Nasal airway function after Le Fort I osteotomy with maxillary impaction: A prospective study using the Nasal Obstruction Symptom Evaluation scale

Background@#This study evaluated changes in nasal airway function following Le Fort I osteotomy with maxillary impaction according to the Nasal Obstruction Symptom Evaluation (NOSE) scale. @*Methods@#This cohort study included 13 patients who underwent Le Fort I osteotomy with maxillary impaction. Nasal airway function was evaluated based on the NOSE scale preoperatively and at 3 months postoperatively. The change in the NOSE score was calculated as the preoperative score minus the postoperative score. If the normality assumptions for changes in the NOSE score were not met, a nonparametric test (the Wilcoxon signed-rank test) was used. Differences in NOSE score changes according to patient characteristics and surgical factors were evaluated using the Kruskal-Wallis test and the Mann-Whitney test. @*Results@#Patients ranged in age from 18 to 29 years (mean±standard deviation [SD], 23.00±3.87 years). Three were men and 10 were women. Eleven patients (84%) had an acquired dentofacial deformity with skeletal class III malocclusion. The preoperative NOSE scores ranged from 40 to 90 (mean±SD, 68.92±16.68), and the postoperative NOSE scores ranged from 25 to 80 (53.84±18.83). The cohort as a whole showed significant improvement in nasal airway function following maxillary impaction (P=0.028). Eleven patients (84%) had either improved (n=8) or unchanged (n=3) postoperative NOSE scores. However, nasal airway function deteriorated in two patients. Patient characteristics and surgical factors were not correlated with preoperative or postoperative NOSE scores. @*Conclusions@#Nasal airway function as evaluated using the NOSE scale improved after maxillary impaction.

Tensile bond strength of chairside reline resin to denture bases fabricated by subtractive and additive manufacturing / 대한치과보철학회지

Purpose@#The purpose of this study was to compare and evaluate the tensile bond strength of chairside reline resin to denture base resin fabricated by different methods (subtractive manufacturing, additive manufacturing, and conventional heat-curing). @*Materials and methods@#Denture base specimens were fabricated as cuboid specimens with a width of 25 mm × length 25 mm × height 3 mm by subtractive manufacturing (VITA VIONIC BASE), additive manufacturing (NextDent Base) and conventional heat-curing (Lucitone 199). After storing the specimens in distilled water at 37°C for 30 days and drying them, they were relined with polyethyl methacrylate (PEMA) chairside reline resin (REBASE II Normal). The subtractive and additive manufacturing groups were set as the experimental group, and the heat-curing group was set as the control group. Ten specimens were prepared for each group. After storing all bound specimens in distilled water at 37°C for 24 hours, the tensile bond strength between denture bases and chairside reline resin was measured by a universal testing machine at a crosshead speed of 10 mm/min. The fracture pattern of each specimen was analyzed and classified into adhesive failure, cohesive failure, and mixed failure. Tensile bond strength, according to the fabrication method, was analyzed by 1-way ANOVA and Bonferroni’s method (α =.05). @*Results@#Mean tensile bond strength of the heat-curing group (2.45 ± 0.39 MPa) and subtractive manufacturing group (2.33 ± 0.39 MPa) had no significant difference (P>.999). The additive manufacturing group showed significantly lower tensile bond strength (1.23 ± 0.36 MPa) compared to the other groups (P<.001). Most specimens of heat-curing and subtractive manufacturing groups had mixed failure, but mixed failure and adhesive failure showed the same frequency in additive manufacturing group. @*Conclusion@#The mean tensile bond strength of the subtractive manufacturing group was not significantly different from the heat-curing group. The additive manufacturing group showed significantly lower mean tensile bond strength than the other two groups.

