Multidirectional lip‐closing force in adults with mandibular deviation

The purpose of this study was to investigate the relationship between multidi‐rectional lip‐closing force and facial soft tissue morphology in adults with mandibular deviation. Fifteen Japanese adults with mandibular deviation participated in this study. The deviation value was defined as the horizontal distance between soft tissue menton and the facial midline. The side of the soft tissue menton relative to the facial midline was defined as the deviated side and the opposite side as the non‐deviated side. The signals of directional lip‐closing force (DLCF) were investigated in 8 directions. Total lip‐closing force (TLCF) was calculated by adding DLCFs in 8 directions. Correlations and differences between the variables were analysed statistically. Significant positive correlations between TLCF and DLCFs were determined in six directions with the exception of the horizontal direction. Significant positive correlations for seven pairs of opposing DLCFs were found. The lower non‐deviated DLCF was smaller than the three pairs of opposing lip‐closing forces. Negative significant correlation was found between the deviation value and the upper deviated DLCF (P < 0·05). In individuals with mandibular deviation, lip‐closing force in the lower non‐deviated direction was found to be smaller than the opposing lip‐closing forces. When mandibular deviation was greater, the upper deviated lip‐closing force was smaller.     

Treatment of a transmigrated and an impacted mandibular canine along with missing maxillary central incisor: A case report

IntroductionTreatment of a case with impacted canines is complex and numerous options are available ranging from disimpaction to forced eruption.ObjectiveThe objective of this case report was to describe the treatment of a 19-year-old male, with a skeletal Class II, dental Class II Division 1 malocclusion, prognathic maxilla, proclined maxillary incisors, with missing left maxillary central incisor and bilateral mandibular canine impaction.MethodologyThe orthodontic treatment plan included forced eruption of the impacted canines and conversion of maxillary left lateral incisor to central incisor.ConclusionProper diagnosis and implementation of orthodontic biomechanics can minimize the amount of prosthetic and surgical intervention needed in the management of transmigrated canine and smile designing.     

Articular soft tissue injuries associated with mandibular condyle fractures and the effects on oral function

The majority of studies debating the optimization of treatment for condylar mandibular fractures focus on the bony aspect first. However, fractures of the mandibular condyle may go together with soft tissue injury of the temporomandibular joint. An electronic literature search for this topic was undertaken. Assessment of quality was carried out using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Sixteen articles were included in this review. The reviewed literature showed that intracapsular fractures and dislocated condylar fractures result in more severe injuries. Serious injury to the disc and capsule of the temporomandibular joint is a contributing factor towards development of complications after closed treatment. The results of this review give an overview of the published studies focusing on articular soft tissue injuries caused by condylar mandibular fractures. Additionally, an overview of the magnetic resonance imaging (MRI) settings used to detect these injuries is provided. Until now, the relation between soft tissue injuries and type of condylar trauma and their influence on clinical outcome has been insufficiently investigated. Before considering reduction of soft tissues next to reduction of the fracture, more research is needed into the impact of soft tissue injuries on oral functioning, in which a uniform classification is used.     

Three-dimensional soft tissue effects of mandibular midline distraction and surgically assisted rapid maxillary expansion: an automatic stereophotogrammetry landmarking analysis

Studies on mandibular midline distraction (MMD) are mostly performed using conventional research methods. Concerning surgically assisted rapid maxillary expansion (SARME), more research is conducted using three-dimensional (3D) techniques. Research on bimaxillary expansion, the combination of MMD and SARME, is reported sparsely. The main objective of this study was to provide a 3D evaluation of soft tissue effects following SARME and/or MMD. Patients who underwent SARME and/or MMD between 2008 and 2013 were included. Stereophotogrammetry was undertaken at the following time points: preoperative (T1), immediately post-distraction (T2), 1 year postoperative (T3). An automatic 3D facial landmarking algorithm using two-dimensional Gabor wavelets was applied for the analysis. Twenty patients who had undergone SARME were included, 12 of whom had undergone bimaxillary expansion. Age at the time of surgery ranged from 16 to 47 years. There was a significant downward displacement of soft tissue pogonion. Furthermore, there was a significant mean increase of 2.20 mm in inter-alar width and a non-significant mean increase of 1.77 mm in inter-alar curvature point width. In conclusion, automatic stereophotogrammetry landmarking analysis of soft tissue effects showed downward displacement of soft tissue pogonion following bimaxillary expansion and transverse widening of the inter-alar width and a tendency towards an increase in inter-alar curvature point width after SARME.     

