The Effects of the Maxillary Movements in Angle Class 2 and 3 Malocclusion Treatment on Nose Air Flow Amount, Rate, and Resistance.

Maxillary movements performed during orthognathic surgery affect the external and internal anatomy of the nose. The functional and anatomical effects may change nasal airway parameters after the surgery, and these alterations can be examined objectively by rhinomanometry. In this study, patients who underwent maxillary orthognathic surgery were divided into 3 groups based on their surgical plans: advancement (group 1), impaction and advancement (group 2), and setdown and advancement (group 3). Preoperative and postoperative rhinomanometric data including the average nasal volume, minimum cross-sectional area, average airflow resistance of the right and left nasal passageways, and an average of both nasal passages were collected. The study included 50 patients who underwent orthognathic surgery between October 2021 and October 2022. There were 20 patients each in group 1 and group 2 and 10 patients in group 3. The average nasal passage volume increased in the advancement (group 1) and impaction-advancement (group 2) groups. In addition, the advancement (group 1) group had a decreased average airflow resistance. Setdown-advancement (group 3) group did not show a positive or negative effect on nasal airway parameters. Maxillary movements during orthognathic surgery revealed no adverse effect on nasal parameters. Moreover, advancement and impaction positively affected nasal functional and anatomical parameters.

Investigation of the Relationship of Functional Improvement and Body Mass Index in Breast Reduction Patients.

INTRODUCTION: Due to macromastia, center of gravity changes and neck, shoulder, back pain become prominent. Macromastia and obesity separately cause pain and an increase in curves of vertebra. The aim of this study is to compare the functional benefits of reduction mammoplasty between obese and non-obese patients. MATERIALS AND METHODS: Data of this retrospective study were collected from archives and include preoperative/postoperative thoracic Cobb angles, preoperative/postoperative VAS scores, BMI and resected breast tissue weight of patients who underwent reduction mammaplasty operations between August 2017 and April 2019 in Plastic, Reconstructive and Aesthetic Surgery Department. RESULTS: This study shows that reduction mammoplasty enables significant decrease both in thoracic kyphosis angles and in neck, shoulder and back VAS scores. However, no significant difference was found in preoperative/postoperative values and mean amount of changes of thoracic kyphosis angles between obese and non-obese patients. Decreases in neck, shoulder and back VAS scores were not found statistically significant between two groups. The breast resection amount was not related to correction of kyphosis, but it enabled only a significant decrease in neck VAS scores. CONCLUSION: Functional improvement was not related to body mass index in reduction mammoplasty patients. Functional benefits were observed similarly in both obese and non-obese patients. A precise threshold value for body weight, body mass index and amount of breast tissue could not be defined as an indication for functional reduction mammoplasty. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Single and double injection paravertebral block comparison in reduction mammaplasty cases: a randomized controlled study.

BACKGROUND: This study compares the analgesic effects and dermatomal blockade distributions of single and double injection bilateral thoracic paravertebral block (TPVB) techniques in patients undergoing reduction mammaplasty. METHODS: After obtaining ethics committee approval, 60 patients scheduled for bilateral reduction mammaplasty were included in the study. Preoperatively, the patients received one of single (Group S: T3-T4) or double (Group D: T2-T3 & T4-T5) injection bilateral TPVBs using bupivacaine 0.375% 20 ml per side. All patients were operated under general anesthesia. The T3-T6 dermatomal blockade distributions on the midclavicular line were followed by pin-prick test for 30 min preoperatively and 48 h postoperatively. All patients received paracetamol 1 g when numeric rating scale (NRS) pain score was ≥ 4, and also tramadol 1 mg/kg when NRS was ≥ 4 again after 1 h. The primary endpoint was NRS pain scores at postoperative 12th h. The secondary endpoints were dermatomal blockade distributions and NRS scores through the postoperative first 48 h, time until first pain and the analgesic consumption on days 1 and 2. RESULTS: Fifty-two patients completed the study. The NRS pain scores at 12th h were similar (right side: P = 0.100, left side: P = 0.096). The remaining NRS scores and other parameters were also comparable within the groups (P ≥ 0.05). Only single injection TPVB application time was shorter (P < 0.001). CONCLUSIONS: The single injection TPVB technique provided sufficient dermatomal distribution and analgesic efficacy with the advantages of being faster and less invasive.

