Morphological CBCT parameters for an accurate differentiation between nasopalatine duct cyst and the normal nasopalatine canal.

BACKGROUND: The incisive foramen width was a traditional imaging criterion for diagnosing nasopalatine duct (NPD) cysts. Recent CBCT studies demonstrated significant dimensional variations of the nasopalatine canal, which raised questions about the accuracy of this criterion. This study investigated whether nasopalatine canal diameters assessed on CBCT images can accurately differentiate NPD cysts from normal nasopalatine canals. METHODS: The study included 19 patients with NPD cysts (12 (63.2%) males, 7 (36.8%) females, mean age 44.7 ± 13.3), and a control group of 164 patients (72 (43.9%) males, 92 (56.1%) females, mean age 47.25 ± 17.74). CBCT images were retrospectively evaluated. The following nasopalatine canal diameters were measured on reference sagittal, coronal, and axial reformation images: nasal opening anteroposterior (AP) and mediolateral (ML) diameter, oral opening AP (APOO) and ML (MLOO) diameter, nasopalatine canal length, minimum ML (minML) diameter, anterior wall expansion (AWE), nasopalatine canal angle, and the mid-level AP diameter (midAP). All parameters were compared between groups. Discriminant functional analysis (DFA) was applied to detect CBCT parameters that best differentiate the NPD cyst from the normal canal. RESULTS: Patients with NPD cyst had significantly greater values of APOO (7.06 ± 2.09 vs. 5.61 ± 1.70), MLOO (6.89 ± 2.95 vs. 3.48 ± 1.24), minML (2.88 ± 1.53 vs. 2.25 ± 1.09), AWE (2.15 ± 0.65 vs. 0.41 ± 0.67), and midAP (4.58 ± 1.61 vs. 2.48 ± 0.96). DFA showed MLOO, AWE, and midAP as the most accurate in distinguishing NPD cyst from the normal canal. When combined in the discriminant function equation X = 0.390·MLOO + 1.010·AWE + 0.288·midAP (cut score 1.669), the differentiation can be performed with a sensitivity and specificity of 98.8% and 76.9%, respectively. CONCLUSION: NPD cysts can be accurately distinguished from the normal nasopalatine canal by measuring MLOO, AWE, and midAP diameter on CBCT images.

Three-dimensional analysis of palatal morphology and PAS in patients with cleft lip and palate prior to orthodontic treatment.

BACKGROUND: Since many different conclusions of craniofacial anomalies and their relation to the posterior airway space coexist, this comparative clinical study investigated the palatal morphology concerning volumetric size, posterior airway space dimension and the adenoids of patients with and without a cleft before orthodontic treatment. METHODS: Three-dimensional intraoral scans and cephalometric radiographs of n = 38 patients were used for data acquisition. The patients were divided into three groups: unilateral cleft lip and palate (n = 15, 4 female, 11 male; mean age 8.57 ± 1.79 years), bilateral cleft lip and palate (n = 8, 0 female, 8 male; mean age 8.46 ± 1.37 years) and non-cleft control (n = 15, 7 female, 8 male; mean age 9.03 ± 1.02 years). The evaluation included established procedures for measurements of the palatal morphology and posterior airway space. Statistics included Shapiro-Wilk-Test and simple ANOVA (Bonferroni) for the three-dimensional intraoral scans and cephalometric radiographs. The level of significance was set at p < 0.05. RESULTS: The palatal volume and cephalometric analysis showed differences between the three groups. The palatal volume, the superior posterior face height and the depth of the bony nasopharynx of patients with cleft lip and palate were significantly smaller than for non-cleft control patients. The superior posterior face height of bilateral cleft lip and palate patients was significantly smaller than in unilateral cleft lip and palate patients (BCLP: 35.50 ± 2.08 mm; UCLP: 36.04 ± 2.95 mm; p < 0.001). The percentage of the adenoids in relation to the entire nasopharynx and the angle NL/SN were significantly bigger in patients with cleft lip and palate than in the non-cleft control. In particular, the palatal volume was 32.43% smaller in patients with unilateral cleft lip and palate and 48.69% smaller in patients with bilateral cleft lip and palate compared to the non-cleft control. CONCLUSIONS: Skeletal anomalies relate to the dimension of the posterior airway space. There were differences among the subjects with cleft lip and palate and these without a cleft. This study showed that the morphology of the palate and especially transverse deficiency of the maxilla resulting in smaller palatal volume relates to the posterior airway space. Even the adenoids seem to be affected, especially for cleft lip and palate patients.

