Search

The aim of this study was to determine whether different evaluation methods may be the cause of the varied outcomes of research that have evaluated the effects of extraction and non-extraction therapy on jaw rotation. This retrospective study consisted of the pre- (T1) and post- (T2) treatment lateral cephalograms of 70 skeletal Class I subjects with an optimal vertical mandibular plane angle, who had undergone fixed orthodontic treatment. Thirty-five of the subjects (20 females and 15 males, mean age: 14.7 years) were treated with four first premolar extractions and 35 (22 females and 13 males, mean age: 15 years) without extractions. T1 and T2 radiographs were superimposed using Björk's structural method and Steiner's method of sella-nasion line registered at sella. A Wilcoxon test was used to evaluate the changes between T1 and T2 and the Mann-Whitney U-test to determine differences between the extraction and non-extraction and Björk and Steiner groups. No significant difference was found between the methods of Steiner and Björk according to the spatial changes of the cephalometric points in the extraction and non-extraction groups. The maxilla showed forward rotation in the extraction group and backward rotation in the non-extraction group with both superimposition methods, but the differences were not significant in either inter- or intraclass comparisons. The mandible showed forward rotation in the extraction group with both superimposition methods but, in the non-extraction group, forward rotation was recorded with Björk's method and backward rotation with Steiner's method. These findings were not significant in either inter- or intraclass evaluations. No significant difference was found between the groups or methods.

Introduction: Ameloblastoma is rare worldwide. Delayed treatment can result in significant morbidity from facial deformity and infiltration of adjacent tissues. Mortality can occur from invasion of vital structures in the head and neck, super infection, recurrent and even distant metastases. Recurrence after radical treatment is not common., Case Report: This paper presents a case of soft issue recurrence in the chin 21 years after radical resection of the mandible for ameloblastoma. The iliac crest bone grafted to the site was not involved in the tumour recurrence. Conclusion. Radical surgical resection is accepted treatment for solid/multicystic ameloblastoma. However, the surgical review should be for life as recurrence can occur after a long interval., (Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

In orthodontic diagnosis, facial symmetry is important. The aim of the present study was to analyse the perception of various degrees of facial asymmetry exhibited by carefully designed virtual three-dimensional (3D) material. Three groups of raters (30 orthodontists, 30 maxillofacial surgeons, and 30 laymen) rated, using a six-point scale, the degree of asymmetry of eight randomly presented 3D faces exhibiting incremental soft tissue alterations. The faces were created by gradually transforming the nose or chin in increments of 2 mm away from the computed symmetry plane. Differences between the groups in analysis of facial asymmetry, the rating of facial stimulus, and right and left facial asymmetry were determined using a t-test. The results demonstrated that raters' profession did not influence the point at which they identified asymmetry. Even laymen were able to detect asymmetries when located near the midline of 3D faces. All raters identified asymmetries of the nose as more negative than those of the same degree of the chin. A left-sided deviation of the nose along the facial symmetry plane lead to a more negative rating of facial appearance, whereas a right-sided deviation of the chin was rated as less attractive. Nasal architecture plays a crucial role in the perception of symmetry. These findings provide clinicians with a greater understanding of how faces are perceived, a process which is of particular interest in treating orthognathic patients, and those with congenital anomalies.

Objective: To examine and compare the maxillofacial characteristics affecting chin deviation three-dimensionally in facial asymmetry patients with mandibular retrusion and mandibular prognathism., Materials and Methods: Maxillofacial computed tomography (CT) scan data were obtained from 48 orthognathic surgery patients (24 cases of mandibular retrusion and 24 cases of mandibular prognathism) with facial asymmetry. Although chin deviation was assessed on the basis of the ANS-to-menton line on frontal cephalograms, its contributing factors were evaluated on three-dimensional CT images. Maxillary height, ramus length, frontal ramal inclination, lateral ramal inclination, mandibular body length, and body height were defined on each side, and right-left differences were calculated and analyzed., Results: In an assessment of chin deviation, subjects in this study showed predominantly left side deviation regardless of the group, and the degree of menton deviation did not reveal significant differences between groups. In a comparison of right-left differences in contributing factors, all values were noted to be greater in the retrusion group, except for body height, which showed no difference between chin-deviated and contralateral sides. In particular, ramus length presented a statistically significant difference between the two groups., Conclusion: Based on the same degree of chin deviation in mandibular prognathism and retrusion in this study, results of right-left differences in contributing factors indicate that chin deviations are expressed easily in mandibular prognathism, whereas they occur only with significant right-left differences in relevant maxillofacial structures in individuals with mandibular retrusion.

Introduction: The concept of "ideal" occlusion in harmony with craniofacial structures is often proposed as an ultimate goal of orthodontic treatment. The aim of this study was to assess the impact of slight variations in posterior occlusion and the history of straight-wire orthodontic treatment on the predictability of incisor inclination and third-order angles., Methods: Axial incisor inclinations, third-order angles, and craniofacial relationships were assessed on lateral headfilms and corresponding dental casts of 75 healthy white subjects, 16 to 26 years old, selected by the general inclusion criterion of a good interincisal relationship. Four groups were formed: group A (n = 17), Angle Class I occlusion subjects with no orthodontic treatment; group B (n = 20), Angle Class I occlusion subjects treated with standardized straight-wire orthodontics; group C (n = 20), up to a half-cusp distal occlusion after straight-wire treatment; and group D (n = 18), up to a half-cusp distal occlusion and no orthodontic treatment. Regression analysis was used to insert predictor angles into selected regression equations of the subjects with "ideal" occlusion, and the absolute differences between predicted and observed response angles were determined., Results: Small differences in incisor inclination were found between subjects with "ideal" occlusion and those who slightly deviated from "ideal" with a mild occlusion of the Angle Class II category. Posterior occlusion was not relevant to the validity of the vast majority of predictor-response pairs. Straight-wire treatment produced incisor inclination that was slightly protruded compared with subjects who had good natural occlusion., Conclusions: The "ideal" posterior occlusion concepts as a general orthodontic treatment goal should be reconsidered., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Accidental entry of foreign bodies into the oro-facial region could be due to trauma, therapeutic interventions or iatrogenic. Various foreign bodies and locations have been reported, for example, wood in the orbit, impression material in the maxillary sinus, tooth fragments in the orbit. All these cases presented with inflammatory reaction and formation of infected granuloma, pus discharging sinus and serious complications like intra-cranial abscesses. Foreign bodies sometimes migrate within the tissues and become symptomatic after a certain period of time. In these cases, it is very difficult to correlate the direct relation between the suspected foreign bodies with the present clinical symptoms. The removal of foreign bodies is often a surgical challenge due to a combination of difficulty in access and close anatomical relationship to vital structures. To prevent complications, foreign bodies should be diagnosed and removed on time.

