顎変形症手術における術中合併症について

The existence of cancellous bone between buccal and lingual cortical plates provides guidance for the desired split plane through the osteotomy lines and interruptions increase the risk of unfavorable fractures during sagittal split ramus osteotomy (SSRO). The aim of this study is to present a rare case of SSRO in the absence of cancellous bone concerning the osteotomy sites, a conservative approach using piezosurgery and bone separators to avoid complications.

Retrospective study of changes in the sensitivity of the oral mucosa: sagittal split ramus osteotomy (SSRO) versus intraoral vertical ramus osteotomy (IVRO)

A clinico-statistical observation was carried out on 305 patients (314 cases) who underwent orthognathic surgery between 1981 and 1994 at Second Department of Oral and Maxillofacial Surgery, Showa University Dental Hospital.The results were as follows:1. The number of patients with jaw deformity has increased in recent years. The average number of patients per year was 22, about 12.4% of the total number of inpatients.2. The age of patients ranged from 15 to 40 years with a mean of 22.3 years.3. The patients were 85 males and 220 females, and the male-female ratio was 1: 2.6.4. The most frequent chief complaint was malocclusion.5. Of these patients, 272 cases (89.2%) had mandibular prognathism with or without another jaw deformity.6. Sagittal splitting ramus osteotomy (SSRO) was performed on 266 cases (84.8%).7. The average operation time and blood loss in SSRO were 4hr. 25min.±1hr. 2min. and 471.7ml±339.1ml, respectively.8. Osteosynthesis of bone fragments in SSRO was carried out as follows: 36 cases with circumferential wiring, 16 cases with sapphire lag screw, 161 cases with two-dimensional positioning screw, 13 cases with three-dimensional positioning screw, and 40 cases with mini-plate fixation.

We present a case of Crouzon disease treated by two-jaw surgery after a Le Fort III osteotomy and bone distraction.The patient was a 17-year, 1-month-old male with facial malformation and malocclusion.At the age of 17 years and 2 months, a Le Fort III osteotomy and bone distraction were performed for midface advancement. After this distraction procedure, orthodontic treatment began for secondary surgery to correct severe openbite, bimaxillary protrusion, and spaced arch.After a partial glossectomy was carried out, preoperative orthodontic treatment commenced. At the age of 19 years and 7 months, a Le Fort I osteotomy and sagittal split ramus osteotomies (two-jaw surgery) were carried out.After postoperative orthodontic treatment, occlusion and the facial profile were improved. Although some spaces developed, the occlusal results were almost preserved throughout the 17 month retention period.

Computed tomography assessment of mandibular morphologic changes and the inferior mandibular border defect after sagittal split ramus osteotomy

Fracture patterns of two sagittal split ramus osteotomy techniques: a cadaveric study.

Sagittal splitting ramus osteotomy is widely performed for correction of mandibular skeletal dentofacial deformities. W e retrospectively studied 325 patients treated with bilateral sagittal splitting ramus osteotomies in order to investigate perioperative unfavorable fracture, and found eight episodes of fracture in eight patients (2.4% of incidence). The most predominant fracture site was the distal segment with vertical and horizontal fracture line. All fractured segments were sufficiently repositioned and fixed in appropriate positions. Slight extension of the intermaxillary fixation period was noted, however, no severe postoperative complication was found.It was considered that incomplete osteotomy, misdirection of horizontal medial osteotomy, and violent bone split caused unfavorable fractures.

The assessment of blood loss in orthognathic surgery for prognathia

Contributing factors to intraoperative clockwise rotation of the proximal segment as a relapse factor after mandibular setback with sagittal split ramus osteotomy