Does krill oil enhancing the new bone formation in orthopedically expanded median palatal suture in rat model? A micro-CT and immunohistochemical analysis.

BACKGROUND: The purpose of this study was to assess the effects of systemically given krill oil (KO) on the development of new bone formation in the sutura palatina media following rapid maxillary expansion (RME). METHODS: 28 4-5 week-old male Wistar albino rats were randomly divided into 4 groups: Control (C), Only Expansion (OE) (no supplement but undergoing expansion and retention), KE (supplemented during both the expansion and retention phases), Krill Oil Nursery Group (KN) (supplemented during the 40-day nursery phase as well as during the expansion and retention phases). A 5-day RME was followed by a 12-day retention period. All rats were euthanized simultaneously. Micro-computerized tomography (Micro-CT), hemotoxylen-eosin (H&E) staining, and immunohistochemical analysis were conducted. Kruskal-Wallis and Dunn tests with Bonferonni corrrection were applied (p < 0.05). RESULTS: Expansion and KO supplementation did not cause a statistically significant change in bone mineral density (BMD), bone volume fraction (BV/TV), spesific bone surface (BS/BV) and trabecular thickness (Tb.Th). While the expansion prosedure increased the trabecular seperation (Tb.Sp), KO supplemantation mitigated this effect. The KE group exhibited a statistically significantly increase in trabecular number (Tb.N) compared to the OE group. Although receptor activator of nuclear factor-kappa-Β ligand (RANKL)/osteoprotegerin (OPG) ratios did not show significant differences between groups, the KE and OE groups demonstrated the lowest and highest value, respectively. KE showed a reduced amount of tartrate-resistant acid phosphatase (TRAP) compared to the OE. CONCLUSION: KO positively affected the architecture of the new bone formed in the mid-palatal suture. In this rat model of RME, results support the idea that administering of KO during the expansion period or beginning before the RME procedure may reduce relapse and enhance bone formation within the mid-palatal suture.

Computer-assisted open exposure of palatally impacted canines for orthodontic eruption: A randomized clinical trial.

OBJECTIVE: This randomized clinical trial aimed to assess the feasibility of computer-assisted open exposure of palatally impacted canines. MATERIALS AND METHODS: Patients aged 11-30 years who required orthodontic eruption for the full palatal impaction of their canines were included in this study. Exclusion criteria were psychosocial and dental contraindications of orthodontic treatment, congenital craniofacial disorders, and trauma in the patient's history in the vicinity of the surgical site. Virtual planning software was used to register the intraoral scans and cone-beam computed tomography data and to design a surgical template. In the test group, exposure of the canines was guided by a surgical template, whereas in the control group, the surgeon relied on the surgical plan to localize the impacted canine. The success of the intervention, duration of surgery, and complications, including excessive hemorrhage, damage to the canine or neighboring anatomical landmarks, and postoperative inflammation of the surgical site were assessed. Postoperative pain was reported by the patients using the visual analog pain scale (VAS). RESULTS: Surgery was deemed successful in all patients in both groups. During healing, no complications were observed. The duration of surgery decreased significantly in the test group (4 min 45.1 s ± 1 min 8.4 s) compared to that in the control group (7 min 22.3 s ± 56.02 s). No statistically significant differences were observed between the VAS scores of the two study groups. CONCLUSIONS: The application of virtual planning and static navigation is a viable approach for the open exposure of palatally impacted canines. CLINICAL TRIAL REGISTRATION NUMBER: NCT05909254. CLINICAL SIGNIFICANCE: Computer-assisted surgery is a feasible method for open exposure of palatally impacted canines, which decreases the duration of surgery compared to the freehand method.

Florid follicular lymphoid hyperplasia of the palate: review of the literature and report of an illustrative case.