The aim of this study was to examine the effects of retraction of anterior teeth and the initial soft tissue profile variables on upper and lower lip changes in Japanese adults. Pre- and post-treatment cephalometric radiographs of 33 Japanese female adults (aged 23.0±5.0 years), with a Class II division 1 malocclusion, who had two or four first premolars extracted, were evaluated. Lateral cephalograms taken with the lips in a voluntary relaxed position were traced and compared. Nine linear and eight angular measurements were constructed for the hard tissue measurements and 16 linear and 2 angular for the soft tissue measurements. Stepwise multiple regression analysis revealed that the horizontal upper lip position could be explained by the position of the maxillary incisor cervical point and the occlusal plane to SN with a 54 percent contribution ratio, and horizontal lower lip position, maxillary incisor tip position, initial interlabial gap, and aesthetic line to the tip of lower lip with a 51 percent contribution ratio. All parameters employed explained the horizontal position of the upper and lower lip with higher than 96 percent confidence. While the horizontal positions could not be predicted by a limited number of parameters, the vertical positions of lips could be explained by three parameters with higher than 62 percent confidence. The predictability found in this study could be beneficial for orthodontists in treatment planning.

Introduction: Although chincups are the preferred treatment for growing children with mandibular prognathism, the mechanism by which chincups improve this condition remains unclear. The aim of this study was to use geometric morphometrics to evaluate changes in the shape of the mandible of prognathic children treated with a chincup., Methods: Geometric morphometrics were used to evaluate the short-term mandibular shape changes in 50 prognathic children treated with chincups compared with 40 untreated matched controls. Twenty-one 2-dimensional mandibular landmarks from cephalograms taken before and after 36 months of treatment or observation were analyzed by Procrustes superimposition and thin plate spline., Results: Permutation tests of the treated patients showed highly significant differences in the mandibular shapes before and after treatment, and compared with the control group after the observation period. The thin plate spline grid deformations indicated more rectangular mandibular configuration, forward condyle orientation, condyle neck compression, gonial area compression, and symphysis narrowing., Conclusions: Early chincup treatment widely modifies the mandibular shape of prognathic children to improve Class III malocclusion., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Our purpose was to evaluate the immediate postoperative outcome of preoperatively planned and predicted positional changes in hard and soft tissue in 100 prospectively and consecutively planned and treated patients; all had various dentofacial deformities that required single or double jaw orthognathic correction using the computerised, cephalometric, orthognathic, surgical planning system (TIOPS). Preoperative cephalograms were analysed and treatment plans and prediction tracings produced by computerised interactive simulation. The planned changes were transferred to models and finally to operation. Five to 6 weeks postoperatively, the changes in profile actually obtained in the hard and soft tissue were cephalometrically assessed. The mean accuracy was relatively high. At the cephalometric reference points where significant differences between planned or predicted, and actually obtained, positional changes in hard and soft tissue were apparent and the inaccuracies were, except for the predicted horizontal position of the lower lip, relatively small. However, the variability of the predicted outcome in individual hard and soft tissues was relatively high. Using the TIOPS planning system with the presently included soft tissue algorithms, the current study shows relatively high mean predictability of the immediately postoperative hard and soft tissue outcome, independent of the extent and direction of required orthognathic correction. Because of the relatively high individual variability, caution is required when presenting the planned and predicted positional changes in the hard and soft tissue preoperatively in individual patients., (Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to assess retrospectively whether, in patients with temporomandibular joint (TMJ) arthralgia, commonly used cephalometric variables of dentofacial morphology can discriminate among magnetic resonanace imaging (MRI)-based TMJ structural characteristic groups of "uni- or bilateral disc displacement without reduction (DDwoR) associated with bilateral osteoarthrosis (OA)" and "uni- or bilateral disc displacement with reduction (DDwR) without OA.", Study Design: Bilateral MRI of the TMJ was performed in 56 consecutive TMJ arthralgia patients to identify individuals with specific structural characteristic of uni- or bilateral TMJ DDwoR, DDwR, and OA. Application of the criteria resulted in a study group of 31 patients with "uni- or bilateral DDwoR with bilateral OA" and 25 with "uni- or bilateral DDwR without OA." Linear and angular cephalometric measurements were taken from lateral cephalograms to apply selected criteria of dentofacial morphology. One-way analysis of variance was used to assess differences in cephalometric variables by MRI-based TMJ group. Then, discriminant function analysis predicted TMJ group membership., Results: A-B plane to facial plane angle, palatal plane to occlual plane, and interincisal angle produced a significantly discriminant function that predicted TMJ group membership (P < .001). This function correctly classified 85.7% of original grouped cases., Conclusions: Cephalometric variables may discriminate among MRI-based TMJ structural characteristic groups. Additional diagnostic information related to MRI-based classification groups was generated., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Purpose: The purpose of the study was to provide quantitative information about the facial soft-tissue characteristics of operated unilateral complete cleft lip and palate (UCCLP) children compared with healthy children during mixed dentition., Methods: Lateral cephalometric radiographs of 48 children with UCCLP who had been operated on before the age of 2 years were analyzed and compared with those of a control group of 60 healthy children with the same age, sex, and ethnic characteristics., Results: The children with operated UCCLP differed from the control group by having a more concave profile, flatter nasal tip, more retrognathic basis nasi, shorter upper lip, thicker upper and lower lip, reduced upper-lip projection, and increased lower-lip projection., Conclusions: The facial soft-tissue morphology in operated UCCLP patients differed from normal controls of the same age, sex, and ethnic group. It may be necessary for children with UCCLP operated before 2 years of age to have some preventive treatment.

