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1.
Braz Oral Res ; 35: e27, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33605357

RESUMEN

The aim of the present overview was to evaluate the outcomes of systematic reviews to determine the incidence of condylar resorption in patients submitted to orthognathic surgery and analyze whether the risk of developing this condition is related to a specific type of surgery. Searches were conducted in the PubMed/MEDLINE, Embase, and Cochrane electronic databases for systematic reviews with quantitative data on condylar resorption due to any type of orthognathic surgery for dentoskeletal deformities published up to May 25, 2019. The AMSTAR 2 and Glenny tools were applied for the quality appraisal. Five systematic reviews were included for analysis. Only one article was considered to have high quality. Among a total of 5128 patients, 12.32% developed condylar resorption. From those patients, 70.1% had double jaw surgery, 23.4% had mandibular surgery alone, and in 6.5% a Lefort I technique was used. Based on these findings, bimaxillary surgery could be considered a risk factor for condylar resorption. However, these results should be interpreted with caution, since other factors, such as pre-operative skeletal deformities, type of movement, and type of fixation, can contribute to the development of this condition. Further studies should consider reporting main cephalometric data, temporomandibular diagnosis, hormonal levels, and tomographic measures before and after the surgery at least every 6 months during the firsts two years to identify accurately risk factors for condylar resorption.


Asunto(s)
Resorción Ósea , Procedimientos Quirúrgicos Ortognáticos , Resorción Ósea/epidemiología , Resorción Ósea/etiología , Cefalometría , Humanos , Incidencia , Cóndilo Mandibular/cirugía , Revisiones Sistemáticas como Asunto
2.
Am J Orthod Dentofacial Orthop ; 159(2): 175-183.e3, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33390311

RESUMEN

INTRODUCTION: The purposes of this research were to identify the buccolingual inclinations of the mandibular teeth and the mandibular symphysis remodeling that result from the orthodontic decompensation movement. METHODS: The sample consisted of 30 adults with Class III dentofacial deformity, who had presurgical orthodontic treatment. Three-dimensional images were generated by cone-beam computed tomography scans at 2 different times (initial and before orthognathic surgery). Three-dimensional virtual models were obtained and superimposed using automated voxel-based registration at the mandible to evaluate B-point displacement, mandibular molar and incisor decompensation movement, and symphysis inclination and thickness. The 3-dimensional displacements of landmarks at the symphysis were quantified and visualized with color-coded maps using 3D Slicer (version 4.0; www.slicer.org) software. RESULTS: The measurements showed high reproducibility. The patients presented mandibular incisor proclination, which was consistent with the movement of tooth decompensation caused by the presurgical orthodontic treatment. Statistically significant correlations were found between the inclination of the mandibular incisors, symphysis inclination, and B-point displacement. Regarding the thickness of the symphysis and the inclination of the incisors, no statistically significant correlation was found. CONCLUSIONS: The buccolingual orthodontic movement of the mandibular incisors with presurgical leveling is correlated with the inclination of the mandibular symphysis and repositioning of the B-point but not correlated to the thickness of the symphysis.


Asunto(s)
Maloclusión de Angle Clase III , Procedimientos Quirúrgicos Ortognáticos , Adulto , Cefalometría , Tomografía Computarizada de Haz Cónico , Humanos , Incisivo/diagnóstico por imagen , Maloclusión de Angle Clase III/diagnóstico por imagen , Maloclusión de Angle Clase III/cirugía , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Reproducibilidad de los Resultados
3.
J Craniomaxillofac Surg ; 49(2): 146-153, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33423893

