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1.
Br J Oral Maxillofac Surg ; 59(8): 898-904, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34420783

RESUMO

The intraoral vertical ramus osteotomy (IVRO) is an orthognathic procedure that is used to correct dentofacial abnormalities, and is performed by approaching the lateral aspect of the mandibular ramus. This approach, however, precludes visualisation of the inferior alveolar nerve (IAN) on the medial side, thereby placing it at risk of iatrogenic damage. The antilingula, a bony prominence on the lateral mandibular ramus, has been proposed as a landmark for prediction of the IAN's location during IVRO. The current study aimed to evaluate the variation in incidence and position of the antilingula, and therefore to determine its suitability as a surgical landmark during IVRO. The study included 480 dry hemimandibles from eight geographical populations from the Duckworth Collection in Cambridge. Skulls were sexed by visual analysis of dimorphic traits. Positional relations were determined through the digitisation of nine anatomical landmarks. The antilingula was identified in all specimens. No significant difference was identified in the positional relation between the antilingula and mandibular foramen between sexes, but multiple differences were identified in this relation between geographical populations. Our data showed that, irrespective of geographical variation, an osteotomy performed 8mm posterior to the antilingula would avoid the mandibular foramen in 98.8% of cases.


Assuntos
Procedimentos Cirúrgicos Ortognáticos , Prognatismo , Humanos , Mandíbula/cirurgia , Nervo Mandibular , Reprodutibilidade dos Testes , Caracteres Sexuais
2.
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
3.
J Hum Evol ; 157: 103031, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34246049

RESUMO

Facial orientation (projection and degree of prognathism) and form in hominins is highly variable, likely related to evolutionary modifications of the microscopic process of bone modeling (the simultaneous cellular activities of bone formation and resorption) during ontogeny. However, in anteriorly projected faces such as those of early hominins, little is known about the link between bone modeling and facial developmental patterns. Similarly, these aspects have been infrequently investigated in extant great apes. In this study, quantitative methods were applied to a cross-sectional ontogenetic sample of 33 chimpanzees (Pan troglodytes verus) and 59 modern humans (Homo sapiens) to compare the development of maxillary prognathism to orthognathism at both microscopic and macroscopic (or morphological) scales using surface histology and geometric morphometric techniques. Chimpanzees express on average lower amounts of bone resorption than humans on the maxillary periosteum throughout ontogeny; however, the premaxilla is consistently resorbed from early stages on. The presence of bone resorption in the chimpanzee premaxilla, such as that seen in some early hominins, suggests a more ape-like pattern of maxillary bone modeling in these specimens. However, this shows that similarities in bone modeling patterns can lead to variations in shape, suggesting that other aspects of facial growth (such as modifications of rates and timings of development, as well as sutural growth) also played a crucial role in facial evolution.


Assuntos
Maxila/anatomia & histologia , Pan troglodytes/anatomia & histologia , Prognatismo , Adulto , Envelhecimento , Animais , Criança , Estudos Transversais , Feminino , Humanos , Masculino
4.
Am J Orthod Dentofacial Orthop ; 160(4): 617-628, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34274200

RESUMO

For the treatment of low-angle mandibular prognathism, rotational mandibular setback surgery is usually performed with Le Fort I maxillary osteotomy to rotate the maxillomandibular complex simultaneously. However, this maxillary surgery can be replaced with the orthodontic intrusion of maxillary posterior teeth. Single-jaw rotational mandibular setback surgery can be done with a surgery-first approach by planning orthodontic rotation of the maxillary occlusal plane with the simulation of the postsurgical forward mandibular rotation. This case report describes this approach applied to a 19-year-old female patient with low-angle mandibular prognathism but without maxillary deficiency. A Class II open bite was formed by the rotational setback surgery. During postsurgical orthodontic treatment, the maxillary total arch was distalized with maxillary molar intrusion using palatal mini-implants and lever. This case report demonstrates that orthodontic rotation of the maxillary occlusal plane and simulation of mandibular rotation can replace maxillary surgery and enable single-jaw rotational mandibular setback surgery with a surgery-first approach.


