Maintenance of a deep bite prior to surgical mandibular advancement.

Adult patients with a Class II skeletal base are often treated by a combined orthodontic and surgical approach. Advancement of the mandible, most often including a bilateral sagittal split osteotomy (BSSO), is preceded by orthodontic alignment and frequently the curve of Spee is levelled. When the chin is prominent, there is a risk of accentuating this as a result of surgery. An option to prevent this is to maintain a deep curve of Spee before surgical advancement. This will result in an opening rotation of the mandible during surgery and thus, a less prominent chin. The aim of this study was to compare, retrospectively, two orthodontic treatment approaches in patients treated by a BSSO. In one group (4 males, 20 females; mean age pre-surgery 29.3 years), the deep bite was maintained (deep bite group) while in the other (3 males, 10 females; mean age pre-surgery 27.1 years) the overbite was normal prior to surgery (level group). Lateral skull radiographs were taken before orthodontic treatment (T0), prior to surgery (T1), and at the end of treatment (T2). Differences between the groups as measured on lateral skull radiographs at T1 and T2 were analysed and quantified using an independent t-test. The results showed that soft tissue pogonion moved significantly further forward in the level than in the deep bite group (P < 0.05). Lower anterior face height and the cranial base-mandibular plane angle increased more in the deep bite than in the level group (P < 0.05 and P = 0.001, respectively). The maintenance of a deep bite prior to mandibular advancement surgery induces an opening rotation of the mandible reducing chin prominence and increasing lower anterior face height post-surgically.

Patient satisfaction related to rigid external distraction osteogenesis.

The aim of this study was to evaluate satisfaction with treatment among cleft lip and palate patients who underwent maxillary advancement using a rigid external distraction (RED) device. Nine patients (four boys, five girls), mean age 17.7 years (SD 4.0), were included in the study. Outcome measures included satisfaction with facial appearance and function (sensitivity/pain, discomfort during daily functioning, daily activities, speech, eating and/or drinking, expression of affection) before, during and after treatment with the RED device assessed by a self-administered questionnaire. Before treatment, the majority of patients were not satisfied with their facial appearance. Some received negative remarks about their appearance and experienced minor functional problems. Dissatisfaction with appearance, negative remarks and functional problems increased significantly during active treatment, and the majority of patients experienced pain or sensitivity. After treatment all patients but one were satisfied with their appearance and level of function. Overall patient satisfaction after treatment with a RED device is high, but the active treatment period, during which the frame is worn, significantly compromises function and may be painful. For most patients, satisfaction with the final result and appearance outweighs the negative factors they reported.

Distraction osteogenesis versus bilateral sagittal split osteotomy for advancement of the retrognathic mandible: a review of the literature.

Bilateral sagittal split osteotomy (BSSO) and distraction osteogenesis (DO) are the most common techniques currently applied to surgically correct mandibular retrognathia. It is the responsibility of the maxillofacial surgeon to determine the optimal treatment option in each individual case. The aim of this study was to review the literature on BSSO and mandibular DO with emphasis on the influence of age and post-surgical growth, damage to the inferior alveolar nerve, and post-surgical stability and relapse. Although randomized clinical trials are lacking, some support was found in the literature for DO having advantages over BSSO in the surgical treatment of low and normal mandibular plane angle patients needing greater advancement (>7 mm). In all other mandibular retrognathia patients the treatment outcomes of DO and BSSO seemed to be comparable. DO is accompanied by greater patient discomfort than BSSO during and shortly after treatment, but it is unclear whether this has any consequences in the long term. There is a need for randomized clinical trials comparing the two techniques in all types of mandibular retrognathia, in order to provide evidence-based guidelines for selecting which retrognathia cases are preferably treated by BSSO or DO, both from the surgeon's and the patient's perspective.

[Distraction osteogenesis of the maxilla in cleft patients. Worth considering]. / Distractie-osteogenese in de bovenkaak bij schisispatiënten. Het overwegen waard.

Three cleft patients were treated with RED-distraction for maxillary hypoplasia. In all patients, the desired advancement could be achieved easily. The occlusion, the lip relation and the facial profile improved remarkably post treatment. Although the treatment was well tolerated by the patients, some limitations of the treatment were also noted, such as a nasal speech and discomfort by the head frame. Distraction osteogenesis in the maxilla has several advantages when compared to the conventional Le Fort 1-osteotomy: atraumatic advancement of the maxilla, absence of need for an autogeneous bone transplant, and applicability at relatively young age. The advantages and disadvantages of distraction osteogenesis must be considered for each individual patient.