Purpose: To estimate in patients with temporomandibular joint (TMJ) arthralgia whether magnetic resonance (MR) imaging findings of bilateral TMJ disc displacement without reduction (DDwoR) and/or osteoarthrosis (OA) are determinants of horizontal mandibular and vertical ramus deficiencies., Patients and Methods: Bilateral MR imaging of the TMJ was performed in 68 consecutive patients with TMJ arthralgia to identify those with bilateral TMJ DDwoR and/or OA. Linear and angular cephalometric measurements were performed to apply selected criteria of horizontal mandibular (gonion-menton [Go-Me] <73 mm and articulare-pogonion [Ar-Pog] <105 mm) and vertical ramus (articulare-gonion [Ar-Go] <45 mm) deficiencies. Logistic regression analysis was used to estimate the association between selected MR imaging and cephalometric parameters., Results: In the age- and gender-adjusted analysis, significant increases in the risk of horizontal mandibular (odds ratio, 7.5:1; P = .031) and vertical ramus (odds ratio, 9.5:1; P = .003) deficiencies occurred with bilateral DDwoR and OA., Conclusion: In patients with TMJ arthralgia, the MR imaging parameters of DDwoR and OA seem important determinants of horizontal mandibular and vertical ramus deficiencies., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to determine whether the surgical outcomes achieved with computer-aided surgical simulation (CASS) are better than those achieved with traditional methods., Materials and Methods: Twelve consecutive patients with craniomaxillofacial (CMF) deformities were enrolled. According to the CASS clinical protocol, a 3-dimensional computer composite skull model for each patient was generated and reoriented to the neutral head posture. These models underwent 2 virtual surgeries: 1 was based on CASS (experimental group) and the other was based on traditional methods 1 year later (control group). Once the 2 virtual surgeries were completed, 2 experienced oral and maxillofacial surgeons at 2 different settings evaluated the 2 surgical outcomes. They were blinded to the planning method used on the virtual models and each other's evaluation results. The primary outcome was overall CMF skeletal harmony. The secondary outcomes were individual maxillary, mandibular, and chin harmonies. Statistical analyses were performed., Results: Overall CMF skeletal harmony achieved with CASS was statistically significantly better than that achieved with traditional methods. In addition, the maxillary and mandibular surgical outcomes achieved with CASS were significantly better. Furthermore, although not included in the statistical model, the chin symmetry achieved by CASS tended to be better. A regression model was established between mandibular symmetry and overall CMF skeletal harmony., Conclusion: The surgical outcomes achieved with CASS are significantly better than those achieved with traditional planning methods. In addition, CASS enables the surgeon to better correct maxillary yaw deformity, better place proximal/distal segments, and better restore mandibular symmetry. The critical step in achieving better overall CMF skeletal harmony is to restore mandibular symmetry., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Liquid injectable silicone has been used for soft tissue augmentation for five decades. Many complications following liquid silicone injection have been reported. To diagnose and manage silicone granuloma remains difficult. Silicone granuloma must be diagnosed with the history of liquid silicone injection and the histology of tissue biopsy. We presented a case of granulomatous reaction after the injection of liquid silicone for chin augmentation forty years ago, causing total facial swelling, which mimicking angioedema initially. We administered methylprednisolone to the patient. Initial response to methylprednisolone was favorable.

Numb chin syndrome is a sensory neuropathy of the inferior alveolar branch of the trigeminal nerve, characterized by unilateral numbness of the chin, the lower lip and the buccal and gingival mucosa. We report a girl with acute lymphoblastic leukemia of B-cell type who initially presented with numb chin syndrome resulting from skull base infiltration.

Introduction: The aim of this study was to distinguish between orthodontic patients with skeletal Class III malocclusions requiring surgery and those not requiring surgery by conducting a receiver operating characteristic analysis of cephalometric variables., Methods: We used lateral cephalometric radiographs of 80 subjects (40 nonsurgical and 40 surgical patients) with Class III malocclusions and obtain 25 cephalometric measurements using computerized cephalometry. Of these, 14 measurements showed statistically significant differences between the 2 groups. Receiver operating characteristic analysis was used to determine the ability of the 14 cephalometric measurements in distinguishing between the 2 groups. Six statistically validated and clinically relevant measurements were used to obtain the optimum discriminant effectiveness., Results: For a Class III malocclusion patient with any 4 of these 6 measurement criteria, the sensitivity was 88% and the specificity was 90% in determining the need for surgical treatment: overjet, ≤-4.73 mm; Wits appraisal, ≤-11.18 mm; L1-MP angle, ≤80.8°; Mx/Mn ratio, ≤65.9%; overbite, ≤-0.18 mm; and gonial angle, ≥120.8°., Conclusions: We selected 6 cephalometric measurements as the minimum number of discriminators required to obtain the optimum discriminant effectiveness of diagnosis between surgical and nonsurgical treatment of skeletal Class III malocclusions., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Background: This study was performed to assess whether intubation is more difficult in obese patients and to assess the ability of a new index: the ratio of the neck circumference to thyromental distance (NC/TM), to predict difficult intubation in obese patients., Methods: The incidence of difficult tracheal intubation in 123 obese (BMI≥27.5 kg m(-2)) and 125 non-obese patients was compared. Difficult intubation was determined using the intubation difficulty scale (IDS≥5). The NC/TM ratio was calculated and its ability to predict difficult intubation in obese patients was compared with that of established predictors including high BMI, the Mallampati score, the Wilson score, NC, width of mouth opening, sternomental distance, TM, and a previous history of difficult intubation., Results: Difficult intubation was more frequent in obese patients than in non-obese patients (13.8% vs 4.8%; P=0.016). Multivariate analysis revealed that the Mallampati score, the Wilson score, and NC/TM independently predicted difficult intubation in obese patients. Among these three indices, NC/TM showed the highest sensitivity and a negative predictive value, and largest area under the curve on an ROC curve., Conclusions: Difficult intubation was more common in obese patients and the NC/TM was a better method for predicting difficult intubation than other established indices.

Introduction: The aim of this prospective clinical study was to evaluate the skeletal, dentoalveolar, and soft-tissue effects of maxillary protraction with miniplates compared with conventional facemask therapy and an untreated Class III control group., Methods: Forty-five subjects who were in prepubertal or pubertal skeletal growth periods were included in the study and divided into 3 groups of 15 patients each. All subjects had skeletal and dental Class III malocclusions with maxillary deficiency, vertically normal growth pattern, anterior crossbite, Angle Class III molar relationship, normal or increased overbite, and retrusive nasomaxillary complex. Before maxillary protraction, rapid maxillary expansion with a bonded appliance was performed in both treatment groups. In the first group (MP+FM), consisting of 5 girls and 10 boys (mean age, 10.91 years), facemasks were applied from 2 titanium miniplates surgically placed laterally to the apertura piriformis regions of the maxilla. The second group (FM) of 7 girls and 8 boys (mean age, 10.31 years) received maxillary protraction therapy with conventional facemasks applied from hooks of the rapid maxillary expansion appliance. The third group of 8 girls and 7 boys (mean age, 10.05 years) was the untreated control group. Lateral cephalometric films were obtained at the beginning and end of treatment or observation in all groups and analyzed according to a structural superimposition method. Measurements were evaulated statistically with Wilcoxon and Kruskal-Wallis tests., Results: Treatment periods were 6.78 and 9.45 months in the MP+FM and FM groups, respectively, and the observation period in the control group was 7.59 months. The differences were significant between the 3 groups (P <0.05) and the MP+FM and FM groups (P <0.001). The maxilla moved forward for 2.3 mm in the MP+FM group and 1.83 mm in the FM group with maxillary protraction. The difference was significant between 2 groups (P <0.001). The protraction rates were 0.45 mm per month in the MP+FM group and 0.24 mm per month in the FM group (P <0.001). The maxilla showed anterior rotation after facemask therapy in the FM group (P <0.01); there was no significant rotation in the MP+FM group. Posterior rotation of the mandible and increased facial height were more evident in the FM group compared with the MP+FM group (P <0.01). Both the maxilla and the mandible moved forward significantly in the control group. Protrusion and mesialization of the maxillary teeth in the FM group were eliminated in the MP+FM group. The maxillomandibular relationships and the soft-tissue profile were improved remarkably in both treatment groups., Conclusions: The undesired effects of conventional facemask therapy were reduced or eliminated with miniplate anchorage, and efficient maxillary protraction was achieved in a shorter treatment period., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

