Young-Soo Jung

Onset of analgesia and analgesic efficacy of tramadol/acetaminophen and codeine/acetaminophen/ibuprofen in acute postoperative pain: A single-center, single-dose, randomized, active-controlled, parallel-group study in a dental surgery pain model

BACKGROUND The combination of tramadol and acetaminophen has demonstrated good efficacy in various clinical pain models. However, there is a need for comparisons of the onset of analgesia and other measures of analgesic efficacy with this combination and other strong combination analgesics for the management of acute pain. OBJECTIVE The goal of this study was to compare the time to onset of analgesia and other measures of analgesic efficacy with tramadol/acetaminophen 75/650 mg (Tr/Ac) and codeine/acetaminophen/ibuprofen 20/500/400 mg (Co/Ac/Ib) in the management of acute pain after oral surgery. METHODS This was a single-center, single-dose, randomized, active-controlled, parallel-group study in healthy subjects who had undergone surgical extraction of > or =1 impacted third molar requiring bone removal. When patients reported at least moderate pain after dental surgery (score > or =5 on a 10-point scale), they were randomized to 1 of 2 treatment groups. The time to onset of analgesia was measured using a 2-stopwatch technique. The time to the onset of perceptible and meaningful pain relief, pain intensity, pain relief, patients overall assessment, and adverse events were recorded for 6 hours after dosing. RESULTS One hundred twenty-eight subjects participated in the study, 64 in each treatment group. The 2 groups were similar in terms of baseline pain severity and demographic characteristics (mean age, 23.7 and 23.4 years in the Tr/Ac and Co/Ac/Ib groups, respectively; mean body weight, 58.5 and 60.3 kg). The median times to the onset of perceptible pain relief were a respective 21.0 and 24.4 minutes, and the median times to the onset of meaningful pain relief were 56.4 and 57.3 minutes. Mean total pain relief and the sum of pain intensity difference were also similar in the early period after dosing (0-4 hours). However, between 4 and 6 hours, Co/Ac/Ib was associated with significant differences in both variables compared with Tr/Ac (P < 0.05). Although similar through the 4-hour assessment, mean pain intensity difference was significantly greater with Co/Ac/Ib at 5 to 6 hours. The proportion of patients assessing their assigned treatment as good or better was significantly greater with Co/Ac/Ib compared with Tr/Ac (P < 0.05). The safety profile of Tr/Ac was comparable to that of Co/Ac/Ib. CONCLUSIONS In this small and selected group of subjects, the onset of analgesia and analgesic efficacy of Tr/Ac was comparable to that of Co/Ac/Ib. Tr/Ac provided rapid and effective analgesia for acute postoperative dental pain in this population.

A simple classification of facial asymmetry by TML system

This study proposes a system for classifying facial asymmetry with accompanying mandibular prognathism to facilitate choice of surgical method. We examined hard and soft tissue measurements obtained from posterior-anterior cephalometric radiographs and clinical facial photographs of 153 patients (86 male, 67 female), classifying them according to menton deviation with transverse asymmetry (T), maxillary cant (M), and lip cant (L). The T-group is subclassified according to direction of transverse asymmetry (H). Statistical analysis of menton deviation, cant and transverse asymmetry was performed for each group. The various relationships observed among the groups indicate that most cases (85%) were not effectively correctable using conventional surgical methods. As such, the authors believe that analysing facial asymmetry in terms of the classification system presented in this study and employing surgical methods appropriate to each case will help achieve more harmonious aesthetic outcomes.

Osteonecrosis of the jaw related to everolimus: a case report

Antiresorptive agent-related osteonecrosis of the jaw results in appreciable morbidity in affected patients. Nowadays many physicians prescribe an antiangiogenic agent for the management of malignant metastases. Everolimus is a serine-threonine kinase that acts as an inhibitor of mammalian target of rapamycin, which results in reduced growth of cells, angiogenesis, and survival of cells. We report the first case to our knowledge of osteonecrosis of the jaw that seemed to result from the additive effect of everolimus.

Postoperative stability following bilateral intraoral vertical ramus osteotomy based on amount of setback

Our aim was to evaluate the postoperative stability associated with differing degrees of mandibular setback and their relations after intraoral vertical ramus osteotomy (IVRO). We planned a retrospective cohort study of 94 patients (mean age (range) 23 (18-46) years) selected from a larger group who had been diagnosed with mandibular prognathism with or without facial asymmetry and who had mandibular setback by IVR osteotomy from 2004 to 2009. The preoperative, 7-day, and 12-month postoperative lateral cephalographs were measured to find out the degree of movement, and the vertical and horizontal positions of menton and pogonion were compared at different time points to measure stability. The mean (SD) setback was 10.5 (5.1) mm, with 0.8 (1.1) posterior relapse at 12 months. The mean surgical change of menton vertically was 3.0 (3.0) mm superiorly, with an additional 1.3 (1.05) mm at 12 months. The amount of posterior relapse was less as the amount of setback increased but not significantly so. The amount of setback therefore has minimal effects on anterior relapse, and cannot be considered singly as a variant that affects the degree of stability. The risk of anterior relapse is low even with a substantial degree of mandibular setback, so overcorrection is not necessary with the IVR osteotomy.

