Identification of a de novo PUF60 variant associated with craniofacial microsomia.

Craniofacial microsomia (CFM), also known as the oculo-auriculo-vertebral spectrum, is a congenital disorder characterized by hypoplasia of the mandible and external ear due to tissue malformations originating from the first and second branchial arches. However, distinguishing it from other syndromes of branchial arch abnormalities is difficult, and causal variants remain unidentified in many cases. In this report, we performed an exome sequencing analysis of a Brazilian family with CFM. The proband was a 12-month-old boy with clinical findings consistent with the diagnostic criteria for CFM, including unilateral mandibular hypoplasia, microtia, and external auditory canal abnormalities. A heterozygous de novo nonsense variant (c.713C>G, p.S238*) in PUF60 was identified, which was predicted to be pathogenic in silico. PUF60 has been reported as a causal gene in Verheij syndrome, but not in CFM. Although the boy showed craniofacial abnormalities and developmental delay that overlapped with Verheij syndrome, the facial asymmetry with unilateral hypoplasia of the mandible observed in this case did not match the previously reported phenotypes of PUF60 variants. Our findings expand the phenotypic range of PUF60 variants that cover CFM and Verheij syndrome.

Robin Sequence Facial Profile After Conservative Treatment: A Long-Term Follow-Up.

INTRODUCTION: Robin sequence (RS) is a congenital clinical condition characterized by micrognathia, glossoptosis, and respiratory distress. Conservative methods could be responsible for releasing feeding and respiratory impairment but little information about mandibular growth is known in long-term follow-up. OBJECTIVE: Assessing the longitudinal behavior of the facial profile of individuals with isolated RS who underwent conservative micrognathia treatment using photographs during the whole craniofacial growth. METHODS: Photographs of the right facial profile of 100 patients were used (50 individuals with isolated RS and 50 individuals without craniofacial anomaly). The individuals with RS were evaluated at 3 different times (T1: infant, T2: mixed dentition, T3: permanent dentition) by measuring the facial convexity angle (FCA; G.Sn.Pog´). A comparison between T3 and control group (C), individuals without craniofacial anomalies and in permanent dentition, was also performed, checking the FCA, nasolabial angle (Ls.Sn.Cm), mentolabial fold (Li.Si.Pog´), facial inferior third (Sn.Gn´.C) angles and the ratio between middle anterior facial height and lower anterior facial height. RESULTS: The T3 group showed an increased angle of facial convexity and increased facial inferior third angle and middle anterior facial height/lower anterior facial height ratio compared with the control group. In the longitudinal evaluation of individuals with isolated RS, significant differences were identified between T1 and T2 groups and T1 and T3 groups showing that the increased facial convexity was higher in the infants and that did not change significantly between the phases of mixed and permanent dentition. CONCLUSIONS: RS showed increased facial convexity in all phases evaluated, but their convexity decreased with growth. When compared with individuals without craniofacial anomalies, the individuals continue to exhibit retrognathism in the permanent dentition. The lack of a mandible projection has led to a considerable number of orthognathic surgeries for the correction of discrepancies.

Oculoauriculofrontonasal syndrome: Refining the phenotype through a new case series and literature review.

The oculoauriculofrontonasal syndrome (OAFNS) is a rare condition, with unknown etiology, characterized by the association of frontonasal dysplasia (FND) and oculoauriculovertebral spectrum (OAVS). Main clinical findings include widely spaced eyes, epibulbar dermoid, broad nose, mandibular hypoplasia, and preauricular tags. Here, we describe a case series of 32 Brazilian individuals with OAFNS and review the literature ascertaining individuals presenting phenotypes compatible with the diagnosis of OAFNS, aiming to refine the phenotype. This series emphasizes the phenotypic variability of the OAFNS and highlights the occurrence of rare craniofacial clefts as a part of the phenotype. The ectopic nasal bone, a hallmark of OAFNS, was frequent in our series, reinforcing the clinical diagnosis. The absence of recurrence, consanguinity, chromosomal, and genetic abnormalities reinforces the hypothesis of a nontraditional inheritance model. The phenotypic refinement provided by this series contributes to an investigation regarding the etiology of OAFNS.