RESUMEN

The aim of this study was to evaluate volumetric changes of the posterior airway space (PAS) following bimaxillary surgery using a high oblique sagittal split osteotomy (HSSO) of the mandibular ramus. The cone beam CTs of Class II and Class III patients taken before (T0) and 6-12 months after surgery (T1) were analyzed using 3D software (Mimics® Innovation Suite 18.0). The PAS was divided into three segments (superior, middle, inferior) by three planes parallel to the Frankfurt horizontal plane intersecting at the posterior nasal spine, the velum palatinum and the epiglottis. Total (TPAS) and partial volumes (SPAS = superior, MPAS = middle, IPAS = inferior) were calculated. For the 25 Class II patients, a highly significant increase (p<0.001) of the total, middle and inferior airway space (TPAS: +33.6%, MPAS: +43.1%, IPAS: +55.9%) was found, while the increase of the upper airway space was statistically not significant (+5.4%, p = 0.074). For the 28 Class III patients, the total, middle and inferior airway space increased statistically insignificantly (TPAS: +4.6%, p = 0.265, MPAS: +2.7%, p = 0.387, IPAS: +2.8%, p = 0.495), while the increase of the upper airway space was statistically significant (+9.7%, p = 0.010). Bimaxillary orthognathic surgery using the HSSO technique led to a significant increase of PAS for Class II patients and could conserve the PAS for Class III patients.


Asunto(s)
Maloclusión de Angle Clase III , Procedimientos Quirúrgicos Ortognáticos , Cefalometría , Tomografía Computarizada de Haz Cónico , Humanos , Maloclusión de Angle Clase III/cirugía , Osteotomía Le Fort , Osteotomía Sagital de Rama Mandibular , Faringe/diagnóstico por imagen
4.
J Craniomaxillofac Surg ; 49(2): 126-134, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33451941

RESUMEN

This study aims to show our institute's experience in the treatment of HH and its associated facial deformities in adults and growing adolescents and to investigate condylar remodeling and volumetric changes and long-term stability of orthognathic surgery in adults. The study included consecutive patients with clinical and radiological features of HH who underwent high condylectomy with or without simultaneous orthognathic surgery from 2013 to 2018. The clinical outcomes were assessed based on functional activities, TMJ pain, and recurrence. Postoperative 3D condylar remodeling and orthognathic stability were evaluated with the use of ITK-Snap and 3D Slicer. Thirteen patients (8 females and 5 males) with a mean age of 26.3 ± 5.79 years (range; 13-34 years) were included with facial asymmetry as the chief complaint. The patients were followed up for a minimum of 12 months and a maximum of 4 years (mean; 16.85 ± 10.04). There were no postoperative complications, and all patients achieved a satisfactory functional and aesthetic outcome using a one-stage surgical procedure. There was no incidence of recurrence or further asymmetries, with long-term stability at the selected points showing a mean difference of less than ±1 mm. The affected condylar volume was significantly reduced following high condylectomy, with mean changes between T1 and T2 of -144. 80 mm3 (p = .012). However, the contralateral condylar volume remained stable, with a mean change of 2.54 mm3 (p = .881). One-stage high condylectomy and orthognathic surgery is a viable measure for the treatment of HH and associated deformities in adults. High condylectomy in early adolescence could result in termination of the disease, and aesthetic improvement with further constant orthodontist-surgeon follow-up is required.


Asunto(s)
Cóndilo Mandibular , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Adulto , Estética Dental , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/patología , Asimetría Facial/cirugía , Femenino , Humanos , Hiperplasia/patología , Hiperplasia/cirugía , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Adulto Joven
5.
J Craniomaxillofac Surg ; 49(2): 93-97, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33357968

RESUMEN

The aim of this prospective study was to compare the expression of the Notch receptor family with the biomarker for stimulation of satellite cells (SC), which are responsible for functional adaptation. Tissue samples from the masseter muscle were taken presurgically and 7 months later. Samples from controls came from the extraction of third molars. The expression of Notch 1 to 4 and the satellite cell markers CD34, Pax7, and MyoD1 were investigated. PCR was used for relative quantification of gene expression, which was calculated with the ΔΔCT method. The study involved 38 white patients - 10 prognathic, 18 retrognathic, and 10 orthognathic controls. The median value for Notch 1 was significantly reduced presurgically for prognathic (0.46, SD 0.45) and retrognathic (0.57, SD 0.35) patients compared with the controls. Postsurgically, Notch 2 was significantly upregulated in the prognathic group (0.55, SD 0.28/1.37, SD 0.85). Similarly, there was upregulation of Notch 3 in the prognathic group (0.33, SD 0.42/0.59, SD 1.37) and downregulation in retrognathic patients (0.59, SD 0.79/0.52, SD 0.97). Upregulations for the satellite cell markers CD34 and Pax7 were also found in prognathic patients. The significant upregulation of Notch 1-3 and CD34 in prognathics, but unchanged MyoD expression, signals high stimulation for SC and maintenance of the regeneration cell pool. A lower expression of Notch and SC in retrognathic patients could be responsible for weak functional adaptation.


