BRAZILIAN JOURNAL OF CRANIOMAXILLOFACIAL SURGERY … · Diogenes Lakrcio Rocha, MD (Brazil) Flavio M. Sturla, MD (Argentina) ... Belini Freire Maia, Bruno Ramos Chcanovic, Leandro

BRAZILIAN JOURNAL OF

CRANIOMAXILLOFACIAL SURGERY

ISSN 151 6-41 87

Official publication of the Brazilian Society of Craniomaxillofacial Surgery

Volume 5 - Number 1 - June 2002 P

*di *- @*

Sociedade Brasileira de Cirurgia

Craniomaxilof acial Brazilian Society of Craniomaxillofacial Surgery

President

Nivaldo Alonso (SP!

Secretary

Marcus Vinicius Martins Collares (RS)

Vice President

Ricardo Lopes da Cruz (RJ)

Treasurer

Max Domingues Pereira (SP)

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Brazilian Journal of Craniomaxillofacial Surgery1 Sociedade Brasileira de Cirurgia Craniomaxilofacial. - Vo1.5, n.1 (Jun.2002). - Porto Alegre : SBCC, 1998 - . v. : il. : 30cm.

Dois nheros por ano, em ingles. ISSN 1516-4187 1. Cirurgia Bucal I. Brazilian Journal of Craniornaxillofacial Surgery. II. Sociedade Brasileira de Cirurgia Craniomaxilofacial.

CDD: 61 7.522 CDU: 616.31-089

BRAZILIAN JOURNAL OF CRANIOMAXILLOFACIAL SURGERY

Official publication of the Brazilian Society of Craniomaxillofacial Surgery

EDITOR

Marcus Vinicius Martins Collares, MD, PhD

Hospital de Clinicas de Pono Alegre

Universidade Federal do Rio Grande do Sul

Brazil

ASSOCIATE EDITOR

Sflvio AntBnio Zanini, MD

Hospital de Reabilitacso de Anomalias Craniofaciais

Universidade de SBo Paulo

Brazil

SCIENTIFIC COUNCIL

Nivaldo Alonso, MD, PhD (Brazil)

Elisa Altmann, MD (Brazil)

Cassio Raposo do Amaral, MD (Brazil)

Carlos Alberto Ballin, MD (Brazil)

Vera Nocchi Cardim, MD (Brazil)

Roberto Corrga Chem, MD, PhD (Brazil)

Edgard Alves Costa, MD (Brazil)

S6rgio Moreira da Costa, MD (Brazil)

Ricardo Lopes da Cruz, MD (Brazil)

Pedro Dogliotti, MD (Argentina)

Jose Carlos Ferreira, MD, PhD (Brazil)

Luis Francisco Fontoura, MD (Brazil)

Omar Gabriel, DDS (Brazil)

Eduardo Grossmann, DDS, PhD (Brazil)

Paulo Hvenegaard, MD (Brazil)

Ian Thomas Jackson, MD (United States of America)

Lufs Paulo Kovalski, MD (Brazil)

Jose Alberto Landeiro, MD (Brazil)

Luis Tresserra Llauradd, MD, PhD (Spain)

Michael T. Longaker, MD (United States of America)

Gilvani Azor de Oliveira e Cruz, MD (Brazil)

Antonio Richieri-Costa, MD, PhD (Brazil)

Diogenes Lakrcio Rocha, MD (Brazil)

Flavio M. Sturla, MD (Argentina)

Fausto Viterbo, MD, PhD (Brazil)

RETROSPECTIVE, DESCRIPTIVE EPIDEMIOLOGIC ASSESSMENT OF FACIAL BONE FRACTURES IN GROWING PATIENTS, FROM 1992 TO 2001, AT HOSPITAL CRISTO REDENTOR, PORTO ALEGRE, RS ..................................... 11 Eduardo Seixas Cardoso, Renata Pittella Canqado, Marilia Gehardt Oliveira, Salete Maria Pretto

USE OF VIDEOENDOSCOPY IN THE DIAGNOSIS OF ORBITAL FLOOR FRACTURES ...... 11 Fernando Cesar A. Lima, Weber Leo Cavalcante, Ricardo Lopes da Cruz

VIDEO-ASSISTED TREATMENT OF FACIAL FRACTURES: INDICATIONS, TECHNICAL ASPECTS, AND INITIAL EXPERIENCE ............................. Dov C. Goldenberg, Nivaldo Alonso, Luiz Gustavo B. Cruz, Claudio E. P. de Souza, Daniel S.C. Lima, Marcus C. Ferreira

COMPLEX FACIAL FRACTURES: TREATMENT ALGORITHM ....................... ClAudio Eduardo Pereira de Souza, Dov Charles Goldenberg, Mauro Leonardis, Daniel Santos Correa Lima, Nivaldo Alonso, Marcus C. Ferreira

EFFICACY OF THE CONVENTIONAL TREATMENT OF MANDIBULAR FRACTURES CAUSED BY GUNSHOTS ................................................................................ 14 Thiago de Almeida Furtado, Adriano do Valle Fernandes, Marcelo Drummond Naves, Gustavo Bellozi de Araujo, Evandro Magalhges Nunes

VESTIBULAR ACCESS ROUTES AND THE TREATMENT OF COMPLEX MANDIBULAR FRACTURES ................................. Belini Freire Maia, Bruno Ramos Chcanovic, Leandro Napier de Souza

HYPERTELEORBITISM: ORBITAL MEDIALIZATION ........ WITH THE FIXED CENTRAL T TECHNIQUE AND NO FLOOR MOBILIZATION

Sergio Pablo Pimentel Vela, Felipe Hund, Vera LLicia Nocchi Cardim

BECKWITH-WIEDEMANN'S SYNDROME: REPORT OF A CASE WITH AN 18-YEAR SEQUENTIAL FOLLOW-UP .... Lidia D'Agostino, Rolf Rode, Paulo Clrnara

FREEMAN-SHELDON'S SYNDROME: MULTIDISCIPLINARY MANAGEMENT (A CASE REPORT) .................... Fabiana Correia Monteiro, Lidia D'Agostino, Marcia Andre, Fabiana Rufino. Margareth Torrecillas Lopez

FOLLOWING CRANIOFACIAL DISJUNCTION IN OSTEOGENIC DISTRACTION PROCEDURES ................................. Rodrigo de Faria Valle Dornelles, Rolf Lucas Salomons, Vera Lucia Nocchi Cardim

THE USE OF OSTEOGENIC MANDIBULAR DISTRACTION IN NEONATES WITH THE PIERRE-ROBIN SEQUENCE ........................ Marcus Vinicius Martins Collares, Rinaldo de Angeli Pinto, Roberto Correia Chem, Ant6nio Carlos Pinto Oliveira, Gustavo Berlim, Ciro Paz Portinho

ORTHODONTICS AND FACIAL ORTHOPEDICS ASSOCIATED WITH

OSTEOGENIC DISTRACTION IN CASES OF CONGENITAL MICROGNATHIA .......... Daniela Franco Bueno, Nelson Bardella Filho, Marcelo P. Vaccari Mazzetti, Lucy Dalva Lopes

APPLICATIONS OF OSTEOGENIC DISTRACTION IN THE TREATMENT OF CRANIOMAXILLOFACIAL DYSPLASIAS ....... Nelson Bardella Filho, Ana Lucia C. Bardella, Lucy Dalva Lopes, Dulce M. F. Soares Martins, Lydia Masako Ferreira

INCIDENCE OF PATIENTS WITH CLEFT LIP AND PALATE AT INSTITUTO DE CIRURGIA PLASTICA CRAN~OFACIAL (SOBRAPAR) .......... Celso Luiz Buzzo, Cassio Raposo Menezes do Amaral, Rita Mancebo Bianco, Cinthia Regina Seraphim, Clariane Viero Vargas, Eliane Teixeira Caixeta Maiello

COLUMELLAR RECONSTRUCTION WITH NASOGENIAN FLAPS ............. Celso Luiz Buzzo, Cassio Raposo Menezes do Amaral, Rita Mancebo Blanco, Clariane Viero Vargas, Cinthia Regina Seraphim. Eliane Teixeira Caixeta Maiello

THE USE OF LABIORH~NOPLASTY IN CASES OF UNILATERAL FISSURES .................. 20 Celso Luiz Buzzo, Cassio Raposo Menezes do Amaral, Jcpiter Neewler Lopes Duarte

AND AN ACRYLIC CONDYLE AFTER RESECTION OF A SOLID AMELOBLASTOMA: A CASE REPORT .......................................................................................... , Christian Barros Ferreira, Jan Peter llg, Andre Caroli Rocha, Araldo Ayres Monteiro Junior

TREATMENT OF AMELOBLASTOMA WITH MARGINAL MANDIBULECTOMY, INFERIOR ALVEOLAR NERVE DISSECTION AND PRESERVATION, AND IMMEDIATE BONE RECONSTRUCTION ..................................... Adalberto Novaes Silva, Paulo Cesar de Jesus Dias

ASSESSMENT OF SEPTAL DEFORMITIES USING NASAL VIDEOFIBROSCOPY IN ADULT PATIENTS WITH TRANSVERSAL MAXILLARY ATRESIA ...................... Adalberto Novaes Silva, Wilma T. Anselmo Lima

