Change in taste sensation after orthognathic surgery.

OBJECTIVE: The objective of this study was to evaluate the effect of orthognathic surgery on taste sensation. MATERIALS AND METHODS: Thirty-five patients scheduled to undergo Le Fort I osteotomy (LFIO), sagittal split ramus osteotomy (SSRO), and bimaxillary surgery (BMS) were evaluated by administering localized and whole-mouth taste tests preoperatively and postoperatively at months 1, 3, and 6. The patients were asked to identify the quality of four basic tastes applied to six locations on the palate and tongue and to rate the taste intensities they perceived. Taste recognition thresholds and taste intesity scores were evaluted according to operation groups and follow-ups. RESULTS: There were significant decreases in the quinine HCl recognition thresholds at the postoperative follow-ups compared to the preoperative in LFIO patients (p = 0.043). There were significant decreases in sucrose taste intensity scores in the right posterolateral part of the tongue at months 3 and 6 compared to preoperative in SSRO patients (p = 0.046), and significant increases in quinine HCL taste intensity scores in the right and left anterior parts of the tongue at month 6 compared to preoperative in LFIO patients (p < 0.05). CONCLUSION: Taste perception is affected due to potential damage to the chemosensory nerves during orthognathic surgical procedures. Generally, non-significant alterations have been observed in taste perception after orthognathic surgery, except for significant alterations in bitter and sweet taste perceptions. CLINICAL RELEVANCE: Maxillofacial surgeons should be aware of taste perception change after orthognathic surgery procedures and patients should be informed accordingly. THE TRIAL REGISTRATION NUMBER (TRN): NCT06103422/Date of registration: 10.17.2023 (retrospectively registered).

Does the Implementation of Virtual Planning has a Significant Impact on Reducing the Revision Rate in Orthognathic Surgery?

PURPOSE: Conventional orthognathic surgical planning has limitations in accurately transferring the relationship between soft tissue and bone. Virtual planning offers enhanced accuracy and visualization through computer simulation. This study aimed to compare the need for reoperation between patients who underwent conventional and virtual surgical planning for orthognathic surgery. MATERIAL AND METHODS: The study included 352 patients who underwent orthognathic surgery. Reoperation rates and reasons for reoperation were evaluated in patients with conventional model surgery planning (143 patients) and virtual planning (209 patients). RESULTS: The reoperation rate was 7.69% for conventional surgery patients and 3.82% for virtual planning patients. Malocclusion was the most common reason for reoperation in both groups. Bilateral sagittal split ramus osteotomies (BSSO) and genioplasty were the most frequently performed revision procedures. CONCLUSION: Virtual planning in orthognathic surgery may lead to a reduced reoperation rate compared with conventional planning methods. The accuracy, visualization, and interdisciplinary collaboration offered by virtual planning can improve surgical outcomes.

The Assessment of External Nasal Valve Efficiency After Le Fort I Surgery.

BACKGROUND: The present study investigated how external nasal valve function is affected after Le Fort I osteotomy using external nasal valve efficiency (ENVE) index. MATERIALS AND METHODS: Twenty-one patients who underwent Le Fort I osteotomy with or without mandibular osteotomy were included in the retrospective study. Preoperative and postoperative standardized videos of basal view of the nose during breathing were recorded, and 2 screenshots were taken, 1 in the resting position and the other after deep inspiration. External nasal valve efficiency was calculated at preoperative and postoperative periods for each patient. RESULTS: Of the 21 patients, 12 were women and 9 were men (mean age, 26.63 ± 8.20 years). The mean ENVE index was 0.75 ± 0.16 for the preoperative period and 0.82 ± 0.17 for the postoperative period. There was a significant difference between these values ( P = 0.002). When the correlation of the ENVE with maxillary movements was analyzed, the ENVE was negatively affected by maxillary impaction ( P = 0.011, r = -0.540). CONCLUSIONS: These findings imply that Le Fort I osteotomy positively affects the ENVE index. However, because of the antagonistic relation between maxillary impaction and ENVE, higher maxillary impaction amounts or isolated maxillary impaction should be carefully planned in patients with low ENVE index.

