2^nd International conference on
Craniofacial Surgery

Biography:

Deanna Mulvihill has her Prof. Tatjana Dostalova, MD., PhD., DrSci., MBA. Charles University 2nd Faculty of Medicine and University Hospital in Motol, Head of Department of Dentistry. Education:  1974 - 1979 - Medical Faculty of Charles University in Prague, specialization dentistry -         Degree Doctor in Medicine. Postgraduate training: 1982 - Attestation of 1st Degree in Dentistry; 1992 - Attestation of 2nd Degree in Prosthetic Dentistry; 2010 – European Prosthodontist Association Recognized Specialist; 2012 - Attestation of Clinical Dentistry; 1989 - Master of Medical Science - diploma received; 2000 –associate professor; 2004 – Professor; 2001 - Doctor of Medical Science; 2004 - Master of Business Administration. 

Abstract:

Recently there has been a great progress in three-dimensional (3D) technologies in field of medicine. Dentistry and maxillofacial surgery haven’t been exceptions. Methods such as model surgery or cephalometric methods of prediction (2D prediction) including video imaging are considered as “gold standards” in orthognatic surgery. However, these techniques, despite being routine part of the diagnosis and treatment planning process, have their limitations. 3D environment adds the third dimension to planning, which moves planning closer to reality and gives us more information for diagnosing a wider range of dentofacial anomalies. The aim of study is to compare treatment planning and therapy results using 2D and 3D techniques and technologies. Methodology & Theoretical Orientation: Our research group consisted of 30 patients with orthognathic surgery plan. The patients came to the Department of Oral and Maxillofacial Surgery on orthodontists and dentists recommendation, and they gave informed consent to take part in the treatment. 2D and 3D analyzes were used to evaluate pre and postoperative data mainly: sets of photos (Canon EOS camera), 3D images from facial scanner VECTRA 3D Imaging system, Fidentis analyst, 2D and 3D Dolphin Imaging Software, CBCT Kavo X-ray and  Cone Beam 3D Imaging analysis  before and after therapy compared  planning and surgery results. Findings:  3D analysis and planning help us monitor therapy. Statistically significant results between 2D and 3D analysis were observed.  Vectra 3D images and Fidentis analyst are basis of 3D communication between mutlidisciplinary team, patients and their families. 3D Dolphin Imaging Software, CBCT Kavo X-ray and Cone Beam 3D Imaging analysis helped us mainly orthognathic treatment planning. Conclusion & Significance: The 3D methods of orthognathic surgery planning and therapy bring the specific information about surgical treatment options for 3D simulation procedures.

Biography:

Abstract:

Background: Despite the lack of consensus regarding the treatment of labio-palatal clefts, each  treatment protocol is the expression of an individual perspective that accumulates the experience of each multidisciplinary group, which all pursue the same goal: to achieve adequate language development with the lowest possible impact on facial growth. The purpose of this work was to show a new protocol of management. This was designed because the authors are convinced that the extensive and aggressive dissections on the palatine mucoperiosteum have deleterious effects on the midface growth. It favors the limited dissection of palate segments, exploiting vomer versatility, designing flaps according to the requirements of each type of cleft (Veau’s classification), (17) and routinely associated to a Furlow-type veloplasty. Methods: Seven hundred and fifty patients with cleft palate (Veau type II, III, and IV) were treated between 1990 and 2016 at “Fundación Hospital de la Misericordia”. The authors combined various techniques, in accordance with the requirements of each type of cleft palate. All surgeries were performed by one of two surgeons (JRGD or OJGD). Results: This protocol has the advantage of using limited dissections on the mucoperiosteum, which preserves the major and minor vascular pedicles, and also dramatically restricts the use of relaxation incisions adjacent to the alveolar rims. No cases of necrosis of the vomer were observed, as it is not completely denuded in the process (only the portion of mucosa necessary to achieve closure of the nasal plane is denuded).  In the experience of the authors, through use of this technique, an incidence of 10% union fistulas was obtained, and only 10% of these required surgical treatment. A pharyngoplasty was required in 12% of the cases. Conclusion: Modifications are presented in the design and dissection of Vomer flaps, so as to use the largest amount of mucosal tissue available, thus facilitating closure of the different clefts, particularly in Veau Group III clefts.