Asunto(s)
Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Humanos , Músculo Masetero , Músculo Esquelético , Estudios Prospectivos , Receptores Notch
6.
J Craniomaxillofac Surg ; 49(2): 75-83, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33358117

RESUMEN

This study aimed to evaluate the outcomes following a dynamic orthognathic surgical procedure performed at the end of growth to treat asymmetric maxillomandibular deformities linked to unilateral micrognathia when conventional orthognathic surgery was not feasible. The dynamic orthognathic surgical procedure (DOSP) combined concomitant mandibular distraction osteogenesis with contralateral poorly stabilized sagittal split osteotomy and Le Fort I osteotomy. Cephalometric studies were retrospectively conducted on pre- and postoperative lateral and frontal cephalographs, and maxillomandibular movements were calculated. Outcome scores were computed by both experts and laypersons based on photographic analyses. There was a significant postoperative increase in height of the micrognathic ramus in all patients (n = 12; p = 0.002). The angle between the occlusal cant and horizontal reference plane decreased significantly in all of the patients, as did the angle between the midline sagittal plane and mandibular tilt (p < 0.001). Postoperative outcome scores showed significant improvements in all cases, according to both expert and layperson groups. This procedure allows correction of maxillomandibular asymmetries linked to micrognathia. However, it cannot resolve all the factors participating in facial asymmetry, such as those originating in the oculo-auriculo-ventricular spectrum or complex tumor sequelae, and second-step procedures may be required.


Asunto(s)
Micrognatismo , Procedimientos Quirúrgicos Ortognáticos , Cefalometría , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/etiología , Asimetría Facial/cirugía , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Micrognatismo/complicaciones , Micrognatismo/diagnóstico por imagen , Micrognatismo/cirugía , Osteotomía Le Fort , Osteotomía Sagital de Rama Mandibular , Estudios Retrospectivos , Resultado del Tratamiento
7.
J Craniomaxillofac Surg ; 49(2): 84-92, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33376041

RESUMEN

OBJECTIVE: The aim of this retrospective and observational study was to compare the accuracy of two different virtual surgical planning (VSP) protocols, namely, the CASS method and the modified CASS method. MATERIALS AND METHODS: The patients underwent bimaxillary orthognathic surgery, planned using either the CASS method or the modified CASS method. Linear and angular discrepancies between the VSP outcome and postoperative outcome for both groups were compared for maxilla, mandible, and chin segments. Aside from the comparison between both groups, additional criteria were used to determine the accuracy of the protocol based on a linear and angular difference between planned and actual outcomes of less than 2 mm and 4°, respectively. The intergroup comparisons were performed by one-way ANOVA, with the level of significance set at 5%. RESULTS: A total of 21 patients, of both genders, were assigned into group I (n = 11), planned with the CASS method, and group II (n = 10), planned with the modified CASS method. Both the CASS and modified CASS methods presented similar accuracy with regard to linear differences for the maxilla, mandible, and chin segments, except for ΔX for the mandibular segment, where the modified CASS method showed slightly better accuracy. However, there was a statistically significant difference with regard to angular differences in the chin segment, with the CASS method shown to be the more accurate. Aside from Δpitch for the chin segment, no linear or angular differences exceeded 2 mm or 4°. CONCLUSION: Although statistically significant differences were found with regard to angular measurements in the chin segment, the accuracy of the modified CASS method for virtual planning can be considered as clinically equivalent, with a performance comparable to that of the CASS method.