Does mandibular osteotomy affect the infraorbital nerve? a prospective study.

OBJECTIVES: The aim of this study was to evaluate the sensory function of the infraorbital nerve after orthognathic surgery (OS). MATERIALS AND METHODS: Patients who underwent Le Fort I osteotomy with or without BSSO for dentofacial deformity treatment were studied. Two groups were created according to whether BSSO was performed. Class A tests were performed to determine the degree of peripheral nerve damage. The Class B test was performed if decreased sensation was detected in at least one of these tests. A Class C test was performed if abnormal sensation was detected. RESULTS: Twenty-eight patients (n=56) who underwent OS were included in this prospective study. Of the patients, 57.1% were female, 42.9% were male, and the mean age was 24.6 (±3.8). Seven patients were in group 1 (n=14), and 21 patients were in group 2 (n=42). In both groups, there were statistically significant differences between T1 and T2 (p<0.001), and the mean NSD score at T2 was higher than that at T1. The mean NSD score in the single jaw group was higher than that in the double jaw group at all time points. CONCLUSIONS: Bimaxillary surgeries had a negative effect on the somatosensory changes that developed in the early period. The upper lip's somatosensorial recovery was faster than IOR and single jaw recovery was faster than double jaw. CLINICAL RELEVANCE: Maxillofacial surgeons performing orthognathic surgery should be aware that in double jaw operations, changes in the somatosensory function of the ION are more severe.

Safe Limits of Lateral Nasal Wall Osteotomy at Le Fort I Surgery.

INTRODUCTION: The aim of this study was to define the difference between lateral nasal wall anatomy and variations as linear and angular in patients with class II and class III dentofacial deformities and to determine a surgical margin for safe entry by establishing an ideal osteotomy line for lateral nasal wall osteotomy during Le Fort I surgery. MATERIALS AND METHODS: Eighty-five patients with dentofacial deformities, who were admitted to Medipol Mega University Hospital between September 2018 and February 2021, and 170 regions, including the right and left, were evaluated. In the axial image taken from coronal sections 5 mm above the deepest point of the nasal floor, lateral nasal wall angulations and linear and angular distances to the descending palatine canal were measured. Class II and class III patients were evaluated according to the right and left regions and gender. RESULTS: The angled right distance values to the descending palatine artery of class III patients are higher than the values of the angled left distance to the descending palatine canal (p = 0.034). The right second angulation levels of class II female patients are higher than those of class II male patients (p = 0.037). Class III male patients have a significantly higher right linear distance to the descending palatine canal and right second angulation levels compared to class III female patients (p1 = 0.009; p2 = 0.003). The right second angulation levels of class II male patients are significantly lower than those of class III male patients (p = 0.003). CONCLUSION: This study described the mean angulations and linear distances between anatomic structures of the lateral nasal wall in patients with class II and class III dentofacial deformities for the purpose of a safe osteotomy. The location of the descending palatine canal and the morphology of the lateral nasal wall are not significantly associated with dentofacial deformity.

Effect of Orthognathic Surgery on Movement of the Cheilion.

The cheilion (Ch), corner of the mouth, is the soft-tissue landmark where the upper and lower lips intersect. Orthognathic surgery can modify Ch position, which can affect facial esthetics. The aims were to evaluate Ch movements resulting from Le Fort I maxillary advancement with maxillary impaction or downgrafting, and with mandibular advancement or setback, and to investigate relationships between surgical movements and Ch movements. The 45 patients had undergone bilateral sagittal split ramus osteotomy with Le Fort I advancement surgery. They were divided into 4 groups according to surgical movement direction. Preoperative and postoperative photographs were calibrated. Standardized methods were used to identify and measure preoperative and postoperative Ch positions. Significant correlations were detected between extent of maxillary downgrafting and inferior movement of the Ch in group 1 ( r =0.988, P =0.001) and group 3 ( r =0.915, P =0.001). Also, significant correlations were detected between extent of mandibular advancement and anterior movement of the Ch in group 3 ( r =0.561, P =0.046) and group 4 ( r =0.661, P =0.005). The findings indicate that, in patients who undergo bilateral sagittal split ramus osteotomy/Le Fort I surgeries, mandibular advancement moves Ch anteriorly and maxillary downgrafting moves Ch inferiorly.