Assuntos
Má Oclusão Classe III de Angle , Procedimentos Cirúrgicos Ortognáticos , Prognatismo , Adulto , Cefalometria , Feminino , Humanos , Má Oclusão Classe III de Angle/diagnóstico por imagem , Má Oclusão Classe III de Angle/cirurgia , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Maxila , Osteotomia de Le Fort , Prognatismo/diagnóstico por imagem , Prognatismo/cirurgia , Dimensão Vertical , Adulto Jovem
5.
PLoS One ; 16(5): e0251759, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34010318

RESUMO

This study aimed to evaluate improvement of tongue-palatal contact patterns during swallowing after orthognathic surgery in mandibular prognathism patients. Thirty patients with mandibular prognathism treated by orthognathic surgery (average age of 27 years, 3 months) and 10 controls (average age 29 years, 6 months) participated in this study. Tongue-palatal contact patterns of patients before and three months after surgery were evaluated by electropalatography (EPG) as well as controls. Whole total of tongue-palatal contact at 0.3, 0.2, and 0.1 sec before complete tongue-palatal contact during swallowing were evaluated. The duration of swallowing phases was also examined. Complete contact of tongue-tip in the alveolar part of individual artificial EPG plate were shown at 0.3, 0.2, and 0.1 sec before complete tongue-palatal contact in the controls, although incomplete contact in the alveolar part were shown at 0.3 sec in mandibular prognathism patients. Whole total of tongue-palatal contact at 0.3 and 0.2 sec before complete tongue-palatal contact was significantly lower in the patients before surgery than in the controls (p<0.05). However, these values increased after surgery. The duration of oral and pharyngeal phase was significantly longer in the patients before surgery than in the controls and the patients after surgery (p<0.01). This study demonstrated that the tongue-palatal contact pattern improved and the duration of oral and pharyngeal phase was shortened in mandibular prognathism patients during swallowing after orthognathic surgery. It is suggested that changes in maxillofacial morphology by orthognathic surgery can induce normal tongue movement during swallowing. (The data underlying this study have been uploaded to figshare and are accessible using the following DOI: https://doi.org/10.6084/m9.figshare.14101616.v1).


Assuntos
Deglutição , Procedimentos Cirúrgicos Ortognáticos , Palato/fisiopatologia , Prognatismo , Língua/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Prognatismo/fisiopatologia , Prognatismo/cirurgia
6.
Sci Rep ; 11(1): 10463, 2021 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001999

RESUMO

Intraoral vertical ramus osteotomy (IVRO) is used to treat mandibular prognathism and temporomandibular disorders. However, the improvement of temporomandibular disorders after IVRO is considered to be due to the anterior and downward movement of the mandibular condyle, which may lead to condylar sag, and in the worst case, condylar luxation. In this retrospective cohort study, we examined factors potentially associated with condylar sag. Univariate analysis indicated that condylar sag was significantly associated with the following factors: magnitude of setback (P = 0.001), less than 3 mm setback (P < 0.001), presence of temporomandibular joint (TMJ) symptoms (P = 0.002), Wilkes classification (P = 0.039), occlusal cant correction ≥ 2 mm (P = 0.018), and mandibular condyle deformation (P < 0.001). Setback magnitude (P = 0.032) and TMJ symptoms (P = 0.007) remained significant in the multivariate analysis. In the receiver operating characteristic curve, the setback magnitude cut-off value for condylar sag after IVRO was 3.25 mm. Thus, the incidence of condylar sag after IVRO is increased with a smaller setback magnitude (≤ 3.25 mm) and the presence of TMJ symptoms. These factors should be evaluated by surgeons during treatment planning for IVRO to estimate condylar sag, and it may be possible to predict the risk of condylar luxation.


