Mechanical Evaluation of Different Stable Internal Fixation Techniques of Sagittal Osteotomy in Mandibular Advance / Evaluación Mecánica de Diferentes Técnicas de Fijación Interna Estable de Osteotomía Sagital en Avance Mandibular

The mandibular advancements performed in orthognathic surgeries can be stabilized with several techniques when using stable internal fixation. This study aims to comparatively evaluate, in vitro, the mechanical strength in a polyurethane mandibular model for four fixation techniques for sagittal split ramus osteotomy mandibular. 60 samples were divided into 4 groups, with 15 units for each group: group A, group B, group C and group D. Advances of 5 mm were made for each subgroup and fixed with 2.0 mm system plates and monocortical screws in the replicas of human hemimandibles in polyurethane resin. The samples were submitted to mechanical tests of linear loading, being evaluated the peak load and peak deformation. Technique B presented higher peak load (Kgf) and techniques A and B presented higher peak strain (p<0.05). Technique D presented lower peak load and lower peak strain (p<0.05). It is concluded that the study based on the development of new techniques for fixation for sagittal osteotomy of the mandibular ramus is of great importance for the advancement of orthognathic surgery, provided by the technical innovation of more favorable plate models.

Los avances mandibulares realizados en cirugías ortognáticas pueden estabilizarse con varias técnicas cuando se utiliza fijación interna estable. Este estudio tuvo como objetivo evaluar comparativamente, in vitro, la resistencia mecánica en un modelo mandibular de poliuretano para cuatro técnicas de fijación para la osteotomía sagital de la rama mandibular. Se dividieron 60 muestras en 4 grupos, con 15 unidades para cada grupo: grupo A, grupo B, grupo C y grupo D. Se realizaron avances de 5 mm para cada subgrupo y se fijaron con placas de sistema de 2,0 mm y tornillos monocorticales en las réplicas de hemimandíbulas humanas en resina de poliuretano. Las muestras fueron sometidas a pruebas mecánicas de carga lineal, siendo evaluadas la carga máxima y la deformación máxima. La técnica B presentó mayor pico de carga (Kgf) y las técnicas A y B presentaron mayor pico de deformación (p<0,05). La técnica D presentó menor carga máxima y menor tensión máxima (p<0,05). Se concluye que el estudio basado en el desarrollo de nuevas técnicas de fijación para la osteotomía sagital de la rama mandibular es de gran importancia para el avance de la cirugía ortognática, proporcionada por la innovación técnica de modelos de placas más favorables.

Comparação da fragilidade gerada por 3 diferentes osteotomias sagitais de mandíbula: estudo in vitro / Comparison of fragility generated by 3 different sagittal mandible osteotomies: in vitro study / Comparación de la fragilidad generada por 3 osteotomías mandibulares sagitales diferentes: estudio in vitro

A osteotomia sagital bilateral de mandíbula (OSBM) foi publicada por Trauner e Obwegeser em 1957, desde então sofreu várias modificações a fim de diminuir as complicações e tornar o procedimento mais simples e previsível. Sendo assim objetivo do presente trabalho foi avaliar e comparar a fragilidade causada na mandíbula por 3 tipos de OSBM. Para isso, foram realizadas as osteotomias propostas por Trauner e Obwegeser modificada por Hunsuck e Epker (I), a de Sant'Ana (II) e de Wolford (III), em 24 hemimandibulas de poliuretano e foi realizado o ensaio mecânico para gerar a fratura sagital. Os dados foram coletados e tabulados, e obteve como resultado que, a maior quantidade de força máxima aplicada foi observada no grupo III, e a menor quantidade no grupo II; com relação à deflexão, apresentou significância estatística entre o grupo II e grupo III; com relação à rigidez, a maior média, foi encontrada no grupo I. Sendo assim, foi possível concluir que dentro deste modelo de estudo a osteotomia II foi capaz de gerar maior fragilidade à hemimandibula de poliuretano com menor quantidade de força. As OBMD dos grupos I e a III também apresentaram ótimos resultados, entretanto necessitaram mais força para alcançar a fratura... (AU)

The bilateral sagittal split osteotomy of the mandible (BSSO) was published by Trauner and Obwegeser in 1957, since then it has undergone several modifications in order to reduce complications and make the procedure simpler and more predictable. Therefore, the objective of this study was to evaluate and compare the fragility caused in the mandible by 3 types of BSSO. For this, the osteotomies proposed by Trauner and Obwegeser modified by Hunsuck and Epker (I), Sant'Ana (II) and Wolford (III) were performed on 24 polyuretha ne hemimandibles, a mechanical test to generate the sagittal fracture. Data were collected and tabulated, and the result was that, the highest amount of maximum force applied was observed in group III, and the lowest amount in group II; with regard to deflection, it was statistically significant between group II and group III; with regard to stiffness, the highest average was found in group I. Therefore, it was possible to conclude that within this study model, osteotomy II was able to generate greater fragility to the polyurethane hemimandible with less force. The BSSO of the groups I and III also showed excelent results, however they required more force to reach the fracture... (AU)

