1
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Ricard D, Ferri J, Schlund M. Presurgical Maxillary Segmented Orthodontics Associated With 3-Piece Le Fort 1 Osteotomy for Palatal Expansion. J Craniofac Surg 2024:00001665-990000000-01838. [PMID: 39190774 DOI: 10.1097/scs.0000000000010518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/09/2024] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE The aim of this study is to assess maxillary transverse dimension following presurgical maxillary segmented orthodontics associated with 3-piece Le Fort 1 osteotomy in a cohort of "long face syndrome" patients with palatal constriction. METHODS Patients with maxillary transverse insufficiency were retrospectively included. They all underwent maxillary segmented orthodontics followed by a 3-piece Le Fort 1 osteotomy with palatal expansion. Palatal width dimensions were collected preoperatively, postoperatively, and at the time of the final follow-up, the stability of the expansion was analyzed. RESULTS Nineteen patients were included. There was no complication. The mean postoperative expansion was 6 mm (range: 3.1-8.7 mm) in the canine region and 4.3 mm (range: 0-9.1 mm) in the second molar region. The mean relapse was 0.36 mm (range: 0-1.4 mm) or 6% (range: 0%-16.1%) in the canine region and 0.17 mm (range: 0-1.3 mm) or 4% (range: 0%-14%) in the second molar region. CONCLUSION Presurgical maxillary segmented orthodontics with 3-piece Le Fort 1 osteotomy has shown high stability of the maxillary transverse dimension in a 1-step surgery without dental tipping. It should be considered as an alternative to rapid palatal expansion.
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Affiliation(s)
- Daniel Ricard
- Department of Oral and maxillofacial surgery, Maxillo Montcalm clinic, Gatineau, Québec, Canada
- Department of Oral and maxillofacial surgery, Outaouais integrated health and social services center, McGill University affiliated hospital, Québec, Canada
| | - Joël Ferri
- Department of Oral and maxillofacial surgery, Lille University, CHU Lille, INSERM, Advanced drug delivery systems, Lille, France
| | - Matthias Schlund
- Department of Oral and maxillofacial surgery, Bordeaux University, CHU Bordeaux, Bordeaux, France
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2
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Chen KY, Yang CY, Fan CN, Kuo CS, Fan SZ, Chen YW. The effects of pterygomaxillary disjunction in surgically assisted rapid maxillary expansion: A systematic review and meta-analysis. Orthod Craniofac Res 2024. [PMID: 38661079 DOI: 10.1111/ocr.12797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE This study aims to assess the expansive effects of pterygomaxillary disjunction (PMD) in surgically assisted rapid maxillary expansion (SARME) surgery using a meta-analysis approach. MATERIALS AND METHODS The study conducted a comprehensive literature search across five databases: PubMed, Scopus, Medline, Embase, and Cochrane, adhering to the PRISMA 2020 guidelines. Dental alterations were assessed using either cone-beam computed tomography (CBCT) or dental casts, while skeletal changes were exclusively measured from CBCT scans. We analysed the dentoskeletal changes between PMD +/- groups and conducted a within-group comparison. The primary focus of the results was on the mean differences observed in pre- and post-operative measurements. RESULTS Dental expansion was larger in the PMD+ group but not statistically significant. Skeletal expansion showed a significantly larger expansion in the posterior region in the PMD+ group (P = .033). Without PMD, anterior palatal expansion was significantly larger (P = .03), and the buccal tipping of posterior teeth was also significantly larger (P = .011) to achieve acceptable dental expansion outcomes. CONCLUSIONS Both PMD +/- groups of SARME surgery can achieve satisfactory dental expansion outcomes. However, bone expansion and tooth inclination are also important factors that influence orthodontic treatment and post-expansion stability. By reducing the bony resistance with PMD, larger posterior palatal expansion and more parallel bony expansion are observed. In contrast, without PMD, there is smaller palatal expansion and greater tooth inclination in the posterior region. This could potentially lead to compromised periodontal conditions following expansion.
