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Background: The aim of this study is to compare the effects of %4 articaine and %2 lidocaine on inferior alveolar nerve block (IANB) for implant surgery in the posterior mandible.Material and Methods: The patients who have inserted implants in the posterior mandible were divided into 2 groups for IANB: lidocaine and articaine. VAS = visual analog scale, pain during surgery and injection, lip numb-ness time, mandibular canal-implant apex distance, age, gender, bone density, implant number, release incision, adjacent teeth, and duration of surgery were analyzed using t-test, Mann-Whitney U test, Spearman's coefficient, and, Pearson's chi-squared test. This trial followed the recommendations of the Consort Statement for reporting randomized controlled trials. Results: 577 patients were included and 1185 dental implants were analyzed. There was no significant difference between the two groups in terms of injection and surgery VAS values (p>0.05). The lip numbness time of lido-caine was 3.06 +/- 3.22min while articaine was found to be 2.96 +/- 3.09min (p>0.05). Mandibular canal-implant apex distance was found to be 2.28 +/- 0.75mm in the articaine and 2.45 +/- 0.86mm in the lidocaine group (p

Pfeiffer syndrome, affecting roughly 1 in 100,000 individuals is characterized by acrocephalosyndactyly – the premature closure of skull sutures (craniosynostosis). These acrocephalosyndactyly syndromes which are often sporadic de novo but also autosomal dominant in inheritance can be characterized by the fact that they often involve FGFR and TWIST genes. In the presented case, a 27-year old male level three trauma admission displayed skull abnormalities on physical examination that history taking confirmed was the result of pediatric surgically corrected Pfeiffer syndrome. Noncontrast brain CT as part of his trauma work-up revealed characteristic Pfeiffer syndrome imaging pattern of midface hypoplasia, nonvisualization of coronal and sagittal sutures, and a degree of obstructive hydrocephalus. Pfeiffer syndrome requires extensive pediatric surgery often with poor adult follow up. The case presented provides good visualization of characteristic skull abnormalities in a surgically corrected adult. By virtue of imaging an adult, this provides readers with a unique look at the long-term viability and the body's resulting physiological adaptations of the extensive mandatory pediatric surgery these patients undergo.

The aim of this retrospective study was to evaluate the relationships between upper jaw movements and nasal soft-tissue changes in patients who have undergone subspinal Le Fort I osteotomy combined with alar cinch suture. Single and multivariate linear regression analyses were used to examine the relationships between greatest inter-alar width (GAW) and maxillary advancement, maxillary impaction, and rotational movements. The database of our referral hospital was searched for patients who had undergone upper jaw surgery with a subspinal LFI osteotomy to correct dentoskeletal deformities between April 2012 and June 2016. Thirty-eight of the patients (15 men and 23 women) who were identified were eligible for inclusion. The average change in inter-alar width (ΔGAW) was +1.7 ± 1.2 mm. GAW increased by 0.3 mm (p 0.0001) for each millimetre of maxillary advancement, and increased by 0.5 mm (p 0.0001) for each millimetre of maxillary impaction. GAW increased by 0.2 mm for each degree of counterclockwise rotation of the occlusal plane (p 0.0001). An analysis of our data compared with the current literature confirmed that subspinal Le Fort I combined with alar cinch suture reduced alar base widening.

In patients with facial trauma, multidetector computed tomography is the first-choice imaging test because it can detect and characterize even small fractures and their associated complications quickly and accurately. It has helped clinical management and surgical planning, so radiologists must communicate their findings to surgeons effectively. In Le Fort fractures, there is a breach between the pterygoid plates and the posterior maxilla. These fractures are classified in three basic patterns that can be combined and associated with various complications. Conceptualized when low-speed trauma was predominant, the Le Fort classification system has become less relevant giving more importance on maxillary occlusion-bearing segments. The classification of naso-orbito-ethmoid depends on the extent of injury to the attachment of the medial canthal tendon, with possible complications like nasofrontal duct disruption. Displaced fractures of the zygomaticomaxillary complex often widen the angle of the lateral orbital wall, resulting in increased orbital volume and sometimes in enophthalmos. Severe comminution or angulation can lead to wide surgical exposure. In orbital fractures, entrapment of the inferior rectus muscles can lead to diplopia, so it is important to assess its positioning and morphology. Orbital fractures can also result in injuries to the globe or infraorbital nerve. Frontal sinus fractures that extend through the posterior sinus wall can create a communication with the anterior cranial fossa resulting in leakage of cerebrospinal fluid, intracranial bleeding. It is essential to categorize fracture patterns and highlight features that may affect fracture management in radiology reports of facial trauma.

