Bone Density of the Midpalatal Suture After Surgically Assisted Rapid Maxillary Expansion: A Retrospective Cohort Study.

OBJECTIVES: To evaluate the bone density in the midpalatal suture after 10 months of surgically assisted rapid maxillary expansion (SARME) with the separation of the maxilla into 2 segments. METHODS: Sixty multislice computed tomography (MCT) from 20 patients undergoing SARME were analyzed in 3 periods of time (1 MCT per patient on each occasion): (1) 1 week before surgery, (2) postsurgery immediately after completing the expander activation, and (3) 10 months after the expander activation. On all occasions, the bone density was measured in Hounsfield units on MCT scans in axial and coronal sections, in the anterior (A1), middle (A2), and posterior (A3) regions of the midpalatal suture. RESULTS: The mean percentage values of bone density in Hounsfield units, from the 10-month postactivation period to preoperative in the A1, A2, and A3 regions were 68.38%, 38.21%, and 55.90%, respectively, in the axial norm, and 64.06%, 36.81%, and 55.50% in coronal norm (A1 = A3>A2), with no significant difference in the tomographic cuts (P >0.05). There was no correlation between patient age or amount of expansion in the expander and bone density. CONCLUSIONS: The bone density in the midpalatal suture 10 months after SARME is lower than preexpansion. A denser new bone formation along the suture concentrates closer to the extremities rather than in the central region. Although the maturation of the new bone formation in the midpalatal suture is lower 10 months after SARME, it appears to be sufficient for satisfactory clinical results, regardless of patient age or the amount of expansion in the expander.

Randomized clinical trial of surgically assisted rapid maxillary expansion with two and three segments for nasal breathing.

OBJECTIVES: To evaluate surgically assisted rapid maxillary expansion (SARME), with osteotomies separating the maxilla into two segments (SARME-2S) and three segments (SARME-3S), on obstruction symptoms and nasal cavity dimensions in patients with maxillary transverse skeletal deficiency (MTSD). MATERIALS AND METHODS: Sixteen patients with MTSD of 7 mm or above were evaluated in each group, for a total of 32 patients. All patients were evaluated pre- and postoperatively up to 10 months after the expander activations. The minimum cross-sectional area (MCA) and the volume of the nasal cavities were identified by acoustic rhinometry. The Nasal Obstruction Symptom Evaluation (NOSE) scale questionnaire was applied. The palate surface area (PSA) was measured, via digitized maxillary models, as a criterion for comparison with the other variables studied. RESULTS: There was no difference between the groups (p = 0.370) and was verified a significant increase in PSA postoperatively. MCA showed a small increase without statistical significance, and together with the volume of the nasal cavities remained constant during the study. NOSE scale scores decreased significantly in the postoperative periods, implying a decrease in nasal obstruction symptoms in both groups. CONCLUSIONS: SARME with two and three segments show similar results, and both may improve nasal obstruction symptoms when present in patients with MTSD. CLINICAL RELEVANCE: SARME, regardless of the chosen surgical technique, should follow the recommendation to correct just the MTSD. While an improvement in nasal breathing is expected, this must be understood as likely, but not certain.

Evaluation of Sagittal and Vertical Changes in Maxillary Dental, Skeletal, and Soft Tissue Following Surgically Assisted Rapid Maxillary Expansion: A Retrospective Longitudinal Study.

OBJECTIVE: To evaluate whether the maxillary complex would be sagittally, vertically, or mutually displaced after the transverse maxillary correction by surgically assisted rapid maxillary expansion and how the facial profile would be affected. MATERIALS AND METHODS: The sample comprised 28 adult patients (mean age 25.8 [age range 19-39 years]; 50% women) with transverse maxillary deficiency greater than 7 mm who underwent the surgical rapid maxillary expansion. Cephalometric analysis (n  = 112), intra- and extra-oral registries, and radiographic records were taken before treatment (T1), right after the end of the expansion (T2), 4 months after the expansion (T3), and 10 months after the end of the expansion (T4). Dental and skeletal cephalometric measurements were evaluated at each time-point, whereas soft tissue cephalometric analyses were determined at 2 time points (T1 and T4). RESULTS: The results indicated that no sagittal, vertical, skeletal, or soft tissue variation was found after the surgical expansion. However, statistically significant dental changes (P  < 0.05) were observed in dental angles (1.NA/1.SN/1.PoOR/1.PP) throughout the different time-points. The authors found statistically relevant posterior inclination of the incisors from T2 to T3 based on multiple comparisons. CONCLUSIONS: Surgically assisted rapid maxillary expansion does not promote anterior and vertical displacement of the maxilla. Notwithstanding, the surgical intervention causes upper incisor palatal inclination.

