Effects of orthopedic treatment (distraction splint) on dentofacial deformities in patients with juvenile idiopathic arthritis.

BACKGROUND: Juvenile idiopathic arthritis (JIA) frequently affects the temporomandibular joint (TMJ), which can alter mandibular growth and development and result in dentofacial deformities. OBJECTIVE: To assess the outcomes of orthopedic treatment with distraction splint (DS) in patients with JIA-related dentofacial deformity. METHODS: The retrospective study involved 30 patients with JIA and unilateral TMJ involvement, another study group of 20 patients with JIA and bilateral TMJ involvement, and a control group of 18 non-JIA orthodontic patients with Class II and III malocclusions. The inclusion criteria were DS treatment and cone-beam computed tomography (CBCT) scans before (T0) and 2 years after treatment (T1). Dentofacial morphology and deformity were evaluated based on a validated three-dimensional CBCT-based morphometric analysis. Intergroup differences in outcome measures were compared at T0 and T1, and intragroup changes between T0 and T1 were assessed using the Kruskal-Wallis test. RESULTS: Initial evaluations at T0 revealed significant differences between the unilateral and bilateral JIA groups and the control group for three out of eight dentofacial deformity variables: inter-side difference in total posterior mandibular height, mandibular axial angle, and posterior/anterior face height (ratio). At follow-up (T1), significant inter-group differences were only observed in total posterior mandibular height indicating that intergroup differences were less pronounced after splint treatment. Assessing inter-group changes between T0 and T1 showed that all parameters remained constant except posterior/anterior face height ratio, which significantly decreased between T0 and T1. CONCLUSIONS: The findings demonstrate the potential of DS treatment for patients with JIA and unilateral or bilateral TMJ involvement to generally support normal dentofacial growth or at least limit further deterioration of dentofacial deformities.

Health-related quality of life, jaw function and sleep-disordered breathing among patients with dentofacial deformity.

BACKGROUND AND OBJECTIVES: Patients with dentofacial deformity (DFD) requiring orthognathic treatment have poor aesthetics, jaw function and psychological well-being, which potentially affect the quality of life. This study aimed to investigate the health-related general, oral and orthognathic quality of life, jaw function and sleep-disordered breathing at different stages of orthognathic surgical treatment. METHODS: A total of 120 consecutive patients with DFD were recruited and grouped as pre-orthodontic treatment (group 1), pre-surgery (group 2), 4 months post-surgery (group 3), 24 months post-surgery (group 4) and in addition 30 controls without DFD (group 0). Outcomes were assessed using general health Short Form Survey (SF-36), Oral Health Impact (OHIP-14), Orthognathic Quality of Life Questionnaire (OQLQ), STOP-Bang and Jaw Function Limitation Scale (JFLS) questionnaires. In addition, presence or absence of pain was recorded. Data were tested with analysis of variance, Kruskal-Wallis test, Tukey post hoc test and structural equation modelling (SEM). RESULTS: Results revealed SF-36 (p = .814) and STOP-Bang (p = .143) total scores did not differ between control and treatment groups. In contrast, OHIP-14, OQLQ and JFLS total scores differed between groups (p = .001). Higher scores were observed in groups 1 (p = .001), 2 (p = .001) and 3 (p = .041) compared to group 0, indicating poor oral health in patients with DFD. Importantly, in group 4, oral health-related quality of life was better, and OHIP-14 (p = .936) and JFLS (p = .572) scores did not differ from controls. OQLQ scores of group 4 were significantly lower than group 1 (p = .001) but higher than group 0 (p = .013). SEM results revealed a significant negative associations of pain with JFLS and OQLQ; OHIP-14 with OQLQ; OHIP-14 with SF-36; and finally STOP-Bang with SF-36. Positive associations were observed between JFLS and OHIP-14; OHIP-14 and OQLQ. CONCLUSION: Oral health-related quality of life and jaw function appears to be improved 24 months after orthognathic surgery. Pain and limitation in jaw function had a negative association with health-related quality of life.

Surgery-First Orthognathic Approach for Correction of Dentofacial Deformity in Unilateral Cleft Lip and Palate.