The Influence of the Hourglass Form of the Neck on Perceptions of Frontal Esthetics.

The purpose of this investigation was to evaluate the effect of the neck concavity angle (NCA) on different occupational groups' perceptions of frontal esthetics. An online survey was developed using Google Forms and sent to the observers through WhatsApp. Male and female frontal silhouettes were created, and NCAs that comprise the hourglass form of the neck were altered in 5 degrees increments from 120 degrees to 170 degrees. Observers were asked to score the images using 0 to 10 numerical rating scale. In all, 279 observers (97 orthodontists, 92 oral-maxillofacial surgeons, and 90 laypeople) participated in this study. For the male and female silhouettes, an NCA of 145 degrees was perceived as the most esthetic, while an NCA of 170 degrees was perceived as the least esthetic by all groups. Generally, an NCA greater than 145 degrees was perceived as less esthetic than an NCA smaller than 145 degrees. There was no significant difference between the scores of the observer groups for the silhouettes except for the female silhouettes with an NCA of 125 degrees or 150 degrees and the male silhouettes with an NCA of 145 degrees or 150 degrees. For both the female and male silhouettes, the further the NCA increased or decreased from 145 degrees, the less esthetic it was perceived to be. A significant increase in NCA was perceived as less esthetic than a significant decrease. The range of NCAs perceived as esthetic varied between 120 degrees and 145 degrees for women and between 130 degrees and 150 degrees for men. These ranges of variability of NCA may provide clinicians with useful information for orthognathic surgical planning.

The Effect of Orthognathic Surgery on the Hourglass Appearance of the Neck.

In frontal view, the transition from the upper aspect of the neck to the inferior border of the mandible has a subtle hourglass appearance. The aim of this study was to evaluate the effect of the orthognathic surgery on the hourglass appearance of the neck in patients with Class II dentofacial deformity. Twenty-six patients with Class II dentofacial deformity who underwent bilateral sagittal split osteotomy alone or in combination with Le Fort I osteotomy and/or genioplasty were included in this study. The width of the most upper part, the width of the narrowest part, the length of the upper part, the height of the upper part, the depth, and the angle of the hourglass were measured on frontal facial photographs obtained preoperatively and at sixth months postoperatively. The decrease in the width of the narrowest part ( P =0.012) and the right ( P <0.001) and left ( P <0.001) angles of the hourglass were statistically significant. Also, increase in the right ( P =0.036) and the left ( P =0.004) depths of the hourglass were statistically significant. Orthognathic surgery procedures performed to correct Class II dentofacial deformity positively affects the hourglass appearance of the neck, therefore neck esthetics should also be considered in the preoperative evaluation of facial esthetics.

Analysis of Inferior Nasal Morphology and Nostrils following Le Fort I Osteotomy.

OBJECTIVE: This study aimed to investigate the soft tissue parameters related to inferior nasal morphology and nostril shape and investigate the change at nostril types according to the Modified Topinard System following maxillary surgery. MATERIALS AND METHODS: Thirty-five patients who underwent Le Fort I osteotomy with or without mandibular osteotomy were included in this retrospective study. Presurgery (T1) and postsurgery (T2) measurements which were the angle between the longitudinal axis of left and right nostril, nostril length, nostril width, alar width, alar base width, columella length, and columella width, were measured on computed tomography images. Nostril types according to Modified Topinard System and nostril shapes were also examined. RESULTS: Following Le Fort I surgery, there was a significant increase in alar base width, alar width, and angle between the longitudinal axis of the left and right nostril (P<0.05). Nasal tip protrusion was decreased with significance (P=0.022). Multiple linear regression analysis showed that every 1 mm maxillary impaction amount leads to a 3.34° increase in the angle between the longitudinal axis of the left and right nostrils (P=0.03, adjusted R2=0.21). Nostril type classification according to Modified Topinard System was changed significantly (P=0.000). CONCLUSION: Surgeons should be aware of the risk of postoperative nonaesthetic results in Modified Topinard System's borderline cases. Modified Topinard classification may be included in preoperative orthognathic planning from the bottom view.

