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OBJECTIVES: The development of 3D computer-assisted technologies over the past years has led to vast improvements in orthognathic surgery. The aim of the present study was to evaluate differences in maxillary position between 3D virtual surgical planning (VSP) and surgical results. MATERIALS AND METHODS: We assessed data from 25 patients who underwent bimaxillary non-segmented orthognathic surgery with 3D VSP. Each patient underwent a postoperative CT scan within 40 days after surgery. We compared the STL (Standard Triangulation Language) file from the VSP with that obtained from the postoperative CT. RESULTS: According to our comparative analysis, the postoperative and VSP 3D models did not statistically differ. The Lin concordance correlation coefficient was always >0.95 for each landmark, but in 21 patients (84 % of the sample) we identified at least one point with a difference of more than 1.5 mm between the postoperative and VSP 3D model on at least one axis. The most frequently observed differences corresponded to sagittal translation and pitch rotation. CONCLUSIONS: An intraoperative clinical and aesthetic evaluation of the consequences of bone movements on patient face is strongly recommended, also when we use VSP because we may have clinically significant differences from the planning.

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OBJECTIVE: This study aims to validate the efficacy of using a digital dental model (DM) with reference to the palatal region of interest (PROI) for assessing orthodontic tooth movement (TM) by comparing it with the analysis of a computed tomography (CT) model with reference to the cranial region of interest (CROI). MATERIALS AND METHODS: Thirty-four patients (mean age: 21 years and 11 months) with jaw deformities underwent DM and CT scans before and after presurgical orthognathic treatment. Linear and angular measurements during TM were conducted in three dimensions using both DM and CT to assess reliability. RESULTS: DM analysis with PROI registration exhibited high levels of reproducibility, with minimal standard errors in X, Y, and Z displacements (<0.15 mm) and 0.43 degrees in angular change. CT analysis with CROI registration demonstrates similarly high reproducibility, with standard errors inferior to DM analysis (<0.20 mm). Bland-Altman analysis indicated agreement in linear changes of each X, Y, and Z displacement between DM and CT measurements, with limits of agreement (LOA) below 0.91 mm. CONCLUSIONS: The results of this study suggest that the PROI, focusing on the third palatal rugae and the horizontal part of the palatal vault, serves as a reliable reference region for evaluating three-dimensional (3D) tooth movement. CLINICAL SIGNIFICANCE: Digital dental models offer distinct advantages including the absence of X-ray exposure, no metal artifacts, and the ability to generate high-resolution 3D models. The methodology demonstrated high precision and reproducibility, supporting its potential clinical utility in orthodontic treatment planning and assessment.

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The primary purpose of this study was to accurately assess linear, volumetric and morphological changes of maxillary teeth roots following multi-segments Le Fort I osteotomy. A secondary objective was to assess whether patient- and/or treatment-related factors might influence root remodeling. A total of 60 patients (590 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The multi-segments group included 30 patients who had either 2-segments or 3-segments Le Fort I osteotomy. The other 30 patients underwent one-segment Le Fort I osteotomy. Preoperative, 1 year, and 2 years postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and fully automated method for evaluating root changes in three dimensions (3D) was applied. No statistical significant differences were found between multi-segments and one-segment Le Fort I for linear, volumetric and morphological measurements. The Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement leading to more root remodeling. This research may allow surgeons to properly assess root remodeling after combined treatment of orthodontics and the different Le Fort I osteotomies.

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OBJECTIVE: This study aimed to evaluate the impact of myofunctional rehabilitation of the orofacial muscles through specific exercises on the recovery of facial expression in patients following orthognathic surgery. MATERIAL AND METHODS: The study included 62 patients who underwent Le Fort I and sagittal split ramus osteotomy (SSRO). Patients were divided into two groups: the first group started immediate post-operative myofunctional rehabilitation of the orofacial muscles through specific exercises. In contrast, patients in Group II did not undergo any myofunctional rehabilitation post-operative exercises. The recovery of facial expressions postoperatively was evaluated in both calm and smiling states by comparing the differences between 3D facial scanning data of chosen facial anatomical structures collected at five key time points: pre-surgery (D0), 2 days (D2), 14 days (D14), 1 month (D30), and 3 months (D90) postoperatively. RESULTS: The analysis revealed that characteristic angles and lengths experienced significant changes post-surgery, with ∠chRnchL and ∠chRsnchL decreasing at D2 and normalizing by D30 in the experimental group, while the control group showed a slower recovery, normalizing by D90. The ChL-R length decreased at D2, returning to normal by D30 in the experimental group and D90 in the control group. The height Li-Ls increased at D2 and normalized by D30 in calm and smiling expressions across single and double jaw surgery patients. These findings underscore the more rapid recovery in the experimental group compared to the control group (P < 0.05; P < 0.005; P < 0.0001). CONCLUSION: Initiating myofunctional rehabilitation immediately following orthognathic surgery enhances facial muscle function recovery, improves patient confidence, and expedites social reintegration. This approach is crucial for functional and psychological benefits.

