Evaluation of Stomatognathic System Parameters After Bariatric Surgery.

PURPOSE: The present study aimed to evaluate electromyographic activity, bite strength, and masticatory muscle thickness in women without obesity and with severe obesity elected for bariatric surgery. Also, patients with obesity underwent bariatric surgery and were re-evaluated 3 and 6 months after surgery to analyze the influence of bariatric surgery outcomes on the stomatognathic system, a functional anatomical system comprising teeth, jaw, and associated soft tissues. MATERIAL AND METHODS: Thirty-seven women were enrolled in the study. Twenty-one women with class II and III obesity according to the body mass index (BMI) and eligible for bariatric surgery composed the obesity pre-surgery group (Ob). Sixteen women with a normal weight according to BMI composed the non-obesity group (NOb). Afterward, the patients from the Ob group were followed up for 3 and 6 months after undergoing Roux-en-Y gastric bypass. Anthropometry, body composition, and parameters of the stomatognathic system were evaluated. RESULTS: The stomatognathic system of the Ob group had less muscle activity and bite strength, but the thickness of masseter and temporal muscles was larger than the NOb group. We also observed a significant change in the muscular activity and bit strength of the stomatognathic system post-bariatric surgery. CONCLUSION: Evaluating the stomatognathic system indicated that women with clinically severe obesity have less masticatory efficiency than non-obese. Also, we found a positive influence of bariatric surgery in masticatory activity after 3 and 6 months. Thus, monitoring the parameters of the stomatognathic system could be important in the indication and outcomes of bariatric surgery.

Transfacial transmandibular approach to the masticator space: Excision of odontogenic myxoma arising from the mandibular condyle.

Odontogenic myxomas are an uncommon benign odontogenic tumor that can present with a wide variety of symptomatology depending on location and potentially be locally destructive. The present case describes a 66-year-old female who presented with left lower facial paresthesia, left aural fullness and hearing loss. She was found to have an odontogenic myxoma that involved the condylar head and extended into the masticator space. In this report we detail our surgical approach utilizing a preauricular transfacial transmandibular approach to the masticator space. In addition, we will discuss various approaches to the masticator space and infratemporal fossa along with considerations on how to manage facial nerve paralysis, facial contour deformities, and post-operative rehabilitation for permanent unilateral condylar head disarticulation.

Fonoaudiologia e cirurgia ortognática: revisão de literatura / Speech therapy and orthognathic surgery: a literature review

Introdução: As deformidades dentofaciais estão associadas às alterações de oclusões dentárias, que podem causar modificações no sistema miofuncional de acordo com o tipo de desproporção. Essas deformidades, podem provocar alterações e/ou adaptações no sistema estomatognático. O objetivo desse estudo foi identificar, com base na literatura arbitrada, a relação entre a Fonoaudiologia e a Cirurgia Ortognática. Método: Foi realizado levantamento bibliográfico sem período específico, nas bases de dados PubMed, SciELO e BVS. Resultados: Foram avaliados 15 artigos de forma crítica, quanto ao tipo de estudo, seus objetivos, número e gênero dos participantes, metodologia, resultados e conclusões. Os artigos foram agrupados com base nos seus objetivos em 1) Grupo Fonoaudiologia (GF); 2) Grupo Mudanças (GM); 3) Grupo Técnicas (GT) e 4) Grupo Outros (GO). Conclusão: Pouco se encontrou sobre a intervenção fonoaudiológica direta, sendo a maioria dos estudos direcionada às mudanças estéticas e funcionais do tecido duro e mole de pacientes submetidos à cirurgia ortognática. Houve também estudos que abordaram métodos e/ou exames específicos para verificar as mudanças nos tecidos moles e duros do perfil facial dos pacientes submetidos à cirurgia ortognática e estudo que detalhou o perfil dos indivíduos que realizaram tratamento para deformidade dentofacial e síndrome da Apneia e Hipopneia do Sono.

