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Background: The temporomandibular joint (TMJ) is a key component of the stomatognathic system, playing a major role in maintaining mandibular stability and function. Temporomandibular disorders (TMDs) are a prevalent disease in the world, with surgical treatment being reserved for complex cases or end-stage TMJ disease. A narrative review was conducted to describe the quantitative and qualitative factors that affect TMJ prosthesis stability. Methods: Studies with a sample size equal to or greater than 10 subjects who underwent surgical procedures for joint replacement using stock or customized ATM prostheses were included. This narrative review examined some variables that may influence in terms of the longevity of the TMJ prosthesis, highlighting issues to be considered in future research. Results: The current development of TMJ prostheses is benefiting from technological advances, offering a suitable adaptation to the patient's anatomy and superior results in functionality and patient satisfaction. However, the biomechanical complexity of the TMJ shows unique challenges compared to other joints in the body, where anatomical, biomechanical, and functional requirements are high. The stability of the TMJ prosthesis is affected by multiple variables, including the selection of biocompatible materials that resist corrosion and wear, the design of the prosthesis, the diagnosis and indication for its use, and the surgeon's experience. The success of TMJ replacement can be measured by improving the patient's quality of life, reducing pain, restoring mandibular functionality, and recovering suitable facial morphology for the patient's conditions. Conclusion: There is a need for training of maxillofacial surgeons in TMJ surgery and replacement, as well as a greater focus on the research and development of systems to simplify surgical design and procedures and to optimize the results of TMJ replacement. [ABSTRACT FROM AUTHOR]

Facial deformities, whether congenital or acquired, often lead to diminished self-esteem, negative body image, social stigma, discrimination, and emotional challenges such as anxiety, depression, and social phobia. Surgical interventions are commonly sought to improve appearance and enhance self-esteem and social acceptance, but the outcomes may not always align with patients' expectations, potentially leading to disappointment. The post-surgical recovery process is both physically and emotionally demanding, necessitating support for managing self-image and social interactions. Successful surgery can lead to improved self-esteem and social interactions, but ongoing support is crucial to address residual issues and ensure continued emotional well-being. The paper underscores the importance of a holistic approach to patient care that integrates psychological support with surgical intervention to optimize outcomes and ensure a comprehensive approach to patients' well-being.

Objective To compare the accuracy of the original-mirror alignment algorithm and a landmark-independent method in constructing the midsagittal plane (MSP) of the cone beam computed tomography in patients with facial deformities, so as to provide a theoretical basis for symmetric analysis. Methods The study was approved by the hospital ethics committee. Cone beam computed tomography data of 30 patients with facial deformities were obtained, and the output was saved in DICOM format. The scan data were imported into Mimics 21.0; after segmentation, three-dimensional (3D) skull models were reconstructed. Furthermore, the 3D scan data of skulls were transformed into mirror skull models using Geomagic Studio 2014 reverse engineering software. The MSP of each skull was generated using both the original-mirror alignment algorithm and the landmark-independent method. Original-mirror alignment algorithm: the original skull model and its mirror model were combined, and the new data to calculate the MSP (S1) of the original data in Geomagic Studio 2014 were obtained. Landmark-independent method: the following anatomical landmarks were determined using Mimics 21.0: nasion (N), crista galli (CG), sella (S), basion (Ba), vomer (V), posterior nasal spine (PNS), incisive foramen (IF), and anterior nasal spine (ANS). The MSP (S2) of best fit was then found by minimizing the mean square distance of these eight anatomical landmarks to a plane in Geomagic Studio 2014. The results of the S1 and S2 models constructed using the original-mirror alignment algorithm and the landmark-independent method, respectively, were scored subjectively by five senior maxillofacial surgeons, and a paired t-test was performed for the two groups. The internal consistency analysis was performed based on secondary experiments to verify the repeatability of the expert evaluation method. Results The average scores of the S1 and S2 models were 65.73 and 75.90, respectively. The average score of the model constructed using the landmark-independent method was significantly higher than that of the model constructed using the original-mirror alignment algorithm (P

Introduction: Hypertrophy of adenoids is a common condition in childhood, resulting in obstructive symptoms such as sleep apnea, snoring, and rhinosinusitis. Adenotonsillectomy is recommended to improve prognosis and quality of life. This case-control study compared facial angles and lip position related to dentofacial and mouth growth in symptomatic children with adenoid hypertrophy and asymptomatic control groups. Materials and Methods: The study included children aged 5 to 7 who presented with obstructive symptoms and confirmed severe adenoid hypertrophy in lateral neck radiography. Standard lateral photography was taken. The Nasofacial and Nasomental angles, and upper and lower lip positions and their distance behind the Ricketts line, were measured and compared with the normal control group. Results: This study included 54 children with severe adenoid hypertrophy and 66 normal children. Facial angles were not significantly different between the two groups, but the mean horizontal position of the upper and lower lip in children with adenoid hypertrophy was significantly lower than in the control group (P value = 0.05). The lips were too close to the Ricketts line compared with the control group. Conclusions: This research demonstrates that children with severe adenoid hypertrophy have more dentofacial disorders than others. Adenotonsillectomy surgery is necessary for children with obstructive symptoms caused by tonsil enlargement, and if symptoms like snoring persist post-surgery, complementary orthodontic treatments should be considered. [ABSTRACT FROM AUTHOR]