Objectives To present a clinical description of the team's treatment techniques. Materials and Methods In Part 1, 30 patients underwent segmental maxillary orthodontics, multisegment Le Fort I, and bilateral sagittal osteotomies of the mandible. Part 1 reported excellent occlusal stability at a mean follow-up of 49.43 months (range, 36–92 months). Cases presented in Part 2 were selected based on availability of excellent technique photographs. The same techniques described in Part 2 cases were used on all Part 1 patients. Results The coordination of arch widths and forms, overbite, overjet, and maxillary curve of Spee corrections were stable using the team protocols for orthodontic and surgical treatment. Conclusions In the study group, long-term three-dimensionally stable occlusal results were achieved. To duplicate these results, specific orthodontic preparation, intraoperative surgical steps, and postsurgical steps must be carefully planned and executed. These steps are described in this article, Part 2.

Objective of the present study is to present a clinical case of panfacial fracture with hybrid treatment through Rigid Internal Fixation and Semi Rigid Fixation of complex mandibular fracture. Female patient, 21 years old, feoderma, admitted to the ICU of Hospital Geral de Taipas after motorcycle accident, evaluated by the Buco Maxillofacial Surgery and Traumatology service in which she was diagnosed with panfacial fracture, with Le Fort I fractures, II, III, Lannelong, nasal fracture and complex mandibular fracture: right angle and left parasymphesis. The CT scan of the face confirmed the presence of Panfacial fracture. A tracheostomy surgical procedure was performed, plus the installation of an upper and lower Erich bar with closed reduction of the mandibular fracture with maxillary mandibular block with an elastic band in the first surgical period. After stabilization of the clinical picture, fixation of the mandibular fracture was performed through the accesses, submandibular and submental with FIR of the fracture of the right mandibular angle and Semi Rigid Fixation of the left parasymphysis fracture and mandibular maxillary block with elastic. The patient was transferred from the UTI to the ward where she was discharged from the hospital with satisfactory facial symmetry, Eagle Class I dental occlusion, preserved mandibular movements and complete absence after 7 months of signs and symptoms of paresthesia and neuropraxia of cranial nerves V and VII. Objetivo del presente estudio es presentar un caso clínico de fractura panfacial con tratamiento híbrido mediante la Fijación Rígida Interna y Fijación Semirrígida de la fractura compleja mandibular. Caso clínico: Paciente femenina de 21 años con feoderma, ingresada en la UCI del Hospital Geral de Taipas tras accidente de motocicleta, evaluada por el servicio de Cirugía y Traumatología Maxilofacial Buco en la que fue diagnosticada de fractura panfacial, con fracturas de Le Fort I, II, III, Lannelong, fractura nasal y fractura mandibular compleja: ángulo recto y parasíntesis izquierda. La tomografía computarizada de la cara confirmó la presencia de fractura panfacial. Se realizó un procedimiento quirúrgico de traqueotomía, más instalación de la barra de Erich superior e inferior con reducción cerrada de la fractura mandibular con bloqueo maxilar mandibular con banda elástica en el primer período quirúrgico. Posterior a la estabilización del cuadro clínico, se realizó la fijación de la fractura mandibular a través de las accesiones, submandibular y submentoniana con FIR de la fractura del ángulo mandibular derecho y Fijación Semirrígida de la fractura de la parasinfisis izquierda y bloqueo maxilar mandibular con elástico. La paciente fue trasladada de la UCI a la sala donde fue dada de alta del hospital con simetría facial satisfactoria, oclusión dental Eagle Clase I, movimientos mandibulares conservados y ausencia completa a los 7 meses de signos y síntomas de parestesia y neuropraxia de pares craneales V y VII. Objetivo do presente estudo é apresentar um caso clínico de fratura panfacial com tratamento híbrido através da Fixação Interna Rígida e Fixação Semi Rígida da fratura complexa mandibular. Paciente do gênero feminino, 21 anos, feoderma, internada na UTI do Hospital Geral de Taipas após acidente motociclístico, foi avaliada pelo serviço de Cirurgia e Traumatologia Buco Maxilo Facial, na qual foi diagnosticada com fratura panfacial, apresentado fraturas Le Fort I, II, III, Lannelong, fratura nasal e fratura complexa mandibular: ângulo direito e parassínfise esquerda. O exame de tomografia computadorizada de face confirmou a presença da fratura panfacial. Foi realizado procedimento cirúrgico de traqueostomia mais instalação de barra de Erich superior e inferior com redução incruenta da fratura mandibular com bloqueio maxilo mandibular com elástico no primeiro tempo cirúrgico. Após estabilização do quadro clínico foi realizado fixação da fratura mandibular através dos acessos, submandibular e submentual com fixação interna rígida da fratura do ângulo mandibular direito e Fixação Semi Rígida da fratura de parassínfise esquerda e bloqueio maxilo mandibular com elástico. A paciente foi transferida da UTI para enfermaria onde recebeu alta hospitalar apresentando simetria facial satisfatória, oclusão dentária Classe I de Eagle, movimentos mandibulares preservados e ausência completa após 7 meses dos sinais e sintomas de parestesia e neuropraxia dos pares cranianos V e VII.

