Effects of sagittal split Ramus osteotomy on condylar position and Ramal orientation in patients with mandibular asymmetry.

OBJECTIVE: The purpose of this study is to assess the impact of Sagittal Split Ramus Osteotomy (SSRO) on the alignment of the condyle and orientation of the Ramal segment following surgery in patients operated for the correction of mandibular asymmetry. METHODS: A total of 27 patients who underwent SSRO were enrolled in this study, and study groups were defined as asymmetric (study group) and symmetric (control group) using linear measurements from the dental midline based on a three-dimensional coordinate system. Differences on preoperative and postoperative values of anterior (AJS), posterior (PJS) and superior joint spaces (SJS), condylar axial angle (CAA), Sagittal Ramal Angle (SRA), and Coronal Ramal Angles (CRA) of study and control groups were measured and compared. The data was analyzed using the "Wilcoxon signed-ranks test" to identify differences between groups. RESULTS: Differences between preoperative and postoperative values of CRA and SRA of the contralateral group showed statistically significant results with p-values of 0.007 and 0.005, respectively. A statistically significant change in CAA angle was found in the control and deviation groups (p = 0.018 and p = 0.010, respectively). CONCLUSIONS: SSRO has inevitable effects on the condylar and ramal orientation. Individuals with asymmetry require particular attention throughout the planning process and beyond. Conjunctive modalities and modifications should be considered and utilized when necessary. Future studies with larger sample sizes, homogenous follow-up periods, and more comprehensive clinical data are needed to substantiate understanding of the response of the condylar segment. CLINICAL RELEVANCE: Orthognathic surgeries inevitably alter the alignment and harmony of temporomandibular structures and may result in change of AJS, PJS, SJS, CAA, SRA, and LRA, which may change the biomechanics of joint and lead to several complications like temporomandibular disorders. Especially in cases with midline asymmetry needs special consideration from planning till the end of the treatment to achieve best results. In severe cases, conjunctive modalities and modifications and other alternatives such as inverted-L osteotomies should be considered.

Influence of Orthognathic Surgery on Oral Health and Quality of Life.

ABSTRACT: Orthognathic surgery is a common treatment modality for moderate to severe dentofacial deformities. This study aimed to determine the early postoperative changes in quality of life (QoL) after orthognathic surgery.Twenty patients were evaluated preoperatively (T0), postoperatively after 1 month (T1), and postoperatively after 3 months (T2). Short Form Oral Health Impact Profile and Orthognathic Quality of life Questionnaire were used as generic oral health-related and condition-specific QoL measures.Oral Health Impact Profile -14 and Orthognathic Quality of life Questionnaire scores significantly decreased from T0-T2. Physical pain, psychological disability, social disability, and handicap scores significantly decreased during this interval. Facial esthetic, function, awareness of facial deformity, and social aspects of deformity were also found to significantly improve. No significant difference was found between age groups; female patients had significantly greater preoperative Oral Health Impact Profil-14 scores than did male patients.Orthognathic surgery not only enhances the skeletal and facial relations, but also has significant positive effects on the patients' QoL, oral health, and psychological status.

Reconstruction and Implant-Supported Rehabilitation of an Iatrogenically Caused Maxillary Alveolar Defect.

Defects of the oral and maxillofacial region may arise from several reasons such as trauma, infection, cyst, tumor, medication related osteonecrosis of the jaw, and misuse of some irritant agents. For reconstruction, autogenous grafts remain the gold standard among the alternatives. In our case, a 42-year-old woman referred to our clinic for implant-supported fixed bridge rehabilitation of her edentulous and defected left 2nd premolar and 1st molar region. In examinations, devitalizing agent-dependent large defect was observed. Anterior iliac crest (AIC) grafting technique was preferred for reconstruction. Consecutively, 16-week bone healing and 3-month implant osseointegration periods were uneventful. After fabrication of the implant-supported fixed bridge, the patient was followed up for 2.5 years with no signs of bone resorption, gingival inflammation, and pain. AIC grafting and implant-borne fixed bridges seem stable and satisfactory methods for large maxillofacial defects.

Evaluation of the temporomandibular joint morphology and condylar position with cone-beam computerized tomography in patients with internal derangement.

OBJECTIVES: To evaluate the relationship between internal derangement and morphological features of the temporomandibular joint by comparing joint morphology between patients with ID and control patients. METHODS: The current study prospectively is evaluated the cone-beam computed images of 106 ID patients and 122 patients with asymptomatic joints; recorded angular and linear measurements. The relationships between these measurements and ID are investigated; the differences between the two groups using paired t tests. RESULTS: There were significant differences in the values of articular slope and the condyle height/glenoid fossa depth (CH/GFD) ratio between patients in the ID and control groups (p < 0.05). There was also a relationship between these parameters and the gender of patients with ID. The condylar position was posterior in the ID group. CONCLUSION: Posteriorly and superiorly located condyles with an increased CH/GFD ratio, condyles located eccentrically, and a steeper posterior slope may be risk factors for ID.

Evaluation of patient satisfaction after botulinum toxin A injection for the management of masticatory myofascial pain and dysfunction - A pilot study.

Objective: To evaluate patient satisfaction with botulinum toxin type A injections for the management of masticatory myofascial pain and dysfunction. Methods: The study group included 25 patients with myofascial pain and dysfunction. Maximum mouth opening (MMO), measured with a ruler, and pain, measured on a 10-cm visual analog scale (VAS), were assessed before treatment and six weeks after treatment. Satisfaction with the treatment, measured on a 10-cm VAS, was obtained six weeks post-treatment. Results: The mean satisfaction score six weeks post-injection was 6.74/10, with a significant improvement in both MMO and pain. Satisfaction was positively correlated with a decrease in pain. Discussion: Botulinum toxin type A injections were well tolerated for the treatment of masticatory myofascial pain and dysfunction in patients with temporomandibular disorder. Improvements were observed in both MMO and pain, with most patients satisfied with the management of pain.