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BACKGROUND: The use of cone beam computed tomography (CBCT) for dentomaxillofacial diagnostics in pediatric dentistry is expanding and concerns have been raised about the radiation risks associated with this imaging modality, especially for children. Dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks (DIMITRA) is a multidisciplinary project focused on optimizing CBCT exposure for children and adolescents. This study aims to clarify the indications behind CBCT scans in children aligned with DIMITRA's recommendations. METHODS: For each CBCT examination, data were collected on patient age at the time of the CBCT examination, gender, reason for request, referring department, CBCT-requested region, and the field of view (FOV) dimension of imaging. The CBCT indications were categorized under six headings according to an adaptation of the DIMITRA project recommendations: impacted teeth, dentoalveolar trauma, orofacial clefts, dental anomalies, bone pathology, syndromes. Indications not categorized in DIMITRA were recorded below the heading "other". RESULTS: The most common indication was the "other" category (34.8%), which included implant, temporomandibular joint dysfunction, orofacial anomalies, foreign object and root canal morphology. The least common indication was "orofacial cleft" (1.9%) and no requests were made for cases related to syndromes. Detection of supernumerary tooth in dental anomalies (68.6%) was the most common CBCT indication, while dentigerous cysts (37.6%) were among the most common CBCT indication in bone pathologies and orofacial anomalies (68.1%) in the other category. The most common size was External Center (15 × 15 cm) (27%) and the least common size was Both Arches/small (8 × 8 cm) (0.4%) when the CBCT FOV was analysed. CONCLUSIONS: Although the option of a smaller FOV size was available, the larger FOV size that included the both jaws were most frequently used. When justifying CBCT requests, patient-specific radiation dose risks should be considered and specific guidelines should be followed.

Asunto(s)

Tomografía Computarizada de Haz Cónico , Humanos , Tomografía Computarizada de Haz Cónico/métodos , Adolescente , Niño , Estudios Transversales , Femenino , Masculino , Preescolar , Dosis de Radiación , Diente Impactado/diagnóstico por imagen , Anomalías Dentarias/diagnóstico por imagen

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Three-dimensional (3D) printing has slowly become an integral part of orthognathic surgery. However, there is a lack of studies evaluating accuracy of orthognathic surgical splints fabricated from subtractive milling versus additive 3D printing. The primary aim of this in vitro study was to compare the differences in trueness between milled and 3D-printed splints, while the secondary aim was to compare the differences in clinical fit of these splints. A sample of eight patients was selected, and STL files of the final orthognathic surgical splint were used to fabricate three splints for each of the eight cases. The first splint was fabricated by subtractive milling (SM), whereas the second and third splints were 3D printed with Digital Light Processing (DLP) and Laser Stereolithography (SLA), respectively. Paired superimposition of scans was performed using a reference model. The clinical fit of the splints to the printed models was also assessed. The mean root mean square (RMS) deviations for the SM, SLA, and DLP were 0.11 ± 0.02, 0.16 ± 0.02 and 0.14 ± 0.02 respectively. The post-hoc analysis showed that the SM splints had the highest accuracy (p<0.01). However, DLP splints showed the best clinical fit, followed by SM and SLA. In conclusion, splints fabricated by SM were more accurate than those fabricated by 3D printing, although this difference may not be clinically significant. The site, rather than the magnitude of the errors, may have a greater effect on the clinical usability of splints. In general, SM and DLP splints demonstrated a good clinical fit and were suitable for the fabrication of surgical splints.

