A. Howard Sather

The effect of Le Fort I maxillary impaction on nasal airway resistance

To evaluate the effect of maxillary superior movement via Le Fort I osteotomy on nasal airway resistance, eleven Caucasian patients whose surgical orthodontic treatment included Le Fort I impaction (range 2 to 8 mm, mean 5.3 mm) were selected. Nasal airway resistance in these patients was determined a few days before and approximately 8 weeks after the Le Fort I surgical procedure. Nasal airway resistance was determined by means of a uninasal active mask rhinomanometric technique. Contrary to the predicted negative effects of maxillary superior movement on nasal airway function, there was a statistically significant improvement in nasal airway resistance (P less than 0.01) after maxillary superior movement. This rather unexpected finding can be explained by examining the effect of maxillary superior movement on the nasal valve area in the anterior nose. The nasal valve area is a teardrop-shaped area bordered by the nasal septum, the caudal end of the upper lateral nasal cartilage, the floor of the nose, and the soft fibrofatty tissue on the lateral aspect of the nose. The apex of the teardrop-shaped area (the angle between the nasal septum and the upper lateral cartilage) is called the nasal valve. In the Caucasian type of nose, the nasal valve accounts for most of the inspiratory resistance to airflow. Maxillary superior movement increases the alar width. It is proposed that this increase in alar width is transmitted at least partially to the nasal valve angle, causing it to widen slightly, paradoxically reducing nasal airway resistance while reducing skeletal intranasal dimensions.

Quadrangular Le Fort I osteotomy: surgical technique and review of 54 patients:

Technical aspects and indications for the quadrangular Le Fort I osteotomy are described. The records of 54 consecutive patients who underwent this procedure for primary correction are reviewed in general terms, and those of 3 patients with significant follow-up are presented in some detail. The procedure gave predictable results, provided acceptable midfacial aesthetic improvement, and was surgically reproducible with few complications. Low surgical and postoperative morbidity was documented. This procedure was used in a similar patient population as the quadrangular Le Fort II osteotomy, and the rationale for choosing between these two procedures is discussed.

Intraoral quadrangular Le Fort II osteotomy

The technical aspects of the intraoral quadrangular Le Fort II osteotomy are described, and the anesthetic technique, blood loss, operating time, intraoperative and postoperative complications, length of hospitalization, and length of fixation in seven cases are reported. This procedure was predictable and reproducible with few complications, had low surgical and postsurgical morbidity, exhibited excellent initial skeletal stability, provided esthetics superior to those achieved with lower osteotomy and onlay bone grafting techniques, and demonstrated versatility within limits.

The effect of topical fluorides, after acid etching of enamel, on the bond strength of directly bonded orthodontic brackets☆

This study tests the hypothesis that the beneficial effects of topical fluoride can be realized without reducing the bond strength of the resin adhesive. Twenty-eight groups of four teeth (third molars and premolars) were extracted from twenty-eight patients and stored in distilled water. Twin brackets on Ormesh pads were bonded to all teeth with Endur adhesive. One tooth from each group was bonded according to the manufacturers instructions. These teeth, Subgroup I, served as controls. Subgroup II teeth were etched for 4 minutes with 50% phosphoric acid containing 2 percent sodium fluoride. Subgroup III teeth received a 3-minute application of a basic phosphate fluoride solution (10(-2)M NA3PO4, 10(3) ppm F) after 1 minute of etching with 50 percent phosphoric acid. Subgroup IV teeth received a 4-minute application of 8 percent stannous fluoride solution after 1 minute of etching with 50 percent phosphoric acid. Each tooth was mounted in a block of improved dental stone; guide wires were used to reproduce bracket orientation. The M.T.S. materials-testing apparatus was used to generate a torsional moment on the bracket at a rate of 1 degree per second. Fluoride uptake by enamel has been shown to be greater in an acid medium or after acid etching. The application of directly bonded orthodontic brackets and pit-and-fissure sealants requires acid etching of the enamel surface. This study supports the use of topical fluoride after acid etching, a procedure that achieves the benefits of increased fluoride uptake without changing the bond strength of the resin adhesive.

Surgical correction of the acromegalic face: A one stage procedure with a team approach

The features of acromegaly are presented with special reference to facial deformity. A one-stage procedure with careful pre-operative planning is advocated. The operating team is composed of a plastic surgeon and an oral surgeon. The frontal protrusion is corrected by osteotomy, the vertical and anteroposterior facial disproportion by bimaxillary procedures, the nasal deformity by rhinoplasty or skull bone grafting, and the macroglossia by tongue resection. This results in an improvement of the patients psyche and frequently improvement in speech.

Oral Facial Abnormalities

Oral facial abnormalities comprise a wide range of occlusal and facial skeletal imbalances which can be congenital, developmental, or acquired. Whenever the occlusal structures are improperly related and the maxilla and mandible are malpositioned to each other or to the cranial base, disharmony of the facial soft tissues will occur.