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A new type of extraoral sagittal osteotomy of the mandibular ramis and retromolar region is described. This is a simple and versatile procedure which may may be used in the correction of prognathism, retrognathism, open bite, and mandibular asymmetry. The procedure shares all the advantages of the intraoral sagittal osteotomy of the mandibular ramus and has several other advantages as well. A case is presented for illustration.
Teeth of seven patients from the Brandywine isolate who had dentinogenesis imperfecta (DI) type III were evaluated by clinical, radiologic, and scanning electron microscopic techniques. The deciduous and permanent teeth were opalescent, and there was marked attrition. Enamel pitting was present on some permanent teeth. Anterior open bites were found in all persons with complete permanent dentitions. Pulps of developing teeth were larger than normal during early development but rapidly became almost completely obliterated. There was increased constriction at the cementoenamel junctions. While radiolucencies were noted at the apices of teeth which had pulp exposures due to attrition, several patients had similar radiolucencies which could not be attributed to caries or attrition. Scanning electron microscopy showed a significant reduction in the number of dentin tubules on fractured dentin surfaces; calcospherites at the calcification front were either irregularly shaped or absent. A single tooth from a patient with DI type II was studied and had similar abnormalities on scanning electron microscopy, although tubules were easier to find and calcospherites at the calcification front were more regular than in DI type III. The findings in DI type III of enamel pitting, enlarged pulps early in tooth development, and radiolucencies at the apices of teeth without pulp exposures support the hypothesis that DI type II and DI type III are different disorders.
Improved knowledge of "normal" temporomandibular joint function and morphology is a basic requisite for the recognition and diagnosis of TMJ abnormalities. Indeed, until such knowledge exists, care must be exercised in the clinical, radiographic, arthrographic, and histologic diagnosis of abnormal temporomandibular structure and/or function. This article discusses variations in TMJ function and morphology in Class I persons and those with skeletal Class II open-bite and Class II deep-bite dentofacial morphologies. These differences are explained on the basis of accepted principles of biomechanics and its influences on cartilaginous growth and bone modeling.
Following surgical procedures in 25 patients, a study was made of the stability of the maxilla after superior repositioning. In cases of open bite, as well as in cases of absolute maxillary hyperplasia or relative mandibular deficiency, a slight overcorrection that led to a stable occlusion was observed. The use of miniplates for stabilization of the maxilla is discussed briefly.
The relationship between clinical findings in the craniomandibular system and radiologic findings in the temporomandibular joint was investigated in 101 adults with rheumatoid arthritis. Radiologic changes were correlated with duration and severity of temporomandibular joint symptoms and general joint disease. The radiologic changes were also associated with loss of occlusal support, anterior open bite, and occlusal interferences. Most joints with crepitus exhibited radiologic erosion. Joints with mutilating changes were silent.
A case that demonstrates the use of three-dimensional computed tomography and anatomic replication in the management of a severe anterolateral open bite deformity is presented. Preoperative surgical treatment planning was facilitated by rehearsal model surgery. Construction of an accurate surgical splint enabled precise positioning of osteotomized segments at surgery.
Radiographic evidence of condylar atrophy was seen in 12 patients out of 206 patients who underwent surgical orthodontic treatment. All 12 patients had the same dentofacial deformity, high-angle mandibular retrognathia (Class II open bite), and all but one had bimaxillary surgery. The etiologic factors are discussed. The dentofacial deformity is considered to be the main reason for condylar resorption, but orthognathic surgery is supposed to stimulate the progress of the disease by increased loading, disk displacement, and immobilization.
