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PubMed1993

A new surgical approach to correcting mandibular prognathism in Oriental patients: report of two cases.

Surgical procedures had been used for the reduction of mandibular prognathism to achieve improved function and aesthetics. However, in Oriental patients mandibular prognathism was often present together with maxillary protrusion. Mandibular set-back surgery alone could not achieve the desired aesthetics in such patients. This report describes a surgical approach involving both maxillary subapical osteotomy and mandibular set-back surgery to correct the problem. This new surgical procedure not only produced optimum aesthetics but achieved the desired results in the shortest possible time.

Adult↗
PubMed1997

Changes in the mechanical advantage of the masseter and temporal muscles following surgical correction of mandibular prognathism.

The purpose of this study was to determine if the mechanical advantage of the masseter and temporal muscles is altered and improved as expected in patients subjected to surgical correction of mandibular prognathism. It aimed also to detect any relationship between (1) the moment arms of the masseter and temporal muscles, the moment arm of the bite force, and any morphologic characteristics considered to be factors in determining the size of the moment arms; and (2) the changes in the moment arms and the changes that the combined orthodontic-surgical treatment could induce in the morphologic characteristics. Presurgical and postsurgical lateral cephalograms of 51 consecutive orthognathic surgery patients with severe mandibular prognathism were used. The radiographs were taken 1 week before surgery and approximately 1 year after surgery. The results indicated that the mechanical advantage of the masseter and temporal muscles had a tendency to increase following correction of the dysplasia. The changes in the moment arms of the masseter and the bite force seem to be dependent on the changes in some morphologic parameters such as the angle between the mandibular line and ramal line, the angle between the anterior cranial base and the mandibular line, and the angle between the anterior cranial base and the functional occlusal plane. The combination of changes in these angles together with the shortening of the mandibular length could also lead to a decrease of the advantage of both muscles.

Adolescent↗
PubMed1998

Three-dimensional computer-graphic demonstration of facial soft tissue changes in mandibular prognathic patients after mandibular sagittal ramus osteotomy.

The purpose of this study is to demonstrate the three-dimensional changes in facial soft tissues in prognathic patients after orthognathic surgery. The soft tissue and skeletal tissue changes were analyzed with a noncontact three-dimensional digitizing system and roentgenographic cephalometry, respectively. Forty prognathic patients with or without asymmetry, who received only mandibular sagittal ramus osteotomy, were included in the study. The preoperative and 3-month postoperative digitized soft tissue images were superimposed from the nose to the forehead. Changes in the facial soft tissue were illustrated using a computer graphic image with tomographic cross sections at 1-cm intervals. Sagittal soft tissue dislocations of 75 facial measurement points were also calculated. Examination of patients with minimum transverse movement of the mandible revealed significant correlation between soft tissue and related hard tissue dislocation in the sagittal dimension in most landmarks at and below the upper lip. This noncontact three-dimensional digitizing system is very useful in analyzing facial soft tissue changes caused by orthognathic surgery.

Adult↗
PubMed1991

[The accuracy of soft tissue profile prediction with the "Dentofacial Planner" in skeletal prognathism].

30 pre- and postoperative lateral cephalograms of patients with mandibular prognathism are used to evaluate the soft tissue profile prognosis given by the "dentofacial planner". As a result, the horizontal displacement of SLS (sulcus labrale superius) and Pg' (soft tissue pogion) in patients with a normal vertical dimension and additional LMF (labiomental fold) in persons with a marked overbite are calculated well. The horizontal changes of the other points analyzed as well as all vertical changes are not predicted satisfactorily in the momentary version 4.22 A (febr. 1989), which will be improved by the company.

Adolescent↗
PubMedDate not supplied

Some ideas on relapse after remodeling of prognathism: aesthetic and functional results.

