Cambios dento-esqueléticos de un paciente con síndrome clase III de Moyers tratado con bloques gemelos

La finalidad de la ortopedia dentofacial consiste en modificar el patrón de crecimiento facial y de las estructuras óseas subyacentes de la cara, como la de los pacientes con síndrome clase III de Moyers. El objetivo de este trabajo es dar a conocer los cambios dento-esqueléticos de un paciente con síndrome clase III de Moyers tratado con bloques gemelos. Se presenta el caso de un paciente masculino de 9 años de edad que acudió a consulta de Ortodoncia de la Clínica Universitaria de Especialidades Estomatológicas "Manuel Cedeño" en abril de 2019, preocupado su papá por la estética del paciente. Mediante el análisis de modelos de estudio, las mediciones cefalométricas y los hallazgos del examen físico se clasificó al paciente como síndrome clase III de Moyers. Se empleó los bloques gemelos clase III como aparato de ortopedia funcional de los maxilares. Los resultados dento-esqueléticos se determinaron a los cuatro meses de iniciada la terapia funcional. Luego del tratamiento se concluyó que con el uso de los bloques gemelos clase III los resultados fueron favorables pues se corrigió la relación de oclusión dentaria y se logró una clase I esquelética máxilo-mandibular.

The purpose of dentofacial orthopedics is to modify the pattern of facial growth and the underlying bone structures of the face, such as that of patients with Moyers class III syndrome. The objective of this work is to present the dento-skeletal changes of a patient with Moyers class III syndrome treated with twin blocks. The case of a 9-year-old male patient who attended the orthodontic consultation of the University Clinic of Stomatological Specialties "Manuel Cedeño" in April 2019 is presented, his father worried about the aesthetics of the patient. By analyzing study models, cephalometric measurements and physical examination findings, the patient was classified as Moyers class III syndrome. Class III twin blocks were used as a functional maxillary orthopedic device. Dento-skeletal results were determined four months after the start of functional therapy. After the treatment, it was concluded that with the use of the class III twin blocks, the results were favorable because the dental occlusion relationship was corrected and a skeletal maxillo-mandibular class I was achieved.

O objetivo da ortopedia dentofacial é modificar o padrão de crescimento facial e as estruturas ósseas subjacentes da face, como a de pacientes com síndrome de Moyers classe III. O objetivo deste trabalho é apresentar as alterações dentoesqueléticas de um paciente com síndrome de Moyers classe III tratado com blocos gêmeos. É apresentado o caso de um paciente do sexo masculino de 9 anos que compareceu à consulta de Ortodontia da Clínica Universitária de Especialidades Estomatológicas "Manuel Cedeño" em abril de 2019, seu pai preocupado com a estética do paciente. Analisando modelos de estudo, medidas cefalométricas e achados do exame físico, o paciente foi classificado como síndrome de Moyers classe III. Blocos gêmeos Classe III foram usados ​​como um dispositivo ortopédico funcional para os maxilares. Os resultados dentoesqueléticos foram determinados quatro meses após o início da terapia funcional. Após o tratamento concluiu-se que com o uso de blocos gêmeos classe III os resultados foram favoráveis, pois a relação de oclusão dentária foi corrigida e uma classe I esquelética maxilomandibular foi alcançada.

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)

Resultados posoperatorios y satisfacción en pacientes operados de cirugía ortognática durante los años 2011-2018 en Hospital San José, Chile