唇腭裂上颌骨发育畸形的早期牵引治疗

目的应用正畸上颌骨前牵引技术对唇腭裂患者在混合牙列早期出现的骨性反进行阻断治疗,研究上颌骨位置的变化情况。方法比较患者治疗前后的头影测量结果,将治疗后的结果与儿童头测量正常值比较,明确上颌骨位置的变化情况。结果治疗后上颌骨的位置前移变化有显著性（P＜0.01）,但与正常值之间也存在一些差异。结论后腭裂患者在混合牙列期,使用正畸方法进行上颌前牵引,可明显促进上颌骨发育.但单纯使用正崎尚不能完全矫正唇腭裂继发的颌骨畸形,必须采用综合治疗。     

牵引成骨术治疗唇腭裂继发颌骨畸形稳定性的研究进展

牵引成骨术（distraction osteogenesis,DO）在口腔颌面外科的应用越来越广,为唇腭裂继发颌骨畸形治疗提供了新的手段。DO按牵引类型主要分为内置式牵引（intraoral distraction osteogenesis, IDO）和外置式牵引（extraoral distraction osteogenesis, EDO）2种,在大距离前徙上颌骨时,唇腭裂牵引成骨术后的长期稳定性和复发的报道还很少。本文就牵引成骨治疗唇腭裂继发颌骨畸形术后的长期稳定性的临床研究进展作一综述。     

唇腭裂术后上颌骨发育不良骨牵引矫治的临床研究

目的:探讨口内入路牵引成骨技术在唇腭裂术后继发上颌骨发育不良患者成年之前矫治中的作用。方法:对12例9～12岁唇腭裂术后继发上颌骨明显发育不良者,采用高位LeFortI型截骨术,将上颌骨完全断离,安装口内牵引器,按一定的速度和频率牵引上颌骨向前,对术前、术后头颅定位X线侧位片进行颅颌面软硬组织的测量分析,数据以SPSS10.0统计软件包进行t检验。结果:本组病例上颌骨牵引前移明显,SNA角增加7°～11°,软组织鼻尖点、鼻底点及上唇最突点明显前移,面部外形得到明显改善,上下前牙获得正常覆牙合、覆盖关系。随访3～36个月,咬合关系保持稳定。结论:骨牵引成骨技术可以很好地用于矫治唇腭裂术后继发上颌骨发育不良,早期解除上颌骨畸形,使面部软组织得到适应性改变,面型更为协调,避免或减轻口颌系统继发畸形和功能障碍,不失为唇腭裂术后继发上颌骨发育不良的有效治疗方法。     

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目的    探讨口内入路牵引成骨术配合语音治疗对唇腭裂术后继发上颌骨发育不良患者的治疗效果。方法    对2007—2009年在南昌大学口腔医院接受治疗的9 ~ 12岁唇腭裂术后继发上颌骨发育不良畸形患者21例采用高位Le Fort I型截骨术,将上颌骨完全断离,安装口内牵引器,术后3个月开始语音训练,定期接受发音指导和语音测评,记录结果并进行统计分析。结果    21例患者手术效果满意,未见严重并发症,通过语音治疗,发音改善明显。结论    骨牵引成骨术用于矫治唇腭裂术后继发上颌骨发育不良,可早期解除上颌骨畸形,在一定程度上改善患者的腭咽闭合功能,再配合语音治疗可有效提高语音效果。     

上颌骨前牵引器与正畸联合治疗单侧唇腭裂的评价

目的:对单侧完全性唇腭裂伴上颌骨发育不足的患者,进行面罩式上颌骨前牵引加正畸治疗,探讨其对颌骨发育的影响。方法:14例患者在治疗前、上颌前牵引后及正畸治疗后分别摄X线头颅侧位定位片,通过9个测量指标数据进行治疗前后的比较分析。数据资料用SPSS10.0软件作统计学处理,治疗前后比较用t检验,以确定上颌前牵引及正畸联合治疗对上下颌骨的影响。结果:本组患者经上颌骨前牵引器牵引加后期正畸治疗,获得满意的效果。切牙覆盖达2mm,咬合关系较稳定;侧面呈直面型。SNA角增加,有高度显著性差异,P<0.001。SNB及下颌平面角SN-MP无变化,P>0.05;颌凸角的差值有显著改变(P<0.001)。结论:单侧完全性唇腭裂伴上颌骨发育不足的患者进行整形加正畸治疗,能促进上颌骨的发育,下颌骨未见显著的变化;通过上颌前牙轴倾度增大,下颌前牙轴倾度变小以及舌代偿,上颌前牙前移,覆牙合覆盖改善。这些改变反应在侧貌上,表现为上颌突度增加,上唇变丰满,凹面形变直面形,上下颌协调。     

