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BACKGROUND: Posttraumatic secondary deformities of facial skeleton may occur because of nonmanagement or ill management of primary injuries, whereas some unexpectedly occur even after dedicated management attempts. Orthognathic surgery (OGS) principles and techniques can be used as an efficient tool to correct posttraumatic craniomaxillofacial deformities or skeletal developmental deformities during trauma management. AIM AND OBJECTIVES: The aims of this study were to describe the different types of posttraumatic secondary deformity and address how to use the principles of orthognathic techniques to correct them. MATERIALS AND METHODS: Patients with orthognathic surgical osteotomies during primary or secondary management of facial trauma (referred to as trauma-OGS) during the period of 2010 to 2018 were retrospectively reviewed. Variables pertaining to patients and surgery were collected, including trauma diagnosis, etiology, duration between trauma/primary surgery and secondary presentation, suggested reason for secondary deformity, intervention undertaken to address, and the surgical outcome. RESULTS: Twenty-seven patients were eligible and extensively reviewed. Etiological categorization of trauma-OGS could be done into posttraumatic deformities (18) and developmental deformities (9). The former group was further categorized as OGS done as primary procedure (8) that included immobile Le Fort fractures and delayed initial treatment, and OGS done as secondary procedure (10) that included complex fractures and condylar fractures. The developmental deformity group was categorized into OGS done simultaneously during trauma management (5) or done as a secondary procedure after trauma management (4). CONCLUSIONS: Application of principles and techniques of OGS in indicated primary or secondary management of facial trauma patients should always be considered. The categorization of scenarios presented in this article relating facial trauma and OGS may further help to understand the application.
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Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Humanos , Estudios Retrospectivos , Huesos Faciales/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , CaraRESUMEN
BACKGROUND: The concept of gingivoperiosteoplasty (GPP) in the mixed dentition stage as compared with secondary alveolar bone grafting (ABG) in management of alveolar cleft has not been much discussed upon. The authors present the experience with extensive GPP and ABG in the mixed dentition stage in complete bilateral alveolar cleft cases. METHODS: A retrospective review of nonsyndromic patients with complete bilateral alveolar cleft operated on with either GPP or ABG (iliac crest) in the mixed dentition stage with at least 1-year follow-up was performed. Dental occlusal radiographs were evaluated for level of bone gain using Bergland and Witherow scales. Statistical evaluation of clinical success and procedure-related complications was conducted using χ2 test and odds ratio. RESULTS: Twenty-four patients in the GPP group and 20 in the ABG group were comparatively studied. Clinical success rate as indicated by Bergland scales I and II (87.5% in GPP vs 82.5% in ABG; P = 0.731), complication rate (20.83% in GPP vs 30% in ABG; P = 0.484), and status of canine eruption showed no significant differences in clinical outcomes in both groups. CONCLUSIONS: The technique of extensive GPP as described by authors shows equal efficacy to secondary ABG for management of bilateral alveolar clefts during the mixed dentition period.
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Injerto de Hueso Alveolar , Labio Leporino , Fisura del Paladar , Injerto de Hueso Alveolar/métodos , Trasplante Óseo , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Dentición Mixta , Humanos , Periostio/cirugía , Estudios RetrospectivosRESUMEN
INTRODUCTION: The information on the hard- and soft-tissue factors correlated with tooth display after LeFort I osteotomy, especially in the surgery-first approach (SFA), are limited. This study aimed to correlate different parameters with the maxillary incisor display in patients with skeletal Class III malocclusion and those with cleft lip and palate (CLP) in SFA. METHODS: This study consisted of 35 patients with skeletal Class III malocclusion and 32 with cleft deformities who had undergone orthognathic surgery. Pretreatment and posttreatment lateral cephalometric analysis were obtained. Maxillary incisor display was measured in photographs. The intraclass correlation coefficient was used to assess the intraexaminer repeatability. The Student t test was used to compare the maxillary incisor display between 2 groups. Analysis of covariance was performed with pretreatment measurement as covariates, and the important determinants for maxillary incisor display were identified by adjusting the baseline measurements. RESULTS: The mean increase of maxillary advancement at point A was 5.25 mm and 1.28 mm downward movement for skeletal Class III malocclusion, whereas it was 4.59 mm advancement and 2.16 mm downward movement for patients with CLP. The resulting maxillary incisor display was 2.86 mm for skeletal Class III malocclusion and 2.56 mm for patients with CLP. The covariates for maxillary incisor display before intervention was significantly associated with the maxillary incisor display after intervention (P <0.001). However, the interaction effect of groups was not seen (P = 0.933). The horizontal position of A, vertical position of ANS, and upper lip length were the most predictable parameters (P <0.001, P <0.001, P = 0.048, respectively) for maxillary incisor display in both groups. CONCLUSIONS: Horizontal position of point A, vertical position of ANS, and upper lip length are the most important determinants for maxillary incisor display for patients with skeletal Class III malocclusion and those with CLP.
