SlideShare ist ein Scribd-Unternehmen logo
1 von 92
Downloaden Sie, um offline zu lesen
Recent Advances in Oral
and Maxillofacial Surgery
By: LIDETU AFEWORK ANJULO
(DMD, MSc, OMFS) and
Dr. BETHEL MESFIN SEYOUM, DMD
Outlines
• Introduction
• Advances in the Field of Radiology
and Imaging
• Intraoperative Navigation
And Robotic Surgery
• Minimal Invasive Surgery and Role of
Endoscopes in Oral and Maxillofacial Region
• Tissue Regeneration/Engineering in
Oral and Maxilla-Facial Surgery
• Advances in Local Anesthetics
• Advances in General Anesthesia
• Advances in TMJ
• Recent Advances in Maxillofacial
Trauma Management
• Approaches to facial skeleton
• Advances in Primary care
• Facial transplant
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
2
Introductions
• As clinicians involved in direct patient care, it
is our fundamental duty to keep abreast with
latest advances in the field of medical
sciences and use these technologies
judiciously for the benefit of the patients.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
3
Advances in the Field of Radiology
and Imaging
• There are faster and powerful computed
tomography (CT) and magnetic resonance
imaging (MRI) machines backed by advanced
soft wares and graphics, which have given the
capability to capture images of any part of the
body in great detail.
• With the use of digital radiography it is possible
to see images instantaneously with decreased
dose of ionizing radiation. The images can be
stored, manipulated, and retrieved easily.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
4
Cont………
• CT angiograms give accurate pictures of
vascular anatomy in vascular lesions. Further,
data generated by CT in the form of ‘Digital
imaging and communication in medicine’
(DICOM) files can be used to construct actual
3 dimensional (3D) models.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
5
Cont………
• MRI is an important tool in
the diagnosis of head and
neck pathologies.
• Major advantage is that it
does not use ionizing
radiations and gives
excellent soft tissue details.
• It is useful in evaluation of
head and neck
malignancies,
temporomandibular joint
(TMJ) pathologies and
vascular lesions.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
6
Cont………
• MRI angiograms are
helpful in differentiation
between high flow and
low flow vascular
malformation.
• DICOM data generated
from MRI can also be
used for production of
stereolithographic
models.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
7
Positron Emission Tomography
(PET) and PET/CT
• These modalities have the potential to help in
staging, identifying responses to nonsurgical
therapy and allowing early detection of
recurrence of patients with head and neck
cancer.
• The positron emission tomography is used to
study in vivo metabolic processes by using
physiologically active compounds labelled
with short acting positron emitting isotopes.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
8
Cont………
• Positron emitting tracers, e.g. oxygen-15, nitrogen-13,
and fluorine-18 can bound to a variety of molecules,
which are used in the human metabolic pathways.
Fluorodeoxyglucose (FDG) is the most widely used
tracer with PET imaging.
• When administered intravenously, FDG is trapped as 2-
deoxyglucose-6-phosphate within cells. The unstable
photon rich fluoro nucleus rids itself of excessive
charge with emission of a positively charged electron,
becoming a more stable nucleus.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
9
Cont………
• These positrons travel a millimetre or less in the tissues
before interacting with electron resulting in an annihilation
reaction, which results in release of two photons at
approximately 180 degrees to one another (gamma
photons). Detection of these photons by detectors is used
to build-up three dimensional representations of these
events. The data are displayed in a manner similar to
conventional sectional imaging.
• These images produced reflect glucose uptake within
various tissues.
• The application of PET-FDG in detection of malignancy
arises because of the hallmark of the malignant cells,
which is increased glucose metabolism.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
10
Cont………
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
11
Cont………
• One of the main advantages
of PET/CT is that, it can
pick-up the lesions in early
stage before these are
morphological evident,
which leads to earlier
diagnosis of tumors.
• It is helpful in head and
neck malignancy to detect
metastatic or recurrent
disease and occult primary
unknown cancer.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
12
Cont………
• It can demarcate tumor
margins at sites, where it is
difficult to evaluate the tumor
clinically.
• It is particularly helpful in
areas, where it is difficult to
separate recurrence from
changes resulting from
previous treatment, such as
surgery and radiotherapy.
• It can establish whether
enlarged lymph nodes contain
tumor or are reactive and it
can detect small foci of
disease
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
13
Cont………
• It assess the whole
body in one step with a
much lower dose of
radiation than whole
body CT.
• Other use of PET/CT is
in evaluating growth
abnormalities of the
temporomandibular
joint such as condylar
hyperplasia
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
14
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
15
Stereophotogrammetry and
Laser Surface Scanning
• These are the two most
commonly used
techniques to capture the
three dimensional surface
images of face.
• Stereophotogrammetry
uses two or three
cameras configured to a
computer to capture a
stereo image of face by
means of triangulation.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
16
Cont………
• In laser surface scanning the
light and camera technology is
used to capture the image
exact position of surface point
on the object.
• Then computer software is
used to synchronize the data
and generate a 3D image.
• These images can be used for
diagnosis, treatment planning
and comparison of surgical
outcome, as these images are
highly accurate (up to 0.5 mm
accuracy).
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
17
Co
• The maxillofacial applications of
these 3D cameras are growing,
especially in orthognathic
surgery, orthodontics and
evaluation of craniofacial
deformities.
• It is possible to superimpose
photographic soft tissue data
over the bony data set obtained
from CTor CBCT. This fusion of
hard tissue images and surface
images of face provides
opportunities for diagnosis and
planning corrective surgeries and
postoperative comparisons.
• 3D cephalometric measurements
can be done on these images.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
18
Rapid Prototyping and
Stereolithography
• Rapid prototyping is the
process of creation of physical
models from medical scan
data.
• The physical model is built in a
layered manner and it
reproduces internal and
external anatomy accurately.
• Medical scan data can be
obtained from CT, CBCT or
MRI. There are many
technologies for
manufacturing of medical
models.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
19
Cont………
• Stereolithography is the
most commonly used
technology and involves
selectively solidifying an
ultraviolet sensitive liquid
medical resin using laser
beam.
• Stereolithographic
models can be used for
diagnosis, surgical
planning, teaching,
custom made implants
and prosthetic devices.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
20
Cont………
• The models allow for wax
replacement of avulsed
structures or generation of
mirror-image structures,
prebending of
osteosynthesis bone plates,
fabrication of templates,
choosing of stock alloplasts.
• These technologies are also
used for making surgical
guides, and scaffolds for
tissue engineering.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
21
INTRAOPERATIVE NAVIGATION
AND ROBOTIC SURGERY
• The development of image-
guided surgery provides new
revolutionary opportunities by
integrating presurgical 3D
imaging and intraoperative
manipulation.
• Integration of imaging with
surgical field allows
visualization of different types
of images and simultaneously
shows structures that are
normally visible
intraoperatively and permit
navigation in areas of
anatomical sensitivity.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
22
Cont………
• Clinical benefits of
image guided surgery
include use of smaller
incisions, direct access
to targeted areas and
consequently less
invasive procedures.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
23
Cont………
• Computer aided surgery
systems are commonly used in
neurosurgery, endoscopic
sinus surgery, and some
orthopedic procedures.
Because of the complex nature
of maxillofacial reconstruction
procedures, these systems are
now being used for
maxillofacial surgery.
• Intra-operative navigation
gives the surgeon control in
difficult access areas and
complex procedures, thus
reducing the chances of
human error.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
24
Cont………
• In computer aided surgical systems a virtual patient is
generated from the preoperative scans. Certain stable
landmarks are identified on both the virtual patient
and actual patient. In technical language, these
markers are known as ‘Fiducial markers’.
• These markers serve as a guide for tracking of the
patient and surgical instrument in space. Tracking is
mainly done with the help of transmitters, which uses