OBJECTIVE: The aim of this report was to review oral follicular lymphoid hyperplasia, with emphasis on palatal lesions. METHOD AND MATERIALS: A comprehensive search was performed on PubMed for case reports and case series of palatal follicular lymphoid hyperplasia published in the English language literature. Relevant data from collated articles was sought, including patient demographics, clinical manifestations, imaging modalities and findings, comorbidities, etiopathogenesis, lesional management, and lesional outcome. A new palatal case has also been provided to illustrate several features of this lesion. RESULTS: In total, 32 cases were assembled to establish clinicopathologic correlations, representing the largest aggregation of published cases. Most of the affected patients were at least 60 years old and with a decisive female predilection. The majority of lesions were ≤ 3 cm, appearing as normal color, purple-red or red, and varied from soft to firm. Notably, 32% of palatal follicular lymphoid hyperplasias were associated with denture wear, and lesional recurrence was recorded in 16% of cases. To date, none of the reported cases of palatal follicular lymphoid hyperplasia has undergone malignant transformation. CONCLUSIONS: Palatal follicular lymphoid hyperplasias often arise as a reactive process. Critical histopathologic and histochemical assessments are necessary to establish benignity. Postoperatively, clinicians should follow patients for at least 5 years for recurrence and remain vigilant for neoplastic change as several published accounts of non-oral follicular lymphoid hyperplasias have undergone malignant transformation, usually to lymphoma.

How palatal vault morphology and screw length influence the accuracy of dynamic computer-guided orthodontic miniscrew insertion. A prospective clinical study.

OBJECTIVES: The aim of this study was to evaluate the influence of palatal vault morphology and screw length on the accuracy of miniscrew insertion in dynamic computer-assisted surgery (d-CAS). METHODS: Twenty-four subjects were allocated into three groups, according to their palatal vault morphology (Group A: medium; Group B: steep/high; Group C: low/flat) and the length of miniscrew used. For each subject, two miniscrews were inserted using a dynamic navigation system. To assess the accuracy of insertion, a postoperative CBCT was performed, and the pre- and post-operative scans were superimposed. Five variables were evaluated: Entry-3D, Entry-2D, Apex-3D, Apex-vertical and angular deviation. Descriptive statistics, Shapiro-wilk, Kruskal-Wallis and Dunn's tests were used for the statistical analysis. The level of significance was P ≤ 0.05. RESULTS: The mean angular deviation values revealed strong discrepancies amongst the groups (Group A:7.11°±5.70°; Group B:13.30°±7.76°; Group C:4.92°±3.15°) and significant differences were found regarding the Apex-3D (P = 0.036) and angular deviations (P = 0.008). A Dunn's test revealed differences in angular deviation between the medium and high/steep palate group (P = 0.004), and between low/flat and high/steep palate group (P = 0.01) but did not confirm any significant difference in the Apex-3D parameter (Group A-B P = 0.10; Group B-C, P = 0.053; Group A-C, P = 1.00). No significant differences were found regarding the length of the miniscrews. CONCLUSIONS: Palatal vault morphology is a factor that influences the accuracy of miniscrew insertion in d-CAS. In subjects with steep and high palatal vaults, insertion accuracy is lower when considering the angular deviation value. Miniscrew length does not influence accuracy. CLINICAL SIGNIFICANCE: Although computer-guided surgery assists the clinician in preventing damage to nearby anatomical structures, individual anatomical variability is a crucial variable. In subjects with a high/steep palate, greater attention should be paid during the planning phase in order to allow for a wide margin from adjacent anatomical structures to achieve better outcomes.

Ultrasonographic analysis of palatal donor site healing accelerated with platelet-rich fibrin following subepithelial connective tissue harvesting.

OBJECTIVE: Platelet-rich fibrin (PRF) contains a variety of growth factors and bioactive molecules that play crucial roles in wound healing and angiogenesis. We aimed to evaluate the effects of PRF on tissue thickness and vascularization of the palatal donor site by ultrasound (USG) following subepithelial connective tissue harvesting. METHODOLOGY: A subepithelial connective tissue graft was harvested from the palatal region with a single incision for root coverage in 20 systemically healthy patients. In the test group (n = 10), the PRF membrane was placed at the donor site, whereas no material was applied in the control group (n=10). Palatal tissue thickness (PTT) and pulsatility index (PI) were evaluated by USG at baseline and on the 3rd, 7th, 14th, 30th, and 90th days after surgery. The early healing index (EHI) was used to evaluate donor site healing for 30 days. RESULTS: PTT was significantly higher in the PRF group on the 3rd and 14th days after surgery when compared to the controls. In the PRF-treated group, PI levels were significantly higher than in the controls, especially on the 14th day. PTT increased significantly 90 days after surgery compared to the test group baseline, but controls showed a significant decrease. The PRF group showed statistically significant improvements in EHI scores compared to controls on days 3, 7, and 14. This study found a negative correlation between PI values and EHI scores on postoperative days three and seven in the test group. CONCLUSION: USG is a non-invasive, objective method to radiographically evaluate the regenerative effects of PRF on palatal wound healing after soft tissue harvesting. To overcome graft inadequacy in reharvesting procedures, PRF application may enhance clinical success and reduce possible complications by increasing tissue thickness and revascularization in the donor area.

