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1.
J Craniofac Surg ; 32(6): 2202-2204, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34516059

RESUMO

ABSTRACT: Repeated sagittal split osteotomy might impose an increased risk for damage of the inferior alveolar nerve. Another contemporary orthognathic issue is surgical management of malocclusion following condylar resorption. Here we describe a modified C-osteotomy technique as a proposed solution for these difficulties in orthognathic surgery. The modified C-osteotomy might induce less stress on the condyles reducing the risk for relapse subsequent to condylar resorption, as well as reduce the risk of inferior alveolar nerve damage.


Assuntos
Má Oclusão , Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Humanos , Mandíbula , Côndilo Mandibular , Nervo Mandibular , Osteotomia Sagital do Ramo Mandibular
2.
Biomed Res Int ; 2021: 9923789, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34337064

RESUMO

Purpose: The aim of this study was to determine changes in the tongue area and pharyngeal airway space (PAS) after intraoral vertical ramus osteotomy (IVRO). Materials and Methods: Serial lateral cephalograms of 40 patients with mandibular prognathism who underwent IVRO were evaluated before (T1), immediately after (T2), and more than 1 year after (T3) surgery. Paired t-tests and Pearson's correlation analysis were used to evaluate the postoperative changes in the mandible, nasopharyngeal airway (NOP), retropalatal pharyngeal airway (RPP), retroglossal pharyngeal airway (RGP), hypopharyngeal airway (HOP), PAS, and tongue area (TA). The null hypothesis states that there are no significant correlations among the extent of mandibular setback and the changes in the TA and PAS after IVRO. Results: Immediately after the operation (T12), the mandible was set back by 12.6 mm. The NOP, HOP, and PAS were significantly reduced by 35.7 mm2, 116 mm2, and 185 mm2, respectively. The TA was increased by 69.6 mm2. The changes in PAS and TA revealed no significant difference between female and male patients at T12, T23, and T13. Moreover, no significant correlations were found among the extent of mandibular setback, TA changes, and PAS changes after IVRO. Thus, the null hypothesis was accepted. Conclusions: At the final follow-up (T13), no significant change was found in the PAS (including NOP, RPP, RGP, and HOP) and TA. The changes in PAS and TA revealed no significant difference between female and male patients at T12, T23, and T13.


Assuntos
Mandíbula/cirurgia , Osteotomia Sagital do Ramo Mandibular , Faringe/patologia , Língua/patologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Período Pós-Operatório , Resultado do Tratamento , Adulto Jovem
3.
J Craniofac Surg ; 32(6): e598-e600, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34387266

RESUMO

ABSTRACT: In this retrospective analysis, we examined temporomandibular joint space volume and condyle position in 10 patients undergoing bilateral sagittal split mandibular ramus osteotomy plus Le Fort I osteotomy to correct mandibular asymmetry. Cone beam computed tomography was used to map temporomandibular joint prior to (T0), immediately after (T1), and at 1 year after surgery (T2). In the deviated side, we detected significant lateral shift of the condyle in 5 patients at T1, and the shift disappeared at T2. In the non-deviated side, we detected significant medial shift of the condyle in all 10 patients at T1; the shift continued in 9 patients at T2. Temporomandibular joint space volume increased significantly at T1 and returned to presurgical volume at T2. In conclusion, there is significant shift in position of condyle in majority of the patients after bilateral sagittal split mandibular ramus osteotomy. The most consistent and persisting change was medial shift on the nondeviated side.


Assuntos
Côndilo Mandibular , Osteotomia Sagital do Ramo Mandibular , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/cirurgia , Estudos Retrospectivos , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/cirurgia
4.
Br J Oral Maxillofac Surg ; 59(8): 965-967, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34456077

RESUMO

Bilateral sagittal split osteotomy (BSSO) is the most common orthognathic surgical procedure for the correction of facial deformities. Like any other surgical procedure, it is also associated with a risk of complications. One of these is described in the literature as notching at the lower inferior border of the mandible. Such discontinuity in the contour of the lower border is often a concern for patients. To overcome this complication, we recommend a modified vertical osteotomy cut while performing BSSO.