Integrating artificial intelligence in orthognathic surgery: A case study of ChatGPT's role in enhancing physician-patient consultations for dentofacial deformities.

Orthognathic surgery, a multidisciplinary treatment for dentofacial deformities, presents complex preoperative preparations and follow-up procedures. This study aims to evaluate the effectiveness of ChatGPT-4, an artificial intelligence-based language model, as a supportive tool during patient consultations for orthognathic surgery. Nine critical questions that candidates for orthognathic surgery should ask during a consultation were identified and posed to ChatGPT-4. The responses were subsequently assessed by experienced plastic surgeons and collaborating orthodontists at a leading orthognathic surgery center. Evaluations focused on the accuracy, clarity, and comprehensibility of the information provided. ChatGPT-4 generated comprehensive, clear, and accurate responses, offering critical technical information to guide patients through the complexities of orthognathic surgery. However, it consistently underscored the necessity of individualized responses and emphasized that specialized medical consultation is crucial for treatment and follow-up plans. While ChatGPT-4 shows promise as a reliable informational resource, it cannot fully replace the nuanced physician-patient relationship, particularly in situations requiring emotional intelligence and specialized expertise. ChatGPT-4 can serve as an informative and guiding assistant during the consultation process for orthognathic surgery, although it cannot substitute for direct medical consultation. This tool could be an asset for both patients and physicians in managing the intricate treatment process of orthognathic surgery.

Evaluation of Shoulder Muscle Improvement in Patients Following Free Latissimus Dorsi Muscle Pedicle Flap Transfer.

Aim: This study aimed to evaluate the clinical outcomes, shoulder muscle strength, and donor site morbidity following the free latissimus dorsi (LD) muscle pedicle flap transfer. Materials: Patients with free LD muscle pedicle flap reconstructions and with asymptomatic shoulders (affected and contralateral side) were included. The follow-up duration was 12 months. The combined shoulder range of motion (ROM), Constant-Murley shoulder (CMS), and quick disabilities of the arm, shoulder, and hand (QuickDASH) scores were measured preoperatively and at 1 year postoperatively. The ratio of the isokinetic muscle strength and total work was measured with an isokinetic dynamometer (Cybex 350®) both preoperatively and at sixth month postoperatively. Results: Twenty patients with a mean age of 37.06 ± 9.74 years and a mean body mass index of 23.49 ± 8.6 kg/m2 were included. The difference in shoulder ROM and CMS and increase in QuickDASH were not significant at the first postoperative year. The peak torque and total work performed decreased by 13%-16% for the adductor and extensor functions at the six month postoperatively, and these differences were significant. Although the adductor peak torque was significantly lower in the postoperative test of the operated side, no significant difference was found between the operated and unaffected shoulder peak torque values. Moreover, no significant difference was noted between the operated and unaffected shoulders in all isokinetic tests pre- and postoperatively. Conclusion: The free LD muscle pedicle flap harvest did not decrease function and ROM at the first postoperative year. The muscle strength and total work of shoulders after the LD muscle transfer returned to the preoperative condition at the sixth month, except adductor and extensor muscle strengths. However, adductor and extensor muscle strengths of the operated shoulders were not significantly different postoperatively.

