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Fundamento: Para la contención del avance mandibular es necesario utilizar un aparato que mantenga la mandíbula en la posición lograda por los aparatos activos y que su diseño no provoque movimientos dentarios indeseados. Objetivo: Describir los cambios clínicos y cefalométricos del aparato funcional postratamiento de Waveney como alternativa en la contención del avance mandibular. Metodología: Se realizó una investigación descriptiva observacional de corte transversal en el servicio Ortodoncia de la Clínica Estomatológica Docente Provincial Dr. Justo Ortelio Pestana Lorenzo de la provincia Sancti Spíritus, desde septiembre 2019 a febrero 2022. Se seleccionaron 20 pacientes que iniciaron su etapa de contención en este período y cumplieron los criterios de inclusión. Se utilizaron métodos del nivel empírico y estadístico. Se analizaron las variables: edad, sexo, variables morfológicas clínicas y cefalométricas, así como resultado de la contención. Resultados: Se constató una edad promedio de 15.6; el 65 % de los escolares pertenecían al sexo femenino. Al año de iniciada la contención se mantuvo el sobrepase incisivo en 2.95 mm, la relación molar de neutroclusión en el 65 %, ángulo SNB en 79°, el ángulo ANB en 2.80°, la posición del incisivo superior 2.45 mm, la posición del incisivo inferior en 1.90 mm y el perfil estético en 0.55 mm. Solo existió incremento en el valor promedio del resalte incisivo de 2.70 mm a 2.75 mm. Conclusiones: Al año de iniciada la contención con el aparato funcional postratamiento de Waveney no se observó modificación de las variables estudiadas, excepto el resalte incisivo con incremento de su valor promedio.
Background: For mandibular advancement containment, it is necessary to use an appliance that holds the jaw in the achieved position by active appliances and that its design does not provoke undesired dental movements. Objective: To describe the clinical and cephalometric changes of the Orthodontic Appliances after the Waveney treatment as an alternative in the mandibular advancement containment. Methodology: A descriptive observational cross-sectional research was conducted at the Dr. Justo Ortelio Pestana Lorenzo Provincial Teaching Stomatology Clinic orthodontic service in Sancti Spíritus province, from September 2019 to February 2022. 20 patients who started their containment stage in this period and fulfilled the inclusion criteria were selected. Empirical and statistical methods were used. The following variables were analyzed: age, sex, clinical morphological and cephalometric variables, as well as the containment result. Results: An average age of 15.6 was found; 65% of the schoolchildren were female. One year after the containment was started, the incisive overpass was maintained at 2.95 mm, the neutroclusion molar rate at 65%, SNB angle at 79°, the ANB angle at 2.80°, the upper incisor position 2.45 mm, the lower incisor position by 1.90 mm and the esthetic profile by 0.55 mm. There was only an average increase in the incisor protrusion value from 2.70 mm to 2.75 mm. Conclusions: One year after containment with the Waveney post-treatment Orthodontic Appliances was initiated no changes were observed in the studied variables, except for incisor protrusion with an increase in its average value.
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Introducción: El carcinoma basocelular es actualmente el cáncer de piel más frecuente, siendo su principal factor de riesgo la exposición a radiación ultravioleta. Su tratamiento es la resección quirúrgica, según riesgo de recurrencia. La reconstrucción facial posterior a la resección se enfrentará según la unidad estética de la cara, lo cual determinará la técnica quirúrgica a utilizar. Material y Método: El siguiente caso clínico aborda la resección de un carcinoma basocelular nodular morfeiforme ubicado en mejilla y ala nasal, y posterior reconstrucción mediante el uso de un Colgajo de Mustardé, con resultado exitoso. Resultados: Evolución favorable, con reseccion completa de la lesion tumoral y vitalidad del colgajo postoperatorio. Cursó con una leve desviación nasal que cedió con masaje de la cicatriz. Se puede plantear una plastía de retoque del ala nasal a futuro. Conclusión: Presentamos un caso clínico de un carcinoma basocelular facial con alto riesgo de recurrencia que fue tratado en forma segura y efectiva con un colgajo de Mustardé.
Introduction: Basal-cell carcinoma is currently the most frequent type of skin cancer, its main risk factor being exposure to ultraviolet radiation. Treatment consists of surgical resection, according to recurrence risk. Post-resection facial reconstruction should be faced according to the aesthetic unit of the face, which will determine the surgical technique. Material and Method: The following clinical case presents the resection of a morpheiform nodular basal-cell carcinoma located on the cheek and nasal wing, and subsequent reconstruction using a Mustarde flap, with successful results. Results: Favorable evolution with complete resection of the tumor lesion and postoperative vitality of the flap. The patient presented a slight nasal deviation that resolved with scar massage. A nasal wing plasty can be considered in the future. Conclusion: We present a facial basal-cell carcinoma clinical case that was safely and effectively treated with a Mustarde flap.