Complications From Surgically Assisted Rapid Maxillary Expansion With HAAS and HYRAX Expanders.

The current study aimed at comparing the number and type of undesired outcomes during and after the maxillary expansion performed with HYRAX and HAAS expanders. A total of 90 patients (41 males and 49 females, 45.6% and 54.4%, respectively) aged 18 to 59 (mean age of 26.1; standard deviation [SD] = 7.4) underwent subtotal Le Fort I osteotomy and pterygomaxillary disjunction following surgically assisted rapid maxillary expansion (SARME) carried out using HAAS (n = 29; 48.3% male and 51.7% female; mean age = 27: SD = 7.7) and HYRAX (n = 61; 44.3% male and 55.7% female; mean age = 26; SD = 7.2) expanders. Post-SARME dento-gingival, radiographic, and clinical undesired outcomes were evaluated. A total of 16 (17.8%) patients experienced at least 1 undesired outcome-7 (7.8%) and 9 (10.0%) in HAAS and HYRAX group, respectively. The most common undesired outcomes were radiographic asymmetric expansion-2 (2.2%) and 3 (3.3%) in HAAS and HYRAX group, respectively-followed by pain during out-of-clinic expansion 4 (4.4%) in HAAS group only-dental darkening 5 (5.5%) in HYRAX group, only, requiring root canal treatment, and local infection-2 (2.2%), 1 in each HAAS and HYRAX groups. Excepting for complications arising from the acrylic stop plate in HAAS expander, the number and severity of complications observed in the current study did not differ due to the use of HAAS and HYRAX appliances to perform maxillary expansion. Hygiene issues do not rule out the use of HAAS. The wider maxillary expansion performed, the more frequent are the cases of asymmetric expansion.

Combined Access for the Treatment of Medial Orbital Wall Fracture: Subciliary and Upper Eyelid Sulcus Incisions.

The present study presents a new surgical approach to treat medial orbital wall fractures, that is, the combined transcutaneous access through subciliary and upper eyelid sulcus incisions. The study performed the retrospective analysis of medical records belonging to 14 consecutive patients with medial orbital wall fracture, who were treated in the Plastic Surgery Division at Federal University of São Paulo, from 2005 to 2013, through the combination of subciliary and upper eyelid sulcus incisions to access the fracture foci. The mean age of the patients was 35.4 years, ranging from 8 to 66 years. Seven out of the 14 patients were women. Ten patients had fractures in the medial and inferior walls, whereas 4 patients had isolated medial wall fracture. Diplopia was found in all cases. Six patients had some type of extraocular muscle limitation. A computed tomography of the face was performed in the postoperative period to assess the orbital contour and the correct position of the grafts, whenever applicable. The patients were assessed for diplopia, enophthalmos, and scar quality. Four patients (28.6%) kept on showing diplopia at supraversion, whereas 2 patients (14.2%) evolved to enophthalmos. There was no need of reoperating the patients to reposition the grafts or the absorbable plaque. No patient evolved to ectropion or apparent scarring. The combined transcutaneous access through subciliary and upper eyelid sulcus incisions provides ample operative field, rapid exposure of the fracture foci, and adequate wall reconstruction. It can also present inconspicuous scar.

One-Step Surgical Correction of Transverse and Anteroposterior Maxillary Deficiencies Using Wire Fixation. A New Approach and Long-Term Stability.