Objectif: La présente étude visait à évaluer les résultats cliniques, la force musculaire de l'épaule et la morbidité au site donneur après un transfert du lambeau pédiculaire libre du grand dorsal. Matériaux: Des patients ayant subi une reconstruction du lambeau pédiculaire libre du grand dorsal et dont les épaules étaient asymptomatiques (côté touché et côté controlatéral) ont participé à l'étude. Le suivi a duré 12 mois. Les chercheurs ont évalué l'amplitude de mouvement (AM) combinée de l'épaule, le score de Constant-Murley (SCM) et le score rapide des incapacités du bras, de l'épaule et de la main (QuickDASH) avant l'opération, puis un an plus tard. Ils ont mesuré le ratio entre la force musculaire isocinétique et le travail total au moyen d'un dynamomètre isocinétique (Cybex 350®) avant l'opération, puis six mois plus tard. Résultats: Au total, 20 patients d'un âge moyen de 37,06 ± 9,74 ans et à l'indice de masse corporelle moyen de 23,49 ± 8,6 kg/m2 ont été inclus dans l'étude. La différence de l'AM et du SCM de l'épaule et l'augmentation du QuickDASH étaient légères pendant l'année suivant l'opération. Le couple de pointe et le travail total effectués avaient diminué de 13 % à 16 % pour la fonction des adducteurs et des extenseurs six mois après l'opération, ce qu'on peut qualifier de différences importantes. Même si le couple de pointe des adducteurs était beaucoup plus faible au test postopératoire du côté opéré, aucune différence importante n'a été observée entre les valeurs du couple de pointe de l'épaule opérée et de celle non touchée. De plus, lors de tous les tests isocinétiques exécutés avant et après l'opération, ils n'ont pas remarqué de différence importante entre l'épaule opérée et l'épaule non atteinte. Conclusion: Le lambeau musculaire pédiculaire libre du grand dorsal ne diminuait pas la fonction et l'AM pendant l'année suivant l'opération. La force musculaire et le travail total des épaules après le transfert du grand dorsal avaient retrouvé leur état préopératoire au sixième mois, sauf la force des muscules adducteurs et extenseurs. Cependant, la force des muscles adducteurs et extenseurs des épaules opérées n'avait pas tellement changé après l'opération.

The predictive effect of neutrophil-lymphocyte and platelet-lymphocyte ratios in the post-operative recurrence of temporomandibular joint ankylosis.

BACKGROUND: Reankylosis is a frequent pathology in patients who are operated for post-traumatic temporomandibular joint (TMJ) ankylosis. In the current practice, ankylosing spondylitis attacks are monitored with the increases in neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). In this study, such a relation between TMJ reankylosis and increase in these ratios was evaluated. METHODS: Patients who were operated between January 2010 and December 2019 for unilateral or bilateral TMJ ankylosis were included in this study. Temporomandibular gap arthroplasty with an interpositional silicone block was performed for each patient by the same operative team. Each patient had standard physiotherapy. All ages and genders were included in the study. Due to the complete blood count differences between children and adults, 18 years of age was used as a cutoff between the groups. A need for reoperation was accepted as reankylosis. The NLR and PLR of children without and with reankylosis and adults without and with reankylosis were compared. RESULTS: Twenty-nine children and 38 adults were included in the study. Mean age of the children and adults were 10.8 and 37.3 years, respectively. Eleven children and eight adults had reankylosis. In patients with reankylosis, NLR and PLR were high significantly, regardless of age. In children, PLR was significantly higher in reankylosis patients. In adults, NLR was significantly higher in reankylosis patients. CONCLUSION: PLR and NLR may be utilized for predicting reankylosis, respectively, in children and adults who were operated for ankylosis due to TMJ fractures.

The relationship between fixation method and early central condylar sagging after bilateral sagittal split ramus osteotomy in orthognathic surgery.

PURPOSE: There is no consensus about the ideal fixation methods and their effects on the condyle after the sagittal split ramus osteotomy (SSRO) procedure. The aim of this study was to compare the incidence, clinical presentation, and treatment of condylar sagging between different fixation methods following SSRO. METHODS: Patients who underwent double jaw surgery between 2007 and 2017 were evaluated retrospectively. Mandibular fixation was maintained using one of three different options: a miniplate and a single bicortical screw, three bicortical screws, or a single bicortical screw. Some patients had malocclusion relapse in the early postoperative period due to condylar sagging, and needed reoperation. The reoperated condylar sagging patients were analysed statistically with respect to their fixation methods. RESULTS: 233 patients (134 females, 99 males) with a mean age of 23.3 years were enrolled in the study. The patients fixated with a single bicortical screw had lower revision surgery rates than those with three bicortical screws or with miniplate with a single bicortical screw (p = 0.034 and p = 0.032, respectively). These differences in central condylar sagging with a need for revision were statistically significant. CONCLUSION: Although a miniplate and a single bicortical screw and three bicortical screws are widely used after SSRO, if the priority is to avoid sagging then it seems that a single screw should be preferred for osteosynthesis.