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Introduction: Anorectal fistulas are some of the commonest surgical proctologic disorders treated by surgeons. Despite the recent introduction of various sphincter preserving techniques, the search for the optimal operation continues. The purpose of this study was to determine the predictors of long-term healing for the endorectal advancement flap. Methods: A retrospective review of a single surgeon experience with the endorectal advancement flap for anorectal fistulas over an 18-year period. The impact of various patient and fistula related factors were analyzed for their impact on the primary endpoint of long-term fistula healing. Results: 87 patients underwent endorectal advancement flap (Male/Female 42.5/57.5%). Median age was 41 years. Sixty-nine patients (79.3%) had anal fistula while 18 patients had rectal fistula (20.7%). An anterior based fistula was noted in 45 patients (51.7%). The most common etiology was cryptoglandular disease (87.4%). The median operative time was 75minutes (range 36-250). Postoperative septic complications were noted in 4 patients (4.6%). Fistula healing was documented in 80 patients (93%). During a median follow-up of 4 months (range 1-38, 1 patient lost to follow-up), recurrence was noted in 8 patients (9.3%), yielding an overall long-term success rate of 83.7%. The long-term healing rate was higher in patients with fistulas from cryptoglandular etiology (86.6%) compared to fistulas from other etiologies (63.6%) [p = 0.027]. Conclusions: The endorectal advancement is associated with a high healing rate, a low postoperative septic complication rate, and infrequent risk for recurrence. Long-term healing without recurrence is achieved more frequently in patients with cryptoglandular etiology of the fistula compared to patients with non-cryptoglandular etiology. (AU)
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Humans , Male , Female , Rectum/surgery , Rectal Fistula/surgery , Postoperative Complications , Recurrence , Health Profile , Retrospective Studies , Treatment OutcomeABSTRACT
Abstract Objectives To evaluate the effectiveness of maxillomandibular advancement surgery in the treatment of Obstructive Sleep Apnea by comparing the pre- and postoperative Apnea and Hypopnea Index, in addition to classifying the degree of evidence and risk of intervention bias. Methods A systematic review of the literature was carried out in the PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE and COCHRANE platforms, including cohort studies with polysomnographic follow-up, without other associated pharyngeal or nasal surgical procedures. The risk of study bias was assessed using the Modified Delphi technique. Pre- and postoperative Apnea and Hypopnea Index data were plotted for meta-analysis, and the quality of evidence was assessed using the GRADE system. Results Of 1882 references, 32 articles were selected for full-text reading, of which four studies were included, totaling 83 adults with obstructive sleep apnea who underwent maxillomandibular advancement. The meta-analysis was in favor of the intervention (DM = −33.36, 95% CI −41.43 to −25.29, p< 0.00001), with a mean percentage reduction in the Apnea and Hypopnea Index of 79.5% after surgery, even though the level of evidence was classified as very low quality by the GRADE system. Conclusion The meta-analysis was in favor of the intervention, characterizing maxillomandibular advancement surgery as an effective treatment for obstructive sleep apnea in adults.
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Background: In acute chemical injury, damage can range from ocular surface epithelial defects to limbal and scleral ischemia. This may subsequently progress to corneal or scleral melting and perforation and finally result in phthisis bulbi. Thus, acute chemical injury is a potentially blinding condition and warrants attention. The accurate technique to assess the damage incurred should be practiced to avoid undertreatment and subsequent complications. Surgical intervention wherever needed should be appropriately timed and should be performed. The primary aim of medical or surgical intervention in acute chemical injury is to attain a stable and epithelized ocular surface. Even a conjunctival phenotype over the cornea is a desirable outcome. Purpose: This video discusses the nuances involved in the assessment and planning of Tenon advancement with amniotic membrane grafting for treating limbal ischemia in acute chemical injury. Synopsis: The video demonstrates the technique of restoration of limbal vascularization by performing Tenon advancement with amniotic membrane grafting and its outcome. Highlights: Ocular surface painting with fluorescein dye is essential to assess the areas of surface involvement. Merely instilling the fluorescein dye in the cul?de?sac will underestimate the extent of the damage. Tenon advancement should ideally be planned between 7 and 10 days following an injury when actual limbal blanching is obvious. A stable and epithelized ocular surface is the desirable outcome irrespective of the epithelial phenotype.
