Comprehensive analysis of lateral nasal wall anatomy to optimize the osteotomy in different skeletal patterns.

PURPOSE: Variations in nasal wall anatomy are crucial in patients with dentofacial deformities undergoing Le Fort I osteotomy. These structural variations heighten the potential for complications during surgical procedures. Hence, the study focused on evaluating the differences in the lateral nasal wall anatomy across different skeletal Classes. METHODS: This study evaluated 86 patients aged 18-43 years with different skeletal Classes. In the axial images acquired from coronal sections, two angulations and the linear distances of the lateral nasal wall were measured in Class I, II, and III patients. The measurement between the piriform opening and the most anterior point of the greater palatine foramen was evaluated in three parts regarding the osteotomy line. Differences between the skeletal patterns were analyzed using an independent sample t-test and Mann-Whitney U test with a significance level of 0.05. The intra-class correlation coefficient was calculated for inter-observer and intra-observer agreement. RESULTS: There was a statistically significant difference between Class I and Class II subjects regarding the anterior lateral nasal wall (p = 0.011) and anterior nasal thickness (a) (0.004). There was a significant difference between Class I and Class III patients regarding anterior nasal thickness (a) (p < 0.001) and total lateral nasal wall length (p < 0.001). CONCLUSION: For instance, the measurements of Class III and Class II patients were relatively different from those of the Class I patients. Therefore, preoperative Cone-Beam Computed Tomographic analysis should be performed for each patient prior to Le Fort I osteotomy to ensure that the procedure is performed safely.

The impact of orthognathic surgery on quality of life for class III dentofacial deformities.

In this study, we aim to evaluate the quality of life in patients with Class III deformities after orthognathic surgery. A total of the 40 patients (26 female and 14 male) were included. The mean age of the patients was 24.85. Patients' ages ranged from 20 to 36 years. All patients received orthodontic treatment before surgery. Sagittal split ramus osteotomy was performed for single jaw patients. Le Fort I osteotomy and sagittal split ramus osteotomy was performed for double jaw patients. Patients completed the Oral Health Impact Profile 14 (OHIP-14) and Orthognathic Quality of Life Questionnaire (OQLQ) three times. [Preoperatively (T0), 1st week after orthognathic surgery (T1) and in the 6th - 12th months after orthognathic surgery (T2)]. There was a statistically significant difference in the dimensions of OHIP-14 when the preoperative (T0) score, postoperative 1st week (T1) score and postoperative 6th - 12th month (T3) score are compared among themselves except for psychological discomfort, physical disability, and handicap. OQLQ total score and preoperative (T0) score was greater than the postoperative 1st week (T1) score and the postoperative 1st week(T1) score was greater than the postoperative 6th - 12th month (T2) scores except oral function. When single jaw and double jaw surgeries were compared, no statistically significant difference was found between OHIP-14 and OQLQ total scores for preoperative, postoperative 1st week, and postoperative 6th - 12th months. When both OHIP-14 and OQLQ scores were examined after orthognathic surgery, the OHRQOL of patients with Class III dentofacial deformity improved significantly.

Long-term evaluation of masseter muscle activity, dimensions, and elasticity after orthognathic surgery in skeletal class III patients.

OBJECTIVE: To evaluate changes in the masseter muscle after orthognathic surgery using electromyography (EMG), ultrasonography (US), and ultrasound elastography (USE) in individuals with skeletal class III anomaly over long-term follow-up and compare with a control group. MATERIALS AND METHODS: The study group included 29 patients with class III dentofacial deformities scheduled to undergo orthodontic treatment and orthognathic surgery. The control group included 20 individuals with dental class I occlusion. Assessment of the masseter muscles using EMG, US, and USE was performed before orthognathic surgery (T1) and at postoperative 3 months (T2) and 1 year (T3) in the study group, and at a single time point in the control group. All assessments were performed at rest and during maximum clenching. Masseter muscle activity, dimension, and hardness were analyzed. RESULTS: Electromyographic activity of the masseter muscle during maximum clenching was increased at postoperative 1 year but did not reach control group values. On ultrasonography, the masseter muscle showed minimal changes in dimension at postoperative 1 year compared to preoperative values and remained below control group values. The postoperative increase in masseter muscle hardness at rest and during maximum clenching persisted at postoperative 1 year. CONCLUSION: The results of this study suggest that after orthognathic surgery, additional interventions and much longer follow-up are needed to ensure better muscle adaptation to the new occlusion and skeletal morphology. CLINICAL RELEVANCE: All assessment methods are useful for comprehensively evaluating changes in the masticatory muscles after orthognathic surgery.

