La cirugía ortognática en el tratamiento del síndrome de apnea obstructiva del sueño / Orthognathic surgery in the treatment of obstructive sleep apnea syndrome

RESUMEN Introducción: El síndrome de apnea obstructiva del sueño provoca somnolencia diurna; incide negativamente sobre el sistema cardiovascular y disminuye la calidad de vida. La cirugía ortognática provoca cambios en el espacio aéreo faríngeo, por lo que ha sido empleada en el tratamiento de dicho síndrome. Objetivo: Caracterizar las técnicas en cirugía ortognática más empleadas en el tratamiento del síndrome de apnea obstructiva del sueño, sus influencias sobre la vía aérea faríngea y efectividad terapéutica. Métodos: Se realizó una revisión de la literatura científica desde diciembre del 2016 a junio del 2017 a través de los buscadores de información y plataformas SciELO, Medline, Pubmed y Hinari. Los descriptores empleados para la búsqueda fueron cirugía ortognática, síndrome de apnea obstructiva del sueño, vía aérea faríngea, avance máxilo mandibular y sus combinaciones. Se obtuvieron 127 artículos de los que se seleccionaron 28 por su contenido, actualidad y objetividad. Análisis e integración de la información: El adelanto quirúrgico del maxilar, mandíbula, mentón o sus combinaciones minimiza los efectos del síndrome de apnea obstructiva del sueño. Es recomendable la cirugía bimaxilar en la corrección de las clases III esqueletales para atenuar posibles efectos perjudiciales sobre la vía aérea por la retroposición mandibular aislada. Conclusiones: La cirugía ortognática de avance, incrementa el espacio faríngeo y mejora la calidad del sueño. Los movimientos de retroposición pueden tener efecto inverso, aspecto importante en la corrección de las clases III esqueletales(AU)

ABSTRACT Introduction: Obstructive sleep apnea syndrome causes daytime sleepiness, affects the cardiovascular system and reduces the quality of life. Since orthognathic surgery brings about changes in the pharyngeal airway space, it has been used to treat this syndrome. Objective: Characterize the orthognathic surgery techniques most commonly used to treat obstructive sleep apnea syndrome, their impact on the pharyngeal airway and their therapeutic effectiveness. Methods: A bibliographic review was conducted from December 2016 to June 2017 using the search engines and platforms SciELO, Medline, Pubmed and Hinari. The search words used were orthognathic surgery, obstructive sleep apnea syndrome, pharyngeal airway, maxillomandibular advancement, and combinations thereof. Of the 127 papers obtained, 28 were selected based on their content, topicality and objectivity. Data analysis and integration: Surgical advancement of the maxilla, mandible, chin or combinations thereof minimizes the effects of obstructive sleep apnea syndrome. Bimaxillary surgery is recommended to correct skeletal class III malocclusion so as to lessen potential damaging effects on the airway caused by isolated mandibular retroposition. Conclusions: Advancement orthognathic surgery broadens the pharyngeal airway space and improves the quality of sleep. The fact that retroposition movements may have an opposite effect is an important aspect to be considered in the correction of skeletal class III malocclusions(AU)

Dental team management for a patient with Klippel-Feil syndrome: case report.

Klippel-Feil syndrome (KFS) is a rare congenital abnormality characterized by a short neck, a low posterior hairline, and limited head movement. Occasionally, patients with KFS may also show signs of deafness, intellectual disability, cardiac malformation, palpebral ptosis, facial nerve paralysis, cleft palate, and scoliosis. Although some researchers have documented this syndrome, scant attention has been paid to craniomaxillofacial manifestations and dental treatment of patients with KFS. The objective of this case report was to describe the planning and execution of dental treatment for a 10-year-old male patient with KFS.

Orofacial aspects in Noonan syndrome: 2 case report.

Noonan syndrome (NS) is an autosomal dominant disorder characterized by dysmorphic facial features in association with short stature and heart disease. A webbed neck, chest deformities, mental retardation, and bleeding disorders are also frequently associated with this pathology. NS is relatively common, with an estimated incidence of 1 per 1,000 to 1 per 2,500 live births. Many cases have been reported in the dental literature, yet only a few of them describe some details of the oral features. The aim of this paper is to describe 2 cases of Noonan syndrome, emphasizing oral and facial aspects and particularities of the dental treatment in subjects affected by this genetic disease.

Apnoea-hypopnoea and mandibular retrusion as uncommon findings associated with Proteus syndrome.

