Paulo José D'Albuquerque Medeiros

Treatment of an ankylosed central incisor by single-tooth dento-osseous osteotomy

This article presents a case of an ankylosed upper central incisor that did not respond to orthodontic mechanics alone or to surgical luxation followed by orthodontic traction. We performed an osteotomy involving the dento-osseous segment in one surgical stage to allow its inferior displacement. The patient was followed for 18 months and the result was considered satisfactory from both the occlusal and periodontal standpoints.

Comparative analysis of two different alar base sutures after Le Fort I osteotomy: randomized double-blind controlled trial

OBJECTIVE The aim of this prospective study was to analyze the efficacy of a new alar base cinch suture by comparing it with the commonly used cinch suture described by Schendel and Delaire in Dr. William Bells book. STUDY DESIGN Thirty-five patients submitted to maxillary impaction and/or advancements of ≥ 3 mm were randomly divided into 2 groups. Group 1 received an extra oral alar base cinch suture, and patients from group 2 received the classic intraoral suture. Alar and alar base width were measured before and after surgery in digital photographs, with the patients head in a submental oblique view. Data were reported as means and standard deviations, and difference between groups were determined using Welch t test. A P value of <.05 was considered to be statistically significant. RESULTS Mean alar base widening was 1.38 mm in group 1 and 2.5 mm in group 2, and mean alar widening was 1.40 mm in group 1 and 2.31 mm in group 2. The difference was statistically significant (P < .05). CONCLUSION Extraoral alar base cinch suture was more effective in maintaining preoperative Alar and alar base width compared with classic intraoral nasal suture.

Calcifying epithelial odontogenic tumor (Pindborg tumor): Report of case

Abstract The calcifying epithelial odontogenic tumor (CEOT) is a rare benign epithelial odontogenic lesion that comprises from 0.2% to 1% of all odontogenic tumors. 1 Clinically in manifests as a bony lesion, accounting for the majority of cases (95%), or as the extremely rare peripheral type (5%). In the past a number of different names have been given to this lesion, such as calcifying ameloblastoma, 1 malignant odontoma, 1 adamantoblastoma, 2 adenoid adamantoblastoma, 3 cystic complex odontoma, 3 uncommon ameloblastoma with calcifications, 1 and others. In 1956, Pindborg 4 delineated this lesion as a distinct entity and named it the calcifying epithelial odontogenic tumor. In 1963, along with a comprehensive review of the literature, Shafer et al 5 suggested the eponym “Pindborg tumor.” The purpose of this article is to report an additional case of the CEOT and discuss important aspects of the radiographic appearance, histologic features, clinical behavior, and surgical management.

Effects of surgical correction of class III malocclusion on the pharyngeal airway and its influence on sleep apnoea

The objective of this study was to evaluate, through cone beam computed tomography, the immediate changes in pharyngeal airway space (PAS) after orthognathic surgery in class III patients, and to determine the influence of surgery on the development of obstructive sleep apnoea hypopnoea syndrome (OSAHS). A prospective study was conducted; 33 patients were divided into three groups: mandibular setback surgery (nine patients), bimaxillary surgery (18 patients), and maxillary advancement surgery (six patients). PAS measurements obtained pre- and postoperatively were compared using the t-test. All patients were assessed clinically for OSAHS before surgery and at 6 months postoperative using the Berlin questionnaire and a combined clinical assessment, which included the assessment of OSAHS symptoms, Epworth Sleepiness Scale score, and body mass index. Patients undergoing isolated mandibular setback surgery demonstrated a decrease in total PAS volume, in hypopharynx volume, and in minimum cross-sectional area of the pharynx immediately after surgery (P<0.05). The clinical analysis did not reveal signs or symptoms of OSAHS in any of the 33 patients. Although patients who underwent mandibular setback surgery alone demonstrated a volume reduction in the PAS and a decrease in minimum cross-sectional area, these reductions were not accompanied by signs or symptoms of OSAHS.

Accuracy of maxillary positioning after standard and inverted orthognathic sequencing

OBJECTIVE This study aimed to compare the accuracy of maxillary positioning after bimaxillary orthognathic surgery, using 2 sequences. STUDY DESIGN A total of 80 cephalograms (40 preoperative and 40 postoperative) from 40 patients were analyzed. Group 1 included radiographs of patients submitted to conventional sequence, whereas group 2 patients were submitted to inverted sequence. The final position of the maxillary central incisor was obtained after vertical and horizontal measurements of the tracings, and it was compared with what had been planned. The null hypothesis, which stated that there would be no difference between the groups, was tested. RESULTS After applying the Welch t test for comparison of mean differences between maxillary desired and achieved position, considering a statistical significance of 5% and a 2-tailed test, the null hypothesis was not rejected (P > .05). Thus, there was no difference in the accuracy of maxillary positioning between groups. CONCLUSIONS Conventional and inverted sequencing proved to be reliable in positioning the maxilla after LeFort I osteotomy in bimaxillary orthognathic surgeries.

