Diagnóstico e tratamento precoce da má oclusão de Classe III com Aparelho Disjuntor Hyrax e Máscara Facial de Petit com avaliação do tempo de uso com micro-sensor: relato de caso clínico / Early diagnosis and treatment of Class III occlusion with Hyrax Isolating Appliance and Petit Face Mask with evaluation of the time of use with micro-sensor: a clinical case report

O sucesso do tratamento precoce da classe III depende de um bom diagnóstico e da cooperação do paciente na utilização do aparelho extrabucal. Neste trabalho, por meio de um chip (Theramon) instalado na Máscara Facial de Petit da paciente, foi possível monitorar a quantidade de horas que a paciente utilizou o aparelho por dia, durante um período de quatro meses. Paciente do sexo feminino, 7 anos e 11 meses de idade portadora da má oclusão de classe III, utilizou o aparelho de disjunção da maxila (Hyrax) modificado, seguido da Máscara Facial de Petit com chip (Theramon) instalado. A média de uso foi maior do que 11 horas de uso diário. O uso deste dispositivo auxilia no monitoramento do tempo de uso do aparelho, cujo sucesso do tratamento depende da utilização deste pelo paciente(AU)

The success of early treatment of class III depends on a good diagnosis and the cooperation of the patient in the use of the extra oral appliance. In this study, the patient was able to monitor the number of hours the patient used the device per day during a period of four months using a Theramon chip installed in the Patient's Facial Mask. A 7-year, 11-month-old male with Class III malocclusion used the modified maxillary disjunction (Hyrax), followed by the Petit Facial Mask with a Theramon chip installed. The average use was greater than 11 hours of daily use. The use of this device assists in the monitoring of the time of use of the device, whose success of the treatment depends on the use of this by the patient(AU)

Anatomical characteristics of mandibular bone in skeletal class I, II and III patients by using cone beam computed tomography images in an iranian population / Características anatômicas do osso mandibular em pacientes Classe I, II e III esquelética usando imagens de Tomografia Computadorizada de Feixe Cônico: em uma População Iraniana

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)

Diagnóstico precoce e tratamento da síndrome de Gorlin-Goltz: acompanhamento de oito anos / Diagnóstico precoz y tratamiento del síndrome de Gorlin-Goltz: seguimiento de ocho años / Early diagnosis and treatment of Gorlin-Goltz syndrome: eight-year follow-up

RESUMO Introdução: A síndrome de Gorlin-Goltz, conhecida também como síndrome do Carcinoma Basocelular Nevóide, é um transtorno hereditário autossômico dominante de alta penetrância e expressividade variável. Foi primeiramente descrita por Jarisch em 1894 e, em 1960 Gorlin e Goltz relacionaram o conjunto de doença de casos anteriormente relatados na literatura, concluindo que se tratava de uma síndrome caracterizada por uma tríade (carcinomas basocelulares, queratocistos odontogênicos múltiplos e anomalias esqueléticas). Atualmente, sabe-se que um amplo espectro de outras manifestações sistêmicas pode estar presente como neurológicas, oftálmicas, genitais, cardiovasculares e endócrinas. Objetivo: O presente artigo tem como objetivo relatar um caso clínico de síndrome de Gorlin-Goltz com proservação de oito anos, bem como destacar a importância do Cirurgião-Dentista no diagnóstico precoce e tratamento da síndrome. Caso clínico: Paciente 10 anos, sexo masculino, compareceu em fevereiro de 2004 ao Serviço de Estomatologia e Cirurgia Bucomaxilofacial da Santa Casa de Misericórdia de São Felix, Bahia, Brasil, acompanhado de sua avó, que relatava a seguinte queixa: "Os dentes do meu neto estão tortos". Ao exame físico foi observado aumento do volume do lado direito da face, hipertelorismo, base nasal larga, bossa frontal, leve prognatismo mandibular e dedos dos pés encurtados. Ao exame físico intrabucal foram identificados dentes fora de posição e desvio de linha média. O paciente foi acompanhado por 8 anos e, durante este tempo, foram realizados exames imaginológicos observando grandes áreas de lesões radiolúcidas com recidiva. O diagnóstico conclusivo de Queratocisto Odontogênico foi então comprovado no exame histopatológico, a hipótese diagnóstica de síndrome de Gorlin-Goltz foi então confirmada. O paciente foi encaminhado para avaliação genética e atualmente encontra-se em proservação na Universidade Estadual de Feira de Santana, Bahia. Conclusão: É essencial o acompanhamento multidisciplinar e a longo prazo nos casos dessa síndrome, oferecendo melhor qualidade de vida a esses pacientes(AU)

