Does Aesthetic Osseous Genioplasty Impact Upper Airway Volume?

BACKGROUND: Although maxillomandibular advancement is the treatment of choice for obstructive sleep apnea syndrome (OSAS) in the presence of underlying maxillomandibular complex hypoplasia, there is still a gap in the literature regarding the impact of genioplasty upon upper airway volume (UAV). OBJECTIVES: The aim of this study was to evaluate the impact of isolated osseous genioplasty upon UAV. METHODS: A retrospective analysis of all patients subjected to isolated osseous genioplasty between July 2015 and July 2022 was conducted. Cone-beam computed tomography was performed preoperatively and postoperatively to assess the chin and hyoid 3-dimensional (3D) spatial position and UAV changes after surgery. RESULTS: A total of 44 patients were included in the study. Regarding surgical movements of the chin, almost all patients received a sagittal movement (n = 42; 39 forward and 3 backward), while in 8 patients a vertical movement (5 upward and 3 downward) was applied, and in 6 patients the chin was centered. Statistically significant increases in total UAV (P = .014) and at the level of the oropharynx (P = .004) were observed. Specifically, chin centering, upward and forward movements enlarged the oropharynx volume (P = .006, .043 and .065, respectively). Chin advancement enlarged the hypopharynx volume (P = .032), as did upward movement of the hyoid bone (P < .001). CONCLUSIONS: Results of the study suggest that aesthetic osseous genioplasty impacts the UAV: each 3D spatial chin movement differently impacts the upper airway by enlarging or narrowing it. However, further studies addressing the apnea-hypopnea index are required to assess its effectiveness in treating OSAS.

Definition of New Three-Dimensional Cephalometric Analysis of Maxillomandibular Sagittal Relationship for Orthodontics and Orthognathic Surgery: Normative Data Based on 700 CBCT Scans.

The objective of the study was to define the norm of new 3-dimensional cephalometric analysis of maxillomandibular sagittal relationship with the patient in Natural Head Position. A cross-sectional study was performed using 700 consecutives cone beam computed tomography datasets of pre-orthodontic patients received for three-dimensional craniofacial analysis. To stablish the clinical norm of the new sagittal reference (linear distance A-B), the correlation with the gold standard (ANB angle) was estimated with the Pearson's correlation coefficient. Subsequently, the prognostic values of the linear distance A-B was calculated to define the clinical norm. The sample was composed by 463 women (66.1%) and 237 men (33.9%). The mean age was 30 ± 14,5 years old (range 6-71 y old). According to the skeletal class classification (ANB), 46.1% (323) were class I, 42% (294) class II, and 11.9% (83) class III. The regression model found that each additional grade of the ANB angle imply a mean increase of 1.24 mm of the distance A-B ( P <0.001). The normative value of the linear distance A-B was obtained through the prognostic values of the distance for the limits of the ANB norm 0 to 4. These values were on the range of 0.52 to 5.48 mm. Therefore, the clinical norm for cephalometric maxillomandibular sagittal relationship using linear distance from point A-B is: 3±2.48 mm. With this new approach, we can define the skeletal sagittal relationship of the patient in natural head position overcoming the limitations of using intracranial or occlusal plane references improving the diagnosis and orthognathic surgical planning process.

Total Customized Alloplastic Reconstruction for Treatment of Severe Temporomandibular Joint Pathologic Conditions: A Case Series of Combined Intraoral and Extraoral Approach.

ABSTRACT: Temporomandibular joint (TMJ) reconstruction with customized alloplastic implants has become a safe and effective treatment option of TMJ end-stage pathology with excellent outcomes reported in the literature. The purpose of this study is to report 5 cases of severe TMJ pathology and customized alloplastic reconstruction using a combined intraoral approach and extraoral approach. Four patients with TMJ involved for benign tumor and one patient with severe TMJ resorption were enrolled. Compromised joints were replaced with customized prosthesis under general anesthesia using an association of intraoral approach/extraoral approach. An implant handpiece with adapted drills for bone drilling and the insertion of screws was used to fixate the mandibular component intraorally; the fossa component was inserted via preauricular approach. The hemimandibulectomies/codilectomy with safety margin were successfully performed and for 2 patients Orthognathic Surgery was also required. Follow-up period was from 15 to 28 months (average 22 months), with no history of surgical site infection or damage to the prostheses. Occlusal relationship and function, as well as facial symmetry were kept stable in all patients. The combination of an intraoral and extraoral approach for total TMJ replacement with customized prosthesis may be an alternative and reliable strategy for pathologic reconstruction, keeping function and reducing aesthetic damage.

