Opioid use disorder in two samples of the Lebanese population: scale validation and correlation with sleep and mood disorders.

BACKGROUND: The revised Opioid Risk Tool (ORT-OUD) is a brief, self-report scale designed to provide clinicians with a simple, validated method to screen for the risk of developing an Opioid Use Disorder (OUD) in patients without a prior history of substance abuse. This study aimed to translate and validate the Arabic version of ORT-OUD in the Lebanese population and assess its clinical validity in a sample of patients with OUD. METHODS: This cross-sectional study in the Lebanese population used several validated scales to assess the risk of OUD, including the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Other tools evaluated chronotype and sleep and mood disturbances. Principal component analysis with Varimax rotation was applied to assess ORT-OUD construct validity. Convergent validity with the Arabic version of ASSIST was evaluated. The ORT-OUD criterion validity was then assessed in a clinical sample of patients with OUD. RESULTS: This study included 581 participants. The prevalence of the OUD risk in the Lebanese population using the ORT-OUD scale and the ASSIST-opioids scale was estimated at 14.5% and 6.54%, respectively. No items of the ORT-OUD were removed; all items converged over a solution of four factors with an eigenvalue > 1, explaining a total of 68.2% of the variance (Cronbach's alpha = 0.648). The correlation coefficients between the ORT-OUD total score and ASSIST subscales were as follows: ASSIST-opioids (r = 0.174; p = < 0.001), ASSIST-sedatives (r = 0.249; p < 0.001), and ASSIST-alcohol (r = 0.161; p = < 0.001). ORT-OUD clinical validation showed a correlation with ASSIST-opioids (r = 0.251; p = 0.093) and ASSIST-sedatives (r = 0.598; p < 0.001). Higher ORT-OUD scores were associated with a family and personal history of alcohol and substance consumption and higher insomnia and anxiety scores. CONCLUSIONS: This study is the first to validate the Arabic version of ORT-OUD in the Lebanese population, an essential step towards improving the detection and management of OUD in this population.

Substance use disorder in the context of the economic crisis, covid-19 pandemic and social unrest: a cross-sectional study across Beirut (2020-2021).

BACKGROUND: Substance use disorder (SUD) is related to the interplay of various factors. The primary objective of this study was to assess the variation in substance use (SU) among a set of Lebanese people undergoing treatment for SUD during the Lebanese economic crisis, COVID-19 pandemic, and Beirut Blast. METHODS: A cross-sectional study including Lebanese adults previously diagnosed with and being treated for SUD at the Skoun center was conducted. Data collection was done using a paper-based Arabic questionnaire tackling the economic crisis, the Covid-19 pandemic, and the Beirut Blast, as well as the following scores: APGAR, PHQ-9, GAD-7 and PCL-6. Data were analyzed using SPSS version 25.0 with P value<0.05 considered significant. A bivariate analysis was conducted to study the association between the use of substances and study variables and scores. RESULTS: The sample included 126 men and 10 women. Most participants had a stable consumption of illicit drugs (58.8%), alcohol (76.5%), prescription drugs (70.6%) and non-prescription drugs (89%). Additionally, most participants had concomitant mild or moderate depression (55.1%), mild or moderate anxiety (50.7%), and PTSD (61.8%). Factors found to significantly increase SU were economic distress, change in employment status, and decrease in working hours. PTSD was also identified as a risk factor for increased illicit drug and alcohol use. Furthermore, severe anxiety was found to be a risk factor for increased alcohol consumption. CONCLUSION: Most participants were able to maintain a stable pattern of SU despite the quadruple crisis in Lebanon highlighting the important role played by Lebanese Non-Governmental Organizations (NGOs) and efforts employed to control SUD.

The association between long-distance migration and PTSD prevalence in Syrian refugees.

