Mandibular Prognathism
Conditions
Keywords
Mandibular Prognanthism,customized plate
Brief summary
Two groups with mandibular prognanthism indicated for mandibular setback by intraoral vertical ramus osteotomy . first group will fixed with maxillomandibular fixation and the second group will fixed by customized plate
Detailed description
Two groups with mandibular prognanthism indicated for mandibular setback by intraoral vertical ramus osteotomy . first group will fixed with maxillomandibular fixation and the second group will fixed by customized plate Interventions: General operative procedures Eligible patients will be randomized in equal proportions between the study group (customized plate fixation of VRO) and the control group (maxillomandibular fixation of VRO). Patients of Both groups will be subjected to: 1. Case history including personal data, medical, surgical history and family history 2. Clinical examination . 3. Radiographic examination in the form of cephalometric radiogragh . 4. Preoperative laboratory tests (complete blood cell count, Hemoglobin count, coagulation profile, liver function, kidney function and blood glucose level). 5. Preoperative anesthesia assessment for fitness for general anesthesia. vertical ramus osteotmy fixed with customized plate * All cases will undergo one surgery under general anesthesia. * Incision was made medial to external oblique ridge from the asendindg ramus to second molar region * Amucoperiosteal flap was reflected to expose the lateral mandibular ramus to the posterior border and the sigmoid notch * The intraoral vertical osteotomy is accomplished by using an oscillating saw to make the cut from the sigmoid notch through the inferior border of the mandible. The osteotomy is placed 5 mm anterior to the posterior border of the mandible to avoid injury to the inferior alveolar neurovascular bundle * 3D virtual planning and 3D mandible model represented fom CBCT in MIMICS * The setback will be simulated according to pre-planned measure * The customized bone plate is positioned to fix the proximal and distal segment together vertical ramus osteotomy fixed with MMF. * All cases will undergo one surgery under general anesthesia. * incision was made medial to external oblique ridge from the asendindg ramus to second molar region . * Amucoperiosteal flap was reflected to expose the lateral mandibular ramus to the posterior border and the sigmoid notch * The intraoral vertical osteotomy is accomplished by using an oscillating saw to make the cut from the sigmoid notch through the inferior border of the mandible. The osteotomy is placed 5 mm anterior to the posterior border of the mandible to avoid injury to inferior alveolar neurovascular bundle. * Patient is placed in maxillomandibular fixation (MMF) using a prefabricated occlusal splint to assure accuracy of the mandibular position. follow up clinical and radiographic evaluation will be performed at the first week postoperative then the patients will recalled for radiograghic evaluation at 2weeks and 2 months .finall follow up visit will be at 6 months postoperative
Interventions
PROCEDUREcustomized fixation plate
* All cases will undergo one surgery under general anesthesia. * Incision was made medial to external oblique ridge from the asendindg ramus to second molar region * Amucoperiosteal flap was reflected to expose the lateral mandibular ramus to the posterior border and the sigmoid notch * The intraoral vertical osteotomy is accomplished by using an oscillating saw to make the cut from the sigmoid notch through the inferior border of the mandible. * 3D virtual planning and 3D mandible model represented fom CBCT in MIMICS * The customized fixation plate is positioned to fix the proximal and distal segment together after setback
PROCEDUREmaxillomandibular fixation
* All cases will undergo one surgery under general anesthesia. * incision was made medial to external oblique ridge from the asendindg ramus to second molar region . * The intraoral vertical osteotomy is accomplished by using an oscillating saw to make the cut from the sigmoid notch through the inferior border of the mandible. * Patient is placed in maxillomandibular fixation (MMF) using a prefabricated occlusal splint to assure accuracy of the mandibular position.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Intervention model description
* A Randomized Controlled Trial * A Trial will be carried out in Hospital of Oral and Maxillofacial surgery departement- faculty of Dentistry , Cairo University * Equal randomization : participant with equal probabilities for intervention * Parallel group study : Each group of patients recieves a single treatment simultaneously
Eligibility
Sex/Gender
ALL
Age
18 Months to No maximum
Healthy volunteers
Yes
Inclusion criteria
All subjects were required: * Patients with mandibular prognanthism indicated for mandibular setback. * All ages \>18 years * Patients should be free from any systemic disease that may affect normal healing of bone, and predictable outcome. * Patients with good general condition allowing surgical procedure under general anesthesia. * Patients with physical and psychological tolerance
Exclusion criteria
* History of mandibular trauma * Previous orthognathic surgery * Degenerative disease of temporomandibular joint * Craniofacial syndrome such as cleft lip or palate * Follow up period will be less than 6 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient Satisfaction | immediately postoperative | Patient were asked to fill out a questionnaire in order to investigate their satisfaction degree after surgery ,according to an adapted (10 cm) visual analogue scale (VAS) from 0 to +10 0 is the least satisfied 10 is the most satisfied |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| stability of Mandible | pre- operative , 2 weeks postoperative , 2 months postoperative , 6 months postoperative | assessed by determining the differences between measurements of three mandibular reference points (B-point, menton, and pogonion) in relation to SNy ,SNx axis obtained at six different time points |
Outcome results
None listed