Assuntos
Luxações Articulares/epidemiologia , Procedimentos Cirúrgicos Bucais/efeitos adversos , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Prognatismo/cirurgia , Transtornos da Articulação Temporomandibular/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Imageamento Tridimensional , Incidência , Luxações Articulares/diagnóstico , Luxações Articulares/etiologia , Luxações Articulares/fisiopatologia , Masculino , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/fisiopatologia , Côndilo Mandibular/cirurgia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Bucais/métodos , Osteotomia/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Prognatismo/complicações , Estudos Retrospectivos , Fatores de Risco , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/fisiopatologia , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/etiologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
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
8.
Head Face Med ; 17(1): 17, 2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34039391

RESUMO

INTRODUCTION: The purpose of this study was to systematically identify variants in NOTCH signaling pathway genes that correlate with mandibular prognathism (MP) in the general Chinese population. METHODS: Targeted sequencing of NOTCH signaling pathway genes was conducted in 199 MP individuals and 197 class I malocclusion control individuals. The associations of common and rare variants with MP, cephalometric parameters, and continuous cephalometric phenotypes were analyzed by principal component (PC) analysis. The associations between rare variants and MP were tested for each gene. RESULTS: Six SNPs, including rs415929, rs520688, and rs423023 in an exonic region of NOTCH4; rs1044006 in an exonic region of NOTCH3; rs1051415 in an exonic region of JAG1; and rs75236173 in the 3'-untranslated region (3'-UTR) of NUMB were associated with MP (P < 0.05). One common variant, rs1051415, in an exonic region of JAG1 was significantly related to PC1 (P  = 3.608 × 10- 4), which explained 24.3% of the overall phenotypic variation observed and corresponded to the sagittal mandibular position towards the maxilla, ranging from a posterior positioned mandible to an anterior positioned mandible. Additionally, 41 other variants were associated with PC1-5 (P  <  0.05). With respect to rare variant analysis, variants within the EP300, NCOR2, and PSEN2 gene showed an association with MP (t   < 0 .05). CONCLUSIONS: An association between NOTCH signaling pathway genes and MP has been identified.


Assuntos
Má Oclusão Classe III de Angle , Prognatismo , Cefalometria , Humanos , Mandíbula , Prognatismo/genética , Transdução de Sinais/genética
9.
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
10.
Sensors (Basel) ; 21(8)2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33917213

RESUMO

The aim of this study was to investigate the correlation between craniofacial morphology, temporomandibular joint (TMJ) characteristics, and condylar functional movement in patients with facial asymmetry using an up-to-date automated real-time jaw-tracking system. A total of 30 patients with mandibular asymmetry and prognathism were included. Three-dimensional (3D) craniofacial and TMJ morphometric variables were analyzed in images captured using cone-beam computed tomography. Three-dimensional condylar movements were recorded during the opening, protrusion, and laterotrusion of the jaw and divided into those for deviated and non-deviated sides. Overall functional and morphometric variables were compared between the sides by a paired t-test. Pearson's correlation analysis and factor analysis were also performed. As a result, significant differences were found between the sides in morphometric and functional variables. The condylar path length was significantly longer and steeper on the deviated side during protrusion and lateral excursion. TMJ morphometric asymmetry, more so than the craniofacial morphologic asymmetry, seemed to be reflected in the functional asymmetry, representing different correlations between the sides, as supported by factor analysis. This study provides evidence explaining why the asymmetric condylar path remained unchanged even after orthognathic surgery for the correction of craniofacial asymmetry.


Assuntos
Assimetria Facial , Prognatismo , Assimetria Facial/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Mandíbula/diagnóstico por imagem , Côndilo Mandibular/diagnóstico por imagem , Articulação Temporomandibular/diagnóstico por imagem
11.
J Craniofac Surg ; 32(2): 694-697, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33705012