an optical source or electromagnetic source.
• There are two transmitters, one to be placed on the
patient and other to be placed on surgical instrument.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
25
Cont………
• Further step in the advancement with fusion of these
technologies is robotic surgery. In robotic surgery, a
robotic arm controlled by the surgeon, sitting far away
from the operation table, actually performs the
procedure.
• Surgery with great precision in difficult areas through
minimal access is possible with the help of robotic arm.
Many advanced hospitals in the world have robotic
surgery suites to perform difficult surgeries in head and
neck with the help of robotic arm (Trans-oral robotic
system—TORS based on Da Vinci robotic arm)
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
26
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
27
Cont………
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
28
Cont………
• TORS has the benefits of being less invasive, with
fewer complications and shorter hospital stays.
There is less blood loss, little scarring, and fewer
temporary and permanent side effects, such as
loss of speech or swallowing ability.
• Surgeons operate with greater precision and
control using the TORS approach, minimizing the
pain, and reducing the risk of possible nerve and
tissue damage linked to large incisions.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
29
Minimal Invasive Surgery and Role of
Endoscopes in Oral and Maxillofacial
Region
• Flexible endoscopes have revolutionized many fields of
surgery including maxillofacial surgery. First application
of endoscopic surgery was in sinus surgery and
functional endoscopic sinus surgery has become a
standard of care.
• Endoscopic surgery has been applied to many areas of
craniomaxillofacial surgery, which includescorrection of
cranial synostosis, esthetic procedures like brow lift,
forehead contoring, frontal sinus fracture repair, orbital
decompression, various osteotomies and fracture
repair including mandibular condyle fractures.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
30
Cont………
• Trauma, orthognathic,
sialoendoscopy, and
TMJ surgery are
commonly performed
with the assistance of
the endoscope.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
31
Cont………
• Endoscopically assisted
approaches have been
advocated for open reduction
and internal fixation of
condylar fractures. This
approach allows fracture
treatment with limited
transoral incision.
• In conjunction with transoral
approach, scars are invisible
and risk of facial nerve
damage is minimal.
• Fiberoptic assisted intubation
for general anesthesia also has
made the job of anesthetist
easy in difficult airway cases.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
32
Tissue Regeneration/Engineering in
Oral and Maxilla-Facial Surgery
• Autogenous bone grafting,
regional or free microvascular
flaps have been the main stay
for reconstruction, but this
causes possible donor and
recipient site morbidity.
• The development of effective
reconstructive procedures
using tissue engineering
techniques without the need
for conventional tissue
transplantation procedures
can have a tremendous impact
on surgery of head and neck
area.
• Tissue engineering is an
interdisciplinary field
comprising of cell biologists,
bio-chemists, material
scientists, engineers, and
clinicians, and an
understanding of the complex
role of the various
components with the aim to
create limitless and readily
available supply of off- the-
shelf tissue regenerates.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
33
Cont………
• Tissue engineering involves the vital
collaboration between the three key
components, stem cells, resorbable scaffolds
and bioactive molecules such as growth
factors.
• The combination of scaffolds and cells is often
referred to as a construct. Constructs may be
fashioned ex vivo, and then implanted into an
individual.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
34
Cont………
Approaches to Tissue Engineering
• (a) Growth factors/Bone Morphogenic Proteins: BMPs are
a group of osteoinductive sequentially arranged amino
acids and polypeptides that are capable of stimulating
adult mesenchymal cells to become osteoblasts and form
bone.
• Adult mesenchymal cells are supplied by periosteum and
paraperiosteal connective tissue.
• Recombinant human BMP-2 (rh-BMP-2) (Infuse,
meditronics) was approved as an alternative to autogenous
bone graft for sinus augmentations and for
localizedalveolar ridge defects associated with extraction
sockets.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
35
Cont………
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
36
Cont………
• (b) Stem Cells: Stem cells can
dedifferentiate in the correct
setting into simple,
unspecified forms. They, then
have the ability to form new
structures based on the
stimulus and chemical factors
that are present in the matrix.
• There are two types of stem
cells – adult stem cells and
embryonic stem cells. Human
embryonic stem cells are
pluripotent stem cells isolated
from the inner mass of human
blastocysts.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
37
Cont………
• Currently, adult stem cells
used in clinical setting are
autologous cells.
• For the tissue engineering of
bone, cells from the bone
marrow and adipose tissue
have been used as autologous
cells, These have the ability to
dedifferentiate from
mesenchymal cells to
osteoblasts and then to
osteocytes, which have the
ability to lay bone in a
laminated form.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
38
Cont………
• The seeded cells can be stimulated physically
with magnetic or galvanic stimulation,
ultrasound, hypoxic or hyperoxic gradients,
growth factors such as transforming growth
factor beta-1 (TGFB-1), bone morphogenetic
proteins (BMPs) or vascular endothelial
growth factor (VEGF), to guide the
differentiation and growth of the cells.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
39
Cont………
• Stem cells from dental pulp from developing
teeth, shed deciduous teeth and dental follicle
provide other source of adult epithelial and
mesenchymal stem cells.
• Third molar removal also presents some
opportunity for harvesting follicular cells,
cementoblast-like cells and dental pulp stem
cells, which have been cultured and studied.
• The receptors of these cells can be characterized,
an important first step in understanding these
cells and their potential future use.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
40
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
41
Cont………
• There is a hope to create synthetic form of
bone, skin, cartilage and muscle that can
function as well as normal tissues depends on
ability to effectively integrate multiple
technologies and components that are
capable of meeting the complex demands of
reconstruction in head and neck area.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
42
Advances in Local Anesthetics
Articaine
• It is a new aminoamide class of local anesthetic,
approved by FDA in 2000 for clinical use. It is available
in 4% strength with 1: 100,000 o 1: 200,000
epinephrine.
• It has thiopentone ring instead of benzene ring, which
makes it more lipid soluble. Therefore, it has got better
tissue penetration and diffusion than the lidocaine.
• Because of better bone penetration and diffusion it
can anesthetise palatal side and anterior lingual sides
with buccal infiltration only.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
43
Reversing Effects of Local Anesthesia
• Soft tissue anesthesia after local anaesthetic
infiltration or block may linger on for several
hours. This may not be desirable in certain case
especially in children.
• In 2009, FDA approved phentolamine mesylate
(Oraverse, Novalar Pharmaceuticals Inc. USA) for
the reversal of the local anesthetic.
• This can be used both in adults and children, but
not recommended below six years of age or
weight <15 kg.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
44
Cont……….
• Phentolamine is an α adrenergic agonist, it
acts by providing vasodilatation, thus
allowing the faster diffusion of local anesthetic
into vascular system.
• It is injected in same volume as the local
anesthetic and it accelerates the reversal of
soft tissue anesthesia.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
45
Local Anesthesia Delivery Devices
• Newer local anesthetic delivery devices
not only provide reduction in pain on
injection and failure rates, but also
produce more precise anesthetised area.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
46
Cont……….
• Vibrotactile, Vibraject,
dental vibe, accupal,
compudent are the few
local anesthetic delivery
devices which uses
vibration technology to
decrease the pain on
injection.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
47
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
48
Submental Intubation in Maxillofacial
Trauma Patients
• Intraoperative assessment of occlusion and
maxillomandibular fixation is often required
for exact reduction of facial fractures.
• Conventional oral tracheal intubation does not
allow intraoperative assessment of the
occlusion and maxillomandibular wiring.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
49
Cont……..
• Submental intubation is a
procedure in which
endotracheal tube is passed
through a surgically created
opening in submental region.
• It allows free intraoperative
access to the dental occlusion
