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Introduction: This prospective double-blinded clinical trial study aimed to compare the direct and indirect techniques of inferior alveolar nerve block (IANB) anesthesia regarding positive aspiration and success rate. Methods: This study included all 250 healthy patients who were referred to the Oral and Maxillofacial Surgery Department, Mashhad Dental School, Mashhad, Iran, for lower teeth extraction. The patients were randomly assigned to two groups. In total, 126 patients were subjected to IANB by a direct technique, and an indirect technique was utilized to perform IANB on the others. The primary and secondary outcomes were positive aspiration and anesthetic success, respectively. The data were statistically analyzed with SPSS software (version 19) using the Chi-square test. Results: The positive aspiration rates were 23 (18.3%) and 7 (5.6%) in the direct and indirect groups, respectively, which was statistically significant (P=0.002). The incidence rates of positive aspiration on the right and left sides were 13 (11%) and 17 (12.9%), respectively, which had no significant difference (P=0.651). Moreover, the success rates of direct and indirect techniques were 106 (84.1%) and 93 (75%) respectively, which was not statistically significant. It is worth mentioning that the success rates were similar on the right (79.7%) and left (79.5%) sides. Conclusion: According to the established results, the indirect technique of IANB has a significantly less positive aspiration rate, compared to the direct technique. This advantage is especially valuable in high-risk patients undergoing inadvertent intravascular injection of an anesthetic drug, which can lead to catastrophic complications.

Introduction: One of the most important causes of cancer death in women is cervical cancer. Early detection of precursors or early stage disease is possible using low-cost and available screening approaches, and this is associated with a reduction in patients' mortality. This study was performed with aim to compare colposcopic findings and histological findings in colposcopic cervical biopsy specimens.Methods: This cross-sectional study was performed in 2016-2017 on 200 patients referred to the gynecology and oncology clinic of Ghaem Hospital in Mashhad with colposcopic indications. These indications included abnormal Pop smear, post coital bleeding, abnormal appearance of cervix and vagina on examination, and existence of high-risk HPV virus in tests. If there was a history of abnormal Pap smear or biopsy due to suspected cervical lesions, the subjects were excluded from the study. Initially, the cause of colposcopy, Pap smear and HPV status were extracted using the information in the file. In the next stage, under the supervision of two gynecologists with oncology fellowship, colposcopy was performed and the findings during colposcopy were recorded. Finally, the data were analyzed with the pathological report. Data were analyzed by SPSS software (version 23).Results: Physician diagnosis at the end of colposcopy was abnormal in 162 patients (81.5%). As a result of colposcopic pathology, the results showed abnormal pathology in 120 patients (60%). The most common pathologies reported were CIN1 (87.4%), CIN2 (9.2%), and CIN3 (2.3%), respectively. There was a correlation between the colposcopic result and the pathological result in 21% of patients (n=42). The sensitivity of colposcopy compared to the pathological result was 89% and its specificity was 30%. The positive and negative predictive value of colposcopy was 65% and 64% compared to the pathological result.Conclusion: Colposcopy has an acceptable sensitivity in the diagnosis of cervical pathological lesions, but has a low specificity. Therefore, this screening / diagnostic test can be used in one of the multi-stage screening stages (after the initial screening with Pap smear) and if there are any abnormalities during the colposcopy, biopsy be performed.

Introduction: A great number of Iranian military forces have sustained sulfur mustard gas exposure during the Iran-Iraq war of 1980-1988 and have survived with dental care needs. Accordingly, this study aimed to discover the prevalence of intraoral lesions and periodontal diseases associated with the percentage of being chemical veterans. Methods: This cross-sectional study was conducted in the summer of 2009 on 40 chemical veterans. The patients were examined using dental mirrors under dental unit light, as well as a periodontal probe, to evaluate soft tissue attachment. The clinical results were then documented on medical records. Data were analyzed using the Chi-square test and two independent sample t-tests in SPSS software (version 19). A p-value less than 0.05 was considered statistically significant. Results: The study population was composed of 40 patients with a mean age of 50.7±9.32 years, mean pocket depth of 1.47±0.31 mm, and mean bleeding on probing of 0.35±0.24 mm. Furthermore, 55% and 27.5% of the patients had xerostomia and temporomandibular joint dysfunction, respectively. However, no significant association was found between these factors and the percentage of being veterans. Conclusion: The study findings showed that 96.7% of the patients had bleeding on probing problem. The mean score of plaque index that is a practical measurement on evaluating oral hygiene was 2.06±0.99. Therefore, informing chemical veterans about their periodontal health by performing regular dental assessments by dental specialists and instructing oral hygiene seem to be this group’s need.

