Stability of Le Fort I maxillary inferior repositioning surgery with rigid internal fixation: a systematic review

Purpose: In syndromic craniosynostosis, the Le Fort III osteotomy is used to correct dental/skeletal imbalance, improve exorbitism, and increase the airway. The purpose of this study is to perform a cost comparison between the standard technique of single-stage rigid internal fixation and distraction osteogenesis (DO) in the Le Fort III osteotomy in this patient population. Method: Hospital cost accounting databases were queried for patients undergoing single-stage advancement (SS) or DO from 2007 to 2016. Nominal cost data were adjusted using the Bank of Canada Consumer Price Index. Reported costs represented the full length of stay for all utilization per patient. Demographic information and cost data for single-stage osteotomy and DO were compared. Results: Total costs for single-stage (n = 8) were higher than distraction (n = 6; mean $CAD57 825 vs $38 268, P < .05). Intensive care unit (ICU) costs for single-stage were significantly higher than distraction (mean, $17 746 vs $5585, P < .005). Distraction cases had higher operating room (OR) costs than single stage, but the difference was not significant (mean, $12 540 vs $9696). Length of stay was significantly longer for SS patients (mean, 11 days vs 7 days, P < .05). Conclusions: This single-institution retrospective cost analysis indicates standard SS rigid internal fixation Le Fort III is more costly than DO. Despite higher OR costs, prolonged ICU and hospital stay was the primary reason behind this difference. This information may be of benefit when advocating for new technology perceived as high cost.

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Ameloblastoma em maxila: sugestão de abordagem cirúrgica

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v7i12.3097 ◽

2019 ◽

Vol 7 (12) ◽

Author(s):

Thalles Moreira Suassuna ◽

Júlio Leite de Araújo-Júnior ◽

Tácio Candeia Lyra ◽

Joaquim Celestino da Silva-Neto ◽

José Wilson Noleto ◽

...

Keyword(s):

