Prevalence of high blood pressure in periodontal patients: A pilot study.

BACKGROUND: Arterial hypertension and periodontal diseases are pathologies with a high prevalence worldwide. Recent evidence suggests a possible causal relationship between them. Patients with moderate or severe periodontitis tend to have higher blood pressure measurements and a 30% to 70% higher likelihood of developing hypertension. OBJECTIVES: The aim of this cross-sectional pilot study was to ascertain the prevalence of high blood pressure in patients with periodontitis. MATERIAL AND METHODS: The study included 40 patients diagnosed with periodontitis who required non-surgical periodontal treatment. Demographic, periodontal and clinical characteristics, including blood pressure measurements, were registered. RESULTS: Fifteen percent of the patients were classified as hypertensive (n = 6), 67.5% as high-normal (n = 27) and 17.5% as normotensive (n = 7). Recent studies have estimated that the prevalence of highnormal blood pressure in the general population ranges between 30% and 50%. These findings suggest that patients with periodontal disease are more likely to have elevated blood pressure than patients with healthy periodontal tissues. CONCLUSIONS: High-normal blood pressure is associated with a 3 times higher likelihood of developing hypertension, so early detection and prevention are crucial public health strategies. Despite the limitations of this pilot study, it highlights the role of dentists in the prevention, diagnosis and blood pressure control to improve health and cardiovascular risk of patients with periodontitis.

Impact of Nonsurgical Periodontal Treatment on Blood Pressure: A Prospective Cohort Study.

OBJECTIVES: Arterial hypertension and periodontitis are two of the most common diseases worldwide and recent evidence supports a causal relationship between them. Despite all antihypertensive strategies, an important number of patients are undiagnosed and a large number of the diagnosed fail to achieve optimal blood pressure (BP) measurements. Some studies point out that periodontal treatment could have positive effects on BP levels. The aim of this study is to determine if nonsurgical periodontal treatment can help BP level control in prehypertensive patients with periodontitis. MATERIALS AND METHODS: Thirty-five patients were included in the study and received nonsurgical periodontal treatment according to necessity. Clinical data, periodontal data, and BP measurements were taken at baseline, periodontal re-evaluation visit (4-6 weeks after treatment), and 6-month follow-up. RESULTS: Periodontal treatment caused a statistically significant reduction (p < 0.05) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at re-evaluation visit of 4.7 (p = 0.016) and 3.4 mm Hg (p = 0.015), respectively. The effect was maintained at 6-month follow-up visit with a reduction in SBP and DBP of 5.2 (p = 0.007) and 3.7 (p = 0.003) mm Hg, respectively. CONCLUSION: Despite the limitations of this study, it suggests that nonsurgical periodontal treatment can be effective in lowering BP levels in patients with prehypertension and periodontitis. Moreover, it highlights the importance of dentists in prevention, detection, and control of this important cardiovascular risk factor.

Accuracy of Virtually Planned Maxillary Distraction in Cleft Patients - An Evaluative Study.

INTRODUCTION: Maxillary distraction may be used to treat severe maxillary hypoplasia in cleft lip and palate (CLP) patients. Three-dimensional (3D) planning has been shown to increase the accuracy of distraction and reduce operative time and complications. The aim of the study was to measure the accuracy of internal maxillary distraction after 3D planning in CLP patients, to add evidence to validate the virtual osteotomy and distraction procedure. MATERIALS AND METHODS: Eleven CLP patients with severe maxillary hypoplasia underwent maxillary distraction using internal distractors. Virtual planning was used to design the osteotomies, the distractor position, and the distraction vector. Cutting and positioning guides transferred this information to the surgical procedure. Four to six month postoperative computed tomography-scan was done before distractor removal; anatomical reference points were compared to the virtual planning to determine accuracy. RESULTS: A high accuracy (point dislocation <1.5 mm) was found in 90% of the points of the surface of the maxilla; the majority of the zygomatic screws were placed within a distance of 0.8-1 mm from their planned position. DISCUSSION: The high accuracy achieved through virtual planning promotes optimal distractor placement; a customized distraction vector has a direct effect on the final position of the maxilla.

Does Periodontal Treatment Help in Arterial Hypertension Control? A Systematic Review of Literature.

