Diagnostic value of qualitative and quantitative enhancement parameters on contrast-enhanced mammography

PURPOSE

To determine whether qualitative and quantitative enhancement parameters obtained from contrast-enhanced mammography (CEM) can be used in predicting malignancy.

METHODS

After review board approval, consecutive 136 suspicious lesions with definite diagnosis were retrospectively analyzed on CEM. Acquisition was routinely started with craniocaudal view and ended with mediolateral oblique view of the affected breast. Lesion conspicuity (low, moderate, high), internal enhancement pattern (homogeneous, heterogeneous, rim), contrast-to-noise ratio (CNR), percentage of signal difference (PSD) and relative enhancement from early to late view were analyzed. PSD and relative enhancements were used to determine patterns of descending, steady or ascending enhancements. Receiver operating characteristic analysis, Cohen's kappa statistics and Spearman correlation tests were used.

RESULTS

There were 29 benign and 107 malignant lesions. 64% of the malignant lesions exhibited high conspicuity compared to 14% of the benign lesions (P < 0.001). CNR values were higher in malignant lesions compared to benign ones (P ≤ 0.004). CNR from early view yielded 82% sensitivity, 72% specificity and PSD yielded 79% sensitivity, 65% specificity. Descending pattern and rim enhancement observed in 44% and 21% of breast cancers, respectively, and both provided 96% positive predictive value for malignancy.

CONCLUSION

Diagnostic accuracy of quantitative parameters was higher than that of qualitative parameters. High CNR, rim enhancement, and descending pattern were features commonly seen in malignant lesions, while low CNR, homogeneous enhancement, and ascending pattern were commonly seen in benign lesions.

A Single Tertiary Center 14-year Experience With Mesenteric Panniculitis in Turkey: A Retrospective Study of 716 Patients

BACKGROUND

Mesenteric panniculitis is a chronic inflammatory process seen in mesenteric tissue. The purpose of this study was to assess the prevalence, clinical, laboratory, and radiological findings, and malignancy in patients diagnosed with mesenteric panniculitis using computed tomography.

METHODS

A total of 716 patients with mesenteric panniculitis were retrospectively evaluated by screening all computed tomography scans performed between January 2005 and December 2018.

RESULTS

Among 65 278 patients undergoing CT, 716 were diagnosed with mesenteric panniculitis. The prevalence of mesenteric panniculitis was 1.1%. The mean age was 56 ± 14 (20-91) years. The malignant and nonmalignant groups comprised 354 (49.4%) and 362 (50.6%) patients, respectively. The mean age of the malignant group was significantly higher than the nonmalignant group (P < .001). The most common malignancy was breast cancer (12.2%). A history of abdominal surgery was present in 179 (25%) patients with mesenteric panniculitis and it is higher in the malignant group than the nonmalignant group (128 [36.1%], 51 [14%], respectively, P < .001). Mean hemoglobin level and leukocyte count were lower in the malignant group than in the nonmalignant group (P < .001, P < .001, respectively). The mean erythrocyte sedimentation rate was higher in the malignant group than in the nonmalignant group (P = .030). Radiological criterion 2 was less common and radiological criterion 5 was more common in the malignant group than the nonmalignant group (91.0%, 96.4%, P = .004; 35.9%, 27.1%, respectively, P = .011).

CONCLUSIONS

It is recommended to conduct research for malignancy in patients with mesenteric panniculitis, especially in the presence of clinical, laboratory, and radiological findings with high-risk features.

Investigation of Effects of Gadolinium-Based Contrast Agents on Uterine Contractility Using Isolated Rat Myometrium

BACKGROUND

Despite concerns about safety, gadolinium-based contrast agents (GBCAs) are still used for abdominal and pelvic imaging during pregnancy. Researchers have mainly focused on teratogenicity, while very little is known about their possible direct effects on uterine contractility, yet free gadolinium potentially impacts contractility through interaction with calcium channels.

PURPOSE

To investigate possible effects of selected GBCAs (namely gadoteridol, gadoversetamide, gadobutrol, gadoterate meglumine, and gadoxetic acid) on the contractility of rat myometrium.

STUDY TYPE

In vitro organ bath study.

ANIMAL MODEL

Myometria were isolated from adult (10-12 weeks old) Sprague Dawley rats, both pregnant (N = 8) and nonpregnant (N = 36).

