Table of contents
April – June 2023
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Stepped genioplasty using cutting and positioning guide: A case reportGermán Laissle Diego Fonseca Fernando Parada Antonio Núñez María Loreto Castellón Carlos Fuenzalida Carlos Bahamondes -
Genioplasty is a procedure used to modify the natural anatomy of the chin, based on an osteotomy of the lower edge of the jaw that allows three-dimensional repositioning of the chin. Currently, various techniques are described to perform genioplasty, being the staggered technique, a modified technique used for elusive chins with vertical excess of the lower third. A genioplasty, virtually previously planned, was performed with a stepped technique using a cutting and positioning guide in an 18- year-old patient with a history of class II dentofacial dysmorphosis that affected both functionally and aesthetically the lower third. Genioplasty with the stepped technique allows addressing the vertical excess of the chin, both at the level of the symphysis, allowing to manage the projection of the chin and deepening of the labiomental fold, achieving smooth transitions between the symphysis and the ramus of the mandible in comparison with other techniques. conventional. The use of cutting and positioning guidance allowed to obtain previously planned intraoperative osteotomies, obtaining virtually predictable and complication-free planned aesthetic results.
KEY WORDS: Genioplasty; Step-technique; Orthognathic surgery; Virtual planning
How to cite
LAISSLE G, FONSECA D, PARADA F, NÚÑEZ A, CASTELLÓN ML, FUENZALIDA C, BAHAMONDES C. Stepped genioplasty using cutting and positioning guide: A case report. Craniofac Res. 2023; 2(2):79-82.
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Osteochondroma of mandibular condyle: Review of treatment alternatives for purpose of a clinical caseCarlos Gaete Paula Astorga Cristóbal Araya Bárbara Alvarado Felipe Pineda -
Osteochondroma is the most common benign bone tumor, representing 10 to 15% of all bone tumors. We present the case of a 44-year-old patient who presented with progressive deviation to the right of 6 months evolution. On examination, he presented facial asymmetry with a right crossbite. The imaging study revealed an exophytic mass of 16x7x10mm located cranially and laterally in relation to the head of the left mandibular condyle, being compatible with an osteochondroma. Complete excision of the lesion was realized using a preauricular approach, accompanied by an arthroplasty with discopexy with an anchor. After the surgical intervention, the patient performed physiotherapy and continued with orthodontic treatment. Condyle osteochondroma is an unusual pathology, until 2010 there were ninety-eight cases described and there are no established treatment algorithms. The objective of this work is to present a case of osteochondroma of the mandibular condyle treated by arthroplasty with preservation of the articular disc.
KEY WORDS: TMJ, arthroplasty, osteochondroma, mandibular condyle.
How to cite
GAETE C, ASTORGA P, ARAYA C, ALVARADO B. Osteochondroma of mandibular condyle: review of treatment alternatives for purpose of a clinical case. Craniofac Res. 2023; 2(2):83-88.
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Structured summary of evidence using Epistemonikos (FRISBEE): experience of a new type of evidence synthesis in maxillofacial surgeryMatías Dallaserra Albertini Juan Pablo Vargas Buratovic Salvador Valladares Pérez Duniel Ortuño Borroto María Francisca Verdugo Paiva Julio Villanueva Maffei -
Oromaxillofacial surgery, dedicated to the diagnosis and treatment of pathologies in the stomatognathic region, faces challenges in clinical decision making due to the lack of randomized clinical trials and methodological limitations in primary studies. Evidence- based medicine, although useful, presents difficulties in this field. To address these limitations, the FRISBEE (FRIendly Summary of the Body Evidence using Epistemonikos) methodology, a structured summary of systematic reviews, is introduced. A FRISBEE seeks to synthesize all relevant biomedical information related to a specific clinical question, using systematic reviews. A detailed process is followed, from the formulation of the clinical question to the synthesis of data using the GRADE methodology, which evaluates the certainty of the evidence. The consulted literature shows 13 FRISBEEs in oromaxillofacial surgery, revealing precise results, such as the use of antibiotic prophylaxis to prevent the loss of bone-integrated implants and post-operative infection in orthognathic surgery. In conclusion, oromaxillofacial surgery faces challenges in the quality and certainty of the available information. FRISBEEs offer a synthesis of evidence that is accessible and easy to interpret, improving decision making in this specialty. Its application has proven to be valuable by providing clear and precise conclusions about various interventions in oromaxillofacial surgery, highlighting its usefulness in clinical practice.