The factors associated with orthorexia nervosa in type 2 diabetes and their effect on diabetes self-management scores.

PURPOSE: This study aimed to determine the factors affecting the ORTO-R scores in individuals with T2DM and to investigate their effect on diabetes self-management. METHODS: The study included 373 individuals with type 2 diabetes between the ages of 18-65 who applied to Akdeniz University Hospital Endocrinology and Metabolic Diseases Polyclinic between January and May 2022. A questionnaire including sociodemographic data, information about diabetes, and nutritional habits, and the ORTO-R and Type 2 Diabetes Self-Management Scales were used to collect data. Linear regression analysis was performed to determine the factors affecting ORTO-R. RESULTS: The linear regression analysis showed that age, gender, education level, and duration of diabetes affected ORTO-R scores in patients with type 2 diabetes. Body mass index, comorbidities (cardiovascular diseases, kidney diseases and hypertension), diabetes-related complications, diabetes treatment method and dieting had no significant contribution to the model (p > 0.05). We also found that education level, comorbidities, diabetes-related complications, diabetes treatment method, dieting, and BMI can affect diabetes self-management. CONCLUSION: It should be kept in mind that type 2 diabetes are at risk of orthorexia nervosa (ON) in terms of various aspects such as age, gender, education level and duration of diabetes. Since the factors affecting the risk of ON and the factors affecting diabetes self-management are intertwined, orthorexic tendencies should be kept under control while trying to increase self-management in these patients. In this respect, developing individual recommendations according to the psychosocial characteristics of patients may be an effective approach. LEVEL OF EVIDENCE: Level V, cross-sectional study.

Electromyographic, Ultrasonographic, and Ultrasound Elastographic Evaluation of the Masseter Muscle in Class III Patients Before and After Orthognathic Surgery.

PURPOSE: The aim of this study was to examine changes in the electromyographic activity, thickness, width, and hardness of the masseter muscle from before to after orthognathic surgery. MATERIAL AND METHODS: The study included 15 patients with Class III dentofacial deformities who were treated with combined orthodontic and orthognathic surgery. Fifteen individuals with normal occlusion and no signs or symptoms of temporomandibular joint dysfunction were used as controls. All records were obtained bilaterally in the study group before surgery (T1), at 3 months after surgery (T2), and in the control group (CG) while at rest and in maximum voluntary contraction (MVC). RESULTS: There was no difference in resting masseter muscle activity between T1, T2, and CG. Resting thickness and width of the masseter muscle did not differ significantly between T1 and T2. MVC masseter muscle activity and thickness increased significantly and width decreased significantly from T1 to T2 but did not reach CG values. Muscle hardness increased from T1 to T2. CONCLUSIONS: The authors' findings indicate that despite improved muscle activity and dimensions, postoperative 3 months is still early period for adaptation of the masseter muscles to the new occlusion and skeletal morphology.

Is It Possible to Protract the Maxilla by Surgically Assisted Rapid Maxillary Expansion and Intermaxillary Class III Elastics?

OBJECTIVE: The purpose of the present study was to evaluate skeletal and soft tissue changes with surgically assisted rapid maxillary expansion (SARME) and intermaxillary Class III elastics. METHODS: A total of 15 patients (mean age: 19.58 years) were included in the study. Each patient underwent SARME with the use of Class III elastics (500 g) applied through miniscrews to stimulate maxillary advancement. Lateral cephalograms and posteroanterior radiographs obtained before treatment (T1), after SARME and elastic use (T2), and after treatment (T3) were analyzed to determine the changes in each phase of treatment. Planimeter was used to evaluate facial soft tissue changes. Wilcoxon signed-rank test was used to evaluate the changes that occur during treatment. RESULTS: SARME provided permanent and efficient maxillary expansion at both skeletal and dental levels (p<0.01). Maxillary skeletal (ANS-Ver and U1i-Ver; p<0.01) and soft tissue (Pr-Ver, Sn-Ver, and ULA-Ver; p<0.01) variables and superior upper labial area (Area 1; p<0.05) increased due to maxillary dental and skeletal changes. Superior lower labial area (Area 3; p<0.05) decreased as a result of slight increase in facial height and changes in maxillary-mandibular incisor relationship at the end of the treatment. CONCLUSION: The results suggest that the improvement in the facial profiles of the patients is related to the significant increase in the bony and dental support of the upper lip region together with the contribution of the superior lower lip area.

