Efficacy and stability of the alar base cinch suture.

The alar base cinch suture is designed to prevent excessive flaring of the nose after Le Fort 1 osteotomy of the maxilla. However, it is difficult to measure the effect of the suture on nasal width during the operation in the presence of a nasal endotracheal tube, and the long-term stability of the manoeuvre has not been well-documented. We have investigated the efficacy and stability of the alar base cinch suture by measuring nasal width in 36 patients before, during, and 12 months after, bimaxillary surgery with submental intubation. The use of submental intubation facilitated accurate measurement of the changes in nasal width produced by the osteotomy and the cinch suture. Intraoperative measurements showed that there was a mean increase in the width of the base of the nose of 3.0 mm, 9% (right and left alar points, al-al) and 3.6 mm, 11% (right and left alar curvature points, ac-ac) after the osteotomy, and that the cinch suture produced a reduction in these increases of 1.6 mm, 53% (al-al), and 2.1 mm, 58% (ac-ac). Measurements taken after the operation at 3, 6, and 12 months showed no significant changes. This indicates that our method of cinch suturing is effective in mitigating the increase in nasal width that is produced by the osteotomy, and that this effect is stable in the medium term.

Quantitative use of photography in orthognathic outcome assessment.

This study reports an independent audit of two aspects of orthognathic surgery, namely control of inter-alar width and mandibular outline asymmetry. Measurements were taken from standardized photographs of a consecutive series of 27 patients, using an on-screen digitizing program (IPTool). All patients had undergone bimaxillary osteotomies involving maxillary impaction and/or advancement, by one surgeon, using a cinch suture for nasal width control. Nine-twelve months after surgery, inter-alar width had increased by just 0.08 cm mean (SD 0.3). Four patients showed an increase of just over 2mm, whilst six showed a small reduction. Based on ratios of size (area) and shape (compactness) of the right and left mandibular segments, there was a small overall improvement in mandibular symmetry (0.019 and 0.005 respectively). Whilst in most of the patients the need for surgery was primarily the correction of antero-posterior and vertical discrepancies, five patients with demonstrable asymmetry showed a clear improvement. In three patients whose asymmetry scores were very mild pre-treatment, there was a small, measured increase in asymmetry, but not to a degree that would be clinically noticeable. At a time when 3D imaging is still unavailable to many clinicians, the results of this study suggest that appropriate measurements taken from carefully standardized conventional photographs can provide a valid and objective means of assessing treatment outcome.

Natural head posture--considerations of reproducibility.

This three-part study investigated the reproducibility of natural head posture (NHP) using radiographs and photographs. In part 1, reproducibility of cephalograms 1 year after the introduction of NHP was investigated and found to be less favourable (Dahlberg coefficient of 2.99 degrees) than most other previous investigations. In order to minimize radiation exposure of patients, reproducibility of photographs and method agreement between photographs and cephalograms were investigated in part 2. Reproducibility of the two photographs was poor (2.71 degrees). However, method agreement between cephalograms and the photographs taken at the same time was good (1.39 degrees). Replacement of the radiographic method with the photographic method for assessing NHP reproducibility appeared justified. Changing the protocol for achieving NHP in part 3 of the study improved reproducibility substantially (1.41 degrees). Various statistical methods were used to assess reproducibility and method agreement. Bland and Altman's graphical representation was found to be the most appropriate for method agreement. The Dahlberg coefficient, commonly used to assess NHP repeatability/reproducibility, does not provide an extreme enough interval to allow a sufficient clinical assessment of a method to be undertaken, compared with the reproducibility coefficient. That is, the latter provides a 95 per cent range, compared with 52 per cent with Dahlberg.

Background considerations to facial aesthetics.

This paper examines the nature of our objectives in attempting to improve facial appearance. Questions are addressed concerning the basis for any collective agreement on "improvement" and the nature of an agreed "ideal", including an exploration of the reasons for its existence. The discussion focuses on the concept of "averageness", as well as supplementary hypotheses. Finally, the origins and validity of contemporary clinical guidelines are addressed.

Task Group for Orthodontics Report.

The UK Specialist Review Group of the General Dental Council's Education Committee has been charged with taking forward the recommendations in the Chief Dental Officer's report 'UK Specialist Dental Training'. The Specialist Review Group has, in turn, established a number of specialty task groups. This report is from the Task Group for Orthodontics. It was submitted in May 1996.

Problems in the orthodontic management of orthognathic cases.

The planning and management of orthodontic treatment for patients requiring surgery is considered in the light of a variety of problems that occur commonly, but have not received much attention in the literature. These problems can be categorized into dental, skeletal, and soft tissue varieties, and some cases are presented in illustration. The occasional need for compromise in treatment planning is suggested and the limitations of an excessive dependence on cephalometrics are discussed.

Dental and skeletal ages in hypopituitary patients.

Skeletal and dental ages were radiographically determined in 14 cases of confirmed growth hormone deficiency. The cases were in the 6.5- to 12-year-age group, and were receiving hormone therapy. Delay in skeletal age ranged from 24.8 to 32.3%, the average being 27.9%. There was very much less delay in dental age, ranging from only 4.3 to 19.7%; the average delay being approximately 9%. Most cases thus fell within normal limits. Seven patients had dental ages assessed before therapy and their dental age delays were comparable to those of the group as a whole. The four patients in the 12-year-old group showed a greater dental age delay then did the others. This could have been simply due to individual variation, or this delay could possibly support the view that dental development does become androgen dependent at puberty. None of the radiographs examined revealed any defects in dental development as has been reported elsewhere. While the small normal patient followed the general trend, the three low birth weight patients did not and it would not be instructive to measure the dental ages of larger numbers of these cases.