A modified incision design was used, wherein the incision was given 1.5 mm apical to marginal gingival following the scalloped contour of marginal gingival from distal of 13 to distal of 23, the mucoperiosteal flap was elevated; vertical osteotomy cuts were placed interdentally to a depth of 1 mm up to the entire length of the root followed by decortications of the labial plate [Figure 2].
Caption: Figure 2: A modified incision design was used, wherein the incision was given 1.5 mm apical to marginal gingival following the scalloped contour of marginal gingival from distal of 13 to distal of 23, the mucoperiosteal flap was elevated; vertical osteotomy cuts were placed interdentally to a depth of 1 mm up to the entire length of the root followed by decortications of the labial plate
Optimal methods of fixation also can be planned before the operation with the customary combination of bicortical positional screws at the ramus and fracture plates using nonlocking screws across the vertical osteotomy
at the body.
Drill holes extended through anterior and posterior cortex to create a path for the vertical osteotomy
. This was followed by transverse osteotomies performed through the proximal and distal parts of bone under fluoroscopy control with oscillating saw followed by vertical osteotomy
through the drill holes in the middle fragment with oscillating saw.
In the close proximity of the vertical osteotomy
line, MC was found to be located in the midthird and less frequently in the inferior third of the corpus.
After elevation of the flaps, a Le Fort I osteotomy and maxillary anterior vertical osteotomy
were performed by using a Lindemann bur (2 mm in diameter, 23 mm in length) (Figure 2).
The position of the vertical osteotomy
site in our method should be close to the posterior border of the mandibular foramen, while the osteotomy lines at the anterior and inferior positions of the mandibular foramen should be cut forward as far as possible; that is, the osteotomy line should be set upwards to the coronoid process and downwards to the direction of the mandibular body.
Accordingly, a linear and vertical osteotomy
of the tibia was done distally inch by inch during attempted extraction without damaging the three Tibial columns.
The body of the mandible was advanced 3.0 mm at the vertical osteotomy
line adjacent to the buccal groove of the left first molar on both sides by sagittal split ramus osteotomy.
So it was decided to increase ramus height by vertical osteotomy
of right ramus, coronoidectomy of the same side to improve mouth opening and a therapeutic augmentation of the mandible via distraction osteogenesis was planned.
During this time, bony union occurs across osteotomy margins (the vertical osteotomy
cut lines and in the distraction zone), and the gingiva expands to the new alveolar bone volume3, 7.
These anatomical features of permanent patellar dislocation can be managed by TKA: vertical osteotomy
to mechanical axis can correct valgus deformity, femoral component can correct trochlear groove dysplasia, mobile bearing insert can improve external tibial torsion, and patella replacement can correct patellar hypoplasia.