Stability between single and segmental maxillary osteotomies in bimaxillary surgery for cleft-associated class III deformity: a CBCT study.

OBJECTIVE: Segmental Le Fort I osteotomy through the cleft is a common strategy to narrow the alveolar cleft in adults. This study compared skeletal stability between single and segmental Le Fort I osteotomies in patients with unilateral cleft lip and palate (UCLP). MATERIALS AND METHODS: This retrospective analysis examined 45 adults with complete UCLP-associated class III deformities who underwent bimaxillary surgery with either single (n = 30) or segmental (n = 15) Le Fort I advancement. Cone beam computed tomography (CBCT) scans of the facial skeleton were acquired before surgery, 1-week postsurgery, and at follow-up. Measures of landmarks from the CBCT images for the two treatment groups were compared for translation (left/right, posterior/anterior, superior/inferior) and rotation (yaw, roll, pitch). RESULTS: Postsurgery, the downward movement of the maxilla was larger in the segmental group than the single group. At follow-up, the maxilla moved backward in both groups, and upward in the segmental group. The mandible moved forward and upward and rotated upward in both groups. The amount of upward movement and rotation was larger in the segmental group than the single group. CONCLUSIONS: Two years after bimaxillary surgery in patients with UCLP-associated class III deformity, greater relapse was found after segmental Le Fort I osteotomies in vertical translation of the maxilla and mandible, and pitch rotation of the mandible compared with single Le Fort I osteotomies. CLINICAL RELEVANCE: The vertical relapse of the maxilla was larger after segmental Le Fort I advancement compared with single Le Fort I advancement in clefts.

Anthropometric and laboratory parameter alterations following bimaxillary orthognathic surgery.

The aim of this study was to investigate the impact of bimaxillary orthognathic surgery on patients' anthropometric measures and laboratory parameters. This study was conducted on patients who underwent bimaxillary orthognathic surgery. Anthropometric measurements were collected before surgery (T0) and at intervals of one week (T1), two weeks (T2), one month (T3), and three months (T4) postoperatively, and laboratory parameters at T0 and T4. Data analysis included repeated-measures ANOVA for assessing weight changes, body mass index (BMI) and fat percentage changes, the Friedman test for muscle mass changes, and independent t tests to understand gender-based differences. Significant reductions were observed in weight (mean differences ranging from 2.26 kg to 3.84 kg, 95.00% CI: 1.29 to 4.62, p < 0.01) and BMI (mean differences ranging from 0.76 to 1.32, 95.00% CI: 0.38 to 1.58, p < 0.01) postoperatively at all follow-up points. Fat percentage changes were significant between T0 - T3 (MD = 1.17, 95.00% CI: 0.26 to 2.08, p < 0.05) and T0 - T4 (MD = 1.28, 95.00% CI: 0.14 to 2.43, p < 0.05). Changes in muscle mass were significant until T3 (MD ranging from 71.00 to 107.0, p < 0.01). Also, haemoglobin levels were significantly higher at T0 than T4 (MD = 0.35, 95% CI: 0 to 0.7). These changes showed no significant gender-based differences (p > 0.05). Our study showed that orthognathic surgery prompts temporary changes in body weight, Body Mass Index, and haemoglobin levels. Future research should explore interventions to mitigate these changes and enhance postoperative recovery.

Customized palatal guide and splint for maxillary expansion.

Customization in orthognathic surgery allows better precision and a reduced surgical time. In Le Fort I osteotomy surgery, the maxillary segmentation is considered one of the most unstable procedures due to transverse instability. Various different types of palatal device have been proposed to address this instability. This note describes a customized bone-borne palatal guide and splint that may help surgeons shorten the surgical time and achieve better three-dimensional repositioning, with more postoperative comfort for the patient and occlusal control for the surgeon.