La osteotomía sagital bilateral de la mandíbula (OSBM) fue publicada por Trauner y Obwegeser en 1957, desde entonces ha sufrido varias modificaciones con el fin de reducir las complicaciones y hacer el procedimiento más simple y predecible. Por lo tanto, el objetivo de este estudio fue evaluar y comparar la fragilidad causada en la mandíbula por 3 tipos de OSBM. Para eso, se realizaron las osteotomías propuestas por Trauner y Obwegeser modificadas por Hunsuck y Epker (I), Sant'Ana (II) y Wolford (III) en 24 hemimandíbulas de poliuretano y se realizó un ensayo mecánico para generar la fractura sagital. Los datos fueron recolectados y tabulados, obteniendo como resultado que, la mayor cantidad de fuerza máxima aplicada se observó en el grupo III, y la menor cantidad en el grupo II; en cuanto a la deflexión, fue estadísticamente significativa entre el grupo II y el grupo III; en cuanto a la rigidez, la media más alta se encontró en el grupo I. Por lo tanto, se pudo concluir que, dentro de este modelo de estudio, la osteotomía II logró generar mayor fragilidad a la hemimandíbula de poliuretano con menor fuerza. El OSBM de los grupos I y III también mostró excelentes resultados, pero requirieron mayor fuerza para llegar a la fractura... (AU)

The pubic symphysis orthotic compression anatomic plate for treatment of fractures and dislocations around the pubic symphysis / 中华创伤骨科杂志

Objective:To evaluate our self-designed pubic symphysis orthotic compression anatomic plate (PSOCAP) in the treatment of fractures and dislocations around the pubic symphysis.Methods:A retrospective study was conducted to analyze the 16 patients with fracture or dislocation around the pubic symphysis who had been treated by our self-designed PSOCAP at Department of Traumatic Surgery, Center for Orthopaedic Surgery, The Third Hospital Affiliated to Southern Medical University from January 2021 to June 2022. There were 8 males and 8 females with an age of (41±19) years. According to the Tile classification for pelvic fractures, there were 3 cases of type B1, 2 cases of type B3, 1 case of type C1.2, 4 cases of type C1.3, 3 cases of type C2, and 3 cases of type C3. There were 8 cases of pubic symphysis separation and 8 fractures of the pubic ramus (2 ones at Nakatani zone Ⅰ and 6 ones at Nakatani zone Ⅱ). Time from injury to surgery was 16 (11, 53) days, ranging from 4 to 348 days. The fractures or dislocations around the pubic symphysis were exposed by the modified Stoppa approach, reduced with the assistance of PSOCAP and fixated with PSOCAP; the posterior pelvic ring was reduced and fixated by corresponding surgical methods. Recorded were the surgical time, intraoperative bleeding, postoperative quality of fracture reduction, surgical complications, and functional recovery at the last follow-up concerning the pelvic anterior ring.Results:Surgery went on successfully in the 16 patients. Their surgical time was (58±15) min, ranging from 40 to 90 min, and their intraoperative bleeding 85 (63, 150) mL, ranging from 50 to 250 mL. According to the Matta scoring, the fracture reduction was evaluated as excellent in 10 cases, as good in 3 cases and as fair in 3 cases. The (10±3)-month follow-up for the 16 patients revealed complete fracture union for all after (12±2) weeks. According to the Majeed scoring at the last follow-up, the pelvic function was evaluated as excellent in 5 cases, as good in 7 cases, and as fair in 4 cases. No such postoperative complications as fracture displacement or internal fixation failure occurred.Conclusion:Owing to the biplane and integrated structure, our self-designed PSOCAP can help reduce the fractures or dislocations around the pubic symphysis to achieve anatomical reduction and strong internal fixation, leading to good clinical efficacy.

Fixation with a retrograde pubic ramus intramedullary nail for anterior pelvic ring fractures / 中华创伤骨科杂志

Objective:To explore the clinical efficacy of a retrograde pubic ramus intramedullary nail (RPRIN) in the treatment of anterior pelvic ring fractures.Methods:A retrospective study was conducted to analyze the 14 patients with anterior pelvic ring fracture who had been treated and followed up at Department of Traumatic Surgery, Tongji Hospital From June 2020 to February 2021. There were 10 males and 4 females with an age of (44.8±12.5) years. By the AO/OTA classification for pelvic fractures, 5 cases were type 61-A, 4 cases 61-B, and 5 cases type 61-C; by the Nakatani classification, 1 case belonged to unilateral zone Ⅰ fracture, 5 cases to unilateral zone Ⅱ fracture, 2 cases to unilateral zone Ⅲ fracture, 3 cases to right zone Ⅱ and left zone Ⅲ fracture, 2 cases to zone Ⅲ fracture on both left and right sides, and 1 case to zone Ⅱ fracture on both sides. The time from injury to operation was (7.8±1.8) days. All the anterior pelvic ring fractures were fixated with a RPRIN. The time and fluoroscopic frequency for placement of every single RPRIN, quality of fracture reduction, and pelvic function and incidence of postoperative complications at the last follow-up were recorded.Results:A total of 18 RPRINs were placed in the 14 patients. For placement of each RPRIN, the time was (35.9±8.6) min, and the fluoroscopic frequency (22.8±1.9) times. No complications such as infection occurred at any surgical incision after RPRIN placement. According to the Matta scoring, the quality of postoperative fracture reduction was assessed as excellent in 7 cases, as good in 5 cases and as fair in 2 cases. The 14 patients were followed up for (18.1+1.5) months. Their X-ray and CT images of the pelvis at the last follow-up showed that the fractures healed well and the intramedullary nails were placed in the cortical bone of the anterior ring of the pelvis. According to the Majeed scoring at the last follow-up, the pelvic function was assessed as excellent in 10 cases, as good in 3 cases and as fair in 1 case. One patient reported discomfort during squatting 2 months after operation but the symptom improved 3 months later without any special treatment. No patient experienced such complications as displacement or slippage of RPRIN, or pain at the insertion site.Conclusion:RPRIN is effective in the treatment of anterior pelvic ring fractures, showing advantages of small surgical incision, limited intraoperative fluoroscopy and short operation time.