BACKGROUND: Although several studies have reported the advantages of the surgery-first approach for orthognathic correction of class III deformity, there is no report of the success of this approach for patients with cleft lip and palate. Therefore, the purpose of this study was to evaluate the stability and outcome of bimaxillary surgery for cleft-related dentofacial deformity using a surgery-first approach. METHODS: Forty-one patients with unilateral cleft lip and palate who consecutively underwent Le Fort I and bilateral sagittal split osteotomies for skeletal class III deformity were included. Cone-beam computed tomographic scans before surgery, 1 week after surgery, and after orthodontic treatment were used to measure the surgical and postsurgical changes in jaw position by landmarks, and outcomes of jaw protrusion and relation, incisor angle and occlusion, and menton deviation after treatment. Self-report questionnaires regarding satisfaction with overall appearance of the face and seven facial regions were administered after treatment. RESULTS: A clinically insignificant relapse was found in the maxilla (<1 mm) and mandible (<2 mm). There was a significant improvement in the jaw protrusion and relation, incisor angle and occlusion, and menton deviation. Responses from the self-report questionnaires completed after treatment indicated that patient satisfaction was high. CONCLUSION: These findings demonstrate surgical-orthodontic treatment with a surgery-first approach can successfully improve cleft-related dentofacial deformity in patients with unilateral cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Do Patients Detect Changes in Breathing After Orthognathic Surgery?

BACKGROUND: Orthognathic surgery addresses facial aesthetics and function in patients with dentofacial deformities. It is associated with changes in upper airway volume (UAV). If changes in UAV are perceived by asymptomatic patients is unclear. PURPOSE: The purpose was to measure associations between changes in UAV and patient-reported benefits using patient-reported outcome measures. STUDY DESIGN: A sample presenting dentofacial deformities without reported breathing problems undergoing orthognathic surgery was retrospectively studied. Patients aged 18-30 years with 12-month follow-up were included. Patients with systemic disease, drug abuse, mental health disorder, or temporomandibular joint dysfunction were excluded. PREDICTOR: The predictor variable was changes in UAV measured in 3-dimensional computed tomography. Subjects were grouped into increased or decreased UAV. MAIN OUTCOME VARIABLE: The primary outcome variable was changes in health-related quality of life measured with Oral Health Impact Profile 49 (OHIP-49). COVARIATES: Weight, height, age, sex, and sub-scaled OHIP-49 were registered. Cephalometric measurements of hard tissue movements were recorded. ANALYSES: Mean, standard deviation, and a level of statistical significance at P < .05 were used. Differences in OHIP-49 were compared using unpaired t-test. The correlation between covariates and outcomes was analyzed using the Spearman's rank test. Analysis of covariance between the predictor and outcome, adjusted for covariates (body mass index), was performed. RESULTS: Fifty-four subjects with a mean age of 20.89 years and 52% males were enrolled. The mean change in UAV was 0.12 cm3 (standard deviation [SD] 9.21, P = .93) with a mean absolute deviation of 7.28 cm3 (SD 5.54). The mean change in OHIP-49 score was 20.93 (SD 28.90). Twenty-seven (50%) subjects had increased UAV (7.4 cm3, SD 6.13) and the other had decreased (-7.17 cm3, SD 5.01) (P = .01). At follow-up, equal levels of mean OHIP-49 score were found, but because of a baseline difference (15.74, P = .048), the subjects with and without increased UAV improved in OHIP-49 score 13.04 (SD 30.53) and 28.81 (SD 25.33), respectively (P = .04). CONCLUSIONS: Because equal levels of OHIP-49 score at follow-up, changes in UAV could not be associated with patient-reported health-related quality of life. Patient-reported outcome measure evaluations of orthognathic surgical treatment for airway obstruction should be performed in patients with a perceived impairment.

Outcome measures of the surgery first approach for orthognathic correction of dentofacial deformities.