PURPOSE: To describe a retrospective assessment of the long-term stability of a new approach using wire fixation for 1-step surgical correction of transverse and anteroposterior maxillary deficiencies. PATIENTS AND METHODS: The authors implemented a case series of 5 adult patients (3 men and 2 women; mean age, 31.4 yr) needing maxillary advancement less than 5 mm and had transverse maxillary deficiency greater than 7 mm who underwent total Le Fort I and median palatal suture osteotomies and had their maxilla advanced and stabilized bilaterally with stainless steel wire. Transverse expansion was performed using a Hyrax expander, which also was used for retention for 4 months after completion of the planned expansion. Follow-up included clinical examination and studies of lateral radiographs and plaster models preoperatively (T0), soon after completion of maxillary expansion (T1), 4 months after T1 (T2), 12 months after T1 (T3), and an average of 4.8 years (minimum, 4 yr 1 month; maximum, 5 yr; standard deviation, 0.3 yr) after T1 (T4). RESULTS: Maxillary expansions measured at the most cervical points on the palatal face of the upper first premolars and of the upper first molars at T2 were 7.8 and 7.4 mm on average, respectively. In all cases, surgery promoted maxillary anteroposterior advancement. Anteroposterior maxillary skeletal measurements of the angle formed by the sella, nasion, and A point; the distance from the vertical reference line to the A point (A-VRL); the distance of the VRL to the cementoenamel junction (CEJ); and the distance from the perpendicular line of the nasion (Nperp) to the CEJ showed a substantially increase at T1 (P < .05) and stability at T2, T3, and T4; however, A-VRL presented a significant relapse at T4 compared with T1 (P = .037) and T2 (P = .027). The soft tissues expanded at the same rate as the skeletal tissues. The anteroposterior soft tissue measurements Nperp to superior lip and Nperp to the A' point showed a substantial increase at T2 (P < .05) and stability at T3 and T4. The measurements associated with anteroposterior correction were stable at T4. CONCLUSION: The proposed technique provides long-term stability of maxillary expansion and anteroposterior repositioning with only 1 surgical intervention. However, considering the small number of patients, a multicenter study is needed before a definitive conclusion can be reached.

Stability of surgically assisted rapid palatal expansion with and without retention analyzed by 3-dimensional imaging.

INTRODUCTION: Surgically assisted rapid palatal expansion (SARPE) is the procedure of choice for treatment of adults with transverse maxillary deficiency greater than 7 mm. There is no consensus about the dentoskeletal effect of an orthodontic retainer on the outcome of SARPE. Our objective was to assess the effectiveness of an orthodontic retainer on dentoskeletal stability. METHODS: Ninety digitized dental casts of 30 adults undergoing SARPE were divided into 2 groups-no retention (n = 15) and retention (n = 15)-and assessed. The dental casts were obtained at 3 checkpoints: (1) 7 days on average before SARPE (preoperatively), (2) 4 months after expansion, and (3) 10 months after expansion was completed. The retention patients received a transpalatal arch just after expander removal, at checkpoint 2. The transpalatal arch was kept for 10 months after completion of the expansion (checkpoint 3 and end of the study). The dental casts were scanned with a Vivid 9i 3D laser scanner (Konica Minolta, Wayne, NJ). The distances measured were premolar and molar intercusp distances, premolar and molar intercervical distances, premolar and molar inter-WALA (Will Andrews and Lawrence Andrews) ridge distances, and palate height at the maxillary first molar. RESULTS: The planned maxillary expansion was within the expected amount (P <0.05). Palatal height at the 4-month checkpoint decreased by 0.79 mm (4.38%) (P <0.001) and again at the 10-month checkpoint by 0.38 mm (0.98%) (P >0.05) but not significantly in both groups. The premolar intercusp distance had a relapse at checkpoint 3 of 1.84 mm (7.18%) (P <0.001) in the no-retention group. Both groups had average relapses of 0.95 mm in the premolar intercervical distances, of 0.88 mm in the premolar inter-WALA ridge distances, of 1.04 mm in the molar intercusp distances, of 0.74 mm in the molar intercervical distances, and of 0.84 mm in the molar inter-WALA ridge distances (P <0.05) at checkpoint 3. CONCLUSIONS: The analysis of relapse in both groups suggests that the use of a transpalatal arch as a retaining device does not improve dento-osseous stability.

Cephalometric measures correlate with polysomnography parameters in individuals with midface deficiency.