Orthognathic surgery is a branch of maxillo-facial surgery increasingly in demand, which deals with the correction of skeletal deformities. The aim of the present study is to identify the most common post-operative complications following orthognathic bimaxillary surgery performed by means of Piezosurgery®. Furthermore, through an examination of the available scientific literature, we wanted to establish whether the frequency of postoperative complications were consistent with those already reported. A retrospective study on 58 patients who underwent orthognathic surgery with a bilateral sagittal osteotomy (BSSO) of the mandibular bone branch, maxillary surgery with Le Fort I mono-segmented or multi-segmented approach, and genioplasty technique using Piezosurgery®. The complications taken into consideration were disorders of the temporomandibular joint (TMJ), paraesthesia and hypoesthesia, asymmetries, nose enlargement, nasal septum deviation, nasal obstruction, dental discolorations, pulpal necrosis, occlusion and masticatory efficiency, gingival recession, periodontal problems, dysgeusia, nausea and vomiting, weeping alterations, hearing problems, delayed healing, superinfection, removal of synthesis means, reoperation, cicatricial outcome, and bilateral pneumothorax. It has been highlighted that a number and type of postoperative complications matched those reported by the most recent literature reviews. Temporomandibular disorders and paraesthesia were the most common ones. The only complication rate that differed from the literature was nerve damage, which was significantly lower. Post-surgical complications depend on the used surgical techniques, clinical work, and treatment methods. The use of piezoelectric devices in orthognathic surgery operations provides an innovative, safe, and effective technique compared to traditional methods.

Historique & Objectifs: Les effets de l’avancement maxillaire (AM) sur l’anatomie velopharyngée ont déjà été étudiés en utilisant la céphalométrie. Cette modalité ne permet toutefois pas de bien caractériser les tissus mous. Le but de cette étude est de comparer la configuration de l’espace vélopharyngé en pré- et post-opératoire, telle que mesurée par tomodensitométrie (TDM). De plus, notre objectif est d’analyser et de comparer les différences dans ces mesures chez les patients avec et sans fente palatine (FP). Méthodologie: Ceci est une étude rétrospective portant sur 44 patients avec et sans FP, traités avec AM pour une hypoplasie maxillaire et une malocclusion dento-squelettique. Les TDM pré- et post-opératoires ont été comparés en se basant sur des repères préétablis. Des distances linéaires, des aires de sections transversales et des mesures volumétriques ont été mesurées en utilisant des reconstructions tridimensionnelles des TDM. Résultats: Pour les distances linéaires mesurées, une différence statistiquement significative a été notée pour les mesures linéaires du nasopharynx et du palais mou (25.1 vs 28.5 mm p=0.001 et 6.5 vs 7.6 mm p=0.026, respectivement). Les aires des sections transversales au niveau du nasopharynx et du palais mou ainsi que l'évaluation volumétrique de l'espace vélopharyngé n'ont pas démontrées une différence statistiquement significative en comparant les mesures en pré- et post-opératoire (p>0,05). En comparant les patients avec et sans FP, une différence statistiquement significative n’a été notée que pour la distance linéaire et l’aire de la section transversale du nasopharynx (p=0.045 et p=0.04, respectivement). Un antécédent de réparation de FP n’était pas prédictif de différences de mesures pré- et post-opératoire. Conclusion: Nos résultats confirment que, bien que certaines modifications structurelles de l’espace vélopharyngé soient inhérentes à l’AM chez les patients avec FP, leurs aires et volumes ne semblent pas changer de façon significative. Ces changements sont indépendants d’une histoire de FP réparée., Background & Purpose: The effects of maxillary advancement (MA) on velopharyngeal anatomy have primarily been studied using lateral cephalometric radiographs. However, with recent advances in orthognathic surgery, there is an increased need for more detailed and precise imaging such as computerized tomographic (CT) scan reconstructions, to help in surgical planning and to measure outcomes. The purpose of this study is to compare the pre-and post-operative velopharyngeal space configuration modifications as measured on CT scans. The aim is also to assess differences in these airway measures between patients with and without history of prior repaired cleft palate (CP). Methods: This is a retrospective cohort study of 44 patients with and without CP who were treated with MA for midface hypoplasia and secondary malocclusion at skeletal maturity. The pre-and post-operative CT scans were compared with respect to pre-established landmarks. Linear distances, cross-sectional areas, and volumes were measured using 3-dimensional (3D) CT scan reconstructions. Results: For the linear distances measured, a statistically significant difference was found when comparing the pre-and post-operative measures of the narrowest part of the nasopharynx and the narrowest part of the retropalatal airway space (25.1 vs 28.5 mm p=0.001 and 6.5 vs 7.6 mm p=0.026, respectively). Retropalatal cross-sectional areas, nasopharyngeal cross-sectional areas and the volumetric assessment of the nasopharyngeal space showed no statistically significant differences when comparing pre-and post-operative scans (p>0.05). The main effect of palatal repair (CP vs. Non-CP) showed that there was only a statistically significant difference for the measures of the narrowest part of the nasopharynx and the nasopharyngeal cross-sectional area (p=0.045 and p=0.04, respectively). Mean changes in the measures did not differ over time (pre-and post-op) depending on whether there was prior history of CP repair. Conclusion: Our results support the hypothesis that although structural modifications of the pharyngeal space are inherent to MA in patients with CP, its surface area and volume do not change significantly. These changes are also independent of history of previous CP repair.