AI is included in a lot of different systems. In facial surgery, there are some AI-based software programs oriented to diagnosis in facial surgery. This study aims to evaluate the capacity and training of models for diagnosis of dentofacial deformities in class II and class III patients using artificial intelligence and the potential use for indicating orthognathic surgery. The search strategy is from 1943 to April 2024 in PubMed, Embase, Scopus, Lilacs, and Web of Science. Studies that used imaging to assess anatomical structures, airway volume, and craniofacial positions using the AI algorithm in the human population were included. The methodological quality of the studies was assessed using the Effective Public Health Practice Project instrument. The systematic search identified 697 articles. Eight studies were obtained for descriptive analysis after exclusion according to our inclusion and exclusion criteria. All studies were retrospective in design. A total of 5552 subjects with an age range between 14.7 and 56 years were obtained; 2474 (44.56%) subjects were male, and 3078 (55.43%) were female. Six studies were analyzed using 2D imaging and obtained highly accurate results in diagnosing skeletal features and determining the need for orthognathic surgery, and two studies used 3D imaging for measurement and diagnosis. Limitations of the studies such as age, diagnosis in facial deformity, and the included variables were observed. Concerning the overall analysis bias, six studies were at moderate risk due to weak study designs, while two were at high risk of bias. We can conclude that, with the few articles included, using AI-based software allows for some craniometric recognition and measurements to determine the diagnosis of facial deformities using mainly 2D analysis. However, it is necessary to perform studies based on three-dimensional images, increase the sample size, and train models in different populations to ensure accuracy of AI applications in this field. After that, the models can be trained for dentofacial diagnosis [ABSTRACT FROM AUTHOR]

Background: The temporomandibular joint (TMJ) is a key component of the stomatognathic system, playing a major role in maintaining mandibular stability and function. Temporomandibular disorders (TMDs) are a prevalent disease in the world, with surgical treatment being reserved for complex cases or end-stage TMJ disease. A narrative review was conducted to describe the quantitative and qualitative factors that affect TMJ prosthesis stability. Methods: Studies with a sample size equal to or greater than 10 subjects who underwent surgical procedures for joint replacement using stock or customized ATM prostheses were included. This narrative review examined some variables that may influence in terms of the longevity of the TMJ prosthesis, highlighting issues to be considered in future research. Results: The current development of TMJ prostheses is benefiting from technological advances, offering a suitable adaptation to the patient’s anatomy and superior results in functionality and patient satisfaction. However, the biomechanical complexity of the TMJ shows unique challenges compared to other joints in the body, where anatomical, biomechanical, and functional requirements are high. The stability of the TMJ prosthesis is affected by multiple variables, including the selection of biocompatible materials that resist corrosion and wear, the design of the prosthesis, the diagnosis and indication for its use, and the surgeon’s experience. The success of TMJ replacement can be measured by improving the patient’s quality of life, reducing pain, restoring mandibular functionality, and recovering suitable facial morphology for the patient’s conditions. Conclusion: There is a need for training of maxillofacial surgeons in TMJ surgery and replacement, as well as a greater focus on the research and development of systems to simplify surgical design and procedures and to optimize the results of TMJ replacement.

Orthognathic surgery is indicated to modify the position of the maxillomandibular structure; changes in the mandibular position after osteotomy can be related to changes in the position of the mandibular condyle in the articular fossa. The aim of this study was to determine changes produced in the mandibular condyle 6 months after orthognathic surgery. A cross-sectional study was conducted that included subjects who had undergone bimaxillary orthognathic surgery to treat dentofacial deformity of Angle class II (group CII) or Angle class III (group CIII). Standardized images were taken using cone-beam computed tomography 21 days before surgery and 6 months after surgery; measurement scales were used to identify the condylar position and its relations with the anterior, superior, and posterior joint spaces. The results were analyzed using the Shapiro–Wilk and Student's t-tests, while considering a value of p < 0.05 as indicating a significant difference. Fifty-two joints from 26 patients, with an average age of 27.9 years (±10.81), were analyzed. All subjects in both group CII and group CIII showed a significant change in the anterior, superior, and posterior joint spaces. However, postoperative changes in the position of the condyle in the articular fossa were not significant in the anteroposterior analysis. We conclude that orthognathic surgery causes changes in the sagittal position of the mandibular condyle in subjects with mandibular retrognathism and prognathism. [ABSTRACT FROM AUTHOR]

