Tatjana Cutovic

Temporomandibular disorders after orthognathic surgery in patients with mandibular prognathism with depression as a risk factor

OBJECTIVE To examine the prevalence of temporomandibular disorders (TMD) after orthodontic-surgical treatment in patients with mandibular prognathism and analyze psychosocial variables related to TMD. MATERIALS AND METHODS The case-control study comprised 40 patients with mandibular prognathism who underwent combined orthodontic-surgical treatment (orthognathic surgery group). Forty-two patients with untreated mandibular prognathism served as a control group. Research diagnostic criteria for temporomandibular disorders was used in order to assess the clinical diagnosis of TMD (Axis I) and to estimate depression, somatization and patients disability related to chronic pain (Axis II). RESULTS The overall prevalence of TMD was not significantly different between the groups. Myofascial pain was significantly higher, while arthralgia, arthritis and arthrosis was significantly lower in the orthognathic group compared with the controls (90.5% vs 50.0%, 0.0% vs 27.8%, respectively) (p < 0.05). Females in orthognathic surgery group showed higher prevalence of TMD (p < 0.05) and myofascial pain (p < 0.01) and increased level of chronic pain (p < 0.05) in comparison with post-operative males. No significant difference in chronic pain, somatization and depression scores was found between investigated groups. With respect to presence of TMD within the groups depression was higher in untreated subjects with dysfunction (p < 0.05). CONCLUSION Prevalence of TMD immediately after completion of orthodontic-surgical treatment for mandibular prognathism is similar to frequency of dysfunction in untreated subjects, is significantly higher in females and is most commonly myogenic. Furthermore, females show an increased level of chronic pain post-operatively. Somatization and depression levels do not differ between patients with corrected prognathism and untreated prognathic patients.

TMD in class III patients referred for orthognathic surgery: Psychological and dentition-related aspects

OBJECTIVE To investigate temporomandibular disorders (TMD), psychosocial, and occlusal variables in class III orthognathic surgery patients with respect to the control subjects, and to compare psychosocial and occlusal features in class III patients with different Research Diagnostic Criteria for TMD (RDC/TMD) diagnoses. MATERIALS AND METHODS The study enrolled 44 class III patients referred for orthognathic surgery and 44 individuals without a malocclusion. TMD, depression and somatization were assessed by RDC/TMD. Occlusal analysis included Helkimos Occlusal Index items, overjet and overbite. RESULTS In the controls, patients with class III deformities had higher prevalence of myogenic TMD, increased grade of chronic pain, and more occlusal deviations. Within the study group, TMD patients reported higher depression score (P < 0.01), myofascial pain was related to higher depression and somatization grades (P < 0.01, P < 0.05 respectively), and disc displacement showed relation with RCP-ICP slide interferences (P < 0.05). CONCLUSION With respect to subjects without a malocclusion, TMD in class III dentofacial deformities is similar in prevalence, but differs in clinical appearance. Occlusal, but not psychosocial features deviate from those in the controls. While psychosocial variables accompanied TMD and myofascial pain, increased RCP-ICP slide was related to disc displacement in class III patients.

Rare Disease: Lobar Holoprosencephaly With a Median Cleft Lip—Case Report

Holoprosencephaly is a complex malformation of the brain associated with the median facial defects. Variability of the clinical picture is the characteristic of this anomaly. In most cases, the degree of severity of the facial anomaly correlates with the degree of damage to the brain. This article aims to present a rare case of child with a milder form of brain anomaly combined with a severe form of facial anomaly. The article also presents the application of a feeding stimulator to improve the childs quality of life. The anomaly was diagnosed by postnatal sonography of the brain, magnetic resonance imaging of the endocranium, and three-dimensional computed tomography of the craniofacial skeleton.

Analysis of occlusal characteristics of identical homozygous twins

Background/Aim. Functionally stable occlusion is characterized by optimal and orthopedic stable position of the condyle, harmonious contact ratio of upper and lower teeth in the final occlusal position of the mandible, optimal relationship of dental arches at the eccentric movement of the lower jaw and stable interocclusal space in physiological position. As there are no ideal order of teeth and absolute intermaxilar harmony nor individually acceptable standards or prototype of functionally optimal occlusion, the aim of this study was to analyze occlusal characteristics of identical twins. Methods. This clinicalepidemiological and functional study involved 30 pairs of identical twins, both males and females, aged 20 to 40 years. The main criterion for the selection of participants was preserved function of orofacial system, as a precondition for application of the Peer Assessment Rating (PAR) index, which is the most reliable tool for diagnosing malocclusion and evaluating occlusal parameters: the distance between the contact points of agonists of front segments of the dental arches, side occlusion of the sagittal, vertical and transversal position, overjet, anterior crossbite, deep and open bite, overbite of incisors and relationship of middle dental arches. Results. Using t-test for independent samples, no significant difference in the values of PAR index, according to gender, was established. The average difference of 0.833 between the twin groups (for male twins: ґ = 7.97, SD = 6.625; for female twins: ґ = 7.13, SD = 5.606) was not statistically significant [t (58) = 0.526; p = 0.601; 95% confidence interval: -2.339–4.005]. Conclusion. The lack of significant differences in occlusal PAR index analysis in both the same and different twin groups, implies the dominance of hereditary factors.