Increased safety in periodontal surgery: Doppler ultrasound for detection of relevant palatal blood vessels-A proof-of-concept and cross-sectional study.

AIM: To evaluate the suitability of a Doppler ultrasound probe in detecting the greater palatine artery or its greater branches non-invasively. MATERIALS AND METHODS: The palatal mucosa of 108 participants (median age 34 years, 51 female) was systematically divided into transversal sectors, each aligning with the positions of the upper molars (M), premolars (P) and canine teeth (C), aiming to facilitate precise and consistent localization of the detected palatal blood vessel across different patients. Blood flow of the palatal blood vessels, presumably, was located by scanning the palatal vault bilaterally using an 8-MHz ultrasound probe linked to a transducer. The distance to the corresponding tooth was measured using a millimetre-scale periodontal probe. RESULTS: Within the regions of M2 to P1, the ultrasound transducer gave a delimitable acoustic pulse signal in 80%-98% of all measurements. The measured median distances between the determined position of the artery and the corresponding teeth ranged from 13 to 15 mm, with smaller distances in the anterior region. In several sectors, the distance was significantly higher for men (C: p = .048; P1: p = .041, M1: p < .01; M2: p = .034). CONCLUSIONS: Use of the Doppler ultrasound transducer might be a promising approach to non-invasively detect relevant palatine blood vessels preoperatively. It, therefore, might have the potential to reduce the risk of accidental injury during palatal surgery.

Análisis de las Variaciones Anatómicas y Dimensionales del Canal Nasopalatino Mediante Tomografía Computarizada de Haz Cónico / Analysis of the Anatomical and Dimensional Variations of the Nasopalatine Canal by Cone Beam Computed Tomography

El conocimiento anatómico del canal nasopalatino (CNP) es fundamental para la realización de cirugías en el sector anterior del maxilar y así prever posibles complicaciones. El objetivo de este trabajo es evaluar y determinar las variaciones anatómicas y dimensionales del CNP según sexo, edad y estado dental. Este estudio transversal analizó un total de 251 imágenes de TCHC obtenidas de la base de datos del Servicio de Imagenología Oral y Maxilofacial de la Facultad de Odontología de la Universidad Andrés Bello, Viña del Mar, Chile. Para evaluar la asociación estadística entre variaciones del CNP con sexo, edad y estado dentario se realizó la prueba T de Student, chi-cuadrado y ANOVA (p0,05). Además, se detectó diferencia significativa entre el estado dentario y la dimensión de la tabla vestibular en relación con el CNP (p<0,01). Se deben considerar las variaciones de CNP para evitar posibles complicaciones durante los procedimientos quirúrgicos.

SUMMARY: Anatomical knowledge of the nasopalatine canal (PNC) is essential for performing surgeries in the anterior sector of the maxilla and thus anticipating possible complications. The objective of this work is to evaluate and determine the anatomical and dimensional variations of the CNP according to sex, age and dental status. This cross-sectional study analyzed a total of 251 CBCT images obtained from the database of the Oral and Maxillofacial Imaging Service of the Faculty of Dentistry of the Andrés Bello University, Viña del Mar, Chile. To evaluate the statistical association between CNP variations with sex, age and dental status, the Student's T test, chi-square and ANOVA (p0.05). In addition, a significant difference was detected between the dental state and the dimension of the vestibular table in relation to the CNP (p<0.01). CNP variations should be considered to avoid potential complications during surgical procedures.