ESTHETIC AND FUNCTIONAL REHABILITATION OF THE MAXILLA AND ALVEOLAR RIDGES WITH CALVARIAL BONE GRAFTS ................. Wilson Cintra Junior, Nivaldo Alonso

THE USE OF TITANIUM MICROANCHORS IN THE TREATMENT OF DISPLACEMENT OF MEDIAL CANTHI .................................. Dov Charles Goldenberg, Nivaldo Alonso, Marcus Castro Ferraira

MANDIBULAR FIBROSARCOMA ................................... Marcela Azevedo Brito, SBrgio Luiz de Miranda

COMPLICATIONS OF PROCEDURES USED IN THE TREATMENT OF SLEEP-RELATED RESPIRATORY DISORDERS ....................... Nelson E. P. Colombini, Jose A. Pinto, Gustavo J. Faller

OBSTRUCTIVE SLEEP APNEA - A NEW OPTION FOR THE CRANIOMAXILLOFACIAL SURGEON (CONCEPTION AND BASIC SURGICAL PROTOCOL) ............................... 26 Nelson E. P. Colombini, Gustavo J. Faller, Wolney B. D'Azevedo

AN ALTERNATIVE IN FACIAL RECONSTRUCTION PROCEDURES ..... Sonja Ellen Lobo

IDIOPATHIC BONE CAVITY IN THE MANDIBULAR CONDYLE ............................ Adriano do Valle Fernandes, Evandro Nunes Magalhaes, Gustavo Bellozi de Aralijo, Marcelo Drummond Naves, M6nica Vieira Salgado, Wagner Rodrigues dos Santos

A SURGICAL APPROACH TO CRANIOFACIAL NEUROFIBROMATOSIS - A CASE REPORT ..................................................................................................... 27 Clarissa Leite Turrer, Ricardo Lopes Cruz

MAXILLARY SINUS LIR. USING MANDIBULAR RAMUS ........................................ BONE GRAFTS - TECHNICAL CONSIDERATIONS

Davidson Rodarte Feliz de Oliveira, Ant6nio Albuquerque de Brito, Aloisio Borges Coelho

ZYGOMATIC FIXATION - AN ALTERNATIVE PROCEDURE FOR THE REHABILITATION OF SEVERELY ATROPHIED MAXILLA ......... Waldemar Daut Polido, Eduardo Marini

SEQUELAE - A CASE REPORT ......................................................... Blas Antonio F. Santander, Mayra Cristina Kimura, Patricia de Paula Shimabuku, Rejane Aparecida de Lima, Vera Lljcia Nocchi Cardim

MULTIDISCIPLINARY TREATMENT OF A PROGNATHIC PATIENT WITH HYPOMAXILLISM ................................................... Rejane Aparecida de Lima, Mayra C. Kimura, Rodrigo Dornelles, Rolf L. Salomons. Vera L. N. Cardim

ZYGOMATICOPLASTY: AN ESTHETIC COMPLEMENT TO ORTHOGNATIC SURGERY (TECHNIQUES AND ALTERNATIVES) ...... Nelson E. Colombini, Wolney B. D'Azevedo, Einar F. Oquendo

PALATINE DISJUNCTION THROUGH ENDONASAL MICROSURGERY ................. Nelson E. P. Colombini, Wolney B. D'Azevedo, Gustavo J. Faller

FUNCTIONAL GENIOPLASTY ....................................................... Rodrigo 0. M. Marinho, David S. Precious

- -

OF A CLINICAL CASE ......................................................................... Paulo Roberto Pelucio CBmara

TREATMENT OF THE ANTEROPOSTERIOR MAXILLARY EXCESS WITH LE FORT I OSTEOTOMY: REPORT OF TWO CASES AND DISCUSSION ...................................................................... AntBnio Albuquerque de Brito, Davidson Rodaite Felix de Oliveira, Yumara Siqueira de Castro

A f t e r the first biennial Brazilian Congress on Craniomaxillofacial Surgery is held, we will

be able to make a preliminary evaluation of the changes in the fields of education and research

regarding craniomaxillofacial surgery.

The downside of holding these meetings every two years is the restricted dissemination of

knowledge outside the Si3o PauloIRio de Janeiro route, in addition to the difficulty in having scientific

studies for ~ublication.

The advantages include the strengthening of extension courses in SBo Paulo (coached by

Nivaldo Alonso) and in Rio de Janeiro (led by Ricardo Cruz), and an expected increase in the

number of papers submitted for presentation.

These facts led us to the decision to publish the abstracts of the papers presented at the

Congress as volume 5, issue 1 of the Brazilian Journal of Craniomaxillofacial Surgery.

As we can see, the current issue of the journal features interesting studies. They comprise

all fields of craniomaxillofacial surgery. We wish to have their extended version, not only on oral

presentation, in the near future.

Hopefully, we will have a better view of the matter after the next meeting, to be held in

Rio de Janeirol2004. Moreover, we expect to have fulfilled the requests to have the journal

indexed by then.

We also strongly suggest that new measures should be taken by the board of the Brazilian

Society of Craniomaxillofacial Surgery to improve the scientific quality of our journal.

Marcus Wcius Mattins Collares, MD, PhD

Editor

We welcome

Original research

Clinical reports

Case reports

Letters t o the editor

Book reviews

Announcements

Please submit to:

Marcus Vinicius Martins Collares, MD, PhD Editor Brazilian Journal of Craniomaxillofacial Surgery Rua Hilario Ribeiro, 2021406 CEP 905 10-040 Porto Alegre, RS Brazil

VII Congresso Brasileiro de Cirurgia Craniomaxilofaciai - Abstracts

RETROSPECTIVE, DESCRIPTIVE EPIDEMIOLOGIC ASSESSMENT QF FACIAL BONE FRACTURES IN GROWING PATIENTS, FROM 1992 TO 2001,

AT HOSPITAL CRISTO REDENTOR, PORT0 ALEGRE, RS

Eduardo Seixas Cardoso, Renata Pittella Canqado, Marilia Gehardt Oliveira, Salete Maria Pretto Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS) - Porto Alegre, Brazil

OBJECTIVE

To assess the prevalence and epidemiologic characteristics of facial bone fractures occurred in growing

patients.

MATERIALS AND METHODS

Paradigm: quantitative; study model: retrospective, descriptive; statistical analysis: parametric, descriptive,

non-inferential; data collection: manual and computer-based; data base: medical records; variables: age, gender,

fracture etiology, fracture location, mode of treatment, presence of associated lesions, and period of the year.

RESULTS

From 1992 to 2001,2,410 trauma patients were hospitalized at Hospital Cristo Redentor, Potto Alegre,

state of Rio Grande do Sul, southern Brazil. Of this total, only 60 individuals (2.49%) presented facial bone

fractures and had up to 12 years of age. Excluding nasal and dento-alveolar fractures, the prevalence

observed corresponds to 1.95%, i.e., 47 patients and 61 fractures. Most of these affected the mandibular

bone, more precisely the parasymphysis and articular process regions, followed by the zygoma and the

arch. Female patients were more common than males, and children from 6 to 12 years of age were the most

prevalent group. The most frequent etiologic factor was runover accidents, followed by car accidents and

falls. Most hospitalizations took place in the summer quarter, and lasted 7 to 12 days, on average. In relation

to modes of treatment, mandibular bone fractures were usually treated with non-surgical options, while

fractures of the middle third of the face were usually treated with surgery. Finally, in the assessment of

associated facial lesions, of the 47 patients included in the study, 15 showed associated lesions -

cranioencephalic trauma was the most common one.

USE OF VIDEOENDOSCOPY IN THE DIAGNOSIS OF ORBITAL FLOOR FRACTURES

Fernando Cesar A. Lima, Weber Leo Cavalcante, Ricardo Lopes da Cruz Hospital Geral de lpanema - Rio de Janeiro, Brazil

BACKGROUND

Orbital floor fracture is a relatively common consequence of facial traumas, and it often remains undiagnosed.

The fracture can be easily diagnosed with computed tomography, but not with conventional radiography. The

present study was developed to show how videoendoscopy, when well indicated, can help in the precise

diagnosis of orbital floor fracture.

Braz J Craniomaxiilofac Surg 2002;5(1) 11

VII Congress0 Brasileiro de Cirurgia Craniomaxilofacial- Abstracts

OBJECTIVE

To demonstrate the use of videoendoscopy in the diagnosis of orbital floor fracture


Clinical case reports in which a precise diagnosis of orbital floor fracture was not possible were selected to

undergo a videoendoscopic test for confirmation of the clinical status.

RESULTSICONCLUSION

Videoendoscopy is a rapid and easy method to be used in the diagnosis of orbital floor fractures, and it

should be indicated whenever a precise diagnosis cannot be obtained via physical examination and computed

tomography.

