Surgical mandibular advancement and changes in uvuloglossopharyngeal morphology and head posture: a short- and long-term cephalometric study in males.
The aim of the present study was to investigate, by means of an extensive cephalometric examination, the alterations which took place in hyoid bone position, head posture, position and morphology of the soft palate, and tongue and sagittal dimensions of the pharyngeal airway after mandibular advancement osteotomy for the correction of mandibular retrognathism. The sample consisted only of adult males who underwent mandibular advancement by bilateral sagittal ramus split osteotomy (BSRO) with rigid fixation. Profile cephalograms were obtained 1-3 days before surgery (20 subjects), and 6 months (20 subjects) and 3 years (19 subjects) after the surgery. Statistical evaluation was performed by paired Student's t-test and Pearson product moment correlation analysis. At the short-term follow-up, hyoid bone and vallecula assumed a more superior (AH perpendicular FH, AH perpendicular ML, AH perpendicular S, V perpendicular FH) and anterior position (AH-C3 Hor, V-C3), which was maintained at the long-term follow-up. The soft palate (NL/PM-U) became more upright at the short-term follow-up. The tongue demonstrated a transient increase in height (H perpendicular VT) and a less upright position (VT/FH) at the long-term observation. In addition, a more upright cervical spine (OPT/HOR, CVT/HOR) was recorded at the long-term follow-up. The pharyngeal airway space at the level of the oropharynx (U-MPW) and the retroglossal space at the base of the tongue (PASmin) showed an increase in the sagittal dimension at the short-term follow-up. Significant widening at the PASmin level was sustained at the long-term follow-up, indicating that mandibular advancement osteotomy could increase airway patency and be a treatment approach for sleep apnoea in selected patients. (+info)
Computer tomographic and radiographic changes in the temporomandibular joints of two young adults with occlusal asymmetry, treated with the Herbst appliance.
Two young patients, one female and one male, with asymmetric occlusal deviation and extreme Angle Class II division 1 malocclusions were treated with the Herbst appliance after cessation of endochondral growth (union of the radius epiphysis). During treatment, computer tomographic (CT) scanning and orthopantomograms of the temporomandibular joints (TMJs) revealed, as a result of bone modelling, asymmetrical new bone formation as a double contour on the distocranial part of the condyles. The treatment results were followed for more than 2 years and the new bone was found to be stable. (+info)
Open bite: stability after bimaxillary surgery--2-year treatment outcomes in 58 patients.
Stability after bimaxillary surgery to correct open bite malocclusion and mandibular retrognathism was evaluated on lateral cephalograms before surgery, 8 weeks post-operatively, and after 2 years. The 58 consecutive patients were treated to a normal occlusion and good facial aesthetics. Treatment included the orthodontic alignment of teeth by maxillary and mandibular fixed appliances, Le Fort I osteotomy, and bilateral sagittal split ramus osteotomy. Twenty-six patients also had a genioplasty. Intra-osseous wires or bicortical screws were used for fixation. Twenty-three patients had maxillo-mandibular fixation (MMF) for 8 weeks or more, six for 4-7 weeks, 14 for 1-3 weeks, and 15 had no fixation. At follow-up 2 years later, the maxilla remained unchanged and the mandible had rotated on average 1.4 degrees posteriorly. Seventeen patients had an open bite. Among them, eight patients had undergone segmental osteotomies. The relapse was mainly due to incisor proclination. The most stabile overbite was found in the group with no MMF after surgery. (+info)
Dentoskeletal morphology in children with juvenile idiopathic arthritis compared with healthy children.
The aim of this study was to evaluate the dentoskeletal relationships in children with juvenile idiopathic arthritis (JIA) compared to healthy children without significant differences in relation to age and sex, by means of lateral cephalometric radiographs. Cephalometric, as well as dental panoramic radiographs were taken of 66 JIA children (27 males and 39 females; age range: 6-19 years; mean age: 11.9 years). The control group consisted of 37 healthy children unaffected by JIA seeking orthodontic treatment, with Class I occlusion (17 males and 20 females; age range: 7.5-17 years; mean age: 11.9 years). All cephalometric landmarks were identified and digitized, and calculations were performed by means of a computerized cephalometric system. The cephalometric findings indicated a tendency towards retrognathism with a short mandible. The lower facial height was increased and the growth pattern of the face was biased towards the vertical direction (clockwise, i.e. with a tendency to open bite) and the interincisal angle was less in the JIA children compared to the healthy children. These findings were in general more pronounced by the JIA children with polyarticular type of the disease as well as with affected condyles. Our study indicated that the dentoskeletal morphology in children with JIA presented some special characteristics when compared to healthy children, which could be attributed to the effects of the disease. (+info)
Face, palate, and craniofacial morphology in patients with a solitary median maxillary central incisor.
