Soft tissue changes after mandibular setback and bimaxillary surgery in Class III patients.

OBJECTIVE: To evaluate the relationship between soft tissue and bone structure for Class III patients before and after bilateral sagittal split osteotomy (BSSO) and bimaxillary orthognathic surgery; to determine the impact of other factors on soft tissue change; and to evaluate correlations between thickness of tissue before surgery, SNA, SNB, and ANB angles, and soft tissue changes. MATERIALS AND METHODS: The study included 78 Class III patients treated only with BSSO or with BSSO and Le Fort I osteotomy. Lateral cephalograms were taken before and 3 months to 1 year after surgery. After all points of the Zagreb82 and Legan and Burstone profile analysis were traced, the ratio of five soft tissue points before and after surgery was evaluated. RESULTS: Soft tissue between points Sn and A and upper lip showed statistically significant changes for patients treated with bimaxillary surgery and BSSO. Only gender had an influence on soft tissue change. The correlation between soft tissue thickness and changes after surgery was significant. A change in SNB angle correlated with upper lip thickness for patients treated with BSSO but not for patients treated with BSSO and Le Fort I. SNA angle changes correlated with soft tissue changes between points Sn and A. CONCLUSION: Results of this study show soft tissue changes after BSSO and BSSO and Le Fort I and eliminate the deficiencies that were indicated in the meta-analysis of soft tissue changes from a previous study.

Altered light-touch sensation after bilateral sagittal-split osteotomy: a prospective study of 50 patients.

OBJECTIVE: To prospectively evaluate the incidence of change in light-touch sensation in the innervated area of the lower alveolar nerve after bilateral sagittal-split osteotomy (BSSO) with attention on the time it takes to rebuild the function of the inferior alveolar nerve. MATERIALS AND METHODS: The sample consisted of 30 women and 20 men with a mean age of 22.14 ± 3.30 years. The neurosensory test was conducted with a 20-mm long monofilament of suture material Prolene (3-0) connected to a plastic holder. These tests were performed 1 day before surgery and every 2 weeks during first 2 months after surgery. After that, patients were tested once every month until the end of the first year. RESULTS: All patients had a disturbance of light-touch sensation after BSSO, but none of these changes was permanent. The average duration of hypoesthesia was 6.6 ± 1.2 with a range from 4 to 9 months. The average duration of hypoesthesia for women was 6.27 ± 1.0 months, and men had hypoesthesia for 7.1 ± 1.2 months on average. This difference was statistically significant. The two oldest female patients, who were 33 and 37 years old at the time of the surgery, experienced altered sensitivity for only 4 months. CONCLUSIONS: After BSSO, all patients experienced disturbed light-touch sensation in the innervated area of the lower alveolar nerve. A faster recovery in the oldest patients and a statistically significant difference between the sexes should be interpreted with caution.

Influence of oral hygiene on oral health of recruits and professionals in the Croatian Army.

OBJECTIVES: Good oral health of soldiers would decrease the number of urgent dental interventions and absences from training and the battlefield and would improve the security of the whole formation. This study shows the habits for maintaining oral health and the oral status of the examined population in the Croatian Army. METHODS: The data were obtained from examinations and questionnaires of 912 Croatian soldiers, 650 of whom were recruits and 262 professional soldiers of the Croatian Army land forces. RESULTS: The results showed that the oral health of the examined population was mostly bad, as a consequence of inadequate prevention of illnesses of the oral cavity associated with insufficient oral hygiene. The most common disease was dental caries (5.84 carious teeth per recruit and 2.71 per professional). Only 14 (1.53%) of 912 examinees had completely healthy teeth. Only one-third of the examinees had no bleeding when tested with a periodontal probe. Acute pain of odontogenic origin was present for 23.5% of examinees. Such oral health makes most of the soldiers unreliable for peace operations that would last >6 months, because it lowers their combat readiness. CONCLUSION: Oral hygiene and oral health are poor. Consequently, combat readiness is low because of the need for frequent dental interventions, which could further lead to absence from the field and appointed tasks. The results emphasize the need for obligatory regular check-ups to improve oral health in the Croatian Army.

A case of canine hypodontia in an early Croatian cemetery Strance-Gorica.

In the old Croatian cemetery Strance-Gorica in the Vinodol region, dating from the 9th to 11th century, osteological parts of the upper and the lower jaws with teeth were found, besides some other archeological finds. Data processing in dentistry regarding a possible presence of hypodontia was carried out on archeological finds (skeletal remains) on 27 persons available for the research. Only one case of canine hypodontia was found and described. In the remaining 26 persons no case of hypodontia was found on the relicts of the upper and lower jaws nor in other teeth groups. The frequency of hypodontia in the old Croatian cemetery Strance-Gorica was 3.7, which corresponds to the frequency of this anomaly in the 20th century population of Croatia.

Large complex odontoma of the left maxillary sinus.

Odontomas as a group are the most common odontogenic neoplasms. They are mixed lesions containing fully formatted dental tissues, both epithelial and mesenchymal, and are usually found during a routine radiographic examination or as a factor in noneruption. Odontomas can be divided into two types: the complex and the compound odontoma. Both types are composed of enamel, dentin, cementum and pulp tissues, but in complex odontomas the tissues are arranged in a haphazard fashion with no discernible dental structures, whereas in compound odontomas the dental tissues exist in a more regular pattern so that the lesion consists of tooth-like structures. We report a case of a 23-year-old man with a large complex odontoma involving the left maxilla and maxillary sinus with clinical, radiographic and histological findings. Because of the size of the mass and its clinical course, benign neoplasms were considered in the differential diagnosis. Surgery was the treatment of choice, and recurrence of the lesion is not expected.

Madelung syndrome (benign lipomatosis): clinical course and treatment.

Madelung syndrome is a rare disease found predominantly in the Mediterranean area. It has a distinctive clinical appearance. Staged surgery is the treatment of choice, which produces substantial improvement in both functional and aesthetic appearance. Recurrences usually occur when it is impossible to resect the disease completely.

Lag screw fixation for straight midline mandibulotomy: four-year experience.

The authors' experience with 2-lag screw technique for the stabilization of a straight midline mandibulotomy approach for oral cavity and oropharyngeal tumors is presented. Fixation is performed with 2.0-mm pretapped screws. A washer is used to prevent sinking of the screw head into spongy bone and to provide equal pressure distribution of the screw head to the bone edges. Lag screw fixation was used in 24 patients, 18 of whom underwent a full dose of irradiation therapy postoperatively. Two patients developed salivary fistula and 1 developed a local infection. In all patients there were no signs of mandibulotomy site instability, no disturbance of the occlusion, and radiography showed excellent bone healing. There were no indications for tooth extraction to complete the osteotomy. Lag screw fixation proved to be an uneventful and straightforward procedure for the stabilization of a straight midline mandibulotomy approach.