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Orthognathic surgery in young patients before completion of skeletal growth is still sharply discussed today. In the following case report of a 6-year-old patient, however, there was a vital indication for treatment. The main clinical symptoms were characterized by impaired hearing as a result of constantly recurring seromucotympanum and adenoids, persistent rhinorrhea and otorrhea, chronic tonsillitis and chronic otitis media. ENT interventions such as the partial C-tonsillectomy, paracentesis with tympanic drainage, adenotomy and tube dilation with balloon catheter did not bring lasting success. Despite antibiotic therapy with aminopenicillins and cephalosporins in ß-hemolytic streptococci, no improvement in the symptoms could ultimately be achieved, so that there was a life-threatening risk of endocarditis with previous pulmonary valve replacement. In our orthognathic consultation, a maxillary retrognathism with a frontal crossbite was diagnosed. With an interdisciplinary consideration of the risks and side effects, an early surgical treatment in the sense of an upper jaw advancement with dilatation of the airways and evacuation of the maxillary sinuses was carried out. The operative challenge consisted of determining an ideal osteotomy line so as not to damage permanent tooth structures. Furthermore, the patient and his family had to understand the expected outcomes, potential risks, and possible complications that might arise from early surgical interventions, such as a subsequent maxillary growth discrepancy. After successful surgery the patient could already be discharged on the 2nd postoperative day and soon no longer showed any complaints or symptoms with regard to the tube ventilation disorder and the seromucotympanum—also no dental or skeletal recurrence has been evident up to now. With 25 years of experience in “Early surgery,” we have learned that orthognathic operations in children and adolescents might have decisive effects on life quality.

The aim of this study was to evaluate volumetric changes of the posterior airway space (PAS) following bimaxillary surgery using a high oblique sagittal split osteotomy (HSSO) of the mandibular ramus. The cone beam CTs of Class II and Class III patients taken before (T0) and 6-12 months after surgery (T1) were analyzed using 3D software (Mimics® Innovation Suite 18.0). The PAS was divided into three segments (superior, middle, inferior) by three planes parallel to the Frankfurt horizontal plane intersecting at the posterior nasal spine, the velum palatinum and the epiglottis. Total (TPAS) and partial volumes (SPAS = superior, MPAS = middle, IPAS = inferior) were calculated. For the 25 Class II patients, a highly significant increase (p0.001) of the total, middle and inferior airway space (TPAS: +33.6%, MPAS: +43.1%, IPAS: +55.9%) was found, while the increase of the upper airway space was statistically not significant (+5.4%, p = 0.074). For the 28 Class III patients, the total, middle and inferior airway space increased statistically insignificantly (TPAS: +4.6%, p = 0.265, MPAS: +2.7%, p = 0.387, IPAS: +2.8%, p = 0.495), while the increase of the upper airway space was statistically significant (+9.7%, p = 0.010). Bimaxillary orthognathic surgery using the HSSO technique led to a significant increase of PAS for Class II patients and could conserve the PAS for Class III patients.

L’ostéotomie sagittale de la mandibule est devenue un standard dans la chirurgie mandibulaire des dysmorphoses dento-faciales. Nous la proposons même pour les dysmorphoses de faible importance. Ceci doit nous forcer à en réduire la morbidité. Nous décrivons une technique opératoire à surface de clivage réduit. La section osseuse suit une ligne oblique depuis l’épine de Spix en bas et en dehors vers la région supra-angulaire. Cette section est complétée par une ostéotomie du bord postérieur de la branche montante. Ce clivage n’atteint jamais le canal dentaire. La protection du nerf alvéolaire est accrue, ce qui diminue considérablement le risque de séquelles nerveuses de cette intervention. La majorité des déplacements mandibulaires sont possibles par cette technique à l’exclusion des propulsions importantes et des augmentations de la hauteur du ramus.

Orthognathic surgery has always been a classical focus of maxillofacial surgery. Since more than 100 years, various surgical techniques for mandibular repositioning have been developed and clinically tested. Since the establishment of plate and screw osteosynthesis, orthognathic surgery became more stable and safe. Nowadays, different surgical methods for mobilising the mandible are existing. This international multicenter analysis (n = 51 hospitals) is providing first evidence based data for the current use of different surgical methods. The dominating techniques were Obwegeser/dal Pont (61%) followed by Hunsuck/Epker (37%) and Perthes/Schlössmann (29%). The main osteosynthesis materials were plates (82%), bicortical screws (23.5%), or a combination of both (5.9%). 47% of all centers reported to use several surgical methods at the same time, depending on the anatomical problem and the surgeon's preference. This shows that different surgical methods seem to work as comparable, safe, and reliable procedures in everydays clinical practise. On this basis, further prospective studies could evaluate possible advantages for our patients.