Introduction: Dentofacial deformities are associated with changes in dental occlusion, which may cause changes in the myofunctional system according to the type of disproportion. These deformities can cause changes and/or adaptations in the stomatognathic system. The objective of this study was to identify the relationship between speech therapy and orthognathic surgery based on refereed publications. Method: A bibliographic survey was conducted without considering a specific publication period in the databases, PubMed, SciELO and BVS. Results: Fifteen articles were critically evaluated with respect to the type of study, objectives, number and sex of participants, methodology, results and conclusions. Based on their aims, the articles were grouped into 1) speech-therapy group (STG); 2) changes group (CG); 3) techniques group (GT) and 4) others group (OG). Conclusion: There is little information regarding direct speech therapy intervention, and the majority of the studies were directed to the aesthetic and functional changes in the hard and soft tissue in patients who underwent orthognathic surgery. Some studies addressed methods and/or specific examination procedures to verify the changes in the soft and hard tissues of the facial profile of patients who underwent orthognathic surgery, and a study detailed the profile of individuals who underwent treatment for dentofacial deformity and apnea-hypopnea syndrome.

[Masticatory system and maxillofacial prosthesis: From pathology to function recovering]. / Appareil manducateur et prothèse maxillo-faciale : de la pathologie à la fonction retrouvée.

Maxillofacial prosthesis (MFP) can be defined as the art and science of esthetic and functional reconstruction of the facial bones, art because it uses hand-crafted and empirical rules, science because of its technical rigorism and its integration in medicine. MFP aims to multidisciplinary rehabilitate patients presenting with cutaneous and underlying structures defects, It also allows for functional speech and swallowing rehabilitation related to temporo-mandibular joint disorders. Whatever the origin, (traumatic, infectious ortumoral), surgical treatment of these TMJ disorders is usually not indicated in first-line. Functional treatment is often sufficient if started early in an observant patient. The aim of our article was to present the different types devices available for the rehabilitation of the masticatory system according to pathology. The first part will treat about the preservation of the TMJ range of motion in a preventive way. A second part will treat about the possibilities to recover the range of motion in a curative way. A third part will treat about mandibular reposition. At last, we will focus on the devices allowing for mandibular kinetic rehabilitation in adults and in a special pediatric case.

Diode endovascular laser treatment in venous malformations of the upper aerodigestive tract.

PURPOSE: Venous malformations of the upper aerodigestive tract can cause pain, dysphagia, obstructive sleep apnea, and rarely bleeding. We studied 980-nm diode endovenous laser therapy. MATERIAL AND METHODS: This is a 2007-2014 retrospective study in our vascular anomalies center. Data on patients' clinical history, polysomnography, magnetic resonance imaging, and treatment were collected. Patients were contacted for Epworth Sleepiness Scale and Eating Assessment Tool (EAT-10) scores to evaluate sleepiness and dysphagia before and after laser therapy. RESULTS: We included 32 patients (mean age 41 years) presenting with obstructive sleep apnea (n = 18) and dysphagia (n = 13). With a mean follow-up of 39 months, average Epworth Sleepiness Scale score fell from 17.3 to 10.4 (p = 0.015), EAT-10 score from 8.2 to 3.5 (p = 0.002) and apnea-hypopnea index from 47.5 to 24.7 (p = 0.01). Of the sleep apnea patients, 89% required continuous positive airway pressure before and 50% afterward (p = 0.016). CONCLUSIONS: Diode endovascular laser treatment seems to be a safe and effective treatment option in venous malformations of the upper airways.

Evaluation of the saliva cortisol levels in patients under prosthetic treatment due to functional disorders of the masticatory organ.

