B. Yi

Effects of the preoperative administration of Yunnan Baiyao capsules on intraoperative blood loss in bimaxillary orthognathic surgery: A prospective, randomized, double-blind, placebo-controlled study

Yunnan Baiyao is a well-known Chinese herbal medicine that has been used as a haemostatic drug for nearly 100 years. The aim of this clinical trial was to evaluate the efficacy and safety of Yunan Baiyao capsules on the reduction of blood loss in bimaxillary orthognathic surgery. 87 consecutive patients scheduled for simultaneous maxillary Le Fort I osteotomies and bilateral sagittal split ramus osteotomies (BSSRO) were enrolled in a prospective, randomized, double-blind, placebo-controlled clinical trial. Patients were administered Yunnan Baiyao capsules or placebo capsules, orally for 3 days before surgery. Intraoperative blood loss was estimated and the safety of Yunnan Baiyao capsules was evaluated. The total blood loss in the Yunnan Baiyao group (mean, 330.5+/-134.4 ml) was significantly lower than in the control group (mean, 420.3+/-175.9 ml). No allergic reactions, thromboembolic events or other side effects were recorded in this trial. It can be concluded that the preoperative use of Yunnan Baiyao capsules, in combination with hypotension anaesthesia, results in a reduction in intraoperative blood loss in bimaxillary orthognathic surgery. Yunnan Baiyao capsules are an effective and safe haemostatic Chinese medicine.

Anterior maxillary segmental distraction for correction of maxillary hypoplasia and dental crowding in cleft palate patients: a preliminary report

To evaluate the feasibility of anterior maxillary segmental distraction (AMSD) to correct maxillary hypoplasia and severe dental crowding in cleft lip and palate (CLP) patients, 7 patients (average age 16.4 years) with maxillary hypoplasia, shortened maxillary dental arch length and severe anterior dental crowding secondary to CLP were selected for this study. After anterior maxillary segmental osteotomy, 3 patients were treated using bilateral internal distraction devices, and 4 patients were treated using rigid external distraction devices. Photographs and radiographs were taken to review the improvement in facial profile and occlusion after distraction. An average 10.25 mm anterior maxillary advancement was obtained in all patients after 10-23 days of distraction and 9-16 weeks of consolidation. The sella-nasion-point A (SNA) angle increased from 69.5 degrees to 79.6 degrees. Midface convexity was greatly improved and velopharyngeal competence was preserved. The maxillary dental arch length was greatly increased by 10.1 mm (P<0.01). Dental crowding and malocclusion were corrected by orthodontic treatment. These results show that AMSD can effectively correct the hypoplastic maxilla and severe dental crowding associated with CLP by increasing the midface convexity and dental arch length while preserving velopharyngeal function, and dental crowding can be corrected without requiring tooth extraction.

Short- and Long-Term Changes of Condylar Position After Bilateral Sagittal Split Ramus Osteotomy for Mandibular Advancement in Combination With Le Fort I Osteotomy Evaluated by Cone-Beam Computed Tomography

PURPOSE Bilateral sagittal split ramus osteotomy (BSSO) may change condylar position, which can be one of the factors contributing to skeletal relapse. This study evaluated short- and long-term changes in condylar position using cone-beam computed tomography (CBCT) and investigated changes in temporomandibular joint (TMJ) signs after BSSO for mandibular advancement in combination with Le Fort I osteotomy. MATERIALS AND METHODS Thirty-one patients were included, and CBCT data of 62 TMJs were collected before surgery (T0), immediately after surgery (T1), 3 months after surgery (T2), and at the last follow-up at 12.1 ± 3.0 months after surgery (T3). The relation of the condyle to the fossa was evaluated by the method of Pullinger and Hollender (Oral Surg Oral Med Oral Pathol 62:719, 1986). Clinical examination, with a special focus on signs of temporomandibular disorder (TMD), was documented at T0, T2, and T3. Repeated-measures analysis of variance (P = .05) and χ2 test (P = .05) were performed. RESULTS Data of 27 patients were used for statistical analysis. Values from the formula of Pullinger and Hollender changed significantly with time, but there was no significant difference between the right and left condyles. Condyles moved inferoposteriorly immediately after surgery (T0 to T1) followed by anterosuperior movement 3 months after surgery (T1 to T2). The superimposed effect showed posterosuperior movement compared with the initial position before surgery (T0 to T2) and this position remained stable at 1-year follow-up (T2 to T3). A decrease of TMD signs over time, from 22.6% (T0) to 12.9% (T2) and 9.7% (T3), was observed, which showed no statistical significance. CONCLUSIONS There were obvious changes in condylar position after BSSO in combination with Le Fort I osteotomy. Condyles tended to be located in a concentric position in relation to the glenoid fossa 3 months after surgery and remained stable during the 1-year follow-up. These changes did not cause an increase of TMD signs.

Cephalometric Analysis of the Facial Skeletal Morphology of Female Patients Exhibiting Skeletal Class II Deformity with and without Temporomandibular Joint Osteoarthrosis

Purpose This study evaluated the differences in the facial morphological characteristics of female patients exhibiting skeletal class II deformity with and without temporomandibular joint osteoarthrosis. Methods Eighty-three female patients with skeletal class II deformity were included in this study; these patients were classified into three groups on the basis of the condylar features shown in cone-beam computed tomography scans: normal group, indeterminate for osteoarthrosis group, and osteoarthrosis group. The cephalometric differences among the three groups were evaluated through one-way ANOVA. Results Of the 83 patients, 52.4% were diagnosed with osteoarthrosis, as indicated by the changes in the condylar osseous component. The cephalometric measurements that represented skeletal characteristics, including mandibular position relative to the cranial base, mandibular plane angle (MP-SN), posterior facial height (S-Go), and facial height ratio, were significantly different among the three groups (p < 0.05). The patients in the osteoarthrosis group yielded the smallest S-Go, the highest MP-SN, and the most retruded mandible. Conclusions Temporomandibular joint osteoarthrosis is commonly observed in female patients with skeletal class II deformity. The morphological characteristics of the facial skeleton in patients with bilateral condylar osteoarthrosis may be altered.

Costochondral Graft in Young Children With Hemifacial Microsomia

Abstract Patients with severely hypoplastic mandibles usually require condylar reconstruction. This study aimed to describe costochondral graft (CCG) for condylar reconstruction and report subsequent outcomes of these grafts in young children with Pruzansky/Kaban type IIB and type III mandibular hypoplasia. This study included 4 young children with type IIB and type III hemifacial microsomia treated with CCG to reconstruct the condyle at the Department of Oral and Maxillofacial Surgery in our hospital from March 2008 to March 2014. Radiographic measurements and clinical examinations were conducted. The mean age of patients at operation was 3.8 years, ranging from 2.8 to 5.3 years. The mean follow-up period was 43.5 months, ranging from 23 to 63 months. Functional improvement was observed in all patients. The ribs had grown in all patients to date. Three patients had clinically improved face appearance with no significant chin point deviation and canting of the occlusal plane. Although the other patient had partly improved face appearance compared with preoperative condition, he still showed clinically significant facial asymmetry and chin deviation. Our results showed that condylar reconstruction with CCG is a feasible method in the treatment of type IIB and type III hemifacial microsomia in young children. These results will provide early preliminary suggestions of growth and stability of CCG in patients <5 years.