Biomedical subjects
Publications and source records attributed to R A West.
The assessment and management of patients with postoperative hemorrhage following Le Fort I osteotomies is discussed. The results of a questionnaire to investigate this complication, as well as the authors' protocol for dealing with this problem, are presented. Three illustrative case histories are also presented.
Orthodontic and orthognathic surgical procedures are important adjuncts to the provision of optimum restorative and periodontal care. Dentoalveolar and skeletal abnormalities of either developmental or acquired origin can be corrected primarily, thus eliminating the necessity for compromise in prosthetic design. Dental relationships that are contributory to irreversible periodontal deterioration can be normalized to facilitate stabilization of the periodontal condition and to increase the longevity of the natural dentition. Maxillofacial surgical treatment is technically complex but is more conservative than many traditionally accepted treatment procedures. It is based on the rationale of conservation of natural structures rather than their radical ablation or their sacrifice to uncontrollable progressive disease processes. Patient participation to establishment of treatment objectives and extensive patient education are essential ingredients in such treatment. Interdisciplinary communication and coordination contribute to a mutual appreciation of treatment possibilities and limitations. Thus, orthodontic and orthognathic surgical options should be considered in planning the solution to a wide variety of periodontal and restorative treatment problems.
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The present study examined changes in recreational and social activities after orthognathic surgery. Because this is often an expectation of patients seeking surgery, it was hypothesized that activity levels would increase gradually after surgery, particularly for patients who become more extroverted and for unmarried patients. Information on the frequencies of recreational and social activities, and the persons with whom these activities were performed, were obtained from 53 patients in a self-administered questionnaire administered at least 2 days before surgery and again 3 weeks, 4 months, and 9 months after surgery. In addition, patients were assessed on introversion-extroversion before and after surgery. The results indicated that (1) for both married and single patients, recreational and social activities dropped immediately after surgery and gradually increased to a level similar to that prior to surgery at nine months after surgery; (2) contrary to expectations, the single patients over age 15 did not increase their recreational and social activities with friends of the opposite sex after surgery; and (3) the degree of change in introversion-extroversion after surgery was not associated with the degree of change in recreational and social activities performed with others. Implications for postsurgical adjustment of orthognathic patients and recommendations for future research are discussed.
In an attempt to determine the impact of surgical orthodontics on patients' personality and perceptions of oral function, fifty-five patients were examined longitudinally. Patients completed five questionnaires during the course of treatment, from 1 month before to 9 months after surgery. Orthodontic appliances were still being worn by 56.1 percent at the 9-month assessment. Satisfaction with surgery, self-esteem, and body image were high throughout the postsurgical stage but showed significant changes. Satisfaction peaked at 4 months but declined at 9 months postsurgery, as did self-esteem and facial body image. Most of this decline was attributable to patients being still under orthodontic treatment, but those with continuing problems of pain, paresthesia, and oral dysfunction were not more likely to report psychological dissatisfaction. Results are examined from the perspectives of integration of body image and patient expectations from orthognathic surgery.
A longitudinal study was conducted of the psychologic characteristics of 74 persons undergoing orthognathic surgery. The effects of neuroticism, locus of control, and expectations upon postsurgical outcomes were examined. The majority of patients scored in the normal range of most personality variables. The findings suggest a generally intact ego and accurate self-concept among orthognathic surgery patients. Expectations of pain and parasthesia were the best predictors of postsurgical outcomes, while neuroticism and locus of control scores predicted some outcomes in the early postoperative stages. The results indicate the importance of preparing orthognathic surgery patients against unrealistic expectations before surgery is undertaken, and of counseling certain patients during the early postoperative period.
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Correction of vertical maxillary excess by Le Fort I osteotomy has become a widely accepted practice. Although the downfracture method is used almost exclusively in most major centres, the total maxillary alveolar osteotomy still has its advocates. Two patients surgically treated by total maxillary alveolar osteotomy and presented in this journal are re-evaluated with respect to the long-term stability of maxillary intrusion. Literature pertaining to the stability of the maxilla following intrusion by Le Fort I osteotomy and after various combinations of anterior and posterior maxillary ostectomy is reviewed. The advantages of the downfracture method are discussed. An alternative method of achieving the desired degree of intrusion is presented, which ensures more intimate bone contact.