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Objective@#To evaluate the effects of non-bracket invisible appliance mandibular advance(MA) on skeletal Class Ⅱ growing patients with mandibular retrusion.@*Methods@#Nineteen skeletal Class Ⅱ growing patients with mandibular retrusion who were treated in the department of stomatology of Changshu traditional Chinese medicine hospital from January 2018 to May 2021 were selected. They had an average age of (12.32±1.51) years old. The treatment group consisted of 10 children who were treated with MA. The control group consisted of 9 children who refused to treat their malocclusion. Cephalometrics of all patients were taken before and after the observation or treatment. The cephalometric data of two groups were analyzed. @*Results@#Compared with the control group, in the treatment gruop SNB angle, L1-NB angle, L1-NB distance, L6-MP distance, Z angle increased significantly (P<0.05);Co-Go distance, Co-Gn distance, SL increased more greatly than the control group; ANB angle, U1-SN angle, U1-NA angle, U1-NA distance, L1-MP distance, FCA angle decreased significantly (P<0.05); SE did not change significantly in the treatment group, but increased significantly in the control group (P<0.05).@*Conclusion @# MA can promote mandibular growth and improve lateral profile. The angle of the lower teeth and the angle of the mandible plane can be controlled by MA appliance.
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OBJECTIVES@#This study aimed to conduct a meta-analysis of the efficacy of mandibular advance clear alig-ners with traditional functional appliances as the control group.@*METHODS@#PubMed, Web of Science, Embase, Cochrane Library, China Biomedical Abstracts Database, China Knowledge Network Database, Wanfang Database, and Weipu Database were used in this study. The two groups of researchers screened the literature and extracted data based on the inclusion and exclusion criteria established by PICOS entries, and used the ROBINS-I scale for quality evaluation. Revman 5.4 and Stata 17.0 software were used for meta-analysis.@*RESULTS@#Nine clinical controlled trials were included in this study with a total sample size of 283 cases. No significant difference was found in SNA, SNB, ANB, Go-Pog, U1-SN, Overjet, and other aspects between the invisible group and the traditional group in the treatment of skeletal class Ⅱ ma-locclusion patients; there was a 0.90° difference in mandibular plane angle between the two groups; the growth of the mandibular ramus (Co-Go) in the traditional group was 1.10 mm more than that in the invisible group; the lip inclination of the lower teeth in the invisible group was better controlled, 1.94° less than that in the control group.@*CONCLUSIONS@#The invisible group can better control the lip inclination of the mandibular anterior teeth when guiding the mandible. Furthermore, the mandibular plane angle (MP-SN) can remain unchanged, but the growth of the mandibular ramus is not as good as the traditional group, and auxiliary measures should be taken to improve it in clinical practice.
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Humans , Malocclusion, Angle Class II/therapy , Mandibular Advancement , Orthodontics, Corrective , Orthodontic Appliances, Functional , Mandible , Orthodontic Appliances, Removable , CephalometryABSTRACT
Objetivo : Determinar la variación de la calidad de vida en pacientes con Síndrome de Apnea Hipopnea Obstructiva del Sueño leve moderado, luego del tratamiento con Dispositivo de Avance Mandibular a una altitud de 3259 msnm. Métodos : Estudio prospectivo, cuasi-experimental. Se incluyeron sujetos con índice de Disturbio Respiratorio (IDR) entre 5 y 30 /hora (medido con poligrafía respiratoria), sin tratamientos previos, que presentaban condiciones para el uso del DAM. Se valoró calidad de vida con el FOSQ (Functional Outcomes Sleep Questionnaire) antes y después de 45 días de tratamiento con DAM. Resultados: 26 completaron el estudio (20 varones). La media (DE) de edad fue: 43 (9.6) años, IMC: 29 (8.6) kg/m2 e IDR: 19 (7.6) /h. Luego de 45 días, se observaron cambios significativos, en el FOSQ (total, dimensiones de productividad general, producción social, nivel de actividad, vigilia y relaciones íntimas/actividad sexual) p <0.001. La media del IDR descendió de 19 (7.6) a 7 (3.8) (p <0.001), la desaturación mínima de O2 incrementó de 77 % (5.2) a 83 % (3.9) (p <0.001), el T90 descendió de 73 % (15.4) a 31 % (16.6) (p <0.001) y el Epworth disminuyó de 11.2 (4.6) a 6.4 (3.5) (p <0.001). Conclusiones : En pacientes con SAHOS leve moderado el tratamiento con DAM produce mejoría significativa en su calidad de vida, reduce nivel de enfermedad expresado en descenso del IDR, mejora el nivel oxigenación y reduce la somnolencia diurna expresado en disminución del puntaje Epworth.
