How does bone thickness affect the split pattern of sagittal ramus osteotomy?

This study examined the influence of bone thickness on the split pattern of sagittal ramus osteotomy at 62 sites using Dolphin 3D software. Four measurements of thickness were obtained from the preoperative computed tomography scans: measurement A was made 1.5mm above the lingula, using the coronal and sagittal planes; measurement B was made at the same height as measurement A and 1mm from the anterior border of the ramus; measurement C was obtained 5mm distal to the last molar and 5mm below the upper border of the mandible; measurement D was made in the area between the first and second molars, 6mm above the mandibular border. Three-dimensional postoperative images were used to classify the split pattern into types, based on the classification of Plooij et al. The data were analyzed using the Kruskal-Wallis test, followed by Dunn post-hoc test. Thirty-five sagittal splits were type I, one was type II, 19 were type III, and seven were type IV. Type I presented the greatest thickness, whereas type IV presented the lowest. There was a statistically significant difference in thickness only for measurement A, when types I and IV were compared. The results indicate that thinner mandibular rami are more prone to bad splits.

Surgically assisted rapid maxillary expansion: a systematic review of complications.

A systematic review of the literature on the complications of surgically assisted maxillary expansion (SARME) was performed. The search strategy was based on the PRISMA guidelines. The PubMed, SCOPUS, and Cochrane Library databases were searched. Data were extracted from the full texts after screening of the abstracts and titles. Human clinical studies encompassing 'maxillary expansion', 'palatal expansion', 'SARME', or 'SARPE' and that reported sufficient data for 'complication' were included. In vitro studies, case reports, meta-analyses, reviews, book chapters, animal studies, and studies with missing or insufficient data were excluded. The final selection included 12 articles for data extraction. A total of 851 patients underwent SARME, with 187 reported complications (21.97%). Epistaxis (2.47%) and postoperative pain (2.00%) were the most often reported minor complications, and asymmetric or inadequate expansion presented an occurrence rate of 4.47%. Minor complications were equally distributed between surgical (49.30%) and orthodontic complications (50.70%). The technique without pterygomaxillary disjunction increased the occurrence of minor complications (29.95% vs. 16.87%), and the expansion pattern with less than 0.5 mm/day increased the occurrence of orthodontic complications (30.93% vs. 1.83%), i.e. asymmetric expansion. In conclusion, SARME procedures mostly present minor complications. Although several types of complication are described in the literature, occurrence rates are low, and technical issues such as pterygomaxillary disjunction and the pattern of distraction can be predictors of the complication risk.

Nasal airway evaluation in obstructive sleep apnoea patients: volumetric tomography and endoscopic findings.

Obstructive sleep apnoea (OSA) results from the recurrent collapse of the upper airway during sleep. Nasal abnormalities influence the stability of the pharynx. The aim of this study was to evaluate the volumetric and anatomical changes of the nasal cavity in patients with OSA. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used to grade nasal obstruction. Sleep-related breathing disorders were evaluated by polysomnography. The nasal airway volume was obtained from computed tomography scans through volumetric reconstruction of the nasal airway. Alterations to the nasal anatomy were identified by nasal fibre-optic endoscopy. Ninety-four patient charts were analyzed. The final sample comprised 32 patients with severe OSA, 16 with moderate OSA, 23 with mild OSA, and 20 without OSA. Three groups were established based on nasal obstruction and OSA. The groups were compared for nasal airway volume (P=0.464) and body mass index (P=0.001). The presence of nasal septum deviation and inferior turbinate hypertrophy were related to the NOSE score (P=0.05 for both), apnoea-hypopnoea index (P=0.03 and P=0.05, respectively), and nasal airway volume (P=0.71 and P=0.78, respectively). In this nasal airway evaluation of OSA patients, the presence of sites of obstruction was correlated with the severity of OSA; this was not the case for the evaluation of the nasal airway volume dimensions.

Evaluation of single implants placed in the posterior mandibular area under immediate loading: a prospective study.

The aim of this study was to evaluate the survival of single dental implants subjected to immediate function. Twelve patients with edentulous areas in the posterior mandible were included in the study. All received at least one regular platform dental implant (3.75mm×11mm or 3.75mm×13mm). Clinical and radiographic parameters were evaluated. The survival rate after 12 months was 83.3%. The implants showed no clinical mobility, had implant stability quotient values (ISQ; Osstell) around 70, bone loss of up to 2mm, and a probing depth of ≤3mm. Although the posterior mandible is an area in which the immediate loading of dental implants should be performed with caution, this treatment presented a good success rate in the present study sample.

Finite element evaluation of three methods of stable fixation of condyle base fractures.

The surgical treatment of mandibular condyle fractures currently offers several possibilities for stable internal fixation. In this study, a finite element model evaluation was performed of three different methods for osteosynthesis of low subcondylar fractures: (1) two four-hole straight plates, (2) one seven-hole lambda plate, and (3) one four-hole trapezoidal plate. The finite element model evaluation considered a load applied to the first molar on the contralateral side to the fracture. Results showed that, although the three methods are capable of withstanding functional loading, the lambda plate displayed a more homogeneous stress distribution for both osteosynthesis material and bone and may be a better method when single-plate fixation is the option.

Volumetric upper airway assessment in patients with transverse maxillary deficiency after surgically assisted rapid maxillary expansion.

