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S C Karras

Publications and source records attributed to S C Karras.

7 recordsLinked to original sources
PubMed2001

Considerations for orthognathic surgery during growth, part 2: maxillary deformities.

The growing patient can present to the clinician with significant dentofacial deformities that require surgical correction. In some cases, certain functional, esthetic, and psychosocial factors may necessitate early surgical intervention. Although there is extensive literature on the effects and stability of orthognathic surgical correction of maxillary deformities in adults, the same is not true for the pediatric and adolescent growing patient. Not much is known about the predictability of orthognathic surgical procedures performed during growth or the effects such procedures have on subsequent facial growth. There is always the possibility that secondary corrective procedures may be required after the initial corrective surgery. This article presents recommendations based on available research and personal clinical experience in surgical correction of maxillary deformities in growing patients. The common maxillary dentofacial deformities, age considerations, and surgical alternatives and sequencing are presented. The treatment of mandibular deformities is addressed in Part 1 of this article.

Adolescent↗
PubMed2001

Considerations for orthognathic surgery during growth, part 1: mandibular deformities.

Management of the growing patient with mandibular dentofacial deformities presents a unique and challenging problem for orthodontists and surgeons. The surgical procedures required for correction of the deformity may affect postsurgical growth and dentofacial development. Further, facial growth may continue postoperatively and negate the benefits of surgery performed, resulting in treatment outcomes that are less than ideal. From individual patient characteristics, the type of deformity, and the indications for early surgical intervention, it is possible to effectively treat many cases during growth. A thorough understanding of facial growth patterns is essential, and each case needs to be evaluated individually. Surgery is often undertaken with the expectation that additional treatment, including more surgery, may be required after the completion of growth. The material presented here is based on the available research and the senior author'ss clinical experience of more than 25 years in the correction of mandibular deformities in the growing patient. Advantages and disadvantages of specific surgical techniques for correction of common mandibular deformities and pertinent age and surgical considerations are discussed. The material should be viewed as a general outline that provides broad guidelines for management of these patients. The management of maxillary deformities will be discussed in Part 2 of this article.

Adolescent↗
PubMed1998

Augmentation genioplasty with hard tissue replacement implants.

PURPOSE: This study assessed the soft tissue changes produced by the placement of hard tissue replacement (HTR) polymer chin implants for augmentation genioplasty and evaluated the dimensional stability as well as any bony changes associated with the implants. PATIENTS AND METHODS: The study group consisted of 18 patients (3 males, 15 females) with an average follow-up of 21.5 months (range, 12 to 44 months). All implants were placed through an intraoral incision and stabilized to the symphysis with a single 2.0-mm diameter titanium screw. Preoperative, postoperative, and long-term cephalometric radiographs were analyzed for changes in soft tissue thickness in the chin region, implant stability, and the presence of bone resorption. RESULTS: The net hard tissue chin augmentation achieved averaged 6.0 mm (range, 4.5 to 9 mm). Average preoperative soft tissue thickness was 12.1 mm (range, 11 to 14.5 mm) and postoperatively it was 10.6 mm (range, 10 to 13.5 mm). The average increase in soft tissue projection was 77.6% (range, 71.4% to 83.3%) of the implant thickness. There was no radiographic evidence of implant migration or bony resorption beneath the implant. CONCLUSIONS: HTR implants appear to be a predictable means of augmenting the chin, providing the desired aesthetic change, without causing resorption of underlying bone.

Adolescent↗
PubMed1997

Autologous fat transplantation around temporomandibular joint total joint prostheses: preliminary treatment outcomes.

PURPOSE: This study evaluated the efficacy of autologous fat grafting to the temporomandibular joint (TMJ) as an adjunct to prosthetic joint reconstruction in preventing fibrosis and heterotopic bone formation and determined its effects on postoperative joint mobility. PATIENTS AND METHODS: Fifteen patients (2 male, 13 female) underwent TMJ reconstruction with Techmedica (Techmedica, Inc, Camarillo, CA) custommade total joint prostheses. Seven patients had bilateral and eight had unilateral surgery, for a total of 22 joints. All patients had autologous fat from the abdomen grafted around the articulating portion of the joint prostheses after the fossa and mandibular components had been stabilized. Twenty patients (2 male, 18 female) without fat grafts served as controls. There were 17 bilateral and 3 unilateral cases, for a total of 37 joints. These were the last 20 patients with adequate data available for inclusion treated before patients receiving primary fat grafting as part of the joint reconstruction. RESULTS: In the control group, the average preoperative maximum interincisal opening (MIO) was 26.8 mm, and at long-term follow-up it was 33.1 mm. Contralateral excursive movements averaged 3.2 mm preoperatively and 1.7 mm at long-term follow-up. In the fat graft group, average preoperative MIO was 26.9 mm, and at long-term follow-up it was 38.7 mm. Contralateral excursive movements averaged 2.3 mm preoperatively and 2.2 mm at long-term follow-up. The differences in measured function between the two groups were found to be statistically significant (P < or = .01). Although both groups experienced a significant decrease in pain, there was no significant difference noted in the patients' perception of their level of pain at long-term follow-up as expressed on visual analog scale evaluations. There was no radiographic or clinical evidence of heterotopic calcifications or limitation of mobility secondary to fibrosis in any of the experimental groups, whereas seven control patients (35%) exhibited this phenomenon and required reoperation. CONCLUSIONS: Autologous fat transplantation appears to be a useful adjunct to prosthetic TMJ reconstruction. Its use appears to minimize the occurrence of excessive joint fibrosis and heterotopic calcification, consequently providing improved range of motion.

Adipose Tissue↗
PubMedDate not supplied

Cervicofacial and mediastinal emphysema as the result of a dental procedure.

Cases of cervicofacial subcutaneous emphysema occurring during dental treatment often result from the use of air-water cooled dental drills during tooth extraction. A case is presented in which a compressed air syringe, used to dry the field, caused diffuse cervicofacial emphysema with retropharyngeal and mediastinal extension. The point of entry appeared to be a 4 mm superficial laceration of the buccal mucosa. Despite the size of the wound, a significant amount of air was able to enter the tissues and spread quite distantly. Though many cases of subcutaneous emphysema go unnoticed, diffuse extension, especially with involvement of deep neck structures and with thoracic extension, must be recognized as they can be potentially life-threatening.

Cheek↗