RESUMO

INTRODUCTION: This study aimed to evaluate the mandibular canal course in individuals with cleft lip palate (CLP) and mandibular prognathism in terms of the sagittal split-ramus osteotomy using cone-beam computed tomography. MATERIALS AND METHODS: Individuals with CLP older than 16 years of age and planned to undergo Le fort I + SSR osteotomies and those with class III occlusion planned to undergo Le fort I + SSR osteotomies were included. The measurements on the cleft side of CLP patients were compared with both their noncleft sides and those with class III occlusion. The course of the inferior alveolar nerve and its position in the mandible were evaluated starting from the mandibular foramen, the first entrance to the mandible, to the mental foramen, the exit from the mandible. RESULTS: The distance between the mandibular canal and the buccal surface of the mandible (B3) on the plane tangent to the distal of the mandibular first molar and perpendicular to the occlusal plane was found to be greater in individuals with CLP (P = 0.011). Buccal cortex thickness (C4) at the level of the mandibular canal on the plane tangent to the distal of the mandibular second molar and perpendicular to the occlusal plane was found to be lower in individuals with CLP (P = 0.021). CONCLUSIONS: The buccal cortex thickness of the mandible corpus and the distance of the mandibular canal to the buccal surface is different in patients with CLP compared to class III individuals' posterior to the mandible. Surgeons should take these differences into consideration during mandibular osteotomy.


Assuntos
Fenda Labial , Prognatismo , Fenda Labial/diagnóstico por imagem , Fenda Labial/cirurgia , Tomografia Computadorizada de Feixe Cônico , Humanos , Mandíbula/diagnóstico por imagem , Osteotomia Sagital do Ramo Mandibular , Palato , Prognatismo/diagnóstico por imagem , Prognatismo/cirurgia
12.
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
13.
J Formos Med Assoc ; 120(9): 1768-1776, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33775535

RESUMO

BACKGROUND/PURPOSE: Three-dimensional computer-assisted orthognathic surgery allows to simulate the space between the mandibular ramus segments, i.e. intersegmental gap, for the correction of facial asymmetry. The purposes of the study were to estimate the screws- and mandible bone-related changes from the early postoperative period to the period after the debonding and to measure the association between the intersegmental gap volume and the screws- and mandible bone-related changes. METHODS: This cone-beam computed tomography (CBCT)-assisted retrospective study assessed the stability of the bicortical positional screw fixations in maintaining the space between the mandibular ramus segments after bilateral sagittal split osteotomy in correction of 31 patients with malocclusion and facial asymmetry. The primary predictor variable was the CBCT-based intersegmental gap volume at early postoperative period (T1). The primary outcome variables were CBCT-based screws- and bone-related measurement changes between the T1 and T2 (at debonding) periods. RESULTS: No significant differences were observed in screws-related linear and angular measurements between T1 and T2 virtual models. Some of mandible bone-related linear and angular measurements had significant differences (P < 0.05) between the T1 and T2 images, but with no clinical repercussion such as need of revisionary surgery. The gap volume and the screws- and bone-related changes had no significant correlations. CONCLUSION: This study contributes to the multidisciplinary-related literature by demonstrating that the bicortical positional screws-based fixation technique in maintaining the three-dimensional-simulated space between the mandibular ramus segments is a stable and clinically acceptable option for correction of facial asymmetry associated with malocclusion, regardless of intersegmental gap size.


Assuntos
Osteotomia Sagital do Ramo Mandibular , Prognatismo , Cefalometria , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Estudos Retrospectivos
14.
Br J Oral Maxillofac Surg ; 59(5): 586-591, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33518395

RESUMO

Resorbable materials are used to fix bony fragments after sagittal split ramus osteotomy (SSRO), but to our knowledge, there is no clear regimen for antibiotic prophylaxis when such materials are used. The purpose of this study therefore was to compare inpatient single-agent and extended dual-agent antibiotic prophylaxis for the prevention of surgical site infections (SSI) in patients after SSRO. This prospective study included 100 patients who underwent SSRO for deformities of the jaw. Cephalometric analysis was performed preoperatively, and at one month and one year postoperatively. Patients were divided into two groups of 50 each. Group A was given cefazolin sodium 1g preoperatively and every eight hours for 48 hours postoperatively. Group B was given cefazolin sodium 1g preoperatively and every eight hours for 48 hours postoperatively, after which they were provided with oral amoxicillin for three days. Both groups were assessed for SSIs for one year postoperatively using the Clavien-Dindo classification. SSIs were documented in seven patients in Group A and six in Group B, with no significant difference between the groups. The two regimens had no significant association with SSI. In conclusion, our results suggest that the inpatient, single-agent, postoperative antibiotic regimen is sufficient to prevent SSI in patients who have SSRO with resorbable plate and screw fixation.