In the surgery-first approach (SFA), orthognathic surgery is performed without the need for presurgical orthodontic treatment. This study was aimed at assessing the treatment durations and occlusal outcomes for a consecutive cohort of patients, with a range of dentofacial deformities, who had completed orthognathic treatment using SFA. The duration of orthognathic treatment was measured. The overall change in occlusion, and the quality of the final occlusion, were evaluated using the patients' study casts. A single, independent, calibrated operator carried out the occlusal scores, using the validated Peer Assessment Rating (PAR) index. This was repeated to test intraoperator reliability. A total of 51 patients completed surgery-first treatment during the study period. The mean (range) age at surgery was 23.3 (15-47) years. The pre-treatment skeletal jaw relationship was Class III in 39 cases, and Class II in 12 cases. The mean (SD) overall treatment duration was 11.7 (5.7) months. The intraexaminer reliability of assessing the occlusion was high. The PAR scores confirmed a significant improvement in the quality of occlusion at the completion of treatment, which compares favourably with previous studies on the conventional orthodontics-first approach. The surgery first approach can be effective at correcting both Class II and Class III malocclusion types with reduced treatment times.

Does cleft lip and palate affect the severity of malocclusion?

OBJECTIVE: The purpose of this study was to evaluate the 3D anatomical features of unilateral (UCLP) and bilateral (BCLP) complete cleft lip and palate with those of skeletal Class III dentofacial deformities. MATERIALS AND METHODS: In total, 92 patients were divided into cleft and noncleft groups. The cleft group comprised 29 patients with UCLP and 17 patients with BCLP. The noncleft group comprised 46 patients with Class III dentofacial deformities. 3D anatomical landmarks were identified and the corresponding measurements were made on the cone-beam computed tomography (CBCT). RESULTS: The differences between the affected and unaffected sides of the patients with UCLP were nonsignificant. The differences between the patients with UCLP and BCLP were nonsignificant except for the SNA angle. Significant differences between the patients with clefts and Class III malocclusion were identified for the SNA, A-N perpendicular, and A-N Pog line, indicating that the maxillae of the patients in the cleft group were more retrognathic and micrognathic. Relative to the noncleft group patients, the cleft group patients had a significantly smaller ramus height. CONCLUSION: The affected and unaffected sides of the patients with UCLP did not exhibit significant differences. The maxillae of the patients with UCLP were significantly more retrognathic than those of the patients with BCLP. The maxillae and mandibles of the patients in the cleft group were more micrognathic and retropositioned relative to those of the noncleft Class III patients. CLINICAL RELEVANCE: The maxillary and mandibular findings indicated greater deficiencies in the patients with UCLP or BCLP than in those with skeletal Class III malocclusion. Appropriate surgical design should be administered.

Integrating artificial intelligence in orthognathic surgery: A case study of ChatGPT's role in enhancing physician-patient consultations for dentofacial deformities.

Orthognathic surgery, a multidisciplinary treatment for dentofacial deformities, presents complex preoperative preparations and follow-up procedures. This study aims to evaluate the effectiveness of ChatGPT-4, an artificial intelligence-based language model, as a supportive tool during patient consultations for orthognathic surgery. Nine critical questions that candidates for orthognathic surgery should ask during a consultation were identified and posed to ChatGPT-4. The responses were subsequently assessed by experienced plastic surgeons and collaborating orthodontists at a leading orthognathic surgery center. Evaluations focused on the accuracy, clarity, and comprehensibility of the information provided. ChatGPT-4 generated comprehensive, clear, and accurate responses, offering critical technical information to guide patients through the complexities of orthognathic surgery. However, it consistently underscored the necessity of individualized responses and emphasized that specialized medical consultation is crucial for treatment and follow-up plans. While ChatGPT-4 shows promise as a reliable informational resource, it cannot fully replace the nuanced physician-patient relationship, particularly in situations requiring emotional intelligence and specialized expertise. ChatGPT-4 can serve as an informative and guiding assistant during the consultation process for orthognathic surgery, although it cannot substitute for direct medical consultation. This tool could be an asset for both patients and physicians in managing the intricate treatment process of orthognathic surgery.

Body mass index and weight loss in patients submitted to orthognathic surgery: a prospective study.