Systematic Review ◽

Recurrence Rate ◽

Surgical Approach ◽

Femoral Condyle ◽

Meta Analysis ◽

Infratemporal Fossa ◽

Le Fort ◽

Maxillary Defect ◽

Le Fort I ◽

Head Neck

Introdução: O ameloblastoma é um tumor benigno, localmente invasivo, originário do epitélio odontogênico e é a neoplasia odontogênica mais comum. Apresentam crescimento lento e sua ocorrência na maxila é pouco frequente. Objetivo: Discutir os métodos de tratamento para os ameloblastomas em maxila e demonstrar a utilidade da osteotomia Le Fort I na abordagem destas lesões. Material e Método: Estudo descritivo de relato de caso. Resultados: Observou-se a erradicação da lesão com uma abordagem de baixa morbidade e que permitiu bom resultado estético e funcional. Conclusão: A ressecção é o método mais indicado para tratamento dos ameloblastomas sólidos, e a sua realização utilizando a osteotomia Le Fort I podem trazer vantagens tanto no trans quanto no pós-operatório.Descritores: Ameloblastoma; Maxila; Osteotomia de Le Fort.ReferênciasKreppel M, Zöller J. Ameloblastoma - Clinical, radiological, and therapeutic findings. Oral Dis. 2018;24(1-2):63-6.Taylor EM, Wu W, Kamali W, Ferraro P, Upton N, Lin J et al. Medial femoral condyle flap reconstruction of a maxillary defect with a 3D printing template. J Reconstr Microsurg Open. 2017;2:e63-8.Menezes LM, Souza CEL, Carneiro JT, Silva Kataoka MS, Júnior SDMA, Pinheiro, JDJV. Maxillary ameloblastoma in an elderly patient: report of a surgical approach. Hum Pathol. 2017;10:25-9.Laborde A, Nicot R, Wojcik T, Ferri J, Raoul G. Ameloblastoma of the jaws: Management and recurrence rate. Eur Ann Otorhinolaryngol Head Neck Dis. 2017;134(1):7-11. Milman T, Ying GS, Pan W, LiVolsi V. Ameloblastoma: 25 year experience at a single institution. Head Neck Pathol. 2016;10(4):513-20.Pogrel MA, Montes DM. Is there a role for enucleation in the management of ameloblastoma? Int J Oral Maxillofac Surg. 2009;38(8):807-12.Antonoglou GN, Sándor GK. Recurrence rates of intraosseous ameloblastomas of the jaws: a systematic review of conservative versus aggressive treatment approaches and meta-analysis of non-randomized studies. J Craniomaxillofac Surg. 2015;43(1):149-57.Almeida RA, Andrade ES, Barbalho JC, Vajgel A, Vasconcelos BC. Recurrence rate following treatment for primary multicystic ameloblastoma: systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2016;45(3):359-67.Rizzitelli A, Smoll N, Chae M, Rozen WM, Hunter-Smith DJ. Incidence and overall survival of malignant ameloblastoma. PLoS One. 2015;10(2):e0117789.Nastri AL, Wiesenfeld D, Radden BG, Eveson J, Scully C. Maxillary ameloblastoma: a retrospective study of 13 cases. Br J Oral Maxillofac Surg. 1995;33(1):28-32.Guha A, Hart L, Polachova H, Chovanec M, Schalek P. Partial maxillectomy for ameloblastoma of the maxilla with infratemporal fossa involvement: A combined endoscopic endonasal and transoral approach. J Stomatol Oral Maxillofac Surg. 2018;119(3):212-15.Quick-Weller J, Koch F, Dinc N, Lescher S, Baumgarten P, Harter P et al. Intracranial ameloblastoma arising from the maxilla: an interdisciplinary surgical approach. J Neurol Surg A Cent Eur Neurosurg. 2017;78(5):582-87.Abtahi MA, Zandi A, Razmjoo H, Ghaffari S, Abtahi SM, Jahanbani-Arkadani H et al. Orbital invasion of ameloblastoma: a systematic review apropos of a rare entity. J Curr Ophthalmol. 2018;30(1):23-34.Bettoni J, Neiva C, Fanous A, Olivetto M, Demarteleire S, Demarteleire C et al. Brain ameloblastoma: metastasis or local extension report of a case and literature review. J Stomatol Oral Maxillofac Surg. 2018;119(5):436-39.Yang R, Liu Z, Peng C, Cao W, Ji T. Maxillary ameloblastoma: factors associated with risk of recurrence. Head Neck. 2017;39(5):996-1000.Kamalpathey LCK, Sahoo MGNK, Chattopadhyay CPK, Issar MY. Access Osteotomy in the Maxillofacial Skeleton. Ann Maxillofac Surg. 2017;7(1):98-103.Alexander R, Weber WD, Theodos LV, Friedman JS. The treatment of large benign maxillary tumors via Le Fort I downfracture: report of two cases and review of the literature. J Oral Maxillofac Surg. 1992;50(5):515-7.Catunda IS, Melo AR, Medeiros Júnior R, Queiroz IV, Neto F, Leão JC. Osteotomia Le Fort I: Aspectos de interesse no tratamento de nasoangiofibroma juvenil. Rev cir traumatol buco-maxilo-fac. 2011;11(4):9-12.Symington OG, Caminiti MF. Le Fort 1 down fracture approach for the treatment of a posterior maxillary ameloblastoma. J Can Dent Assoc. 1995;61(12):1048-52.Iwaki LC, Tolentino ES, Lustosa RM, Jacomacci WP, Casaroto AR, Leite PC et al. Le Fort I osteotomy for the removal of a rare unicystic ameloblastoma lesion in the maxillary sinus. Gen Dent. 2016;64(3):16-9.

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Diagnosis dan Penatalaksanaan Fraktur Le Fort I-II disertai Fraktur Palatoalveolar Sederhana

Jurnal Kesehatan Andalas ◽

10.25077/jka.v7i0.854 ◽

2018 ◽

Vol 7 ◽

pp. 78

Author(s):

Dewi Yuri Lestari ◽

Al Hafiz ◽

Effy Huriyati

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Open Reduction Internal Fixation ◽

Le Fort ◽

Le Fort I

Pendahuluan: Fraktur pada sepertiga tengah wajah (midface) memerlukan pemeriksaan yang teliti dan penatalaksanaan yang tepat. Fraktur palatoalveolar jarang terjadi dan dapat terjadi bersamaan dengan fraktur lain pada trauma wajah. Pada beberapa dekade terakhir, berbagai modalitas penatalaksanaan fraktur sepertiga tengah wajah telah dicoba. Penatalaksanaan fraktur sepertiga tengah wajah dengan menggunakan fiksasi dengan miniplate dan screw mengungguli teknik-teknik terdahulu. Laporan Kasus: Dilaporkan satu kasus fraktur Le fort I-II dan fraktur palatoalveolar sederhana pada seorang laki-laki umur 19 tahun. Telah dilakukan Open Reduction Internal Fixation (ORIF) dengan miniplate dan screw serta pemasangan wire. Simpulan: ORIF dengan miniplate dan screw telah menjadi pilihan pada fraktur maksilofasial karena lebih stabil dalam hal fungsi dan fiksasi tulang yang lebih baik. Berdasarkan indikasi, fiksasi intermaksila, palatum splint, dan wire dapat digunakan secara tersendiri atau kombinasi untuk penatalaksanaan fraktur palatoalveolar.

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