The relationship between fixation method and early central condylar sagging after bilateral sagittal split ramus osteotomy in orthognathic surgery.

PURPOSE: There is no consensus about the ideal fixation methods and their effects on the condyle after the sagittal split ramus osteotomy (SSRO) procedure. The aim of this study was to compare the incidence, clinical presentation, and treatment of condylar sagging between different fixation methods following SSRO. METHODS: Patients who underwent double jaw surgery between 2007 and 2017 were evaluated retrospectively. Mandibular fixation was maintained using one of three different options: a miniplate and a single bicortical screw, three bicortical screws, or a single bicortical screw. Some patients had malocclusion relapse in the early postoperative period due to condylar sagging, and needed reoperation. The reoperated condylar sagging patients were analysed statistically with respect to their fixation methods. RESULTS: 233 patients (134 females, 99 males) with a mean age of 23.3 years were enrolled in the study. The patients fixated with a single bicortical screw had lower revision surgery rates than those with three bicortical screws or with miniplate with a single bicortical screw (p = 0.034 and p = 0.032, respectively). These differences in central condylar sagging with a need for revision were statistically significant. CONCLUSION: Although a miniplate and a single bicortical screw and three bicortical screws are widely used after SSRO, if the priority is to avoid sagging then it seems that a single screw should be preferred for osteosynthesis.

Orthodontic treatment and follow-up of a patient with cerebral palsy and spastic quadriplegia.

INTRODUCTION: This report describes the clinical orthodontic management of a patient with spastic quadriplegia and cerebral palsy. Guidelines to overcome difficulties encountered during the treatment period are suggested. METHODS: A 13-year-old boy with cerebral palsy and spastic quadriplegia complained of an undesirable oral appearance because of his malocclusion. He had a Class II molar relationship, with severe maxillary and moderate mandibular anterior crowding. Enamel hypoplasia was apparent on all teeth. He had losses of body function and upper extremity function of 70% and 39%, respectively. His physical limitations necessitated a treatment approach that did not rely on patient-dependent appliances. The treatment plan called for maxillary first premolar extractions, mandibular incisor protrusion, and air rotor stripping. RESULTS: The patient's oral function and esthetic appearance were significantly improved. Aligned dental arches with good occlusion were obtained. The patient's self-confidence improved during the treatment period. CONCLUSIONS: Physical appearance can influence personality and social acceptability. Corrective orthodontic treatment for patients with physical handicaps can improve not only oral function, but also self-confidence and self-esteem.

Nasal profile changes with le fort I maxillary advancement surgery.

Introduction : The purpose of this study was to quantify anteroposterior facial soft tissue changes with respect to underlying skeletal movements after Le Fort I maxillary advancement surgery by using lateral cephalograms taken before and after the operation. Materials and Methods : The study group consisted of 20 patients (10 women, 10 men; mean age 23.4 ± 1.4 years) having a Class III skeletal deformity caused by a retrognathic maxilla. All patients were treated by Le Fort I maxillary advancement osteotomy. Lateral cephalograms were taken before and 1.6 ± 0.4 years after surgery. Results : The anteroposterior position of A-point and anteroposterior position of maxillary incisor were significantly protracted (-2.69 ± 3.34 and -2.68 ± 3.21, respectively; P < .01). The nasal anteroposterior and superoinferior positions (NASALAP and NASALSI, respectively) were significantly changed (-2.70 ± 6.81, P < .01, and -2.55 ± 5.80, P < .05, respectively) and nasal elevation and protraction were observed after Le Fort I maxillary advancement surgery. Conclusions : The changes in anteroposterior and superoinferior positions of A-point were correlated with the nasal superoinferior position (r = -0.71 , P < .05; r = 0.72, P < .05) after Le Fort I maxillary advancement surgery.

Interdisciplinary treatment of a patient with amelogenesis imperfecta, a skeletal Class III relationship, and an anterior open bite.

An adult woman with amelogenesis imperfecta, a skeletal Class III relationship, long face syndrome, and a severe anterior open bite received interdisciplinary treatment (orthodontics, orthognathic surgery, and prosthodontics). Presurgical orthodontic treatment was followed by a maxillary posterior impaction with anterior advancement and a mandibular setback. After surgery, the patient received ceramic crowns. Function and esthetics were successfully re-established.