Background: Nasolabial cysts are non-odontogenic cysts that arise from the nasal alar area. Sublabial resection of the nasolabial cyst is considered an effective surgical modality of treatment. Objective: This study aimed to evaluate the clinical presentation, diagnosis and treatment of nasolabial cyst at a tertiary care teaching hospital in eastern India. Methods: This was a retrospective study of 38 cases of nasolabial cysts managed between May 2018 and June 2022. The detailed clinical presentations, investigations and treatment of nasolabial cysts of the patients were studied. Results: Out of 38 cases of the nasolabial cyst, 22 (57.9%) were seen on the left side, 13 (34.2%) were seen on the right side and 3 were seen bilaterally. The most common presenting complaint was facial swelling (84.2%). Computed tomography of the nose and paranasal sinuses was done in 24/38 (70.5%) patients studied. Surgical excision of the nasolabial cysts was done by intraoral sublabial approach in 32 (84.2%) cases and 6 underwent endoscopic transnasal marsupialisation. The most common post-operative complication was post-operative facial/perinasal swelling. One case of recurrence was reported who underwent endoscopic transnasal marsupialisation. Conclusions: Nasolabial cysts are an uncommon clinical entity but manifest cosmetic deformity and nasal obstruction. Intraoral sublabial excision and endoscopic transnasal marsupialisation are important surgical techniques for the nasolabial cyst. The post-operative complications and chance of recurrence are rare. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of simultaneous TMJ ankylosis (TMJA) release with uniplanar mandibular distraction in the management of facial deformity, improvement in function and obstructive sleep apnoea in growing patients. Material and Methods: Ten patients in the age group of 5–15 years with unilateral/bilateral TMJA and mild to moderate OSA and short body length but ramus height within normal limits were treated with simultaneous ankylosis release and uniplanar mandibular distraction osteogenesis. Clinical, radiographic, and OSA parameters were evaluated and followed up for 1 year. Results: Average mandibular body length increased by 16.6 mm, mouth opening by 26.9 mm, SNB angle by 9.53°, pharyngeal airway space by 6.29 mm, chin discrepancy corrected by 5.05 mm, apnoea–Hypopnoea index decreased by 15.9, N┴Pog by 12.27 mm, oxygen saturation (Spo2) by 4.1%, and oxygen desaturation index by 17.89%. All clinical, radiographic, and OSA parameters improved and were statistically significant except for mandibular plane angle and with minimal complications. Conclusion: Simultaneous TMJA release with uniplanar mandibular Distraction osteogenesis may be recommended as the treatment of choice in growing patients with mild to moderate OSA and facial deformity, as it causes simultaneous correction of micrognathia, facial asymmetry, OSA and prevents the need for an additional surgery. [ABSTRACT FROM AUTHOR]

Purpose: Manufacturing a spectacle frame for a facially deformed individual is challenging because of facial asymmetry. One of the solutions is the customization of spectacle frames. Customization of spectacle frames for facially deformed individuals requires a better understanding of the facial anthropometry of deformed faces. This study aimed to analyze the facial anthropometry of deformed faces to understand the range of variability. The results of this study will be used to find customization methods in the future. Methods: We measured and analyzed the 12 facial parameters of individuals with facial deformities using the ImageJ software. Results: The data collected were normally distributed. Paired sample test revealed a statistically significant difference between innercanthus distances (right innercanthus distance [RICD] and left innercanthus distance [LICD]). Correlation analysis showed a positive difference between horizontal and vertical pupillary distance-innercanthus distance (PD-ICD) (0.68, 0.75, and 0.81) and pupillary distance-helix distance (PD-HD) (0.57, 0.68, and 0.59) relations. PD-ICD correlations are stronger compared to the PD-HD relation. Conclusion: Altering the frame center distance and the temple heights are the most important for asymmetric faces. Large population-based data are required to make concrete decisions to design a spectacle frame for asymmetric faces.

