The feasibility of using Patients Concerns Inventory (PCI) in managing Malaysian oral cancer patients

The feasibility of using the Patients Concerns Inventory (PCI) to identify oral cancer patient concerns during consultation in oral and maxillofacial specialist clinics in Malaysia was assessed. A cross-sectional study was conducted using a consecutive clinical sampling technique of all new and follow-up oral cancer patients. Surgeons and counter staff were also recruited. Two-thirds of patients were elderly, 63.9% female, 55.6% Indian, 63.9% of lower-level education, and half had the lowest level household income. Patient status was mostly post-treatment (87.5%) and most were at cancer stage III/IV (63.9%); 59.7% had surgery. Patients took an average 5.9 min (95% CI 5.1–6.7 min) to complete the PCI. Physical domain appeared highest (94.4%); social/family relationship issues (4.2%) were lowest. Significant associations included patient age–personal function (P = 0.02); patient education level–emotional status (P = 0.05) and social/family relationship issues (P = 0.04), and patient TNM staging–personal function (P = 0.03). The patients’ mean feasibility score for the PCI was 5.3 (95% CI 5.1–5.5) out of 6. Patients (93.1%) and surgeons (90%) found the PCI to be feasible. Only 57.1% of counter staff agreed on the use of the PCI during patient registration. Overall, the PCI was considered feasible, thus favouring its future use in routine oral cancer patient management.     

Burnout syndrome in oral and maxillofacial surgeons: a critical analysis

The aim of this study was to determine the prevalence of burnout syndrome among Brazilian oral and maxillofacial surgeons and its relationship with socio-demographic, clinical, and habit variables. The sample of this study comprised 116 surgeons. The syndrome was quantified using the Maslach Burnout Inventory (General Survey), which defines burnout as the triad of high emotional exhaustion, high depersonalization, and low personal accomplishment. The criteria of Grunfeld et al. were used to evaluate the presence of the syndrome (17.2%). No significant differences between the surgeons diagnosed with and without the syndrome were observed according to age (P = 0.804), sex (P = 0.197), marital status (P = 0.238), number of children (P = 0.336), years of professional experience (P = 0.102), patients attended per day (P = 0.735), hours worked per week (P = 0.350), use of alcohol (P = 0.148), sports practice (P = 0.243), hobbies (P = 0.161), or vacation period per year (P = 0.215). Significant differences occurred in the variables sex in the emotional exhaustion subscale (P = 0.002) and use or not of alcohol in the personal accomplishment subscale (P = 0.035). Burnout syndrome among Brazilian surgeons is average, showing a low personal accomplishment.     

Sinonasal melanoma: a systematic review of the prognostic factors

The objective was to evaluate the available published data on sinonasal melanoma and analyse its clinical features, treatment modalities, and prognostic factors. An electronic search was undertaken in March 2018 in multiple databases. Eligibility criteria included publications with sufficient clinical, histological, and immunohistochemical information to confirm the diagnosis. Seventy-three publications (439 cases) were included. The lesion was more prevalent in females than in males. There was a higher prevalence in the seventh and eighth decades of life. The lesions mainly presented as epistaxis and commonly involved the nasal cavity. Age (>67.6 years; P = 0.0012), primary location (middle turbinate; P = 0.0112), disease stage (advanced disease stage; P = 0.0026), treatment (radiotherapy; P = 0.0111), recurrence (recurrence presented; P = 0.0137), and distant metastasis (distant metastasis presented; P = 0.0011) were independently associated with a lower survival rate. Recurrence was significantly correlated with age (>67.6 years; P = 0.0021), sex (males tended to present a higher recurrence rate than females; P = 0.0051), disease stage (stages III and IV presented a higher recurrence rate than stages I and II; P = 0.0331), and histological type (amelanotic lesions presented a higher index of recurrence than melanotic lesions; P = 0.0095). In conclusion, sinonasal melanoma is a neoplasm with a poor prognosis, presenting a 30.69% possibility of survival after 5 years.     