Assuntos
Procedimentos Cirúrgicos Ortognáticos , Osteotomia Sagital do Ramo Mandibular , Humanos , Mandíbula/cirurgia , Estudos Retrospectivos
5.
J Craniofac Surg ; 32(8): 2666-2670, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34260465

RESUMO

ABSTRACT: The aim of the study is to evaluate clinical methods to obtain a significantly improved fitting of patient specific implants (PSI) in bilateral sagittal split osteotomies and to evaluate the use of electromagnetic navigation as a potential guide for condyle positioning. A prospective study using (1) a solid bite registration index during preoperative computed tomography, (2) critical planning with regard to the condylar rotation, (3) a piezoelectric saw throughout the mandibular osteotomy, and (4) intraoperative navigation to determine the position of the PSIs and the mandibular segments intraoperatively was performed. Ten patients were treated. Five underwent bilateral sagittal split osteotomies and 5 bimaxillary osteotomy. All of the PSIs fitted precisely onto the mandible and the screws into the predrilled screw holes. The predetermined occlusion was obtained. A precise fitting of the PSIs in the lower jaw seems to be possible to achieve with above-mentioned methods. The intraoperative navigation system gives a possibility to verify the surgical outcome during surgery but is not accurate enough to be used as a virtual drill guide alone.


Assuntos
Implantes Dentários , Osteotomia Mandibular , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Côndilo Mandibular , Osteotomia Sagital do Ramo Mandibular , Estudos Prospectivos
6.
J Craniofac Surg ; 32(7): e682-e686, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34260469

RESUMO

ABSTRACT: This study aimed to assess the effect of bone buttressing at the vertical osteotomy site on postoperative stability after mandibular setback surgery and determine factors contributing to postoperative relapse. This retrospective study was conducted on patients who received mandibular setback surgery using bilateral sagittal split ramus osteotomy. Patients were divided into two groups: group I, intimate bony contact, and group II, bony gap of 2 mm or more. Using lateral cephalograms taken before surgery, 1 week after surgery, and 6 months after surgery, surgical changes, and postoperative relapse were compared between 2 groups. To assess associations between postoperative relapse and other variables, Pearson correlation analysis and multiple linear regression analysis were performed. Twenty-eight patients were evaluated (17 in group I and 11 in group II). Mean relapse was greater in group II (1.8 mm) than in group I (1.2 mm), although there were no significant differences between 2 groups (P = 0.203). Postoperative relapse was significantly associated with intraoperative clockwise rotation of the proximal segment (P < 0.001) and the amount of mandibular setback (P = 0.038). Bony gap was only correlated with postoperative counterclockwise rotation of the proximal segment (P = 0.014). In the regression analysis, intraoperative clockwise rotation of the proximal segment significantly predicted postoperative relapse (P < 0.001, R2 = 0.388). The absence of bone buttressing at the vertical osteotomy site may not significantly affect postoperative stability after mandibular setback surgery, and it is important to minimize intraoperative clockwise rotation of the proximal segment for better postoperative stability.


Assuntos
Prognatismo , Cefalometria , Seguimentos , Humanos , Mandíbula/cirurgia , Osteotomia de Le Fort , Osteotomia Sagital do Ramo Mandibular , Recidiva , Estudos Retrospectivos
7.
Biomed Res Int ; 2021: 4439867, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34285911

RESUMO

Purpose: The purpose of the present study was to review the literature regarding the blood loss and postoperative pain in the isolated sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO). Materials and Methods: Investigating the intraoperative blood loss and postoperative pain, articles were selected from 1970 to 2021 in the English published databases (PubMed, Web of Science, and Cochrane Library). Article retrieval and selection were performed by two authors, and they independently evaluated them based on the eligibility criteria. The articles meeting the search criteria had especially at least 30 patients. Results: In the review of intraoperative blood loss, a total of 139 articles were retrieved and restricted to 6 articles (SSRO: 4; IVRO: 2). In the review of postoperative pain, a total of 174 articles were retrieved and restricted to 4 articles (SSRO: 3; IVRO: 1). The mean blood loss of SSRO and IVRO was ranged from 55 to 167 mL and 82 to 104 mL, respectively. The mean visual analog scale (VAS) scores of the first postoperative day were 2 to 5.3 in SSRO and 2.93 to 3.13 in IVRO. The mean VAS scores of the second postoperative day were 1 to 3 in SSRO and 1.1 to 1.8 in IVRO. Conclusion: Compared to traditional SSRO, IVRO had a significantly lower amount of blood loss. However, the blood transfusion is not necessary in a single-jaw operation (SSRO or IVRO). Postoperative pain was similar between SSRO and IVRO.