Evaluation of maxillary palatal process pneumatization by cone-beam computed tomography.

PURPOSE: The aim of this study is to investigate the pneumatization type of the palatal process (PTP) and angular and distance measurements of neighbouring structures on cone beam computed tomography (CBCT) images. MATERIALS AND METHODS: 400 maxillary sinuses (MS) of 200 patients (96 female; 104 male; mean age: 43.2) were retrospectively evaluated. PTP was divided into three as types 1,2 and 3 and evaluated at distances 4, 8, 16, and 24 mm posterior to incisive foramen. The sinus and alveolar ridge height, palatonasal recess angle (PRA) and palatal junction angle (PJA) were also measured and recorded. RESULTS: PTP I (101, 25.3%) was the most frequent type, followed by PTP II (95, 23.8%), and the least was PTP III (4, 1%). In patients with PTP I, the alveolar ridge height in the 4 mm and 8 mm group was significantly higher than in the patients with PTP II and III (p<0.05). In patients with PTP I, PRA in the 4 mm and 16 mm groups was significantly higher than in patients with PTP II and III (p<0.05). Sinus and alveolar ridge height, PRA and PJA did not differ significantly between the right and left sides in the 4 mm, 8 mm, 16 mm, and 24 mm groups (p>0.05). CONCLUSION: Knowing the anatomy of the MS is very important for a successful surgical procedure in this area. Anatomy and pathology of the MS can be understood more clearly in CBCT.

Investigation of the relationship between maxillary dimensions and labial and palatal maxillary impacted canines using cone beam computed tomography.

OBJECTIVES: To compare the maxillary dimensions of individuals with labial and palatal bilateral maxillary canine impaction and a control group of individuals with no impaction using CBCT. METHODS: 45 patients were included in the study with age range of 13 to 18 and consisted of 22 females and 23 males. The sample included three groups of 15 patients as the control, labial and palatal group. The measurements made on the axial and coronal planes were made on the levels of the 1st premolar and the 1st molar. Also nasal cavity and anteroposterior depth were measured. RESULTS: The maxillary anteroposterior depth, basal first molar width, alveolar first molar and premolar width and first molar palatal vault depth of the control group were significantly higher than labial and palatal groups (p<0.05).The basal first premolar width of the control group was significantly higher than palatal group (p<0.05). The first premolar palatal vault depth and nasal cavity width of the palatal group were significantly lower than other groups (p<0.05). CONCLUSIONS: The basal and alveolar widths associated with the molars and the palatal depths were lower in the impacted group than control group. The anatomical structures in the female patients were affected by the position of impaction to a higher extent in comparison to the anatomical structures in the male patients.

Effects of wearing removable dentures and aging on palatal mucosa blood flow by laser doppler.

Aim: The purpose of this work is to analyze the effects of removable dental prostheses and aging on blood microcirculation in the palatal mucosa. Settings and Design: Blood flow was measured in two groups using the Laser Doppler Flowmeter at three specific anatomical sites: Retro incisive papilla, medial raphe, and Schroeder area. Materials and Methods: Group 1 included young, healthy dentulous individuals (mean age: 23 ± 3 years), and Group 2 contained elderly edentulous individuals (mean age: 62 ± 11.69 years). For Group 1, measurements were taken in a single session; for Group 2, the measurements were taken in two sessions: The first just before the prosthetic load (E1) and again 1 week after new dentures were provider (E2). Statistical Analysis Used: Statistical analyses were performed using SAS software, Version 9.4 of the SAS System for Windows, Copyright © 2017 SAS Institute Inc. (Cary, NC, USA). A P < 0.05 was classified as statistically significant. Results: Measurements of blood flow of the palatal mucosa showed that the healthy young dentulous participants had significantly lower perfusion unit values than the elderly edentulous participants at all three anatomical sites (P < 0.05). For Group 2, the comparisons between the measurements taken before (E1) and after (E2) new dentures were provided showed no significant differences. Conclusion: Our results indicate that the process of aging significantly modifies the blood flow of the palatal mucosa while wearing removable dental prostheses does not modify the blood flow of the palatal mucosa in a 1week period. These results are not influenced by systemic pathology (e.g., diabetes, cardiovascular diseases) or smoking.

Investigation of the palatal soft tissue volume: a 3D virtual analysis for digital workflows and presurgical planning.