Intraoperative blood loss and surgical time according to the direction of maxillary movement

Background@#Excessive bleeding is one of the most severe complications of orthognathic surgery (OGS). This study investigated the associations of intraoperative blood loss and surgical time with the direction of maxillary movement. @*Methods@#This retrospective study involved patients who underwent OGS from October 2017 to February 2020. They were classified based on whether maxillary setback was performed into groups A1 and B1, respectively. Relative blood loss (RBL, %) was used as an indicator to compare intraoperative blood loss between the two groups. The surgical time of the two groups was also measured. Subsequently, the patients were reclassified based on whether posterior impaction of the maxilla was performed into groups A2 and B2, respectively. RBL and surgical time were measured in the two groups. Simple linear and multiple regression analyses were performed. P-values <0.05 were considered to indicate statistical significance. @*Results@#Eighteen patients were included. The RBL and surgical time for the groups were: A1, 13.15%±5.99% and 194.37±42.04 minutes; B1, 12.41%±1.89% and 196.50±46.07 minutes; A2, 13.94%±3.82% and 201.00±39.70 minutes; and B2, 9.61%±3.27% and 188.84±38.63 minutes, respectively. Only RBL showed a statistically significant difference between the two groups (A2 and B2, P=0.04). @*Conclusions@#Unlike maxillary setback, posterior impaction of the maxilla showed a significant association with RBL during surgery. When performing posterior impaction of the maxilla, clinicians need to pay particular attention to surgery and postoperative care.

Orbital Floor Fracture

The medial wall and floor of the bony orbit are frequently fractured because of the delicate anatomy. To optimize functional and aesthetic results, reconstructive surgeons should understand the anatomy and pathophysiology of orbital fractures. Appropriate treatment involves optimal timing of intervention, proper indications for operative repair, incision and dissection, release of herniated tissue, implant material and placement, and wound closure. The following review will discuss the management of orbital floor fractures, with the operative method preferred by the author. Special considerations in operation technique and the complication are also present in this article.

Analysis of the Development of the Nasal Septum and Measurement of the Harvestable Septal Cartilage in Koreans Using Three-Dimensional Facial Bone Computed Tomography Scanning

BACKGROUND: The septal cartilage is the most useful donor site for autologous cartilage graft material in rhinoplasty. For successful nasal surgery, it is necessary to understand the developmental process of the nasal septum and to predict the amount of harvestable septal cartilage before surgery. METHODS: One hundred twenty-three Korean patients who underwent three-dimensional (3D) facial bone computed tomography (CT) were selected for evaluation of the midsagittal view of the nasal septum. Multiple parameters such as the area of each component of the nasal septum and the amount of harvestable septal cartilage were measured using Digimizer software. RESULTS: The area of the total nasal septum showed rapid growth until the teenage years, but thereafter no significant change throughout the lifetime. However, the development of the septal cartilage showed a gradual decline due to ossification changes with aging after puberty in spite of a lack of change in the total septal area. The area of harvestable septal cartilage in young adults was 549.84+/-151.26 mm2 and decreased thereafter with age. CONCLUSIONS: A 3D facial bone CT scan can provide valuable information on the septal cartilage graft before rhinoplasty. Considering the developmental process of the septal cartilage identified in this study, septal surgery should not be performed until puberty due to the risk of nasal growth impairment. Furthermore, in elderly patients who show a decreased cartilage area due to ossification changes, septal cartilage harvesting should be performed carefully due to the risk of saddle nose deformity.

Treatment of Chronic Osteomyelitis in the Hand with Anterolateral Thigh Free Flap and Autologous Iliac Bone Graft

Adequate debridement and flap operations are effective treatment methods for chronic osteomyelitis. Several flap operations have been described for treating chronic osteomyelitis in various regions. We performed anterolateral thigh fasciocutaneous free flap and iliac bone graft for treating posttraumatic chronic osteomyelitis in hand. The result was successful with satisfactory control of osteomyelitis and avoiding amputation of fingers.

The Usefulness of the Endonasal Incisional Approach for the Treatment of Nasal Bone Fracture

BACKGROUND: Among all facial fractures, nasal bone fractures are the most common, and they have been reduced by closed reduction (CR) for a long time. But several authors have reported suboptimal results when using CR, and the best method of nasal bone reduction is still being debated. We have found that indirect open reduction (IOR) through an endonasal incisional approach is a useful method for more accurate reduction of the nasal bone. METHODS: A retrospective chart review was performed of 356 patients who underwent reduction of a nasal bone fracture in our department from January, 2006, to July, 2011. We treated 263 patients with IOR. We assessed patients' and doctors' satisfaction with surgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing to mucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsal augmentation rhinoplasty. RESULTS: According to the analysis of the satisfaction scores, both patients and doctors were significantly more satisfied in the IOR group than the CR group (P<0.05). Mucosal injury with nasal bleeding occurred much less in the IOR group (5.3%) than the CR group (12.9%). Dorsal augmentation rhinoplasty with IOR was performed simultaneously in 34 cases. Most of them (31/34) showed satisfaction with the outcomes. CONCLUSIONS: IOR enables surgeons to manipulate the bony fragment directly through the endonasal incisional approach. However, we propose that CR is the proper technique for patients under 16 and for those with comminuted nasal bone fractures because submucosal dissection in IOR can damage the growth or circulation of nasal bone.