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Affiliation(s)
- Kuei-Yuan Chen
- School of Dentistry, National Defense Medical Center, Taipei, Taiwan
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Cheng-Yu Yang
- School of Dentistry, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Ning Fan
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Shan Kuo
- School of Dentistry, National Defense Medical Center, Taipei, Taiwan
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Shou-Zen Fan
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Anesthesiology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yuan-Wu Chen
- School of Dentistry, National Defense Medical Center, Taipei, Taiwan
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei, Taiwan
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3
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Jara SM, Thuler ER, Hutz MJ, Yu JL, Cheong CS, Boucher N, Evans M, Dedhia RC. Posterior Palatal Expansion via Subnasal Endoscopy (2PENN) for Maxillary Deficiency: A Pilot Study. Laryngoscope 2024; 134:1970-1977. [PMID: 37772955 PMCID: PMC10947985 DOI: 10.1002/lary.31060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 05/01/2023] [Accepted: 06/28/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE Surgically assisted rapid palatal expansion (SARPE) addresses transverse maxillary deficiency, a known contributor to nasal obstruction. The purpose of this study was to assess the feasibility, preliminary outcomes, and safety of posterior palatal expansion via subnasal endoscopy (2PENN), a modified SARPE procedure, aimed at achieving anterior and posterior maxillary expansion. METHODS This prospective case series included consecutive adult patients with findings of transverse maxillary deficiency that underwent the 2PENN procedure from 4/2021 to 4/2022. Patients completed pre- and post-operative clinical evaluations, Nasal Obstruction and Septoplasty Effectiveness (NOSE) questionnaires, and computed tomography (CT), with measures including expansion at the level of the posterior nasal spine (PNS), first maxillary inter-molar distance (IMD), and anterior nasal spine (ANS). RESULTS The cohort (N = 20) was middle-aged (39 ± 11 years), predominantly male (80%), and overweight (BMI 28 ± 4 kg/m2 ). The majority (85%) of patients had sleep breathing issues, of which 10 (59%) had polysomnography-confirmed obstructive sleep apnea (OSA). Full anterior-posterior separation of the mid-palatal suture line was evident on all post-operative CT scans, with mean expansion at the PNS of 3.6 ± 1.3 mm, IMD of 6.1 ± 1.6 mm and ANS of 7.0 ± 1.6 mm (p < 0.001). Following surgery, mean NOSE scores improved from 57 ± 23 to 14 ± 13 (p < 0.001). One patient required maxillary antrostomy for post-operative sinusitis. CONCLUSION 2PENN is an effective and safe technique for achieving both anterior and posterior maxillary expansion in patients with transverse maxillary deficiency. Further study is warranted to better understand the effect of 2PENN in patients with OSA, particularly as it relates to improving pharyngeal patency. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1970-1977, 2024.
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Affiliation(s)
- Sebastian M Jara
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Eric R Thuler
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Michael J Hutz
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jason L Yu
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Crystal S Cheong
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Normand Boucher
- Department of Orthodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Marianna Evans
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Raj C Dedhia
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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4
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Barone S, Bennardo F, Salviati M, Calabria E, Bocchino T, Michelotti A, Giudice A. Can different osteotomies have an influence on surgically assisted rapid maxillary expansion? A systematic review. Head Face Med 2024; 20:16. [PMID: 38459578 PMCID: PMC10921779 DOI: 10.1186/s13005-024-00415-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/10/2024] [Indexed: 03/10/2024] Open
Abstract
The purpose of this study was to systematically review the randomized and non-randomized clinical trials (RCT; nRCT) concerning the different available osteotomies for surgically assisted rapid maxillary expansion (SARME): pterygomaxillary disjunction (SARME + PD vs SARME-PD) and segmental Le Fort I osteotomy (2-piece vs 3-piece). Outcomes focused on skeletal, dental, upper airway changes, complications, and relapse. Two authors investigated five databases (PubMed, Cochrane Library, Google Scholar, Scopus, Web of Science) until August 2023. The Cochrane Collaboration Tool and the Newcastle-Ottawa scale were used for the quality assessment of the included RCTs and nRCTs, respectively. A total of 554 articles were retrieved and after duplicates removing and full-text reading, 40 studies were included. Two RCTs showed a low risk of bias, one an unclear risk and one a high risk. Among the non-RCTs, 15 studies showed a good quality, while 21 exhibited a fair quality score. SARME + PD resulted in more homogeneous posterior bone expansion, with minimal dental effects. No difference between 2-piece and 3-piece in asymmetric expansion was observed, although 3SO showed 1-2 mm of more transverse increase. The oropharynx minimum cross-sectional area, the nasopharynx and the oropharynx volume were greater in SARME + PD. Both dental and bone relapse can occur but no differences between the groups were observed. All osteotomies guaranteed a correction of transverse maxillary deficiency. Lower side effects were described in SARME + PD. Two-piece and 3-piece segmental Le Fort I osteotomies did not show any differences in the symmetry and amount of expansion.