Resumen Introducción: Las dismorfosis dentofaciales (DDF) corresponden a un conjunto de alteraciones en la forma, posición o tamaño de los huesos maxilares. La cirugía ortognática es el tratamiento quirúrgico de elección para tratar este tipo de alteraciones, permitiendo la reposición de los maxilares y restitución de las funciones masticatorias, fonéticas y respiratorias, así como la estética facial. Objetivo: Describir resultados posoperatorios y el grado de satisfacción de los pacientes que optaron por la cirugía ortognática durante los años 2011-2018 por el equipo de Cirugía Maxilofacial del Hospital San José. Material y Método: Estudio retrospectivo, se evaluaron los protocolos operatorios de 44 pacientes operados de cirugía ortognática. Criterio de inclusión: pacientes mayores de 15 años con diagnóstico de DDF clases II y III no asociado a síndrome craneofacial. Se aplicó una encuesta a estos pacientes para conocer el grado de satisfacción con respecto a la cirugía ortognática efectuada, presencia de pérdida de sensibilidad neurológica y localización anatómica de ésta si la hubiese. Posteriormente, se relacionaron las variables género, edad del paciente al momento de la cirugía, pérdida de sensibilidad neurológica, tiempo de evolución posoperatorio y clase esqueletal con el nivel de satisfacción del paciente respecto a la cirugía ortognática. Resultados: Un 90,9% de los pacientes está satisfecho con los resultados de la cirugía. No existe una relación estadísticamente significativa entre el grado de satisfacción con la cirugía ortognática y las variables, sexo, edad de operación, pérdida de sensibilidad neurológica (del nervio mentoniano, que da inervación sensitiva al tejido blando del mentón, labio inferior, encía por vestibular de incisivos, canino y primer premolar inferior), tiempo de evolución posterior a la cirugía y clase esqueletal. Conclusión: Existe un alto nivel de satisfacción en los pacientes intervenidos mediante cirugía ortognática. Las cinco variables analizadas no influyen en el nivel de satisfacción de los pacientes posterior a la cirugía ortognática.

Abstract Introduction: Dentofacial deformities are a set of alterations in the shape, position or size of the maxillary bones. Orthognathic surgery is the surgical treatment of choice for this type of alterations, allowing the replacement of the maxillary and restitution of masticatory, phonetic and respiratory functions, as well as facial aesthetics. Aim: Describe post-operative results and level of satisfaction in patients who opted for orthognathic surgery during the years 2011-2018 by the Maxillofacial Surgery team of San José Hospital. Material and Method: Retrospective study, the surgical protocols of 44 patients who underwent orthognathic surgery were evaluated. Inclusion criteria: patients over 15 years old with diagnosis of DDF class II and III not associated with any craniofacial syndrome. A survey was applied to these patients to know the degree of satisfaction with respect to the orthognathic surgery carried out, the presence of loss of neurological sensitivity and its anatomical location, if any. Subsequently, the variables gender, patient age at the time of surgery, loss of neurological sensitivity, time of postoperative evolution and skeletal class were related to the level of satisfaction of patients with orthognathic surgery. Results: 90.9% of patients are satisfied with the results of the surgery. There is no statistically significant relationship between the level of satisfaction patients with orthognathic surgery and the variables, gender, age at the time of surgery, loss of neurological sensitivity (of the mentonian nerve, that gives sensitive innervation to the soft tissue of the chin, lower lip, gum by vestibular of incisors, canine and first lower premolar), time of postoperative evolution and skeletal class. Conclusion: There is a high level of satisfaction in patients undergoing orthognathic surgery. The five variables analyzed do not influence the level of patient satisfaction after orthognathic surgery.

Caso Clínico: Manejo Perioperatorio en Pacientes con Acromegalia / Case Report: Perioperative Management in Patients with Acromegaly