Craniofacial and airway morphology of individuals with oculoauriculovertebral spectrum.

OBJECTIVES: The objectives of this study were to characterize the craniofacial and airway morphology of oculo-auriculo-vertebral spectrum (OAVS) individuals using computed tomography (CT) examination. SETTING AND SAMPLE POPULATION: This sample included individuals in the age range from 5 to 14 years, consisted of a group of 18 OAVS individuals (12 females and 6 males), Pruzansky-Kaban1 IIB and III and by a paired control group matched by age and sex for comparison of morphometric and airway variables. MATERIALS AND METHODS: Through the CT examination, airway analysis was performed using Dolphin Imaging® Software, and seven morphometric measurements were performed to evaluate craniofacial morphology by Materialize Mimics® Software. To compare airway and morphometric variables, the control group was used. Student's t test and Mann-Whitney U test were performed to compare differences between the groups. RESULTS: Statistically significant differences were showed between the control and OAVS groups for the variables: total airway (TA) area, volume and MAA, RP area, RP volume, RP MAA, RG volume, RG MAA, total posterior height diff, Md incl and y-axis asymmetry. Pearson and Spearman's correlation showed mostly moderate correlations between Mand Occlusal canting AS with TA area and RP volume, Ax-Gn with TA area and Hy-C3 with TA volume. CONCLUSIONS: The OAVS's airway was altered and worse than the control group. Our results suggest that the contralateral side of OAVS individuals is unaffected; however, longitudinal assessments are needed to confirm it. Hyoid bone and postural measures play an important role in interpreting airway features of individuals with and without OAVS.

Congenital Midline Cervical Cleft: A Variant of Tessier Number 30 Cleft Causing Micrognathia.

Congenital midline cervical cleft is a rare and generally isolated malformation of the ventral neck region with no clear etiology established. Mandibular deformities, such as micrognathia, could be considered as a consequence of a cleft cervical contracture. Complete surgical excision of the subcutaneous fibrous cord at an early age is the primary treatment modality, minimizing growth development problems on surrounding affected tissue. The aim of this study is to describe the clinical, surgical, and histological findings in a female child with congenital midline cervical cleft along with a relevant literature review. Three years follow-up after surgery exhibited satisfactory functional and cosmetic results.

Comparison Between Treacher Collins Syndrome and Pierre Robin Sequence: A Cephalometric Study.

OBJECTIVE: The aim of this study was to compare the dentoskeletal pattern of Treacher Collins syndrome (TCS) and nonsyndromic Pierre Robin sequence (PRS). DESIGN: Retrospective. SETTING: Single center. PATIENTS: Eighteen patients diagnosed with TCS (Group TCS) or PRS (Group PRS) in rehabilitation treatment at a single center. Group TCS was composed of 9 patients (4 male, 5 female) with a mean age of 12.9 years (standard deviation = 4.8). Group PRS was composed of 9 patients paired by age and sex with group TCS. MAIN OUTCOME MEASURE(S): Cone beam computed tomography-derived cephalometric images taken before the orthodontic or the orthodontic-surgical treatment were analyzed using Dolphin Imaging (Dolphin Imaging 11.0 & Management Solutions). Variables evaluating the cranial base, the maxillary and mandibular skeletal components, maxillomandibular relationship, the vertical components and the dentoalveolar region were measured. Intergroup comparisons were performed using t tests. The significance level considered was 5%. RESULTS: Intergroup differences in the mandible size and growth pattern were observed. Group TCS showed a smaller mandibular length (Co-Go, Co-Gn) and a higher palatal plane (SN-Palatal Plane) and mandibular plane angles (SN-Go.Gn) compared to group PRS. No differences between TCS and PRS were observed for the sagittal position of the maxilla, maxillomandibular relationship, and dental components. CONCLUSIONS: Treacher Collins syndrome presented a decreased mandible and a more severe vertical growth pattern compared to PRS.