Sex Estimation of Medial Aspect of the Ischiopubic Ramus in Adults Based on Deep Learning / 法医学杂志

OBJECTIVES@#To investigate the reliability and accuracy of deep learning technology in automatic sex estimation using the 3D reconstructed images of the computed tomography (CT) from the Chinese Han population.@*METHODS@#The pelvic CT images of 700 individuals (350 males and 350 females) of the Chinese Han population aged 20 to 85 years were collected and reconstructed into 3D virtual skeletal models. The feature region images of the medial aspect of the ischiopubic ramus (MIPR) were intercepted. The Inception v4 was adopted as the image recognition model, and two methods of initial learning and transfer learning were used for training. Eighty percent of the individuals' images were randomly selected as the training and validation dataset, and the remaining were used as the test dataset. The left and right sides of the MIPR images were trained separately and combinedly. Subsequently, the models' performance was evaluated by overall accuracy, female accuracy, male accuracy, etc.@*RESULTS@#When both sides of the MIPR images were trained separately with initial learning, the overall accuracy of the right model was 95.7%, the female accuracy and male accuracy were both 95.7%; the overall accuracy of the left model was 92.1%, the female accuracy was 88.6% and the male accuracy was 95.7%. When the left and right MIPR images were combined to train with initial learning, the overall accuracy of the model was 94.6%, the female accuracy was 92.1% and the male accuracy was 97.1%. When the left and right MIPR images were combined to train with transfer learning, the model achieved an overall accuracy of 95.7%, and the female and male accuracies were both 95.7%.@*CONCLUSIONS@#The use of deep learning model of Inception v4 and transfer learning algorithm to construct a sex estimation model for pelvic MIPR images of Chinese Han population has high accuracy and well generalizability in human remains, which can effectively estimate the sex in adults.

Application and development of orthognathic surgery in treatment of syndromic craniosynostosis / 中国修复重建外科杂志

OBJECTIVE@#To summarize the application and recent development of orthognathic surgery in treating syndromic craniosynostosis.@*METHODS@#The related literature at home and abroad in recent years was extensively reviewed, and the indications, routine procedures, and protocols of orthognathic surgery in the treatment of syndromic craniosynostosis were summarized and analyzed.@*RESULTS@#Craniosynostosis is a common congenital craniofacial malformation. Syndromic craniosynostosis usually involves premature fusion of multiple cranial sutures and is associated with other deformities. Orthognathic surgery is the necessary and effective means to improve the midfacial hypoplasia and malocclusion. Le Fort I osteotomy combined with sagittal split ramus osteotomy are the common surgical options. Orthognathic surgery should combine with craniofacial surgery and neurosurgery, and a comprehensive long-term evaluation should be conducted to determine the best treatment plan.@*CONCLUSION@#Orthognathic surgery plays an important role in the comprehensive diagnosis and treatment of syndromic craniosynostosis. The development of digital technology will further promote the application and development of orthognathic surgery in the treatment of syndromic craniosynostosis.

Establishment of a three-dimensional coordinate system for measuring the recurrence rate after orthognathic surgery and evaluation and analysis of the degree of recurrence / 口腔疾病防治