Transverse maxillary deficiency is commonly found in patients with sleep apnea and is also related to abnormal breathing patterns. Maxillary expansion procedures promote widening of the nasal floor and reduce the resistance to airflow, and have a positive influence on nasopharynx function. In order to evaluate volume changes in the upper airway, 15 adult patients with transverse maxillary deficiency underwent surgically assisted rapid maxillary expansion (RME) until a slight overcorrection of the crossbite was obtained. Cone beam computed tomography (CBCT) volumetric images were obtained at three predefined time points. The mean age of the patients was 30.2 (±7.4) years; nine were females and six were males. The area, volume, and the smallest transverse section area of the airway were assessed using Dolphin Imaging 3D software. Statistical comparisons were made of the changes between time periods. No statistically significant differences were found for volume or area. However a significant difference was found between the preoperative and immediate postoperative smallest transverse section area (P<0.05). Maxillary expansion, as an isolated procedure, does not result in a statistically significant improvement in the airway dimensions and results in an inferior relocation of the smallest transverse section area.

Orthognathic surgery with or without induced hypotension.

This study involved a retrospective evaluation of patients subjected to surgery for dentofacial deformities treated without induced controlled hypotension (group I, n=50) and a prospective evaluation of patients who were subjected to surgery under hypotensive general anaesthesia (group II, n=50). No statistical differences were found between the study groups with regard to the duration of surgery. However, there were statistically significant differences in the need for blood transfusion and the occurrence of bradycardia during the maxillary down-fracture. Hypotensive anaesthesia decreased the need for a blood transfusion and the occurrence of bradycardia, and is therefore considered highly beneficial for patients undergoing orthognathic surgery.

In vitro biomechanical evaluation of sagittal split osteotomy fixation with a specifically designed miniplate.

Recent studies have evaluated many methods of internal fixation for sagittal split ramus osteotomy (SSRO), aiming to increase stability of the bone segments while minimizing condylar displacement. The purpose of this study was to evaluate, through biomechanical testing, the stability of the fixation comparing a specially designed bone plate to other two commonly used methods. Thirty hemimandibles were separated into three equal groups. All specimens received SSRO. In Group I the osteotomies were fixed with three 15 mm bicortical positional screws in an inverted-L pattern with an insertion angle of 90°. In Group II, fixation was carried out with a four-hole straight plate and four 6mm monocortical screws. In Group III, fixation was performed with an adjustable sagittal plate and eight 6mm monocortical screws. Hemimandibles were submitted to vertical compressive loads, by a mechanical testing unit. Averages and standard deviations were submitted to analysis of variance using the Tukey test with a 5% level of significance. Bicortical screws presented the greatest values of loading resistance. The adjustable miniplate demonstrated 60% lower resistance compared to bicortical screws. Group II presented on average 40% less resistant to the axial loading.

Anatomic study of the mandibular foramen, lingula and antilingula in dry mandibles, and its statistical relationship between the true lingula and the antilingula.

The authors verified the anatomical location of the mandibular foramen, lingula and antilingula in dry mandibles, aiming to obtain information that could be used when performing mandibular osteotomies. Forty-four mandibles (88 sides) were evaluated. The distances were measured using a sliding calliper, with the mandibles fixed in a reproducible position. Results showed that the mandibular foramen is on average 5.82 mm below the lingula. Regarding the statistical comparison between the mandibular foramen entrance and the antilingula position, there is no correlation between the position of those two structures in the studied sample. The mandibular foramen is slightly posterior in relation to the centre of the ramus. The lingula is an important anatomic landmark for ramus surgery, and for determining the distance to the mandibular foramen entrance. The use of the antilingula as a landmark for the position of the vertical ramus osteotomy is not recommended.

Fixation of autogenous bone grafts with ethyl-cyanoacrylate glue or titanium screws in the calvaria of rabbits.

This study compared the fixation of autogenous onlay bone grafts with cyanoacrylate glue (Super Bonder) and with titanium screws. Twenty rabbits underwent bilateral parietal ostectomies. Bone segments were fixed anteriorly to the resulting bone defect. In group I, the grafts were fixed with 4 mm long, 1.5 mm diameter screws; in group II, adhesive was used. The animals were killed after 5, 15, 30, 60 and 120 days. Histomorphometric analysis was used to quantify the maintenance of the graft area. Discrete areas of inflammatory reaction were seen in both groups after 5 days and for group II after 15 days. After 30 days, new bone formation was seen at the interface of the grafts. After 120 days, the graft was incorporated into the host bed in group I and partially incorporated in group II. There was a significant statistical difference regarding the mean graft areas between 15 and 120 days (p<0.001) and between fixation methods (p<0.002). Fixation with adhesive promoted a significantly greater area of bone graft than screw fixation, independent of time period. The adhesive was biocompatible, presented similar stability to the screw and maintained the bone area, although there was a delay in graft incorporation.

Rigid internal fixation with titanium versus bioresorbable miniplates in the repair of mandibular fractures in rabbits.

The purpose of this study was to compare by qualitative histology the efficacy of rigid internal fixation with titanium system and the Lacto Sorb system in mandibular fractures in rabbits. Thirty male adult rabbits Oryctolagus cuniculus were used. Unilateral mandibular osteotomies were performed between the canine and first premolar. The animals were divided into two groups: for Group I-rigid internal fixation was performed with titanium system 1.5 mm (Synthes, Oberdorf, Switzerland), with two screws of 6 mm (bicortical) on each side of the osteotomy. For Group II-rigid internal fixation was performed with PLLA/PGA system 1.5 mm (Lacto Sorb, WLorenz, Jacksonville, FL, USA). The histological analysis evaluated the presence of inflammatory reaction, degree of bone healing and degree of resorption of the Lacto Sorb screws. The results of both fixation systems were similar, only with a small difference after 15 and 30 days. In Group I a faster bony healing was noted. But after 60 days, bony healing was similar in both groups. It is concluded that both PLLA/PGA and titanium plates and screws provide sufficient strength to permit mandibular bone healing. The resorption process of PLLA/PGA osteosynthesis material did not cause acute or chronic inflammatory reaction or foreign body reaction during the studied period.