To determine the association between cephalometric measurements and polysomnographic parameters in Brazilian patients with midface deficiency. This was a primary, clinical, observational, longitudinal, retrospective, analytical, and single-center study. Forty-eight patients with midface deficiency were divided into two groups as follows: those who underwent surgically assisted rapid palatal expansion (SARME) and those who received maxillary advancement (MA). Pre- and post-operative cephalometric and polysomnography measurements were obtained. Pearson's correlation was used to verify the presence of any significant associations between PSG scores and cephalometric measurements. Associations between BMI (Body Mass Index) and AHI (Apnea Hypopnea Index) as well as arousals were observed. In the SARME group, associations between AHI and SNA, UAS and MP-H, arousals and SNA, and Co-A and MP-H were noted. Associations between AHI and Co-A, PoOr-A and MP-H, arousals and UAS, and between minimum saturation of O2 and SNA, SNB, and Co-A were observed in the MA group. This study demonstrates the alterations in the middle third of the face that were related to sleep disturbance. In addition, it shows the associations between the polysomnographic parameters and the cephalometric representations corresponding to the analyzed deformities and transverse or anteroposterior maxillary deficiencies.

Aplasia cutis congenita: management of a large skull defect with acrania.

Aplasia cutis congenita is a rare disorder characterized by absence of skin. Lesions typically occur on the vertex and are sometimes small, but they can affect deep tissues such as the skull bone and dura. Mortality is related to the depth and size of the lesion and can amount to a rate of more than 50% when full thickness is involved. The treatment remains controversial -- both surgical and conservative managements are described. Minor lesions can be controlled with nonsurgical treatment, but large defects require early surgery. We report the case of a female newborn with acrania and scalp aplasia cutis congenita, which was treated with a bipedicle scalp flap based on the temporal vessels. Full- and partial-thickness skin grafts were used to cover the donor site on the temporo-occipital region. Postoperatively, the patient developed a liquorice cyst, which was treated with a shunt, and she has been followed up for evaluation of the bony defect closure and skull morphology. Her neuropsychomotor development is normal.

Prediction of transverse maxillary dimension using orthodontic models.

The main objective of this study was to quantify the transverse maxillary dimensions using orthodontic cast models of individuals with natural normal occlusion. Sixty-eight pairs of orthodontic models were evaluated with the respective posteroanterior radiographies of white adults (38 women and 30 men; mean age, 17 years and 5 months). The models were placed in Class I molar occlusion, and on each pair, 4 points were marked on the alveolar buccal ridge (2 on the premolar region and 2 on the molar), determining the upper and lower transverse interpremolar and intermolar dimensions. The variables analyzed in the 3 measurements, obtained from the cephalometric radiographies and the cast models, showed no statistical differences. The upper intermolar distance was 57.20 +/- 2.60 mm; the lower intermolar, 55.16 +/- 2.40 mm; the upper interpremolar, 42.17 +/- 2.19 mm, and the lower interpremolar; 39.67 +/- 1.77 mm. On the posteroanterior cephalograms, the maxillary width was 65.97 +/- 3.42 mm and the mandibular width was 87.92 +/- 4.60 mm. There was intraresearcher and interresearcher correlation. There was no sexual dimorphism. The method proposed in this study can predict the transverse maxillary dimension, applying the formula ym = 8.62 + 0.88xm (ym = expected upper intermolar distance, xm = lower intermolar distance) for the molar region, and ypm = 4.87 + 0.94xpm (ypm = expected upper interpremolar distance, xpm = lower interpremolar distance) for the premolar region.

Self-esteem and depression in patients presenting angle class III malocclusion submitted for orthognathic surgery.

OBJECTIVE: To assess self-esteem and depression in patients submitted for orthognathic surgery. METHODS: Assessment was realized on 29 patients, male and female, aged 17 to 46, presenting Angle Class III malocclusion and referred for surgical treatment, during the preoperative (orthodontic preparation) and postoperative (six-month postoperative) periods. Either maxillomandibular or isolated procedures were performed. Two previously validated standardized measurement instruments for this area were used: the UNIFESP-EPM Rosenberg Self-Esteem Scale and the Self-Report Questionnaire-20 (SRQ-20). Descriptive and inferential statistical analysis (Repeated Measures Analysis of Variance and the Bonferroni test) verified possible interactions between the pre and postoperative periods, genders and types of surgery. Significance was determined at 5%. RESULTS: Females showed improved self-esteem, presenting lower mean values after surgery (8.9 to 6.3). Regarding depression, a significant reduction in the number of depressive symptoms (p=0.002) occurred for female patients. CONCLUSIONS: Female patients presented improved self-esteem and diminished depressive symptoms due to surgical intervention; whereas male patients showed no alteration in self-esteem and depression with surgical intervention.