Objective treatment outcome assessment of a completely customized lingual appliance: A retrospective study

ObjectiveTo assess the outcome quality of subjects treated with a completely customized lingual appliance (CCLA) in a postgraduate university program, using the ABO Objective Grading System (OGS), by testing the null-hypothesis of a significant proportion of post-treatment cases exceeding an adjusted ‘exam failure’ threshold value of OGS = 24.Materials and MethodsThis retrospective single-arm study included 66 consecutively debonded CCLA cases (m/f 19/47; mean age: 25.1 ± 9 years) treated at Hannover Medical School (MHH, Hannover, Germany). The discrepancy index (DI) was assessed on initial plaster casts. The OGS of the cast-radiograph evaluation was scored for both set-up and post-treatment casts, including the seven components of alignment/rotation, marginal ridges, buccolingual inclination, overjet, occlusal contacts, occlusal relationships and interproximal contacts, to parameterize differences between those.ResultsDI score distribution (≥ 20, < 20) was 25 (37.9%)/41 (62.1%) subjects. Mean initial DI was 17.3 ± 8.5. Mean set-up OGS was 10.4 ± 4.4 (min-max: 3–21), mean final OGS was 17.7 ± 5.9 (min-max: 7–33), and the difference 7.3 (post-treatment - set-up) was statistically significant (p < 0.0001; 95% CI [5.8, 8.7]). The null-hypothesis was rejected: A statistically significant proportion of the final casts (n = 58; 87.8%) scored below OGS = 24 by exact binomial test (P < 0.0001; 95% CI [77.5%, 94.6%]). The rate of a final OGS score < 24 was not significantly different (P = 0.98) between both DI (≥ 20, < 20) groups.ConclusionsThe outcome quality of the CCLA treatment in this postgraduate university setting was high and therefore sufficient for a vast majority of treated cases to pass the ABO-OGS clinical examination.     

Incidence of bleeding after minor oral surgery in patients on dual antiplatelet therapy: a systematic review and meta-analysis

Bleeding is a feared complication of minor oral surgery in patients on treatment with antiplatelet agents and there is no agreed strategy regarding the cessation or not of antiplatelet treatment. The aim of this systematic review was to evaluate bleeding with minor oral surgery in patients on dual antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT), or no antiplatelet therapy (no APT). The PubMed, Embase, Web of Science, and Cochrane Library databases were screened. Sixteen studies were included. DAPT was continued in all studies. The perioperative bleeding risk was significantly higher for DAPT than for SAPT (risk ratio (RR) 10.16, P =  0.010; risk difference (RD) 0.35, P =  0.269), but not higher compared to no APT (RR 6.50, P =  0.057; RD 0.19, P =  0.060). The postoperative bleeding risk was significantly elevated for DAPT compared to SAPT (RR 2.61, P =  0.010) and no APT (RR 3.63, P =  0.035), but only by 1% (RD 0.01, P =  0.103) and 1% (RD 0.01, P =  0.421), respectively. Clinically, this may be considered quite similar. Additionally, local haemostatic measures could control all reported bleeding and no lethal events occurred. Therefore, DAPT interruption is not advised before minor oral surgery.     

Efficiency of arthrocentesis treatment for different temporomandibular joint disorders

This study was performed to determine whether arthrocentesis therapy has different outcomes in three groups of patients with different temporomandibular disorders (TMDs). A clinical trial was conducted including 45 patients with 45 unilaterally affected joints divided into three groups (n = 15): osteoarthritis (OA), disc displacement with reduction (DDWR), and disc displacement without reduction (DDWoR). All patients underwent the same arthrocentesis treatment protocol. The outcome variables, including visual analogue scale evaluations and measurements of mandibular motion (in millimetres), were recorded at baseline and at 1 and 6 months postoperative. Inter-group assessments showed significant short-term differences in joint sounds (P = 0.016) and significant long-term differences in masticatory efficiency (P = 0.046) and protrusive movement (P = 0.048). The estimation of mean changes between baseline and long-term follow-up revealed significant differences in joint sounds (P < 0.001), disruption in daily activities (P = 0.002), maximum mouth opening (P = 0.008), and protrusive movement (P = 0.002) between the groups. Arthrocentesis therapy may be useful to improve clinical symptoms and range of mandibular movement in patients with all three types of TMD. However, the benefit of arthrocentesis may be greater for patients with DDWoR than for those in the other groups.     