Patients with Treacher Collins syndrome have a known difficult airway particularly if intubation is required. In most institutions that perform full mouth dental restoration (FMDR) procedures the patient is nasally intubated to protect the airway from debris and irrigation fluid. For patients with Treacher Collins syndrome the actual intubation and securing the airway can be more difficult and traumatic than the actual dental restoration itself. However, there is an airway technique using nasopharyngeal airways combined with a dental technique called "dry prepping" that can provide those patients a safe way of receiving an FMDR without intubation. A recent case report of a 29-month-old child with Treacher Collins syndrome received an FMDR without intubation. [ABSTRACT FROM AUTHOR]

Long-standing temporomandibular joint (TMJ) ankylosis may compromise facial form and function. Treatment planning needs to address both the ankylosis and the facial deformity. A 21-year-old male patient with unilateral TMJ ankylosis of the right side with gross facial asymmetry was planned for a two-stage surgical procedure. First-stage surgery was done to release fibrous ankylosis, create a new functional joint and achieve adequate mouth opening. A vertical ramus osteotomy with superior repositioning of the proximal ramal segment and interpositional temporalis myofascial flap was done to achieve a functional joint and correct the facial height discrepancy. As the mouth opening was

Background: The purpose of this single-centre prospective clinical study was to evaluate the correction of severe facial deformity and Obstructive sleep apnoea hypopnoea syndrome (OSAHS) in 22 patients aged from 9 to 42 years (mean 20.09) of bilateral Temporomandibular joint ankylosis. Materials and Methodology: Patients underwent multisegment distraction using external bilateral bidirectional distractors. Facial deformity was evaluated clinically in terms of mouth opening and neck chin angle and cephalometrically in terms of corpus length (gonion-pogonion), ramal height (articulare-gonion), chin deficiency (N perpendicular to Pog and SNB). OSAHS was evaluated through Epworth sleepiness scale, Berlin's questionnaire, pharyngeal airway space, apnoeic hypoapnoeic index, oxygen desaturation index, average arterial oxygen saturation and minimal fall in O2 saturation. Patients were followed up for a period of 13–74 months (mean 28.68). Results: Statistically highly significant results were obtained in all parameters. Complications encountered were pin infection (13.63%), loosening of pins (4.5%), wound dehiscence (9.09%), tooth fracture (4.5%) and parotid fistula (9.09%). Intermediate segment necrosis and vector loss were not observed. Conclusion: This study is a large case series using two corticotomy cuts for external bilateral bidirectional distracters with concomitant neo callous moulding in patients both pre- and post-ankylosis release. It is extremely efficient in correcting mandibular corpal and ramal deficiency as well as improving OSAHS. [ABSTRACT FROM AUTHOR]

Purpose: Patients with syndromic 46, XY disorders/differences of sex development (DSD) are characterized by gonadal and phenotypic genders inconsistent with their chromosomal sexes as well as abnormalities of multiple extragonadal organs. They are caused by mutations in specific genes, which are expressed in the affected organs and regulate their development, and over fourteen genes have been identified. In this study, we aimed to determine the underlying cause of a patient with syndromic 46, XY DSD and review the clinical presentations and genetic findings of all reported similar cases. Methods: Whole-exome sequencing (WES) was performed to find a molecular cause of the patient. In silico tools were used to analyze the pathogenicity of the variants. Reports of cases with similar clinical features and involved genes were summarized by searching through PubMed/MEDLINE using keywords " PPP2R3C " or " G5PR " and "46,XY disorders of sex development". Results: Compound heterozygous variants (p.F229del/p.G417E) in PPP2R3C were identified in the 24-year-old female by WES and verified by Sanger sequencing. The patient presents complete testicular dysgenesis, low birth weight, facial deformity, cubitus valgus, and decreasing number of CD19+ B lymphocytes and CD4+ T lymphocytes. A total of thirteen 46, XY DSD cases with four homozygous PPP2R3C mutations (p.Leu103Pro, p.Leu193Ser, p.Phe350Ser, and p.Ser216_Tyr218dup) have been reported previously, and their clinical manifestations are roughly similar to those of our patient. Conclusion: Novel compound heterozygous variants in PPP2R3C cause specific syndromic 46, XY gonadal dysgenesis, which broadened the pathogenic variants spectrum of PPP2R3C. The typical phenotype of PPP2R3C mutation is complete 46, XY gonadal dysgenesis with multiple extragonadal anomalies, including facial deformities, skeletal system abnormalities, muscle abnormalities, impaired nervous system, impaired hearing and vision, heart and kidney anomalies, and gastrointestinal dysfunction. [ABSTRACT FROM AUTHOR]

Aim: The aim of the current survey was conducted to assess the knowledge, attitude, and awareness regarding orthognathic surgery among orthodontic patients. Materials and Methods: This is cross-sectional web-based questionnaire survey conducted among orthodontic patients in Tamil Nadu. The self-administered questions related to awareness of orthognathic surgery were collected from 500 subjects. The statistical analysis was done using the Statistical Package for the Social Sciences (V 22.0). The frequency distribution was computed. Results: This survey revealed that 466 (93.2%) respondents had awareness about the role of orthognathic surgery. 332 (66.4%) had given the correct responses related to differentiating skeletal and dental malocclusion, 454 (90.6%) had the awareness of risk factors associated with orthognathic surgery and 40 (7.0%) were experienced regarding the procedure. Conclusion: The result of the current study showed that it clearly implies that the population was aware of orthognathic surgery as a treatment modality for correcting skeletal deformities.

