Arthroscopic discopexy technique with anchors for treatment of temporomandibular joint internal derangement: Clinical and magnetic resonance imaging evaluation

PurposeThe objective of this study was to describe a technique of arthroscopic discopexy with anchors used to treat temporomandibular joint internal derangement.Materials and methodsThis study involved patients with unilateral temporomandibular dysfunction refractory to conservative treatment, and whose magnetic resonance imaging (MRI) examinations showed internal derangement of the temporomandibular disc, with anterior disc displacement. Maximal interincisal opening (MIO), joint pain, joint noise, and disc position were the variables assessed by clinical examination and MRI before and 6 months after the surgery.ResultsThe sample consisted of 20 patients. In the postoperative evaluation, MIO had increased from 33.8 ± 4.83 mm to 35.1 ± 4.08 mm (p = 0.04), while joint pain had decreased from 7.5 ± 1.42 points to 2.05 ± 1.47 points (p = 0.001). With regard to joint noise, 19 of the patients had presented with clicking or crepitation but after 6 months these were completely absent. Disc repositioning was complete in 15 of the patients and partial in the other five.ConclusionThe technique of arthroscopic discopexy with anchors was shown to be effective in treating temporomandibular internal derangement, with good clinical results.     

Morphometric analysis of temporomandibular joint elements

Purpose

To study the morphology of temporomandibular joint (TMJ) elements and examine the feasibility of a novel biofidelic articular disc casting technique.

Three-dimensional attachment morphometry and volumetric changes of masticatory muscles after free fibular flap reconstruction of the mandibular condyle

This retrospective case-series study aimed to elucidate the three-dimensional attachment morphometric features and to quantify the volumetric changes of the masticatory muscles following free fibular flap reconstruction of the mandibular condyle. Navigation software (iPlan, version 3.0; Brainlab) was used to perform delineation and volumetric measurement of the masticatory muscles using DICOM data.In total, 30 patients were included in this retrospective case series. In 25 cases (83.33%), the lateral pterygoid muscle achieved reattachment within 6 months postoperatively. The medial pterygoid muscles on the affected side achieved ectopic attachment in all cases. However, masseter reattachment on the affected side was achieved in only three cases. On the normal side, the volumes of lateral pterygoid muscle, medial pterygoid muscle, and masseter had recovered to almost preoperative levels at 1 year postoperatively. On the affected side, the volume of medial pterygoid muscle had decreased significantly (p = 2.4e-04) at 3 months postoperatively. The volumes of lateral pterygoid muscle and masseter showed mild decreases at 3 months postoperatively, but these were not significant (p = 0.52 and p = 0.05 for the pterygoid muscle and masseter, respectively). At 6 months after surgery, with the exception of the volume of the lateral pterygoid muscle (p = 0.06), the total volume of the masticatory muscles decreased significantly on the affected side. The volumes of lateral pterygoid muscle, medial pterygoid muscle, and masseter showed significant decreases at 1 year postoperatively (p = 0.03, p = 4.7e-08, and p = 1.1e-05, respectively) on the affected side. The postoperative volumes of the masseter, medial pterygoid, and lateral pterygoid muscles showed significant decreases due to the loss of reattachment.The results of this study may not help to ascertain whether reattachment of masticatory muscles will lead to better function. As a consequence, clinical trials of higher quality are needed.     

Therapy of antigen-induced arthritis of the temporomandibular joint via platelet-rich plasma injections in domestic pigs

The aim of this animal study was to investigate the effect of platelet-rich plasma (PRP) injections into the temporomandibular joint (TMJ) to treat antigen-induced arthritis AIA.AIA was induced via the application of bovine serum albumin (BSA) into the TMJ. Clear histological signs and protein analysis results indicating inflammation of the TMJ were observed. Afterwards, two PRP injections were performed over an interval of 2 weeks.Concentration levels of the proinflammatory cytokines IL-1β (PRP: 33.7 ± 5.6 pg/mg, untreated: 50.0 ± 2.9 pg/mg; p = 0.04) and TNF-α (PRP: 20.7 ± 2.5 pg/mg, untreated: 31.4 ± 2.7 pg/mg; p = 0.03) were significantly decreased in the PRP-treated joints. A significant reduction in signs of histological inflammation, such as hyperplasia of the synovial membrane, leucocyte infiltration, cartilage surface alterations, and an increase in cartilage-specific glycosaminoglycan content, was observed.This animal study supports the understanding of the underlying effects of PRP treatment in the TMJ, and may enhance novel PRP therapies in the future.     

