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Introduction: Rhinocerebral mucormycosis (RCM) is devastating disease causing local morbidity as well mortality in some individuals. Many patients have lost their one side or bilateral maxilla and zygomatic bone. Patients survive with such facial deformity and become social cripple. We are proposing technique where existing denture is used as a template and also as temporary prosthesis for plating the fibula in best prosthetical position. Patients and methods: Thirty patients were included in the study those fit inclusion criteria. All of them underwent unilateral or bilateral maxillary reconstruction by free microvascular fibular flap for bony as well soft tissue reconstruction. Eight patients have unilateral defect, and 22 had bilateral defects. Results: Out of 30, 1 patient had flap failure due to venous congestion, in all 29 patients flap was well taken. In that patient, we did salvage fibular flap from other lower limb and that was well taken. Other than minor local infection and hyper-granulation tissue formation in oral cavity, we did not have any major complications. Conclusion: This provides best opportunity for prosthetic as well cosmetic rehabilitation. For young and fit patients, this is the best reconstruction option. This approach gives best opportunity for both hard and soft tissue reconstruction and simultaneous dental rehabilitation. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

Summary: A 6‐year‐old horse was presented to a referral hospital in England for assessment of a rapidly expanding, hard swelling of the incisive region. Clinical and ancillary examinations revealed that the disease had spread beyond the incisive region, and advanced diagnostic imaging including computed tomography (CT) was recommended. Histopathology of biopsy samples taken from the lesions led to a diagnosis of a parasitic osteomyelitis caused by Halicephlobus gingivalis. The disease continued to progress rapidly, with neurological signs appearing soon after discharge from the hospital, and the horse was humanely destroyed. This report describes the computed tomographic changes associated with the lesions, treatment and clinical progression of this rare disease, which was ultimately fatal. Given the rapid progression in this case, it remains unclear if the prognosis is better if it is diagnosed early in the pathogenesis and medical and surgical treatments started earlier. CT revealed distinctive, very unusual changes that contributed to the ultimate histopathological diagnosis. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate where exactly children and adolescents of the same group look when they interact with each other, and attempt to record and analyse the data recorded by eye-tracking technology. 60 subjects participated in the study, evenly divided into three age categories of 20 each in pre-school/primary school age (5–9 years), early adolescence (10–14 years) and late adolescence/transition to adulthood (15–19 years). Age groups were matched and categorized to be used both for creating the picture series and testing. Photographs of patients with both unilateral and bilateral cleft lip and palate were used to create the series of images which consisted of a total of 15 photos, 5 of which were photos of patients with surgically treated cleft deformity and 10 control photos with healthy faces, that were presented in random order. Using the eye-tracking module, the data on "area of first view" (area of initial attention), "area with longest view" (area of sustained attention), "time until view in this area" (time of initial attention) and "frequency of view in each area" (time of sustained attention) were calculated. Across all groups, there was no significant difference for the individual regions for the parameters of initial attention (area of first view), while the time until first fixation of one of the AOIs (time until view in this area) was significant for all facial regions. A predictable path of the facial scan is abandoned when secondary facial deformities are present and attention is focused more on the region of an existing deformity, which are the nose and mouth regions. There are significant differences in both male and female participants' viewing of faces with and without secondary cleft deformity. While in the age group of the younger test persons it was still the mouth region that received special attention from the male viewers, this shifted in the male test persons of the middle age group to the nose region, which was fixed significantly more often and faster. In the female participants, the mouth and nose regions were each looked at for twice as long compared to the healthy faces, making both the mouth and the nose region are in the focus of observation. [ABSTRACT FROM AUTHOR]

Introduction Today, beauty has become a marker for societal acceptance of a person. An ugly face can cause undue awkwardness & distress which may lead to various psychosocial problems. Facial deformity is the commonest cause leading to unattractive look. The adolescents get easily influenced and affected by facial deformity, as the importance of external beauty has been emphasized on their mind since childhood. To assess the Self Concept of the adolescents having Facial Deformity (Male and Female, Urban and Rural) Material and Methods The objectives were framed to see the influence of facial deformity, location (urban/rural) and gender on selfconcept of adolescents. The sample size of the present study was 403 adolescents; the age group ranged from 12 to 18 yrs. There were three independent variables which varied at two levels (with deformity-without deformity, urban-rural, male-female) and so 2 X 2 X 2 factorial design was used. The tool was administered and scoring was done in accordance with the scoring system given in the respective manual. Results After statistical analysis, the results showed that the selfconcept was low in adolescents with facial deformity, rural and female adolescents. Conclusion Adolescents need to be counselled as facial beauty is not the only marker to build one’s self concept. [ABSTRACT FROM AUTHOR]

Dental procedures contribute to the contamination of equipment and surfaces with potential infections. Measures implemented to combat the COVID-19 pandemic, resulted in significant impacts on mental health and daily life which also affected oral health behaviors, routine diet, oral care habits, and dental appointments. So, this study aims to understand the oral health behavior during the pandemic and its association with fear of COVID-19. Material and Methods Among the various web engines available, google is the most commonly used by the general public worldwide. Hence we used Google search Engine to know the awareness of dental ailments and the treatment modalities among the general public. Five keywords were selected for each dental specialty. All the key words were run through google trends web engine. Results Majority of the subjects who opted that they don’t have changes in brushing habit during pandemic belongs to age group 18-25 years (52%). Subjects who opted that they don’t have changes in sugary food intake during pandemic were 26% and the subjects who opted that they have increased sugary food intake were also 26%. 60% of the people who have a dental problem stated that they didn’t visit the dentist due to fear of COVID-19. Conclusion Regardless of age and educational background, many individuals were reluctant to visit dental clinics during the pandemic due to concerns about potential COVID-19 exposure. Those who became more cautious about their oral hygiene showed a greater fear of COVID-19. This caution resulted in changes in their food consumption frequency and preferences. [ABSTRACT FROM AUTHOR]