[Inactive Graves' ophthalmopathy and self-esteem]. / Auto-estima na forma inativa da oftalmopatia de Graves.

PURPOSE: To assess the self-esteem of Graves' ophthalmopathy patients in the inactive phase. METHODS: Thirty euthyroid patients were evaluated in the inactive phase of disease with age ranging from 26 to 65 years, average of 43 +/- 11,0 years, called study group and 39 individuals without Graves' ophthalmopathy with age ranging from 18 to 67 years, average of 41 +/- 13,4 years, selected from the general population called control group. To evaluate the self-esteem the Rosenberg UNIFESP/EPM self-esteem scale, applied by means of an interview, was utilized. The self-esteem scores in the two studied groups were compared by means of the non-parametric Mann-Whitey test. The same test was applied to compare the obtained scores in the Graves' ophthalmopathy group considering disease severity. RESULTS: No alteration with statistical significance in Graves' ophthalmopathy patients' self-esteem was observed (P=0.057). The study group presented, on average, lower self-esteem values when compared with the control group. There was no difference of self-esteem mild and moderate-severe patients (P=0.2710). CONCLUSION: Graves' ophthalmopathy in the inactive phase did not affect the patients' self-esteem in the group studied.

[Exenteration: a retrospective study]. / Exenteração: estudo retrospectivo.

PURPOSE: To review all cases of orbit exenteration performed at the Orbit Sector, Ophthalmology Department - Federal University of São Paulo, from 1998 to 2003. METHODS: We reviewed conditions leading to orbital exenteration in 21 patients at the Orbit Sector of Unifesp-EPM from August 1998 to May 2003. Data regarding sex, age, race, primary lesion site, visual acuity at the moment of diagnosis, previous surgeries related to the exenteration, type of performed surgery, histopathologic diagnosis, postoperative complications and use of adjuvant treatment were collected. RESULTS: 21 patient charts were retrospectively analyzed. Ages ranged from 5 to 91 years (mean of 58.5 years). Of these, 12 were male and 9 were female, most of them Caucasian. All lesions that led to exenteration were malignant neoplasias; however, none were metastatic. Lesions originated from eyelids in twelve patients, from bulbar conjunctiva in six and from the orbit in three. Cases were also classified as squamous cell carcinoma (eleven cases), basal cell carcinoma (four cases), sebaceous gland carcinoma (two cases), rhabdomyosarcoma (two cases), mucoepidermoid carcinoma (one case) and adnexal microcistic carcinoma (one case). Visual acuity at the moment of diagnosis ranged from 20/40 to no light perception. Only six patients had been submitted to previous surgeries related to the exenteration. After surgery, three patients suffered graft necrosis, one presented ethmoidal sinus fistula to the orbit and one presented orbital socket shrinkage. Six patients needed postoperative radiotherapy and two had been previously submitted to chemotherapy. CONCLUSION: Most patients analyzed in our study presented lesions that are usually small in the beginning; however, they can disseminate to the orbit in the absence of adequate treatment.

Three-wall decompression technique using transpalpebral and endonasal approach in patients with Graves' ophthalmopathy.

PURPOSE: To evaluate the effects of the three-wall decompression technique using transpalpebral and endonasal approach in patients suffering from Graves' ophthalmopathy. METHODS: In this prospective study, we present a consecutive series of 15 subjects (17 eyes) who were submitted to orbital decompression by removing the inferior and lateral walls using transpalpebral incision combined with a transnasal endoscopic resection of the medial wall. The surgical technique involved the preservation of the bone structure between the lamina papyracea of the ethmoid and the maxillary orbital floor. MAIN RESULTS: The mean ocular recession based on Hertel measurements was 6.00 mm (range, 4-9 mm). None of the patients presented pre-operation diplopia, and one developed post-operation diplopia. Visual acuity was preserved in all cases. CONCLUSION: It is safe and efficient to perform three-wall decompression, combining transpalpebral and endoscopic transnasal approach, with preservation of the bone structure and the bone lateral to the infraorbital canal with fixation by two titanium plates on the lateral edge and removal of intraorbital fat, which results in significant proptosis reduction and minimal complications.