Asunto(s)
Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Cirugía Asistida por Computador , Computadores , Femenino , Humanos , Imagenología Tridimensional , Masculino , Planificación de Atención al Paciente , Estudios Retrospectivos
8.
Angle Orthod ; 90(5): 723-733, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-33378482

RESUMEN

OBJECTIVES: To systematically evaluate the effect of the surgery-first approach (SFA) on oral health-related quality of life (OHRQoL) in patients with dentofacial deformities. MATERIALS AND METHODS: An electronic database search and hand search of selected journals and references were carried out. Studies investigating the OHRQoL of patients receiving SFA with or without a control group were included. The risk of bias was assessed by the Cochrane risk of bias tool in randomized clinical trials (RCTs) and the Newcastle-Ottawa Scale in non-RCTs. RESULTS: A total of seven articles met the eligible criteria and were included, of which six were cohort studies and one was an RCT, and six assessed the OHRQoL of the SFA with conventional orthodontic-surgical treatment (COST) as a control and one without. A total of 214 patients were examined, with sample sizes in studies ranging from 9 to 50. A total of 3 articles successfully measured the OHRQoL both before and after treatment in both the SFA and conventional orthodontic-surgical treatment groups. A total of six cohort studies were classified as low to moderate risk of bias, and the RCT was classified as high. CONCLUSIONS: The SFA could improve the OHRQoL of patients with dentofacial deformities similar to conventional orthodontic-surgical treatment at the end of complete treatment. In addition, it increases OHRQoL immediately at the beginning of treatment without a deterioration.


Asunto(s)
Procedimientos Quirúrgicos Ortognáticos , Calidad de Vida , Humanos , Salud Bucal
9.
Angle Orthod ; 90(5): 715-722, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-33378484

RESUMEN

OBJECTIVES: To assess changes in the maxillary sinus (MS) and pharyngeal airway space (PAS) after bimaxillary orthognathic surgery using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The CBCT scans of 48 patients were divided into two groups: group 1: maxillary advancement and mandibular setback (n = 24); group 2: maxillomandibular advancement (n = 24). The CBCTs were acquired 1 to 2 months preoperatively and 6 to 8 months postoperatively. A kappa test was used to determine intra- and interexaminer agreement. Area, volume, and linear measurements of MSs and PASs obtained before and after surgery were compared using a mixed model (P < .05). RESULTS: All variables of the MS showed significant postsurgical reductions in both groups, except the MS length, which showed a significant increase in group 2. Volume and minimum axial area of PAS showed statistically significant postsurgical increases in both groups (P < .05). CONCLUSIONS: Despite the reduction in the MS and the increase in the PAS, results indicated that the airway was not negatively affected after maxillomandibular advancement and maxillary advancement with mandibular setback.


Asunto(s)
Maloclusión de Angle Clase III , Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Cefalometría , Tomografía Computarizada de Haz Cónico , Humanos , Maloclusión de Angle Clase III/diagnóstico por imagen , Maloclusión de Angle Clase III/cirugía , Mandíbula , Seno Maxilar , Faringe/diagnóstico por imagen
10.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artículo en Inglés | MEDLINE | ID: mdl-33372024

RESUMEN

Ossifying fibroma (OF) is a rare, benign, fibro-osseous lesion of the jawbone characterised by replacement of the normal bone with fibrous tissue. The fibrous tissue shows varying amount of calcified structures resembling bone and/or cementum. The central variant of OF is rare, and shows predilection for mandible among the jawbone. Although it is classified as fibro-osseous lesion, it clinically behaves as a benign tumour and can grow to large size, causing bony swelling and facial asymmetry. This paper reports a case of large central OF of mandible in a 40-year-old male patient. The lesion was treated by segmental resection of mandible. Reconstruction of the surgical defect was done using avascular fibula bone graft. Role of three-dimensional printing of jaw and its benefits in surgical planning and reconstruction are also highlighted.


Asunto(s)
Fibroma Osificante/cirugía , Neoplasias Mandibulares/cirugía , Adulto , Asimetría Facial/etiología , Fibroma Osificante/complicaciones , Fibroma Osificante/diagnóstico , Fibroma Osificante/diagnóstico por imagen , Peroné/trasplante , Humanos , Imagenología Tridimensional , Maxilares/anatomía & histología , Masculino , Neoplasias Mandibulares/complicaciones , Neoplasias Mandibulares/diagnóstico , Neoplasias Mandibulares/diagnóstico por imagen , Procedimientos Quirúrgicos Ortognáticos , Impresión Tridimensional , Tomografía Computarizada por Rayos X
11.
Angle Orthod ; 90(4): 548-555, 2020 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-33378504

