Cephalometric Evaluation of Pharyngeal Airway Space Changes in Class III Patients Undergoing Orthognathic Surgery

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Use of Rectangular Grid Miniplates for Fracture Fixation at the Mandibular Angle

Purpose: The aim of this study was to evaluate the clinical outcome of patients with mandibular angle fractures treated by intraoral access and a rectangular grid miniplate with 4 holes and stabilized with monocortical screws.Patients and Methods: This study included 45 patients with mandibular angle fractures from the Department of Oral and Maxillofacial Surgery São Paulo State University, Araraquara, Brazil, and from the Clinic of Oral and Maxillofacial Surgery at the University of Frankfurt, Germany. The 45 fractures of the mandibular angle were treated with a rectangular grid miniplate of a 2.0-mm system by an intraoral approach with monocortical screws. Clinical evaluations were postoperatively performed at 15 and 30 days and 3 and 6 months, and the complications encountered were recorded and treated.Results: The infection rate was 4.44% (2 patients), and in 1 patient it was necessary to replace hardware. This patient also had a fracture of the left mandibular body; 3 patients (6.66%) had minor occlusal changes that have been resolved with small occlusal adjustments. Before surgery, 15 patients (33.33%) presented with hypoesthesia of the inferior alveolar nerve; 4 (8.88%) had this change until the last clinical control, at 6 months.Conclusions: The rectangular grid miniplate used in this study was stable for the treatment of simple mandibular angle fractures through intraoral access, with low complication rates, easy handling, and easy adjustment, with a low cost. Concomitant mandibular fracture may increase the rate of complications. This plate should be indicated in fractures with sufficient interfragmentaty contact. (C) 2011 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 69:1436-1441, 2011

Incidence of Maxillary Sinusitis Following Le Fort I Osteotomy: Clinical, Radiographic, and Endoscopic Study

Purpose: The correction of maxillomandibular deformities may require maxillary osteotomy procedures that usually present low rates of postoperative complications, such as maxillary sinusitis. The present study evaluated the incidence of maxillary sinusitis after Le Fort I osteotomy in 21 adult patients who underwent maxillary surgery (Le Fort I osteotomy) or bimaxillary surgery (Le Fort I osteotomy plus sagittal mandibular osteotomies) for correction of dentofacial deformities.Patients and Methods: Verification of the presence of maxillary sinusitis was assessed through a brief questionnaire, x-rays (Waters views), and nasal endoscopy before surgery and 6 to 8 months after surgery.Results: Analysis of results showed an incidence of 4.76% of maxillary sinusitis as a postoperative complication in the studied population.Conclusion: Symptomatic patients with a positive radiographic finding or an increased risk for postoperative sinusitis will benefit from endoscopic evaluation to aid in treatment planning and follow-up. 0 2011 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 69:346351, 2011

Actinic cheilitis: Clinical and histological features

Purpose: The purpose of this study was to analyze the clinical and histological features of actinic cheilitis (AC).Patients and Methods: A total of 29 patients with AC were clinically evaluated, and incisional biopsies were performed to confirm the clinical diagnosis. Histological features were analyzed, and dysplasia was classified as mild, moderate, or severe. The chi(2) test was used for the following variables: gender, age, race, and smoking habits. The degree of dysplasia was related to these variables (Fisher's test) to test for independence between them (P <.05).Results: of the patient group, 72.41% were male, 75.86% were overage 40 years, 93.10% were white, and 72.41% were nonsmokers. Clinically, all patients presented with multifocal lesions. The following manifestations were seen: dryness, atrophy, scaly lesions, swelling of the lip, erythema, ulceration, blurred demarcation between the lip vermilion border and the skin, marked folds along the lip vermilion, white spots or plaques, crusts, blotchy areas, and areas of pallor. Keratosis, granulosis, hyperplasia, acanthosis, or atrophy and dysplasia were found in the epithelial tissue; elastosis, inflammatory infiltrate, and vasodilatation were found in the connective tissue. Dysplasia was mild in 10.34% of the patients, moderate in 27.59%, and severe in 62.07%. Absence of sample homogeneity was observed in regard to gender, age, race, and smoking habits. It was not possible to reject the hypothesis of independence between mild, moderate, or severe dysplasia and gender, age, race, and smoking habits.Conclusions: Dryness, atrophy, and scaly lesions were the most common clinical findings observed. Dysplasia, inflammatory infiltrate, and vasodilatation, as well as elastosis, were the most common histological findings observed. Gender, age, race, or smoking habits were not related to the degree of dysplasia in the sample. (c) 2008 American Association of Oral and Maxillofacial Surgeons.

