The stability of bilateral sagittal ramus osteotomy and vertical ramus osteotomy after bimaxillary correction of class III malocclusion

Introduction

The purpose of this retrospective cephalometric study was to compare the stability of bilateral sagittal split osteotomy (BSSO) with extra-oral vertical ramus osteotomy (VRO) after correction of class III malocclusion by means of bimaxillary orthognathic surgery.

Methods

The sample comprised 51 consecutively treated patients, 38 females and 13 males, with a mean age of 19.1 years. All had a one-piece Le Fort I osteotomy with maxillary advancement and mandibular setback. VRO was performed in 30 cases, and BSSO was performed in 21 cases. Lateral cephalograms were obtained before surgery, within 1 week of surgery and 1 year after surgery.

Results

The mean forward movement of the maxilla was 5.6 mm in both groups (p < 0.001). The mean horizontal surgical change in the VRO group was 4.4 mm (p < 0.001), and in the BSSO group it was 5.4 mm (p < 0.001). In the VRO group, the horizontal relapse was 1.2 mm (p < 0.001), and in the BSSO group, it was 1.4 mm (p < 0.001).

Conclusion

There was no difference in the stability between the BSSO and VRO groups. The average relapse in the whole sample was 26% of the surgical movement.     

A prospective study on the clinical effectiveness of the stainless steel crown Herbst appliance

ObjectivesTo evaluate the clinical performance of the stainless steel crown Herbst (cHerbst) used as a single appliance for a single phase therapy.Materials and methodsA total of 180 consecutive Class II patients were treated with cHerbst for one year and followed up one year after the end of treatment.ResultsClass I relationship was achieved in all 175 patients who finished the functional phase of treatment, 58 patients continued treatment with fixed appliances while 21 patients (12%) showed relapse. Seventy two patients (41.1%) obtained and maintained stable Class I relationship one year after treatment with the cHerbst appliance used as a single appliance. Altogether 46 episodes of appliance breakages were observed and most of them could be repaired at the chair side. Patients’ questionnaire revealed that in general the appliance was easy to tolerate and did not cause esthetic or functional problems.ConclusionsThe crown Herbst appliance is a viable therapeutical option in patients with Class II malocclusions and it is characterized by low complication rate along with good patient compliance.     

Umschriebene Dysplasien des Temporallappens bei psychomotorischer Epilepsie

Zusammenfassung Klinisch-pathologischer Bericht über 2 Fälle mit symptomatischer Schlaf-Grand-mal und psychomotorischer Epilepsie bei umschriebener Mißbildung des Temporallappens.Im Fall 1 fand sich, bei elektrencephalographisch nachgewiesenem temporolateralem Herdbefund, eine umschriebene gliös-neuronale Dysplasie der 2. Temporalwindung links, gekennzeichnet durch eine Verwerfung der Rindenschichtung, durch diffus über die Schichten 3–6 verteilte Riesenganglienzellen und durch eine korrespondierende Markabblassung mit dort angereicherten Monstregliazellen. Bei fehlender Wachstumstendenz wurde der Herd als umschriebene Hamartie gedeutet und von der tuberösen Hirnsklerose abgegrenzt.Die zweite Beobachtung mit einer 28jährigen Anfallsvorgeschichte, einer hochgradigen hirnorganischen Wesensveränderung und elektrencephalographisch mit einer rechtsbetonten bitemporalen fokalen Dysrhythmie wies neuropathologisch ein gliös-vasales Hamartom mit Verkalkung und pseudocystischer Auflockerung im Windungstal zwischen T₁ und T₂ rechts auf, das als kombinierte neuroektodermal-mesodermale Fehlbildung gedeutet wurde. Dieser Herd wurde vom Angiogliom und von den verschiedenen Phakomatosen abgegrenzt. Bei Berücksichtigung der Klinik, der Lokalisation und der Verkalkung des Angioms kann der Befund der primär klinisch-röntgenologisch konzipierten Gruppe des Hämangioma calcificans zugerechnet werden, wobei unser Fall eine weitere histologische Differenzierung dieser Gruppe erlaubt.

