Gülnaz Marşan

Oropharyngeal airway changes following bimaxillary surgery in Class III female adults.

AIM The aim of this study was to evaluate oropharyngeal airway changes following Le Fort I maxillary advancement and impaction with mandibular setback in Class III deformity. SUBJECTS AND METHODS 53 female Class III patients (mean age: 24.9+/-0.8 years) had Le Fort I maxillary advancement with impaction, and mandibular setback osteotomies. Lateral cephalograms were taken before (T0), one week postoperatively (T1) and 1.3+/-0.2 years after (T2) bimaxillary surgery. Paired t and Pearson tests were used to evaluate the changes. RESULTS The mandibular plane-hyoid, upper retropalatal airway space (URP) and hyoid to horizontal reference plane (HY-HOR) distances significantly increased and the third vertebra to menton, hyoid to vertical reference plane (HY-VER) distances decreased in the T0-T1 period. Relapses were found in mandibular plane to hyoid (MP-HY), URP, HY-HOR, third cervical vertebra to menton (C3-Me) and HY-VER distances in T1-T2 period. Correlations were found between the mandibular retraction and increases of the narrowest retropalatal (r: 0.29, p<0.05) and lowest retropalatal airway spaces (r: -0.30, p<0.05) and posterior movement of hyoid (r: 0.60, p<0.001). CONCLUSIONS Bimaxillary surgery caused an increase in the URP, together with posterior and inferior movement of hyoid bone one week postoperatively. Some relapse was found in these changes over one year later.

Changes in soft tissue profile after mandibular setback surgery in Class III subjects

The aim of this study was to investigate changes in hard and soft tissue profile after mandibular setback surgery. Lateral cephalograms of 25 Class III subjects were assessed before and 1.5+/-0.4 years after mandibular setback surgery. Paired t test, Pearson correlation test and linear regression analysis were used to evaluate the changes in soft tissue profile. Significant changes were found in skeletal (SNB -3.6+/-0.9 degrees, ANB 3.7+/-1.0 degrees, overjet 5.0+/-1.2 and overbite 2.5+/-1.1 mm, P<0.001), soft tissue (facial convexity 5.9+/-1.6 degrees, P<0.001; labiomental fold 0.6+/-0.6 mm, P<0.001; upper and lower lip protrusion 0.5+/-0.8 mm, P<0.01; -3.3+/-1.2 mm, P<0.001), and upper and lower lip lengths (0.9+/-1.2mm, P<0.01; -1.8+/-2.1 mm, P<0.001). Correlations were found between facial convexity and SNB and ANB angles and between upper lip length and SNB and ANB angles. The change in lower lip length was correlated with SNB, ANB, overjet and overbite. Lower lip retrusion was correlated with overjet and a significant correlation was found between the retrusion of lower incisor and lower lip. Mandibular setback surgery was effective in producing an orthognathic profile in adult Class III subjects with mandibular prognathism.

Changes in pharyngeal (airway) morphology in Class III Turkish female patients after mandibular setback surgery

INTRODUCTION The aim of this study was to evaluate changes in the pharyngeal and lower facial morphology in Turkish female Class III patients 1.5+/-0.4 years after mandibular setback surgery (bilateral sagittal split osteotomy), and orthodontic multi-bracket treatment. Only women with mandibular prognathism were selected because sex differences in pharyngeal airway changes were evident. MATERIAL AND METHODS Lateral cephalograms of 25 Turkish female Class III patients (mean age: 25.4+/-2.6 years) with mandibular prognathism, were assessed before and 1.5+/-0.4 years after operation. Paired t and Pearson tests were used. RESULTS The pharyngeal airway morphology showed significant changes in soft-palate length and posterior reference line (PRL) to point of posterior tongue. The decrease in PTV-Pg distance was correlated with the decreases in PRL-PSP, PRL-PTO and PRL-E distances. It was considered normal for the pharyngeal airway morphology to adapt after surgery to improve the hard tissue relationship. CONCLUSION The lower facial morphology significantly changed and the pharyngeal airway narrowed 1.5+/-0.4 years after mandibular setback surgery.

Changes in head posture and hyoid bone position in Turkish Class III patients after mandibular setback surgery

The aim of this study was to determine the changes in head posture and hyoid bone position after mandibular setback osteotomy in Turkish adult Class III patients. Serial lateral cephalograms of 42 Turkish Class III patients (24 female, 18 male patients, mean age: 25.4+/-1.2 years) who underwent mandibular setback surgery were evaluated preoperatively, 1.2+/-0.6 years, 2.3+/-0.8 and 4.2+/-0.9 years postoperatively. A mean mandibular setback of 5.6+/-0.8mm was associated with a posterior and inferior movement of the hyoid bone and a significant flexion in the neck posture. Surgical correction of mandibular prognathism altered the position of the hyoid bone by downward repositioning carrying the root of the tongue downwards immediately postoperatively, but followed with a tendency to return to its original position.