Three-dimensional comparison of mandibular morphology in young people with Treacher Collins syndrome and Pierre Robin sequence.

INTRODUCTION: Treacher Collins syndrome (TCS) and nonsyndromic Pierre Robin sequence (PRS) share mandibular deficiency as a similar clinical finding. This study aimed to compare the mandibular size and morphology of subjects with TCS and PRS. METHODS: Group TCS was composed of 17 subjects (7 male, 10 female) with a mean age of 11.5 years (standard deviation, 4.4) from a single center. Group PRS was composed of 17 subjects paired by age and sex with group TCS. Preorthodontic cone-beam computed tomography examinations of all patients were evaluated using Mimics Innovation Suite 17.0 (Materialise, Leuven, Belgium). Nine 3-dimensional measurements were performed in segmented 3D images of the mandible. Intragroup comparisons were performed using paired t tests. Intergroup comparisons were performed using analysis of variance and Tukey tests. The significance level considered was 5%. RESULTS: TCS showed a significant dimensional difference between less and more affected sides for ramus, condyles, and mandibular body. The mandibular dimensions in PRS were more symmetrical. Group TCS presented a smaller mandibular effective length and mandibular body length compared with PRS. The condyle width and height and the ramus width were also decreased in TCS. The gonial angle was greater in TCS compared with the PRS group. CONCLUSIONS: Young subjects with TCS presented a smaller, more vertical, and more asymmetrical mandible compared with nonsyndromic PRS.

Can palatal splint improve stability of segmental Le Fort I osteotomies?

OBJECTIVES: The purpose of this study was to evaluate the influence of a palatal splint on stability in multi-segment maxillary osteotomies. SETTING AND SAMPLE POPULATION: Retrospective series of fifty-one adult patients, consecutively operated with bilateral sagittal split osteotomy (BSSO) and three-piece maxillary osteotomies, divided according to the use of a palatal splint (Group 1, n = 30) or no palatal splint (Group 2, n = 21). MATERIALS AND METHODS: Maxillary surgical casts (T1) and post-retention casts (T2), taken at least six months after discontinuation of orthodontic retention, were digitized (MicroScribe-3DX), measured and compared. Fifty-one landmarks were identified on the maxillary, transverse dimension changes and arch length were calculated. Longitudinal changes in all measurements were assessed by t test. RESULTS: Post-surgical transverse instability in group 1 ranged from 0.3 ± 0.4 to -1.3 ± 0.2 mm and was statistically significantly smaller than in group 2 that ranged from -1.0 ± 0.3 to -2.5 ± 0.5 mm. CONCLUSIONS: The use of a palatal splint after segmental Le Fort I maxillary osteotomy improved transverse stability in the posterior region. The post-surgical transverse instability occurred only between canine gingival points and thus suggesting no clinical relevance.

Hyoid Bone Position and Head Posture in Patients With Richieri-Costa Pereira Syndrome (EIF4A3 Mutations).

Robin sequence with cleft mandible and limb anomalies, known as Richieri-Costa-Pereira syndrome (RCPS), is an autosomal recessive acrofacial dysostosis characterized by mandibular cleft and other craniofacial anomalies and respiratory complications. The aim of this cross-sectional study was to describe the hyoid and head posture of 9 individuals with RCPS using cephalometric measurements and provide a discussion about its implications in obstructive sleep apnea syndrome (OSAS). The study was conducted on lateral cephalograms of patients with RCPS and 9 selected age-matched controls in tertiary cleft center in Brazil. The cephalograms were digitized and analyzed on a software to obtain the vertical and horizontal hyoid position, its relationship with the mandible and the relation of the cranial base and postvertebral line. The t test was used for analysis of means and Levene's test for equality of variances.Cephalometric measurements H-S (vertical distance between hyoid bone and sella) (Supplemental Digital Content, Figure 1, http://links.lww.com/SCS/B247) and H-C4lp (horizontal position of the hyoid in relation to the post-pharyngeal space) showed statistically significant difference compared to controls (P < 0.05). Therefore, the hyoid bone was more inferiorly and posteriorly positioned in the study group compared with the control group. The vertebrae measurements did not present differences compared to controls. The described position of hyoid bone could be involved in the severe OSAS of RCPS patients.