FIELD STRENGTH/SEQUENCE

NA.

ASSESSMENT

Myometrial strips were suspended in tissue bath containing physiological saline and isometric contractions were recorded. GBCAs were added to the tissue bath cumulatively, and their effects on contractility parameters (quantified by amplitude, frequency, and area under contractility curve [AUC]) were evaluated by 10-minute intervals.

STATISTICAL TESTS

Normality data, checked by Shapiro-Wilk test, were transformed by arcsine when needed. One- or two-way analysis of variance was performed, where appropriate, followed by Student-Newman-Keuls test. A P value of <0.05 was considered statistically significant.

RESULTS

All of the assayed GBCAs elicited some alterations in the myometrial contractility in a concentration-dependent manner. Gadoterate meglumine, gadoxetic acid, and gadoversetamide caused a concentration-dependent significant attenuation in AUC (oxytocin-induced, from 100% during control period to 45.1 ± 9.0% (nonpregnant) and 59.9 ± 8.5% (pregnant), for 90 μM gadoterate meglumine; respectively), and frequency of the spontaneous and oxytocin-induced contractions. Gadobutrol and gadoteridol at highest dose significantly attenuated mean AUC and frequency of oxytocin-induced contractions of nonpregnant myometrium.

DATA CONCLUSION

Results from this in vitro study indicate that GBCAs elicit modulation of myometrial contractions at clinically relevant concentrations. These effects may account, at least partially, for the known potential side effects (rare cases of miscarriages and elective abortion) of these agents.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY: Stage 5.

Radiological manifestations of thoracic hydatid cysts: pulmonary and extrapulmonary findings

Hydatid cyst caused by the larval form of Echinococcus is a worldwide zoonosis. The lungs and liver are the most common sites involved. While the lung parenchyma is the most common site within the thorax, it may develop in any extrapulmonary region including the pleural cavity, fissures, mediastinum, heart, vascular structures, chest wall, and diaphragm. Imaging plays a pivotal role not only in the diagnosis of hydatid cyst, but also in the visualization of the extent of involvement and complications. The aim of this pictorial review was to comprehensively describe the imaging findings of thoracic hydatid cyst including pulmonary and very unusual extrapulmonary involvements. An outline is also given for the findings of complications and differential diagnosis of thoracic hydatid cyst.

Chondrocyte proliferation, viability and differentiation is declined following administration of methylphenidate utilized for the treatment of attention-deficit/hyperactivity disorder

PURPOSE

Methylphenidate (MPH) derivative drugs are used because of psychostimulants effects on attention-deficit hyperactivity disorder in children and adults. As far as we know, toxic or anti-proliferative effects of MPH against cartilage tissue were not studied in the literature. The present study was carried out to investigate the possible effects of MPH on the proliferation, viability and differentiation of primary human chondrocytes, in vitro.

METHODS

Monolayer primary chondrocyte cultures were prepared using osteochondral tissue obtained from patients who underwent a total knee prosthesis operation. Stock solution of MPH was prepared and aliquots having 1-1000 µM concentrations of the drug was composed. These solutions were applied to the wells containing cultured chondrocyte samples within the well plates. Control groups were composed of pure chondrocyte culture and no solution was added into them. All groups were evaluated at 24, 48 and 72 h in order to determine the possible negative effects of the drug on the chondrocytes. The data were evaluated by Tukey's honestly significantly different test following analysis of variance.

RESULTS

In the group where MPH was applied, it was found that viability, proliferation and stage-specific embryonic antigen-1 protein expression were decreased in comparison to the control group.

CONCLUSIONS

It was emphasized that clinicians should not disregard the fact that this drug might suppress chondrocyte cell proliferation and chondrogenic differentiation.

Orientation dependent tribological behavior of TiN coatings

The preferred growth direction of cathodic arc physical vapor deposition-produced TiN coatings changes from (1 1 1) to (2 2 0) with high voltage pulsed bias application in the presence of Ar gas. In this study, tribological properties of these coatings were investigated via reciprocating wear tests against an inert counterbody for observing the role of orientation on tribological properties. Friction coefficients and wear of (2 2 0) oriented coatings were observed to be significantly lower compared to (1 1 1) oriented coatings. Micro-Raman investigations of the wear debris formed during tribotest revealed clear differences between (1 1 1) and (2 2 0) oriented films. Wear debris obtained from (2 2 0) oriented coatings consisted of nc TiO2 phases (anatase and rutile) whereas (1 1 1) oriented coatings produced amorphous Ti oxides. This behavior is attributed to the orientation dependent oxidation kinetics of the coatings as verified with isothermal oxidation tests. A mechanism for improved tribological behavior is proposed based on the obtained results.