Postsurgical stability of oropharyngeal airway changes following counter-clockwise maxillo-mandibular advancement surgery

Purpose: This study evaluated oropharyngeal airway changes and stability following surgical counter-clockwise rotation and advancement of the maxillo-mandibular complex.Methods and Patients: Fifty-six adults (48 females, 8 males), between 15 and 51 years of age, were treated with Le Fort I osteotomies and bilateral mandibular ramus sagittal split osteotomies to advance the maxillo-mandibular complex with a counter-clockwise rotation. The average postsurgical follow-up was 34 months. Each patient's lateral cephalograms were traced, digitized twice, and averaged to estimate Surgical changes (T2-T1) and Postsurgical changes (T3-T2).Results: During surgery, the occlusal plane angle decreased significantly (8.6 +/- 5.8 degrees) and the maxillo-mandibular complex advanced and rotated counter-clock-wise. The maxilla moved forward (2.4 +/- 2.7 mm) at ANS and the mandible was advanced 13.1 +/- 5.1 min at menton, 10 +/- 4.4 mm at point B, and 6.9 +/- 3.7 mm at lower incisor edge. Postsurgical hard tissue changes were not statistically significant. While the upper oropharyngeal airway decreased significantly (4.2 +/- 3.4 min) immediately after surgery, the narrowest retropalatal, lowest retropalatal airway, and the narrowest retroglossal airway measurements increased 2.9 +/- 2.7, 3.7 +/- 3.2, and 4.4 +/- 4.4 mm, respectively. Over the average 34 months Postsurgical period, upper retropalatal airway increased 3.9 +/- 3.7 mm, while narrowest retropalatal, lowest retropalatal airway, and narrowest retroglossal airway remained stable. Head posture showed flexure immediately after Surgery (4.8 +/- 5.9 degrees) and extension postsurgically (1.6 +/- 5.6 degrees).Conclusion: Maxillo-mandibular advancement with counter-clockwise rotation produces immediate increases in middle and lower oropharyngeal airway dimensions, which were constrained by changes in head posture but remain stable over the postsurgical period. The upper oropharyngeal airway space increased only on the longest follow-up. (C) 2006 American Association of Oral and Maxillofacial Surgeons.

All-on-four concept and immediate loading for simultaneous rehabilitation of the atrophic maxilla and mandible with conventional and zygomatic implants

We report the simultaneous rehabilitation of an edentulous patient with a hybrid (zygomatic and conventional implants) all-on-four implant-supported prosthesis for the maxilla and a standard (conventional implants) all-on-four implant-supported prosthesis for the mandible. The transfer impression was made with a multifunctional guide and the upper and lower prostheses were placed 24 h postoperatively. Clinical and radiographic examinations showed no infection or bony resorption 2 years later. Simultaneous maxillary and mandibular rehabilitation with all-on-four immediate loading is a viable, fast and effective option for edentulous patients. (C) 2009 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons.

Comparative Study of the Mechanical Resistance of 2 Separate Plates and 2 Overlaid Plates Used in the Fixation of the Mandibular Condyle: An In Vitro Study

Purpose: The objective of this study was to carry out a comparative evaluation of the mechanical resistance of 2 rigid internal fixation techniques for fractures of the mandibular condyle using miniplates.Materials and Methods: Fort), polyurethane resin replicas of human hemimandibles were used. The hemimandibles were sectioned to simulate a high subcondylar fracture and then stabilized with 2 fixing techniques using 2.0-mm system plates and screws. The fixation techniques were 2 separate 4-hole plates with 8 screws, and 2 overlaid 4-hole plates with 4 screws. Each system was submitted to load tests, with the application of the load in mediolateral and anteroposterior directions in an Instron 4411 universal assay machine (Instron, Norwood, MA).Results: Load values and peak displacement were measured. Means and standard deviations were evaluated by analysis of variance (P < .05) and Tukey tests, in which it was verified that the anteroposterior peak load value was affected by the arrangement of the plates on the models, although no differences were observed between the groups for the mediolateral peak load. The arrangement of the plates did not have any influence on peak displacement. Similarly, the final value of the mediolateral load was not affected by the arrangement of the plates on the model.Conclusion: The experimental model with 2 separate plates was statistically superior to the model with 2 overlaid plates only in relation to anteroposterior peak load. Despite showing superiority in mediolateral peak load and peak displacement, there was no statistical difference between the groups for these parameters. (C) 2009 American Association of Oral and Maxillofacial Surgeons

Treatment of oral myiasis caused by Cochliomyia hominivorax: two cases treated with ivermectin

