How does changing the vector of transport disc distraction affect the outcomes of surgery in patients of temporomandibular joint ankylosis with obstructive sleep apnea?

PURPOSE

Temporomandibular joint ankylosis (TMJA) in children is associated with retrognathia, reduction in pharyngeal airway volume (PAV), and obstructive sleep apnea (OSA). Distraction-osteogenesis (DO) is the proven method in the management of OSA. There is paucity in literature about the effect of distraction vector on PAV. It can be expected that an oblique vector would improve PAV and relieve OSA. Thus, the study was designed to explore the feasibility, advantages, and disadvantages of this modified technique for managing TMJA and OSA simultaneously.

MATERIALS AND METHOD

The investigators designed a prospective study on patients of TMJA with retrognathia. Ethical approval was obtained (IECPG-547/14.11.2018). In all patients, simultaneous ankylosis release and mandibular distraction were performed. Primary outcome variables were improvement in 3-dimensional (3D) PAV and maximal interincisal opening (MIO). Secondary outcome variables were changed mandibular length, distraction relapse, and re-ankylosis. Paired t-test and multivariate ANOVA were used to assess all the parameters.

RESULT

The study included 13 joints in 8 patients of TMJA with retrognathia (2 unilateral and 6 bilateral ankylosis) with mean age of 14.25 ± 7.37 years. Mean distraction performed was 19 ± 4.0 mm. There was a statistically significant improvement of PAV by 225% (p = 0.002), a reduction in Epworth's scale (p = 0.017), an increase in MIO (p = 0.001), and an increase in mandibular length. Three patients had re-ankylosis at the 25-month follow-up.

CONCLUSION

The results of the present study conclude that modification of distraction vector improves 3D PAV and MIO in TMJA patients, with the added advantage of a reduction in overall treatment time and improved patient compliance.

Oral health-related quality of life in patients with cleft lip and/or palate or Robin sequence

PURPOSE

To compare the oral health-related quality of life (OHRQoL) in patients with cleft lip and/or palate or Robin sequence versus a healthy control group using the Child Oral Health Impact Profile (COHIP-G19). Factors such as age, gender, and cleft type were considered.

METHODS

Over an 8-month period, the OHRQoL was surveyed by using the COHIP-G19 questionnaire. Included were patients with a craniofacial disorder (n = 61; average age 11.24 years) and a healthy control group (n = 70, average age 12.63 years) for a total of 131 patients (average age 11.99 years) from the Department of Orthodontics University Hospital Tübingen, Germany. These were divided into two age groups (6-11 years; 12-18 years).

RESULTS

Statistically, patients with a craniofacial disorder presented a significantly lower OHRQoL than the control group (p = 0.0055). In the craniofacial disorder group, older patients revealed a significantly (p = 0.005) lower OHRQoL than the younger patients. Female patients showed in nearly all groups a better OHRQoL than male patients, but this difference was not statistically significant (p > 0.05). Males with a craniofacial disorder scored significantly lower than males without (p = 0.016); females showed no differences between the groups. Visibility, location, and severity of the craniofacial malformation did not have a significant influence on the OHRQoL.

CONCLUSION

The occurrence of a craniofacial malformation impacted the OHRQoL especially in older and male affected patients, unrelated to the expression level or localization. An early instruction about oral health, rehabilitation and functional training should be considered in therapy.

Osseous genioplasty versus chin implants: early complications and patient satisfaction

Osseous genioplasty and chin augmentation with implants are the two main treatment options for retrognathia. This retrospective cohort study was performed to compare the prevalence of complications and patient satisfaction following osseous genioplasty and chin augmentation by implant. Eighty patients were included: 38 underwent advancement osseous genioplasty and 42 received chin implants (alloplastic, either Medpor or Silastic) intraorally or extraorally. The patients were assessed for complications 12 months after surgery, including neurosensory disturbances, infection or extrusion, wound dehiscence, and the need for reoperation. Patient satisfaction was evaluated using a visual analogue scale. The infection rate was significantly higher in the chin implant group than in the genioplasty group (P = 0.028). Moreover, dehiscence and the need for reoperation appeared to be more common following chin augmentation with implants. However, there was no significant difference in the prevalence of neurosensory disturbances between the two groups (P = 0.137). In the chin implants group, the extraoral approach resulted in a lower dehiscence rate than the intraoral approach. Patients in the genioplasty group had significantly higher satisfaction scores than those in the chin implant group (P = 0.001). Overall, the rates of the complications assessed were lower and patient satisfaction was higher after osseous genioplasty when compared to chin augmentation with implants.

Comparison of Class II open bite correction by temporomandibular joint prostheses or bimaxillary orthognathic surgery

INTRODUCTION

The aim of this study was to evaluate the outcome of skeletal Class II and anterior open bite patients who received simultaneous Le fort I osteotomies with temporomandibular joint (TMJ) prostheses or bimaxillary orthognathic surgery.