Arterial hypertension and periodontal diseases are two of the pathologies with more prevalence worldwide. In the last few years, several scientific evidences have demonstrated the relationship between both diseases. Besides the etiopathogenic and causal relationship, some recent publications have pointed out that the therapeutic approach of periodontitis could have positive effects on the control of arterial hypertension.The aim of this systematic review is to determine whether there is a decrease in or better control of blood pressure after performing nonsurgical periodontal treatment in patients with periodontitis.A thorough search in PubMed, Scopus, and ISI Web of Science databases with the keywords "'periodontal disease' OR 'periodontitis' OR 'periodontal' AND 'blood pressure' OR 'hypertension' OR 'arterial hypertension'" was conducted. The quality of the reported information was assessed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for systematic reviews.Eight articles were considered for this systematic review. Five of the studies showed statistically significant reduction in systolic blood pressure (SBP) values.Despite the limitations of the review, nonsurgical treatment of periodontal disease seems to reduce SBP values. Further research with larger and longer-term clinical trials are needed to demonstrate this potential positive effect.

Twenty four years of oral and maxillofacial surgery malpractice claims in Spain: patient safety lessons to learn.

PURPOSE: Oral and maxillofacial surgery (OMS) malpractice risk is of special interest due to both the aesthetic component of some procedures and the complexity of the pathologies involved. This study aims to identify relevant factors involved in OMS professional liability (PL) claims to help achive better management of risks and improve patient safety. METHODS: We performed a retrospective analysis of 315 OMS claims opened between 1990 and 2014 from the database of the PL Department of the Catalonian Council of Medical Colleges, and identified their clinical, economical and juridical characteristics. RESULTS: OMS showed a high rate of compensation (33.8%). Dental implant surgery, third molar surgery and rhinoplasty presented the greatest exposure to claims, and in these cases, lack of osteointegration of dental implants, neurologic injury of inferior dentoalveolar/lingual nerves and a poor aesthetic result were the most frequently compensated sequelae. Statistically, significant association was found between this perioperative complications group and the presence of PL. Poorly documented patient information (informed consent document) was also significantly related with PL outcome. CONCLUSIONS: OMS is a specialty of medium risk for claims, especially oral surgery cases. Surgical complications, such as neurologic damage after oral/head and neck procedures and poor aesthetic results, do occur and deserve special attention to improve patient safety, as well as patient-information procedure.

Management of Ankyloglossia and Breastfeeding Difficulties in the Newborn: Breastfeeding Sessions, Myofunctional Therapy, and Frenotomy.

The problems of suction in newborns give rise to multiple consequences for both the mother and the newborn. The objective of this paper is to present a case of ankyloglossia ("tongue-tie") and the suction problems that were treated by a multidisciplinary team. The subject is a 17-day-old male patient, with ankyloglossia and suction problems during breastfeeding (pain in the breastfeeding mother, poor weight gain, and long breastfeeds). The patient followed the circuit established in our centre between the services of Oral and Maxillofacial Surgery and Breastfeeding and Speech Therapy and Orofacial Rehabilitation (CELERE). The evolution following the breastfeeding sessions, the myofunctional stimulation, and the lingual frenotomy was very favourable, thereby solving the suction problems that the newborn presented. All our patients receive breastfeeding sessions and myofunctional therapy as treatment. We know that a frenotomy is not always necessary and we believe that the stimulation of sucking before and after the surgical intervention is important in order to improve the final result.

Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol

BACKGROUND: Partial ankyloglossia is a limitation which restricts the possibility of protrusion and elevation of the tip of the tongue due to the shortness of either the lingual frenulum or the genioglossus muscles or both. The principal objective of this paper is to present our protocol of action for the treatment of ankyloglossia. The specific objectives are to study patients with ankyloglossia treated by the Service of Maxillofacial Surgery and the Service of Speech Therapy of our pediatric Hospital, describe the diagnostic procedures, the pre-surgical intervention, the surgical technique undertaken and the post-surgical rehabilitation taking into account the level of collaboration of the patients, and finally, describe the surgical complications and the referral of patients. MATERIAL AND METHODS: This is a descriptive study of healthy patients, without any diagnosis of syndrome, ranging between 4 and 14 years that have been surgically treated and rehabilitated post-surgery within a period of 2 years. RESULTS: 101 frenectomies and lingual plasties have been performed and patients have been treated following the protocol of action that we hereby present. After the surgical intervention, the degree of ankyloglossia has been improved, considering correction in 29 (28%) of the patients (95% CI: 20%, 38%), reaching, with the post-surgical orofacial rehabilitation, a correction of 97 (96%) of the participants (95% CI: 90%, 98%). CONCLUSIONS: The chosen surgical technique for moderate-severe ankyloglossia in our centre is the frenectomy and lingual plasty. The myofunctional training begins one week before the surgical intervention so that the patients learn the exercises without pain

Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol.

BACKGROUND: Partial ankyloglossia is a limitation which restricts the possibility of protrusion and elevation of the tip of the tongue due to the shortness of either the lingual frenulum or the genioglossus muscles or both. The principal objective of this paper is to present our protocol of action for the treatment of ankyloglossia. The specific objectives are to study patients with ankyloglossia treated by the Service of Maxillofacial Surgery and the Service of Speech Therapy of our pediatric Hospital, describe the diagnostic procedures, the pre-surgical intervention, the surgical technique undertaken and the post-surgical rehabilitation taking into account the level of collaboration of the patients, and finally, describe the surgical complications and the referral of patients. MATERIAL AND METHODS: This is a descriptive study of healthy patients, without any diagnosis of syndrome, ranging between 4 and 14 years that have been surgically treated and rehabilitated post-surgery within a period of 2 years. RESULTS: 101 frenectomies and lingual plasties have been performed and patients have been treated following the protocol of action that we hereby present. After the surgical intervention, the degree of ankyloglossia has been improved, considering correction in 29 (28%) of the patients (95% CI: 20%, 38%), reaching, with the post-surgical orofacial rehabilitation, a correction of 97 (96%) of the participants (95% CI: 90%, 98%). CONCLUSIONS: The chosen surgical technique for moderate-severe ankyloglossia in our centre is the frenectomy and lingual plasty. The myofunctional training begins one week before the surgical intervention so that the patients learn the exercises without pain.

The effects of healing abutments of different size and anatomic shape placed immediately in extraction sockets on peri-implant hard and soft tissues. A pilot study in foxhound dogs.

OBJECTIVES: The aim of this animal study was to compare the effects of narrow, concave-straight and wide anatomic healing abutments on changes to soft tissues and crestal bone levels around implants immediately placed into extraction sockets in foxhound dogs. MATERIALS AND METHODS: Forty-eight titanium implants (Bredent Medical GMBH, Germany) of the same dimensions were placed in six foxhound dogs. They were divided into two groups (n = 24): test (implants with anatomic abutment) and control (implants with concave-straight abutment). The implants were inserted randomly in the post extraction sockets of P2 , P3 , P4, and M1 bilaterally in six dogs. After eight and twelve weeks, the animals were sacrificed and samples extracted containing the implants and the surrounding soft and hard tissues. Soft tissue and crestal bone loss (CBL) were evaluated by histology and histomorphometry. RESULTS: All implants were clinically and histologically osseointegrated. Healing patterns were examined microscopically at eight and twelve weeks. After eight and twelve weeks, for hard tissues, the distance from the implant shoulder to the first bone-to-implant contact (IS-C) was higher for control group in the lingual aspect with statistical significance (P < 0.05). For soft tissues (STL), the distance from the top of the peri-implant mucosa to the apical portion of the junction epithelium (PM-Je) was significantly less on the lingual aspect in the test group (with wider abutment) at eight and twelve weeks (P < 0.05). The distance from the top of the apical portion of the junction epithelium to the first bone-to-implant contact (Je-C) was significantly higher in the test group (wider abutment) in the lingual aspect at eight and twelve weeks (P < 0.05). There was no connective tissue contact with any abutment surface. CONCLUSIONS: Within the limitations of this animal study, anatomic healing abutments protect soft and hard tissues and reduce crestal bone resorption compared with concave-straight healing abutments.