Effect of Horizontal Osteotomy Level on Complication Rates and Neurosensory Deficits After Sagittal Split Ramus Osteotomy.

Horizontal osteotomy is one of the most critical step at sagittal split ramus osteotomy (SSRO) and determination of the ideal height of this horizontal osteotomy is essential to avoid nerve and vessel injury. PURPOSE: The aim of this study was to evaluate the level of the medial horizontal ramus cut as a risk factor for unfavorable outcomes in the SSRO. MATERIALS AND METHODS: Sixty-four patients with dentofacial deformity who applied to Oral & Maxillofacial Surgery Department between August 2018 and August 2019 and undergone orthognathic surgery were evaluated. Out of 64, 49 patients had SSRO with or without maxillary surgery and genioplasty. Twenty-six patient had postoperative computed tomography scan with 6-months follow-up. Finally, 26 patient with 52 SSRO sides were included in this study. Computed tomography scans were evaluated and classification according to osteotomy levels was made. Postoperative neurosensory deficit, bleeding, and intraoperative complications such as bad split, visible damage to inferior alveolar bundle were assessed. Age, gender, neurosensory deficit, bad splits were analyzed and correlated with the level of the osteotomies. RESULTS: Fifteen osteotomies were above lingula, 24 between apex and base of lingula, and 14 below lingula. One bad split occurred, and no visible damage to the inferior alveolar bundle was seen. There was no significant difference between osteotomy groups in terms of visual analogue scale (VAS) scores (P > 0.05) but in all groups; women's VAS scores are statistically significantly higher than men. (P: 0.036). CONCLUSION: There is no correlation between the horizontal osteotomy level and intraoperative or postoperative complications. The low medial horizontal osteotomy can be safely performed in SSRO.

Analysis of Gull in Flight Appearance and Related Parameters Following Le Fort I Osteotomy.

ABSTRACT: The present study aimed to investigate how "Gull in Flight" appearance and alar-columellar relationship change following maxillary surgery. Thirty-three patients who underwent Le Fort I osteotomy with or without mandibular osteotomy were included in this retrospective study. Measurements which were angle of columella triangle, alar-rim angle, columella lobular angle, and distance of points forming "Gull in Flight" appearance were evaluated on pre and postoperative frontal and lateral photos of patients. Data was submitted to statistical analysis and significance level was determined as 0.05. Following Le Fort I surgery, distance of points forming "Gull in Flight" appearance with respect to canthus was decreased significantly (P < 0.05). Positions of these points to each other were not changed (P > 0.05). Every 1 mm maxillary impaction led to 0.58 mm reduction in y3 (the distance from the point that illustrates Gull's body) (P = 0.032). There was a decrease in angle of columella triangle, alar-rim angle and increase in columella lobular angle. However, these changes were not found significant (P > 0.05). Angle of columella triangle was increased 2.51 degree for every 1 mm maxillary advancement (P = 0.028). In conclusion, maxillary surgery had an impact on nasal region from frontal view. However, "Gull in Flight" appearance which is one of the aesthetic parameters in nose was not changed following maxillary surgery.

Radiographic assessment of the response of teeth following trauma during screw placement for maxillo-mandibular fixation.