and the nasal pyramid.
• Therefore, simultaneous
treatment of all the facial
fractures, without
interference of the tube or
the need of switching tube
from nasal to oral or vice
versa during surgery.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
50
Retromolar Intubation Technique
• In this technique, the
endotracheal tube is placed in
the retromolar space behind
the last erupted teeth.
• Arora and Rattan, for the first
time demonstrated that there
is sufficient space in
retromolar region for
successful placement of the
endotracheal tube in children
and certain adults.
• Intermaxillary fixation of teeth
is possible
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
51
LIDETU
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
52
Advances in TMJ Arthroscopy and One
Point Arthroscopy
• The TMJ arthroscope is
a small, tube like
camera that projects
the image of the joint
onto a monitor,
allowing the surgeon to
view the inside the joint
without making any
large incisions.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
53
BUCCAL PAD OF FAT IN
TMJ RECONSTRUCTION
• In this technique dead space
created after gap arthroplasty
is blocked with the help of
buccal pad of fat.
• Buccal pad of fat is harvested
through the same preauricular
approach as used for TMJ
surgery.
• Blunt dissection is done
anteromedial to the coronoid
process, where buccal pad of
fat is located and it is
transposed to TMJ area.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
54
.
• This fat can completely
block the dead space as
compared to any other
tissue, because of its
fluidity.
• This prevents formation
of blood clot, which is
primary factor for
heterotopic bone
formation and
reankylosis of TMJ.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
55
LIDETU
Cont……..
• To manage the panfacial complex fractures, there have
been improvements in techniques of fracture fixation and
reduction.
 Other advances in the field of surgery are also applicable to
trauma management. This include
 improved diagnostic imaging,
 minimal access surgery and endoscopic surgery,
 biomaterial advances,
 intra-operative imaging,
 rapid prototyping techniques,
 computer assisted surgery, and
 customised implants.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
57
Intermaxillary Fixation Screws
• Special screws for
intermaxillary fixation are
available, which have a hole
for passage of wire below the
screw head.
• The screws are inserted above
the root apices in maxilla and
mandible, and wire is passed
through the holes to close the
mouth in occlusion.
• Screws are quick to place,
maintain better oral hygiene,
and there is no risk of prick
injury, as compared to fixation
with arch bars and wires.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
58
Rapid IMF
• An adjustable flexible plastic
band that wraps around the tooth
to create an anchorage point for
temporary maxillomandibular
fixation and immobilization.
• These have been developed to
reduce the risk of needle-stick
injury.
• Intermaxillary fixation is done
with the help of elastic chain.
• These anchorage points can
retain intermaxillary fixation up
to three weeks.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
59
Resorbable Implants
• Drawbacks of currently used
titanium implants may include
soft tissue irritation and cold
intolerance, creation of
distortion artefact on
computed tomography and
magnetic resonance imaging,
weakening of bone from
excessively rigid fixation,
‘‘stress shielding’’ possible
interference with facial
growth, implant migration
over time, and the possible
need for subsequent implant
removal.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
60
Resorbable plates
• Resorbable plates
provide initial osseous
fixation strength for
direct bone healing and
then they disappear
over a period of time
leaving behind no
foreign body.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
61
Self-Drilling, Self-Tapping Screws
• The self-drilling principle has
the advantage of avoiding the
necessity to drill a hole, thus
shortening the process of
osteosynthesis and requiring
less instrumentation.
• The self-drilling, self-tapping
screws were essentially equal
to the retentiveness of self
tapping screws in thin bone,
but were much superior in
cancellous bone.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
62
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
63
Cont……..
• This is presumably due to self-drilling screws
compressing rather than cutting the cancellous
bone around the threads of the screws.
• The clinical implication is that self-drilling, self-
tapping screws are much superior when fixing
screws into a cancellous bone graft.
• It should be noted that self-drilling screws may be
difficult to apply in extremely dense bone such as
the mandible.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
64
LOCKING PLATES AND SCREWS
SYSTEM
• In locking plates, the screw locks not
only to the bone, but to the bone
plate as well.
• This is accomplished by having a
screw with a double thread.
• One thread will engage the bone;
another will engage a threaded area
of the bone plate.
• Since the plate locks to the screw
rather than gaining its rigidity by
being compressed against the bone,
it also avoids the cortical necrosis,
which is sometimes seen under a
plate ,which is compressed against
the bone.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
65
Locking plate and screw systems have several
advantages over the conventional screw systems.
Locking plate and screw
• It becomes unnecessary for the
plate to intimately contact the
underlying bone in all areas.
• As the screws are tightened, they
“lock” to the plate,thus
stabilizing the segments without
the need to compress the bone to
the plate.
• A decreased incidence of
inflammatory complications from
loosening of the hardware.
• Provide more stable fixation
CONVENTIONAL plate and screw
• require precise adaptation
of the plate to the
underlying bone.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
66
Multidirectional Fixation.
• Another advancement in locking
technology is multidirectional
fixation.
• TriLock technology (Medartis, Basel,
Switzerland) represents a significant
step forward in multidirectional and
angular stable fixation.
• The spherical three-point wedge-
locking creates a connection between
the head of the screw and the plate
hole which is stable in angle and axial
plane.
• The locking can be adjusted up to
three times within ± 15º without loss
of stability.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
67
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
68
Trapezoidal Condylar Plates
• The primary stability
achieved by TCPs is
superior to that obtained
by single plating
techniques, by axial lag
screw osteosynthesis, and
by rectangular plates in
the sagittal plane.
• This is due both to the 3D
concept and to the
trapezoidal shape itself.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
69
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
70
Delta Plate Fixation for Condylar
Fractures
• The plate’s delta shape can
handle changing loads, with
the highest tensile strain
occurring at the anterior and
lateral surfaces and the
highest compressive strains on
the posterior surface.
• The plate can be easily placed
in the confined space at the
condylar neck.
• These plates are made of pure
1.3-mm-thick titanium and
are fixed with 2.0-mm TriLock
titanium monocortical screws.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
71
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
72
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
73
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
74
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
75
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
76
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
77
Cont……..
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
78
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
79
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
80
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
81
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
82
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
83
Cont……..
• Various grafts are available for condylar reconstruction after
removing the ankylotic mass such as:
 costochondral,
 sternoclavicular,
 posterior border of mandibular ramus,
 fibular, coronoid process, and
 metatarsophalangeal,
 alloplastic graft like hydroxyappatite collagen and
 recently condylar distraction osteogenesis.
To date, there is no ideal autogenous graft for condylar
reconstruction that satisfies the complex anatomy and the
myriad of functions of a missing condyle.
International Journal of Dental Research, 2 (2) (2014) 45-49
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
84
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
85
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
86
Microparotidectomy incision
• Minimal invasive surgical incision used by
experienced hands.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
87
FACIAL TRANSPLANT
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
88
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
89
lLIDETU
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
90
References
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
91
Recent and Latest Advances in Oral and Maxillofacial surgery, Dr. Lidetu Afework Anjulo and Dr. Bethel Mesfin Seyoum, Wolaita Sodo University