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Labio Leporino , Fisura del Paladar , Maloclusión de Angle Clase III , Humanos , Labio Leporino/complicaciones , Labio Leporino/cirugía , Incisivo , Fisura del Paladar/complicaciones , Fisura del Paladar/cirugía , Maloclusión de Angle Clase III/cirugía , Maloclusión de Angle Clase III/complicaciones , Maxilar/cirugíaRESUMEN
BACKGROUND: Midface retrusion is a common problem in patients with cleft lip and palate owing to the lack of adequate growth of the maxilla. Midface advancement surgery is a definite treatment for midface retrusion; however, the subsequent oropharyngeal airway changes might result in velopharyngeal insufficiency (VPI) in affected patients. Determining the predictors of VPI beforehand and modifying the surgical procedure would be beneficial. MATERIALS AND METHODS: A retrospective review of 42 patients with cleft lip and palate who underwent orthognathic surgery from 2013 to 2014 was performed. A total of 25 patients met the inclusion criteria and had undergone complete pre- and postsurgery videofluoroscopy, nasopharyngoscopy (NPS), and speech assessment. We compared 2 groups of patients, those who showed NPS finding changes of more than 0.1 (8 patients) and those without changes (17 patients), by measuring the distances of the contact point to the tip of the velum, gap size at maximum closure (MC) and rest, contact area length, lateral wall closure rate, closure velocity, and 2 angles (from the velum to the hard palate and genu) at MC and rest. The amount of maxillary advancement was also recorded. RESULTS: Among the 8 patients with NPS finding changes, 3 underwent Furlow palatoplasty for VPI. No significant difference was found in the amount of maxillary advancement between the groups (5.8 vs 5.7 mm). Significant differences were found in the preoperative gap size at MC and angle at the genu at MC (P = 0.035 and .012). These could be considered as the predictors before surgery. After surgery, a significant difference was found in the contact area, lateral wall closure rate, and gap size at MC (P = 0.005, 0.018, and 0.01). CONCLUSION: Videofluoroscopy is a relatively applicable method of determining dynamic changes in the velum function. By performing videofluoroscopy before midface advancement surgery in patients with cleft lip and palate, we may predict the risk of VPI and consider alternative surgical strategies.
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Labio Leporino , Fisura del Paladar , Cirugía Ortognática , Insuficiencia Velofaríngea , Labio Leporino/cirugía , Fisura del Paladar/diagnóstico por imagen , Fisura del Paladar/cirugía , Humanos , Estudios Retrospectivos , Resultado del Tratamiento , Insuficiencia Velofaríngea/etiología , Insuficiencia Velofaríngea/cirugíaRESUMEN
BACKGROUND: Mandibular angle fracture are frequently associated with presence of third molar. This study aimed at assessing the role of third molar with angle fracture in relation to its positioning and the remaining bone between the apex of third molar and inferior border of mandible. METHODS: A retrospective study of all patients who reported for treatment of mandibular fracture between January 2019 to January 2021 were undertaken. Patient's data and orthopantamogram radiographs were obtained from there medical records. The collected data included presence/absence of mandibular angle fracture, presence/absence of mandibular third molar, angulation and positioning of third molar along with residual bone height. Statistical analysis was done in SPSS version 20 with p-value set at p<0.05 Results: Total of 86 mandibular fracture reported in the study period, of which 34 (39.53%) had angle fracture. Third molar was present in 31 (45.6%) cases and was associated with angle fracture with statistical significance of p<0.026. Mesioangular impaction (86.4%) with class II (57%) ramus relation and position B (72.7%) in occlusal relation were associated with angle fracture in comparison to non-angle fracture group where angulation and occlusal position were statistically significant p<0.001 and p=0.002, respectively. Residual bone height was also found to be less in angle fracture group in comparison to other mandibular fracture group showing statistical significance (p<0.023). CONCLUSIONS: Patient with partially erupted mandibular third molar are more frequently associated with angle fracture and the residual bone height could also be a good predictor for risk of angle fracture.
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Fracturas Mandibulares , Humanos , Mandíbula/diagnóstico por imagen , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/epidemiología , Fracturas Mandibulares/etiología , Tercer Molar/diagnóstico por imagen , Nepal/epidemiología , Estudios RetrospectivosRESUMEN
The purpose of the study was to estimate the chronology of third molar mineralization in Han population of southwestern China and find its unique characteristics so that it would provide a reference in several legal cases like forensic age estimation. The study used Demirjian's staging method to study 2192 orthopantomograms of 984 male and 1208 female subjects aged between 8 and 25 years. The statistical data was analyzed by Student's t test and ANOVA. The conclusions of the study are: (1) The chronological mineralization age of third molars of Han population in Southwestern China is similar to the Turkish and the Japanese, was earlier than the Austrian and Han of South China, but later than the Spanish. (2) The mineralization timing of the third molars between two sides in maxilla or mandible has no significant differences in the same gender group. (3) There is no significant difference in mineralization of third molars between male and female, except for tooth 48 in Demirjian's stage E. (4) The mineralization of third molar in maxilla is earlier than mandible.
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Determinación de la Edad por los Dientes/métodos , Tercer Molar/crecimiento & desarrollo , Calcificación de Dientes , Adolescente , Adulto , Análisis de Varianza , Niño , China/etnología , Etnicidad , Femenino , Odontología Forense , Humanos , Masculino , Radiografía Panorámica , Caracteres Sexuales , Adulto JovenRESUMEN
Supernumerary teeth occur frequently in human dentition, but presence of multiple supernumerary teeth in patients without any associated syndrome or systemic disorder is a rare phenomenon. Presence of supernumerary teeth in itself is not a problem and may not require removal in all cases but in certain conditions, they may be associated with several clinical complications and require removal. Here, we present a 14 year old female who complained of non emergence of permanent teeth. Orthopantomogram initially showed presence of fifteen impacted supernumerary teeth distributed in all quadrants, but later, cone-beam computed tomography further revealed four additional teeth, totaling to nineteen supernumerary teeth. Consultation with concerned specialists ruled out any syndromes or systemic disorders which led us to the diagnosis of "non-syndromic multiple supernumerary teeth" and this probably is the highest number of supernumerary teeth reported in a single non-syndromic patient till date.