Influence of tumour necrosis factor alpha on epithelial–mesenchymal transition of oral cancer cells in co-culture with mesenchymal stromal cells

Tumour progression in head and neck squamous cell carcinoma (HNSCC) is influenced by the surrounding stroma and inflammatory cytokines such as tumour necrosis factor alpha (TNF-α). The aim of this study was to test the hypothesis that TNF-α modulates the interactions of HNSCC cell line PCI-13 and bone marrow mesenchymal stromal cells (BMSCs) and influences markers of epithelial–mesenchymal transition (EMT). Following induction with TNF-α, mono- and co-cultures of BMSCs and the established HNSCC cell line PCI-13 were analyzed; protein expression of E-cadherin and vimentin and qRT-PCR expression of Snail, Twist, MMP14, vimentin, E-cadherin, and β-catenin were examined, and changes in cellular AKT signalling were analyzed. TNF-α induced a significant decrease in E-cadherin (64.5 ± 6.0%, P = 0.002) and vimentin (10.4 ± 3.5%, P = 0.04) protein expression in co-cultured PCI-13, while qRT-PCR showed a significant increase in β-catenin (BMSCs P < 0.0001; PCI-13 P = 0.0005) and Snail (BMSCs P = 0.009; PCI-13 P = 0.01). TNF-α also resulted in a down-regulation of AKT downstream targets S6 (38.7 ± 20.9%, P = 0.01), p70S6 (16.7 ± 12%, P = 0.05), RSK1 (23.6 ± 28.8%, P = 0.02), and mTOR (27.4 ± 17.5%, P = 0.004) in BMSC co-cultures. In summary, while reducing the expression of vimentin and AKT-signalling in PCI-13 and BMSC, respectively, TNF-α introduced an inflammatory-driven tumour–stroma transition, marked by an increased expression of markers of EMT.     

Indications and outcomes for 100 patients managed with a pectoralis major flap within a UK maxillofacial unit

There are few studies reporting the role of the pedicled pectoralis major (PPM) flap in modern maxillofacial practice. The outcomes of 100 patients (102 flaps) managed between 1996 and 2012 in a UK maxillofacial unit that preferentially practices free tissue reconstruction are reported. The majority (88.2%) of PPM flaps were for oral squamous cell carcinoma (SCC), stage IV (75.6%) disease, and there was substantial co-morbidity (47.0% American Society of Anesthesiologists 3 or 4). The PPM flap was the preferred reconstruction on 80.4% of occasions; 19.6% followed free flap failure. Over half of the patients (57%) had previously undergone major surgery and/or chemoradiotherapy. Ischaemic heart disease (P = 0.028), diabetes mellitus (P = 0.040), and methicillin-resistant Staphylococcus aureus (MRSA) infection (P = 0.013) were independently associated with flap loss (any degree). Free flap failure was independently associated with total (2.0%) and major (6.9%) partial flap loss (P = 0.044). Cancer-specific 5-year survival for stage IV primary SCC and salvage surgery improved in the second half (2005–2012) of the study period (22.2% vs. 79.8%, P = 0.002, and 0% vs. 55.7%, P = 0.064, respectively). There were also declines in recurrent disease (P = 0.008), MRSA (P < 0.001), and duration of admission (P = 0.014). The PPM flap retains a valuable role in the management of advanced disease combined with substantial co-morbidity, and following free flap failure.     