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Focal dysplasia of the temporal lobe in psychomotor epilepsy

Summary Clinico-pathological report on two cases with symptomatic sleep grand mal and psychomotor epilepsy due to focal dysplasia of the temporal lobe.In case one, the electroencephalogram showed a focus over the left temporal region. Histological examination revealed a focal glio-neuronal dysplasia involving the second temporal gyrus on the left, with greatly disturbed cortical lamination containing many giant nerve cells scattered throughout the layers 3–6. The underlying white matter was demyelinated showing abnormal glial cells. The lack of any growth tendency permitted classification of the lesion as a hamartia and made it possible to differentiate it from tuberous sclerosis.The second case had a long history of epileptic seizures over 28 years with development of a chronic brain syndrome. It showed significant changes in the electroencephalogram with bitemporal focal dysrhythmia and a maximum over the right temporal lobe. Pathologically an intracerebral glio-vascular hamartoma with calcification and pseudocyst formation was found at the level of the first right temporal sulcus. The hamartoma was considered to be a neuroectodermal-mesodermal malformation and was differentiated from the angioglioma and from the phakomatoses. In view of the clinical findings, the localization and the calcification our observation was classed as haemangioma calcificans; it provided an additional histological means of differentiation of this group, which was originally determined by clinical and roentgenological features.

     

Soft tissue response after Class III bimaxillary surgery: Impact of surgical change in face height and long-term skeletal relapse

Objective:To analyze the impact of surgical change in anterior face height and skeletal relapse on the long-term soft tissue profile.Materials and Methods:Cephalometric radiographs of 81 patients taken before surgery and at five time points during a 3-year follow-up period were analyzed. All patients had Le Fort I and bilateral sagittal split osteotomies. The patients were divided into three subgroups according to the change in anterior face height during surgery. Calculations of soft to hard tissue ratios were based on the long-term soft tissue response relative to the surgical repositioning.Results:The horizontal surgical repositioning varied considerably, depending on whether anterior face height was increased or decreased. For upper lip prominence, the pattern of long-term change was the same irrespective of change in face height. In all groups, upper lip thickness decreased in both the short term and the long term, particularly in patients with surgical increase in face height. Lower lip thickness increased in the short term but decreased during the follow-up period. There were significant associations between horizontal soft tissue and corresponding hard tissue changes, except for soft tissue A-point and upper lip, when face height was increased. The ratios were higher for mandibular variables than for maxillary variables, particularly for B-point and pogonion when anterior face height had decreased.Conclusion:A change in facial height influences the soft tissue response. The mandibular soft tissues closely follow skeletal relapse beyond 2 months postsurgery. The findings have clinical implications for the relative maxillary and mandibular repositioning when planning surgery.     

The influence of craniofacial morphology on the upper airway dimensions

Objective:To evaluate the influence of craniofacial morphology on the upper airway dimensions in healthy adult subjects.Materials and Methods:The records of 276 healthy 17- to 27-year-old patients were extracted from the cone-beam computed tomography image database of the Institute of Stomatology, Riga Stradins University. Dolphin 11.7 software was used to evaluate craniofacial anatomy and semiautomatic segmentation of the upper airway. Measurements of oropharyngeal airway volume (OPV), minimal cross-sectional area (CSAmin), and nasopharyngeal airway volume (NPV) were obtained. The presence of adenoid tissues was recorded. Associations between variables were analyzed by Spearman''s correlation coefficients, and multivariate linear regression analysis was used to identify factors that had a possible influence on upper airway dimensions.Results:The following factors were identified as influencing the variability of NPV (23%): SNA angle, gender, and presence of adenoids. Statistically significant, although weak, correlations were found between SNB angle and OPV (r  =  0.144, P < .05) and CSAmin (r  =  0.182, P < .01).Conclusion:The results suggest that craniofacial morphology alone does not have a significant influence on upper airway dimensions.