Purpose: Patients with syndromic 46, XY disorders/differences of sex development (DSD) are characterized by gonadal and phenotypic genders inconsistent with their chromosomal sexes as well as abnormalities of multiple extragonadal organs. They are caused by mutations in specific genes, which are expressed in the affected organs and regulate their development, and over fourteen genes have been identified. In this study, we aimed to determine the underlying cause of a patient with syndromic 46, XY DSD and review the clinical presentations and genetic findings of all reported similar cases.Methods: Whole-exome sequencing (WES) was performed to find a molecular cause of the patient. In silico tools were used to analyze the pathogenicity of the variants. Reports of cases with similar clinical features and involved genes were summarized by searching through PubMed/MEDLINE using keywords “PPP2R3C” or “G5PR” and “46,XY disorders of sex development”.Results: Compound heterozygous variants (p.F229del/p.G417E) in PPP2R3C were identified in the 24-year-old female by WES and verified by Sanger sequencing. The patient presents complete testicular dysgenesis, low birth weight, facial deformity, cubitus valgus, and decreasing number of CD19+ B lymphocytes and CD4+ T lymphocytes. A total of thirteen 46, XY DSD cases with four homozygous PPP2R3C mutations (p.Leu103Pro, p.Leu193Ser, p.Phe350Ser, and p.Ser216_Tyr218dup) have been reported previously, and their clinical manifestations are roughly similar to those of our patient.Conclusion: Novel compound heterozygous variants in PPP2R3C cause specific syndromic 46, XY gonadal dysgenesis, which broadened the pathogenic variants spectrum of PPP2R3C. The typical phenotype of PPP2R3C mutation is complete 46, XY gonadal dysgenesis with multiple extragonadal anomalies, including facial deformities, skeletal system abnormalities, muscle abnormalities, impaired nervous system, impaired hearing and vision, heart and kidney anomalies, and gastrointestinal dysfunction.

Purpose: Manufacturing a spectacle frame for a facially deformed individual is challenging because of facial asymmetry. One of the solutions is the customization of spectacle frames. Customization of spectacle frames for facially deformed individuals requires a better understanding of the facial anthropometry of deformed faces. This study aimed to analyze the facial anthropometry of deformed faces to understand the range of variability. The results of this study will be used to find customization methods in the future. Methods: We measured and analyzed the 12 facial parameters of individuals with facial deformities using the ImageJ software. Results: The data collected were normally distributed. Paired sample test revealed a statistically significant difference between innercanthus distances (right innercanthus distance [RICD] and left innercanthus distance [LICD]). Correlation analysis showed a positive difference between horizontal and vertical pupillary distance-innercanthus distance (PD-ICD) (0.68, 0.75, and 0.81) and pupillary distance-helix distance (PD-HD) (0.57, 0.68, and 0.59) relations. PD-ICD correlations are stronger compared to the PD-HD relation. Conclusion: Altering the frame center distance and the temple heights are the most important for asymmetric faces. Large population-based data are required to make concrete decisions to design a spectacle frame for asymmetric faces. [ABSTRACT FROM AUTHOR]

Introduction: Finite element analysis (FEA) is a method to mimic the biomechanical behaviour of an object under various loading scenarios, and may be used during virtual planning of the TMJ prosthesis. Here we present an interesting case report where FEA was done to biomechanically evaluate patient specific total joint replacement prosthesis for bilateral TMJ replacement. Case report: A 22 year old young girl visited our outpatient clinic with a chief complaint of retruded chin and limited mouth opening for the last 15 years. After clinical and radiographic examination, her corrective surgery was virtually planned on Mimics software. The Implants were studied under simulated loading scenarios in ANSYS to understand the structural integrity of the implant for different loading conditions. Results: Maximum Von-Mises Stress on Condylar component is 151.9 MPa and Maximum Von-Mises Stress on Fossa component is 0.377 MPa. The minimum safety factor of the fossa component was about 15, which is safe enough to complete 100 million cycles. The maximum von-mises stress were detected at the screw holes in the condylar components of the implant. The screw holes were therefore the areas prone to highest chance of failure in the design. Conclusion: We conclude that FEA based biomechanical analysis is important prerequisite during customized reconstruction of TMJ. In today's scenario of patient specific TMJ reconstruction, FEA based designing and planning of stress distribution along the bone and calculation of maximum strain in the prosthesis, further aids in the proper designing of this implant and enhances the post-operative clinical results.