Evaluation of long-term soft tissue changes after bimaxillary orthognathic surgery in Class III patients.

OBJECTIVE: To assess soft tissues in the short and long term after bimaxillary surgery in Class III patients by comparing the hard tissue changes and results between time periods. MATERIALS AND METHODS: Twenty-six Class III adult patients treated with bimaxillary surgery were included in the study. Cephalometric records were taken before surgery (T1) and 5 months (T2), 1.4 years (T3), 3 years (T4), and 5 years (T5) after surgery. RESULTS: There was no significant relapse in skeletal parameters. Overjet was significantly reduced between T4-T3 time intervals (P < .01). There were significant increases in Sn-HR, ULA-HR, LLA-HR, B-B(∧) (P < .01), and B(∧)-HR (P < .05) between T4-T3 time intervals. There was no significant change in the soft tissue parameters between T5-T4 time intervals. CONCLUSION: Soft tissue vertical relapse occurs in skeletally stabile Class III bimaxillary surgery patients in the first 3 years after surgery.

Pharyngeal airway space, hyoid bone position, and head posture after bimaxillary orthognathic surgery in Class III patients: long-term evaluation.

OBJECTIVE: (1) To determine the effect of bimaxillary orthognathic surgery on pharyngeal airway, hyoid bone, and craniocervical posture in Class III bimaxillary surgery patients. (2) To evaluate short-term and long-term results. (3) To compare short- and long-term values. MATERIALS AND METHODS: Twenty-six Class III adult patients treated with bimaxillary surgery were included in the study. Cephalometric records were taken before treatment (T1), before surgery (T2), and 5 months (T3), 1.4 years (T4), 3 years (T5), and 5 years (T6) postsurgery. RESULTS: No significant differences were identified in craniocervical angulation between time intervals. There was a significant superior movement of hyoid bone at postsurgery (T3; P < .05); however, adaptation occurred to the normal position in the long term. A nonsignificant decrease occurred at the oropharyngeal middle pharyngeal distance parameter; however, this was compensated with a significant increase between T5 and T6 (P < .001). A significant decrease was observed in the hypopharyngeal Go-P parameter between T3 and T1 (P < .01), but it recovered with a nonsignificant increase in the long term. A significant increase in nasopharyngeal area was observed between T3 and T1 (P < .05). The hypopharyngeal area significantly increased between T5 and T6, and PNS-R significantly increased between T3 and T1 (P < .05). CONCLUSION: The pharyngeal areas adversely affected after surgery recover at long-term follow-up; thus, adaptation occurs after bimaxillary surgery.

Recurrent glandular odontogenic cyst treatment.

The glandular odontogenic cyst (GOC) is a rare odontogenic cyst. Although none of the clinical or radiographic features of GOC are unique or pathognomonic, the lesion has a potentially aggressive behavior. Treatment of GOC includes curettage and enucleation or excision and cryotherapy; however marginal resection is usually considered a more reliable approach due to the low incidence of recurrence. In this article, we present a case with GOC which recurred five years after the initial surgical treatment.

Pharyngeal airway space, hyoid bone position and head posture after orthognathic surgery in Class III patients.

OBJECTIVE: To determine the effect of orthognathic surgery on pharyngeal airway in Class III patients and to (1) compare the results of different surgical techniques, (2) determine the change at the position of the hyoid bone, and (3) evaluate the craniocervical posture changes related to pharyngeal airway change. MATERIALS AND METHODS: Forty-eight Class III adult patients were included in the study to assess airway space after orthognathic surgery. Nine patients were treated with maxillary advancement, seven patients were treated with mandibular set back, and 32 patients were treated with bimaxillary surgery. Cephalometric records were taken before treatment, after surgery, and about 1 year after surgery (at the end of the treatment). RESULTS: No differences were determined at the position of hyoid bone and craniocervical posture. Nasopharyngeal area was significantly increased in all groups (P < .05). Oropharyngeal area and SPSS and IPS parameters were significantly decreased after mandibular set back operation (P < .05). In bimaxillary and maxillary advancement groups, PPS parameter was significantly increased (P < .01), and IPS parameter was significantly decreased (P < .05). No differences were detected at oropharyngeal and hypopharyngeal areas in bimaxillary and maxillary advancement groups. CONCLUSION: Different surgical procedures have different effects on pharyngeal airway space.