BACKGROUND: Refugees are forced migrants but there is a large variation in the distance that refugees cover and there is a paucity in the evidence of how this may affect refugees' health and health care needs. OBJECTIVE: We investigated the association between long-distance migration and post-traumatic stress disorder (PTSD), a serious psychiatric disorder associated with deteriorating mental and somatic health. METHODS: Included from 2016-2019 were adult Syrian refugees in Lebanon and Denmark that arrived up to 12 months prior to inclusion. PTSD was assessed using the Harvard Trauma Questionnaire and the estimate of association was obtained by multiply imputing missing data and adjusting for confounding by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience and general mental well-being, reporting the bootstrap 95-percentile confidence interval (95% CI). Additionally, a number of sensitivity analyses were performed. RESULTS: Included were 599 participants in Lebanon (mean age 35 years old, 73% being female) and 133 participants in Denmark (mean age 30 years old, 47% being female). After multiply imputing missing data and propensity score-weighted adjustment for confounding, migration to Denmark instead of Lebanon was associated with an increase in PTSD prevalence of 9 percentage point (95% CI [-1; 19] percentage point). CONCLUSIONS: Long-distance migration may be associated with an increase in PTSD prevalence in refugees. The migration could be an important factor to consider when assessing refugees' and asylum seekers' health. Practitioners should consider "long-distance migration" in refugee health screenings and in particular when assessing the risk of post-traumatic stress disorder. Future research should be designed to ultimately lead to studies of relevant interventions to lower the risk of post-traumatic stress disorder in refugees.

The Relationship Between Anxiety Disorders and Parkinson's Disease: Clinical and Therapeutic Issues.

PURPOSE OF REVIEW: This paper seeks to describe anxiety's different symptomatologic presentations in Parkinson's disease (PD), its longitudinal course and predictors, as well as its motor and non-motor correlates. It also reviews the available screening tools and different treatment modalities. RECENT FINDINGS: In PD, longitudinal predictors of anxiety are mostly non-motor non-dopaminergic symptoms. The longitudinal course of anxiety is mainly a stable one. The Parkinson Anxiety Scale and the Geriatric Anxiety Scale are the 2 recommended screening tools. A third of PD patients suffer from an anxiety disorder at any time point. It can precede or follow PD motor symptoms. Anxiety is associated with demographic, disease-related motor and non-motor features. There is a lack of studies evaluating psychotropic treatment of anxiety in PD. Adjustment of dopaminergic treatment is indicated when anxiety is associated with motor fluctuations. DBS can be useful as well as CBT and body-mind interventions.

Lebanese People Living with HIV: Psychiatric Co-morbidities and Psycho-Social Environment.

Data are lacking on the psychiatric and psycho-social profiles of Middle-Eastern people living with HIV (PLHIV). Our study aimed to establish the prevalence and correlates of mental illness in a sample of Lebanese PLHIV, and to delineate their socio-cultural reality. PLHIV, either attending a private ID clinic or a non-governmental organization, were interviewed. A total of 94 patients were included. Sixty-nine (73.4%) were found to have at least one psychiatric disorder. Only nine participants were currently receiving psychotropic medications. The most common diagnosis was major depression, occurring in half of the subjects. Homosexual or bisexual orientation predicted the presence of a current depression (p = 0.024), and ART status was negatively associated with current depression (p = 0.028). The rate of psychiatric disorders is clearly higher than that of the general population. PLHIV with a homosexual or bisexual orientation face a double stigma, perhaps making them more vulnerable to depression. Our findings need to be replicated in larger studies with more representative samples.

Prospective, multi-centric benchmark study assessing delirium: prevalence, incidence and its correlates in hospitalized elderly Lebanese patients.