VIDEO-ASSISTED TREATMENT OF FACIAL FRACTURES: INDICATIONS, TECHNICAL ASPECTS, AND INITIAL EXPERIENCE

Dov C. Goldenberg, Nivaldo Alonso, Luiz Gustavo B. Cruz, Claudio E.P. de Souza, Daniel S. C. Lima, Marcus C. Ferreira

Hospital das Clhicas da Faculdade de Medicina da Universidade de S6o Paulo - SHo Paulo, Brazil

INTRODUCTION

The conventional access routes used in the treatment of facial fractures may result in unesthetic scars and

operative complications, in addition to interfering with the adequate visualization of the fracture focus and the

positioning of bone grafts, in some cases. The introduction of video-assisted surgical methods in plastic surgery

has helped in the treatment of several conditions. In the case of facial fractures, it has shown to be useful as a

diagnostic tool, as a treatment complement, and also as a method of treatment in itself. Fractures affecting the

frontal region, orbital floor and mandibular condyle have been the most common indications for video-assisted

surgeries.

OBJECTIVES

This study aimed at assessing the indications and technical aspects of the video-assisted performance of

access routes in cases of fractures affecting the frontal bone, orbital floor, and mandibular condyle, based on

the initial experience of the authors.

PATIENTS AND METHODS

Between March 2001 and March 2002, 14 patients presenting with facial bone fractures were submitted to video-assisted treatment. Six of the fractures were condylar, 5 were orbital, and 3 affected the frontal bones.

Access routes and the associated advantages, disadvantages, and contraindications were assessed.

RESULTS

in the cases of frontal fracture, 3 incisions made into the scalp allowed for adequate instrumentation and

focus reduction; a small superciliary incision also had to be performed, for the placement of plates and screws.

In the orbital fractures, the transmaxillary access route allowed the diagnosis of floor fractures, the visualization

12 Braz J Craniomaxillofac Surg 2002;5111

ViI Congresso Brasileiro de Cirurgia Craniornaxiiofacial - Abstracts

of hernia and its reduction, and also helped in the placement of bone grafls and their adequate positioning. In

condylar fractures, the intraoral access route, associated with two extraoral, punctiform incisions for the passage

of transcutaneous screws and with the traction applied on the ramus, ensured an adequate visualization. All

these aspects reinforced the indication of the method for the treatment of lower condylar and subcondylar fractures.

CONCLUSIONS

The video-assisted performance of access routes showed to be useful in the treatment of facial fractures,

and constitutes an additional alternative method, with potential advantages in terms of reduction of external

scars, improved visualization and consequent reduction of the fracture focus.

COMPLEX FACIAL FRACTURES: TREATMENT ALGORITHM

Claudio Eduardo Pereira de Souza, Dov Charles Goldenberg, Mauro Leonardis, Daniel Santos Correa Lima, Nivaldo Alonso, Marcus C. Ferreira

Hospital das Clinicas da Faculdade de Medicina da Universidade de SSio Paulo - Sfio Paulo. Brazil

OBJECTIVES

This study aimed at showing the most frequent etiologies that are present in complex facial traumas and at

assessing the association of facial fractures with othertraumas, in addition to clinical and complementarydiagnoses,

time and planning of the surgical treatment.


From February 1999 to April 2001,112 patients submitted to surgery for facial fractures were selected. Of these, 16 presented complex fractures, which affected several bones (extremely severe traumas). Fourteen

patients were males, and two were females, with a mean age of 24 years. Surgery was performed as early as

possible, and the approach was chosen taking into consideration aspects such as exposure of the fracture

focus, standard incisions, and rigid fixation. Afler the performance of initial measures and image diagnosis,

treatment was defined according to the presencelabsence of neurosurgical traumaand of concomitant mandibular

and upperlmiddle third fractures.

RESULTS

The most frequent cause of trauma was car accident (13 cases), followed by physical violence. Complex

fractures usually affected the orbits, naso-orbito-ethmoidal bone, maxilla, and frontal bone fractures. Multiple

fractures affecting both the upper and middle thirds of the face and the mandible occurred in only 4 cases.

Neurologic impairment was observed in 8 of the 16 cases, and the eyes were affected in 9 (partial loss of sight

in 7 cases, and total loss in 2). Late complications, such as enophthalmus and telecanthus, were observed in 5

and 6 cases, respectively.

CONCLUSIONS

Complex facial traumas still represent a significant portion of cases seen at a tertiary hospital. The

involvement of the upper and middle thirds of the face, more common when compared to the lower third, seems

to be related to the mechanism of trauma. The standard, sequential approach used in the study helped in the

management of conditions and was associated with improved results.

Braz J Craniomaxiilofac Surg 2002;5/11 13

Vii Congress0 Brasileiro de Cimrgia Craniornaxilofaciai - Abstracts

EFFICACY OF THE CONVENTIONAL TREATMENT OF MANDIBULAR FRACTURES CAUSED BY GUNSHOTS

Thiago de Almeida Furtado, Adriano do Valle Fernandes, Marcelo Drummond Naves, Gustavo Bellozi de Araujo, Evandro Magalhies Nunes

Hospital Maria Amelia Links (FHEMIG), Faculdade de Odontologia, Universidade Federal de Minas Gerais - Belo Horizonte, Brazil

OBJECTIVE To analyze the efficacy of the conventional treatment of mandibularfractures caused by gunshots, namely,

the non-surgical approach.

MATERIALS AND METHODS The conventional treatment was applied to 23 patients diagnosed with mandibular fractures caused by

gunshots at the Service of Bucomaxillofacial Surgery at Hospital Maria Amelia Lins. Patients were followed and

assessed in the pre- and trans-operative periods and for up to 180 days immediately afler surgery. Clinical and

radiographic data were observed, and data were recorded in a descriptive data sheet.

RESULTS In our study, 21 patients were males, and most were 21 to 25 years old (21%) and 31 to 35 years old

(30%). A total of 30 mandibular fractures were diagnosed, predominantly at the corpus (46.5%) and the angle

(23%). Of all fractures, 52% were caused by 38 caliber guns. Fractures were usually compound (73%) and comminuted (84%). On examination, clinical signs such as bone mobility and crackling (87%), absence of infection signs (82%), and limited mouth opening (82%) were common. Treatment was successful in 53% of

cases and unsuccessful in 13%; in addition, 34% of patients left the study prior to completing the postoperative

follow-up period.

CONCLUSIONS Mandibular fractures caused by gunshots were mostly compound and comminuted, and the conventional

treatment showed to be effective in these cases. In view of the social origin and difficulties faced by the group of patients studied, an adequate postoperative follow-up and consequent assessment of results is often impossible.

VESTIBULAR ACCESS ROUTES AND THE TREATMENT OF COMPLEX MANDIBULAR FRACTURES

Belini Freire Maia, Bruno Ramos Chcanovic, Leandro Napier de Souza

Mandibular fractures have been treated with wire osteosynthesis associated with intermaxillary blocking

for several years. With the introduction of rigid internal fixation, in the end of the 60s, extremely rigid systems employing plates and screws started to be used for the treatment of these fractures, and several innovations

have already been made to the method since then. Finally, in the 70s, asa result of studies carried out in France

by Michelet (1971) and Champy (1975), a new system was developed, in which miniature plates and screws were used via an intraoral access route. This new procedure was soon known all over the world, and since then

it is the treatment of choice for cases of mandibular fractures, independently of complexity. The present study

will present the case of a complex mandibularfracture surgically treated via a wide vestibular access route, with

exposure of the whole symphysis and mandibular corpus bilaterally, and the following application of miniplates and screws according to the model preconized by Champy.

14 Braz J Craniomaxillofac Surg 2002;5/1/

VII Congress0 Brasileiro de Cirurgia Craniomawilofacial- Abstracts

HYPERTELEORBITISM: ORBITAL MEDlALlZATlON WlTH THE FIXED CENTRAL T TECHNIQUE AND NO FLOOR MOBILIZATION

Sergio Pablo Pimentel Vela, Felipe Hund, Vera Lucia Nocchi Cardim Hospital SBo Joaquim da Real e Benemerita Sociedade Portuguesa

de Beneficiencia - SIio Paulo, Brazil

OBJECTIVES

To show the result of the fixed central T technique with orbital medialization and without floor mobilization, as used in the treatment of hyperteleorbitism.

MATERIALS AND METHODS We report the case of M.A.F.F., a 16-year old patient submitted to surgery for the treatment of Tessier's

hyperteleorbitism level Ill. The patient did not present dysraphia, and middle third of the face was normal. Due to the presence of primary frontonasal dysplasia, the orbital medialization technique was employed (fixed central

T) with no mobilization of the floor. Surgery was carried out intracranially, via acoronal and longitudinal transnasal access route, as in the form of an horizontal Z, whosecentral axis was positioned in parallel with internal ligaments.

RESULTS Tomographic control showed a variation in the angle of oculomotor nelve axes from 82 to 72 *, and in the

internal interorbital distance from 40 to 33 mm.

CONCLUSION The technique herein described is an alternative mode of treatment with effective results (from a esthetic

and functional point of view) and low morbidity.

