A.HUTSEBAUT, A. GRYSOLLE, A. VERDONCK, J. SCHOENAERS
MAXILLARY DISTRACTION OSTEOGENESIS WITH A RIGID EXTERNAL DISTRACTION SYSTEM. CLINICAL EXPERIENCE.

Distraction osteogenesis has become an important technique to treat dissymmetry due to congenital malformations, diseases or traumas.
Bone distraction is the process of generating new bone in a gap between two bone segments in response to the application of graduated tensile stress across the bone gap.
Maxillary advancement by distraction has the advantage to provide new bone in combination with simultaneous expansion of the soft-tissue functional matrix.

At the University Hospital Leuven we have some experience with maxillary advancement using a RED (rigid external distraction) device.
Six subjects underwent maxillary advancement with a rigid external distraction device after a Le Fort I osteotomy.
There were 4 male and 2 female patients, ages 13.2 to 44.9  years. (mean 22.08 years)
The subjects included 2 unilateral cleft lip and palate (UCLP), 3 with bilateral CLP, 1 with Binder syndrome.

We will show in this presentation our results including distraction distance, stability and soft-tissue profile change.
All patients had correction of the maxillary hypoplasia with positive skeletal convexity and dental overjet after maxillary distraction.

 
P. LEYDER ; C. MEDARD ; H. CHAUSSARD,
MORPHOLOGICAL IMPACT OF VARIOUS GENIOPASTY PROCESSES IN MASSIVE SYMPHYSYS.
Department of Maxillo-Facial Surgery, Hopital R. Ballanger 93600 AULNAY SOUS BOIS

The authors aim will be to link the morphological impact of a genioplasty with the kind of process chosen for patients showing a massive apparance.
It consists in a retrospective study analysing clinically the pre and post surgical morphology of clins. The authors focuse on understanding which elements contribute to cause these massive appearences.
Various genioplasty processes were used. When the choice of a simple surgical act may enough be efficent, the authors highlight the issues of more complex technical choice. Thus, the operation might confronted to the incertainties of its fulfilment and the decision taken might cause indesirable effects or too strong morphological changes.
If it occurs that substraction genioplasty is not feasible, the authors suggest to completely change the overlapping bone flap genioplasty, so that the pogonion projection will not be exagerated and that an adaptation to the almost specific morphological issues of sheletal classe III malocclusion may be formed.

 
M.BIGORRE, L. MATTEI, G. CAPTIER, JL RAKOTOARIMANANA, P. MONTOYA 
SOFT TISSUE PROFILE CHANGES AFTER MAXILLARY DISTRACTION

The purpose of this study was to examine preoperative to postoperative changes of soft tissue profiles in the face of patients who underwent maxillary distraction and we have tried to correlate this changes with skeletal modifications.
Sixteen patients were examined: 11 patients had a unilateral cleft lip and palate, 2 patients had a bilateral cleft lip and palate and 3 patients had an Apert's syndrome. At the time of maxillary distraction, the patients were between 10 to 24 years old (average:  14.5 years old). 
Lefort I osteotomy followed by distraction with a Rigid External Distraction RED system of Polley-Figueroa were performed on all patients.
The changes of soft tissue profile were appreciated with a comparative lateral cephalograms analysis according to Burstone, Legan and Bell carried out before surgery, and 6 months post surgery.
The preoperative facial concavity (G-Sn-Pg') was reduced by 15°. The nasolabial angle increased by 8.25°at the expense of the nasocolumelar angle increased by 18.5°. 
The nasal tip and the columelar basis point moved 4 mm and 10 mm respectively forward.
The mandibular adaptation involved a 8° increase of chin angle (Sn-Gn-C) but little changes of vertical profile. This study showed a correlation between the progress of the anterior nasal spine and the nasal projection. The labial projection was influenced by  the protractive force axes.
This study showed the importance of control of  the protractive force axes for the skeletal and the soft tissue displacement.

 
J. KOERBER
SKELETAL AND DENTO-ALVEOLAR STABILITY OF THE COMBINED TREATMENT (ORTHODONTIC-SURGERY) IN ANTERIOR OPEN BITE DEFORMITIES

A review of literature  consisting of treatment of anterior open bite (AOB) is presented. In general orthodontic treatment of AOB deformity is not succesfull. A Le Fort I intrusion osteotomy with or without BSSO is indicated when a vertical maxillary hyperplasia, an anteroposterior Class II molar relation and a transverse maxillary deficiency has to be corrected. This surgical correction is preceded by dento-alveolar decompensation with orthodontic treatment.
This review shows a shortage of studies in large groups of patients with AOB deformities concerning the stability of surgical-orthodontic treatment. Also the adaptation of the orofacial soft tissues is not well understood.

A retrospective study to evaluate the stability of osteotomies in AOB patients at KULeuven was carried out. The aim, methods and results are presented and critically discussed.

 
E.GERE (1), K.OUOBA (2), B.COSTINI (3), P.SEGUIN (4), P.BELLITY (5), E.LAIGLE (6)
MISSION HUMANITAIRE NOMA AU BURKINA-FASSO OCTOBRE –NOVEMBRE 2002 : BILAN ET PERPECTIVES .

(1) Service de Chirurgie Maxillo-Faciale, HIA Robert Picqué, 33998 Bordeaux Armées. (2) Service d'ORL, CHN Yalgado Ouedraogo, Ouagadougou. (3) Chirurgien Plasticien, Eden Palace, 06000 Cannes. (4) Hôpital Bellevue, bd Pasteur, 42000 St Etienne. (5) Chirurgien Plasticien, 75000 – Neuilly (6) IPMC/CNRS 06560 Sophia Antipolis

A la demande de plusieurs organisations humanitaires, 2 équipes chirurgicales se sont succédées à Ouagadougou au Burkina-Fasso pour opérer 54 enfants ou adultes jeunes atteints de séquelles de noma.
Nous présentons le bilan de cette mission :
- organisation multinationale et moyens mis en œuvre
- revue des patients pris en charge
- bilan techniques des interventions effectuées
perspectives d'avenir

 
K. BORGHGRAEF; J. FERRI; N. NEYT; C. DE CLERCQ; H. SCHAUTTEET
MANDIBULAR HYPERPLASIA

Mandibular hyperplasia can result in complex facial asymmetry composed of degrees of condylar and ramus overgrowth, malocclusion and complementary maxillary deformity. Different diagnostic entities, described by Obwegeser and Delaire are showed with clinical cases. Early diagnose and treatment is necessary to prevent gross facial asymmetry and complementary maxillary deformation. Different treatment planning for the separate entities is discussed. Early high condylectomy is the treatment of choise in most cases.