BACKGROUND: With the increase in the proportion of elderly Lebanese patients, little is known about delirium's prevalence, incidence and correlated factors. AIMS: To identify the prevalence, incidence and factors associated with overall and incident delirium in hospitalized elderly Lebanese patients. METHODS: A convenient sample was recruited from three university hospitals affiliated to the Lebanese university faculty of medical sciences. We included patients aged more than 65 years. Baseline factors were examined upon presentation and the confusion assessment method (CAM) was used to detect prevalent delirium upon admission or within the first 48 h. Enrolled patients were then assessed every other day to detect incident delirium cases. RESULTS: Among the 230 patients included, delirium prevalence was 17% and incidence 8.7%. We found that a history of falls (odds ratio (OR) = 5.12; p = 0.001), immobilization (OR = 7.33; p = 0.035), polypharmacy (OR = 5.07; p = 0.026) along with tachycardia (OR = 6.94; p = 0.03) and severe anemia (OR = 12.5; p = 0.005) upon admission were significant factors associated with overall delirium (incident and prevalent delirium cases). Whereas, living alone was significantly associated with lower odds for overall delirium (OR = 0.03; p = 0.02). Moreover, current smoking (OR = 14; p = 0.02), low oxygen saturation (OR = 9.6; p = 0.008) and severe anemia (OR = 8.4; p = 0.013) upon admission remained significantly associated with higher odds for incident delirium along with urine catheter placement (OR = 7.8; p = 0.015). CONCLUSION: Secondary to the burden of delirium and its impact on mortality among elderly population, trying to understand and adjust modifiable factors would promote more appropriate prevention strategies.

Depression and religiosity and their correlates in Lebanese breast cancer patients.

BACKGROUND: Breast cancer bears considerable morbidity and mortality and is well known to increase the risk of major depression, whereas religiosity has been reported to be protective. We searched for an association between depression and religiosity in breast cancer patients. We also sought to find an association between depression and various sociodemographic and disease variables. METHODS: One hundred two patients were interviewed. Sociodemographic, cancer profile, and religiosity questionnaires were administered. We screened for depressive disorders by using the Mini-International Neuropsychiatric Interview and the Beck Depression Inventory. RESULTS: Most of our participants (n = 79; 77.4%) had high religiosity score. The prevalences of lifetime major depression, current major depression, and major depression after cancer diagnosis were 50.9%, 30.1%, and 43.1%, respectively. We could not find a correlation between religiosity and current depression, while the association with depression after cancer diagnosis was close to but did not reach statistical significance (P = .055) and in favor of a deleterious role of religiosity. Depression was only linked to marital status and insurance coverage. No association was found with disease-related variables. CONCLUSIONS: Religiosity does not seem to be protective against depression development. The stress of cancer appears to be the main culprit in increasing the risk of depression.

Adverse childhood experiences in substance use disorder outpatients of a Lebanese addiction center.

Childhood adversities (CAs) are well reviewed in mental health and addiction research internationally. However, these variables have not been studied within the framework of addiction in the Middle East region. The present study reports the prevalence of Childhood Adversities in a sample of outpatients seeking treatment for Substance Use Disorder. We used the Adverse Childhood Experiences - International Questionnaire (ACE-IQ) to map out the prevalence of childhood adversities. The studied population was composed of a clinical outpatient sample that met criteria for substance use disorder (N = 144). Results indicated that almost all the sample reported having experienced at least 1 CA, whereby three quarters of the clinical sample reported experiencing 6 or more adversities. Childhood adversities are highly prevalent in a Lebanese substance use disorder population which raises the need for better screening strategies and more understanding of Adverse Childhood Experiences in this specific population.

Post-traumatic stress disorder in a sample of Syrian refugees in Lebanon.

INTRODUCTION: Lebanon is the main hosting country for the Syrian crisis, with more than one million Syrian refugees. The objective of this study was to determine the prevalence of post-traumatic stress disorder (PTSD), and identify its possible predictors, in a sample of Syrian refugees living in camps in Lebanon. METHOD: We conducted a household survey on Syrian refugees between 18 and 65years old in 6 camps of the Central Bekaa region, using the Mini International Neuropsychiatric Interview (M.I.N.I.) as a diagnostic tool. RESULTS: Among the 452 respondents, we found a lifetime prevalence of PTSD of 35.4%, and a point prevalence of 27.2%. The lifetime prevalence of SUD was 1.99% and the point prevalence 0.66%. Multivariate logistic regression could not identify any predictor of current PTSD among a list of demographic variables, but identified the Syrian hometown as a significant predictor of lifetime PTSD (p=.013), with refugees from Aleppo having significantly more PTSD than those coming from Homs (adjusted OR 2.14, 95% CI [1.28, 3.56], p=.004). DISCUSSION: PTSD was a real mental health issue in our sample of adult Syrian refugees in Central Bekaa camps, unlike SUD.

