Salvage or Solution: Alloplastic Reconstruction in Hemifacial Microsomia.

Autor:	Polley JW; 1 Department of Plastic and Dermatologic Surgery, Helen DeVos Children's Hospital, Grand Rapids, MI, USA., Girotto JA; 1 Department of Plastic and Dermatologic Surgery, Helen DeVos Children's Hospital, Grand Rapids, MI, USA., Fahrenkopf MP; 2 Spectrum Health Integrated Plastic Surgery Residency, Grand Rapids, MI, USA., Dietze-Fiedler ML; 2 Spectrum Health Integrated Plastic Surgery Residency, Grand Rapids, MI, USA., Kelley JP; 2 Spectrum Health Integrated Plastic Surgery Residency, Grand Rapids, MI, USA., Taylor JC; 3 Grand Rapids Ear Nose Throat, Grand Rapids, MI, USA., Lazarou SA; 4 American Craniofacial Associates, Athens, Greece., Demetriades NC; 4 American Craniofacial Associates, Athens, Greece.
Jazyk:	angličtina
Zdroj:	The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association [Cleft Palate Craniofac J] 2019 Aug; Vol. 56 (7), pp. 896-901. Date of Electronic Publication: 2018 Dec 13.
DOI:	10.1177/1055665618817669
Abstrakt:	Introduction: Skeletal reconstruction in severe grades of hemifacial microsomia (HFM) continues to be challenging. Traditional techniques of autografts and osseous distraction for reconstruction of the glenoid fossa, condyle, and ramus can fall short of expectations and can create new problems. This intercontinental study analyzes the role of alloplastic skeletal rehabilitation in severe HFM. Methods: Ten consecutive patients with Pruzansky grade III HFM were reconstructed between October 2014 and July 2017 at 2 craniofacial centers following the same protocol. Data were gathered retrospectively from the medical records, including photographs and virtual planning records. Pre and postoperative photos were taken to compare occlusal status, interincisal opening, sagittal mandibular projection, and posterior facial height. Alloplastic reconstruction was accomplished using a custom designed titanium implant. Results: Ten consecutive skeletally mature patients with HFM with failed traditional reconstructions were successfully treated with virtually planned alloplastic reconstructions (11 joints) and simultaneous orthognathic surgery. The glenoid fossa, condyle, and ramus on the affected sides were reconstructed with custom designed titanium implants. All patients achieved occlusal stabilization, normalization of posterior facial height and sagittal mandibular projection, and maintenance or improved inter-incisal opening. There were no major complications or repeated surgeries. Follow-up ranges from 6 to 50 months. Conclusion: Alloplastic reconstruction allows for precise vertical reconstruction of the ramus and condyle and sagittal repositioning of the mandibular body. The glenoid fossa component is firmly anchored to the skull base assuring a stable centric relation on the reconstructed side. Consistent and acceptable results can be achieved in skeletally mature patients.
Databáze:	MEDLINE
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