BACKGROUND/AIM: Maxillo-mandibular fixation (MMF) screws have gained popularity in recent years for inter-maxillary fixation. MMF screw application involves the risk of dental injury. However, knowledge about the healing responses after root damage in humans is limited, thereby warranting the need to classify the radiographic assessment of healing to enable better prediction of the healing response and effective management of the potential complications. The aim of this study was to assess and classify the radiographic assessment of the responses after root damage to evaluate the long-term outcomes. MATERIAL AND METHODS: The dental records of patients who underwent orthognathic surgery or trauma management during 2014-2016 at an Oral and Maxillofacial Surgery Department were retrospectively analyzed. The data regarding dental injuries resulting from MMF screw application were evaluated. In total, 16 patients with 34 roots damaged from MMF screw application were enrolled. Post-operative orthopantomographs were analyzed by visual inspection of the affected areas to clarify the extent of root healing. The inter- and intra-rater reliability assessments were subsequently performed. RESULTS: The results indicated substantial inter- and intra-rater reliability of the responses. Most cases of root damage that were not radiographically related to the pulp (Schulte-Geers Class III defects) had complete or partial healing responses. In addition, 20% of the defects related to the pulp had additional resorption of the bone/dental tissues during the follow-up period. CONCLUSIONS: Three different radiographic responses of root damage following MMF screw trauma were identified. Understanding these different responses is important to guide the management of the potential complications. This proposed radiographic assessment can be used to present root healing data in a more standardized and reliable manner.

Comparison of Success Rate of Dental Implants Placed in Autogenous Bone Graft Regenerated Areas and Pristine Bone.

Autogenous bone grafting still has been considered as the "gold standard" and wildly used in the case of alveolar bone reconstruction. The aim of the present study is to evaluate the success rate of implants placed in autogenous block augmented ridges and implants placed in pristine bone (PB). This study included 113 patients. Fifty-three patients were treated with autogenous block grafts and particulate bone, after 6 months of healing implant placements were performed in autogenous bone augmented (ABA) areas. In 60 patients implant placement was performed, with no need for grafting and implants were placed into the PB. Follow-up data (pain, mobility, exudation from peri-implant space, success rate, marginal bone resorption) were collected after 5 years of prosthetic loading. The cumulative implant success rate at the 5-year examination was 92.45% for the ABA group and 85% for PB group. There were 3 failed implants in the ABA group and 3 in PB group. Average marginal bone loss was 1.47 mm on ABA group and 1.58 mm on PB group. No statistically significant differences for pain, exudation from peri-implant space, implant mobility, implant success, peri-implant bone loss parameters, and patient satisfaction level were found between groups. The obtained data demonstrated that the success rate of implants placed in regenerated areas are very similar to the success rate of implants those placed in PB.

Surgical Protocol for a Safe Lateral Nasal Wall Osteotomy.

PURPOSE: The purpose of this study was to define the anatomy and anatomic variations of the lateral nasal wall area to identify safe access points, determine the optimum osteotomy line for Le Fort I osteotomies, and define a surgical protocol. MATERIALS AND METHODS: The angulations and widths of 160 lateral nasal walls and the distances of the greater palatine canal were measured on axial images from coronal sections 5 mm over the deepest point of the nasal base. RESULTS: The average angle between the anterior lateral nasal wall and the medial maxillary sinus wall was 160 degrees in females and 165.67 degrees in males for the right and 155.90 degrees in females and 163.22 degrees in males for the left side. Statistically significant differences were found in the lengths, angulations, and widths of the lateral nasal walls between females and males. CONCLUSION: This study described the mean angulations and linear distances between anatomic structures of the lateral nasal wall and it defines the "Medipol protocol" for a safe osteotomy.

Changes of Stress Distributions Around Pterygomaxillary Junction With Different Osteotome Angulations.

The aim of this study was to investigate how the alteration of the angulation of osteotome at pterygomaxillary junction affects lateral pterygoid plate, maxillary tuberosity, palatal surface of maxilla, palatine bone and body of sphenoid bone. Following reconstruction of 3D modelling of maxilla, Osteotomes' tip was angulated 45 and 90 to sagittal plane to simulate pterygomaxillary osteotomy. Finite element analyses (FEA) was performed and Von Misses stress distributions were analyzed for two different angulations. Independent sample t test was used to compare differences between 45 and 90 angulations. Von Misses stress values on lateral pterygoid plate were higher in 45 angulation (0.71 ±â€Š0.21 MPa) than 90 angulation (0.54 ±â€Š0.28 MPa). This difference was statistically significant (P < 0.01). Placement of osteotome's tip with 90 angulation had higher stress value than 45 angulation on maxillary tuberosity region. However; difference wasn't significant (P = 0.44). Stress values on body of sphenoid bone were 0.45 ±â€Š0.17MPa for the case of 90 angulation and 0.19 ±â€Š0.09MPa for 45 angulation. Difference between these values were statistically significant (P < 0.01). Possible risk of unfavourable lateral pterygoid plate fracture and complications related with body of sphenoid bone during pterygomaxillary osteotomy was remarkably increased in case of narrow angulation (45). Keeping osteotome at right angle with sagittal plane may avoid these complications.