Improving bony stability in maxillofacial surgery: use of osteogenetic materials in patients with profound (≥5 mm) maxillary advancement, a clinical study

PURPOSE LeFort I osteotomy is a part of the standard surgical regimen in the treatment of patients with Class III dentofacial deformity. Inadequate osteosynthesis between the segments is a problem in patients with profound (> or =5mm) maxillary advancement. In this study an ideal ossification is aimed for by applying a combination of osteoinductive and osteoconductive materials. PATIENTS AND METHODS Ten patients with Class III deformity were included in this study. At least 5mm of advancement was performed on each patient, while mean maxillary advancement was 5.7 mm. Human demineralised bone matrix (DBM, 1 cc) and 20 mg bovine bone collagen-protein extracts (Colloss) were applied in between the segments following rigid fixation. Recurrence rates were calculated via cephalometric analyses. Multislice tomography images were collected after the 3 and 12 months in an effort to document ectopic or abnormal bone growth patterns, if any present. Four patients underwent a second operation for plate removal 12 months postoperatively. Bone biopsies were collected from the anterior maxillary wall. RESULTS The cephalometric analyses performed after 3 and 12 months were identical to the analyses calculated 1 week postoperatively for each patient, ruling out recurrences. No abnormal or ectopic bone growth was observed. Peroperative examination of four patients revealed a complete or near to complete osteosynthesis line at the anterior maxillary wall. The microscopic examinations of the bony samples retrieved from these borders revealed abundant osteoblasts, osteocytes, osteoclasts and a bony regeneration mimicking intramembranous ossification with its trabecular organisation. CONCLUSIONS It is possible to achieve an acceptable line of osteosynthesis in cases in need of profound maxillary advancement by applying DBM and Colloss inbetween the bony segments.

Condylar asymmetry in different occlusion types.

Abstract Aims: The purpose of this study was to investigate the relationship between vertical asymmetries of the mandibular condyle with different occlusion types, including Angle Cl I, Cl II, Cl III malocclusions and unilateral posterior crossbite (UPC) in adolescent patients. Methodology: A total number of 120 patients (60 girls, 60 boys with a mean age of 13·64±1·58 years) with no signs and symptoms of temporomandibular disorders were included in the study [n = 30 for each group; Group I: normal occlusion, Group II: Angle Class II malocclusion, Group III: Angle Class III malocclusion and Group IV: UPC]. The asymmetry index for each patient was measured using panoramic radiographs. The results were analyzed using Kruskal–Wallis and Mann–Whitney U test at the 95% confidence level. Results: The results of the analyses showed no statistically significant differences between the gender and the age of the patients for condylar height asymmetry (P>0·05). No statistically significant difference was found between the occlusion types, according to condylar asymmetry level. The patients with UPC showed a significantly different level of condylar height asymmetry compared to the Class I, II and III occlusion types (P<0·05; P<0·01). Conclusions: Patients with UPC have asymmetric condylar heights. These patients might be at risk for developing skeletal mandibular asymmetries in the future. Early correction of posterior crossbite can help practitioners prevent skeletal asymmetries.

Bimaxillary surgery in Class III malocclusion: Soft and hard tissue changes

The aim of this study was to quantify anteroposterior facial soft tissue changes with respect to underlying skeletal movements after Le Fort I maxillary advancement and mandibular setback surgery with sagittal split osteotomy in Class III skeletal deformity by using lateral cephalograms taken before and after the operation. The material consisted of 31 patient (15 female, 16 male cases, mean age was 26.7 ± 2.5 years) with Class III skeletal deformity. All patients were treated by Le Fort I maxillary advancement and mandibular setback surgery with sagittal split osteotomy. Lateral cephalograms were taken before and 1.4 ± 0.3 years after surgery. Wilcoxon test was used to compare the pre- and post-surgical measurements. Pearson correlation test was used to compare the relationships between the skeletal, dental and facial soft tissue changes. In the maxilla, the APOINTAP (the anteroposterior position of A point) and ITIPAP (the anteroposterior position of upper incisor) showed significant protractions (-3.19 ± 3.63, and -3.19 ± 4.52, p < 0.01). In the mandible, the L1TIPAP (the anteroposterior position of lower incisor, -3.20 ± 5.83, p < 0.01), L1TIPSI (the superoinferior position of lower incisor, -2.43 ± 10.31, p < 0.05), BPOINTSP (the superoinferior position of B point, -2.28 ± 12.51, p < 0.05) and BPOINTAP (the anteroposterior position of B point, -3.19 ± 9.31, p < 0.01) showed significant retractions and upper positions after bimaxillary surgery. The insignificant decrease in soft tissue Pog-Vert distance was correlated the significant upper position of B point and lower incisor (r: 0.851, p < 0.001 and r: 0.842, p < 0.001).