The Chronologic Prevalence of Temporomandibular Joint Disorders Associated With Bilateral Intraoral Vertical Ramus Osteotomy

PURPOSE The purpose of this study was to evaluate the long-term stability of the improvement of symptoms associated with temporomandibular joint (TMJ) disorders after intraoral vertical ramus osteotomy for the treatment of mandibular prognathism. MATERIALS AND METHODS A total of 217 patients who had undergone bilateral intraoral vertical ramus osteotomy (BIVRO) from 1998 to 2005 were evaluated preoperatively and 1, 3, 6, 12, 18, and 24 months postoperatively regarding mouth opening, clicking, and pain of the TMJ. A retrospective study was conducted based on the results. RESULTS Remarkable improvement of TMJ symptoms after BIVRO was reliable. Preoperative TMJ sounds disappeared after BIVRO in 94.3% of joints, and most of the joints that were sound free preoperatively remained without TMJ sounds postoperatively (98.2%). However, 19 joints exhibited recurrence, and transient TMJ sounds were observed in 35 joints. Preoperative TMJ pain had improved in 97.9% of joints at 1 month postoperatively, and TMJ pain was not observed in any joints at 18 months after surgery. Joints that were pain free before surgery remained without pain, although there were 20 joints that exhibited transient TMJ pain. The mean mouth opening was 50.0 mm before surgery, which decreased to 34.92 mm at 1 month postoperatively. This was followed by an increase to 44.44 mm to 48.75 mm at 6 months postoperatively, and thereafter mouth opening showed 94.72% to 97.5% recovery compared with the preoperative state. CONCLUSIONS BIVRO can be used as a method of choice for relieving undesirable TMJ symptoms such as sound and pain, as well as for repositioning the condyle head to its physiologic position. Such favorable effects of BIVRO on the TMJ were not remarkably affected with time.

Recovery pattern of mandibular movement by active physical therapy after bilateral transoral vertical ramus osteotomy.

PURPOSE The purpose of the present study was to evaluate the effect of an active physical therapy (PT) protocol after transoral vertical ramus osteotomy and to investigate the rehabilitation patterns of mandibular movement. MATERIALS AND METHODS The study included 187 patients diagnosed with mandibular prognathism with or without facial asymmetry who had undergone bilateral transoral vertical ramus osteotomy from 2001 to 2009. The subjects were evaluated preoperatively and 1, 3, 6, 12, 18, and 24 months postoperatively in terms of the periods of PT and range of mandibular movement. The data were analyzed using 1-way analysis of variance (significance level, P < .05). RESULTS Of the 187 patients, 108 (57.8%) did not receive repeat intermaxillary fixation (IMF) during the PT period, 58 (31.0%) received it once, 15 (8.0%) twice, and 6 patients more than 3 times. The average PT period for all was 10.9 days (range 5 to 45). The mean maximal mouth opening was 50.7 mm before surgery, decreasing to 33.9 mm at 1 month postoperatively. This was followed by an increase to 46.3 mm at 6 months postoperatively, with the maximal mouth opening thereafter showing 93.9% to 95.7% recovery compared with the preoperative state. CONCLUSIONS About 88% of the patients with transoral vertical ramus osteotomy responded well to the reduced IMF duration and active PT protocols, receiving repeat IMF less than twice. It required about 6 months to recover 90% of the preoperative maximal mouth opening and 12 months to recover near preoperative levels statistically. The benefits of reduced IMF duration and the PT protocols seem to promote rehabilitation of the masticatory muscles and prevention of mandibular hypomobility.

Stability of maxillary position after Le Fort I osteotomy using self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws.

PURPOSE The purpose of this study was to evaluate the stability of Le Fort I osteotomy using self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws. PATIENTS AND METHODS Nineteen patients who had Le Fort I osteotomy and internal fixation using self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws were evaluated both radiographically and clinically. Changes in maxillary position after operation were documented 1 week, 1, 3, 6 mo, and/or 1-yr postoperatively with lateral cephalometric tracings. Complications of the self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws were evaluated by follow-up roentgenograms and clinical observation. A mixed model analysis for repeated measures was used for statistical analysis. RESULTS Maxillary position was stable after operation with no change between time points (P > .05). There were no complications with the self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws. CONCLUSIONS Internal fixation of the maxilla after Le Fort I osteotomy with self-reinforced biodegradable poly-70L/30DL-lactide miniplates and screws is a reliable method for maintaining the postoperative maxillary position after Le Fort I osteotomy.