The efficiency of a surgical treatment is evaluated, mainly, by the stability of the results achieved, whether they are functional, aesthetic, or psychological. Relapse is the greatest problem in prognathism surgery. Among the probable causes of relapse, muscular actions are the main one. The author emphasizes the value of complete preoperative preparation, which includes clinical, cephalometric, occlusal, and functional analysis, and presents his surgical program: complete detachment of the periosteum of the ramus on the muscular area (the pterygomasseteric belt), a different surgical technique, L sagittal subcondylian osteotomy, and a maxillomandibular fixation (MMF) of just 6 to 10 days. He compares the results: relapses fall from a mean of 20% or more to a mere 2.4%, recovery of almost-normal function is achieved after about 1 month, and the treatment is more safe and comfortable for the patient.

Adolescent↗
PubMed1977

Treatment of marked anteroposterior and transverse discrepancies in mandibular prognathism.

A case report of a patient with a severe skeletal Class III malocclusion has been presented. The patient's marked anteroposterior discrepancy was complicated by the fact that his buccolingual occlusion was normal. The solution to this case thus involved a correction of the transverse discrepancy in addition to the anteroposterior discrepancy, which required orthodontic and surgical solutions. A discussion of mandibular prognathism has also been presented.

Adolescent↗
PubMed1981

What happen to them? Postoperative survey of patients 10 years after surgical correction of mandibular prognathisms.

Forty-four patients were examined 10 years after their mandibular protrusions had been surgically corrected, and the findings were related to those of previous examinations 6 weeks and 2 years postoperatively. The intention was to describe changes in facial morphology, dental arches, and marginal bone height in the anterior region and to record the patients feeling in relation to functional esthetics and social fitness. In the majority of the patients the mandible was in a relatively stable position. A small increase of the mandibular prognathism was common, however. The length of the mandibular dental arch was reduced, and so was the mandibular intercanine width. The mandibular intermolar width was increased. The mandibular anterior teeth displayed a continuous tendency toward crowding. According to the answers to a questionnaire presented to the patients before they were examined by the persons who had provided the treatment, they were generally satisfied with the results of the treatment and would not have hesitated to undergo the treatment once more if necessary.

Adolescent↗
PubMed1984

Mandibular function and dysfunction in patients with mandibular prognathism.

There are indications that in patients with mandibular prognathism there is a great risk of mandibular dysfunction symptoms. The present study was undertaken to verify this and to investigate whether surgical correction of the sagittal discrepancy would improve the functional abilities. The material comprised a group of 28 untreated patients with mandibular protrusion and another group of 44 patients who were operated on 10 years ago. The functional status and subjective symptoms were recorded according to the principles introduced by Helkimo. The results indicate a great reduction of the subjective symptoms in the treated group, and even the objective evaluation shows a reduction of the dysfunctional symptoms in the treated persons, particularly in relation to the movement capacity of the mandible. The number of occluding teeth was significantly greater in the treated persons, and the number of occlusal interferences was smaller. Thus, it seems that a repositioning of the mandible to a correct sagittal position will improve function. A normal anatomic foundation may therefore be an important factor in securing normal mandibular function.

Adolescent↗
PubMed1976

Patient motivation and response to surgical correction of prognathism.

Twenty-five patients operated upon between 1969 and 1973 for correction of mandibular prognathism were recalled in 1975 and asked to evaluate their attitudes toward the procedure and the postoperative results. All but one were satisfied with the results. Postoperative numbness of the lip and chin lasting more than 6 months was commonly noted following the intraoral sagittal split method. This did not influence the patient's satisfaction with the operation. The minimal postoperative scar following the extraoral oblique osteotomy was not a negative factor. Most patients underwent the surgical procedure for esthetic reasons. A large number (68 per cent) noted a change in personality postoperatively. A rationale for selective preoperative psychologic counseling is suggested.

Consumer Behavior↗
PubMed1977

Mandibular prognathism and apertognathia associated with cleidocranial dysostosis in a father and son.

No reports to date have described apertognathia as an associated finding of cleidocranial dysostosis. The case of a patient with prognathism and apertognathia associated with cleidocranial dysostosis is reported. Periodontal, restorative, prosthetic, and oral surgical services were necessary to rehabilitate this patient orofacially. A review of the syndrome and of the patient's familial history is presented.