Made available in DSpace on 2020-12-12T02:45:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Objectives: The purpose of this study was to evaluate the influence of a palatal splint on stability in multi-segment maxillary osteotomies. Setting and Sample Population: Retrospective series of fifty-one adult patients, consecutively operated with bilateral sagittal split osteotomy (BSSO) and three-piece maxillary osteotomies, divided according to the use of a palatal splint (Group 1, n = 30) or no palatal splint (Group 2, n = 21). Materials and Methods: Maxillary surgical casts (T1) and post-retention casts (T2), taken at least six months after discontinuation of orthodontic retention, were digitized (MicroScribe-3DX), measured and compared. Fifty-one landmarks were identified on the maxillary, transverse dimension changes and arch length were calculated. Longitudinal changes in all measurements were assessed by t test. Results: Post-surgical transverse instability in group 1 ranged from 0.3 ± 0.4 to −1.3 ± 0.2 mm and was statistically significantly smaller than in group 2 that ranged from −1.0 ± 0.3 to −2.5 ± 0.5 mm. Conclusions: The use of a palatal splint after segmental Le Fort I maxillary osteotomy improved transverse stability in the posterior region. The post-surgical transverse instability occurred only between canine gingival points and thus suggesting no clinical relevance. School of Dentistry São Paulo State University (UNESP) Hospital for Rehabilitation of Craniofacial Anomalies University of São Paulo (USP) Private Practice School of Dentistry São Paulo State University (UNESP)

ABSTRACTSurgically Assisted Rapid Palatal Expansion vs. Segmental Le Fort I Osteotomy: An Analysis of Transverse Stability Using Cone Beam Computed TomographyWilliam M. Yao, DDSOBJECTIVE: To examine the immediate and subsequent skeletal and dental effects of surgical widening of the maxilla via two orthognathic procedures, Segmental Le Fort Osteotomy and Surgically Assisted Rapid Palatal Expansion (SARPE), using cone beam computed tomography (CBCT). METHODS: A total of thirteen subjects satisfied the inclusion criteria for this study (9 Le Fort and 4 SARPE). Patient ages averaged 28.4 years (range 17.1 - 45.3) in the Le Fort group and 19.2 years (range 17.0 - 23.2) in the SARPE group. Three CBCT scans were taken at time-points defined as follows: Le Fort (T0 = preoperative, T1 = post-operative, T2 = 6+ months postoperative) and SARPE (T0 = preoperative, T1 = post-expansion retention, T2 = 6+ months). Skeletal and dental width measurements were recorded using 3D imaging software, Anatomage In Vivo 5.x (Anatomage, San Jose, CA).CONCLUSIONS: Surgical expansion of the maxilla in the transverse dimension without performing separation of the pterygomaxillary junction resulted in less than 1 mm of skeletal expansion. During expansion with a multisegmental Le Fort procedure, more expansion occurred skeletally than dentally, with a posterior and anterior ratio of dental:skeletal expansion of 0.70 and 0.58, respectively. During expansion with a SARPE procedure, significantly more expansion occurred dentally than skeletally, with a posterior and anterior ratio of dental:skeletal expansion of 25.19 and 31.80, respectively. In both groups, relapse was more dental than skeletal, with the SARPE group showing a higher ratio of dental:skeletal change. The forces generated by expansion via a Hyrax appliance in a SARPE procedure may cause slight increase in width from T1 to T2 due to changes in the biomechanical system resulting from osteotomy.

The effect of bimaxillary orthognathic surgery on facial mimicry was assessed longitudinally in 15 patients with dentoskeletal class III facial dysmorphism (seven men, eight women, mean age 28 years). The patients were analysed pre-surgery and at 6, 12, and 24 months post-surgery while performing verbal (five vowels) and non-verbal (open and closed mouth smile, lip purse) soft tissue facial movements. The three-dimensional motions of right and left nasogenian, crista philtri, cheilion, and lower lip landmarks were detected by an optoelectronic instrument, and a total mobility index was obtained. Differences between the sides were quantified by the symmetry index. Patient values were compared to those collected previously from healthy volunteers by computing z-scores. On average, no significant differences were found in the mobility of the buccal soft tissues at 24 months after surgery (ANOVA P-value, range 0.075-0.808), with positive median z-scores (pooled mean value close to 0.6). Symmetry indices ranged around the control reference values, showing no stage-related differences (Friedman test P-value, range 0.252-0.937), and exceeding 90% for all movements at 24 months after surgery. Bimaxillary osteotomy does not compromise facial mimicry in either verbal or non-verbal facial movements.

