Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 1069 - файл
.pdf
Facial Trauma 17
https://t.me/med1917
Stranc MF, Robertson GA. Aclassification of injuries of the nasal
skeleton. Ann Plast Surg. 1979;2(6):468–74.
Sunderland S. Aclassification of peripheral nerve injuries produc-
ing loss of function. Brain. 1951;74(4):491–516. doi: 10.1093/
brain/74.4.491.
Veras RB, Kriwalsky MS, Eckert AW, Schubert J, Maurer P. Long-
term outcomes after treatment of condylar fracture by intraoral access: Afunctional and radiologic assessment. J Oral
Maxillofac Surg. 2007;65(8):1470–6.
Zide MF, Kent JN. Indications for open reduction of mandibular
condyle fractures. J Oral Maxillofac Surg. 1983;41(2):89–98.
doi: 10.1016/0278-2391(83)90214-8.
Zingg M, Laedrach K, Chen J, etal. Classification and treat-
ment of zygomatic fractures: Areview of 1,025 cases. J Oral
Maxillofac Surg. 1992;50(8):778–90.
t.me/Dr_Mouayyad_AlbtousH
https://t.me/med1917
3
https://t.me/med1917
Jaw Deformity
ORTHOGNATHIC
Orthognathic Values
e following list describes common cephalometric values used
in assessment, planning, diagnosis and surgical outcomes in
orthognathic surgery.
AP maxillary:
●
Steiner SNA=81 ± 3
AP mandible:
●
Steiner SNB=79 ± 3
AP maxillo-mandibular:
●
Steiner ANB=2 ± 2
Occlusal plane is 7 or 8 degrees to Frankfort plane incisors:
●
Maxillary incisor inclination (Steiner)=22 ± 6 to NA line
●
U1-SN=104
●
Also, the aesthetic line dictates that a tangential line o the
labial surface of U1 should be at a right angle to the Frankfort
plane
●
Mandibular incisor inclination (Steiner)=25 ± 7 to NB line or
Down’s IMPA=90 ± 5 degrees
DOI: 10.1201/9781003156895-3 19
t.me/Dr_Mouayyad_AlbtousH
20 Classifications and Lists in Oral and Maxillofacial Surgery
https://t.me/med1917
Chin:
●
Holdaway ratio is 0.5 in women, 1 in men [lower incisor to
Pogonian (Pog) versus Pog to NB line]
●
So tissue thickness is 7 ± 2mm
Obstructive Sleep Apnoea (OSA) Classes
e following list classies obstructive sleep apnoea according to
aetiology, which can include impairment of breath control and
eort or a reduction in airow.
●
Obstructive
●
Central
●
Mixed
OSA Routine Referral from Primary Care
e score that follows allows the assessment of OSA in the primary care setting and indicates when to complete a routine
referral to OMFS care for a sleep study and further management.
●
Epworth score OVER 10
OSA Severity
e severity of OSA can be ascertained by the Apnoea Hypopnea
Index (AHI) and Respiratory Disturbance Index (RDI) to aid
diagnosis and management.
●
Mild – AHI > 5, RDI > 10
●
Moderate – AHI > 15, RDI > 30
●
Severe – AHI > 30, RDI > 50
t.me/Dr_Mouayyad_AlbtousH
Jaw Deformity 21
https://t.me/med1917
Fujita Classification of Sites of Airway
Obstruction in OSA
is classication describes anatomical sites of obstruction in
relation to OSA.
●
Type 1 – retropalatal (10%)
●
Type 2 – retropalatal AND retrolingual (20%)
●
Type 3 – retrolingual (70%)
OSA Urgent Referral (2WW)
e following list species the criteria which warrant urgent
referral to OMFS.
●
Suspected H&N cancer
●
Working with machinery, hazardous occupation
●
Respiratory/heart failure
●
Severe OSAS symptoms and coexistent COPD
FURTHER READING
Fujita S. Pharyngeal surgery for obstructive sleep apnea and
snoring. In: Fairbanks DNF, Fujita S, Ikematsu T, Simmons FB,
eds. Snoring and obstructive sleep apnea. New York: Raven
Press; 1987: 101–28.