Anatomical Measurement of the Masseter Muscle and Surface Mapping of the Maximal Thickness Point Using Computed Tomography Analysis

PURPOSE: Masseter muscle is an important muscle of mastication. Because it has a great influence on the shape of low facial contour, patients who have masseteric hypertrophy show square-shaped jaw appearance. As aesthetic procedures for the reduction of the masseter muscle volume, radiofrequency ablation or botulinium toxin injection is at the center of attention. Authors studied the anatomical measurement of the thickness and width of masseter muscle and the surface mapping of the maximal thickness point using computed tomography(CT) scan to identify the useful guide for the injection of botulinum toxin in masseteric hypertrophy patients. METHODS: We analyzed 2 mm-thickness OMU(ostiomeatal unit) CT of 112 normal people(224 masseter muscles) taken from June 2009 to May 2010. First, we measured the thickness, width and depth of the masseter muscle from the skin surface and analysed each by side, sex and age, respectively. The distribution of the thickness of the muscle and the correlation of thickness and width of the muscle were studied also. Second, we underwent surface mapping of the maximal thickness point using CT analysis by means of checking the vertical and horizontal distance from the angle of the mandible. RESULTS: The average thickness and width of the masseter muscle was 17.73 mm and 40.78 mm in the male patients and were 14.33 mm and 37.42 mm in the female patients. Statistically, both figures of the male patients were larger than those of the female patients. However, the depth of the muscle from the skin surface in female patients (7.37 mm) was larger than that of the male patients(6.15 mm). There were no statistical difference in side or age. The width and thickness of the masseter muscle were in the positive correlation. The location of maximal thickness point of the masseter muscle was 27.77 mm vertically and 27.68 mm horizontally in the male patients, and 25.19 mm vertically and 25.42 mm horizontally in the female patients from the angle of mandible. CONCLUSION: We were able to present statistical evidence of the diagnosis and treatment of the masseteric hypertrophy regarding the anatomical measurements such as the thickness and width. And the maximal thickness point of the masseter muscle may be a useful guide for the clinical procedures of botulinium toxin injection.

Removal of a Movable Foreign Body in the Flexor Tendon Sheath of the Hand: A Case Report

Traumatic implantation of foreign material into the hand is common. Such material may be palpable or identified by plain radiographs or ultrasonography. Surgical exploration and removal is usually a simple procedure, with the foreign material found close to the point of insertion. However, migration of foreign material within the flexor sheath can occur very rarely. We report the patient who had a movable foreign material in the flexor tendon sheath of the hand. Using milking method, foreign material in the flexor sheath was successfully removed.

A Case Report of Focal Ossification of the Auricular Cartilage

PURPOSE: The focal ossification of auricular cartilage is an unusual clinical entity in which the ear becomes partially or totally rigid and immalleable. This condition may result from cold injury, local trauma, inflammation, or various systemic diseases. Patients may feel mild discomfort, but there are usually no other serious symptoms. We present a case of focal ossification of auricular cartilage in which the cause is unknown. METHODS: A healthy 58-year-old man presented with a 2-year history of hard mass of right posterior auricular area. He denied any precipitating historical events like cold injury and inflammation. Routine testing did not demonstrate systemic abnormalities. Ultrasonographic examination revealed a 22 x 10 x 11 mm sized heterogenous isoechoic mass showing an acoustic shadow. RESULTS: Excisional biopsy was performed under local anesthesia. Histological examination revealed the ossification with deposition of trabecular bone in normal elastic cartilage. The patient was healed without any problems and satisfied with the result. CONCLUSION: We report clinical experience of focal ossification of auricular cartilage, which is quite a rare clinical entity. It should be considered that there is the possibility of ossification of cartilage when it meets the benign mass of the ear.