Objective: To determine the variation of the Quality of Life in patients with mild to moderate Obstructive Sleep Apnea Hypopnea Syndrome, after treatment with the Mandibular Advancement Device at an altitude of 3259 masl. Methods: Prospective, quasi-experimental study. Subjects with respiratory disturbance index (RDI) between 5 and 30 / hour (measured with respiratory polygraphy), without previous treatments, with conditions for the use of MAD were included. The quality of life was assessed with the FOSQ (questionnaire of functional sleep results) before and after 45 days of treatment with MAD. Results: 26 completed the study (20 males). The mean (SD) of the age was 43 (9.6) years, BMI was 29 (8.6) kg / m2, and the RDI was 19 (7.6) / hour. After 45 day, significant changes were observed, with respect to the baseline values, in the FOSQ score (total calculation, general productivity, social outcome, activity level, vigilance and intimate relationships/sexual activity, p <0.001). The mean RDI decreased from 19 (7.6) to 7 (3.8) (p <0.001), the minimum desaturation of O2 increased from 77 (5.2) to 83 (3.9) (p <0.001), the T90 decreased from 73 (15.4) to 31 (16.6) (p <0.001) y Epworth's score decreased from 11.2 (4.6) to 6.4 (3.5) (p <0.001). Conclusions : In patients with mild-moderate OSA, treatment with MAD produces significant improvement in their quality of life, reduces the level of disease expressed in decreased RDI, improves oxygenation level and reduces daytime sleepiness expressed in decreased Epworth score.
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Abstract Introduction In the literature, evidence is lacking on the predictive value of druginduced sleep endoscopy (DISE) for oral appliance treatment (OAT). Objectives The aim of the present study is to evaluate whether DISE with concomitant mandibular advancement maneuver can predict failure of OAT. Methods An observational retrospective study including patients diagnosed with obstructive sleep apnea (OSA) who previously received OAT. Results of DISE were analyzed in a group with documented OAT failure (apnea-hypopnea index [AHI] >10 events/hour or < 50% reduction) and a group with OAT benefit (AHI <10 events/hour or >50% reduction). The upper airway was assessed using the velum, oropharynx, tongue base, epiglottis (VOTE) classification. Additionally, a mandibular advancement maneuver, manually protruding the mandible by performing a jaw thrust, was performed to mimic the effect of OAT. Results The present study included 50 patients with OAT failure and 20 patients with OAT benefit. A subgroup analysis of patients with OAT failure and an AHI <30events/hour included 26 patients. In the OAT failure group, 74% had a negative jaw thrust maneuver. In the subgroup with an AHI <30 events/hour, 76.9% had a negative jaw thrust maneuver. In the OAT benefit group, 25% had a negative jaw thrust maneuver (p< 0.001). Conclusions A negative jaw thrust maneuver during DISE can be a valuable predictor for OAT failure, independent of AHI. Drug-induced sleep endoscopy should be considered as a diagnostic evaluation tool before starting OAT.
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Background:To review the types of operations done for hypospadias to analyze the results and complications of different operations.Material And Methods:Patient case file and operation theater records of 40 pediatric patients from august 2020-July2021 used to obtain the required data.The age at surgery, types of hypospadias at presentation, types of operations done, complications, and results of surgeries were analyzed over a 1-year period. Result:This study in the pediatric age group showed the most common type of hypospadias being distal penile (45%) for which most common surgery being performed is Snodgrass (TIPU) (69%) with no acute (80%) and chronic complication (75%) at time of discharge. Complications rate highest when used for distal hypospadias(3-33 %). Commonest complication noted in literature is urethro-cutaneous fistula (29%). Also fistula rate is higher when TIPU is used for posterior hypospadias. Conclusion:Despite most challenging surgery in hypospadias, one may achieve desirable results by selecting appropriate surgical approaches in these patients. Careful selection of patients and attention to detailed technical factors may help reduce the complication rate. TIPU remains good option for most patients with anterior hypospadias.
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Background: A prospective clinical study was conducted to assess the effectiveness of the two -layered closure of recurrent Oroantral Fistula using Buccal Fat Pad and Buccal Advancement Flap. Materials and methods: Twenty patients with persistent OAFs larger than 5 mm were treated with two layered closure using Buccal Fat Pad and Buccal Advancement Flap. They were followed clinically and radiographically for 5 years after surgery to monitor the durability and effectiveness of the two layered closure of the OAF. Result: The procedure was successful in all patients. The healing process was satisfactory,with no breakdown or liquefaction necrosis postoperatively. No complications were observed during the follow-up period. Conclusion: The results of this study support the view that the use of the double-layered closure using BFP with buccal advancement flap is a durable, convenient, and effective method for the treatment of a persistent large OAF.