Introduction: This study was conducted to compare three rotary files of Superfile III Denco, Sp1 Gold v taper, and ProTaper in terms of debris extrusion to find the best treatment option. Methods: In total, 51 extracted mandibular premolars were randomly assigned to three groups (n=17). Rotary systems of Sp1 Gold v taper, Superfile III Denco, and ProTaper Universal were used in the first, second, and third groups, respectively. Canals were prepared up to the F2 file, and this process was conducted only by one operator. Moreover, an Orifice shaper specific to each group was used first, and files were removed from canals and then cleaned by wet gauze. In the preparation procedure, canals were washed to extract all debris from the canal. Eppendorf tubes were used to collect debris. Results: Mean debris values extruded from canals in the Sp1 gold, Superfile Denco, and ProTaper Universal files were 0.0025, 0.0008, and 0.0014, respectively. There was no significant difference among debris extruded by Superfile Denco III, SP1 gold V taper, and ProTaper Universal files (P

Introduction: The present study aimed to investigate the etiology and epidemiology of maxillofacial spaces infection in patients referred to Kamyab Hospital, Mashhad, during 2016-2019. Materials and Methods: The medical records of patients who had been referred to Kamyab Hospital in Mashhad due to maxillofacial abscess were reviewed in this cross-sectional study. The research variables included gender, age, offending tooth, type of abscess, symptoms, systemic problems, smoking and alcohol use, type of antibiotics prescribed, type of anesthesia and surgical procedure, length of hospitalization, postsurgical complications. Data were analyzed in SPSS software (version 19). Results: The present study was con conducted on 209 cases (including 86 (41.1%) females and 123(58.9%) males) with a mean age of 35.45±14.19 years. A number of 58 (27.8%) patients used cigarettes and tobacco and 26 (12.4%) subjects consumed alcohol. Moreover, 34 (16.3%) cases had a systemic disease. The highest frequency of offending tooth was related to lower third molar in 56 (26.8%) cases. The most infected site was submandibular in 108 (51.7%) cases, and the most abscess-related symptom was swelling in 179 (85.6%) subjects. The most common complication was Ludwig's angina, and the most prescribed antibiotic was clindamycin in 151 cases. Conclusion: As evidenced by the results of the present study, maxillofacial abscesses can cause irreversible complications for patients. Patients with infected pterygomandibular and submasseteric spaces were more likely to be hospitalized longer than others.

Introduction: This study aimed to compare the knowledge, attitude, and practice of the technicians and their supervision of dental clinics in Mashhad. Materials and Methods: In this study, the researchers examined 84 clinics and distributed the questionnaire among the technicians. The quality of the sterilization was evaluated by biological and chemical indicators and the results of the questionnaire. The biological and chemical indicators were placed inside the autoclave. The questionnaire investigated the incubation method, autoclave numbers, device performance monitoring method, indicator type, device temperature and pressure, and the number of times the device was turned on during the day, as well as the knowledge, attitude, and performance of the technicians. The collected data were analyzed in SPSS software (version 19). Results: Based on the findings, class B autoclaves were used in only 59% of the clinics. It was revealed that 7%, 26%, and 31% of the clinics applied biological testing, chemical testing, and physical methods to assess autoclave performance, respectively. The results of biological tests were positive in 20% of clinics, and 11.9% of chemical indicators did not show sufficient color change. It was also found out the knowledge, attitude, and performance scores were significantly higher in the dental technicians than those in the physician technicians. Conclusion: According to the results of this study, it is recommended that the technicians of the dental department of public clinics be dentists as well. Public clinics should pay more attention to the quality of sterilization and infection control. The improvement of the technicians' knowledge will lead to better performance and consequently to an increase in the quality of sterilization and infection control.

