Search

Purpose Patients with documented metal hypersensitivity to cobalt-chromium-molybdenum (CoCrMo) alloy with trace nickel requiring TMJ total joint prosthesis (TJP) may have adverse reactions to the metals in the standard TMJ Concepts TJP. This study aimed to determine if these patients can be successfully treated by eliminating CoCrMo alloy and constructing the mandibular components of all-titanium (Ti) alloy. Patients and Methods This retrospective cohort study evaluated metal hypersensitive patients (MHG) that received the TMJ Concepts TJP modification of all-Ti alloy mandibular components with outcome results compared to a control group (CG) of non–metal-sensitive patients that received the standard TMJ Concepts prostheses. The primary predictor variables were the 2 groups, MHG and CG. Primary variables evaluated using Likert scales included TMJ pain, headache, jaw function, diet, and disability. Maximum incisal opening and quality of life were measured. Secondary variables included: age, gender, effect of the number and type of prior TMJ. Scores for pre- and postsurgery parameters (nonparametric variables) were analyzed using a Mann-Whitney U test (α = 0.05). Results The MHG (n = 30) received the Ti alloy TJP and CG (n = 46) received the standard TJP, with statistically significant improvements in all variables in both groups and no statistically significant difference in outcome variables between the 2 groups. Patients with 0 to 1 previous TMJ surgeries had better outcomes in all parameters except maximum incisal opening compared to patients with 2 or more previous TMJ surgeries. Conclusions Patients with documented hypersensitivity to CoCrMo alloy, requiring TMJ Concepts TJP may experience improvement in TMJ pain, headache, jaw function, diet, disability, jaw opening, and quality of life when the mandibular components are manufactured from all-Ti alloy, eliminating the CoCrMo alloy. The larger the number of previous TMJ surgeries and exposure to failed alloplastic implants, the less improvement in treatment outcomes.

Dental occlusion ties (Minne Ties®) are a new example of the concept of an oral zip tie used to establish maxillomandibular fixation (MMF). Each tie uses a blunt introducer that is easily passed between embrasures and fed through a self-locking, unidirectional clasp. Five to six ties are used to establish MMF. They are fast, easy to use, and relatively safe because there are no sharps or wires associated with their use. The authors report their experience using this MMF method for temporomandibular joint replacement surgery, where over the last 2 years, over 65 collective cases have been completed using this method.

Post orthognathic surgery patient management is critical for high-quality and predictable outcomes. Surgeons and orthodontists must have the knowledge and ability to implement postsurgical management protocols and strategies to provide the best care and outcomes possible. This article presents basic concepts, philosophies, treatment protocols, risks, and potential complications associated with postsurgical patient management. Postsurgical orthodontic goals are to maximize the occlusal fit and provide predictable means to retain the occlusion. Aggressive orthodontic mechanics may be required to provide the best occlusal fit. Complications can occur, but early recognition of complications and implementation of corrective tactics should minimize adverse outcomes.

Purpose Different treatment options for patients with arthrogenous Temporomandibular Disorders (TMDs) have been reported. However, evidence regarding the most effective intervention using network meta-analysis (NMA) has not been performed. Thus, we conducted a NMA of randomized clinical trials (RCTs) to identify the most effective treatment of arthrogenous TMDs with respect to pain reduction and improved mouth opening, and to generate a ranking according to their effectiveness. Material and methods An electronic search on three major databases was undertaken to identify RCTs published before August 2019, comparing up to fourteen different treatments against control/placebo patients for arthrogenous TMDs with respect to pain reduction and improved mouth opening. The treatment variables were controls/placebo, conservative treatment (muscle exercises and occlusal splint therapy), occlusal splint therapy alone, intraarticular injection (IAI) of hyaluronic acid (HA) or corticosteroid (CS), arthrocentesis with or without HA, CS and platelet-rich plasma (PRP), arthroscopy with or without HA and PRP, open joint surgery, and physiotherapy. Frequentist NMA was performed using STATA software. Studies meeting the inclusion criteria were divided according to the length of follow-up (short-term (≤5 months) and intermediate-term (≥6 months to 4 years) and type of TMJ arthrogenous disorders; internal derangement (ID) and TMJ osteoarthritis (OA). The standardized mean differences (SMD) in post-treatment pain reduction and maximum mouth opening (MMO) were analysed. Results Thirty-six RCTs were identified that performed comparative outcome assessments for pain and 33 RCTs for MMO. At the short term (≤5 months), IAI-HA (SMD = −2.8, CI: −3.7 to −1.8) and IAI-CS (SMD = −2.11, CI: −2.9 to −1.2) (all very low quality evidence) achieved a substantially greater pain reduction than control/placebo. At intermediate term (≥6 months), a statistically significant decrease in posttreatment pain intensity was observed following Arthroscopy-PRP (SMD = −3.5, CI: −6.2 to −0.82), Arthrocentesis-PRP (SMD = −3.08, CI: −5.44 to −0.71), Arthroscopy-HA (SMD = −3.01, CI: −5.8 to −0.12), TMJ surgery (SMD = −3, CI: −5.7 to −0.28), IAI-HA (SMD = −2.9, CI: −4.9 to −1.09) (all very low quality evidence), Arthroscopy-alone (SMD = −2.6, CI: −5.1 to −0.07, low quality evidence) and Arthrocentesis-HA (SMD = −2.3, CI: −4.5 to −018, moderate-quality evidence) when compared to the control/placebo groups. Relative to MMO, the most effective treatments for short- and intermediate-term improvement were the arthroscopy procedures (PRP > HA > alone, all very low-quality evidence) followed by Arthrocentesis-PRP (very low-quality evidence) and Arthrocentesis-HA (moderate-quality evidence). The non-invasive procedures of occlusal splint therapy, physical therapy, conservative therapy, placebo/control provided significantly lower quality outcomes relative to pain and MMO. Conclusion The results of the present meta-analysis support a paradigm shift in arthrogenous TMJ disorder treatment. There is a new evidence (though on a very low to moderate quality level) that minimally invasive procedures, particularly in combination with IAI of adjuvant pharmacological agents (PRP, HA or CS), are significantly more effective than conservative treatments for both pain reduction and improvement of MMO in both short (≤5 months) and intermediate term (6 months–4 years) periods. In contrast to traditional concepts mandating exhaustion of conservative treatment options, minimally invasive procedures, therefore, deserve to be implemented as efficient first-line treatments (e.g. IAIs and/or arthrocentesis) or should be considered rather early, i.e. as soon as patients do not show a clear benefit from an initial conservative treatment.