In this article, we report the successful use of miniscrews in a patient with an Angle Class III malocclusion, lateral open bite, midline deviation, and severe crowding. Simultaneously resolving such problems with conventional Class III treatment is difficult. In this case, the treatment procedure was even more challenging because the patient preferred to have lingual brackets on the maxillary teeth. As a result, miniscrews were used to facilitate significant asymmetric tooth movement in the posterior and downward directions; this contributed to the camouflage of the skeletal mandibular protrusion together with complete resolution of the severe crowding and lateral open bite. Analysis of the jaw motion showed that irregularities in chewing movement were also resolved, and a stable occlusion was achieved. Improvements in the facial profile and dental arches remained stable at the 18-month follow-up., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Purpose: The purpose of this study is to compare the time-course changes in condylar long-axis and skeletal stability after sagittal split ramus osteotomy (SSRO) with an unsintered hydroxyapatite (u-HA)/poly-L-lactic acid (PLLA) plate, PLLA plate, or titanium plate., Patients and Methods: Of 60 Japanese patients diagnosed with mandibular prognathism, 20 underwent SSRO with a u-HA/PLLA plate system, 20 underwent SSRO with a PLLA plate system, and 20 underwent SSRO with a conventional titanium plate system. The time-course changes in condylar long-axis and skeletal stability were assessed by use of axial, frontal, and lateral cephalograms., Results: Compared with the u-HA/PLLA group, the titanium group showed a significantly greater change in the right condyle angle between initially and 1 month (P = .0105) and intercondylar axes angle between 1 and 3 months (P = .0013). The PLLA group showed a significantly greater change than the titanium group (P = .0043) and u-HA/PLLA group (P = .0002) in terms of ramus inclination between 1 and 3 months; however, there were no significant differences among the 3 groups in the other measurements for each time interval., Conclusion: This study suggests that there are no significant differences in postoperative time-course changes among a u-HA/PLLA plate system, PLLA plate system, and conventional titanium plate system., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Aim: To investigate cephalometric craniofacial parameters (skeletal and dental) of β-thalassemic-major patients and to compare findings with a group of healthy patients in the same age group., Methods: Fifty-one Syrian thalassemic-major patients aged 8-12 years were recruited. Lateral cephalometric radiographs were taken. Linear and angular cephalometric measurements were recorded and compared with Syrian controls (n=50) in the same age group., Results: Thalassemic patients, when compared with controls, showed significant retrognathia in the mandible (reduced sella [mid-point of sella turcica]-nasion [most anterior point on the frontonasal suture] B-point [deepest point on the concavity of the mandibular profile between the alveolar crest and the point of the chin] angle, and decreased sella-nasion-pogonion [most anterior point on the bony chin] angle, P<0.0001), a significant decrease in ramus height (articulare-gonian=36.51 ± 3.87 mm, P<0.0001). They also exhibited a significant class II skeletal pattern (P<0.0001) and a convex facial profile as the nasion A-point (deepest point on maxillary profile between the anterior nasal spine and the alveolar crest) pogonion angle and maxillomandibular A-point-nasion P-point angle increased. They also showed a highly-significant decrease in the total posterior facial height (sella gonion [most posterior, inferior point on the angle of the mandible]=64.24 ± 5.73 mm, P<0.0001) and significant increase in the total anterior facial height (N-Me = 110.78 ± 6.66 mm, P=0.009) when compared to controls., Conclusion: Thalassemic patients exhibited a skeletal class II malocclusion, retrognathia of the mandible, a short height of the ramus, an increase in anterior facial height, and a decrease in posterior facial height., (© 2011 Blackwell Publishing Asia Pty Ltd.)

Numb chin syndrome (NCS) is a rare yet potentially ominous sensory neuropathy characterised by unilateral hypoesthesia or paraesthesia over the lower lip, chin and occasionally gingival mucosa. Recognising NCS clinically is important as this may be a subtle sign of occult malignancy progression or relapses. Current expert opinion is that patients with NCS without apparent cause should be assumed to have a malignant aetiology until proven otherwise. By far the most common non-haematologic neoplastic cause of NCS is breast cancer, while the most common haematologic neoplastic cause is non-Hodgkin lymphoma (NHL). The pathophysiology of NCS has been shown to be either direct compression of the mental nerve by tumour mass, leptomeningeal invasion or a bony lesion at mental foramen. Here we report a case of NHL presenting with NCS with no evidence of metastasis in brain parenchyma, cerebrospinal fluid or mandibular bone. Instead, diffuse dural thickening and focal lesion in clivus were identified. We propose that these may represent novel mechanisms of NCS.

The aim of the present morphometric investigation was to evaluate the effects of bone-anchored maxillary protraction (BAMP) in the treatment of growing patients with Class III malocclusion. The shape and size changes in the craniofacial configuration of a sample of 26 children with Class III malocclusions consecutively treated with the BAMP protocol were compared with a matched sample of 15 children with untreated Class III malocclusions. All subjects in the two groups were at a prepubertal stage of skeletal development at time of first observation. Average duration of treatment was 14 months. Significant treatment-induced modifications involved both the maxilla and the mandible. The most evident deformation consisted of marked forward displacement of the maxillary complex with more moderate favourable effects in the mandible. Deformations in the vertical dimension were not detected. The significant deformations were associated with significant differences in size in the group treated with the BAMP protocol.

Purpose: This study evaluated the functional and cosmetic results of mandibular basal osteotomy, introducing new indications and fixation alternatives., Materials and Methods: Ten patients 19 to 46 years old (mean, 32.3 years) were treated by orthognathic surgery, including mandibular basal osteotomy for correction of deficiency, excess, or asymmetry of the inferior mandibular border. An intraoral approach based on 3 incisions to the anterior and posterior mandible was used to maintain and protect soft tissues surrounding the mental nerve. After marking the bone inferior to the nerve, a reciprocal saw completed the osteotomy design and individual rigid fixation according to movement was executed. All patients were 3-dimensionally treated and the evaluation included clinical, radiographic, and photographic analysis pre and postoperatively; all patients were followed for a minimum of 12 months., Results: All patients showed excellent functional and cosmetic results. Nine patients (9/10) were treated for advancement of the inferior border (mean, 6.89 ± 2.57 mm; P < .05). One of them underwent simultaneous inferior (3 mm) and lateral (4 mm) repositioning and 3 had combined lateral movement (mean, 3.5 ± 0.58 mm; P < .05). One patient (1/10) required posterior (4 mm) and inferior (5 mm) repositioning of the basal segment., Conclusions: Mandibular basal osteotomy is an innovative technique that is strongly predictable for correction of deficiency, excess, and/or asymmetry of the inferior mandibular border, decreasing morbidity and many other complications of traditional bone grafts and alloplastic techniques., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

A thorough knowledge of the anatomy of the aging face is essential to a safe and effective operation. Over time, the face undergoes changes in skin and subcutaneous tissues evidenced by rhytides and thinning. There are also changes in the tone and character of facial muscles. Changes in fat structures in the face cause aesthetic changes that can be addressed surgically. Knowledge of the anatomy of the face and neck will aid in understanding the changes that occur with aging and will allow for a more complete strategy in rejuvenating the aging face., (© Thieme Medical Publishers.)