Biography:

Hazem Ahmed Mostafa, MD., PhD, is an internationally recognized neurosurgeon with over two decades of clinical and research experience. He has devoted his career to developing and providing rigorous, comprehensive and compassionate care to those with cancer, neurological degenerative diseases and pediatric disorders. He’s affectionately known as Dr Brain and Spine.

Abstract:

Craniofacial anomalies are rare complex pathologies which needs a craniofacial team composed of neurosurgeon, a craniofacial plastic surgeon, and an ophthalmologist. Anomalies at craniofacial region either due to developmental malformation of the brain (neural tube defects) or premature closure of cranial or skull base sutures resulting in skull deformities and problems in normal physiological neurological development. Each of pathologies needs special neurological surgery management, sometimes the management is multi-staged.  Neurosurgical management varied from diagnosis, the surgical procedures and long-term follow up. Hence, we describe the pathology of craniofacial anomalies and its associated syndromes in addition to the proper investigation needed for diagnoses and predict possible short and long-term complication. Also, what craniofacial anomalies care giver should be focusing on regarding neurological issues such as intra-cranial pressure early detection and treatment if high and optic nerve problems. Also dural repair, dealing with brain parenchyma and its vasculature, and better cosmetic outcome according to craniofacial metrics.

Biography:

Xiaozhen Lin completed his dental and medical education and received the degree of doctor of dental surgery (DDS) at the Fourth Military Medical University (Xi’an, China). During his doctoral training program, Dr. Lin received a national support from the Chinese government to do research work at the University of Michigan School of Dentistry. After returning in 2012, he joined the Chinese People’s Liberation Army General Hospital (PLAGH), a top-rank hospital in China, to work as an official attending surgeon in oral and maxillofacial surgery (OMS). From 2013 to 2015, he completed his post-doctoral fellowship at the Ninth People’s Hospital affiliated to the Shanghai Jiaotong University School of Medicine, where the OMS have a world-renowned academic reputation. He returned to PLAGH to work an OMS surgery to present. In 2017, he was prompted to clinical associate professor.

Abstract:

Statement of the Problem: The authors aimed to test the hypothesis that in orthognathic surgery the maxilla could be repositioned using spatial distances from Glabella to 3 maxillary dental landmarks as references. Methodology & Theoretical Orientation: An asymmetric skeletal Class 3 malocclusion patient was involved and bimaxillary orthognathic surgery was planned. Virtual surgery was simulated and spatial distances from Glabella to midpoint of the upper dentition (U0) and bilateral medial-buccal cusp of the first molar (6L and 6R) were measured. These distances were used as the repositioning references and were imported intraoperatively into a digital caliper after the maxilla was mobilized, the repositioning of maxilla was manipulated till all the true spatial distances reached the references. Postoperative computed tomography head model was superimposed onto the planned head model, the maxillary repositioning error was assessed using spatial distances between the pre- and postoperative dental landmarks. Findings: The asymmetric skeletal Class 3 malocclusion was corrected through bimaxillary surgery and the errors at U0, 6R and 6L was 1.37, 1.79, and 1.45 mm. Conclusion & Significance: The maxilla could be repositioned using spatial distances from Glabella to 3 maxillary dental landmarks as references.

Biography:

Jimmy Kayastha, is a Consultant in Oral and Maxillofacial Medicine and Surgery at Dental Health Solutions Inc., San Francisco, California. He served as the Director for Advanced Education in General Dentistry Residency program at the Marshfield Clinic, Wisconsin. He was appointed Adjunct Clinical Faculty at Case Western Reserve University and Miami Valley Hospital, Ohio. He earned his doctorate from Nova Southeastern University, Florida. He completed his General Practice Residency at Miami Valley Hospital and Oral Medicine Residency at Carolinas Medical Center. He then completed a Fellowship from the Cleveland Clinic and Orofacial Pain Fellowship at Walter Reed National Military Medical Center, Maryland and Glasgow Dental Hospital, United Kingdom. He is an internationally recognized speaker has captivated medical and dental professionals worldwide to motivate real change. He has had scientific publications in the Journal American Medical Informatics Association, Journal American Dental Association and Journal of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology.

Abstract:

Since the beginning of modern healthcare, medicine and dentistry have existed as separate healthcare domains. The systemic separation began a century ago, and health care policy has historically reinforced it. While this separation appeared to serve well for many years, significant changes in healthcare have occurred and this separation is now obsolete and may be harmful. This artificial division of care into organizational silos ignores the fact that the mouth is part of the body.