BECKWITH-WIEDEMANN'S SYNDROME: REPORT OF A CASE WlTH AN 18-YEAR SEQUENTIAL FOLLOW-UP

Lidia D'Agostino, Rolf Rode, Paulo CSmara lnstituto de Cirurgia Plastlca Santa Cruz

The authors report the case of A.A.J., male, diagnosed with Beckwith-Wiedemann's syndrome, currently

with 22 years of age and followed since the chronological age of 4 years. The syndrome is characterized by skeletal and dentofacial abnormalities, in addition to macroglossia. In this specific case, speech therapy was

used with the aim of improving muscle tonus and correcting tongue position so as to normalize stomatognatic

functions and prevent the need for partial giossectomy. Treatment plan included isometric and isotonic exercises (carried out in weekly sessions) for adequacy of the muscle tonus of the tongue and lips. In view of difficulties

related to the maintenance of tongue position and lip sealing, caused by the patient's anterior cross and open bite, a resin-made device aimed at limiting the tongue position was developed. The device was molded on the

patient's lower teeth and filled the sublingual space, simulating the postoperative position of the mandible. The

use of the device contributed to the proprioception of the tongue and consequently to the success of the speech therapist's job. Tongue retroposition was successful, since it coapted to the palate. The authors conclude that

the diagnosis of macroglossia should be followed by a careful study of the patient's muscle tonus and facial

skeletal conditions, mainly in terms of the oral cavity, so as to establish a treatment plan that is able to eliminate the effects of this problem on the patient's dento-osteo-mandibulargrowih, consequently minimizing future surgical

intewentions and preventing the need for invasive and unnecessary procedures, as is the case of partial glossecomy.

Braz J Craniomaxillofac Surg 2002;5/11 15

VII Congresso Brasileiro de Cirurgia Craniomaxilofacial- Abstracts

FREEMAN-SHELDON'S SYNDROME: MULTIDISCIPLINARY MANAGEMENT (A CASE REPORT)

Fabiana ~ o r r e i a Monteiro, Lidia D'Agostino, Marcia Andre, Fabiana Rufino, Margareth Torrecillas Lopez

Hospital BeneficEncia Portuguesa, School of Dentistry, Universidade de SHo Paulo, and lnstituto de Cirurgia PlAstica Santa Cruz - Sgo Paulo, Brazil

The Freeman-Sheldon syndrome is also known ascraniocarpotarsal dystrophy, distal type II arthrogryposis, Windmiil-Vane-Hand's syndrome, or whistling face syndrome. Freeman-Sheldon's syndrome is a rare congenital

myopathy, characterized by three main signs: a whistling-like facial expression; ulnar deviation of the hand, with flexion contracture at the fingers; foot deformities.

Patients affected by this syndrome present multiple facial contractures, which are associated with

microstomy, micrognathia, and neck stiffness - these are the conditions that resul in the "whistling face". Hypertelorism is also present, as well as narrow and antimongoloid eyelid folds, a saddle nose, and an ogival

palate. Finally, in addition to limb myopathy, several patients develop visible scoliosis and stature deficiency. The case of R.A.S., a byear old male patient born to clinically normal and non-consanguineous parents, was seen at the School of Dentistry at Universidade de Sao Paulo with adiagnosis of Freeman-Sheldon's syndrome.

On clinical examination, important manifestations of the syndrome were observed: great difficulty in opening the mouth, caries-related lesions, and dental malocclusion. Due to the complexity of the pathology, a multidisciplinary

treatment plan was developed so as to prioritize myofunctional aspects, followed by dental and orthodontic

treatment. The results obtained up to the present moment confirm the advantages of multidisciplinary management.

ELASTIC TRACTION OF THE MIDDLE THIRD OF THE FACE FOLLOWING CRANIOFACIAL DISJUNCTION IN OSTEOGENIC DISTRACTION PROCEDURES

Rodrigo de Faria Valle Dornelles, Rolf Lucas Salomons, Vera L~ic ia Nocchi Cardim Hospital S3o Joaquim da Real e Benemerita Sociedade Portuguesa

de Beneficiencia, SHo Paulo, Brazil

OBJECTIVES

Osteogenic distraction of the middle third of the face, carried out with elastics and Erich arch bars applied

to the teeth, allow the growth and maintenance of results obtained in advancement procedures in patients presenting craniofaciostenoses.


Between 1981 and 2001.42 patients with craniofaciostenoses were operated using class Ill elastic traction

at the middle third of the face, after craniofacial disjunction, for advancement of the frontomaxillary monoblock.

Bone grafts were used only on the lateral walls of the orbits, with semi-rigid fixation, so that the maxilla remained initially retropositioned. Afler a7-day latency period, elastic traction was applied to the maxilla, which was gradually

placed in a more anterior position, reaching a class II occlusion afler approximately 4 days. After this time, elastic

traction was decreased with the aim of maintaining the result obtained.

16 Braz J Craniomaxillofac Surg 2002;5(11

VII Congresso Brasileiro de Cirurgia Craniornaxilofacial -Abstracts

RESULTS The pterigomaxillary area presented perfect ossification in all cases. In addition, the result was definitively

maintained in adult patients, and maintained for 1.5 year in children; of these, 52.6% maintained the result until

the adult age.

CONCLUSION Elastic traction only requires the placement of Erich arch bars on the patients' teeth, making the procedure

more simple when compared to the use of distractors, with a similar osteogenic result.

THE USE OF OSTEOGENIC MANDIBULAR DISTRACTION IN NEONATES WITH THE PIERRE-ROBIN SEQUENCE

Marcus Vinicius Martins Collares, Rinaldo de Angeli Pinto, Roberto Correia Chern, AntBnio Carlos Pinto Oliveira, Gustavo Berlim, Ciro Paz Portinho

Hospital de Clinicas de Porto Alegre - Porto Alegre, Brazil

INTRODUCTION The Pierre-Robin sequence (PRS) is characterized by micrognathia, glossoptosis, palatal anomalies, and

severe respiratory and nutritional dysfunctions. Several techniques have been used to treat the condition, such

as positional therapy, labio-lingual suture, pelviplasty, and tracheostomy. Osteogenic distraction is a mandibular

lengthening technique based on the llizarov principle that has been used in children older than 2 years.

OBJECTIVES

To analyze the result of osteogenic mandibular distraction in the treatment respiratory and dietary dysfunctions in neonates presenting PRS and to propose the systematization of the management of these

patients according to clinical classification.

METHODS

The study describes a series of 16 patients with PRS submitted to osteogenic mandibular distraction with external distraction devices provided with four pins (using external approach and osteotomy). The application of traction started on the 1st postoperative day at a rate of 0.5 mm twice a day. The consolidation period was either

equal to the duration of distraction or set at 2 weeks (minimum). The following aspects were assessed: age at the beginning of treatment, distraction distance, duration of distraction, complications, time to extubation

(postoperatively) and oral nutrition during the postoperative period, presencelabsence of apnea after distraction, and mean oxygen saturation values before and after distraction.

RESULTS

Mandibular growth and bone consolidation were observed in all cases. The main respiratory parameters analyzed (SaO,) and the nutritional pattern also showed improvement. There were no important complications associated with the method.

Braz J Craniomaxillofac Surg 2002;5/ 11 17

1/11 Congresso Brasileiro de Cirurgia Craniomaxilofacial - Abstracts

DISCUSSION

We propose the following classification for the management of patients with PSR: type I (no dysfunction),

clinical treatment; type II (no respiratory dysfunction, with nutritional dysfunction), clinical therapy, with surgeryon

the 15th to 30th day of life if no improvement is observed; type Ill (respiratory difficulty only while at rest, significant

nutritional impairment), clinical therapy, with surgeryon the 10th to 15th day of life if no improvement is observed;

type IV (sleep apnea, with our without nutritional impairment), same as type II; type V (unable to breathe without

mechanical help), surgery on the 5th day of life.

CONCLUSION

Osteogenic distraction is an effective (with low morbidity and high resolution rates) treatment for respiratory

and nutritional abnormalities resultingfrom micrognathia in PRS, even in less severe manifestations of the sequence.

ORTHODONTICS AND FACIAL ORTHOPEDICS ASSOCIATED WITH OSTEOGENIC DISTRACTION IN CASES OF CONGENITAL MICROGNATHIA

Daniela Franco Bueno, Nelson Bardella Filho, Marcelo P. Vaccari Mauett i , Lucy Dalva Lopes Centro de ReabilitaqHo das Deformidades Faciais - S2o Paulo, Brazil

OBJECTIVES

To assess the importance of early multidisciplinary management of congenital mandibular deformities,

such as Pierre-Robin sequence, Treacher Collins'syndrome, and hemifacial microsomies, through the association

of orthodontics and facial orthopedics with craniofacial surgeries (osteogenic distraction). This is important

mainly in more severe cases, where the obtainment of good functional results contributes to the survival of

these patients.


Patients (newborns up to 12-year old children) carrying severe congenital mandibular deformities and

referred to osteogenic distraction were seen at our rehabilitation center. In cases presenting risk of death,

distraction was performed prior to maxillary orthopedic intervention. In the other cases, early or preventive

orthopedic treatment was carried out prior to, during and after osteogenic distraction. Radiographs, models,

photos and tomographs were used to determine diagnosis and treatment plan. At the end of the treatment, new

radiographs, tomographs and models were obtained for the assessment of esthetic and functional results.

RESULTS Esthetic and functional results were satisfactory. Improvement was observed in respiration and suction in

newborns, and in respiration, mastication and deglutition in children (due to the mandibular increase resulting

from the association of osteogenic distraction and orthopedicslorthodontics).

CONCLUSION In severe cases of congenital micrognathia, maxillary orthopedics and orthodontics, associated with

osteogenic distraction, allowed for mandibular and facial growth within normal standards, reestablishing these

patients' vital functions and providing a satisfactory estheticlfunctional result in view of the limitations of these

pathologies.