This article reviews the clinical behavior, the histologic conditions, and the treatment of a benign osteoblastoma associated with an aneurysmal bone cyst of the mandibular condyle and ramus. A 14-year-old boy, otherwise healthy, was referred for pain and enlargement in his right temporomandibular joint-cheek region. The swelling was firm and tender, a slight facial asymmetry was present, and the mouth-opening capacity was reduced. During a 6-weeks period from the primary examination to surgery the lesion expanded extensively, anesthesia appeared in the right inferior alveolar nerve and a lateral open bite developed on the affected side. Computed tomography displayed a total destruction of the right mandibular condyle and ramus to the level of the mandibular foramen. The lesion was radiolucent without distinct borders to adjacent bone. Surgery revealed a bluish, well-vascularized predominantly cystic tumor. The lesion included the temporomandibular joint disk but without overgrowth to the temporal component. After resection of the lesion, the condyle and the mandibular ramus was reconstructed with the use of an autogenous costochondral graft. The postoperative healing was uncomplicated. At follow-up 2 years after surgery the boy was free of recurrence with normal motor and sensory nerve function.
Acromegaly results from the over production of growth hormone after the age at which the epiphyses of the bones have fused. The most common cause is an adenoma of the anterior pituitary gland. Early signs and symptoms are subtle and delayed diagnosis is common. The health consequences of untreated acromegaly are considerable. A brief description of the condition is given and a case report is included. The condition of the patient was first diagnosed after a dental examination at which he voiced a complaint of the inability to incise and a progressive open bite that he attributed to prosthetic treatment. On the basis of his intraoral radiograph history, it is probable that he developed the disease more than 5 years before its diagnosis.
Twenty-six persons with Laband syndrome have been reported in the literature to date. We report two further unrelated cases and suggest that a skeletal anterior open bite and symmetric soft tissue swelling of the vault of the palate be added to the variable features associated with the syndrome. There is clear evidence in the literature of autosomal dominant inheritance but our analysis indicates that in some cases recessive transmission is likely.
The purpose of the study was to examine the relationship between ear infections and dentition, sucking habits, pacifier sucking and atopic and allergic diseases in a historic cohort survey. The series comprised 944 5-year-old children representing about 3/4 of the whole age cohort. The parents completed a questionnaire that asked for details of the children's ear infections, sucking habits and atopic or allergic diseases diagnosed by a physician. The dental status was examined by the child's own local dentist. The children who had used a pacifier had a greater risk of having recurrent attacks of acute otitis media in their history than those who had not used a pacifier (risk ratio (RR), 1.43; 95% confidence interval (CI), 1.06-1.93; P = 0.02). Mouth breathing was significantly associated with acute otitis media (RR, 1.87; CI, 1.28-2.73; P = 0.01), as was open bite (RR, 1.36; CI, 1.01-1.84; P = 0.04), but no other mode of malocclusion. The population attributable risk of otitis media caused by pacifier amounted to a total of 478 attacks or 0.7 per child. The association between otitis media and the use of a pacifier remained even after adjusting for mouth breathing and the measures of malocclusion. Neither thumb sucking nor atopic eczema showed such an association.
Intra-oral, rigid, non-compressive fixation was used in a feasibility study in 10 consecutive sagittal split osteotomies using two 3.5 or 2.7 mm diameter AO screws on each side. Seven patients were prognathic, three were retrognathic, and two had severe mandibular asymmetry. Lower third molars were removed concurrently in three patients. Horizontal and vertical stability was assessed by means of repeated, digitised cephalometry before operation, at 24-48 h and at 6 months. Intermaxillary fixation (IMF) was necessary during the first 48 h in one patient where the lingual fragments were too small. Intermaxillary elastics were used later in three patients. This method was straightforward, reliable, required no skin incisions and stability was similar to that following the use of transbuccal screw fixation. Mean horizontal relapse at 6 months (0.6 mm; maximum: 1.5 mm) was 8% of operative movement. Unsatisfactory occlusion (anterior open bite) necessitated removal of screws at 28 days in one patient. This was carried out intra-orally under local anaesthesia. These results suggest that stable, screw fixation for sagittal split osteotomies can be achieved without recourse to an external approach.