Cephalometric Findings in Nine Individuals With Richieri-Costa-Pereira Syndrome.

The Richieri-Costa-Pereira syndrome (RCPS) is an autosomal-recessive acrofacial dysostosis caused by mutations in EIF4A3, characterized by mandibular cleft comprising other craniofacial anomalies and limb defects such as cleft palate/Robin Sequence, microstomia, absence of mandibular central incisors, minor ear anomalies, clubfeet and first and 5 ray defects. The findings from this study are useful for better understanding the morphological consequences of disorders of EIF4A3, and having a better picture of the anatomic characteristics of the syndrome for a better therapeutic planning. Twenty-four angular and linear variables were measured to assess anteroposterior and vertical (superior-inferior) position of the cranial base, maxilla, mandible, and facial profile. The cephalometric radiographic analysis was performed on 9 individuals with RCPS, obtained at a mean age of 10.3 years, and compared with randomly selected age-matched 9 controls, without clefts and with well-balanced faces, with mean age of 10.6 years (both groups range 8.1 to 13.7 years). t test was used for analysis of means and Levene test for equality of variances. The syndrome group presented severe mandibular hypoplasia and retrognathism (P = 0.009, P = 0.001), greater facial convexity (N'PnPog and N'SnPog, P < 0.05) in syndrome group compared with the control group (P = 0.003, P = 0.004). In conclusion, in the RCPS group, most craniofacial defects affect the lower facial third, considering the severely affected mandible.

Three-Dimensional Evaluation of Dental Arches in Individuals with Syndromic Craniosynostosis.

Objective: Individuals with syndromic craniosynostosis present alterations in the dental arches due to anomalies caused by the early fusion of the craniomaxillary sutures. This study aimed to compare intradental and interdental dimensions between individuals with Apert and Crouzon syndromes and nonsyndromic controls. Materials and Methods: Digital models were obtained from the archive of a public tertiary care hospital. The sample consisted of 34 patients (Apert n = 18, Crouzon n = 16) and 34 nonsyndromic controls matched for gender and age. Measurements of perimeter, length, intercanine and intermolar distances (upper and lower), overjet, and molar ratio were performed. Statistical comparisons were performed using ANOVA and Tukey tests (p < 0.05). Results: Patients with Apert and Crouzon syndromes have severely reduced maxillary transverse dimensions, perimeter, and length of the upper arch compared to the control group (p < 0.001). The lower arch is less impacted. Patients with Apert syndrome had an anterior crossbite (p < 0.001), while patients with Crouzon syndrome had an edge-to-edge bite (p < 0.011). Patients with Apert and Crouzon syndromes do not have serious transverse proportion problems when comparing the upper and lower arches. Conclusions: In this sample, both the Apert and Crouzon groups have severely compromised upper arches compared to the control group. Mild dentoalveolar expansion in the maxilla should be sufficient for the transverse adaptation of the dental arches before frontofacial advancement.

Three-dimensional dental arch changes of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusion.

INTRODUCTION: This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods. METHODS: Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches. RESULTS: During orthodontic preparation, the maxillary and mandibular transverse dimensions measured at the premolar regions were increased and maintained throughout the follow-up period. Intercanine width was increased only in the upper arch during orthodontic preparation. Maxillary arch length was reduced during orthodontic finalization, only. Upper and lower arch depths were stable in the study periods. Differences between changes in centroid and gingival points suggested that upper and lower premolars buccaly proclined during the pre-surgical period. CONCLUSIONS: Maxillary and mandibular dental arches presented transverse expansion at premolar regions during preoperative orthodontic preparation, with a tendency towards buccal tipping. The transverse dimensions were not altered after surgery. No sagittal or vertical changes were observed during the follow-up periods.