OBJECTIVE: To compare the body mass index (BMI) and the weight loss (WL) in patients with dentofacial deformities who underwent monomaxillary versus bimaxillary orthognathic surgery. MATERIALS AND METHODS: This prospective longitudinal study included 69 patients with dentofacial deformities who underwent surgical orthodontic treatment. Patients were divided into two groups according to the type of orthognathic surgery: monomaxillary or bimaxillary. A preoperative nutritional assessment based on BMI was performed; the percentage of involuntary WL between the preoperative and postoperative periods was also calculated. Data were collected at preoperative and 10, 40, and 90 days postoperative (PO). Statistical analysis was performed using SPSS 17.0 (IBM Corp., Armonk, NY, USA), and data are reported with 95% confidence interval. RESULTS: According to BMI, patients who underwent monomaxillary surgery presented: underweight = 2.6%, normal weight = 51.3%, overweight = 35.9%, and obese = 10.3%. The subjects who underwent bimaxillary surgery presented: normal weight = 43.3%, overweight = 36.7%, and obese = 20%. BMI was similar between the groups at all time points (preoperative, p= 0.237; 10 days PO, p= 0.325; 40 days PO, p= 0.430; and 90 days PO, p= 0.609). All patients lost weight postoperatively, and WL was similar among the PO measurements (p= 0.163). CONCLUSIONS: Although both monomaxillary and bimaxillary orthognathic surgeries resulted in WL and lower BMI, there was no statistically significant difference in these metrics between the two types of surgery.

Impact of patient age on the functional and psychosocial outcomes of orthognathic treatment.

Orthognathic treatment has been demonstrated to enhance oral function and quality of life. In the UK, prior approval criteria have been trialled to govern the provision of orthognathic surgery within the National Health Service (NHS). These include the patient's age and presence of functional concerns. The purpose of this paper was to examine the outcomes of orthognathic treatment with respect to patient age at the start of treatment. This was a retrospective evaluation of a single surgeon's experience of patients treated for dentofacial deformity over a 17-year period. A total of 118 patients completed pre-treatment and post-treatment questionnaires. There were significant improvements (p < 0.001) in reported functional problems, and in Body Satisfaction Scale (BSS), General Health Questionnaire (GHQ-12), and in Anxiety questionnaire scores. There was no difference in outcome when younger and older patients were compared. Orthognathic treatment produced positive functional and psychosocial outcomes irrespective of the patient's age at the start of treatment.

Rehabilitation of Dentofacial Asymmetry Secondary to Unilateral Temporomandibular Joint Ankylosis with Dual Distraction and Fixed Orthodontics - Stability at Three-year Follow-up.

Optimal rehabilitation of asymmetric dentofacial deformity secondary to unilateral temporomandibular joint (TMJ) ankylosis is often a challenge. The purpose of this case series is to present an insight into esthetic, occlusal and functional rehabilitation of two patients with varying degree of asymmetric Class II dentofacial deformities secondary to long-standing unilateral TMJ ankylosis. The patients were treated with one-stage surgical protocol employing simultaneous dual distraction technique along with interpositional arthroplasty. Dual distraction technique entailed the simultaneous use of two distractors which allowed for proper control of proximal condylar segment during the course of distraction and lowering the risk of ankylosis recurrence. Thereafter, comprehensive fixed orthodontic mechanotherapy involving the use of temporary anchorage devices was instituted to align and level the compensated dentition. Post-treatment records showed significant improvements in skeletal disharmony and functional stability with good functional occlusion. At the three-year follow-up, the morphological and functionally acceptable results were reasonably well-maintained, with no signs of relapse. Through the two cases reported here, we would like to highlight that one-stage concurrent arthroplasty and dual distraction technique is a safe, stable, and reliable approach for surgical and functional rehabilitation of an adult asymmetric dentofacial deformity secondary to unilateral TMJ ankylosis. Meticulously executed comprehensive orthodontic manipulations involving use of acrylic bite-blocks, elastic traction, and temporary skeletal anchorage device play a crucial role in enhancing the final occlusal outcomes.