INTRODUCCIÓN: La acromegalia es una enfermedad crónica, progresiva y multisistémica causada por la hipersecreción de la hormona de crecimiento de un macroadenoma hipofisario en funcionamiento. Ciertas características clínicas de esta patología son de interés anestésico sobre todo aquellas que afectan la vía aérea superior, los sistemas respiratorio y cardíaco y el sistema metabólico. CASO CLÍNICO: Paciente de sexo masculino de 34 años de edad, que presentó incremento progresivo de tamaño de pies, manos, nariz, huesos del cráneo y aumento del tamaño de la lengua, diagnosticado de acromegalia por macroadenoma hipofisiario productor de hormona de crecimiento. Se sumaron más tarde SAHOS severo, insuficiencia mitral y tricúspidea leve; motivo por el cual se programa para resección de macroadenoma hipofisiario por acceso transepto-esfenoidal. Durante la evaluación preanestésica el paciente fue catalogado como Riesgo Quirúrgico ASA III, Riesgo Cardiaco de Lee 0.04 %, NYHA I, probabilidad alta de vía aérea difícil. Transquirúrgico: Inducción anestésica con propofol, 120 mg, remifentanilo 0.2 mcg/kg/min, rocuronio 50 mg. Se logró intubación orotraqueal atraumática utilizando McCoy hoja N4, con tubo endotraqueal reforzado N 7.5. EVOLUCIÓN: Fue llevado a Terapia Intensiva donde permaneció para control posquirúrgico. El paciente permaneció hospitalizado durante 7 días y fue dado de alta en condiciones estables, sin déficit neurológico. Se mantiene aún en seguimiento por el SAHOS severo que presenta. Se ha reportado que han mejorado sus episodios de apnea nocturna. CONCLUSION: Los pacientes con enfermedad de la glándula pituitaria sometidos a cirugía pueden presentar una serie de desafíos anestésicos, desde el manejo de la vía aérea hasta cambios hemodinámicos y ventilatorios importantes durante el procedimiento quirúrgico. Es importante prever y prevenir las complicaciones y corregirlas a tiempo, para evitar lesiones irreversibles que aumenten la morbilidad del paciente.(au)

BACKGROUND: Acromegaly is a chronic, progressive and multisystemic disease caused by growth hormone hypersecretion by a functioning pituitary macroadenoma. Some clinical features of this disease are important for anesthetic management, especially those that affect the upper airway, and the cardiac, respiratory and metabolic systems. CASE REPORT: Male 34 year old patient, with progressive increase of feet, hands, nose, skull bone and tongue size, diagnosed with acromegaly caused by growth hormone producing pituitary macroadenoma. Later he presents with severe SAHOS, mitral and mild tricuspid insufficiency; so transsphenoidal resection of pituitary macroadenoma was programed. During preanesthetic evaluation was classified as ASA III Surgical Risk, Lee Cardiac Risk 0.04%, NYHA I, and high probability of difficult airway. The anesthetic induction scheme was: propofol 120 mg, remifentanil 0.2 mcg / kg / min, rocuronium 50 mg. Atraumatic orotracheal intubation using McCoy leaf N4, with reinforced endotracheal tube N 7.5 was achieved. EVOLUTION: The patient was taken to Intensive Care Unit for post-surgical control. The patient remained hospitalized for 7 days and was discharged in stable condition without neurological deficit. He is still in follow up of the severe SAHOS. It has been reported improvement of the episodes of night apnea. CONCLUSION: Patients with pituitary gland disease undergoing surgery can present some anesthetic challenges, from the airway management, to the important hemodynamic and ventilatory challenges during the surgical procedure. It is important to anticipate and prevent the possible complications and correct them in time in order to avoid irreversible injuries that increase the patient's morbidity.(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)

The Influence of Facial Asymmetry on Stress Distributions in Temporomandibular Joints for Patients with Mandibular Prognathism / 医用生物力学

Objective To explore the effects of facial asymmetry on stress distributions in temporomandibular joints (TMJs) for patients with mandibular prognathism. Methods Eight 3D maxillofacial models were established in MIMICS based on cone-beam CT of 4 mandibular prognathism patients with asymmetry and 4 mandibular prognathism patients without asymmetry. Muscle forces and boundary conditions corresponding to the unilateral occlusion (unilateral molar chewing) were applied on the models in ABAQUS. The maximum and the minimum principal stresses of TMJ were chosen for analysis. Results There were significant differences in the maximum and minimum principal stresses at the condyles between the mandibular prognathism patients with and without facial asymmetry under unilateral occlusions (P<0-05). Compared with patients without facial asymmetry, the stresses on the condyle in patients with asymmetry increased by 2-3 times, and the stresses on articular fossa increased by 5-7 times. Among the mandibular prognathism patients with asymmetry, the stresses of the ipsilateral TMJ in patients with temporomandibular disorder (TMD) were significantly higher than those in patients without TMD. Conclusions Facial asymmetry increased the stresses of the articular fossa and condyle in patients with mandibular prognathism. TMD would cause greater stresses in ipsilateral TMJ of the mandibular prognathism patient with asymmetry. Therefore, different treatment strategies should be considered for mandibular prognathism with facial asymmetry.

