduces the risk ofanaesthesia by having only one anaes-thetic. A single surgery also reduces thecosts.

The disadvantages of simultaneoussurgery include difficulty planning and pre-dicting the outcome, the need to change themethod of intubation during surgery, andthe need for a surgeon capable of perform-ing both procedures, or a team of surgeonsmust be available. Additionally, patientselection becomes extremely important.

Patients requiring mandibular surgeryare ideal candidates for simultaneous nasaland orthognathic surgery. This is similar tothe common performance of simultaneousnasal and genial surgery. The most con-tentious issue is performing simultaneousmaxillary and nasal surgery.

Because the maxilla is the foundationof the nose, treatment planning and patientselection is much more demanding in suchcases. There is no question that there isless predictability of the nasal outcomethan if such cases were performed in iso-lation, with the orthognathic surgery beingperformed first. However, there are somenasal deformities that can predictably beperformed with maxillary (or bimaxillary)surgery.

The nasal deformities that are mostpredictably performed in conjunction withmaxillary surgery are septal problems,nasal humps, asymmetries, saddle noses,and tip malformations. Less predictableare alterations in tip projection androtation.

This lecture will illustrate casesin which nasal surgery was perform-

ed simultaneously with orthognathicsurgery.

doi:10.1016/j.ijom.2009.03.072

Symposia 415

SL14.4Benefits and limitations ofthree-dimensional virtualplanning of orthognathicsurgeryG.R.J. SwennenDivision of Maxillo-Facial Surgery,Department of Surgery, General HospitalSt-Jan Bruges, Ruddershove, Bruges,Belgium; and 3D Facial Imaging ResearchGroup (3D FIRG) Bruges-Nijmegen,Belgium

Recent advances in three-dimensional (3D)medical image computing allow unprece-dented virtual diagnosis, treatment plan-ning and evaluation of treatment outcomeof maxillofacial deformity. The introduc-tion of cone-beam computed tomography(CBCT) scanning in a natural verti-cal seated position has made a majorbreakthrough in treatment planning oforthognathic surgery.

This lecture shares the preliminaryexperiences of the clinical use of 3D virtualimaging in routine treatment of maxillo-facial deformity and aims to underscoreits potential, benefits and limitations.

doi:10.1016/j.ijom.2009.03.073

Symposium 15: Navigation

SL15.1Navigation-guided oral andmaxillofacial surgeryG.F. Shen ∗, S.L. Zhang, C.T. Wang,X.D. WangDepartment of Oral and MaxillofacialSurgery, Affiliated Shanghai Ninth People’sHospital School of Medicine, ShanghaiJiao Tong University, Shanghai, China

Background and Objectives: Advancesin the field of computer-assisted surgeryenables the surgical procedures to beless invasive and more accurate inimage diagnosis, preoperative simulationand intraoperative navigation. This paperaimed to establish and evaluate the three-dimensional (3D) navigation techniqueused in oral and maxillofacial surgery.Methods: The 3D visual simulationsoftware called TBNAVIS-CMFS wascreated by Visual C++ 6.0 and Visu-alization Toolkit (VTK), and a DELLAW-PRECISION 450DT workstation wasset up based on the Optical Position-ing and Tracking System (Polaris, NDI,

bone segment movement were simulatedthrough the software. Subsequently, weperformed reconstruction of jaw defor-mity, orthognathic surgery, recontouring