Surgically assisted maxillary expansion with or without pterygoid disjunction alters maxillomandibular positioning.

PURPOSE: This study aimed to analyze alterations in mandibular positioning after surgically assisted maxillary expansion (SARME) with and without pterygoid disjunction (PD). METHODS: Cone-beam computed tomography scans of 24 healthy individuals (18-45 years old) with transverse deficiency, superior to 5 mm, underwent SARME with or without PD. The aspects prospectively assessed were (1) alignment and position of the head (ITK-Snap and 3D Slicer software); (2) McNamara's and Steiner-Tweed-Wits' cephalometric analysis (Dolphin Imaging®); and (3) colorimetric evaluation based on 3D correspondence analysis (3D Slicer software). RESULTS: A decrease in 1-NA and 1-SN angles as well as an increased occlusal plane in both groups was observed. Superior-inferior and anteroposterior spatial displacements of the chin were statistically significant in the PD group. Altered colorimetric patterns were also observed in the PD group. CONCLUSIONS: This study found more evident tooth inclination in the group without PD; mandibular alterations were more evident in the PD group. Further studies with 3D analysis are strongly recommended for more comprehensive results.

Effects of Pterygomaxillary Separation on Skeletal and Dental Changes After Surgically Assisted Rapid Maxillary Expansion: A Single-Center, Double-Blind, Randomized Clinical Trial.

PURPOSE: Surgically assisted rapid maxillary expansion (SARME) is a procedure routinely performed to correct transverse maxillary deformities and can be performed with or without pterygomaxillary disjunction (PD). The aim of the present study was to measure the effect of the amount of expansion and stability of SARME with or without PD. PATIENTS AND METHODS: We designed and implemented a double-blind, randomized clinical trial. The patients were randomly assigned to 2 groups: group 1, SARME without PD; and group 2, SARME with PD. Cone-beam computed tomography scans were performed at 3 points: baseline (T0), after maxillary expansion (T1), and at the end of the retention period (T2). Dental and bone expansion and dental inclination at the maxillary canine and first molar regions were assessed. Two-way repeated measures analysis of variance was used to evaluate the differences between the 2 groups at the 3 evaluation periods (T0, T1, and T2), using a level of significance of P < .05. RESULTS: A total of 24 patients underwent maxillary surgical expansion (group 1, n = 12; and group 2, n = 12). Both techniques promoted a significant transverse dental expansion in the first molar at T2 (with PD, 5.4 mm; vs without PD, 6.4 mm; change, -6.18 mm to 1.48 mm). However, no statistically significant differences were observed between the 2 groups. The tipping molars at T2 remained at a higher level in the SARME, no PD group than in the SARME, PD group (with PD, 2.3°; vs no PD, 4.6° for 3 teeth; change, -12.72° to 5.57°; and with PD, 1.6° vs without PD, 3.6° for 14 teeth; change, -9.96° to 9.83°). CONCLUSIONS: SARME with and without PD is a reliable method for obtaining maxillary expansion, with slight differences in the patterns of skeletal and dental alterations.

The use of Le Fort I Approach in the resection of an extensive ossifying fibroma.

INTRODUCTION: Ossifying fibroma (OF) is a well-defined benign neoplasm characterized by slow growth and predilection for the posterior mandible site, usually treated by conservative surgical approaches. In this context, Le Fort I Approach (LFIA) has been increasingly used providing good visualization and an easy access to the lesion. It also allows removal of the lesion quickly. Although there are case reports using LFIA for the management of benign neoplasms, odontogenic cysts and tumors of the middle third of face, to our knowledge, only one article describes the use of surgical LFIA for OF of the maxilla. Thus, the objective of this study was to report the second paper on the use of horizontal osteotomy of the maxilla in the resection of an extensive OF and conduct a brief literature review on this surgical approach. CASE REPORT: The following case report describes a 33-year-old man who was diagnosed with OF. Oral examination showed a painless swelling of hard consistency, covered by normal mucosa in edentulous alveolar ridge of the maxillary posterior region of the right side. Tomographic slices revealed that the image with mixed density had a centrifugal growth, with expansion of the buccal and lingual cortical with an upper displacement of the maxillary sinus. The patient was admitted to the hospital for surgical resection of the lesion via LFIA. Satisfactory functional results were obtained after 18-month follow-up period. In addition, no recurrence or clinical complaints were noted. DISCUSSION: LFIA shall be considered as a feasible option when planning surgery for removal of extensive benign lesions located in midfacial region because it is a predictable technique and routinely performed by the oral and maxillo-facial surgeons.