Body fat composition and weight changes after double-jaw osteotomy.

Nutritional problems might be observed after surgical procedures. In this study, body weight and fat composition changes have been investigated in dentofacial deformity patients after the double-jaw osteotomy procedure. Thirty Angle class 3 patients operated on with double-jaw osteotomies during the period of March 2006 to July 2008 were included in the study. Interocclusal splints were applied continuously in the first 2 weeks after surgery, whereas intermittent splint was used for the next 2 weeks. Patients were analyzed before surgery and on the first month after surgery with the help of Tanita Composition Analyzer 310 bioimpedance method for weight, fat mass, and fat-free mass values. Results were evaluated statistically with the paired-sample test using SPSS version 13.0. Although significant results were obtained in female patients before surgery (weight [P = 0.011], body mass index [BMI; P = 0.012], fat mass [P = 0.010], and fat-free mass [P = 0.051, not significant]), none of the values were significant for male patients (P = 0.747, P = 0.747, P = 0.645, and P = 0.803, respectively). Weight gain was observed in 9 patients (30%). In contrast, weight gain was not seen in underweight patients. No sex differences in terms of weight gain/loss and fat composition have been observed. Interocclusal splint in female patients operated on with double-jaw osteotomies might cause nutritional deficiency in the first month after surgery. This eventually causes fat and weight loss, which may lead to poor wound healing and recovery later.

Changes in head posture and hyoid bone position in Turkish Class III patients after mandibular setback surgery.

The aim of this study was to determine the changes in head posture and hyoid bone position after mandibular setback osteotomy in Turkish adult Class III patients. Serial lateral cephalograms of 42 Turkish Class III patients (24 female, 18 male patients, mean age: 25.4+/-1.2 years) who underwent mandibular setback surgery were evaluated preoperatively, 1.2+/-0.6 years, 2.3+/-0.8 and 4.2+/-0.9 years postoperatively. A mean mandibular setback of 5.6+/-0.8mm was associated with a posterior and inferior movement of the hyoid bone and a significant flexion in the neck posture. Surgical correction of mandibular prognathism altered the position of the hyoid bone by downward repositioning carrying the root of the tongue downwards immediately postoperatively, but followed with a tendency to return to its original position.

Treatment of a patient with a severe Class III and open bite: a case report.

The Class III malocclusion with mandibular prognathism and open bite can be a result of excessive mandibular growth, underdevelopment of the maxilla, environmental factors, and trauma to the jaws. Correction of this malocclusion can involve an orthodontic or a combined orthodontic-orthognathic approach. Skeletal asymmetries can complicate this situation, making treatment more difficult. This skeletal Class III deformity with skeletal open bite case presentation involves treatment with a combined orthodontic-bimaxillary orthognathic approach following rhinoplasty. In addition, the patient's postoperative skeletal and dental stability was well-maintained after 1 year postoperation.

Oropharyngeal airway changes following bimaxillary surgery in Class III female adults.

AIM: The aim of this study was to evaluate oropharyngeal airway changes following Le Fort I maxillary advancement and impaction with mandibular setback in Class III deformity. SUBJECTS AND METHODS: 53 female Class III patients (mean age: 24.9+/-0.8 years) had Le Fort I maxillary advancement with impaction, and mandibular setback osteotomies. Lateral cephalograms were taken before (T0), one week postoperatively (T1) and 1.3+/-0.2 years after (T2) bimaxillary surgery. Paired t and Pearson tests were used to evaluate the changes. RESULTS: The mandibular plane-hyoid, upper retropalatal airway space (URP) and hyoid to horizontal reference plane (HY-HOR) distances significantly increased and the third vertebra to menton, hyoid to vertical reference plane (HY-VER) distances decreased in the T0-T1 period. Relapses were found in mandibular plane to hyoid (MP-HY), URP, HY-HOR, third cervical vertebra to menton (C3-Me) and HY-VER distances in T1-T2 period. Correlations were found between the mandibular retraction and increases of the narrowest retropalatal (r: 0.29, p<0.05) and lowest retropalatal airway spaces (r: -0.30, p<0.05) and posterior movement of hyoid (r: 0.60, p<0.001). CONCLUSIONS: Bimaxillary surgery caused an increase in the URP, together with posterior and inferior movement of hyoid bone one week postoperatively. Some relapse was found in these changes over one year later.