Background This study aimed to analyze 3-dimensional nasolabial soft tissue changes following double jaw surgery with Le Fort I maxillary advancement and relate them to underlying surgical movements. Methods Pre- and post-surgical cone-beam computed tomography images of 37 maxillomandibular surgery patients with ≥2 mm of advancement at A-point were analyzed. Lateral cephalograms were constructed to determine horizontal and vertical surgical movements and 3-dimensional facial images were created from the CBCTs to calculate linear and angular changes. Results Alar base width increased 1.9 mm, nasal tip protrusion decreased 0.74 mm, the upper lip flattened 7.71 degree and increased 0.9 mm in length, nasal tip was displaced 2.47 mm superiorly causing an increased concavity of 5.52 degree for the overall dorsal surface and 3.99 degree at the supratip break angle (SBA), nasal tip angle decreased 2.16 degree and nasolabial angle decreased 7.37 degree. Correlations were found between underlying surgical movements and nasal tip protrusion, SBA, nasolabial angle (NLA), and nasal tip elevation (NTE). Multiple linear regression equations were calculated to predict changes in SBA from horizontal change at A-point, NLA from horizontal change at B-point, and NTE from the change at A-point horizontally and U1-tip vertically. Conclusion Double jaw surgery with maxillary advancement has significant effects on nasolabial anatomy.

Purpose To determine skeletal and occlusal surgical changes and long-term stability outcomes for patients diagnosed with juvenile idiopathic arthritis (JIA) after TMJ reconstruction with TMJ Concepts patient-fitted total joint prostheses (TJP) and concomitant maxillary orthognathic surgery. Material/Methods A retrospective cohort study was conducted of all patients diagnosed with JIA, receiving TJP, and concomitant maxillary orthognathic surgery between 1991 and 2019, at Baylor University Medical Center treated by 1 surgeon. Patient evaluations presurgery (T1), immediate postsurgery (T2), and at longest follow-up (LFU) (T3) were analyzed using 20 cephalometric landmarks to compute 29 linear and angular measurements to determine surgical changes, long-term skeletal and occlusal stability, as well as oropharyngeal airway changes. Comparative data were tested for significance (α = 0.05) using paired and unpaired t tests. Results Forty-two patients met the JIA inclusion criteria, with a median age of 17.5 years and median postsurgical follow-up of 26 months. There were significant surgical changes (T1-T2) (P ≤ .05) for all parameters associated with mandibular linear and angular surgical changes, except for the horizontal position of posterior nasal spine and the vertical/horizontal position of gonion, indicating highly stable surgical outcomes. There were significant improvements in the oropharyngeal airway dimensions. Conclusions This study suggests that TMJ Concepts patient-fitted TJP for TMJ reconstruction in conjunction with maxillary orthognathic surgery for counterclockwise rotation of the maxillo-mandibular complex for the JIA patients provides long-term skeletal and occlusal stability as well as dimensional improvement in the oropharyngeal airway.

Evaluate the feasibility of using mini-anchors for the treatment of chronic mandibular dislocation and to identify the variables that affect the success of this approach.A retrospective cohort study evaluated 9 patients with bilateral recurrent dislocation of the mandible (18 operated joints), treated by a mandibular translation control system using the mini-anchor technique. Data was collected using a Visual Analog Scale (VAS) for subjective parameters and measurements for objective parameters prior to surgery (T1) and at the longest available follow-up (T2) with a minimum of a 12 months interval. Patients subjectively rated their facial pain/headache, jaw function, disability, temporomandibular joint (TMJ) pain and diet. Objective functional changes were determined by measuring the interincisal opening and lateral excursions at T1 and T2.Significant subjective improvements in pain and dysfunction (89 to 94%) were observed (P.01) from T1 to T2 in all parameters. The comfortable and guarded interincisal opening without mandibular dislocation increased by 41%, the maximum interincisal opening reduced 12 mm, and lateral excursions improved by 43%.Patients with recurrent mandibular dislocations with or without disc dislocation can be treated effectively by the mini-anchor translation control system.

The purpose of this chapter is to present various surgical procedures that can be used in the treatment of a retrognathic mandible that can contribute to obstructive sleep apnea (OSA) by decreasing the oropharyngeal airway. The maxilla is commonly retruded with a high occlusal plane angle facial morphology. This combination of skeletal deformity can displace the tongue posteriorly into the oropharyngeal space severely compromising the functional airway. Patients with OSA may benefit from double jaw orthognathic surgery to advance the maxillomandibular complex forward usually with a counterclockwise rotation that will predictably increase the oropharyngeal airway. Temporomandibular joint (TMJ) surgery may also be indicated to correct coexisting TMJ pathology for predictable and stable outcomes. This chapter focuses only on various mandibular osteotomies that may be incorporated in the management of the adolescent and adult OSA patients. Maxillary osteotomy techniques are presented in another chapter. Particular attention is directed toward the mandibular ramus sagittal split osteotomy, as this is the primary osteotomy technique used for advancing the mandible.

Patients with obstructive sleep apnea (OSA) commonly have a retruded maxilla and mandible and a high occlusal plane angle (HOP) facial morphology creating a decrease in the oropharyngeal airway resulting in OSA. The focus of this chapter is on the HOP facial morphology; clinical, radiographic, and occlusal diagnostic characteristics; treatment protocols; and outcomes for surgical counterclockwise rotation (CCWR) of the maxillomandibular complex. Common temporomandibular joint (TMJ) pathologies are presented that can be contributory to the development of OSA as well as postsurgical relapse if the orthognathic surgery is performed and the TMJ pathology ignored. Treatment protocols are presented to address the jaw deformity requiring CCWR of the maxillomandibular complex as well as management protocols for coexisting TMJ pathologies in order to provide highly predictable outcomes.

The purpose of this chapter is to present the diagnostic importance of magnetic resonance imaging (MRI) in evaluation of temporomandibular joint (TMJ) pathologies that may be associated with the obstructive sleep apnea (OSA) patient. MRI is one of the most important tools available for diagnosis and treatment planning patients with TMJ disorders. However, it is estimated that 40–60% of TMJ MRIs are misread by radiologists. The presence of TMJ pathology can contribute to maxillary and mandibular hypoplasia as well as decrease function of the oropharyngeal airway. Therefore, it is important for the oral and maxillofacial surgeon to accurately interpret TMJ MRIs, so that a coexisting TMJ pathology is identified and appropriate treatment protocol is selected to provide stable and predictable outcomes. This chapter presents the MRI findings of the common TMJ pathologies associated with OSA.