Evaluating the remodeling of condyles reconstructed by transport distraction osteogenesis in the treatment of temporomandibular joint ankylosis

PurposeThis study aimed to evaluate the remodeling of condyles reconstructed by transport distraction osteogenesis (DO) in patients with temporomandibular joint (TMJ) ankylosis.Patients and methodsTwenty-one patients with 26 affected joints were followed up for 34.1 ± 13.3 months. Patients who had undergone gap arthroplasty and TMJ reconstruction by DO were included. Maximal mouth opening (MMO) and occlusion were recorded. Computed tomography images were obtained preoperatively (T0), upon completing distraction (T1), upon removal of the distraction device (T2), and >2 years postoperatively (T3). The following were measured: mandibular ramus height, distance between gonion and Frankfurt plane (Go–FN), condylar width, and condyle–ramus angulation.ResultsOf the 21 patients, one showed re-ankylosis, while five exhibited anterior open bite. From T1 to T3, the total amount of resorption of ramus height reached up to 8.2 ± 4.6 mm (p < 0.001), in comparison with a total distraction length of 13.8 ± 4.1 mm; the mean resorption rate was 59.4%. Similarly, Go–FN decreased by 6.2 ± 4.0 mm (p < 0.001).ConclusionOur findings indicated that DO combined with gap arthroplasty was an effective method for the treatment of TMJ ankylosis to improve MMO. The reconstructed condyle exhibited a high frequency of resorption in height.     

Clinical investigation of botulinum toxin (prabotulinumtoxin A) for bruxism related to masseter muscle hypertrophy: A prospective study

This study aims to confirm the effectiveness and safety of a prabotulinumtoxin type A (praBTX-A) injection in patients with bruxism and masseter hypertrophy.The study included patients who ground or clenched their teeth while sleeping and had computed tomography (CT) scans that showed a maximum thickness of the masseter muscle of 15 mm or more. The praBTX-A was administered bilaterally into the masseter muscles; 15 U/side for group 1, 25 U/side for group 2, and 35 U/side for group 3. CT scans and bruxism questionnaires were conducted before and eight weeks after the injection.Thirty-seven patients were enrolled, but three dropped out due to loss of follow-up. After injection, masseter thickness decreased to 15.1 ± 2.0 mm for group 1, 14.3 ± 2.9 mm for group 2, and 13.4 ± 1.8 mm for group 3 (p = 0.043). Group 3 showed a statistically significant lower masseter thickness compared to group 1 (p = 0.039). Both subjective and objective frequencies of bruxism decreased for all groups, but there were no significant differences in either subjective (p = 0.396) or objective frequencies (p = 0.87) between the groups after the injection.The results of this study suggest that praBTX-A injection is a safe and effective treatment for bruxism and masseter hypertrophy. A dosage of 35 IU/side can effectively decrease masseter thickness and relieve bruxism symptoms. Even the minimum dosage of 15 IU/side can contribute to improvements in bruxism symptoms. This investigation provides valuable information for managing bruxism that is associated with hypertrophic masseter muscles.     

Posterior bending osteotomy: An effective measure to secure facial symmetry in orthognathic surgery

