Cranial structure and condylar asymmetry of adult patients with rheumatoid arthritis.

OBJECTIVE: The aim of this prospective cross sectional study was to evaluate the cranial structure and condylar asymmetry of adult patients with rheumatoid arthritis (RA) diagnosed after 25 years of age compared to a healthy adult control group. METHODS: Eighteen adult patients (57.4 ± 11.4 years) with RA were compared with a control group. Cephalometric analysis and the Habets method for the calculation of the condylar asymmetry were used. The main cephalometric data investigated were focused on the diagnosis of hyperdivergent cranial structure (NSL/ML, NL/ML), backwards rotation of the mandible (Fh/ML), short vertical ramus (Ar:Go), steep mandibular plane (ML/Oc). RESULTS: The cephalometric data considered were not significantly different in the RA vs controls except for the steepness of the occlusal plane (NL/Oc), which was steeper in the patients group (P < 0.02) and the ramus of the mandible which was greater in patients. The asymmetry of the condyles was significant (P < 0.003) and different from the control group, but that of the ramus was not. CONCLUSIONS: In this study, RA patients diagnosed after 25 years of age did not show a different pattern of growth with respect to the control group. As expected, the condyles showed a difference being asymmetrical in RA patients due to the high turnover of this joint reacting to severe systemic inflammation in conditions of continuous functional work, load and forces. This study follows a previous study with the same research plan conducted on young JIA patients who showed a different pattern of growth of the skull leading to a severe hyperdivergent cranial structure with backward rotation of the mandible; this is mainly due to the insufficient growth of the condylar site exposed to the inflammatory process during development. Unlike JIA patients, this study showed that RA patients follow an individual growth pattern not affected by inflammation, even if they show joint asymmetry.

Juvenile/Adolescent Idiopatic Scoliosis and Rapid Palatal Expansion. A Pilot Study.

The question of whether orthodontic therapy by means of rapid palatal expansion (RPE) affects the spine during development is important in clinical practice. RPE is an expansive, fixed therapy conducted with heavy forces to separate the midpalatal suture at a rate of 0.2-0.5 mm/day. The aim of the study was to evaluate the influence of RPE on the curves of the spine of juvenile/adolescent idiopathic scoliosis patients. Eighteen patients under orthopedic supervision for juvenile/adolescent idiopathic scoliosis and independently treated with RPE for orthodontic reasons were included in the study: Group A, 10 subjects (10.4 ± 1.3 years), first spinal radiograph before the application of the RPE, second one during the orthodontic therapy with RPE; Group B, 8 patients (11.3 ± 1.6 years), first radiograph during the use of RPE second one after the removal. Group A showed a significant worsening of the Cobb angle (p ≤ 0.005) at the second radiograph after RPE. Group B showed a significant improvement of the Cobb angle (p = 0.01) at the second radiograph after removal of RPE. Based on the results, the use of RPE during adolescence might influence the spinal curves of patients with idiopathic scoliosis.

Adverse effects of the bite-raised condition in animal studies: A systematic review.

OBJECTIVE: To provide a systematic review of the effects of the bite-raised condition in animal models, a widespread technique in modern orthodontics. DESIGN: A systematic review of the literature was conducted. Original articles were searched through Pubmed, Cochrane Central database and Embase until December 2018. RESULTS: 242 articles were identified through database searching. After removing the duplicates, 198 articles were screened by reviewing the abstracts. 27 full text articles were assessed for eligibility and, after 7 exclusions, 20 articles were included in the review process. Studies selected by the review process concerned animal models. Histological, molecular, biochemical and electromyographical studies were evaluated. The results, with a high level of agreement in different animals, showed that the bite-raised condition is a source of stress, inducing increased plasma corticosterone, urinary cortisol and HPA axis alterations; it predisposes the organism to react to subsequent stressful stimulation with a significantly greater incretion of glucocorticoids, thus inducing hypersensitivity to novel forms of stress; it affects the structure of the hippocampus, reducing the number of neurons, increasing the number of glial cells and worsening memory and spatial orientation; it alters the electromyographical activity of masticatory muscles. CONCLUSIONS: The results of research conducted on animal models do not necessarily apply directly to human beings. More clinical research, with special attention to adolescent patients, is necessary to clarify whether, in humans, the bite-raised condition is accompanied by adverse effects comparable to those observed in animals.