Objective@# To establish a three-dimensional coordinate system that can accurately measure the recurrence rate after orthognathic surgery, and evaluate and analyze the degree of recurrence.@*Methods @#Data from patients who underwent orthognathic surgery in a hospital were selected to reconstruct three-dimensional images with spiral CT. The two researchers used the multiplane assisted positioning method to fix the points three times and screened them using intra-andintreclass correlation coefficients (ICC). Reproducible and accurate landmark points were drawn to establish different coordinate systems and calculate the facial asymmetry index (AI) to determine the coordinate system with the best mid-sagittal plane symmetry. This coordinate system and lateral radiographs were used to separately measure the recurrence rate, and evaluate and analyze the three-dimensional recurrence degree of orthognathic surgery.@*Results @#Ten landmark points that may be repeatedly fixed were obtained, including N (nasion), K (K point), ANS(anterior nasal spine), PNS (posterior nasal spine), Ptm(pterygomaxillary fissure), Gn (gnathion), IZ(IZ point), MZ (MZ point), Ms (mastoideale), Cor (coronion) and and Go (gonion). Three coordinate systems were established, and the most suitable coordinate system was the upper edge point of the left infraorbital foramen. The inner upper edge of the right infraorbital foramen and both sides of the midpoint of the ear points constituted the horizontal plane (HP), which passed through the outermost point of the left zygomatic frontal suture and the outermost point of the right zygomatic frontal suture and was perpendicular to the horizontal plane to constitute the coronal plane (CP). It was perpendicular to the two planes to form a sagittal plane (SP). Two-dimensional and three-dimensional measurements of recurrence were performed on 112 patients, and new three-dimensional recurrence evaluation results were obtained. Less than 40% had low recurrence, 40% to 61% had moderate recurrence, and greater than 61% had high recurrence.@*Conclusion@#This study established a three-dimensional coordinate system suitable for measuring the recurrence rate after orthognathic surgery, obtained a new three-dimensional recurrence evaluation result, and provided a clinical experimental basis for evaluating the effect of orthognathic surgery and improving stability.

Sex estimation by metric analysis of the angle of mandible and the mandibular ramus: a systematic review / Estimación sexual mediante análisis métrico del ángulo de la mandíbula y de la rama mandibular: revisión sistemática

SUMMARY: Sex estimation is the first step in human identification. The mandibular ramus and the condyle have been widely used as indicators for sexual diagnosis because they are regions that undergo important morphological changes which increase sexual dimorphism. The object of the present study was to carry out a systematic review to determine the metric parameters of the mandibular ramus that present the greatest sexual dimorphism, and to sex estimation from the angle of mandible (MA). We included documents in English, Spanish and Portuguese which analysed sex estimation or sex diagnosis by metric analysis of the mandibular ramus in humans. The search was conducted in PubMed/MEDLINE, EMBASE, LILACS, up to December 2020. The risks of bias were analysed using the AQUA tool. The search identified 538 studies. After exclusion of duplicates and irrelevant articles, 39 studies were included for qualitative analysis. Of these, 18 studies were carried out on dry mandibles and 21 by imaging techniques, totalling 7270 participants of 14 different nationalities. We found 14 sex-estimation parameters in the mandibular ramus, plus the MA. Sex estimation by the MA is variable; it is a good predictor only for some populations. The height of the mandibular ramus, the angle of mandible, the bicondylar angle and the height of the coronoid process were the estimation parameters cited in the greatest number of studies. The mandibular ramus presents great sexual dimorphism and can be used as a sex predictor in different populations. Although some parameters of the mandibular ramus can present accuracy of almost 80 % when analysed in isolation, more accurate sex estimation is achieved when the parameters are analysed in conjunction.

RESUMEN: La estimación sexual es el primer paso en la identificación humana. La rama mandibular y el cóndilo se han utilizado ampliamente como indicadores para el diagnóstico sexual debido a que son regiones que sufren cambios morfológicos importantes, aumentando el dimorfismo sexual. El objetivo del presente estudio fue realizar una revisión sistemática a fin de determinar los parámetros métricos de la rama mandibular que presentan mayor dimorfismo sexual, bien estimar el sexo a través del ángulo de la mandíbula (AM). Se incluyeron artículos en Inglés, Español y Portugués que analizaron la predicción sexual o el diagnóstico sexual mediante análisis métrico de la rama mandibular en humanos. La búsqueda fue realizada a través de PubMed/MEDLINE, EMBASE, LILACS, con límite hasta Diciembre 2020. El análisis de los riesgos de sesgos se realizó con la herramienta AQUA. Fueron identificados 538 estudios. Tras la exclusión de duplicados y estudios fuera del tema fueron incluidos 39 estudios para análisis cualitativa. De estos, 18 estudios fueron realizados en mandíbulas secas y 21 en exámenes de imagen, totalizando 7270 participantes de 14 nacionalidades distintas. Fueron encontrados 14 parámetros predictores del sexo en la rama mandibular más el AM. La predicción sexual a través del AM es variable, siendo un buen predictor solamente para algunas poblaciones. La altura de la rama mandibular, ángulo bigoníaco, ángulo bicondilar y la altura del proceso coronoides fueron los parámetros predictivos citados en mayor número de estudios. La rama mandibular presenta gran dimorfismo sexual y puede ser utilizada como predictor del sexo en diferentes poblaciones. A pesar que algunos parámetros de la rama mandibular pueden presentar una precisión de casi 80 % cuando analizadas de forma aislada, una mayor predicción sexual es alcanzada cuando los parámetros son analizados en conjunto.