Plication of the Suprahyoid Muscles Concomitant with Genioplasty to Improve the Aesthetics of the Submandibular Region / Plicatura de los Músculos Suprahioideos Concomitante con Genioplastia para Mejorar la Estética de la Región Submandibular

In addition to functionally correcting skeletal facial deformities, orthognathic surgery also has a great impact on aesthetics and facial proportions. However, patients who have soft tissue changes, such as tissue flaccidity, may not achieve an ideal result, and require complementary surgical techniques that promote aesthetic refinement. The literature on less invasive techniques is limited, and therefore, this work aims to report a surgical technique performed concomitantly with genioplasty to refine the harmony of the submandibular region, in a simple and effective way. Patient with skeletal class II deformity, with lack of mandibular definition and submandibular flaccidity, underwent bimaxillary advancement orthognathic surgery with advancement genioplasty to correct chin retrusion. Due to limited results with bone repositioning alone, plication of the suprahyoid musculature was performed in association with the same approach used in the genioplasty. As a result, there was traction in the cervical region, with a consequent decrease in the submental-cervical angle and improvement in submandibular aesthetics. Furthermore, there was no need for extensive surgical intervention and no impairment of the functional results of the orthognathic surgery itself. Therefore, it can be concluded that plication of the suprahyoid musculat ure concomitantly with genioplasty is a technique that promotes aesthetic gains in the cervical region.

Además de corregir funcionalmente las deformidades faciales esqueléticas, la cirugía ortognática también tiene un gran impacto en la estética y las proporciones faciales. Sin embargo, los pacientes que tienen cambios en los tejidos blandos, como la flacidez, pueden no lograr un resultado ideal y requieren técnicas quirúrgicas complementarias que promuevan el refinamiento estético. La literatura sobre técnicas menos invasivas es limitada, por lo que este trabajo tiene como objetivo reportar una técnica quirúrgica realizada concomitantemente con la genioplastia para refinar la armonía de la región submandibular, de manera simple y efectiva. Se trató a un paciente con deformidad esquelética clase II, con falta de definición mandibular y flacidez submandibular, intervenida de cirugía ortognática de avance bimaxilar con genioplastia de avance para corregir la retrusión del mentón. Debido a los resultados limitados solo con el reposicionamiento óseo, se realizó la plicatura de la musculatura suprahioidea en asociación con el mismo abordaje utilizado en la genioplastia. Como resultado, hubo tracción en la región cervical, con la consiguiente disminución del ángulo submentoniano-cervical y mejoría en la estética submandibular. Además, no hubo necesidad de una intervención quirúrgica extensa ni deterioro de los resultados funcionales de la cirugía ortognática en sí. Por lo tanto, se puede concluir que la plicatura de la musculatura suprahioidea concomitantemente con la genioplastia es una técnica que promueve ganancias estéticas en la región cervical.

The effect of mandibular advancement for mandibular deficiency dentofacial deformities on laryngeal grade and intubation difficulty: a preliminary study.

OBJECTIVE: The purpose of this study was to evaluate mandibular advancement for cases of mandibular deficiency with changes in vocal cord grade and intubation difficulty at subsequent surgery requiring intubation. STUDY DESIGN: This retrospective case series included patients with a diagnosis of mandibular deficiency (Class II skeletal dentofacial deformity) who underwent mandibular advancement surgery (T1) followed by a subsequent surgery (T2) which required intubation. The primary predictor variable was mandibular advancement. The primary outcome variable was the change in laryngeal grade-Cormack and Lehane-after mandibular advancement. A secondary outcome was intubation difficulty after mandibular advancement. RESULTS: Eight patients were included in the study. At T1, the average laryngeal grade was 1.6. There was 1 difficult intubation. The average time to T2 was 9 months. At T2, all patients were intubated on their first attempt, and all had a Cormack-Lehane Grade I view of the vocal cords. There were no difficult intubations at T2. Analysis showed a significant association between mandibular advancement and laryngeal grade at T2 (P = .03; 95% CI 0.07-1.13). CONCLUSIONS: This preliminary investigation found an association between mandibular advancement for cases of mandibular and improved laryngeal grade at subsequent intubation without any difficult intubations.

Treatment of dentofacial deformities secondary to condylar hyperplasia.

