Maxillofacial and dental surgery

This chapter discusses the anaesthetic management of maxillofacial and dental surgery. It describes sedation for dentistry and anaesthesia for dental procedures including extractions. It then gives an overview of maxillofacial surgery. Specific surgical procedures covered include extraction of buried or impacted teeth; repair of fractures of the maxilla, orbit, facial skeleton and mandible; maxillofacial tumour surgery; facial reconstructive surgery, and maxillary or mandibular osteotomy.

Application research of master-slave cranio-maxillofacial surgical robot based on force feedback

Background: The complex anatomical structure, limited field of vision, and easily damaged nerves, blood vessels, and other anatomical structures are the main challenges of a cranio-maxillofacial (CMF) plastic surgical robot. Bearing these characteristics and challenges in mind, this paper presents the design of a master-slave surgical robot system with a force feedback function to improve the accuracy and safety of CMF surgery. Methods: A master-slave CMF surgical robot system based on force feedback is built with the master tactile robot and compact slave robot developed in the laboratory. Model-based master robot gravity compensation and force feedback mechanism is used for the surgical robot. Control strategies based on position increment control and ratio control are adopted. Aiming at the typical mandibular osteotomy in CMF surgery, a scheme suitable for robot-assisted mandibular osteotomy is proposed. The accuracy and force feedback function of the robot system under direct control and master-slave motion modes are verified by experiments. Results: The drilling experiment of the mandible model in direct control mode shows that the average entrance point error is 1.37 ± 0.30 mm, the average exit point error is 1.30 ± 0.25 mm, and the average posture error is 2.27° ± 0.69°. The trajectory tracking and in vitro experiment in the master-slave motion mode show that the average position following error is 0.68 mm, and the maximum force following error is 0.586 N, achieving a good tracking and force feedback function. Conclusion: The experimental results show that the designed master-slave CMF robot can assist the surgeon in completing accurate mandibular osteotomy surgery. Through force feedback mechanism, it can improve the interaction between the surgeon and the robot, and complete tactile trajectory movements.

The effects of mandibular osteotomy on maxillary orthodontic tooth movement and bone remodelling in a rat model

Summary Objectives The accelerated tooth movement phenomenon after orthognathic surgery has been observed. However, the underlying mechanism remains unclear. There is no experimental study showing the effect of orthognathic surgery on orthodontic tooth movement of the opposing jaw. Therefore, the present study aimed at investigating if mandibular osteotomy enhances maxillary tooth movement and bone remodelling. Materials and methods Fifty-four male Sprague-Dawley rats were randomly divided into two groups: maxillary tooth movement (TM) and maxillary tooth movement + mandibular surgery (TM + MS). The orthodontic force was delivered to move the left maxillary first molar mesially. The surgical intervention was performed on the left mandible. Microcomputed tomography, histological analysis, enzyme-linked immunosorbent assay, and quantitative real-time polymerase chain reaction were used to assess changes at 3, 7, and 21 days after surgery. Results The mandibular osteotomy accelerates the rate of maxillary tooth movement with decreased bone volume fraction on the seventh day. Bone resorption was observed on the third and seventh day after mandibular osteotomy. It was found that serum interleukin-1β level increased significantly in the TM + MS group compared with the TM group, as well as the high expression level of cathepsin K and tumour necrosis factor receptor-associated factor 5 of the orthodontic tooth on the third and seventh day after mandibular osteotomy. Conclusion Data from the present study suggested that mandibular osteotomy accelerates maxillary osteoclast activity and post-operative tooth movement, providing evidence for accelerated tooth movement phenomenon after orthognathic surgery.