MATERIALS AND METHODS

Patients with condylar resorption (CR) were treated by TMJ prostheses and orthognathic surgery and divided into two groups. Cephalometric radiographs were obtained before and after operation to find out the surgical alteration by comparing measures at different time points.

RESULTS

23 patients were included. Mean overbite of the patients was increased by 3.39 mm in TMJ prostheses group and 3.24 mm in orthognathic group. Occlusal plane angle was averagely rotated -6.06° and 1.31°; mandibular plane counterclockwise rotated 12.23° and 5.81°, respectively. The increase of ramus height in TMJ prostheses group were significantly greater than orthognathic surgery group (8.02 ± 1.96 mm vs. -0.09 ± 1.29 mm). The overall treatment effect was stable in both groups during the 1-year follow up.

DISCUSSION

Two surgical plans seem to be reliable treatments of anterior open bite and mandibular retrognathism caused by temporomandibular disease. TMJ prostheses with simultaneous Le fort I osteotomies close open bite by lengthening the height of ramus and rotating maxillo-mandibular complex counterclockwise, while bimaxillary orthognathic surgery by rotating maxilla clockwise and mandible counterclockwise without rebuilding ramus.

Torque control with set-up and auxiliary spring in an adult severe class II case treated by lingual straight-wire appliance, premolar extractions and orthognathic surgery

This case report describes a complex full-step class II high angle case in an adult patient treated with lingual straight-wire appliance, premolar extractions and orthognathic surgery. With the twofold aim of obtaining ideal occlusal relationship and aesthetic improvement, surgical treatment with appropriate biomechanical strategies, including extraction choice and torque control during space closure, are needed to achieve the planned results. This case report demonstrates the possibility of solving successfully severe sagittal, transverse and vertical discrepancies in an adult patient with surgical treatment by means of an invisible technique. This report also underlines the need for precise biomechanical control, including set-up overcorrections and an auxiliary spring to manage teeth inclination, in lingual orthodontics extraction cases.

Reverse Forsus vs. facemask/rapid palatal expansion appliances in growing subjects with mild class III malocclusions : A randomized controlled clinical study

PURPOSE

To investigate the skeletal, dental, and soft tissue effects of reverse Forsus (RF; 3M Unitek, Monrovia, CA, USA) and facemask/rapid palatal expansion (FM/RPE) appliances in growing subjects with class III malocclusions.

METHODS

The data of this prospective randomized controlled trial (RCT) were derived from pre- and posttreatment/observation lateral cephalograms of 45 subjects with mild class III malocclusions: group 1 (8 girls, 7 boys; mean age 10.54 years) received a FM/RPE appliance; group 2 (6 girls, 9 boys; mean age 10.49 years) received the RF appliance; and an untreated control group (7 girls, 8 boys; mean age 10.66 years) was matched to the treatment groups with regard to sagittal skeletal and dental classifications. Angular and linear measurements were evaluated using lateral cephalograms. Statistical analyses were performed by one-way analysis of variance, Kolmogorov-Smirnov test, Kruskal-Wallis, paired-samples t‑test, and Wilcoxon test, whereby p < 0.05 was accepted to be statistically significant.

RESULTS

The intermaxillary (ANB), interdental (overjet), and sagittal lip relations in the FM/RPE and RF groups showed significant improvements compared to the control group (p < 0.05). Although the anterior and inferior traction of the maxilla was greater in the FM/RPE group compared to the RF group (p < 0.05), both treatment groups showed similar clockwise rotation of the mandible compared to the control group. While significantly more proclination of maxillary incisors occurred in the RF group compared to the FM/RPE and control groups (p < 0.05), both treatments led to significantly retroclined mandibular incisors compared to the control group (p < 0.001).

CONCLUSION

Both therapies led to intermaxillary and interdental improvements. The RF appliance had a limited effect on the maxilla and it mostly had dentoalveolar effects when compared to FM/RPE therapy.

Evaluation of external apical root resorption caused by fixed functional treatment of class II malocclusion : Cast splint Herbst appliance vs. Forsus fatigue resistant device

INTRODUCTION

The aim of this study was to evaluate and compare the effects of class II fixed functional treatment with a cast splint Herbst appliance (HA; Herbst Set I, Dentaurum, Ispringen, Germany) and Forsus fatigue resistant device (FRD; 3M Unitek Corp., Monrovia, CA, USA) on external apical root resorption (EARR) in posterior teeth.

METHODS

In all, 40 patients (15 male and 25 female) with class II division 1 malocclusion were treated with two fixed functional appliances: HA (20 patients, mean age 14.60 ± 1.14 years) and FRD (20 patients, mean age 14.15 ± 1.28 years). The vestibular lengths of the first molars and premolars were measured on panoramic radiographs and converted to actual tooth length using the magnification coefficient (MC), which was calculated using dental models. Intragroup comparisons of pre- and posttreatment tooth lengths were performed with the paired t‑test and Wilcoxon signed-rank test, while intergroup comparisons were performed with the Mann-Whitney U test.