RESUMEN Introducción: El síndrome de Gorlin-Goltz, conocido también como síndrome del carcinoma basocelular nevoide, es un trastorno hereditario autosómico dominante de alta penetración y expresividad variable. En 1960, Gorlin y Goltz relacionaron el conjunto de enfermedades de casos con anterioridad informados en la literatura, y concluyeron que se trataba de un síndrome caracterizado por una tríada (carcinomas basocelulares, queratocistos odontogénicos múltiples y anomalías esqueléticas). Actualmente, se conoce que un amplio espectro de otras manifestaciones sistémicas puede estar presente, como neurológicas, oftálmicas, genitales, cardiovasculares y endocrinas. Objetivo: describir un caso clínico de síndrome de Gorlin-Goltz con seguimiento de ocho años, así como destacar la importancia del dentista en el diagnóstico precoz y tratamiento del síndrome. Caso clínico: Paciente de 10 años, de sexo masculino, acudió en febrero de 2004 al Servicio de Estomatología y Cirugía Maxilofacial de la Santa Casa de Misericordia de São Félix, Bahia, Brasil, acompañado de su abuela, que refería: "Los dientes de mi nieto están torcidos". En el examen físico se observó aumento del volumen del lado derecho de la cara, hipertelorismo, base nasal ancha, bóveda frontal, leve prognatismo mandibular y dedos de los pies acortados. En el examen físico intrabucal se identificaron dientes fuera de posición y desviación de línea media. El paciente tuvo seguimiento por ocho años y durante este tiempo se realizaron exámenes imaginológicos en los que se observaron grandes áreas de lesiones radiolúcidas con recidiva. El diagnóstico conclusivo de queratocisto odontogénico fue comprobado en el examen histopatológico; la hipótesis diagnóstica del síndrome de Gorlin-Goltz fue entonces confirmada. El paciente fue dirigido para evaluación genética y actualmente se encuentra en seguimiento en la Universidad Estadual de Feira de Santana, Bahia. Conclusiones: Es esencial el seguimiento multidisciplinario y a largo plazo en los casos de este síndrome, a fin de ofrecer mejor calidad de vida a esos pacientes(AU)

ABSTRACT Introduction: Gorlin-Goltz syndrome, also known as nevoid basal cell carcinoma syndrome, is an autosomal dominant inherited disorder of high level penetrance and variable expressiveness. In 1960 Gorlin and Goltz listed the disease cases previously reported in the literature, concluding that it was a triad syndrome (basal cell carcinomas, multiple odontogenic keratocysts and skeletal anomalies). It is now known that a broad spectrum of other systemic manifestations may be present, such as neurological, ophthalmic, genital, cardiovascular and endocrine. Objective: Describe a clinical case of Gorlin-Goltz syndrome and its eight-year follow-up, and highlight the importance of the dentist in the early diagnosis and treatment of the syndrome. Case report: A 10-year-old male patient attended the Oral and Maxillofacial Surgery Service of Santa Casa de Misericordia Hospital in Sao Felix, Bahia, Brazil, in February 2004, accompanied by his grandmother, who reported that her grandson's teeth "were crooked". Physical examination revealed an increase in the volume of the right side of the face, hypertelorism, broad nasal base, frontal bossing, mild mandibular prognathism and shortened toes, whereas oral examination found ill-positioned teeth and midline deviation. The patient was followed up for eight years, and during this time imaging tests were performed which showed large areas of recurrent radiolucent lesions. Diagnosis of odontogenic keratocyst was verified by histopathological examination, confirming the diagnostic hypothesis of Gorlin-Goltz syndrome. The patient was referred for genetic evaluation and is currently being followed up at the State University of Feira de Santana, Bahia. Conclusions: Multidisciplinary long-term follow-up is essential in cases of this syndrome to improve the quality of life of patients(AU)

Manejo integral estético de una anomalía dentofacial / Comprehensive esthetic management of a dentofacial anomaly

RESUMEN Introducción: Las anomalías dentofaciales son trastornos del crecimiento dental y facial que afectan tanto a niños como a adultos. Objetivo: Presentar un caso clínico, en que en la búsqueda de armonía, por una anomalía dentofacial, se aplicaron principios del manejo multidisciplinario de cirugía ortognática y de otoplastia. Caso clínico: Paciente masculino de 18 años de edad que refiere inconformidad estética y en el que, mediante el análisis de modelos de estudio, mediciones de las telerradiografías indicadas y los hallazgos del examen físico, se llegó al diagnóstico de prognatismo mandibular con exceso vertical del mentón. Se ejecuta tratamiento ortodóncico-quirúrgico, realizándose osteotomía sagital mandibular y mentonoplastia de reducción de altura. Se emplearon como medios de fijación interna los tornillos bicorticales en la zona de ángulo mandibular y miniplacas en la región del mentón. Tres meses después se realizó otoplastia, para corregir la presencia de orejas prominentes, con el logro de un resultado funcional y estético satisfactorio. Conclusiones: Con la aplicación de los principios del manejo multidisciplinario de cirugía ortognática, combinada con la realización de una otoplastia, los resultados fueron positivos. Se alcanzó el objetivo de brindar armonía facial, con mejoría funcional y estética, y una alta satisfacción del paciente(AU)