Dentofacial deformities secondary to condylar hyperplasiais a kind of disease presenting facial asymmetry, malocclusion, temporomandibular joint dysfunction, and other symptoms caused by non-neoplastic hyperplasia of the condyle. The etiology is still unknown, and currently, pre- and post-operative orthodontics accompanied by orthognathic surgery, temporomandibular joint surgery and jawbone contouring surgery are the main treatment methods. A personalized treatment plan was developed, considering the active degree of condyle hyperplasia, the severity of the jaw deformity, and the patient's will, to correct deformity, obtain ideal occlusal relationship, and regain good temporomandibular joint function. Combined with the author's clinical experience, the etiology, clinical and imageological features, treatment aims, and surgical methods of condylar hyperplasia and secondary dentofacial deformities were discussed in this paper.

Maxillomandibular Advancement Efficacy in Obstructive Sleep Apnea Patients With Class 2 Versus 3 Dentofacial Deformity.

OBJECTIVE: To compare the efficacy of maxillomandibular advancement (MMA) for patients with obstructive sleep apnea (OSA) with class 2 versus 3 dentofacial deformities (DFDs). STUDY DESIGN: Retrospective chart review. SETTING: Tertiary sleep surgery center. METHODS: Patients with OSA and DFD class 2 versus 3 undergoing MMA at Stanford Sleep Surgery between 2014 and 2021 were matched by preoperative body mass index (BMI), age, and sex. Postoperative outcome was compared with polysomnography measures and patient-reported outcome measures (PROMs). RESULTS: Twenty-eight matched subjects, 14 in each deformity group were identified and assessed. The mean age (standard deviation) was 34.29 (10.21) and 33.86 (10.23) for classes 2 and 3, respectively. The apnea-hypopnea index (AHI) decreased from 43.42 (28.30) to 9.6 (5.29) (p < .001) and 37.17 (35.77) to 11.81 (15.74) (p = .042) in class 2 and 3 subjects, respectively. The oxygen desaturation index (ODI) changed from 30.48 (24.02) to 6.88 (3.39) (p = .024) and 11.43 (11.40) to 5.44 (7.96) (p = .85) in class 2 and 3 subjects, respectively. The Epworth sleepiness scale changed from 8.93 (5.28) to 3.91 (2.70) (p = .018) and 10.23 (4.38) to 4.22 (3.07) (p = .006) in class 2 and 3 subjects, respectively. CONCLUSION: Among age, sex, and BMI-matched subjects, MMA is equally effective in both dentofacial class 2 and 3 groups, both objectively and subjectively. Preoperatively, dentofacial class 2 patients with OSA presented with the more severe disease with higher AHI and ODI. Dentofacial class 3 patients with OSA may require additional attention to improve nasal function outcomes.

Assessment of temporomandibular disorders and their relationship with life quality and salivary biomarkers in patients with dentofacial deformities: A clinical observational study.

A close relationship between dentofacial deformities (DFD) and temporomandibular disorders (TMD) has been suggested, which might impact the quality of life (QoL) and psychological aspects. We evaluated the presence of TMD in DFD patients, correlating these findings with QoL and salivary levels of biochemical markers of pain and psychological disorders. The study enrolled 51 patients, which were distributed into three groups: (i) orthodontic, (ii) TMD, and (iii) DFD. TMD diagnosis was conducted according to Axis I and II of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). QoL was evaluated by the Oral Health Impact Profile (OHIP-14). The salivary levels of interleukin-1ß (IL-1ß) were determined by ELISA, while glutamate and serotonin amounts were evaluated by mass spectroscopy. DFD individuals had a positive diagnosis for TMD, as indicated by the Axis I (DC/TMD). They exhibited poorer outcomes regarding pain, functional, and psychological dimensions, according to the Axis II DC-TMD. The QoL evaluation demonstrated poorer outcomes for DFD individuals, accompanied by greater IL-1ß salivary contents. Notably, glutamate levels had a positive correlation with behavioral parameters in Axis II DC-TMD, with a mild relevance for serotonin. DFD patients display chronic myofascial pain featuring TMD, with altered psychological symptoms and poor QoL, encompassing changes in pain mediators. Data bring new evidence about the relevance of TMD in DFD patients, which likely impacts the QoL and the salivary levels of biochemical markers of functional, painful, and psychological disorders.