KEY WORDS: Oromaxillofacial surgery, FRISBEE, clinical evidence, GRADE methodology.
How to cite
DALLASERRA AM, VARGAS BJP, VALLADARES PS, ORTUÑO BD, VERDUGO PMF, VILLANUEVA MJ. Structured summary of evidence using Epistemonikos (FRISBEE): experience of a new type of evidence synthesis in maxillofacial surgery. Craniofac Res. 2023; 2(2):89-95.
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Melkersson Rosenthal Syndrome: An unusual diagnosis and presentationPablo Navarro Wike Sergio Gutiérrez Braghetto Salazar Claudia Mancilla Villalobos -
The Melkersson-Rosenthal syndrome is characterized as a rare neuro-muco-cutaneous clinical syndrome, whose distinctive features include the simultaneous presentation of a triad of clinical signs: recurrent facial paralysis, orofacial edema, and fissured tongue. This combined manifestation is observed in only 8% to 25% of documented cases. The case of a patient diagnosed with Melkersson-Rosenthal syndrome with a two-year history is presented. The presence of the classical triad is noteworthy, and such a comprehensive presentation is infrequently reported in the existing literature. Clinical and histopathological findings associated with the case are discussed.
KEY WORDS: Fissured tongue, facial palsy, orofacial swelling, Melkersson-Rosenthal Syndrome.
How to cite
NAVARRO WP, GUTIÉRREZ BS, MATURANA AA, ARAVENA SJP, MANCILLA VC. Melkersson Rosenthal Syndrome: An unusual diagnosis and presentation. Craniofac Res. 2023; 2(2):96-99.
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Influence of unilateral posterior crossbite in the development of the stomatognathic system: a literature reviewPaola Berdeja Felipe Soto Valentina Morales María Fernanda Atria -
The literature suggests posterior crossbite as a risk factor for the development of maxillomandibular developmental disorders. However, the results of these studies are heterogeneous and outdated, which prevents asserting the influence of this malocclusion on the craniofacial system. The aim was to collect available information regarding the influence of posterior crossbite on the skeletal, articular and neuromuscular systems to establish general conclusions about its association and lay the foundations for the generation of new studies that allow the development of protocols and evidence-based decisions. A search of the literature was carried out in Pubmed, Scopus, Cochrane and Epistemonikos databases, with the strategy: crossbite AND temporomandibular OR asymmetry NOT orthognathic, contemplating studies from 2013 to 2023. A total of 2,852 articles were collected, of which 14 studies met the established inclusion criteria. The posterior crossbite would have a positive relationship for the development of asymmetries in both musculature and bone structures such as the jaw and structures relevant to the temporomandibular joint. More studies are needed that use complementary tests as a method of diagnosis/ analysis that reduce the overlapping of structures and distortion, thus reducing the possibility of error, in this way it is possible to standardize the results obtained and establish reliable conclusions to be used in clinical practice.
KEY WORDS: Malocclusion, posterior crossbite, facial asymmetry, temporomandibular disorders.
How to cite
BERDEJA P, SOTO F, MORALES V, ATRIA MF.Influence of unilateral posterior crossbite in the development of the stomatognathic system: A literature review. Craniofac Res. 2023; 2(2):100-104.
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Traumatic injuries in maxillofacial region in children: emergency procedures to be adoptedDeepak Viswanath Nayanlata Saxena -
Pediatric facial trauma differs from adult facial trauma because it necessitates a basic knowledge of the developing patient. Traumatic injury is still the leading cause of death in children, with much of it being the result of a brain injury. The craniofacial region of children grows rapidly, making it more visible and vulnerable to harm. The frequency and causation of facial fractures in children change with age. Understanding the patient’s dentition stage can have a major impact on treatment management. The development of the alveolus is tooth dependent, and the lack of growing teeth will have a substantial influence on the growth and development of the maxilla and mandible, and hence on treatment. This review lays emphasis on maxilofacial trauma in the children.
