Publication date: Available online 5 February 2019
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Ashish P. Sharma, Dale E. Stringer
Abstract
Correction of maxillofacial skeletal dental deformities often includes surgical interventions in the maxilla and mandible. LeFort I maxillary osteotomies are performed to correct maxillary horizontal, vertical and transverse discrepancies. Repositioning of the maxilla creates an inter-positional gap in bone which may lead to psuedoarthrosis, instability, mobility, infection and eventual relapse. Grafting the inter-positional gap with bone creates mechanical stops to prevent relapse, provides a matrix for secondary ossification, accelerates bony union and inhibits soft tissue herniation. This can be accomplished utilizing autogenous bone harvested from the patient. Donor sites include calvarium, rib and iliac crest bone. Although, these donor sites have their advantages and specific indications, they require a second surgical site, which can lead to potential complications such as infection, donor site morbidity, pneumothorax and gait disturbances.
In conjunction with LeFort I maxillary osteotomy, for correction of maxillary deformities, bilateral sagittal split mandibular osteotomy is a common procedure used for mandibular advancement, setback and correction of mandibular asymmetry with or without concurrent genioplasty. Five patients (one male and four female) underwent orthognathic surgery for correction of their maxillofacial skeletal dental deformities at Loma Linda University Hospitals between 2015 and 2017.
This case series describes a technique to harvest autogenous bone from the posterior aspect of the distal sagittal split osteotomy segment of the mandible, which is milled and used to graft the inter-positional gap in the maxilla. Principles of guided bone regeneration are incorporated to improve surgical outcomes.
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