Estabilidad del tratamiento ortodóncico-quirúrgico de avance mandibular mediante osteotomía sagital bilateral de rama mandibular en pacientes clase II. Revisión narrativa / Stability of the orthodontic-surgical treatment of mandibular advancement through bilateral sagittal split osteotomy in class II patients. Narrative review

RESUMEN: Introducción: La anomalía esqueletal clase II posee un 16 a 22,5% de prevalencia mundial. Cuando estos pacientes se someten al avance mandibular mediante osteotomía sagital de rama mandibular pueden presentar un grado de inestabilidad postoperatoria evidenciándose como recidiva de éste. Objetivo: Describir la estabilidad del avance mandibular mediante osteotomía sagital bilateral de rama mandibular en pacientes clase II esqueletal. Material y método: Se realizó una búsqueda electrónica en las bases de datos PubMed, EBSCO, The Cochrane Library, Tripdatabase y Scopus mediante las palabras clave "mandibular stability", "skeletal stability", "mandibular advancement", "sagittal split osteotomy", "sagittal split ramus osteotomy", "class II", "class III" y "distraction osteogenesis", relacionadas entre sí con los términos booleanos AND, OR y NOT. También se incluyeron los términos MeSH "mandibular advancement" y "Sagittal Split Ramus Osteotomy". Paralelamente se realizó una búsqueda manual en las revistas AJODO, BJOMS, JOMS y EJO. Resultados y discusión: Se seleccionaron 29 artículos: 24 estudios observacionales analíticos, 2 revisiones sistemáticas y 3 ensayos clínicos aleatorizados. El avance mandibular mediante osteotomía sagital de rama mandibular es estable. No obstante, se debe tener en cuenta la existencia de múltiples factores pre e intraquirúrgicos que podrían generar recidiva del tratamiento.

ABSTRACT: Introduction: The class II skeletal anomaly has a 16-22,5% prevalence worldwide. When class II patients undergo mandibular advancement through Bilateral Sagittal Split Osteotomy (BSSO), they can present a postoperative instability, evidenced as a relapse. Objective: To describe the stability of mandibular advancement through BSSO in skeletal class II patients. Materials and method: An electronic search was performed in the databases PubMed, EBSCO, The Cochrane Library, Tripdatabase and Scopus using the keywords "mandibular stability", "skeletal stability", "mandibular advancement", "sagittal split osteotomy", "sagittal split ramus osteotomy", "class II", "class III" and "distraction osteogenesis", related to each other with the Boolean terms AND, OR and NOT. Also "mandibular advancement" and "Sagittal Split Ramus Osteotomy" MeSH terms were included. In parallel, a manual search in the journals AJODO, BJOMS, JOMS and EJO was performed. Results and discussion: 29 articles were selected: 24 analytic observational studies, 2 systematic reviews and 3 randomized clinical trials. Mandibular advancement through BSSO is stable. However, multiple pre and intraoperative factors that could cause a treatment relapse must be taken into account.

Evaluation of the Different Methods for Fixation of Sagittal Ramus Split Osteotomy of the Mandibular Ramus in Relation to Stability for Mandibular Advancement: A Systematic Review

Aims: The purpose of this study was to perform a systematic review of the literature on the different fixation methods available for sagittal ramus split osteotomyassociated with mandibular advancement testedin vitroto evaluate stability of each method.Study Design:Systematic review.Methodology:Following the PRISMA model for systematic reviews, a query was made in the PubMed, Bireme and Cochrane Library databases, identifying articles that reported the different fixation methods for sagittal ramus split osteotomyfor mandibular advancement. Results:A total of 352 articles were identified, 11 papers of which, after evaluation in relation to the inclusion and exclusion criteria, were systematically reviewed.

Coronary anomalies and anatomical variants detected by coronary computed tomographic angiography in Kashmir, India

Background: Coronary Artery Anomalies (CAAs) presenting in adulthood are rare and associated with adverse cardiac events, including sudden cardiac death. Coronary artery anomaly is the second most common cause of Sudden Cardiac Death (SCD) in young athletes. Cardiac Computed Tomographic Angiography (CTA) is a readily available non-invasive imaging modality that provides high-resolution anatomical information of the coronary arteries. Multi-detector row CT is superior to conventional angiography in defining the ostial origin and proximal path of anomalous coronary branches.Methods: This was a prospective study included 186 patients who underwent coronary CTA from December 2018 to November 2019 in Government medical College, Srinagar on a 256 slice CT. The indications for coronary CTA were an equivocal, or non-diagnostic stress test, atypical chest pain, suspected anomalous coronary, as well as the evaluation of cardiac cause of syncope.Results: Ramus intermedius was the most common anatomical variant seen in 25 patients (13.4%). The prevalence of coronary anomalies in this study was 5.66% including myocarding bridging. The most common anomaly was high take off of coronary artery from sinotubular junction accounting for 1.6%.Conclusions: Coronary Computed Tomographic angiography is much superior in detecting coronary artery anomalies than invasive coronary angiography because of the absence of soft tissue information like as is needed in myocardial bridging. Proper knowledge of the anomalies and their clinical significance is highly important in planning treatment and easing hardships of cardiologists in dealing with them.