Rapid palatal expansion (RPE): Meta-analysis of long-term effects.

OBJECTS: Rapid palatal expansion (RPE) is a widespread orthopaedic procedure used in several clinical situations. The aim of the study was to provide a systematic review and meta-analysis of transverse intercanine and intermolar width changes after RPE and long-term effects. SETTING AND SAMPLE POPULATION: A systematic literature search was conducted until January 2018 on original studies with RPE treatment. MATERIAL AND METHODS: Intercanine and intermolar distance were measured at the start of RPE (T1, median age 9.2 years) and at the end of treatment (T2). The long-term evaluation was conducted on a subset of articles with 5-year follow-up (T3). RESULTS: Eighteen studies T1-T2 and 5 studies T3 were selected. Regarding the intercanine distance, the RPE resulted in a gain of space T1-T2 of 3.73 mm with a significant heterogeneity (P < 0.0001; I2  = 94.21%) and a relapse T2-T3 of -0.81 mm with a significant heterogeneity (P < 0.0001; I2  = 95.8%); the overall gain of space was 2.91 mm. Regarding the intermolar distance, the RPE resulted in a gain of space T1-T2 of 4.85 mm with a significant heterogeneity (P < 0.0001; I2  = 92.41%) and a relapse T2-T3 of -0.47 mm with a significant heterogeneity (P < 0.0001; I2  = 87.5%); the overall gain of space was 4.38 mm. Meta-regression analysis showed that at younger age, the amount of anterior expansion is similar to posterior. With increasing age, the anterior opening diminishes significantly more than the posterior, being half of the posterior at 15 years. CONCLUSION: Because long-term results were obtained with simultaneously fixed appliances and long upper retention, RPE should be carefully considered before using.

Cranial structure and condylar asymmetry of patients with juvenile idiopathic arthritis: a risky growth pattern.

The aim of the study was to evaluate the cephalometric differences and condylar asymmetry between patients with juvenile idiopathic arthritis (JIA) and normal control group. Sixty-two JIA patients with a latero-lateral cephalogram and orthopantomography, seeking for orthodontic therapy, and 62 normal matched subjects were comprised in the study. Cephalometric analysis was used for the evaluation of facial morphology while the method of Habets et al. (J Oral Rehabil 15(5): 465-471, 1988) was used to compare the condyles in orthopantomography. The significance of between-group differences was assessed using the Mann-Whitney test, as appropriate. The results showed a prevalence of the upper maxilla with hypomandibulia (class II), hyperdivergency with short vertical ramus posterior and posterior rotation of the mandible in JIA children (SNB, ANB, NSL/ML, Fh/ML, NL/ML, ArGo, ML P < 0.0001, ML/Oc P < 0.004, ArGo/GoGn P = 0.02, no difference for SNA). The condyles of the JIA group resulted highly asymmetric (P < 0.0001). The growth pattern of JIA patients resulted clearly different from normal subjects. This serious impairment of the cranial growth may be considered as an indicator of the need for early and continuous orthognatodonthic therapy during the entire period of development for all JIA patients, independently from temporomandibular joint signs or symptoms. To this end, it is important that rheumatologists and orthognathodontists set up a multidisciplinary treatment planned to control the side effects of a deranged growing pattern, to strictly avoid any orthodontic therapies that may worsen function and growth, and to promote treatments improving the physiology and biology of the cranial development.

Improvement of masticatory kinematic parameters after correction of unilateral posterior crossbite: Reasons for functional retention.

OBJECTIVE: To evaluate reverse-sequencing chewing cycles (RSCC) and their kinematic parameters on both sides before and after correction with the Function Generating Bite (FGB) appliance. MATERIALS AND METHODS: Forty-seven patients, 8.3 ± 1.1 (mean ± SD) years of age, with unilateral posterior crossbite (35 on the right side, 12 on the left side) and 18 age-matched controls (9.1 ± 0.8 years) were selected for the study from the orthodontic division of the University of Turin, Italy. The crossbite was corrected in all patients using FGB, and mandibular motion was recorded with a kinesiograph K-7 (Myotronics, Tukwila, Wash), during chewing on both sides of a soft and a hard bolus before and after correction. RESULTS: After correction, the percentage of RSCC significantly decreased for soft and hard (P < .001) boluses and fell within the normal range for 75% of the patients. The indices of the chewing pattern (closure angle, axis, maximum lateral excursion) significantly improved (P < .001), becoming symmetric between sides. CONCLUSIONS: The results of this study showed that the functional appliance, FGB, was able to lower the percentage of RSCC significantly, bringing them back to the normal range in 75% of cases, and to improve the kinematic parameters that become symmetric between sides.