Weitere ähnliche Inhalte

Was ist angesagt?

Internal derangement of tmj
Internal derangement of tmjInternal derangement of tmj
Internal derangement of tmjDrKamini Dadsena
 
Arthrocentesis of the temporomandibular joint
Arthrocentesis of the temporomandibular jointArthrocentesis of the temporomandibular joint
Arthrocentesis of the temporomandibular jointAhmed Adawy
 
Submandibular and retromandibular approach
Submandibular and retromandibular approachSubmandibular and retromandibular approach
Submandibular and retromandibular approachJamil Kifayatullah
 
ORTHOGNATHIC SURGERY.ppt
ORTHOGNATHIC SURGERY.pptORTHOGNATHIC SURGERY.ppt
ORTHOGNATHIC SURGERY.pptDentalYoutube
 
Mandibular osteotomies in orthognathic surgery of Face
Mandibular osteotomies in orthognathic surgery of FaceMandibular osteotomies in orthognathic surgery of Face
Mandibular osteotomies in orthognathic surgery of FaceSapna Vadera
 
Secondary alveolar bone grafting
Secondary alveolar bone graftingSecondary alveolar bone grafting
Secondary alveolar bone graftingTejaswini Pss
 
Surgical approaches to tmj
Surgical approaches to tmjSurgical approaches to tmj
Surgical approaches to tmjAditi Rajvanshi
 
Orthognathic complications
Orthognathic complicationsOrthognathic complications
Orthognathic complicationsArjun Shenoy
 
Symphysis & Angle MANDIBULAR FRACTURES
Symphysis & Angle MANDIBULAR FRACTURES Symphysis & Angle MANDIBULAR FRACTURES
Symphysis & Angle MANDIBULAR FRACTURES Dr-Faisal Al-Qahtani
 
Arthrocentesis of Temporomandibular Joint
Arthrocentesis of Temporomandibular JointArthrocentesis of Temporomandibular Joint
Arthrocentesis of Temporomandibular JointDrKamini Dadsena
 
oral and maxillofacial surgery
oral and maxillofacial surgeryoral and maxillofacial surgery
oral and maxillofacial surgeryJoel D'silva
 
Mandibular osteotomies
Mandibular osteotomiesMandibular osteotomies
Mandibular osteotomiesRam Yadav
 

Was ist angesagt? (20)

Internal derangement of tmj
Internal derangement of tmjInternal derangement of tmj
Internal derangement of tmj
 
Bone grafts in oral surgery
Bone grafts in oral surgeryBone grafts in oral surgery
Bone grafts in oral surgery
 
Arthrocentesis of the temporomandibular joint
Arthrocentesis of the temporomandibular jointArthrocentesis of the temporomandibular joint
Arthrocentesis of the temporomandibular joint
 
Genioplasty
GenioplastyGenioplasty
Genioplasty
 
Submandibular and retromandibular approach
Submandibular and retromandibular approachSubmandibular and retromandibular approach
Submandibular and retromandibular approach
 
ORTHOGNATHIC SURGERY.ppt
ORTHOGNATHIC SURGERY.pptORTHOGNATHIC SURGERY.ppt
ORTHOGNATHIC SURGERY.ppt
 
Mandibular osteotomies in orthognathic surgery of Face
Mandibular osteotomies in orthognathic surgery of FaceMandibular osteotomies in orthognathic surgery of Face
Mandibular osteotomies in orthognathic surgery of Face
 
Bsso
BssoBsso
Bsso
 
Maxillary Orthognathic surgery
Maxillary Orthognathic surgeryMaxillary Orthognathic surgery
Maxillary Orthognathic surgery
 
Genioplasty
GenioplastyGenioplasty
Genioplasty
 
Orthognathic surgery
Orthognathic surgeryOrthognathic surgery
Orthognathic surgery
 
Rigid internal fixation
Rigid internal fixationRigid internal fixation
Rigid internal fixation
 
Secondary alveolar bone grafting
Secondary alveolar bone graftingSecondary alveolar bone grafting
Secondary alveolar bone grafting
 
Condylar fractures
Condylar fracturesCondylar fractures
Condylar fractures
 
Surgical approaches to tmj
Surgical approaches to tmjSurgical approaches to tmj
Surgical approaches to tmj
 
Orthognathic complications
Orthognathic complicationsOrthognathic complications
Orthognathic complications
 
Symphysis & Angle MANDIBULAR FRACTURES
Symphysis & Angle MANDIBULAR FRACTURES Symphysis & Angle MANDIBULAR FRACTURES
Symphysis & Angle MANDIBULAR FRACTURES
 
Arthrocentesis of Temporomandibular Joint
Arthrocentesis of Temporomandibular JointArthrocentesis of Temporomandibular Joint
Arthrocentesis of Temporomandibular Joint
 
oral and maxillofacial surgery
oral and maxillofacial surgeryoral and maxillofacial surgery
oral and maxillofacial surgery
 
Mandibular osteotomies
Mandibular osteotomiesMandibular osteotomies
Mandibular osteotomies
 

Ähnlich wie Recent and Latest Advances in Oral and Maxillofacial surgery, Dr. Lidetu Afework Anjulo and Dr. Bethel Mesfin Seyoum, Wolaita Sodo University

Teleradiology , teleoncology, tele pathology 31.12.2020
Teleradiology , teleoncology, tele pathology 31.12.2020Teleradiology , teleoncology, tele pathology 31.12.2020
Teleradiology , teleoncology, tele pathology 31.12.2020Shazia Iqbal
 
recent advances in implant dentistry
recent advances in implant dentistryrecent advances in implant dentistry
recent advances in implant dentistryDr.Pallavi Chavan
 
3 d imaging in endodontics a new era in diagnosis and treatment
3 d imaging in endodontics a new era in diagnosis and treatment3 d imaging in endodontics a new era in diagnosis and treatment
3 d imaging in endodontics a new era in diagnosis and treatmentH. Myriam Ocampo Guabloche
 
What is a Brain CT Imaging Perfusion Study?
What is a Brain CT Imaging Perfusion Study?What is a Brain CT Imaging Perfusion Study?
What is a Brain CT Imaging Perfusion Study?Carestream
 