Assuntos
Perda Sanguínea Cirúrgica , Osteotomia Sagital do Ramo Mandibular/efeitos adversos , Dor Pós-Operatória/etiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-34274287

RESUMO

OBJECTIVE: This study aimed to assess mandibular morphologic changes to the condyle, ramus, mandibular body, and inferior mandibular border defect after sagittal split ramus osteotomy in class II and III patients. STUDY DESIGN: The relationships among the condyle, ramus, and mandibular body measured by computed tomography preoperatively and postoperatively were assessed and factors related to the reduction of the condylar square and mandibular inferior border defect were examined. RESULTS: Patients included 72 female patients with jaw deformity (36 skeletal class II cases, 36 skeletal class III cases). Postoperative reduction of the condylar square was significantly correlated with preoperative condylar height in patients with class II (P = .0297) vs preoperative condylar height and preoperative mandibular height in patients with class III (P < .0001). A mandibular inferior border defect was found in 18 of 72 class II sides (25.0%) and was significantly related to the position of the osteotomy line and attachment side of the inferior border cortex (P < .0001). CONCLUSIONS: This study's findings suggest that the postoperative reduction of the condyle could be associated with preoperative condylar height. However, the mandibular inferior border defect in class II advancement surgery could be independently associated with technical factors in sagittal split ramus osteotomy.


Assuntos
Má Oclusão Classe III de Angle , Osteotomia Sagital do Ramo Mandibular , Feminino , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Côndilo Mandibular , Tomografia Computadorizada por Raios X
9.
J Oral Maxillofac Surg ; 79(11): 2320-2333, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34245697

RESUMO

PURPOSE: Three-dimensional (3D) assessment of orthognathic surgery is often time consuming, relies on manual re-identification of anatomical landmarks or is limited to non-segmental osteotomies. The purpose of the present study was to propose and validate an automated approach for 3D assessment of the accuracy and postoperative outcome of segmental bimaxillary surgery. METHODS: A semi-automatic approach was developed and validated for virtual surgical analysis (VSA) of segmental bimaxillary surgery using a pair of pre- and postoperative (2 weeks) cone-beam computerized tomography (CBCT) scans. The output of the VSA, the accuracy of the surgical outcome, was calculated as 3D translational and rotational differences between the planned and postoperative movements of the individual bone segments. To evaluate the reliability of the proposed VSA, intra-class correlation coefficients (ICC) were calculated at a 95% confidence interval on measurements of 2 observers. The VSA was deemed reliable if the ICC was excellent (> 0.80) and the absolute difference of the repeated intra- and inter-observer translational and rotational measurements were significantly lower (p < 0.05) than a hypothesized clinical relevant threshold of 1 voxel (0.45 mm) and 1 degree, respectively. RESULTS: A total of 10 subjects (6 male; 4 women; mean age 24.4 years) with skeletal class 2 and 3, who underwent segmental bimaxillary surgery, 3-piece Le Fort I, bilateral sagittal split osteotomy and genioplasty, were recruited. The intra- and inter-observer reliability was excellent, ICC range [0.96 - 1.00]. The range of the mean absolute difference of the repeated intra- and inter-observer translational and rotational measurements were [0.07 mm (0.05) - 0.20 mm (0.19)] and [0.11˚ (0.08) - 0.63˚ (0.42)], respectively. This was significantly lower than the hypothesized clinical relevant thresholds (P < .001). CONCLUSION: The validation showed that the VSA has excellent reliability for quantitative assessment of the postoperative outcome and accuracy of segmental bimaxillary surgery.


Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Adulto , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Imageamento Tridimensional , Masculino , Osteotomia de Le Fort , Osteotomia Sagital do Ramo Mandibular , Reprodutibilidade dos Testes , Adulto Jovem
10.
Br J Oral Maxillofac Surg ; 59(6): 678-682, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33952406

RESUMO

To identify the potential risk factors for bad splits, we calculated the incidence of bad splits from 484 patients with 964 cases of sagittal split ramus osteotomy (SSRO) and investigated the association between the occurrence of bad splits and risk factors such as gender, patients' age, class of occlusion, unimaxillary or bimaxillary surgery, presence of the lower third molar, thickness of the ascending ramus, and the distance from the mandibular canal to the buccal cortical bone. The results showed that 40 sides (4.149%) with bad splits occurred in 36 patients (7.438%). The mean (SD) gap width from the canal to the buccal cortex for the bad split group, at 4.02 (1.20)mm, was narrower (p=0.003; OR=0.689; 95% CI=0.538 to 0.882) than the normal split group 4.80 (1.72)mm. On the contrary, no statistical significance (p>0.05) was detected between the patients with bad splits and those with normal splits for the other factors. In conclusion, SSRO patients with narrower distances from the mandibular canal to the buccal cortex were more prone to bad splits. More attention should be paid to patients with this risk factor during future surgeries.


Assuntos
Mandíbula , Osteotomia Sagital do Ramo Mandibular , Humanos , Mandíbula/cirurgia , Dente Serotino , Osteotomia Sagital do Ramo Mandibular/efeitos adversos , Estudos Retrospectivos , Fatores de Risco
11.
J Craniomaxillofac Surg ; 49(7): 545-555, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33992517

RESUMO

The aim of this prospective observational study was to investigate the parameter 'hidden blood loss' (HBL) in the context of orthognathic surgery, incorporating undetected bleeding volumes occurring intra- and postoperatively. Orthognathic bleeding volumes were recorded at three different time points. At the end of the operation the visible intraoperative blood loss (VBL) was measured. Additionally, the perioperative blood loss was calculated 24 h and 48 h postoperatively using the 'haemoglobin balance method'. Analysis of the HBL was based on the difference between the visible intraoperative blood loss (VBL) and calculated blood loss (CBL), determined 48 h after surgery. 82 patients (male 33, female 49) were included in this study, of whom 41 underwent bimaxillary surgery and of whom 41 underwent Bilateral Sagittal Split Osteotomy (BSSO). Statistically significant differences with reference to the absolute bleeding volumes were found when comparing the two treatment modalities. In terms of HBL, a bleeding volume of 287.2 ml (±265.9) in the bimaxillary group and 346.9 ml (±271.3) in the BSSO cohort was recorded. This accounted for 32.2% (bimaxillary surgery) and 62.6% (BSSO) of the CBL after 48 h (BIMAX vs. BSSO, p < 0.001). HBL is a valuable adjunct to record within the perioperative management of orthognathic surgery to further improve patient safety and postoperative outcomes.


Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Perda Sanguínea Cirúrgica , Feminino , Humanos , Masculino , Osteotomia Sagital do Ramo Mandibular , Período Pós-Operatório , Estudos Prospectivos
12.
J Craniomaxillofac Surg ; 49(10): 898-904, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33994293

RESUMO

The aim of this retrospective study was to compare three-dimensional (3D) soft tissue and hard tissue changes between orthodontics-first approach (OFA) and surgery-first approach (SFA) after mandibular setback surgery. All patients underwent bilateral sagittal split osteotomy, and were examined by lateral cephalograms and 3D optical scanner before surgery (T0) and 1 (T1), 3 (T2), and 12 (T3) months after surgery. Three standard angles (FMA, U1 to FH, IMPA) were measured as hard tissue change and the 2 sets of 3D data were superimposed, and volumetric differences were calculated as soft tissue change. Statistical analyses were performed by using unpaired t-tests. Differences with P < 0.05 were considered significant. A total of 39 patients with mandibular prognathism were included in this study. The OFA group consisted of 24 patients and the SFA group of 15 patients. The SFA group exhibited more labial inclination from T1 to T2 (p = 0.008) and T2 to T3 (p = 0.003) than did the OFA group. There were no significant changes at maxilla and mandible at each term of T0, T1, T2 and T3 (p > 0.05), but compared to before surgery, mandibular volume in SFA group significant increased at 1year (p = 0.049) after surgery. We found that the soft tissue changes after the SFA differed significantly from those after the OFA; thus, soft tissue predictions require more care. An analysis of our data compared with OFA and SFA for the patient with mandibular prognathism confirm that the mandibular soft tissue changes by postoperative orthodontic treatment and occlusal relationship in SFA.


