practice & scope of oral-craniomaxillofacial surgery · 9 clinical approach surgical procedures...
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Practice & Scope
of
Oral-Craniomaxillofacial Surgery
Roberto M. Pangan DMD., MD.
Clinical Assoc. Prof
Craniomaxillofacial-Plastic Surgery Section
Dept. of ENT – U.P. P.G.H.
D.M.D. / D.D.S.
Otorhinolaryngology
Plastic surgery
Ophthalmology
Craniomaxillofacial Surgery
orthopedic
Neurosurgery
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Pathologic Physiologic
ANATOMIC UNIT
( Face )
Functional - Aesthetic
Reconstructive Surgery
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Cleft Anomaly
Persistence of embryonic clefts
Cleft lip-palate Facial cleft
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Clinical Approach
surgical procedures non-surgical procedures
cheiloplastypalatoplastyventilation tube insertionalveolar bone graftingvelopharyngoplastycolumellar lengtheningorthognathic surgerydistraction osteogenesisrhinoseptoplastylip revision
parent counselingmolding appliancespeech therapypt.counselingdental careorthodontic tx.
Multidisciplinaryteam
Interdisciplinary referralvs.
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Multidisciplinary team
SurgeonOtologist
Pediatrician
Orthodontist
PedodontistProsthodontist
Rehabilitation Med.Speech therapist
Psychiatrist
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Surgical Goals
• Complete anatomical closure of cleft -palate
• Functioning velopharyngeal mechanism
Criteria for Success
• Normal speech development
• Absence of fistula
• No secondary maxillary growth inhibition
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ConceptConcept•skeletal surgery
•alveolar bone grafting•orthognathic surgery
•rhinoseptoplasty
•revision cheiloplasty
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ANKYLOSISTMJ Ankylosis
8th weektemporal blastemas
condylar blastemas
9th – 10th wk.ossification
formation of condylar cartilage
12th wk. formation of lower joint compartment
14th wk. formation of upper joint compartment
Embryology
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Cranio-maxillofacial trauma
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Indications
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Surgical Approaches
Intraoral
Extraoral
Combined extraoral - intraoral
Fixation Method
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postcondylar fracture syndrome
mandibular deviation
shortened vertical ramus height
canting of oclussal plane
decreased translation
internal derangement
Assael, l. A. : Hard tissue Trauma. Temporomandibular Disorders: 1990
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Developmental Anomalies
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Neoplastic disorders
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Ameloblastoma( benign epithelial odontogenic tumor )
Adamantinoma ( Malassez, 1885 )
Ameloblastoma ( Churchill, 1934 )
Potential epithelial sources:
- enamel organ
- reduced enamel epithelium
- odontogenic rests (rests of Malassez/Serres)
- epithelial lining of dentigerous cysts
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Histologic Classification
- follicular- plexiform- Acanthomatous- spindle
* unicystic
Treatment Strategies
Radical Surgery( Axhausen )
Conservation Surgery ( Pichler, Trauner )
1. Marsupialization/Enucleation2. Enucleation w/ curettage3. Enucleation w/ peripheral
ostectomy
Primary Reconstruction
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unicystic ameloblastoma
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“Ameloblastomas exhibit biological heterogeneity andhistological appearances do not always allow their behavior to be predicted.”
Oral Dis. 1999 Apr. 5 (2) : 111-6Ong’uti MN, Howells GL,Williams DM
Oral Diseases Research Center,Royal London School of Medicine and Dentistry, UK
Ameloblastoman = 35
SOLID Cystic
1995 - 2005
11/35 = 31% 24/35 = 67%
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Ameloblastoma (solid type)
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Ameloblastoma
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1995 – 2005
N = 24 PatientsCystic Mandibular
Ameloblastoma
Mandibular conservation surgery
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Conservative treatment
1. Surgical enucleation of cystic ameloblastoma
2. Smoothening of bony septations and loculations
3. Exteriorize bony cavity
4. 4% 5FU cream application into healing bony cavity q 3-4 days x 4weeks.
Ameloblastoma n=24
3/24 = 12% 16/24 = 67%
5/24 = 21%
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25.0%Associated w/ unerupted tooth
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0
1
2
3
4
5
0-10yrs 11-20yrs. 21-30yrs. 31-40yrs. 41-50yrs.
femalemale
age/sex distributionN=24 patients
Female = 58% Male = 42%
=
=
=
25%
62.5%
12.5%
Distribution of mandibular ameloblastoma in 24 patients
N= 6
N= 15
N= 3
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Cystic ameloblastoma
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Cystic ameloblastoma w/intraluminal tumor nodules
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0 1 2 3 4 5 6 7 8 9 10123456789
101112131415161718192021222324
follow-up period
N=24
yrs.
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Results
(+) bone regeneration
(+) functional rehabilitation
15/24 = 63% w/o residual sensory deficit
4/24 = 17% w/ minimal mandibular asymmetry
6/24 = 25% w/ mild sensory deficit
3/24 = 12% w/ bothersome sensory deficit
2/24 = 8% -pathologic fracture
Treatment period : 6-12 months