Orthodontic--surgical treatment and respiratory function: rhinomanometric assessment.

BACKGROUND: Several correlations between morphological and/or positional alterations of the jaws and respiratory functional impairments have been reported. Nasal airway obstruction represents a critical issue with no clearly defined gold standard as for its measurement. Rhinomanometry was adopted by multiple Authors to evaluate whether patients with malocclusion developed respiratory functional changes after an orthodontic-surgical treatment. However, there are contrasting findings in the literature regarding the possibility of improving the respiratory function by means of surgically-assisted rapid palatal expansion (SARPE) or bimaxillary repositioning of the bony bases. METHODS: Ten patients aged from 18 to 30 years and scheduled for orthodontic-surgical treatment of maxillary constriction volunteered as participants for this study. Orthognathic surgery consisted in: 1) SARPE in 4 patients; 2) Le Fort I down fracture combined with a bilateral sagittal split osteotomy (BSSO) in 6 patients. All patients underwent a computerized rhinomanometric test before treatment (T0) and 40 days after surgery, at the time of the inter-maxillary splint removal (T1). Specifically, all 10 patients received AAR evaluations, while 6 patients received both active anterior (AAR) and active posterior rhinomanometry (APR). RESULTS: Both AAR and APR tests showed a decrease in mean nasal resistance following the intervention. As for the AAR, a difference of 0.19 Pa/s/cm3 was found. The difference found for APR at a reference pressure of 75 Pa was 0.24 Pascal/s/cm3, while for APR at 150 Pa it was 0.20 Pa/s/cm3. CONCLUSIONS: This study helps to confirm respiratory benefits obtainable after mono and bi-maxillary orthognathic surgery.

Cone Beam Computed Tomography Assessment of Maxillary Sinus Floor Augmentation Using Beta-Tricalcium Phosphate Alone or in Combination with Platelet-Rich Plasma: A Randomized Clinical Trial.

PURPOSE: The aim of this study was to evaluate and compare the long-term clinical and radiographic outcomes between a bone graft substitute mixture (beta-tricalcium phosphate [ß-TCP] and plateletrich plasma [PRP]) and ß-TCP bone graft substitute alone used for sinus floor elevation. MATERIALS AND METHODS: This randomized clinical trial included patients with an atrophic maxilla referred for maxillary sinus floor elevation. The elevated sinus cavities of patients were randomly filled with ß-TCP plus PRP (study group) or ß-TCP alone (control group). Residual bone crest height, vertical bone height gain, and bone graft resorption were measured on cone beam computed tomography (CBCT) images at 10 days and 6 months postoperatively. Incidence of sinus membrane perforations and maxillary sinus infections were recorded. Paired t and Student t tests were used for intragroup and intergroup comparisons, respectively. RESULTS: The sample was composed of 18 subjects: nine subjects in the control group (mean age, 31.51 years) and nine subjects in the study group (mean age, 34.01 years). The mean residual bone crest height was found to be < 5 mm in both groups (4.88 mm in the control group and 2.70 mm in the study group, with no significant difference). From the 10-day to 6-month postoperative visit, mean vertical bone height gains were changed from 12.48 to 11.59 mm in the study group and from 14.77 to 13.19 mm in the control group, with no significant difference. The mean vertical bone graft resorption was -1.58 mm in the study group and -0.89 mm in the control group, with no significant difference. Sinus membrane perforation was observed in 3 of 18 patients. CONCLUSION: In this study, PRP plus ß-TCP graft substitute did not produce significantly more vertical bone height gain or significantly less vertical bone graft resorption compared with ß-TCP graft substitute alone. Within the limitations of this study, however, it can be concluded that both grafting materials produced sufficient vertical bone height gain for safe implant placement.

Assessment of nasal septum after Le Fort I osteotomy with computer tomography.

The purpose of this study was to evaluate the effects of Le Fort I osteotomy on nasal septum deviation and differences in left and right airway sizes, and to determine whether the nasal septum was affected by differences in the direction of movement. Forty patients underwent conventional Le Fort I osteotomy, and computed tomography (CT) was performed preoperatively, and 1 week and 1 year postoperatively. The nasal septum angle and airway area were measured at the anterior, middle, and posterior positions on the CT images Patients were divided into 2 groups depending on each difference in movement (impaction ≥5 mm or other; anterior movement or other; and impaction asymmetry or other). There were no significant differences in the nasal septum angle and the airway of all patients. Among the patient groups, there were no significant differences in the nasal septum angle and airway. We concluded that conventional LI osteotomy did not influence the nasal septum deviation or the left and right airway asymmetry. Differences in the method of moving the maxilla have not been shown to affect changes in the nasal septum.

A minimally invasive surgical approach for large cyst-like periapical lesions: a case series.

Various conservative approaches have been utilized to manage large periapical lesions. This article presents a relatively new, very conservative technique known as surgical fenestration which is both diagnostic and curative. The technique involves partially excising the cystic lining, gently curetting the cystic cavity, performing copious irrigation, and closing the surgical site. This technique allows for decompression and allows the clinician the freedom to take a biopsy of the lesion, as well as perform other procedures such as root resection and retrograde sealing, if required. As the procedure does not perform a complete excision of the cystic lining, it is both minimally invasive and cost-effective. The technique and the concepts involved are reviewed in 4 cases treated with this novel surgical approach.

New osteotomy for transport of a disc of alveolar bone to close an oronasal fistula during distraction osteogenesis for reconstruction of a maxillary defect: in vitro assessment.