BACKGROUND: In mucogingival and implant surgery, an autologous soft tissue graft from the palate is the gold standard for reconstructing missing keratinised soft tissue and volume. Previously, presurgical measurements of the graft harvesting site were described with two-dimensional (2D) linear measurements. The present observational clinical study aimed to evaluate a three-dimensional (3D) measurement method for determining the present palatal soft tissue volume for each patient individually. METHODS: Pre-existing cone beam computed tomography (CBCT) scans of 20 patients were converted into 3D Standard Tessellation Language models of the bone surface. Intraoral impressions of the maxilla were taken and digitised to visualise the gingival surface. The resulting virtual models of bone (reference value) and gingival (actual value) surfaces were merged, with tooth surfaces used for registration. The region between the central incisors and the hard palate was subdivided into 5 regions of interest (ROIs). The distance between palatal bone and gingival surface was analysed both volumetrically and linearly, and the results were statistically evaluated for the ROIs. RESULTS: The average gingival surface area on the palate was 19.1 cm2, and the mean volume was 58.2 cm3 (± 16.89). Among the ROIs, the mean linear value was highest in the most distal region, from the second molar to the hard palate (4.0 ± 1.09 mm) and lowest in the canine region (1.9 ± 0.63 mm). For mean distance, significant differences were found for the anterior palate and the most posterior palate in comparison with all other ROIs (p < 0.01). The volume measurements also declined significantly and steadily between the posterior (1.9 ± 1.0 cm3) and anterior palates (0.4 ± 0.2 cm3). CONCLUSIONS: By merging digital data, palatal soft tissue could be quantified virtually. The results were reliable and comparable to previous findings with linear measurement methods. This 3D soft tissue volume analysis method fully exploited the diagnostic potential of data that are frequently collected for presurgical planning in oral surgery (i.e., CBCT + surface scans). This evaluation method might be useful for volumetric and linear measurements in other applications in anatomy and for determining palatal soft tissue dimensions in the planning stage before surgical interventions. TRIAL REGISTRATION: This observational clinical trial was retrospectively registered in the German Clinical Trials Register, reference number: DRKS00023918.

Three-dimensional analysis of the palatal morphology in growing patients with Apert syndrome and Crouzon syndrome.

Patients with Apert syndrome or Crouzon syndrome present with severe defects in oral-maxillofacial growth and development. In this study, we conducted a quantitative three-dimensional (3D) analysis of the palatal morphology of patients with Apert syndrome and Crouzon syndrome. Four patients with Apert syndrome (average age, 11.0 ± 0.8 years) and five with Crouzon syndrome (average age, 10.1 ± 1.6 years) were investigated. The participants' maxillary dental casts were scanned and analyzed using 3D imaging. Palatal width, depth, cross-sectional area, and palatal angle (PW, PD, PCA, and PA, respectively) were measured, and standard scores were calculated based on sex- and age-matched Japanese standard values; the actual palatal surface areas (PSA) and palatal volumes (PV) were also measured. Our results show that patients with Apert syndrome and Crouzon syndrome had a very narrow PW (standard score: -3.79 and - 0.47, respectively). 3D analysis revealed that patients with Apert syndrome had a significantly shallower PD (standard score: -1.35) than those with Crouzon syndrome (standard score: 2.47), resulting in a smaller PCA (standard score: -5.13), PSA (5.49 cm2 ), and PV (1.11 cm3 ) and larger PA (standard score: -0.12) than those in patients with Crouzon syndrome. This might be due to the former having a narrower and shallower palate caused by the predominant swelling of the palatal mucosa. These findings improve our understanding of the differences in palatal morphology between Apert syndrome and Crouzon syndrome patients.

Skeletal and alveolar changes in conventional rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE): a prospective randomized clinical trial using low-dose CBCT.

