Biomedical subjects
Publications and source records attributed to O Hadjianghelou.
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Thirty-five cases of sagittal split ramus osteotomies with wire osteosynthesis as the exclusive procedure used to correct a dentoskeletal Class II deformity, were selected to form a homogeneous group for cephalometric evaluation of the short- and long-term, skeletal and dental changes. The group was statistically described as having severe micromandibulism, mild micromaxillism and mild dento-alveolar maxillary protrusion. The skeletal relapse within the first postoperative year was due to horizontal and dorsocranial rotational changes of the tooth-bearing segment. The joint-bearing segment rotated ventrocranially. As an overall result, the mandibular body was not lengthened but advanced. The relapse at the occlusal level was considerably less, partly due to the rotational component of the skeletal relapse mechanism, partly due to the compensating retroclination of the upper anterior teeth. With the condyles correctly repositioned at surgery, no relationship could be found between postoperative changes in condylar position and skeletal relapse. There was no difference in the average amount of skeletal relapse between the subgroup with the Dal Pont modification of the buccal osteotomy and the subgroup with the buccal osteotomy directed to the mandibular angle. The average skeletal relapse was greater in the combined surgical orthodontic cases, due to increased alveolar tooth mobility.
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Two different ways of correcting micromandibularism inherent in the bird-face deformity have been described. Both procedures may be applied to correct the symmetric or the asymmetric types of bird-face deformity. Both have the elongation in the front area by means of one- or two-step advancement genioplasty in common. The difference between the two procedures lies mainly in the way the elongation of the mandibular body is achieved. Procedure 2 advocates the elongation of the mandible by means of vertical osteotomy within the tooth-bearing area, and procedure 1 advocates the elongation of the mandible behind the tooth-bearing area by means of the extended sagittal split osteotomy. Both procedures are demonstrated by drawings and by cases of patients who have been operated on.
An alternative method to temporary lower jaw reconstruction with a reconstruction plate prosthesis is described. To prevent penetration of an alloplastic condyle transplant through the skull base, and to restore joint function, we have reimplanted the resected condyle after its fixation to the reconstruction plate. Postoperatively, there have been no complications. Joint function has been almost completely restored. The reimplanted condyle has been investigated after 28 months. It has undergone remarkable changes.
The article gives a detailed description of a temporal approach to the retromaxillary infracranial space and to the orbit, developed by one of the co-authors (H. Obwegeser) of this article. Case reports show the broad spectrum of indication in surgery of benign, and especially of malignant, tumours in this region. Surgery is performed via an extended type of incision in the scalp. The cheekbone and the coronoid process, or the upper portion of the ascending ramus of the lower jaw, can be osteotomized and transposed as muscular flaps. The great advantages of this surgical procedure are an excellent overview, absence of visible scarification, and preservation of all tumour-free parts of the facial skeleton, combined with the possibility of radical en-bloc removal of the neoplasm.
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In a radiographic follow-up study the extent, frequency and direction of condylar displacement after surgical correction of bite anomalies by sagittal splitting of the mandibular rami was investigated. 35 patients were involved in the study. Pre- and post-operatively P.A.-views of the skull, linear tomograms and individualized lateral oblique radiographs of each temporomandibular joint were taken. Postoperative changes of condylar position were measured on the lateral oblique radiographs. The results indicate that condylar displacements are found frequently after sagittal splitting of the rami. Most of them are combined with rotation or tilting of the axis of the condyle or the condylar neck. Method of osteosynthesis and direction of movement of the tooth bearing fragment seem to influence the direction and amount of condylar displacement.
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A modified instrumentation for the percutaneous screwing of mandibular fragments is presented. Functionally stable osteosynthesis in the mandible may be obtained by the tractional screws and osteosynthesis plate (DCP, EDCP). It is possible to use the 2-mm miniscrew and also the 2.7- and 3.5-mm corticalis screw. Thus, it seems possible to use percutaneous, functionally stable osteosynthesis with plates and screws for certain types of fractures and corrective osteotomies of the mandible. In addition, the same technique applies to the sagittal splitting of the ascending ramus after Obwegeser for the correction of mandibular prognathism.
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The efficacy of postoperative pain treatment after dental surgery procedures depends not only on the type of substance used but also on the time it is taken and the dose administered. Direct postoperative administration of 400 mg Ibuprofen (2nd administration after 6 hours) resulted in considerably greater pain relief, without increasing the risk for the patient, than when the drug was taken as required.