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Orthodontic-surgical considerations of dental and bone corrections in cleft Cleft lip and palate is a collective term for a heterogeneous group of congenital abnormalities at the level of the lips and mouth. It is the most frequent congenital craniofacial disorder and is subdivided into cleft palate and cleft lip with or without cleft palate. The condition has a major impact on the patient’s speech, hearing, appearance, nutritional intake and mental stress. Therefore, the goal of the treatment is to restore function and form with ultimately a satisfied patient. After primary surgery, closing lip and palate clefts, dento-maxillofacial growth should be monitored, adjusted and corrected. Orthodontic-surgical treatment should provide restoration of the jaw wall, tooth arch, occlusion and facial relationships. This aspect of multidisciplinary treatment is subject to specific clinical challenges for the orthodontist, oral and maxillofacial surgeon and restorative dentistry team. The orthodontic-surgical interventions in dental and bony corrections run from birth to adult age and include a postnatal presurgical orthopedic intervention (0 to 4 months), an early orthopedic-orthodontic treatment (2,5 to 6/7 years), a conventional orthopedic-orthodontic treatment (from the age of 7), the placement of a bone graft or bone-in-gnatho (BIG) intervention, a definitive orthodontic treatment (12 to 14 years) and finally, if necessary, orthognathic surgery (from the age of 17).

Orthognathic surgery involving the mandible can lead to remodelling of the temporomandibular joint (TMJ). Cone beam computed tomography (CBCT) provides an easily accessible three-dimensional (3D) approach to study this entity. A systematic review of the literature was performed with the aim of identifying condylar remodelling analysis protocols using CBCT-derived 3D models. The search yielded 10 eligible studies. The systematic review identified three pillars of a condylar remodelling analysis protocol that were retrievable from each of the included studies: (1) registration, (2) segmentation, and (3) analysis. The studies lacked consensus on how these pillars should be transferred to their respective protocol. Through critical assessment, criteria for a universal condylar remodelling analysis are suggested: (1) performance of a regional voxel-based registration of baseline and postoperative CBCT scans using an anatomical region not prone to postoperative changes, (2) application of a (semi-)automated 3D segmentation algorithm, (3) performance of a combination of both volumetric and surface-based 3D condylar analysis, and (4) extensive validation of each step of the protocol. The homogenization of condylar remodelling analysis protocols and their incorporation into virtual planning software suites raises the potential for the inclusion of larger numbers of patients in future prospective studies in order to gain evidence-based data. ispartof: INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY vol:49 issue:2 pages:207-217 ispartof: location:Denmark status: published

The aim of this retrospective observational study was to assess the potential agreement between independent magnetic resonance imaging (MRI) and arthroscopic findings and their respective contributions to a final diagnosis in patients with refractory temporomandibular joint disorders. Two dentomaxillofacial radiologists and two oral and maxillofacial surgeons scored 50 joints. All observers, who were blinded to additional clinical information, used a specific scoring form and selected one or more diagnostic labels. Agreement between MRI and arthroscopy and their contributions to the final diagnosis were assessed as primary outcomes using Fleiss' kappa. Intra-modality agreement and the correlation between signal intensity ratio (SIR) measurements on MRI and synovitis grading on arthroscopy were assessed as secondary outcomes. Agreement between MRI and arthroscopy was poor. A fair level of agreement was only reached for reduction capacity of the disc and disc perforation. Arthroscopic diagnostic labels matched better with the final diagnosis, suggesting a bigger contribution to that diagnosis. Higher SIR measurements correlated with higher synovitis grading scores for the retrodiscal tissue and the posterior band of the disc. Intra-modality agreement was better in arthroscopy. When blinded to clinical information, arthroscopy and MRI observations can lead to different conclusions. The diagnostic outcomes of both examinations should be considered and integrated into a final diagnosis. ispartof: INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY vol:50 issue:5 pages:657-664 ispartof: location:Denmark status: published

After orthognathic surgery for class II dentofacial deformity, remodelling of the mandibular condyle will take place. In a number of cases, this may evolve towards a phenomenon of condylar resorption. Yet, studies on the occurrence of this complication after the correction of a class III deformity are scarce. A systematic review of the literature was performed with the aim of identifying reports on condylar resorption or remodelling after orthognathic surgery for class III dentofacial deformity. A search of the international databases yielded 12 eligible studies. Eight studies reported some degree of postoperative condylar remodelling, while symptoms of condylar resorption were only described in a limited group of patients. Thus, the literature may show evidence of condylar remodelling after orthognathic treatment of class III patients, and anecdotal reports of condylar resorption exist. The small sample sizes, heterogeneity in methods and outcomes, and use of two-dimensional radiographs indicate the need for updated long-term research. In the future, the use of cone beam computed tomography data for volumetric and morphological condylar analysis in combination with three-dimensional cephalometry may provide the opportunity to further elucidate this phenomenon and better characterize its aetiology. ispartof: INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY vol:48 issue:2 pages:193-202 ispartof: location:Denmark status: published