Management of Maxillary Deformity with Segmental Osteotomy followed by Implant Insertion in ß-Thalassemia Major Patient.

AIM: The aim of this report is to present the management of the maxillary deformity and subsequent implant therapy of a case with ß-thalassemia major. BACKGROUND: ß-thalassemia is a hematologic disorder that results from the abnormality of the ß-globulin chain synthesis. The best known thalassemia-induced dentofacial problem is the maxillary enlargement, and this undesirable growth of maxilla affects not only the facial esthetics but also dental occlusion, and leads to functional deficiency. CASE DESCRIPTION: A 16-year-old female patient with ß-thalasse-mia major was referred with the complaints of severe facial deformity and malocclusion, resulting in psychosocial and functional problems for her. The dentofacial deformity was characterized by an excessive premaxillary growth both in sagittal and vertical planes. Anterior maxillary osteotomy was performed with bilateral canines extraction, and dental implants were inserted to the canine regions, following bone healing. Postoperative course was free of problems with the crown restorations in function. Recurrence has not been occurred at 6 years follow-up. CONCLUSION: With maintaining hemoglobin level over 10 gm/dl, correction of maxillary defects is stable for long-term in ß-thalassemia major patient. Implant application to these patients may lead to unforeseeable results. CLINICAL SIGNIFICANCE: Although having some difficulties, such as overbleeding and stability problems, maxillary enlargement can be treated by segmental osteotomies successfully in ß-thalassemia major patient. Implant failure frequency may be higher, but many other studies are needed for determining implant survival rate in ß-thalassemia major patients.

Management of bisphosphonate-related osteonecrosis of the jaw with a platelet-rich fibrin membrane: technical report.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a challenging complication resulting from the long-term application of bisphosphonates. In most cases, BRONJ occurs after a surgical procedure involving the jawbone. Currently, the management of BRONJ remains controversial, and there is no definitive treatment other than palliative methods. Platelet-rich fibrin (PRF) represents a relatively new biotechnology for the stimulation and acceleration of tissue healing and bone regeneration. This technical note describes the total closure of moderate bone exposure in persistent BRONJ in 2 weeks with a double-layer PRF membrane. PRF may stimulate gingival healing and act as a barrier membrane between the alveolar bone and the oral cavity. PRF may offer a fast, easy, and effective alternative method for the closure of bone exposure in BRONJ.

Change in inferior sclera exposure following Le Fort I osteotomy in patients with midfacial retrognathia.

PURPOSE: For facial esthetic reasons, no sclera should be exposed above or below the irises when the head of a patient who has a normal skeletal pattern is in a neutral position and the eyelids are in a relaxed position. This study evaluated the decrease in sclera exposure after maxillary advancement or impaction in patients with midfacial hypoplasia. PATIENTS AND METHODS: Forty-seven consecutive patients (24 male, 23 female) who underwent Le Fort I osteotomy were included. The patients were divided into 2 groups according to type of maxillary movement: group I underwent maxillary advancement (n = 23) and group II underwent maxillary advancement and impaction surgery (n = 24). Standardized preoperative and 6-month postoperative photographs of the frontal view of patients were evaluated using Adobe Photoshop CS5. The proportion of inferior sclera exposure to eye height was determined, and the proportional difference between the preoperative and postoperative orbital views was statistically analyzed. RESULTS: The proportion of inferior sclera exposure to eye height decreased by a ratio of 0.07 (P = .001) in the right and left eyes of the 47 patients, with an average maxillary advancement of 6.1 mm. The proportion of inferior sclera exposure to eye height of the right and left eyes decreased from 0.1 to 0.02 and from 0.09 to 0.02, respectively, in group I (P = .001). The proportion of inferior sclera exposure to eye height decreased in group II by a ratio of 0.06 in the right and left eyes (P = .001). CONCLUSION: Inferior sclera exposure in patients with midfacial hypoplasia and retrognathia decreases significantly in accordance with the change in the lower eyelid position after maxillary advancement or impaction surgeries.