To evaluate non-invasively the morphological features of both lateral pterygoid muscle (LPM) and masseter muscle by using diffusion tensor Imaging on two patients affected by mandibular asymmetry.Two female patients with mandibular excess and asymmetry who underwent Le Fort I osteotomy and bilateral sagittal split osteotomy were recruited for this study. Morphological (TDiffusion tensor imaging was able to identify the muscle geometrical morphology and diffusion microstructural changes. Both at T0 and T1, mean FA values had no significant differences between the right and left side of masseter (at T0: p = 0.91; at T1: p = 0.54) and LPM (at T0: p = 0.92; at T1: p = 0.43), respectively. Both patients reported a significant improvement in FA mean values of the left LPM (p = 0.03) between T0 and T1, whereas no diffusion parameters' changes were observed for the bilateral masseter muscles and right LPM.We found that after the surgery the LPM ipsilateral to the deviation side showed a significant increase of FA compared to the baseline. Although preliminary, our findings suggest that diffusion tensor imaging may represent a promising tool to investigate non-invasively the masticatory muscles in temporomandibular joint disorders.

Bakalaura darba tēma ir „Aprūpes nodrošināšanā pacientiem ar Le Fort lūzumu”. Tēmas aktualitāte ik pa brīdim sabiedrībā parādās informācija par dažādu ķermeņa daļu (pārsvarā – roku, kāju un galvas) traumām – lūzumiem, sasitumiem sastiepumiem – un to profilaksi, taču salīdzinoši tiek pieminētas sejas traumas. Taču to nevar izskaidrot ar retāku sejas traumatismu. Sejas un žokļu ķirurgi ik dienu sniedz palīdzību vairākiem pacientiem, kas absolūtas neapdomības vai nelaimīgas nejaušības dēļ nonākuši neapskaužamā situācijā. Viens no tiem ir Le Fort lūzums. Pētījuma mērķis: noskaidrot aprūpes nodrošināšanu pacientiem ar Le Fort lūzumu. Pētījuma uzdevumi: Veikt literatūras analīzi par Le Fort un tās aprūpes īpatnībām; Izanalizēt Virdžinijas Hendersones māszinību teoriju saistībā ar aprūpes nodrošināšanu pacientiem ar Le Fort lūzumu; Izstrādāt kvalitatīvā pētījuma instrumentu – novērošanas protokolu; Veikt pētījumu; Apkopot un izanalizēt iegūtos datus; Izdarīt secinājumus. Pētījuma jautājums: Kāda ir aprūpes nodrošināšana pacientiem ar Le Fort lūzumu? Pētījuma metodoloģija: neeksperimentāls, kvalitatīvs, novērošanas protokols. Datu iegūšanai tikai izmantota protokols ar 12 jautājumiem. Pētījumā piedalījās 10 pacienti. Pētījuma rezultāti tika aprakstīti un analizēti atbilstoši novērošanas protokola prasībām un aptvēra tādas tēmas kā problēmas ar Le Fort lūzumu, kas varētu būt radušies saistībā ar darba pienākumu veikšanu. Pētījuma rezultātu analīze ļauj secināt, ka Le Forl lūzums ir ļoti specifisks un sarežģīts, kas ierobežo pacienta darbības uz ilgu laiku. Atslēgas vārdi: Lūzums, Le Fort, aprūpe., The subject of the Bachelor thesis is "Providing Care to Patients with a Le Fort Fracture". The actuality of the reseach from time to time, in society, information about various injuries (mainly of hands, feet and head) of the body - fractures, bruising sprains - and their prevention appear on the body, but relatively similar are facial injuries. But this can not be explained by the less frequent facial trauma. Facial and jaw surgeons give daily help to a number of patients who, in absolute unconsciousness or unlucky chance, are in an uncomfortable situation. One is Le Fort's fracture. The aim of the reseach: To find out the provision of care for patients with Le Fort fracture. Research tasks: To conduct literature analysis of Le Fort and its care features; To analyze the Virginia Henderson Nursing Theory in providing care for patients with Le Fort fracture; Develop a qualitative research tool - an observation protocol; Veikt pētījumu; Collect and analyze the data obtained; Make conclusions. Research question: What is providing care for patients with Le Fort fracture? Research methodology: non-experimental, qualitative, observation protocol. Only 12 questions were used to get the data. The study was attended by 10 patients. The results of the reseach were described and analyzed in accordance with the requirements of the observation protocol and covered topics such as problems with the Le Fort fracture that might have occurred in connection with the performance of work duties. The analysis of the research results suggests that Le Forl's fracture is very specific and complex, which limits the patient's activities for a long time. Keywords: Fracture, Le Fort, care.