Application of Polymerase Chain ReactionRestriction Fragment Length Polymorphism (PCRRFLP) Technique in the Analysis of MYO1H Single Nucleotide Polymorphism in Malay Mandibular Prognathism Patients

@#Genetic studies have reported the association between polymorphism in MYO1H with mandibular prognathism. MYO1H is found in skeletal muscle sarcomeres and is expressed in the mandibular jaw cartilage signifying its importance during craniofacial development. This study aimed to characterise the genotype and allele of MYO1H single nucleotide polymorphism (SNP) (rs3825393) and to associate the SNP with mandibular prognathism in Class III skeletal malocclusion. This was a casecontrol study, which involved 57 Malay subjects with 30 Class I (control) and 27 Class III skeletal base patients (case). Cephalometric measurements were taken prior to collection of saliva samples. MYO1H SNP (rs3825383) was genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Chi-square (χ2 ) test was used to compare genotype and allele frequencies between the groups while Hardy-Weinberg Equilibrium (HWE) was applied to assess distribution of genotype frequency in both classes. MYO1H SNP (rs3825393) did not yield significant association with mandibular prognathism with p = 0.33; OR = 0.66; 95% CI = 0.289~1.518, that was reflected by no significant difference in allele (p > 0.05) and genotype (p > 0.05) frequency between control and study group. Nevertheless, AA genotype depicted the highest frequency in both groups. The genotype distribution in both groups was in concordance with HWE (p > 0.05). Our data showed no association of MYO1H SNP (rs3825393) with mandibular prognathism. Interestingly, we observed Allele A representing the major allele in Malay population. Presence of MYO1H SNP (rs3825393) was detected in samples analysed. Larger number of samples is required to confirm the involvement of MYO1H polymorphisms in mandibular prognathism.

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.

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.

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.

Surgery-first approach for Angle class Ⅲ malocclusion: clinical retrospective analysis of 185 cases / 中华整形外科杂志

Objective@#The purpose of this study was to explore the surgery-first approach in sequential combined orthodontic-orthognathic treatment to shorten total treatment duration and improve the clinical outcome.@*Methods@#This study included 185 patients with Angle classⅢ malocclusion. The patients were divided into 3 different types according to cephalometry analyses and facial features. ①Type Ⅰ: mandibular prognathism or asymmetry mandibular prognathism; ②Type Ⅱ: mandibular prognathism and maxillary retrusion; ③ Type Ⅲ: mild Angle′s Class Ⅲ malocclusion, cross bite in anterior teeth, or normal overlap and overbite relation with midfacial hypoplasia. All of patients received surgery first approach therapy. The surgical procedures were chosen according to different malformation types. Type Ⅰ was treated with the sagittal split ramus osteotomy (SSRO). Type Ⅱ was treated by Le Fort Ⅰmaxillary osteotomy combined with SSRO. Type Ⅲ underwent anterior subapical osteotomy combined pyriform aperture augmentation with biomaterials as well as maxillary anterior orthodontics. All patients received postoperative rapid orthodontic treatment for 6-12 month after 2 weeks of operation. Using the straight arch wire techniques and the class Ⅲ intermaxillary traction, we removed the overcrowding upper and lower teeth, the compensatory axial tilt of teeth, and the deviation of the dental arch and maintained the neutral relationship of the molar. The mandible Hawley retaining devices were used during the maintaining stage.@*Results@#The cases in study acquired satisfactory clinical outcome, which included the shortened overall treatment duration, the significantly improved facial features, the corrected occlusion relationship, and the restored function of mastication and temporomandibular joint. There were some complications as follows: intraoperative fracture (6 cases, 3.24%), the inferior alveolar nerve bundle injury (2 cases, 1.1%), and temporary open-bite that diminished by inter-maxillary elastic distraction one month after operation (19 cases, 10%). All cases in this study accepted postoperative orthodontic treatment. Follow-up time ranged from 6 months to 5 years. The cephalometric analysis results of 126 cases who had complete image data and over 6 months of follow-up showed that hard and soft tissue indexes were restored to normal range after combined orthognathic-orthodontic treatment. The stability of the maxillary and occlusive relationship of SFA(surgery-first approach) was similar to that of the COS(conventional orthodontics-first system) [relapse ratio=(T2-T1)/(T1-T0)×100%]. Over six months of follow-up , SNB and ANB showed that the average relapse ratio were 22% and 19.8%, whereas the relapse angle are less than 2°.@*Conclusions@#The Surgery-first approach could be used to treat most patients with Angle skeletal Class Ⅲ malocclusion, but the indications and the surgical procedures should be noticed and chosen.