Dentofacial effects of skeletal anchored treatment modalities for the correction of maxillary retrognathia.

INTRODUCTION: The aim of this clinical study was to investigate the skeletal, dentoalveolar, and soft-tissue effects of 2 skeletal anchorage rationales for Class III treatment compared with an untreated Class III control group. METHODS: Fifty-one subjects who were in the prepubertal or pubertal growth period were included in the study. In group 1 (n = 17), facemasks were applied from miniplates placed in the lateral nasal walls of the maxilla, and intermaxillary Class III elastics were applied from symphyseal miniplates to a bonded appliance on the maxilla in group 2 (n = 17). These skeletal anchored groups were compared with an untreated control group (n = 17). Lateral cephalometric radiographs were obtained at the beginning and the end of the observation periods in all groups and analyzed according to the structural superimposition method. Differences between the groups were assessed with the Wilcoxon signed rank test or the paired-samples t test. RESULTS: The treatment periods were 7.4 and 7.6 months in groups 1 and 2, respectively, and the untreated control group was observed for 7.5 months. The maxilla moved forward by 3.11 mm in group 1 and by 3.82 mm in group 2. The counterclockwise rotation of the maxilla was significantly less in group 1 compared with group 2 (P <0.01). The mandible showed clockwise rotation and was positioned downward and backward in the treatment groups, and it was significantly greater in group 2 compared with group 1 (P <0.01). Changes in the maxillary incisor measurements were negligible in group 1 compared with group 2. A significant amount of mandibular incisor retroclination was seen in group 1, and a significant proclination was seen in group 2. The maxillomandibular relationships and the soft-tissue profiles were improved remarkably in both treatment groups. CONCLUSIONS: The protocols of miniplates with facemasks and miniplates with Class III elastics offer valid alternatives to conventional methods in severe skeletal Class III patients. However, the 2 maxillary protraction protocols demonstrated significant skeletal and dentoalveolar effects. The miniplate with facemask protocol is preferred for patients with severe maxillary retrusion and a high-angle vertical pattern, whereas in patients with a decreased or normal vertical pattern and retroclined mandibular incisors, miniplates with Class III elastics can be the intraoral treatment option. Therefore, the exact indication of the procedure should be considered carefully.

Assessment of nasal respiration and three-dimensional airway volume changes in orthognathic surgery patients.

OBJECTIVES: The aim of this study was to evaluate the effect of maxillary movements in orthognathic surgery on nasal airway volume change and its correlation with airflow and resistance. MATERIALS AND METHODS: This study included 25 patients (8 male, 17 female) with Class II (6 patients) or Class III (19 patients) malocclusion. All patients underwent Le Fort I and bilateral sagittal split ramus osteotomy. Nasal airflow and resistance were measured by using rhinomanometry and acoustic rhinometry pre and six months post-operatively. Nasal volume was measured using computed tomography before surgery and six months after surgery. RESULTS: Nasal volume increased in 10 out of 11 patients with CCW (counterclockwise) rotation and decreased in 1 patient while, nasal volume increased in 5 patients with CW (clockwise) rotation and decreased in 9 patients. Superior nasal airway volume increased significantly, while the effects on nasal flow and resistance were not significant. Additionally, no significant correlation was found between airway volume changes and variations in airflow and resistance. CONCLUSION: CCW rotation in orthognathic surgery patients significantly increased superior nasal airway volume but did not improve nasal airway flow and resistance.