The purpose of this chapter is to provide a comprehensive approach for clinical, occlusal, and cephalometric analyses directed toward the diagnosis of patients with obstructive sleep apnea (OSA). Patients with OSA commonly have a hypoplastic maxilla and mandible, a high occlusal plane angle, and upper airway obstruction. In addition, OSA patients may have temporomandibular joint (TMJ) pathology that can coexist with a dentofacial deformity, can be the etiology of the dentofacial deformity, or develop as a result of the dentofacial deformity. Many patients with OSA can benefit from orthognathic surgery but may also require TMJ surgery to establish stable, predictable, and pain-free results. This chapter focuses primarily on the clinical, radiographic, and dental model analyses so important in the diagnosis and treatment planning for the correction of patients with OSA.

In the United States, 5–12% of adults have at least one symptom of temporomandibular joint (TMJ) disorders, including TMJ osteoarthritis (TMJ-OA). However, there is no chondroprotective agent that is approved for clinical application. We showed that LOXL2 is elevated in the regenerative response during fracture healing in mice and has a critical role in chondrogenic differentiation. Indeed, LOXL2 is an anabolic effector that attenuates pro-inflammatory signaling in OA cartilage of the TMJ and knee joint, induces chondroprotective and regenerative responses, and attenuates NF-kB signaling. The specific goal of the study was to evaluate if adenoviral delivery of LOXL2 is anabolic to human and mouse TMJ condylar cartilage in vivo and evaluate the protective and anabolic effect on cartilage-specific factors. We employed two different models to assess TMJ-OA. In one model, clinical TMJ-OA cartilage from 5 different samples in TMJ-OA cartilage plugs were implanted subcutaneously in nude mice. Adenovirus LOXL2 -treated implants showed higher mRNA levels of LOXL2, ACAN, and other anabolic genes compared to the adenovirus-Empty-treated implants. Further characterization by RNA-seq analysis showed LOXL2 promotes proteoglycan networks and extracellular matrix in human TMJ-OA cartilage implants in vivo. In order to evaluate if LOXL2-induced functional and sex-linked differences, both male and female four-month-old chondrodysplasia (Cho/+) mice, which develop progressive TMJ-OA due to a point mutation in the Col11a1 gene, were subjected to intraperitoneal injection with Adv-RFP-LOXL2 every 2 weeks for 12 weeks. The data showed that adenovirus delivery of LOXL2 upregulated LOXL2 and aggrecan (Acan), whereas MMP13 expression was slightly downregulated. The fold change expression of Acan and Runx2 induced by Adv-RFP-LOXL2 was higher in females compared to males. Interestingly, Adv-RFP-LOXL2 injection significantly increased Rankl expression in male but there was no change in females, whereas VegfB gene expression was increased in females, but not in males, as compared to those injected with Adv-RFP-Empty in respective groups. Our findings indicate that LOXL2 can induce specifically the expression of Acan and other anabolic genes in two preclinical models in vivo. Further, LOXL2 has beneficial functions in human TMJ-OA cartilage implants and promotes gender-specific anabolic responses in Cho/+ mice with progressive TMJ-OA, suggesting its merit for further study as an anabolic therapy for TMJ-OA.

Purpose Patients with juvenile idiopathic arthritis (JIA) and TMJ involvement may have major dentofacial deformities, pain, and jaw dysfunction. The aim of this study was to evaluate surgical outcomes for JIA patients relative to TMJ pain, headache, jaw function, diet, disability, and quality-of-life (QOL) after TMJ reconstruction with patient-fitted total joint prostheses (TJP) and concomitant orthognathic surgery. Methods A retrospective cohort study was conducted on a JIA patient group (JIAG) with significant dentofacial deformity, reconstructed with TJP and concomitant orthognathic surgery, and was compared to a control group (CG) of non-JIA patients that received the same surgical protocol with similar surgical movements. Primary predictors were the 2 groups: JIAG and CG. Data were evaluated and compared presurgery and at longest follow-up using Likert analog scales for the primary variables: TMJ pain, headache, jaw function, diet, and disability. Maximum interincisal opening (MIO) was measured in mm. QOL was rated in JIAG as improved, same, or worse. Comparative data were tested for significance (α = 0.05) using Wilcoxon signed rank and paired T-tests. Results Forty JIAG patients (8 males, 32 females) met the inclusion criteria, median age 17.5 years, median follow-up 26.5 months, and 26 CG patients (1 male, 25 females), median age 35.5 years, follow-up 24 months. Significant improvements ( P ≤ .05) occurred postsurgery for TMJ pain, headache, jaw function, diet, and disability for both groups. Mean increase MIO for JIAG was 36.4 to 43.3 mm, for CG was 35.2 to 37.8 mm. Thirty-eight JIA patients (95%) improved in QOL, 2 had no change, and none were worse. Conclusions This study suggests that patient-fitted TJP for TMJ reconstruction in conjunction with orthognathic surgery for the JIA patient provides long-term improvement relative to TMJ pain, headache, jaw function, diet, disability, MIO, and QOL.

Made available in DSpace on 2018-11-26T17:54:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-08-01 Purpose: Maxillary segmentation involving interdental osteotomies can have an adverse effect on the interdental crestal bone and adjacent teeth. The purpose of the present study was to evaluate the effect of interdental osteotomies on surrounding osseous and dental structures, including adjacent teeth, using cone beam computed tomography (CBCT), in patients who underwent segmental maxillary osteotomies. Patients and Methods: The present retrospective cohort study evaluated interdental osteotomy (IDO) sites between the lateral incisors and canines in patients treated with 3-piece Le Fort I osteotomies. CBCT scans were assessed using Kodac Dental Imaging software at specific intervals: T0 (before surgery), T1 (immediately after surgery), and T2 (a minimum of 11 months after surgery). The statistical analysis using a linear regression model was adjusted to compare the variables at the different intervals. Injury to the dental structures was assessed by radiological evidence of dental damage, the requirement for endodontic treatment, or tooth loss. Results: We evaluated 94 IDO sites in 47 patients in the present study. The mean inter-radicular distance at T0 was 2.5 mm. A statistically significant increase was seen in the inter-radicular distance (between T1 and T0) of 0.72 mm, with a reduction of the alveolar bone crest height (between T2 and T0) of 0.19 mm (P < .001) for the group that underwent IDO. A weak correlation was found for this increase in the inter-radicular distance, with changes in the alveolar crest bone height. The potential complications associated with interdental osteotomies such as iatrogenic damage to the tooth structure, the need for endodontic treatment, and tooth loss were not encountered in any patients. Conclusions: We found very low morbidity for the interdental alveolar crest and the integrity of teeth adjacent to interdental osteotomies for patients who underwent maxillary segmentation between the lateral incisors and canines. (C) 2018 American Association of Oral and Maxillofacial Surgeons Univ Fed Bahia, Residency Oral & Maxillofacial Surg, Salvador, BA, Brazil Univ Fed Bahia, Sch Dent, Dept Oral & Maxillofacial Radiol, Salvador, BA, Brazil Texas A&M Univ, Coll Dent, Dept Oral & Maxillofacial Surg, Baylor Univ,Med Ctr, Dallas, TX USA State Univ Sao Paulo, Araraquara Dent Sch, Dept Pediat Dent, Araraquara, SP, Brazil State Univ Sao Paulo, Araraquara Dent Sch, Dept Pediat Dent, Araraquara, SP, Brazil