PubMedID: 25931369 Background: The amount of postoperative maxillary relapse of two different bone graft materials after Le Fort I osteotomy were compared in this study. Objectives: The aim of this study is to compare postoperative maxillary relapse rates using heterologous and autologous graft materials after Le Fort I osteotomy. Material and Methods: A total of 80 patients who had developmental malocclusion were analyzed retrospectively in this study. Twenty nine (36.2%) and 51 (63.8%) patients underwent Le Fort I osteotomy, and Le Fort I and bilateral sagittal split ramus osteotomy (two-jaw surgery), respectively. Forty two (52.5%) maxillary bone gaps were filled with heterologous bone grafts (group A) and 38 (47.5%) were filled with autologous bone grafts (group B) after Le Fort I osteotomy. The cephalometric graphics and measurements were taken before (T1), 1 week after (T2), and 1 year after (T3) the surgery. The results were documented and determined by the Dolphin imaging 10.5 (Dolphin Imaging, Chatsworth, Calif.) computer program for skeletal relapse. Whether or not the relationship between group A's and B's maxillary relapse rates was evaluated in the postoperative period. Results: It was observed that both graft materials have positive effects on maxillary relapse rate in the postoperative period. When the groups are compared to each other, the relapse rates were similar between group A (8.3%) and group B (10.8%) (p > 0.05). Conclusions: Heterologous bone graft material (Osteoplant®-Flex) is thought to be a good alternative to autologous grafts in decreasing the relapse rates and reducing the morbidity of the donor area of the patients who underwent Le Fort I osteotomy. © Copyright by Wroclaw Medical University.

OBJETIVO: avaliar a estabilidade de cirurgias bimaxilares com fixação interna rígida, na qual promoveu-se uma rotação anti-horária da mandíbula e conseqüente redução do ângulo do plano oclusal. METODOLOGIA: foram estudados 15 pacientes com padrão facial de Classe II e deficiência mandibular. Os movimentos cirúrgicos foram avaliados por meio de medidas lineares e angulares realizadas no programa CefX, obtidas de telerradiografias cefalométricas em norma lateral em três diferentes tempos: (T0) pré-operatório, (T1) pós-operatório imediato e (T2) pós-operatório de no mínimo 6 meses. RESULTADOS E CONCLUSÕES: os resultados demonstraram que a cirurgia bimaxilar promove mudanças faciais significativas e, principalmente, que a rotação anti-horária da mandíbula com redução do ângulo do plano oclusal mostrou-se estatisticamente estável, sendo uma opção confiável em cirurgias de pacientes com padrão facial de Classe II com deficiência mandibular.AIM: to access the surgical stability combined with rigid internal fixation, where the counter-clockwise jaw rotation was carried out, and consequently the occlusal plane reduction. METHODS: fifteen Class II skeletal facial standard patients were studied. The surgical movements were assessed by linear measures and angles accomplished at the CefX program, collected from cephalometric teleradiography lateral norms in three different moments: (T0) presurgical, (T1) instantaneous postsurgical and (T2) postsurgical at least six months. RESULTS AND CONCLUSION: the results showed that the bimaxillary surgery causes meaningful facial changes and mainly, the counter-clockwise mandible rotation and consequently the occlusal plane angle reduction showed statistically stable, suggesting a reliable opinion in Class II standard facial surgeries with defective mandibular.

The aim of this study was to test a new collagen matrix (Mucoderm) positioned during oral implant abutment connection. A patient previously treated with Le Fort I for bone augmentation and 8 implants showing minimal amount of keratinized tissue was selected for an extensive keratinized tissue augmentation and deepening of the oral vestibule by apically positioning a split palatal flap and palatal grafting with Mucoderm. Clinical data at 9 and 14 days and 1 and 2 months showed resorption of the collagen graft, augmentation of the keratinized tissue around the implants, and deepening of the vestibule, with minimal morbidity and reduced surgical treatment time. However, some vestibular keratinized tissue contraction was evident. The new collagen matrix may be a promising material as a substitute for an autologous gingival/connective tissue graft. Despite the preliminary results of this innovative article, before drawing any general conclusion, the benefit of the procedure should be further evaluated by prospective clinical trials.

Merleau-Ponty's reversibility thesis argues that self, other and world are inherently relational, interdependent at the level of ontology. What is at stake in the reversibility thesis is whether it overcomes skeptical objections in both assuring real communication and avoiding solipsism in assuring real difference; the Other must be a genuine, irreducible Other. It is objected that across the domains of reversibility, symmetry and reciprocity are not guaranteed. I argue that this is a non-problem; rather the potentialities for asymmetry and non reciprocity in fact guarantee the irreducibility of the Other; reversibility needs to be appreciated as dialectical or aesthetic, not as a literal or 'mechanistic' reversal. A further criticism targets the viability of ontology itself, whether alterity is ever compatible with ontology. This paper considers these objections from two of Merleau-Ponty's contemporaries—Claude Lefort and Emmanuel Levinas. Levinas developed a philosophy which while intersecting with Merleau-Ponty's at important junctures, nonetheless arrived at an entirely different destination. I argue alongside Martin Dillon against the objections of Lefort, and alongside Dan Zahavi against the objections of Levinas. Both of these interpreters, I propose remain faithful to the core directions and spirit of Merleau-Ponty's endeavours without becoming diverted by the less significant inconsistencies.