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Affiliation(s)
- Selene Barone
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Francesco Bennardo
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Marianna Salviati
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Elena Calabria
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Tecla Bocchino
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Ambra Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Amerigo Giudice
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy.
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5
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Yoon A, Kim TK, Abdelwahab M, Nguyen M, Suh HY, Park J, Oh H, Pirelli P, Liu SYC. What changes in maxillary morphology from distraction osteogenesis maxillary expansion (DOME) correlate with subjective and objective OSA measures? Sleep Breath 2023; 27:1967-1975. [PMID: 36806968 DOI: 10.1007/s11325-022-02761-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 02/23/2023]
Abstract
OBJECTIVES To correlate skeletal and airway measures on imaging with polysomnographic and self-reported measures after distraction osteogenesis maxillary expansion (DOME), in the effort to identify clinically relevant sites of expansion to guide treatment for adult patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS This is a retrospective study reviewing subjects who underwent DOME and had the complete set of the following data: peri-treatment cone-beam computed tomography (CBCT) scans, polysomnography (PSG), Epworth Sleepiness Scale (ESS), and nasal obstruction symptom (NOSE) scores. RESULTS Of 132 subjects who underwent DOME, 35 met inclusion criteria (71% men, mean age 27.7 ± 6.5 years, mean BMI 26.0 ± 6.4 kg/m2) and were enrolled in the study. There was a significant reduction in the NOSE score from 11.4 ± 5.5 to 3.6 ± 3.1, in the ESS score from 12.0 ± 4.6 to 7.1 ± 4.7, and in the apnea-hypopnea index (AHI) from 17.1 ± 15.8 to 7.01 ± 6.2 (p < 0.0001), after DOME. Nasal floor width at the nasopalatine canal level showed a statistically significant correlation with AHI reduction (p < .0001). CONCLUSIONS DOME is significantly associated with reduction of nasal obstruction, sleepiness, and severity of OSA. The findings suggest that expansion at the anterior third of the bony nasal passage, specifically where the nasopalatine canal is located predicts its clinical efficacy. This site may be a useful target anatomically via imaging.
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Affiliation(s)
- Audrey Yoon
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA.
| | - Tae Keong Kim
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - Mohamed Abdelwahab
- Division of Sleep Surgery, Department of Otolaryngology Head & Neck Surgery, School of Medicine, Stanford University, 801 Welch Road, Stanford, CA, 94305, USA
| | - Mai Nguyen
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - Hee Yeon Suh
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - Joorok Park
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - Heesoo Oh
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - Paola Pirelli
- Pediatric Dentistry and Orthodontics, Department of Clinical Science and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology Head & Neck Surgery, School of Medicine, Stanford University, 801 Welch Road, Stanford, CA, 94305, USA.
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6
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Martinovic D, Tokic D, Puizina-Mladinic E, Kadic S, Lesin A, Lupi-Ferandin S, Kumric M, Bozic J. Oromaxillofacial Surgery: Both a Treatment and a Possible Cause of Obstructive Sleep Apnea-A Narrative Review. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010142. [PMID: 36676088 PMCID: PMC9866782 DOI: 10.3390/life13010142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder. It is characterized by a nocturnal periodic decrease or complete stop in airflow due to partial or total collapse of the oropharyngeal tract. Surgical treatment of OSA is constantly evolving and improving, especially with the implementation of new technologies, and this is needed because of the very heterogeneous reasons for OSA due to the multiple sites of potential airway obstruction. Moreover, all of these surgical methods have advantages and disadvantages; hence, patients should be approached individually, and surgical therapies should be chosen carefully. Furthermore, while it is well-established that oromaxillofacial surgery (OMFS) provides various surgical modalities for treating OSA both in adults and children, a new aspect is emerging regarding the possibility that some of the surgeries from the OMFS domain are also causing OSA. The latest studies are suggesting that surgical treatment in the head and neck region for causes other than OSA could possibly have a major impact on the emergence of newly developed OSA, and this issue is still very scarcely mentioned in the literature. Both oncology, traumatology, and orthognathic surgeries could be potential risk factors for developing OSA. This is an important subject, and this review will focus on both the possibilities of OMFS treatments for OSA and on the OMFS treatments for other causes that could possibly be triggering OSA.