Osteotomia periférica no tratamento de cisto odontogênico glandular / Peripheral osteotomy in the treatment of glandular odontogenic cyst / Osteotomía periférica en el tratamiento del quiste odontogénico glandular

O objetivo deste artigo é relatar um caso de COG em sínfise mandibular, tratado com enucleação e osteotomia periférica. Relato de Caso: Paciente do sexo feminino, 58 anos de idade, foi encaminhada para avaliação de uma lesão mandibular, apresentando-se assintomática no momento da consulta. Foi observado um leve aumento de volume vestibular na região da sínfise mandibular, sem sensibilidade ao toque. Na tomografia foi observada imagem hipodensa, multiloculada, bem delimitada, na região de sínfise, próxima as raízes dentárias e a basilar mandibular, além de um dente incluso intralesional. Foi realizada biópsia incisional e exame histopatológico, através do qual foi estabelecido o diagnóstico de COG. Como forma de tratamento, o paciente foi submetido a enucleação com curetagem de toda lesão e a osteotomia periférica, além da remoção do dente incluso. Após um ano de acompanhamento, a paciente encontra-se livre de recorrências. Conclusão: Por fim, este caso destaca a importância de um tratamento eficaz de COG com a osteotomia periférica, considerando o tamanho da lesão, suas características e sua localização, a fim de reduzir suas chances de recidiva... (AU)

The aim of this article is to report a case of COG in mandibular symphysis, treated with enucleation and peripheral osteotomy. Case Report: A 58-yearold female patient was referred for evaluation of a mandibular lesion, instrument was asymptomatic at the time of consultation. An increase in vestibular volume was observed in the region of the mandibular symphysis, without sensitivity to touch. The tomography showed a hypodense, multiloculated, well-delimited image in the symphysis region, close to tooth roots and a mandibular basilar, in addition to an intralesional impacted tooth. An incisional biopsy and histopathological examination were performed, through which the diagnosis of COG was established. As a form of treatment, the patient underwent enucleation with curettage of the entire lesion and peripheral osteotomy, in addition to removal of the impacted tooth. After a year of follow-up, the patient is free from recurrences. Conclusion: Finally, this case highlights the importance of an effective treatment of COG with peripheral osteotomy, considering the size of the lesion, its characteristics and its location, in order to reduce its chances of recurrence... (AU)

El objetivo de este artículo es reportar un caso de COG en la sínfisis mandibular, tratado con enucleación y osteotomía periférica. Caso Clínico: Paciente femenino, de 58 años de edad, fue remitida para valoración de lesión mandibular, presentándose asintomática al momento de la consulta. Se observa ligero aumento de volumen vestibular en la región de la sínfisis mandibular, sin sensibilidad al tacto. En la tomografía se observó una imagen hipodensa, multiloculada, bien delimitada en la región de la sínfisis, próxima a las raíces dentarias y la base de la mandíbula, además de un diente intralesional. Se realizó biopsia incisional y examen histopatológico, a través del cual se estableció el diagnóstico de GOC. Como forma de tratamiento, el paciente fue sometido a enucleación con curetaje de toda la lesión y osteotomía periférica, además de extracción del diente impactado. Después de un año de seguimiento, un paciente está libre de recurrencias. Conclusión: Finalmente, este caso destaca la importancia de un tratamiento efectivo de la GOC con osteotomía periférica, considerando el tamaño de la lesión, sus características y su ubicación, para reducir sus posibilidades de recurrencia... (AU)

Association Between Maxillary Segmentation and Perioperative Complications in Le Fort I Osteotomy.

The Le Fort I osteotomy is used to reposition the maxilla to correct numerous maxillofacial and occlusal deformities. The aim of this study was to delineate perioperative complication rates associated with Le Fort I osteotomy and determine whether the number of maxillary segments or bone grafting yielded increased complication rates. Patients undergoing Le Fort I osteotomy from 2012 to 2019 were identified from the multi-institution "National Surgical Quality Improvement Program" database using Current Procedure Terminology codes. The predictor variables of interest included maxillary segmentation defined as 1, 2, or 2 pieces and the presence or absence of bone graft. Perioperative complications were collected as the primary outcome variable, including superficial and deep space infections, wound dehiscence, airway complication, peripheral nerve injury, and hemorrhage. The secondary outcome variables included readmission and reoperation rate within the 30-day postoperative period. Complication rates were compared using multivariate analysis across groups stratified by the number of maxillary segments and inclusion of bone grafting. Of the 532 patients that met the inclusion criteria, 333 (63%) underwent 1-piece, 114 (21%) 2-piece, and 85 (16%) 2-piece Le Fort I osteotomy procedures. A total of 48 patients exhibited complications (9%), with hemorrhage (2.3%) being the most common complication observed. The number of maxillary segments was not a significant predictor of perioperative complications ( P = 0.948) nor was the use of bone grafting ( P = 0.279).