RESUMEN

OBJECTIVES: To evaluate intersegmental displacement during long-term follow-up after bilateral sagittal split osteotomy (BSSO) by mandibular body area superimposition. MATERIALS AND METHODS: Cone-beam computed tomography (CBCT) images of 23 patients ages 18-37 years with class III malocclusion before orthognathic surgery were obtained. A three-dimensional (3D) CBCT examination was performed at four stages: surgery (T0), 6 months after surgery (T1), 1 year after surgery (T2), and long-term follow-up (6.1 ± 2.1 years, T3). The CBCT datasets were superimposed on the symphyseal area and the lower part of the distal segment of the mandible between T0 and the other time points (T1, T2, and T3). The reference points (both condyle, coronoid, and sigmoid) were estimated by the CBCT analyzed program. RESULTS: The coronoid, condylion, and sigmoid showed changes within 6 months after surgery, but there was no significant change in the intersegmental displacement between 6 months and 6 years after surgery. The distances between the left and right coronoid, condylion, and sigmoid from T0 to T3 were noted. CONCLUSIONS: The change in intersegmental displacement between T0 and T3 affecting relapse after orthognathic surgery was not significantly different. This suggests that the mandible itself may have a stable morphology during the follow-up period.


Asunto(s)
Maloclusión de Angle Clase III , Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Adulto , Tomografía Computarizada de Haz Cónico , Estudios de Seguimiento , Humanos , Imagenología Tridimensional , Maloclusión de Angle Clase III/diagnóstico por imagen , Maloclusión de Angle Clase III/cirugía , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Osteotomía Sagital de Rama Mandibular , Estudios Retrospectivos , Adulto Joven
12.
J Craniomaxillofac Surg ; 48(11): 1028-1034, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33008698

RESUMEN

The aim of this study was to describe a surgical technique that can be used to solve dentofacial deformities in cleft palate patients with maxillary hypoplasia in order to increase maxillary alveolar bone width, without modifying the skeletal base, and therefore, keeping the velopharyngeal function unaltered. Four patients with a history of cleft palate not associated with syndrome and treated under conventional surgical protocol during their childhood, underwent PAOO surgery incorporating L-PRF, followed by an accelerated orthodontic treatment with checkups every two weeks. All patients reached the desired occlusion without modifying their skeletal bases and velopharyngeal function. Orthodontic treatments were finished between 10 and 14 months after surgery without complications. There were no observed complications in the velopharyngeal postsurgical function and an increase in the arch width was achieved in all cases, along with a reduced orthodontic treatment time. The clinical results obtained confirm that PAOO technique is a safe and reliable complement to orthognathic surgery in the surgical treatment of cleft patients. By increasing the perimeter of the maxillary dentoalveolar ridge, the segmentation of the maxilla could be avoided, increasing the post operatory stability of these patients.


Asunto(s)
Labio Leporino , Fisura del Paladar , Ortodoncia , Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Niño , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Humanos , Maxilar/cirugía
13.
Am J Orthod Dentofacial Orthop ; 158(5): 674-683, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33008712

RESUMEN

INTRODUCTION: This study aimed to assess the accuracy of virtual surgical planning (VSP) performed by Dolphin Imaging software (version 11.9; Dolphin Imaging and Management Solutions, Chatsworth, Calif). METHODS: Ten people requiring bimaxillary surgery and genioplasty were followed up prospectively. All patients had preoperative cone-beam computed tomography, plaster models, and photographs allowing for VSP. Interocclusal intermediate surgical splints were produced using a 3-dimensional (3D) printer. Postoperative images were acquired 15 days after surgery using cone-beam computed tomography. ITK-Snap (version 3.6; Cognitica, Philadelphia, Pa) allowed the segmentation of reliable 3D models. Geomagic Qualify 2013 (3D Systems, Rock Hill, SC) and MeshValmet (version 3.0) were used to identify the differences between VSP and actual surgical results through the root mean square values and the 3D translational displacement (3-axes) of the 3D centroid of each model. RESULTS: Discrepancies between the VSP and the actual result were found at the mandible (P = 0.013) and the chin (P = 0.013) when considering the root mean square values. In addition, 3D centroid differences were found in the transverse and sagittal direction of the right ramus (P = 0.034 and P = 0.005, respectively) and the sagittal aspect of the left ramus (P = 0.025). Considering 2 mm as a threshold of clinical relevance, almost all the bone fragments (maxilla, proximal, and distal mandibular segments) were accurately corrected by surgery, although not in the chin. CONCLUSIONS: On the basis of the obtained values, it is possible to consider the Dolphin Imaging software as clinically acceptable for performing virtual orthognathic surgical planning.


