Prof. Johan P. Reyneke online-seminars

Prof. Dr. Johan P Reyneke, BChD, MChD, FCMFOS (SA), PhD online-seminars

18 December 2020 / 22 January / 19 February / 19 March 2021

Edicational and counseling center EdMed in association with the Beauty Institute Galaxy are glad to invite you to take part in online-seminars from one of the well-known maxillofacial surgeons, holder of three international professorships (USA, Mexico, South Africa) Prof. Johan P Reyneke.

The following topics will be covered:

• The art and science of condylar positioning during orthognathic surgery
• Unfavorable nasal changes following le Fort I maxillary osteotomies and management
• Segmentelising the maxilla in orthognathic surgery
• Temporomandibular joint reconstruction: The end of costo-chondral implants?

The event will be held on the Zoom online-platform.

The art and science of condylar positioning during orthognathic surgery 18.12.2020

The accurate intra-operative positioning of the mandibular condyle in the glenoid fossa during orthognathic surgery is without a doubt the most challenging maneuver and the most critical of an orthognathic procedure. The orthognathic surgeon can, under excellent vision, reposition the skeletal elements and establish a planned occlusion however, the positioning of the condyle is unsighted. For this part of the procedure, the surgeon has to depend on tactile methods as well as experience, to achieve the ideal and nontraumatic relationship between condylar/fossa position and the new occlusion.

During this webinar, I will discuss recommended methods of condylar positioning used performing 6400 bilateral sagittal split osteotomies. Intra-operative differential diagnosis incorrect condylar positioning:

• Mobility at the osteotomy sight
• Failure of fixation during placement of rigid fixation
• Central condylar sag
• Peripheral condylar sag- type I
• Peripheral condylar sag- type II
• The intraoperative diagnosis of a malpositioned condyle
• Correction of Condylar sags

Unfavorable nasal changes following le Fort I maxillary osteotomies and management 22.01.2021

It is important to understand the relationship between the maxilla, nasal bones, and nasal structures to avoid unfavorable nasal changes following le Fort I maxillary osteotomy. There are several esthetic and functional complications that may occur to the nose when the maxilla is repositioned during orthognathic surgery:

• Flaring of the ala
• Increased nostril visibility
• Tipping up of the nasal tip
• Buckling of the nasal septum
• Compression of the inferior turbinate
• Increase in the naso-labial angle

The etiology of each of the above complications will be discussed and recommendations of how to avoid these undesirable nasal effects following le fort I osteotomy will be demonstrated using clinical cases.

Segmentelising the maxilla in orthognathic surgery 19.02.2021

The le Fort I down fracture of the maxilla allows the surgeon to segmentalize the maxilla and correct skeletal and dental problems in all three dimensions. Indications for surgical segmentalizing the maxilla:
• Maxillary expansion
• Maxillary narrowing
• Differential superior/inferior repositioning of anterior and posterior segments (leveling the occlusal curve)
• Improving incisor angulation
• Closing interdental spaces
• Opening interdental spaces – Bolton discrepancy
• Correcting intra arch asymmetry – arch form
• Control the curve of Spee and/or Wilson

The orthodontic principles for the planning and preparation before segmental surgery will be highlighted. The orthodontist will be made aware of surgical maneuvers that will assist in finishing difficult cases in a shorter treatment time with more stable results.

Principles of positioning the interdental osteotomies between canine and first premolar or canine and lateral incisor allow for specific corrections and have certain advantages. The surgical technique, as well as tips and traps to simplify the procedures, will be discussed and demonstrated using clinical cases.

Temporomandibular joint reconstruction: The end of costo-chondral implants? 19.03.2021

In the not distant past, a costochondral graft was considered to be the golden standard for temporomandibular reconstruction. Indications for the end-stage reconstruction of the temporomandibular joint are generally:
• Post-traumatic severely displaced condylar fractures
• Ankylosis of the TMJ
• Developmental deformities
• Congenital deformities
• Neoplasms
Costo chondral grafts, however, has several disadvantages:
1. Harmonious growth? (poor correlation)
2. Resorption of the graft
3. Ankylosis or re-ankylosis
4. Overgrowth of the graft
5. Requires a second surgical sight for the harvesting of the graft

The history of the development of alloplastic materials for TM joint replacement, indications, and the surgical implementation of stock, as well as custom made (patient-matched) implants, will be discussed and demonstrated. Clinical cases will be used to demonstrate why the author considers the days of costochondral grafts for TM joint reconstruction to be numbered.