Made available in DSpace on 2018-11-26T17:54:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-08-01 National Institute of Dental & Craniofacial Research of the National Institutes of Health of the United States Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Introduction: In this study, we quantitatively assessed 3-dimensional condylar displacement during counterclockwise maxillomandibular advancement surgery (CMMA) with or without articular disc repositioning, focusing on surgical stability in the follow-up period. Methods: The 79 patients treated with CMMA had cone-beam computed tomography scans taken before surgery, immediately after surgery, and, on average, 15 months postsurgery. We divided the 142 condyles into 3 groups: group 1 (n = 105), condyles of patients diagnosed with symptomatic presurgical temporomandibular joint articular disc displacement who had articular disc repositioning concomitantly with CMMA; group 2 (n = 23), condyles of patients with clinical verification of presurgical articular disc displacement who had only CMMA; and group 3 (n = 14), condyles of patients with healthy temporomandibular joints who had CMMA. Presurgical and postsurgical 3-dimensional models were superimposed using voxel-based registration on the cranial base. Three-dimensional cephalometrics and shape correspondence were applied to assess surgical and postsurgical displacement changes. Results: Immediately after surgery, the condyles moved mostly backward and medially and experienced lateral yaw, medial roll, and upward pitch in the 3 groups. Condyles in group 1 showed downward displacement, whereas the condyles moved upward in groups 2 and 3 (P 0.001). Although condylar displacement changes occurred in the 3 groups, the overall surgical procedure appeared to be fairly stable, particularly for groups 1 and 3. Group 2 had the greatest amount of relapse (P 0.05). Conclusions: CMMA has been shown to be a stable procedure for patients with healthy temporomandibular joints and for those who had simultaneous articular disc repositioning surgery. Sao Paulo State Univ, Araraquara Sch Dent, Dept Orthodont & Pediat Dent, Araraquara, SP, Brazil Univ Michigan, Sch Dent, Dept Orthodont & Pediat Dent, Ann Arbor, MI 48109 USA Univ Fed Rio de Janeiro, Sch Dent, Dept Orthodont, Rio De Janeiro, Brazil Univ Texas Hlth Sci Ctr San Antonio, Sch Dent, San Antonio, TX 78229 USA Univ N Carolina, Sch Med, Dept Psychiat, Chapel Hill, NC 27515 USA Baylor Univ, Med Ctr, Texas A&M Univ, Dept Oral & Maxillofacial Surg,Coll Dent, Dallas, TX USA Sao Paulo State Univ, Araraquara Sch Dent, Dept Orthodont & Pediat Dent, Araraquara, SP, Brazil National Institute of Dental & Craniofacial Research of the National Institutes of Health of the United States: R01DE024450 FAPESP: 2013/22417-0

Made available in DSpace on 2018-12-11T17:13:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-12-01 The aim of this study was to evaluate midpalatal suture maturation in adults, as observed in cone beam computed tomography (CBCT) images. CBCT scans from 78 subjects (64 female and 14 male, age range from 18 to 66 years) were evaluated. Midpalatal suture maturation was verified on the central cross-sectional axial slice in the superior–inferior dimension of the palate, using methods validated previously. Intra-examiner agreement was analyzed by weighted kappa test. Multinomial logistic regression was used to test whether sex and chronological age (adults

Made available in DSpace on 2018-12-11T17:13:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-12-01 This study investigated predictive risk factors of condylar remodeling changes after counterclockwise maxillomandibular advancement (CCW-MMA) and disc repositioning surgery. Forty-one female patients (75 condyles) treated with CCW-MMA and disc repositioning had cone beam computed tomography (CBCT) scans taken pre-surgery, immediately after surgery, and at an average 16 months post-surgery. Pre- and post-surgical three-dimensional models were superimposed using automated voxel-based registration on the cranial base to evaluate condylar displacements after surgery. Regional registration was performed to assess condylar remodeling in the follow-up period. Three-dimensional cephalometrics, shape correspondence (SPHARM-PDM), and volume measurements were applied to quantify changes. Pearson product–moment correlations and multiple regression analysis were performed. Highly statistically significant correlation showed that older patients were more susceptible to overall condylar volume reduction following CCW-MMA and disc repositioning (P ≤ 0.001). Weak but statistically significant correlations were observed between condylar remodeling changes in the follow-up period and pre-surgical facial characteristics, magnitude of the surgical procedure, and condylar displacement changes. After CCW-MMA and disc repositioning, the condyles moved mostly downwards and medially, and were rotated medially and counterclockwise; displacements in the opposite direction were correlated with a greater risk of condylar resorption. Moreover, positional changes with surgery were only weakly associated with remodeling in the follow-up period, suggesting that other risk factors may play a role in condylar resorption. Department of Orthodontics and Pediatric Dentistry Araraquara School of Dentistry Sao Paulo State University (UNESP) Department of Orthodontics and Pediatric Dentistry School of Dentistry University of Michigan Private practice Department of Orthodontics School of Dentistry Federal University of Rio de Janeiro San Antonio School of Dentistry University of Texas Health Science Center Department of Psychiatry School of Medicine University of North Carolina Departments of Oral and Maxillofacial Surgery and Orthodontics Texas A&M University Health Science Center Baylor College of Dentistry Baylor University Medical Center Department of Orthodontics and Pediatric Dentistry Araraquara School of Dentistry Sao Paulo State University (UNESP)