Assuntos
Osteotomia Sagital do Ramo Mandibular , Prognatismo , Antibioticoprofilaxia , Parafusos Ósseos , Humanos , Pacientes Internados , Mandíbula , Estudos Prospectivos
15.
Aesthetic Plast Surg ; 45(4): 1564-1572, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33616716

RESUMO

BACKGROUND: Surgery-first sagittal split ramus osteotomies (SF-SSRO) are an effective treatment for patients with dental malocclusion. However, some patients with mandibular prognathism usually have facial deficiencies which cannot be corrected completely after orthognathic surgery. These are not accepted because the remaining facial contours are in disharmony. METHODS: Twenty-five patients, who were unsatisfied with their appearances after SF-SSRO and orthodontics, were included. The preoperative CTs were used to investigate patients for facial deformity. To achieve a harmonious facial contour, mandible long-curve osteotomy/mandible U-shaped osteotomy, genioplasty or facial autologous fat grafting was selected depending on patients' contour deformities with the assistance of CAD. RESULTS: Among the patients who underwent osteotomy, the gonial angle was improved from 111.16° ± 9 to 111.58° ± 9.06 after SF-SSRO because of distal fragment setback and rotation. After facial refine surgery, the gonial angle was significantly increased to 121.69°±2.41 (p < 0.05). And the mandibular width was decreased from 11.29 cm ± 0.44 to 10.45 cm ± 0.39 (p < 0.05) after mandibular outer plate griding. All patients were shown no signs of infection, massive bleeding, and osteonecrosis in the early stage. After follow-up time, they were all satisfied with their results and most of them recovered from lip numbness. CONCLUSIONS: This study indicated the clinical feasibility of two-stage orthognathic and facial bone contouring surgery for the treatment of dentofacial deformities. Two-stage facial contouring surgery can provide esthetic improvement for more accuracy in refining the facial contour. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Procedimentos Cirúrgicos Ortognáticos , Prognatismo , Grupo com Ancestrais do Continente Asiático , Desenho Assistido por Computador , Humanos , Mandíbula , Osteotomia Sagital do Ramo Mandibular
16.
Bull Tokyo Dent Coll ; 62(1): 27-39, 2021 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-33583878

RESUMO

Aggressive periodontitis during adolescence has a poor prognosis due to rapid alveolar bone resorption. Few studies have investigated long-term follow-up after surgical orthodontic treatment performed in conjunction with that for invasive periodontitis. Here, we report a case of mandibular prognathism accompanied by generalized aggressive periodontitis and crowding. A 31-year-old woman was referred to our department for treatment of masticatory dysfunction due to reverse overjet. The patient exhibited a class III molar relationship, protrusion of the ANB of -6.0°, and severe maxillary crowding. Initial periodontal examination revealed deep periodontal pockets and extensive inflammation. Mandibular prognathism accompanied by generalized aggressive periodontitis and crowding was diagnosed. Therefore, it was necessary to adopt an interdisciplinary approach involving surgical, orthodontic, and periodontal treatment. Prior to commencement of orthodontic treatment, plaque control, scaling, and root planing of all teeth were performed by a periodontist to suppress inflammation and reduce probing depth. During pre-surgical orthodontic treatment, the maxillary first premolars were extracted to reduce crowding of the maxillary incisors. To correct the mandibular prognathism, the mandible was repositioned by sagittal split ramus osteotomy. Proper occlusion of the incisors and maximum intercuspation were achieved by post-surgical orthodontic treatment. After completion of active orthodontic treatment, acceleration of inflammation was observed together with aggravated resorption of the alveolar bone surrounding the molars. However, reduction of probing depth and inflammation were observed after scaling and root planing. The surgical-orthodontic treatment time was 1 year and 11 months, which was followed by a 2-year retention period. There was no tooth loss due to periodontitis, and an overall satisfactory outcome was achieved.


