CBCT location of the fusion between the buccal and lingual cortical in the mandibular ramus: Importance to sagittal split osteotomy

Background: Mandibular Sagittal Split Osteotomy (MSSO) is a popular technique in orthognathic surgery used both to advance and to retreat the mandible. However, MSSO may incur in important complications, such as bad splits and sensorineural injuries. Knowing the location of the fusion between the buccal and lingual cortical (FBLC) in the mandibular ramus and the bone thickness in the region where osteotomies will be performed is determinant in MSSO planning to avoid complications. The aim of this study was to document and evaluate possible differences between sexes regarding the location of the FBLC in relation to the superior cortical of mandibular foramen (MF) and bone thickness in the region of interest for MSSO in a Brazilian population. Material and Methods: Eighty five cone-beam Computed Tomography (CBCT) scans were used to perform linear measurements to determine the location of the FBLC. Bone thickness from the mandibular canal (MC) to the cortical external surfaces and the diameter of the MC were measured at three different points: mandibular ramus (A), mandibular angle (B) and mesial of the second molar (C). Results: The FBLC was located at a mean distance of 8.3 mm from the superior cortical of the MF in males and 8.1 mm in females. There was no difference between males and females regarding the mean bone thickness from the MC to the buccal external surface at all the points investigated (p>0.05). Bone thickness from the lingual external surface to the MC was bigger among females than males in regions B and C (p < 0.05). The diameter of the MC was bigger among males in regions B and C. Conclusions: Sexual dimorphism regarding mandibular bone thickness but not regarding the location of FBLC was present. This fundamental knowledge may assist to the panning of MSSO (AU)

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The bite force and craniofacial morphology in patients with acromegaly: A pilot study

OBJECTIVES: Acromegaly is a metabolic disorder caused by increased growth hormone secretion. As a consequence of acromegaly some typical craniofacial morphology changes appear. This pilot study was conducted to compare the bite force and the characteristic size and shape of the craniofacial components of acromegalic patients with the healthy Turkish individuals. In additon, the correlations between bite force and craniofacial morphology of patients with acromegaly and control individuals were evaluated. Study DESIGN: The maximum bite force of the participants was recorded with strain-gage transducer. Lateral x-ray ray scans were made under standard conditions, in centric occlusion. On cephalograms, the linear and angular measurements was performed. RESULTS: Patients with acromegaly showed increased anterior and posterior total face height, ramus length, width of frontal sinuse, gonial angle and a negative difference between maxillary and mandibular protrusions. In addition, females with acromegaly showed larger lower anterior face height and sella turcica, decreased facial angle, increased mandibular plane angle. The cephalometric measurements, except one did not showed correlation with the bite force in acromegalic patients. In control group, significant correlations were observed between anterior total face height and anterior lower face height, mandibular plane angle and gonial angle. CONCLUSIONS: The greater changes were observed in the mandible. The maximum bite force of patients with acromegaly showed no difference from healthy individuals. The non-significant difference of bite force between healthy participants and acromegalic patients provide important information for dental treatment and prosthetic rehabilitation of acromegalic patients

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Dermatitis de contacto por el uso de aparatos ortodóncicos extraorales. A propósito de 3 casos / Contact dermatitis associated with the use of extraoral orthodontic appliances: a presentation of 3 cases

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Control of drooling using transdermal scopolamine skin patches. A case report

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Transdermal scopolamine has been shown to be very useful in the management of drooling, particularly in patientswith neurological or neuropsychiatric disturbances or severe developmental disorders. In this paper, we present the case of a 24-year-old patient with a diagnosis of cerebral palsy and a severe problem of drooling, exacerbated by marked mandibular prognathism. After exclusion of other therapeutic alternatives, it was decided to use sustainedrelease transdermal scopolamine patches (Scopoderm TTS). This technique consists of the application every three days of a patch with 1.5 mg of scopolamine in the area of the mastoid apophysis; the patch releases a dose of 0.5 mgof the active substance over each 24 hour period. The patient underwent periodic clinical and laboratory follow-up over a period of three years, achieving satisfactory results with no significant undesirable effects (AU)

El dentista general y el paciente con "prognatismo". Parte I: Enfoque diagnóstico / The general dentist anf the patient with "prognatism". Part I: Diagnostic approach

El propósito de este artículo es aclarar conceptos fundamentales sobre las maloclusiones de clase III, las no siempre bien llamadas "prognatismos". Se ofrece al dentista general información fundamental para diagnosticar este tipo de pacientes y decidir cúando deben ser referidos al ortodoncista. Se describen las claves diagnósticas que permiten diferenciar los problemas dentarios de los funcionales y los esqueléticos (AU)

the purpose of this article is to clarify some important concepts about Class III maloclusions (the inadequate called "prognatisms"). Some basic information to diagnose and refer to the orthodontist these patients is offered to the general dentist. The diagnostic keys that make possible to distinguish dental, functional and skeletal problems are described (AU)

Valoración clínica integral del prognatismo y su tratamiento con avance maxilar (Le Fort I) / Clinical evaluation of prognathism and his treatment with maxillary advancement (Le Fort I)