Asunto(s)
Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Cirugía Asistida por Computador , Tomografía Computarizada de Haz Cónico , Humanos , Imagenología Tridimensional , Philadelphia
14.
Stomatologiia (Mosk) ; 99(5): 38-45, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33034175

RESUMEN

THE AIM: To evaluate versality and accuracy of computer navigation in orthognathic surgery, analyzing the position of osteotomized bone fragments on virtual and postoperative 3D models. MATERIAL AND METHODS: During our study we operated 27 patients with different asymmetric deformations of facial skeleton (13 patients with Class III Angle, 11 patients with Class II Angle and 3 patients with hemifacial microsomia). In 7 clinical cases optical navigation stations BrainLab 18070 Kick («BrainLab¼, Germany) and Stryker CranialMap CMF Version 2.0 («Stryker¼, USA) were used for preoperative virtual planning. In other clinical cases (20 patients) preoperative planning performed with using of 3D-cephafolometric programs Dolphin Imagin¼ and Blender 2.79. Intraoperative control of osteotomized bone fragments performed with using of optical navigation stations BrainLab 18070 Kick («BrainLab¼, Germany) and Stryker CranialMap CMF Version 2.0 («Stryker¼, USA). RESULTS: Mean surgical time was 181 minutes (150-210 min). Mean time of registration procedure was 5 minutes (3-8 min). Mean target registration error (TRE) was 0.9±0.18 mm. Absolute difference values between actual and virtual movements of maxilla was from 0.72 to 1.12 mm in vertical, from 0.56 to 0.94 mm in sagittal (COP) and from 0.39 to 0.58 mm in transversal (MSP) planes. CONCLUSION: Intraoperative control of maxilla-mandibular complex with using of computer navigation in orthognathic surgery allows to simplify bone fragments positioning, reduce surgery time, obtain a satisfactory aesthetic treatment result with occlusion restoration.


Asunto(s)
Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Cirugía Asistida por Computador , Humanos , Imagenología Tridimensional , Mandíbula
15.
Stomatologiia (Mosk) ; 99(5): 103-110, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33034186

RESUMEN

The article presents two cases of sisters with malocclusion: distal deep bite with typical skeletal and soft tissue deformation. In the first case classic three-steps orthognatic treatment plan was realized: orthodontic preparation with subsequent orthognatic bi-maxillar surgery with genioplasty. In second one we made contour-plasty with implants. Two different plans follow to two different results. Discussion around all differences of two approaches is the main interest of this overview.


Asunto(s)
Maloclusión , Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Mentoplastia , Humanos
16.
J Craniomaxillofac Surg ; 48(10): 928-932, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32873467

RESUMEN

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.


Asunto(s)
Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Adulto , Placas Óseas , Femenino , Humanos , Técnicas de Fijación de Maxilares , Masculino , Mandíbula , Osteotomía Sagital de Rama Mandibular , Estudios Retrospectivos , Adulto Joven
17.
Dental Press J Orthod ; 25(4): 75-84, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32965391

RESUMEN

Adult patients with anterior open bite and hyperdivergent retrognathic phenotype demand complex treatments, as premolar extractions, molar intrusion or orthognathic surgery. In the present clinical case, a young adult patient without significant growth, with Class I and anterior open bite, was treated with four premolar extractions. The therapeutic result shows good intercuspation, good facial esthetic, good function balance, and stability in a two-year post-fixed treatment follow-up.