From periodontal mechanoreceptors to chewing motor control: A systematic review.

PURPOSE: This critical review summarizes the current knowledge of the structural and functional characteristics of periodontal mechanoreceptors, and understands their role in the signal pathways and functional motor control. METHOD: A systematic review of the literature was conducted. Original articles were searched through Pubmed, Cochrane Central database and Embase until january 2016. RESULT: 1466 articles were identified through database searching and screened by reviewing the abstracts. 160 full-text were assessed for eligibility, and after 109 exclusion, 51 articles were included in the review process. Studies selected by the review process were mainly divided in studies on animal and studies on humans. Morphological, histological, molecular and electrophysiological studies investigating the periodontal mechanoreceptors in animals and in humans were included, evaluated and described. CONCLUSION: Our knowledge of the periodontal mechanoreceptors, let us conclude that they are very refined neural receptors, deeply involved in the activation and coordination of the masticatory muscles during function. Strictly linked to the rigid structure of the teeth, they determine all the functional physiological and pathological processes of the stomatognathic system. The knowledge of their complex features is fundamental for all dental professionists. Further investigations are of utmost importance for guiding the technological advances in the respect of the neural control in the dental field.

Methodological quality and outcome of systematic reviews reporting on orthopaedic treatment for class III malocclusion: Overview of systematic reviews.

OBJECTIVES: The aim of this overview of systematic reviews was to investigate methodological quality and outcome of current systematic reviews (SRs) reporting on orthopaedic treatment for class III malocclusion. MATERIALS AND METHODS: Computerized and manual searches were performed in Medline, Google Scholar, Cochrane Library, Embase, LILACS, SciELO, American Journal of Orthodontics and Dentofacial Orthopaedics, Angle Orthodontist, European Journal of Orthodontics, Journal of Orthodontics, Conference abstracts and Grey literature. No restrictions were set on language or date of publication. The search covered the starting date of the relevant databases until 30 April 2015. MeSH terms and free-text terms included 'malocclusion', 'Angle class III', 'orthodontic appliances', 'functional', facemask, review and meta-analysis. Screening of eligible studies, assessment of the methodological quality of the SRs and data extraction were conducted in duplicate and independently by two reviewers. Methodological quality was assessed using AMSTAR (assessment of multiple systematic reviews). RESULTS: A total of 222 studies were retrieved and after removal of duplicates, irrelevant studies, literature reviews and surgical approach treatments, 14 SRs and/or meta-analyses were included for qualitative synthesis. Mean AMSTAR score was 7.7/11 with a range of 3-10. There was evidence to demonstrate that face mask therapy can move the maxilla forward whilst causing a backward rotation of the mandible and increased facial height. There was also some evidence of mandibular growth retardation with chin cup therapy. CONCLUSIONS: Orthopaedic appliances can improve a class III malocclusion in growing patients over the short-term; however, each appliance has a characteristic effect on the underlying skeletal pattern.

Condylar asymmetry in patients with juvenile idiopathic arthritis: Could it be a sign of a possible temporomandibular joints involvement?

OBJECTIVES: The aim of the study was to evaluate the condylar and ramal asymmetry of the mandible in patients with juvenile idiopathic arthritis (JIA) using orthopantomographies (OPTs). METHODS: A total of 30 JIA patients with confirmed diagnosis of JIA and a routine OPT, seeking for orthodontic therapy, free of specific symptoms of temporomandibular joint involvement, and 30 normal matched subjects with OPT were comprised in the study. The method of Habets et al. was used to compare the condyles and rami in OPT. The significance of between-group differences were assessed using Mann-Whitney test. RESULTS: The results showed a high significant difference in the range of asymmetry of the condyle, being the patient group highly asymmetrical (P < 0.0001). No differences were found in the range of asymmetry of the ramus between groups (P = 0.47). The intra-group comparison between males and females showed a difference in the patient group (P = 0.04), being the females more asymmetric. CONCLUSIONS: Knowing that the temporomandibular joint (TMJ) is highly susceptible to inflammatory alterations during growth, even in absence of symptomatology, and being the OPT a cost-benefit favorable imaging tool widespread in the dental field, the latter could be used as a first screening examination in JIA patients to calculate the condylar asymmetry index. The use of this screening tool will help the physicians in addressing the patients that should undergo a more detailed TMJ imaging to early detect TMJ abnormalities and to early set up a targeted therapy of the related cranial growth alterations.