18 Braz J Craniomaxillofac Surg 2002;5/11

VII Congress0 Brasileiro de Cirurgia Craniomaxilofacial - Abstracts

APPLICATIONS OF OSTEOGENIC DISTRACTION IN THE TREATMENT OF CRANIOMAXILLOFACIAL DYSPLASIAS

Nelson Bardella Filho, Ana Lucia C. Bardella, Lucy Dalva Lopes, Dulce M. F. Soares Martins, Lydia Masako Ferreira

Universidade Federal de SLo Paulo - SBo Paulo, Brazil

Bone deficiency is a very common characteristic of craniomaxillofacial anomalies, and its treatment has

always been challenging to health practitioners that act in this field. One of the main concerns in the treatment of

this condition is related to the acquisition of an organic material that is identical to that of the patient to be treated.

Along the past few years, osteogenic distraction has become an alternative technique in the treatment of

craniomaxillofacial dysplasias, minimizing the need for the use of bone grafts. The aim of this study was to

present some alternative applications of osteogenic distraction that have been successfully used in the treatment of patients carrying craniomaxillofacial anomalies. The study was carried out based on the history of osteogenic

distraction found in the literature produced by the national and international scientific communities, and aimed at

comparing the benefits brought by these techniques with those of conventional procedures.

INCIDENCE OF PATIENTS WITH CLEFT LIP AND PALATE AT INSTITUTO DE CIRURGIA PLASTICA CRANIOFACIAL (SOBRAPAR)

celso Luiz Buzzo, Cassio Raposo Menezes do Amaral, Rita Mancebo Blanco, Cinthia Regina Seraphim, Clariane Viero Vargas, Eliane Teixeira Caixeta Maiello

lnstituto de Cirurgia Plastica Craniofacial (Sobrapar) - Campinas, Brazil

OBJECTIVES

To assess the incidence and predisposing factors associated with cleft lip and palate in a period of 2 years.

MATERIALS AND METHODS The authors performed a retrospective evaluation of 86 patients presenting cleft lip and palate who were

admitted to the hospital of our institution (Sobrapar) between March 2000 and March 2002, and who had not

been submitted to any previous treatment. The following data were analyzed: origin, sex, age, skin color, birth weight and stature, type of fissure, associated pathologies, family history, as well as data referring to maternal

habits during gestation.

RESULTS

Most patientscamefrom thecountlyside of thestateof SBo Paulo, more precisely from the region of Campinas. Most children were admitted during the 1st month of life. No prevalence was observed in terms of age, and most

patients were whites. Mean birthweight was 31 08 g, and mean stature at birth was 46.7 cm. Among cleft lip cases,

unilateral fissures were the most common ones, and they were more prevalent in males. Cases of posterior cleft

palate also predominated, but there was no predominance of sex. Unilateral cleft lip and palate occurred more

frequently in females, and bilateral cases in males. In 32.55% (28) of the patients assessed, there were intercurrences during gestation. In addition, 19.76% (17) presented family history of cleft lip and palate. A total of 18 mothers

(20.93%) were tobacco smokers, while 12 (1 3.95%) consumed alcohol during pregnancy.

CONCLUSIONS

Afler assessment of the data obtained, it was possible to outline the current incidence and predisposing factors associated with cleft lip and palate at our service. We conclude that, with some minor exceptions, our

results confirmed those found in the literature.

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VN Congresso Brasileiro de Cirurgia Craniomaxilofacial - Abstracts

COLUMELLAR RECONSTRUCTION WITH NASOGENIAN FLAPS

Celso Luiz Buuo, Cassio Raposo Menezes do Amaral, Rita Mancebo Blanco, Clariane Viero Vargas, Cinthia Regina Seraphim, Eliane Teixeira Caixeta Maiello

lnstituto de Cirurgia Plastica Craniofacial (Sobrapar) - Campinas, Brazil

OBJECTIVES To report the case of a patient presenting nasal deformity (at the columeila and anterior portion of the

cartilaginous septum) caused by an infectious process. The deformity was repaired with a nasogenian flap, aiming at restoring the patient's facial appearance as well as anatomical, functional, and esthetic functions.


Surgical treatment was carried out with a nasogenian flap (left side), preserving local vascuiarization, followed by the rotation of the flap and its passage through a subcutaneous tunnel directed to the midline of the nasal

base. The flap was fixed to the middle third of the nasal base and tip with simple 5.0 mononyion sutures, and oral mucosa was grafted into the posterior portion.

RESULT

The nasogenian flap showed to be adequate and provided a satisfactory esthetic result at the donor site (imperceptible scar).

CONCLUSIONS

The nasogenian flap showed to be a reliable method for wlumellar reconstruction. In addition, it has advantages related to scars and to the color and texture of skin, as well as with the reestablishment of functional and esthetic functions.

THE USE OF LABIORHINOPLASTY IN CASES OF UNILATERAL FISSURES

Celso Luiz Buuo, Cassio Raposo Menezes do Amaral, Jupiter Neewler Lopes Duarte lnstituto de Cirurgia Plastica Craniofacial (Sobrapar) - Campinas, Brazil

OBJECTIVES

This study aimed at presenting a new technique for iabiorhinoplasty, which was developed in our service in association with the University of Goteborg (Sweden).


Labiohinoplasties were carried out in 53 patients presenting cleft lip and palate. Age ranged from 0 to 2

years, and patients were followed for approximately 7 years.

RESULTS Excellent esthetic and functional results were observed.

CONCLUSION

In afollow-up period of 7 years, the alternative technique showed to result in more symmetric nostrils, and

scars were well positioned, with no retractions or level differences in the mucocutaneous line.


VII Congress0 Brasileiro de Cirugia Craniomaxilofacial - Abstracts

MANDIBULAR RECONSTRUCTION WlTH A RECONSTRUCTIVE PLATE AND AN ACRYLIC CONDYLE AFTER RESECTION OF A SOLID AMELOBLASTOMA: A CASE REPORT

Christian Barros Ferreira, Jan Peter Ilg, Andre Caroli Rocha, Araldo Ayres Monteiro Jlinior Hospital das Clinicas da Faculdade de Medicina da Universidade de S5o Paulo - SSo Paulo, Brazil

OBJECTIVES

To present a case of resection of mandibular solid ameloblastoma followed by reconstruction using an acrylic condyle and a reconstructive plate, and to discuss the characteristics of the tumor and its therapeutic

aspects.


Report of the case of a male, 19-year old patient (light brown skin), who presented with asymptomaticvolume

increase in the left hemiface lasting for 1 Oyears. Panoramic radiograph of the mandible and computed tomography

of the face were requested. The initially predictive diagnosis of solid ameloblastoma was later confirmed by an incisional biopsy. Surgerywas planned to becaniedoutviaasubmandibularaccess route (going from the symphysis to the left mandibular angle), and consisted of segmental mandibulectomy followed by disarticulation and posterior

reconstruction of the defect with an endoprosthesis (reconstructive plate and acrylic condyle),

RESULTS Postoperative radiographic examinations showed that the endoprosthesis was well positioned, and no

relapse was obsewed along a 4-year follow-up. The patient developed skin and mucosa anesthesia at the left

hemimandible, as a result of the resection of the inferior alveolar nerve. The extraoral scar presented a satisfactory aspect, the patient's face was symmetric, and mouth opening had no deviations, with normal lateral movements to the left and right. In addition, the patient showed no signs of motor deficit.

CONCLUSIONS

Ameloblastorna is the most significant odontogenic neoplasia found in the clinical practice due to its prevalence and treatment difficulties that result from its locally aggressive behavior. Diagnosis should be based

on incisional biopsy. Treatment of thecase herein described was based on tumor extension, which did not allow the use of less invasive methods. Reconstruction with the reconstructive plate and the acrylic condyle showed

adequate esthetic, functional, and biological results.

TREATMENT OF AMELOBLASTOMA WlTH MARGINAL MANDIBULECTOMY, INFERIOR ALVEOLAR NERVE DISSECTION AND PRESERVATION,

AND IMMEDIATE BONE RECONSTRUCTION

Adalberto Novaes Silva, Paulo Cesar de Jesus Dias Hospital Unlversitario da Universidade Federal de Mato Grosso - Cuiaba, Brazil

INTRODUCTION

Amelobiastoma is a benign neopiasia with great clinical importance, due to its invasive behavior and

potential relapse after conventional surgical treatment.

Braz J Craniomaxillofac Surg 2002;5/1) 21

VII Congress0 Brasileiro de Cirurgia Craniornaxilofacial - Abstracts

OBJECTIVES

To discuss the therapeutic management of ameloblastomas affecting the mandibles of young patients

(adolescents).


Two cases of ameloblastoma in adolescents, with involvement of the mandibular corpus and angle, will be

described and discussed. Treatment was similar in both cases, with the use of an intraoral access route. First,

marginal resection of the mandible was carried out, aimed at providing a safety margin and maintaining the

mandibular base. The inferior alveolar nerve was dissected and preserved. Then, immediate bone reconstruction

was carried out with the use of a block graft taken from the anterior iliac bone and fixed to the receptor site with

titanium plate and screws. Teeth affected by the neoplasia were temporarily replaced with a partially removable

prosthesis in order to prevent extrusion of the corresponding superior dentoalveolar segment.