Comparative study of postoperative stability between conventional orthognathic surgery and a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy for skeletal class III correction

OBJECTIVES: The purpose of this study is to compare the postoperative stability of conventional orthognathic surgery to a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy (BSSRO). MATERIALS AND METHODS: The study included 20 patients who underwent BSSRO for skeletal class III conventional orthognathic surgery and 20 patients who underwent a surgery-first orthognathic approach. Serial lateral cephalograms were analyzed to identify skeletal changes before surgery (T0), immediately after surgery (T1), and after surgery (T2, after 1 year or at debonding). RESULTS: The amount of relapse of the mandible in the conventional orthognathic surgery group from T1 to T2 was 2.23±0.92 mm (P<0.01) forward movement and −0.87±0.57 mm (non-significant, NS) upward movement on the basis of point B and 2.54±1.37 mm (P<0.01) forward movement and −1.18±0.79 mm (NS) upward movement on the basis of the pogonion (Pog) point. The relapse amount of the mandible in the surgery-first orthognathic approach group from T1 to T2 was 3.49±1.71 mm (P<0.01) forward movement and −1.78±0.81 mm (P<0.01) upward movement on the basis of the point B and 4.11±1.93 mm (P<0.01) forward movement and −2.40±0.98 mm (P<0.01) upward movement on the basis of the Pog. CONCLUSION: The greater horizontal and vertical relapse may appear because of counter-clockwise rotation of the mandible in surgery-first orthognathic approach. Therefore, careful planning and skeletal stability should be considered in orthognathic surgery.

El dimorfismo sexual en distintas relaciones cráneo-mandibulares / Sexual dimorphism in different craneomandibular relationships

La estimación del sexo en base a restos esqueletales es uno de los principales objetivos de las ciencias forenses. Esta estimación se basa en las diferencias de forma y tamaño que existen entre mujeres y hombres (dimorfismo sexual). En este trabajo se analiza la asociación entre el dimorfismo sexual de la mandíbula y las distintas relaciones cráneo-mandibulares (ortognata, prognata y retrognata). Se analizaron 4 medidas faciales (altura facial, altura de la rama de la mandíbula, ancho mínimo de la rama mandibular, largo del cuerpo de la mandíbula) en tele-radiografías de 114 pacientes chilenos de sexo y relación cráneo-mandibular conocidos para evaluar si, al igual que en poblaciones de otras partes del mundo, estas son sexualmente dimórficas. Los resultados indican que con la excepción del largo del cuerpo de la mandíbula, las demás variables permiten una elevada clasificación correcta del sexo de los individuos (88,6 % de los casos). Se concluye que una relación cráneo-mandibular retrognata o prognata, no afecta la estimación confiable del sexo de los individuos de población chilena.