Percutaneous screw fixation versus traditional plate fixation for treating pubic branch fracture / 中国组织工程研究

BACKGROUND: Fracture of the pubic branch is a common type of anterior pelvic ring injury. Fixation of the pubic branch fracture can reduce the stress level of the posterior pelvic ring fixation system and reduce the separation of the pubic symphysis, which is beneficial to the stability of the pelvic ring. Both percutaneous screw fixation and traditional open reduction and internal fixation can be used to fix pubic branch fractures, but which method is better has not been confirmed. OBJECTIVE: To compare the efficacy of percutaneous screw fixation with conventional open reduction and plate fixation for pubic branch fracture. METHODS: Sixty-five patients of pubic branch fracture undergoing the surgical treatment at the Second Hospital of Anhui Medical University between January 2014 and December 2018 were included. The patients were randomly divided into percutaneous screw fixation group (n=33) and open reduction and plate fixation group (n=32). The patients signed the informed consents and the study was approved by the ethics committee of the hospital. The number of cases, sex, age, fracture classification, and American Society of Anesthesiologists score had no significant difference between two groups. The operation time, total blood loss, postoperative transfusion cases, incision length, postoperative discharge time and complications in both groups were recorded. Postoperative Matta score, Visual Analogue Scale score before and after surgery, and Majeed score during follow-up were recorded. RESULTS AND CONCLUSION: (1) Thirty patients in both groups were followed up, which was 8-59 months in the percutaneous screw fixation group, and 8-57 months in the open reduction and plate fixation group. (2) The percutaneous screw fixation group had smaller incision, lower incision infection rate, less bleeding, and shorter postoperative hospitalization time (P 0.05). (4) The excellent and good rate of Matta score in the percutaneous screw fixation group was less than that in the open reduction and plate fixation group, and the difference was insignificant (P > 0.05). (5) There was no significant difference in the Majeed score at postoperative 6 months between two groups (P > 0.05). (6) Our results indicate that percutaneous screw fixation can achieve the same good effect as traditional plate fixation, and has the advantages of less trauma and faster postoperative recovery compared with traditional plate fixation.

A morphometric study of mandibular foramen in dry adult human mandibles of indian population in telangana state

Background: Mandibular foramen is an irregular foramen located just above the centre of the medial surface ofthe ramus of the mandible. Mandibular foramen is leading to mandibular canal through which inferior nerveand vessels will transmit and supply the teeth of lower jaw.The Mandibular foramen is an important anatomical landmark for the inferior nerve blocks, mandibularosteotomies and implant treatment. The inferior nerve block is the commonest local anaesthetic techniquewhich is used for anaesthetizing lower jaw in various surgical and dental procedures on mandible andmandibular teeth such as removal of impaction, reduction of fractures and tooth extraction. Inferior alveolarnerve block failure is not uncommon and it occurs even with experienced hands due to variations in position ofmandibular foramen.A thorough knowledge of anatomy of mandibular foramen is very essential hence aim of this study was todetermine the exact position of mandibular foramen by studying dry adult human mandibles of telanganapopulation.Material and methods: The present study was conducted using 60 dry adult human mandibles obtained fromanatomy department of Shadan institute of medical sciences,Hyderabad and VRK womens medicalcollege,Hyderabad. The data was tabulated and statistically analysed.Result: The mean distance of mandibular foramen to anterior border of ramus (MF-AB)was16.67±2.73mm(R)and16.56±2.52mm(L),to posterior border of ramus(MF-PB) was 12.67±2.37mm(R) and 13.03±2.43mm(L),to mandibularnotch (MF-MN) 21.04±2.95mm(R) and 20.24±2.94mm(L),to angle of mandible was 23.005±3.92mm(R) and22.36±3.89mm,base of mandible or inferior border (MF-MB) was 24.38±3.86mm(R) and 24.42±4.44mm(L), tip ofcoronoid process (MF-CrT) 35.68±3.25mm(R) and 35.19±3.47mm (L).Conclusion: The present study gives a fair knowledge of the position of mandibular foramen and provides usefulinformation for successful local anaesthesia ( inferior nerve block),to the maxillofacial surgeons,radiologistsand oncologists performing operations on the mandible to prevent complications and misinterpretations

Morphometric analysis of the mandibular ramus and its clinical and medicolegal significance

Background: During natural calamities entire skeleton of single person could not be found. In such case, determination of sex with fragments of the bone available required range of data with proven accuracy. Hence this study is aimed at to provide range of data for minimum number of parameters of the ramus of the mandible.Methods: Three hundred dry mandibles of known sexes and bearing all teeth or intact alveolar margin were included in the study. Vertical height; maximum and minimum breadths of the ramus of the mandible were measured. All the data were analyzed for significance of the occurrence in relation to sex and laterality by means of paired t-test.Results: On the basis of all the three parameters together, we got 95% accuracy in determination of sex. Statistically significant differences were found in all parameters between male and female mandibles. The laterality distributions for all the parameters were found to be insignificant.Conclusions: Accurate determination of sex from the available bone fragments such as the ramus of the mandible required wide number of data from the least parameters that could be utilized medicolegally.