Adult↗
PubMed1982

A comparative study of wire osteosynthesis versus bone screws in the treatment of mandibular prognathism.

In sagittal split osteotomies as well as in vertical osteotomies for reduction of the mandible, wire and bone screw osteosynthesis has been used in the Department of Oral and Maxillofacial Surgery of the University of Erlangen-Nuremberg within the last few years in a total of 221 cases of mandibular prognathism. In about one half of these cases a conventional wire osteosynthesis was performed, and in the other half a stable osteosynthesis with bone screws was used. One hundred twenty-one cases could be included in a follow-up study, and a true comparison could be made between the two methods. The results of our study were quite interesting: There were no signs of an increase in temporomandibular joint problems when the bone screw technique was used. However, slightly more alterations in the mandibular nerve were found. The relapse tendency, on the other hand, was minimal in cases in which bone screws were applied, in comparison with those in which wire osteosynthesis was used.

Bone Screws↗
PubMed1989

Changes in the facial profile following correction for mandibular prognathism.

A retrospective study of 33 patients was undertaken to investigate the changes occurring in the facial profile following surgical correction of mandibular prognathism. The parameters measured included surface area, shift of selected points, facial outline length and directional measurement in relation to the sella-nasion plane. The calculation of linear regression equations enabled prediction of the shift of selected soft tissue points and facial outline length. It is considered, that the analysis provides an accurate picture of the behaviour of the soft tissues in response to a given amount of bony movement following correction of the deformity.

Adolescent↗
PubMed1986

Three-dimensional prediction of mandibular movement in the treatment of prognathism.

The three-dimensional movements of the mandible that might occur during surgical correction of mandibular prognathism were analyzed preoperatively in 40 patients. Direct measurements were made on the dental models used to predict postoperative occlusion, and the results were transferred to the cephalometric tracings using three-dimensional coordinate transformation. Menton, gonion, and two bony points on the posterior borders of the ascending rami were chosen on the frontal and lateral cephalograms for prediction of the antero-posterior, vertical, and lateral movements. In most cases a reasonable amount of movement without much lateral shift at the posterior border of the mandible was predicted to occur when the postoperative position of the mandible was established to provide a stable occlusion. However, there were five cases in which predicted lateral movement at one of the posterior borders exceeded 5 mm, and, in four of them, protrusion of the mandible was not accompanied by lateral deviation. It was concluded that careful preoperative planning and postoperative treatment are necessary in these cases because a large amount of lateral movement at the site of operation might lead to postoperative relapse following ramus osteotomy.

Cephalometry↗
PubMed1986

Long-term neurosensory deficits following transoral vertical ramus and sagittal split osteotomies for mandibular prognathism.

Twenty-six patients who had been treated for mandibular prognathism by either bilateral sagittal split osteotomy or transoral vertical ramus osteotomy were evaluated by neurosensory examination. Neuropathy was demonstrable in 28.8% of the 52 mental nerves examined. The incidence of neuropathy was significantly higher in the bilateral sagittal split osteotomy group than in the transoral vertical osteotomy group.

Adolescent↗
PubMed1984

Weight changes after jaw fixation due to sagittal split ramus osteotomy for correction of prognathous.

Body weight changes, energy intake and symptoms experienced were studied in 13 patients whose jaws were fixated due to osteotomy for protruding mandible. All except one patient lost weight and the mean weight loss was 7.5 +/- 5.3 kg. The weight reduction was higher in the obese patient (11 +/- 4.2 kg), but also patients of normal weight lost 4.7 +/- 4.6 kg. The reduction of daily energy intake from the preoperative state as 1.5 +/- 1.0 MJ and was in obese patients about twice as much as in the lean ones (2.1 +/- 0.8 MJ and 1.0 +/- 1.0 MJ, respectively). The reduction of energy intake per loss of body weight by 1 kg was in all patients 8.5 +/- 0.67 MJ, in obese 8.3 +/- 0.64 MJ and in lean patients 8.6 +/- 0.75 MJ. The loss of weight was temporary and the patients regained their weights largely or wholly after the fixation period. Ten patients of the 13 felt hunger during fixation period, two had abdominal pains, five constipation and two pollacisuria. Jaw fixation due to osteotomy for protruding mandible decreased the food intake of the patients much and deteriorated their nutritional status by considerable weight loss. Thus advice about fortifying the diet is indicated so that the patients could consume food of high energy content during intermaxillary fixation due to sagittal split ramus osteotomy for correction of prognathous.