Assuntos
Má Oclusão Classe III de Angle , Ortodontia Corretiva , Prognatismo , Cefalometria , Seguimentos , Humanos , Má Oclusão Classe III de Angle/cirurgia , Má Oclusão Classe III de Angle/terapia , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Maxila , Osteotomia Sagital do Ramo Mandibular , Prognatismo/cirurgia , Prognatismo/terapia , Estudos Retrospectivos , Resultado do Tratamento
13.
J Craniomaxillofac Surg ; 49(10): 891-897, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33994296

RESUMO

The retrospective cohort study aimed to assess the incidence and characteristics of these complications in patients who underwent orthognathic procedures. Data on the intraoperative and the postoperative complications were extracted from the patients' medical files. Procedures were further subdivided into single-jaw procedures and bimaxillary procedures. A total of 209 orthognathic procedures were carried out in 190 patients. 184 (88%) were performed to treat angle class III malocclusion, while 25 (12%) aimed to treat class II malocclusion. A total of 94 complication events were observed (44.9% of 209 procedures). 22 of them occurred in single-jaw procedures (28.2% of 78 single jaw operations), and 72 occurred in bimaxillary procedures (55% of 131 bimaxillary operations). When compared regarding the type of complication, complication rates were comparable between the study groups with the exception of late-stage malocclusion. A significant difference (p-value = 0.028) in malocclusion incidences between the bimaxillary and single-jaw groups were observed (9 events, 4.3% and zero events, 0%, respectively). The majority of the complications during and following orthognathic surgical procedures are temporary or minor and require little or no treatment at all.


Assuntos
Má Oclusão Classe III de Angle , Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Cefalometria , Humanos , Má Oclusão Classe III de Angle/cirurgia , Osteotomia de Le Fort , Osteotomia Sagital do Ramo Mandibular/efeitos adversos , Estudos Retrospectivos
14.
J Craniomaxillofac Surg ; 49(8): 639-648, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33994298

RESUMO

This study was performed to evaluate the relationship between condylar height reduction and changes in condylar surface computed tomography (CT) values in jaw deformity patients following orthognathic surgery. Mandibular advancement by sagittal split ramus osteotomy (SSRO) with Le Fort I osteotomy was performed in class II patients, and mandibular setback by SSRO with Le Fort I osteotomy was performed in class III patients. The maximum CT values (pixel values) at five points on the condylar surface and the condylar height, ramus height, condylar square, ramus angle, and gonial angle in the sagittal plane were measured preoperatively and 1 year postoperatively. Disc position was classified as anterior disc displacement (ADD) or other types by using magnetic resonance imaging (MRI). Ninety-two condyles of 46 female patients were prepared for this study. Their temporomandibular joints (TMJs) were divided into two groups based on class (46 joints in class II and 46 joints in class III) and two groups based on the findings (25 joints with ADD and 67 joints with other findings). ADD with and without reduction was observed in two joints in the class III group and in 23 joints in the class II group. The distribution of ADD incidence had not changed 1 year after surgery. Condylar height decreased 1 year after surgery in both class II patients (mandibular advancement) (p < 0.0001) and class III patients (mandibular setback) (p = 0.0306). Similarly, condylar height decreased 1 year after surgery both in patients who showed ADD (p = 0.0087) and those with other types (p = 0.0023). Significant postoperative increases at all angle sites on the condylar surface were found in the class II (p < 0.05) and ADD (p < 0.05) groups. This study showed that an enhanced condylar surface CT value might be one sign of condylar height reduction related to sequential condylar resorption, in combination with ADD.