BACKGROUND: This prospective randomized clinical trial aimed to evaluate the immediate and short-term skeletal, dentoalveolar, and periodontal effects of rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE) in adolescent and young adult patients. METHODS: This study followed a two-arm, parallel, randomized clinical trial design that recruited patients with transverse maxillary deficiency in a 1:1 allocation ratio. Forty patients (14 men and 26 women) requiring maxillary expansion were randomly allocated to the RPE (n = 20, age = 14.0 ± 4.5) or MARPE (n = 20, age = 14.1 ± 4.2) groups. The assignment was performed via computer-generated block randomization, with a block size of four. Upon identical (35 turns) amount of expansion, low-dose cone-beam computed tomography images were taken before treatment (T0), immediately after expansion (T1), and after a 3-month consolidation period (T2). The primary outcome of this study comprised the assessment of midpalatal suture separation. Secondary outcomes included, skeletal, dentoalveolar, and periodontal measurements, which were performed at each time point. RESULTS: The frequency of midpalatal suture separation was 90% (18/20) and 95% (19/20) for the RPE and MARPE groups, respectively. A greater increase in nasal width in the molar region (M-NW) and greater palatine foramen (GPF) was observed immediately after the expansion (T1-T0) and consolidation periods (T2-T0) in the MARPE group compared to the RPE group (P < 0.05). The MARPE and RPE groups showed similar dentoalveolar changes except for the maxillary width (PM-MW, M-MW). The MARPE group presented greater bilateral first premolar (PM-MW) and molar (M-MW) maxillary width in relation to the RPE group (P < 0.05). Through the expansion and consolidation periods (T2-T0), lesser buccal displacement of the anchor teeth was observed in the MARPE group (PM-BBPT, PM-PBPT, M-BBPT [mesial and distal roots], and M-PBPT)( P < 0.05). CONCLUSIONS: Midpalatal suture separation was observed in 90% and 95% of patients in the RPE and MARPE groups, respectively. Both RPE and MARPE groups exhibited significant triangular basal bone expansion and skeletal relapse during consolidation. Under identical amounts of expansion, the MARPE group showed lower decrease in the skeletal, dentoalveolar and periodontal variables after consolidation. The reinforcement of RPE with miniscrews contributes to the maintenance of the basal bone during consolidation period. Trial registration WHO Institutional Clinical Trials Registry Platform (IRB No. KCT0006871 / Registration date 27/12/2021).

Treatment of deep-seated palatal vascular malformations by bleomycin sclerotherapy.

BACKGROUND: Vascular malformations of the head and neck are common. The management of these lesions is complex and challenging due to the high complication rate and recurrence following treatment. Palatal vascular malformations (PVMs) are infrequent and present as slow growing lesions in the palate with recurrent bleeding and pain. These lesions are best managed by sclerotherapy due to their posterior location and risk of bleeding if surgery is attempted. Many sclerosants have been used for treating PVMs but the use of intralesional bleomycin for these lesions has not been reported at length. This paper describes the use of intralesional bleomycin injections for the treatment of deep-seated palatal vascular malformations. METHODS: Intralesional bleomycin injections were given directly into the lesion with the patients under short general anaesthesia. The total dose of bleomycin ranged between 8 and 15 IU, which depends upon the body weight and was repeated every four weeks till the resolution of lesion was observed. RESULTS: All the lesions in 12 patients regressed significantly with serial bleomycin injections. Clinically, the involved palatal mucosa became normal and magnetic resonance imaging demonstrated the significant regression of the lesion in all the cases. No complications were encountered with the use of intralesional bleomycin. CONCLUSIONS: Intralesional bleomycin injections have proved to be an emerging modality in the management of remotely situated palatal vascular malformations. Their rapid regressive effect on the lesion coupled with a high safety margin makes bleomycin sclerotherapy the first choice of treatment for palatal vascular malformations.

Anatomical and Morphological Assessment of Nasopalatine Canal in Pediatric and Adolescent Population via Cone Beam Computed Tomography.

