Three Surgical Steps to Reconstructing Car Crash Victims' Upper Jaws; Function and Appearance Restored

Main Category: Cosmetic Medicine / Plastic Surgery
Article Date: 20 Mar 2005 - 20:00 PDT

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A surgical process most often associated with orthopedic surgery has been found effective in the intricate reconstruction of patients with severe bone loss in the anterior maxilla -- the front portion of the upper jaw. Distraction osteogenesis reconstructs skeletal deformities through the gradual, controlled displacement of surgically created fractures to enable simultaneous expansion of soft tissue and bone volume.

The March 2005 issue of the Journal of Oral and Maxillofacial Surgery reports on the success of a surgical technique that employs distraction osteogenesis, bone grafts and dental implants to achieve both functional and aesthetic results for five patients whose injuries in motor vehicle accidents left them with such severe bone and soft tissue loss in the front portion of their upper jaws that traditional surgical procedures were insufficient to correct their problems. Michael S. Block, DMD, the principal author of the study ("Reconstruction of severe anterior maxillary defects using distraction osteogenesis, bone grafts, and implants"), says the technique is promising. "It can be a viable treatment option for the patient involved in a car accident, or accidental shooting, or facing jaw tumor removal."

Dr. Block and David G. Baughman, DDS, MD, oral and maxillofacial surgeons who both practice in New Orleans, La., utilized a treatment plan that combined bone grafts, tissue expanders and the gradual movement of the underlying bone.

The distraction osteogenesis provided a platform for hard tissue grafting and even more importantly, for the necessary soft tissue genesis needed to cover the graft.

The process began with a preoperative workup during which diagnostic casts were used to create a temporary appliance with teeth, which guided the OMS during the distraction phase. Prior to and throughout the process, the patients were educated about the entire treatment plan.

Identical treatment for 5 consecutive patients

According to the Journal study, "After a week for initial healing, distraction was accomplished with 0.5 mm increments two times each day, until the desired length of distraction was accomplished." All five patients needed bone grafts following the distraction process because although adequate tissue mass was attained, bone mass was inadequate. The grafting occurred between 8 and 14 weeks post-distraction. Four to six months later, seeing that the bone was restored, the surgeons removed the screws that held the grafts in place inside of the mouth. With the bone grafting complete, the final phase -- dental implants -- began.

Dental implant restorations proved an excellent way to restore function, improving aesthetics and easily maintained. The Journal study shows that "In all 5 patients, dental implants were placed ranging from 4 to 7 per patient, depending on the span of the defect. A fixed prosthesis was placed in 2 patients with low smile lines and fixed/removable bar clip prostheses were used in the remaining 3 patients. No implants have been lost with follow-up ranging from 6 months to 3 years."

Dr. Block said that in addition to motor vehicle accidents causing the critical trauma these five patients endured, some people might have similar effects from severe periodontal disease or from shooting accidents.

The Journal of Oral and Maxillofacial Surgery is the peer-reviewed journal of the American Association of Oral and Maxillofacial Surgeons, the professional organization representing more than 7,000 oral and maxillofacial surgeons in the United States. AAOMS supports its members' ability to practice their specialty through education, research, and advocacy. AAOMS members comply with rigorous continuing education requirements and submit to periodic office examinations, ensuring the public that all office procedures and personnel meet stringent national standards.

American Association of Oral and Maxillofacial Surgeons
http://www.aaoms.org

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