[Evaluation of condylar fractures treatment]. / Fraturas do côndilo mandibular: análise clínica retrospectiva das indicações e do tratamento.

BACKGROUND: We analysed 40 patients with mandibular condylar process fractures, treated through the closed (intermaxilary fixation or conservatively) or open methods (wire internal fixation,titanium miniplates, bone reduction or articular exploration), from January 1993 to January 1999. METHODS: We evaluated these patients clinically with pre-determined criteria through the temporomandibular articulation touching (ATM), by observing the mandibular symmetry, dental oclusion, deviation to the mouth opening and maximum interincisal opening, besides the questionnaire about the complaints at ATM, disfunction of the mastication system and satisfaction of the treatment. We found an index of good clinical results of, at least, 70% (in the maximum interincisal opening) in the patients submitted to IMF. In the conservative method, we found an index of, at least, 42.9% and in the patients submitted to wire open reduction, at least, 28.6% (in the ATM touching exam) without significant difference in the clinical exams; the pain index at ATM in the closed method was 3.7% and in the open one was 15.4%; mastication disfunction was 22.2% in the closed method and 15.4% in the open one; we only found 7.1% dissatisfied patients in the closed method. There was no significant difference in the method results. CONCLUSIONS: The closed method - with IMF and conservative - and the open reduction - with ORIF - brought good clinical results in an evaluation up to 6 months. We could also conclude that there is no difference in the complaint results after the open or closed treatment according to the patients' opinion.

TGF-ß1 on induced osteogenic differentiation of human dermal fibroblast.

PURPOSE: To evaluate the role of transforming growth factor beta 1 (TGF-ß1) on the induced osteogenic differentiation of human dermal fibroblasts. METHODS: We performed four groups with cultured dermal fibroblasts according to the culture medium: CONTROL (DMEM culture medium); TGF-ß1 (DMEM culture medium with 10 ng/ml of TGF-ß1); OSTEOG (DMEM culture medium with 0.5 µg/ml of ascorbic acid, 10 mmol/l of ß-glycerophosphate and 10 nmol/L of dexamethasone); and OSTEOG/TGF-ß1 (osteogenic medium with 10 ng/ml of TGF-ß1). Alkaline phosphatase (ALP) activity and the amount of osteocalcin (OC) in the supernatant, as well as the capability to form calcium phosphate deposits, were analysed for 28 days RESULTS: There were significant differences (p<0.05) between CONTROL and TGF-ß1 groups in comparison with OSTEOG and OSTEOG/TGF-ß1 groups in the ALP activity and OC amount. Although, both osteogenic groups had the same behavior with regard the expression curve during the experimental time, the OSTEOG/TGF-ß1 group achieved significantly higher ALP and OC levels and showed no significant difference in the levels of mineralized deposits and in comparison with the levels found in the OSTEOG group. CONCLUSION: The addition of transforming growth factor beta 1 to the osteogenic culture medium increased the activity of alkaline phosphatase and the amount of osteocalcin, but TGF-ß1 did not alter the presence of mineralized calcium phosphate deposits.

Low-level laser therapy on bone repair of rat tibiae exposed to ionizing radiation.

OBJECTIVE: The purpose of this study was to evaluate the effects of low-level laser therapy (LLLT) on the repair of rat tibiae exposed to ionizing radiation (IR). BACKGROUND DATA: IR causes structural changes that delay bone tissue repair. Properly dosed, LLLT improves the bone repair process. METHODS: Seventy-two healthy Wistar rats were distributed into the following groups: Group I, sham control; Group II, LLLT; Group III, IR; and Group IV, IR and LLLT. Groups III and IV received a single dose (30 Gy) of gamma radiation and underwent surgery 28 days later. A noncritical sized bone defect (diameter 2.5 mm) was surgically created in all groups. Groups II and IV received three applications of postsurgical LLLT (GaAlAs, 808 nm, 100 mW, 0.028 cm(2), 3.57 W/cm(2), 20 sec, 2 J,≅71.4 J/cm(2)) on alternate days. Histomorphometry was assessed following digital image analysis. RESULTS: The samples were evaluated on days 7, 14, and 21 after surgery; the IR protocol resulted in a significant reduction (p<0.018) in bone formation in Group III compared with Group I. Significant increases (p<0.006) in newly formed bone were noted in Group IV compared with Group III. No significant differences were observed between Group I and Group IV. CONCLUSIONS: LLLT increased the newly formed bone area during the initial phase of the tibiae repair process in rats exposed to IR.