Assuntos
Periodontite Agressiva , Má Oclusão Classe III de Angle , Má Oclusão , Prognatismo , Adulto , Feminino , Seguimentos , Humanos , Má Oclusão Classe III de Angle/cirurgia , Mandíbula , Prognatismo/cirurgia
17.
Int J Oral Maxillofac Surg ; 50(7): 933-939, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33168369

RESUMO

The sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) are two common orthognathic procedures for the treatment of mandibular prognathism. This randomized clinical trial compared the surgical morbidities between SSRO and IVRO for patients with mandibular prognathism over the first 2 years postoperative. Ninety-eight patients (40 male, 58 female) with a mean age of 24.4±3.5 years underwent bilateral SSRO (98 sides) or IVRO (98 sides) as part or all of their orthognathic surgery. IVRO presented less short-term and long-term surgical morbidity in general. The SSRO group had a greater incidence of inferior alveolar nerve deficit at all follow-up time points (P< 0.01). There was more TMJ pain at 6 weeks (P= 0.047) and 3 months (P= 0.001) postoperative in the SSRO group. The SSRO group also presented more minor complications, which were related to titanium plate exposure and infection. There were no major complications for either technique in this study. Despite the need for intermaxillary fixation, IVRO appears to be associated with less surgical morbidity than SSRO when performed as a mandibular setback procedure to treat mandibular prognathism.


Assuntos
Má Oclusão Classe III de Angle , Prognatismo , Adulto , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Osteotomia Mandibular , Morbidade , Osteotomia Sagital do Ramo Mandibular , Prognatismo/cirurgia , Adulto Jovem
18.
J Craniofac Surg ; 32(1): e94-e98, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32881823

RESUMO

ABSTRACT: This study aimed to investigate the changes in tongue-palatal contact patterns in patients with mandibular lateral deviation by electropalatography (EPG) before and after sagittal split ramus osteotomy (SSRO). Ten mandibular asymmetry patients who underwent SSRO participated in the study. Tongue-palatal contact patterns for the production of /t/ and /s/ sounds were observed using EPG before surgery and 3 months after surgery, and the changes in EPG pattern were examined. The number of electrode contacts in the 2 vertical columns of the EPG plate was calculated both in the mandibular deviation side and the nondeviation side. The EPG patterns for /t/ and /s/ showed asymmetry before surgery but became normal after surgery. Before surgery, the number of electrode contacts in the 2 vertical columns in the mandibular deviation side was significantly lower than that in the nondeviation side and the normal participants during /t/ and /s/ articulation. However, the number of electrode contacts in the deviation side significantly increased after surgery. This study demonstrated that the tongue-palatal contact patterns for /t/ and /s/ articulation shifted to the direction of mandibular deviation and improved after SSRO.


Assuntos
Má Oclusão , Osteotomia Sagital do Ramo Mandibular , Placas Ósseas , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Prognatismo , Língua
19.
Am J Med Genet A ; 185(1): 46-49, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33030227