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Fifty-two cases of surgical advancement of the mandible were evaluated by retrospective cephalometric and computer analysis for longitudinal skeletal and dental changes an average of 3 1/2 years after surgery. Postsurgical treatment response appeared to be a multifactorial biologic phenomenon with considerable individual variability. Results showed generally good stability after mandibular advancement, with a minimal to moderate tendency toward skeletal relapse during intermaxillary fixation. Positional change of the proximal segment was the most important parameter in determining stability or relapse of the advanced mandible. Anteroinferior displacement of the condyle and increased posterior facial height were found to be important factors in the skeletal relapse observed during the period of intermaxillary fixation. The magnitude of mandibular advancement was a reliable surgical predictor of postsurgical relapse. Preoperative mandibular plane angle, postfixation intersegment instability, and patient's age cannot be isolated as being solely responsible for specific postsurgical changes.
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Recent years have seen broad technical advancements in the field of orthognathic surgery. Recognition that conventional orthodontic-orthopedic treatment is ineffective in resolving facial-skeletal deformities and associated malocclusions has led to the development of cooperative therapeutic efforts. Joint diagnosis and treatment planning and analysis of longitudinal treatment responses based on traditional orthodontic principles have contributed to continuing advancement of knowledge and improvement in standards of care. A team approach to the management of patients requires the sharing of knowledge, skills, and responsibility. By combining these with a high level of education of patients, cosmetic and functional changes of lasting benefit can be achieved.
Condylysis has not previously been described as a complication of a mixed collagen vascular disease. A case is presented in which apertognathia and mandibular retrognathism occurred secondary to condylysis in a 26-year-old woman with features of rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and Sjögren's syndrome. The disease was manifested by polyarthritis, morning stiffnes, subcutaneous nodules, and acrosclerosis. Important laboratory findings included RA slide latex negative, increased DNA binding, ANA positive, ENA negative, and an abnormal parotid scan. The malocclusion secondary to condylysis was corrected by surgical procedures usually employed for the treatment of mandibular retrognathism and apertognathia on a developmental basis.
Hypersomnia sleep apnea (HSA) is characterized by apneic episodes during sleep and daytime hypersomnolence. Patients afflicted as a result of upper airway obstruction have been treated traditionally with permanent tracheostomy. Three patients with HSA and mandibular retrognathism are presented. Each patient had a retrognathic mandible that stemmed from a different cause. Surgical advancement of their underdeveloped mandibles corrected the symptoms of HSA rapidly. The literature concerning HSA is reviewed and the advantages of mandibular surgery in selected cases are discussed.
Numerous articles identifying pneumomediastinum as an immediate complication of dental and oral surgical procedures have been published. A patient who developed a spontaneous pneumomediastinum as a delayed complication, apparently not directly related to the surgical procedure, is presented in this report.
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1. Treatment of Class II, Division 1 malocclusions should be accomplished by normalization of the abnormal structures that are identified diagnostically. 2. In the presence of mandibular retrognathism and unfavorable growth potential (limited amount, undesirable direction), surgical mandibular lengthening should be incorporated into the treatment plan. 3. Compensation for mandibular retrognathism by conventional orthodontic and facial orthopedic treatment incurs the risk of (a) increase in nasolabial angle, (b) reduction in upper lip support, (c) increase in lower facial concavity, (d) excessive proclination of lower incisors with compromise of labial periodontal support, and (e) protracted duration of appliance therapy and accompanying detrimental periodontal and root resorption effects.
Serial cephalometric evaluations were made of 15 patients a year after advancement genioplasty to assess skeletal changes, to relate these changes to net soft tissue profile change, and to develop predictive criteria for treatment planning. Coefficients of variance of regression equations, which incorporated selected independent variables, indicated that the variables, interval of time until follow-up records, and the extent of postsurgical horizontal resorption contributed only slightly to the observed variance in prominence of the soft tissue chin. For purposes of prediction, a ratio of 4:3 is recommended for the surgical horizontal advancement of the symphysis versus the net horizontal change in soft tissue chin point.