Asunto(s)
Mordida Abierta/diagnóstico por imagen , Mordida Abierta/terapia , Métodos de Anclaje en Ortodoncia , Procedimientos Quirúrgicos Ortognáticos , Cefalometría , Humanos , Fenotipo , Técnicas de Movimiento Dental , Adulto Joven
18.
PLoS One ; 15(9): e0238494, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32886686

RESUMEN

The purposes of this study were to investigate the influence of the orthodontics-first approach (OFA) and surgery-first approach (SFA) on changes in the signs and symptoms of temporomandibular joint disorders (TMDs) and to compare pre- and postoperative orthodontic treatment duration and total treatment duration between the two approaches. This retrospective study recruited 182 adult patients with malocclusions treated with OFA and SFA and recorded variables such as age, gender, skeletal classification, and signs and symptoms of TMD (clicking and pain disorders) before the start of the surgical-orthodontic treatment and after surgery. Changes in the signs and symptoms of TMD and treatment duration were evaluated within each approach and compared between two approaches. A binary logistic regression was performed to assess the influence of the variables on the postoperative signs and symptoms of TMD. There were no significant postoperative changes in temporomandibular joint (TMJ) pain for OFA and SFA, whereas a significant reduction was found in TMJ clicking after surgery for both approaches. According to binary logistic regression, the type of surgical-orthodontic treatment (OFA or SFA) was not a significant risk factor for postoperative TMJ clicking and pain, and the risk of postoperative TMJ clicking and pain was significant only when TMJ clicking (OR = 10.774, p < 0.001) and pain (OR = 26.876, p = 0.008) existed before the start of the entire treatment, respectively. With regard to the treatment duration, SFA (21.1 ± 10.3 months) exhibited significantly shorter total treatment duration than OFA (34.4 ± 11.9 months) (p < 0.001). The results of this study suggest that surgical-orthodontic treatment using SFA can be a feasible option of treatment for dentofacial deformities based on the equivalent effect on TMD and shorter overall treatment period compared to conventional surgical-orthodontic treatment using OFA.


Asunto(s)
Procedimientos Quirúrgicos Ortognáticos/efectos adversos , Procedimientos Quirúrgicos Ortognáticos/métodos , Articulación Temporomandibular/cirugía , Adulto , Huesos Faciales , Femenino , Humanos , Masculino , Ortodoncia , Cirugía Ortognática , Dolor/complicaciones , Estudios Retrospectivos , Trastornos Somatomorfos/complicaciones , Trastornos de la Articulación Temporomandibular/terapia
19.
Rev. esp. cir. oral maxilofac ; 42(3): 107-118, jul.-sept. 2020. ilus, tab
Artículo en Español | IBECS | ID: ibc-196626

RESUMEN

OBJETIVOS: El objetivo es presentar el protocolo de trabajo, resultados clínicos y cambios en la vía aérea superior de una cohorte de 20 pacientes con síndrome de apnea/hipopnea obstructiva del sueño, intervenidos de avance maxilomandibular con rotación antihoraria. MATERIAL Y MÉTODOS: Un comité multidisciplinar determina la indicación quirúrgica, que los pacientes consienten. Se llevan a cabo tomografías computarizadas y polisomnografías antes y después de la cirugía, como protocolo habitual de trabajo. El comité ético de investigación clínica regional aprobó el estudio. Longitudes, volúmenes, área mínima, dimensión anteroposterior, dimensión transversal y otras medidas son determinadas en la vía aérea. El análisis estadístico es descriptivo y comparativo por pares con p < 0,05. RESULTADOS: Los movimientos planificados son 10,40 mm de avance y 2,11 mm de impactación anterior. El índice de apnea/hipopnea se reduce 30,50 puntos y la saturación de oxígeno capilar periférica mínima aumenta 5,00 puntos. Los resultados clínica y estadísticamente significativos son: 10,98 mm de acortamiento y 6,26 mm3 de incremento de volumen, especialmente en el compartimento retro-palatal; 91,45 mm2, 3,68 mm y 8,00 mm de aumento de área, dimensión antero-posterior y dimensión transversal respectivamente; el hioides avanza 1,92 mm. CONCLUSIONES: El avance maxilomandibular con rotación antihoraria en síndrome de apnea/hipopnea del sueño moderado-severo logra a corto plazo índice de apnea/hipopnea < 15 en el 80 % y saturación de oxígeno periférica capilar > 85 en el 75 % de nuestra serie. Los principales cambios en vía aérea son: acortamiento, incremento de volumen y áreas, forma elíptica y posicionamiento antero-superior del hioides