Compound muscle action potential scan and MScanFit motor unit number estimation during Wallerian degeneration after nerve transections.

BACKGROUND: Compound muscle action potential (CMAP) scan and MScanFit have been used to understand the consequences of denervation and reinnervation. This study aimed to monitor these parameters during Wallerian degeneration (WD) after acute nerve transections (ANT). METHODS: Beginning after urgent surgery, CMAP scans were recorded at 1-2 day intervals in 12 patients with ANT of the ulnar or median nerves, by stimulating the distal stump (DS). Stimulus intensities (SI), steps, returners, and MScanFit were calculated. Studies were grouped according to the examination time after ANT. Results were compared with those of 27 controls. RESULTS: CMAP amplitudes and MScanFit progressively declined, revealing a positive correlation with one another. SIs were higher in WD groups than controls. Steps appeared or disappeared in follow-up scans. The late WD group had higher returner% than the early WD and control groups. CONCLUSIONS: MScanFit can monitor neuromuscular dysfunction during WD. SIs revealed excitability changes in DS.

Nasal soft- and hard-tissue changes following tooth-borne and hybrid surgically assisted rapid maxillary expansion: A randomized clinical cone-beam computed tomography study.

PURPOSE: The aim of this study was to assess the effects of tooth/bone-borne (hybrid) and tooth-borne (TB) surgically assisted rapid maxillary expansion (SARME) on the width of the nasal soft and hard tissue. PATIENTS AND METHODS: Twenty skeletally mature patients (nine males and 11 females; mean age 19.4 years) with transverse maxillary hypoplasia were randomly assigned to hybrid or TB devices. The patients had undergone SARME operations, performed by the same surgical team using the same procedure (Le Fort I osteotomy with pterygomaxillary dysjunction, midline osteotomy, and no down-fracture). Nasal soft- and hard-tissue changes were analyzed using CBCT preoperatively (T0), at the end of the active expansion phase (T1), and after 6 months of retention (T2). The study was approved by the relevant ethics committee. RESULTS: The skeletal and soft-tissue nasal parameters increased significantly in the T0-T1 and T0-T2 periods in both groups (P < 0.05). No statistically significant differences between the groups were observed. The mean piriform aperture width increased from 1.26 mm in T0-T1 to 0.97 mm in T1-T2 and 2.17 mm in T0-T2 (P < 0.008). In the soft tissue, the alar base width increased to 2.78 mm and the alar width to 2.95 mm in T0-T2 (P = 0.001). There was a positive correlation (63.6%) between the changes in skeletal and soft-tissue values. CONCLUSION: The hybrid and TB devices led to similarly significant widening effects in nasal soft and hard tissues in both the short term and 6 months after SARME.

Myositis Ossificans Traumatica of the Medial Pterygoid Muscle After Third Molar Tooth Extraction: A Case Report and Review of Literature.

Myositis ossificans (MO) is a rare non-neoplastic disorder characterized by heterotopic ossification in soft tissues, mainly muscles. MO traumatica is characterized by ossification of the soft tissues after acute or repetitive trauma, burns, or surgical intervention. Muscular or soft tissue trauma is usually present as the underlying etiology. MO traumatica usually involves the extremity muscles. The number of reported cases involving the masticatory muscles is extremely low. The most common clinical sign of this condition is progressive limitation of mouth opening. Surgical resection of the ossified tissue has been the most commonly used treatment for this disorder, with a high postoperative recurrence rate. We report a case of traumatic MO of the medial pterygoid muscle to draw attention to the possibility of the condition in patients with a limited mouth opening and to review the reported data about MO traumatica involving the medial pterygoid muscle.