We describe a new osteotomy for transport of a disc of alveolar bone, which can simultaneously close an oronasal fistula with two layers of mucoperiosteum during distraction osteogenesis for reconstruction of a maxillary defect.

Postoperative tomographic assessment of veneer bone grafting with implant placement in the maxillary anterior region.

Various ridge augmentation and sinus lift procedures were performed in severely resorbed alveolar crests of a maxilla to provide some volume for implant treatment. It was reported that the outcome of maxillary sinus lift procedures was evaluated with conventional tomography or computerized tomography, and that grafted bone around implants markedly progressed in resorption, particularly at the implant apex. However, veneer bone grafting with implant placement has not been evaluated after treatment with imaging techniques. Therefore, the purpose of this study was to assess veneer bone grafting after maxillary anterior implant treatment. Seven patients with a mean age of 24 years, with implants placed in the maxillary anterior region with or without autogenous veneer bone grafting were postoperatively examined using conventional tomography. On tomograms, the ratio of bone-to-implant contact and the area of bone were measured in labial bones with bone grafts, and they were compared with the values without bone grafts. In cases with bone grafting, the average ratio of bone-to-implant contact was 63.6%, whereas 81.8% was formed in cases without bone grafting. The average area of bone was 12.9 mm and 23.4 mm in patients with and without bone grafting, respectively. No significant difference was found between the implants with and without bone grafts. Resorbed labial bone was observed in the maxillary anterior region with and without veneer bone grafting.

Reconstruction of extensive maxillary defects using zygomaticus implants.

PURPOSE: Maxillary reconstruction after maxillectomy remains a great challenge for the reconstructive oral and maxillofacial surgeon. This article is a clinical retrospective analysis of patients reconstructed with zygomaticus implants after maxillary ablation. PATIENTS AND METHODS: The design of the study was a retrospective review of 9 patients requiring near-total or total maxillectomy for pathologic reasons. Clinical records, photographs, and radiographs were studied. Financial billing statements were reviewed to determine charges for implant reconstruction and method of payment. RESULTS: Maxillary reconstruction using zygomaticus and standard endosseous implants was performed in 9 patients. Maxillary resection was performed for the following reasons: salivary gland malignancy (n = 2), squamous cell carcinoma (n = 5), maxillary mucormycosis (n = 1), and extensive maxillary atrophy and infection secondary to subperiosteal maxillary implant placement (n = 1). A total of 28 zygomaticus implants and 10 standard endosseous implants were used to reconstruct the 9 patients. Six zygomaticus implants and 3 standard endosseous implants failed. The time of zygomaticus implant placement ranged from placement at the time of resection to 3.2 years after the resection. Five patients received radiation therapy. Five patients have been reconstructed with a maxillary obturator and have been functioning with the prosthesis for a minimum of 2 years. CONCLUSION: The combination of zygomaticus and standard endosseous implants can be used to reliably reconstruct patients after extensive resection of the maxilla.

Effects of sinus lifting on voice quality. A prospective study and risk assessment.

A variety of potential complications associated with sinus lift surgery have been reported in the literature. However, potential alterations of voice quality following sinus elevation have so far not been mentioned or evaluated scientifically. For the majority of patients, slight changes of the voice pattern are of no importance. However, for voice professionals, whose voices have become part of their distinctive profession or trademark, minimal changes may have dramatic consequences. This specific group of patients, such as speakers, actors and singers, depend on the particular quality and timbre of their voice for their livelihood. Consequently, the purpose of this study was to assess the effects of sinus lifting on voice quality in the above patient group. In a collaborative interdisciplinary effort, the Departments of Oral Surgery and Otorhinolaryngology, Section of Phoniatrics and Logopedics, thoroughly evaluated a series of voice parameters of four patients undergoing sinus lifting pre- and postoperatively. The parameters analyzed included pitch, dynamic range, sound pressure level, percent jitter, percent shimmer and noise-to-harmonics ratio with special emphasis on formant analysis. No changes were detected in any of the commonly evaluated parameters. These were rated subjectively by patients and their friends or relatives and objectively with instrumental tools under isolated phoniatric lab conditions. In conclusion, sinus lift surgery appears to be a safe, predictable evidence-based method for regenerating the highly atrophic posterior maxilla, which does not jeopardize the individual characteristic voice pattern of high-profile patients critically dependent on their voices for their livelihood.

Assessment, documentation, and treatment of a developing facial asymmetry following early childhood injury.

Prepubertal trauma is often implicated as the cause of asymmetric growth of the mandible. A series of photographs taken before and after early childhood injury to the orofacial complex illustrates the development of a three-dimensional dentofacial deformity in a patient. The diagnosis and combined surgical orthodontic treatment plan to correct the facial asymmetry and malocclusion are discussed.

Technical note: maxillofacial biomodelling--preliminary result.

A new technique of manufacturing three-dimensional (3D) hard tissue biomodels is described. The models, derived from computed tomography data, were constructed by a computer-controlled manufacturing device known as stereolithography apparatus (SLA). Selected cases of patients with facial deformities were presented to illustrate clinical applications of the SLA biomodelling. Physical demonstration of the bony internal anatomy in these patients promoted better conceptualization of the disease process, allowing optimal input into the management decision, pre-operative planning and choice of surgical technique with a consequent reduction in operating time and potential reduction in peri-operative morbidity. Limitations of the solid modelling technique include cost, a lengthy production time which renders it unsuitable for emergency cases, and radiation exposure of the patient. With wider use and further technological development, these drawbacks will be minimized. The 3D SLA biomodels may in future become an adjunct, not only to maxillofacial surgery, but also to other medical specialties.