ABSTRACT Introduction: Dentofacial anomalies are dental and facial growth disorders affecting children and adults alike. Objective: Present a clinical case of dentofacial anomaly in which principles of the multidisciplinary management of orthognathic surgery and otoplasty were applied to achieve harmony. Case report: A male 18-year-old patient reports esthetic dissatisfaction. Analysis of study models, measurements taken by teleradiography and findings of the physical examination led to the diagnosis of mandibular prognathism with a vertically extended chin. Orthodontic-surgical treatment was performed, consisting in sagittal mandibular osteotomy and height reduction mentoplasty. Bicortical screws were used for internal fixation in the mandibular angle area and miniplates in the chin region. Otoplasty was performed three months later to correct the presence of protruding ears, achieving satisfactory functional and esthetic results. Conclusions: Application of the principles of the multidisciplinary management of orthognathic surgery, combined with the conduct of otoplasty, led to positive results. The objective of achieving facial harmony was fulfilled, alongside functional and esthetic improvement and high patient satisfaction(AU)

Evaluación radiográfica de la estabilidad en medidas cefalométricas de pacientes Clase III sometidos a cirugía ortognática bimaxilar / Radiographic evaluation of stability in cephalometric measurements of Class III patients undergoing bimaxillary orthognathic surgery

Objetivo: evaluar, a través de medidas cefalométricas de los planos sagital y vertical, la estabilidad de pacientes con maloclusión clase III sometidos a cirugía ortognática bimaxilar. Métodos: se aplicó estudio longitudinal en 20 pacientes (11 mujeres), en un promedio de edad de 22.5 años y con diagnóstico de hipoplasia del tercio medio facial y prognatismo mandibular, tratados con ortodoncia y cirugía ortognática bimaxilar. Se realizaron tres radiografías cefálicas laterales por cada paciente: la primera, previa al procedimiento quirúrgico (T1), otra a los 8 meses posquirúrgicos (T2) y la tercera, a los 18 meses posquirúrgicos (T3). Posteriormente, se evaluaron los cambios en el plano X y Y en los tres tiempos realizando las pruebas estadísticas pertinentes con el fin de observar diferencias. Resultados: se encontraron medidas más estables en el maxilar superior en sentido vertical y sagital, y se observó que la mandíbula es menos estable a los movimientos quirúrgicos, principalmente en sentido vertical (diferencias estadís-ticamente significativas p<0.05). Conclusión: la cirugía ortognática bimaxilar en casos de clase III es muy estable (especialmente en el maxilar); dicha estabilidad fue definida solamente con medidas cefalométricas, sin tener en cuenta variables como la función o las características clínicas de los pacientes.

Objective: To evaluate cephalometric stability in the sagittal and vertical planes of class III malocclusion patients undergoing bimaxillary orthognathic surgery Class III skeletal malocclusion is reported as the most frequently dentofacial alteration treated in combination with orthodontics and orthognathic surgery. It is important to evaluate the stability or relapse of the surgical treatment performed on these patients. Methods: A longitudinal study were conducted in 20 patients (11 women), with an average of 22.5 years old, diagnosis of hypoplasia of the facial middle third and mandibular prognathism, treated with orthodontics and bimaxillary orthognathic surgery. Three lateral cephalic radiographs were taken for each patient: one prior to the surgical procedure (T1), another at 8 post-surgical months (T2) and finally at 18 post-surgical months (T3). The changes on the X and Y planes were evaluated the same three times, performing the relevant statistical tests in order to observe differences. Results: More stable measurements were found in the upper jaw in the vertical and sagittal direction, while the mandible is less stable to surgical movements, mainly in the vertical direction (statistically significant differences p<0.05). Conclusion: bimaxillary orthognathic surgery in class III malocclusion is very stable (especially in the maxilla). It is important to keep in mind the maxillary biomechanics in order to offer an accurate treatment to these patients. Further studies are required in order to investigate possible associated predictor factors.

