Effect of Orthognathic Surgery on Breathing in Patients with Cleft lip and Palate: 20-Year Experience at a Tertiary Hospital in Brazil.

OBJECTIVE: To verify the effect of orthognathic surgery (OS) on nasal dimensions and its correlation with respiratory symptoms in patients operated on over the past 20 years. DESIGN: Retrospective study. SETTING: Tertiary level craniofacial hospital. PARTICIPANTS: 535 patients with CLP previously repaired, without syndromes, age over 18, who performed OS between 2000 and 2019 and rhinomanometric evaluation pre and post OS. INTERVENTIONS: Maxillary advancement isolated and combined with turbinectomy and/or mandibular osteotomy. MAIN OUTCOME MEASURES: Minimum nasal cross-sectional area (CSA) assessed by posterior (PR) and anterior rhinomanometry (AR), nasopharyngeal cross-sectional area (NCSA) verified by modified AR, and self-perceived respiratory symptoms through a questionnaire. RESULTS: After OS, there was a significant increase in CSA assessed by PR (p < .001) and AR (p < .001), while there was no significant difference in NCSA (p = 0.319). Regarding respiratory symptoms after OS, 26.3% showed improvement in nasal obstruction, 28.5% in oronasal breathing, 18.5% in snoring, and 5.2% in respiratory obstruction during sleep. However, a weak correlation between increased CSA and improvement of symptoms was observed. In the first decade, lower values of CSA (p < .001) and NCSA (p < .001) were observed compared to the second decade. Both periods showed a significant increase in CSA (p < .001). CONCLUSIONS: Nasal dimensions and breathing symptoms were improved by OS when combined with turbinectomy. Comparing the results of patients operated on between two different decades, patients had more favorable conditions for breathing in the most recent decade of care. However, this was not statistically correlated with the improvement in patient symptoms in this study.

Intrusive luxation of permanent upper central incisor into the nasal cavity: A case report.

This case report outlines a rare complete intrusion of a permanent, maxillary central incisor (tooth 11) into the nasal cavity, with a late diagnosis and treatment. An eight-year-old boy was referred to an oral and maxillofacial surgery service with absence of tooth 11 after an episode of a fall from his own height. Approximately 50 days after the trauma, the patient presented with a complaint of obstruction of the right nostril. The clinical examination and tomographic evaluation showed that the tooth had been intruded into the nasal cavity on the right side. The tooth in question was removed under general anesthesia by direct approach through the right nostril. The patient was followed up for approximately one year without complications. This case demonstrates the importance of a detailed evaluation during the first examination after intrusive luxation, so the correct diagnosis is made and the correct treatment is performed to avoid greater morbidity and complications for the patient.