Prevalence of signs and symptoms related to temporomandibular disorders and orofacial pain in patients indicated for orthognathic surgery: a meta-analysis.

OBJECTIVE: To evaluate the prevalence of signs and symptoms related to temporomandibular disorders (TMD) and orofacial pain in patients with indication for orthognathic surgery. METHODS: The search was carried out in seven electronic databases and gray literature. Studies that evaluated the frequency of signs and symptoms related to TMD and orofacial pain were included. The risk of bias was assessed using the Joanna Briggs Critical Appraisal tool. A meta-analysis of proportions with a random effect model was performed and the GRADE tool judged the certainty of evidence. RESULTS: After searching the databases, 1859 references were retrieved, 18 of which were selected for synthesis. The prevalence of individuals with at least one TMD symptom was 51% [CI95% = 44-58%], and 44% of the subjects had temporomandibular joint click/crepitus [CI95% = 37-52%]. Additionally, 28% exhibited symptoms related to muscle disorders [CI95% = 22-35%], 34% had disc displacement with or without reduction [CI95% = 25-44%], and 24% had inflammatory joint disorders [CI95% = 13-36%]. The prevalence of headache was 26% [CI95% = 8-51%]. The certainty of evidence was considered very low. CONCLUSION: Approximately 1 in 2 patients with dentofacial deformity presents some sign and symptom related to TMD. Myofascial pain and headache may be present in approximately a quarter of patients with dentofacial deformity. CLINICAL RELEVANCE: A multidisciplinary treatment is necessary for these patients, involving a professional with expertise in the management of TMD.

Does orthognathic surgery have an incidentally beneficial effect on mild or asymptomatic sleep apnoea?

A prospective study was performed to assess the effect of orthognathic surgery on mild obstructive sleep apnoea (OSA) in patients with an underlying dentofacial deformity treated for occlusal and/or aesthetic reasons. As the main outcome variables, changes in upper airway volume and apnoea-hypopnoea index (AHI) were evaluated at 1 and 12 months of follow-up, in patients undergoing orthognathic surgery with widening movements of the maxillomandibular complex. Descriptive, bivariate, and correlation analyses were performed; significance was set at P < 0.05. Eighteen patients diagnosed with mild OSA were enroled (mean age 39.8 ± 10.0 years). An overall upper airway volume widening of 46.7% after orthognathic surgery was observed at 12 months of follow-up. The AHI decreased significantly from a median 7.7 events/hour preoperatively to 5.0 events/h at 12 months postoperative (P = 0.045), and the Epworth Sleepiness Scale score decreased from a median 9.5 preoperatively to 7 at 12 months postoperative (P = 0.009). A cure rate of 50% was obtained at 12 months of follow-up (P = 0.009). Despite the limited sample size, this study provides evidence that in patients with an underlying retrusive dentofacial deformity and mild OSA, a slight decrease in AHI is obtained after orthognathic surgery due to upper airway enlargement, which could be added as a beneficial effect of orthognathic surgery.

The impact of orthognathic surgery on quality of life for class III dentofacial deformities.

In this study, we aim to evaluate the quality of life in patients with Class III deformities after orthognathic surgery. A total of the 40 patients (26 female and 14 male) were included. The mean age of the patients was 24.85. Patients' ages ranged from 20 to 36 years. All patients received orthodontic treatment before surgery. Sagittal split ramus osteotomy was performed for single jaw patients. Le Fort I osteotomy and sagittal split ramus osteotomy was performed for double jaw patients. Patients completed the Oral Health Impact Profile 14 (OHIP-14) and Orthognathic Quality of Life Questionnaire (OQLQ) three times. [Preoperatively (T0), 1st week after orthognathic surgery (T1) and in the 6th - 12th months after orthognathic surgery (T2)]. There was a statistically significant difference in the dimensions of OHIP-14 when the preoperative (T0) score, postoperative 1st week (T1) score and postoperative 6th - 12th month (T3) score are compared among themselves except for psychological discomfort, physical disability, and handicap. OQLQ total score and preoperative (T0) score was greater than the postoperative 1st week (T1) score and the postoperative 1st week(T1) score was greater than the postoperative 6th - 12th month (T2) scores except oral function. When single jaw and double jaw surgeries were compared, no statistically significant difference was found between OHIP-14 and OQLQ total scores for preoperative, postoperative 1st week, and postoperative 6th - 12th months. When both OHIP-14 and OQLQ scores were examined after orthognathic surgery, the OHRQOL of patients with Class III dentofacial deformity improved significantly.

