Factors influencing neurosensory disturbance after bilateral sagittal split osteotomy: retrospective analysis after 6 and 12 months.

OBJECTIVE: The aim of this study was to analyze several factors regarding their possible influence on neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) after bilateral sagittal split osteotomy (BSSO). STUDY DESIGN: We investigated the possible influence of sex, age at the time of surgery, total operating time, intraoperative nerve encounter, advancement versus setback, fixation method, additional genioplasty, side, and region (lower lip vs. chin) on subjective neurosensory outcome a half-year after surgery. Results of a battery of neurosensory testing methods are also presented; 103 out of the initial 128 patients were available for further follow-up 1 year after surgery. RESULTS: Normal subjective sensibility was found in 74.6% and 77.2% of the regions after 6 and 12 months, respectively. Multiple regression models revealed significant effects of age, region, and total operating time after 6 months, and significant effects of age, region, and sex after 12 months. CONCLUSIONS: NSD of the IAN after BSSO is influenced by age, total operating time (at 6 months), and sex (at 12 months). Significantly higher rates of NSD were found in the chin region.

Treatment of Bone Metastases in Patients with Advanced Breast Cancer.

Bone metastases are usually associated with a variety of skeletal related events (SREs), a term covering both complications (pathological fractures, spinal cord compression) and the need for therapeutic intervention (radiotherapy, surgery to bone) for painful bone lesions and/or lesions carrying a high risk of fracture by which the patient's quality of life, functioning, and independence may be compromised. In view of the availability of improved therapeutic approaches for oncological diseases and the resulting improvements of median overall survival, the aim of preventing and delaying the occurrence of SREs becomes more important. To avoid, wherever possible, therapies requiring hospitalization, is another relevant goal. In recent years, bisphosphonates, along with available tumor-specific medication (chemotherapy, hormone therapy), constituted the standard of care for preventing skeletal complications in treating patients with bone metastases. Recently, a therapeutical alternative with potentially superior efficacy has been found in denosumab, a fully human monoclonal antibody that binds to the receptor activator of nuclear factor-κB ligand (RANKL), thus preventing osteoclast-mediated bone resorption and specifically interfering with bone metabolism.

Psychologic implications of orthognathic surgery in patients with skeletal Class II or Class ill malocclusion.

The psychologic profile of 100 consecutive patients undergoing orthognathic surgery for correction of Class II or Class III malocclusion was monitored in a prospective observational study. Patients and their relatives or friends completed questionnaires about their self-image before surgery, 6 weeks postoperatively, and 6 months postoperatively. Preoperatively, patients with Class III malocclusion felt significantly less attractive (P = .03), had slightly higher attention to physical appearance, and had slightly stronger feelings of insecurity regarding their facial appearance compared with Class II patients. Grading of attractiveness/self-confidence improved significantly in Class III patients at 6 weeks postoperatively (P = .006), while in Class II patients the improvement was less pronounced and only significant at 6 months postoperatively (P = .002). Grading of attractiveness/self-confidence by relatives/friends of patients with Class II and Class III was similar preoperatively, but was significantly higher for Class III patients 6 weeks postoperatively in comparison with Class II patients (P = .048). These data indicate that the psychologic profiles are significantly different between Class II and Class III patients preoperatively and show different dynamics postoperatively.

The impact of bilateral sagittal split osteotomy on mandibular width and morphology.

PURPOSE: In this study, we examined mandibular width before and 1 year after bilateral sagittal split osteotomy. PATIENTS AND METHODS: Forty-two patients (28 females and 14 males) underwent bilateral sagittal split osteotomy. Fifty-six points or angles on the lateral cephalogram and 15 points or angles in the posteroanterior cephalogram were obtained before surgery and 1 year after surgery. Mandibular width was measured on the posteroanterior cephalogram (from gonion to gonion [Go to Go]). Changes in mandibular width were also measured by monitoring changes in an angle formed between a constructed line along the outside of the left and right ascending rami of the mandible and the facial midline. Association of the mandibular width with a variety of standard skeletal parameters was calculated. RESULTS: Mandibular width increased from 99.7 +/- 7.2 mm (mean +/- SD) to 101.1 +/- 6.1 mm. It remained unchanged in 17 patients, increased in 23 patients, and decreased in 2 patients. Analysis revealed a significant inverse correlation of the changes in mandibular width with the changes in posterior facial height (P =.05) and a significant positive correlation with the angle formed by the facial midline and the left ascending ramus (P >.005). All other changes were not significantly correlated with the changes in mandibular width. Multiple regression analysis revealed that the change in posterior facial height is an independent parameter for the changes in mandibular width (P =.041 for mandibular width at Go-Go). CONCLUSIONS: This study establishes a clinically important association between frontal view parameters with parameters derived from lateral view analysis.