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Affiliation(s)
- Dinko Martinovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Daria Tokic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, 21000 Split, Croatia
| | - Ema Puizina-Mladinic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Sanja Kadic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Antonella Lesin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Slaven Lupi-Ferandin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-21-557-871
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7
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Liu SYC, Ibrahim B, Abdelwahab M, Chou C, Capasso R, Yoon A. A Minimally Invasive Nasal Endoscopic Approach to Distraction Osteogenesis Maxillary Expansion to Restore Nasal Breathing for Adults with Narrow Maxilla. Facial Plast Surg Aesthet Med 2022; 24:417-421. [PMID: 35179990 DOI: 10.1089/fpsam.2021.0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients with narrow high-arch palate present with limited response to standard septal, turbinate, and valve procedures for nasal obstruction. Objective: To measure the effectiveness of minimally invasive nasal endoscopic (MINE) Lefort I osteotomy among subjects with narrow high-arched palate in managing nasal obstruction. Methods: Prospective cohort study was performed where subjects with narrow high-arched palate underwent MINE distraction osteogenesis maxillary expansion (DOME) from August 2019 to January 2021. Nasal obstruction symptom evaluation (NOSE) score, mean time to opioid cessation, and mean duration of cranial nerve V2 hypoesthesia were evaluated. Results: Among 12 subjects, the. mean NOSE score decreased from 58.89 to 15.83 (p = 0.004). There were no complaints of lip mobility or deformity. Conclusion: MINI-DOME can reduce nasal obstruction in a certain phenotype of patients and further improve patient-centric outcomes by limiting the approach to the Lefort I osteotomy to an endoscopic nasal approach.
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Affiliation(s)
- Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Badr Ibrahim
- Division of Sleep Surgery, Department of Otolaryngology Head and Neck Surgery, University of Montreal, Montreal, Canada
| | - Mohamed Abdelwahab
- Division of Sleep Surgery, Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Courtney Chou
- Division of Sleep Surgery, Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Robson Capasso
- Division of Sleep Surgery, Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Audrey Yoon
- Division of Sleep Medicine, Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
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8
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Barone TR, Cahali MB, Vasconcelos C, Barone JR. A comparison of tooth-borne and bone-anchored expansion devices in SARME. Oral Maxillofac Surg 2020; 24:181-187. [PMID: 32291547 DOI: 10.1007/s10006-020-00837-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/08/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Major adult maxillary transverse discrepancies are usually treated with surgically assisted rapid maxillary expansion (SARME), utilizing a combination of surgical and orthodontic techniques. Unfortunately, a consensus has not been reached on topics ranging from the best surgical technique that should be performed to the ideal expander type that should be installed. The present study sought to evaluate the efficiency and stability of the maxillary expansion achieved with two types of expanders following the same SARME procedure without pterygomaxillary disjunction (PMD). METHODS Twenty-four patients with a maxillary transverse deficiency were enrolled in the study. All patients underwent the same SARME, and 12 received a bone-anchored (KLS Martin®) and 12 were installed with a tooth-borne (Hyrax®) expander. Dental impressions were collected both preoperatively and 1 year postoperatively. These casts were scanned and the distances between specific interdental and intergingival points were measured and analyzed. Statistical analyses were performed to assess the effects expander type had on the efficiency of the maxillary expansion and long-term stability. RESULTS Expansion in the anterior maxillary and premolar regions was found to be similar in both groups. In contrast, the tooth-borne device resulted in a significantly greater expansion in the molar region. CONCLUSION The SARME technique without PMD is highly effective at treating adults with maxillary transverse deficiencies, and the type of expander selected depends on the location of the larger maxillary constriction region of each patient.