Evaluation of the Effects of Temporomandibular Joint Disk Displacement and Its Progression on Dentocraniofacial Morphology in Symptomatic Patients Using Lateral Cephalometric Analysis

Abstract The aim of this study was to evaluate the effects of disk displacement (DD) and its progression on dentocraniofacial morphology in symptomatic patients and compare the results with asymptomatic volunteers. Skeletal and dental Class I female patients with DD, diagnosed using magnetic resonance imaging (MRI) and lateral cephalometric analysis were included in the study. Subjects were grouped as follows: control group with bilateral normal disk position (group 1, n=12), unilateral DD with reduction (group 2, n=16), bilateral DD with reduction (group 3, n=26), unilateral DD without reduction (group 4, n=12), and bilateral DD without reduction (group 5, n=8). Thirty-two (32) cephalometric variables were measured, and statistically significant differences were found in 11. Dental and soft tissue measurements did not reveal any differences, but variables related to the mandible showed statistically significant differences. Progression of DD was associated with an increase in all angular measurements related to vertical skeletal relationships and articular angle and a decrease in the ratio of posterior face height to anterior face height indicating clockwise rotation of the mandible. Similarly, the height of ramus was decreased with the progression of DD. The results of this study demonstrated that the presence of DD in skeletal Class I female patients effects facial morphology, and its progression makes the differences more significant and remarkable. These results emphasize the importance of early diagnosis and treatment in the management of DD.

Facial soft tissue changes after maxillary impaction and mandibular advancement in high angle class II cases.

The aim of this study was to determine the vertical and anteroposterior alterations in the soft, the dental and the skeletal tissues associated with the facial profile after Le Fort I maxillary impaction in conjunction with sagittal split osteotomy for mandibular advancement performed in patients with a high angle Class II skeletal deformity. The study population consists of 21 patients (11 females and 10 males, mean age 24.5±1.6 years) who underwent Le Fort I maxillary impaction in conjunction with sagittal split osteotomy for mandibular advancement. Lateral cephalograms were obtained prior to the surgery and 1.3±0.2 years postoperatively. Wilcoxon test was performed to compare the pre- and postsurgical cephalometric measurements. Pearson correlation test was carried out to determine the relative changes in skeletal, dental and the facial soft tissues. The insignificant decrease in the nasolabial angle was correlated with the significant decrease in the vertical position of the nose due to the nasal protraction noticed after bimaxillary surgery. The retraction of both the upper lip and the upper incisors was correlated with the insignificant decrease in the columella-lobular angle. The insignificant decrease in both the vertical height of the mandibular B point and the lower incisors was correlated with the insignificant decrease in vertical height of the soft tissue pogonion, attributable to the resulting superior movement of the soft tissues of the chin and the counter clockwise rotation of the mandible after maxillary impaction and bilateral sagittal split osteotomy, respectively. Le Fort I maxillary impaction in conjunction with mandibular sagittal split osteotomy for mandibular advancement significantly affected the vertical and anteroposterior positions of the maxilla and the mandible, respectively. When performed in combination, these surgical techniques may efficiently alter the position of upper incisor and the nasal position in both vertical and anteroposterior directions. Bimaxillary orthognathic surgery seems to be an efficient method for obtaining satisfactory results in the appearance of the soft, the dental and the skeletal tissues associated with the facial profile in patients with high angle Class II skeletal deformity.

Body fat composition and weight changes after double-jaw osteotomy.

Nutritional problems might be observed after surgical procedures. In this study, body weight and fat composition changes have been investigated in dentofacial deformity patients after the double-jaw osteotomy procedure.Thirty Angle class 3 patients operated on with double-jaw osteotomies during the period of March 2006 to July 2008 were included in the study. Interocclusal splints were applied continuously in the first 2 weeks after surgery, whereas intermittent splint was used for the next 2 weeks. Patients were analyzed before surgery and on the first month after surgery with the help of Tanita Composition Analyzer 310 bioimpedance method for weight, fat mass, and fat-free mass values. Results were evaluated statistically with the paired-sample test using SPSS version 13.0.Although significant results were obtained in female patients before surgery (weight [P = 0.011], body mass index [BMI; P = 0.012], fat mass [P = 0.010], and fat-free mass [P = 0.051, not significant]), none of the values were significant for male patients (P = 0.747, P = 0.747, P = 0.645, and P = 0.803, respectively). Weight gain was observed in 9 patients (30%). In contrast, weight gain was not seen in underweight patients. No sex differences in terms of weight gain/loss and fat composition have been observed.Interocclusal splint in female patients operated on with double-jaw osteotomies might cause nutritional deficiency in the first month after surgery. This eventually causes fat and weight loss, which may lead to poor wound healing and recovery later.