Botulinumtoxin-Injektion als Rezidiv-Prävention nach Unterkiefer-Vorverlagerung
Die Fragestellung, die es in der vorliegenden Studie zu klären galt, war die Beobachtung des Rezidivs nach langstreckigen Unterkiefervorverlagerungen unter temporärer Ruhigstellung der suprahyoidalen Muskulatur mit Botulinumtoxin nach der von Umstadt 1996 entwickelten Methode. Als Alternative zur My...
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Format: | Doctoral Thesis |
Language: | German |
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Philipps-Universität Marburg
2009
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Online Access: | PDF Full Text |
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The question of the study was to obtain the relapse after long distance mandibular advancement while immobilization of the suprahyoidal mussels by using the 1996 developed method of H. E Umstadt. Instead of cutting the suprahyoidal mussels, which involves the adverse effects of a usual mandibular advancement, the risk of distinct haematoma in the submundibular area and scar contraction, 23 patients were treated with Botulinumtoxin to immobilize the suprahyoidal mussels. The combinated orthognatic surgery and orthodontic treatment of the mandibular retrognathism has been established during the last decades. The method of choice is the retromolar sagittal split of the lower jaw with advancement of the dental segment. A lot of studies showed that the osteosynthesis with screws or the combination of plates and screws obtained the most reliable results. The examined patients were treated with the semi-rigid osteosynthesis using set screws. The applied method with set screws is the best compromise between stability and the functional adjustment of the temporo-mandibular joints. The bone treatment is pretty well developed. Although this innovative development long distance mandibular advancements showed distinct relapse of 10 % to 50 % during the postoperative period depending on the method of surgery and osteosynthesis. The main problem is still the soft tissue management. The main reason of developing a relapse is the retral traction of the suprahyoidal mussels. Lateral X-rays of the scull were produced and analyzed before surgery and up to two years after surgery. On the basis of the X-rays two distances concerning the mandibular bone, the SNB-angle and the posterior airway space were analyzed. Conclusion of the study: 1. The relapse concerning the mandibular bone is with 5 % considerable lower than the results of comparable studies. 2. The t-Test showed no differences concerning the analyzed ranges of the mandibular after surgery compared to the ranges one and two years after surgery. 3. In the ratio to the base of the skull the mandibular showed a relapse of 3 % after one year and 5 % after two years after surgery. 4. A high correlation has been found between the SNB-angel and the posterior airway space. 5. Despite of the immobilisation of the suprahyoidal mussels with botulinumtoxin in combination with mandibular advancement the posterior airway space showed no constriction. 6. No patient showed side effects, which had not been seen even after conventional surgery. The results show an amazing advantage in the soft tissue management with reduced postoperative risks of complications and a reduced relapse.