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Affiliation(s)
- T R Barone
- IAMSPE/HSPE, Avenida Ibirapuera 981, Sao Paulo, Sao Paulo, Brazil. .,, Sao Paulo, Brazil.
| | - M B Cahali
- IAMSPE/HSPE, Avenida Ibirapuera 981, Sao Paulo, Sao Paulo, Brazil
| | - C Vasconcelos
- IAMSPE/HSPE, Avenida Ibirapuera 981, Sao Paulo, Sao Paulo, Brazil
| | - J R Barone
- IAMSPE/HSPE, Avenida Ibirapuera 981, Sao Paulo, Sao Paulo, Brazil
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9
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Surgically assisted rapid maxillary expansion: a systematic review of complications. Int J Oral Maxillofac Surg 2019; 49:325-332. [PMID: 31500954 DOI: 10.1016/j.ijom.2019.08.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022]
Abstract
A systematic review of the literature on the complications of surgically assisted maxillary expansion (SARME) was performed. The search strategy was based on the PRISMA guidelines. The PubMed, SCOPUS, and Cochrane Library databases were searched. Data were extracted from the full texts after screening of the abstracts and titles. Human clinical studies encompassing 'maxillary expansion', 'palatal expansion', 'SARME', or 'SARPE' and that reported sufficient data for 'complication' were included. In vitro studies, case reports, meta-analyses, reviews, book chapters, animal studies, and studies with missing or insufficient data were excluded. The final selection included 12 articles for data extraction. A total of 851 patients underwent SARME, with 187 reported complications (21.97%). Epistaxis (2.47%) and postoperative pain (2.00%) were the most often reported minor complications, and asymmetric or inadequate expansion presented an occurrence rate of 4.47%. Minor complications were equally distributed between surgical (49.30%) and orthodontic complications (50.70%). The technique without pterygomaxillary disjunction increased the occurrence of minor complications (29.95% vs. 16.87%), and the expansion pattern with less than 0.5 mm/day increased the occurrence of orthodontic complications (30.93% vs. 1.83%), i.e. asymmetric expansion. In conclusion, SARME procedures mostly present minor complications. Although several types of complication are described in the literature, occurrence rates are low, and technical issues such as pterygomaxillary disjunction and the pattern of distraction can be predictors of the complication risk.
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10
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Distraction Osteogenesis Maxillary Expansion (DOME) for adult obstructive sleep apnea patients with narrow maxilla and nasal floor. Sleep Med 2019; 65:172-176. [PMID: 31606311 DOI: 10.1016/j.sleep.2019.06.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/02/2019] [Accepted: 06/05/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study correlates objective and subjective measurements associated with obstructive sleep apnea (OSA) to define the efficacy of Distraction Osteogenesis Maxillary Expansion (DOME) to treat adult OSA patients with narrow maxilla and nasal floor. METHODS This is a retrospective study reviewing cases from September 2014 through April 2018 with 75 eligible subjects. Inclusion criteria required OSA confirmed by attended polysomnography (PSG). Pre- and Post-operative clinical data were measured at the Stanford Sleep Medicine and Stanford Sleep Surgery Clinics. DOME is a two-step process starting with insertion of custom-fabricated maxillary expanders anchored to the hard palate by mini-implants followed by minimally invasive osteotomies. After maxillary expansion was complete, orthodontic treatment to restore normal occlusion was initiated. Perioperative Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Nasal Obstruction Symptom Evaluation (NOSE), and Oxygen Desaturation Index (ODI) were measured for 43, 72, 72, and 34 subjects respectively. Statistical analysis was performed using paired T-test with significance set at p-value < 0.05. RESULTS The mean age of test subjects was 30.5 ± 8.5 years with a gender distribution of 57 males and 18 females. There was a significant reduction in pre and post-operative NOSE score (10.94 ± 5.51 to 3.28 ± 2.89, p < 0.0001), mean ESS score (10.48 ± 5.4 to 6.69 ± 4.75, p < 0.0001), and AHI (17.65 ± 19.30 to 8.17 ± 8.47, p < 0.0001) with an increased percentage of REM sleep (14.4 ± 8.3% to 22.7 ± 6.6%, p = 0.0014). No significant adverse effects were identified. CONCLUSIONS DOME treatment reduced the severity of OSA, refractory nasal obstruction, daytime somnolence, and increased the percentage of REM sleep in this selected cohort of adults OSA patients with narrow maxilla and nasal floor.