Effectiveness of nicotine patch for the control of pain,oedema, and trismus following third molar surgery: a randomized clinical trial

The aim of this study was to evaluate the effectiveness of a nicotine patch for the control of pain, oedema, and trismus following lower third molar surgery. A prospective, randomized, triple-blind, split-mouth trial was performed involving 20 patients who underwent two surgical procedures at different times. A patch containing 14 mg nicotine was used in the experimental group, whereas a patch without nicotine (placebo) was used in the control group. The nicotine patch was effective at controlling pain after 4 hours and 8 hours (P =  0.023 and P =  0.005, respectively). The nicotine patch also had a significant effect on the control of oedema at 24 hours (P =  0.002), 48 hours (P =  0.001), and 72 hours (P =  0.005) following the intervention. Postoperative mouth opening was significantly greater among the patients who received the nicotine patch after 72 hours and 7 days. The number of rescue analgesics required was lower (P =  0.026) and the level of satisfaction was significantly higher (P =  0.008) when the patch was used, although higher levels of nausea were found in the nicotine group (P =  0.031 at 30 minutes, P =  0.008 at 4 hours). The nicotine patch was effective at controlling pain, oedema, and trismus following third molar surgery.     

Locking versus non-locking plate fixation in the management of mandibular fractures: a meta-analysis

The aim of the present study was to test whether there is a significant difference in the clinical outcomes between locking and non-locking plate fixation in the management of mandibular fractures. An electronic search without time or language restrictions was undertaken in December 2013. Eligible studies were clinical human studies, either randomized or not. The search strategy identified 10 publications. The I² statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used for the random-effects model in the case of heterogeneity being detected, or the fixed-effects model in the case of heterogeneity not being detected. The estimates of an intervention were expressed as the risk ratio (RR) with 95% confidence interval. Eight studies were judged to be at high risk of bias, whereas two studies were considered at moderate risk of bias. There was no statistically significant effect on the outcome of postoperative infection (P = 0.17), malocclusion (P = 0.15), hardware failure (P = 0.77), hardware removal (P = 0.95), wound dehiscence (P = 0.98), or paraesthesia (P = 0.20) in favour of locking plate fixation. The test for overall effect showed that the difference between the procedures did not significantly affect the incidence of postoperative complications (P = 0.21), with RR 0.79 (95% CI 0.54–1.14).     

Nocturnal sleep architecture is altered by sleep bruxism

ObjectiveSleep is a complex behaviour phenomenon essential for physical and mental health and for the body to restore itself. It can be affected by structural alterations caused by sleep bruxism. The aim of this study was to verify the effects of sleep bruxism on the sleep architecture parameters proposed by the American Academy of Sleep Medicine.DesignThe sample comprised 90 individuals, between the ages of 18 and 45 years, divided into two groups: with sleep bruxism (n = 45) and without sleep bruxism (n = 45). The individuals were paired by age, gender and body mass index: a polysomnography was performed at night.ResultsStatistically significant differences were found between (P ≤ 0.05) individuals with sleep bruxism and individuals without sleep bruxism during total sleep time (P = 0.00), non-rapid eye movement (NREM) total sleep time (P = 0.03), NREM sleep time stage 3 (P = 0.03), NREM sleep latency (P = 0.05), sleep efficiency (P = 0.05), and index of microarousals (P = 0.04).ConclusionsSleep bruxism impairs the architecture of nocturnal sleep, interfering with total sleep time, NREM sleep latency, and sleep efficiency.     

Airway changes and prevalence of obstructive sleep apnoea after bimaxillary orthognathic surgery with large mandibular setback

This study used three-dimensional computed tomography and polysomnography to evaluate the effect of a large mandibular setback on the postoperative pharyngeal airway space and obstructive sleep apnoea (OSA). Twelve patients who underwent bimaxillary surgery for a mandibular setback movement of >9 mm were included in this study. Changes in the pharyngeal airway space and polysomnography parameters based on the surgical movements were analyzed. The median mandibular setback movement was 11.08 mm. The total pharyngeal, oropharyngeal, and hypopharyngeal volumes, and the retroglossal cross-sectional area were significantly decreased postoperatively (P = 0.006; P = 0.005; P = 0.012; P = 0.005, respectively). The apnoea–hypopnoea index (AHI) increased significantly after surgery (P = 0.021). There were significant positive correlations between the preoperative inferiorly located hyoid bone and both AHI and respiratory disturbance index (RDI) postoperative (P = 0.008 and P = 0.027) and between the postoperative inferiorly dislocated retropalatal level and both AHI and RDI postoperative (P = 0.002 and P = 0.014). Four patients (33.3%) developed new onset OSA postoperatively. Large mandibular setback movements significantly reduced the pharyngeal airway space in the setting of bimaxillary surgery (P = 0.006).     