The term myiasis is applied to the injurious action that larvae of certain diptera Cause to the organism of Vertebrate animals in the living or dead tissue in which they grow. Because of its great destructive potential. appropriate and preventative treatment are necessary. Among, the sites of infestation. the human mouth is a common site. mainly in tropical countries. We present two cases of oral myiasis Caused by Cochliomyia hominivorax spp. Ivermectin is all extremely effective semi-synthetic macrolides, in the treatment of, this condition. (C) 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Rigid internal fixation with titanium versus bioresorbable miniplates in the repair of mandibular fractures in rabbits

The purpose of this study was to compare by qualitative histology the efficacy of rigid internal fixation with titanium system and the Lacto Sorb® system in mandibular fractures in rabbits. Thirty male adult rabbits Oryctolagus cuniculus were used. Unilateral mandibular osteotomies were performed between the canine and first premolar. The animals were divided into two groups: for Group I - rigid internal fixation was performed with titanium system 1.5 mm (Synthes, Oberdorf, Switzerland), with two screws of 6 mm (bicortical) on each side of the osteotomy. For Group II-rigid internal fixation was performed with PLLA/PGA system 1.5 mm (Lacto Sorb®, WLorenz, Jacksonville, FL, USA). The histological analysis evaluated the presence of inflammatory reaction, degree of bone healing and degree of resorption of the Lacto Sorb® screws. The results of both fixation systems were similar, only with a small difference after 15 and 30 days. In Group I a faster bony healing was noted. But after 60 days, bony healing was similar in both groups. It is concluded that both PLLA/PGA and titanium plates and screws provide sufficient strength to permit mandibular bone healing. The resorption process of PLLA/PGA osteosynthesis material did not cause acute or chronic inflammatory reaction or foreign body reaction during the studied period. © 2004 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Comparative Analysis of 2 Techniques of Double-Gloving Protection During Arch Bar Placement for Intermaxillary Fixation

Purpose: This study was conducted to comparatively evaluate, in a prospective and randomized manner, 2 techniques for providing double-gloving protection during arch bar placement for intermaxillary fixation. Materials and Methods: A total of 42 consecutive patients in whom application of an Erich bar was indicated for intermaxillary fixation were equally divided into 2 groups. In group 1, 2 sterile surgical gloves were used; in group 2, a nonsterile disposable inner glove was used under a sterile surgical glove. Wilcoxon, Mann-Whitney, Kruskal-Wallis, and binomial statistical tests were used to analyze the findings. Results: A total of 103 perforations were found in the outer gloves (47 in group 1 and 56 in group 2), along with 5 perforations in inner gloves in both groups (α = .01). No significant statistical difference was found between groups in terms of inner glove perforations (α = .05). The nondominant hand presented with 70.9% of the perforations, statistically significant to 1%. Conclusions: Both double-gloving techniques were found to provide effective clinician protection. The use of a nonsterile disposable glove under the surgical glove is possible for less-invasive procedures, offering the same safety as using 2 sterile surgical gloves while decreasing operational costs. This method does not eliminate the need to change gloves when a perforation is suspected or noted during the surgery, however. © 2007 American Association of Oral and Maxillofacial Surgeons.

Reconstruction of Mandibular Segmental Defects Using the Guided-Bone Regeneration Technique With Polylactide Membranes and/or Autogenous Bone Graft: A Preliminary Study on the Influence of Membrane Permeability

Purpose: Bone maintenance after mandibular reconstruction with autogenous iliac crest may be disappointing due to extensive resorption in the long term. The potential of the guided-bone regeneration (GBR) technique to enhance the healing process in segmental defects lacks comprehensive scientific documentation. This study aimed to investigate the influence of polylactide membrane permeability on the fate of iliac bone graft (BG) used to treat mandibular segmental defects. Materials and Methods: Unilateral 10-mm-wide segmental defects were created through the mandibles of 34 mongrel dogs. All defects were mechanically stabilized, and the animals were divided into 6 treatment groups: control, BG alone, microporous membrane (poly L/DL-lactide 80/20%) (Mi); Mi plus BG; microporous laser-perforated (15 cm2 ratio) membrane (Mip), and Mip plus BG. Calcein fluorochrome was injected intravenously at 3 months, and animal euthanasia was carried out at 6 months postoperatively. Results: Histomorphometry showed that BG protected by Mip was consistently related to larger amounts of bone compared with other groups (P ≤ .0001). No difference was found between defects treated with Mip alone and BG alone. Mi alone rendered the least bone area and reduced the amount of grafted bone to control levels. Data from bone labeling indicated that the bone formation process was incipient in the BG group at 3 months postoperatively regardless of whether or not it was covered by membrane. In contrast, GBR with Mip tended to enhance bone formation activity at 3 months. Conclusions: The use of Mip alone could be a useful alternative to BG. The combination of Mip membrane and BG efficiently delivered increased bone amounts in segmental defects compared with other treatment modalities. © 2008 American Association of Oral and Maxillofacial Surgeons.