Three-dimensional dental arch changes of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusion

INTRODUCTION: This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods. METHODS: Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches. RESULTS: During orthodontic preparation, the maxillary and mandibular transverse dimensions measured at the premolar regions were increased and maintained throughout the follow-up period. Intercanine width was increased only in the upper arch during orthodontic preparation. Maxillary arch length was reduced during orthodontic finalization, only. Upper and lower arch depths were stable in the study periods. Differences between centroid and gingival changes suggested that upper and lower arch premolars buccaly proclined during the pre-surgical period. CONCLUSIONS: Maxillary and mandibular dental arches presented transverse expansion at premolar regions during preoperative orthodontic preparation, with a tendency towards buccal tipping. The transverse dimensions were not altered after surgery. No sagittal or vertical changes were observed during the follow-up periods. .

INTRODUÇÃO: esse estudo avaliou as alterações tridimensionais ocorridas na morfologia das arcadas dentárias de pacientes submetidos ao tratamento ortodôntico-cirúrgico para a correção da má oclusão de Classe II, em três períodos distintos: (T1) modelos iniciais, (T2) modelos pré-cirúrgicos imediatos (de 1 a 15 dias antes da cirurgia) e (T3) modelos pós-cirúrgicos (mínimo de 6 meses após a remoção do aparelho ortodôntico). MÉTODOS: pontos previamente demarcados em cada modelo foram digitalizados por meio do digitalizador tridimensional MicroScribe-3DX, cujas coordenadas, armazenadas em planilhas do programa Excel, deram origem a valores que possibilitaram a avaliação da largura, comprimento e profundidade das arcadas dentárias. RESULTADOS: durante o preparo ortodôntico, houve aumentos nas distâncias transversais superiores e inferiores medidas na região de pré-molares que se mantiveram no período total de acompanhamento. Apenas a distância intercaninos superior apresentou alterações de aumento durante o preparo ortodôntico, assim como a largura da arcada superior, que diminuiu durante a fase de finalização. A profundidade de ambas as arcadas manteve-se estável nas fases avaliadas. Diferenças entre as mudanças dos pontos centroide e gengival sugerem que os pré-molares superiores e inferiores inclinaram para vestibular durante o preparo ortodôntico pré-cirúrgico. CONCLUSÇÕES: conclui-se que as arcadas dentárias superiores e inferiores sofreram expansão transversal na região de pré-molares durante o preparo ortodôntico pré-cirúrgico, com tendência à inclinação vestibular de todos os dentes posteriores. Após a cirurgia, as dimensões transversais ...

Tratamento em paciente com fissura pré-forame completa: o que o ortodontista precisa saber? / Orthodontic treatment in complete cleft lip: what does the orthodontist must know?

Este trabalho descreve o tratamento ortodôntico corretivo de uma adolescente do sexo feminino com fissura pré-forame incisivo completa. A paciente apresentava Padrão I, má oclusão de Classe I, presença de incisivo lateral superior supranumerário na região da fissura e apinhamento anterossuperior moderado. O reparo do lábio foi realizado aos 6 meses de idade. O defeito ósseo alveolar foi restabelecido por meio da cirurgia de enxerto ósseo alveolar secundário (EOAS) de origem autógena, aos 11,5 anos de idade. Houve boa formação de osso alveolar na região da fissura permitindo movimentação ortodôntica convencional nesta área 3 meses após o EOAS. O tratamento ortodôntico durou 2,5 anos. Foi alcançada oclusão satisfatória e estável. As radiografias finais indicaram aspecto saudável do periodonto na região de canino e incisivo lateral esquerdos. A paciente com fissura pré-forame incisivo apresenta algumas particularidades, como a ruptura da continuidade do rebordo ósseo alveolar, no entanto, o tratamento corretivo convencional pode ser realizado da maneira convencional após o procedimento de enxerto ósseo alveolar. (AU)