This study aimed to compare the effectiveness of posterior bending osteotomy and grinding techniques for orthognathic surgery in patients with facial asymmetry. Patients who had undergone Le Fort I osteotomy and bilateral sagittal split ramus osteotomy, and who presented with a menton shift and setback difference exceeding 4 mm, were enrolled. Cone-beam computed tomography was performed before surgery (T0), immediately after surgery (T1), and 6 months after surgery (T2). Overall, 38 patients were included and divided into posterior bending osteotomy (n = 23) and grinding (n = 15) groups.Significant differences were observed between the posterior bending osteotomy and grinding groups on the treated side. In the grinding group, the gonion on the treated side was displaced slightly outward, resulting in a significant difference between both sides (non-treated side: 50.52 ± 4.20 [T0] and 48.67 ± 4.37 [T2]; treated side: 50.88 ± 4.55 [T0] and 51.00 ± 3.95 [T2]; p = 0.038). In the posterior bending osteotomy group, bilateral inward movements of the gonion were observed, and the distance from the midsagittal plane to the gonion did not differ significantly between the sides (non-treated side: 46.74 ± 4.41 [T0] and 45.54 ± 3.95 [T2]; treated side: 47.43 ± 4.93 [T0] and 45.18 ± 3.52 [T2]; p = 0.224). The yawing movement of the proximal segment was greater in the grinding group than in the posterior bending osteotomy group (non-treated side: p = 0.839; treated side: p = 0.025).Posterior bending osteotomy is recommended over the grinding method for patients with severe facial asymmetry, in order to ensure a symmetric and esthetic facial profile by allowing passive adaptation between the mandibular segments.     

Clinical course of masticatory function recovery following arthrocentesis in patients with unilateral mandibular condyle head fracture

The aim of this study was to investigate the clinical course of masticatory function recovery following arthrocentesis. Patients with a unilateral condylar head fracture who underwent arthrocentesis for therapeutic reasons were evaluated and compared with patients with a unilateral condylar head fracture who did not undergo arthrocentesis. At 3 months after treatment, the occlusal contact area and maximum bite force in patients with a fracture treated with arthrocentesis were greater than in those who did not receive arthrocentesis at the same time points, although the differences were not significant. Moreover, at 1 and 3 months following arthrocentesis, mean (±SD) occlusal contact area (1 month: 1.99 ± 0.55 mm², p = 0.01; 3 months: 2.90 ± 1.36 mm², p = 0.03) and maximum bite force (1 month: 82.45 ± 15.04 N, p = 0.01; 3 months: 101.11 ± 14.53 N, p = 0.01) on the fractured side in patients who underwent that treatment were significantly reduced when compared with those on the non-fractured side. The authors conclude that if the priority is to avoid open reduction and internal fixation, then the arthrocentesis approach might be a less invasive alternative, albeit with the price of a prolonged healing interval.     

Masseter-facial neurorrhaphy for facial palsy reanimation: What happens after masseter denervation? Histomorphometric and stomatognathic functional analysis

The aim of the present study was to analyse the consequences of masseter muscle denervation. In facial palsy surgical treatment, the masseteric nerve constitutes an important nerve source for facial reanimation due to its anatomical position and large amount of available axons.Computed tomography and/or magnetic resonance imaging were performed in 30 control subjects, and three radiologists separately measured the longitudinal diameter (LD), anteroposterior diameter (APD), transverse diameter (TD), and skeletal muscle area (SMA) of the masseter muscles as reference values. Regarding the facial palsy group, from 2009 to 2018, 11 patients (4 men and 7 women) were selected on the following inclusion criteria: diagnosis of unilateral facial paralysis, minimum follow-up of 14 months, absence of temporomandibular dysfunction, presence of complete dentition (to minimise bias of stomatognathic evaluation), complete clinical and radiological records. The mean LD, APD, TD, and SMA values of the healthy and denervated masseter muscles were obtained and compared. Stomatognathic function was clinically examined through mean mouth opening (MMO) and Maximum Bite Force (MBF). Furthermore, facial symmetry analysis (FSA) was carried out using EMOTRICS Software.Reference values obtained were as follows: mean LD = 69 ± 5.9 mm (range: 59–85 mm); mean APD = 40.2 ± 3.3 mm (range: 34–48 mm); mean TD = 15.5 ± 3.1 mm (range: 11–26 mm); and mean SMA = 43.8 ± 13.5 mm³ (range: 26–85.8 mm³). No statistically significant difference was observed between the healthy facial palsy groups's masseter muscles and reference values. As the latter, in denervated masseter muscles, no statistically significant difference was observed for APD value in contrast to LD, TD and SMA that showed statistically significant difference in comparison with control population (p < 0.05, CI 95%). Moreover fibro-adipose degeneration was consistently observed, with its degree being directly proportional to the denervation time. MMO and MBF mean values were, respectively, 54.75 mm in men, 44.4 mm in women and 705N.None of the latter showed a statistically significant difference with respect to the control population and the parameters present in the literature, indicating that masseter-facial neurorrhaphy is a safe and effective procedure for facial reanimation with good functional and aesthetic outcomes.     