Rehabilitation of an adolescent with ectodermal dysplasia. Two-stage orthognathic, graft, and implant surgery: case report.

A 16-year-old girl presenting with ectodermal dysplasia has undergone double jaw orthognathic surgery to correct mandibular prognathism and maxillary anteroposterior deficiency. Ten months later the patient had a second surgery that included the placement of 11 implants along with bone grafting to the maxilla and mandible. Fourteen months after the second surgery, the definitive ceramic work was fabricated and screw retained. Even though the patient was still an adolescent at the time of the first surgery, psychological effects of the deformity may require an early solution for this kind of patient.

Autologous blood injection for the treatment of recurrent mandibular dislocation

The purpose of the present study was to evaluate the effectiveness of autologous blood injection in the treatment of recurrent temporomandibular joint dislocation. Eleven patients diagnosed with recurrent dislocation of the joint that could not be self-reduced, received bilateral injections of autologous blood in the superior joint compartment and pericapsular region. During a follow-up period ranging from 24 to 35 months (average 29.6 months), eight patients (72.7%) did not show new episodes of dislocation. The most advocated treatment for recurrent dislocation is eminectomy, which involves a skin incision, with the risk of damaging the facial nerve, requires general anaesthesia, and presents an average success rate of 85% according to the literature. Autologous blood injection is a simple, rapid, minimally invasive, and cost-effective technique, with a low possibility of complications, and is a feasible alternative treatment before surgical intervention.

Avoiding condylar displacement after intraoral vertical ramus osteotomy.

The intraoral vertical osteotomy is a versatile and simple technique usually applied to correct mandibular prognathism. Its greatest advantages include ease of performance and minimum neurosensory disturbances, whereas maxillomandibular fixation is pointed as its major disadvantage. Another important concern about this technique is condylar displacement, which may lead to temporomandibular dysfunction. Technical notes to avoid condylar luxation are discussed after 15 years of experience using this osteotomy as the technique of choice to correct mandibular prognathism. Three similar cases are presented, where 1 condyle was displaced from the glenoid fossa, resulting in mandibular deviation during function in patients requiring small mandibular setback.

Simulação computadorizada do perfil facial em cirurgia ortognática: precisão cefalométrica e avaliação por ortodontistas

AIM: To verify the accuracy of a video imaging software on the soft tissue profile prediction of patients who underwent different types of orthognathic surgery. METHODS: Presurgical and posttreatment lateral cephalograms and photographs of 32 patients were used. Profile predictions were obtained from hard tissue manipulation on the presurgical tracings. Prediction evaluation was applied to the total sample and to subgroups with maxillary impaction or downgraft (V) or without surgeries in the vertical plane (AP). Points of predictions soft tissue line were compared with those of the posttreatment tracing. Prediction and posttreatment profile images were subjectively compared by 20 orthodontists. Five regions (overall profile, nose, upper lip, lower lip and chin) were graded from 0 to 100 with a visual analog scale. RESULTS AND CONCLUSIONS: Soft-tissue profile points showed location variability, with more than 60% of the errors up to 2mm and 17% greater than 3mm. Statistically significant differences in the cephalometric analysis were more frequently observed on the vertical plane. Nasolabial and mentolabial prediction angles were more acute than those of the posttreatment tracings. The aesthetic analysis showed greater mean values in comparison with other studies, varying from 56.00 for the lower lip to 75.42 for the nose. Prediction images precision showed no significant difference between cases with or without vertical changes. This program can be considered useful in orthodontic and surgical clinical practice. However, based on some observed limitations, the authors recommend caution in treatment planning and case presentation, and some predictions may require improvement with enhancement tools.

Sleep-disordered breathing following mandibular setback: a systematic review of the literature.

IntroductionA mandibular setback reduces space in the pharyngeal airway, and it has been suggested that it might induce sleep-disordered breathing.ObjectivesAn evidence-based literature review was conducted to identify the effect of mandibular setback on the respiratory function during sleep.MethodsThe authors performed a systematic review of pertinent literature published up to 2014. A structured search of literature was performed, with predefined criteria. A survey of the PubMed, ScienceDirect, and Cochrane database was performed. A manual search of oral and maxillofacial surgery-related journals was accomplished. Potentially relevant studies then had their full-text publication reviewed.ResultsA total of 1,780 publications were evaluated, through which nine papers (seven case series and two case–control studies) were selected for the final review. No evidence of sleep disorder after six months was related in 223 patients. In one study, two patients developed obstructive sleep apnea syndrome after surgery, and in another two studies, seven patients presented an increase of obstructive apneas/hypopneas events and oxygen desaturation index. Most of the patients analyzed were young and thin.ConclusionThere was no evidence of postoperative sleep apnea syndrome after a mandibular setback surgery. However, one should always consider a potential reduction of the upper airway space during the treatment plan. Obese patients and those submitted to large amounts of mandibular setbacks present a higher chance to develop obstructive sleep apnea syndrome.