This work describes the corrective orthodontic treatment of a female adolescent with alveolar cleft lip. The patient presented Class I skeletal pattern, Class I malocclusion, presence of a supernumerary lateral incisor at the cleft region, and moderate maxillary incisor crowding. Lip repair was executed at 6 months of age. The alveolar cleft was restored through secondary alveolar bone graft surgery (SABG) performed at 11.5 years of age using autogenous bone from the iliac crest. The successful alveolar bone filling permitted conventional orthodontic movement at the maxillary arch three months after SABG. Total orthodontic treatment time was 2.5 years. Adequate occlusion and aesthetic smile were achieved. Final radiographs showed normal aspect of periodontal bone at the left maxillary lateral incisor and canine region. The treatment of an alveolar cleft lip patient has some peculiarities, such as the disruption in continuity of the alveolar bone arch. However, the corrective orthodontic approach can be performed conventionally after the alveolar bone grafting procedure. (AU)

Análise de Bolton: uma proposta alternativa para a simplificação de seu uso / Bolton analysis: an alternative proposal for simplification of its use

INTRODUÇÃO: as discrepâncias entre o tamanho mesiodistal dos dentes superiores e inferiores e seus efeitos sobre a oclusão têm sido relatados há muito tempo. O método proposto por Bolton para o diagnóstico de discrepância de tamanho dentário é, inegavelmente, um dos mais difundidos no meio ortodôntico, devido à sua relativa simplicidade. Entretanto, a aplicação desse método requer cálculos matemáticos e o uso de tabelas que, muitas vezes, inviabilizam a sua utilização durante a avaliação clínica. OBJETIVO: avaliar o método proposto por Wolford, que não requer o uso de tabelas, como alternativa ao método tradicional de Bolton. MÉTODOS: a amostra foi composta por 90 pares de modelos dentários iniciais de pacientes adultos, com diferentes más oclusões. A proporção entre os dentes inferiores e superiores foi calculada para cada paciente, resultando na obtenção de dois índices (a razão total e a razão anterior). Os índices foram obtidos por meio do método originalmente proposto por Bolton e por um método alternativo, composto por duas fórmulas (uma simplificada e a variação da mesma), que foram analisadas separadamente. RESULTADOS: comparadas ao método de Bolton, as fórmulas simplificadas mostraram uma tendência de superestimar as discrepâncias dentárias inferiores (total e anterior), embora em pequena proporção. CONCLUSÕES: ambas as fórmulas do método alternativo podem ser utilizadas em substituição ao método tradicional, uma vez que mostraram diferenças médias menores que 0,58mm quando comparadas ao método de Bolton, não apresentando, portanto, significância clínica.

INTRODUCTION: Mesiodistal size discrepancies of upper and lower teeth and their effect on occlusion have been related. Bolton's method for tooth size discrepancies is, undeniably, one of the most commonly-used methods in orthodontics because of its simplicity. However, the application of this method requires mathematical calculations and use of tables, which often prevents its clinical use. PURPOSE: Evaluate an alternative method for Bolton's analysis proposed by Wolford that does not require table information. MATERIAL AND METHODS: The sample was composed of 90 initial dental casts of adult patients, with different malocclusions. The ratio between the sum of widths of maxillary and mandibular teeth was calculated for each patient, resulting in the attainment of two indices: The overall ratio and the anterior ratio. Indices were calculated by Bolton's method and by an alternative method, using two different formulas (one simplified and a variation of the same formula) that were separately analyzed. RESULTS: In comparison with Bolton's method, the Simplified Formulas demonstrated a slight trend towards an overestimation of the inferior dental discrepancies (overall and anterior). CONCLUSION: Both formulas employed for the alternative method may be used to substitute the traditional method, since each demonstrated, on average, differences of less than 0.58 mm when compared with Bolton's method and no clinical significance.