Goyal M, Johnson J. Obstructive sleep apnea diagnosis and
management. Mo Med. 2017;114(2):120–24.
Singh Rathore A, Dhar V, Arora R, Diwanji A. Cephalometric
norms for Mewari children using Steiner’s analysis. Int J Clin
Pediatr Dent. 2012;5(3):173–7.
t.me/Dr_Mouayyad_AlbtousH
22 Classifications and Lists in Oral and Maxillofacial Surgery
https://t.me/med1917
TEMPOROMANDIBULAR JOINT (TMJ)
Acute Synovitis Index
is index describes the severity of synovium involvement in
TMJ disorders.
1. Minimal
2. Moderate – early hyperaemia
3. Considerable – moderate hyperaemia
4. Total hyperaemia which obliterates vascular patterns
Classification of Condylar Sag
e following classication describes change in the position of
condyle in relation to glenoid fossa aer surgical intervention/
rigid xation, which can result in altered occlusion.
●
Central (positioned wrongly)
●
Peripheral
●
Type 1 – resorption
●
Type 2 – sliding down edge of glenoid
Classification of Traumatic TMJ Ankylosis
is system describes ankylosis of the TMJ following trauma.
Ahigher score correlates with increased severity of ankylosis.
1. Fibrous
2. Lateral bony with more than 50% of the normal condyle head
remaining (compared to other side)
3. Less than 50% of normal condyle head remaining
4. Complete bony ankyloses
t.me/Dr_Mouayyad_AlbtousH
Jaw Deformity 23
https://t.me/med1917
Indications for TMJ Replacement in General
e following list describes general criteria that warrant the
replacement of the TMJ.
●
End-stage arthritis
●
Recurrent ankyloses
●
Failed treatment with autogra/other
●
Loss of vertical height
Indications for TMJ Replacement According to
Sidebottom et al.
e following list describes indications for TMJ replacement as
highlighted by Sidebottom et al.
●
Prerequisite of failed conservative treatment with diagnosis by
CT or MRI at a minimum
●
Disease causing condylar bone loss and symptomatic indications
Disease:
●
Osteoarthritis (OA)
●
Rheumatoid arthritis (RA)/ankylosing spondylitis (AS)/psoriatic arthritis (PsA)
●
Ankylosis
●
Post-trauma
●
Post-op
●
Previous prosthesis/costochondral gra/congenital deformity/
multiple procedures failed previously
Symptoms:
●
Dietary score less than 5/10
●
Maximal incisal opening (MIO) < 35mm
●
Occlusal collapse
●
Excessive condylar resorption
●
Quality of life (QOL) issues
Contraindicated if local infection, severe immunocompromise,
ASA 3/severe comorbidity.
t.me/Dr_Mouayyad_AlbtousH
24 Classifications and Lists in Oral and Maxillofacial Surgery
https://t.me/med1917
Sawhney Types of Ankyloses (1980s)
is classication describes ankyloses according to the degree of
limitation in the mobility of the TMJ.
1. Fibrous
2. Lateral bony fusion
3. Bony bridge (ramus to temporal bone/arch)
4. Mass of bone (ramus to skull base)
Stages of Chondromalacia of Disc
e following list describes the pathological changes associated chondromalac ia of the articula r disc in the TMJ as per ar throscopic ndings.
1. Soening
2. Furrowing
3. Fibrillation
4. Crater formation/subchondral bone exposure
Stages of Internal Derangement
e following list describes stages of displacement of the TMJ
articular disc in relation to the condylar head. More advanced
stages are associated with crepitus and degeneration.
1st Clicking
2nd Locking
3rd Limited opening (closed lock, <27mm and severe pain)
4th Increased opening again (crepitus and degeneration – pain
reduced as no impingement)
Topazian Stages of Ankylosis (1960s)
is classication describes ankylosis of the TMJ according to the
degree of anatomical involvement of various parts of the mandible.