Meta-analysis of surgical approaches to the treatment of parotid pleomorphic adenomas and recurrence rates.

INTRODUCTION: Different types of surgical management of pleomorphic adenoma of the parotid gland are associated with different recurrence rates. MATERIAL AND METHODS: A systematic review of literature until 2014 with meta-analysis was conducted. Inclusion criteria were original studies of patients with surgical management for pleomorphic adenoma of the parotid gland and recurrence rates, with a median follow-up period of 5 years. The Newcastle-Ottawa Quality Assessment Scale (NOQAS) was used to assess the quality. RESULTS: Sixteen studies were included. Four studies show a low recurrence rate (0.01, 95% confidence interval [CI] = 0.00-0.02) after total parotidectomy. Twelve studies show a low recurrence rate (0.02, 95% CI = 0.01-0.03) after superficial parotidectomy. Six studies show a low recurrence rate (0.02, 95% CI = 0.01-0.04) after limited parotidectomy. Six studies demonstrate a low recurrence rate (0.01, 95% CI = 0.00-0.04) after extracapsular dissection. Five studies report a low-to-medium recurrence rate (0.08, 95% CI = 0.03-0.14) after extracapsular enucleation. CONCLUSION: Information about recurrence rates, times of recurrence in relation to type of surgical treatment, and significance of capsule rupture is very poor. With regard to recurrence rates and surgical approaches, the types of operations that show the lowest recurrence rate are total parotidectomy and extracapsular dissection. Controversies over surgical treatment of PA of parotid gland remain, and the safest surgical method for the removal of this tumors has not been identified.

Oral self-injuries: clinical findings in a series of 19 patients

OBJECTIVES: Self-injury (SI) is defined as a behavioral disturbance consisting of a deliberate harm to one's own body without suicidal intent, it is not uncommon and ranges in severity from simple nail-biting to more extreme forms of self-mutilation. The head neck region may be the target of such lesions. SI is associated with several medical conditions, of which it can represent the first clinical sign. Aim of this paper is to describe a series of oral SI, giving special emphasis to the clinical findings, etiology and the management of lesions. MATERIAL AND METHODS: A total of 19 patients with oral SI were prospectively examined; attention was paid to the occurrence and characterization of oral lesions. The management of the lesion also varied depending on the patient medical history, on the etiology of the psychiatric behavior, and on the severity, frequency, and method of inflicting injury. Periodic examinations were performed (after two weeks, three months and six months) and registered. RESULTS: All the patients healed gradually and healing was conditioned by the disease underlying. The treatment consisted of behavior modification in 11 cases, pharmacological treatment in 11 cases, psychotherapy in 2 cases, mouth guard in 9 cases, surgery in 2 cases, extractions in 1 case. CONCLUSIONS: Oral SI are uncommon in the clinical practice. They may be associated with a known disease or maybe the consequence of this, but often they may be the first sign of a psychiatric disorder

Oral self-injuries: clinical findings in a series of 19 patients.

OBJECTIVES: Self-injury (SI) is defined as a behavioral disturbance consisting of a deliberate harm to one's own body without suicidal intent, it is not uncommon and ranges in severity from simple nail-biting to more extreme forms of self-mutilation. The head neck region may be the target of such lesions. SI is associated with several medical conditions, of which it can represent the first clinical sign. Aim of this paper is to describe a series of oral SI, giving special emphasis to the clinical findings, etiology and the management of lesions. MATERIAL AND METHODS: A total of 19 patients with oral SI were prospectively examined; attention was paid to the occurrence and characterization of oral lesions. The management of the lesion also varied depending on the patient medical history, on the etiology of the psychiatric behavior, and on the severity, frequency, and method of inflicting injury. Periodic examinations were performed (after two weeks, three months and six months) and registered. RESULTS: All the patients healed gradually and healing was conditioned by the disease underlying. The treatment consisted of behavior modification in 11 cases, pharmacological treatment in 11 cases, psychotherapy in 2 cases, mouth guard in 9 cases, surgery in 2 cases, extractions in 1 case. CONCLUSIONS: Oral SI are uncommon in the clinical practice. They may be associated with a known disease or may be the consequence of this, but often they may be the first sign of a psychiatric disorder.

