RESUMEN
BACKGROUND: Andrews' analysis is a commonly utilized instrument to aid in esthetic positioning of the anteroposterior position of the maxillomandibular complex; however, there is limited data regarding use in non-Caucasian subjects. PURPOSE: The purpose of this study was to document laypersons preferences of anteroposterior position of the maxillomandibular complex in relation to Andrews' lateral profile analysis in African American (AA) and Caucasian subjects. STUDY DESIGN, SETTING, SAMPLE: A cross-sectional study was implemented to evaluate the esthetics of AA and Caucasian subjects. Photographs were taken and simulated with anteroposterior maxillomandibular complex positioning in varying relationships to Andrews' goal anterior line limit. A survey was then designed to select the preferred simulation of the facial profile of each subject. INDEPENDENT VARIABLE: The independent variable was the race of the study subjects. MAIN OUTCOME VARIABLE: The main outcome was the layperson's preferred lateral facial profile for each subject. COVARIATES: The covariates included age, race, sex, education level, income, of the laypersons. ANALYSES: A proportion test was used to decide which profile was preferred. Logistic regression analyses were conducted to assess the association between the preference and respondent demographics. P < .05 was considered significant. RESULTS: A total of 264 surveys were distributed, and 250 complete surveys were utilized (response rate = 95%). Respondents were majority male (51.2%), aged 35-44 (37.2%), college-educated (57.2%), earning between $20,000 and $50,000 annually (44%), and identified as Caucasian (77.2%). For the female subjects, the respondents preferred +4 and + 6 mm anterior to goal anterior line limit with 54.2% for the Caucasian and 65.9% for the AA subjects (difference = 11.7%; 95% CI:2.7 to 20.7%; P = .008). For the males, 47.4% of the respondents chose 0 mm and +2 mm for the AA subject, while only 24.9% preferred +2 mm for the Caucasian male (difference = 22.5%; 95% CI: 13.8 to 31.1%; P < .0001). Respondent demographics were not found to influence selection. CONCLUSION AND RELEVANCE: The preferred facial profile as judged by laypersons differs between Caucasian and AA subjects when defined through Andrews' analysis.
RESUMEN
Background: Tranexamic acid (TXA) is utilized frequently in orthognathic surgery to limit blood loss and improve surgical field visualization. This antifibrinolytic has been proven effective with use of concomitant hypotensive anesthesia. Despite proven efficacy, there is a recent push to avoid perioperative hypotensive anesthesia due to risks of organ hypoperfusion, cardiac ischemia and postoperative nausea. Aims: The aim is to study the efficacy and safety of utilizing TXA without controlled hypotensive anesthesia. Methods: The authors identified two cohorts of subjects that underwent bimaxillary orthognathic surgery both with and without TXA administration and compared operative and perioperative variables. A retrospective analysis was completed evaluating intraoperative MAP measurements in subjects treated both with and without TXA using descriptive and bivariate analysis. Results and conclusion: Sixty-three subjects met inclusion criteria. The TXA cohort experienced 11.5% less time under hypotensive anesthesia when compared to the group that did not receive TXA. Additionally, surgical length was decreased by more than 28 min when subjects received TXA. No subjects required a blood transfusion or experienced any TXA-related complications. Given the recommendations to limit hypotensive anesthesia perioperatively, TXA is a useful adjunct in orthognathic surgery to limit controlled hypotensive anesthesia.
RESUMEN
The rigid external distraction (RED) device is reported to have the ability to three-dimensionally reposition the maxilla. The purpose of this study is to assess the ability of RED to intentionally alter the maxillary pitch.Retrospective cohort study.Institutional practice.A retrospective chart review was completed over the past 12 years and a total of 50 patients met the inclusion criteria.Cephalometric changes and alteration in palatal plane angle.Cephalometric analysis of standardized landmarks was completed on calibrated, standardized lateral cephalograms. Pre-distraction and post-consolidation variables were compared via a two-tailed paired t-test.The mean age at surgery of 12.2 ± 3.2 years. Through distraction osteogenesis (DO), the maxilla was moved anteriorly with a mean distraction distance of 8.4 ± 4.8â mm. The mean change in the angles sella-nasion-A-point angle (SNA), sella-nasion-B-point angle (SNB), and A-point-nasion-B-point angle (ANB) were 10.2 ± 4.8, 0.9 ± 2.7, and 9.3 ± 4.1, respectively. The mean change in the palatal plane angle was -4.4 ± 3.7. The mean change in the vertical position of the anterior nasal spine (ANS) and posterior nasal spine (PNS) in relation to the Frankfort horizontal (FH) were -2.0 ± 4.1â mm and 1.7 ± 3.8â mm, respectively.This study documents short-term findings of RED in a large cleft lip and palate (CLP) population. Despite positioning of distraction eyelets superior to the theoretical center of resistance, a counterclockwise (CCW) rotation of the palatal plane occurred. This suggests that adjunctive methods of vector control should be considered if clockwise (CW) rotation of the palatal plane is intended with the RED device.