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Background:Hypospadias is one of the commonest congenital anomaly in boys which requires either a single stage repair or staged repair. The success of the procedure depend upon the type, anatomy, experience of the surgeon, method of repair and preoperative hormonal stimulation. Aim: The aim of the study was to evaluate the various preoperative factors responsible for outcome of single stage repair in distal penile, mid penile and proximal penile hypospadias. Methods: There were 48 patients in this observational study which were divided into two groups. Group A comprised of 24 patients with glanular and coronal hypospadias while Group B comprised of 16 patients with distal penile, 5 mid penile and 3 proximal penile types with minimal chordae. All the 24 (50%) patients in group A underwent meatal advancement and glanuloplasty incorporated (MAGPI) repair while in group B 15 (31.25%) patients underwent Tabularized Incised Plate (TIP) repair and 9 (18.75%) patients underwent combined TIP and Mathieu抯 repair. Results: Overall operative success rate observed in the study was 41 (85.41%) patients. In 7 (14.58%) patients urethrocutaneous fistula as a major complication occurred which included 1 patient in Group A and 2 patients with Distal Penile Hypospadias (DPH), 2 patients with Mid Penile Hypospadias (MPH) and 2 patients with Proximal Penile Hypospadias (PPH) in Group B. In 2 (4.16%) patients, mild meatal stenosis was noted which settled with meatal dilatation. Urethrocutaneous fistula (UCF) disappeared in 2 (4.16%) patients on follow up with regular urethral dilatation. Conclusion: MAGPI is the ideal procedure for glanular/coronal hypospadias. For distal penile hypospadias, TIP alone or combined TIP and Mathieu抯 repair gives equally good results. Preoperative testosterone therapy reduces the incidence of complications in a single stage hypospadias repair.
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Background: To investigate whether fixed functional therapy for mandibular advancement with the Forsus™ appliance would produce any changes in the cervical spine posture. Materials and Methods: This prospective clinical exploratory study was conducted on 12 patients (six females and six males) with a mean age of 15 ± 1.3 years, having mandibular retrusion, Class II malocclusion, who were treated with the Forsus™ appliance. Lateral cephalogram was taken twice, once at the baseline (T1) before the commencement of the treatment and once following termination of fixed functional treatment (T2). Eleven measurements representing the vertical and the sagittal craniofacial proportions, and the head posture, were taken into account. Data were analyzed using SPSS version 22. The variations between before and after treatment measurements were collated using paired t-test. P < 0.05 was considered statistically significant. Results: No significant differences were noticed in the angle linking the horizontal lines of the head and the superior crest of the spinal column before and after the treatment, with P = 0.73. The cervical curvature angle also failed to show any significant difference with P = 0.14. Conclusion: Fixed functional therapy with the Forsus™ device resulted in dentoalveolar and soft tissue alterations alone but did not alter the cervical spine posture.
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Objective:To evaluate the short time outcome about repairing of lateral incomplete cleft lip with two different treatments: new rotation advancement technique and Tennison technique.Methods:Twenty-seven cases of lateral incomplete cleft lip were repaired by the two different treatments, and 12 indexes were employed to evaluate the short time outcome of post-operation.Results:All the patients who were treated with the new rotation advancement technique and Tennison technique in this study obtained satisfactory lip and nasal symmetry immediately. There was no significant difference between the two techniques in the treatment of the patients with unilateral incomplete cleft lip.Conclusions:Though the new rotation advancement technique does not show the obvious improvements about repairing of lateral incomplete cleft lip, invisible incision and keeping the nostril sill will definitely benefit the patients because of reducing the risk of more scars.
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Objective:To investigate the effect of V-Y advancement flap in the treatment of foot spoke injury in children.Methods:Clinical data of 8 patients, including 6 males and 2 females aged 2.5-5.0 (mean, 3.5) years old with foot spoke injury admitted to the Third Ward of Department of Orthopaedic Surgery, Xingtai General Hospital of North China Medical and Health Group from June 2019 to October 2021, were analysed retrospectively. Soft tissue defect around achilles tendon was 2.0 cm×3.0 cm-2.5 cm×4.0 cm. The size of the flap was 2.5 cm×3.5 cm-3.0 cm×4.5 cm. All patients underwent emergency debridement followed by V-Y advancement flap repair, and direct suture of the skin and tissues at donor site. The blood supply, survival and healing of flap of donor site were observed after operation. The shape of the heel and the functional recovery of the affected limb were examined on regular basis at the outpatient clinic.Results:All 8 flaps survived and the wounds had primary healing. The patients entered the follow-up for 6-12 months, with an average of 8 months. The texture and colour of the flap recipient site were good. The shape of the flap pedicle, the donor site and recipient site were satisfactory. The shoes wearing of the affected foot were not affected after surgery. The ankle function was good. The average extension was 25.8°(20°-30°), plantar flexion 32.5°(25°-40°), and the foot sensation and motion were close to normal. The average foot function score on American Association on Foot and Ankle Surgery(AOFAS) was 91.7±6.4. Five cases were excellent and 3 were good.Conclusion:The V-Y advancement flap demonstrates an ideal alternative method for treatment of small area of soft tissue defect around Achilles tendon, due to the simple operation, satisfactory shape of flap after repair, and favorable limb function.