Sex assessment using bone remains is one of the main goals of forensic sciences. This assessment is possible because of the morphological and size differences between women and men (sexual dimorphism). In this work we study the association between sexual dimorphism and the different positions of the mandible and skull (prognathism, retrognathism and orgotnatism). We analyze 4 facial measurements in 114 teleradiographies of Chilean patients with known sex and positional relationship of the mandible and cranium, to evaluate if, as in populations of other parts of the world, these are sexually dimorphic. The results indicate that, with the exception of mandible width, the rest of the variables allows a high correct classification of individuals by sex (88.6 % of the cases). We conclude that the relation between different positions of the mandible and skull does not affect a reliable sex assessment in Chilean population.

Acromegaly: Oral Diagnostician’s Role in Diagnosis: A Case Report.

Acromegaly is an acquired disorder related to overproduction of growth hormone (GH). The condition, though described more than 120 years ago, was only later found to be due to pituitary over secretion and adenomas. It is a rare condition with a tendency toward overgrowth of the mandible, maxillary widening, tooth separation, and skeletal malocclusion which makes its diagnosis important for us dentists. The majority of the cases in the past have been diagnosed by physicians and endocrinologists. Here, we present a case of a 38-year-old male patient who presented with the complaint of increase in the size of lips and forward movement of the jaws since 1 year. Clinical features, radiographic features, and arrival at the diagnosis of Acromegaly with the subsequent referral and treatment are discussed.

Pyknodysostosis (Rare Skeletal Defect): A Case Report.

Pyknodysostosis is a defective bone disease that is responsible in many bone deformities. We report a case with recurrent urti, growth retardation, facial dysmorphism, delayed eruption of teeth & inability to gain weight properly since childhood and successful treatment of the patient by supportive measures.

Effects of airway evaluation parameters on the laryngeal view grade in mandibular prognathism and retrognathism patients

BACKGROUND: Failure to maintain a patent airway can result in brain damage or death. In patients with mandibular prognathism or retrognathism, intubation is generally thought to be difficult. We determined the degree of difficulty of airway management in patients with mandibular deformity using anatomic criteria to define and grade difficulty of endotracheal intubation with direct laryngoscopy. METHODS: Measurements were performed on 133 patients with prognathism and 33 with retrognathism scheduled for corrective esthetic surgery. A case study was performed on 89 patients with a normal mandible as the control group. In all patients, mouth opening distance (MOD), mandibular depth (MD), mandibular length (ML), mouth opening angle (MOA), neck extension angle (EXT), neck flexion angle (FLX), thyromental distance (TMD), inter-notch distance (IND), thyromental area (TMA), Mallampati grade, and Cormack and Lehane grade were measured. RESULTS: Cormack and Lehane grade I was observed in 84.2%, grade II in 15.0%, and grade III in 0.8% of mandibular prognathism cases; among retrognathism cases, 45.4% were grade I, 27.3% grade II, and 27.3% grade III; among controls, 65.2% were grade I, 26.9% were grade II, and 7.9% were grade III. MOD, MOA, ML, TMD, and TMA were greater in the prognathism group than in the control and retrognathism groups (P < 0.05). The measurements of ML were shorter in retrognathism than in the control and prognathism groups (P < 0.05). CONCLUSIONS: Laryngoscopic intubation was easier in patients with prognathism than in those with normal mandibles. However, in retrognathism, the laryngeal view grade was poor and the ML was an important factor.

Surgical Correction of Asymmetric Mandibular Prognathism with Modifi ed Bilateral Sagittal Split Osteotomy Technique: A Clinical Study.

Introduction: An asymmetrical face consists of multitude of the minor asymmetrical component, the mandibular component being most common. The asymmetric mandibular prognathism (AMP) is one of the most common forms of asymmetry caused by genetic and epigenetic factors and environmental condition such as trauma, functional deviations due to dental interference. The present study was undertaken to assess the effi cacy of a modifi ed bilateral sagittal split osteotomy (BSSO) technique in correction of AMP. Purpose: The purpose of the study was to investigate the skeletal stability and changes of proximal segments position postoperatively following surgical correction of AMP with modifi ed BSSO technique and analyze the effect of such changes on the incidence of signs and symptoms of temporomandibular joint (TMJ) disorders. Materials and Methods: Patients with AMP were included in the study. All the patients underwent surgical correction by modifi ed BSSO technique. The patient clinical and cephalometric fi ndings (pre-operative, immediate post-operative, and 6 months postoperatively) were recorded in a proforma and subjected to statistical analysis. Results: A total of six (n = 6) participated in the study. Five out six patients had pre-existing TMJ problems. In lateral cephalogram, the mean mandibular setback of Point B was 7.75 mm. In frontal cephalogram, the mean mandibular deviation decreased 2.55 mm after surgery. Minimal relapse was noted 6 months post-operatively suggestive of good skeletal stability with minimal complications. Conclusions: The modifi ed BSSO technique was effective in the treatment of AMP.