Purpose There is still controversy about whether orthognathic surgery negatively or positively affects temporomandibular disorders (TMDs). The purpose of this study was to determine whether orthognathic surgery has a beneficial or deleterious effect on pre-existing TMDs. Materials and Methods A systematic review and meta-analysis were conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched 3 major databases to locate all pertinent articles published from 1980 to March 2016. All subjects in the various studies were stratified a priori into 9 categories based on subdiagnoses of TMDs. The predictor variables were those patients with pre-existing TMDs who underwent orthognathic surgery in various subgroups. The outcome variables were maximal mouth opening and signs and symptoms of a TMD before and after orthognathic surgery based on the type of osteotomy. The meta-analysis was performed using Comprehensive Meta-Analysis software (Biostat, Englewood, NJ). Results A total of 5,029 patients enrolled in 29 studies were included in this meta-analysis. There was a significant reduction in TMDs in patients with a retrognathic mandible after bilateral sagittal split osteotomy (BSSO) ( P = .014), but no significant difference after bimaxillary surgery (BSSO and Le Fort I osteotomy) ( P = .336). There was a significant difference in patients with prognathism after isolated BSSO or intraoral vertical ramus osteotomy and after combined BSSO and Le Fort I osteotomy ( P = .001), but no significant difference after BSSO ( P = .424) or bimaxillary surgery (intraoral vertical ramus osteotomy and Le Fort I osteotomy) ( P = .728). Conclusions Orthognathic surgery caused a decrease in TMD symptoms for many patients who had symptoms before surgery, but it created symptoms in a smaller group of patients who were asymptomatic before surgery. The presence of presurgical TMD symptoms or the type of jaw deformity did not identify which patients' TMDs would improve, remain the same, or worsen after surgery.

Purpose This study was designed to determine the stability of counterclockwise rotation (CCWR) of the maxillomandibular complex (MMC) in orthognathic surgery with or without surgical correction of coexisting temporomandibular joint (TMJ) pathology. Materials and Methods The authors implemented a systematic review and meta-analysis. A search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was performed. Inclusion criteria were studies that analyzed CCWR of the MMC in regard to skeletal stability after orthognathic surgery in patients with or without pre-existing TMJ pathology that was or was not surgically corrected concomitantly. The predictor variables were patients who underwent CCWR of the MMC in the following subgroups: 1) healthy TMJs (presumed healthy based on history, clinical evaluation, and radiographic analysis but without magnetic resonance imaging [MRI] confirmation), 2) no TMJ assessment, 3) untreated TMJ disc displacement (confirmed by MRI), 4) TMJ disc displacement (confirmed by MRI) repositioned using Mitek anchors, and 5) reconstruction with TMJ total joint prosthesis. Outcome variables were surgical relapse for angular and linear measurements. Postsurgical mean changes for the occlusal plane (OP) and linear measurements using a fixed-effects model with a 95% confidence interval were analyzed. Results A total of 345 patients enrolled in 12 studies were included in this study. There was significant OP relapse and horizontal relapse at the B point and menton for studies with untreated TMJ disc displacement and studies without TMJ assessment (P < .005). There was significant horizontal relapse at the A point for studies with healthy TMJs, without assessment of the TMJs, and with TMJ reconstruction with total joint prostheses (P < .005). There was no significant vertical relapse at the B and A points for all subgroup analyses (P < .005). Conclusion The result of the meta-analysis suggests that CCWR of the MMC is a stable procedure for patients with healthy TMJs, patients undergoing concomitant TMJ disc repositioning with Mitek anchors, and patients with TMJ patient-fitted total joint prostheses but unstable in the presence of untreated TMJ disc displacements and when TMJ status is not assessed.

Post orthognathic surgery patient management is critical for high-quality and predictable outcomes. Surgeons and orthodontists must have the knowledge and ability to implement postsurgical management protocols and strategies to provide the best care and outcomes possible. This article presents basic concepts, philosophies, treatment protocols, risks, and potential complications associated with postsurgical patient management. Postsurgical orthodontic goals are to maximize the occlusal fit and provide predictable means to retain the occlusion. Aggressive orthodontic mechanics may be required to provide the best occlusal fit. Complications can occur, but early recognition of complications and implementation of corrective tactics should minimize adverse outcomes.

Made available in DSpace on 2019-10-04T12:39:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-07-01 Introduction: Pharyngeal airway space (PAS) assessment has been used in the past for a better understanding of orthodontic and surgical outcomes; however, this analysis could be unreliable. Our objective was to evaluate possible changes in the PAS reading in the same patient from their consecutive cone-beam computed tomography (CBCT) scans. Methods: We evaluated a total of 27 patients' CBCT scans obtained at 2 time points with the use of a standardized acquisition protocol. The mean age at T0 was 31 years (range 17-62 years) and the follow-up records (T1) were taken after 4-6 months. Dolphin Imaging software was used to measure the volumes of the nasopharynx, oropharynx, and hypopharynx. We also evaluated the craniocervical position with the use of a lateral cephalogram. Results: The variables exhibited high intraclass correlation coefficients (ICCs) when measuring the same CBCT scan twice (T0 and T0). However, The ICC between the measurements performed on the first and second CBCT scans (T0 and T1) showed that the only variable with high reproducibility between the 2 scans was cranial base, with an ICC >0.97. Average differences of 682.1 mm(3), 2255.3 mm(3), and 517.4 mm(3) were found for the nasopharynx, oropharynx, and hypopharynx, respectively. Regarding the cephalometric angles, average differences between T0 and T1 scans were 0.6 degrees, 2.7 degrees, and 0.4 degrees for OPT.CVT, OPT.SN, and cranial base, respectively. Conclusions: Different CBCT exams with equal scanning and patient positioning protocols can result in different 3D PAS readings. A more careful interpretation of CBCT volumetric data to achieve adequate conclusions of the clinical outcomes is necessary. Univ Texas San Antonio, Hlth Sci Ctr, San Antonio Sch Dent, San Antonio, TX USA Sao Paulo State Univ, Araraquara Dent Sch, Dept Pediat Dent, Araraquara, SP, Brazil Baylor Univ, Med Ctr, Baylor Coll Dent, Dept Oral & Maxillofacial Surg,Texas A&M Univ Hlt, Dallas, TX USA Sao Paulo State Univ, Araraquara Dent Sch, Dept Pediat Dent, Araraquara, SP, Brazil

Introduction: Obstructive sleep apnea (OSA) is a secondary cause of intracranial hypertension (IH). Decreased jugular venous drainage has been seen in patients with idiopathic IH.Clinical Presentation: A complex case of a 48-year-old female whose idiopathic IH was put into remission after counterclockwise maxillomandibular advancement (CC-MMA), despite persistence of her OSA.Conclusion: This case highlights the relationship between OSA and IH and points to the significant morbidity that can result from mild OSA and from what are considered borderline intracranial pressures. This indicates the need for a high index of suspicion for actual underlying pathology that can be surgically corrected when patients manifest symptoms of a somatic syndrome. This is the first report in the medical literature of clinical elimination of IH by CC-MMA. The authors propose that this positive outcome was effected via mandibular advancement producing a decrease in jugular venous resistance, allowing improved absorption of cer...