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The purpose of this study was to assess and compare the complication rates of single-jaw orthognathic surgery between outpatients and inpatients, and to examine their impact on the outcome of care setting. A retrospective cohort study was performed of patients who underwent single-jaw orthognathic procedures. Outpatients between 2008 and 2023 were selected as the study group, while inpatients between 1997 and 2023 were enrolled as the control group. The predictor variable was the patient care setting. The primary outcome variable was the occurrence of overall complications. Secondary outcomes included surgery-, anesthesia-, and patient-related complications. Other study variables included age, sex, surgery, and anesthetic procedures. Descriptive, bivariate, and multiple logistic regression statistics were computed and the significance level was set at p ≤ 0.05. The sample included 307 patients with a mean age of 23.1 years ±9.5 years, of whom 55% were female. The outpatient and inpatient groups consisted of 123 (40.1%) and 184 (59.9%) patients, respectively. Of the 123 outpatients, 104 (85.5%) were discharged on the day of surgery. Age (p = 0.012) and ketamine administration (p = 0.022) were significantly associated with complications among outpatients. Outpatient setting and age were significantly associated with overall complications (OR 2.48; 95% confidence interval [CI] 1.34-4.66, p = 0.003 and OR 0.94, 95% CI 0.88-0.98, p = 0.021, respectively) and anesthetic-related complications (OR 4.43, 95% CI 2.03-10.5, p = 0.0003 and OR 0.92, 95% CI 0.83-0.98, p = 0.041, respectively). The study demonstrated that outpatient orthognathic surgery had a high success rate but also identified a higher rate of anesthetic-related complications among outpatients, particularly in younger patients and in those receiving ketamine.

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Orthognathic surgery enables patients with severe jaw malocclusions to normalise their chewing function and, as such, to improve their quality of life. Over the last few years, digitalisation has been set in motion by intraoral scanners and the improvement of planning software in the field of oral and maxillofacial surgery. Previous studies based on plaster cast models showed that the virtual occlusion based on digitally scanned models can be comparable to conventional methods. This retrospective crossover study aimed to prove that the virtual occlusion finding with the IPS CaseDesigner® (version 2.3.5.2, KLS Martin, Tuttlingen, Germany) is accurate enough to use intraoral scans exclusively. MATERIALS AND METHODS: A total of 23 orthognathic surgery patients receiving an intraoral scan for their treatment were included in this study. Two experienced maxillofacial surgeons haptically performed the occlusion finding on three-dimensional (3D) stereolithographic models using the fully digital pathway. One surgeon repeated the procedure a second time to evaluate intra-observer variability. The study aimed to show the difference between these two planning methods by upholding the surgical accuracy of less than 2 mm in translation and 2° in rotation. The conventional haptic occlusion was set as a reference throughout the whole study. The data were tested with a one-sample Wilcoxon test for the fit into the surgical accuracy. RESULTS: The difference between the virtual and conventional groups was significantly smaller than the surgical accuracy (all p < 0.001). Both translational movements (anterior/posterior (median 0.51 mm [0.28, 0.88]), left/right (median 0.46 mm [0.20, 0.87]), cranial/caudal (median 0.37 mm [0.11, 0.69])) and rotations (Roll (median 0.71° [0.29, 1.35]), Pitch (median 0.72° [0.29, 1.44]), Yaw (median 1.09° [0.33, 1.60])) were in the range of surgical accuracy (2 mm/2°). The most significant differences were found in the anterior/posterior translation (median 0.51 mm [0.28, 0.88]) and the Yaw rotation (median 1.09° [0.33, 1.60]). CONCLUSION: These results demonstrate that the entirely virtual workflow in orthognathic surgery, including intraoral scanning and the virtual semi-automatic occlusion finding, represents a reliable and state-of-the-art alternative to the conventional haptic method.

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Background: The present study aims to determine the effect of Transcutaneous Electrical Nerve Stimulation (TENS) on neuro-sensory disturbance after orthognathic surgery. Materials and methods: In a randomized clinical trial, the participants via split-mouth sampling were randomly divided into two intervention (n=27) and control (n=27) groups. In the intervention group, participants received TENS physiotherapy. TENS physiotherapy was performed on the day after surgery, 1, 2, 3, and 4 weeks after surgery, along with prescriptions for the use of painkillers. On the control group, no physical therapy was performed and the patients only used painkillers (immediately after the operation). Paresthesia was evaluated using the 2-point discrimination (TPD) test and the semi-quantitative sensory-neural disorders test called brush stroke 6 months after the surgical procedures. Self-reported sensory-neural disorders were measured and reported for each patient before and 6 months after surgery using the visual analog scale (VAS). Results: A total of 54 patients participated in this study. The mean TPD score in the TENS group and the control group 6 months after the operation were 5.76 (SD=0.73) and 6.14 (SD=0.54), respectively (P=0.003). The mean VAS score in the TENS group and the control group 6 months after the operation was 6.48 (SD=0.50) and 5.80 (SD=0.63), respectively (P=0.005). Also, 66.7 and 38.9% in the TENS and control groups, respectively, performed the brush stroke test correctly (P=0.007). Conclusion: In sum, the benefits of TENS physiotherapy can be effective in reducing complications such as pain in dental surgery treatments or orthognathic surgeries.