Background: The sterilization cycle is one of the most important parts of infection control. Accordingly, the present study was conducted to assess the quality of steam sterilization and compare the knowledge, attitude, and practice of clinical directors in dental clinics, based on the experimental work in one of the most important and famous dental departments and clinics in the Northeast of Iran. Methods: This cross-sectional study was conducted from June to September 2017 in 84 dental outpatient clinics of Mashhad, Iran. The status of sterilization quality was evaluated using biological (BI) and chemical indicators (CI) and the results of a questionnaire. The participants include the technical manager and operator of the Autoclave, who were included in this study according to the inclusion criteria by stratified cluster sampling. Information on their knowledge, practices, and attitudes were evaluated. Also, BI and CI were used to evaluate the autoclave accuracy. The data were analyzed by Mann-Whitney U, Wilcoxon signed-rank, and Fisher’s exact tests using SPSS (Version 19, SPSS Inc., Chicago, IL, USA). Results: In this study, the results of 69 (82.1%) biological test were negative. Based on the questionnaire results, 64 (76%) clinics used CI, and only 4 (5%) clinics used CI and BI to evaluate the sterilization quality. The mean scores of attitude (P = 0.001), knowledge (P = 0.001), and practice (P < 0.001) of the technical manager in dental clinics were significantly higher than those in outpatient clinics. Also, there was a significant association between the knowledge and practice of the clinics’ technical managers (P < 0.001). Conclusion: According to the results, 93.3% of the clinics that had a positive biological test were outpatient clinics. Also, it was revealed that insufficient knowledge, attitude, and practice lead to imperfect sterilization. Also, the mean score of dentists was higher than that of general practitioners, therefore, in addition to suggesting training programs for managers, it is recommended that employ a dental practitioner as the technical manager of outpatient clinics. In order to control infection in clinics, it is recommended to monitor the sterilization process in clinics according to the instructions of the monitoring units.

Introduction: The present study aimed to evaluate the incidence of obstructive sleep apnea (OSA) after monomax mandibular setback surgery using a combination of Berlin, STOP-BANG, and Epworth SleepScale questionnaires. Materials and Methods: This double-blind quasi-experimental before-after study was carried out on a total of healthy patients with class III deformity and eligible for orthognathic mandibular setback surgery. Age, gender, body mass index, neck circumference, and amount of mandibular setback were recorded in the study checklist. The incidence of OSA was assessed for allthe patients 1 week before the operation and 1 and 6 months following the surgery using the aforementioned questionnaires under the supervision of a pulmonary specialist. Descriptive and analytical statistics were analyzed by SPSS software (version 17). A p-value of less than 0.05 was considered statistically significant. Results: A total of 30 patients, including 15 males and 15 females, with a mean age of 25.77±4.76 years participated in this study. The mean scores of OSA questionnaires increased a month after mandibular setback surgeryusing bilateral sagittal split osteotomy, compared to those reported before the operation; however, 6 months following the surgery, the results numerically reduced closer to the patient’s normal condition. The amount of mandibular setback was directly correlated with the incidence of OSA in patients 1 and 6 months after the surgery based on all the three questionnaires; nevertheless, it was significantly and directly correlated with STOP-BANG questionnaire (p < /em>Conclusion: The obtained results of the present study indicated that there was no evidence of severe OSA 6 months following mandibular setback surgery. Additionally, obese patients and those submitted to a large amount of mandibular setback presented a higher chance of developing OSA. The findings of the present study showed that the results of the numerical changes of the sleep questionnaires and incidence of OSA 1 and 6 months after the surgery and before the operation were significantly lower in patients with mandibular setback up to 5 mm, compared to those with equal or greater than 5 mm.

Aim: We aimed to identify the percutaneous exposure incident (PEI) by private dentists in Mashhad, Iran. Methods: Subjects included 199 dentists enrolled in this study. A questionnaire consisting of 11 questions was sent to the dentists for data collection. Information was collected on knowledge about dangers of PEI, a history of needlestick or sharps injuries over the past 12 months, types of devices causing the needlestick or sharps injuries, HBV vaccination, knowledge about PEI protective and therapeutic protocol, and reporting PEI to the specialist. The first ten questions were corrected and each sheet received a score ranging from 0 to 10. Result: 95 women (47.7%) and 104 men (52.3%) participated in this study aged between 27–72 years old. The findings showed that a total of 132 dentists (66.3%) had experiences with PEI. 45 (22.6%) of them had experiences with PEI in the past year. Files and needles were found to be the most frequent tools causing PEI, each with 29.7% of frequency. 16.6%, 8.6, 5.7, and 9.7% were obtained for dental burs, band, and surgical baled, respectively as other tools responsible for injuries. Results of the question about causes of needlestick injuries showed that personal carelessness is the most frequent reason (53.8%) followed by inappropriate disposal of the needles (7.6%). Conclusion: The personal carelessness and inappropriate disposal of needles were reported as the most common reasons for PEI injuries. It is suggested to educational programs for dentists should focus on preventing the PEI.