To measure and identify factors associated with treatment outcomes for patients with temporomandibular joint (TMJ) ankylosis treated with TMJ Concepts patient-fitted total joint prostheses and autogenous fat grafts.This retrospective cohort study evaluated records of patients with TMJ ankylosis from a single private practice, treated from 1992 to 2011, who met the following inclusion criteria: 1) radiographic evidence of bony ankylosis, 2) limited incisal opening, 3) minimum of 12 months' follow-up, and 4) treatment with TMJ Concepts (Ventura, CA)/Techmedica (Camarillo, CA) total joint prostheses and fat grafts. For each patient, the number of previous TMJ surgical procedures, as well as the estimated age of ankylosis onset, age at surgery, and length of postoperative follow-up, was recorded. Subjective evaluations were made with Likert-like scales (from 0 to 10) for 1) TMJ pain, 2) headache and facial pain, 3) jaw function, 4) diet, and 5) disability. Objective evaluations included maximal incisal opening and excursion movements. Nonparametric statistics were used for analysis.There were 32 patients (22 female and 10 male patients) with 48 ankylosed TMJs (16 bilateral and 16 unilateral) in this study, with a mean age of 39 years (range, 11 to 68 years), 2 or more previous TMJ surgical procedures in 69%, and a mean follow-up period of 68 months (range, 12 to 168 months). Trauma was the major etiology of TMJ ankylosis, occurring in 17 of 32 patients (53%). The following improvements occurred: The median value for TMJ pain changed from 8.0 preoperatively to 1.5 at longest follow-up; headache, from 8 to 3.5; facial pain, from 8 to 4; jaw function, from 8 to 2.5; diet, from 7 to 3; and disability, from 7 to 1.5. The median incisal opening was 14.5 mm (interquartile range, 6.3 to 20 mm) preoperatively and 35 mm (interquartile range, 30 to 40 mm) at longest follow-up. The median left lateral excursion improved from 0.5 to 2 mm, and the median right lateral excursion improved from 1 to 1.3 mm. All of these improvements were highly significant (P.001, Wilcoxon tests). Equally favorable outcomes were found in patients with 12 to 48 months of maximal follow-up and patients with more than 48 months of maximal follow-up.The treatment of TMJ ankylosis with the TMJ Concepts patient-fitted total joint prosthesis in combination with fat grafting around the articulation area of the prosthesis is a viable and predictable method for improving pain levels, function, and quality of life, as well as prevention of reankylosis of the TMJ.

Patients with temporomandibular joint (TMJ) pathology and coexisting dentofacial deformities can be corrected with concomitant TMJ and orthognathic surgery (C-TMJ-OS) in one surgical stage or separated into two surgical stages. The two-stage approach requires the patient to undergo two separate operations (one surgery to correct the TMJ pathology and a second operation to perform the orthognathic surgery) and two general anesthetics significantly lengthening the overall treatment time. Performing C-TMJ-OS in a single operation significantly decreases treatment time, provides better outcomes, but requires careful treatment planning and surgical proficiency in the two surgical areas. There are TMJ pathologies that require total joint prostheses for best results. The application of computer technology for TMJ and orthognathic surgical planning and implementation has significantly improved the accuracy and predictability of treatment outcomes.

This chapter presents the diagnostic criteria, treatment planning, and surgical protocols for the application of computer-assisted surgical simulation (CASS) for patients requiring TMJ total joint replacement and orthognathic surgery (C-TJR-OS). The CASS protocol decreases the preoperative workup time and increases the accuracy of model preparation and subsequent surgery.

End-stage temporomandibular joint (TMJ) disease due to a multitude pathophysiologic process can benefit from TMJ replacement. The traditional method has been used to reconstruct the TMJ using autogenous tissues from various donor sites in the body. However, as materials and understanding how to use those materials have advanced, the pendulum is now moving much more toward alloplastic reconstruction. This chapter will compare and contrast the two types of reconstruction methods for reconstructing the diseased TMJ.

Surgery of the temporomandibular joint apparatus is rarely the first line of treatment for articular disc disorders or internal derangements. However, persistent symptoms following nonsurgical treatment modalities, as well as failed prior less invasive joint procedures (e.g., arthrocentesis, arthroscopy), may warrant open-joint surgery.

Made available in DSpace on 2018-12-11T17:02:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-01-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) National Institute of Biomedical Imaging and Bioengineering National Institutes of Health Objective To quantitatively compare condylar morphology using cone beam computed tomography (CBCT) and multislice spiral computed tomography (MSCT) virtual three-dimensional surface models. Study Design The sample consisted of secondary data analyses of CBCT and MSCT scans obtained for clinical purposes from 74 patients treated with condylar resection and prosthetic joint replacement. Three-dimensional surface models of 146 condyles were constructed from each scan modality. Across-subject models were approximated and voxel-based registration was performed between homologous CBCT and MSCT images, making it possible to create average CBCT- and MSCT-based condylar models. SPHARM-PDM software provided matching points on each corresponding model. ShapeAnalysisMANCOVA software assessed statistically significant differences between observers and imaging modalities. One-sample t-tests evaluated the null hypothesis that the mean differences between each CBCT- and MSCT-based model were not clinically significant (.68). During pairwise comparison, the mean difference observed was.406 mm (SD,.173). One sample t-test showed that mean differences between each set of paired CBCT- and MSCT-based models were not clinically significant (P = .411). Conclusion Three-dimensional surface models constructed from CBCT images are comparable to those derived from MSCT scans and may be considered reliable tools for assessing condylar morphology. Department of Orthodontics Faculdade de Odontologia de Araraquara UNESP Universidade Estadual Paulista, Rua Humaitá 1680 Department of Orthodontics School of Dentistry University of Michigan Private Practice Department of Orthodontics Universidade Federal Do Rio de Janeiro Departments of Oral and Maxillofacial Surgery and Orthodontics Texas A and M University Health Science Center Baylor College of Dentistry Baylor University Medical Center Department of Psychiatry University of North Carolina Department of Periodontics and Oral Medicine School of Dentistry University of Michigan Department of Orthodontics Faculdade de Odontologia de Araraquara UNESP Universidade Estadual Paulista, Rua Humaitá 1680 FAPESP: 2013/22417-0 National Institutes of Health: R01 DE024450

Combined orthognathic and total joint reconstruction cases can be predictably performed in 1 stage. Use of virtual surgical planning can eliminate a significant time requirement in preparation of concomitant orthognathic and temporomandibular joint (TMJ) prostheses cases. The concomitant TMJ and orthognathic surgery-computer-assisted surgical simulation technique increases the accuracy of combined cases. In order to have flexibility in positioning of the total joint prosthesis, recontouring of the lateral aspect of the rami is advantageous.