Osteogenesis imperfecta and combined orthodontics and orthognathic surgery: a case report on two siblings

Osteogenesis imperfecta is a heterogeneous group of connective tissue diseases that is predominantly characterized by bone fragility and skeletal deformity. Two siblings with undiagnosed type I osteogenesis imperfecta underwent orthognathic surgery for the treatment of facial asymmetry and mandibular prognathism. The authors report two cases of combined orthodontics and orthognathic surgery in patients with type I osteogenesis imperfecta, mandibular prognathism, and facial asymmetry.

Association of the P561T and C422F polymorphisms of the growth hormone receptor gene with facial dimensions / Asociación de los polimorfismos P561T y C422F del gen receptor de la hormona del crecimiento con dimensiones faciales

Background: Growth hormone plays a significant role in determining craniofacial morphology. Mutations of its receptor gene might be associated with mandibular prognathism (MP). Purpose: The aim of the current study was to evaluate growth hormone receptor (GHR) gene polymorphisms in relation to facial dimensions. Material and Method: The study enrolled 65 participants with class III profile in MP group and 60 orthognathic control participants. Genomic DNA was extracted from a blood sample from the patients and the P561T and C422F polymorphisms of GHR gene were screened by PCR-RFLP method followed by Sanger sequencing of randomly selected samples to validate the genotyping results. Chi square was used to compare distribution of polymorphism in MP and control groups (p<0.05). Results: Heterozygous P561T mutation was found in 10.77% and 8.33% of MP and control groups, respectively (p=0.644) while none of the subjects had the C422F mutation. Sanger sequencing confirmed the genotyping results from the PCR-RFLP method. P561T polymorphism was significantly associated with ramus and lower facial height in MP patients and with ramus height in orthognathic patients (p<0.05). Conclusion: The results indicate that the P561T polymorphism of the GHR gene is associated with the vertical dimension of the mandible in an Iranian population.

Antecedentes: La hormona del crecimiento desempeña un papel importante en la determinación de la morfología craneofacial. Las mutaciones de su gen receptor podrían estar asociadas con el prognatismo mandibular (PM). Propósito: El objetivo del presente estudio fue evaluar dos polimorfismos del gen del receptor de la hormona del crecimiento (RHC) en relación con las dimensiones faciales. Materiales y Métodos: El estudio incluyó a 65 participantes con perfil de clase III en el grupo MP y 60 participantes de control ortognático. El ADN genómico se extrajo de una muestra de sangre de los pacientes y los polimorfismos P561T y C422F del gen RHC se seleccionaron mediante el método PCR-RFLP seguido de la secuenciación por Sanger de muestras seleccionadas al azar para validar los resultados del genotipo por RFLP. El test chi cuadrado se utilizó para comparar la distribución del polimorfismo en el grupo MP y grupo control (p<0.05). Resultados: Se encontró mutación heterocigota P561T en 10.77% y 8.33% de los grupos PM y control, respectivamente (p=0.644) mientras que ninguno de los sujetos tenía la mutación C422F. La secuenciación de Sanger confirmó los resultados de genotipado por el método PCR-RFLP. El polimorfismo P561T se asoció significativamente con la rama y la altura facial más baja en pacientes con PM y con la altura de la rama en pacientes ortognáticos (p<0.05). Conclusión: Los resultados indican que el polimorfismo P561T del gen RHC está asociado con la dimensión vertical de la mandíbula en una población iraní.

Association between P561T polymorphism in growth hormone receptor gene and mandibular prognathism: systematic review and metaanalysis

Objective: Through a systematic review and meta-analysis, the aim this study was evaluating the association between the P561T polymorphism in GHR (rs6184) with skeletal Class III malocclusion in different populations. Methods: A broad search for studies was conducted using the databases: PubMed, Web of Science, Scopus, Cochrane, Google Scholar and Open Grey until December 2018. The study design according to PECOS was: P-Orthodontic patients; E- polymorphism P561T in GHR; C- absence of polymorphism P561T in GHR; O- linear dimension alterations in maxilla and mandibular measurements; S- Cross-sectional studies. The selected studies were qualified by 10-point scoring sheet methodological quality. The subgroups evaluation was performd according to the linear measurements evaluated in two or more studies, as follows: body height, N-S, A'-PTM', Gn-Go, Pog'-Go, and Co-Go.A fixed effect model was used and the mean differences were performed using the inverse-variance meta-analysis. The I2 (95%) was used to measure statistical heterogeneity between studies, where I2 values of 25%, 50%, and 75% signified low, medium, and high heterogeneity, respectively. Results: The initial search identified 146 studies. After excluding duplicate abstracts, 138 were selected. Seven studies were included in the systematic review. Only one study was classified as having low methodological quality. Three studies were included in the meta-analysis. The meta-analysis demonstrated an association between the Co-Go linear measure and CC genotype (p<0.0001), with a mean difference and confidence interval of 3.79 [2.06, 5.52]. CC was associated with greater mandibular height. Conclusion: The polymorphism P561T in GHR is associated with Co-Go measurement in Asians, with low level of evidence.