OBJECTIVES: To present the working protocol, clinical outcomes and upper airway changes of a 20-patient cohort with moderate-severe obstructive sleep apnea/hypopnea syndrome undergoing maxillo-mandibular advancement with counterclockwise rotation. MATERIAL AND METHODS: A multidisciplinary committee determines the surgical indication, which patients consent. Computed tomographies and polysomnographies are performed before and after surgery, as the usual clinical practice protocol. The clinical investigation ethics institutional review board approved the study. Lengths, volumes, minimum area, antero-posterior dimension, transverse dimension and other measurements are determined in the upper airway. Statistical analysis is descriptive and comparative by pairs with p < 0.05. RESULTS: Planned movements are 10.40 mm of advance and 2.11 mm of anterior impaction. Apnea/hypopnea index reduces by 30.50 points and minimum peripheral capillary oxygen saturation increases by 5.00 points. Clinically and statistical significant findings are: 10.98 mm of shortening and 6.26 mm3 of volume enlargement, especially in the retro-palatal compartment; 91.45 mm2, 3.68 mm and 8.00 mm of area, antero-posterior dimension and transverse dimension widening respectively; hyoid bone advances 1.92 mm. CONCLUSIONS: Maxillo-mandibular advancement with counterclockwise rotation in moderatesevere obstructive sleep apnea/hypopnea syndrome achieves in short-term follow-up apnea/hypopnea index < 15 in 80 % and minimum peripheral capillary oxygen saturation > 85 in 75 % of our series. Main upper airway changes are: shortening, volume and area increase, elliptical shape, and antero-superior hyoid bone movement


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Apnea Obstructiva del Sueño/cirugía , Elevación del Piso del Seno Maxilar/métodos , Anomalías Maxilomandibulares/cirugía , Sistema Respiratorio/anatomía & histología , Manejo de la Vía Aérea/métodos , Cuidados Posoperatorios/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Polisomnografía/estadística & datos numéricos
20.
Am J Orthod Dentofacial Orthop ; 158(4): 555-563, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32747146

RESUMEN

INTRODUCTION: To determine the psychosocial effects of a facial skeletal mal-relationship with its subsequent surgical correction in a group of patients treated using surgical orthodontics compared with a matched group of nontreated controls. METHODS: This study was approved by The Ohio State University Institutional Review Board. Subjects were patients presenting with facial skeletal mal-relationships whose proposed treatment plans included orthognathic surgery. This study used valid and reliable questionnaires: Orthognathic Quality of Life Questionnaire (OQLQ), Beck Depression Inventory II (Children's Depression Inventory - 2), Satisfaction with Life Scale, and State Trait Anxiety Inventory (State Trait Anxiety Inventory for Children), administered at 3 different stages of treatment (time 1 = initial pretreatment, time 2 = before oral surgery, and time 3 = at completion of treatment). Matched controls recruited at each time point completed the same questionnaires. RESULTS: A total of 267 subjects were recruited to participate in this study. There were no significant differences between treatment and control groups in age, sex, education level, or employment status at any of the 3 time points. The randomization test was used to compare values for all outcome variables between groups at the 3 stages of treatment. For the pretreatment period, T1, there were significant differences between patients and controls in domains 1 (P = 0.0126), 2 (P = 0.0000), and 3 (P = 0.0000) of the OQLQ (social aspects, facial esthetics, and oral function, respectively) as well as total OQLQ (P = 0.0000). For the presurgery period, T2, there were significant differences between patients and controls in domains 2 (P = 0.0136) and 3 (P = 0.0001) of the OQLQ (facial esthetics and oral function) as well as total OQLQ (P = 0.0291). Finally, for the posttreatment period, T3, there was a significant difference between patients and controls only in domain 3 (P = 0.0196) of the OQLQ (oral function). CONCLUSIONS: The psychosocial profile of patients with a facial skeletal mal-relationship does not differ from the general population in depression, anxiety, and overall satisfaction with life. However, these patients do report a reduced quality of life based on condition-specific measures in social aspects, facial esthetics, and oral function. Concerns about oral function remain even up to 2 years after treatment is completed.


Asunto(s)
Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Niño , Estética Dental , Humanos , Ohio , Calidad de Vida , Encuestas y Cuestionarios , Estados Unidos
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