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Purpose: The aim of this study was to test a prototype device called occlusal force diagnostic system in relation to occlusal force adaptation following orthognathic surgery. Methods: Retrospective study of 10 patients scheduled for a bimaxillary osteotomy involving a combination of maxillary Le Fort I impaction procedure coupled with a sagittal split advancement of the mandible; in a 3 years follow-up period. Results: The selection of examiner is not a variable that affects the occlusal force (N) measured by FSS sensors in any of the experimental conditions tested. The sensor position and the surgery recovery time affect the occlusal force irrespective of the examiner selection and/or the surgery recovery time. Conclusion: The piezoelectric sensors used in the present study have shown high reliability and validity of measurement. The surgery recovery time impacts the occlusal force (N), with a 50% increase in occlusal force (N) measured after 6 months post-surgery, with the value keeping stable at 36 months. This suggests that the patient is only fully recovered from the functional point-of-view at 6 months, having from that point on an improved and stable masticatory function.

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PURPOSE: Perioperative bleeding is a serious concern during orthognathic surgery. Tranexamic acid (TXA), a synthetic lysine analog with antifibrinolytic properties, reduces blood loss across various surgical fields. This study aimed to investigate the effectiveness of preoperative TXA administration in reducing intraoperative and postoperative blood loss following combined Le Fort I and sagittal split ramus osteotomies at our hospital. METHODS: This single-center, retrospective cohort study included patients who underwent combined Le Fort I and sagittal split ramus osteotomies between November 2017 and October 2022. The primary outcome was the volume of intraoperative blood loss. RESULTS: Among 1,329 eligible patients, 87 were included in the analysis (32 in the TXA group and 55 in the control group, where no TXA was administered). The median (interquartile range) intraoperative blood loss was 200.0 (157.5-237.5) mL in the TXA group and 260.0 (180.0-350.0) mL in the control group, showing a significant difference between the groups (p = 0.0365). However, postoperative blood drainage within 24 h and 24-48 h did not differ significantly between the two groups. CONCLUSION: A single intravenous administration of TXA was associated with a decrease in intraoperative bleeding without severe adverse events during combined Le Fort I and sagittal split ramus osteotomies. However, postoperative blood loss, nausea, vomiting, and autologous blood transfusion were not significantly associated with this administration.

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This paper examines the relationship between roll rotation of the jaws and changes in alar base or lip line asymmetry in the coronal plane following orthognathic correction. The study involved patients with preoperative frontal alar base and lip line asymmetries greater than 0.5° (because it corresponds to the minimum asymmetry perception threshold) and underwent bimaxillary orthognathic surgery without (Group I) or with (Group II) genioplasty. The alar base angle (ABA), lip line cant angle (LLCA), maxillary cant angle (MxCA), and mandibular cant angle (MnCA) were measured using preoperative and 12 months postoperative cone beam computed tomography (CBCT) images. Thirty-four patients were included in the study. Significant correlations were found between changes in MxCA and ABA besides between changes in MnCA and LCA in Groups I (P = 0.016, P˂0.001, respectively) and II (P = 0.002, P˂0.001, respectively). The mean of the change in ABA/the change in MxCA and the change in LLCA/the change in MnCA ratios for Group I were 0.59 ± 1.57 and 0.73 ± 0.94, respectively, while those for Group II were 0.46 ± 3.70 and 0.39 ± 2.00, respectively. Angular measurements from jugular and mental foramina points, aligned with the bony midline, offer a convenient tool for predicting alar base and lip symmetry during bimaxillary orthognathic surgery planning.