Condylar resorption (CR) is a common sequela of some temporomandibular joint (TMJ) abnormalities. CR can result in jaw deformities and dysfunction, malocclusion, pain, headaches, and airway obstruction. Most cases can be classified into 1 of 4 categories based on cause: (1) adolescent internal CR; (2) reactive (inflammatory) arthritis; (3) autoimmune and connective tissue diseases; and (4) other end-stage TMJ pathologic abnormality. MRI is helpful in differentiating the cause and defining treatment options. This article presents the nature and progression of the different TMJ CR pathologic abnormalities, clinical and imaging characteristics, and treatment options to produce predictable and stable outcomes.

Made available in DSpace on 2018-11-29T03:50:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-12-01 National Institute of Dental & Craniofacial Research of the National Institutes of Health Objective. The aim of this study was to validate the ability of cone beam computed tomography (CBCT) to measure condylar internal trabecular bone structure and bone texture parameters accurately. Study Design. Sixteen resected condyles of individuals undergoing temporomandibular joint replacement were collected and used as samples. These condyles were then radiographically imaged by using clinically oriented dental CBCT and research oriented micro-computed tomography (micro-CT). The CBCT scans were then compared with the gold standard micro-CT scans in terms of 21 bone imaging parameters. Descriptive histologic investigation of the specimens was also performed. Results. Significant correlations were found for several imaging parameters between the CBCT and micro-CT images, including trabecular thickness (r = 0.92), trabecular separation (r = 0.78), bone volume (r = 0.90), bone surface area (r = 0.79), and degree of anisotropy measurements (r = 0.77). Conclusions. Measurements of trabecular thickness, trabecular separation, bone volume, bone surface area, and degree of anisotropy obtained from high-resolution dental CBCT images may be suitable bone imaging biomarkers that can be utilized clinically and in future research. Univ Michigan, Sch Dent, Ann Arbor, MI 48109 USA Univ Fed Rio de Janeiro, Sch Dent, Rio De Janeiro, Brazil Univ Michigan, Sch Dent, Dept Pediat Dent & Orthodont, Ann Arbor, MI 48109 USA Univ N Carolina, Chapel Hill, NC USA Univ Michigan, Biomed Sci Res Bldg, Ann Arbor, MI 48109 USA Baylor Univ, Med Ctr, Dallas, TX 75226 USA Univ Estadual Paulista, Araraquara Dent Sch, Araraquara, SP, Brazil Univ Estadual Paulista, Araraquara Dent Sch, Araraquara, SP, Brazil National Institute of Dental & Craniofacial Research of the National Institutes of Health: R01 DE024450

Background Adolescent internal condylar resorption (AICR) is a temporomandibular joint (TMJ) pathology that develops predominately in teenage females during pubertal growth (onset between ages 11 and 15 years), with a distinct clinical, radiographic, and magnetic resonance imaging (MRI) presentation. Clinical and imaging presentation: The condition usually occurs bilaterally with: (1) Progressive retrusion of the mandible; (2) High occlusal plane angle facial morphology; (3) Worsening Class II occlusion; and (4) TMJ symptoms such as pain, headaches, noises, etc. MRI imaging demonstrates decreased condylar head size and anterior disc displacement. Treatment protocol: AICR can be successfully treated when the condyles and discs are salvageable with the following surgical protocol: (1) Removal of bilaminar tissue surrounding the condyle; (2) Reposition the disc with the Mitek anchor technique; and (3) Orthognathic surgery to advance the maxillo-mandibular complex in a counterclockwise direction. Conclusion AICR can be successfully treated using the specific protocol presented herein to provide stable and predictable outcomes.

Objective To evaluate treatment outcomes for patients with TMJ adolescent internal condylar resorption (AICR) treated by a specific surgical protocol, including: (1) Removal of bilaminar tissue surrounding the condyle, (2) Articular disc repositioning with Mitek anchor technique, and (3) Concomitant orthognathic surgery. Methods This study evaluated 24 AICR patients treated by the specific surgical protocol with clinical subjective and objective examinations and lateral cephalogram assessments for surgical changes and long-term outcomes. Results Mean age at diagnosis was 16.5 years, and mean follow-up was 30.3 months. All 24 patients had significant reduction in TMJ pain, facial pain, and headaches, with improvement in jaw function, diet, and disability. Cephalometric analysis showed significant surgical changes but good long-term occlusal and skeletal stability. Conclusion Patients with AICR treated with the specific surgical protocol demonstrated good skeletal and occlusal stability as well as improvement in TMJ pain, headaches, jaw function, diet, and disability.

Posterior dislocation of the mandibular condyle is a rare disorder caused by trauma to the chin accompanied by damage to the external auditory canal. Treatment of posterior condylar dislocation (PCD) is directed at repositioning the condyle into the glenoid fossa, preventing recurrent dislocations, and maintaining patency of the ear canal. With early intervention, closed reduction with manual manipulation is successful but could be ineffective for chronic protracted PCD. This case report describes an elderly patient with a chronic protracted PCD resulting from a blow to the chin and in which manual reduction was unsuccessful. An open arthroplasty for condylar reduction and application of a "reverse" double Mitek mini anchor technique was required to prevent recurrence of PCD, with a successful outcome.