Three-dimensional changes in condylar position in skeletal class Ⅲ patients with mandibular deviation after bilateral sagittal split ramus osteotomy / 中华口腔医学杂志

Objective@#To investigage the three-dimensional changes in condylar position after bilateral sagittal split ramus osteotomy (BSSRO) in skeletal class Ⅲpatients with mandibular deviation using cone-beam CT (CBCT).@*Methods@#Twenty-five skeletal class Ⅲ patients with mandibular deviation were included. The patients (12 males and 13 females, aged 19-25 years, average age 22.4 years) were treated in the Department of Orthodontics, Affiliated Stomatological Hospital, Nanchang University from October 2013 to March 2017. The patients were divided into T1, T2 and T3 groups (T1 group: CBCT taken within 1 week before operation; T2 group: CBCT taken within 1 week after operation; T3 group: CBCT taken 6-8 months after surgery). Three sets of image data of condyles on both sides (deviation side and contralateral side) were obtained. After the DICOM data collection, the software of Mimics 17.0 was used to perform three-dimensional reconstruction and condylar position measurements: the distance from the condylar top (CoT) to the standard horizontal plane (SHP), the middle sagittal plane (MSP) and the sella coronal plane (SCP) (CoT-SHP, CoT-MSP, CoT-SCP); the distance from the condylar center (CoC) to SHP, MSP and SCP (CoC-SHP, CoC-MSP, CoC-SCP); the angle from the condyle cella plane (CCP) to SHP, MSP and SCP (CCP-SHP, CCP-MSP, CCP-SCP); the angle from the condyle sagittal plane (CSP) to SHP, MSP and SCP (CSP-SHP, CSP-MSP, CSP-SCP) and the distance of the anterior, superior, posterior, medial, central and lateral joint space. One-way ANOVA and LSD-t test were used to compare the changes in condylar position at different periods (T1, T2, and T3).@*Results@#Within 1 week before operation on the deviation side, CoT-SHP [(2.5±1.3) mm], CSP-MSP (41.2°±8.4°) and the posterior joint space [(2.0±0.6) mm] were obviously increased (P<0.05), and CoT-SCP [(9.1±3.3) mm], CCP-MSP (78.2°±5.2°) were decreased significantly (P<0.05); on the contralateral side, CoT-MSP [(50.4±3.1) mm], CCP-MSP (80.6°±6.0°), the anterior joint space [(2.2±0.6) mm] and the medial joint space [(2.6±0.6) mm] were obviously increased (P<0.05), and CCP-SCP (11.4°±8.8°) were decreased significantly (P<0.05). Six to eight months after surgery, CoT-SHP [(2.2±1.0) mm] and the posterior joint space [(1.9±0.5) mm] on deviation side and CoT-SCP [(8.4±2.8) mm] on the contralateral side were increased significantly (P<0.05). No significant difference was found in other measurements (P>0.05).@*Conclusions@#The condylar position in skeletal class Ⅲ patients with mandibular deviation was asymmetrical. Within 1 week after the operation of BSSRO, the condyle on the deviation side was moved forward, downward and inward. Meanwhile, the condyle on the contralateral side was moved backward and outward. Six to eight months after surgery, the condylar position on both sides was gradually restored to the pre-operative condylar position.

A Study Of Mandibular Foramen In North Indian Population

Background: Mandibular foramen (MF), present on the medial surface of ramus of the mandible, leads to themandibular canal through which inferior alveolar nerve (IAN) and vessels transmit. IAN block is a commonanaesthetic procedure before dental and reconstructive surgeries. Surgeons usually do IAN block in their clinicsand encounter failure of block because of variable position of MF.Objective: The present study was carried out to find the most common position of MF in north Indian population.Materials and Methods: Study was done on 50 dry adult human mandibles of unknown sex and age of northIndian origin. Height was measured from the angle of the mandible to the highest point on condyloid process.Mid point of the line joining these points was noted. The position of MF was observed in relation to pre noted midpoint.Results: MF was placed below the level of mid point in 40 mandibles (80%).Conclusion: The knowledge of most common position of MF will help the surgeons to reduce the chance ofunsuccessful IAN block.

Study Of Mandibular Ramus As Predictor Of Sex

Background: Methods based on measurements and morphometry are accurate and can be used in determinationof sex. Even the bony remains like mandibular ramus can be used to predict the sex of the individual which willbe of help for forensic experts. Morphometry of mandibular ramus will also be of importance for anthropologists,anatomists and prosthetists.Materials and Methods: Coronoid height, maximum ramus breadth, minimum ramus breadth and maximumramus height was measured in 200 adult cadavers.Results: The coronoid height varied from 42.02 mm to 68.46 mm in males and it varied from 40.08 mm to 66.76mm in females. The maximum ramus breadth in male mandible varied from 28.84 mm to 42.28 mm and infemales it varied from 27.44 mm to 41.42 mm. The minimum ramus breadth in males varied from 21.92 mm to36.80 mm, in females it varied from 17 mm to 34.26 mm. The maximum ramus height in males varied from 47.76mm to 68.64 mm and in females it varied from 42.56 mm to 69.56 mm.Conclusion: All the parameters measured were higher in males than females. Comparison studies revealed thatthe South Indian parameters were lesser than Thais, Croatians and Africans.