RESULTS

Pretreatment tooth length values decreased significantly with HA and FRD therapies for all posterior teeth. The maximum resorption was observed in the mandibular first premolar with a mean of 0.81 mm following HA and 1.55 mm following FRD treatment. While no significant difference existed between the EARR values of the HA and FRD groups for maxillary teeth, the amount of EARR of mandibular posterior teeth in the FRD group was significantly higher than in the HA group.

CONCLUSIONS

In patients treated with HA or FRD, the tooth length of posterior teeth decreased to a clinically minor but statistically significant degree. The root resorption effect of FRD therapy in mandibular posterior teeth was significantly higher than that of HA therapy.

A Clinical Re-Evaluation of an Unexplored Technique for Post Gap Arthroplasty Retrognathic Mandible

Aims

The current manuscript explores the viability of reverse sagittal split osteotomy technique for correction of ankylotic cases with post gap arthroplasty mandibular retrognathia to achieve socially acceptable esthetic results.

Method

Reverse sagittal split osteotomy which was introduced by Collins et al in 1983 was performed with certain modifications on two cases to correct mandibular hypoplasia in post gap arthroplasty cases. The paper also highlights intraoral as well as extraoral approach for performing the osteotomy along with better management of bad split under direct vision.

Result

It was observed that the reverse sagittal split technique for advancement of mandible in cases of tmj ankylosis-induced dentofacial deformity provided better proximal control, reduced chances of bad split, greater range of advancement (11-14 mm) with esthetically acceptable results. The osteotomy cuts on lateral surface of mandible make the procedure effectively easier and quicker with better control over proximal segment and management under direct vision.

Conclusion

When Distraction Osteogenesis and conventional orthognathic is not a choice in management of dentofacial deformity of post-release ankylosis cases due to the poor proximal control and concern over bad split, reverse sagittal split can be an appropriate choice to manage these deformities without any donor site morbidity.

Long-term three-dimensional condylar remodeling during presurgical orthodontics and after orthognathic surgery of mandibular retrognathia with high mandibular plane angle

OBJECTIVES

Patients with high mandibular plane facial morphology are the most dominant facial type who experience TMJ abnormalities with resultant condylar resorption, affecting the orthodontic and orthognathic treatment outcomes. The study aimed to quantitatively assess the three-dimensional condylar remodeling during the presurgical orthodontics and after orthognathic surgery of the retrognathic mandible with a high mandibular plane angle. The study also investigated the correlation between the resultant remodeling based on the hypothesis that condylar resorption following orthognathic surgery is a part of a progressive presurgical resorption process.

MATERIALS AND METHODS

The study included adults with mandibular retrognathism and high mandibular plane angle who have computed tomography scans (CT) obtained before any treatment (T0), after completion of presurgical treatment before surgery (T1), and at long-term follow-up after surgery (T2). DICOM of CT scan was gathered and processed using ITK-SNAP and 3D Slicer software. The interval between T0 and T1 was represented as a presurgical phase, while between T1 and T2 was defined as a postsurgical phase (T1-T2).

RESULTS

Twenty-five patients (50 condyles) were included with a mean age of 23 ± 3.2 years. The mean of the follow-up during the presurgical phase was 19.8 ± 7.1 months and 15.5 ± 5.5 months during the postsurgical phase. The condylar volume during the presurgical phase (T0-T1) was relatively stable (- 3.3 ± 37.2mm³). However, during the postsurgical phase (T1-T2), the volume was significantly reduced - 113.8 ± 98.3mm³ (P < 0.001). Localized condylar surface resorption during the postsurgical phase was significantly higher than during the presurgical phase (P < 0.05). No correlation was found between the localized condylar surface remodeling during the presurgical and postsurgical phases. However, a negative statistically significant correlation existed between the overall condylar volume changes during the presurgical and postsurgical phases (r = 0.502, P < 0.001).

CONCLUSION

Significant condylar resorption following orthognathic surgery of the retrognathic mandible with a high mandibular plane angle might occur regardless of the presurgical status of the condyle.

CLINICAL RELEVANCE

The study provided an evidence to be discussed with the patients and considered throughout the treatment of mandibular retrognathia with high mandibular plane angle.

Fetal markers for the detection of infants with craniofacial malformation

Facial clefts and Robin sequence (RS) share the timing of the diagnosis during the course of pregnancy, their association with genetic diseases and the subsequent management following the initial diagnosis. If a suspicion of a facial cleft or RS is made, a detailed anatomical examination of the fetus should be carried out to identify further anomalies. This may also involve genetic testing including a microarray or an exome analysis. Interdisciplinary counseling, including pre- and postnatal experts with sufficient experience in the management of such neonates, should be involved in this counseling. Parents should be informed about disease-specific therapeutic options and postnatal outcome. Delivery should take place in a center with experience in craniofacial malformations where clinicians are prepared for potentially life-threatening airway obstruction immediately after birth.