Diagnostic medical imaging
Diagnostic medical imagingDiagnostic medical imaging
Diagnostic medical imagingPostDICOM
 
Telepathology-An overview
Telepathology-An overviewTelepathology-An overview
Telepathology-An overviewGurleen Oberoi
 
ADVANCED DIGNOSTIC AIDS - new.ppt
ADVANCED DIGNOSTIC AIDS - new.pptADVANCED DIGNOSTIC AIDS - new.ppt
ADVANCED DIGNOSTIC AIDS - new.pptPriyaD36
 
Survey on Automatic Kidney Lesion Detection using Deep Learning
Survey on Automatic Kidney Lesion Detection using Deep LearningSurvey on Automatic Kidney Lesion Detection using Deep Learning
Survey on Automatic Kidney Lesion Detection using Deep LearningIRJET Journal
 
First of its kind in South India GE IQ PET/CT at MIOT Hospitals
First of its kind in South India GE IQ PET/CT at MIOT HospitalsFirst of its kind in South India GE IQ PET/CT at MIOT Hospitals
First of its kind in South India GE IQ PET/CT at MIOT HospitalsMIOT Hospitals
 
The And Drug Administration ( Fda )
The And Drug Administration ( Fda )The And Drug Administration ( Fda )
The And Drug Administration ( Fda )Jamie Boyd
 
IRJET- Lung Cancer Detection using Digital Image Processing and Artificia...
IRJET-  	  Lung Cancer Detection using Digital Image Processing and Artificia...IRJET-  	  Lung Cancer Detection using Digital Image Processing and Artificia...
IRJET- Lung Cancer Detection using Digital Image Processing and Artificia...IRJET Journal
 
Machine learning for real-time prediction of complications induced by flexibl...
Machine learning for real-time prediction of complications induced by flexibl...Machine learning for real-time prediction of complications induced by flexibl...
Machine learning for real-time prediction of complications induced by flexibl...IJECEIAES
 
University of Toronto - Radiomics for Oncology - 2017
University of Toronto  - Radiomics for Oncology - 2017University of Toronto  - Radiomics for Oncology - 2017
University of Toronto - Radiomics for Oncology - 2017Andre Dekker
 
Integrating Medical Robots for Brain Surgical Applications
Integrating Medical Robots for Brain Surgical ApplicationsIntegrating Medical Robots for Brain Surgical Applications
Integrating Medical Robots for Brain Surgical ApplicationsDR.P.S.JAGADEESH KUMAR
 

Ähnlich wie Recent and Latest Advances in Oral and Maxillofacial surgery, Dr. Lidetu Afework Anjulo and Dr. Bethel Mesfin Seyoum, Wolaita Sodo University (20)

PHYS459_Thesis
PHYS459_ThesisPHYS459_Thesis
PHYS459_Thesis
 
macular hole
macular holemacular hole
macular hole
 
43rd Publication- IJPSR- 4th Name.pdf
43rd Publication- IJPSR-  4th Name.pdf43rd Publication- IJPSR-  4th Name.pdf
43rd Publication- IJPSR- 4th Name.pdf
 
Teleradiology , teleoncology, tele pathology 31.12.2020
Teleradiology , teleoncology, tele pathology 31.12.2020Teleradiology , teleoncology, tele pathology 31.12.2020
Teleradiology , teleoncology, tele pathology 31.12.2020
 
JOURNAL CLUB PRESENTATION (20L81S0705-PA)
JOURNAL CLUB PRESENTATION (20L81S0705-PA)JOURNAL CLUB PRESENTATION (20L81S0705-PA)
JOURNAL CLUB PRESENTATION (20L81S0705-PA)
 
recent advances in implant dentistry
recent advances in implant dentistryrecent advances in implant dentistry
recent advances in implant dentistry
 
3 d imaging in endodontics a new era in diagnosis and treatment
3 d imaging in endodontics a new era in diagnosis and treatment3 d imaging in endodontics a new era in diagnosis and treatment
3 d imaging in endodontics a new era in diagnosis and treatment
 
What is a Brain CT Imaging Perfusion Study?
What is a Brain CT Imaging Perfusion Study?What is a Brain CT Imaging Perfusion Study?
What is a Brain CT Imaging Perfusion Study?
 
Diagnostic medical imaging
Diagnostic medical imagingDiagnostic medical imaging
Diagnostic medical imaging
 
Telepathology-An overview
Telepathology-An overviewTelepathology-An overview
Telepathology-An overview
 
Elective ii
Elective iiElective ii
Elective ii
 
ADVANCED DIGNOSTIC AIDS - new.ppt
ADVANCED DIGNOSTIC AIDS - new.pptADVANCED DIGNOSTIC AIDS - new.ppt
ADVANCED DIGNOSTIC AIDS - new.ppt
 
Iort dr kiran
Iort  dr kiran Iort  dr kiran
Iort dr kiran
 
Survey on Automatic Kidney Lesion Detection using Deep Learning
Survey on Automatic Kidney Lesion Detection using Deep LearningSurvey on Automatic Kidney Lesion Detection using Deep Learning
Survey on Automatic Kidney Lesion Detection using Deep Learning
 
First of its kind in South India GE IQ PET/CT at MIOT Hospitals
First of its kind in South India GE IQ PET/CT at MIOT HospitalsFirst of its kind in South India GE IQ PET/CT at MIOT Hospitals
First of its kind in South India GE IQ PET/CT at MIOT Hospitals
 
The And Drug Administration ( Fda )
The And Drug Administration ( Fda )The And Drug Administration ( Fda )
The And Drug Administration ( Fda )
 
IRJET- Lung Cancer Detection using Digital Image Processing and Artificia...
IRJET-  	  Lung Cancer Detection using Digital Image Processing and Artificia...IRJET-  	  Lung Cancer Detection using Digital Image Processing and Artificia...
IRJET- Lung Cancer Detection using Digital Image Processing and Artificia...
 
Machine learning for real-time prediction of complications induced by flexibl...
Machine learning for real-time prediction of complications induced by flexibl...Machine learning for real-time prediction of complications induced by flexibl...
Machine learning for real-time prediction of complications induced by flexibl...
 