Hypertrophy of the facial region is rare developmental malformation. The aim of this study is to report a case of partial facial hemihypertrophy describing its clinical features and debatable heterogeneity of etiologies, along with the review of literature to supplement to its current knowledge in English literature. PubMed search was done from 1986 to 2018, using the terms “Partial facial hemi-hypertrophy” or “Facial hemi-hypertrophy” or “Facial Gigantism” and 95 articles were identified. After manual reviewing and screening, 27 results were included in the analysis. Men are more commonly affected than women, with right side showing more involvement than the left side. Both hard and soft tissues are involved on the affected site. Reconstructive surgeries are usually planned after cessation of physiological growth. It includes orthognathic surgeries or osteotomies. Multiple soft tissue debulking procedures may be performed including excision of excess subcutaneous tissue and masticatory muscles, face-lift surgeries, lip reduction surgery, or parotidectomy. No malignant transformation has been reported in literature. The great variation of asymmetries caused by facial hemihypertrophies requires a combination and variety of sequential treatment procedures to gain adequate functional and cosmetic results. Hence, treatment of such malformation varies radically.

Aim: The aim of the current survey was conducted to assess the knowledge, attitude, and awareness regarding orthognathic surgery among orthodontic patients. Materials and Methods: This is cross-sectional web-based questionnaire survey conducted among orthodontic patients in Tamil Nadu. The self-administered questions related to awareness of orthognathic surgery were collected from 500 subjects. The statistical analysis was done using the Statistical Package for the Social Sciences (V 22.0). The frequency distribution was computed. Results: This survey revealed that 466 (93.2%) respondents had awareness about the role of orthognathic surgery. 332 (66.4%) had given the correct responses related to differentiating skeletal and dental malocclusion, 454 (90.6%) had the awareness of risk factors associated with orthognathic surgery and 40 (7.0%) were experienced regarding the procedure. Conclusion: The result of the current study showed that it clearly implies that the population was aware of orthognathic surgery as a treatment modality for correcting skeletal deformities. [ABSTRACT FROM AUTHOR]

Poor facial cosmesis resultant from dysgnathias usually accounts for a range of these individuals' psychological and social problems. Disturbances of both esthetics and function are caused by jaw deformity and associated structures' deformity such as malocclusion. The correction of these deformities is one of the most challenging and intriguing aspects of maxillofacial surgery. Despite having become routine only relatively recently, rigid internal fixation has advanced rapidly, its results are consistent and predictable and thus, its knowledge applies in orthognathic surgery besides other areas of maxillofacial surgery. The bilateral sagittal split osteotomy (BSSO) is a common orthognathic procedure performed on the mandible. First described by Trauner and Obwegeser in 1957, modified by Dal Pont and refined by Epker, several modifications of the BSSO have been introduced aiming to enhance surgical convenience, minimize morbidity, and maximize stability. The aim of this article is to review the literature of this technique from the historical perspective and to present a standard operation technique. [ABSTRACT FROM AUTHOR]

The aim of this research was to analyze the morphology of the nasal septum and inferior nasal concha bone in class III facial deformities prior to orthodontic treatment in orthognathic surgery candidates. 40 subjects were included in this research. The inclusion criteria were an Angle class III, negative overjet and SNA angle less than 80º. Patients with facial asymmetry, facial trauma or who had undergone maxillofacial or ENT procedures were excluded. CBCT images were obtained for all the patients and the nasal septum deviation, morphology of inferior nasal concha bone and ostium of the maxillary sinus were analyzed and related to the complexity of the facial deformity expressed by the ANB angle and dental relations. The measurement was standardized by ICC and the data was analyzed using a chi square test and Spearman’s coefficient with a p value < 0.005 for statistical significance. Nasal septal deviation was observed in 77.5 %. The deviation angle was 13.28º (±4.68º) and the distance from the midline to the most deviated septum was 5.56 mm (±1.8 mm) with no statistical relation to the complexity of the facial deformity. The deviated nasal septum showed inferior nasal concha bone hypertrophy on the concave side of the nasal septum deviation (p=0.049). The open or closed condition of the maxillary sinus ostium was not related to any conditions in the septum or complexity of the facial deformity. Inferior nasal concha bone hypertrophy could be related to nasal septal deviation. The nasal condition in a class III facial deformity could not differ from the general population; careful in orthognathic surgery as to be assume in the Le Fort I Osteotomy and nasal approach related to nasal septum deviation and inferior nasal concha bone. [ABSTRACT FROM AUTHOR]