The emergent understanding of how oral health affects overall health, and vice versa, suggests that continuation of this separation leads to incomplete, inaccurate, inefficient and inadequate treatment of both medical and dental disease. We are entering the era of accountability and need to focus on oral and craniofacial health as well as its connection to systemic health, research and education. This will assure the highest quality of care and safety for the patients and the communities. Emerging evidence shows a relationship between poor oral hygiene, cardiovascular disease and other chronic diseases – the common link is inflammation. Even though technology and the market are constantly changing, there is one thing which always remains the same – the human concern for health. The strength of overall healthcare in a community relies on an interdisciplinary approach. Its integration.

Biography:

DDS – PHD, Oral maxillofacial surgeon, Chairman of Oral Maxillofacial depto. at  9 de Julho Hospital, Coordinator from TMJ Fellow program at São Luiz Hospital Rede D'or Coordinator, TMJ arthroscopist surgeon since 1988 at Michael Reese hospital (USA), Member from world college of surgeons, Member from Brazilian college of Oral maxillofacial, Speaker in many TMJ meeting, Developed the Double anchors technique for disc replacement, Developed the TMJ prosthesis in PEEK.

Abstract:

The TMJ (temporomandibular joint) is a complex joint, with distinct anatomical and functional characteristics, difficult to treat. Many authors, from the early twentieth century, reported techniques for TMJ reconstruction, aiming at returning its shape and ideal function. Many prototypes have been developed in pursuit of the ideal prosthesis, which adheres to the principles of biomechanics and biocompatibility, with good long-term performance and lower cost. Based on 10 years of experience(1990 to 2000),with 125 patients who underwent TMJ reconstruction using full custom prosthesis in gold (unilateral and bilateral), with a new design and shorter than the prosthesis found in the market. A new surgical technique  was  perfomed,  less traumatic, than used by others surgeons in the world. Because of the high cost of gold alloys, ensued in search of a suitable material, to follow the ideal characteristics. Among the new materials, highlights PEEK LT1 20% Ba, is a polymer derived from petroleum (Invibio, UK), thermoplastic, biocompatible, inert and high stability and resistance. Successfully used as the material of choice for orthopedic implants and spine. This study demonstrates the feasibility of a custom prosthesis in PEEK LT1 20%Ba, with protocol development for TMJ reconstruction. Keywords: TMJ, reconstruction, customized prosthesis, PEEK LT1 20%Ba.

Biography:

Motoki Katsube, MD, started his career as a Plastic and Reconstructive Surgeon, especially focused on craniofacial surgery. He is a Board Certified Fellow of the Japan Society of Plastic and Reconstructive Surgery, Japan Society of Cranio-Maxillo-Facial Surgery, and Japan Society for Surgical Wound Care. He is studying for a PhD at the Graduate School of Medicine, Kyoto University. He has passion in the facial growth of humans during the prenatal period and believes that such research could lead to elucidate the pathogenesis of congenital facial anomalies and contribute to the development of the fundamentals of their treatment. He applied geometric morphometrics for that quantification and will apply geometric morphometrics for clinical practice.

Abstract:

Three-dimensional simulation has been well developed and become almost common for presurgical planning; in addition, several studies have reported on the growth evaluation of children. Nevertheless, the estimation of the facial growth of humans in the early prenatal period has still remained difficult because the facial skeletons of the human foetuses drastically change in size and shape. To quantify and simulate the shape change, we applied geometric morphometrics (GM). GM is an analysis based on the landmark coordinates and can retain complete geometric information. Materials and Methods: Magnetic resonance images were obtained from 53 human embryos and foetuses in the early foetal period. A total of 65 landmarks were defined on the surface of the facial skeleton. To standardise the mouth-opening condition, the landmarks of the mandible were rotated around the axis connecting bilateral condyles. We calculated and visualised the shape change of the facial skeleton with growth. Furthermore, we calculated the degree of the development. Results: The human midfacial skeleton developed in anterolateral direction in the early prenatal period. The mandible relatively decreases in length in the anteroposterior dimension and widens in the lateral dimension. The facial skeleton rapidly grew until around 13 weeks of gestation (gw); consequently, the human foetuses acquired the shape of the facial skeleton similar to that of the neonate around that period. Conclusion and Significance: We could quantify the growth trait of the human facial skeleton in the early foetal period and illustrate it in three dimensions; that is, we could provide the growth estimation model, which enables us to easily grasp the development intuitively. In addition, if we apply GM for the morphological analysis of young patients undergoing surgery, we may produce the prediction of the influence of the treatment in facial growth in three dimensions, as well as perform its quantification.