University of Toronto - Radiomics for Oncology - 2017
University of Toronto  - Radiomics for Oncology - 2017University of Toronto  - Radiomics for Oncology - 2017
University of Toronto - Radiomics for Oncology - 2017
 
Integrating Medical Robots for Brain Surgical Applications
Integrating Medical Robots for Brain Surgical ApplicationsIntegrating Medical Robots for Brain Surgical Applications
Integrating Medical Robots for Brain Surgical Applications
 

Kürzlich hochgeladen

Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 

Kürzlich hochgeladen (20)

Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 

Recent and Latest Advances in Oral and Maxillofacial surgery, Dr. Lidetu Afework Anjulo and Dr. Bethel Mesfin Seyoum, Wolaita Sodo University

  • 1. Recent Advances in Oral and Maxillofacial Surgery By: LIDETU AFEWORK ANJULO (DMD, MSc, OMFS) and Dr. BETHEL MESFIN SEYOUM, DMD
  • 2. Outlines • Introduction • Advances in the Field of Radiology and Imaging • Intraoperative Navigation And Robotic Surgery • Minimal Invasive Surgery and Role of Endoscopes in Oral and Maxillofacial Region • Tissue Regeneration/Engineering in Oral and Maxilla-Facial Surgery • Advances in Local Anesthetics • Advances in General Anesthesia • Advances in TMJ • Recent Advances in Maxillofacial Trauma Management • Approaches to facial skeleton • Advances in Primary care • Facial transplant LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 2
  • 3. Introductions • As clinicians involved in direct patient care, it is our fundamental duty to keep abreast with latest advances in the field of medical sciences and use these technologies judiciously for the benefit of the patients. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 3
  • 4. Advances in the Field of Radiology and Imaging • There are faster and powerful computed tomography (CT) and magnetic resonance imaging (MRI) machines backed by advanced soft wares and graphics, which have given the capability to capture images of any part of the body in great detail. • With the use of digital radiography it is possible to see images instantaneously with decreased dose of ionizing radiation. The images can be stored, manipulated, and retrieved easily. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 4
  • 5. Cont……… • CT angiograms give accurate pictures of vascular anatomy in vascular lesions. Further, data generated by CT in the form of ‘Digital imaging and communication in medicine’ (DICOM) files can be used to construct actual 3 dimensional (3D) models. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 5
  • 6. Cont……… • MRI is an important tool in the diagnosis of head and neck pathologies. • Major advantage is that it does not use ionizing radiations and gives excellent soft tissue details. • It is useful in evaluation of head and neck malignancies, temporomandibular joint (TMJ) pathologies and vascular lesions. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 6
  • 7. Cont……… • MRI angiograms are helpful in differentiation between high flow and low flow vascular malformation. • DICOM data generated from MRI can also be used for production of stereolithographic models. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 7
  • 8. Positron Emission Tomography (PET) and PET/CT • These modalities have the potential to help in staging, identifying responses to nonsurgical therapy and allowing early detection of recurrence of patients with head and neck cancer. • The positron emission tomography is used to study in vivo metabolic processes by using physiologically active compounds labelled with short acting positron emitting isotopes. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 8
  • 9. Cont……… • Positron emitting tracers, e.g. oxygen-15, nitrogen-13, and fluorine-18 can bound to a variety of molecules, which are used in the human metabolic pathways. Fluorodeoxyglucose (FDG) is the most widely used tracer with PET imaging. • When administered intravenously, FDG is trapped as 2- deoxyglucose-6-phosphate within cells. The unstable photon rich fluoro nucleus rids itself of excessive charge with emission of a positively charged electron, becoming a more stable nucleus. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 9
  • 10. Cont……… • These positrons travel a millimetre or less in the tissues before interacting with electron resulting in an annihilation reaction, which results in release of two photons at approximately 180 degrees to one another (gamma photons). Detection of these photons by detectors is used to build-up three dimensional representations of these events. The data are displayed in a manner similar to conventional sectional imaging. • These images produced reflect glucose uptake within various tissues. • The application of PET-FDG in detection of malignancy arises because of the hallmark of the malignant cells, which is increased glucose metabolism. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 10
  • 11. Cont……… LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 11
  • 12. Cont……… • One of the main advantages of PET/CT is that, it can pick-up the lesions in early stage before these are morphological evident, which leads to earlier diagnosis of tumors. • It is helpful in head and neck malignancy to detect metastatic or recurrent disease and occult primary unknown cancer. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 12
  • 13. Cont……… • It can demarcate tumor margins at sites, where it is difficult to evaluate the tumor clinically. • It is particularly helpful in areas, where it is difficult to separate recurrence from changes resulting from previous treatment, such as surgery and radiotherapy. • It can establish whether enlarged lymph nodes contain tumor or are reactive and it can detect small foci of disease LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 13
  • 14. Cont……… • It assess the whole body in one step with a much lower dose of radiation than whole body CT. • Other use of PET/CT is in evaluating growth abnormalities of the temporomandibular joint such as condylar hyperplasia LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 14
  • 15. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 15
  • 16. Stereophotogrammetry and Laser Surface Scanning • These are the two most commonly used techniques to capture the three dimensional surface images of face. • Stereophotogrammetry uses two or three cameras configured to a computer to capture a stereo image of face by means of triangulation. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 16
  • 17. Cont……… • In laser surface scanning the light and camera technology is used to capture the image exact position of surface point on the object. • Then computer software is used to synchronize the data and generate a 3D image. • These images can be used for diagnosis, treatment planning and comparison of surgical outcome, as these images are highly accurate (up to 0.5 mm accuracy). LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 17
  • 18. Co • The maxillofacial applications of these 3D cameras are growing, especially in orthognathic surgery, orthodontics and evaluation of craniofacial deformities. • It is possible to superimpose photographic soft tissue data over the bony data set obtained from CTor CBCT. This fusion of hard tissue images and surface images of face provides opportunities for diagnosis and planning corrective surgeries and postoperative comparisons. • 3D cephalometric measurements can be done on these images. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 18
  • 19. Rapid Prototyping and Stereolithography • Rapid prototyping is the process of creation of physical models from medical scan data. • The physical model is built in a layered manner and it reproduces internal and external anatomy accurately. • Medical scan data can be obtained from CT, CBCT or MRI. There are many technologies for manufacturing of medical models. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 19
  • 20. Cont……… • Stereolithography is the most commonly used technology and involves selectively solidifying an ultraviolet sensitive liquid medical resin using laser beam. • Stereolithographic models can be used for diagnosis, surgical planning, teaching, custom made implants and prosthetic devices. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 20
  • 21. Cont……… • The models allow for wax replacement of avulsed structures or generation of mirror-image structures, prebending of osteosynthesis bone plates, fabrication of templates, choosing of stock alloplasts. • These technologies are also used for making surgical guides, and scaffolds for tissue engineering. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 21
  • 22. INTRAOPERATIVE NAVIGATION AND ROBOTIC SURGERY • The development of image- guided surgery provides new revolutionary opportunities by integrating presurgical 3D imaging and intraoperative manipulation. • Integration of imaging with surgical field allows visualization of different types of images and simultaneously shows structures that are normally visible intraoperatively and permit navigation in areas of anatomical sensitivity. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 22
  • 23. Cont……… • Clinical benefits of image guided surgery include use of smaller incisions, direct access to targeted areas and consequently less invasive procedures. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 23
  • 24. Cont……… • Computer aided surgery systems are commonly used in neurosurgery, endoscopic sinus surgery, and some orthopedic procedures. Because of the complex nature of maxillofacial reconstruction procedures, these systems are now being used for maxillofacial surgery. • Intra-operative navigation gives the surgeon control in difficult access areas and complex procedures, thus reducing the chances of human error. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 24