One of the main etiological factors of the stomatognathic system dysfunction is stress and psychoemotional disorders. During stressful situations, there is an increase in the level of cortisol, the so-called stress hormone. Literature data indicate the existence of a correlation between blood cortisol levels and its amount in the saliva. This spurred an inspiration to undertake open, non-randomised studies, the objective of which was to conduct a comparative assessment of the saliva cortisol levels in patients with functional disorders of the masticatory system and in healthy volunteers, as well as to compare the results of cortisol levels with the results of survey-based tests with the use of Endler and Parker's CISS survey. Cortisol level was assessed due to its association with stress present in the body as one of the primary etiological factors of the stomatognathic system dysfunction, and hence the association of elevated cortisol levels assessed in the morning with the occurrence of dysfunctions of the stomatognathic system. The subject of the study is a group of 30 patients, of both sexes, aged between 20 and 46, who reported to the Dental Prosthetic Out-Patient Clinic of the Institute of Dentistry, Jagiellonian University in Cracow, for prosthetic treatment due to the painful form of functional masticatory organ disorders. The control group consisted of 30 subjects, aged between 19 and 41, in whom dysfunctions of the stomatognathic system were excluded. Collection of saliva for testing was performed at a fixed hour (9 am) into plastic test tubes with a stopper. Immediately after collection, the saliva was frozen at the temperature of -18 °C. The assessment of the cortisol levels was conducted by the high performance liquid chromatography (HPLC) with UV detection at the Department of Analytical Chemistry, Faculty of Pharmacy, Department of Laboratory Medicine of the Gdansk Medical University. Moreover, a 20-minute psychological test was conducted with the use of the CISS (coping inventory for stressful situations) survey in order to assess the patients in terms of their abilities to cope with stressful situations. The results obtained were submitted to a statistical analysis based on the conventional calculation procedures. The test group revealed significantly higher cortisol levels compared with the results obtained by the control group. The findings of the CISS survey confirmed the predominance of the emotion-focused strategy of coping with stressful situations in the test group. The results support the view that the psychoemotional factor is, to a considerable extent, conducive to the development of functional disorders. The elevated cortisol levels in patients with psychological disorders concur with the findings by other authors. The results obtained confirm that psychoemotional disorders may be one of the etiological factors of the stomatognathic system dysfunctions. The CISS survey, which was not used in similar studies before, makes it possible to obtain information on the subject's method of coping with stress, thus allowing for the initiation of a relevant psychological therapy aiding the prosthetic treatment.

Alterações do sistema miofuncional orofacial na síndrome de Parry-Romberg: revisão crítica da literatura / Alterations of the myofunctional orofacial system in the Parry-Romberg syndrome: a critical literature review

INTRODUÇÃO Esta revisão qualitativa da literatura analisou publicações científicas internacionais sobre possíveis alterações miofuncionais orofaciais em pacientes acometidos pela Síndrome de Parry-Romberg, por meio da base de dados PubMed. MÉTODOS: O levantamento realizado limitou-se a seres humanos, de qualquer faixa etária, no idioma inglês, entre os anos 2002 e 2012. As publicações sem acesso completo, repetidas por sobreposição das palavras-chave, revisões de literatura, cartas ao editor e as não relacionadas diretamente ao tema foram excluídas. RESULTADOS: Foram identificados 719 estudos, sendo 21 dentro dos critérios estabelecidos. Com base nos estudos selecionados, pacientes acometidos pela Síndrome de Parry-Romberg podem apresentar alterações dos tecidos mole e duro, tais como atrofia dos músculos esternocleidomastoideo, masseter e pterigoideos; atrofia na região da bochecha e depressão da prega nasolabial; desvio dos lábios e nariz; atrofia unilateral da língua; atrofia do ângulo da boca; reabsorção progressiva do osso da maxila e da mandíbula; atrofia do arco zigomático, do osso frontal e assimetria facial; desenvolvimento atrófico das raízes ou reabsorção patológica dos números de dentes permanentes; redução da mandíbula e erupção atrasada dos dentes superiores e inferiores. CONCLUSÃO: Apesar do crescente interesse pelo diagnóstico e pela descrição sintomatológica de indivíduos com Síndrome de Parry-Romberg, a escassez de publicações que abordem tratamentos funcionais e interdisciplinares é evidente. Verifica-se a necessidade da realização de estudos mais específicos que visem à melhoria da qualidade de vida desses pacientes.

INTRODUCTION This qualitative literature review analyzed international scientific publications on possible orofacial myofunctional alterations in patients with Parry-Romberg syndrome by using PubMed. METHODS: The survey was conducted in English, between 2002 and 2012, and was limited to human beings of any age. Publications without full access, duplicated by overlapping keywords, literature reviews, letters to the editor, and those not directly related to the research topic were excluded. RESULTS: We identified 719 studies, of which 21 were within the established criteria. Based on the selected studies, patients with Parry-Romberg syndrome may show changes in soft and hard tissues such as atrophy of the sternocleidomastoid, masseter, and pterygoid muscles; atrophy in the cheek region and depression of the nasolabial fold; deviation of the lips and nose; unilateral tongue atrophy; atrophy of the mouth angle; progressive resorption of the maxilla and mandible bone; atrophy of the zygomatic arch and frontal bone, and facial asymmetry; atrophic root development or pathological resorption of permanent tooth numbers; and jaw reduction and delayed eruption of the upper and lower teeth. CONCLUSION: Despite the growing interest in the diagnosis and symptomatic description of individuals with Parry-Romberg syndrome, publications that address functional and interdisciplinary treatments are scarce. Therefore, specific studies aimed at improving the quality of life of these patients are needed.