Loeys-Dietz Syndrome

Loeys-Dietz syndrome is an autosomal dominant aortic aneurysm syndrome characterized by multisystemic involvement. The most typical clinical triad includes hypertelorism, bifid uvula or cleft palate and aortic aneurysm with tortuosity. Natural history is significant for aortic dissection at smaller aortic diameter and arterial aneurysms throughout the arterial tree. The genetic cause is heterogeneous and includes mutations in genes encoding for components of the transforming growth factor beta (TGFβ) signalling pathway: TGFBR1, TGFBR2, SMAD2, SMAD3, TGFB2 and TGFB3. Despite the loss of function nature of these mutations, the patient-derived aortic tissues show evidence of increased (rather than decreased) TGFβ signalling. These insights offer new options for therapeutic interventions.

Arthroplasty Followed by Distraction Osteogenesis Versus Distraction Osteogenesis Followed by Arthroplasty in the Management of TMJ Ankylosis: A Comparative Study

Aim

To compare treatment outcome of arthroplasty followed by distraction osteogenesis (AFD) and distraction osteogenesis followed by arthroplasty (DFA) in the management of mandibular deficiencies in temporomandibular joint (TMJ) ankylosis.

Materials and methods

A total of 20 patients with TMJ Ankylosis were included in the study. Patients were randomly divided into two groups. Group 1 consisted of patients for whom arthroplasty was done prior to distraction osteogenesis (AFD) for the correction of deficient mandible. Group 2 included patients where distraction osteogenesis was performed prior to arthroplasty (DFA). The treatment outcome was assessed based on maximum interincisal distance, overjet, corpus length, ramus height, upper airway, lower airway, duration of the procedure and the complications for the treatment at the end of 3, 6 and 12 months.

Results

After the treatment was ended, the patients of both groups had increase in mouth opening and appearance was improved remarkably. There was general increase in all the parameters in both the groups. But at the end of 12 months, airway and the ramus height were more stable and the control of the proximal segment was superior in DFA group. Open bite was noticed in 2 cases of AFD group which was treated by elastics. There required additional surgery for the removal of distractors in the AFD Group. Establishing the airway during the surgery was easier in AFD group.

Conclusion

The study concludes that distraction followed by arthroplasty was a better procedure for the management of TMJ ankylosis owing to its stable results and less number of surgeries.

Effect of fixed functional appliances on pharyngeal airway dimensions in Skeletal Class II individuals - A scoping review

BACKGROUND

Skeletal Class II malocclusion due to a retrognathic mandible produces a backwardly positioned tongue and soft palate, emanating compromised upper airway dimensions and breathing difficulties.

AIMS

The present review aims to explore and concise the findings of the existing studies assessing the effects of fixed functional appliances on pharyngeal airway dimensions by advancing the mandible.

DESIGN

A literature search was carried out on MEDLINE/PubMed, Cochrane Library, Science direct, Semantic Scholar and Google Scholar databases for studies up to December 2020, resulting in 1037 studies. Specified inclusion/exclusion criteria guided the selection of 18 relevant articles. The sample size, type of the appliance, method of assessment and outcomes of these articles were assessed in detail and tabulated.

RESULTS

Out of 18 studies included, 12 were retrospective longitudinal and the remaining were clinical trials. Majority of the studies (72%) reported a positive influence of the fixed functional appliances on the dimensions of the oropharyngeal and hypopharyngeal airways with minimal effects on nasopharyngeal airway.

CONCLUSION

Thus, it can be concluded that fixed functional appliances have a beneficial effect on the middle and lower pharyngeal airway dimensions by advancing the mandible.

Effects of rapid maxillary expansion or alternating rapid maxillary expansion and constriction on nasal mucociliary clearance : A randomized clinical trial

PURPOSE

This parallel trial aimed to evaluate the changes in nasal mucociliary clearance (MCC) after a rapid maxillary expansion (RME) protocol or an alternating rapid maxillary expansion and constriction (Alt-RAMEC) protocol in orthodontic patients.

METHODS

This trial included 36 patients with a mean age of 14.38 years, with a narrow maxillary arch, bilateral posterior crossbite, no narrowing of the mandibular arch, no previous orthodontic treatment, and no nasal or systemic disease. Patients were randomly distributed into two groups (n = 18 each)-one group was treated with the RME protocol and the other group was treated with the Alt-RAMEC protocol. MCC was evaluated using the saccharine transit time (STT) test, which was measured for each individual before expansion (T0), after expansion (T1), and after a 4-month retention phase (T2). The study was single blinded, and blinding was applied only to the outcome assessor. The primary objective was to evaluate the effect of the Alt-RAMEC and RME protocols on MCC. The secondary objective was to determine the relationship between age, sex, and MCC. The χ ² test and independent samples t‑test were used to evaluate the data.