Value of the neutrophil-to-lymphocyte ratio in predicting post-pericardiotomy syndrome after cardiac surgery

OBJECTIVE

Post-pericardiotomy syndrome (PPS) occurs in 10-40% of patients after cardiac surgery. PPS is considered an autoimmune phenomenon. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory marker that is associated with various cardiovascular diseases. Studies have reported that the NLR increases in certain autoimmune diseases. This study examined whether the NLR is helpful to predict the occurrence of PPS after elective on-pump coronary artery bypass graft (CABG) surgery.

PATIENTS AND METHODS

The records of patients who underwent elective first-time on-pump CABG were reviewed retrospectively. In total, 72 patients with PPS were included in the study, and 100 patients who did not develop PPS were included as the control group. Peripheral blood samples collected preoperatively and on postoperative day 1 were used to calculate the NLR.

RESULTS

No differences in preoperative white blood cell (WBC) count, neutrophil count, lymphocyte count, or NLR were observed between the patients with PPS and the control group. The WBC (p < 0.001) and neutrophil counts (p < 0.001) and NLR (p = 0.01) were significantly higher during the postoperative period in patients with PPS than in the control group. A receiver operating characteristic curve analysis showed that the postoperative NLR predicted PPS with 60% sensitivity and 59% specificity (area under the curve, 0.61; 95% confidence interval [CI], 0.51-0.70; p = 0.017), using a cut-off of 8.34. The postoperative WBC count (odds ratio [OR], 1.6; 95% CI, 1.36-2.03; p < 0.001) and NLR (OR, 3.3; 95% CI, 1.56-7.01; p = 0.002) were independently associated with PPS.

CONCLUSIONS

The postoperative NLR may be useful to predict the development of PPS in patients undergoing on-pump CABG.

Anomalous small cardiac vein draining into the superior vena cava

Coronary venous anatomy is little studied, and an abnormal coronary vein drainage is a rarely reported entity. Few cases about abnormal drainage of the great cardiac vein into the superior vena cava have been reported in literature. Herein we present a case of anomalous small cardiac vein draining into superior vena cava.

Analysis of genetic relationships among perennial and annual Cicer species growing in Turkey using RAPD markers

Random amplified polymorphic DNA (RAPD) fragments were used to assess genetic relationships among Cicer spp. growing in Turkey. Seven 10-mer primers selected from a 50 random oligonucleotide primer set, depending on their ability to amplify genomic DNA in all species, were used to detect RAPD variation in 43 wild and cultivated accessions representing ten species. These primers yielded 95 reproducible amplification products, 92 of which were polymorphic. Pairwise genetic distances of accessions estimated according to Nei and Li (1979) were used to produce a dendrogram using UPGMA. The dendrogram contained two main clusters, one of which comprised accessions of the four perennial species ( Cicer montbretii, Cicer isauricum, Cicer anatolicum and Cicer incisum) together with the accessions of the three annual species ( Cicer pinnatifidum, Cicer judaicum and Cicer bijugum), and the other cluster included the remaining three annual species ( Cicer echinospermum, Cicer reticulatum and Cicer arietinum). Analysis of RAPD variation showed that C. incisum is the most similar perennial species to annuals, and C. reticulatum is the closest annual species to chickpea. These results generally agree with our allozyme study which was carried out using same Cicer collection and previous studies of relationships among annual species. The results also show that RAPD markers can be used to distinguish Cicer species and to survey genetic variation and relationships among taxonomic units in this genus.