Introduction: Augmentation of atrophic alveolar ridges is an important aspect of functional restoration in modern oral rehabilitation. Vertical bone resorption of the dentoalveolar ridges remains a serious challenge for successful dental implant placement. The premaxilla region is one of the most challenging areas for implant restoration. Nasal floor approximation in anterior maxilla in concomitant with atrophy made where sufficient amount of augmentation is not possible make nasal lifting as an alternative technique. Report of a case: In this report, we described a successful case of nasal floor lifting for dental implant placement in an atrophic premaxilla. Conclusion: It might be concluded that nasal floor membrane lifting may be a reliable technique for implant recipient site rehabilitation in severe vertically atrophied premaxilla. However, further clinical trials are needed to support its relevancy.

Statement of the problem: Nowadays leishmaniasis is a common infectious disease around the world which is caused by a protozoan parasite named Leishmania. This parasite is transmitted to human by an infected female sand fly. This disease has three clinical forms; mucosal forms are rare in Iran. Purpose: The purpose of this study was to report a case of leishmaniasis with lip and oral mucosal involvement that healed successfully. Results: This article is about patients with lip leishmaniasis with oral-mucosal involvement, clinical features were diffuse lip swelling and ulcer in right lower lip vermilion and buccal mucosa. A smear was caught which proved the diagnosis of leishmaniasis. Thereafter, the patients were referred to a dermatologist for treatment and follow up showed complete healing of the lesions. Conclusion: Oral mucosal leishmaniasis is rare. However, the swelling may cause different complications like loss of teeth or respiratory obstruction. It should be noted that time is a key point in treatment. So, it is necessary for us to train the differential diagnosis of chronic ulcerated oral lesions to our dentists.

Introduction: Gag reflex is common during dental procedure such as, taking radiography, oral examination and alginate impression. This reflex has negative impact on the quality of any dental procedure. Acupuncture is traditional alternative medicine by inserting needle in special point in body. Because of cross-infection and other risks; studies have suggested the laser acupuncture that use low level laser (LLLT) or photobiomodulation instead of needle. Various anti-gagging points have been identified; include Neiguan Pericardium 6 (PC6), large intestine point or He Gu point (LI4), Conception Vessel 24 (CV24) and Shenmen, Stomach and Throat points on ears and P6 point is a one of the best point to control nausea and vomiting and is located at medial of the forearm below the palm. The purpose of this study was to report controlling gag reflex during routine dental procedure whit stimulation P6 acupuncture point with low power laser A patient who has sever gag reflex and for this reason this reason her oral hygiene level is awful, also clinical examination showed multiple caries. We controlled her gag reflex with stimulation P6 point on her wrist whit 6 J/cm2 energy density and 980 nm wavelengths. Gag reflex was successfully controlled. Conclusion: LLLT acupuncture needs less time, low invasive and much safer than other methods. Because of point P6 location it seems this point is more suitable than other anti-gaging points. Dentist who tried LLLT acupuncture must be trained and also adequate equipment should be in their dental office.

Introduction: This prospective double-blinded clinical trial study aimed to compare the direct and indirect techniques of inferior alveolar nerve block (IANB) anesthesia regarding positive aspiration and success rate. Methods: This study included all 250 healthy patients who were referred to the Oral and Maxillofacial Surgery Department, Mashhad Dental School, Mashhad, Iran, for lower teeth extraction. The patients were randomly assigned to two groups. In total, 126 patients were subjected to IANB by a direct technique, and an indirect technique was utilized to perform IANB on the others. The primary and secondary outcomes were positive aspiration and anesthetic success, respectively. The data were statistically analyzed with SPSS software (version 19) using the Chi-square test. Results: The positive aspiration rates were 23 (18.3%) and 7 (5.6%) in the direct and indirect groups, respectively, which was statistically significant (P=0.002). The incidence rates of positive aspiration on the right and left sides were 13 (11%) and 17 (12.9%), respectively, which had no significant difference (P=0.651). Moreover, the success rates of direct and indirect techniques were 106 (84.1%) and 93 (75%) respectively, which was not statistically significant. It is worth mentioning that the success rates were similar on the right (79.7%) and left (79.5%) sides. Conclusion: According to the established results, the indirect technique of IANB has a significantly less positive aspiration rate, compared to the direct technique. This advantage is especially valuable in high-risk patients undergoing inadvertent intravascular injection of an anesthetic drug, which can lead to catastrophic complications. [ABSTRACT FROM AUTHOR]