Finite element analysis (FEA) is a method to mimic the biomechanical behaviour of an object under various loading scenarios, and may be used during virtual planning of the TMJ prosthesis. Here we present an interesting case report where FEA was done to biomechanically evaluate patient specific total joint replacement prosthesis for bilateral TMJ replacement. A 22 year old young girl visited our outpatient clinic with a chief complaint of retruded chin and limited mouth opening for the last 15 years. After clinical and radiographic examination, her corrective surgery was virtually planned on Mimics software. The Implants were studied under simulated loading scenarios in ANSYS to understand the structural integrity of the implant for different loading conditions. Maximum Von-Mises Stress on Condylar component is 151.9 MPa and Maximum Von-Mises Stress on Fossa component is 0.377 MPa. The minimum safety factor of the fossa component was about 15, which is safe enough to complete 100 million cycles. The maximum von-mises stress were detected at the screw holes in the condylar components of the implant. The screw holes were therefore the areas prone to highest chance of failure in the design. We conclude that FEA based biomechanical analysis is important prerequisite during customized reconstruction of TMJ. In today's scenario of patient specific TMJ reconstruction, FEA based designing and planning of stress distribution along the bone and calculation of maximum strain in the prosthesis, further aids in the proper designing of this implant and enhances the post-operative clinical results. [ABSTRACT FROM AUTHOR]

The chin affects facial esthetics and the harmony between frontal and lateral views and is one of the most important anatomic structures of the lower third of the face. Chin osteotomy is aimed at ensuring the harmonization of the facial profile by balancing the size and form of the lower third of the face. It is assumed that the isolated genioplasty surgery will improve the pharyngeal airway space (PAS) by promoting muscle changes, specifically by pulling forward the hyoid bone and decompressing the hypopharynx region. Two patients without obstructive sleep apnea syndrome (OSAS) underwent isolated chin osteotomy for esthetic purposes. Forward movement of the chin by the Pg point was 7 mm in one case and 11 mm in another case. They were evaluated by preoperative and postoperative cone-beam computed tomography scans. The upper airway space was subdivided into retropalatal and retroglossal spaces. After this, the upper airway space was analyzed through the following criteria: 1) three-dimensional, high-altitude, cross-sectional surfaces; 2) transverse and anteroposterior diameter changes. Isolated segmental genioplasty was used after precise virtual planning and resulted in the PAS increase only in one case. There was a relevant correlation between the vertical and horizontal chin change and the hypopharynx. There was an average of a 1.6-fold increase in the total volume of the upper airway space. The retroglossal space was increased 1.5-fold. In another case, there was no relevant correlation between the vertical and horizontal chin change and the PAS. Isolated segmental chin osteotomy provides predictable esthetic results in the correction of different mandible anterior deformities and may contribute to an increased volume and a morphologic airway change. Further studies should be conducted to evaluate the effect of isolated segmental genioplasty on the pharyngeal airway space. [ABSTRACT FROM AUTHOR]

The aim of this investigation was to define the volume and area of the airway in subjects with Class II and Class III skeletal deformity. A cross-sectional study was designed including subjects with facial deformity defined by Steiner's analysis in subjects with indication of orthognathic surgery who presented diagnosis by cone beam computerised tomography. We determined the measurements of maximum area, minimum area and volume of the airway. The data were compared using Spearman's test, with statistical significance defined as p<0.05. 115 subjects were included: 61.7 % Class II and 38.3 % Class III, mean age 27.8 years (± 11.6). A significant difference was observed in the area and volume measurements in the groups studied, with significantly smaller measurements found in Class II (p=0.034). The minimum area was 10.4 mm2 smaller in Class II patients than in Class III, while the general volume of the airway was 4.1 mm3 smaller in Class II than in Class III. We may conclude that Class II subjects present a smaller airway volume than Class III subjects. [ABSTRACT FROM AUTHOR]

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The cephalometric analyses from a lateral cranial radiograph, are wide and varied considering both functional and facial aesthetic patterns. Among the measurement techniques in cephalometry, Ricketts and McNamara are widely used; they both give importance to determine the position of the maxilla and mandible with different skeletal relationships. The objective of this research is to compare both techniques in a young population of Ecuador. A concordance analysis was performed using Cohen's kappa index between the results of the measurements corresponding to 44 lateral cephalic radiographs of young subjects between 18 and 27 years of age, of both sexes. In relation to the maxillary position, 56.82% (95% CI: 42.18% - 71.45%) coincide in the diagnosis of maxillary protrusion. Cohen's kappa concordance index was 0.599 (95% CI: 0.354-0.854) with a p-value < 0.05. In relation to the mandibular position, 50.0% (95% CI: 35.23% - 64.77%) coincide in the diagnosis of mandibular retrusion. Cohen's kappa index was 0.460 (95% CI 0.229 - 0.691) with a p-value < 0.05. It is concluded that, despite handling different cephalometric reference points, the two craniofacial measurement techniques are useful for the study of maxilla and mandible position. There are differences between some analyses of both studies that may affect the therapeutic selection of potential patients. [ABSTRACT FROM AUTHOR]