Soft and hard tissue changes after bimaxillary surgery in Turkish female Class III patients.

INTRODUCTION: Treatment of severe Class III malocclusion frequently requires a combination of orthodontics and orthognathic surgical procedures. The aims of this retrospective study were to assess the results of bimaxillary surgery on Turkish female subjects presenting with Class III malocclusions and to evaluate the correlation between soft and hard tissue changes. MATERIAL AND METHODS: The sample consisted of 44 Turkish female Class III patients (mean age was 28.3+/-3.7 years) treated with bilateral sagittal split osteotomy and Le Fort I advancement with maxillary impaction. Lateral cephalograms were taken immediately before and 2.6+/-0.7 years after bimaxillary surgery. Paired t-test, Pearson correlation test and linear regression analysis procedures were used to assess the degree of correlation in terms of soft to hard tissue changes between the two cephalograms. All subjects presented with a presurgical concave profile. RESULTS: Maxillary advancement and impaction combined with mandibular setback surgery corrected the facial concavity and the improvement of horizontal and vertical positions. The lengths of the upper and lower lips and the horizontal position of the soft tissue pogonion were improved. The decrease in facial convexity angle was correlated with the increases in SNA angle and N-A distance. The significant increase in labiomental fold depth was significantly correlated with the significant decreases in N-ANS and ANS-Gn distances. The protrusion of the upper lip was correlated with the increases in SNA angle and N-A distance and also with the decrease in SNB angle. The retrusion of the lower lip was correlated with the decrease in N-B distance. The decrease in Sn to A distance was correlated with the increases in SNA, ANB and NAPg angles and N-A distance and also with the decrease in ANS-Gn distance. The increase in Pg' to Pg distance was correlated with the increases in SNA, ANB, NAPg angles and N-A distance. The increase in Si to B distance was correlated with the increases in SNA angle and N-A distance and also with the decreases in N-ANS and ANS-Gn distances. The decrease in Ls to U1 distance was correlated with the increases in SNA and ANB angles and with the increase in N-A distance and with the decreases in N-B and N-Pg distances. The decrease in Li to L1 distance was correlated with the increase in N-A distance. The elongation of the upper lip was correlated with the decrease in ANS-Gn distance. The increase in nasolabial angle was correlated with the decrease in ANS-Gn distance. CONCLUSION: Maxillary and mandibular soft and hard tissue movements showed significant correlations in horizontal and vertical directions 2.6+/-0.7 years after bimaxillary surgery.

Changes in pharyngeal (airway) morphology in Class III Turkish female patients after mandibular setback surgery.

INTRODUCTION: The aim of this study was to evaluate changes in the pharyngeal and lower facial morphology in Turkish female Class III patients 1.5+/-0.4 years after mandibular setback surgery (bilateral sagittal split osteotomy), and orthodontic multi-bracket treatment. Only women with mandibular prognathism were selected because sex differences in pharyngeal airway changes were evident. MATERIAL AND METHODS: Lateral cephalograms of 25 Turkish female Class III patients (mean age: 25.4+/-2.6 years) with mandibular prognathism, were assessed before and 1.5+/-0.4 years after operation. Paired t and Pearson tests were used. RESULTS: The pharyngeal airway morphology showed significant changes in soft-palate length and posterior reference line (PRL) to point of posterior tongue. The decrease in PTV-Pg distance was correlated with the decreases in PRL-PSP, PRL-PTO and PRL-E distances. It was considered normal for the pharyngeal airway morphology to adapt after surgery to improve the hard tissue relationship. CONCLUSION: The lower facial morphology significantly changed and the pharyngeal airway narrowed 1.5+/-0.4 years after mandibular setback surgery.