RESULTS

The STT decreased after expansion and retention in the RME group. In the Alt-RAMEC group, the STT decreased after expansion and slightly increased after retention. When the RME and Alt-RAMEC groups were compared, the STT showed a significant difference after expansion and retention (p < 0.05). No significant relationship was observed between age and sex and STT (p > 0.05).

CONCLUSION

This study demonstrated that the Alt-RAMEC protocol improved MCC and had a positive effect on nasal physiology by increasing the nasal volume more than that achieved by RME.

Prenatal diagnosis of a 1.651-Mb 19q13.42-q13.43 microdeletion in a fetus with micrognathia and bilateral pyelectasis on prenatal ultrasound

OBJECTIVE

We present prenatal diagnosis of a de novo 1.651-Mb 19q13.42-q13.43 microdeletion in a fetus with micrognathia and bilateral pyelectasis on prenatal ultrasound.

CASE REPORT

A 32-year-old woman underwent amniocentesis at 28 weeks of gestation because of fetal micrognathia and bilateral pyelectasis on prenatal ultrasound. Amniocentesis revealed a karyotype of 46,XX. Simultaneous array comparative genomic hybridization (aCGH) analysis on the DNA extracted from uncultured amniocytes revealed the result of arr 19q13.42q13.43 (55,028,722-56,680,564) × 1.0 [GRCh37 (hg19)] or a 1.651-Mb microdeletion encompassing 44 Online Mendelian Inheritance in Man (OMIM) genes including NLRP7, GP6, TNNT1, TNNI3 and DNAAF3. The parents did not have such a deletion and decided to continue the pregnancy. At 37 weeks of gestation, a 2560-g female baby was delivered by cesarean section because of oligohydramnios and decreased fetal movements. The baby manifested cleft palate, micrognathia and retrognathia at birth. She was doing well at age three months. Her body weight was 5.3 Kg (15th-25th centile), and body length was 59.2 cm (25th-50th centile). Renal sonogram showed bilateral mild pelvic dilation. She manifested no psychomotor retardation and no other internal organ abnormalities during pediatric follow-ups.

CONCLUSION

A 19q13.42-q13.43 microdeletion can be associated with micrognathia, retrognathia, cleft palate and bilateral pyelectasis at birth.

Skeletal and dentoalveolar contributions during Class II correction with Forsus™ FRD appliances : Quantitative evaluation

PURPOSE

Primary objective of the study is to quantify and evaluate the skeletal and dental contributions during sagittal Class II correction with the Forsus™ fatigue resistant device (FRD; 3M Unitek Corp., Monrovia, CA, USA). Secondary objective is to evaluate the overall vertical, soft tissue and chin-throat relation changes with the Forsus™ appliance.

PATIENTS AND METHODS

A retrospective sample of 27 Class II patients treated with the Forsus™ FRD appliance was compared to 20 untreated control subjects who were matched according to age and craniofacial morphology. Pre-Forsus™ (T0) and Post-Forsus™ (T1) cephalograms were subjected to composite cephalometric analysis. Growth changes were subtracted from the treatment changes to obtain the treatment effects of the appliance. The data were analyzed using Student's t‑test and independent t test.

RESULTS

Significant differences were found between the treated and the control group in 16 of 29 measured variables. The overjet and molar relation improved by 4.23 mm and 4.49 mm, respectively. This was mainly achieved by backward movement of maxillary incisors (1.4 mm) and molars (1.22 mm) and forward movement of mandibular incisors (2.26 mm) and molars (2.70 mm). Overbite decreased by 2.24 mm with no changes in mandibular and nasal plane angles.

CONCLUSION

The Forsus™ FRD was effective in correcting Class II malocclusion mainly at the dentoalveolar level. The net skeletal and dentoalveolar contributions towards both overjet and molar correction was 13% and 87%, respectively. The improvement in soft tissue profile and chin-throat configuration was statistically insignificant.

Three-dimensional changes in the location of soft tissue landmarks following bimaxillary orthognathic surgery

OBJECTIVES

We sought to determine the amount of three-dimensional (3D) movement of soft tissue landmarks in patients who underwent bimaxillary orthognathic surgery.

MATERIALS AND METHODS

We recruited 28 patients (11 women and 17 men), who had received one-piece Le Fort I osteotomy with maxillary advancement and impaction, and bilateral sagittal split ramus osteotomy for mandibular setback. The 3D images were acquired 1-7 days before surgery and at least 6 months after surgery using stereophotogrammetry. We recorded 50 coordinate measurements and correlated the movements between soft and hard tissues. Paired samples t‑test, independent samples t‑test, and Pearson's correlation analysis were used for statistical analysis.

