Evaluation of Long-term Stability of Bilateral Sagittal Split Osteotomy in Individuals with Different Growth Patterns.

OBJECTIVE: Bilateral sagittal split osteotomy (BSSO) is a routinely used surgical step for the correction of a class III with mandibular prognathism. Many factors influence the stability of the surgical correction achieved. This study was designed to access the role of growth pattern in the surgical stability after a BSSO correction. MATERIALS AND METHODS: A total of 18 individuals (6 vertical growers, 6 horizontal growers, and 6 normal growing individuals) were considered for the study. Five parameters, horizontal plane (HP)-pogonion (POG) angle, HP-occlusal plane angle, POG height, POG depth, and Point B depth, were measured and compared postsurgically and in the follow-up phase. RESULT: Vertical growing individuals showed greater tendency for relapse and clockwise rotation of mandible postsurgically. No major difference was observed in the normal and horizontal growing individuals. When planning BSSO on vertical growing patient, utmost care should be taken to prevent posttreatment relapse to ensure better surgical stability.

Oropharyngeal Airway: The Orthodontist Perspective.

Dentofacial morphology can be altered by nasorespiratory obstruction depending on the magnitude, duration, and time of occurrence. More recent findings suggest that nasal-oral breathing per se is not necessarily harmful to craniofacial growth. However, in instances where the nasopharyngeal or oropharyngeal airspace is small, exaggerated postural responses in obligatory mouth breathers may be detrimental to craniofacial growth. Extended head posture which was observed in mouth breathers is found to influence the position of the mandible. Deviated nasal septum , allergies, chronic infection , hypertrophied inferior turbinates, adenoidal pad, and faucial tonsils hypertrophies are the common etiologicalfactors affecting the pharyngeal airway. The orthodontist will be the first clinician to attend the child to observe any change in the breathing pattern such as mouth breathing during examination or during the treatment. The cause of nasal obstruction in children can usually be determined by a thorough history and physical exam. The goals of the evaluation are to determine specific causes ofproblems, the severity of the obstruction, and the presence of associated medical complications. Rapid expansion exerts its effect by dilating the anterior nares, through the preferential expansion of the anteroinferior aspect of the nasal cavity. A mean decrease in nasal resistance has been demonstrated after surgical maxillary impaction. Airway can be evaluated by physical examination, functional examination, and different imaging techniques such as CT MR, cephalometry, acoustic reflection, nasal pharyngoscopy, and fluoroscopy. A multidisciplinary approach involving orthodontist, oral and maxillo facial surgeon, ENT surgeon, and sleep study researchers is needed for management.