Gingival bleeding of a high-flow mandibular arteriovenous malformation in a child with 8-year follow-up.

Intraosseous arteriovenous malformations (AVMs) in the head and neck region are uncommon. There are several types and they can have a wide range of clinical presentations. Depending on the blood flow through the AVM, the treatment may be challenging for the attending team and may lead to life-threatening hemorrhages. A clinical case report is presented. A 9-year-old girl, seen for gingival bleeding during oral hygiene, was found to have a high-flow AVM located within and around the mandible. Two-stage treatment consisted of intra-arterial embolization followed by intraoral injection of a sclerosing agent 8 weeks later. At the 8-year follow-up, imaging study showed no evidence of recurrent lesion inside or outside the bone. The final outcome is a correct occlusion with a symmetric facial result. This case shows that conservative treatment may be the first treatment option mostly in children. Arteriography and transcortical injection were enough to control the AVM.

Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial

Alveolar osteitis (AO) is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine (CHX), which has proved to be effective. OBJECTIVES: The aim of this randomized double-blind clinical trial was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO. Study DESIGN: The study was a randomized, double-blind, clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d'Hebron and was approved by the Ethics Committee. A total of 160 patients randomly received0.2% bioadhesive gel (80 patients) or bioadhesive placebo (80 patients).RESULTS: 0.2% bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22% compared to placebo with differences that were not statistically significant. Smoking and the use of oral contraceptives were not related to higher incidence of dry socket. Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences.0.2% bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses. CONCLUSIONS: A 22% reduction of the incidence of alveolar osteitis with the application of 0.2% bioadhesive chlorhexidinegel compared to placebo with differences that were not statistically significant was found in this clinical trial. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extractions and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance

Effect of implant design in immediate loading. A randomized, controlled, split-mouth, prospective clinical trial.

OBJECTIVES: The aim of this study was to evaluate the effect of two different designs, tapered vs cylindrical, on the primary stability of implants placed with an immediate loading protocol in edentulous mandibles to support fixed prostheses within occlusal contacts during the first 48 h. MATERIAL AND METHODS: Tapered and cylindrical implants were placed in a split-mouth study using the same implant protocol in ten patients with edentulous jaws. A total of 20 tapered implants (test group) and 20 cylindrical implants (control group) were placed. All implants were loaded immediately with provisional fixed prostheses during the healing period before the final restoration. The implants were evaluated at the implant placement by analyzing the insertion torque values (ITVs) and the resonance frequency analysis (RFA) and after the healing period of three months, the success of those implants and the marginal bone loss were evaluated. RESULTS: Two cylindrical implants were mobile within the same patient and no tapered implants failed, resulting in implant survival rates of 90% and 100%, respectively after three months. The ITVs were statistically significantly different (P = 0.0210) for the tapered implants than for the cylindrical implants. However, no statistically significant differences in RFA values were found (P = 0.6063) when comparing the implant designs and the primary stability measured with implant stability quotient (ISQ) values. The control group resulted in a mean bone loss after three months of 0.91 mm while the test group resulted 0.42 mm. CONCLUSION: The tapered implant achieved greater primary stability values measured with ITVs and less marginal bone loss than the cylindrical implants.

Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial.

UNLABELLED: Alveolar osteitis (AO) is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine (CHX), which has proved to be effective. OBJECTIVES: The aim of this randomized double-blind clinical trial was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO. STUDY DESIGN: The study was a randomized, double-blind, clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d'Hebron and was approved by the Ethics Committee. A total of 160 patients randomly received 0.2% bioadhesive gel (80 patients) or bioadhesive placebo (80 patients). RESULTS: 0.2% bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22% compared to placebo with differences that were not statistically significant. Smoking and the use of oral contraceptives were not related to higher incidence of dry socket. Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences. 0.2% bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses. CONCLUSIONS: A 22% reduction of the incidence of alveolar osteitis with the application of 0.2% bioadhesive chlorhexidine gel compared to placebo with differences that were not statistically significant was found in this clinical trial. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extractions and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance.

Influence of collar design on peri-implant tissue healing around immediate implants: A pilot study in Foxhound dogs.