Stability of surgically assisted rapid maxillary expansion and orthopedic maxillary expansion after 3 years' follow-up.

OBJECTIVE: To evaluate the stability of surgically assisted rapid palatal expansion (SARME) and orthopedic maxillary expansion (OME) after 3 years of follow-up, and compare these changes with a control group. MATERIALS AND METHODS: The subjects of the study were divided into three groups. Group 1 was composed of 10 patients (6 males, 4 females) with a mean age of 15.51 years (range: 13.33-17.58 years) and treated with OME, Group 2 comprised 10 patients (7 males, 3 females) with a mean age of 19.01 years (range: 16.25-25.58 years) and treated with SARME. Group 3 was the control group, consisting of 10 untreated, skeletal Class 1 subjects (6 males, 4 females) with a mean age of 15.27 years (range: 13.42-17.00 years) and matched to the OME group for sex and age. Lateral cephalometric and posteroantererior films were taken before expansion (T1), postexpansion (T2), and 3 years after the retention period (T3). RESULTS: After OME and SARME, significant increases were observed for both dental and skeletal transverse widths (P < .01). After 3 years of follow-up, maxillary basal width decreased 1.35 +/- 0.44 mm in the SARME group and 1.19 +/- 0.41 mm in the OME group, while upper molar width decreased 2.23 +/- 1.24 mm in the SARME group and 2.79 +/- 1.01 mm in the OME group. CONCLUSIONS: Both the OME and SARME procedures remained stable after 3 years of follow-up with some amount of postretention relapse, compared with the control group.

Changes in nasopharyngeal airway following orthopedic and surgically assisted rapid maxillary expansion.

INTRODUCTION: The aim of this study was to compare changes in soft-palate morphology and nasopharyngeal relations after orthopedic rapid maxillary expansion (RME) and surgically assisted RME (SARME). METHODS: A group of 10 patients received RME, a second group of 10 patients received SARME, and a third group of 10 patients served as an untreated control group. Lateral and posteroanterior cephalograms were obtained for each individual at preexpansion/precontrol and postexpansion/postcontrol. In addition to descriptive parameters, the angulation, length, and thickness of the soft palate and superior and inferior pharyngeal spaces and the ratios of the length of the soft palate to the length of the superior and inferior pharyngeal spaces were evaluated. Paired t-tests were performed to analyze changes within groups, and analysis of variance and Duncan tests were used to compare changes among groups. RESULTS: No statistically significant differences were found in changes in measurements related to soft-palate morphology or nasopharyngeal dimensions among the SARME, RME, and control groups; however, increases in soft-palate angulation and superior and inferior pharyngeal spaces after expansion/control were greater in the SARME group than in other groups. CONCLUSIONS: No statistically significant differences were found between changes in the nasopharyngeal airway after RME and SARME.

Intravascular papillary endothelial hyperplasia and osteoma: a case report of an individual with 2 different pathologies.

Intravascular papillary endothelial hyperplasia (IPEH) is an unusual, benign, non-neoplastic, vascular lesion characterized histologically by papillary fronds lined by proliferating endothelium. Osteoma is a benign osteogenic lesion characterized by proliferation of compact or cancellous bone. Osteoma of the maxillary sinus is an uncommon lesion. The purpose of this report is to present a case with 2 different lesions (intravascular papillary endothelial hyperplasia and osteoma) occurring at the same time in 1 patient that may or may not be related to each other and to stress the value of diagnostic imaging.

Two-stage treatment of TMJ ankylosis by early surgical approach and distraction osteogenesis.