Concepts, protocol, variations and current trends in surgery first orthognathic approach: a literature review

ABSTRACT In the current era of expedited orthodontics, among many clinicians, tertiary care hospitals and patients, surgery first orthognathic approach (SFOA) has gained popularity. The advantages of SFOA (face first approach) are the reduced overall treatment duration and the early improvement in facial esthetics. In SFOA, the absence of a presurgical phase allows surgery to be performed first, followed by comprehensive orthodontic treatment to achieve the desired occlusion. The basic concepts of surgery early, surgery last, SFOA and Sendai SFOA technique along with its variations are reviewed in the present article. The recent advancement in SFOA in the context of preoperative preparation, surgical procedures and post-surgical orthodontics with pertinent literature survey are also discussed.

RESUMO Na presente era da Ortodontia de resultados acelerados, a cirurgia ortognática com benefício antecipado (COBA) ganhou popularidade entre muitos clínicos, hospitais terciários e pacientes. A vantagem da COBA é a redução da duração total do tratamento, juntamente com a melhora precoce da estética facial. Na COBA, a ausência de uma fase pré-cirúrgica permite que a cirurgia seja realizada antes e, só então, venha o tratamento ortodôntico abrangente para se alcançar a oclusão desejada. Os conceitos básicos de cirurgia primeiro, cirurgia por último, COBA e a técnica COBA de Sendai, bem como suas variações, são aqui revistos. Também são discutidos no presente artigo, junto com a revisão da literatura pertinente, os recentes avanços da COBA no contexto do preparo pré-cirúrgico, dos procedimentos cirúrgicos e da Ortodontia pós-cirúrgica.

Morphometric Study of Dry Adult Human Mandible Using Minimum Ramus Breadth and Mandibular Angle in Mahakaushal Region

Proper analysis of human skeletal remains is very essential for medico legal and anthropological work. The mandible is the largest and the strongest bone of face. Mandible retains its shape better than other bones, so, it plays an important role for forensic osteology and anthropological works, hence, aim of present study to measure and compare the measurement of mandibular ramus and to assess the utility of mandibular ramus as aid in gender determination. 52 dry and adult human mandibles of known sex (29 male and 23 female) were used in this study. Measurement of the ramus and angle of the mandible were measured by sliding Vernier caliper and with the help of protector and the result was statistically analyzed using IBM SPSS software. In results it is found that angle of mandible in 29 male & 23 female mandibles of right side, mean & SD is 122.24 ± 6.71 & 124.61 ± 5.33 respectively and "P" value is 0.1734. Similarly in case of left side mean & SD is 121.59 ± 6.65 & 124.17 ± 5.87 respectively and "P" value is 0.1489. While measuring minimus ramus breadth it is noticed that mean & SD for right side in male and female are 31.44 ± 2.68 & 29.22 ± 3.040 respectively and the "P" value is 0.0073, on the other that, mean & SD for left side in male and female are 31.56 ± 2.47 & 29.31 ± 3.53 respectively and the "P" value is 0.0095Measurement of mandibular ramus may be used to differentiate between male and female bones and to determine the position of mandibular foramen and canal by maxillofacial and plastic surgeons to preserve the neurovascular bundles of mandible during surgeries.

Computed tomography-guided bone block harvesting from the mandibular ramus / Toma de bloque óseo de rama mandibular guiada por tomografía computadorizada

SUMMARY: The aim of this study was to ascertain the distance from the mandibular canal to the lateral, medial and upper zones of the mandibular ramus in order to identify safety margins that reduce the risk of nerve injuries in the process of removing a bone graft. A descriptive study was conducted, analyzing bilaterally 20 CBCT exams from different patients, taking measurements at 4 points in the central, lateral and medial areas of the corresponding mandibular ramus, which was located at a distance of 5 mm between each line, starting at the distal point of the second molar. Forty hemimandibles were included in this study, estimating a vertical distance for the 4 points of analysis, from between 16 and 17 mm, a distance laterally of 5 mm approximately and medially approximately from 3 to 3.9 mm; the lateral zone was significantly larger than the medial zone. It is estimated that the maximum achievement of a bone block from the area posterior to the second molar must be 13 mm deep and 3 mm laterally to minimize the risks of injuries to the inferior alveolar neurovascular bundle.

RESUMEN: El objetivo de esta investigación fue conocer la distancia que existe desde el canal mandibular a la zona lateral, medial y a la zona superior de la rama mandibular a fin de identificar márgenes de seguridad que minimicen el riesgo de lesiones nerviosas en el proceso de retiro de un injerto óseo. Se realizó un estudio descriptivo, analizando bilateralmente 20 exámenes CBCT de pacientes distintos, realizando mediciones en 4 puntos de la zona central, lateral y medial de la rama mandibular correspondiente, los cuales fueron ubicados con distancia de 5 mm entre cada línea, iniciando en el punto distal del segundo molar. Cuarenta hemimandíbulas fueron incluidas en esta investigación, estimando una distancia vertical, para los 4 puntos de análisis, de entre 16 y 17 mm, una distancia hacia lateral de 5 mm aproximadamente y hacia medial aproximadamente de 3 a 3,9 mm; la zona lateral fue significativamente mas grande que la zona medial. Se estima, que la obtención máxima de un bloque óseo desde la zona posterior al segundo molar debe ser con 13 mm de profundidad y 3 mm desde lateral para minimizar los riesgos de lesiones al paquete neurovascular alveolar inferior.