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Many factors need to be considered when selecting treatment protocol for surgical correction of skeletal open bite deformities. In order to achieve stable long-term results, it is essential to explore the origin of the open bite, including dysfunction of the temporomandibular joint, tongue and compromised nasal breathing, in addition to the skeletal deformity. Recurrence of skeletal open bite is associated with relapse of the expanded transverse width. Three-dimensional virtual planning allows different treatment options to be explored and final decisions to be made together with the orthodontist. This study presents a treatment protocol for predictable and stable widening of the maxillary transverse width over the long term, involving premolar extraction and rounding and shortening of the upper dental arch by advancing the molar segments. The stability of inter-canine, inter-premolar, and inter-molar distances, as well as overjet and overbite, were measured in 16 patients treated with this technique; measurements were obtained pre- and post-surgery, and the mean follow-up was 43 months. Orthodontic treatment was designed digitally and finished with robotically bent wires (SureSmile), which allowed exact planning of the overall treatment, thus making orthognathic surgery more predictable for the patient. The changes in transverse width were significant and stable over time.

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The transfer of a virtual orthognathic surgical plan to the patient still relies on the use of occlusal splints, which have limitations for vertical positioning of the maxilla. The use of real-time navigation has been proposed to enhance surgical accuracy. This systematic review (PROSPERO CRD42024497588) aimed to investigate if surgical navigation can improve the three-dimensional accuracy of orthognathic surgery. The inclusion criteria were orthognathic surgery, use of intra-operative navigation and quantitative assessment of surgical accuracy. The exclusion criteria were non-bimaxillary orthognathic surgeries, non-clinical studies, studies without post-operative 3D analysis and publications not in the English language. A search of PubMed, Embase and Cochrane Library generated 940 records, of which 12 were found relevant. Risk of bias was assessed done using the Joanna Briggs Institute Critical Appraisal Checklist Tool. Among the included studies, there were nine of observational character and three randomized control studies (RCTs). All studies demonstrated promising outcomes with reported good surgical accuracy within a 2 mm difference between the planned and post-surgical result. Meta-analysis of two RCTs was carried out and results were in favor of surgical navigation with a total odds ratio of 4.44 [2.11, 9.37] and an overall effect outcome of Z = 3.92 (p < 0.0001). Navigation was up to 0.60 mm more accurate than occlusal wafers only (p < 0.001). However, there were variations in the application of surgical navigation and methods of analysis, leading to a heterogenous data set. Future studies should focus on standardized protocols and analysis methods to further validate the use of surgical navigation in orthognathic surgery. Despite some limitations, surgical navigation shows potential as a valuable tool in improving the accuracy of orthognathic surgery.

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BACKGROUND: Relapses following orthognathic surgery have been reported to exceed 2% to 50%, depending on multiple factors. This study aimed to analyze the stability after orthognathic surgery in patients with mandibular ramus height asymmetry through 3D reconstruction using Cone-beam CT. METHODS: This retrospective cohort study investigated patients who underwent mandibular setback surgery using bilateral sagittal split ramus osteotomy. Three-dimensional CT scans were taken at three different time points. Evaluation of the postoperative stability involved measuring changes in the x, y, and z axes as well as roll and yaw rotations of the mandible at specific landmarks (B point, mental foramen) on 3D CT scans obtained immediately after surgery and 6-12 months postoperatively. They were categorized into four groups based on bilateral mandibular height asymmetry through Asymmetry index (AI). The one-way ANOVA was implemented to compare the intergroup differences and Tukey's post hoc test was employed. Additionally, the Pearson correlation coefficient was also calculated. RESULTS: A total of 24 patients were included in this study. The corresponding AI, representing the degree of asymmetry in both mandibles, were calculated as Group 1 was 1.25 ± 0.64%, Group 2 was 2.89 ± 0.47%, Group 3 was 5.03 ± 0.51%, and Group 4 was 9.40 ± 1.99%. The x-axis change in Group 4 was significantly larger at 1.71 mm compared to Group 1 at 0.64 mm. The mandibular roll, Group 4 showed a statistically significant increase at 1.33° compared to Group 1 at 0.35°. And there was a significant positive correlation observed between x-axis change and AI (p = 0.019), as well as between mandibular roll and AI (p = 0.025). CONCLUSION: After orthognathic surgery, stability was influenced by numerous factors, with the findings of this study suggesting that the degree of ramus height asymmetry in the mandible can be considered one contributing factor.