Background: The mandibular sagittal split ramus osteotomy (SSRO) is a routine operation performed to correct mandibular deformity including mandibular retrusion, protrusion, deficiency, and asymmetry. The SSRO remains a challenging procedure for junior surgeons due to a lack of adequate morphological knowledge necessary for success in clinical practice. Virtual reality (VR) and three-dimensional printed (3DP) models have been widely applied in anatomy education. The present randomized, controlled study was performed to evaluate the effect of traditional educational instruments, VR models, and 3DP models on junior surgeons learning the morphological information required to perform SSRO.Methods: Eighty-one participants were randomly assigned to three learning groups: Control, VR, and 3DP. Objective and subjective tests were used to evaluate the learning effectiveness of each learning instrument. In the objective test, participants were asked to identify 10 anatomical landmarks on normal and deformed models, draw the osteotomy line, and determine the description of SSRO. In the subjective test, participants were asked to provide feedback regarding their subjective feelings about the learning instrument used in their group.Results: The objective test results showed that the VR and 3DP groups achieved better accuracy in drawing the osteotomy line (p = 0.027) and determining the description of SSRO (p = 0.023) than the Control group. However, there was no significant difference among the three groups regarding the identification of anatomical landmarks. The VR and 3DP groups gave satisfactory subjective feedback about the usefulness in learning, good presentation, and enjoyment. The Control and 3DP groups reported positive feelings about ease of use.Conclusion: The current findings suggest that VR and 3DP models were effective instruments that assisted in the morphological understanding of SSRO-related anatomical structures. Furthermore, 3DP models may be a promising supplementary instrument to bridge the gap between conventional learning and clinical practice.

Intraoral vertico-sagittal ramus osteotomy: modification of the L-shaped osteotomy

Does Intraoral Miniplate Fixation Have Good Postoperative Stability After Sagittal Splitting Ramus Osteotomy? Comparison With Intraoral Bicortical Screw Fixation

Objective Summarize cases of blood loss exceed 400 ml in completely video-assisted lobectomy procedure,and retrospective analysis the cause of injury of blood vessels in the operation and discuss the intro-operative measurement.Methods From September 2009 to April 2013,1006 patients underwent VATs lobectomy in our institution,with a median blood loss of 206.7 ml.There were 125 patients that the blood loss were exceed 400 ml (82 male,43 femal) with a median age of 62.0 years.The median diameter of the solid tumor was 3.2 cm.The lobectomy consist of 42 cases of right upper lobe,40 cases of left upper lobe,19 cases of right lower lobe,15 cases of left lower lobe and 9 cases of right middle lobe.The procedure consist of 99 cases of simple lobectomy,4 cases lobectomy combine with partial chest wall resection,16 cases of compound lobectomy,3 cases of sleeve lobectomy with bronchoplasty and 3 casesof pneumonectomy.The main procedure was completely video-assisted anatomical lobectomy with mediastinal lymphadenectomy as we have reported.Results All procedures were uneventful,with a median operative time of 269.3 minutes,a median blood loss of 666.1 ml.Among 125 cases with ＞ 400 mlof blood loss,there were 3 cases of injury of pulmonary vein,2 cases were repaired endoscopiclly (In one ease,the bleeding point was clipped directly and repaired with 5-0 non-absorbable suture.In another case,the pericardium was opened,the hilar vessels were blocked,and the wound was repaired with 5-0 non-absorbable suture) and 1 case that the vein was torn and massive bleeding occurred when passing an instrument through the posterior wall of the vein and conversion to open thoracotomy was performed to control bleeding and repair the vein with 5-0 non-absorbable suture.There were 13 cases of injury of pulmonary artery,in 2 cases that the proximal trunk of ipsilateral pulmonary artery was blocked endoscopically and hemostasis was assured and then repaired the pulmonary artery with 5-0 non-absorbable suture endoscopiclly and in 11 case,conversion to open thoracotomy was performed to control bleeding and to repair the artery.The median duration of chest tube drainage was 8.0 days; median length of hospital stay was 11.1 days.There were 22 cases need blood transfusion in the operation or postoperation.All patients recovered well,47 patients (36.0％) experienced a minor complication.Conclusion Injury of blood vessels was common and troublesome in completely thoracotomy lobectomy,and always lead to conversion to thoracotomy.The surgeon should deal with it based on the character of vessles,condition of injury and experience of the surg con. Key words: Video-assisted thoracoscopic surgery; Lobectomy ; Bleeding; Injury ; Blood vessls

Invited Discussion on: "Risk Factors Analysis for Different Types of Unfavorable Fracture Patterns During Sagittal Split Ramus Osteotomy-A Retrospective Study of 2008 Sides".

Comparative Efficacy of Granisetron and Droperidol After Orthognathic Surgery for Prophylaxis of Postoperative Nausea and Vomiting: A Retrospective Study