The occurrence of a solitary median maxillary central incisor (SMMCI) is a very rare condition and might be a sign of a mild degree of holoprosencephaly. In this investigation, material from 10 patients, nine girls and one boy with a SMMCI (8-17 years of age) registered in orthodontic clinics was examined. The purpose was to evaluate the clinical characteristics and craniofacial morphology in this group of patients. Oral photographs, study casts, profile radiographs, and orthopantomograms were analysed. The study showed that this group of SMMCI patients were characterized by an indistinct philtrum, an arch-shaped upper lip, absence of the fraenulum of the upper lip, a complete or incomplete mid-palatal ridge, a SMMCI, and nasal obstruction or septum deviation. The craniofacial morphology of the nine girls, compared with normal standards for girls showed a short anterior cranial base, a short, retrognathic and posteriorly inclined maxilla, and a retrognathic and posteriorly inclined mandible. Furthermore, the sella turcica had a deviant morphology in five of the 10 subjects. The results indicate that the presence of a SMMCI should not be considered as a simple dental anomaly, since it may be associated with other clinical characteristics and more complex craniofacial malformations. It is therefore suggested that the SMMCI condition in future studies is classified according to clinical symptoms and craniofacial morphology. (+info)
Mandibular advancement using an intra-oral osteogenic distraction technique: a report of three clinical cases.
Osteogenic distraction has been used for decades to lengthen limbs and now attention is focused upon its use within the craniofacial skeleton. This paper addresses distraction of the mandible. It is proposed that mandibular osteogenic distraction could be a possible adjunct to the orthodontic treatment of those adult patients with skeletal anomalies, who would benefit from combined orthodontic/orthognathic treatment. Three consecutive cases from one unit are presented, where adult patients with severe Class II division 1 malocclusions have undergone orthodontic treatment combined with mandibular osteogenic distraction, instead of conventional bilateral sagittal split osteotomies. (+info)
Preemptive effects of a combination of preoperative diclofenac, butorphanol, and lidocaine on postoperative pain management following orthognathic surgery.
The aim of the study was to investigate whether preemptive multimodal analgesia (diclofenac, butorphanol, and lidocaine) was obtained during sagittal split ramus osteotomy (SSRO). Following institutional approval and informed consent, 82 healthy patients (ASA-I) undergoing SSRO were randomly assigned to 1 of 2 groups, the preemptive multimodal analgesia group (group P, n = 41) and the control group (group C, n = 41). This study was conducted in a double-blind manner. Patients in group P received 50 mg rectal diclofenac sodium, 10 micrograms/kg intravenous 0.1% butorphanol tartrate, and 1% lidocaine solution containing 10 micrograms/mL epinephrine for regional anesthesia and for bilateral inferior alveolar nerve blocks before the start of surgery. Postoperative pain intensity at rest (POPI) was assessed on a numerical rating score (NRS) in the postanesthesia care unit (PACU) and on a visual analogue scale (VAS) at the first water intake (FWI) and at 24, 48, and 72 hours after extubation. POPI in the PACU was significantly lower in group P than in group C, whereas there were no significant differences at FWI, 24, 48, and 72 hours after extubation in both groups. Preemptive multimodal analgesia was not observed in this study. (+info)
The fetal mandible: a 2D and 3D sonographic approach to the diagnosis of retrognathia and micrognathia.
OBJECTIVE: To define parameters that enable the objective diagnosis of anomalies of the position and/or size of the fetal mandible in utero. DESIGN: Fetuses at 18-28 gestational weeks were examined by two- and three-dimensional ultrasound. The study included normal fetuses and fetuses with syndromes associated with known mandible pathology: Pierre Robin sequence or complex (n = 8); hemifacial microsomia (Treacher-Collins syndrome, n = 3); postaxial acrofacial dysostosis (n = 1). Fetuses with Down syndrome (n = 8) and cleft lip and palate without Pierre Robin sequence or complex (n = 18) were also studied. Retrognathia was assessed through the measurement of the inferior facial angle, defined on a mid-sagittal view, by the crossing of: 1) the line orthogonal to the vertical part of the forehead at the level of the synostosis of the nasal bones (reference line); 2) the line joining the tip of the mentum and the anterior border of the more protruding lip (profile line). Micrognathia was assessed through the calculation of the mandible width/maxilla width ratio on axial views obtained at the alveolar level. Mandible and maxilla widths were measured 10 mm posteriorly to the anterior osteous border. RESULTS: In normal fetuses, the inferior facial angle was constant over the time span studied. The mean (standard deviation) value of the inferior facial angle was 65.5 (8.13) degree. Consequently, an inferior facial angle value below 49.2 degree (mean - 2 standard deviations) defined retrognathism. All the fetuses with syndromes associated with mandible pathology had inferior facial angle values below the cut-off value. Using 49.2 degree or the rounded-up value of 50 degree as a cut-off point, the inferior facial angle had a sensitivity of 1.0, a specificity of 0.989, a positive predictive value of 0.750 and a negative predictive value of 1.0 to predict retrognathia. In normal fetuses, the mandible width/maxilla width ratio was constant over the time interval studied. The mean (standard deviation) value was 1.017 (0.116). Consequently, a mandible width/maxilla width ratio < 0.785 defined micrognathism. Mandible width/maxilla width ratio values were below this cut-off point in eight and in the normal range in four fetuses with syndromes associated with mandible pathology. CONCLUSIONS: Retrognathia and micrognathia are conditions that can be separately assessed. The use of inferior facial angle and mandible width/maxilla width ratio should help sonographic recognition and characterization of fetal retrognathic and micrognathic mandibles in utero. (+info)