Associations between temporomandibular disorders, pain, jaw and masticatory function in dentofacial deformity patients: A cross-sectional study.

BACKGROUND AND OBJECTIVE: Patients with dentofacial deformity often present with impaired masticatory function, orofacial pain and temporomandibular disorders (TMD). This study investigates the relationship between TMD, pain, jaw and masticatory function at different stages of orthognathic surgical (OS) treatment. METHODS: A total of 120 OS patients were prospectively recruited and grouped as pre-orthodontic (group 1), pre-surgery (group 2), 4-month post-surgery (group 3), 24-month post-surgery (group 4), in addition to 30 controls (group 0). Outcomes were assessed using: Jaw Function Limitation Scale (JFLS), McGill pain questionnaire, DC/TMD instrument, voluntary maximum bite force (MVBF), and masticatory efficiency (ME) using two-coloured chewing gum. Data were analysed using structural equation modelling. RESULTS: The prevalence of non-painful TMD did not differ between groups (p = .827). However, the prevalence of painful TMD differed between groups (p = .001). Among the painful TMDs, the highest prevalence was observed for masseter myalgia in group 2 (p = .031), and importantly group 4 did not differ from group 0 (p = .948). The MPQ score was significantly higher in group 1 (p = .001) compared to group 0, and the JFLS score was significantly higher in groups 1, 2 and 3 compared to group 0. Notably, MPQ (p = .756) and JFLS (p = .572) scores in group 4 were not different from group 0. However, MVBF (p = .996) and ME (p = .991) did not differ between groups 1 and 4. The association of self-reported pain and jaw function with the masticatory function was observed in OS patients. CONCLUSION: OS was not associated with a negative impact on TMD. Jaw function and pain levels were similar to controls at the 24-month follow-up. The masticatory function was further affected by the surgery and seems to require a longer recovery time. Moreover, it was confirmed that pain and TMD were associated with limitations in jaw function and impacts on masticatory function.

Rehabilitation of severe dentofacial deformity after early radiotherapy of retinoblastoma: a case report.

BACKGROUND: Retinoblastoma is an intraocular cancer of infancy and childhood, which has been treated with radiation therapy and chemotherapy. Radiation on growing patients can cause deterioration in maxillofacial growth and development that leads to severe skeletal discrepancies between the maxilla and mandible, and dental problems such as crossbite, openbite, and hypodontia. CASE PRESENTATION: We present the case of a 19-year-old Korean man with chewing disability and dentofacial deformities. He had undergone enucleation of the right eye and radiation therapy of the left eye due to retinoblastoma 100 days after birth. Subsequently, he received cancer therapy for the secondary nasopharyngeal cancer at the age of 11 years. He was diagnosed with severe skeletal deformity including sagittal, transverse, and vertical growth deficiency of the maxilla and midface, and with class III malocclusion, severe anterior and posterior crossbite, posterior openbite, multiple missing upper incisors, right premolars, and second molars, and impaction of the lower right second molars. To restore impaired functions and esthetics of the jaw and dentition, the orthodontic treatment combined with two jaw surgery was performed. At the end of surgical orthodontics, dental implants were placed for prosthetic treatment of missing teeth. Additional plastic surgery for zygoma elevation was done with calvarial bone graft followed by fat graft. Facial esthetics and occlusal functions of patient were favorably enhanced with the improvement of skeletal discrepancy and the rehabilitation of maxillary dentition by prosthetic work. At the 2-year follow-up, the skeletal and dental relationships and implant prosthetics were well maintained. CONCLUSION: In an adult patient with dentofacial deformities caused by early cancer therapy in the head and neck area, interdisciplinary interventions including additional plastic surgery of zygoma depression and prosthetic work of missing teeth as well as surgical-orthodontic treatment could establish favorable facial esthetics and oral rehabilitation.