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.

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.

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.

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.

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.

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.

The effects of articaine hydrochloride on wound healing: an experimental study.

PURPOSE: The aim of the study was to examine the effect of articaine hydrochloride (AH) on the healing of surgical wounds and to compare healing with that of lidocaine. MATERIALS AND METHODS: Forty rats were used in this study. The rats were randomly separated into 4 groups. Three groups were given 2% lidocaine, 4% AH, or injectable saline, and the fourth was a control group. Skin specimens underwent the breaking strength test (BST) and histologic examination at 1 week after the surgical procedure. The skin specimens of the rats were subjected to a pulling force of 10 mm/min across the incision line. The strength value at the moment of breaking in the tissue was expressed in Newtons. Histologic examination was performed as well, and wound healing was graded. RESULTS: Both the histologic grade and BST values in the lidocaine and AH groups were significantly lower than those of the control and saline groups (P <.01). Similarly, the histologic and BST values of the AH and lidocaine groups were statistically significant (P <.05, P <.001). Some necrotic regions were observed at the incision region in 2 samples from the AH group. CONCLUSION: The results of the study showed that AH is as safe a local anesthetic agent as lidocaine from the standpoint of wound response.

Peripheral osteoma of the oral and maxillofacial region: a study of 35 new cases.

PURPOSE: The purpose of this article was to present 35 new cases of peripheral osteoma of the oral and maxillofacial region with an analysis of the literature. PATIENTS AND METHODS: We performed a search of our files for the past 5 years for peripheral osteoma of the oral and maxillofacial region. The criteria used to diagnose osteoma included the radiographic and histologic features. RESULTS: The 35 patients, which included 23 males (65%) and 12 females (35%), ranged in age from 14 to 58 years, with a mean age of 29.4 years. Most of the osteomas were located in frontal bone (28.57%), mandible (22.85%), and maxilla (14.28%). CONCLUSION: Peripheral osteomas of the jaw bones are uncommon, and accordingly, patients with osteoma should be evaluated for Gardner's syndrome. In addition, it is appropriate to provide both clinical and radiographic follow-up after surgical excision of a peripheral osteoma.