Objetivo: Por meio de uma revisão sistemática e meta-análise, o objetivo deste estudo foi avaliar a associação entre o polimorfismo P561T em GHR (rs6184) com a maloclusão de Classe III esquelética em diferentes populações. Métodos: Uma ampla pesquisa de estudos foi realizada utilizando os bancos de dados PubMed, Web of Science, Scopus, Cochrane, Google Scholar e Open Grey até dezembro de 2018. O desenho do estudo de acordo com o PECOS foi: P-Pacientes ortodônticos; Polimorfismo P561T em GHR; Causência de polimorfismo P561T em GHR ; O-alterações na dimensão linear das medidas maxilares e mandibulares; S- Estudos transversais. Os estudos selecionados foram qualificados pela qualidade metodológica em uma escala de 10 pontos. A avaliação emsubgrupos. O subgrupo foi realizada de acordo com as medidas lineares avaliadas em dois ou mais estudos, como a seguir: altura corporal, N-S, A'-PTM ', Gn-Go, Pog'-Go. Foi utilizado o modelo de efeito fixo e as diferenças médias foram realizada usando a metanálise de variância inversa. O I2 (95%) foi utilizado para medir heterogeneidade estatística entre estudos, em que valores de I2 de 25%, 50% e 75% significaram baixa, média e alta heterogeneidade, respectivamente. Resultados: A pesquisa inicial identificou 146 estudos. Após excluir resumos duplicados, 138 foram selecionados. Sete estudos foram incluídos na revisão sistemática. Apenas 1 estudo foi classificado como de baixa qualidade metodológica. Três estudos foram incluídos na meta-análise. A metaanálise demonstrou uma associação entre a medida linear Co-Go e o genótipo CC (p<0,0001), com diferença média e intervalo de confiança de 3,79 [2,06; 5,52]. CC foi associado com maior altura mandibular. Conclusão: O polimorfismo P561T em GHR está associado à medida Co-Go em asiáticos, com baixo nível de evidência.

Myosin 1H and the soft tissue profile of african american females with mandibular prognathism

Introduction: The aim of this study was to explore the influence of Myosin 1H on the soft tissue profile of African American females. Methods: Fourteen African American females from the University of Pittsburgh School of Dental Medicine Dental Registry and DNA Repository with the ancestral genotype GG, marker rs10850110, locus 12q24.11 were analyzed. For this investigation, measurements were taken of the eleven items that comprise the Holdaway soft tissue analysis. Profile differences between ethnicity and corresponding normative values were explored by independent-sample t tests for all facial profile measurements. Student's t test for independent means was used to determine differences with accepted norms. Significance was set a p<0.05. Results: There were significant differences between four of the eleven Holdaway values and the reported values for African Americans. The mean convexity value of the African American female group was 1.0 mm less the normative value of 5.7 mm (p>0.000). In contrast, the H angle of the African American females was larger than the normative value. Conclusions: Our study confirms previous research that Myosin 1H contributes to mandibular prognathism. It agrees with the idea that Myosin 1H is less influential in the maxillary soft tissue complex. Understanding the genetic influence of soft tissue growth would allow improved therapies and prevention approaches.

Introduçâo: O objetivo desse estudo foi determinar a influência da miosina 1H nos tecidos moles de mulheres americanas negras. Métodos: Foram estudadas quatorze mulheres americanas negras participantes do projeto Dental Registry and DNA Repository da Faculdade de Odontologia da Universidade de Pittsburgh com o genótipo comum GG do marcador rs10850110, localizado no lócus 12q24.11. Medidas de onze parâmetros que compõem a análise de tecidos moles de Holdaway foram utilizadas. Diferenças entre etnicidade e medidas normais correspondentes, foram exploradas através do teste t de Student de amostras independentes para todas as medidas faciais. O teste t de Student para médias independentes foi usado para determinar diferenças em comparação à medidas normais. A significância foi estabelecida em p<0,05. Resultados: Houve uma diferença estatisticamente significante entre quatro das onze medidas de Holdaway. A convexidade média da mulher americana negra foi de 1,0 mm a menos que o valor normal de 5.7 mm (p>0.000). Em contraste, o ângulo H das mulheres americanas negras foi maior que o valor normal. Conclusões: O nosso estudo confirma resultados anteriores que a miosina 1H contribui para o prognatismo mandibular. Nossos resultados concordam com a ideia de que a miosina 1H tem menor influência nos tecidos moles da maxila. Entender a influência genética no crescimento dos tecidos moles irá possivelmente permitir melhorar as abordagens de tratamento e prevenção atuais.