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The aim of this study is to evaluate the changes in nasolabial soft tissues following Le Fort I osteotomies, focusing on the impact of maxillary vertical repositioning. This retrospective study included 39 patients with a history of Le Fort 1 osteotomy between 2013 and 2021. Patients were grouped based on their maxillary movement into three categories: pure advancement (group A), advancement with impaction (group B), and advancement with downward repositioning (group C). Preoperative and postoperative CBCT (Cone Beam Computed Tomography) data were analyzed to measure the changes in nasolabial soft tissues. The current study utilized Mimics Suite 20.0 for measuring linear and angular variables. The evaluated variables included intercanthal distance, nasal dorsal length, tip protrusion, mouth width, alar width, upper lip height, nostril dimensions, and angles of nasolabial, alar base, and upper lip. Among them intercanthal distance, nasal dorsal length, or tip protrusion showed no statistical difference (p > 0,05). Mouth width, alar width, alar base angle were increased and upper lip angle was decreased significantly (p < 0.001). Changes in upper lip height and nasolabial angle differed among the groups of the study. While upper lip height increased significantly in groups A and C (p < 0.05), there was a slight decrease in Group B with no significance (p > 0.05). Nasolabial angle decrased significantly on Groups A and B (p < 0.05). The results of this study revealed changes in several soft tissue parameters, some of which occurred regardless of vertical repositioning of the maxilla. Within the limitations of the study, maxillary advancement surgery can affect the aesthetics of the nasolabial region and cause specific changes in related soft tissues. Understanding these changes is essential to establish realistic patient expectations and achieve optimal functional and aesthetic outcomes.

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OBJECTIVES: To evaluate changes of the upper airway and oral cavity volumes in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery, and to analyze the correlation between postoperative upper airway decrease and the amount of jaw movement and oral cavity volume reduction. MATERIALS AND METHODS: Thirty patients (16 males and 14 females) undergoing bimaxillary surgery were included. Three-dimensional reconstruction of the upper airway and oral cavity were performed using preoperative (T0) and postoperative (T1) (6 months) cone-beam computed tomography scans. RESULTS: The volume, sagittal area and minimum cross-sectional area of the upper airway were diminished (P < .001). The decrease in volume and minimum cross-sectional area in the oropharyngeal region of the upper airway were weakly correlated with B-point posterior movement (P < .05). Total oral cavity volume was decreased, with maxillary oral volume increasing and mandibular oral volume decreasing (P < .001). Upper airway decrease was highly correlated with total oral volume reduction and mandibular oral volume reduction, with the most significant correlation being with total oral volume reduction (P < .001). CONCLUSIONS: Class III bimaxillary surgery reduced the volume, sagittal area, and minimum cross-sectional area of the upper airway as well as oral cavity volume. Upper airway changes were weakly correlated with anterior-posterior mandibular movement but significantly correlated with oral cavity volume changes. Thus, oral cavity volume reduction is a crucial factor of upper airway decrease in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery.

Asunto(s)

Tomografía Computarizada de Haz Cónico , Imagenología Tridimensional , Maloclusión de Angle Clase III , Boca , Procedimientos Quirúrgicos Ortognáticos , Humanos , Tomografía Computarizada de Haz Cónico/métodos , Maloclusión de Angle Clase III/cirugía , Maloclusión de Angle Clase III/diagnóstico por imagen , Femenino , Masculino , Procedimientos Quirúrgicos Ortognáticos/métodos , Adulto , Boca/diagnóstico por imagen , Imagenología Tridimensional/métodos , Adulto Joven , Proyectos Piloto , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Adolescente , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Orofaringe/diagnóstico por imagen , Orofaringe/patología , Faringe/diagnóstico por imagen

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OBJECTIVES: To compare upper airway changes following bimaxillary surgery for correction of Class III deformity between patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) and to compare the preoperative and postoperative upper airway among patients with UCLP and BCLP to healthy controls. MATERIALS AND METHODS: Sixty adults with CLP-related skeletal Class III deformity (30 UCLP and 30 BCLP) who consecutively underwent bimaxillary surgery were studied retrospectively. Cone-beam computed tomography (CBCT) was performed before and after surgery to measure upper airway and movements of facial skeletal and surrounding structures. CBCT images from 30 noncleft skeletal Class I adults, matched by age, gender, and body mass index and without surgical intervention, served as controls. RESULTS: After surgery, the volume of the nasopharynx increased in patients with CLP (both P < .001). Patients with CLP did not differ from controls in postoperative volume of the nasopharynx or oropharynx. However, the nasal cavity differed significantly between patients with CLP and controls (P < .001). CONCLUSIONS: After bimaxillary surgery, the nasal cavity of patients with CLP differed significantly compared with the controls. Volumes of the nasopharynx and oropharynx did not differ between patients with CLP after surgery and controls.