Influência da hiperplasia condilar no crescimento craniofacial e estabilidade do tratamento de pacientes classe III pós surto de crescimento pubertáro / Influence of condylar hyperplasia on post pubertal class III patients craniofacial growth and treatment stability

A estabilidade do tratamento cirúrgico da classe III tem sido uma preocupação com relatos de pequenas ou significativas alterações mandibulares pós-cirúrgicas, Alguns pacientes afetados pela instabilidade do tratamento podem manter relação oclusal aceitável com compensações ortodônticas pós-cirúrgicas, mas outros irão desenvolver alterações oclusais e esqueléticas de forma significativa, necessitando de intervenção adicional ortodôntica e cirúrgica gerando custo adicional e aumento da morbidade. Muitas variáveis têm sido apontadas como preditoras da instabilidade do tratamento, mas poucos estudos sugerem a hiperplasia condilar (HC) como um fator de risco para a correção cirúrgica da Classe III. 51 pacientes classe III foram selecionados consecutivamente de uma população de pacientes operados entre 1996 e 2007 por um único cirurgião. Telerradiografias em norma lateral foram selecionadas nas seguintes fases: diagnóstico inicial, imediatamente antes da cirurgia, imediatamente após a cirurgia e com pelo menos um ano de acompanhamento pós-cirúrgico. Um total de 19 pontos de referência foram identificados e digitalizados através da utilização do software DFPlus (Dentofacial Software Inc, Toronto, Ontario, Canada). Estes pontos de referência foram utilizados para calcular 21 medidas lineares e/ou angulares e 10 medidas horizontais e verticais. A amostra que apresentava classe III associada a hiperplasia condilar obteve maior taxa de crescimento mandibular total pós puberal (2,6 mm) e maior comprimento do corpo (2,2 mm). Diante de uma má oclusão esquelética de classe III associada a HC, a adoção de uma abordagem de tratamento diferenciada é de fundamental importância para a obtenção de resultados estáveis, embora os tratamentos que envolvam a manipulação da articulação temporomandibular (ATM) sejam vistos com cautela por muitos profissionais da área de cirurgia, para algumas patologias articulares, como a hiperplasia condilar, é necessário a intervenção cirúrgica na ATM em conjunto com a cirurgia ortognática para que resultados previsíveis em longo prazo sejam obtidos, evitando assim uma segunda cirurgia para a correção definitiva do problema

Class III surgical treatment stability has been a concern with reports of minor or significant post-surgical mandibular change. Most of the patients affected by treatment instability may retain acceptable oclusal relation while some of the skeletal position changes. Other affected patients have to undergo further treatment generating additional cost and increased morbidity. Many variables have been identified as predictors of treatment instability, but few reports suggest condylar hyperplasia as a risk factor for class III surgical correction. 51 class III patients records were consecutively selected from the patient population operated between 1996 and 2007 by the senior author. Lateral cephalometric radiographs were selected at the following periods: initial, immediate before surgery, immediate after surgery and at least one year follow-up). A total of 19 landmarks were identified and digitized using DFPlus software (Dentofacial Software Inc, Toronto, Ontario, Canada). These landmarks were used to compute 21 traditional linear and/or angular measurements and 10 horizontal and vertical measurements. During the observational period in the present sample condylar hyperplasia promoted higher post pubertal total mandibular growth rate (2.6 mm) and higher corpus length (2.2 mm). Appropriate condilar hyperplasia diagnosis and customized approach are mandatory in order to obtain stable results for Class III surgical treatment. Although treatments that involving manipulation of the temporomandibular joint to be viewed with caution by many professionals in the field of surgery, for some articular pathologies, such as condylar hyperplasia, it is necessary to approach the TMJ together with orthognathic surgery so that stable long term results are obtained, thereby avoiding a second surgery for the final remediationv of the problem