  • 25. Cont……… • In computer aided surgical systems a virtual patient is generated from the preoperative scans. Certain stable landmarks are identified on both the virtual patient and actual patient. In technical language, these markers are known as ‘Fiducial markers’. • These markers serve as a guide for tracking of the patient and surgical instrument in space. Tracking is mainly done with the help of transmitters, which uses an optical source or electromagnetic source. • There are two transmitters, one to be placed on the patient and other to be placed on surgical instrument. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 25
  • 26. Cont……… • Further step in the advancement with fusion of these technologies is robotic surgery. In robotic surgery, a robotic arm controlled by the surgeon, sitting far away from the operation table, actually performs the procedure. • Surgery with great precision in difficult areas through minimal access is possible with the help of robotic arm. Many advanced hospitals in the world have robotic surgery suites to perform difficult surgeries in head and neck with the help of robotic arm (Trans-oral robotic system—TORS based on Da Vinci robotic arm) LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 26
  • 27. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 27
  • 28. Cont……… LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 28
  • 29. Cont……… • TORS has the benefits of being less invasive, with fewer complications and shorter hospital stays. There is less blood loss, little scarring, and fewer temporary and permanent side effects, such as loss of speech or swallowing ability. • Surgeons operate with greater precision and control using the TORS approach, minimizing the pain, and reducing the risk of possible nerve and tissue damage linked to large incisions. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 29
  • 30. Minimal Invasive Surgery and Role of Endoscopes in Oral and Maxillofacial Region • Flexible endoscopes have revolutionized many fields of surgery including maxillofacial surgery. First application of endoscopic surgery was in sinus surgery and functional endoscopic sinus surgery has become a standard of care. • Endoscopic surgery has been applied to many areas of craniomaxillofacial surgery, which includescorrection of cranial synostosis, esthetic procedures like brow lift, forehead contoring, frontal sinus fracture repair, orbital decompression, various osteotomies and fracture repair including mandibular condyle fractures. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 30
  • 31. Cont……… • Trauma, orthognathic, sialoendoscopy, and TMJ surgery are commonly performed with the assistance of the endoscope. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 31
  • 32. Cont……… • Endoscopically assisted approaches have been advocated for open reduction and internal fixation of condylar fractures. This approach allows fracture treatment with limited transoral incision. • In conjunction with transoral approach, scars are invisible and risk of facial nerve damage is minimal. • Fiberoptic assisted intubation for general anesthesia also has made the job of anesthetist easy in difficult airway cases. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 32
  • 33. Tissue Regeneration/Engineering in Oral and Maxilla-Facial Surgery • Autogenous bone grafting, regional or free microvascular flaps have been the main stay for reconstruction, but this causes possible donor and recipient site morbidity. • The development of effective reconstructive procedures using tissue engineering techniques without the need for conventional tissue transplantation procedures can have a tremendous impact on surgery of head and neck area. • Tissue engineering is an interdisciplinary field comprising of cell biologists, bio-chemists, material scientists, engineers, and clinicians, and an understanding of the complex role of the various components with the aim to create limitless and readily available supply of off- the- shelf tissue regenerates. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 33
  • 34. Cont……… • Tissue engineering involves the vital collaboration between the three key components, stem cells, resorbable scaffolds and bioactive molecules such as growth factors. • The combination of scaffolds and cells is often referred to as a construct. Constructs may be fashioned ex vivo, and then implanted into an individual. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 34
  • 35. Cont……… Approaches to Tissue Engineering • (a) Growth factors/Bone Morphogenic Proteins: BMPs are a group of osteoinductive sequentially arranged amino acids and polypeptides that are capable of stimulating adult mesenchymal cells to become osteoblasts and form bone. • Adult mesenchymal cells are supplied by periosteum and paraperiosteal connective tissue. • Recombinant human BMP-2 (rh-BMP-2) (Infuse, meditronics) was approved as an alternative to autogenous bone graft for sinus augmentations and for localizedalveolar ridge defects associated with extraction sockets. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 35
  • 36. Cont……… LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 36
  • 37. Cont……… • (b) Stem Cells: Stem cells can dedifferentiate in the correct setting into simple, unspecified forms. They, then have the ability to form new structures based on the stimulus and chemical factors that are present in the matrix. • There are two types of stem cells – adult stem cells and embryonic stem cells. Human embryonic stem cells are pluripotent stem cells isolated from the inner mass of human blastocysts. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 37
  • 38. Cont……… • Currently, adult stem cells used in clinical setting are autologous cells. • For the tissue engineering of bone, cells from the bone marrow and adipose tissue have been used as autologous cells, These have the ability to dedifferentiate from mesenchymal cells to osteoblasts and then to osteocytes, which have the ability to lay bone in a laminated form. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 38
  • 39. Cont……… • The seeded cells can be stimulated physically with magnetic or galvanic stimulation, ultrasound, hypoxic or hyperoxic gradients, growth factors such as transforming growth factor beta-1 (TGFB-1), bone morphogenetic proteins (BMPs) or vascular endothelial growth factor (VEGF), to guide the differentiation and growth of the cells. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 39
  • 40. Cont……… • Stem cells from dental pulp from developing teeth, shed deciduous teeth and dental follicle provide other source of adult epithelial and mesenchymal stem cells. • Third molar removal also presents some opportunity for harvesting follicular cells, cementoblast-like cells and dental pulp stem cells, which have been cultured and studied. • The receptors of these cells can be characterized, an important first step in understanding these cells and their potential future use. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 40
  • 41. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 41
  • 42. Cont……… • There is a hope to create synthetic form of bone, skin, cartilage and muscle that can function as well as normal tissues depends on ability to effectively integrate multiple technologies and components that are capable of meeting the complex demands of reconstruction in head and neck area. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 42
  • 43. Advances in Local Anesthetics Articaine • It is a new aminoamide class of local anesthetic, approved by FDA in 2000 for clinical use. It is available in 4% strength with 1: 100,000 o 1: 200,000 epinephrine. • It has thiopentone ring instead of benzene ring, which makes it more lipid soluble. Therefore, it has got better tissue penetration and diffusion than the lidocaine. • Because of better bone penetration and diffusion it can anesthetise palatal side and anterior lingual sides with buccal infiltration only. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 43
  • 44. Reversing Effects of Local Anesthesia • Soft tissue anesthesia after local anaesthetic infiltration or block may linger on for several hours. This may not be desirable in certain case especially in children. • In 2009, FDA approved phentolamine mesylate (Oraverse, Novalar Pharmaceuticals Inc. USA) for the reversal of the local anesthetic. • This can be used both in adults and children, but not recommended below six years of age or weight <15 kg. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 44
  • 45. Cont………. • Phentolamine is an α adrenergic agonist, it acts by providing vasodilatation, thus allowing the faster diffusion of local anesthetic into vascular system. • It is injected in same volume as the local anesthetic and it accelerates the reversal of soft tissue anesthesia. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 45
  • 46. Local Anesthesia Delivery Devices • Newer local anesthetic delivery devices not only provide reduction in pain on injection and failure rates, but also produce more precise anesthetised area. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 46
  • 47. Cont………. • Vibrotactile, Vibraject, dental vibe, accupal, compudent are the few local anesthetic delivery devices which uses vibration technology to decrease the pain on injection. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 47
  • 48. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 48
  • 49. Submental Intubation in Maxillofacial Trauma Patients • Intraoperative assessment of occlusion and maxillomandibular fixation is often required for exact reduction of facial fractures. • Conventional oral tracheal intubation does not allow intraoperative assessment of the occlusion and maxillomandibular wiring. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 49