Ganhos funcionais mensurados pelo MBGR e impacto na qualidade de vida em sujeito submetido à cirurgia ortognática: relato de caso / Functional gains measured by MBGR and impact on quality of life in subject submitted to orthognathic surgery: case report

Resumo:O tema proposto é Intervenção Fonoaudiológica pré e pós Cirurgia Ortognática. Foi realizada avaliação (por meio do Protocolo de Avaliação Miofuncional Orofacial MBGR com escores) e intervenção fonoaudiológica em período pré-operatório (por três meses) e pós-operatório iniciado no 20º dia (por três meses), após a liberação do cirurgião. Além disso, investigou-se o impacto da deformidade dentofacial na qualidade de vida do paciente, por meio do Oral Health Impact Profile - versão reduzida. Na avaliação pré-operatória, foram encontradas mastigação bilateral simultânea, presença de ruídos na Articulação Temporomandibular e fechamento labial assistemático durante a realização da função. Durante a deglutição houve contração da musculatura perioral e presença de resíduos após essa função. Encontrou-se na fala distorção no fonema /r/. Houve dor à palpação nos músculos mastigatórios e diminuição da tonicidade na musculatura perioral e mastigatória. Encontrou-se alto impacto na qualidade de vida, totalizando em 32 pontos. Na avaliação após a intervenção fonoaudiológica, observou-se melhora nas funções de mastigação (pré: 4 pontos, pós: 1 ponto), deglutição (pré:14, pós :5), respiração (pré: 3, pós: 1) e fala (pré: 7, pós: 1), na mobilidade muscular (pré: 8, pós 1), na tonicidade da musculatura (pré 5, pós: 0) e na dor à palpação (pré: 10, pós: 2). Houve melhora na postura dos lábios e melhora significante na qualidade de vida, passando de 32 para 8 pontos. Constatou-se melhora na fisiologia das funções estomatognáticas, diminuição da dor à palpação, equilíbrio no tônus, na mobilidade muscular e melhora na qualidade de vida.

Abstract:The proposed theme is Speech Therapy Intervention before and after orthognathic surgery. Evaluation (through MBGR Protocol of Orofacial Myofunctional Evaluation with scores) and speech therapy intervention were performed in the preoperative (three months) and postoperative periods, started on the 20th day (for three months) after the surgeon's liberation. In addition, it was investigated the impact of dentofacial deformity in the patient's life quality through the Oral Health Impact Profile - reduced version. In the preoperative evaluation, Simultaneous bilateral chewing, presence of noise in the temporomandibular joint and unsystematic lip closure were found while performing the function. During swallowing, there was contraction of the perioral muscles and presence of residues after this function. It was found, in speech, distortion in the /r/ sound. There was pain on palpation in the masticatory muscles and decreased tone in the perioral and masticatory muscles. It was found high impact on quality of life, totaling 32 points. In the evaluation after speech therapy intervention, improvement was observed in the chewing functions (pre: 4 points, post: 1 point), swallowing (pre: 14, post: 5), breathing (pre: 3, post: 1) and speech (pre: 7, post: 1), muscle mobility (pre: 8, post: 1), tonicity of the muscles (pre: 5, post: 0) and pain on palpation (pre: 10, post: 2). There was improvement in the posture of the lips and significant improvement in quality of life, from 32 to 8 points. It was found an improvement in the physiology of the stomatognathic functions, decreased pain on palpation, balance in tone, muscle mobility and improved quality of life.