Adolescent↗
PubMed1987

Periodontal status of mandibular incisors following excessive proclination. A study in adults with surgically treated mandibular prognathism.

The present study was undertaken to examine whether excessive proclination of mandibular incisors results in gingival retraction. In patients with surgically treated mandibular prognathism, 29 with more than 10 degrees proclination of mandibular incisors and 33 with minimal change in incisor inclination during presurgical orthodontic phase were selected. A total of 21 and 19 patients, respectively, could meet for a clinical follow-up examination including Visible Plaque Index, Gingival Bleeding Index, probing pocket depth, and length of supracrestal connective tissue attachment. Study models and intraoral color slides were also made. The mean postoperative times at this examination were 7.8 (SD 2.5) and 8.1 (SD 2.8) years, respectively. Clinical crown height was measured on the study models taken before and after appliance therapy, at the 3-year postoperative control (check) and at the follow-up examination. The number of teeth with recession was determined from the color slides taken at the same intervals; the thickness of the symphysis was measured on the cephalograms taken before treatment. The results demonstrated significantly more increase in clinical crown height and significantly more teeth developing recession both during appliance therapy and during the period from removal of appliance to the 3-year postoperative control in the patients with excessive proclination than in the patients with minimal change in incisor inclination. The correlation coefficient between width of symphysis and increase in clinical crown height in patients with excessive proclination was statistically significant. Only minimal changes were observed from 3 years postoperatively to the follow-up examination. No differences in clinical measurements were observed between the groups and bone dehiscences were not found.

Adult↗
PubMed1991

An American Board of Orthodontics case report. Correction of a Class III mandibular prognathism and asymmetry through orthodontics and orthognathic surgery.

The Class III malocclusion with mandibular prognathism can involve many factors, among which are excessive mandibular growth, underdevelopment of the maxilla, environmental factors, and trauma to the jaws. The correction of this malocclusion can involve an orthodontic or a combined orthodontic-orthognathic approach. Skeletal asymmetries can complicate this situation, making treatment either more difficult, more complicated, or both. This case presentation involves treatment with a combined orthodontic-orthognathic approach. [This case was presented to the American Board of Orthodontics in partial fulfillment of the requirements for the certification process conducted by the Board.]

Adolescent↗
PubMed2006

Bite force, occlusal contact area and masticatory efficiency before and after orthognathic surgical correction of mandibular prognathism.

The purpose of this study was to evaluate bite force, occlusal contact area and masticatory efficiency before and after sagittal split ramus osteotomy in 27 patients with mandibular prognathism, in comparison with 27 control subjects with normal occlusion. Bite force and occlusal contact area were simultaneously measured with a computerized occlusal analysis system, the Dental Prescale system. Masticatory efficiency was estimated by a low-adhesive colour-developing chewing-gum system. The data were collected at initial medical consultation, immediately before surgery, and at 6 weeks, 3 months, 6 months, 1 year and more than 2 years after surgery. Both bite force and occlusal contact area of the patients before surgery were significantly less than those of the controls. Although all three parameters had improved after orthognathic surgery, the bite force and occlusal contact area did not reach the values of the controls within 2 years postoperatively; masticatory efficiency at 2 years after surgery drew near to control levels. Bite force correlated with occlusal contact area in the patients postoperatively, whereas masticatory efficiency did not correlate with either of the other two parameters. These results suggest that further adjustment of occlusion and mechanical advantage should be considered before the end of treatment.

Adolescent↗