Efficacy of tissue engineered bone grafts containing mesenchymal stromal cells for cleft alveolar osteoplasty in a rat model

The development of sufficient tissue engineered bone grafts for alveolar cleft osteoplasty could reduce the necessity of autogenous bone grafts and its donor site morbidity. The aim of the study was to evaluate tissue engineered bone grafts in an artificially created bone defect.Bone grafts were created in vitro colonizing a synthetic hydroxyapatite–tricalciumphosphate scaffold (BONITmatrix^®) with either undifferentiated mesenchymal stromal cells (group 1) or osteogenic differentiated mesenchymal stromal cells (group 2). Cells were multiplied from bone marrow of donor rats. Unmodified scaffolds (group 3) and the tissue engineered bone grafts were inserted into artificial maxillary defects of 54 Lewis rats. In 18 animals the defects remained unfilled (control). After one, three and six weeks the rats were sacrificed. The defect was evaluated radiologically and histologically with regard to the remaining defect volume and diameter. Statistical analysis followed.The bone grafts led to a specific bone formation at the defect margin. No complete reunion of any defect was observed within the healing time. After six weeks, the remaining defect volume was 6.86 ± 3.21 mm³ (control), 4.08 ± 1.36 mm³ (group 1), 5.00 ± 0.84 mm³ (group 2) 5.50 ± 1.05 mm³ (group 3). The remaining defect diameter measured 2.63 ± 0.52 mm (control), 2.39 ± 0.23 mm (group 1), 2.53 ± 0.22 mm (group 2) and 2.70 ± 0.66 mm (group 3). In all experimental groups the defect volume and diameter decreased over time, which was significant for group 1 (p = 0.014), group 2 (p = 0.025) and group 3 (p = 0.048). The defect volume and width was significantly reduced for bone grafts containing undifferentiated cells compared to control (p = 0.035) or scaffolds only (p = 0.05).ConclusionTissue engineered bone grafts induce a pronounced bone formation in artificial bone defects compared to unfilled controls or scaffolds only.     

A systematic review and meta-analysis of randomized controlled trials comparing arthrocentesis with conservative management for painful temporomandibular joint disorder

The aim of this study was to determine whether arthrocentesis is superior to conservative treatment in the management of painful temporomandibular joint disorders with restricted opening. A systematic review was undertaken of prospective randomized controlled trials (RCT) comparing arthrocentesis to conservative management, identified in the MEDLINE and PubMed databases. Inclusion criteria included a 6-month follow-up, with clinical assessment of the patients and painful restricted mouth opening. Data extracted included pain measured on a visual analogue scale and maximum mouth opening measured in millimetres. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2 for RCTs, and a meta-analysis with the random-effects model was undertaken. Of 879 records retrieved, seven met the inclusion criteria; these RCTs reported the results at 6 months for 448 patients. One study had a low risk of bias, four studies had an uncertain risk, and two had a high risk of bias. In the meta-analysis, arthrocentesis was statistically superior to conservative management at 6 months for an increase in maximum mouth opening (1.12 mm, 95% confidence interval 0.45–1.78 mm; P = 0.001; I² = 87%) and borderline superior for pain reduction (−1.09 cm, 95% confidence interval −2.19 to 0.01 cm; P = 0.05; I² = 100%). However, these differences are unlikely to be clinically relevant.     

Temporomandibular dysfunction post-craniotomy: Evaluation between pre- and post-operative status

ObjectiveTo identify risk factors associated with post-operative temporomandibular joint dysfunction after craniotomy.MethodsThe study sample included 24 patients, mean age of 37.3 ± 10 years; eligible for surgery for refractory epilepsy, evaluated according to RDC/TMD before and after surgery. The primary predictor was the time after the surgery. The primary outcome variable was maximal mouth opening. Other outcome variables were: disc displacement, bruxism, TMJ sound, TMJ pain, and pain associated to mandibular movements. Data analyses were performed using bivariate and multiple regression methods.ResultsThe maximal mouth opening was significantly reduced after surgery in all patients (p = 0.03). In the multiple regression model, time of evaluation and pre-operative bruxism were significantly (p < .05) associated with an increased risk for TMD post-surgery.ConclusionA significant correlation between surgery follow-up time and maximal opening mouth was found. Pre-operative bruxism was associated with increased risk for temporomandibular joint dysfunction after craniotomy.     

