Larry M. Wolford

Velopharyngeal anatomy and maxillary advancement

This study was undertaken to evaluate the radiographic changes in the static velopharyngeal mechanism following total maxillary advancement. Records of 21 patients treated for maxillary retrusion were evaluated. Two groups were present: 13 non-cleft patients and 8 cleft-lip patients. The findings demonstrate an anatomical change in the velopharyngeal mechanism following total maxillary advancement. A similar change occurred in both groups; however, the magnitude is differed. The angle of the soft palate to hard palate increased with surgery (2 degrees per mm. advancement noncleft and 1 degree per mm. cleft). An increase in soft palate length was also seen (.5mm. per mm. advancement non-cleft and .4 mm. per mm. cleft). A pharyngeal need ratio prediction method was established (pharyngeal depth/soft palate length). A ratio of .68--.84 in this study was observed. A ratio greater than one was found to indicate probable velopharyngeal incompetence.

Mandibular deficiency syndrome

Abstract Persons with Class II malocclusion have extremely variable esthetic, skeletal, neuromuscular, occlusal, and growth characteristics. In order to achieve optimum esthetic and functional treatment results, with good stability, this variability must be appreciated. In this article the variability of these traits is outlined and discussed with regard to their clinical significance.

Mandibular deficiency syndrome: II. Surgical considerations for mandibular advancement

Eight factors which contribute to the successful surgical correction of the deficient mandible have been briefly discussed. Consideration of the recommendations made will permit surgeons to avoid pitfalls, regardless of the specific surgical technique used to advance the mandible, and will result in improved treatment results. The type of mandibular deficiency syndrome and its severity will dictate which factors need to be considered in a given case. A modified sagittal osteotomy is described as our preferred surgical technique to achieve these objectives and minimize untoward sequelae.

Surgical-orthodontic correction of vertical maxillary excess

Superior repositioning of the maxilla via maxillary ostectomy has proved to be useful method of treating patients with vertical maxillary excess. It is indicated primarily in patients with lip incompetence, excessive exposure of maxillary anterior teeth, long lower facial height, contour-deficient chin, and either Class I or Class II malocclusion. We have used this procedure as routine treatment for vertical maxillary excess over the past 5 years. Timing of the surgery is not so important in non-open-bite patients, and the procedure can be done with equal success before any orthodontic intervention, during orthodontic treatment, and following all orthodontic procedures. Timing is primarily dependent upon the orthodontists desires. Since the surgery can produce a much simpler orthodontic problem, thus reducing treatment time and allowing a better over-all result, we recommend that it be done as early in treatment as possible. Clinically, the over-all improvement in facial appearance and the predictability and stability of the results have made this a most versatile and effective procedure when carried out with good planning, proper execution and attention to detail.

Comparison of Silastic and Proplast implants in the temporomandibular joint after condylectomy for osteoarthritis.

This study was undertaken to compare the long-term stability of Silastic and proplast when used as alloplastic implants following high condylectomy. Twelve patients with osteoarthritis of the temporomandibular joint (TMJ) were treated either unilaterally or bilaterally. The follow-up period ranged from one to four years. In all ten TMJs that received Silastic implants and in ten that received Proplast implants, there were no discernible differences relative to comfort, masticatory function, or TMJ mobility. Although Silastic and Proplast had similar functional characteristics, Proplast implants had better long-term stability than the Silastic implants.

Mandibular deficiency syndrome. III. Surgical advancement of the deficient mandible in growing children: treatment results in twelve patients.

The surgical-orthodontic correction of mandibular deficiency in growing children (8 to 16 years of age) can be employed to achieve excellent results. Mandibular advancement by a modified sagittal osteotomy proves to be an acceptable procedure with good skeletal stability. Dentofacial growth following surgery will be harmonious and not adversely affected. Direction of growth varies, with the mandibular plane angle becoming more vertical with an increasing mandibular plane angle.

Experiences with microsurgical reconstruction of the inferior alveolar nerve

Abstract In select cases, immediate or delayed inferior alveolar nerve reconstruction is indicated. The current state of the art indicates that when nerve reconstruction is to be undertaken, optimal results are achieved via microsurgical instrumentation. Specific technical and biologic considerations that have been found to be relevant in microsurgical reconstruction of the inferior alveolar nerve are discussed.

Transcutaneous electrical stimulation as an adjunct in the management of myofascial pain-dysfunction syndrome.

Twenty-one patients, 14 women and seven men, presenting with symptoms of the MPD syndrome, were treated with a regimen based on a neuromuscular theory of occlusion involving TES. Evaluation of treatment results shows 95% success immediately after therapy and an 86% success 1 year after therapy. No effort was made to establish a personality profile on the patients nor to incorporate active psychotherapy in treatment.

The use of freeze-dried bone in middle-third face advancements

A considerable quantity of bone is required for grafting in most middle-third face advancements. In many patients, especially children, the additional surgery needed to obtain large quantities of autogenous bone adds considerable time and morbidity to the primary operative procedure. During the past 3 years we have utilized freeze-dried bone allografts processed by the Tissue Bank, Naval Medical Research Institute, Bethesda, Maryland. Eighteen patients undergoing various types of middle-third face advancement have received allografts and have been followed closely for at least 12 months postoperatively. Although the duration of follow-up is limited, the results to date have been encouraging. Osteotomies in all eighteen patients healed. Nine of the eighteen patients studied had no complications and healed uneventfully. Four patients developed infections postoperatively, necessitating partial removal of the graft material, and all subsequently healed without further difficulty. Four patients had intraoral exposure of the grafts postoperatively--three in the pterygoid maxillary area and one in the palate. However, no clinical infections developed in these patients and the exposed grafts healed uneventfully. One patient extruded a small sequestrum of bone, without infection, 2 years postoperatively.

Simultaneous inferior alveolar nerve graft and osseous reconstruction of the mandible

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