Purpose The aim of this study was to examine the total volume and cross-sectional areas of the pharyngeal airway after bilateral condylar replacement and mandibular advancement surgery. Materials and Methods A total of 137 patients (126 women and 11 men) underwent bilateral temporomandibular joint total joint replacement performed by 1 surgeon. A subsample of 30 patients who underwent condylar replacement and only mandibular advancement were evaluated for impact on the airway. Measurements were taken preoperatively, postoperatively, and at a follow-up 1 year after surgery on cone beam computed tomography scans. InVivoDental 3-dimensional imaging (Anatomage, San Jose, CA) was used to measure airway space regarding total volume (in cubic centimeters); minimum cross-sectional area (in square millimeters); minimum cross sections of the first, second, and third cervical vertebrae; and whether the patient had mandibular retrognathia before surgery. A second operator was used to test for interoperator error. Descriptive and bivariate statistics were computed, and the P value was set at .05. Results There was a significant increase in all measurements at the follow-up visit compared with the preoperative visit. There were no significant differences between groups based on simultaneous Le Fort I surgery, mandibular retrognathia, and gender. However, there were statistically significant differences in cross sections 1 and 2, as well as minimum cross-sectional area, regarding age. Condylar replacement and mandibular advancement have a significant association with an increase in airway space. The intraclass correlation coefficient showed excellent agreement between interoperator measurements. Conclusions Patients undergoing bilateral temporomandibular joint replacement and mandibular advancement surgery showed an increase in pharyngeal airway space at a 1-year follow-up. In this study, age was significantly associated with the cross-sectional areas of the airway, with older patients having smaller values.

Purpose The purpose of this study was to determine the rate of facial nerve injury (FNI) when performing (ORIF) of mandibular condylar fractures by different surgical approaches. Materials and methods A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when (ORIF) of mandibular condylar fractures was performed using different surgical approaches. The main outcome variable was transient facial nerve injury (TFNI) and permanent facial nerve injury (PFNI) according to the fracture levels, namely: condylar head fractures (CHFs), condylar neck fractures (CNFs), and condylar base fractures (CBFs). For studies where there was no delineation between CNFs and CBFs, the fractures were defined as CNFs/CBFs. The dependent variables were the surgical approaches. Results A total of 3873 patients enrolled in 96 studies were included in this analysis. TFNI rates reported in the literature were as follows: A) For the transoral approach: a) for strictly intraoral 0.72% (1.3 in CNFs and 0% for CBFs); b) for the transbuccal trocar instrumentation 2.7% (4.2% in CNFs and 0% for CBFs); and c) for endoscopically assisted ORIF 4.2% (5% in CNFs, and 4% in CBFs). B) For low submandibular approach 15.3% (26.1% for CNFs, 11.8% for CBFs, and 13.7% for CNFs/CBFs). C) For the high submandibular/angular subparotid approach with masseter transection 0% in CBFs. D) For the high submandibular/angular transmassetric anteroparotid approach 0% (CNFs and CBFs). E) For the transparotid retromandibular approach a) with nerve facial preparation 14.4% (23.9% in CNFs, 11.8% in CBFs and 13.7% for CNFs/CBFs); b) without facial nerve preparation 19% (24.3% for CNFs and 10.5% for CBFs). F) For retromandibular transmassetric anteroparotid approach 3.4% in CNFs/CBFs. G) For retromandibular transmassetric anteroparotid approach with preauricular extension 2.3% for CNFs/CBFs. H) For preauricular approach a) deep subfascial dissection plane 0% in CHFs b) for subfascial approach using traditional preauricular incision 10% (8.5% in CHFs and 11.5% in CNFs). I) For retroauricular approach 3% for CHFs. PFNI rates reported in the literature were as follows: A) for low submandibular approach 2.2%, B) for retromandibular transparotid approach 1.4%; C) for preauricular approach 0.33%; D) for high submandibular approach 0.3%; E) for deep retroparotid approach 1.5%. Conclusion According to published data for CHFs, a retroauricular approach or deep subfascial preauricular approach was the safest to protect the facial nerve. For CNFs, a transmassetric anteroparotid approach with retromandibular and preauricular extension was the safest approach to decrease risk of FNI. For CBFs, high submandibular incisions with either transmassetric anteroparotid approach with retromandibular or transmassetric subparotid approach, followed by intraoral (with or without endoscopic/transbuccal trocar) were the safest approaches with respect to decreased risk of FNI.

Summary Objective To assess 3D morphological variations and local and systemic biomarker profiles in subjects with a diagnosis of temporomandibular joint osteoarthritis (TMJ OA). Design Twenty-eight patients with long-term TMJ OA (39.9 ± 16 years), 12 patients at initial diagnosis of OA (47.4 ± 16.1 years), and 12 healthy controls (41.8 ± 12.2 years) were recruited. All patients were female and had cone beam CT scans taken. TMJ arthrocentesis and venipuncture were performed on 12 OA and 12 age-matched healthy controls. Serum and synovial fluid levels of 50 biomarkers of arthritic inflammation were quantified by protein microarrays. Shape Analysis MANCOVA tested statistical correlations between biomarker levels and variations in condylar morphology. Results Compared with healthy controls, the OA average condyle was significantly smaller in all dimensions except its anterior surface, with areas indicative of bone resorption along the articular surface, particularly in the lateral pole. Synovial fluid levels of ANG, GDF15, TIMP-1, CXCL16, MMP-3 and MMP-7 were significantly correlated with bone apposition of the condylar anterior surface. Serum levels of ENA-78, MMP-3, PAI-1, VE-Cadherin, VEGF, GM-CSF, TGFβb1, IFNγg, TNFαa, IL-1αa, and IL-6 were significantly correlated with flattening of the lateral pole. Expression levels of ANG were significantly correlated with the articular morphology in healthy controls. Conclusions Bone resorption at the articular surface, particularly at the lateral pole was statistically significant at initial diagnosis of TMJ OA. Synovial fluid levels of ANG, GDF15, TIMP-1, CXCL16, MMP-3 and MMP-7 were correlated with bone apposition. Serum levels of ENA-78, MMP-3, PAI-1, VE-Cadherin, VEGF, GM-CSF, TGFβ1, IFNγ, TNFα, IL-1α, and IL-6 were correlated with bone resorption.

This retrospective study assessed the outcome of 603 patients undergoing partial inferior turbinectomies (PIT) in association with Lefort I osteotomy. The study included 1234 patients from a single private practice; these patients had dentofacial deformities and underwent Lefort I osteotomy procedures. For the full patient group, 888 patients (72%) were women; in the turbinectomy group, 403 (67%) were women. The anteroposterior, transverse, and vertical dimensions of the mandible, maxilla, and occlusal plane of each subject were assessed, in addition to cephalometric analysis and determination of the presence or absence of temporomandibular joint disorders. PIT, when indicated, was performed after downfracture of the maxilla, providing access to the turbinates where approximately two thirds of the total turbinate volume was removed and septoplasty was completed if indicated. Hypertrophied turbinates causing significant nasal airway obstruction were present in 603 (49%) of the 1234 patients undergoing Le Fort I osteotomy. The results of this study showed that PIT performed simultaneously with Le Fort I osteotomy is a safe method of managing nasal airway obstruction related to hypertrophied turbinates with minimal complications.