Opiate agonist treatment to improve health of individuals with opioid use disorder in Lebanon.

BACKGROUND: Opioid agonist therapy has been widely used to reduce harms among individuals with opioid use disorder but its effectiveness has not been evaluated in the Middle East North African (MENA) region. This study aims to evaluate the effectiveness of a program using opioid agonist therapy in combination with psychosocial support on improving psychological and social well-being, reducing arrest, and reducing risky behavior in individuals with opioid use disorder in Lebanon. METHODS: A one-group pre-test post-test design study was performed at SKOUN Lebanese Addiction Centre between January 2013 and December 2014. Eighty-six out of 181 patients agreed to participate and completed the 3-month assessment and 38 concluded the 12-month assessment. Psychological (depression and anxiety, quality of life), substance dependence/abuse, behavioral (injecting behavior, sharing needles and paraphernalia), and social outcomes were evaluated at baseline, 3, and 12 months post-treatment. RESULTS: Remarkable statistical significance improvements were observed 3 months after treatment in most outcome variables including quality of life, anxiety, substance dependence, overdose, employment, and injecting behavior. Improvements were sustained 12 months after treatment. CONCLUSION: Results support expanding the access to opioid agonist therapy in other MENA countries to treat substance dependence and reduce harms among individuals with opioid use disorder.

Instability of palatal rugae following rapid maxillary expansion.

BACKGROUND: Existing evidence on changes of the palatal rugae following rapid maxillary expansion (RME) is scarce and inconclusive, particularly immediate post-expansion changes in three-dimensional assessments. OBJECTIVES: Our aims were to assess the dimensional stability of the palatal rugae in the antero-posterior and transverse dimensions following RME treatment, as well as the three-dimensional changes in palatal volume and area. MATERIAL AND METHODS: The sample consisted of the dental casts of 30 adolescents (16 males; 14 females, age 11.46 ± 1.42 years) who underwent RME. The models, available at T1 (pretreatment) and T2 (immediately after expansion) were scanned using a laser scanning system. Various parameters were recorded including individual ruga transverse and antero-posterior linear and angular measurements; palatal dimensions (width, length, volume, surface area, vault depth/height); and dental characteristics (interincisor, intercanine, interpremolar, and intermolar distances). Statistical analyses included paired t-tests for group comparisons, and Pearson moment product for associations among variables. RESULTS: Palatal rugae were altered by RME in all dimensions in both linear and angular measurements, almost equally on right and left sides, albeit the average linear changes were about 1 mm. Correlation coefficients among rugal and dental measures suggested an association between rugae changes and the underlying bony movements. Except for the first rugae that had higher correlations to the intercanine width, the correspondence of changes seems to be asymmetric, thus not precisely predictable. CONCLUSIONS: The results suggest a variable trend in the rugae response to expansion, likely reflecting the constitutional asymmetric pattern or nature of pairs of rugae.

Prevalence of depression in Syrian refugees and the influence of religiosity.