Sagittal split osteotomy has been performed routinely for correction of mandibular prognathism, retrognathia, mild open bite, and asymmetry. Intraoperative and early or late postoperative complications were evaluated in 258 patients operated on by this technique. With meticulous performance of the operation and long-term maxillomandibular fixation, complications can be negligible, and relapse, the most problematic postoperative issue, can be significantly reduced.
A retrospective study of the osseous and soft tissue changes of the chins of ten patients treated for vertical maxillary excess by Le Fort I osteotomy and advancement genioplasty was undertaken. The patients were characterized by excessive lower anterior facial height, obtuse or normal nasolabial angles, prominent maxillary incisors, lip incompetence, everted lower lips, anterior open bites, lack of chin prominence, and excessive chin height. A change in the proportion of osseous to soft tissue of 1.0 to 0.87 was obtained by advancement genioplasty and concomitant superior repositioning of the maxilla by Le Fort I osteotomy.
A study was performed to identify the area within the maxilla where vertical maxillary deformities are expressed. Analysis of the maxillas of individuals who displayed 4 mm or more of the central incisors at rest were compared with those who displayed less than 1 mm. Similarly, individuals who had greater than or equal to 2 mm negative incisor overbite (open-bite) were compared with those who had greater than or equal to 2 mm positive overbite. The results showed that the vertical position of the maxillary skeleton (palate) was similar in all groups. The vertical excess was found to lie within the dentoalveolus. The clinical implications of these results are discussed.
Monkey mandibular condyles were frozen in situ and subsequently examined clinically and histologically. The frozen bone served as a structural matrix for the formation of new, vital bone. No ankylosis, open-bite deformity or loss of function was observed.
Transposition of the mental nerve in association with orthognathic surgery was performed 25 times in 16 patients. Indications for transposition generally were use of the premolar region for surgical correction of anterior open bite or dentoalveolar prognathism. In one case, reduction of the mandibular base was the surgical indication. Postoperative hypesthesia occurred in 16 mental nerves but sensibility gradually returned to normal in almost all the patients at between six and 18 months. Partial nerve damage occurred accidentally in three cases with reduced sensibility at follow-up.
PURPOSE: This is a retrospective evaluation of a protocol for management of failed alloplastic temporomandibular joint (TMJ) disc implants. PATIENTS AND METHODS: The criteria for implant failure were defined as any one or combination of the following symptoms and signs: TMJ pain, jaw hypomobility, occlusal changes, and radiographic evidence of bone pathology related to the implant. The protocol consisted of removal of the implant, aggressive joint debridement, recontouring of the articulating surfaces, and placement of a pedicled temporalis muscle/fascia flap (TF) for joint lining. Arch bars and maxillomandibular guiding elastics were used if extensive condylar recontouring was necessary. No attempt was made to reconstruct the condyle or correct occlusal abnormalities at the time of implant removal. All 27 patients (42 joints) treated by this protocol during the study period were included for evaluation. There were 24 Proplast/Teflon (PTI) (Vitek, Inc, Houston, TX), 11 Silastic (SI) (Dow Corning, Midland, MI), and 7 Christensen Fossa implants (CFI) (TMJ Implants, Golden, CO) implants removed. RESULTS: The mean follow-up period was 38.3 months (range, 3 to 65 months). Pain was well controlled in 24 of 27 patients (88.9%). Preoperative and postoperative mean maximal incisal opening (MIO) was 32.1 mm and 39.8 mm, respectively. Two patients (7.4%) required a second TMJ operation for persistent pain and limitation of opening. To date, 7 patients (25.9%) have required a secondary procedure (unilateral vertical ramus osteotomy, n = 1; Le Fort I osteotomy, n = 6) to correct occlusal prematurity on the operated side or bilateral open bite. The remaining patients have required no additional surgical treatment. CONCLUSIONS: The results of this study indicate that a proposed protocol is an effective means of controlling pain and improving jaw motion in patients with failed alloplastic TMJ disc implants.