Influence of Surgeon Experience on Surgical Outcome of Maxillomandibular Advancement for Obstructive Sleep Apnea.

The primary aim of this study was to assess the association between clinical efficacy outcomes (i.e., polysomnography (PSG) results) of maxillomandibular advancement (MMA) and surgeons' experience. The second aim was to assess the association between the occurrence of postoperative complications of MMA and surgeons' experiences. Patients treated with MMA for moderate to severe obstructive sleep apnea (OSA) were enrolled in this retrospective study. The patient population was divided into two groups based on two different surgeons performing MMA. The associations between surgeons' experience on the one hand and PSG results and postoperative complications on the other hand were investigated. A total of 75 patients were included. There was no significant difference in baseline characteristics between the two groups. The reductions in apnea-hypopnea index and oxygen desaturation index were both significantly greater in group-B than group-A (p = 0.015 and 0.002, respectively). The overall success rate after MMA was 64.0%. There was a negative correlation between surgeon experience and surgical success (odds ratio: 0.963 [0.93, 1.00], p = 0.031). No significant association was found between surgeon experience and surgical cure. Additionally, there was no significant association between surgeon experience and the occurrence of postoperative complications. Within the limitations of this study, it is concluded that surgeon experience may have little to no influence on the clinical efficacy and safety of MMA surgery in OSA patients.

Limitations of Jaw Movement in Fibrodysplasia Ossificans Progressiva: A Review.

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder characterized by heterotopic ossification (HO) of the skeletal muscles, fascia, tendons and ligaments. Patients often experience limitations in jaw function due to HO formation in the maxillofacial region. However, no studies have yet analyzed the age of onset and location of HO and the type of restrictions it may yield in the maxillofacial region. The aim of this study was to evaluate all existing literature on the site of onset of HO and associated functional restrictions of the jaw. To this end, a scoping review was performed focusing on limitations of jaw movement in FOP patients. The literature search resulted in 725 articles, of which 30 articles were included for full study after applying the exclusion criteria. From these articles 94 FOP patients were evaluated for gender, age, presence and age at which HO started in the maxillofacial region, location of HO, whether HO was caused spontaneous or traumatic and maximum mouth opening. Formation of HO is slightly more common in female patients compared to male patients, but the age of HO onset or the maximum mouth opening does not differ between genders. Trauma-induced HO occurred at a significantly younger age than spontaneous HO. Interestingly, a difference in maximum mouth opening was observed between the different ossified locations in the maxillofacial region, with ossification of the masseter muscle resulting in the smallest and ossification of the zygomatic arch resulting in the largest maximum mouth opening. This review revealed that the location of the maxillofacial region affected by HO determines the degree of limitations of the maximum mouth opening. This finding may be important for establishing clinical guidelines for the dental management of FOP patients.

Effects of different nose types on class II treatments for female patients.

BACKGROUND: The aim of this study was to evaluate the effect of different nose types on the perception of facial aesthetics following camouflage treatment and orthognathic surgery for skeletal class II female patients. METHODS: A pre-treatment profile photograph of a skeletal class II adult patient was selected from the department archive. Two constructed photographs were created to represent orthognathic surgery and camouflage treatments with the aid of computer software. A total of 18 constructed images was composed using three profiles (pre-treatment, post-camouflage, and post-orthognathic surgery) and six nose types. These photographs were shown to the three groups (orthodontists, plastic surgeons, and lay people), and they were asked to assign an attractiveness score to each photo ranging from 0 to 100, with 0 indicating the least attractive and 100 indicating the most attractive. RESULTS: For the convex nose profiles, anterior movement of the mandible obtained by orthognathic surgery did not result in a significant change in the scores given by the lay people. When surgical or camouflage treatment was not implemented and, instead, just rhinoplasty was performed for these profiles, there was a significant increase in the aesthetic scores given by all groups. For the straight nose profiles, orthognathic surgery increased the attractiveness scores given by all groups. Furthermore, for all the profiles, extraction treatment did not affect the aesthetic scores given by any of the groups (P > 0.05). CONCLUSIONS: The lay people perceived that having a convex-bridged nose was a bigger problem than having a retrognathic profile. Overall, in terms of skeletal and dental orthodontic treatments, nose shape should be considered during the treatment planning process.