Orthognathic Surgery in the Young Cleft Patient: Preliminary Study on Subsequent Facial Growth

Purpose: This study evaluated the long-term effects of orthognathic surgery on subsequent growth of the maxillomandibular complex in the young cleft patient. Patients and Methods: We evaluated 12 young cleft patients (9 male and 3 female patients), with a mean age of 12 years 6 months (range, 9 years 8 months to 15 years 4 months), who underwent Le Fort I osteotomies, with maxillary advancement, expansion, and/or downgrafting, by use of autogenous bone or hydroxyapatite grafts, when indicated, for maxillary stabilization. Five patients had concomitant osteotomies of the mandibular ramus. All patients had presurgical and postsurgical orthodontic treatment to control the occlusion. Radiographs taken at initial evaluation (T1) and presurgery (T2) were compared to establish the facial growth vector before surgery, whereas radiographs taken immediately postsurgery (T3) and at longest follow-up (T4) were used to determine postsurgical growth. Each patient's lateral cephalograms were traced, and 16 landmarks were identified and used to compute 11 measurements describing presurgical and postsurgical growth. Results: Before surgery, all patients had relatively normal growth. After surgery, cephalograms showed statistically significant growth changes from T3 to T4, with the maxillary depth decreasing by -3.3° ± 1.8°, Sella-nasion-point A by -3.3° ± 1.8°, and point A-nasion-point B by -3.6° ± 2.8°. The angulation of the maxillary incisors increased by 9.2° ± 11.7°. Of 12 patients, 11 showed disproportionate postsurgical jaw growth. Maxillary growth occurred predominantly in a vertical vector with no anteroposterior growth, even though most patients had shown anteroposterior growth before surgery. The distance increased in the linear measurement from nasion to gnathion by 10.3 ± 7.9 mm. Four of 5 patients operated on during the mixed dentition phase had teeth that erupted through the cleft area. A variable impairment of postoperative growth was seen with the 2 types of grafting material used. No significant difference was noted in the effect on growth in patients with unilateral clefts versus those with bilateral clefts. The presence of a pharyngeal flap was noted to adversely affect growth, whereas simultaneous mandibular surgery did not. After surgery, 11 of 12 patients tended toward a Class III end-on occlusal relation. Conclusions: Orthognathic surgery may be performed on growing cleft patients when mandated by psychological and/or functional concerns. The surgeon must be cognizant of the adverse postsurgical growth outcomes when performing orthognathic surgery on growing cleft patients with the possibility for further surgery requirements. Performing maxillary osteotomies on cleft patients would be more predictable after completion of facial growth. © 2008 American Association of Oral and Maxillofacial Surgeons.

Verruciform xanthoma and neurofibromatosis: A case report

We report an unusual case of verruciform xanthoma in a patient with neurofibromatosis and some clinical features of oral lichen planus. © 2010 The British Association of Oral and Maxillofacial Surgeons.

Tracheostomy-dependent child with temporomandibular ankylosis and severe micrognathia treated by piezosurgery and distraction osteogenesis: Case report

Ankylosis of the temporomandibular joint in children is one the most difficult and complex conditions managed by oral and maxillofacial surgeons, and often leads to some facial deformity. Distraction osteogenesis of the mandible provides an excellent treatment for mandibular airway obstruction in children who do not respond to conservative measures, and allows for early removal of the tracheostomy. We report the case of a 1-year-old boy with severe micrognathia and temporomandibular ankylosis who was dependent on a tracheostomy; he was treated with piezosurgery and mandibular advancement by distraction osteogenesis. © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Psychosocial impact on anophthalmic patients wearing ocular prosthesis

The aim of this study was to assess the improvement in psychosocial awareness of anophthalmic patients wearing ocular prostheses and its relationship with demographic characteristics, factors of loss/treatment, social activity, and relationship between professional and patient. Surveys including a form for evaluation of psychosocial pattern were conducted with 40 anophthalmic patients rehabilitated with ocular prosthesis at the Center of Oral Oncology in the authors' dental school from January 1998 to November 2010. The improvement in psychosocial awareness was assessed by comparing the perception of some feelings reported in the period of eye loss and currently. Wilcoxon tests were applied for comparison of patients' perception between the periods. χ2 tests were used to assess the relationship between the improvement in psychosocial awareness and the variables of the study. In addition, the logistic regression model measured this relationship with the measure of odds ratio. The feelings of shame, shyness, preoccupation with hiding it, sadness, insecurity and fear were significant for improvement in psychosocial awareness. It was concluded that the anophthalmic patients wearing an ocular prosthesis has significant improvement in psychosocial awareness after rehabilitation. © 2012 International Association of Oral and Maxillofacial Surgeons.