Objective: To evaluate the efficacy of the written explanation given to patients when obtaining informed consent for oral surgery, taking the surgical extraction of the impacted mandibular third molar as the clinical model for this study., Patients and Methods: This study included 87 patients requiring surgical extraction of an impacted lower third molar. Residents of the Oral Surgery Department explained verbally and in writing 7 possible complications that could arise as a result of the operation, after which informed consent was obtained from the patient. These complications were as follows: altered sensation of the homolateral lower lip and chin; altered sensation of the tongue; swelling; trismus; pain; allergies; and infection. The patients completed a Corah anxiety test on the same day, as well as a preoperative questionnaire about their level of understanding of the informed consent. Seven days after the operation, the patients returned to have their stitches removed and for a postoperative interview., Results: A total of 87 patients participated in the study. Of these, 64% (n = 56) had understood the objective of the informed consent. All but 1 (1%) of the patients remembered having been informed of the possible risks before the operation. Changes in sensation of homolateral lower lip and chin (98%, n = 85) and of the tongue (86%, n = 75) were among the complications most recalled by the patients. Ninety-six percent of patients (n = 84) preferred to be informed preoperatively, and 71% (n = 61) described the signs and symptoms to be exactly as explained by the residents., Conclusions: Patients do not remember the majority of the information they receive before giving informed consent. Paresthesia of the lower lip and chin on the operated side and of the tongue are among the most recalled complications. This may be due to the seriousness of this complication, to the effect it can have on the patients' daily life, and to the possibility that it may be irreversible., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Debate continues regarding unilateral or bilateral treatment for mandibular condylar fractures. This retrospective study evaluates the functional outcomes of bilateral condylar process fractures after surgical intervention. From May 1994 to December 2004, 51 adult patients with bilateral mandibular condylar process fractures were studied. There were 33 cases of bilateral condylar fractures (type I); 12 cases of condylar-subcondylar fractures (type II); and six cases of bilateral subcondylar fractures (type III). All patients underwent open reduction and internal fixation. Four patients had chin deviation, six had malocclusion, three had poor chewing function and eight had limited mouth opening. Type I patients had a significantly higher incidence of limited mouth opening (P=0.039) and associated maxillary fractures (n=12) and psychiatric disease (n=6) which yielded significantly poor functional outcomes. Complications included transient facial paresis (n=4), fracture and loosening of postoperative plates (n=3) and surgical wound infections (n=2). Open reduction with rigid fixation for bilateral condylar fractures provided satisfactory functional outcomes in this study. Concomitant maxillary fractures and underlying psychiatric problems are poor outcome factors. Aggressive rehabilitation in the first 9 months is important for early functional recovery., (Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Aim: To evaluate the effects of rapid maxillary expansion (RME) and face mask combination therapy on the soft and hard tissue profile and to determine the possible correlations between hard and soft tissue changes., Methods: Soft and hard tissue parameters were measured in cephalometric radiographs of 33 subjects. The treatment group consisted of 18 Class III patients (11 males and 7 females, mean age 11.7 ± 1.9 years), and the control group contained 15 untreated Class III subjects (10 males and 5 females, mean age 9.1 ± 2.5 years). Soft tissue Arnett analysis was used to evaluate the profile changes in both groups after treatment or observation. Paired- and independent-sample t tests were used for statistical evaluation., Results: Combined RME and face mask therapy produced significant and favorable skeletal changes in both arches. The Class III incisal relationship was corrected by protrusion of the maxillary incisors and retrusion of the mandibular incisors. The soft tissue profile showed significant increase in convexity and facial height., Conclusion: Significant forward and downward displacement of the maxilla and an opening rotation of the mandible were observed as a result of RME and face mask therapy. The soft tissue profile also improved significantly., (© 2011 BY QUINTESSENCE PUBLISHING CO, INC.)

Objective: The purpose of this study was to analyze craniofacial characteristics from lateral head profile radiographs of patients with cri-du-chat (CdC) syndrome., Study Design: The craniofacial morphology of 10 CdC patients was evaluated using standard cephalometric methods, measuring 39 craniofacial variables on cephalometric x-ray images., Results: The principal characteristics were skeletal class II malocclusion, caused by mandibular retrognathism, dental biprotrusion, and a small upper airway. Additionally, 70% of patients had a steep palatal plane angle; the cranial base angle was flattened, also in 70% of patients., Conclusions: Results indicated that the deletion of 5p had an impact on the cranial base, maxilla, mandible, and upper airway, causing distinctive features to become apparent through irregular growth., (Copyright © 2010 Mosby, Inc. All rights reserved.)

The present article illustrates a treatment option for managing the skeletal Class II malocclusion complicated by a deep bite and short face in an adult and emphasizes the limitations of such an approach and its potential complications. The patient had an inadequate tooth display upon smiling and a deep lower curve of Spee. Treatment consisted of a double jaw surgery with a maxillary three-piece LeFort to expand, downgraft, and advance the maxilla and a bilateral sagittal split osteotomy to advance the mandible. Treatment was staged so that the leveling of the mandibular arch was completed postsurgically by extrusion of the mandibular buccal segments. During surgery, the mandible was rotated clockwise at the osteotomy site to bring the chin down. This treatment approach resulted in a dramatic increase in the lower facial height, as well as an improvement in skeletal and occlusal relationships, with a much improved tooth display upon smiling, despite the few complications that occurred., (© 2011 BY QUINTESSENCE PUBLISHING CO, INC.)

Introduction: The aim of this study was to evaluate 3-dimensional facial shells by incorporating a population-specific average template with a group of Class III subjects preparing to have orthognathic surgery., Methods: The Class III group included 14 male (MCIII) and 15 female (FCIII) subjects. We used 43 male and 44 female Class I subjects to construct average male (AvM) and female (AvF) faces. Coordinates of 3 points on the facial templates of groups MCIII and FCIII and the templates AvM and AvF were compared. MCIII-AvM and FCIII-AvF superimpositions were evaluated for differences., Results: Vertical distances (sella to soft-tissue pogonion) were statistically significantly higher for the AvM (9.1%) and MCIII (10.1%) than for the AvF and FCIII, respectively (P < 0.05). The distances of soft-tissue pogonion in the horizontal x-axis were positive in 80% of the FCIII group and 85.7% of the MCIII group. The Class III subjects differed from the average face in the lower two thirds, but, in 50% (MCIII) and 60% (FCIII), they differed also in the upper facial third., Conclusions: (1) The average and Class III Slovenian male morphologic face heights are statistically significantly higher than those of the female subjects. (2) The Slovenian Class III male and female subjects tend toward a left-sided chin deviation. (3) Differences between Class III patients and a normative data set were determined., (Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Angle Class II division 1 malocclusion has been one of the most encountered problems in the orthodontic practice. In growing patients, mandibular repositioning appliances are the method of choice to induce mandibular growth and are termed functional appliances. This study was carried out to investigate the possible effect of the Sabbagh Universal Spring2 (SUS2) on the dental and skeletal cephalometric measurements in the permanent dentition of ten growing patients with Class II division 1 malocclusion and to compare its effect with the similar available data of similar fixed functional appliances. It was concluded that the Sabbagh Universal Spring2 appliance works well with the treatment philosophy of Class II division 1 malocclusion with retruded mandible by advancing the mandible anteriorly.