Does proclination of maxillary incisors really affect the sagittal position of point A?

OBJECTIVE: To examine the effect of maxillary incisor proclination due to orthodontic treatment upon the sagittal position of point A and evaluate the effect of this possible movement of point A on sella-nasion-point A (SNA) angle. MATERIALS AND METHODS: A study group was formed from 25 subjects (12 male and 13 female) who had Class II division 2 malocclusion with retroclined upper incisors, and a control group was formed from 25 subjects (12 male and 13 female) who had minor crowding in the beginning of the treatment and required no or minimal maxillary anterior tooth movement. Treatment changes in maxillary incisor inclination, sagittal position of point A, SNA angle, and movement of incisor root apex and incisal edge were calculated on pretreatment and posttreatment lateral cephalographs. RESULTS: Maxillary incisors were significantly proclined (17.33°) in the study group and not significantly proclined (1.81°) in the control group. This proclination resulted in 2.12-mm backward movement of the root apex and 5.76-mm forward movement of the incisal edge of maxillary incisors. Point A moved 1.04 mm backward (P  =  .582) and 0.48 mm (P  =  .811) forward in the study and control groups, respectively. Incisor root apex and incisal edge almost remained stable in the control group. No significant change was observed in the value of the SNA angle in both the study and control groups. CONCLUSIONS: Proclination of maxillary incisors accompanied by backward movement of incisor root apex caused posterior movement of point A. However, this posterior movement does not significantly affect the SNA angle.

A genetic survey of 1935 Turkish men with severe male factor infertility.

Male factor infertility is the sole reason in approximately 25% of couples who suffer from infertility. Genetic factors such as numerical and structural chromosomal abnormalities and microdeletions of the Y chromosome might be the cause of poor semen parameters. The results of karyotype analyses and Y-chromosome microdeletions of 1935 patients with severe male factor infertility, which is the largest series from Turkey, were assessed retrospectively. The frequency of cytogenetic abnormalities among 1214 patients with non-obstructive azoospermia (NOA) and 721 patients with severe oligoasthenoteratozoospermia (OAT) were 16.40 and 5.83% respectively. The overall incidence of Y-chromosome microdeletion was 7.70%. The incidence of Y chromosome microdeletion in patients with NOA and OAT was 9.51 and 1.86% respectively. The abnormality rate increased with the severity of infertility. Some patients (n = 22) were carriers of both chromosomal abnormalities and Y-chromosome microdeletions. Results suggest the need for genetic screening and proper genetic counselling before initiation of assisted reproduction treatment.

Assisted reproductive technique outcome in testicular sperm extraction-intracytoplasmic sperm injection cycles with poor female response: a report on 8 years' experience.

OBJECTIVE: To evaluate the outcome in couples composed of azoospermia and a poor responder female undergoing assisted reproductive techniques (ARTs). STUDY DESIGN: A retrospective study was performed involving 97 men suffering from nonobstructive azoospermia (NOA) whose partners had a poor response to ovarian stimulation. Poor response was defined as retrieval of fewer than 5 oocytes. Main outcome measures were implantation rate (IR), clinical pregnancy rate per embryo transfer (CPR/ET) and early pregnancy loss rate (EPLR). RESULTS: Overall IR, CPR/ET and EPLR were found to be 16%, 23% and 15%, respectively, which were significantly lower than those in NOA men with normoresponder partners except EPLR (25%, 52% and 24%, respectively). When the results were further stratified according to number of oocytes retrieved and body mass index, no significant difference was observed between the groups. However, when the results were analyzed according to the woman's age, a significantly lower CPR/ ET was found in poor responder women aged > or = 38 years (11% vs. 33%; p = 0.03). CONCLUSION: Although success of ART is suggested to be high once motil spermatozoa are found in testicular sperm extraction in NOA cases, poor response to ovarian stimulation might be considered as one of the strongest determinants of the outcome.