Biography:

Abstract:

Background: The Pierre Robin sequence (PRS) has been defined as the presence of micrognathia, glossoptosis, and respiratory obstruction in the neonatal period. Since its original description, different therapeutic approaches have been proposed obtaining different success rates, but there is no consensus about its management. Methods: A literature review was conducted in PubMed, Embase, and Cochrane databases, for the period of January,1985 to November, 2016. A number of 23 articles resulting from clinical studies, discussing diagnostic tests or therapeutic approaches, and directly or indirectly comparing diagnostic or treatment modalities were selected and assessed using the GRADE methodology. Results: After reviewing and analyzing the selected articles, an evidence-based algorithm for diagnosis and integral management of PRS patients was designed. Conclusion: Based on the anatomical principles and natural evolution of PRS, the clinical scenario must be evaluated thoroughly as a dynamic event to develop a management sequence that minimizes morbidity and mortality and accelerates patients’ reinsertion to normal life. Keywords: Distraction osteogenesis, maxillomandibular discrepancy, micrognathia, Pierre Robin sequence, tongue–lip adhesion.

Biography:

Hazem Ahmed Mostafa, MD., PhD, is an internationally recognized neurosurgeon with over two decades of clinical and research experience. He has devoted his career to developing and providing rigorous, comprehensive and compassionate care to those with cancer, neurological degenerative diseases and pediatric disorders. He’s affectionately known as Dr Brain and Spine.

Abstract:

Introduction: Over the past 30 years there has been a significant reduction in mortality following severe TBI together with improved outcome. This has been largely due to the use of evidence-based protocols emphasizing the correction of parameters implicated in secondary brain injury. The main parameters are cerebral blood flow, cerebral oxygenation and management of co-morbidities. Neuroinflammation is a well-established secondary injury mechanism following TBI. Evolving treatment strategies: Inspired by success in Parkinson’s and other neurodegenerative diseases, stem cell based therapy is believed to provide biobridges, can stabilize blood-brain barrier, reduce the oxidative stress and provide immunomodulation and neuroprotection. Hyperbaric oxygen may alleviate secondary insult in TBI through the modulation of the inflammatory response. Animal studies showed that hyperbaric oxygen improves neuroplasticity, reduce the inflammatory markers and neuronal apoptosis following TBI. Sources of stem cells: Modulating endogenous stem cells or Cell transplantation (using exogenous stem cells) from fetal/embryonic, bone marrow stromal cells, umbilical cord cells or induced pluripotent stem cells (iPSCs). There is plenty of literature showing good response of stem cell therapy, mesenchymal stem cells in particular, on the outcome in rat TBI models. The animal models indicate some vulnerability of the stem cells to the hostile environment of neuroinflammation, which may limit their potential. Conclusion: The results although very encouraging, are still in the laboratory/preclinical phase and lots of technical, ethical and logistic issues have to be solved before shifting to clinical trials. Hyperbaric oxygenation can provide less hostile microenvironment helping with repair and provide better use of stem cell induced growth factors. Keywords: Stem Cells, Hyperbaric Oxygen, Traumatic Brain Injuries (TBI), Secondary Brain Injury, Neuroinflammation.

Biography:

Abstract:

Introduction: The zygomaticomaxillary complex (ZMC) with its prominent convexity in the face is highly vulnerable to injury. Its fractures are inherently unstable due to superficial muscular aponeurotic system (SMAS) and strong masseteric muscle attachment. The ZMC is also called beauty or cheek bone. Less than optimal results of restoration of form and function after fixing it back to the pre-injury state have resulted in variety of techniques. In this study, we evaluated a novel approach to the reduction, fixation and stabilization of ZMC fractures with optimum aesthetic results in order to prevent post traumatic malar depression, the cause of unaesthetic appearance and restricted jaw function. Aim: The purpose of this study was to fix the (Midface fractures) ZMC fractures  with open reduction and fixation using trans facial fixation technique and  then evaluating pre and post management malar depression along with mouth opening along with conventional methods of ORIF. Materials and Methods: We report a case series of patients who were treated by open reduction and internal fixation of zygomatic- maxillary complex fractures by a single surgeon in the maxillofacial department at the Armed Forces Institute of Dentistry Rawalpindi. We utilized lateral eyebrow and transoral incision for reduction and fixation of ZMC fractures. A 10.5 cm long mini/micro titanium plate was adapted and fixed by passing it below the arch through lateral eye brow incision and brining it behind the zygomatic buttress to the front of maxilla. Then its both ends are fixed at frontozygomatic bone above and nasomaxillary buttress of anterior maxilla after optimal reduction of ZMC. Both fixing areas define the prominence of face and are well placed ahead of ZMC in the face. It gives advantage for addressing projection, the most important aspect required during reduction and fixation, along with post management stability. Patients were evaluated and compared for preoperative findings of malar depression and mouth opening with post op finding. During the follow-up, the patients were routinely evaluated using computed tomography. Results: Treatment was successful in all cases; there were no complications at surgery or postoperatively. During follow-up, all patients had satisfactory facial symmetry, no noticeable scar,and no functional impairment. However due to limited number of patients and follow up time, further large scale, multicenter studies are recommended.

Biography:

Umair Ansari is an Australian trained doctor who is currently undertaking a training pathway in maxillofacial surgery. His research history includes publications in hand surgery and orthopaedic fracture management, and has extensive experience working at the registrar level in both orthopaedic surgery and emergency medicine. With a keen interest in sport, this study served to answer the niche question of return to sport post maxillofacial sporting fracture.

Abstract:

Objectives: This systematic review aimed to summarize the current evidence on return to sport of the professional athlete post maxillofacial fracture injury. A secondary aim was to formulate clinical practice guidelines to aid the clinician in recommending a plan for early return to sport. Materials and Methods: A literature search was performed on a total of six databases using subject headings and keywords. Articles relating to the topic areas of maxillofacial fractures, professional athletes, and return to sport were identified. All papers that contained data or expert opinion on time to return to sport post treatment were retrieved. An analysis of study design and appraisal of each paper was then performed, and the clinical recommendations recorded. Findings: A total of 223 papers were identified in our literature search, of which 16 were included (1 prospective and 2 retrospective, 6 case-based, 6 reviews, and 1 survey). Recommendations on return to sport varied between 3 to 12 weeks, depending upon fracture configuration and sport. Many authors (n=9) identified a role for protective facemasks and suggested a graded increase in rehabilitation exercise (n=5) from aerobic to strength training, followed by a return to competitive sport. Conclusion:  Based on the available literature, the authors of this paper would advise a conservative approach on return to sport for the professional athlete. The possibility of an early return to sport can be broached via patient discussions referencing the available clinical data. Further research efforts are required to better define the safe parameters for which an early return to sport may be recommended.

Biography:

Anelise Sabbag has been a speech-language pathologist for 25 years. She received her BA from Franca University, Franca - SP – Brazil, in 1991 and her Specialization in Orofacial Motricity in Franca University, Franca - SP – Brazil, in 1999 and Master's degree in Health, Interdisciplinary linked to the Human Development and Rehabilitation Department (DDHR) of the Faculty of Medical Sciences (FCM _ UNICAMP). She has extensive experience working with multiply handicapped, neuromotor impairments, craniofacial deformities, orofacial physiology, language and voice. In addition, she has a strong background with children that have clefts and craniofacial diagnoses. In 2003 she was invited to coordinate the Cleft Lip and Palate Team of Speech Pathologist in the SOBRAPAR - Brazilian Society of Research and Assistance for Craniofacial Rehabilitation –Campinas – São Paulo- Brazil. She has lectured at universities, state association meetings and national and international conventions.

Abstract:

OBJECTIVE: To assess the electromyographic activity of the masseter and temporal muscles in cleft patients who underwent one-stage palate repair versus two-stage palate repair. METHODS: Thirty-two patients with nonsyndromic complete unilateral cleft lip and palate operated by two different protocols for palate repair, one-stage (group 1, n=16) versus two-stage with delayed hard palate closure (group 2, n=16) were available in the retrospective longitudinal study. Standardized electromyographic records of the masseter and anterior portion of temporal muscles were obtained with two repetitions during mastication and rest. RESULTS: No statistically significant (all p>0.05) differences were observed in the electromyographic data between the groups 1 and 2. CONCLUSION: There were similar electromyographic activity of masseter and temporal muscles during mastication and at rest after one-stage and two-stage palate closure.