Transgingival fixation screws are used for intermaxillary fixation in different situations. The aim of this study was to evaluate the risk of root trauma and tooth loss using pre-drilled transgingival fixation screws. Material and methods 521 patients with mean age 26.9 (SD 9.9) years who had orthognathic surgery or trauma to the maxilla or mandible were selected for the study. Postoperative orthopantomographs (OPT) taken before and after screw removal were examined. The location of the screws and dental-root “hits” were recorded. Results 1663 screws were inserted either to the maxilla or to the mandible. 285 teeth (17.1%) showed radiologically proven contact between the dental roots and the screws or the dental roots were hit by the screw (screw inserted with more than the screws radius into the root). In three cases (0.2%) teeth were lost due to apical or periradicular inflammation, four teeth (0.2%) had to be root filled and five teeth (0.3%) were persistent painful at the follow-up examination before miniplate removal 10.3 (SD 8.1) months post-surgery. Conclusion Dental problems occurred in 0.7% at the screw insertions sites. The use of transgingival fixation screws showed a low risk of tooth loss. Root defects healed without any incident. However surgeons must be aware of possible consequences to provide a safe treatment.

Objectives: To analyse if Hybrid-RME has different effects on skeletal, dental and periodontal aspects when compared with those of Hyrax-RME or Hyrax-SARME. Methods: In this retrospective multicentre-study 28 patients with a severe nasomaxillary constriction were treated either with a Hyrax-type RME (6 patients, 13.92 ± 0.36 years), with a Hybrid-RME (7 patients, 17.20 ± 2.80 years) or with a surgical assisted Hyrax-SARME (15 patients, 30.58 ± 9.26). This study was performed in analogy to the method published by Garib, et al. using the freeware OsiriX 4.0. All measurements were performed twice with an interval of two weeks and the calculated mean value of both measurements was used for statistical evaluation, which was performed using SPSS 21 for Mac. Results: The age differences between all groups were significant (p

Stones of the salivary glands may cause recurrent swelling, ascending inflammation, and colic-like pain. Previously, in order to get rid of these stones, the gland usually had to be removed surgically in spite of the associated risks to adjacent structures, especially the facial nerve. We treated 104 salivary gland stones in patients 14 to 78 years old using the Storz Modulith SL 10 lithotripter. Each session (average 3.6 per patient) consisted of 1000 impulses at 2 Hz and 16 to 18 kV. No anesthesia was required. Earplugs were applied to patients being treated for parotid gland stones. With the aid of SWL and drug-induced salivation, 17 (59%) of the patients with parotid gland stones and 42 (56%) of those with submandibular gland stones obtained either total stone clearance or sufficient fragmentation to permit spontaneous passage. Four patients required surgery. The remaining patients are still being treated. The noninvasive SWL for salivary gland stones is noninvasive and painless and has a considerable success rate. It can be performed on an outpatient basis.

Different devices are available to aid surgically-assisted maxillary expansion. In this study we have evaluated the changes to the anchoring teeth, the hard palate, and the lower nasal passage made by tooth-borne distraction devices. Thirty-one patients (mean (SD) age 28 (2) years) with deficiencies in the transverse width of the maxilla were examined by computed tomography and cone beam scans before and after operation. The data were analysed with the help of Wilcoxon's signed rank test and Spearman's r correlation. The mean (SD) distraction width was 6.5 (2.3) mm. All anchorage teeth were tilted (p

Different devices to perform a mandibular symphyseal distraction osteogenesis (MSDO) are available. This study evaluates how tooth borne distraction devices change to the teeth, the mandible and the condyles.19 patients (mean age 27.1) with anterior width deficiencies of the mandible were examined with routine pre- and postoperative CT-scans 1 month before and 4 months after a mean distraction width of 5.68 mm (SD 0.88). The anchorage teeth of the tooth borne device were examined concerning displacement of their axes as well as the movement of the condyles and the mandibular symphysis. The data were evaluated using Wilcoxon signed rank test and Spearman rho correlation.Significant tilting of the anchorage teeth was observed (p0.01). The axes changed by 3.32° (SD 1.57) in the first premolar and by 2.63° (SD 1.75) in the first molar. A total of 2.67 mm (SD 1.17) of bone was formed on the symphysis. A significant correlation was found between distraction width and intercoronal distance changes of the anchorage teeth (p0.01). No significant change of the intercondylar distance was found pre- and postoperatively in the Wilcoxon test.MSDO with tooth borne devices has strong effects on the anchorage teeth. No severe effects on the condyles were observed. The postoperative width gain is a result of newly generated bone in the symphysis and tooth tilting. Nevertheless stable postoperative bite corrections are achievable.

Surgically assisted rapid maxillary expansions (SARME) are commonly used to widen the maxilla. This study evaluates long term stability of surgically assisted rapid palatal expansion without performing osteotomy of the pterygoid plates and its effects on nasal airway volume.13 patients (mean age 31, 23+/-6, 11) with a maxillary transverse deficit of at least 5mm were examined 1 month before and on average 63 months after a mean palatal distraction of 8.29+/-1.68mm by acoustic rhinometry. Profiles of the nasal airway volumes were collected. A cast model analysis was performed. The data were evaluated using Wilcoxon signed rank test.A V-shaped movement of the segments was observed. The gain for total nasal volume was 23.25%. Findings indicate a significant enhancement of nasal volume in all patients (P0.01) as result of the maxillary expansion. No relapse occurred in the study group.SARME provides a long term stable orthodontic bite correction and permanently enhances the nasal airways. A transverse shift of the segments can be achieved over the whole bony palate even when no osteotomy of the pterygo-maxillary suture is performed.