Desde hace décadas el tratamiento habitual del prognatismo es la retrusión mandibular. Clásicamente nos apoyamos en la cefalometría para confirmar el diagnóstico y realizar predicciones preoperatorias que guian el plan quirúrgico y lograr una oclusión normal mediante la retrusión mandibular. Sin embargo, en algunos pacientes el estudio clínico sugiere hipoplasia del tercio medio de la cara y para su tratamiento se deben realizar avances del maxilar para mejorar la apariencia facial y la oclusión. La cirugía ortognática ha evolucionado en sus indicaciones y técnicas, y por lo tanto en sus objetivos. Inicialmente el objetivo primordial era la corrección de la oclusión, mientras que actualmente domina es la estética facial, sin olvidar la corrección oclusal. Debido a que los resultados de la expansión de los tejidos blandos son más predecibles que los de la contracción, preferimos realizar un avance maxilar con osteotomías tipo LeFort I para tener una contribución estética más previsible de los tejidos blandos. Analizamos el resultado de 16 pacientes con medidas cefalométricas de prognatismo, pero con evidencia clínica de hipoplasia en el tercio medio facial. Todos los pacientes fueron intervenidos mediante avance maxilar por osteotomías tipo LeFort I, que en algunas ocasiones se combinan con retroposición mandibular, mentoplastía u otro procedimiento sobre la mandíbula en caso de deformidad importante de la misma(AU)

By decades, the classic and traditional treatment of congenital prognathism has been the surgical mandibular retrusion. For many years we have used cephalometric values to make the diagnosis and the preoperative predictions that would give us the surgical plan for the treatment of this pathology which consistent in a mandibular retrusion to achieve normal occlusion. In some of our patients we have seen that the cephalometric analysis present signs of prognathism values even though the clinical study and the external appearance tended to look-like a hypoplasia of the facial medial third instead. Techniques and indications for ortognatig surgery have been evolutioned, and obviously the treatment goals. The primary objective was the occlusion’s correction, but now the most important thing is the facial esthetics, obviously not forgetting the oclusal correction. The results of the tissue expansion are more predictable than contraction outcomes, we rather to perform a maxillary advancement with LeFort I osteotomy to predict the soft-tissue changes. The present study evaluates the result of 16 patients with cephalometric confirmation of prognathism, even though the clinical study and the external appearance tended to look-like a hypoplasia of the facial medial third. All of them received surgical correction through maxillary advancement with LeFort I osteotomy, sometimes was also used mandibular retrusion, chin surgery, or another surgical procedure in the mandible in case of mandibular deformity (AU)

Osteotomía subcondílea en el tratamiento de las deformidades mandibulares / S.rbeondylar osteotomy in the treatment of mandibular deformites

La corrección quirúrgica del prognatismo mediante intervenciones en las ramas ascendentes de la mandíbula, fue la opción que sustituyó a las técnicas de ostectomíasquereducían el volumen mandibularo más exactamente la longitud del cuerpo bilateralmente. Se realizan osteotomías subcondíleas oblícuas por encima de la espina de Spix, preservando el paquete vásculo-nervioso que, partiendo de la escotadura sgmoidea, llegan al borde posterior de la mandíbula. Desde el año 1974 hemos empleado la técnica subcondílea oblicua (OSO) por vía intraoral en 367 casos para la corrección del prognatismo (AU)

Ortodoncia y vías aéreas superiores / Orthodontics and upper airway

Entre los objetivos generales del tratamiento en ortodoncia y los combinados de ortodoncia y cirugía ortognática, están lograr una buena oclusión y una mejoría estética, sobre todo en el caso de deformidades dentoesqueléticas severas. Sin embargo, en muchas ocasiones no se tienen en cuenta los parámetros de la vía aérea superior a la hora de realizar los objetivos del tratamiento convencional. Los pacientes con alteraciones obstructivas durante el sueño, representan para los odontólogos y estomatólogo un tipo de paciente diferente al normal, en los que el tratamiento, va dirigido a mejorar la saturación de oxígeno. Aquí, las consideraciones funcionales se imponen a las puramente estéticas. Es conveniente a la hora de realizar un diagnóstico ortodoncico, quirúrgico o mixto de un paciente, tener en cuenta las connotaciones inherentes a la vía aérea superior (VAS) que el tratamiento pueda a acarrear. No podemos pretender conseguir una buena estética a expensas de generar pacientes más propensos a los transtornos estenosantes de la VAS . (AU)

Atelectasia pulmonar secundaria a arrancamiento adenoideo, una complicación infrecuente de la intubación nasotraqueal / Pulmonary atelectasia secondary to adenoid uprooting. A rare complication of nasotracheal intubation

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Eritropoyetina y cirugía de cadera a un testigo de Jehová anémico con espondilitis anquilopoyética, hepatopatía crónica y enfermedad de Crohn / Erythropoietin and hip surgery in a Jehová´s Witness with anemia, ankylopoietic spondylitis, chronic liver disease and Crohn´s disease

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