Background Cryotherapy (the application of ice for therapeutic purposes) is one of the most common treatment modalities used in the immediate management of acute soft tissue injury. Despite its widespread clinical use, the precise physiological responses to therapeutic cooling have not been fully elucidated, and effective evidence-based treatment protocols are yet to be established (BMC Musculoskelet Disord 2007;8:125). Patients and methods From January 2008 to July 2008, 10 patients (4 men and 6 women) affected by dental-skeletal classes II and III were treated. Considering the biologic effects and the low temperature achieved, in this study, a cooling and compression system, at fixed temperature and adjustable for maxillofacial cutaneous tissues, called Hilotherapy system (Hilotherm GmbH, Ludwigsburg, Germany) was used. Results With the use of Hilotherapy system, the swelling and pain decrease in intensity and time, allowing a quicker path to recovery of mandibular dynamics, a better comfort for patients, and an easy management of patients by medical attendants. Conclusions The Hilotherapy system has been proven to have a safe and effective use as a cold therapy to control postsurgery course.

Objective The aim of this study was to investigate the prevalence of reverse-sequence chewing cycles in skeletal class III patients before and after orthodontic-surgical therapy to evaluate whether the occlusal and skeletal correction is followed by a functional improvement. Study Design Twenty skeletal class III patients (11 males and 9 females, 22.7 ± 3.0 years old) were recruited for this study. All patients received orthodontic and surgical treatment. Chewing cycles were recorded with a kinesiograph before (T0) and after (T1) therapy. Results A significant decrease in the number of reverse chewing cycles after surgical correction was exhibited in all recordings, when chewing either soft or hard boluses, on both the right and the left side. Conclusions Evaluation of the prevalence of reverse chewing cycles could be considered an indicator of functional adaptation after therapy and a method for the early detection of nonresponding patients who may require further consideration using a different approach.

Even if the relationship between condylar position and/or temporomandibular disorders (TMDs) and dentofacial deformity is controversial in literature, several patients presenting malocclusion refer to pain and TMDs as the main trouble. There are also various opinions concerning the alterations or improvements of temporomandibular joint symptoms after orthognathic surgery. In agreement with the experience of Universitat Wurzburg, the purpose of this study was to evaluate the validity of splint technique to reproduce centric condyle positioning in bimaxillary osteotomy surgeries for the patients with skeletal-facial disorders and coexisting TMDs. The present study is based on a sample of patients with maxillomandibular malocclusion and coexisting TMDs who underwent bimaxillary osteotomy surgeries with splint technique. All patients underwent a protocol consisting of various steps: Pretreatment evaluation consisted of a questionnaire on subjective symptoms, clinical examinations, photographs of the occlusion, plaster casts, bite registrations, examination of the posture; instrumental examinations; panoramic, teleradiography, and cephalometric analysis; stratigraphy of TMD; and electromyography. Presurgical treatment consisted of therapy by modified Farrar splint associated with a pharmacologic therapy for the acute symptoms; orthodontic treatment associated with a global reeducation of the posture and a pompage of the masticatory muscles; and manufacturing of an occlusal splint in the most posterior asymptomatic position. Surgical treatment consisted of bimaxillary osteotomies performed after registering condyle position by a "repositioning" plate. The condyle position is guided by the intermaxillary fixation with the interposition of the occlusal splint. Surgery on maxillary is performed through Le Fort I osteotomy and fixation. Later, sagittal splint osteotomy of mandible is performed. Position of ramus and TMD complex is guided by the positioning of the plates modeled previously and fixed to maxillary and ramus in the same relationship registered with the splint. Finally, fixation of mandibular osteotomies is performed. Postsurgically patients underwent orthodontic treatment (to stabilize occlusal and articular changes) and physical therapy. After the end of treatment, stability of results was investigated with clinical, radiologic, and electromyographic valuations. The authors' experience suggests that, as in orthognathic surgery, identification of a correct condyle-fossa relationship (achieved by splint and repositioning plate) is essential to guide osteosynthesis after sagittal split osteotomy in patients affected by TMDs and ultimately affects the stability of the procedure.

Ultrasonic bone-cutting surgery has been recently introduced as a feasible alternative to the conventional tools of cranio-maxillo-facial surgery, due to its technical characteristics of precision and safety. The device used is unique in that the cutting action occurs when the tool is employed on mineralized tissues, but stops on soft tissues. This technical note illustrates the use of Piezosurgery for all osteotomies of surgically assisted rapid maxillary expansion (SARME). The procedure, including pterygo-maxillary detachment, can be completed under local anaesthesia. Other advantages include minimal risk of jeopardizing critical anatomic structures (e.g. palatine artery), minimal intraoperative bleeding and postoperative swelling, and minimal thermal damage to bone surfaces. Narrow and rectilinear osteotomies can be easily performed with varying vibrating scalpels, at the cost of a longer operative time.