Asunto(s)

Labio Leporino , Fisura del Paladar , Tomografía Computarizada de Haz Cónico , Maloclusión de Angle Clase III , Maxilar , Nasofaringe , Humanos , Femenino , Masculino , Tomografía Computarizada de Haz Cónico/métodos , Fisura del Paladar/cirugía , Fisura del Paladar/diagnóstico por imagen , Labio Leporino/cirugía , Labio Leporino/diagnóstico por imagen , Maloclusión de Angle Clase III/cirugía , Maloclusión de Angle Clase III/diagnóstico por imagen , Estudios Retrospectivos , Adulto , Nasofaringe/diagnóstico por imagen , Maxilar/cirugía , Maxilar/diagnóstico por imagen , Procedimientos Quirúrgicos Ortognáticos/métodos , Orofaringe/diagnóstico por imagen , Adulto Joven , Cavidad Nasal/diagnóstico por imagen , Estudios de Casos y Controles , Adolescente , Resultado del Tratamiento

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OBJECTIVES: To determine the difference between orthodontic camouflage and orthodontic-orthognathic surgery using the traditional cephalometric measurement IMPA and the newly proposed IA/PAMD, the angle between the long axis of the lower incisor (IA) and the principal axis of the mandibular alveolus (PAMD). MATERIALS AND METHODS: This study included 40 cases each in the orthodontic camouflage group (OG) and orthodontic-orthognathic surgery group (SG). The differences between the IMPA and IA/PAMD before and after treatment were compared between the two groups. T0 lateral cephalometric images of the 10 cases with the highest and lowest increase in the IA/PAMD were analyzed to identify characteristics associated with a higher risk of overdecompensation of the lower incisors during presurgical orthodontic treatment. RESULTS: Both the OG and SG showed a significant improvement in hard- and soft-tissue measurements. However, in the OG, there was significant lingual inclination of the lower incisor but only a small change in the IA/PAMD. In the surgical group, the IMPA was close to 90° after treatment, but the IA/PAMD significantly increased. CONCLUSIONS: In orthodontic camouflage, the lower anterior teeth were significantly moved lingually with a better root-bone relationship. However, this relationship deteriorated in some surgical patients. Therefore, it is important to conduct cephalometric or cone-beam computed tomography examinations during preoperative orthodontics to identify and prevent possible periodontal risks.

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Cefalometría , Incisivo , Maloclusión de Angle Clase III , Procedimientos Quirúrgicos Ortognáticos , Humanos , Incisivo/diagnóstico por imagen , Cefalometría/métodos , Maloclusión de Angle Clase III/cirugía , Maloclusión de Angle Clase III/terapia , Maloclusión de Angle Clase III/diagnóstico por imagen , Femenino , Masculino , Procedimientos Quirúrgicos Ortognáticos/métodos , Mandíbula/cirugía , Mandíbula/diagnóstico por imagen , Adolescente , Adulto Joven , Ortodoncia Correctiva/métodos , Adulto

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Evidence demonstrates efficacy of maxillomandibular advancement (MMA) treatment of obstructive sleep apnea (OSA) and airway expansion. Patient studies are limited to pre/post-surgery comparisons. This cadaveric study evaluated intra-individual relationships between magnitudes of MMA advancement and airway changes. MMA with distraction osteogenesis devices and incremental advancement of the maxillomandibular complex, was performed on cadavers (n = 5). Computed tomography at each 2-mm advancement was used to measure volume and dimension of the oropharyngeal airway. Three-dimensional shape analysis visualized magnitudes and locations of changes. Incremental advancements caused volume, anteroposterior, and lateral dimensions to increase progressively, while length decreased. Changes were significant at lower advancements. Comparisons of MMA indicate alterations in airway volume from 4 to 6 mm and 6 to 8 mm were relatively greater than the changes from 8 to 10 mm (P = 0.044, P = 0.028, respectively), 10 to 12 mm (P = 0.024, P = 0.023), and 12 to 14 mm (P = 0.021, P = 0.019). These results may expand MMA application suggesting 6-8 mm advancements provide substantial increases in airway volume. MMA may be an OSA treatment option when large advancements are not possible. Lower magnitudes of advancement decrease risks of unfavorable facial esthetics from excess protrusion.