Aim: To identify the craniofacial characteristics that contribute to long-term stability of protraction facemask treatment of Class III malocclusion., Methods: Fifty subjects who met the following criteria were recruited: subjects with an anterior crossbite and 'Wits' appraisal < -3.5 mm; subjects who had been successfully treated with a protraction facemask (at the end of active orthopaedic treatment the overjet was overcorrected by more than 4 mm); the facemask treatment was started at either CS1 or CS2 and the subjects were followed until CS4; no subject had a congenital craniofacial deformity. Based on the occlusal status at CS4, three groups were identified: Stable group (SG), Unstable group (USG) and a Failed group (FG). One-way analysis of variance and Scheffe's post-hoc multiple comparisons were used to analyse the differences between the groups. Stepwise discriminant analysis was used to identify the craniofacial characteristics able to predict the stability of protraction facemask treatment., Results: There were no statistically significant differences between USG and FG. The N-S-Ar was significantly larger and Co-Gn, Wits and LAFH significantly smaller in the SG group as compared with the USG and FG groups. The critical score between SG and USG was 0.368 and between USG and FG it was -0.981. Individuals with scores higher than 0.368 showed relatively stable occlusions at CS4, whereas anterior crossbites returned in individuals with scores less than -0.981 at CS4. The overall percentage of correctly classified cases was 74 per cent, with 90.0 per cent in SG and 73.3 per cent in FG., Conclusions: A severe maxillo-mandibular discrepancy, an increased vertical dimension and a prognathic mandible were unfavourable factors for long-term stability following early treatment of severe Class III subjects with protraction facemasks.

Introduction: To increase stability and mandibular setback movement, surgical maxillary impaction is normally performed with mandibular setback surgery in treating adult skeletal Class III patients. This article demonstrates the use of microimplants for anchorage to intrude molars and the resultant rotation of the maxillary occlusal plane clockwise to increase the surgical mandibular setback and reduce the posterior vertical dimension instead of maxillary surgical impaction., Methods and Results: A 21-year-old man with mandibular prognathism was treated with mandibular setback surgery that included orthodontic treatment for decompensation. Microimplants placed into the palatal alveolar bone between the maxillary first and second molars were used to intrude the maxillary posterior teeth and change the occlusal plane clockwise. This produced 4 mm more of distal movement of the chin during mandibular setback surgery compared with the surgical prediction with no change in the occlusal plane. These results were similar to those of 2-jaw surgery with maxillary posterior impaction., Conclusions: The intrusion of the maxillary posterior teeth with microimplants might prevent the need for maxillary surgery in adult skeletal Class III patients., (Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Purpose: To evaluate the ratio of soft tissue to hard tissue in bilateral sagittal split setback osteotomy with rigid internal fixation or wire fixation., Materials and Methods: A literature search was performed using PubMed, Medline, CINAHL, Web of Science, the Cochrane Library, and Google Scholar Beta. From the original 766 articles identified, 8 articles were included. Two articles were prospective and 6 retrospective. The follow-up period ranged from 1 year to 12.7 years for rigid internal fixation. Two articles on wire fixation were found to be appropriate for inclusion., Results: The differences between short- and long-term ratios of the lower lip to lower incisors for bilateral sagittal split setback osteotomy with rigid internal fixation or wire fixation were quite small. The ratio was 1:1 in the long term and by trend slightly lower in the short term. No distinction was seen between the short- and long-term ratios for mentolabial fold. The ratio was found to be 1:1 for the mentolabial fold to point B. In the short term, the ratio of the soft tissue pogonion to the pogonion showed a 1:1 ratio, with a trend to be lower in the long term. The upper lip showed mainly protrusion, but the amount was highly variable., Conclusions: This systematic review shows that evidence-based conclusions on soft tissue changes are difficult to draw. This is mostly because of inherent problems of retrospective studies, inferior study designs, and the lack of standardized outcome measurements. Well-designed prospective studies with sufficient samples and excluding additional surgery, ie, genioplasty or maxillary surgery, are needed., (Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the craniofacial morphology of Malay children with repaired UCLP and compare the data with non-cleft Malay children., Methods: Twenty Malay children with repaired UCLP (12 boys, 8 girls; Mean age: 10.5 years) and 20 normal Malay children (8 boys, 12 girls; Mean age: 9.72 years) were recruited from the Combined Cleft Lip and Palate Clinic and the Department of Children's Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, Malaysia. Lateral cephalometric radiographs were taken with the head orientated parallel to the floor. Thirty-one linear and angular variables were measured on the lateral cephalometric radiographs with Dolphin Imaging Software Version 10.0 (Dolphin Imaging, Chatsworth, CA, USA). The data were analysed with the Mann-Whitney U test and the level of significance was set at p < 0.05., Results: In the UCLP group, the girls had deeper overbites than the boys (p = 0.011), and in the Control group the girls had a significantly more acute cranial base angle (NSBa, p = 0.017) and a less protrusive lower lip (LL-E line, p = 0.21). The data for the boys and girls were combined. Subjects in the UCLP group had a more acute cranial base angle, shorter and more retruded maxillae and were more skeletal III than the subjects in the Control group. In the UCLP group, the upper and lower incisors were less proclined than in the Control group, the interincisal angle was more obtuse and the overjet reduced by 6 mm. There were no significant facial height differences. The nasolabial angle (Col-Sn-UL) was significantly more obtuse and the upper lip relative to the E line more retrusive in the UCLP group. There was no significant difference between the groups in facial heights or the maxillo-mandibular planes angle., Conclusion: Malay children with repaired UCLP have small, retrusive maxillae. The mandible in this group of children was of normal size and position, relative to the cranial base. Pressure from the repaired upper lip may be responsible for the retruded maxillae, retroclined incisors and obtuse nasolabial angle.