Assuntos
Má Oclusão Classe III de Angle , Cirurgia Ortognática , Feminino , Humanos , Má Oclusão Classe III de Angle/diagnóstico por imagem , Má Oclusão Classe III de Angle/cirurgia , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/cirurgia , Osteotomia Sagital do Ramo Mandibular , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/cirurgia , Tomografia Computadorizada por Raios X
15.
Biomed Res Int ; 2021: 5586498, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33791365

RESUMO

Purpose: This study investigated the relationship between the shortest buccal bone marrow of the ramus and skeletal patterns. Materials and Methods: Using cone-beam computed tomography data (specifically, the A point-nasion-B point (ANB) angle), we divided patients into three groups as follows: skeletal class I (0° < ANB < 4°), class II (ANB: ≥4°), and class III (ANB: ≤0°). Sixteen vertical sections in the coronal plane were taken starting from slice 0 (original intact mandibular canal) anteriorly at 2 mm intervals to slice 15 (30 mm). The thickness of the mandible (M) and shortest buccal bone marrow (SBM) were measured. The data of SBM were divided into two groups (SBM ≥ 1 mm and SBM < 1 mm). For each skeletal pattern, an SBM value < 1 mm was considered to indicate a high possibility of postoperative nerve paresthesia and bad split. Results: The three skeletal pattern groups also did not significantly differ in their M values for all sections. The mean SBM values of class III (0.91-2.11 mm) at 6-16 mm anterior to the mandibular foramen were significantly smaller than those of class II (1.53-3.17 mm). Comparing the occurrence ratio of SBM < 1 mm, the highest and lowest probabilities in class III (55% and 21.7%, respectively) were significantly larger at 6-20 mm anterior to the mandibular foramen than those in class II (28.3% and 5%, respectively). Conclusion: Class III had a significantly shorter SBM distance and higher SBM occurrence probability than class II at the mandibular ramus region, implying that class III participants are more likely than class II participants to have nerve paresthesia and bad split after sagittal split ramus osteotomy.


Assuntos
Medula Óssea , Tomografia Computadorizada de Feixe Cônico , Mandíbula , Osteotomia Sagital do Ramo Mandibular , Adulto , Medula Óssea/diagnóstico por imagem , Medula Óssea/cirurgia , Feminino , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia
16.
Artigo em Inglês | MEDLINE | ID: mdl-33926841

RESUMO

BACKGROUND: Bilateral sagittal split osteotomy (BSSO) is one of the most frequently used treatments for jaw deformity worldwide. However, lower lip hypoesthesia is a postoperative complication of BSSO. Trigeminal somatosensory evoked potential can be used to evaluate neural pathway abnormalities by measuring latency. The purposes of this study were to measure latency before and after BSSO and to examine the relationship between latency and the duration of hypoesthesia recovery. STUDY DESIGN AND METHODS: This observational retrospective case-control study analyzed data recorded from 2013 to 2018. We divided the patient data into 5 groups according to recovery time. Using the latency obtained in trigeminal somatosensory evoked potential as the main outcome, we examined the relationship between hypoesthesia recovery time and latency. RESULTS: The group with unresolved postoperative hypoesthesia 6 months after surgery had significantly greater latency values extension than the group without postoperative hypoesthesia. CONCLUSION: By measuring the degree of prolongation of latency before and after surgery, it is possible not only to indicate the presence of hypoesthesia but also to predict the hypoesthesia recovery period.


Assuntos
Hipestesia , Prognatismo , Estudos de Casos e Controles , Potenciais Somatossensoriais Evocados , Humanos , Hipestesia/etiologia , Lábio , Mandíbula , Osteotomia , Osteotomia Sagital do Ramo Mandibular , Estudos Retrospectivos
17.
Sci Rep ; 11(1): 8755, 2021 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888844

RESUMO

With modern-day technical advances, high sagittal oblique osteotomy (HSOO) of the mandible was recently described as an alternative to bilateral sagittal split osteotomy for the correction of mandibular skeletal deformities. However, neither in vitro nor numerical biomechanical assessments have evaluated the performance of fixation methods in HSOO. The aim of this study was to compare the biomechanical characteristics and stress distribution in bone and osteosynthesis fixations when using different designs and placing configurations, in order to determine a favourable plating method. We established two finite element models of HSOO with advancement (T1) and set-back (T2) movements of the mandible. Six different configurations of fixation of the ramus, progressively loaded by a constant force, were assessed for each model. The von Mises stress distribution in fixations and in bone, and bony segment displacement, were analysed. The lowest mechanical stresses and minimal gradient of displacement between the proximal and distal bony segments were detected in the combined one-third anterior- and posterior-positioned double mini-plate T1 and T2 models. This suggests that the appropriate method to correct mandibular deformities in HSOO surgery is with use of double mini-plates positioned in the anterior one-third and posterior one-third between the bony segments of the ramus.