BACKGROUND: Many surveys have underlined the high levels of distress Syrian refugees have endured since the conflict aroused in their country, yet few have used reliable diagnostic tools for the clinical assessment of resulting mental disorders. The aim of our study is to assess for the onset of new depressive disorders following the Syrian war, and to investigate the correlation of religiosity with depression. METHODS: Single individual interviews were used, in a sample of 310 Syrian forced migrants, retrospectively assessing for depressive disorders with onset at different timelines of the conflict outbreak. Religiosity was assessed in a cross-sectional design using a reliable, recently developed and tested tool. Bivariate analysis and logistic regression analysis were used with a level of significance at 0.05. RESULTS: The prevalence of current depression was 43.9% (95% Confidence Interval (CI): 38.5-49.4%) with no difference across all socio-demographic factors, including gender. The overall mean for religiosity for the current sample was moderate (mean=9.76; standard deviation SD=2.34). No substantial correlation was found with religiosity. The prevalence rate for pre-war depression was 6.5% (95% CI: 4.2-9.8%) following the global pattern of socio-demographic epidemiological characteristics. Prevalence for past depression was 27.1% (95% CI: 22.5-32.3%); for current dysthymia: 4.5% (95% CI: 2.7-7.4%); for prewar and past dysthymia: 1% (95% CI: 0.3-2.8%), all with no significant differences detected across all demographic variables. CONCLUSION: In this retrospective study on a sample of Syrian refugees who fled their country after the war, we found a substantial emergence of depressive disorders with no meaningful correlation with the level of religiosity.

Dentoalveolar bone height in Class I adults with different vertical patterns: A cross-sectional study.

BACKGROUND: Facial divergence during growth and development affects both the anterior and posterior alveolar bone dimensions in the maxilla and mandible, and the dentoalveolar compensation mechanism in severe vertical skeletal discrepancies remains unclear. AIMS: To evaluate the: (1) difference in dentoalveolar heights among subjects with different vertical facial patterns; (2) association between the dentoalveolar bone height and other cephalometric variables; (3) effect of sex on dentoalveolar height measurements. MATERIAL AND METHODS: Non-growing subjects with skeletal Class I (0°

Comparison of post-surgical soft tissue changes between bilateral cleft patients treated with and without a modified nasoalveolar molding appliance: A cohort study.

INTRODUCTION: The advantages of nasoalveolar molding (NAM) treatment for cleft lip and palate (CLP) patients have been well documented. A modified design for bilateral CLP was introduced. AIMS: This paper aimed to: 1- quantify the soft tissue changes after applying modified NAM treatment to these patients; and 2-compare post-surgical changes to a control group where no NAM was used. MATERIAL AND METHODS: At a tertiary care paediatric hospital, a historical cohort group of complete BCLP patients (n=15) was compared to a prospectively collected group of complete BCLP patients who underwent NAM therapy (n=15). In the NAM group (mean age: 1.1mos±0.2), a new modification of the NAM appliance was implemented. In the control group (mean age: 5mos±0.2), no NAM treatment was adopted prior to lip closure surgery. Soft tissue nasolabial segments were measured on initial (T1), post-NAM (T2) and 3 months post-surgery (T3) photographs; measurements were analysed statistically. RESULTS: In the NAM group, cleft size was reduced by 68 to 70% in 4-5months and all measurements improved between T1 and T2. Columellar crest inclination decreased by 74%, columellar length increased by 184%, nostril and bialar widths decreased by 36% and 16%, respectively. The lip philtrum was elongated by 49.5%. At T3, all soft tissue variables statistically improved better in NAM versus non-NAM groups. CONCLUSION: The modified NAM appliance provided improved results of lip approximation and nasal measurements compared to non-NAM treatment.

The « patient casting ¼: a key decision in orthognathic surgery / Le « casting du patient ¼: clé de décision en chirurgie orthognathique

Introduction: The surgical orthodontic patient is a patient whose management is specific. The success of this protocol goes beyond of the right indication and the control of the pre-surgical orthodontic preparation of the treatment. The coordination revolves around a multidisciplinary team, namely an orthodontist, a maxillofacial surgeon, a physiotherapist, a speech therapist, a general practitioner, etc. but also with the collaboration of a specialized psychotherapist. Material and Method: Does the ideal « patient ¼ exist in orthognathic surgery? The decision criteria are morphological (occlusal, aesthetic and cephalometric) but also psychosocial. Results: A new classification called « psychological ¼ is proposed in this article. Conclusion: This new classification can be considered as a key decision in the « casting ¼ of the surgical orthodontic patient and represents a first basis for further investigations in this field.