Masticatory efficiency and bite force in individuals with normal occlusion.

OBJECTIVE: The aim of the study was to evaluate and correlate masticatory efficiency (ME) and maximum bite force (MBF) in adult individuals of both genders with normal occlusion. DESIGN: The study was conducted in a university research centre. ME and MBF were evaluated in 55 adults (27 men and 28 women) with normal occlusion. All subjects chewed four fuchsin capsules (two on the right and two on the left molar region) for 15 chewing cycles with a 3-min interval between capsules. The concentration of fuchsin in the capsules was determined by spectrophotometry and stratified by gender and chewing side. Bite force (BF) was measured three times on both the left and right molars; the highest value of the three measurements on each side was taken as the MBF. RESULTS: ME was higher in women (right side, 1.17±016µg/mL; left side, 1.20±0.15µg/mL) than in men (right side, 0.92±0.24µg/mL; left side, 0.89±0.24µg/mL). The MBF was higher in men (right side, 632±174N; left side, 627±170N) compared with women (right side, 427±140N; left side, 420±112N). No significant differences in chewing efficiency and BF were found between sides for both genders. CONCLUSIONS: Women showed the highest ME, while men had the highest MBF, with no correlation between these two parameters among genders.

Effects of surgically assisted rapid maxillary expansion on nasal dimensions using acoustic rhinometry.

OBJECTIVE: The objective of this study was to evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on nasal dimensions using acoustic rhinometry. STUDY DESIGN: Twenty-seven patients ranging in age from 18 to 53 years were evaluated as having a maxillary transverse deficiency larger than 7 mm, a bilateral cross-bite, and no evidence of nasal obstruction. All patients underwent evaluation of the nasal cavity by acoustic rhinometry both before and 6 months after SARME. The Wilcoxon test was used to evaluate minor cross-sectional areas (MCA) and the nasal volume of the right and left nasal cavities, and these parameters were measured with and without the application of topical nasal decongestant before and after SARME. RESULTS: In comparison with preoperative measurements, minor cross-sectional areas and nasal volumes were significantly larger after SARME. There was a statistically significant difference associated with the use of nasal decongestant; the minor cross-sectional areas and nasal volume of the right and left nasal cavities were smaller when nasal decongestants were not used. CONCLUSIONS: Surgically assisted rapid maxillary expansion increases the minor cross-sectional areas and volume of the nasal cavities. Acoustic rhinometry is an objective method for evaluating the geometry of the nasal cavity in patients with transverse maxillary deficiency.

Classification of midpalatal suture opening after surgically assisted rapid maxillary expansion using computed tomography.

OBJECTIVE: The aim of this study was to classify the opening of the midpalatal suture (MPS) after surgically assisted rapid maxillary expansion (SARME) with disjunction of the pterygomaxillary suture through computed tomography (CT) analysis. STUDY DESIGN: Seventy adults with bilateral transverse deficiency of the maxilla underwent SARME with pterygomaxillary disjunction. Seventy tomographies were performed before the surgery and 70 were performed after the final activation. The Hass appliance was used in 29 patients and Hyrax in 41 patients. The MPS opening was classified into 2 types: type I, total MPS opening from the anterior nasal spine to the posterior nasal spine, and type II, total MPS opening from the anterior nasal spine to the transverse palatine suture, with partial or nonexistent opening posterior to transverse palatine suture. RESULTS: Type I opening was observed in 22 patients (31.5%), and type II opening in 48 patients (68.5%). In 5 cases, the opening posterior to the transverse palatine suture was paramedian. CONCLUSION: Computed tomography allows the evaluation and classification of midpalatal suture openings after SARME with pterygomaxillary disjunction in type I (total) and type II (partial) MPS openings.