Distribution of orthognathic surgery among the Swedish population: a retrospective register-based study.

OBJECTIVE: The aim of this study was to provide a nationally representative assessment of orthognathic procedures performed in hospitalised patients in Sweden and study regional differences in prevalence, demographic parameters and hospitalisation time. MATERIAL AND METHODS: From the Swedish National Board of Health and Welfare's register, all the patients undergoing orthognathic surgery between 2010 and 2014 were identified. Outcome variables were categorised into: (1) Surgical methods and regional distribution (2) Demographic variations (3) Hospitalisation time. RESULTS: The population-prevalence-rate of orthognathic procedures over the 5-year period was 6.3 (SD 0.4) per 100,000 persons, a regional difference in the prevalence was found. Most common were Le Fort I osteotomies (43.4%) and bilateral sagittal split osteotomies (41.6%), 39% of the patients had bimaxillary surgery. The majority of the surgery was performed in the age group 19-29 (68.8%). The mean hospital stay was 2.2 days (SD = 0.9, range 1.7-3.4). A significant regional difference (p ≤ 0.001) was found in hospitalisation time for single-jaw versus bimaxillary surgery. CONCLUSIONS: Regional differences in the distribution of orthognathic surgery and demographic variations were found in Sweden in 2010-2014. The underlying causes of variations are still unknown and request further investigation.

Evaluation of treatment with unilateral mandibular sagittal split ramus osteotomy and maxillary osteotomy in patients with condylar osteochondroma and mandibular asymmetry: A retrospective case series.

The aim of the study was to describe an approach where condylar resection with condylar neck preservation was combined with Le Fort I osteotomy and unilateral mandibular sagittal split ramus osteotomy (SSRO). Patients with a unilateral condylar osteochondroma combined with dentofacial deformity and facial asymmetry who underwent surgery between January 2020 and December 2020 were enrolled. The operation included condylar resection, Le Fort I osteotomy and contralateral mandibular sagittal split ramus osteotomy (SSRO). Simplant Pro 11.04 software was used to reconstruct and measure the preoperative and postoperative craniomaxillofacial CT images. The deviation and rotation of the mandible, change in the occlusal plane, position of the "new condyle" and facial symmetry were compared and evaluated during follow-up. Three patients were included in the present study. The patients were followed up for 9.6 months on average (range, 8-12). Immediate postoperative CT images showed that the mandible deviation and rotation and occlusion plane canting decreased significantly postoperatively; facial symmetry was improved but still compromised. During the follow-up, the mandible gradually rotated to the affected side, the position of the "new condyle" moved further inside toward the fossa, and both the mandible rotation and facial symmetry were more significantly improved. Within the limitations of the study it seems that for some patients a combination of condylectomy with condylar neck preservation and unilateral mandibular SSRO can be effective in achieving facial symmetry.

Morphological Changes in Total and Inferior Part of Maxillary Sinus After Le Fort I Osteotomy, as Determined by Cone-Beam Computed Tomography.

To investigate morphological changes of the total and inferior part of the maxillary sinus following Le Fort I osteotomy. 21 skeletal class II and 49 skeletal III patients who underwent orthognathic surgery were enrolled in this retrospective study. Cone-beam computed tomography taken before (T1) and 6 to 24 months after (T2) orthognathic surgery were imported into Mimics 20.0 software to analyze morphological changes of the total and inferior part of the maxillary sinus. Volume of the whole maxillary sinus was significantly reduced after surgery ( P ≤0.008), while the volume of the inferior part of the maxillary sinus was significantly greater than before surgery ( P ≤0.004). Maxillary sinus floor moved occlusally after Le Fort I osteotomy. Movement in the pitch direction of the posterior maxilla affected the state of the maxillary sinus mucosa after orthognathic surgery. Le Fort I osteotomy exerts a significant impact on the morphology of the total and inferior part of the maxillary sinus.