Background: Developmental dysplasia of the hip (DDH) is a condition that affects the femoral head and the acetabulum and leads to hip subluxation and dislocation. Infants with DDH are usually treated using splints that immobilize their hip joint and are forced on their back for long periods of time. The link between positioning and facial asymmetries is poorly understood., Objective: To compare the facial morphologies of children with DDH to a group of healthy controls., Subjects and Methods: Fifty-six Finnish patients born with DDH were matched on the basis of gender and age to a control group. Three-dimensional surface images were captured using the 3dMDface system. Using RF6 PP2 software, anthropometric landmarks were plotted and used to calculate asymmetry based on 3D co-ordinates in a reference framework., Results: There was statistically significant difference between all paired facial shells. Relative to the control group, DDH boys and girls presented a chin-point deviation to the right, a more prominent left orbital ridge, a more protrusive nose and upper lip. The gender-specific subgroups show a similarity of 66.54 and 65.22% in girls and boys, respectively., Conclusions: Patients with DDH present a facial asymmetry when compared to healthy controls. Gender characteristics are marked whether subjects are affected with DDH or not. Three-dimensional surface imaging is a powerful diagnostic and research tool., (© 2010 John Wiley & Sons A/S.)

Introduction: The objective of this study was to compare the degrees of skeletal and dental asymmetry between subjects with Class II subdivision malocclusions and subjects with normal occlusions by using cone-beam computed tomography., Methods: Thirty subjects with Angle Class II subdivision malocclusions (mean age, 13.99 years) and 30 subjects with normal occlusions (mean age, 14.32 years) were assessed with 3-dimensional cone-beam computed tomography scans. Independent t tests were used to compare orthogonal, linear, and angular measurements between sides and between groups., Results: Total mandibular length and ramus height were shorter on the Class II side. Pogonion, menton, and the mandibular dental midline were deviated toward the Class II side. Gonion and the anterior condyle landmark were positioned more posteriorly on the Class II side. The mandibular dental landmarks were located more latero-postero-superiorly, and the maxillary dental landmarks more latero-antero-superiorly on the Class II side. There was loss of maxillary arch length, and the mandibular molar was closer to the ramus on the Class II side., Conclusions: The etiology of Class II subdivision malocclusions is primarily due to an asymmetric mandible that is shorter and positioned posteriorly on the Class II side. A mesially positioned maxillary molar and a distally positioned mandibular molar on the Class II side are also minor contributing factors., (Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: The purpose of this study was to investigate the dimensional changes in each skeletal unit in the mandibles of patients with facial asymmetry and mandibular prognathism., Methods: The patients consisted of 50 adults with mandibular prognathism, divided into the symmetry group (n = 20) and the asymmetry group (n = 30) according to the degree of menton deviation. Three-dimensional computed tomography scans were obtained with a spiral computed tomography scanner. Landmarks were designated on the reconstructed 3-dimensional surface models. The lines to represent condylar, coronoid, angular, body, and chin units were used. Ramal and body volumes were measured in the hemi-mandibles., Results: In the asymmetry group, condylar and body unit lengths were significantly longer, and coronoid unit length was significantly shorter on the nondeviated side than on the deviated side (P <0.01). Angular and chin unit lengths were not significantly different between the 2 sides (P >0.05). Ramal volume was significantly greater on the nondeviated side (P <0.01), but body volume was not significantly different between the 2 sides (P >0.05)., Conclusions: Both condylar and body units appeared to contribute to mandibular asymmetry, with a more central role of the condylar unit., (Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: In this cephalometric investigation, we analyzed the treatment effects of bone-anchored maxillary protraction (BAMP) with miniplates in the maxilla and mandible connected by Class III elastics in patients with Class III malocclusion., Methods: The treated sample consisted of 21 Class III patients consecutively treated with the BAMP protocol before the pubertal growth spurt (mean age, 11.10 ± 1.8 years) and reevaluated after BAMP therapy, about 1 year later. The treated group was compared with a matched control group of 18 untreated Class III subjects. Significant differences between the treated and control groups were assessed with independent-sample t tests (P <0.05)., Results: Sagittal measurements of the maxilla showed highly significant improvements during active treatment (about 4 mm more than the untreated controls), with significant protraction effects at orbitale and pterygomaxillare. Significant improvements of overjet and molar relationship were recorded, as well as in the mandibular skeletal measures at Point B and pogonion. Vertical skeletal changes and modifications in incisor inclination were negligible, except for a significant proclination of the mandibular incisors in the treated group. Significant soft-tissue changes reflected the underlying skeletal modifications., Conclusions: Compared with growth of the untreated Class III subjects, the BAMP protocol induced an average increment on skeletal and soft-tissue advancement of maxillary structures of about 4 mm, and favorable mandibular changes exceeded 2 mm., (Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Background: To date, no study has determined if rapid followed by slow maxillary expansion (also termed 'semi-rapid' expansion) has the same effects on the dentofacial skeleton as rapid maxillary expansion., Objective: To determine the vertical and sagittal changes in the facial skeleton during and following rapid then slow maxillary expansion (R-SME)., Methods: Bonded maxillary expansion appliances were used to separate the maxillae over six days by activating the midline screws twice a day. The screws were then activated three times a week until sufficient expansion was obtained (Mean: 3.4 months) and used as retainers for six months. Cephalometric measurements at the start of expansion (T1), end of expansion (T2) and end of retention (T3) were compared with paired t-tests. Pearson correlation coefficients were used to determine the associations between the expansion (dental and skeletal) and the cephalometric changes., Results: The maxillae moved forward a small, but statistically significant, extent during expansion. The upper molars were extruded and the mandible 'rotated' downward and backward. Although the vertical height of the facial skeleton (SN/GoMe, S-Go, N-Me, ANS-Me) increased significantly during expansion, the changes were small and highly variable. Some dimensions (SN/GoMe) relapsed during retention, while others (S-Go, N-Me) increased., Conclusions: Rapid then slow maxillary expansion caused a small, but statistically significant, forward movement of the upper facial skeleton, a small downward and backward rotation of the mandible and a small increase in face height. The changes were similar to those found during rapid maxillary expansion.