Mandibular resection and defect reconstruction guided by a contour registration-based augmented reality system: A preclinical trial

The aim of this study was to verify the feasibility and accuracy of a contour registration-based augmented reality (AR) system in jaw surgery.An AR system was developed to display the interaction between virtual planning and images of the surgical site in real time. Several trials were performed with the guidance of the AR system and the surgical guide. The postoperative cone beam CT (CBCT) data were matched with the preoperatively planned data to evaluate the accuracy of the system by comparing the deviations in distance and angle.All procedures were performed successfully. In nine model trials, distance and angular deviations for the mandible, reconstructed fibula, and fixation screws were 1.62 ± 0.38 mm, 1.86 ± 0.43 mm, 1.67 ± 0.70 mm, and 3.68 ± 0.71°, 5.48 ± 2.06°, 7.50 ± 1.39°, respectively. In twelve animal trials, results of the AR system were compared with the surgical guide. Distance deviations for the bilateral condylar outer poles were 0.93 ± 0.63 mm and 0.81 ± 0.30 mm, respectively (p = 0.68). Distance deviations for the bilateral mandibular posterior angles were 2.01 ± 2.49 mm and 2.89 ± 1.83 mm, respectively (p = 0.50). Distance and angular deviations for the mandible were 1.41 ± 0.61 mm, 1.21 ± 0.18 mm (p = 0.45), and 6.81 ± 2.21°, 6.11 ± 2.93° (p = 0.65), respectively. Distance and angular deviations for the reconstructed tibiofibular bones were 0.88 ± 0.22 mm, 0.84 ± 0.18 mm (p = 0.70), and 6.47 ± 3.03°, 6.90 ± 4.01° (p = 0.84), respectively.This study proposed a contour registration-based AR system to assist surgeons in intuitively observing the surgical plan intraoperatively. The trial results indicated that this system had similar accuracy to the surgical guide.     

Predictive factors in temporomandibular joint arthroscopy: a prospective cohort short-term outcome study

Improving the outcomes of surgical treatment of the temporomandibular joint (TMJ) is beneficial from a patient and health-economy perspective. Optimizing conditions for a successful result can be reached using validated, strict diagnostic criteria and by identifying patient-specific factors predicting the outcome. The aim of this study was to investigate possible predictive factors in TMJ arthroscopy. A prospective cohort study including 93 patients undergoing arthroscopy was conducted. The outcome was graded as successful (53%, n = 49), good (25%, n = 23), intermediate (20%, n = 19), or deteriorated (2%, n = 2) using a predefined set of objective and subjective outcome measures. The outcome was correlated with preoperative and perioperative variables and the diagnosis. Preoperative bilateral masticatory muscle tenderness on palpation was the only variable significantly correlated with a negative outcome in the adjusted regression analysis (odds ratio (OR) 2.56, P = 0.048). Low age (OR 1.03, P = 0.05) and bilateral joint surgery/operated side (OR 0.24, P = 0.05) were found to correlate with an unsuccessful outcome in the unadjusted analysis. Eighty-nine percent of the patients with osteoarthritis benefited from arthroscopy, while corresponding figures were 80% for disc displacement without reduction and 64% for chronic inflammatory arthritis. Preoperative bilateral masticatory tenderness might be a useful predictive factor suggesting the consideration of revised non-invasive therapy before surgery.     