The aetiology of Proteus syndrome (PS) is yet unclear. This disease includes partial gigantism of the hands and/or feet, nevi, hemihypertrophy due to overgrowth of long bones, subcutaneous tumours, macrocephaly, cranial hyperostosis, and pulmonary and renal abnormalities. This case report is about a 17-year-old boy with two uncommon findings associated with PS: apnoea-hypopnoea and mandibular retrusion. A multidisciplinary team was important to provide professional care for this patient. Dentists and physicians proposed an adjusted treatment plan. Maxillary disjunction was achieved with a combination of orthodontic treatment and surgical procedure. This represented the initial care for malocclusion treatment and also the preparation for orthognathic surgery. The oral maxillofacial surgeon and the otorhinolaryngologist proposed this approach in an attempt to improve pharynx airflow. The patient has been followed for almost 3 years.

Association between breastfeeding duration and mandibular retrusion: a cross-sectional study of children in the mixed dentition.

INTRODUCTION: In this study, we examined the relationships among breastfeeding duration, nonnutritive infantile sucking habits, Class II facial patterns with mandibular retrusion, and Class II dental relationships. METHODS: A sample of 249 children in the mixed dentition was examined by 2 orthodontists. Data about the duration of breastfeeding and nonnutritive sucking habits were obtained by written questionnaires answered by the parents. RESULTS: The chi-square test did not indicate a statistically significant association between breastfeeding duration and mandibular deficiency or Class II malocclusion. However, statistically significant associations were found between short breastfeeding duration (<6 months) and nonnutritive sucking habits, and between nonnutritive sucking habits and Class II malocclusions. CONCLUSIONS: These findings point to the hypothesis that nonnutritive sucking habits may work as a dominant variable in the relationship between breastfeeding duration and the occurrence of Class II malocclusion. However, the prevention of mandibular deficiency should not be listed as one of the advantages of breastfeeding.

Respuesta del complejo mentolabial a los procedimientos de retroposición mandibular y mentonoplastias de altura / Response of the mentolabial complex to the procedures of mandibular retroposition and height mentonoplasties

Se realizó un estudio prospectivo y longitudinal de 24 pacientes tratados con retroposición mandibular y reposición superior del mentón, en el período comprendido entre 1990 y 1997, para lo cual se aplicaron las técnicas de osteotomía sagital modificada de la rama y ostectomía oblicua del mentón con pedículo de tejido blando en su porción anterior. El movimiento posterior del incisivo inferior se asoció con el movimiento anteroposterior del labio inferior y el pogonion blando, en una relación de 1:0,76 y 1:0,91 mm, respectivamente. El pogonion óseo se asoció con el movimiento posterior de su homólogo blando en una relación de 1:0,86 mm. El punto B acompaño a su contraparte ósea en una proporción de 1:0,88 mm. Asimismo, la reducción vertical del mentón disminuyó la longitud del labio inferior en 0,68 mm por cada milímetro de reducción del primero; mientras que el pogonion blando se desplazó superiormente en 0,96 mm por cada milímetro en que se redujo la altura del mentón. Se establecen otros valores pronósticos para el componente mantolabial, de importancia en la planificación cefalométrica(AU)

A prospective and longitudinal study of 24 patients treated with mandibular retroposition and upper reposition of the chin by the techniques of modified branch sagital osteotomy and oblique osteotomy of the chin with pedicle of soft tissue in its anterior portion, from 1990 to 1997, was conducted. The posterior movement of the inferior incisor was associated with the anteroposterior movement of the lower lip and the soft pogonion in a ratio of 1:0.76 and 1:091 mm. The osteal pogonion was associated with the posterior movement of its soft homologue in a ratio of 1:086 mm. Point B accompanied its osteal counterpart in a proportion of 1:0.88 mm. Likewise, the vertical reduction of the chin decreased the length of the lower lip in 0.68 mm per every millimiter of reduction of the first;| whereas the soft pogonion upperly displaced 0.96 mm per each millimeter of reduction of the chin height. Other prognostic values were established for the mentolabial component that are important for cephalometric planning(AU)

Relación entre posición mandibular y postura cervical en pacientes con retrognatismo / Relation between mandibular position and cervix posture in patients with retrognatism

Se estudió un grupo de 18 pacientes portadores de una dismorfosis dentoesqueletal clase II, con el objeto de determinar un tipo de relación entre retrognatismo y postura cervical. Usamos telerradiografías de perfil tomadas en posición habitual de cabeza, utilizando los análisis cefalométricos de Delaire y Solow. Los resultados obtenidos permitieron concluir que existe una relación directa entre la posición retruída mandibular que presentan los pacientes con dismorfosis dentoesqueletal clase II y la postura cervical, determinando que entre más posterior es la posición mandibular, mayor es la extensión anterior de la columna cervical