Selected Orthodontic Principles for Management of Cranio-Maxillofacial Deformities

The Impact of Clinical and Craniofacial Changes on the Surgical Outcomes of Lateral Pharyngoplasty in the Treatment of Obstructive Sleep Apnea

Objective  To verify if maxillomandibular retrusion, obesity, and increased neck circumference are factors of worse surgical prognosis for lateral pharyngoplasty in apneic patients. Materials and Methods  We evaluated 53 patients with obstructive sleep apnea who underwent lateral pharyngoplasty. Clinical evaluation was performed before the surgical procedure and included the measurement of body mass index (BMI) in kg/m 2 , neck circumference in centimeters, and a clinical evaluation of the facial profile obtained through the natural position of the oriented head. The polysomnographic evaluation was performed with at a minimum of 6 months after surgery, and polysomnographic results were correlated with the preoperative clinical data. Results  The mean age of the patients was 38.8 years; the mean BMI was of 29.28kg/m 2 , and 84.9% of the sample was composed of men and 15.1% of women. There was a significant reduction in the mean value of the main respiratory parameters verified by polysomnography, such as apnea-hypopnea index (AHI) from 31.60 events per hour to 8.15 ( p  < 0.001); NadirO 2 went from 81% to 85% ( p  = 0.002) and mean oxyhemoglobin saturation from 94% to 95% ( p  = 0.024). It was also observed that the greater the maxillomandibular retrusion, the lower the mean reduction of the AHI after surgery. The increase in neck circumference proved to be a factor associated with the surgical outcome, and for each 1-cm decrease in the neck circumference, the chance of surgical success increased 1.2-fold. Conclusion  Lateral pharyngoplasty is an efficient surgical obstructive sleep apnea treatment. The lower the neck circumference measurement, the greater the chances of surgical success, and clinically evaluated maxillomandibular retrusion can reduce the magnitude of improvement in respiratory parameters after lateral pharyngoplasty in apneic patients.

Current Trends in Orthognathic Surgery

Orthognathic surgery has evolved significantly over the past century. Osteotomies of the midface and mandible are contemporaneously used to perform independent or coordinated movements to address functional and aesthetic problems. Specific advances in the past twenty years include increasing fidelity with computer-assisted planning, the use of patient-specific fixation, expanding indications for management of upper airway obstruction, and shifts in orthodontic-surgical paradigms. This review article serves to highlight the contemporary practice of orthognathic surgery.

CBCT Analysis of Dento-Skeletal Changes after Rapid versus Slow Maxillary Expansion on Deciduous Teeth: A Randomized Clinical Trial

The aim of the present study was to compare skeletal and dental changes after rapid maxillary expansion (RME) and slow maxillary expansion (SME) performed by a Leaf Expander (LE) with upper deciduous teeth as anchorage and using 3D CBCT (Cone Beam Computed Tomography) analysis. Mixed dentition patients were randomly divided in two groups, according to the different expansion used anchored on maxillary primary second molars: the RME group (n = 16) was treated with a Hyrax type expander, whereas the SME group (n = 16) was treated with an LE expander. CBCT scans were performed before (T1) and after treatment (T2) and analyzed with a custom landmarks system. A paired t-test was used for intragroup analysis between T1 and T2, and a Student t-test was used for intergroup analysis; statistical significance was set at 0.05. Both RME and SME groups showed a statistically significant increase in dental and skeletal diameters. Group comparisons between T1 and T2 showed a significant expansion rate in the RME group for upper permanent molars (p = 0.025) but not for deciduous molars (p = 0.790). Moreover, RME showed higher increases for skeletal expansion evaluated at nasal walls (p = 0.041), whereas at pterygoid plates did not show any significant differences compared with the SME group (p = 0.849). A significant transverse expansion could be achieved with the expander anchored on deciduous teeth. RME and SME produced effective both skeletal and dentoalveolar transverse expansion; RME produced more anterior expansion than SME but less control regarding the permanent molar decompensation. SME by LE therefore could be an efficient and helpful alternative in the treatment of transverse maxillary deficiency in growing patients.

Common Patterns of Developmental Dentofacial Deformities: A Biologic Classification System

Jaw disharmonies that are recognized after birth and that present in association with the pre-pubertal growth spurt are called developmental dentofacial deformities. These deformities occur during the normal growth phase of the face with degrees of either excess or deficiency in one or more vectors of the jaws. Clinical observation combined with radiographic analysis confirms that developmental dentofacial deformities tend to occur in 6 distinct and repetitive biologic patterns. Once the individual’s jaw growth pattern is known, the natural progression of their deformity, the functional consequences on speech articulation, chewing ability, swallowing mechanism, and breathing, and the locations of skeletal dysmorphology that require surgical intervention fall into place. The purpose of the manuscript is to review the 6 common patterns.