RESULTS

Patients' ages ranged from 17-31 years (mean 20.4 ± 3.0 years). The mean advancement and impaction of the maxilla was 4.7 ± 1.2 and 2.2 ± 1.0 mm, respectively. The mean setback of the mandible was 4.2 ± 1.6 mm. Menton (Me) moved significantly closer to the midsagittal plane, and the bilateral alare (Al) and alar curvature (Ac) moved laterally. In addition, pronasale (Prn), bilateral Al, Ac, subnasale (Sn), subspinale (Ss), labiale superior (Ls), sublabiale (Sl), pogonion (Pog), and Me moved upwards. The bilateral cheek bone (Cbp), Al, Ac, Prn, Sn, Ss, Ls, and stomion (Sto) moved forward. Li, Sl, Pog, and Me moved backward. Interestingly, poor correlation was found between soft tissue landmarks and hard tissue movements.

CONCLUSION

We observed 3D coordinate changes in several soft tissue landmarks in the middle and lower thirds of the face. The results of this study may be useful for estimating postoperative changes in similar patients.

Orthognathic surgery in class II patients: a longitudinal study on quality of life, TMD, and psychological aspects

OBJECTIVES

To evaluate, longitudinally, the impacts of orthognathic surgery in patients with skeletal class II malocclusion on oral health-related quality of life (OHRQoL), temporomandibular disorders (TMD) and psychological symptoms.

MATERIALS AND METHODS

Forty-three patients with skeletal class II malocclusion who were submitted to orthognathic surgery were evaluated during their preoperative and postoperative periods. They answered the short version of the Oral Health Impact Profile (OHIP-14) and were also diagnosed according to Axes I and II of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The evolution of OHRQoL and TMD before and after surgery was verified, and the relationships among these variables were found through statistical analysis using Wilcoxon, McNemar, chi-square, and Mann-Whitney tests, with a 5% significance level.

RESULTS

The median of the overall OHIP-14 score and five domains decreased after orthognathic surgery (p < 0.05), the functional limitation domain increased (p = 0.014), and the physical disability domain did not show an association (p = 0.133). There were improvements in articular pain (p = 0.016), chronic pain (p = 0.019), and nonspecific physical symptoms excluding pain (p = 0.013). In addition, an association was found between poorer OHRQoL (overall scale and domains) and the Axis II variables of the RDC/TMD (p < 0.05).

CONCLUSION

Orthognathic surgery improved perceived OHRQoL, articular pain, and chronic pain. The conditions of Axis II of the RDC/TMD interfered with OHRQoL postoperatively.

CLINICAL RELEVANCE

Although orthognathic surgery improves QoL and some TMD conditions in skeletal class II patients, poorer postoperative outcomes are observed when psychological conditions are present.

Total facial nerve injury during mandibular distraction osteogenesis

INTRODUCTION

Over the last 10-15 years, usage of internal mandibular distraction systems has increased in the pediatric population, particularly for craniofacial syndromes. Mandibular distraction osteogenesis (MDO) has been shown to be effective in avoiding tracheostomy or achieving early decannulation in patients with micro-retrognathic mandibles in hemifacial microsomia or Pierre Robin sequence. As the frequency of the application of MDO has increased, so has the awareness and management of subsequent complications from the procedure. In this study, we discuss a complication involving paresis and eventual recovery of cranial nerve (CN) VII after the application of an MDO internal device at our institution in two cases. We also review the literature and propose multiple anatomic considerations that can impact more than just the marginal branch of CN VII.

METHOD

This study is a retrospective case study from our institution and a review of the literature. Pubmed was queried for terms singularly and in combination including "mandibular distraction osteogenesis", "facial nerve", "cranial nerve", "complications", "micrognathia", "retrognathia". After reviewing the results, studies discussing complications of MDO that involved CN VII were reviewed and included.

RESULTS

In the literature review and our retrospective review, CN VII injuries from MDO vary in their length and timing of onset. Management of this complication depended on the timing of onset and ranged from conservative management to removal of the distraction device. Majority (7/9) of the cases resolved to an eventual House-Brackmann of 0/6 with conservative measures.

CONCLUSION

Total facial nerve injury in association with MDO, has been scarcely reported, though the facial nerve is at great risk given its intimate location near the mandible particularly in neonates. It is encouraging that though it could be a devastating complication, out of all the cases reported, the large majority resolve with a combination of time and steroids.

Three-dimensional evaluation of treatment results of the Alt-RAMEC and facemask protocol in growing patients

PURPOSE

The aim of this retrospective study was to evaluate the skeletal, dental, and soft tissue effects of the alternating rapid maxillary expansions and constrictions (Alt-RAMEC) protocol combined with a facemask in prepubertal patients.