Introduction: Le patient orthodontique chirurgical est un patient dont la prise en charge est spécifique. La réussite de ce protocole va au-delà de la pose de la bonne indication et de la maîtrise de la préparation orthodontique pré-chirurgicale du traitement. La coordination s'articule autour d'une équipe pluridisciplinaire, à savoir un orthodontiste, un chirurgien maxillofacial, un kinésithérapeute, un orthophoniste, un omnipraticien, entre autres, mais également avec la collaboration d'un psychothérapeute spécialisé. Matériel et méthode: Le « patient idéal ¼ existe-t-il en chirurgie orthognathique ? Les critères de décisions sont morphologiques (occlusaux, esthétiques et céphalométriques), mais aussi psycho-sociaux. Résultats: Une nouvelle classification dite « psychologique ¼ est proposée dans cet article. Conclusion: Cette nouvelle classification peut être considérée comme une clé de décision dans le « casting ¼ du patient orthodontique chirurgical et représente une première base pour de plus amples investigations dans ce domaine.

Effectiveness of orthopaedic treatments on the enlargement of the upper airways: Overview of systematic reviews.

OBJECTIVE: The aims of this overview are to evaluate the three-dimensional effects of orthopaedic treatment (OT) and myofunctional therapy (MT) on the enlargement of the upper airways (UA). METHODS: A search of the MEDLINE/PubMed and EMBASE databases was conducted up to July 2022 and completed by hand search. After selection of the title and abstract, systematic reviews (SR) dealing with the impact of OT and/or MT on UA containing only controlled studies were included. The methodological quality of the SR was assessed by the AMSTAR-2, Glenny and ROBIS tools. A quantitative analysis was done with Review Manager 5.4.1. RESULTS: Ten SR were included. The risk of bias was judged low for one SR according to ROBIS. Two SR presented a high level of evidence according to AMSTAR-2. In the quantitative analysis and about the orthopaedic mandibular advancement therapies (OMA), while a significant increase in superior (SPS) [(Mean difference (MD): 1.19; CI 95% [0.59; 1.78]; P<0.0001)] and middle (MPS) pharyngeal space [(MD: 1.10; CI 95% [0.22; 1.98]; P=0.01)] existed in the short-term for both OMA, it was greater for removable. On the other hand, there was no significant change in the inferior pharyngeal space (IPS). Four other SR targeted the short-term efficacy of class III OT. Only treatments with face mask (FM) or face mask+rapid maxillary expansion (FM+RME) allowed a significant increase in SPS [(MD FM: 0.97; CI 95% [0.14; 1.81]; P=0.02/MD FM+RME: 1.54; CI 95% [0.43; 2.66]; P=0.006)]. This was neither the case for chin cup nor in all cases in IPS. The last two SR explored the effectiveness of RME, whether or not associated with bone anchorage, on the dimensions of the UA or on the reduction of the apnoea/hypopnea index (AHI). A significant superiority of the effects of the devices with mixed or only bone anchorages existed concerning the width of the nasal cavity, the nasal airflow and the reduction of the nasal resistance. But, the qualitative analysis showed no significant reduction in AHI after RME. CONCLUSIONS: Despite the heterogeneity of the included systematic reviews and their unfortunately not always low risk of bias, this synthesis showed that orthopaedics could provide some short-term improvement in AU dimensions, mainly in the upper and middle areas. Indeed, no devices improved the IPS. Class II orthopaedics improved SPS and MPS; class III orthopaedics, except for the chin cup, improved only SPS. RME, optimised with bone or mixed anchors, mostly improved the nasal floor.

Morphometric analysis of palatal rugae in different malocclusions.