Early treatment of an ectopic premolar to prevent molar-premolar transposition.

Orthodontic treatment is planned on an individual, case-by-case basis after thoroughly considering the patient's overall facial and dental characteristics, the expected duration of treatment, costs, patient preferences, and the orthodontist's experience. This article reports the treatment of a patient with a maxillary premolar-molar transposition in the permanent dentition that was successfully managed with orthodontic treatment. A girl, aged 10 years 2 months, came for treatment with an ectopic maxillary left premolar. Radiographic analysis indicated a developing complete transposition of the maxillary left premolar. The patient was treated with extraction of the deciduous molar and surgical exposure and ligation of the premolar. Eruption was properly guided, and the correct order of the 2 teeth was restored in the arch. This challenging treatment approach is described in detail, including the mechanics used to align the ectopic premolar. Early treatment can, in many cases, prevent a molar-premolar transposition.

Mandibular lip bumper for molar torque control.

Treatment effects of lip bumpers alone include flaring of the mandibular incisors, distalization and uprighting of the mandibular first molars, and buccal expansion of the canines, premolars, and molar. Lip forces are transmitted through this appliance onto the molars. Moreover the lip bumper is able to derotate, expand or constrict, upright and reinforce the anchorage whereas torque control is lacking. Aim of this paper is the presentation of a new type of lip bumper that allows the molar torque control.

Meta-analysis of skeletal mandibular changes during Frankel appliance treatment.

The purpose of this study was to perform a meta-analysis of articles to verify the mandibular changes produced by the Fränkel-2 (FR-2) appliance during the treatment of growing patients with Class II malocclusions when compared with untreated growing Class II subjects. The literature published from January 1966 to January 2009 was reviewed with search engines. A quality analysis was performed. The effects on primary end points were calculated with random-effect models. Heterogeneity was assessed using Q statistic and investigated using study-level meta-regression. A total of nine articles were identified. The quality of the studies ranged from low to medium. Meta-analysis showed that the FR-2 was associated with enhancement of mandibular body length [0.4 mm/year 95 per cent confidence interval (CI) 0.182-0.618], total mandibular length (1.069 mm/year, 95 per cent CI 0.683-1.455), and mandibular ramus height (0.654 mm/year, 95 per cent CI 0.244-1.064). A consistent heterogeneity among studies was found for all the considered linear measurements. The FR-2 appliance had a statistically significant effect on mandibular growth. Nevertheless, the heterogeneity of the FR-2 effects, the quality of studies, the differences in age, skeletal age, treatment duration, and the inconsistent initial diagnosis seem to overstate the benefits of the FR-2 appliance. An evidence-based approach to the orthodontic outcomes of FR-2 appliance is needed, by selecting and comparing groups of children with the same cephalometric characteristics with and without treatment.

Salivary gland biopsy: a comprehensive review of techniques and related complications.

OBJECTIVE: This study proposes a revision of the literature on the current techniques employed in salivary gland biopsy. METHODS: A systematic review of the literature between January 1990 and January 2010 was conducted using MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. The search terms were: 'biopsy AND parotid AND Sjögren'; 'biopsy AND sublingual salivary gland AND Sjögren'; 'biopsy AND minor salivary gland AND Sjögren'; 'biopsy AND labial salivary gland AND Sjögren' and 'biopsy AND salivary glands AND connective disorders'. RESULTS: No study reporting submandibular salivary gland biopsy was found; 3 studies reported sublingual salivary gland biopsy; 1 study reported palate biopsy; 4 studies reported parotid gland biopsy and 21 studies reported minor salivary gland biopsy. CONCLUSION: Biopsy of salivary glands must be performed as last investigation and only when the other items are not complete enough to satisfy the diagnosis. The knowledge of complications and sequelae may be useful in order to minimize the risk.

Fine-needle aspiration cytology of salivary gland lesions: a systematic review.