El retropropulsor y estimulador de Buño: su uso en los prognatismos mandibulares, cambios cefalométricos / The retropropulsor and Buño stimulator: use in mandibular prognathism, cephalometric changes

Introducción: el problema de los prognatismos mandibulares es motivo de interés permanente para genetistas, antropólogos, ortopedistas, ortodoncistas, pediatras, cirujanos y psiquiatras. Se realizó un estudio prospectivo con el uso del retropropulsor y timulador del profesor Indalecio Buño en 24 pacientes con prognatismos mandibulares en dentición mixta. Objetivo: conocer los cambios cefalométricos durante el uso del retropropulsor y estimulador. Material y método: se les realizaron telerradiografías de perfil, antes y doce meses después, comparando los cambios cefalométricos obtenidos como resultado de cambios esqueletales y dentoalveolares logrados, teniendo en cuenta el sexo también. Resultados: estadísticamente se encontró aumento del ángulo SNA y reducción del ángulo SNB muy significativos, lo que representó un cambio muy significativo del ángulo ANB. Conclusiones: en relación con el sexo, hubo cambios muy significativos en el ángulo SNA en los varones y en el ángulo SNB en las hembras, además de una variación muy significativa en las hembras, del ángulo 1 SNB. Estos cambios ayudaron en la mejoría del perfil, cóncavo, así como a descruzar las mordidas anteriores que caracterizan a los pacientes con prognatismos mandibulares en el síndrome de clase III.

Introduction: a prospective study was conducted with the use of the retropropulsor and stimulator of Professor Indalecio Buño in 24 patients with mandibular prognathism in mixed dentition. Objective: to know the cephalometric changes during the use of the retropupulsor and stimulator. Material and methods: patients underwent lateral radiographs before and twelve months after, comparing cephalometric changes obtained as a result of skeletal and dentoalveolar changes achieved, taking into account sex too. Results: statistically increase of SNA angle and very significant reduction in SNB angle were found, which represented a significant change of the ANB angle. Conclusions: regarding sex, there were significant changes in the SNA angle in males and in females in SNB angle, in addition to a significant variation in females of 1 SNB angle. These changes helped in improving the profile, concave, and to uncross previous bites that characterize patients with class III mandibular prognathism syndrome.

Three-dimensional evaluation of lingual split line after bilateral sagittal split osteotomy in asymmetric prognathism

OBJECTIVES: The aim of this study was to evaluate the pattern of lingual split line when performing a bilateral sagittal split osteotomy (BSSO) for asymmetric prognathism. This was accomplished with the use of cone-beam computed tomography (CBCT) and three-dimensional (3D) software program. MATERIALS AND METHODS: The study group was comprised of 40 patients (20 males and 20 females) with asymmetric prognathism, who underwent BSSO (80 splits; n=80) from January 2012 through June 2013. We observed the pattern of lingual split line using CBCT data and image analysis program. The deviated side was compared to the contralateral side in each patient. To analyze the contributing factors to the split pattern, we observed the position of the lateral cortical bone cut end and measured the thickness of the ramus that surrounds the mandibular lingula. RESULTS: The lingual split patterns were classified into. The true "Hunsuck" line was 60.00% (n=48), and the bad split was 7.50% (n=6). Ramal thickness surrounding the lingual was 5.55+/-1.07 mm (deviated) and 5.66+/-1.34 mm (contralateral) (P=0.409). The position of the lateral cortical bone cut end was classified into three types: A, lingual; B, inferior; C, buccal. Type A comprised 66.25% (n=53), Type B comprised 22.50% (n=18), and Type C comprised 11.25% (n=9). CONCLUSION: In asymmetric prognathism patients, there were no differences in the ramal thickness between the deviated side and the contralateral side. Furthermore, no differences were found in the lingual split pattern. The lingual split pattern correlated with the position of the lateral cortical bone cut end. In addition, the 3D-CT reformation was a useful tool for evaluating the surgical results of BSSO of the mandible.