Effects of spring-loaded posterior bite-block appliance on masticatory muscles

The effects of spring-loaded posterior bite-blocks on masticatory muscles were investigated to evaluate the correlation between masticatory muscles and craniofacial form in long-faced children. The appliance was used in 10 subjects (6 girls and 4 boys) with a chronological mean age of 10.40 +/- 1.12 years for the treatment of skeletal anterior open bite. Electromyographic activity of the anterior and posterior temporal and masseter muscles was recorded before and after treatment during postural position, maximal biting, chewing, swallowing, postural position with the appliance in the mouth, and maximal biting with the appliance in the mouth. After treatment, increases in SNB and overbite (P <.05, P <.001, respectively) and decreases in ANB, SNGoAr, and overjet parameters were found to be statistically significant (P <.05, P <.01). When the measurements related to muscle activity were examined, increases in anterior temporal postural (P <.05), anterior temporal chewing (P <.01), masseter chewing (P <.05), posterior temporal chewing (P <. 05), and masseter swallowing (P <.01) were found to be statistically significant. A positive correlation was found between ANB and anterior temporal postural and a negative correlation between SNGoAr and masseter swallowing. The increase in muscle activities was considered to occur as a result of the appliance used.

A comparison of sagittal and vertical effects between bonded rapid and slow maxillary expansion procedures

The purpose of this study was to determine the vertical and sagittal effects of bonded rapid maxillary expansion (RME), and bonded slow maxillary expansion (SME) procedures, and to compare these effects between the groups. Subjects with maxillary bilateral crossbites were selected and two treatment groups with 12 patients in each were constructed. The Hyrax screw in the RME treatment group and the spring of the Minne-Expander in the SME treatment group were embedded in the posterior bite planes, which had a thickness of 1 mm. At the end of active treatment these appliances were worn for retention for an additional 3 months. Lateral cephalometric radiographs were taken at the beginning and end of treatment, and at the end of the retention period. The maxilla showed anterior displacement in both groups. The mandible significantly rotated downward and backward only in the RME group. The inter-incisal angle and overjet increased in both groups. No significant differences were observed for the net changes between the two groups.

Comparison of dental arch and arch perimeter changes between bonded rapid and slow maxillary expansion procedures

The purpose of this study was to evaluate and compare the dental effects of bonded rapid maxillary expansion (RME) and bonded slow maxillary expansion (SME) treatment methods. Subjects with a maxillary bilateral crossbite were selected and two treatment groups each with 12 patients were constructed. At the beginning of treatment, the average chronological ages were 11.96 years for the RME group and 12.31 years for the SME group. The Hyrax screw in the RME treatment group and the spring of the Minne-Expander in the SME treatment group were embedded in the posterior bite planes, which had a thickness of 1 mm. The treatment time for the RME group varied from 0.70 to 1.60 months and for the SME group 1.00-5.16 months. At the end of active treatment the appliances were worn for retentive purpose for an additional 3 months. Orthodontic casts taken at the beginning and end of treatment, and at the end of the retention period formed the material for the study. Increases in the transversal width between the upper molars, upper first premolars, upper canines, lower canines, and in the upper arch perimeter were obtained. The increase in the upper inter-canine width was found to be significantly greater in the RME group compared with the SME group. Regression analysis indicated that arch perimeter gain through the treatment could be predicted as 0.65 times the amount of the posterior expansion for the RME group and 0.60 times the amount of posterior expansion for the SME group.

Clinical value of preoperative intraoral ultrasonography in tonsillectomy

In this prospective study, 43 chronic tonsillitis patients underwent intraoral ultrasonography preoperatively and the width and thickness of tonsils and tonsillocarotid distances were measured. Positive correlation was obtained in postoperative measurements compared with ultrasonographic measurements of tonsils. The mean tonsillocarotid distances were 8.6 mm in the left and 8.25 mm in the right tonsillar fossa. This study showed that preoperative intraoral ultrasonography was to be help of tonsillectomy operations particularly in surgical anatomical orientation.

The effect of peritonsillar corticosteroid infiltration in tonsillectomy

A prospective, randomized, double-blind, placebo-control clinical study was performed to determine the effects of peritonsillar infiltration of dexamethasone on peroperative and postoperative morbidity in patients undergoing tonsillectomy with local anesthesia. A total of fifty-two patients, aged 14-34, were randomized to infiltrate dexamethasone (0.5 mg/kg, maximum dose, 12 mg) or placebo with local anesthetic at the peritonsillar region. Incidence of postoperative complications, pain medications, appetite, oral intake (type of diet) and fever were also compared between the two groups. Demographics of dexamethasone and placebo groups were similar. No statistically significant differences were noted peroperative procedures, postoperative complications, pain medication, appetite, oral intake (type of diet) between the two groups of patients.