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Objective:To explore the method and effect in repairing the defect of fingertip with lateral V-Y advancement flap with one side palmar proper digital artery.Methods:From October 2014 to May 2019, Department of the Hand and Foot Surgery, the Third People's Hospital of Jining(Yanzhou District People's Hospital of Jining City) treated 34 digits of 27 cases with a defect area of 0.5 cm×0.5 cm-1.5 cm×2.0 cm. A lateral V-Y advancement flap with one side palmar proper artery was used to repair the fingertip defect, and the flap size was 1.7 cm×1.0 cm-4.5 cm×1.5 cm. Twenty cases entered long-time follow-up after operation, with 7 cases lost in follow-up, 16 cases were reviewed at outpatient and 4 by WeChat.Results:All the flaps of 34 digits of 27 cases survived. The color of the flaps were close to or completely normal to the surrounding tissue, the texture was soft and the appearance was good. The TPD of the flap was 2.0-6.0 mm. The follow-up time ranged from 22 to 77 months, with an average of 31.45 months. The flexion and extension function of the digits were good with total range of motion(ROM) of the thumb was > 90 °; total active motion (TAM) of the fingers was 260 °-200 °. The fingers of 1 case had hook nail or hook finger deformity. According to the Evaluation Trial Standard of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, 18 cases were excellent and 2 cases were good.Conclusion:The lateral V-Y advancement flap with one side palmar proper digital artery is easy to operate. The blood supply of the flap is reliable, with good sensation. The flexion and extension of the digits are good, and the appearance and texture of the flap are good.
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Objective:To explore the clinical application and effect of repairing the donor site of ipsilateral fibular hallux flap with the transverse V-Y advancement flap of the great toe.Methods:Form January 2017 to January 2020, the donor sites of the ipsilateral fibular hallux flap were repaired by the transverse V-Y advancement flap of the great toe in the Department of Hand Surgery, 521 Hospital of Weapon Industry on 20 patients, including 16 males and 4 females with an average age of 33 (18-52) years old. First, the donor site of the fibular hallux flap was sutured to reduce the size of wound. The width of the remaining wound was 0.4 to 1.6 cm, and the area of the remaining wound was 0.5 cm×0.8 cm-1.6 cm×1.8 cm. Then the remaining wound was repaired with the transverse V-Y advancement flap of the ipsilateral great toe. The distance for transfer of transverse advancement V-Y flap was 0.2-0.8 cm, and the area of the transverse V-Y advancement flap was 1.0 cm×1.4 cm-1.8 cm×2.4 cm. The end of postoperative follow-up was scheduled in July 2021. The follow-up items included: survival of the transverse V-Y advancement flap, wound infection, appearance, shape, texture and sensation of the V-Y advancement flap, pain on the V-Y advancement flap and the great toe, cold tolerance and the scar condition at the donor site of the ipsilateral fibular hallux flap and the V-Y advancement flap, the appearance, sensation and flexion and extension of the great toe at the donor site, other discomforts in the donor site of great toe, walking and other functions affected by the discomforts.Results:The postoperative follow-up lasted from 12 to 18(average of 14) months. All the V-Y advancement flaps survived without infection at the donor sites of the great toe, and donor sites healed primarily. The appearance, shape and texture of the advancement V-Y flap were close to the skin of the same area of the contralateral great toe. The TPD of the V-Y advancement flap and the ipsilateral great toe ranged from 4 to 7 mm. The average score of the Visual analog scale(VAS) was 0.3 and 0.6 respectively in the evaluation of cold tolerance of the advancement V-Y flap and the ipsilateral great toe. The average score of the Vancouver scar scale(VSS) was 0.2 and 1.2 respectively in the scar evaluation of the V-Y advancement flap and the ipsilateral great toe. There was no visual difference between the appearance of the great toe at the donor site and the contralateral toe. There was no pain and other discomfort on the V-Y advancement flap and the ipsilateral great toe. The functions of the donor foot were not affected in walking, running, jumping and tiptoeing in all cases.Conclusion:It is a simple, safe and effective method to repair the donor site of the small-area ipsilateral fibular hallux flap by the transverse V-Y advancement flap of the great toe. It only causes a small wound but the appearance and function of the ipsilateral great toe can be repaired with a transverse V-Y advancement flap of the great toe.