Changes of transverse mandibular width after intraoral vertical ramus osteotomy

OBJECTIVE The purpose of this study was to analyze the long-term changes in the horizontal transverse mandibular width (TMW) between the angles of mandible after intraoral vertical ramus osteotomy (IVRO) with respect to hard and soft tissues. STUDY DESIGN A total of 107 from a pool of 207 patients with mandibular prognathism who had undergone bilateral IVRO were retrospectively evaluated radiographically and photographically. A comparison study of the changes of horizontal transverse width in hard and soft tissues after surgery was performed using preoperative, and 1-, 3-, 6-, and 12-month postoperative posteroanterior (PA) cephalograms and clinical photos. Three groups were divided according to the amount of mandibular setback performed (Group 1: <5 mm, Group 2: 5-10 mm, Group 3: >10 mm). RESULTS The overall average amount of mandibular setback in all patients was 8.58 mm. Statistically significant increases of TMW in hard and soft tissue from preoperative to postoperative 1 month were seen. TMW in hard tissue showed a gradually decreasing pattern postoperatively from 1 month to 1 year, and the changes were statistically significant at 1 year postop. TMW in soft tissue was not changed uniformly after 1 month, and showed less than 1% change at 1-year postoperatively compared with preoperatively. The amount of increase in the TMW postoperatively was not proportional or statistically significant to the amount of mandibular setback performed. CONCLUSIONS The results show that mandibular setback using BIVRO did not significantly influence the TMW changes in soft tissue. Therefore, IVRO technique can be safely used without compromising esthetic results through soft tissue TMW increase.

Stability of Pre-Orthodontic Orthognathic Surgery Using Intraoral Vertical Ramus Osteotomy Versus Conventional Treatment

PURPOSE Postoperative skeletal and dental changes were evaluated in patients with mandibular prognathism who underwent mandibular setback surgery using an intraoral vertical ramus osteotomy (IVRO) with and without presurgical orthodontic treatment. MATERIAL AND METHODS This retrospective cohort study included consecutive patients with skeletal Class III malocclusions who underwent IVRO. Patients treated with pre-orthodontic orthognathic surgery (POGS) were compared with patients treated with conventional surgery (CS) with presurgical orthodontics (control) using lateral cephalograms (taken preoperatively, 7 days postoperatively, and 12 months postoperatively). Predictor (group and timing), outcome (cephalometric measurements over time), and other (ie, baseline characteristics) variables were evaluated to determine the differences in postoperative horizontal and vertical positional changes of the mandible, such as point B. Baseline demographics were similar between the groups (N = 37; CS group, n = 17; POGS group, n = 20). The data were analyzed with an independent t test, the Mann-Whitney U test, the Fisher exact t test, Pearson correlation analysis, and simple linear regression analysis. RESULTS The mean setback of the mandible at point B was similar, but the mandible of the POGS group, particularly the distal segment, moved superiorly during the postoperative period in conjunction with the removal of premature occlusal contacts (P < .001). In the CS group, the mandible had significantly more backward movement 12 months after surgery compared with the POGS group (P < .01). In the POGS group, horizontal and vertical postsurgical changes were linearly correlated with the amount of setback and vertical movement of the mandible. CONCLUSIONS Mandibular setback surgery using IVRO without presurgical orthodontics leads to considerably different postoperative skeletal and dental changes compared with conventional treatment, with more superior movement being observed at point B during the 1-year postoperative period.

Orthognathic surgery and temporomandibular joint symptoms

The aim of this article is to review temporomandibular joint symptoms as well as the effects of orthognathic surgery(OGS) on temporomandibular joint(TMJ). The causes of temporomandibular joint disease(TMD) are multifactorial, and the symptoms of TMD manifest as a limited range of motion of mandible, pain in masticatory muscles and TMJ, Joint noise (clicking, popping, or crepitus), myofascial pain, and other functional limitations. Treatment must be started based on the proper diagnosis, and almost symptoms could be subsided by reversible options. Minimally invasive options and open arthroplasty are also available following reversible treatment when indicated.TMD manifesting in a variety of symptoms, also can apply abnormal stress to mandibular condyles and affect its growth pattern of mandible. Thus, adaptive developmental changes on mandibular condyles and post-developmental degenerative changes of mandibular condyles can create alteration on facial skeleton and occlusion. The changes of facial skeleton in DFD patients following OGS have an impact on TMJ, masticatory musculature, and surrounding soft tissues, and the changes of TMJ symptoms. Maxillofacial surgeons must remind that any surgical procedures involving mandibular osteotomy can directly affect TMJ symptoms, thus pre-existing TMJ symptoms and diagnoses should be considered prior to treatment planning and OGS.