Sistema miofuncional orofacial e trauma de face: revisão crítica da literatura / Changes in the orofacial myofunctional system after treatment for facial trauma: a critical review of the literature

Introdução: Esta revisão qualitativa da literatura levantou publicações científicas internacionais sobre a funcionalidade do sistema miofuncional orofacial nos traumas faciais, por meio da base de dados PubMed. Método: O levantamento realizado limitou-se a seres humanos, de qualquer faixa etária, no idioma inglês, entre os anos de 2005 e 2011. As publicações sem acesso completo, repetidas por sobreposição das palavras chave, estudos de caso, revisões de literatura, cartas ao editor e as não relacionadas diretamente ao tema foram excluídas. Resultados: Foram identificados 831 estudos, sendo 14 dentro dos critérios estabelecidos. Notou-se que a avaliação mais frequente foi a da função mandibular e depois análise de tratamentos; ocorreu mais fratura no côndilo que ângulo mandibular; utilizou-se mais tratamento cirúrgico juntamente com o conservador, seguido pelo somente cirúrgico e finalmente somente conservador; a maior incidência de traumas faciais foi em adultos do sexo masculino; poucas pesquisas foram realizadas com crianças e grupo-controle; utilizaram-se mais avaliações da função mandibular e clínicas, na maioria pré e pós-cirurgia; a força de mordida e a área oclusal apresentaram melhora póstratamento, no entanto a assimetria mandibular permaneceu; os valores de abertura máxima da boca atingiram a normalidade, porém inferiores ao grupo-controle; houve persistência de alterações na mobilidade mandibular e dor, mesmo após o tratamento; e a terapia miofuncional melhorou o quadro de alterações. Conclusão: É necessário mais publicações sobre o tratamento fonoaudiológico baseado na abordagem miofuncional orofacial nos traumas faciais.

Introduction: This qualitative literature review aims to highlight international scientific publications selected from the PubMed database that describe the changes in the function of the orofacial myofunctional system after facial trauma and the associated treatment outcomes. Methods: Studies published in English between 2005 and 2011 and including individuals of all age groups were included in this review. Publications that were not open access, studies appearing more than once because of overlapping keywords, case studies, literature reviews, letters to the editor, and studies that were not directly related to the subject were excluded. Results: A total of 831 studies were identified, 14 of which fulfilled the established criteria. Assessment of jaw function was the most frequent evaluation performed in the included studies, followed by the analysis of treatments. The incidence of condylar fractures was higher than that of mandibular angle fractures. The majority of cases were managed by surgery combined with conservative treatment, followed by surgery alone and conservative treatment alone. Adult men exhibited a higher incidence of facial trauma. Few studies included children or control groups. Further assessment of jaw and clinical functions before and after surgery revealed the following findings. The bite force and occlusal contact area improved after treatment, whereas mandibular asymmetry persisted even after surgery. The maximum mouth opening returned to normal after treatment, although the range of mouth opening was lower in patients with facial trauma than in controls. Persistent mobility in the mandibular teeth and pain were observed even after treatment. Myofunctional therapy resulted in an overall improvement in jaw function. Conclusions: Although the number of studies on facial trauma is increasing, few studies address the use and benefits of orofacial myofunctional therapy in this field. Further studies on orofacial myofunctional therapy combined with surgery and/ or conservative treatment for facial trauma are necessary.

The rise of transoral robotic surgery in the head and neck: emerging applications.