Introduction: This study was conducted to compare three rotary files of Superfile III Denco, Sp1 Gold v taper, and ProTaper in terms of debris extrusion to find the best treatment option. Methods: In total, 51 extracted mandibular premolars were randomly assigned to three groups (n=17). Rotary systems of Sp1 Gold v taper, Superfile III Denco, and ProTaper Universal were used in the first, second, and third groups, respectively. Canals were prepared up to the F2 file, and this process was conducted only by one operator. Moreover, an Orifice shaper specific to each group was used first, and files were removed from canals and then cleaned by wet gauze. In the preparation procedure, canals were washed to extract all debris from the canal. Eppendorf tubes were used to collect debris. Results: Mean debris values extruded from canals in the Sp1 gold, Superfile Denco, and ProTaper Universal files were 0.0025, 0.0008, and 0.0014, respectively. There was no significant difference among debris extruded by Superfile Denco III, SP1 gold V taper, and ProTaper Universal files (P<0.05). Conclusions: All instrumentation systems cause the extrusion of debris to the apical area. According to the results of the present study, there was no significant difference among debris extruded by Superfile Denco, SP1 Gold, and ProTaper Universal files. It should be mentioned that because of variations in the study designs, the direct comparison of different studies that addressed this problem is not possible, and in vivo studies should be performed to evaluate its clinical relevance [ABSTRACT FROM AUTHOR]

Aim: We aimed to identify the percutaneous exposure incident (PEI) by private dentists in Mashhad, Iran. Methods: Subjects included 199 dentists enrolled in this study. A questionnaire consisting of 11 questions was sent to the dentists for data collection. Information was collected on knowledge about dangers of PEI, a history of needlestick or sharps injuries over the past 12 months, types of devices causing the needlestick or sharps injuries, HBV vaccination, knowledge about PEI protective and therapeutic protocol, and reporting PEI to the specialist. The first ten questions were corrected and each sheet received a score ranging from 0 to 10. Result: 95 women (47.7%) and 104 men (52.3%) participated in this study aged between 27–72 years old. The findings showed that a total of 132 dentists (66.3%) had experiences with PEI. 45 (22.6%) of them had experiences with PEI in the past year. Files and needles were found to be the most frequent tools causing PEI, each with 29.7% of frequency. 16.6%, 8.6, 5.7, and 9.7% were obtained for dental burs, band, and surgical baled, respectively as other tools responsible for injuries. Results of the question about causes of needlestick injuries showed that personal carelessness is the most frequent reason (53.8%) followed by inappropriate disposal of the needles (7.6%). Conclusion: The personal carelessness and inappropriate disposal of needles were reported as the most common reasons for PEI injuries. It is suggested to educational programs for dentists should focus on preventing the PEI. [ABSTRACT FROM AUTHOR]

Statement of the problem: Nowadays leishmaniasis is a common infectious disease around the world which is caused by a protozoan parasite named Leishmania. This parasite is transmitted to human by an infected female sand fly. This disease has three clinical forms; mucosal forms are rare in Iran. Purpose: The purpose of this study was to report a case of leishmaniasis with lip and oral mucosal involvement that healed successfully. Results: This article is about patients with lip leishmaniasis with oral-mucosal involvement, clinical features were diffuse lip swelling and ulcer in right lower lip vermilion and buccal mucosa. A smear was caught which proved the diagnosis of leishmaniasis. Thereafter, the patients were referred to a dermatologist for treatment and follow up showed complete healing of the lesions. Conclusion: Oral mucosal leishmaniasis is rare. However, the swelling may cause different complications like loss of teeth or respiratory obstruction. It should be noted that time is a key point in treatment. So, it is necessary for us to train the differential diagnosis of chronic ulcerated oral lesions to our dentists. [ABSTRACT FROM AUTHOR]

Orthokeratinized Odontogenic Cyst (OOC) is a rare odontogenic cyst, which is important because it has a low recurrence potential, but it has a percentage of the potential for malignant changes. OOC characteristics can be different from OKC (odontogenic keratocyst), which was once classified in its category. The microscopic view of OOC cyst is the reason for its easy identification from OKC, the orthokeratinized epithelial covering and the clear granular layer, and the hyperplasia of the basal layer, and the smooth surface of this cyst. OOC cyst treatment is conservative and can be usually carried out by enucleation. In terms of gender predominance, it is often reported in men. Furthermore, OOC is more common in the 3rd and 4th decades of life. Hereby, we report a rare case of OOC in the posterior mandible of a young adult 18-year-old boy and its treatment method. The clinical and diagnostic points of view and the treatment options were discussed in this article., Competing Interests: None declared.