Comparison of tooth-borne and hybrid devices in surgically assisted rapid maxillary expansion: A randomized clinical cone-beam computed tomography study.

PURPOSE: The objective of this 2-arm, parallel, single-center trial was to compare the skeletal, dental, and periodontal effects of tooth-borne (TB) and hybrid devices in surgically assisted rapid maxillary expansion (SARME). MATERIALS AND METHODS: Twenty consecutive patients (9 male and 11 female) with skeletal transverse maxillary deficiency seeking treatment at the Department of Orthodontics at Istanbul University in Istanbul, Turkey, were randomly assigned to 2 groups (10 patients each). Hybrid devices were inserted in the first group and TB (Hyrax) devices in the second. All of the patients had undergone SARME operations, which were carried out by the same surgeons using the same procedure (a Le Fort I osteotomy with pterygomaxillary dysjunction). All of the patients had similar transverse deficits, and 7 mm of expansion was achieved in all of them over 14 days. CBCT was carried out preoperatively (T0), at the end of the active expansion phase (T1), and after 6 months of retention (T2). Measurements were made using Mimics 16.0. RESULTS: Anterior skeletal maxillary widening parameters increased significantly in the T0-T1 and T0-T2 periods in the 2 groups (P = 0.001). There was significantly less dental expansion anteriorly with the hybrid devices (T0-T2: 4.03 mm vs. 6.29 mm). The first molars tipped buccally more in the group with TB devices during the T0-T1 phase (P = 0.029) and moved upright more than those in the group with hybrid devices during the retention phase (P = 0.035). Dental tipping, buccal alveolar bone resorption, and root resorption were observed significantly more often with the TB devices. CONCLUSION: Hybrid RME devices, with similar skeletal effects, different dental movement patterns, and fewer dental and periodontal side effects, thus appear to be a beneficial alternative to TB devices for SARME procedures.

Nasal profile changes with le fort I maxillary advancement surgery.

Introduction : The purpose of this study was to quantify anteroposterior facial soft tissue changes with respect to underlying skeletal movements after Le Fort I maxillary advancement surgery by using lateral cephalograms taken before and after the operation. Materials and Methods : The study group consisted of 20 patients (10 women, 10 men; mean age 23.4 ± 1.4 years) having a Class III skeletal deformity caused by a retrognathic maxilla. All patients were treated by Le Fort I maxillary advancement osteotomy. Lateral cephalograms were taken before and 1.6 ± 0.4 years after surgery. Results : The anteroposterior position of A-point and anteroposterior position of maxillary incisor were significantly protracted (-2.69 ± 3.34 and -2.68 ± 3.21, respectively; P < .01). The nasal anteroposterior and superoinferior positions (NASALAP and NASALSI, respectively) were significantly changed (-2.70 ± 6.81, P < .01, and -2.55 ± 5.80, P < .05, respectively) and nasal elevation and protraction were observed after Le Fort I maxillary advancement surgery. Conclusions : The changes in anteroposterior and superoinferior positions of A-point were correlated with the nasal superoinferior position (r = -0.71 , P < .05; r = 0.72, P < .05) after Le Fort I maxillary advancement surgery.

Suprafascial pre-expansion of perforator flaps and the effect of pre-expansion on perforator artery diameter.