Morphological changes of the human face after massive weight-loss due to bariatric surgery

The aim of this study was to evaluate the morphological changes in the face of obese patients during massive weight loss using a more reliable method than two dimensional photographs or tape measures. The faces of 23 patients were recorded prior to and six months after bariatric surgery. Distances between important anatomical landmarks of the face were calculated and the volume of the neck was compared. The distance between the Tragion and Subnasale (132.7 ± 6.804 mm to 131.5 ± 6.866 mm; p = 0.0003), and the distance between Tragion and Stomion became significantly longer 136.0 ± 8.016 mm to 134.3 ± 7.698 mm; p = 0.0031), while distances between the Tragion and Pogonion (150.2 ± 8.216 mm to 148.3 ± 8.383 mm; p < 0.0001), Tragion and Menton (152.3 ± 9.037 mm to 148.9 ± 9.623 mm; p < 0.0001), and Tragion and tip of the nose (144.9 ± 7.273 mm to 144.0 ± 7.416 mm; p = 0.0023) were significantly reduced. The mean volume loss of the neck was 75.218 ± 40.197 ml. No significant correlation was found between total weight loss and cervical volume loss (r = 0.3447; p = 0.1072). The morphological changes of the face after massive weight loss vary in different areas of the face. Patients and their attending physicians must be aware of the face's morphology change after massive weight loss in an extent that does not correlate with the total weight loss of the patient.     

Quantitative description of masseter muscle involvement in craniofacial microsomia

Masseter deficits are common in craniofacial microsomia (CFM), however studies on masseter muscle involvement are limited. The aim of this study was to describe the morphology and functional involvement of the masseter muscles quantitatively. Ninety-eight patients with CFM who underwent three-dimensional computed tomography and surface electromyography were included. The mean action potential during maximum voluntary contraction in the intercuspal position was recorded. Asymmetry of the compound muscle action potential (ACMAP) was calculated as an indicator of functional involvement. Differences between the affected and unaffected sides, the correlation between morphology and function, and the relationship between ACMAP and the OMENS-Plus classification were assessed by paired t-test, Pearson correlation analysis, and Spearman correlation analysis. The masseter muscle was absent on the affected side in 11 patients. In the remaining 87 patients, the mean volumes of the affected and unaffected masseters were 5.22 ± 2.47 cm³ and 9.62 ± 3.30 cm³, respectively, with mean action potentials of 41.40 ± 28.52 uV and 73.78 ± 45.90 uV, respectively. Both morphology and the function of the masseter showed moderate correlation with the OMENS ‘M’ classification. No significant correlation was found between ACMAP and the OMENS-Plus soft tissue grading. A masseter function classification is proposed: type I, ACMAP < 0.2; type II, ACMAP 0.20–0.34; type III, ACMAP 0.35–0.54; type IV, ACMAP ≥ 0.55. The masseter function classification may be a beneficial tool in patients with CFM.     

Three-dimensional development of the palate in bilateral orofacial cleft newborns 1 year after early neonatal cheiloplasty: Classic and geometric morphometric evaluation

ObjectivesThe aim of this study was to assess palatal growth in newborns with complete bilateral cleft lip and palate (cBCLP) and bilateral cleft lip and palate with tissue bridges (BCLP + B) 1 year after early neonatal cheiloplasty (ENC).Material and methodsThe methodology was based on classic and morphometric analysis of dental models of newborns with cBCLP or BCLP + B. These analyses included metric analysis, coherent point drift-dense correspondence analysis, superprojection methods, and multivariate statistics. Dental casts were observed in two age categories, which were compared with each other. The first cast was obtained from each patient before ENC (T0, 5 ± 5 days) and the second one prior to palatoplasty (T1, 12 ± 6 months).ResultsFifty-two dental models obtained from 26 newborns with cBCLP and BCLP + B were evaluated. The results showed that over the 12-month period, alveolar clefts were narrowed in both cleft types due to anterior growth combined with the formative effect of suturing. This was confirmed by decreases in the dimensions of the right (T0 9.93 ± 2.80 mm, T1 6.64 ± 2.43 mm; p ≤ 0.003) and left (T0 10.71 ± 4.13 mm, T1 6.69 ± 4.29 mm; p ≤ 0.003) alveolar clefts in cBCLP patients. Similar reductions in alveolar cleft widths occurred on the left side (T0 11.69 ± 4.75 mm, T1 4.34 ± 2.97 mm; p ≤ 0.001) of BCLP + B patients, while on the right side, which was connected by a combined tissue bridge, there was non-significant narrowing of the alveolar cleft (T0 1.61 ± 1.34 mm, T1 1.04 ± 0.70 mm; p = 0.120). The ENC did not restrict posterior palatal growth, meaning that intertuberosity width was extended in cBCLP (T0 32.80 ± 3.15 mm, T1 35.86 ± 2.80 mm; p ≤ 0.001) and in BCLP + B neonates (T0 34.01 ± 2.15 mm, T1 36.21 ± 2.14 mm; p ≤ 0.004). Width and length measurements in the observed groups showed growth tendencies equivalent to those in noncleft or LOP patients. Palatal variability was greater in neonatal cBCLP, but was reduced during the monitored period, approximating that for BCLP + B. Regions with the most notable palatal growth were located primarily at the premaxilla and at the anterior and partially posterior ends of the maxillary segments.ConclusionEarly neonatal cheiloplasty had no negative effect on palatal growth in any direction. There was no reduction in the length or width of the palate during the first year of life, nor was there narrowing of the dentoalveolar arch. The formative effect of the operated lip on the anterior part of the palate was confirmed. This, in combination with the favorable growth, lead to closure of the alveolar cleft.     