Extended Maxillary Osteotomy Guide: A Design That Allows Manipulation of the Osteotomy Direction on the Posterior and Inner Walls of the Maxilla.

PURPOSE: Design an extended osteotomy guide (EOG) for Le Fort I osteotomy to improve the safety of surgery. MATERIALS AND METHODS: The digital Le Fort I osteotomy guide was designed in MIMICS 23.0. Twenty-eight patients were randomized into 2 groups. Patients in the experimental group used EOG, and patients in the control group used a traditional osteotomy guide (TOG). Virtual designs and actual postoperative outcomes were compared by cone-beam computed tomography. The safety of the operation was confirmed by the accuracy of the osteotomy direction and depth on the inner and posterior walls of the maxilla. RESULTS: All positioning deviations of both osteotomy guides were <0.3 mm (P>0.05). The osteotomy depths on the inner and posterior walls with the EOG and TOG deviated by 0.789±1.179 and 1.811±1.345 mm (P=0.004) and 0.648±0.999 and 1.262±0.942 mm (P=0.030), respectively. The angles of deviation of the osteotomy direction on the inner and posterior walls by the EOG and TOG were 2.025±2.434 and 5.069±2.391 degrees (P<0.001) and 2.772±2.979 and 8.653±4.690 degrees (P<0.001), respectively. CONCLUSIONS: The EOG was more accurate than TOG for manipulating osteotomy direction and depth on the inner and posterior maxillary walls. Thus, EOG could ensure higher surgical safety than TOG.

Pattern of pterygomaxillary disarticulation associated with Le Fort I maxillary osteotomy.

Pterygomaxillary disarticulation (PMD) contributes to surgical complications of Le Fort 1 osteotomy and is associated with undesirable fractures of the pterygoid plates. The aim of this paper was to investigate the patterns of PMD in Le Fort I osteotomies using Rowe's disimpaction forceps, and to evaluate correlations with age and anatomical measurements. Cone-beam computed tomography (CBCT) scans of 70 consecutive orthognathic patients were retrospectively evaluated to study four patterns of PMD: Type 1 - PMD at, or anterior to, the pterygomaxillary junction (PMJ); Type 2 - PMD posterior to the PMJ; Type 3 - PMJ separation with comminuted fracture of the pterygoid plates; Type 4 - disarticulation of the maxilla involving the pterygoid plates above the level of the osteotomy line. The preoperative anteroposterior and mediolateral thicknesses of the PMJ and the length of the medial and lateral pterygoid plates were assessed. Satisfactory PMD was achieved in all cases and no severe complications were reported, including vascular, dental, mucosal, or neural damage. The most common PMD was Type 1 (54.3%), followed by Type 2 (40%). Comminuted fracture of the pterygoid plates was limited to 5.7% of cases, and no Type 4 was detected. A weak correlation was detected between PMJ thickness and PMD pattern (p = 0.04). No statistically significant correlation was detected between patients' age and type of PMD. PMD of Le Fort I maxillary osteotomy using a Smith spreader and Rowe's disimpaction forceps proved safe, with minimal damage to the pterygoid plates.

Le Fort I osteotomy with segmentation for the treatment of maxillary dentoalveolar protrusion: a single-centre, 10-year outcome study.

A retrospective study was conducted to evaluate the stability and complications of Le Fort I osteotomy with segmentation for the treatment of bimaxillary dentoalveolar protrusion. A total of 120 consecutive patients who had undergone orthognathic surgery between 2008 and 2017 at a single centre were recruited. Lateral cephalometric radiographs were taken before surgery, within 6 weeks after surgery, and at 2 years after surgery. U1-SN and U1-PP underwent mean uprighting of 8.7° and 9.6°, respectively, and mean relapse of 2.1° and 2.6°, respectively (both P < 0.05). The only significant risk factor for relapse was the use of intermaxillary fixation (risk ratio (RR) 1.2, P = 0.01). The most common complication was wound dehiscence (41.7%), which was a significant risk factor for wound infection (RR 3.3, P < 0.01) and fixation hardware exposure (RR 3.7, P < 0.01). Other common complications were gingival recession (40.8%), periodontal bone loss (40%), and blood loss requiring transfusion (26.7%), the latter of which was associated with the preoperative diagnosis of vertical maxillary excess (RR 2.4, P = 0.01). Some degree of relapse occurred in more than 90% of the patients by 2 years after surgery. The procedure is not without risks and complications but may be useful in severe cases.

