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2008 Annual Meeting Abstracts

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Simulating Osteotomies with Porous Alloplastic Implants -Rationale, Technique and Long Term Results
Michael J. Yaremchuk, M.D..
Massachusetts General Hospital, Boston, MA, USA.


PURPOSE:
The visual effects of skeletal osteotomies can be simulated with alloplastic implants. This paper presents the rationale, technique and long term results of this surgery.
METHODS: A retrospective chart review of all patients who underwent facial skeletal augmentation to simulate the visual effects of osteotomies using porous implants from 1990 to 2007 was performed.
Concept - When the occlusion is normal or has been normalized by orthodontics, the visual effects of skeletal osteotomies can be simulated with alloplastic implants. Implants augmenting the: infraorbital rim and upper midface simulate the Le Fort III (image 1); pyriform aperture-Le Fort I (image 2); chin and posterior mandible- horizontal and sagittal osteotomies (image 3).
Surgical technique - Porous implants were placed by the author through intraoral and submental incisions, carved to correct the skeletal deficiencies, and immobilized with titanium screws.Systemic antibiotics were administered preoperatively and for 5 days postoperatively. Suction drains were used routinely.
RESULTS: 294 patients had surgery (91 male, 203 female). 60 of the 294 patients (20%) had had previous osteotomy or implant surgery. (Average age -34 years (range 17-68). Average follow-up was 24 months (range 1week-16 years). No implants were extruded or migrated, formed clinically apparent capsules, or caused symptoms attributable to bio-incompatibility or bone resorption. 10 patients (10/108=9%) had upper midface implants which became visible with time. 4 patients (1.4%) had infections (all had had previous surgery, 2 had previous infections).14 patients (14/294=5%) required revision surgery to correct displeasing contours. Eight (8/234=3%) had primary surgery. Eight ( 8/60=13%) had secondary surgery. Three patients (3/294=1%) requested implant removal. Image 4 shows a patient who had Le fort III, Le Fort I, sagittal split and horizontal osteotomies simulated with implants (left-preop, right-postop). Image 5 diagrams the surgery.
CONCLUSION:
Screw immobilized, porous implant augmentation of the facial skeleton can simulate the visual effect of osteotomies with high patient satisfaction and low morbidity.
Secondary implant surgery has a higher rate of infection (6%vs 1%) and revisional surgery ((13%vs3%).
Large implants placed under thin upper midface skin become visible with time.


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