PURPOSE: The aim of this study was to provide a systematic review of fine-needle aspiration (FNA) cytology on salivary gland lesions. MATERIALS AND METHODS: A review of the literature was carried out using PubMed, SCIRUS, and the Cochrane Central Register of Controlled Trials (CENTRAL). The present study included only data correlating cytological and histological diagnoses. RESULTS: Of the patients, 484 received a histological diagnosis of malignant tumor; cytological diagnosis was concordant in 387 (79.95%), discordant in 97 (20.04%). A total of 1,275 patients received a histological diagnosis of benign tumor; cytological diagnosis was concordant in 1,219 (95.608%) and discordant in 56 (4.39%). In all, 154 patients received a histological diagnosis of non-neoplastic lesion; cytological diagnosis was concordant in 145 (94.156%) and discordant in 9 (5.84%). CONCLUSION: FNA is a safe diagnostic tool that has a reliable sensitivity and specificity for the assessment of salivary gland pathology. FNA cytology may be useful in routine preoperative diagnostic testing.

Orthodontic movement of impacted cuspid in fibrodysplastic bone: a case report.

A case of orthodontic replacement of impacted cuspid in fibrodysplastic maxillary bone in a 12-year-old girl is reported. Fibrodysplastic bone is classically described as a fibrous bone without osteoblastic rimming. It is well known that orthodontic forces lead to tooth movement through proliferation and increased activity of bone cells (osteoblasts and osteoclasts). The reported case clinically support the latest histological studies suggesting that in fibrodisplastic bone osteoblasts are present but altered in shape and therefore difficult to recognize in sections.

Effects of repeated cycles of sterilisation on the mechanical characteristics of titanium miniplates for osteosynthesis.

AIM: This study investigates the changes occurring in the mechanical characteristics of osteosynthesis titanium miniplates when exposed to repeated sterilization cycles. METHODS: For this study Medicon (c) titanium miniplates were used. The characteristics of miniplates were evaluated using the Penetration Resistance test, MSC/Pal2 Software, and the Finite Elements Method (F.E.M.). Surface roughness measurements were also carried out. Statistical analysis was conducted using the One way ANOVA model. The significance level was set at >0.05. RESULTS: The one way ANOVA analysis between HV value and increased sterilization cycles showed P>0.029; between the Ra value and increased sterilization cycles it was P>0.325; between the Rq value and increased sterilization cycles it was P>0.703. The Finite Element Model shows an amplified deformed shape of the miniplate at a load of 196 [N]. At this load value the equivalent 'von Mises stress' reaches the value of sigmaP0.2, shown by the ASTM F 67-95 standard. Stress distribution comparison between the six-holed plate and the equivalent straight miniplate shows more consistent behaviour for the Medicon (c) miniplate. The rigidity of the Medicon (c) miniplate is 14.46, lower than that for the equivalent straight miniplate (R=23.4). The ANOVA analysis between the break load and increased sterilization cycles showed P>0.175; between the break position and increased sterilization cycles it showed P>0.016. CONCLUSIONS: Experimental static tests have shown that all tested miniplates did not have notable differences and this suggests that sterilization cycles do not affect mechanical characteristics.

Obesity and craniofacial variables in subjects with obstructive sleep apnea syndrome: comparisons of cephalometric values.

BACKGROUND: The aim of this paper was to determine the most common craniofacial changes in patients suffering Obstructive Sleep Apnea Syndrome (OSAS) with regards to the degree of obesity. Accordingly, cephalometric data reported in the literature was searched and analyzed. METHODS: After a careful analysis of the literature from 1990 to 2006, 5 papers with similar procedural criteria were selected. Inclusion criteria were: recruitment of Caucasian patients with an apnea-hypopnea index (AHI) >10 as grouped in non-obese (Body Mass Index - [BMI] < 30) vs. obese (BMI > or = 30). RESULTS: A low position of the hyoid bone was present in both groups. In non-obese patients, an increased value of the ANB angle and a reduced dimension of the cranial base (S-N) were found to be the most common finding, whereas major skeletal divergence (ANS-PNS ;Go-Me) was evident among obese patients. No strict association was found between OSAS and length of the soft palate. CONCLUSION: In both non-obese and obese OSAS patients, skeletal changes were often evident; with special emphasis of intermaxillary divergence in obese patients. Unexpectedly, in obese OSAS patients, alterations of oropharyngeal soft tissue were not always present and did not prevail.