El concepto de umbral craneofacial y su código de lectura ABC / The concept of craniofacial threshold and its ABC reading code

Durante el crecimiento y desarrollo de la cabeza, ésta lo hace en diferentes direcciones y proporciones, habiendo un límite entre la armonía /desarmonía conocido como umbral. Se hace referencia a este concepto, la forma de escribirlo y leerlo por medio de un código que lo simboliza. Objetivo: Poner al alcance de la comunidad médica un código de lectura e identificación de fenotipos craneofaciales sindrómicos y no sindrómicos. Conclusiones: Se considera que este concepto de umbral craneofacial y su código de lectura pueden ser usados en la enseñanza e investigación de la armonía-desarmonía durante el crecimiento y desarrollo de la cabeza, resultando ser de gran utilidad en la comprensión rápida y sencilla de la lectura del fenotipo craneofacial (AU)

During the growth and development of the head, it does so in different directions and proportions, there being a limit between the harmony / disharmony known as threshold. Reference is made to this concept, the way of writing it and reading it by means of a code that symbolizes it. Objective: To put within reach of the medical community, a code of reading and identification of syndromic and non-syndromic craniofacial phenotypes. Conclusions: It is considered that this concept of a craniofacial threshold and its reading code can be used in the teaching and research of harmony / disharmony during the growth and development of the head, being very useful in the quick and easy comprehension of the reading of the craniofacial phenotype (AU)

Reabilitação oral com prótese total em paciente prognata: relato de caso / Oral rehabilitation with total prosthesis in prognata patient: case report

Introdução: Indivíduosedêntulos apresentam diversas alterações que comprometem as funções do sistema estomatognático (SE), como a diminuição da capacidade mastigatória, alteração fonética e comprometimento estético. A reabilitação oral protética assume uma função de grande importância para o paciente edêntulo prognata, podendo ser considerada primordial para a sua condição de saúde geral e qualidade de vida, reabilitando as funções do SE e reinserindo o indivíduo no ambiente social. Objetivo: Apresentar um relato da técnica protética realizada no intuito de promover ao paciente prognata uma reabilitação tanto funcional quanto estética após a confecção das próteses totais, utilizando a técnica convencional de moldagem. Métodos: Trata-se de um relato de caso, envolvendo um paciente voluntário que necessitava de uma nova prótese total. Utilizaram-se passos clínicos e laboratoriais. Resultados: Constataram-se melhorias significativas na retenção, estabilidade e estética do aparelho protético, bem como uma melhora na oclusão do paciente. Conclusão: A técnica proporcionou facilidade de adaptação em virtude da grande melhora nas funções de mastigação e fonação, principalmente, quando consideradas as condições desfavoráveis da discrepância significativa do tamanho do interarco presente em pacientes prognatas.

Introduction: Individuals with different functions such as the functions of the stomatognathic system (SE), such as decreased chewing capacity, phonetic alteration and aesthetic impairment. The prosthetic oral rehabilitation assumes a function of great importance for the patient with prognosis, being able to be paramount for general health and quality of life. Rehabilitation as functions of SE and reinserting the individual into the social environment. Objective: to establish a prosthetic technique performed with no intention to promote the prognosis of a person over a series of years after the creation of a conventional molding technique. Methods: This is a case report, reporting a volunteer patient who needs a new total prosthesis. Clinical and laboratory stepswere used. Results: It as found to improve the retention, stability and aesthetics of the device as an improvement in patient occlusion. Conclusion: An issue that maybe easier to correct on a large scale in the chewing and phonation functions is greater than the disadvantages to dental discrepancy of the inter-arch size present in prognostic patients.

Anesthesia for elective bilateral sagittal slip osteotomy of the mandible and genioplasty in a young man with Klippel-Feil syndrome, Sprengel deformity, and mandibular prognathism

Klippel-Feil syndrome is characterized by congenital fusion of two or more cervical vertebrae, a low hair line at the back of the head, restricted neck mobility, and other congenital anomalies. We report a 16-year-old young man with Klippel-Feil syndrome, Sprengel deformity of the right scapula, thoracic kyphoscoliosis, and mandibular prognathism with an anterior open bite. He was treated with orthodontic treatment and maxillofacial surgery. An anticipated difficult airway due to a short neck with restricted neck movements and extrinsic restrictive lung disease due to severe thoracic kyphoscoliosis increased his anesthesia risk. Due to his deviated nasal septum and contralateral inferior turbinate hypertrophy, we chose awake fiber optic orotracheal intubation followed by submental intubation. Considering the cervical vertebral fusion, he was carefully positioned during surgery to avoid potential spinal injury. He recovered well and his postoperative course was uneventful.