Effect of maxillary surgical movement on nasal cavity and maxillary sinus dimensions and function after Le Fort I osteotomy.

This study was designed to evaluate the effects of different maxillary movements performed in Le Fort I surgery on the anatomy of the nasal cavity and maxillary sinus, occurrence of rhinosinusitis, and nasal airflow. Patients were divided into three groups: group I underwent pure advancement, group II underwent advancement with yaw rotation, and group III underwent advancement with impaction movements. All evaluations were performed using pre- and postoperative computed tomography images and surveys. Twenty-eight patients were enrolled. The mean pre- and postoperative nasal air volumes in group I were 22.74 ± 6.32 cm3 and 25.17 ± 6.19 cm3, respectively, showing a significant increase (P = 0.041). The mean pre- and postoperative maxillary sinus air volumes were 33.94 ± 13.72 cm3 and 26.28 ± 14.12 cm3 in group II and 35.29 ± 9.58 cm3 and 28.65 ± 8.42 cm3 in group III, respectively, showing significant reductions (P = 0.028 and P = 0.007, respectively). For all movements, the occurrence of septum deviation and nasal airflow impairment was not statistically significant. Pure maxillary advancement movement enhanced nasal cavity air volume. The yaw rotation movement significantly increased quantitative clinical rhinosinusitis symptoms. The risk of airflow impairment following Le Fort I surgery is low.

The Impact of Maxillary Osteotomy on Fricatives in Cleft Lip and Palate: A Perceptual Speech and Acoustic Study.

INTRODUCTION: Abnormal facial growth is a recognized outcome in cleft lip and palate (CLP), resulting in a concave profile and a class III occlusal status. Maxillary osteotomy (MO) is undertaken to correct this facial deformity, and the surgery can impact speech articulation, although the evidence remains limited and ill-defined for the CLP population. AIMS: The aim of the study was to investigate the impact of MO on the production of the fricatives /f/ and /s/, using perceptual and acoustic analyses, and to explore the nature of speech changes. METHODS: Twenty participants with CLP were seen 0-3 months pre-operatively (T1) and 3 months (T2) and 12 months (T3) after MO. A normal group (N = 20) was similarly recruited. Perceptual speech data was collected according to a validated framework and ratings made on audio and audio-video recordings (VIDRat). Spectral moments were centre of gravity (CG), standard deviation (SD), skewness (SK) and kurtosis (KU). Reliability studies were carried out for all speech analyses. RESULTS: For the CLP group, VIDRat identified dentalization/interdentalization as the main type of pre-operative error for /s/ with a statistically significant improvement over time, χ2(2) = 6.889, p = 0.032. Effect sizes were medium between T1 and T3 (d = 0.631) and small between T2 and T3 (d = 0.194). For the acoustic data, effect sizes were similarly medium between T1 and T2 (e.g., SK, /f/ d = 0.579, /s/ d = 0.642) and small between T1 and T3 across all acoustic parameters. Independent t tests showed mainly statistically significant differences between both groups at all time points with large effect sizes (e.g., T2 CG, t = -4.571, p < 0.001, d =1.581), indicating that /s/ was not normalized post-operatively. For /f/, differences tended to be at T1 with large effect sizes (e.g., CG, t = -2.307, p = 0.028, d = 0.797), reflecting normalization. CONCLUSIONS AND IMPLICATIONS: This is the first speech acoustic study on /f/ for individuals with CLP undergoing MO. The surgery has a positive impact on /f/ and /s/, which appear to stabilize 3 months post-operatively. Speech changes are an automatic and a direct consequence of the physical changes brought about by MO, effecting articulatory re-organization. The results of the study have direct clinical implications for the clinical care pathway for patients with CLP undergoing MO.