1. At condylar process
2. To sigmoid
3. To coronoid
t.me/Dr_Mouayyad_AlbtousH
Jaw Deformity 25
https://t.me/med1917
Wolford Classification of Condylar Hyperplasia
is classication describes hyperplasia of the condyle of the
mandible. e higher degree of complexity warrants more
advanced surgical options to include condylectomy and total jaw
replacement.
●
Type 1 – horizontal vector (hormonal in adolescence), slower
growing side more likely to have disc displacement
●
1a bilateral – protocol is TREAT EARLY with high condylectomy, reposition discs, orthognathic surgery OR WAIT
(until growth complete but worse deformity)
●
1b unilateral – TREAT EARLY (as preceding)
●
Type 2 – vertical vector (osteochondroma)
●
2a – large elongated and deformed condyle, protocol is
LOW condylectomy, contralateral disc repositioning,
orthognathic with or without inferior border recontouring,
alternative is condylectomy with rib/total jaw replacement
(TJR)/orthognathic lengthening
●
2b – exophytic mass, mostly anteromedially
Wilkes Classification of TMJ Internal
Derangement
is classication describes internal derangement of the TMJ
according to pain, opening, disc location, anatomy and perforation (PODIA).
1. Painless, normal opening, disc slightly forwards, normal disc
anatomy
2. Painful click, intermittent lock, displaced with reduction,
deformed disc
3. Pain with any movement, locked and restricted, displaced no
reduction, early bone changes
4. Pain at rest, moderate bony changes
5. Severe pain, perforation of retrodiscal tissue ± disc also,
severe bony changes
t.me/Dr_Mouayyad_AlbtousH
26 Classifications and Lists in Oral and Maxillofacial Surgery
https://t.me/med1917
FURTHER READING
Brabyn PJ, Capote A, Muñoz-Guerra MF, Zylberberg I, Rodríguez-
Campo FJ, Naval-Gías L. Arthroscopic management of synovial
chondromatosis of the temporomandibular joint. Case series
and systematic review. J Maxillofac Oral Surg. 2018;17(4):401–9.
Dimitrouli, G. Management of temporomandibular joint disor-
ders: Asurgeon’s perspective. Aust Dent J. 2018;63:S79–90.
He D, Yang C, Chen M, etal. Traumatic temporomandibular joint
ankylosis: Our classification and treatment experience. J Oral
Maxillofac Surg. 2011;69(6):1600–7.
Jędrzejewski M, Smektała T, Sporniak-Tutak K, Olszewski R.
Preoperative, intraoperative, and postoperative complications in orthognathic surgery: Asystematic review. Clin Oral
Investig. 2015;19(5):969–77.
Politi M, Toro C, Costa F, Polini F, Robiony M. Intraoperative
awakening of the patient during orthognathic surgery:
Amethod to prevent the condylar sag. J Oral Maxillofac
Surg. 2007;65(1):109–14.
Sawhney CP. Bony ankylosis of the temporomandibular
joint: Follow-up of 70 patients treated with arthroplasty
and acrylic spacer interposition. Plast Reconstr Surg.
1986;77(1):29–40.
Sidebottom AJ. Guidelines for the replacement of temporoman-
dibular joints in the United Kingdom. Br J Oral Maxillofac
Surg. 2008;46(2):146–7.
Topazian RG. Etiology of ankylosis of temporomandibular joint:
Analysis of 44 cases. J Oral Surg Anesth Hosp Dent Serv.
1964;22:227–33.
Wilkes CH. Internal derangements of the temporomandibular
joint. Pathological variations. Arch Otolaryngol Head Neck
Surg. 1989;115(4):469–77.
Wolford LM, Movahed R, Perez DE. Aclassification system for
conditions causing condylar hyperplasia. J Oral Maxillofac
Surg. 2014;72(3):567–95.
Young AL. Internal derangements of the temporomandibular
joint: Areview of the anatomy, diagnosis, and management.
JIndian Prosthodont Soc. 2015;15(1):2–7.
t.me/Dr_Mouayyad_AlbtousH
Соседние файлы в папке @xirurgi_2025