Orthognathic surgery and aligners. A comparative assessment of periodontal health and quality of life in postsurgical orthodontic treatment with aligners versus traditional fixed appliances: a randomized controlled trial.

BACKGROUND: Removable clear aligners have become very popular in the last few decades, but they are still little used in the field of orthognathic surgery (OS). The objective of this study was to compare periodontal health and quality of life (QoL) associated to postsurgical orthodontic treatment. MATERIAL AND METHODS: Patients with dentofacial deformities undergoing OS were randomly allocated to receive postsurgical orthodontic treatment with either fixed orthodontic appliances or Invisalign. The main outcomes were periodontal health and QoL. Plaque index, probing depth and bleeding on probing were assessed as periodontal health indicators. QoL was assessed through the Orthognathic Quality of Life Questionnaire (OQLQ-22) and the Oral Health Impact Profile (OHIP-14). Data were analyzed before surgery and end of treatment. Total duration of treatment was also recorded. RESULTS: Twenty-eight patients were randomized, (16 women, 12 men). Periodontal assessment showed better outcomes for the Invisalign group: bleeding on probing (p=0.013), plaque index (p=0.001) and probing depth (p<0.001). The QoL questionnaires showed significant differences in favor of the Invisalign group: OHIP-14 (p=0.004) and OQLQ-22 (p=0.002). Total duration of treatment was similar in both groups (p=0.575). CONCLUSIONS: Compared to traditional orthodontics with fixed appliances, patients managed with clear aligners after OS (surgery-first approach) had better periodontal health and QoL outcomes.

Cervical necrotizing fasciitis and diabetic ketoacidosis: literature review and case report.

Necrotizing fasciitis (NF) is a rare polymicrobial infection that can be life-threatening. It is a rapidly progressive inflammatory process affecting the deep fascia, with secondary necrosis of the subcutaneous tissue. It is characterized by its fulminant course and its high mortality rate. Most cases of NF affect the abdomen, groin, and extremities. NF in the neck is reported to be rare and most cases are odontogenic in origin. Misdiagnosis and delayed treatment can result in death from sepsis, mediastinitis, carotid artery erosion, jugular vein thrombophlebitis, or aspiration pneumonia. The diagnosis is based on a combination of clinical history and predisposing factors, Gram staining and culture, imaging, and surgical exploration. Early and aggressive surgical treatment and intensive medical care are essential. The aim of this article is to report a case of severe and extensive cervical NF worsened by a diabetic ketoacidosis as a first appearance of diabetes mellitus.

Osteotomía de avance del marco orbitario para el tratamiento del exoftalmos endocrino severo / Advancement osteotomy of the orbital rim for the treatment of severe endocrine exophthalmos

La orbitopatía tiroidea es una enfermedad debilitante del sistemavisual caracterizada por presentar cambios en los tejidos blandos orbitariosy periorbitarios debidos a un proceso inflamatorio, o a la consecuenciadel mismo, y que se relaciona con alteraciones sistémicas de la glándulatiroides. Aparte de las alteraciones estéticas que ocasiona, los pacientespueden presentar queratitis de repetición por exposición, diplopia, dolorretrobulbar, compresión del nervio óptico e incluso ceguera. La cirugíaconstituye el tratamiento definitivo del exoftalmos en la orbitopatía deGraves, mejorando la proptosis y la visión, así como diminuyendo la sintomatologíaocular, con una morbilidad mínima. Presentamos un casode exoftalmos severo que fue intervenido mediante osteotomía y avancedel marco orbitario superior, lateral e inferior, remoción parcial de dos paredesorbitarias y lipectomía. Los resultados estéticos y el alivio de la sintomatologíaocular resultaron satisfactorios

Thyroid-associated orbitopathy is a debilitating diseaseof the visual system that is characterized by changes in the softtissuesof the orbit and periorbita as a result of an inflammatoryprocess, or as a consequence of this, and related to systemic disordersof the thyroid gland. Apart from the aesthetic changes that arise,patients may also present persistent keratitis due to exposure,diplopia, retrobulbar pain, compression of the optic nerve and evenblindness. Surgery represents the definitive treatment forexophthalmos in Graves’ orbitopathy as improvements are shownin proptosis and vision. A decrease is also experienced in ocularsymptomatology and there is minimal morbidity. We present thecase of severe exophthalmos that was surgically operated on withan advancement osteotomy of the supero-, lateral- and infraorbitalrim, with partial removal of two of the orbital walls with lipectomy.The aesthetic results and the relief of the ocular symptoms weresatisfactory

Retromolar intubation.

PURPOSE: A simple technique of retromolar intubation does not interfere with dental occlusion and offers clear advantages in craniofacial, orthognathic, oncologic, and trauma surgery procedures. PATIENTS AND METHODS: Thirty-nine subjects underwent different surgical procedures using this intubation technique. The possible surgical and anesthetic complications were analyzed. RESULTS: After the analysis of the studied variables and modes, we noticed that there was not a significant increase in complications or surgical time compared with other classic intubation methods. A retromolar bone graft could be obtained if necessary. CONCLUSION: This technique does not impede operating on the nasal pyramid and allows intraoperative assessment of the new surgical profile, while permitting establishment of normal occlusion.

Benign fibro-osseous lesions in Paget's disease of the jaws.

A clinicopathologic study of five patients with Paget's disease of the jaws is reported. All patients had well-documented cases of osteitis deformans with polyostotic involvement. Histologic studies of facial bones could be performed because surgery was necessary for either cosmetic or functional reasons. Three specimens consisted of maxillary bone, and two were mandibular. Microscopically, all cases showed multiple and irregular fibroproliferative lesions containing mineralized structures intermingled with bone characteristic of Paget's disease. The purpose of this article is to present these fibro-osseous lesions in relation to Paget's disease of the jaws and to emphasize their close resemblance to other benign fibro-osseous lesions of the jaws, especially cementifying and ossifying fibroma, and florid osseous dysplasia.