Perioperative evaluation of glycaemic status in neck dissection: a retrospective analysis at a single hospital centre

Diabetes mellitus is generally considered a risk factor for impaired wound healing. This study aimed to evaluate the glycaemic status of patients undergoing neck dissection and describe its impact on postoperative outcomes, especially wound healing. A retrospective analysis was performed of the preoperative, intraoperative, and postoperative glycaemic data obtained from the medical charts of 60 adult patients who had undergone 64 neck dissections. Nine of the 64 procedures were performed in diabetic patients (14.1%). The average glucose values were: preoperative 5.99 ± 1.25 mmol/l, intraoperative 8.90 ± 2.62 mmol/l, and postoperative 10.01 ± 2.49 mmol/l. All registered preoperative hyperglycaemia cases (eight cases) were diabetic. Postoperative insulin therapy was done in 14 procedures (21.9%). Wound healing complications were found in five patients (7.8%); there was no wound infection. There was no association of wound healing complications with preoperative diabetic status (P = 1.000), preoperative glucose control (P = 1.000), preoperative (P = 0.469), intraoperative (P = 0.248), and postoperative (P = 0.158) glucose values, or with postoperative glucose control (P = 0.577). These data do not support the association of stress-induced hyperglycaemia or diabetes mellitus with postoperative wound healing problems in neck dissection.     

Identification of appropriate outcome indices in head and neck cancer and factors influencing them

Audit of early postoperative outcomes adjusted for patient case mix is still in its infancy in head and neck surgery. Nevertheless the role for audit of early postoperative outcomes is obvious. The primary outcome measure of this study was to identify factors that are associated with early mortality or morbidity after surgery for head and neck squamous cell carcinoma (HNSCC). The secondary outcome measure was to develop a pilot score that allows for risk-adjustment of outcome data to facilitate departmental audit. In this series the mortality rate was low (2.8%), in keeping with other published series. Complications, including those causing death, occurred after 38.1% of operations. Independent risk factors for mortality on logistic regression were shown to be previous HNSCC (P = 0.03), estimated blood loss (l) (P = 0.03), and extracapsular spread (P = 0.05). Age (P = 0.01), tracheostomy (P < 0.01), estimated blood loss (l) (P = 0.05), and duration of anaesthesia (P < 0.01) were independent predictors of complications. Models predicting for risk demonstrated good discrimination (area under the curve statistics) for mortality (0.86) and morbidity (0.81). These pilot scores need external validation and may herald a means of facilitating risk-adjustment in the audit of early outcomes, allowing meaningful comparison of surgeons and their units over time.     

Vertical bone augmentation and regular implants versus short implants in the vertically deficient posterior mandible: a systematic review and meta-analysis of randomized studies

The aim of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of short dental implants (≤7 mm) versus vertical bone augmentation followed by regular dental implants (>7 mm) in the deficient posterior mandible. In total, eight RCTs (six using interpositional sandwich grafting and two using a guided bone regeneration technique) were reported in 17 articles at different time points. In the meta-analysis of the sandwich group, the relative risk (RR) for implant loss at 1 year was in favour of short implants (RR 0.41, P = 0.02), while no significant difference was found at 3 years (RR 0.65, P = 0.43), 5 years (RR 1.08, P = 0.86), or 8 years (RR 1.53, P = 0.52). The risk of complications was in favour of short implants (RR 0.34, P = 0.0002), as was the mean difference in marginal bone resorption after 1 year (−0.09 mm, P = 0.17), 3 years (−0.32 mm, P < 0.00001), 5 years (−0.65 mm, P < 0.00001), and 8 years (−0.88, P < 0.00001). The mean residual osseointegration length of the implants was between 2.94 mm and 4.44 mm in the short implants group and between 7.97 mm and 8.62 mm in the regular implants group after 5 years. In conclusion, in the deficient atrophic posterior mandible, short implants and regular implants demonstrate comparable outcomes within the first 5 years. Patients who are fit for surgery should be informed about the risks and benefits of both options.     

