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      Condylectomy and “surgery first” approach: An expedited treatment for condylar hyperplasia in a patient with facial asymmetry

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          ABSTRACT

          Condylar Hyperplasia (CH) is a self-limiting pathology condition that produces severe facial deformity at the expense of mandibular asymmetry. In this case report a 15-year-old female patient was diagnosed with Unilateral Condylar Hiperplasia (UCH) by mean of single-photon emission computed tomography (SPECT) and histological study. A high condylectomy in the right condyle was performed to stop the active status of the hyperplasia. A month after condylectomy, orthognathic jaw impaction and asymmetric mandibular setback surgery was performed with the Surgery First Approach (SFA). After 10 days, orthodontic appointments were made every two weeks during 4 months. The active phase of treatment lasted 14 months. Excellent facial and occlusal outcomes were obtained and after 24 months in retention the results remained stable.

          RESUMO

          A hiperplasia condilar (HC) é uma condição patológica autolimitante que produz deformidades faciais severas devido à assimetria mandibular. Nesse estudo de caso, uma paciente de 15 anos de idade foi diagnosticada com hiperplasia condilar unilateral (HCU), por meio de uma tomografia computadorizada por emissão de fóton único (SPECT) e de um estudo histológico. Uma condilectomia alta no côndilo direito foi realizada para interromper o status ativo da hiperplasia. Um mês após o procedimento, foram realizadas a impacção ortognática de maxilar e a cirurgia de retroposicionamento assimétrico da mandíbula, por meio de abordagem do tipo benefício antecipado. Depois de 10 dias, consultas ortodônticas passaram a ser feitas a cada duas semanas, durante 4 meses. A fase ativa do tratamento durou 14 meses. Excelentes resultados oclusais e faciais foram obtidos e, após 24 meses de contenção, os resultados permaneceram estáveis.

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          The biology of fracture healing. An overview for clinicians. Part I.

          The bone healing process normally unites fractures, arthrodeses, osteotomies, and bone grafting operations. The process normally proceeds in successive stages named the fracture, granulation, and modeling/remodeling stages. A separate regional acceleratory phenomenon speeds up each of the other stages. The osteoclast and osteoblast cells that make intercellular substances of each stage do not exist in sufficient numbers to heal the bone at the moment of fracture or operation. They are made by local multicellular mediator mechanisms that contain precursor and supporting cells, capillaries, lymph, and innervation, plus local autocrine and paracrine regulation. Under the influences of local and systemic agents, these mediator mechanisms determine whether new local osteoclasts and osteoblasts will appear, in addition to when, where, how many, what kind, and for how long. Errors in those functions can then lead to several kinds of retarded or otherwise abnormal bone healing that will be discussed in Part II of this work.
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            The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension

            A hierarchy of stability exists among the types of surgical movements that are possible with orthognathic surgery. This report updates the hierarchy, focusing on comparison of the stability of procedures when rigid fixation is used. Two procedures not previously placed in the hierarchy now are included: correction of asymmetry is stable with rigid fixation and repositioning of the chin also is very stable. During the first post-surgical year, surgical movements in patients treated for Class II/long face problems tend to be more stable than those treated for Class III problems. Clinically relevant changes (more than 2 mm) occur in a surprisingly large percentage of orthognathic surgery patients from one to five years post-treatment, after surgical healing is complete. During the first post-surgical year, patients treated for Class II/long face problems are more stable than those treated for Class III problems; from one to five years post-treatment, some patients in both groups experience skeletal change, but the Class III patients then are more stable than the Class II/long face patients. Fewer patients exhibit long-term changes in the dental occlusion than skeletal changes, because the dentition usually adapts to the skeletal change.
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              Surgery-first accelerated orthognathic surgery: postoperative rapid orthodontic tooth movement.

              Clinically, we have observed the phenomenon of postoperatively accelerated orthodontic tooth movement in patients who had orthognathic surgery. This phenomenon lasts for a period of 3 to 4 months. However, the underlying mechanisms of this phenomenon have not been well studied yet. The purpose of this prospective clinical pilot study was to study the postoperative changes in bone physiology and metabolism and the corresponding responses in the dentoalveolus, such as the changes in tooth mobility.
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                Author and article information

                Journal
                Dental Press J Orthod
                Dental Press J Orthod
                dpjo
                Dental Press Journal of Orthodontics
                Dental Press International
                2176-9451
                2177-6709
                Jul-Aug 2017
                Jul-Aug 2017
                : 22
                : 4
                : 86-96
                Affiliations
                [1 ]Universidad del Valle, Facultad de Salud, Escuela de Odontología, Departamento de Ortodoncia (Cali/ Valle del Cauca, Colombia).
                [2 ]Universidad CES, Facultad de Odontología, Departamento de Ortodoncia (Medellín/Antioquia, Colombia).
                Author notes
                Contact address: Rosana Martínez-Smit Carrera 48 # 12sur - 70 Edificio Profesional el Crucero Oficina 603 Medellin- Antioquia, Colombia - E-mail: Rosana29@ 123456gmail.com
                Article
                10.1590/2177-6709.22.4.086-096.oar
                5573015
                10398f45-72d2-4cc1-b0b2-539a951f063f

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 03 March 2016
                : 12 December 2016
                Page count
                Figures: 10, Tables: 1, Equations: 0, References: 50, Pages: 11
                Categories
                Original Article

                condylar hyperplasia,surgery first,orthodontics.
                condylar hyperplasia, surgery first, orthodontics.

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