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Abstract Introduction Non-response to palatal surgery for OSA is a problem. Residual lateral wall hypopharyngeal collapse is the proposed mechanism of failure. Objective This study aims to evaluate the role of transpalatal advancement pharyngoplasty in non-responders to primary palatal surgery with residual lateral wall hypopharyngeal collapse. Methods This is a retrospective study that was conducted on patients who underwent transpalatal advancement pharyngoplasty for residual lateral wall hypopharyngeal. Inclusion criteria were age greater than 18-years, OSA proved by the polysomnography with apnea hypopnea index >15, lateral wall collapse at the level of hypopharynx as proved by drug-induced sleep endoscopy and had a previous tonsillectomy or previous palatal surgery for OSA. Exclusion criteria were those with no history of tonsillectomy or any other surgery for OSA and those with a missed followup. Data of included patients were collected and included gender, age, polysomnographic data like the apnea hypopnea index, oxygen desaturation and the calculated preoperative Epworth sleepiness scale. The early outcome included symptom improvement as measured by Epworth sleepiness scale score and lateral pharyngeal wall evaluation by nasopharyngoscopic examination in the first postoperative month. Late outcome measurement was performed by the 6-month postoperative polysomnography. Data were analyzed using SPSS program. Results The study included 37 patients with a mean age of (40.43 ± 6.51). The study included 26 men and 11 women. There was a statistically significant improvement of apnea hypopnea index from 37.8 ± 9.93 to 9.9 ± 2.55. In addition, a statistically significant improvement of lowest oxygen saturation from 78.9 ± 3.39 to 83.3 ± 3.31 was encountered. The patients improved clinically, and this improvement was measured by statistically significant improvement of Epworth sleepiness scale score and snoring visual analogue scale. Conclusion Transpalatal advancement pharyngoplasty widens the retropalatal airway and has a great role in the management of the vertical palate phenotype. In addition, it can have a role in the management of lateral walls, especially lateral wall hypopharyngeal collapse.
Resumo Introdução A ausência de resposta à cirurgia palatina para AOS é um problema. O colapso residual da parede lateral da hipofaringe é um mecanismo de falha proposto. Objetivo Avaliar o papel da faringoplastia com avanço transpalatino em pacientes que não responderam à cirurgia palatina primária com colapso residual da parede lateral da hipofaringe. Método Estudo retrospectivo que será feito em casos que receberam faringoplastia com avanço transpalatino para parede lateral da hipofaringe residual. Os critérios de inclusão foram idade maior que 18 anos, AOS comprovada por polissonografia com índice de apneia e hipopneia > 15, colapso da parede lateral ao nível da hipofaringe comprovado por endoscopia do sono induzido por drogas e submetidos a amigdalectomia ou cirurgia palatina anterior para AOS. Os critérios de exclusão foram pacientes sem histórico de amigdalectomia ou qualquer outra cirurgia para AOS e aqueles com perda de seguimento. Os dados dos pacientes incluídos foram coletados e incluíram sexo, idade, dados polissonográficos, como índice de apneia e hipopneia, dessaturação de oxigênio e a escala de sonolência de Epworth calculada no pré‐operatório. O desfecho inicial incluiu melhoria dos sintomas medida pelo escore da escala de sonolência de Epworth e avaliação da parede lateral da faringe por exame nasofaringoscópico no primeiro mês do pós‐operatório. A medida do desfecho tardio foi feita pela polissonografia pós‐operatória de 6 meses. Os dados foram analisados no programa SPSS. Resultados O estudo incluiu 37 pacientes com média de 40,43 ± 6,51 anos. O estudo incluiu 26 homens e 11 mulheres. Houve uma melhoria estatisticamente significante do índice de apneia e hiponeia de 37,8 ± 9,93 para 9,9 ± 2,55. Além disso, foi encontrada uma melhoria estatisticamente significante da menor saturação de oxigênio de 78,9 ± 3,39 para 83,3 ± 3,31. Os pacientes melhoraram clinicamente e essa melhoria foi medida pela melhoria estatisticamente significante no escore da escala de sonolência de Epworth e na escala escala visual analógica do ronco. Conclusão A faringoplastia com avanço transpalatino alarga a via aérea retropalatina e tem um papel importante no manejo do fenótipo do palato vertical. Além disso, ela pode ter um papel no manejo das paredes laterais, especialmente no colapso da parede lateral da hipofaringe.