Reduction glossectomy of congenital macroglossia due to lymphangioma

Macroglossia is a rare clinical condition defined as an enlarged tongue. Macroglossia can cause structural deformities like diastema and disproportionate mandibular growth and present functional disorders such as dysarthria, dysphonia, and respiratory problems. A 7-year-old boy who had lymphangiomatous macroglossia was treated with a reduction glossectomy by anchor-shaped combination of a U-shape and modified key-hole resection. Postoperatively, the reduced tongue was contained completely within the oral cavity, but open bite remained due to prognathism. Sensory and motor nerves to the tongue appeared to be intact, and circulation was adequate. This patient will be monitored for recurrence of tongue enlargement.

Implant treatment on anterior cross-bite of a patient who had orthognathic surgery 20 years ago / 대한치과보철학회지

Orthognathic surgery of skeletal Class III malocclusion improves oral function and facial appearance. The greater amount of skeletal discrepancy, the greater amount of teeth movement required for decompensation, and this often causes pathological changes in periodontal tissue especially in lower anterior dentition. We made a Top-Down treatment plan with personalized analysis using Face Hunter, Plane System and ARCUS Digma II, in order to resolve severe mobility and cross-bite of lower anterior teeth for 49-year-old female patient who had undergone orthognathic surgery 20 years ago due to skeletal Class III malocclusion and mandibular prognathism. Lower anterior teeth were extracted and alveoloplasty was done. After healing of the wound, immediate loading was conducted immediately after implant placement. Final restorations were fabricated Zirconia using CAD/CAM, and inserted intraorally screw-retained type. During 6-month follow-up, no abnormal episodes of restorations were observed, and obtained satisfactorily both of functional and esthetic outcomes.

Complete denture of a skeletal class III patient with occlusal scheme in consideration: A case report / 대한치과보철학회지

Occlusal disharmony is frequently observed among edentulous patients. When artificial teeth come into contact, the unfavorable displacing force may lead to the discomfort, mucosal trauma, or even neuromuscular alterations and emotional disturbances. An optimal occlusal scheme is a critical factor for successful complete dentures. For this case, an edentulous patient with significant interarch size discrepancy due to mandibular prognathism contributing to inadequate function of dentures was treated with complete dentures. The posterior cross-bite tooth setup for compensating the abnormal jaw relations provided a stable and retentive complete denture prosthesis, which was considered adequate by both patient and dentist.

Positional change in mandibular condyle in facial asymmetric patients after orthognathic surgery: cone-beam computed tomography study / 대한악안면성형재건외과학회지

BACKGROUND: We evaluated change in the mandibular condyle after orthognathic surgery using cone-beam computed tomography (CBCT) in patients with facial asymmetry. METHODS: Thirty patients with skeletal class III malocclusion and mandibular prognathism or facial asymmetry were classified into two groups according to the amount of menton deviation (MD) from the facial midline on anteroposterior (AP) cephalogram: group A (asymmetry, MD ≥ 4 mm; n = 15) and group B (symmetry, MD < 4 mm; n = 15). Position and angle of condylar heads on the axial, sagittal, and coronal views were measured within 1 month preoperatively (T0) and postoperatively (T1) and 6 months (T2) postoperatively. RESULTS: On axial view, both groups showed inward rotation of condylar heads at T1, but at T2, the change was gradually removed and the condylar head returned to its original position. At T1, both groups showed no AP condylar head changes on sagittal view, although downward movement of the condylar heads occurred. Then, at T2, the condylar heads tended to return to their original position. The change in distance between the two condylar heads showed that they had moved outward in both groups, causing an increase in the width between the two heads postoperatively. Analysis of all three-dimensional changes of the condylar head positions demonstrated statistically significant changes in the three different CBCT views in group B and no statistically significant changes in group A. CONCLUSIONS: There was no significant difference between the two groups in condylar head position. Because sagittal split ramus osteotomy can be performed without significant change in symmetrical and asymmetrical cases, it can be regarded as an effective method to stabilize the condylar head position in patients with skeletal class III malocclusion and mandibular prognathism or facial asymmetry.