The use of robotics in the field of head and neck surgery has provided surgeons with the ability to access anatomic locations that were previously only managed via open techniques. This has resulted in decreased overall morbidity, excellent functional results and the promise of equivalent oncologic outcomes. Transoral robotic surgery (TORS) provides access to the oropharynx, hypopharynx, larynx, oral cavity, parapharyngeal space and skull base vial the oral aperture. Studies reviewing the application of TORS to these subsites have been promising, and for many applications TORS has been accepted as a safe and efficacious option for surgical management. However, despite these promising results, TORS remains a surgical instrument that requires sound surgical skill, clinical judgment and oncologic principles, and should be chosen based on the needs of the individual patient and the comfort of the treating surgeon. In this article, we review the history of TORS, relevant anatomy and provide a review of the literature, highlighting the applications, advantages, functional outcomes and disadvantages of TORS for each anatomic subsite.

Exploring CBCT-based DICOM files. A systematic review on the properties of images used to evaluate maxillofacial bone grafts.

Previous studies suggests that cone beam computerized tomography (CBCT) images could provide reliable information regarding the fate of bone grafts in the maxillofacial region, but no systematic information regarding the standardization of CBCT settings and properties is available, i.e., there is a lack of information on how the images were generated, exported, and analyzed when bone grafts were evaluated. The aim of this study was to (1) do a systematic review on which type of CBCT-based DICOM images have been used for the evaluation of the fate of bone grafts in humans and (2) use a software suggested in the literature to test DICOM-based data sets, exemplifying the effect of variation in selected parameters (windowing/contrast control, plane definition, slice thickness, and number of measured slices) on the final image characteristics. The results from review identified three publications that used CBCT to evaluate maxillofacial bone grafts in humans, and in which the methodology/results comprised at least one of the expected outcomes (image acquisition protocol, image reconstruction, and image generation information). The experimental shows how the influence of information that was missing in the retrieved papers, can influence the reproducibility and the validity of image measurements. Although the use of CBCT-based images for the evaluation of bone grafts in humans has become more common, this does not reflect on a better standardization of the developed studies. Parameters regarding image acquisition and reconstruction, while important, are not addressed in the proper way in the literature, compromising the reproducibility and scientific impact of the studies.

Functional outcomes of free tissue transfer in head and neck cancer reconstruction.

Free tissue transfer with microvascular anastomosis has transformed surgical outcomes for head and neck cancer patients. Microvascular reconstruction has allowed surgeons to perform more aggressive ablative surgery. This paper considers the extent to which this method of reconstruction has improved functional outcomes in these patients.

Estudio biomecánico experimental del sistema musculo-esquelético masticatorio. Aplicaciones para el estudio de la osteosíntesis / Experimental Biomechanical Study of the Musculo-Skeletal Masticatory System. Applications to the Study of Osteosynthesis

El comportamiento biomecánico del sistema músculoesqueléticodista mucho de estar esclarecido. Los modelos matemáticos han mostradoimportantes limitaciones, y los ensayos biomecánicos se han visto frustradospor la dificultad de simular las cargas musculares y la distribución delas tensiones en el espesor mandibular. En el presente trabajo se desarrollaun simulador estático del sistema músculo esquelético masticatorio que reproducefielmente la situación fisiológica, empleándose la foto elasticidad tridimensionalpara el estudio de los cambios tensionales que ocurren en laestructura mandibular en diversas situaciones fisiopatológicas. Los resultadosde los ensayos demuestran que la fotoelasticidad 3D aplicada en el simuladorda resultados muy útiles para el análisis de la aplicación hueso-materialde osteosíntesis utilizado en la práctica clínica(AU)

The biomechanical behavior of the masticatory system isnot well known. The mathematical models that have been developedto date are limited and experimental studies have not yet solvedthe problem of reproducing muscular forces and stress distributionsin the internal mandibular structure. A static simulator of themasticatory system was developed in the present study and threedimensionalphotoelasticity was used to analyze stress distributionin several physiologic and pathologic situations. The results showedthat the simulator and 3D photoelasticity were useful for studyinginteractions and ostheosynthesis materials used in daily clinicalpractice(AU)

Functional outcomes after free flap reconstruction of the upper aerodigestive tract.