BACKGROUND: This study addresses the "pre-expanded perforator flap concept" by demonstrating a case series of relevant reconstructive procedures and evaluate the perforator vessel diameter changes that happen during the pre-expansion procedure. METHODS: Fourteen patients were treated with 15 flaps. One patient was treated with two pre-expanded internal mammary artery perforator flaps. In other cases, thoracodorsal, circumflex scapular, lumbar, intercostal, lateral circumflex femoral, and deep inferior epigastric artery perforator flaps were used. Technical details and rate of complications were noted. Evaluations of the flap pedicles were done both by hand held Doppler and by color Doppler ultrasound (CDU). RESULTS: Flaps successfully served to resurface and release thick and rigid broad scar tissues and contractures in 11 of relevant 12 patients (in one patient with 50% flap loss, adequate contracture release could only be obtained with addition of a secondary split thickness skin graft to the residual flap) and provided a good source of tissue for anterior neck reconstruction of one patient and penis reconstruction of another patient. In six patients, perforator artery diameters were measured by CDU both before and after the expansion process and a significant increase secondary to the pre-expansion procedure was detected (Pre-expansion mean: 0.48 ± 0.08 mm; post-expansion mean: 0.65 ± 0.10 mm; P < 0.05). Flaps as large as 30 × 20 cm were harvested. Totally three partial flap necroses were experienced in 15 flap procedures. CONCLUSIONS: Suprafascial pre-expansion of the perforator flaps seems to provide a solution to achieve broader and thinner perforator flaps with larger perforator arteries.

Creating a neoconchal complex using the adjustable conchal sliding technique in prominent ear correction.

An oversized aural concha plays a significant role in prominent ear deformities and should be taken into consideration during preoperative examination. In the current study, we present a procedure known as the conchal sliding technique as an alternative to more disruptive methods. Twenty-four patients (9 females and 15 males; 47 ears in total) underwent a conchal sliding procedure between 2006 and 2010. During the surgery, a wide subperichondrial dissection is performed after a posterior elliptical incision. After the concha is exposed as a hemisphere, it is split along its long axis to reveal the medial and lateral cartilage segments. These segments are gently scrolled upon each other. Transposition of the lateral segment posteriorly to the medial segment replaces the whole ear toward the posterior direction. Three mattress sutures (4-0 polypropylene) reliably secure the repositioned and setback conchal bowl. If needed, an antihelix can be formed using neoconchal-scaphal mattress sutures. Median follow-up period was 24.3 months (range, 6-48 mo). A unilateral hematoma developed in 1 patient and an anterior step deformity occurred in another. No recurrence, infection, necrosis of the skin, distortion of the auditory canal, or formation of keloid was observed in any of the patients. The median cephaloauricular angle was measured as 46 degrees before the surgery and 26 degrees after the surgery, whereas the distance between the helix and the mastoid was 23 mm before the surgery and 11 mm after the surgery. All the patients were satisfied with the results. This technique provides stable and natural results by creating a safe neoconchal complex. It may be a safe and reliable solution to an oversized aural concha, enabling natural-looking and positive cosmetic results.

Does partial expander deflation exacerbate the adverse effects of radiotherapy in two-stage breast reconstruction?

BACKGROUND: The optimum protocol for expander volume adjustment with respect to the timing and application of radiotherapy remains controversial. METHODS: Eighteen New Zealand rabbits were divided into three groups. Metallic port integrated anatomic breast expanders of 250 cc were implanted on the back of each animal and controlled expansion was performed. Group I underwent radiotherapy with full expanders while in Group II, expanders were partially deflated immediately prior to radiotherapy. Control group did not receive radiotherapy.The changes in blood flow at different volume adjustments were investigated in Group II by laser Doppler flowmetry. Variations in the histopathologic properties of the irradiated tissues including the skin, capsule and the pocket floor, were compared in the biopsy specimens taken from different locations in each group. RESULTS: A significant increase in skin blood flow was detected in Group II with partial expander deflation. Overall, histopathologic exam revealed aggravated findings of chronic radiodermatitis (epidermal atrophy, dermal inflammation and fibrosis, neovascularisation and vascular changes as well as increased capsule thickness) especially around the lower expander pole, in Group II. CONCLUSIONS: Expander deflation immediately prior to radiotherapy, may augment the adverse effects, especially in the lower expander pole, possibly via enhanced radiosensitization due to a relative increase in the blood flow and tissue oxygenation.

Replantation of scalp avulsion following a go-kart accident: a case report.