A Modified Procedure for Anterior Maxillary Osteotomy.

ABSTRACT: Anterior maxillary osteotomy is a traditional operation in the treatment of maxillary protrusion. Varies fields about operation have been changed or improved in those years to avoid different kinds of complications. In our study, the authors would present 1 kind of improved anterior maxillary osteotomy surgical method. The study was conducted at the Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Guangzhou, Guangdong province. Patients are divided into improved group and general group. Patients after surgery were claimed to have regular return visits. Occlusion, tooth vitalities, postoperative complications would be well evaluated. The operative time, blood losses, complications showed no different at maxillary operation. Our procedure could give much better and direct sight of anterior maxillary bone, and the simplified osteotomy lines could help maxilla move, reduce the times spent on hard tissue cut off or grind. The modified procedure can meet clinical command, improve dentofacial deformities, and gives convenience to surgeon.

Three-dimensional morphological and biomechanical analysis of temporomandibular joint in mandibular and bi-maxillary osteotomies.

Orthognathic surgery is a typical approach for treating maxillofacial deformities. However, orthognathic surgery results in positional changes in the condyles. In a previous review, the effects of orthognathic surgery on temporomandibular joints (TMJs) are not provided. Hence, in this study, we investigate the morphological changes in TMJs after mandibular and bi-maxillary osteotomies. The relationship between the morphological parameters of TMJs and symptoms of temporomandibular disorders (TMDs) is discussed. Finite element contact stress analysis is performed, and the results show that the two abovementioned surgeries can improve maxillofacial deformities, although the positions of the condyles are changed. Moreover, preoperative stress asymmetry of the left and right TMJs is observed, which remain after the surgeries. TMD patient-specific analysis shows that three joint spaces (medial joint space, lateral joint space, superior joint space) are significantly correlated with TMD symptoms.

Single-Sided Segmental Maxillary Osteotomies for Alveolar Cleft Deformities.

ABSTRACT: Although the use of a one-sided segmental maxillary osteotomy has been described for repairing alveolar clefts, there remains little consensus regarding the indications and outcomes of such approaches. This brief clinical note aims to summarize previous studies of one-sided segmental maxillary osteotomies for alveolar cleft (AC) repair. A literature search yielded only 2 articles that described the use of a single-sided segmental maxillary osteotomies (SMO) for AC repair. The overall outcomes for the implementation of SMO in correcting AC were positive without major or minor complications. Although the available studies show promising results for the single-sided SMO technique, further validation is warranted to assess the indications and outcomes for this technique.

Displacement and stress distribution of the craniomaxillofacial complex under different surgical conditions: a three-dimensional finite element analysis of fracture mechanics.

OBJECTIVE: To provide a simplified treatment strategy for patients with maxillary transverse deficiency. We investigated and compared the fracture mechanics and stress distribution of a midline palatal suture under dynamic loads during surgically-assisted rapid palatal expansion. METHODS: Based on the cone-beam computed tomography (CBCT) data of a 21-year-old female volunteer, a three-dimensional model of the cranio-maxillofacial complex (including the palatal suture) was constructed. A finite element analysis model was constructed based on meshwork. After the yield strength of the palatal suture was set, an increasing expansion force (0-500 N) was applied within 140 ms to calculate the time-load curve, which mimicked nonsurgical bone expansion (model A). The same method was used to evaluate the fracture process, time and stress distribution of the palatal suture in maxillary lateral osteotomy-assisted (model B) and LeFort osteomy I (LFIO)-assisted expansion of the maxillary arch (model C). RESULTS: Compared with model A, the palatal suture of model B and model C showed a faster stress accumulation rate and shorter fracture time, and the fracture time of model B and model C was almost identical. Compared with model A, we discovered that model B and model C showed greater lateral extension of the maxilla, and the difference was reflected mainly in the lower part of the maxilla, and there was no difference between model B and model C in lateral extension of the maxilla. CONCLUSIONS: Compared with arch expansion using nonsurgical assistance (model A), arch expansion using maxillary lateral wall-osteotomy (model B) or LFIO had a faster rate of stress accumulation, shorter time of fracture of the palatal suture and increased lateral displacement of the maxilla. Compared with arch expansion using LFIO (model C), arch expansion using lateral osteotomy (model B) had a similar duration of palatal suture rupture and lateral maxillary extension. In view of the trauma and serious complications associated with LFIO, maxillary lateral wall-osteotomy could be considered a substitute for LFIO.