PURPOSE OF REVIEW: When the complex structures of the upper aerodigestive tract are disrupted after resection of head and neck tumors, an appropriate reconstructive option should be chosen in an attempt to regain maximum function. Reconstructions using microvascular free tissue transfer offer unparalleled flexibility, both in tissue composition and in placement. This article will examine functional outcomes after free flap reconstruction of the upper aerodigestive tract. RECENT FINDINGS: With the maturation of free tissue transfer techniques, functional outcomes are being analyzed with increasing frequency. Recent reports show promising results for free flap reconstruction of oral cavity, oropharyngeal, and hypopharyngeal soft tissue defects, as well as for bony mandibular and maxillary defects. SUMMARY: For both soft tissue and bony defects of the upper aerodigestive tract, microvascular free flaps provide good functional outcomes. In the future, randomized studies are needed to compare the functional outcomes of microvascular free flaps with those of other reconstructive options.

Surgical strategies in the treatment of complex obstructive sleep apnoea in children.

Complex OSA in children is a challenging problem that requires careful team management. Evaluation includes history, physical examination and appropriate radiological and endoscopic studies. Twelve-channel polysomnography, with or without a pH probe, is mandatory in children with OSA to determine the severity and to document the efficacy of treatment. A variety of individual problems and nuances arise and will continue to do so. Clinical experience and a high degree of suspicion in the craniofacial population is necessary to rule out the existence of OSA in a given patient. Newer treatment modalities, such as distraction osteogenesis of the mandible and midface, have revolutionised treatment of OSA during childhood. Although still the gold standard of care, tracheostomy is not a benign procedure and the toll on both the patient and family can be devastating.

Proposición de técnica de corrección del mentón y ángulo goniaco recto / Proposal of chin correction technique and straight gonial angle

Se presenta a una paciente con deformidad facial consistente en tener el ángulo goniaco recto y prominente y la altura facial del tercio inferior disminuido. Esta paciente fue estudiada por el equipo de cirugía ortognática, llegándose mediante el estudio clínico y cefalométrico al diagnóstico y a su planificación quirúrgica. Se presenta esta técnica quirúrgica que consistió en conformar previamente sobre los calcos cefalométricos la plantilla del hueso a retirar en la ostectomía, cuyos segmentos óseos utilizamos para aumentar la altura del tercio inferior de la cara, no utilizándose injertos de otras regiones corporales como la cresta iliaca por ejemplo. Se obtuvo una ejecución quirúrgica más viable, de corta duración, y con excelentes resultados, al ser el hueso injertado de la misma mandíbula. Se aprecian los resultados favorables desde el punto de vista estético(AU)

It is presented a patient with facial consistent deformity in having the straight prominent gonial angle and the lower third facial height decreased. Throughout a clinical and cephalometric diagnosis and its surgical planning, this patient was studied by the team of orthognathic surgery. It is reported this surgical technique that consisted on preforming on cephalometric rubbings the template of the bone to withdraw in the ostectomy which bone segments are used to increase the height of the lower third of the face, there is no use of grafts of other bodily regions such as the iliac crest . A more viable surgical execution was obtained; it had a short duration, and with excellent results, as the grafted bone was of the jaw itself. From the aesthetic point of view, the results are also appreciated(AU)

Proposición de técnica de corrección del mentón y ángulo goniaco recto / Proposal of chin correction technique and straight gonial angle

Se presenta a una paciente con deformidad facial consistente en tener el ángulo goniaco recto y prominente y la altura facial del tercio inferior disminuido. Esta paciente fue estudiada por el equipo de cirugía ortognática, llegándose mediante el estudio clínico y cefalométrico al diagnóstico y a su planificación quirúrgica. Se presenta esta técnica quirúrgica que consistió en conformar previamente sobre los calcos cefalométricos la plantilla del hueso a retirar en la ostectomía, cuyos segmentos óseos utilizamos para aumentar la altura del tercio inferior de la cara, no utilizándose injertos de otras regiones corporales como la cresta iliaca por ejemplo. Se obtuvo una ejecución quirúrgica más viable, de corta duración, y con excelentes resultados, al ser el hueso injertado de la misma mandíbula. Se aprecian los resultados favorables desde el punto de vista estético

Cirugía ortognática. consideraciones anestésicas / Orthognatic surgery: anesthetic considerations

Se realiza un estudio acerca del método anestésico utilizado en 15 pacientes que se les efectuó cirugía ortognática en el Servicio de Cirugia Maxilofacial del Hospital Clinicoquirúrgico "10 de Octubre". Se enfatizaron aspectos fundamentales en la conducción transoperatoria de estos pacientes. Se exponen las conclusiones