KEY WORDS: ATLS, pediatric maxillofacial trauma, pediatric distraction osteogenesis, tracheostomy, airway management dilemmas.
How to cite
VISWANATH D, SAXENA N. Traumatic injuries in maxillofacial region in children: Emergency procedures to be adopted. Craniofac Res. 2023; 2(2):105-110.
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Predictability evaluation of virtual surgical planning in linear and angular mandibular movements after orthognathic surgery in malocclusion class II and III patients. A retrospective studyCavalieri-Pereira, L Macedo CJO Coral, AJ -
The orthognathic surgery is the procedure to correct dentofacial deformities. Today the Virtual Surgical Planning (VSP) is the best tool to visualize the possible maxillomandibular final position. One of the most asked questions is: since the mandible is a mobile bone, the VSP can be predictable for the final result of the positioning of the mandible? Then a retrospective and observational study was developed to find the VSP predictability in mandibular movements after orthognathic surgery. Were research in class II and III patients using Composite Skull (Computed Tomography CT associated with dental scan). Linear and angular measurements were done comparing VSP to postoperative CT, with at least 6 months after surgery. Eight patients were included in the study. The cephalometric analysis was done using the Proplan software (Materialise Proplan CMF, São Paulo, Brazil). The results of the simulated in VSP and real movements of mandibular points were compared, calculating their linear and angular differences. A total of fourteen measurements were done and evaluated through of the t test, Bland-Altman, Wilcoxon and the Dahlberg error. In addition to being evaluated by clinically acceptable bias (+/- 2 mm). In the total, 4 differences were statistically significant (Chin height, HFP/Me, HFP/LLM, Coronal/Pg, FMA angle). The mean bias in linear measurements ranged from -3.23 mm (Coronal Plane/Pg) to 3.71 mm (PHF/Me). The VSP seems to be a precise and reproducible method as a way of elaborating treatments, reliably transferred to the patient through surgical guides. Although the 4 differences were statistically significant, when clinical measurements compared with them, only 2 measurements (HFP/Me and Coronal/Pg) result in a clinical significantly difference, 25% and 50%, respectively, result that can be explained by the absence of genioplasty guides.
KEY WORDS: Orthognathic surgery, mandibular surgery, malocclusion.
How to cite
CAVALIERI-PEREIRA L, MACEDO CJO, CORAL, AJ. Predictability evaluation of virtual surgical planning in linear and angular mandibular movements after orthognathic surgery in malocclusion class II and III patients. A retrospective study. Craniofac Res. 2023; 2(2):111-120.
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Incidence of maxillofacial trauma during the COVID-19 pandemic according to the World Health Organization (2020 – 2023): experience at the Dr. Teodoro Gebauer Weisser Traumatological Institute, ChileSáez Haydar V Huaiquivil Pavie J Hernández P Cerda P Nuñez C Gazitúa G -
The COVID-19 pandemic between the years 2020-2023 caused multiple sanitary measures and different public policies that had a direct impact on the incidence of maxillofacial trauma. Maxillofacial fractures occur frequently on daily activities, as accidents such of traffic, work, social, sports, among others, where all were fully restricted in the pandemic period. The objective of thisstudy has been to evaluate how the SARS-CoV-2 pandemic and related public health measures have impacted the incidence and characteristics of maxillofacial fractures. The following investigation consists of a retrospective, descriptive analysis of patients with surgically resolved maxillofacial fractures operated under general anesthesia by the Maxillofacial Surgery and Traumatology team of the Instituto Traumatologico Dr. Teodoro Gebauer Weisser during the COVID-19 pandemic, between the date’s march 11, 2020 until may 5, 2023, the start and end dates of the pandemic decreed by the World Health Organization. The most affected patients were male and between 20 and 40 years of age, mainly caused by second- or third-party aggression. The most affected facial third was the lower one, while the diagnosis with the highest occurrence rate was mandibular angle fracture. This study represents an initial analysis of maxillofacial trauma in the context of the COVID-19 pandemic. Despite the fact that our results partially coincide with the global context, a greater number of studies and statistical analyzes are suggested to better understand the impact of the COVID-19 pandemic in maxillofacial trauma. There is still no information supported in the national scientific literature that supports the reason why these changes occurred in Chile and despite the existence of various hypotheses, comparative studies are required in relation to the previous years of the pandemic with those of the pandemic to obtain an analysis of the national situation.
