Non-progressive mandibular changes in children with Type I and II craniofacial microsomia.

OBJECTIVE: To describe the mandibular growth of craniofacial microsomia (CFM) patients during early childhood to adolescence with attention to symmetry. MATERIALS AND METHODS: Altogether 61 CFM patients were studied at the Cleft Palate and Craniofacial Center, Helsinki University Hospital between 1986 and 2006. In this cohort study, we measured and analysed 293 radiographs (posteroanterior, panoramic and lateral); 165 radiographs of 40 patients met the final inclusion criteria. The vertical height of the ramus in anteroposterior and panoramic radiographs, the length of the mandible in anteroposterior radiographs and the maxillary protrusion and mandibular retrognathia in lateral cephalograms were measured in four different age groups. RESULTS: A statistical difference existed between the groups in the vertical height of the ramus and in the mandibular length. The vertical height of the ramus measured from the panoramic radiograph grew on both sides, and the ratios remained unchanged. In the sagittal dimension, the maxilla and mandible grew forward, but no significant differences emerged between the groups. CONCLUSIONS: Results suggest that mild-type CFM is not progressive in nature. During growth, mandibular asymmetry measured in the horizontal, vertical and sagittal planes did not increase.

Effect of Maxillomandibular Advancement Surgery on Pharyngeal Airway Volume and Polysomnography Data in Obstructive Sleep Apnea Patients.

PURPOSE: To study volumetric changes in the upper airway in patients with obstructive sleep apnea (OSA) after maxillomandibular advancement (MMA) and compare those findings with polysomnographic (PSG) data of the same patients. MATERIALS AND METHODS: The study included 20 patients with OSA (1 woman and 19 men; mean age, 48 yr; range, 31 to 59 yr). Mean values of angles formed by the sella, nasion, and B point and the sella, nasion, and A point before surgery indicated mandibular and maxillary retrognathia, respectively. All patients were treated with MMA and pre- and postoperative orthodontics. Pre- and post-treatment cone-beam computed tomograms were used to measure upper airway volume and PSG data were used to examine the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI-3 or ODI-4). In addition, Epworth Sleepiness Scale (ESS) score, General Health Questionnaire (GHQ-12) score, and amount of MMA were collected from patients' files. RESULTS: Mean maxillary and mandibular advancement was 4.6 ± 1.9 and 9.3 ± 1.7 mm, respectively. A statistically relevant increase (mean, 64.1%) in airway volume was found, with large individual variation. ODI-3 or ODI-4 and AHI values showed statistically relevant improvements from before to after surgery. ODI-3 or ODI-4 score decreased from 12.3 ± 9.8 to 4.0 ± 4.2 and AHI score decreased from 21.4 ± 13.8 to 5.8 ± 7.2. ESS scores showed improvement (lower scores) after surgery for most patients (n = 15), whereas GHQ-12 scores showed improvement (lower scores) for only 6 patients. CONCLUSION: MMA increases upper airway volume and lessens OSA symptoms according to PSG data. MMA can be considered curative treatment for OSA; however, residual apnea as measured by the AHI can be found in many patients.

Introduction and assessment of orthognathic information clinic.

BACKGROUND/OBJECTIVES: Orthognathic treatment is routine practice to rehabilitate severe malocclusions and dentofacial deformities. Because orthognathic treatment is elective, patient's involvement in deciding whether to proceed with treatment is vital. Interaction and communication between patient and treating team plays a key role in achieving post-treatment satisfaction. To achieve satisfaction, an orthognathic 'information clinic' for prospective orthognathic patients was established at Oral and Maxillofacial Unit, Tampere University Hospital, Finland. 'Information clinic' includes short talks with power-point presentation given by orthodontist, oral hygienist, oral and maxillofacial surgeon, psychologist, and previous patient. Aim of the study was to set up an 'information clinic' and, more specifically, 1. to assess patients' opinions on the 'clinic' during pilot phase (2013-14) and 2. to analyse general statistics during the first 3 years (2013-16). METHODS: During the pilot phase, patient opinions, based on voluntary questionnaire, were obtained from 85 people. General data were collected for the clinics run in 2013-16. RESULTS: Seventy-two per cent of respondents reported the information provided to help in their decision-making to proceed/not proceed with treatment. Majority considered the information about the surgical aspects and meeting patient who had undergone orthognathic treatment to be the most important part of the clinic. Between March 2013 and 2016, 290 prospective orthognathic patients were invited to 29 'information clinics'. One hundred and ninety-four patients attended, of whom 137 were female and 57 male (age range 15-67 years). CONCLUSIONS: The questionnaire and verbal feedback from the patients was positive; hence, the 'information clinic' is now offered as a routine process to all prospective orthognathic patients in our clinic.

Acoustic comparison of vowel sounds produced before and after orthognathic surgery for mandibular advancement.

PURPOSE: The effects of orthognathic surgery on the phonetic quality of speech were studied by analyzing the main acoustic features of vowel sounds. PATIENTS AND METHODS: Five men with dentofacial deformities undergoing surgical operation for correction of malocclusion were enrolled in the study. The speech material consisted of 8 vowels in sentence context. Every utterance was repeated 10 times in 3 different sessions: before the operation, 6 weeks after the operation, and 30 weeks after the operation. The acoustic features (F1, F2, F0, duration) of vowels were measured and analyzed. RESULTS: At the group level, no significant acoustic changes were found between the 3 different sessions in any parameter measured (all F values <1). The results show that the operation had individual and variable effects on vowel quality, ranging from slightly affected to completely unaffected. The 2 lowest vocal-tract resonances changed in frequency for 2 of the subjects, and 1 subject had short-term changes returning to the presurgical level. Significant changes of F0 were observed for 1 subject, and 3 of the subjects had short-term changes. No significant changes were found for duration. One subject had no significant changes in any parameter measured. CONCLUSIONS: No long-lasting perceptually significant changes were identified in vowel production in patients undergoing a variety of orthognathic procedures. The facial skeleton (consisting of palate, maxilla, mandible, dentition, nasal cavity, etc) imposes direct limits on the morphology of the resonating vocal tract cavities, and is therefore of immediate relevance to both speech articulation and acoustics.