Temporomandibular joint (TMJ) ankylosis is characterized by the formation of bone or fibrous adhesion of the anatomic joint components, which replaces the normal articulation and limitation of mouth opening. Early surgical intervention is considered as a treatment procedure to release the joint ankylosis and to maintain the function of the joint. Longstanding temporomandibular joint ankylosis which starts during the active growth period in early childhood resulting in facial asymmetry. Thus, the importance of the evaluation for the facial asymmetries and unfavorable remodeling of the mandible has to be considered during the initial treatment planning. Further operations, either osteotomies or distraction osteogenesis, are required for the treatment of maxillofacial deformities. The present study reports a case of unilateral TMJ ankylosis treated by interpositional arthroplasty prior to distraction osteogenesis for the treatment of mandibular secondary deformity. Various treatment procedures and timing protocols are reviewed and discussed.

Surgically assisted rapid maxillary expansion compared with orthopedic rapid maxillary expansion.

The objective of this study is to evaluate and compare the dental and skeletal changes occurring during orthopedic rapid maxillary expansion (RME) and surgically assisted RME during the active phase of treatment. The study was divided into two groups. The first group of 10 patients (six males, four females; mean age, 15.51 years) received orthopedic RME. The second group of 10 patients (seven males, three females; average age: 19.01 years) received surgically assisted RME (SARME). All patients underwent maxillary expansion with occlusal-coverage Hyrax-type expanders activated two turns a day (0.25 mm per turn). Preexpansion and postexpansion lateral and posteroanterior cephalograms were obtained for each patient. Statistically significant differences between the SARME and RME groups were found in the N-ANS, SN/ PP (P < .01) and SNA, SNB, mandibular dentoalveolar, and maxillary bony base (P < .05) measurements. Clinically, there is no difference in patient response between the RME and SARME groups. The only difference between the groups was their indication for RME or SARME, which is based on the age and skeletal maturation of the patient.

Osteochondroma of the mandibular condyle: report of a case and review of the literature.

Osteochondromas rarely affect the mandibular condyle. An unusual case of an osteochondroma occurring in the left mandibular condyle in a 40-year-old man who presented with mandibular deviation and malocclusion is reported; this represents the 37th documented case in the English-language literature. The tumor was resected through condylectomy. Four-year follow-up assessments revealed satisfactory function and occlusion, without evidence of recurrence of the tumor.

Displacement of avulsed tooth into soft tissue of chin resulting from epileptic attack trauma.

Maxillofacial trauma is the main cause of emergency admittance to dental clinics. Mental retardation and epileptic status are important factors in an increase in the risk of dental injuries. Tooth avulsion, which is the total displacement of a tooth out of its socket, is an infrequently observed entity. Maxillary central incisors are the most commonly affected teeth. The case of a patient with severe dental injury resulting from an epileptic attack is presented. He had several teeth avulsed and displacement of a tooth into the soft tissue of the chin.

Treatment of temporomandibular joint ankylosis with temporalis superficial fascia flap.

Temporomandibular joint (TMJ) ankylosis is characterized by the formation of bony or fibrous mass, which replaces the normal articulation and limitation of mouth opening. This study aims to determine the efficacy of arthroplasty and interpositional fascia flap in the treatment of unilateral and bilateral TMJ ankylosis in three young adult men. Our operative protocol for unilateral and bilateral TMJ ankylosis entailed resection of ankylotic mass, intraoral ipsilateral and bilateral arthroplasty, interpositional tissue transfer to the TMJ with temporalis superficial fascia flap, maxillomandibular fixation, and early mobilization and aggressive physiotherapy. Early postoperative initial exercise, physiotherapy, and strict follow-up play an important role in preventing postoperative adhesions. The temporalis superficial facia flap is an autogenous graft that has the advantages of close proximity to the TMJ minimal surgical morbidity, and successful clinical results. It was found to be a valuable option for TMJ ankylosis reconstruction.

Dentin dysplasia type I: report of atypical cases in the permanent and mixed dentitions.

Dentin dysplasia type I is a rare hereditary disturbance of dentin formation characterized clinically by nearly normal appearing crowns and severe hypermobility of teeth. Radiographic analysis shows obliteration of all pulp chambers, short, blunted, and malformed roots, and periapical radiolucencies of noncarious teeth. This paper presents 2 cases demonstrating both classic and atypical features of type I dentin dysplasia in the mixed and permanent dentitions. The clinical, radiographic, and histopathologic\findings of this condition and treatment are described.

Ameloblastic fibrodentinoma. A case report.

A case report of an ameloblastic fibrodentinoma (AFD) in a 21-year-old female patient is presented. This rare, benign tumor was surgically treated. The histological findings and follow-up are presented.