Post-retention results of spring-loaded posterior bite-block therapy

In this study, ten patients who were treated with spring-loaded posterior bite blocks (SLPBB), were evaluated over a period of two years in order to test the effects of the appliance and the incidence of relapse. Successful treatment with SLPBB was achieved in skeletal and dental open bite cases. However, the use of acrylic bite blocks for retention during the post-treatment growth period, did not prevent relapse.

Enamel fluoride levels after orthodontic band cementation with glass ionomer cement

The aim of this investigation was to examine the fluoride uptake by enamel after application of glass ionomer cement for orthodontic band cementation compared with zinc phosphate cement. The study was conducted on 21 children whose mean age was 14 years. All the children were reared in the Middle Anatolian cities where the water fluoride concentration was below the level of 0.50 ppm. The subjects were randomly divided into three groups. The first experimental group, had seven subjects whose teeth were topically fluoridated with 2 per cent NaF solution, before orthodontic band cementation with zinc phosphate cement. The second experimental group also had seven subjects whose orthodontic bands were cemented with glass ionomer cement. The third group, consisted of seven control subjects and no dental procedures were performed in this group. All the participants were followed for 3 months and at the end of this period maxillary first premolars, which were in the ninth developmental stage according to Nolla (1960), were extracted for orthodontic purposes. The enamel fluoride concentrations were determined on the left maxillary first premolars at three successive etch depths by means of a fluor ion electrode, whereas the calcium concentrations were determined with an atomic absorption spectrophotometer. The results of this investigation showed that in both cementation groups enamel fluoride concentrations at three successive etch depths were highly increased compared with the control group. However, the difference between the cementation groups was not statistically significant.

Are lipoprotein profile and lipoprotein (a) levels altered in men with psoriasis?

BACKGROUND

Previous studies have demonstrated that patients with psoriasis may have an increased risk of a variety of noncutaneous diseases, including arterial and venous occlusive diseases. Changes in plasma lipid and lipoprotein composition in patients with psoriasis may be the reason for the increased risk of atherosclerosis in these patients. Lipoprotein (a) (Lp(a)) is a genetically determined lipoprotein associated with an increased prevalence of atherosclerotic and thrombotic cardiovascular diseases.

OBJECTIVE

The aim of this prospective study was to determine the lipid profile and to define the significance of Lp(a) levels in men with psoriasis. The other purpose was to learn whether a correlation exists between psoriasis area and severity index score and serum Lp(a) or other lipids.

METHODS

Serum Lp(a) levels were measured with a commercially available noncompetitive enzyme-linked immunosorbent assay in 32 men with psoriasis and in 13 healthy men. Total serum cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, apolipoprotein A-I and apolipoprotein B levels, and atherosclerotic risk factors other than hyperlipidemia were determined. Secondary hyperlipidemia from various diseases and drugs was ruled out in both groups.

RESULTS

Serum Lp(a) levels were higher in men with psoriasis than in healthy male subjects, but the difference was not significant (p = 0.063). Serum fasting glucose levels were also found to be higher in the psoriasis group (p < 0.05). Higher serum Lp(a) and fasting glucose levels tended to occur in patients with extensive and severe skin involvement. No statistical differences were observed in the total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, apolipoprotein A-I, and apolipoprotein B levels between the two groups (p > 0.05).

CONCLUSION

Our results suggest that the increased Lp(a) level might be a factor involved in occlusive vascular disorders in patients with psoriasis and that patients with extensive and severe skin involvement are more predisposed to relatively high Lp(a) levels.

Vascular involvement in Behçet's disease

Behçet's disease (BD) is a multisystem disorder characterized by recurrent oral and genital ulcerations with uveitis. At onset it may present with manifestations of vascular involvement instead of the classical triad. We analyzed 137 patients with BD and 38 had vascular involvement with a prevalence of 27.7%. Male to female ratio was 4.4 and associations of positive pathergy test (76.3%) and eye lesions (57.8%) were higher compared to patients without vascular involvement. Patients with subcutaneous thrombophlebitis were more likely to develop major venous occlusions (22.2%) in the lower extremities and inferior vena cava. Arterial lesions were less frequent features constituting 12.0% of vascular complications in BD.