INTRODUCTION: Anatomical and morphological structure of nasopalatine canal (NPC) is important for surgical techniques carried out on the maxilla. The aim of the present study was to analyze the anatomical and morphological characteristics of the NPC among pediatric and adolescent population using cone beam computed tomography (CBCT). MATERIALS AND METHODS: A total of 437 cases were analyzed using CBCT images in this retrospective, cross-sectional study. Shape was analyzed as hourglass, cone, funnel, banana, cylindrical, and tree branch like. Number of foramina Stenson (FS) was evaluated through coronal, axial, and sagittal views. Landmark evaluation involved; diameter of FS, diameter of incisive foramen, diameter at the mid-canal length, NPC length, and narrowest buccal bone thickness. Pathology presence near NPC was evaluated to determine alterations on the landmark metrics. RESULTS: Nasopalatine canal shape distribution revealed 32% hourglass, 9.6% conic, 10.8% funnel, 11.9% banana, 29.5% cylindrical and 6.2% tree branch. Number of FS (P = 0.021; P < 0.05), diameter of FS (P = 0.041; p < 0.05), NPC length (P: 0.020; P < 0.05), and narrowest buccal bone thickness from the mid-canal length was significantly higher in males (P: 0.000; P < 0.05). Diameter of incisive foramen and diameter at the mid-canal length revealed no significance among genders (P1 = 0.318, P2 = 0.105; P > 0.05). Incidence of pathology near NPC is 20.8% and was not affected by gender (P = 0,192; P > 0.05). CONCLUSIONS: The current study demonstrates significant variations of NPC morphology among patients. Therefore, CBCT analysis is highly recommended for clinicians to reduce the complications in oral and maxillofacial surgery practices and to provide better surgical outcomes.

Drug-Induced Sleep Endoscopy and Hypoglossal Nerve Stimulation Outcomes: A Multicenter Cohort Study.

OBJECTIVES/HYPOTHESIS: To determine the association between findings of blinded reviews of preoperative drug-induced sleep endoscopy (DISE) and outcomes of hypoglossal nerve stimulation (HNS) for obstructive sleep apnea (OSA). STUDY DESIGN: Cohort study. METHODS: A retrospective, multicenter cohort study of 343 adults who underwent treatment of OSA with HNS from 10 academic medical centers was performed. Preoperative DISE videos were scored by four blinded reviewers using the VOTE Classification and evaluation of a possible primary structure contributing to airway obstruction. Consensus DISE findings were examined for an association with surgical outcomes based on therapy titration polysomnogram (tPSG). Treatment response was defined by a decrease of ≥50% in the apnea-hypopnea index (AHI) to <15 events/hour. RESULTS: Study participants (76% male, 60.4 ± 11.0 years old) had a body mass index of 29.2 ± 3.6 kg/m2 . AHI decreased (35.6 ± 15.2 to 11.0 ± 14.1 events/hour; P < .001) on the tPSG, with a 72.6% response rate. Complete palate obstruction (vs. none) was associated with the greatest difference in AHI improvement (-26.8 ± 14.9 vs. -19.2 ± 12.8, P = .02). Complete (vs. partial/none) tongue-related obstruction was associated with increased odds of treatment response (78% vs. 68%, P = .043). Complete (vs. partial/none) oropharyngeal lateral wall-related obstruction was associated with lower odds of surgical response (58% vs. 74%, P = .042). CONCLUSIONS: The DISE finding of primary tongue contribution to airway obstruction was associated with better outcomes, whereas the opposite was true for the oropharyngeal lateral walls. This study suggests that the role for DISE in counseling candidates for HNS extends beyond solely for excluding complete concentric collapse related to the velum. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:1676-1682, 2021.

Immediate dental and skeletal influence of distractor position on surgically assisted rapid palatal expansion with or without pterygomaxillary disjunction.

The outcome of surgically assisted rapid palatal expansion (SARPE) can be affected by pterygomaxillary disjunction (PMD) and the distractor position. In this study, SARPE was performed, with or without PMD, in 20 fresh cadaver heads. Transverse expansion was conducted twice using a bone-borne distractor in the anterior and posterior positions, resulting in four groups (n=10). Cone beam computed tomography scans were completed before and after SARPE to evaluate maxillary changes. A comparative anterior decrease and posterior increase in midpalatal opening resulted from SARPE with PMD combined with a posteriorly placed distractor. Significant differences in the internal transverse changes were found between the two SARPE techniques combined with an anterior distractor at the level of the premolars and molars for alveolar ridge width (P=0.040, P=0.024), and at the level of the molars for the dental crown width (P=0.017) and corresponding tooth cusp width (P=0.018). In contrast, using a posteriorly placed distractor led to a significant difference for tooth cusp width only (P=0.050). No statistically significant differences were found between external transverse changes or between distractor positions. PMD is more important in achieving a more uniform and parallel transverse expansion pattern than the distractor position. However, a posterior distractor seems to intensify the effects of PMD.