KEY WORDS: Maxillofacial trauma, SARS-COV 2, pandemic.
How to cite
SÁEZ H, HUAIQUIVIL PJ, HERNÁNDEZ P, CERDA P, NUÑEZ C, GAZITÚA G. Incidence of maxillofacial trauma during the COVID 19 pandemic according to the World Health Organization (2020 – 2023): experience at the Dr. Teodoro Gebauer Weisser Traumatological Institute, Chile. Craniofac Res. 2023; 2(2):121-126.
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Cervical tuberculous lymphadenitis about a case reportSáez Haydar V Huaiquivil Pavie J Hernández P Cerda P Nuñez C Gazitúa G -
Tuberculosis (TB) is a transmissible bacterial disease caused by Mycobacterium tuberculosis. TB is one of the leading causes of death worldwide. Head and neck TB (HNTB) is the term used to describe tuberculous involvement in the head and neck areas. The diagnosis and treatment of HNTB remains a challenge due to the non-specific clinical presentation of the disease and the paucibacillary nature, and many times the requirement for invasive procedures. The case of a patient 16-year-old female attended due to the presence of a mass in the right submandibular region of 4 years of evolution. CT imaging studies with and without contrast, Doppler ultrasound, and laboratory tests are requested. Surgery is planned by the Maxilofacial Surgery team in conjuction with the Head and Neck Surgery team, where it is decided to perform an excisional biopsy with a right cervicotomy approach for diagnostic confirmation of the lesion in the Operating Room (OR) under general anesthesia. Then patient was referred to general medicine for pharmacological management. Tubercu- losis continues to be a global health problem. The route of Mycobacterium tuberculosis to head and neck lymph nodes remains controversial, particularly in patients without pulmonary tuberculosis. The differential diagnosis of cervical tuberculous lymphadenopathy is challenging. There are infectious and noninfectious causes that must be thoroughly studied to rule out differential diagnoses. Multidisciplinary management is essential for the clinical picture to remit completely.
KEY WORDS: Tuberculosis, extra pulmonary tuberculosis, lymphadenitis.
How to cite
SÁEZ H, HUAIQUIVIL PJ, HERNÁNDEZ P, CERDA P, NUÑEZ C, GAZITÚA G. Incidence of maxillofacial trauma during the COVID 19 pandemic according to the World Health Organization (2020 – 2023): experience at the Dr. Teodoro Gebauer Weisser Traumatological Institute, Chile. Craniofac Res. 2023; 2(2):121-126.
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Arthroscopy compared to arthrocentesis for the treatment of temporomandibular disordersJuan Pablo Vargas Buratovic Matías Dallaserra Albertini Carlos Cortez Fuentes Felipe Astorga Mori Osvaldo Gahona Gutierrez Francisca Quinlan Binelli Diego Bustamante Correa Salvador Valladares Perez -
There is uncertainty regarding whether arthroscopy and visualization of the compartments could be more effective for joint lavage compared to arthrocentesis for the treatment of temporomandibular disorders. We conducted a search in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the identified reviews, analyzed the data from the primary studies, performed a meta-analysis and prepared a summary table of the results using the GRADE method. We identified 4 systematic reviews that together included 8 primary studies, of which 2 correspond to randomized trials. We conclude that: 1. Arthroscopy compared to arthrocentesis could reduce postoperative complications (low level of certainty of evidence). 2. Arthroscopy compared to arthrocentesis probably achieves a greater increase in mouth opening. 3. Arthroscopy compared to arthrocentesis may not make any difference in postoperative pain (low certainty of evidence).
KEY WORDS: Arthroscopy, arthrocentesis, temporomandibular disorders, epistemonikos, GRADE.
How to cite
VARGAS BJP, DALLASERRA AM, CORTEZ FC, ASTORGA MF, GAHONA GO, QUINLAN BF, BUSTAMANTE CD, VA- LLADARES PS. Arthroscopy compared to arthrocentesis for the treatment of temporomandibular disorders. Craniofac Res. 2023; 2(2):134-140.