The effects of the spring-loaded posterior bite-block on the maxillo-facial morphology

The purpose of this study was to determine the effects of the spring-loaded bilateral posterior occlusal bite-block on the maxillo-facial morphology, with emphasis on the response of the facial structures to the progressively increased vertical dimension. Our sample consisted of two groups: eleven open-bite subjects having a mean age of 10.30 years, treated with spring-loaded posterior bite-blocks over a mean period of 0.49 +/- 0.08 years (6 months); and twelve open bite subjects with a mean age of 9.84 years, treated by means of passive posterior bite-block and vertical chin-cap for a mean period of 0.67 +/- 0.03 years (8 months). The average daily use of the appliances was 16 hours. The study was carried out on lateral head films taken prior to and after treatment, which was concluded when an overbite of 1-1.5 mm was achieved. The results did not reflect any statistically significant difference between the groups when considering the changes in the horizontal growth pattern of the mandible, the decrease of the lower and the total anterior facial heights, or the overbite achieved by the two types of posterior bite-blocks. The artificial increase of the vertical dimension contributed to a statistically significant increase in the ramal inclination in both groups, though greater in the spring-loaded posterior bite-block group.

[The occurrence of cavitation after orthodontic bonding. A case report]

In this case report occurrence of cavitation on the lingual enamel surfaces of teeth after orthodontic direct bonding a canine to canine lingual retainer is presented and possible reasons which might play a role in their formation was investigated by "SEM" and "electron microprobe analyzer". Although the morphologic structure is normal, a mineral loss is detected and it is thought that an easier dissolution of enamel is occurred by the penetration of saliva and plaque microorganisms throughout the enamel-resin junction.

[An evaluation of appliance hygiene index on patients wearing removable orthodontic appliance]

The appliance hygiene performance and its relationship with stomatitis lesions were investigated on 124 patients who were using maxillary removable orthodontic appliance. The patients were divided into five groups according to the appliance wearing periods. Appliance hygiene index (AHI) showed no significant difference between the groups except the fifth group and the prevalence of stomatitis was found as 8.9 percent. There was not any significant correlation between the quantity of plaque and the degree of stomatitis.

[Interrelationships between orthodontics and periodontics]

It has been known that orthodontic appliances have been a local etiologic factor contributing to periodontal problems. Properly executed tooth movement should be accompanied by a more favorable periodontal response rather than an adverse reaction. Today guiding the patient's orthodontic therapy with fixed and removable appliances requires a sophisticated knowledge of the periodontium. The purpose of this article is to describe several interrelationships between orthodontics and periodontics and to highlight frequent problem areas.

[The use of spring-loaded posterior bite-block in the treatment of open-bite]

The treatment objectives of open-bite cases which occurs as a result of the excess vertical growth of nasomaxillary complex, increase in the upper and lower posterior vertical dentoalveolar development, downward and backward growth of the mandible are restraining of the growth capacity of these regions and leading the growth of the mandible on the horizontal plane. One of the treatment alternatives of these cases is the spring-loaded posterior bite block; a functional orthopedic appliance. In this case report which the effects of spring-loaded posterior bite block therapy on craniofacial and dentoalveolar structures have been shown; three cases having chronological ages of 9 years 8 months; 10 years 4 months and 10 years 1 month were presented and the treatment results were discussed. The common effects of spring-loaded posterior bite-block therapy observed in three cases are; the restraint of the vertical growth of the maxilla and of both lower-upper posterior dentoalveolar structures, change in the growth pattern of the mandible from vertical towards horizontal plane.

[Effects of activator and activator + anterior high-pull headgear on the growth direction of Class 2 cases]

In this study which the effects of activator and activator + anterior high-pull headgear on the growth direction of skeletal class 2 cases for a period of approximately 9 months; 33 cases having a mean age of 10.59 years; ANB angles 4.5 degrees and over were studied. Activator treatment has been applied to the 11 of the 22 treatment cases, the others have had the activator + anterior high-pull headgear treatment. The control group, 11 patients, has only been observed in terms of the growth and development without having any treatment. At the end of the study; it was found that the decrease in ANB angle and the increase in SL dimension in the treatment groups; the increase in anterior lower face height in the activator group and the increase in the ratio of posterior to anterior face height were statistically significant.