PURPOSE: The study aims to assess the soft tissue level (STL) and crestal bone level (CBL), of titanium dental implants with different mixed collar abutments configurations. MATERIALS AND METHODS: This study included 48 implants with the same dimensions. They were divided into two groups of 24 implants each one: implants with a polished collar of 2 mm plus a roughened area of 0.8 mm (CONTROL) and implants with a polished collar of 0.8 mm plus a micro-threated and roughened area of 2 mm (TEST). The implants were inserted randomly in the post-extraction sockets of P2, P3, P4, and M1 bilaterally in the lower jaw of six foxhound dogs. STL and CBL were evaluated after 8 and 12 weeks by histology and histometry. RESULTS: All implants were clinically and histologically osseointegrated. Healing patterns examined microscopically at 8 and 12 weeks for both groups yielded similar qualitative findings for the STL evaluation, without significant differences between groups (P > 0.05). CBL was significantly higher in the buccal side in comparison with the lingual side for both groups (P < 0.05); the comparison between groups at 8 weeks showed IS-B (distance from the implant shoulder to the top of the bony crest) and IS-C (distance from the implant shoulder to the first bone-to-implant contact) values significantly higher for control group in comparison with test (P < 0.05). At 12 weeks, CBL showed increased values for both groups that were higher in controls group in comparison with test (P < 0.05). CONCLUSIONS: Bony crest resorption could not be avoided both at test and control sites. However, the neck conformation at the test sites reduced the buccal bone resorption. Soft tissue dimensions were similar both at the test and control sites.

Novel hybrid drilling protocol: evaluation for the implant healing--thermal changes, crestal bone loss, and bone-to-implant contact.

OBJECTIVES: To evaluate a new hybrid drilling protocol, by the analysis of thermal changes in vitro, and their effects in the crestal bone loss and bone-to-implant contact in vivo. MATERIALS AND METHODS: Temperature changes during simulated osteotomies with a hybrid drilling technique (biologic plus simplified) (test) versus an incremental drilling technique (control) were investigated. One hundred and twenty random osteotomies were performed (60 by group) in pig ribs up to 3.75-mm-diameter drill to a depth of 10 mm. Thermal changes and time were recorded by paired thermocouples. In a parallel experiment, bilateral mandibular premolars P2, P3, P4, and first molar M1 were extracted from six dogs. After 2-month healing, implant sites were randomly prepared using either of the drilling techniques. Forty eight implants of 3.75 mm diameter and 10 mm length were inserted. The dogs were euthanized at 30 and 90 days, and crestal bone loss (CBL) and bone-to-implant contact (BIC) were evaluated. RESULTS: The control group showed maximum temperatures of 35.3 °C ± 1.8 °C, ΔT of 10.4 °C, and a mean time of 100 s/procedure; meanwhile, the test group showed maximum temperatures of 36.7 °C ± 1.2 °C, ΔT of 8.1 °C, and a mean time of 240 s/procedure. After 30 days, CBL values for both groups (test: 1.168 ± 0.194 mm; control: 1.181 ± 0.113 mm) and BIC values (test: 43 ± 2.8%; control: 45 ± 1.3%) were similar, without significant differences (P > 0.05). After 90 days, CBL (test: 1.173 ± 0.187 mm; control: 1.205 ± 0.122 mm) and BIC (test: 64 ± 3.3%; control: 64 ± 2.4%) values were similar, without significant differences (P > 0.05). The BIC values were increased at 90 days in both groups compared with the 30-day period (P < 0.05). CONCLUSIONS: Within the limitations of this study, the new hybrid protocol for the preparation of the implant bed without irrigation, increase the temperature similarly to the incremental conventional protocol, and requires twice the time for the completion of the drilling procedure in vitro. Crestal bone loss and bone-to-implant contact in the hybrid drilling protocol are comparable with the conventional drilling protocol and do not affect the osseointegration process in vivo.

Thermal changes and drill wear in bovine bone during implant site preparation. A comparative in vitro study: twisted stainless steel and ceramic drills.