METHODS

The study group (mean age 9.74 ± 1.46 years) consisted of 20 patients with class III malocclusion characterized by maxillary retrognathism. They were treated with a facemask for 7 months following a 9‑week Alt-RAMEC protocol. Cone-beam computed tomography (CBCT) records and three-dimensional (3D) photographs taken before (T0) and after the protraction and retention period (T1) were evaluated. The study group was compared with a well-matched control group of 16 untreated patients (mean age 9.44 ± 0.79 years) with the same malocclusion. The records for the control group included cephalometric radiographs and 3D photographs.

RESULTS

In the study group, significant forward movements of A point (3.49 mm), nasal (2.91 mm) and zygomatic bones were achieved. Intermolar, internasal, and interzygomatic widths increased. Soft tissue points followed the hard tissue movements, apart from b and pog. In the control group, A (0.97 mm), B (1.69 mm), Pog, and b points presented forward movement. Significant differences were found regarding the forward movement of the maxilla between the groups.

CONCLUSION

The Alt-RAMEC/facemask protocol was effective not only in the maxillary region but also in the midface.

Skeletal Surgery for Obstructive Sleep Apnea

This article focuses on the role of skeletal surgery within the modified Stanford protocol with particular attention focused on the evolved role of MMA. First, surgery in patients presenting with congenital dentofacial deformity or characteristic drug-induced sleep endoscopy findings, then the growing role of maxillary expansion in a newly identified patient phenotype, and finally genioglossus advancement, are discussed. Less commonly used and validated techniques, such as isolated mandibular advancement and maxillomandibular expansion are not discussed in this article.

A Triad of Temporomandibular Joint Ankylosis, Mandibular Retrognathia and Severe Obstructive Sleep Apnoea: Case report

The surgical management of paediatric patients with temporomandibular joint (TMJ) ankylosis, mandibular retrognathia and obstructive sleep apnoea (OSA) is challenging. We report a nine-year-old boy who presented to the Department of Oral Health, Sultan Qaboos University Hospital, Muscat, Oman, in 2016 with complaints of limited mouth opening, loud snoring and excessive daytime sleepiness. He was diagnosed with TMJ ankylosis, mandibular retrognathia and severe OSA. The patient initially underwent mandibular distraction and, subsequently, release of the TMJ ankylosis and rib graft reconstruction. The overall patient outcome was successful, with improvement in OSA-related symptoms, good facial symmetry and adequate mouth opening.

Impact of early intravelar veloplasty at six months on mandibular growth in patients with Pierre Robin Sequence

Pierre Robin Sequence (PRS) combines mandible microretrognathia, asynchronism of the pharynx and tongue, glossoptosis and, in some cases, cleft palate. Its principal functional consequences are respiratory and feeding problems during the neonatal period. In this study, we focused on the impact of early closure of the cleft at six months on mandibular growth in patients with PRS. We performed a retrospective study of 15 patients followed for PRS and undergoing surgery performed by the same senior surgeon (HB) at our cleft center between 2005 and 2012. These patients underwent early closure of the cleft (at a mean age of 5.87 months) by intravelar veloplasty, as described by Sommerlad. Only one article with exploitable data analyzing facial and mandibular growth in a cephalometric study of children with PRS has been published. The children in this series, constituting the control group for our study, underwent veloplasty between the ages of 12 and 18 months, often accompanied by labioglossoplasty, and the cephalometric study was carried out between the ages of four and seven years. We compared this control group in which surgery was performed at 12-18 months with our series of children undergoing surgery at six months, in a cephalometric study based on teleradiographic profile measurements performed between the ages of four and seven years. We found that early closure of the cleft soft palate yielded results identical to those for the control group in terms of mandibular growth, without the need for labioglossopexy. Finally, early intravelar veloplasty led to early functional improvement in terms of speech and phonation.

Effect of removable functional appliances on mandibular length in patients with class II with retrognathism: systematic review and meta-analysis

BACKGROUND

Orthopedic functional devices, are used to improve mandibular length in skeletal class II patients. However, the orthopedic functional device with the best effect to increasing the mandibular length, has not been identified before. Thus, the aim of the present investigation was to evaluate Randomized Controlled Trials (RCT), to determine the best functional appliance improving mandibular length in subjects with retrognathism.

METHODS

A systematic review and meta-analysis was performed, including studies published and indexed in databases between 1966 and 2016. RCTs evaluating functional appliances' effects on mandibular length (Condilion-Gnation (Co-Gn) and Condilion-Pogonion (Co-Po)), were included. Reports' structure was evaluated according to 2010 CONSORT guide. The outcome measure was distance between Co-Gn and/or Co-Po after treatment. Data were analyzed with Cochran Q Test and random effects model.