OBJECTIVES: Studies of the association between palatal rugae (PR) and malocclusion are scarce. While unstable following treatment such as rapid maxillary expansion, we hypothesized that PR differ among malocclusions because of genetic determination but also different environmental conditions during development. Our goal was to assess the possible association between PR morphometric measurements and both sagittal and vertical characteristics of malocclusion. METHODS: Maxillary pretreatment dental casts of 243 nongrowing individuals (115 males, 128 females, age 25.5 ± 7.5 years) were laser scanned (Perceptron ScanWorks® V5, Hallam VIC, Australia); angular and linear measurements of the first three PR were recorded in transverse and anteroposterior directions. Cephalometric measurements were obtained from corresponding digitized lateral cephalograms. Statistics included analyses of variance to compare PR measurements among sagittal (class I, class II divisions 1 and 2, class III) and vertical (hypodivergent, normodivergent, hyperdivergent) malocclusion groups and the Pearson correlations among PR dimensions and cephalometric measurements. RESULTS: PR measurements were statistically different between malocclusions, especially with respect to vertical patterns. A majority of transverse and anteroposterior rugae measurements were greatest in class II division 2 subjects. PR were more anteriorly directed in hypodivergent than hyperdivergent groups; the transverse separation between opposing rugae points was smaller. Correlations were generally low. CONCLUSIONS: The findings suggest the possibility for PR to adapt to environmental effects in developing malocclusions, mostly in the class II division 2 phenotype. This premise reinforces the need to explore in longitudinal studies the long-term environmental influences on rugae superimposed on their genetically determined morphological pattern.

Unilateral sagittal split osteotomy: effect on mandibular symmetry in the treatment of class III with laterognathia.

The bilateral sagittal split osteotomy is considered the standard surgery to correct facial asymmetries. More recently, unilateral sagittal split osteotomy (USSO) was used to treat such malocclusions. AIM: To assess facial symmetry following USSO in the treatment of class III laterognathia. METHODS: Frontal facial photographs of four groups of patients were assessed: (1) pre-surgical group (n = 30) with skeletal asymmetry, (2) postsurgical group assessing patients of the first group 2 years after USSO, (3) control group (n = 30) of patients judged to have harmonious facial norms, and (4) mirrored group (n = 30) in which the control photographs were altered by duplicating the right half side of the face to replace the left half, thus creating perfectly symmetrical faces. All 120 photographs were distributed to 40 expert orthodontists to evaluate and score facial symmetry using the visual analog scale. Skin sensitivity and temporomandibular joint (TMJ) disorders were also assessed clinically pre and postsurgically. RESULTS: Statistically significant differences were observed between the pre-surgical group and each of the postsurgical and control groups (p < 0.001). The control and postsurgical groups received similar scores of symmetry (p = 0.774). The mirrored group received statistically significantly higher symmetry scores than either of the control or the postsurgical groups (p < 0.001). A reduction in TMJ disorders was noted after USSO and all patients reported normal skin sensation 2 years post-surgery. CONCLUSION: When indicated, USSO is a dependable and practical surgical approach to correct facial asymmetries associated with class III malocclusion.

Facial soft tissue thickness differences among different vertical facial patterns.

In forensic facial approximation, facial soft tissue thickness (FSTT) measurements play a major role. These values are affected by many factors such as ethnicity, age and sex, in addition to measurement errors. We hypothesize that an additional source of error is the lack of consideration of facial type in the assessment of FSTT norms. The purpose of this study was to: 1- evaluate the presence of significant effects of vertical facial type within the FSTT measurements in adults and 2- assess the correlations between FSTT and hard and soft tissue cephalometric measurements. The sample consisted of the lateral cephalometric radiographs of 222 adult individuals (87 males; 135 females, 23.49±6.24 years of age) with normal occlusion and balanced profiles. Hard and soft tissue cephalometric measurements were taken, in addition to FSST at 10 facial landmarks. The sample was categorized into 3 vertical pattern groups based on the MP/SN angle: hypodivergent, normodivergent and hyperdivergent. Statistical analyses included MANOVA test and Pearson moment product for associations among variables. Statistically significant effect of vertical divergence on FSTT values was limited to the levels of Stomion, Labiomentale and Pogonion and FSTT measurements were associated with measurements related to the lower face (Lm and Pog) Moderate to high correlations between mandibular length and ramus length and FSTT values related to the lower face (LL, Lm and Pog mainly) emphasize further the important role of the underlying skeleton.