Accelerated cranial distraction protocol for one-piece fronto-orbital distraction osteogenesis without bandeau in patients with craniosynostosis

This study aimed to compare the bony relapse ratios of standard and accelerated distraction protocols (ADP) in one-piece fronto-orbital distraction osteogenesis (DO).Patients with unilateral or bilateral coronal synostoses who underwent one-piece fronto-orbital DO were included. The accelerated cranial distraction protocol included a 3-day latency period and a distraction rate of 1–2 mm/day, followed by a 4-week consolidation period. Intracranial volume was measured using computed tomography (CT) before the surgery, at the end of the consolidation period, and 1 year after the removal of distractors. The intracranial volume changes and relapse ratios were calculated.This study included 32 patients; of these, 16 were included in each of the ADP and standard protocol (SP) groups. The mean ages were 1.4 years and 1.6 years in the ADP and SP groups, respectively (p = 0.895). In the ADP and SP groups, the expanded volumes were 270.9 ± 90.3 cm³ and 284.6 ± 149.7 cm³ (p = 0.91) and the growth-corrected expanded volumes were 162.1 ± 67.5 cm³ and 177.1 ± 105.2 cm³, respectively (p = 0.867). The relapse and growth-corrected relapse ratios showed no significant differences between the two groups, suggesting similar stability between the two protocols. The relapse ratios were 7.1 ± 4.8% and 7.3 ± 5.0% (p = 0.91) and the growth-corrected relapse ratios were ?3.0 ± 3.3% and ?2.4 ± 2.7%, respectively (p = 0.498).Within the limitations of the study, it seems that the ADP can shorten the distraction period without compromising stability. This may contribute to resolving the disadvantages and highlighting the advantages of DO.     

CAD/CAM and conventional reconstruction of the mandibular condyle by fibula free flap: a clinical and radiological evaluation

The aim of this study was to analyse the radiological and clinical outcomes of condylar reconstruction by fibula free flap (FFF), comparing conventional freehand and CAD/CAM techniques. Fifteen patients (nine CAD/CAM, six freehand) who underwent condylar reconstruction with a FFF were reviewed retrospectively regarding pre- and postoperative computed tomography/cone beam computed tomography scans and clinical function. After surgery, all patients were free of temporomandibular joint pain. Mean postoperative mouth opening was 30.80 mm, with no significant difference between the freehand and CAD/CAM groups. In all patients, laterotrusion was decreased to the contralateral side (P = 0.002), with no difference between freehand and CAD/CAM, while the axis of mouth opening deviated to the side of surgery (P < 0.001). All patients showed significant radiological deviation of the fibular neocondyle in the laterocaudal direction (lateral: P = 0.015; caudal: P = 0.001), independent of the technique. In conclusion, reconstruction of the mandibular condyle by FFF provided favourable functional results in terms of mouth opening, reduction of pain, and mandibular excursions. Radiological deviation of the neocondyle and deviation of laterotrusion and mouth opening did not impair clinical function. CAD/CAM planning facilitated surgery, decreased the surgery time, and improved the fit of the neocondyle in the fossa.