  • 50. Cont…….. • Submental intubation is a procedure in which endotracheal tube is passed through a surgically created opening in submental region. • It allows free intraoperative access to the dental occlusion and the nasal pyramid. • Therefore, simultaneous treatment of all the facial fractures, without interference of the tube or the need of switching tube from nasal to oral or vice versa during surgery. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 50
  • 51. Retromolar Intubation Technique • In this technique, the endotracheal tube is placed in the retromolar space behind the last erupted teeth. • Arora and Rattan, for the first time demonstrated that there is sufficient space in retromolar region for successful placement of the endotracheal tube in children and certain adults. • Intermaxillary fixation of teeth is possible LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 51
  • 52. LIDETU LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 52
  • 53. Advances in TMJ Arthroscopy and One Point Arthroscopy • The TMJ arthroscope is a small, tube like camera that projects the image of the joint onto a monitor, allowing the surgeon to view the inside the joint without making any large incisions. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 53
  • 54. BUCCAL PAD OF FAT IN TMJ RECONSTRUCTION • In this technique dead space created after gap arthroplasty is blocked with the help of buccal pad of fat. • Buccal pad of fat is harvested through the same preauricular approach as used for TMJ surgery. • Blunt dissection is done anteromedial to the coronoid process, where buccal pad of fat is located and it is transposed to TMJ area. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 54
  • 55. . • This fat can completely block the dead space as compared to any other tissue, because of its fluidity. • This prevents formation of blood clot, which is primary factor for heterotopic bone formation and reankylosis of TMJ. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 55
  • 57. Cont…….. • To manage the panfacial complex fractures, there have been improvements in techniques of fracture fixation and reduction.  Other advances in the field of surgery are also applicable to trauma management. This include  improved diagnostic imaging,  minimal access surgery and endoscopic surgery,  biomaterial advances,  intra-operative imaging,  rapid prototyping techniques,  computer assisted surgery, and  customised implants. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 57
  • 58. Intermaxillary Fixation Screws • Special screws for intermaxillary fixation are available, which have a hole for passage of wire below the screw head. • The screws are inserted above the root apices in maxilla and mandible, and wire is passed through the holes to close the mouth in occlusion. • Screws are quick to place, maintain better oral hygiene, and there is no risk of prick injury, as compared to fixation with arch bars and wires. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 58
  • 59. Rapid IMF • An adjustable flexible plastic band that wraps around the tooth to create an anchorage point for temporary maxillomandibular fixation and immobilization. • These have been developed to reduce the risk of needle-stick injury. • Intermaxillary fixation is done with the help of elastic chain. • These anchorage points can retain intermaxillary fixation up to three weeks. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 59
  • 60. Resorbable Implants • Drawbacks of currently used titanium implants may include soft tissue irritation and cold intolerance, creation of distortion artefact on computed tomography and magnetic resonance imaging, weakening of bone from excessively rigid fixation, ‘‘stress shielding’’ possible interference with facial growth, implant migration over time, and the possible need for subsequent implant removal. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 60
  • 61. Resorbable plates • Resorbable plates provide initial osseous fixation strength for direct bone healing and then they disappear over a period of time leaving behind no foreign body. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 61
  • 62. Self-Drilling, Self-Tapping Screws • The self-drilling principle has the advantage of avoiding the necessity to drill a hole, thus shortening the process of osteosynthesis and requiring less instrumentation. • The self-drilling, self-tapping screws were essentially equal to the retentiveness of self tapping screws in thin bone, but were much superior in cancellous bone. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 62
  • 63. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 63
  • 64. Cont…….. • This is presumably due to self-drilling screws compressing rather than cutting the cancellous bone around the threads of the screws. • The clinical implication is that self-drilling, self- tapping screws are much superior when fixing screws into a cancellous bone graft. • It should be noted that self-drilling screws may be difficult to apply in extremely dense bone such as the mandible. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 64
  • 65. LOCKING PLATES AND SCREWS SYSTEM • In locking plates, the screw locks not only to the bone, but to the bone plate as well. • This is accomplished by having a screw with a double thread. • One thread will engage the bone; another will engage a threaded area of the bone plate. • Since the plate locks to the screw rather than gaining its rigidity by being compressed against the bone, it also avoids the cortical necrosis, which is sometimes seen under a plate ,which is compressed against the bone. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 65
  • 66. Locking plate and screw systems have several advantages over the conventional screw systems. Locking plate and screw • It becomes unnecessary for the plate to intimately contact the underlying bone in all areas. • As the screws are tightened, they “lock” to the plate,thus stabilizing the segments without the need to compress the bone to the plate. • A decreased incidence of inflammatory complications from loosening of the hardware. • Provide more stable fixation CONVENTIONAL plate and screw • require precise adaptation of the plate to the underlying bone. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 66
  • 67. Multidirectional Fixation. • Another advancement in locking technology is multidirectional fixation. • TriLock technology (Medartis, Basel, Switzerland) represents a significant step forward in multidirectional and angular stable fixation. • The spherical three-point wedge- locking creates a connection between the head of the screw and the plate hole which is stable in angle and axial plane. • The locking can be adjusted up to three times within ± 15º without loss of stability. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 67
  • 68. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 68
  • 69. Trapezoidal Condylar Plates • The primary stability achieved by TCPs is superior to that obtained by single plating techniques, by axial lag screw osteosynthesis, and by rectangular plates in the sagittal plane. • This is due both to the 3D concept and to the trapezoidal shape itself. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 69
  • 70. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 70
  • 71. Delta Plate Fixation for Condylar Fractures • The plate’s delta shape can handle changing loads, with the highest tensile strain occurring at the anterior and lateral surfaces and the highest compressive strains on the posterior surface. • The plate can be easily placed in the confined space at the condylar neck. • These plates are made of pure 1.3-mm-thick titanium and are fixed with 2.0-mm TriLock titanium monocortical screws. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 71
  • 72. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 72
  • 73. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 73
  • 74. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 74
  • 75. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 75
  • 76. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 76
  • 77. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 77
  • 78. Cont…….. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 78
  • 79. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 79
  • 80. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 80
  • 81. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 81
  • 82. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 82
  • 83. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 83
  • 84. Cont…….. • Various grafts are available for condylar reconstruction after removing the ankylotic mass such as:  costochondral,  sternoclavicular,  posterior border of mandibular ramus,  fibular, coronoid process, and  metatarsophalangeal,  alloplastic graft like hydroxyappatite collagen and  recently condylar distraction osteogenesis. To date, there is no ideal autogenous graft for condylar reconstruction that satisfies the complex anatomy and the myriad of functions of a missing condyle. International Journal of Dental Research, 2 (2) (2014) 45-49 LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 84
  • 85. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 85
  • 86. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 86
  • 87. Microparotidectomy incision • Minimal invasive surgical incision used by experienced hands. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 87
  • 88. FACIAL TRANSPLANT LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 88
  • 89. LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 89
  • 90. lLIDETU LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 90
  • 91. References LIDETU and BETHEL, WOLAITA SODO UNIVERSITY 91