RESULTS

Along 2 years of follow-up, no evidence of clinicallradiological relapse has been observed, and the

reconstructed area presents the necessary conditions to undergo rehabilitation with osteointegrated implants. Complaints of paresthesia in the mentonian region (at the operated side) are present in both patients, but are

not significant.

CONCLUSIONS

The surgical treatment of ameloblastomas with preservation of the mandibular base and inferior alveolar

bone was carried out taking into consideration the patients' age. The use of the intraoral access route favored

the obtainment of adequate esthetic results. The follow-up of the present cases was too short to assure the

impossibility of relapse. However, the technique described in this study should be considered in some specific circumstances.

ASSESSMENT OF SEPTAL DEFORMITIES USING NASAL VIDEOFIBROSCOPY IN ADULT PATIENTS

WITH TRANSVERSAL MAXILLARY ATRESIA

Adalberto Novaes Silva, Wilma T. Anselmo Lima Hospital Universitario da Universidade Federal de Mato Grosso - Cuiaba, Brazil

INTRODUCTION

The occurrence of maxillary deformities in association with respiratory problems, mainly nasal obstruction, has called the attention of several investigators for the possibility of an interrelation between these two conditions.

The objectives of the present study were to assess the co-occurrence of nasal obstruction and septa1 deformities in adult patients presenting posterior cross bite and to discuss the performance of an integrated surgical treatment

(maxillary surgerylseptoplasty) in these patients.

22 Braz J Craniomaxillofac Surg 2002;5/1/

VII Congresso Brasileiro de Cirurgia Craniomaxilofacial- Abstracts

MATERIALS AND METHODS Otorhinola~yngological assessment with emphasis on the examination of the nasal cavity was carried out

through nasofibroswpy in 30 adult patients presenting posterior cross bite and an indication for orthodontic1

surgical treatment (surgically assisted maxillary advancement).

RESULTS Of the patients studied, 56.7% reported nasal obstruction, and 43.3% has not complaints of respiratory

problems. Taking the nasofibroscopic results into consideration, septal deformities were present in 100% of the

cases, and their topographic classification, according to Cottle, were as follows: compromising of area I in

13.4%, area II in 83.3%, area Ill in 90%, area IV in 83.3%, and area V in 3.3%.

CONCLUSIONS We observed that adult patients with posterior cross bite do not necessarily present nasal obstruction. The

nasofibroscopic examination showed to be of extreme importance for the diagnosis of septal deformities in adult patients with posterior cross bite. We emphasize the importance of the co-work of the maxillofacial surgeon

and the otorhinolaryngologist, so as to carry out both surgeries (maxillary osteotomy and septoplasty)

simultaneously in cases where both procedures are necessary.

ESTHETIC AND FUNCTIONAL REHABILITATION OF THE MAXILLA AND ALVEOLAR RIDGES WITH CALVARIAL BONE GRAFTS

Wilson Cintra Junior, Nivaldo Alonso Hospital Professor Edmundo Vasconcelos - SSo Paulo, Brazil

OBJECTIVE Patients (mainly youngsters) with maxillary and alveolar ridge atrophy resulting from loss of teeth caused

by severe trauma or periodontal diseases should be submitted to a surgical procedure aiming at increasing

bone tissue height and thickness so as to allow the placement of osteointegrated implants or dental prostheses.

The objective of the present study was to describe a cortical bone graft technique carried out in the maxillary sinus floor and alveolar ridges with the aim of increasing bone density (both horizontally and vertically) and

consequently improving the esthetic and functional oral rehabilitation process.


After clinical evaluation, maxillofacial physical examination, and radiological assessment (including face

radiograph, panoramic radiograph of the mandible, and thin-slice computed tomography or dental scan), 17 patients with ages ranging from 32 to 55 years were operated between July 1998 and June 2001, with the aim

of creating a bone site where osteointegrated implants or dental prostheses could posteriorly be placed. Postoperative clinical and radiological assessments were also carried out.

RESULTS

All patients obtained sufficient bone thickness at the end of treatment and could start oral rehabilitation. After a mean period of 6 months postoperatively, 14 patients started rehabilitation treatment with osteointegranted

implants, and three patients statted to use a removable dental prosthesis, with satisfactory esthetic and functional

Braz J Craniomaxillofac Surg 2002;5(11 23

Vll Congress0 Brasileiro de Cirurgia Craniornaxilofacial - Abslracts

results in all cases. Two patients presented partial dehiscence of the mucosal sutures, but the performance of

complementary surgeries and continuous aseptic routines assured synthesis completion - the rate of bone

absorption resulting from this complication was not significant and had no effects on final results.

CONCLUSIONS In spite of the small size of our sample, the bone graft technique provided satisfactory esthetic and functional

results and allowed the beginning of rehabilitation in all operated patients, with the use of either osteointegrated

implants or removable prostheses. A small rate of cortical bone graft reabsorption was observed, which is in

accordance with data found in the literature.

THE USE OF TITANIUM MICROANCHORS IN THE TREATMENT OF DISPLACEMENT OF MEDIAL CANTHl

Dov Charles Goldenberg, Nivaldo Alonso, Marcus Castro Ferraira Hospital das Clinicas da Faculdade de Medicina da Universidade de SZio Paulo - SZo Paulo, Brazil

OBJECTIVES The treatment of deformities affecting the medial canthus of the orbit is still considered a challenge in the

field of craniofacial surgery. The classical techniques, namely transnasal canthoplasty and canthopexy, have

been associated with a high rate of relapse and inadequate positioning of the medial canthal tendon, in addition

to the risk for contralateral ocular lesion. On the other hand, ipsilateral techniques are associated with technical

difficulties, and results are not always satisfactory. The present study proposes a new treatment option for

cases of deformities of the medial canthus of the orbit, through the use of titanium microanchors.


Six cases of patients presenting telecanthus and displacement of the medial canthi of posttraumatic,

tumoral and congenital etiology were submitted to medial canthoplasty with microanchors. Results were assessed

by means of anthropometric measurements of the orbital region prior to and right after surgery, and also 1

month, 6 months, and 1 year after surgery. The following measurements were included: intercanthal distance,

distance between the medial canthus and the midline, orbital width, and distance between the lateral canthus

and the midline.

RESULTS

At 6 months and 1 year after surgery, the technique presented satisfactory results in terms of clinical aspects

and method stability. In addition, it allowed for the safe and fast ipsilateral fixation of the medial canthal tendon.

CONCLUSIONS

The performance of ipsilateral canthoplasty with microanchors proved to be a safe, simple, and effective

method for the treatment of displacement of the medial canthi and posttraumatic telecanthus. Due to its recency,

the assessment of long-term results is necessary in order to certify this therapeutic option.


VII Congress0 Brasileiro de Cirurgia Craniomaxilofacial- Abstracts

MANDIBULAR FIBROSARCOMA

Marcela Azevedo Brito, Sergio Luiz de Miranda Hospital lsraelita Albert Einsten and Universidade de Santo Amaro - Santo Amaro, Brazil

OBJECTIVES

To describe an extremely rare clinical case of malign odontogenic tumor of mesenchymal origin.


Diagnosis was based on anatomopathological examination and was originally defined as arneloblastoma.

Once the tumor started to present an abnormal evolution, a new examination was carried out; this second test

yielded a diagnosis of ameloblastic fibrosarcoma. This change in diagnosis required the performance of a more

radical form of treatment: partial hemimandibulectomy associated with radiotherapy.

RESULTS

First diagnosis consisted of ameloblastoma, and the condition was treated twice at another service with the

conventional method. After some time, the neoplasia evolved to an ameloblastic fibrosarcoma. The patient

sought medical assistance again, and this time surgery and radiotherapy were carried out. After treatment, no

local relapse was observed, but there were metastases in the pulmonary, hepatic, and abdominal areas, which caused the patient's death.

CONCLUSIONS Fibrosarcoma is an odontogenic neoplasia whose mesenchymal component makes it resemble a sarcoma,

while its epithelial component makes it take the appearance of a benign lesion. The tumor affects young adults

more frequently, and there is no predominance of sex. The mandible is the most commonly affected organ.

Frequent signs and symptoms include pain, edema, and rapid growth, leading to significant bone destNcti0n

and dental mobility in some cases. Conventional treatment is usually followed by relapses, which may or may

not be accompanied by local or distant metastases.

COMPLICATIONS OF PROCEDURES USED IN THE TREATMENT OF SLEEP- RELATED RESPIRATORY DISORDERS

Nelson E. P. Colombini, Jose A. Pinto, Gustavo J. Faller Clinica Medica Nelson Colombini - SHo Paulo. Brazil

OBJECTIVES

To show the incidence of complications associated with the surgical treatment of sleep-related respiratoly

disorders. We report the spectrum of complications found in our case series, with a focus on anesthetic,

transoperative and postoperative complications.

METHODS

Ourseriesof 785 patients diagnosed with sleep-related respiratory disorders was selected between Feb ru~n~

1996 and January 2002.