Background: We aimed to compare the emergence from anesthesia between the isolated mandibular setback and bimaxillary orthognathic surgeries in Skeletal Class III Patients., Methods: All healthy patients with skeletal class III deformity admitted to Mashhad Dental School, Mashhad, Iran from the years 2017 to 2018 were included in this study. They were candidates for either bimaxillary orthognathic surgery (Bimax surgery) through a combination of mandibular setback surgery plus maxillary advancement or isolated mandibular setback (Monomax surgery). The predictor variable was the type of jaw displacement and anesthesia duration, while the outcome variable was the duration of emergence from general anesthesia. The duration of emergence from anesthesia was calculated from the time the patient was transported to the recovery room until the time of safely discharging from the recovery room. For statistical analysis, the significance level was set at 0.05 using SPSS 21., Results: A total of 81 consecutive patients, comprising 45 (55.6%) males and 36 (44.4%) females, with an average age of 23.15±4.58 years were recruited. Among the participating patients, 56 (69.1%) underwent bimaxillary surgery while the other 25 (30.9%) were treated with Monomax surgery. Regardless of the type of performed surgery, the duration of general anesthesia was the only factor to be significantly correlated to the length of emergence from anesthesia (P= 0.001)., Conclusion: Increased exposure time to general anesthesia might result in a longer emergence from anesthesia, despite the type of performed orthognathic surgery. Further clinical trials are needed to support the relevancy., Competing Interests: The authors have no conflict of interest to disclose.

Background: We aimed to evaluate the possibility of temporomandibular joint (TMJ) dysfunction following mandibular advancement surgery in skeletal class 2 patients., Methods: All healthy non-syndromic patients with Class 2 deformity, who were eligible for mandibular advancement surgery, were included in this before-after quasi-experimental study. The main intervention was mandibular advancement through bilateral sagittal split osteotomy (BSSO). Maxillary impaction or setback surgery using LeFort 1 osteotomy was simultaneously performed in some cases. Variables such as TMJ pain, clicking, crepitus, or any other type of sounds or complaint as well as the amount of maximum mouth opening (MMO) were evaluated before surgery and two months postoperatively., Results: Thirty patients including 15 men and 15 women with a mean age of 23.3 ±2.7 yr were studied. The mean amount of mandibular advancement displacement was 3.30 ± 0.87 mm. The rate of TMJ dysfunctions and complaints was relatively low two months postoperatively when compared to the preoperative state. Postoperative evaluation demonstrated that there was no significant correlation between the presence of TMJ symptoms and dysfunctions and the type of surgery. After treatment was completed, the mean MMO reduced significantly from 39.03±5.86 to 38.12±6.05 ( P <0.001)., Conclusion: Mandibular advancement with BSSO surgery in skeletal class 2 patients did not clinically lead to TMJ dysfunctions. Among all the investigated factors, only preoperative pain, noises, or complaints were proven to have predictive value for postoperative TMJ dysfunction., Competing Interests: None declared.

Background: This study aimed to investigate the positional changes of the hyoid bone following orthognathic surgery in skeletal class III patients., Methods: This double-blinded quasi-experimental study was carried out in Mashhad University of Medical Sciences, Iran, from Apr 2019 to Jun 2020. All skeletal Class III patients who were candidates for orthogenetic surgery were included. They underwent mandibular setback surgery using bilateral sagittal split osteotomy. Cephalometric assessments in relation to hyoid bone position and posterior airway space (PAS) were conducted one day preoperatively (T0), as well as one week (T1), six months (T2) and one year (T3) postoperatively, determining the parameters like the Long axis of the hyoid bone (LAH), Retrognation (RGn), Hyoidale (H), Palatal plane (PP), Mandibular plane (MP) and C3 Vertebrae (C3). All cephalograms were examined using AudaxCeph, Planmeca software. The data analysis was performed via SPSS-19 ( P <0.05)., Results: 25 class III patients, including 18 females (72%) and 7 males (28%) with a mean age of 24.32±5.87, were studied. The cephalometric analysis demonstrated significant decreases in variable angles during the follow-up periods, except for LAH-MP angle ( P <0.001). The hyoid bone moved downward and backward relative to its original position following the mandibular setback surgery. However, the bone gradually returned to the preoperative location between 6 to 12 months postoperatively., Conclusion: The findings revealed the downward and backward movement of the hyoid bone following the mandibular setback surgery, returned near to its preoperative position after 1 year, postoperatively., Competing Interests: The authors have no conflict of interests to declare.