Semi-Automated Three-Dimensional Condylar Reconstruction.

The objective was to validate a semi-automated segmentation method for 3-dimensional (3D) reconstruction of the mandibular condyle from cone beam computed tomography (CBCT) data and illustrate its application in volumetric analysis of the condyle.Ten CBCT datasets were used to validate the proposed semi-automatic method for 3D rendering of mandibular condyles. First, a standardized orientation protocol of the skull was applied. After defining the volume of interest, a grey-scale cut-off value was selected to allow an automatic reconstruction of the condyle's surface. Subsequently, condylar contour was optimized manually. The whole process was repeated twice by 2 independent investigators. Volumetric measurements of the condyle were used as a measure of conformity between both investigators. The reproducibility of condylar volume reconstruction was excellent for intra-examiner measurements (CV = 3.65%, intraclass correlation coefficient = 0.97) and good for inter-examiner measurements (CV = 7.15%, ICC = 0.89). The overall mean time required for the segmentation process was 6.31 + 2.78 minutes. The proposed protocol provides an accurate and reproducible tool for 3D reconstruction of the mandibular condyle using CBCT data. Its implementation will enable adequate follow-up of morphological changes in bone tissue with a Hounsfield unit-based imaging segmentation method.

Sialolith removal in the submandibular region using surgical diode laser: report of two cases and literature review.

PURPOSE: Sialolithiasis is defined as the presence of one or more calcified structures within the duct of a major or minor salivary gland. It occurs as a result of deposition of calcium salts around an accumulation of organic debris in the duct lumen. The main signs and symptoms are edema and bacterial infection with abscess formation. METHODS: This study aimed to report two cases of submandibular sialolithiasis treated surgically with diode laser and conduct a review of the literature by means of a systematic search. In the two cases, the calculi were located in the distal part of the submandibular duct and could be palpated intraorally. Surgery was performed in an outpatient setting under local anesthesia. A linear incision was made in the floor of the mouth, in the region of the opening of Wharton's duct, to expose and remove the calculi. Laser cutting was performed using a diode laser module coupled to a 400-µm optical fiber emitting at a wavelength of 980 nm (infrared), 2.5 W output power, and in continuous pulse mode. RESULTS: The use of diode laser is a safe and minimally invasive option for this type of procedure. CONCLUSION: Offering advantages such as enhanced coagulation properties and high-quality incision, absence of bleeding, low risk of nerve damage, and few comorbidities.

Intraoral technique for locking reconstruction plate fixation using an implant handpiece with adapted drills.

BACKGROUND: Locking reconstruction plates are used in the treatment of jaw trauma and diseases if there is a need for surgical resection and to prevent pathologic fracture after tumor excision. Fixation is typically performed using an extraoral approach. METHODS: This article describes a technique for the intraoral fixation of locking reconstruction plates that uses prototyping to model the plate before the procedure as well as an implant handpiece with adapted drills for bone drilling and the insertion of screws into relatively inaccessible areas. CONCLUSION: Intraoral fixation not only prevents nerve damage and facial scarring but also minimizes the plate's risk of extraoral exposure and reduces surgical morbidity. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1436-1439, 2016.

Correction of facial asymmetry resulting from hemimandibular hyperplasia: surgical steps to the esthetic result.

Hemimandibular hyperplasia is a facial deformity in which there is an increase in the condyle, neck of the condyle or ramus, and an occlusal cant. Different surgical treatments are proposed in the literature, from simple low or high condylectomy to more complex procedures combining osteotomies in different sites of the mandible. Surgical procedure is defined by the scintigraphic diagnosis of activity or inactivity in the center of condylar growth. The case report describes a 35-year-old female patient with hemimandibular hyperplasia on the left side with inactivity of condylar growth, successfully treated with bilateral sagittal split ramus osteotomy associated with a basilar osteotomy in form of "L" on the affected side. The surgical technique was easily executed, with an improvement in function, aesthetics, and patient satisfaction. Correction of facial asymmetry caused by excessive growth of the mandible using this basilar osteotomy in the form of "L" combined with bilateral sagittal split ramus osteotomy proved to be a relatively simple technique of easy execution with a low risk of nerve damage.