The mandibular symphysis as a starting point for the occlusal-level reconstruction of panfacial fractures with bicondylar fractures and interruption of the maxillary and mandibular arches: Report of two cases

Panfacial fractures represent a challenge, even for experienced maxillofacial surgeons, because all references for reconstructing the facial skeleton are missing. Logical reconstructive sequencing based on a clear understanding of the correlation between projection and the widths and lengths of facial subunits should enable the surgeon to achieve correct realignment of the bony framework of the face and to prevent late deformity and functional impairment. Reconstruction is particularly challenging in patients presenting with concomitant fractures at the Le Fort I level and affecting the palate, condyles, and mandibular symphysis. In cases without bony loss and sufficient dentition, we believe that accurate fixation of the mandibular symphysis can represent the starting point of a reconstructive sequence that allows successful reconstruction at the Le Fort I level. Two patients were treated in our department by reconstruction starting in the occlusal area through repair of the mandibular symphysis. Both patients considered the postoperative facial shape and profile to be satisfactory and comparable to the pre-injury situation.     

Special distraction osteogenesis before bone grafting for alveolar cleft defects to correct maxillary deformities in patients with bilateral cleft lips and palates: Distraction osteogenesis performed separately for each bone segment

IntroductionPatients with bilateral cleft lips and palates have premaxillary protrusion and characteristic jaw deformities involving three-dimensional malposition of the premaxilla and bilateral maxillary bone segments. This study examined patients with bilateral cleft lips and palates who had deviation and hypoplasia of the premaxillas and bilateral maxillary segments. Before bone grafting, the patients were treated with special distraction performed separately for each bone segment using a halo-type external device. This report describes this novel treatment method which produced good results.Material and methodsThe subjects were five patients with severe jaw deformities due to bilateral cleft lip and palate. They were treated with maxillary Le Fort I osteotomy and subsequent distraction performed separately for each bone segment using a halo device. In three of five patients, premaxillary osteotomy was not performed, and osteotomy and distraction were performed only for the right and left lateral segments with severe hypoplasia.ResultsAll patients achieved distraction close to the desired amount. The widths of the alveolar clefts were narrowed, and satisfactory occlusion and maxillary arch form were achieved. After the surgery, three of five patients underwent bone grafting for bilateral alveolar cleft defects and the bone graft survival was satisfactory.ConclusionsThis method had many benefits, including narrowing of alveolar clefts, improvement of maxillary hypoplasia, and achievement of a good maxillary arch form. In addition, subsequent bone grafting for alveolar cleft defects was beneficial, dental prostheses were unnecessary, and frequency of surgery and surgical invasiveness were reduced. This method is a good surgical procedure that should be considered for patients with bilateral cleft lips and palates who have premaxillary protrusion and hypoplasia of the right and left lateral segments.     

Hybrid mandibular Bologna midline distractor in combination with surgically assisted rapid maxillary expansion for transverse facial expansion: clinical and cephalometric results

Transverse maxillomandibular hypoplasia can be treated with surgically assisted rapid maxillary expansion (SARME) in association with mandibular symphyseal distraction (MSD). This paper introduces a hybrid mandibular Bologna midline distractor (BMD); the effectiveness of the distractor in combination with SARME for the treatment of transverse skeletal deficiency was evaluated. This two-centre study included 10 patients with a transverse arch width deficit>7 mm and dental crowding, in both the maxilla and mandible, treated with SARME and MSD. The study design was partly retrospective (seven patients) and partly prospective (three patients). Frontal and lateral cephalometric analyses, as well as measurements on dental models, were performed at three different times: before treatment, after the distraction, and 6 months after postoperative orthodontic treatment. The cephalometric analyses and measurements on dental impressions confirmed a balanced and stable skeletal and dental mandibular expansion. An average symphyseal expansion of 7.8 mm was obtained, resolving dental crowding without dental extractions. In conclusion, mandibular expansion performed with the BMD in combination with SARME appears to be a viable surgical approach to transverse maxillomandibular hypoplasia. This technique allows the surgeon to obtain a balanced skeletal and dental expansion, with a low level of relapse.