Braz J Craniomaxillofac Surg 2002;5111 25

v,r Congresso Brasileiro de Cirurgia Craniomaxilofacial- Abstracts

RESULTS

The rate and type of complications observed in a total of 945 procedures were assessed. The most commonly

observed were: hemorrhage, loco-regional hematomas, edema causing upper airway obstruction, infections, loss

of fixation in skeletal procedures, hypoesthesia of the lower dental nerve and loss of occlusion relation. These

complications were effectively controlled with either complementary surgical procedures or clinical treatment, and

did not result in death or in the need for blood transfusion in any case. Tracheostomy was required in 12 cases.

CONCLUSION

The rate of complications observed in our series is not different from the data found in the medical literature.

However, we emphasize the morbidity that is usually associated with surgical procedures carried out in the upper

airways, and which is significantly increased in patients presenting moderate and severe apnea.

OBSTRUCTIVE SLEEP APNEA - A NEW OPTION FOR THE CRANIOMAXILLOFACIAL SURGEON

(CONCEPTION AND BASIC SURGICAL PROTOCOL)

Nelson E. P. Colombini, Gustavo J. Faller, Wolney B. D'Azevedo Clinica Medica Nelson E. P. Colombini - SZo Paulo, Brazil

OBJECTIVES

To focus on the importance of the rnaxillofacial surgeon in the treatment of patients with apnea, since the

procedures recommended for these cases belong to the field of this specialist.


A multicenter assessment of 785 cases surgically treated between 1995 and 2000 was carried out, with the subsequent establishment of a protocol aimed at guiding professionals interested in treating these cases.

RESULTS

The protocol showed to be effective in 70 to 98% of patients. In cases of mild apnea, results were positive

in about 90% (reduction of the apnealhypoapnea index); in cases of moderate apnea, treatment effectiveness

was more difficult to be achieved, due to the craniofacial alterations presented by patients and to associated

morbidities (in our series, the success rate ranged between 70 and 95%); severe apnea with a corporeal mass

index of up to 33 was controlled in 98% of cases, with the use of maxillomandibular advancement associated

with laser-assisted midline glossectomy.

CONCLUSION

Significant improvement has been observed in the surgical procedures used to treat obstructive sleep

apnea, mainly in terms of evolution of surgical procedures and comprehension of the inter-relation between the

craniofacial and pharyngeal structures. Each case presents variables that should be taken into consideration in

the selection of surgical procedures. Some examples include: corporeal mass index, hypoapnea, and desaturation

during sleep. The comprehension of facial typology and its effect on the disease studied are the key factors for

the success of treatment.


VII Congresso Brasiieiro de Cirurgia Craniomaxiiofaciai - Abstracts

TISSUE ENGINEERING: AN ALTERNATIVE IN FACIAL RECONSTRUCTION PROCEDURES

Sonja Ellen Lobo

Several materiais have been studied and used in tissue reconstruction procedures, including bioceramics

with calcium radicals. The respect fortissue engineering principles is a main factor forthe obtainment of effective

results, as is the respect for architectonic, surface topography, porosity, and biocompatibility characteristics, in

addition to the properties of osteoconduction and osteoinduction related to the material used. All these aspects

contribute to a compatible and adequate tissue neoformation. These aspects will be discussed in the present

study, and some clinical cases will be presented.

IDIOPATHIC BONE CAVITY IN THE MANDIBULAR CONDYLE

Adrlano do Valle Fernandes, Evandro Nunes MagalhBes, Gustavo Bellozi de Araujo, Marceio Drummond Naves, M6nica Vieira Salgado, Wagner Rodrigues dos Santos

Hospital Maria Amelia Lins - Belo Horizonte, Brazil

Report of the case of F.P.S., a female, leukodermic, 18-year old patient who was referred to the Service of

Bucomaxillofacial Surgery and Traumatology of our hospital by an orthodontist due to the asymptomatic

radiographic finding of an alteration at the right mandibular condyle region during a routine examination. The

patient presented no history of trauma. On clinical examination, the skin and mucosa of the surrounding areas

presented normal color and texture, with no volume increase, no limitation to mandibular movements, and no

other sign of articular dysfunction. On conventional and tomographic radiography, a well-defined radiolucid

area was detected at the region of the right mandibular condyle, measuring about 4 x 6 mm in diameter, with no

signs of cortical expansion or bone continuity solution. Aspiration punch biopsy was carried out, followed by the

preparation of cytological slides for histopathological examination, which revealed the presence of sanguineous

cells. This finding, in association with the clinical and radiographicfindings above mentioned and the postoperative

evolution of the case, determined the diagnosis of idiopathic bone cavity. Radiographic follow-up every 3 months

along 1 year showed complete cicatrization of the bone.

A SURGICAL APPROACH TO CRANIOFACIAL NEUROFIBROMATOSIS - A CASE REPORT

Clarissa Leite Turrer, Ricardo Lopes Cruz lnstituto Fernandes Figueiras (FIOCRUZ) - Rio de Janeiro, Brazil

Neurofibromatosis was first described by Von Recklinghausen in 1882 as a syndrome characterized by

multiplefibromas, skin pigmentation, alterations in the central nelvous system and skeletal anomalies. It consists

of an autosomic dominant inherited disease, and the gene mutations associated with it result in a various range

of clinical statuses, of different severity. The most severe forms of neurofibromatosis are associated with deformities

that compromise the patient's life. The present study describes a clinical case of craniofacial neurofibromatosis

affecting the orbitopalpebral area, as well as the steps of the transdisciplinary surgical treatment carried out with

the aim of providing ocular rehabilitation. We also describe technical limitations and results of the treatment, as

well as the subsequent improvement of the patient's clinical status and life.

Braz J Craniomaxillofac Surg 2002;5(11 27

VII Congress0 Brasileiro de Cirurgia Craniornaxilofacial - Abstracts

MAXILLARY SINUS LIFT USING MANDIBULAR RAMUS BONE GRAFTS - TECHNICAL CONSIDERATIONS

Davidson Rodarte Feliz de Oliveira, AntBnio Albuquerque de Brito, Aloisio Borges Coelho

The height of the posterior regions of the maxilla represents a limiting factor to its rehabilitation with grafts

in a great part of the Brazilian population. This is partly due to early tooth extractions, very common in oursetting,

which lead to high rates of alveolar bone reabsorption along the patient's life, and consequently tothe pneurnatization

of the maxillary sinuses. The lift of maxillary sinuses using bone grafts constitutes an important surgical technique

in the viabilization of the use of osteointegrated implants in the posterior regions of the maxilla. Several grafl

donor sites have already been described in the literature. The present study proposes the use of mandibular

ramus bone grafts due to several advantages: easy access, low morbidity, availability of bone volume, and the

same origin (intramembranous) as that of the receptor site.

ZYGOMATIC FIXATION -AN ALTERNATIVE PROCEDURE FOR THE REHABILITATION OF SEVERELY ATROPHIED MAXILLA

Waldemar Daut Polido, Eduardo Marini M5e de Deus Center - Porto Alegre, Brazil

Reconstruction of the atrophied maxilla usually requires the use of iliac crest bone graft. The techniques

most frequently used to treat this problem take grafts from other sites and therefore require hospitalization, a

long time without the use of total prostheses, and a long time of treatment. Although the success rate associated

with the use of bone grafts is relatively high, it rarely goes over 90%. Taking these data into consideration, and

due to the current need for solving severe cases of maxiilectomy, Professor Branemark and his team developed

a fixation technique aimed at providing efficient bone anchorage to allow rehabilitation with a fixed prosthesis,

thus discarding the need for longer and more invasive surgical procedures. In 1989, zygomatic fixation started

to be used as an alternative procedure for the rehabilitation of severely atrophied maxillas, and its indications

and contraindications, advantages and disadvantages started to be studied.

A MULTIDISCIPLINARY APPROACH TO THE ASSESSMENT AND TREATMENT OF A PATIENT PRESENTING PROGNATHISM,

HYPOMAXILLISM, AND BURN SEQUELAE - A CASE REPORT

Blas Antonio F. Santander, Mayra Cristina Kimura, Patricia de Paula Shimabuku, Rejane Aparecida de Lima, Vera Lucia Nocchi Cardim

Hospital da Real e Benemerita Sociedade Portuguesa de Beneficencia de SSo Paulo - SSo Paulo. Brazil

OBJECTIVES

The authors describe the clinical case of a patient with maxillomandibular disproportion and the assessment

and therapeutic approach carried out in the case. Through the description of speech-related, orthodontic and

surgical aspects, the routine of the service is described, as well as the intercurrences observed in the specific

case herein described.

28 Braz J Craniomaxillofac Surg 2002;5(11

VII Congresso Brasileiro de Cirurgia Craniornaxilofacial - Abstracts


A 42-year old male patient presenting progmathism, hypomaxillism and cicatricial retraction due to burn

sequelae was submitted to orthodontic and oral preparation for a combined surgery involving advancement of

the mid third of the face and mandibular retrusion, together with the filling of the pyriform fossa with a bone graft

taken from the mandibular external cortical bone. Due to the compromise of teeth (absence of upper molars),

transskeletal maxillary orthopedic treatment was carried out for the maintenance of results.

RESULTS

After 6 months of treatment with myofunctional therapy and orthodonticcare, the patient started to use the

definitive prosthesis, with unequivocal esthetic and functional gains.

CONCLUSION

The use of a multidisciplinary approach in the care, treatment and follow-up of patients potentially submitted

to orthognatic surgery is of paramount importance in the detection of problems, in the management of cases and

in the posterior maintenance of surgically-obtained results.

