RESUMO
INTRODUCTION: We investigated whether ACTN3, ENPP1, ESR1, PITX1, and PITX2 genes which contribute to sagittal and vertical malocclusions also contribute to facial asymmetries and temporomandibular disorders (TMD) before and after orthodontic and orthognathic surgery treatment. METHODS: One hundred seventy-four patients with a dentofacial deformity were diagnosed as symmetric or subdivided into 4 asymmetric groups according to posteroanterior cephalometric measurements. TMD examination diagnosis and jaw pain and function (JPF) questionnaires assessed the presence and severity of TMD. RESULTS: Fifty-two percent of the patients were symmetric, and 48% were asymmetric. The asymmetry classification demonstrated significant cephalometric differences between the symmetric and asymmetric groups, and across the 4 asymmetric subtypes: group 1, mandibular body asymmetry; group 2, ramus asymmetry; group 3, atypical asymmetry; and group 4, C-shaped asymmetry. ENPP1 SNP-rs6569759 was associated with group 1 (P = 0.004), and rs858339 was associated with group 3 (P = 0.002). ESR1 SNP-rs164321 was associated with group 4 (P = 0.019). These results were confirmed by principal component analysis that showed 3 principal components explaining almost 80% of the variations in the studied groups. Principal components 1 and 2 were associated with ESR1 SNP-rs3020318 (P <0.05). Diagnoses of disc displacement with reduction, masticatory muscle myalgia, and arthralgia were highly prevalent in the asymmetry groups, and all had strong statistical associations with ENPP1 rs858339. The average JPF scores for asymmetric subjects before surgery (JPF, 7) were significantly higher than for symmetric subjects (JPF, 2). Patients in group 3 had the highest preoperative JPF scores, and groups 2 and 3 were most likely to be cured of TMD 1 year after treatment. CONCLUSIONS: Posteroanterior cephalometrics can classify asymmetry into distinct groups and identify the probability of TMD and genotype associations. Orthodontic and orthognathic treatments of facial asymmetry are effective at eliminating TMD in most patients.
Assuntos
Deformidades Dentofaciais/classificação , Deformidades Dentofaciais/genética , Receptor alfa de Estrogênio/genética , Assimetria Facial/classificação , Assimetria Facial/genética , Diester Fosfórico Hidrolases/genética , Pirofosfatases/genética , Transtornos da Articulação Temporomandibular/genética , Adulto , Deformidades Dentofaciais/complicações , Deformidades Dentofaciais/cirurgia , Assimetria Facial/complicações , Assimetria Facial/cirurgia , Feminino , Genótipo , Humanos , Masculino , Procedimentos Cirúrgicos Ortognáticos , Complicações Pós-Operatórias/etiologia , Índice de Gravidade de Doença , Transtornos da Articulação Temporomandibular/etiologiaRESUMO
Nasal obstruction (NO) is a common symptom present in 25% of the general population, which significantly interferes with the quality of life. The different facial profiles and malocclusion patterns could be associated with the degree of NO. In order to evaluate the nasal function in patients with different facial morphology patterns, the authors developed a prospective study in which 88 patients from a dentofacial deformities center were included. These patients were submitted to fibrorhinoscopy (Mashida, ENT PIII) with a 3.2-mm cannula under topical anesthesia to evaluate septal deviation, inferior and medium turbinates, and pharyngeal tonsils. The 88 patients included in the study were divided into 3 groups according to the classification of the facial profile, distributed as follows: 32 class I, 28 class II, and 28 class III; the data collected was statistically analyzed by analysis of variance and the results are shown. The patients included in this study presented similar prevalence of NO with the reduction of airway function efficiency. Although it was not a statistically different, the group II presented higher mean Nasal Obstruction Syndrome Evaluation scores.
Assuntos
Deformidades Dentofaciais/complicações , Má Oclusão/complicações , Obstrução Nasal/complicações , Adolescente , Adulto , Deformidades Dentofaciais/classificação , Endoscopia , Feminino , Humanos , Masculino , Mandíbula/anormalidades , Maxila/anormalidades , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Estudos Prospectivos , Índice de Gravidade de Doença , Conchas Nasais/diagnóstico por imagem , Adulto JovemRESUMO
The present study aimed to establish the profile of patients who underwent orthognathic surgery in a private clinic by evaluating their demographic characteristics, their facial types, and aspects related to the surgical procedures that were performed. The sample consisted of 419 medical records from male and female patients aged 15 to 62 years who underwent orthognathic surgery between 2001 and 2011. A single examiner collected data by evaluating a database of information extracted from medical records, particularly radiographic and photographic analyses. The following criteria were evaluated: gender, age, skin color, type of orthognathic surgery, type of associated temporomandibular joint (TMJ) surgery, complications, and recurrences. Seventeen patients were rejected because they had incomplete records. The average age of the patients was 28.5 years old; most were females (255 patients) and faioderm (295 patients). The most prevalent facial pattern was Pattern III (n = 166, 41.3%). Orthognathic surgery that affected the maxilla, jaw, and chin was the most prevalent type (n = 199, 49.5% of cases). A genioplasty was performed concurrently with combined surgeries and single-jaw surgery in 76.86% of patients (n = 309). TMJ surgery was performed concomitantly with orthognathic surgery in 4% of cases (n = 16). The most common postoperative complication was infection/inflammation (n = 12). We concluded that there was a higher frequency of orthognathic surgery among women and young people, the brunette skin phenotype was prevalent, and most patients had a combination of maxillary and mandibular problems.
Assuntos
Deformidades Dentofaciais/epidemiologia , Procedimentos Cirúrgicos Ortognáticos/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Queixo/cirurgia , Deformidades Dentofaciais/classificação , Estudos Epidemiológicos , Feminino , Mentoplastia/estatística & dados numéricos , Humanos , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Recidiva , Estudos Retrospectivos , Fatores Sexuais , Pigmentação da Pele/fisiologia , Infecção da Ferida Cirúrgica/epidemiologia , Articulação Temporomandibular/cirurgia , Adulto JovemRESUMO
Masticatory efficiency may be impaired in individuals with dentofacial deformities. The objective of the present study was to determine the condition of masticatory efficiency in individuals with dentofacial deformities. 30 patients with class II (DG-II) and 35 patients with class III (DG-III) dentofacial deformity participated in the study, all had an indication for orthognathic surgery. 30 volunteers (CG) with no alterations of facial morphology or dental occlusion and with no signs or symptoms of temporomandibular joint dysfunction also participated. Masticatory efficiency was analysed using a bead system (colorimetric method). Each individual chewed 4 beads, one at a time, over 20s measured with a chronometer. The groups were compared in terms of masticatory efficiency using analysis of variance (ANOVA), with the level of significance set at P<0.05. Masticatory efficiency was significantly greater in CG (P<0.05) than in DG-II and DG-III in all chewing tasks tested, with no significant difference between DG-II and DG-III (P>0.05). It was observed that the presence of class II and class III dentofacial deformity affected masticatory efficiency compared to CG, although there was no difference between DG-II and DG-III.