OBJECTIVES: The purpose was to assess thermal changes and drill wear in bovine bone tissue with the use of twisted stainless steel and zirconia-based drills, during implant site preparation. METHODS: A total of 100 implant site preparations were performed on bovine ribs using a surgical unit linked to a testing device, in order to standardize/simulate implant drilling procedures. Bone temperature variations and drilling force were recorded when drilling at a depth of 8 and 10 mm. A constant irrigation of 50 ml/min. (21±1°C) and drilling speed of 800 r.p.m. were used. Scanning electron microscopy analysis was preformed prior and after drilling. RESULTS: Mean temperature increase with both drills at 8 mm was 0.9°C and at 10 mm was 2°C (P<0.0001). Statistical significant higher bone temperatures were obtained with stainless steel drill (1.6°C), when comparing with the ceramic drill (1.3°C) (P<0.05). Temperature increase was correlated with higher number of perforations (P<0.05) and drilling load applied. There was no significant association between drilling force applied and temperature increase by either drill or at either depth. No severe signs of wear of either drill were detected after 50 uses. CONCLUSIONS: Drill material and design, number of uses, depth and drilling load applied appear to influence bone temperature variations during implant site preparation. Drilling depth was a predominant factor in bone temperature increase. Both drills can be used up to 50 times without producing harmful temperatures to bone tissue or severe signs of wear and deformation.

Abordaje intraoral en el síndrome de Eagle. Presentación de un caso clínico / Intraoral approach in Eagle syndrome. A case report

El síndrome de Eagle es una patología infrecuente secundaria a la elongación de la apófisis estiloides y/o calcificación del ligamento estilo-hioideo. La mayoría de pacientes afectados no presentan sintomatología, aunque la presión ejercida por esta estructura morfológicamente alterada contra estructuras vecinas puede desencadenar una gran variedad de síntomas, incluyendo dolor cervicofacial, sensación de cuerpo extraño en la orofaringe, aumento en la secreción salival, cefalea y dificultad para la deglución, el habla o los movimientos de la lengua. Presentamos el caso de una paciente de 50 años de edad con el síndrome de Eagle. La tomografía computerizada en haz de cono confirmó la sospecha clínica. Como tratamiento se realizó la resección parcial de ambas apófisis estiloides mediante un abordaje intraoral. La presentación clínica, el diagnóstico diferencial y el tratamiento se describen en este artículo(AU)

Eagle syndrome is a rare condition resulting from either the elongation of the temporal styloid process or calcification of the stylohyoid ligament. Most patients are asymptomatic, but when this structure presses against other parts of the head and neck it can originate a wide range of symptoms, including cervico-facial pain, foreign body sensation in oropharynx, increased saliva secretion, headache and difficulty with swallowing, speaking and neck or tongue movements. The case of a 50-year-old woman with Eagle syndrome is reported. Cone-beam computed tomography (CBCT) confirmed the clinical suspicion. The intraoral approach was used for the partial resection of both styloid processes. The clinical presentation, diagnosis, management and differential diagnosis are described(AU)

Effect of mono- and bimaxillary advancement on pharyngeal airway volume: cone-beam computed tomography evaluation.

PURPOSE: To evaluate pharyngeal airway volume changes after forward movements of the maxilla or mandible, or both, using cone-beam computed tomography. PATIENTS AND METHODS: A retrospective evaluation of 30 patients who underwent maxillomandibular advancement, maxillary advancement, or mandibular advancement was performed. Three groups of 10 subjects each were established: group 1, bimaxillary surgery (Le Fort I maxillary osteotomy and mandibular bilateral sagittal split osteotomy with maxillomandibular advancement); group 2, maxillary advancement (Le Fort I maxillary osteotomy); and group 3, mandibular advancement (bilateral sagittal split osteotomy). Pre- and postoperative cone-beam computed tomography scans were taken in each case, and the changes in pharyngeal airway volume were compared. RESULTS: A statistically significant increase in the pharyngeal airway volume occurred systematically. The average percentage of increase was 69.8% in group 1 and 78.3% in group 3. Group 2 exhibited a lower magnitude of increase (37.7%). CONCLUSION: Cone-beam computed tomography provides a new method for airway evaluation using a noninvasive, rapid, low-radiation, cost-effective scan. It seems the influence of mandibular advancement on the pharyngeal airway volume is greater than the effect of the forward movement of the maxilla.