With the development of microsurgery, successfully replanted cases of scalp avulsions have been reported. In spite of previous publications of replantations based on a single artery and vein, it is now accepted that multiple anastomoses increase the success rate. We present herein the case of a successfully replanted avulsion in a child who caught her hair in a go-kart motor belt, and we discuss the mechanism of injury and number of anastomoses.

Bimaxillary reconstruction with a single free fibular osteoseptocutaneous flap.

Flap combinations including free fibula have been commonly used to reconstruct composite maxillomandibular defects. On the other hand, a single free osteoseptocutaneous may be rarely used to reconstruct the bimaxilla. In this article, we report a bimaxillary reconstruction in a 63-year-old man with a single fibular osteoseptocutaneous free flap.

Inappropriate use of foreign materials in temporomandibular joint ankylosis surgery: report of two cases.

Gap and interpositional arthroplasties are the most commonly used methods in the treatment of temporomandibular joint ankylosis. Complete resection of ankylotic segments, fibrotic band release and creating gap between the condyle and the glenoid fossa have great importance. Two patients were admitted to our clinic with complaints of difficulty in opening mouth and joint pain. In physical examination, maximum mouth opening values were recorded as 7 mm in one patient and 9 mm in another. An operation was planned due the presence of radiological grade 4 bilateral bony ankylosis. During the operation, foreign materials were found in the joint spaces of the patients. The first patient had a piece of nylon bag in the joint space, whereas the second patient had a silicon sheath used for wound therapy. Following removal of these materials, as a result of the recreation of joint spaces and the placement of suitable silicon blocks, 32 and 34 mm of mouth openings were noted during follow-up. In conclusion, recreated temporomandibular joint spaces after ankylosis surgery may be filled with a variety of autogenous or non-autogenously materials. However, the use of wrong materials inevitably causes recurrence and even worsens the primary condition.

Minimally invasive approaches in severe panfacial fractures.

BACKGROUND: Minimally invasive approaches to severe panfacial fractures are being used increasingly to reduce surgical trauma and the related complications. In this study, it was aimed to determine the ideal surgical approaches in severe panfacial fractures. METHODS: Sixteen patients with severe panfacial fractures were included in this study. Minimally invasive approaches were used for Le Fort III fracture in six patients, for Le Fort II fracture in four patients, and for bilateral maxillary and orbital floor fractures in six patients. We used subciliary, intraoral vestibular, lateral eyebrow incisions to reach orbital, maxillary, zygomaticomaxillary buttress, and nasoethmoidal fractures, respectively. RESULTS: All fractures were repaired with miniplates and screws. No hematoma, wound infections or other complications were observed. CONCLUSION: Minimally invasive approaches in severe panfacial fractures are considered suitable and effective in terms of aesthetic results.

Body fat composition and weight changes after double-jaw osteotomy.

Nutritional problems might be observed after surgical procedures. In this study, body weight and fat composition changes have been investigated in dentofacial deformity patients after the double-jaw osteotomy procedure. Thirty Angle class 3 patients operated on with double-jaw osteotomies during the period of March 2006 to July 2008 were included in the study. Interocclusal splints were applied continuously in the first 2 weeks after surgery, whereas intermittent splint was used for the next 2 weeks. Patients were analyzed before surgery and on the first month after surgery with the help of Tanita Composition Analyzer 310 bioimpedance method for weight, fat mass, and fat-free mass values. Results were evaluated statistically with the paired-sample test using SPSS version 13.0. Although significant results were obtained in female patients before surgery (weight [P = 0.011], body mass index [BMI; P = 0.012], fat mass [P = 0.010], and fat-free mass [P = 0.051, not significant]), none of the values were significant for male patients (P = 0.747, P = 0.747, P = 0.645, and P = 0.803, respectively). Weight gain was observed in 9 patients (30%). In contrast, weight gain was not seen in underweight patients. No sex differences in terms of weight gain/loss and fat composition have been observed. Interocclusal splint in female patients operated on with double-jaw osteotomies might cause nutritional deficiency in the first month after surgery. This eventually causes fat and weight loss, which may lead to poor wound healing and recovery later.