ABSTRACT
RESUMEN Fundamento: El estudio sobre los aparatos actuales de la ortopedia funcional de los maxilares puede aportar nuevos conocimientos para el perfeccionamiento del tratamiento de pacientes con retrognatismo mandibular. Objetivo: Profundizar en los nuevos aparatos de la ortopedia funcional de los maxilares para el tratamiento de pacientes con retrognatismo mandibular. Desarrollo: Se realizó una revisión bibliográfica en las bases de datos SciELO, PubMed, Ebsco, Cumed y Lilacs. En la búsqueda se revisaron 37 artículos, de ellos más del 80 % son de los últimos cinco años. Se identificaron bases teóricas de la ortopedia funcional de los maxilares en el tratamiento de pacientes con retrognatismo mandibular y los aparatos que se utilizan en la actualidad. Conclusiones: Existen nuevas opciones de aparatos funcionales, en su mayoría fijos y clasificados como dentosoportados pasivos, para el tratamiento de pacientes con retrognatismo mandibular.
ABSTRACT Background: The study of the current jaw functional orthopedic appliances can provide new knowledge for the improvement of the patients' treatment with mandibular retrognathia. Objective: To study deeply the current jaw functional orthopedic appliances for the patients' treatment with mandibular retrognathia. Development: A bibliographic review was conducted in the SciELO, PubMed, Ebsco, Cumed and Lilacs databases. A total of 37 articles were reviewed, more than 80 % from the last five years. Theoretical bases on the jaw functional orthopedics in the patients' treatment with mandibular retrognathia and current appliances in use were identified. Conclusions: New functional appliance options, mostly fixed and classified as passive dent supportive, are available for the patients' treatment with mandibular retrognathia.
Subject(s)
Orthodontic Appliances , Retrognathia , Activator Appliances , Mandibular Advancement , Orthodontic Appliances, FixedABSTRACT
Abstract Three-dimensionally evaluation of the treatment changes of a Herbst appliance using a lower anchorage unit not touching the lingual surface of the lower incisors. The sample consisted of 23 Class II:1 patients (12 males, 11 females) with a mean age of 15.7±1.7 years treated with a Flip-Lock Herbst® appliance (TP Orthodontics, Inc., La Porte, IN, USA). The lower anchorage unit for the Herbst appliance consisted of two anchor bands connected by a lingual arch with 3mm distance from the incisor's lingual surface. Treatment changes in mandibular incisor inclination, overjet and overbite were evaluated by means of cone beam computed tomography images (i-CAT® Classic unit, Imaging Sciences International, Hatfield, PA, USA) obtained before and after treatment with the Herbst appliance. On average, there was a statistically significant increase in mandibular incisor inclination (2.6+1.8°) and a reduction in overjet (3.2+2.2mm) and overbite (1.3+0.9mm). Genders did not differ significantly. Incisor proclination was however only seen in 74% of the patients. The changes in mandibular incisor inclination were associated with the changes in overjet (/r/ = 0.1 to 0.5) and overbite (/r/ = 0.3 to 0.7). A Herbst appliance with a mandibular anchorage unit distant from the incisor's lingual surface results in smaller amounts of mandibular incisor proclination compared to literature. However, as it induces canine anchorage loss, the decreased amount of proclination may not prevail after multibracket treatment.(AU)
Resumo Avaliação tridimensional das alterações induzidas pelo aparelho Herbst utilizando a unidade de ancoragem inferior afastada da superfície lingual dos incisivos. A amostra incluiu 23 pacientes Classe II:1 (12 masculino, 11 feminino), média de idade 15,7 ± 1,7, tratados com aparelho Herbst Flip-Lock® (TP Orthodontics, Inc., La Porte, IN, EUA). A unidade de ancoragem inferior do aparelho Herbst consistiu-se de duas bandas conectadas por um arco lingual afastado 3mm da superfície lingual do incisivo. As alterações induzidas pelo tratamento na inclinação dos incisivos inferiores, trespasse horizontal e trespasse vertical foram avaliadas por meio de imagens de tomografias computadorizadas de feixe cônico (i-CAT® Classic unit, Imaging Sciences International, Hatfield, PA, USA) obtidas antes e após o tratamento com aparelho Herbst. Na média, houve diferença significativa com aumento da inclinação dos incisivos inferiores (2,6+1,8°) e diminuição do trespasse horizontal (3,2+2,2mm) e do trespasse vertical (1,3+0,9mm). Não houve diferença estatística entre os sexos. No entanto, a vestibularização do incisivo ocorreu em apenas 74% dos pacientes. As alterações na inclinação dos incisivos inferiores apresentam correlação estatisticamente significativa com as alterações no trepasse horizontal (/r/ = 0,1 a 0,5) e no trespasse vertical (/r/ = 0,3 a 0,7). O aparelho Herbst com uma unidade de ancoragem inferior afastada da superfície lingual dos incisivos resulta em menor quantidade de vestibularização do incisivo inferior em comparação com a literatura. Entretanto, como isto induz perda de ancoragem do canino, a diminuição da vestibularização pode não prevalecer ao final tratamento ortodôntico com braquetes. (AU)