Changes in Pharyngeal Airway Space and Craniocervical Angle after Anterior Bimaxillary Subapical Osteotomy.

PURPOSE: This study explored the effects of genioplasty (Gep) and anterior subapical osteotomy of the maxilla and mandible (ASOMx+ASOMd) on the pharyngeal airway dimensions of patients with bimaxillary protrusion (BiP). METHOD: Thirty-two patients were divided into 2 groups. Group 1 received ASOMx+ASOMd, and group 2 received ASOMx+ASOMd+Gep. The cephalograms of the patients were collected before surgery and 2 months after surgery. Changes in the landmarks, related cephalometric angles (gonial, SN-GoGn, Y-axis, and SN-C2C4 angles), and 2 pharyngeal airway dimensions (uvulo-pharyngeal airway [UOP] and tongue-pharyngeal airway [TOP]) were analyzed. RESULTS: Before surgery, the parameters (incisor superius, incisor inferius, menton, most superior and anterior point of the hyoid bone, tip of the uvula, inferoanterior point on the second cervical vertebra, and inferoanterior point on the fourth cervical vertebra) and measured angles (SNA, SNB, ANB, gonial, SN-GoGn, Y-axis, and C4C2-SN) of both groups showed no significant differences. Following ASOMx, the patients in groups 1 and 2 exhibited a setback by 7.0 and 6.6 mm, respectively. After ASOMd, groups 1 and 2 exhibited 4.9 and 5.3 mm setbacks, respectively. No significant difference in the amount of setback was observed between groups 1 and 2. The postoperative horizontal and vertical positions of Me in group 2 were significantly forward by 6.1 mm and upward by 1.5 mm, respectively. Regarding pharyngeal airway dimensions, TOP was decreased in group 1 (1.7 mm) and group 2 (1.3 mm). In the postoperative Pearson correlation coefficient test, the horizontal and vertical positions of Me showed no significant correlation with TOP in both groups. Therefore, Gep did not prevent the reduction of TOP in group 2. CONCLUSION: After bimaxillary anterior subapical osteotomy, the TOP of patients with BiP was decreased, and this situation was unavoidable, regardless of whether Gep was performed.

Are Vowels Normalized After Maxillary Osteotomy? An Acoustic Study in Cleft Lip and Palate.

BACKGROUND: Maxillary hypoplasia is a common skeletal condition in cleft lip and palate (CLP). Maxillary osteotomy is typically used to reposition the maxilla in CLP with maxillary hypoplasia. Previous studies have suggested that vowel articulations are adjusted postsurgically due to altered vocal tract configuration and articulatory reorganization. This acoustic study aims to investigate whether vowels are normalized postoperatively and to explore the nature of articulatory reorganization. METHODS AND PROCEDURES: A prospective study was conducted to examine the vowel production of a group of individuals with CLP (N = 17) undergoing maxillary osteotomy and a group of normal controls (N = 20), using speech acoustic data. The data were collected at 0 to 3 months presurgery (T1), 3-months (T2), and 12-months (T3) postsurgery. General linear model repeated measures and independent t-tests were undertaken on F1, F2, and vowel space area. RESULTS: General linear model repeated measures revealed no main effects of time for F1 (F [2, 22] = 1.094, P = 0.352), F2 (F [2, 22] = 1.269, P = 0.301), and vowel space area (F [2, 28] = 0.059, P = 0.943). Independent t-tests showed statistically significant differences (P < 0.05) for all acoustic parameters and all vowels between the CLP and the normal groups at all time points. CONCLUSIONS: Vowels were not normalized after maxillary osteotomy despite positive anatomical changes within the oral cavity. Individuals with CLP tended to adjust their vowel articulatory gestures to match presurgical patterns. The nature of articulatory reorganization appears to be prompt, sensory-driven, complete, and permanent.