RESULTS

Five studies were included in the meta-analysis. The overall difference in mandibular length was 1.53 mm (Confidence Interval (CI) 95% 1.15-1.92) in comparison to non-treated group. The Sander Bite Jumping reported the greatest increase in mandibular length (3.40 mm; CI 95% 1.69-5.11), followed by Twin Block, Bionator, Harvold Activator and Frankel devices.

CONCLUSIONS

All removable functional appliances, aiming to increase mandibular length, are useful. Sander Bite Jumping was observed to be the most effective device to improve the mandibular length.

Glossoptosis

Glossoptosis causes varying degrees of airway obstruction and feeding difficulties. It can occur as a consequence of micrognathia in Robin Sequence, but can also occur in children with hypotonia. Despite several attempts to classify severity in Robin Sequence patients, taking into account symptoms, presence of concomitant syndromes or malformations, and even endoscopic findings, there is still no general consensus. Furthermore, several management recommendations have been reported without an agreement about indications, efficacy, or risks of each treatment option. The present article provides an overview of clinical presentation, diagnosis, management, and prognosis of patients with glossoptosis.

Unilateral Ankylosis of Temporomandibular Joint (TMJ) with Contralateral Condylar Aplasia and Related Orthopedic Deformity - Syndromic or Nonsyndromic?

Condylar aplasia which means "failure of development" is a rare condition and can be unilateral or bilateral. Mandibular condylar Aplasia without any association with syndrome is extremely rare. Temporomandibular joint (TMJ) ankylosis results from trauma, infection and inadequate surgical treatment of the condylar area. Congenital cases are very rare. We report case of congenital unilateral aplasia of left mandibular condyle with ankylosis of right condyle, with an associated orthopedic deformity in a nine-year-old male patient, which may be a part of some unreported syndrome that has not been mentioned so far in literature. As per our best knowledge, no other case including such clinical features has been reported.

Skeletal malocclusion: a developmental disorder with a life-long morbidity

The likelihood of birth defects in orofacial tissues is high due to the structural and developmental complexity of the face and the susceptibility to intrinsic and extrinsic perturbations. Skeletal malocclusion is caused by the distortion of the proper mandibular and/or maxillary growth during fetal development. Patients with skeletal malocclusion may suffer from dental deformities, bruxism, teeth crowding, trismus, mastication difficulties, breathing obstruction and digestion disturbance if the problem is left untreated. In this review, we focused on skeletal malocclusion that affects 27.9% of the US population with different severity levels. We summarized the prevalence of class I, II and III of malocclusion in different ethnic groups and discussed the most frequent medical disorders associated with skeletal malocclusion. Dental anomalies that lead to malocclusion such as tooth agenesis, crowding, missing teeth and abnormal tooth size are not addressed in this review. We propose a modified version of malocclusion classification for research purposes to exhibit a clear distinction between skeletal vs. dental malocclusion in comparison to Angle’s classification. In addition, we performed a cross-sectional analysis on orthodontic (malocclusion) data through the BigMouth Dental Data Repository to calculate potential association between malocclusion with other medical conditions. In conclusion, this review emphasizes the need to identify genetic and environmental factors that cause or contribute risk to skeletal malocclusion and the possible association with other medical conditions to improve assessment, prognosis and therapeutic approaches.

Mandibular volumetric increase following distraction osteogenesis

INTRODUCTION

Mandibular distraction osteogenesis (MDO) for the treatment of Pierre Robin sequence (PRS) enables mandibular lengthening and improves airway and feeding function. It remains unknown how the post-distracted mandibular volume compares to a normal control population. The aim of this study was to analyze mandibular volume and symmetry following bilateral MDO and compare post-distraction measurements to a non-distracted, normal age- and sex-matched control cohort.

METHODS

Demographic information and three dimensional-computed tomographic (CT) images were obtained from normal control and distracted PRS patients. Mandibular volume and symmetry indices were calculated and results statistically analyzed. P values ≤0.05 were considered statistically significant.

RESULTS

24 CT scans and 48 hemimandibles were analyzed (8 control patients: mean age = 5.6 months, 3 females; 8 distracted patients: mean age pre-distraction = 1.8 months, mean age post-distraction = 5.3 months, 3 females). No complications were encountered in the distracted group. The mean pre- and post-distraction volume in the MDO group measured 7238.1 mm(3) and 15,360.6 mm(3), respectively (P = 0.0003) and the mean percent increase in mandibular volume following distraction was 113.3%. The mean symmetry index increased after distraction from 0.91 to 0.95 (P = 0.31). Matched normal control mandibles measured 13,488.6 mm(3) versus post-distraction mandibles at 15,360.6 mm(3) (P = 0.40). Normal control and post-distraction symmetry indices were 0.99 and 0.95, respectively (P = 0.68).

CONCLUSION

Distraction resulted in a significantly increased mandibular volume and an observed preservation in mandibular symmetry. Post-distraction volume was increased compared to normal controls but remained less symmetrical.