Factors influencing relative speech intelligibility in patients with oral squamous cell carcinoma: a prospective study using automatic,computer-based speech analysis

Oral squamous cell carcinoma (OSCC) and its treatment impair speech intelligibility by alteration of the vocal tract. The aim of this study was to identify the factors of oral cancer treatment that influence speech intelligibility by means of an automatic, standardized speech-recognition system. The study group comprised 71 patients (mean age 59.89, range 35–82 years) with OSCC ranging from stage T1 to T4 (TNM staging). Tumours were located on the tongue (n = 23), lower alveolar crest (n = 27), and floor of the mouth (n = 21). Reconstruction was conducted through local tissue plasty or microvascular transplants. Adjuvant radiotherapy was performed in 49 patients. Speech intelligibility was evaluated before, and at 3, 6, and 12 months after tumour resection, and compared to that of a healthy control group (n = 40). Postoperatively, significant influences on speech intelligibility were tumour localization (P = 0.010) and resection volume (P = 0.019). Additionally, adjuvant radiotherapy (P = 0.049) influenced intelligibility at 3 months after surgery. At 6 months after surgery, influences were resection volume (P = 0.028) and adjuvant radiotherapy (P = 0.034). The influence of tumour localization (P = 0.001) and adjuvant radiotherapy (P = 0.022) persisted after 12 months. Tumour localization, resection volume, and radiotherapy are crucial factors for speech intelligibility. Radiotherapy significantly impaired word recognition rate (WR) values with a progression of the impairment for up to 12 months after surgery.     

Resveratrol improves bone repair by modulation of bone morphogenetic proteins and osteopontin gene expression in rats

This study investigated the effect of resveratrol on bone healing and its influence on the gene expression of osteogenic markers. Two calvarial defects were created and one screw-shaped titanium implant was inserted in the tibia of rats that were assigned to daily administration of placebo (control group, n = 15) or 10 mg/kg of resveratrol (RESV group, n = 15) for 30 days. The animals were then sacrificed. One of the calvarial defects was processed for histomorphometric analysis and the tissue relative to the other was collected for mRNA quantification of bone morphogenetic protein (BMP)-2, BMP-7, osteopontin (OPN), bone sialoprotein (BSP), osteoprotegrin (OPG), and receptor activator of NF-κB ligand (RANKL). Implants were removed by applying a counter-torque force. Histomorphometric analysis revealed higher remaining defect in the calvarial defects of the control group than the RESV group (P = 0.026). Resveratrol increased the counter-torque values of implant removal when compared to control therapy (P = 0.031). Gene expression analysis showed a higher expression of BMP-2 (P = 0.011), BMP-7 (P = 0.049), and OPN (P = 0.002) genes in the RESV group than in the control group. In conclusion, resveratrol improved the repair of critical-sized bone defects and the biomechanical retention of implants. Indeed, this natural agent may up-regulate the gene expression of important osteogenic markers.     

Survival probability of zirconia-reinforced lithium silicate ceramic: Effect of surface condition and fatigue test load profile

ObjectivesThe present investigation evaluated the step stress accelerated test (SSALT) load profiles on the survival probability of a glass ceramic under two surface conditions (polished or roughened).MethodsSuprinity–ZLS blocks (Vita Zhanfabrik) were shaped into cylinders, cut in a sawing machine, and crystalized according to the manufacturer's instructions. 60 discs were obtained (Ø = 12 mm, thickness = 1.2 mm) and randomly assigned into two surface conditions: “p” polished surface (400–1200-grit SiC papers), and “r” roughened surface (200-grit SiC papers). Profilometry was performed in all discs to evaluate average surface roughness prior to flexural fatigue strength testing. 3 discs of each group were submitted to biaxial flexural strength in an universal testing machine (0.5 mm/min) and the mean load to failure (N) was calculated to determine SSALT profiles. 27 specimens per surface condition were assigned into three profiles – Mild (n = 9), Moderate (n = 9), and Aggressive (n = 9), and submitted to the fatigue test (60–320 N, 140,000 cycles at 1.4 Hz). The results were analyzed using the Kaplan-Meier and Wilcoxon tests (5%), 2-way ANOVA and Tukey test (α = 5%).ResultsKaplan-Meier and generalized Wilcoxon showed (P = 0.002) that polished groups showed higher survival probability than roughened condition (P < 0.05). A rough internal surface impacted deleteriously on the fatigue strength and reliability of ZLS ceramic. Both surface conditions were more sensitive to the aggressive profile than the other profiles, even worst for the roughened group. Regardless the load profile, 0% survival probability was observed at 384 MPa for polished condition. While for roughened, aggressive tested specimens did not survived 147 MPa followed by moderate at 312 MPa and mild at 384 MPa. The failure modes showed fracture marks originating from superficial grooves for both surface conditions.SignificancePolished specimens are sensitive to the load profile variation, confirming the effect of surface morphology on the fatigue results.     