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11
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Grybauskas S, Moser L, Esteves L, Cintra O, Schneider-Moser U. An interview with Simonas Grybauskas. Dental Press J Orthod 2018; 23:14-35. [PMID: 30304151 PMCID: PMC6150705 DOI: 10.1590/2177-6709.23.4.014-035.int] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/20/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Simonas Grybauskas
- » Simonas is graduated from the Kaunas University of Medicine and acquired his dental degree in 2000. » He completed his training in Oral Surgery (2003) and Maxillofacial Surgery (2006) at Vilnius University. » In 2008 he acquired his Medical degree and became a double qualified oral and maxillofacial surgeon. » He passed the exams and became a member of the Royal College of Surgeons of Edinburgh in 2005. » In 2009, he was awarded a PhD degree by Riga Stradins University (Latvia). » Consultant in Oral and Maxillofacial Surgery at Vilnius University. » Private practice S'OS (Simonas Grybauskas' Orthognathic Surgery). » Visiting professor at University of Ferrara, Italy. » Author of scientific publications. » A professor who has delivered more than 100 lectures on orthognathic and reconstructive surgery in international conferences and courses. » A member of the Lithuanian Association of Maxillofacial Surgery since 2002, a member of the Baltic Association of Maxillofacial and Plastic Surgery since 2003, and a member of the European Association for Cranio-Maxillofacial Surgery since 2005. » Host and director of two major international events - the 1st and the 2nd Baltic Sea Conferences on Orthognathic Surgery and Orthodontics, in Vilnius in 2009 and in Riga in 2015. » Dedicated, for most of his time, to orthognathic and reconstructive surgery and development of virtual surgical planning techniques
| | - Lorenz Moser
- » MD, University of Innsbruck (1973-79). » DDS, University of Innsbruck (1981-83). » Postgraduate Orthodontic Training University of Innsbruck (1983-86). » Private practice of Orthodontics in Bolzano (Italy), since 1986. » Diplomate European Board of Orthodontists (EBO, 1997). » Diplomate Italian Board of Orthodontists (IBO, 1999). » Active member of Angle Society of Europe (ASE, since 2001). » President of IBO and member of SIDO (Società di Ortodonzia Italiana) council (2002/2003). » Visiting professor, University of Ferrara (Italy). » Secretary of the Angle Society of Europe (2004-2006). » Chairman EBO Examination Committee (2006-2008)
| | - Lucas Esteves
- » Graduation, dental school at Universidade Baiana de Medicina e Saúde Pública. » Residency program at Pedro Ernesto hospital (UERJ, Brazil). » Post-graduation, master program at Universidade Grande Rio (Rio de Janeiro, Brazil). » Post-graduation, doctorate program, Universidade Federal da Bahia (Bahia, Brazil). » Post-graduation, Oklahoma University (Oklahoma, USA). » Post-graduation at Vilnius / Lithuania. » Private practice in orthognathic surgery and TMJD. » Public service in craniofacial deformities at Santa Casa hospital (coordinator, Salvador/Bahia, Brazil)
| | - Octávio Cintra
- » Graduated in Dentistry, Faculdade de Odontologia de Piracicaba/UNICAMP (Brazil). » Residency in Bucomaxilofacial Surgery and Traumatology, Santa Casa de Misericórdia de São Paulo. » Fellowship in Bucomaxilofacial Surgery, Southwestern Medical Center at Dallas, Parkland Memorial Hospital, University of Texas (Dallas, Texas/USA). » Vice-president, South American Arnett Foundation (SAAF). » Member of Latin American Division of Strasbourg Osteosynthesis Research Group (SORG, Santa Barbara, CA/USA)
| | - Ute Schneider-Moser
- » DDS, University of Mainz (Germany, 1985). » Private practice in Bolzano (Italy) together with Dr. Lorenz Moser (since 1987). » Active member of the Società di Ortodonzia Italiana (SIDO, since 1990). » Diplomate of the Italian Board of Orthodontists (IBO, 1999 ) » Visiting professor at the l'Università di Sacro Cuore (Rome, since 2003), for the program of Logopedics at the Scuola Provinciale Superiore di Sanità "Claudiana" (Bolzano, Italy). » Specialty in Orthodontics, University of Ferrara (Italy, 2010). » Member of the Edward H. Angle Society of Orthodontists, Angle East (EHASO, since 2011). » Visiting professor at the Department of Orthodontics of the University of Ferrara (Italy, since 2011). » President of the Accademia Italiana di Ortodonzia (AIdOr, 2012)
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