MULTIDISCIPLINARY TREATMENT OF A PROGNATHIC PATIENT WITH HYPOMAXILLISM

Rejane Aparecida de Lima, Mayra C. Kirnura, Rodrigo Dornelles, Rolf L. Salornons, Vera L. N. Cardim

Hospital Beneficencia Portuguesa de Sao Paulo - Silo Paulo, Brazil

OBJECTIVE

Patients presenting maxillomandibular disproportion require a multidisciplinary treatment, with the

participation of a speech therapist working in conjunction with plastic surgeons and dentists, among other

professionals, in order to contribute to the diagnosis, planning and pre- and postoperative management of

cases. In orthognatic surgery, inter-related structural and functional elements are involved, and speech therapy

aims at assessing the maxiilofacial complex in its dynamic form, thus associating functional problems with

structural elements that may negatively interfere with surgical results.


The use if orofacial myotherapy, with isometric (focused on tonicity) and isotonic (focused on mobility)

exercises, was selected to correct functional and muscular alterations. The authors report the case of S.L.M.F,

34 years old, who presented with maxillomandibular disproportion and was treated by a multidisciplinary team,

with pre- and postoperative follow-up focused on speech-related aspects.

RESULTS

After 1.5 year of postoperative follow-up, the patient was rehabilitated, and surgicaVorthodontic results were maintained.

CONCLUSION

The multidisciplinary management of patients presenting maxillornandibular disproportion, with the help of

a speech therapist so as to adequately restore the speech function, promotes balance among functional and

structural elements, resulting in facial harmony and preventing relapse.


Vll Congresso Brasileiro de Cirurgia Craniomaxilofacial - Abstracts

ZYGOMATICOPLASTY: AN ESTHETIC COMPLEMENT TO ORTHOGNATIC SURGERY

(TECHNIQUES AND ALTERNATIVES)

Nelson E. Colombini, Wolney B. D'Azevedo, Einar F. Oquendo Clinica Medica Nelson Colombini - SBo Paulo, Brazil

OBJECTIVES

In the present study, we describe the application of different zygomaticoplasty techniques in conjunction

with lower Le Fort I osteotomy in cases where correction of the nasogenian segment can be carried out with a

Z osteotomy and where the zygomatic component can be esthetically repaired with less complex techniques.


Eight cases were submitted to osteotomy as suggested by Powell & Hilley, together or not with orthognatic

surgery. The procedure consists in the filling of a gap with lyophilized or autogenous bone grafts, followed or not

by fixation with miniplates and screws of with 1.5 mm in diameter. In women, procedures of zygomaticfeminilization

may still be improved by the inversion of the Bichat ball to cover the osteotomized region.

RESULTS

The esthetic results obtained with zygomaticoplasty are as good as or better than those obtained with

quadrangular osteotomy or upper Le Fort I osteotomy, as observed the cases herein described.

CONCLUSIONS

The use of Powell's technique in zygomaticopiasties is fast, efficient, associated with low morbidity and

satisfactory esthetic results. It may be performed in combination of lower Le Fort I osteotomy or alone. In

addition, its association with blepharoplasty is also advocated by the authors.

PALATINE DISJUNCTION THROUGH ENDONASAL MICROSURGERY

Nelson E. P. Colombini, Wolney B. D'Azevedo, Gustavo J. Faller Clinica Medica Nelson Colombini - SSo Paulo, Brazil

OBJECTIVES

To describe the petformance of palatine disjunction via an endonasal access route and to discuss the

advantages and observations made along a 6-year experience.


We describe 6 cases operated between 1996 and 2001, and report its advantages and indications.

RESULTS

The use of an endonasai access route in the performance of palatine disjunction is totally adequate to the

patient concerning physiological aspects. In addition, in one only surgical procedure, it allows forthe correction of

nasal cavities and cornets and for the manipulation of the osteomeatal space (whenever necessary). Surgically-


VII Congresso Brasileiro de Cirurgia Craniornavilofacial - Abstracts

assisted palatine disjunction is of paramount importance in the treatment of two basic situations: cases of insufficient

upper maxilla (above 5 mm from one side to the other), where it can help both in the preparation for surgery (in

association with orthodontia) and during the orthognatic period (postorthodontia); and cases of lower septa1

deviations or problems in the valvular area or Cottle's area. None of our patients presented complications related

to the procedure.

CONCLUSION

We used the basic septoplasty technique, with amplification of Cottle's lower tunel, in order to make room

for the entry of the modified microsaw. The modified technique herein described showed to be a natural, little

aggressive, and equally effective procedure for the performance of palatine disjunction, and is likely to be widely

used in maxillofacial surgeries in the future.

FUNCTIONAL GENIOPLASTY

Rodrigo 0. M. Marinho, David S. Precious Hospital Lifecenter - Belo Horizonte, Brazil, and Dalhousie University - Halifax, Canada

INTRODUCTION

The term "genioplasty" has classically been used to name as a cosmetic surgical procedure. However,

it is known that changes in form (anatomy) lead to changes in function. Functional genioplasty is a typical

example of this principle, due to the alteration of the position and anatomical form of the menton and its

myocutaneous structures.

OBJECTIVES AND CASE REPORT

This study has the aim of defining clinical indications for the use of functional genioplasty. In addition,

differences between this surgical technique and the classical treatment are reported based on the presentation

of clinical cases.

RESULTS

In all cases submitted to this surgical technique, excellent functional and cosmetic results were obtained.

It is important to emphasize the simplicity of the technique, the low morbidity levels associated with it and

the extremely low incidence of functional alterations in the mentonian nerve.

CONCLUSION

Functional genioplasty is a simple surgical procedure that may be used to correct functional and

cosmetic problems in patients who carry dentofacial deformities. It allows for the anatomical and

functional improvement of the menton, once it restores bones, muscles and the skin of the anterior and

lower portions of the face.


VII Congresso Brasileiro de Cirurgia Cran~ornaxilofacial - Abstracts

SURGICALLY-ASSISTED RAPID MAXILLARY EXPANSION - REPORT OF A CLINICAL CASE

Paulo Roberto Pelucio CBmara

Occlusion problems are assessed in antero-posterior, vertical, and transversal directions. The variables

that determine whether a case should receive orthodontic or orthosurgical treatment include the intensity of the

problem and the degree of esthetic and/or functional compromise associated with the lesion. Treatment of

transversal problems usually implies the performance of maxillary expansion and, depending on the patient's

age, either removable devices (higher effect on teeth) or fixed expanders, such as Haas's or Hyrax's models

(significant effect on the maxillary bone), may be used. However, when the growing phase is over, the palatine

suture closes, and the orthopedic results commonly obtained with this form of treatment are lost. In these cases,

it is recommended to use a surgical procedure, so that the effect of expansion over bone tissues may be effective

and so that the upper and lower dental arches obtain an adequate coordination. The objective of this study was

to describe a clinical case and to show the effects of expansion on the maxilla of an adult patients submitted to

surgery in association with use of Hyrax-type expanders.

TREATMENT OF THE ANTEROPOSTERIOR MAXILLARY EXCESS WITH LE FORT I OSTEOTOMY:

REPORT OF TWO CASES AND DISCUSSION

AntBnio Albuquerque de Brito, Davidson Rodarte Felix de Ollvelra, Yumara Siqueira de Castro

INTRODUCTION

Le Fort I maxillary osteotomy, as proposed by Bell in 1975, gave origin to a wide range of surgical techniques

aimed at the treatment of maxillary deformities. However, some procedures present a higher morbidity rate, so

that extreme care must be taken in the planning of treatment, as is the case of maxillary anteroposterior retraction.

OBJECTIVE

To report two cases of dentofacial deformity with anteroposterior maxillary excess treated with horizontal

retraction. In addition, we aim at discussing, based on the literature and on the experience of the authors,

considerations on the surgical technique and treatment plan.

RESULTS

Surgeries were performed without intercurrences, and lasted 4 hours and 18 minutes on average;

hospitalizations lasted 33 hours, on average. Patients showed an adequate evolution in the postoperative

period, with dental and skeletal stability and no manifestations of respiratory, speech, sleep or deglutition

alterations.

CONCLUSIONS

1) versatility of Le Fort I osteotomy;

2) reliability of the osteotomized maxilla vascularization;

3) need for preoperative assessment of velo-pharyngeal competency;

4) versatility in the plan of treatment, focusing on esthetic results;

5) need for the presence of less conventional procedures among the therapeutic options;

6) attention to the treatment plan, in order not to confer an "old" appearance to the patient.

32 Braz J Craniornaxillofac Surg 2002;5(11

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Vega KJ, Pina I, Krevsky B. Heart transplantation is associated wi th an increased risk for pancreatobiliary disease. Ann Intern Med 1996;124:980-3.

' Craniomaxillofac Surg 2002;5/11 33

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34 Braz J Craniomaxillofac Surg 20C

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0 trauma craniomaxilofacial associado ao trauma cranio~nc~falico pod€ r~sul tar Em IESOES ou s ~ q i j ~ l a s do Sis t~ma N~rvoso C~ntra l d~ alta c o m p l ~ x i d a d ~ . € por ESSE motivo q u ~ a T ~ c h n i c a r ~ trabalha e invest€ na ~ducacao continuada.

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