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

Copyright of Revista Española de Cirugía Oral y Maxilofacial is the property of Sociedad Espanola de Cirugia Oral y Maxilofacial (SECOM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Growth and development of the head-and-neck are complex and early processes associated with higher chances of malformation. Any malformation of the hard or soft tissue of the head-and-neck leads to a common effect of facial asymmetry. Facial asymmetry is attributed to various other causes also. This article is about the significance of understanding the concepts in the management of facial asymmetry for a successful treatment outcome that satisfies the objectives and goals of the treatment and limits the complications. [ABSTRACT FROM AUTHOR]

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

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

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

Copyright of Revista Española de Cirugía Oral y Maxilofacial is the property of Sociedad Espanola de Cirugia Oral y Maxilofacial (SECOM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

Background: Patients with craniofacial clefts who have had reconstructive surgery often develop problems, such as contour deformity that will cause psychological issues. Micro and nano fat grafting are various methods utilized to overcome these issues. Case and Operation Technique: This case series describes two patients with facial contour deformities due to Tessier 3 and 4 craniofacial clefts, respectively. Each patient underwent secondary reconstruction correction surgery followed by a combination of micro and nano fat grafting. Discussion: Results on day 7 after surgery were promising. Growth factors and stem cells in nano fat complemented the micro fat properties, thus increasing the survivability rate. Conclusion: This case series demonstrates that the combination of micro and nano fat shows promising results for overcoming facial contour deformity. [ABSTRACT FROM AUTHOR]

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

Background: Dento-maxillofacial deformities are often associated with nasal deviation, and patients often complain of nasal deviation after orthognathic surgery. This study aimed to quantitatively evaluate the facial visual attention given to dento-maxillofacial deformities accompanying nasal deviation from the perspective of patients and determine whether orthognathic surgery could alter this outcome. Methods: The scanning paths of 137 patients were recorded using an eye-tracking device; recordings were made while the patients viewed images of dento-maxillofacial deformities associated with various degrees of nasal deviation before or after orthognathic surgery. Visual attention focused on the lower face and nose was analyzed. Results: When viewing postoperative faces, the participants focused more visual attention on noses and less on the lower face than they did on preoperative faces. Interestingly, for preoperative faces, nasal deviation could significantly increase participants' visual attention to the lower face, and visual attention to noses was significantly increased when noses were deviated 12°, while for postoperative faces, a nasal deviation of 4° or more was associated with a significant increase in participants' visual attention to the nose. Conclusions: Patients tended to focus their visual attention on the lower region of preoperative faces and ignored nose irregularities. Orthognathic surgery can alter visual attention, shifting it from the lower face to the nose, and a deviation of 4° or more could be a potential concern for patients. Clinicians must inform patients preoperatively about preexisting nasal deviations, which can guide surgical planning and help manage patient expectations. Level of evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

Acrocephalosyndactyly or Apert syndrome is a rare disorder in which the fingers and toes are fused, giving the appearance of webbed hand and feet. Also, there is craniosynostosis, leading to severe mid-face hypoplasia and characteristic facial deformities. Here there is a genetic mutation in the fibroblast growth factor receptor 2 (FGFR2) gene with autosomal dominant inheritance. A case of an 8-year-old male child is reported here with frontal bossing, acrocephaly, prominent ocular hypertelorism with divergent strabismus, saddle-shaped nose, mid-face hypoplasia, crowded anterior teeth, sparse hair and severe bilateral syndactyly of the feet and hands. [ABSTRACT FROM AUTHOR]

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

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

Skeletally mature patients with cleft lip and palate commonly present with skeletofacial deformities characterized by varying degrees of intrinsic and acquired dentoskeletal and soft tissue abnormalities. These abnormalities are associated with scarring from previous surgeries and the asymmetric midline and facial contour that impose challenges for adequate reconstruction. These patients frequently require 2-jaw orthognathic surgery to improve occlusal function and for correction of facial deformities. In this article, we have detailed a 3-dimensional computer-assisted single-splint 2-jaw orthognathic surgery technique as a surgical approach for cleft skeletofacial reconstruction, allowing for the surgery to be tailored according to the specific needs and requests of the patients. Further, we have addressed the multidimensionality and specificities of cleft treatment, the wide versatility, adaptability, and applicability of this technique, and the patient-centered rationale for the adoption of this method. [ABSTRACT FROM AUTHOR]

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

Background: There is a relationship between facial deformity and angulation of impaction which is studied by many authors. Aims and Objectives: To assess relation between the type of mandibular third molar impaction and skeletal deformity. Materials and Methods: A cross sectional study was carried on 152 orthopantomograms (OPG) and lateral cephalometric of patients of 18 years and above (106 males and 46 females) and the type of lower third molar impactions and facial deformity was recorded. Results: 106 (69.7%) were males and 46 (31.3%) were females. The commonest impaction angulation was mesio-angular impaction which was found in 98 teeth out of which 65 belonged to males (66.3%) and 33 belonged to females (33.7%). The majority of the impacted teeth were found in patients who had skeletal class I facial profile (78.2%) out of which, most of them (44%) had mesioangular impaction while least had inverted impaction (1.6%). Conclusion: Mandibular third molar impaction is significantly associated with anteroposterior skeletal molar relationship. [ABSTRACT FROM AUTHOR]

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