El enoftalmos postraumático se define como la discrepancia entre el volumen orbitario y su contenido; este balance puede verse alterado por múltiples factores, como el secuestro tardío del contenido orbitario por atrapamiento en el sitio de la fractura, herniación del contenido orbitario, necrosis del tejido adiposo orbitario, contracción cicatricial del tejido retrobulbar, pérdida del sistema de suspensión ligamentario del globo ocular y aumento de volumen de la cavidad orbitaria. El presente estudio aborda el problema del enoftalmos postraumático como una deformidad difícil de corregir. Están descritos abordajes cutáneos extensos como el coronal, el subciliar o el intraoral; la técnica descrita por Henry Kawamoto en 1998 describe un procedimiento de menor invasión mediante abordajes de mínima exposición que permiten la refracturación y el alineamiento del cuerpo zigomático, brindando así grandes ventajas sobre las técnicas convencionales. Presentamos el método aplicado en el servicio de Cirugía Reconstructiva del Centro Médico del Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM) para el manejo de pacientes con enoftalmos como secuela de traumatismos del complejo cigomático-malar; para ello empleamos un método por asistencia con modelos estereolitográficos para la planificación quirúrgica del diseño de osteotomías para corregir la deformidad facial y para determinar las dimensiones del defecto a reparar, así como el tipo y cantidad de materiales aloplásticos o autólogos a emplear. Compartimos la experiencia de los casos tratados en nuestro Servicio entre 2006 y 2010.Post-traumatic enophthalmos is defined as the discrepancy between the orbital volume and its content; this balance can be altered by many factors, such as the entrapment or herniation of the orbital content at the fracture site, orbital adipose tissue necrosis, scar contraction of the retrobulbar tissue, loss of the eyeball suspension system and the increase in orbital volume. This paper deals with the management of post-traumatic enophthalmos as a difficult deformity to treat. Extensive cutaneous approaches have been described, as the coronal, intraoral and subciliar. In 1998 Henry Kawamoto described approaches less invasive allowing minimal exposure, based on the fracturing and re-alignment of the zygomatic body, thus providing great benefits. This method is applied at the Plastic and Reconstructive Surgery Department of the Instituto de Seguridad Social del Estado de Mexico y Municipios (ISSEMyM) in the management of enophthalmos as a post-traumatic sequelae, with stereolithographic assistance for surgical planning and re-fracturing design of the facial deformity and to determine the size of the defects to repair with autologous or alloplastic materials. We is share our experience with cases treated by our department between 2006 and 2010.

Maxillary sinus atelectasis is a rare and relatively unknown disease. Most patients present with non-sinonasel complaints. Negative intracavitary pressure due to ostial obstruction is suggested as the most probable etiology. Two patients with sinus atelectasis are presented in this paper: Case 1 presented with enophthalmus and maxillary sinus opacity and atelectasis in imaging. Endoscopic uncinectomy and midle antrostomy was done for this patient. Case 2 presented with mid-facial deformity and depression. Caldwel-Luc procedure with inferior meatal antrostomy was done. In 1 year follow up, they were asymptomatic and with no deterioration of facial deformity.

Dentofacial deformities present some shades and variations that determine the inclusion of different anatomical components as part of the disease; the aim of this study was to ascertain the nasal characteristics in patients with a Class III dentofacial deformity. A descriptive study was conducted on 20 patients diagnosed with a Class III facial deformity and a surgical indication; frontal and lateral as well as CT images were taken to analyze variables of nasal morphology and deformities associated with the nasal bridge, tip and septum. The results showed that the nasal angles are outside normal parameters and that the basal width of the nose is approximately 3 mm smaller than the intercanthal width; 45% of the subjects have lateral deviations, 50% bridge deformity and 80% septum deviation. It is concluded that there are nasal deformities in subjects with a Class III facial deformity and that this component must be carefully evaluated in the preoperative stage. [ABSTRACT FROM AUTHOR]

Background: Nasal hematoma/abscess is an uncommon entity, but capable of leading to serious consequences if not handled meticulously, and with urgency. Objective: To present the management, and outcome of nasal septal hematoma/abscess in a Nigerian tertiary institution. Method: Consecutive patients diagnosed with nasal septal hematoma/abscess over a 10-year period, treated at the University of Nigeria Teaching Hospital, Enugu, Nigeria, were prospectively studied. The processes leading to diagnosis, treatment, and outcome were sequentially evaluated. Results: Fifty-three patients (37 males and 16 females), age 5-65 years (with mean age of 23.10 years), were included. Surgical drainage of the hematoma/abscess, intranasal packing with insertion of drain was performed with total resolution of problem in all the cases. Conclusion: Incision and drainage, and intranasal packing with insertion of drain was effective in treating nasal septal hematoma/abscess. [ABSTRACT FROM AUTHOR]