Introduction: The aim of this study was to determine the reliability and the measuring error (by means of the smallest detectable error) of 11 angular and 4 linear measurements commonly used for cephalometric analysis., Methods: Twenty-five digital lateral cephalograms were randomly selected and traced with Viewbox software (version 3.1.1.13, dHAL Software, Kifissia, Greece). This was repeated 3 times by 2 observers during 3 sessions. There was at least 1 week between each session. Differences were analyzed with a repeated measurement analysis of variance (ANOVA). Intraobserver and interobserver reliabilities were calculated with intraclass correlation coefficients (ICC) based on absolute agreement. Measurement error was determined by means of the smallest detectable difference., Results: The intraobserver agreement of the measurements was good (ICC >0.82). SNA, SNB, ANB, and ANS-Me had the smallest intraobserver errors for both observers (>1.86 mm or degrees). Except for SN-FH (ICC = 0.76), interobserver agreement was good (ICC >0.87)., Conclusions: Determining the appropriate measuring error of cephalometric measurements by means of the smallest detectable difference is necessary to find the true difference between the start and the end of active treatment. Depending on the magnitude of clinical significance, the measuring error was possibly clinically significant for all variables tested and, therefore, questions the use of these variables to detect the true treatment effect., (Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Purpose: The purpose of this study was to analyze the relationship between mandibular movement and facial morphology parameters measured using 3-dimensional CT data., Materials and Methods: We have developed a mandibular movement tracking and simulation system. The mandibular movement data were acquired from 22 subjects (6 males and 16 females), 3 who had no clinical facial deformities and 19 who had orthofacial deformities. The subjects voluntarily performed maximum mouth opening and closing movements. Three-dimensional maximum linear movements of selected points (bilateral condylions, infradentale, and pogonion) were calculated to represent mandibular movement. Facial morphology values were measured 3-dimensionally from CT data and bilateral morphological values were divided into 2 groups according to the mandibular deviation, the deviated side, and counter-deviated side groups. Correlation coefficients were calculated to evaluate the relationship between mandibular movements and facial morphology., Results: Maximum linear movements of all selected points on the mandible were positively correlated with sella-nasion-point A (SNA) and sella-nasion-point B (SNB). Movements of the infradentale and pogonion were significantly correlated with ramus inclination, lateral mandibular body angle, ramus length, and mandibular body length. Condylar movement was positively correlated with lateral mandibular body angle and mandibular body length. Multiple stepwise linear regression analysis was performed to evaluate the model predicting the effect of morphological values on mandibular movement. Condylar movement was associated with the SNA (R(2) value = 0.32 for the deviated side, R(2) value = 0.26 for the counter-deviated side), and movement of the infradentale was associated with both SNA and ramus length (R(2) value = 0.57). Movement of the pogonion could be predicted by SNA, mandibular length, and condylar head length (R(2) value = 0.65)., Conclusion: The 3D facial morphology values were associated with variations in mandibular movement, and morphological parameters contributed to predicting the movement of the mandible with different degrees., (Copyright © 2010 Mosby, Inc. All rights reserved.)

The calcifying epithelial odontogenic tumor was first described as an entity by Danish pathologist Jens Pindborg in 1955. It is an uncommon and locally invasive benign odontogenic tumor. The most characteristic findings are the presence of amyloid-like substance and calcified concentric liesegang rings.

In this study the authors evaluate and quantify the residual bony defect in the mandibular symphysis and its effect on the soft tissue contour a minimum of 1 year after harvesting chin bone. 59 ASA I cleft lip and palate patients, aged 8-19 years were included. In all patients an autologous bone graft from the mandibular symphysis was harvested for transplantation to the alveolar cleft. Lateral cephalograms were used to measure the donor site defects, and the effects on the soft tissue contour. An evident residual defect was measured at the donor site 1 year after harvesting chin bone. A significant relation was seen between age at time of surgery and size of the defect 1 year postoperatively. In older patients a larger defect remained. Using the current surgical technique of harvesting chin bone, complete bony repair of the defect was not achieved. This study shows postoperatively persisting defects that comprise on average 14% of the original peroperative defects. A significant increase in soft tissue thickness was seen at the mandibular symphysis at a minimum of 1 year postoperatively. These changes in the soft tissue chin contour 1 year after harvesting bone are similar to normal growth changes., (Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Aim: The aim of this study was to evaluate the skeletal and dentoalveolar changes due to treatment with twin block and Thurow appliances in patients with Class II occlusions., Method: The sample consisted of 19 randomly selected patients in each group, as well as 20 individuals in the control group. All patients were treated during the prepubertal growth spurt for 12 months. Lateral cephalograms were analyzed at the beginning of active treatment and 12 months later. All data were tested with the ANOVA and Bonferroni tests., Results and Conclusion: These tests showed that the twin block promotes a significant increase (P<.001) in the total length of the mandible, as well as an increase in anterior facial height. In contrast, ANB and NAPog were reduced. In both treatment groups, the maxillary incisors retruded significantly (P<.001), although more so in the twin block group. In the Thurow appliance group, the mandibular incisors protruded significantly (P<.001). All other differences between the two treated groups were not significant., (© 2010 BY QUINTESSENCE PUBLISHING CO, INC.)

In the past orthodontists frequently used extra-oral force to slow down skeletal growth in their treatment of Class II malocclusions; more modern practice relies less on applying distal force to the maxilla than on stimulating forward growth of the mandible. Does this change in therapeutic design have any repercussions in facial esthetics? To evaluate the impact of treatment on the appearance of the profile, we conducted a study with 64 patients in the adolescent dentition stage with a Class II, division 1 malocclusions. None had teeth extracted or preliminary orthodontic treatment. We divided them into two sections; we treated the first group of 33 patients with the Distal Active Concept (DAC), which encourages forward movement and growth of the mandible, and we treated the second group of 31 patients with Extra-Oral Force (EOF) in combination with a full-banded appliance. Comparing the results with cephalometric profile analyses, we found that the soft tissue contour of the lower part of the face showed considerably more sagittal development in the children treated by DAC than those treated by EOF., (© EDP Sciences, SFODF, 2010.)

Objective: To evaluate whether mandibular setback surgery (MSS) for Class III patients would produce gradients of three-dimensional (3D) soft tissue changes in the vertical and transverse aspects., Materials and Methods: The samples consisted of 26 Class III patients treated with MSS using bilateral sagittal split ramus osteotomy. Lateral cephalograms and 3D facial scan images were taken before and 6 months after MSS, and changes in landmarks and variables were measured using a Rapidform 2006. Paired and independent t-tests were performed for statistical analysis., Results: Landmarks in the upper lip and mouth corner (cheilion, Ch) moved backward and downward (respectively, cupid bow point, 1.0 mm and 0.3 mm, P < .001 and P < .01; alar curvature-Ch midpoint, 0.6 mm and 0.3 mm, both P < .001; Ch, 3.4 mm and 0.8 mm, both P < .001). However, landmarks in stomion (Stm), lower lip, and chin moved backward (Stm, 1.6 mm; labrale inferius [Li], 6.9 mm; LLBP, 6.9 mm; B', 6.7 mm; Pog', 6.7 mm; Me', 6.6 mm; P < .001, respectively). Width and height of upper and lower lip were not altered significantly except for a decrease of lower vermilion height (Stm-Li, 1.7 mm, P < .001). Chin height (B'-Me') was decreased because of backward and upward movement of Me' (3.1 mm, P < .001). Although upper lip projection angle and Stm-transverse projection angle became acute (Ch(Rt)-Ls-Ch(Lt), 5.7 degrees; Ch(Rt)-Stm-Ch(Lt), 6.4 degrees, both P < .001) because of the greater backward movement of Ch than Stm, lower lip projection angle and Stm-vertical projection angle became obtuse (Ch(Rt)-Li-Ch(Lt), 10.8 degrees ; Ls-Stm-Li, 23.5 degrees , both P < .001) because of the larger backward movement of Li than labrale superius (Ls)., Conclusions: Three-dimensional soft tissue changes in Class III patients after MSS exhibited increased gradients from upper lip and lower lip to chin as well as from Stm to Ch.