Implant handpiece with adapted drills in orthognathic surgery: preventing facial scars.

The attachment of bilateral sagittal-split osteotomy of the mandibular ramus with bicortical screws or the combination of miniplates and a bicortical screw is complicated through the intraoral approach because of the angle required for insertion of screws, so it is necessary to use a trocater. This article aimed to report a technique developed and used in 60 patients, wherein an implant handpiece with adapted drills was used in the intraoral attachment. The setting was performed intraorally to prevent scarring and extraoral facial nerve damage, which may be caused by extraoral and transbuccal approaches routinely performed when using the trocater. The versatility of the handpiece implant allows for the insertion of monocortical and bicortical screws and rigid internal fixation of mandibular sagittal-split osteotomy, as well as surgical time reduction, decreasing postoperative morbidity.

Pharyngeal airway changes in Class III patients treated with double jaw orthognathic surgery--maxillary advancement and mandibular setback.

PURPOSE: The pharyngeal airway may change after skeletal movement in patients who have undergone orthognathic surgery. The aim of this study was to evaluate the skeletal and pharyngeal airway changes in subjects with a Class III facial pattern who underwent double-jaw surgery (maxillary advancement and mandibular setback). MATERIALS AND METHODS: The present retrospective study assessed preoperative (T0), 2- to 4-month postoperative (T1), and 6- to 12-month postoperative (T2) radiographs of subjects with a Class III facial pattern treated at São Lucas Hospital (Porto Alegre, Brazil) using imaging software (Dolphin Imaging 3D 11.5). Five measurements of the pharyngeal airway space (nasopharynx; upper, middle, and lower oropharynges; hypopharynx) were evaluated and correlated with the skeletal movement of the jaws (lines perpendicular to the Frankfurt horizontal plane passing through the nasion point to points A and B). The Student t test for paired samples was used to assess the presence of significant differences between the intervals, and the Spearman correlation coefficient was used to assess the significant correlation existing between the skeletal movement and the pharyngeal airway changes. The results were considered at a maximum level of significance of 5% (P < .05). RESULTS: In the sample of 58 subjects (38 female and 20 male, 18 to 48 years old), measurements of the nasopharynx, upper oropharynx, and middle oropharynx increased, whereas measurements of the lower oropharynx and hypopharynx decreased during these periods (T0 to T1, T0 to T2). Decreases from T1 to T2 in the measurements of the nasopharynx and upper oropharynx were also identified. A correlation between the jaw movements and the change in airway measurement was found between the line perpendicular to the Frankfurt horizontal plane passing through the nasion point to point A and the nasopharynx and between the line perpendicular to the Frankfurt horizontal plane passing through the nasion point to point B and the lower oropharynx for T0 to T1 and T0 to T2. CONCLUSIONS: A correlation between skeletal movements and changes in the measurements of pharyngeal airway was found between maxillary advancement and the nasopharynx, with proportions of 102.8% and 85.5% in the short and medium terms, respectively, and between mandibular setback and the low oropharynx, with proportions of 44.8% and 43.5% in the short and medium terms. A correlation for pharyngeal airway measurements was found between those located anatomically near each other, showing the importance of the pharyngeal muscles in this relation.

Impacted foreign bodies in the maxillofacial region-diagnosis and treatment.

Foreign bodies are often encountered by oral and maxillofacial surgeons and may present a diagnostic challenge to the trauma surgeon due to many factors such as the size of the object, the difficult access, and a close anatomic relationship of the foreign body to vital structures. They are usually a result of injuries or operations. Fragments of broken instruments can be left behind and entire teeth or their fragments can be displaced during extraction. The approach to this kind of injury should be sequential and multidisciplinary, beginning with the trauma unit that will provide maintenance of the airways, hemodynamic stabilization, and, but only if necessary, neurologic, ophthalmologic, and vascular evaluation. With a view to illustrating and discussing the diagnosis and treatment of this kind of injury, this study reports impacted foreign bodies in oral and maxillofacial region. The following data were collected: age, sex, race, etiology, occurrence of fracture, anatomic location of the fracture, daytime of the traumatic event, type of the object, signal and symptoms, type of imaging examination used, type of anesthesia, approach, transoperative complication, period between surgery and hospital liberation, and the occurrence of death. Foreign body injuries in the maxillofacial region can place the patient's life at risk, so a correct initial treatment performed by a multidisciplinary team increases the survival of this kind of patient.