RESUMO

Retrognathia (recessed chin) and prognathism (prominent chin) often present as signs of an underlying condition. Accurate clinical definitions are important. Yet their definitions were according to "clinical impression", or to seldom used X-ray criteria. We propose a statistical and anthropometric definition of retrognathia and prognathism based upon the ratio between the goniomaxillar length (distance between the gonion at the mandible angle and the subnasale and the goniomandibular length (distance between the mandible angle and the most anterior point of the bony chin). We assumed that an increase in the ratio indicates retrognathia and a decrease reflects prognathism. We conducted a prospective, observational, anthropometric study in 204 consecutive healthy term infants. Measurements took place on the second day of life, using sliding calipers. Mean ± SD of goniomandibular length (5.1 ± 0.3 cm), goniomaxillar length (5.4 ± 0.3 cm), were calculated. All measurements correlated significantly with gestational age, and with infant birthweight. The mean ± SD goniomaxillar length/goniomandibular length ratio was 1.06 ± 0.05. We defined a normal ratio as being within 2 SD of the mean, that is, between 0.96 and and 1.16. This ratio correlated with neither gestational age nor with birthweight. We conclude that the goniomaxillar length/goniomandibular length ratio can be calculated whenever retro - or prognathism is suspected. A ratio outside of the 95% confidence interval should help in making this diagnosis. An increase in this ratio beyond 2 SD above the mean (1.16) could be interpreted as retrognathia and a decrease beyond 2 SD below the mean (0.96) as prognathism.


Assuntos
Cefalometria , Prognatismo/diagnóstico , Retrognatismo/diagnóstico , Adulto , Queixo/diagnóstico por imagem , Queixo/patologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/patologia , Maxila/diagnóstico por imagem , Maxila/patologia , Mães , Prognatismo/diagnóstico por imagem , Prognatismo/patologia , Retrognatismo/diagnóstico por imagem , Retrognatismo/patologia
20.
Braz. dent. sci ; 24(2): 1-12, 2021. tab, ilus
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1178269

RESUMO

Objetive: This study aimed to compare the anatomical characteristics of the mandible in patients with skeletal class I, II and class III disorders using cone beam computed tomography (CBCT). Material and Methods: CBCT scans of patients between 17 to 40 years taken with NewTom 3G CBCT system with 12-inch field of view (FOV) were selected from the archive. Lateral cephalograms were obtained from CBCT scans of patients, and type of skeletal malocclusion was determined (Class I, II or III). All CBCT scans were evaluated in the sagittal, coronal and axial planes using the N.N.T viewer software. Results: The ramus height and distance from the mandibular foramen to the sigmoid notch in class II patients were significantly different from those in skeletal class I (P < 0.005). Distance from the mandibular canal to the anterior border of ramus in class III individuals was significantly different from that in skeletal class I individuals (P < .005). Conclusion: Length of the body of mandible in skeletal class I was significantly different from that in skeletal class II and III patients. Also, ramus height in skeletal class I was significantly different from that in skeletal class II patients. CBCT had high efficacy for accurate identification of anatomical landmarks. (AU)


Objetivo: Este estudo teve como objetivo comparar as características anatômicas da mandíbula em pacientes com desordem esquelética Classe I, II e III usando imagens de tomografia computadorizada de feixe cônico (TCFC). Material e Métodos: Foram selecionadas de arquivo, imagens de TCFC (Sistema NewTon 3G) com FOV (campo de visão) 12 polegadas e incluindo pacientes entre 17 a 40 anos. Cefalometrias laterais foram obtidas a partir das imagens de TCFC e o tipo de maloclusão esquelética foi determinada (Classe I, II ou III). Todas as imagens de TCFC foram avaliadas nos planos sagital, coronal e axial usando o software de visualização N.N.T. Resultados: A altura do ramo e distância do forame mandibular para a incisura da mandíbula em pacientes Classe II foi significativamente diferente daqueles Classe I esquelética (p< 0.005). A distância do canal mandibular até a borda anterior do ramo em indivíduos Classe III foi significativamente diferente daqueles indivíduos Classe I esquelética (p<0.005). Conclusão: O comprimento do corpo da mandíbula na Classe I esquelética foi diferente significativamente daqueles pacientes em Classe II e III esquelética. Além disso, a altura do ramo na Classe I esquelética foi significativamente diferente daqueles pacientes Classe II esquelética. A TCFC apresentou alta eficácia para a identificação precisa de marcos anatômicos. (AU)


Assuntos
Humanos , Adolescente , Adulto , Prognatismo , Retrognatismo , Tomografia Computadorizada de Feixe Cônico , Anatomia , Mandíbula
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