Assuntos
Análise de Elementos Finitos , Mandíbula/cirurgia , Osteotomia Sagital do Ramo Mandibular/métodos , Fenômenos Biomecânicos , Fixação Interna de Fraturas , Humanos , Imageamento Tridimensional
18.
Int J Oral Maxillofac Surg ; 50(10): 1329-1335, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33678492

RESUMO

In the bilateral sagittal split osteotomy, a short lingual cut is made on the medial side of the ramus; however, in some cases, a true fracture occurs on the buccal side of the ramus. The purpose of this study was to evaluate the relationship between the splitting pattern of the mandible and the form of the mandible, the surgical technique used, and the postoperative occurrence of relapse after 'unfavorable' splits. The investigation examined 143 patients in whom a short lingual cut was attempted. The rate of unfavorable split was 14.7% (42/286). A strong correlation was observed between the reach of the lateral bone cut to the inferior border of the mandible and an unfavorable split. According to multivariate regression, the factors leading to an insufficient lateral bone cut were the degree of inward curvature of the ramus (P=0.001) and the position of the lateral bone cut (P=0.002). There was no significant difference in relapse between cases of unfavorable and normal splits. An unfavorable split does not affect the prognosis of the occlusion, but it is important to confirm the inward curvature of the ramus and set the position of the lateral bone cut adequately to avoid unfavorable splits.


Assuntos
Mandíbula , Osteotomia Sagital do Ramo Mandibular , Humanos , Mandíbula/cirurgia , Língua
19.
Oral Maxillofac Surg ; 25(4): 533-540, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33677785

RESUMO

PURPOSE: To compare the intraoperative utility of bur and saw and to examine the pattern of lingual split during bilateral sagittal split osteotomy of mandible. MATERIAL AND METHODS: This study prospectively compares the intraoperative utility of bur and saw in bilateral sagittal split osteotomy as split-mouth model. Study includes 16 patients (representing 32 sagittal split osteotomies) divided into two groups. The procedure to be performed was explained to the patient, followed by written informed consent. The institutional ethical committee approved the clinical study and all subjects gave informed consent. RESULTS: We found that the ease of handling of the bur was good compared to saw. The duration required for completion of osteotomy using bur was less compared to saw. CONCLUSIONS: The use of surgical drills and burs is still the gold standard in most developing nations and countries in transition like India. Depending upon the expertise of the surgeon, availability of precise dissecting instruments, one can go with either of the instrument for BSSO.


Assuntos
Mandíbula , Osteotomia Sagital do Ramo Mandibular , Humanos , Índia , Mandíbula/cirurgia , Estudos Prospectivos , Instrumentos Cirúrgicos
20.
Artigo em Inglês | MEDLINE | ID: mdl-33737017

RESUMO

OBJECTIVE: In the present study, we assessed the rate of complications and morbidity after mandibular setback with bilateral intraoral vertical ramus osteotomy (IVRO). STUDY DESIGN: In total, 133 patients were included. The prevalence of neurosensory disturbance (NSD), surgical site infection (SSI), and other complications were registered 2 months and 1 year after surgery. The correlations between complications and age, sex, American Society of Anesthesiologists classification, body mass index, blood loss, and operative time were evaluated. RESULTS: NSD was reported for 6.8% of the patients (9 of 133) 2 months after surgery (3.8% of the operated sites). The prevalence was significantly higher in female patients (P < .05). Two patients described persistent unilateral reduced sensibility after 1 year (1.5%). In total, 0.8% of the operated sites (2 of 266) had persistent NSD after 1 year. None of the patients required prolonged hospitalization, and 95.5% (127 of 133) were discharged the day after surgery. None of the patients experienced severe bleeding, and only 1 patient developed SSI. There were no significant correlations between patient-specific or intraoperative parameters evaluated and registered complications. CONCLUSIONS: This study shows that IVRO is a safe surgical technique associated with a low complication rate. IVRO can be an alternative technique for mandibular setback in patients who can tolerate postoperative maxillomandibular fixation.


Assuntos
Prognatismo , Cefalometria , Estudos de Coortes , Feminino , Humanos , Mandíbula , Osteotomia Sagital do Ramo Mandibular/efeitos adversos , Estudos Retrospectivos
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