OBJETIVO: avaliar a estabilidade de cirurgias bimaxilares com fixação interna rígida, na qual promoveu-se uma rotação anti-horária da mandíbula e conseqüente redução do ângulo do plano oclusal. METODOLOGIA: foram estudados 15 pacientes com padrão facial de Classe II e deficiência mandibular. Os movimentos cirúrgicos foram avaliados por meio de medidas lineares e angulares realizadas no programa CefX, obtidas de telerradiografias cefalométricas em norma lateral em três diferentes tempos: (T0) pré-operatório, (T1) pós-operatório imediato e (T2) pós-operatório de no mínimo 6 meses. RESULTADOS E CONCLUSÕES: os resultados demonstraram que a cirurgia bimaxilar promove mudanças faciais significativas e, principalmente, que a rotação anti-horária da mandíbula com redução do ângulo do plano oclusal mostrou-se estatisticamente estável, sendo uma opção confiável em cirurgias de pacientes com padrão facial de Classe II com deficiência mandibular. AIM: to access the surgical stability combined with rigid internal fixation, where the counter-clockwise jaw rotation was carried out, and consequently the occlusal plane reduction. METHODS: fifteen Class II skeletal facial standard patients were studied. The surgical movements were assessed by linear measures and angles accomplished at the CefX program, collected from cephalometric teleradiography lateral norms in three different moments: (T0) presurgical, (T1) instantaneous postsurgical and (T2) postsurgical at least six months. RESULTS AND CONCLUSION: the results showed that the bimaxillary surgery causes meaningful facial changes and mainly, the counter-clockwise mandible rotation and consequently the occlusal plane angle reduction showed statistically stable, suggesting a reliable opinion in Class II standard facial surgeries with defective mandibular.

Purpose The aim of this study was to evaluate skeletal stability after double jaw surgery for correction of skeletal Class III malocclusion to assess if there were any differences between resorbable plate and screws and titanium rigid fixation of the maxilla. Patients and Methods Twenty-two Class III patients had bilateral sagittal split osteotomy for mandibular setback stabilized with rigid internal fixation. Low level Le Fort I osteotomy for maxillary advancement was stabilized with conventional titanium plate and screws in 12 patients (group 1) and with resorbable plate and screws in 10 patients (group 2). Lateral cephalograms were taken before surgery, immediately postoperatively, 8 weeks after surgery, and 1 year postoperatively. Results Before surgery both groups were balanced with respect to linear and angular measurements of craniofacial morphology. One year after surgery, maxillary stability was excellent in both groups. In group 1 no significant correlations were found between maxillary advancement and relapse. In group 2, significant correlations were found between maxillary advancement and relapse at A point and posterior nasal spine. No significant differences in postoperative skeletal and dental stability between groups were observed. Conclusion Surgical correction of Class III malocclusion after combined maxillary and mandibular procedures appears to be a fairly stable procedure for maxillary advancements up to 5 mm independently from the type of fixation used to stabilize the maxilla. Resorbable devices should be used with caution for bony movements of greater magnitude until their usefulness is evaluated in studies with large maxillary advancements.

Inferior repositioning of the maxilla to correct vertical maxillary deficiency has been one of the more unstable orthognathic procedures performed. Different surgical techniques have been proposed to stabilize downward movement of the maxilla. The aim of this study was to evaluate the skeletal stability of maxillary anterior downgrafting using bone biological plates in association to bone plates and bone graft for skeletal stabilization.The records of 6 patients were evaluated cephalometrically, analyzing the presurgical, immediate postsurgical and long-term follow-up radiographs. All patients had one-piece Le Fort I osteotomy with anterior downgraft of at least 2 mm at point A. Any horizontal movement of the maxilla concomitant with the downgraft was no more than 5 mm. Rigid fixation with titanium miniplates and screws and with bone biological plate was used to stabilize the maxilla. In the sample of 6 patients, 3 underwent one-jaw (maxilla only) surgery and 3 two-jaw surgery.The mean surgical inferior downgrafting at point A was 5+/-1.4 mm (P0.001) with a relapse of 0.16+/-1. 63 mm (3.2% of surgical movement). The mean surgical inferior downgrafting at the anterior nasal spine (ANS) was 5.66+/-1.36 mm (P0.001) with a relapse of 0.41+/-1.56 mm (7.32% of surgical movement). Relapse in the vertical dimension failed to reach any statistical significance for all maxillary landmarks.Anterior downgrafting of the maxilla with this fixation method seems to be a stable and predictable procedure. The use of bone biological plates seems to substantially improve skeletal stability even if further investigations with a more consistent sample of patients is required.