Racial disparity of Crouzon syndrome in maxilla and mandible

The racial disparity of facial features in craniosynostosis patients is not fully understood. The aim of this study was to explore the difference in maxillary and mandibular morphology and spatial position in Asian and Caucasian Crouzon syndrome patients. Ninety-one computed tomography scans were included (12 Asian Crouzon syndrome patients, 22 Asian controls; 16 Caucasian Crouzon syndrome patients, 41 Caucasian controls) and measured using Materialise software. The maxillary and mandibular volumes of Asian patients were both reduced by 19% (P = 0.102 and P = 0.187), and those of Caucasian patients were reduced by 15% (P = 0.142) and 14% (P = 0.211) when compared to the respective race-specific controls. Maxilla length of Asian patients was reduced by 6.36 mm (14%, P = 0.003), while the reduction in Caucasian patients was 4.88 mm (10%, P = 0.038). ANS was retracted 11.99 mm (P < 0.001) in Asian patients and 11.54 mm (P < 0.001) in Caucasian patients. The ANB angle was narrowed by 13.17° (P < 0.001) in Asian patients compared to Asian controls, and by 7.02° (P < 0.001) in Caucasian patients compared to Caucasian controls. The retrusive midface profiles of Asian and Caucasian Crouzon syndrome look similar; both result from the combined effect of hypoplastic size and backward displacement. However, the insufficiency was found to be more a failure of the anteroposterior maxillary length in Asian patients, and more due to posterior maxillary positioning in Caucasian patients. Therefore, prognathism in Crouzon syndrome patients is more likely caused by displacement rather than elongation of mandibular length in both races. Crouzon syndrome results in the same extent of overall volume deficiency of the maxilla and mandible in these races.     

Nasomaxillary effects of miniscrew-assisted rapid palatal expansion and two surgically assisted rapid palatal expansion approaches

This retrospective study was performed to evaluate nasomaxillary changes in 36 patients at an advanced stage of skeletal maturity who underwent miniscrew-assisted rapid palatal expansion (MARPE) or surgically assisted rapid palatal expansion (SARPE) with/without an alar base cinch. Cone beam computed tomography images taken before and after expansion were analysed. Changes in the width of the dental arch (D66S, D66I), maxillary base (MxMol), and nasal floor and nasal cavity in the molar and canine regions (NaFMol, NaFCan, NaCMol, NaCCan) were compared, as well as changes in the choanal aperture (CA) and nasal soft tissue (NW). The MARPE technique produced smaller dental changes (D66S; P = 0.025) and greater nasomaxillary expansion (MxMol, P = 0.010; NaCMol, P = 0.016; NaCCan, P = 0.017; NaFMol, P = 0.001; CA, P = 0.002) than both SARPE techniques. Changes in NW did not differ significantly between the groups (P = 0.200). MARPE uniformly increased the anterior and posterior widths of the nasal cavity. SARPE expanded the nasal cavity in a ‘V-shape’ pattern. Changes in the nasal cavity and choanal aperture related to the amount of dental arch expansion were greater for MARPE than for SARPE. All three approaches increased the width of the nasal soft tissue, although the cinch in SARPE limited this increase.