The adhesion of mandibular condyle to the glenoid fossa by bone or fibroblastic tissue is called temporomandibular joint (TMJ) ankylosis. Trauma and infection are the main reasons for affecting TMJ ankylosis. TMJ arthroplasty is the treatment of choice for this situation. This study was aimed at reporting a new technique for the treatment of chronic TMJ ankylosis caused as a result of a car accident in patients who referred to Ghaem Teaching Hospital, Mashhad, Iran. The primary Maximum Mouth Opening (MMO) of the patient was equal to 2.5 mm. Interpositional arthroplasty was done using Temporoparietal Fascia Flap (TPFF) based on the superficial temporal artery. The MMO was increased to 35 mm after regular post-operative physiotherapy and a one-year follow-up. There was no sign of reanykylosis during this time. Interpositional arthroplasty using TPFF could be an appropriate treatment option. TPFF is thin and has a reliable blood supply. It seems that TPFF has less complication compared to other Interpositional materials like temporalis muscle flap., Competing Interests: The authors have no conflict of interests to declare.

Background: The possibility of mandibular bad spilt might happen during bilateral sagittal split osteotomy (BSSO). This study investigated the effect of impacted mandibular third molars on bad spilt incidence during BSSO., Methods: Totally, 140 patients under 40 years old who were candidates for BSSO surgery due to class 3 skeletal discrepancy were divided randomly into two equal groups. The impacted mandibular third molars were presented in one group during BSSO (Exposed), and the third molars were removed at least six months before surgery for the other group (Unexposed). All cases underwent BSSO using the same technique by a single surgeon. A bad split was diagnosed by inter-operative clinical examination and postoperative panoramic radiography., Results: Four bad split occurrences were observed including three patients in the group which impacted mandibular third molars were presented and one patient in the group without impacted mandibular third molars. The incidence of bad fracture in the exposed group was 3.7 times more than the unexposed group. The incidence of the bad fracture in exposed group was 3.7 times more than unexposed group. The chance of fractures in females was 1.7 times higher than males. With one year addition to the patient's age, chance of fracture increased 0.985 times more., Conclusion: Overall incidence of bad split fracture in presence of mandibular third molars in females and at older ages increased during BSSO. The extraction of impacted mandibular third molars, six months before the BSSO is recommended to prevent the bad split incidence during the operation.

Background: We aimed to detect the changes in nasalance, articulation errors, and speech intelligibility after bimaxillary orthognathic surgery in skeletal class III patients., Methods: This double-blinded before and after quasi-experimental study was conducted in the Department of Maxillofacial Surgery, Qaem Hospital, Mashhad, Iran from Mar 2019 to Apr 2020. The main intervention was maxillary advancement with LeFort I osteotomy and mandibular setback surgery with bilateral sagittal split osteotomy (BSSO). The nasalance score, speech intelligibility, and articulation errors were evaluated one week preoperatively (T 0 ), 1 and 6 months (T 1 , T 2 ) postoperatively by a speech therapist. The significance level was set at 0.05 using SPSS 21., Results: Eleven women (55%) and 9 men (45%) with a mean age of 31.95 ± 4.72 yr were enrolled. The mean maxillomandibular discrepancy was 6.15 ± 1.53 mm. The mean scores of nasalance for the oral, nasal, and oral-nasal sentences were significantly improved postoperatively ( P <0.001). Pre-operative articulation errors of consonants /r/, /z/, /s/ and /sh/ were corrected following the surgery. The percentage of speech intelligibility was significantly increased over time ( P <0.001)., Conclusion: The patients might show a normal articulation pattern and a modified nasalance feature, following maxillary advancement plus mandibular setback surgery.