Effect of Orthognathic Surgery on the Posterior Airway Space in Patients Affected by Skeletal Class III Malocclusion.

INTRODUCTION: Dentofacial deformity refers to deviations from normal facial proportions and dental relationships that are severe enough to be handicapping. These anomalies involve many aspects of patient's life and are sometimes also associated with a reduction of pharyngeal air space. Through orthognathic surgery it is possible to treat dentofacial deformities: this kind of surgery has several effects on skeletal structures and it has changes, as it is demonstrated by many studies, also on the upper airways. The orthognathic surgeries commonly used to correct this deformity are the mandibular setback and the maxillary advancement procedures. This study aims to evaluate the effects of maxillary and mandibular surgery on pharyngeal airway dimensions in skeletal class III malocclusions. MATERIALS AND METHODS: This study considers 76 patients, treated between 2007 and 2013 by maxillary advancement (11 patients), maxillary advancement and mandibular setback (39 patients), maxillary advancement, mandibular setback and genioplasty reduction (26 patients). Cranial latero-lateral radiography was used to compare oropharyngeal airway morphologies before and 1 year after surgery. CONCLUSION: The surgeon should consider bimaxillary surgery rather than mandibular setback surgery to correct a class III deformity to prevent the development of obstructive sleep apnea syndrome; in fact, bimaxillary surgery might have less effect on reduction of the pharyngeal airway than mandibular setback surgery only.

Maxillary Sinus Augmentation with Autologous and Heterologous Bone Graft: A Clinical and Radiographic Report of Immediate and Delayed Implant Placement.

PURPOSE: The aim of this study was to evaluate cumulative survival rate of implants placed on augmented maxillary sinus using a mixture of autologous bone harvested from the maxillary tuberosity and bovine-derived HA and to assess the height of the grafted material through radiographic evaluation. METHODS: Thirty-five patients were treated with maxillary sinus augmentation and 93 implant fixtures were installed. The height of the augmented sinus and the gain of bone volume were measured by Cone Beam CT Scan and intraoral radiographs immediately after augmentation and up to 48 months subsequently. Changes in the height of the sinus graft material were calculated radiographically. RESULTS: The cumulative survival rate was 98.92 % in all 93 implants. Additionally, normal healing process without any complication was observed in all patients. The original sinus height was a mean of 4.52 mm (range 2.0-6.4 mm) and the augmented sinus height was a mean of 14.1 mm (range 12.0-16.5 mm) after the surgery. The bone volume gain was a mean 9.613 mm (range 7-13 mm). CONCLUSIONS: Within the limitations of this study, it would appear from the clinical and radiographic results that the sinus lift procedure with autologous bone graft harvested from the maxillary tuberosity combined with deproteinized bovine bone allows for a predictable outcome regarding the amount of bone formation in sinus floor augmentation and the immediate placement of implants, when possible, is recommended.

Augmentation of atrophic posterior maxilla by short implants and osteotome technique.

UNLABELLED: INTRODUCTION. Edentulous ridge in the posterior maxilla is often compromised by reduced bone volume. This anatomical condition limits the implant placement of 10 mm in length without sinus augmentation. The use of shorter implants with osteotome technique minimizes the need of more extensive sinus floor elevation, thus reducing the duration and morbidity of the treatment. MATERIALS AND METHODS. A prospective study was conducted of all patients treated between Nov 2007 and Nov 2008 who received endosseous implants that were less than 10 mm in length. Patient age, gender, height bone residual of posterior maxilla, location of implants, number and type of implants and Albrektsson criteria for success were assessed. RESULTS: A total of 25 implants of 8 mm in length were placed with primary stability in 11 patients. Cumulative survival rates for implants were 100%. CONCLUSION. This simplified treatment modality can make implant rehabilitation of the atrophic posterior maxilla more accessible.

Nasolabial changes after maxillary advancement.

BACKGROUND: Improving facial aesthetics has been shown to be a strong motivating factor in patients who decide to undergo orthognathic surgery. The nasolabial region is a keystone of facial aesthetics and thus is of central importance in planning and execution of orthognathic surgery. This article was performed to study modifications of nasolabial area after maxillary advancement. METHODS: Forty-two patients undergoing orthognathic surgery were considered. In those patients, after Le Fort I osteotomy, only maxillary advancement was performed. RESULTS: For each patient, several points in the nasolabial area were marked, and the distances between these landmarks were measured before and 6 months after surgery. CONCLUSIONS: The outcomes of this study show a general trend in the widening of the alar base with an associated shortening of the columellar length and lengthening of the base of the nose.

Plates removal in orthognathic surgery and facial fractures: when and why.

BACKGROUND: There is agreement that symptomatic plates should be removed, but there is no consensus among maxillofacial surgeons on the need for routine removal of asymptomatic plates. Only by evaluating long follow-up studies conducted with large-volume data that guidelines about when to remove and why remove plates used for internal rigid fixation can be traced. MATERIALS AND METHODS: This study was conducted as a retrospective study. Clinical findings of all the patients presented at the department of maxillofacial surgery of 2 Italian hospitals, in whom miniplates were inserted between January 2004 and December 2007, were included: a follow-up of these patients was conducted until August 2009. RESULTS: The region most involved with plates' insertion was the upper maxilla (49.8%), followed by mandibular body (38.1%), angle (7.9%), condyle (2.4%), and symphysis (1.8%). The region most involved in plates' removal was the maxilla in 9%, followed by mandibular body in the 7.5%. All plates inserted in angle regions were removed. Plates placed in the condylar area did not need any plate removal. CONCLUSIONS: From this study, there is no evidence to support the advice for routine removal of titanium miniplates from the maxillofacial skeleton, although when using plates in the mandibular angle region, it would be necessary to inform the patient about the very high probability of a second operation necessary for the plates' removal.

Warthin tumor: a potential source of diagnostic error.

PURPOSE: Warthin tumor, also known as papillary cystadenoma lymphomatosum, is a fairly common tumor. It makes up 14% to 30% of parotid tumors. There has been much interest in this tumor because of its typical and intriguing morphologic features: the association of benign-looking lymphoid and epithelial components and its frequent occurrence in the intraparotid or periparotid lymph nodes. Moreover, multifocal and/or bilateral Warthin tumors have been reported, and malignant transformation of Warthin tumor and its association with other malignancies have been documented. Warthin tumor can sometimes be confused with other pathologic lesions because of symptoms and signs that accompany the disease, so it could be treated as other pathologic lesions. PATIENTS AND METHODS: We present 3 patients. The first one had a differentiated squamous cell carcinoma, no lymph node metastasis, and a Warthin tumor of the left parotid gland. The other 2 patients presented monoclonal gammopathy and a high tracer uptake in the left parotid gland by the 18F-fluorodeoxyglucose positron emission tomography/computed tomography total body. RESULTS AND CONCLUSIONS: The aim of this study was to evaluate the clinical and histopathologic features of 3 cases where clinical presentation of a Warthin tumor lies in the possible errors in diagnosis and decision making and not least in the management of the patient.