Three-dimensional analysis of the anterior loop of the inferior alveolar nerve in relation to the growth pattern of the mandibular functional subunit / 대한악안면성형재건외과학회지

BACKGROUND: The purpose of the present study was to investigate the differences in the position and shape of the anterior loop of the inferior alveolar nerve (ALIAN) in relation to the growth pattern of the mandibular functional subunit. METHODS: The study was conducted on 56 patients among those who had undergone orthognathic surgery at the Gangnam Severance Hospital between January 2010 and December 2015. Preoperative computerized tomography (CT) images were analyzed using the Simplant OMS software (ver.14.0 Materialise Medical, Leuven, Belgium). The anterior and inferior lengths of ALIAN (dAnt and dInf) and each length of the mandibular functional subunits were measured. The relationship between dAnt, dInf, and the growth pattern of the mandibular subunits was analyzed. RESULTS: The length of the anterior portion of ALIAN (dAnt) reached 3.34 ± 1.59 mm in prognathism and 1.00 ± 0.97 mm in retrognathism. The length of the inferior portion of ALIAN (dInf) reached 6.81 ± 1.33 mm in prognathism and 5.56 ± 1.34 mm in retrognathism. The analysis of Pearson’s correlation coefficiency on all samples showed that the lengths of functional subunits were positively correlated with the loop depth. The length of the symphysis area in prognathic patients was positively correlated with the anterior loop depth (p = 0.005). CONCLUSIONS: Both the anterior and inferior length of ALIAN are longer in prognathic patients. Especially, it seems to be associated with the growth of the symphysis area.

Aberrant growth of the anterior cranial base relevant to severe midface hypoplasia of Apert syndrome / 대한악안면성형재건외과학회지

BACKGROUND: A 9-year-old male showed severe defects in midface structures, which resulted in maxillary hypoplasia, ocular hypertelorism, relative mandibular prognathism, and syndactyly. He had been diagnosed as having Apert syndrome and received a surgery of frontal calvaria distraction osteotomy to treat the steep forehead at 6 months old, and a surgery of digital separation to treat severe syndactyly of both hands at 6 years old. Nevertheless, he still showed a turribrachycephalic cranial profile with proptosis, a horizontal groove above supraorbital ridge, and a short nose with bulbous tip. METHODS: Fundamental aberrant growth may be associated with the cranial base structure in radiological observation. RESULTS: The Apert syndrome patient had a shorter and thinner nasal septum in panthomogram, PA view, and Waters’ view; shorter zygomatico-maxillary width (83.5 mm) in Waters’ view; shorter length between the sella and nasion (63.7 mm) on cephalogram; and bigger zygomatic axis angle of the cranial base (118.2°) in basal cranial view than a normal 9-year-old male (94.8 mm, 72.5 mm, 98.1°, respectively). On the other hand, the Apert syndrome patient showed interdigitating calcification of coronal suture similar to that of a normal 30-year-old male in a skull PA view. CONCLUSION: Taken together, the Apert syndrome patient, 9 years old, showed retarded growth of the anterior cranial base affecting severe midface hypoplasia, which resulted in a hypoplastic nasal septum axis, retruded zygomatic axes, and retarded growth of the maxilla and palate even after frontal calvaria distraction osteotomy 8 years ago. Therefore, it was suggested that the severe midface hypoplasia and dysostotic facial profile of the present Apert syndrome case are closely relevant to the aberrant growth of the anterior cranial base supporting the whole oro-facial and forebrain development.

Full Arch Restoration through Orthognathic Surgery after Implantation on the Patients with Mandibular Prognathism and Loss of Posterior Teeth: A Case Report

In case of loss of many teeth due to dental caries or periodontal disease, improvement of masticatory function and aesthetics can be obtained through implant treatment. However, if the patient does not have a normal intercondylar relationship, it is difficult to achieve an ideal occlusal relationship with only prosthetic treatment. In particular, oral reconstruction with orthodontic treatment or orthognathic surgery is necessary for patients with mandibular prognathism. However, if the posterior occlusion collapses due to severe caries or periodontal disease, orthognathic surgery may be difficult. The occlusal vertical stop is very important for the stability of the mandibular position during occlusal reconstruction through orthognathic surgery. The patient in this case had posterior occlusion collapsed due to the caries of a large number of posterior teeth, and showed mandibular prognathism and long face. We planned a full arch restoration with orthognathic surgery and extracted the hopeless teeth. To secure the vertical stop required for orthognathic surgery, the implant was placed before surgery. After the orthognathic surgery and the final prosthesis application, the results were satisfactory for the improvement of the aesthetics and the restoration of the masticatory function.

Authors' Reply to Letter to the Editor “Effects of airway evaluation parameters on the laryngeal view grade in mandibular prognathism and retrognathism patients”

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