Predictability of Mandibular Autorotation After Le Fort I Maxillary Impaction in Case of Vertical Maxillary Excess.

A retrospective study of 20 patients treated for vertical maxillary excess between 2009 and 2010, solely by superior surgical repositioning of the maxilla. Clinical and radiological cephalometric parameters were analyzed statistically and their impact on achieving the predicted postoperative mandibular autorotation and on relapse. According to our study, patients presenting with an anterior open bite and a low occlusal plane angle might fail to achieve the predicted mandibular autorotation and are prone to postoperative relapse. No correlation was found between the extent of maxillary impaction and the presence of autorotation.

Microflora of normal maxillary sinuses: does it justify perioperative antibiotic treatment in sinus augmentation procedures.

OBJECTIVES: To investigate bacterial flora of normal maxillary sinuses in order to facilitate perioperative antibiotic management in sinus augmentation procedures. MATERIALS AND METHODS: Specimens of maxillary sinus mucosa were harvested during planned orthognatic surgery in 18 patients with no evidence of rhinosinusitis. The samples were processed according to hospital routine for aerobic and anaerobic cultures. RESULTS: Ten maxillary sinuses were found sterile. Twenty-six (72%) maxillary mucosa specimens were culture-positive. Aerobes were recovered in 21 sinus samples (58%), predominantly as polymicrobial flora (18 cultures, 50% of all specimens), S. aureus in 2 sinuses of the same patient (6% of the samples), and Bacillus sp. in 1 sinus (3%). Anaerobes were isolated in 20 of 26 culture-positive specimens (56% of all sinus samples). They were recovered alone in 5 samples. Fifteen anaerobic cultures were polymicrobial (42% of all samples). Propionibacterium acnes was isolated from another 5 sinuses (14%) of 3 patients. CONCLUSIONS: Our data support the policy of perioperative antibiotic prophylaxis in sinus augmentation procedures where Schneiderian membrane is perforated. CLINICAL RELEVANCE: Evaluating the need of a perioperative antibiotic therapy in sinus augmentation procedures.

Sequence of treatment in mandibular prognathism patients.

Intraoral vertical ramus osteotomy (IVRO) and advancement genioplasty are effective and predictable methods of treating selective individuals with mandibular prognathism. The sequence of performing these procedures does have a clinical effect, but this is not found in the literature. The purpose of this article is to introduce the clinical implication of the sequence of procedures and to recommend the preferred sequence based on experience. A retrospective study was conducted on 75 patients treated by IVRO with or without genioplasty. In 31 patients, IVRO was performed without genioplasty; only one patient suffered from transient hypoesthesia. When IVRO was performed before genioplasty (sequence I) in 20 patients, nine suffered from mental nerve hypoesthesia. However, when IVRO was performed after genioplasty (sequence II) in 24 patients, permanent mental nerve anesthesia occurred in five patients and mental nerve hypoesthesia in 15 patients. Based on these results, it is recommended that IVRO be performed before genioplasty.