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This study aimed to evaluate the differential positional changes of the proximal and distal segments during mandibular setback surgery relapse. Thirty patients with mandibular prognathism who underwent bilateral sagittal split ramus osteotomy were included. Skull models from pretreatment, postsurgery, and post-treatment cone-beam computed tomography were superimposed to evaluate condylar displacement and rotational changes, and to determine the center of rotation (CRot) in the proximal and distal segments. During postsurgical relapse, the proximal segment rotated 2.4 ± 2.1° counterclockwise, with the CRot located near the mandibular condyle. The distal segment rotated 2.0 ± 2.3° counterclockwise, resulting in forward and upward movement of the chin. The displaced condyle partially returned to its original position during postsurgical orthodontic treatment. A vertical bony step (VBS) between the proximal and distal segments commonly occurs during mandibular setback surgery. As the VBS increases, the CRot of the distal segment shifts posterosuperiorly, following a predictable pattern outlined by regression equations. These findings suggest that relapse after mandibular setback surgery consistently occurs in an anterosuperior direction, with translatory movement becoming more prominent as the VBS increases. Including these regression equations in presurgical planning can enhance the precision of relapse simulations and help clinicians more accurately anticipate postsurgical relapse.

We present a case report of a 26-year-old female suffering from Coffin–Siris Syndrome, who underwent orthodontic treatment and surgery to solve her malocclusion and to improve her aesthetics and functional occlusion. Methods: The presurgical phase involved multibracket self-ligating attachments, namely a Damon prescription. The patient underwent maxillofacial surgery to correct the severe skeletal malocclusion and to relocate the bone bases to the right position. Post-surgical orthodontic treatment was performed to complete the alignment. Results: The patient’s aesthetics and functional abilities improved. Conclusions: Syndromic patients can undergo orthodontic treatment if comorbidities and collaboration allow it. The support and collaboration of families and psychotherapists must be considered, but clinical cases of syndromic patients can be faced and solved. Obviously, each syndromic patient is considered unique, and the risk–benefit ratio must be correctly assessed for each one.

Objectives. This study evaluated the surgical outcomes of patients with Beckwith-Wiedemann syndrome who underwent tongue-reduction surgery and analyzed whether the malocclusion and mandibular prognathism caused by macroglossia could be improved. Methods. A retrospective medical record review was performed for 11 patients with Beckwith-Wiedemann syndrome whose macroglossia was surgically treated. Demographic data, symptoms and signs, and intraoperative and postoperative surgical outcomes were evaluated. Surgery was performed by a single surgeon using the “keyhole” technique, involving midline elliptical excision and anterior wedge resection. Preoperative and postoperative plain skull lateral X-rays were evaluated to assess prognathism improvement. Results. The median age at the time of surgery was 35.09 months, and the ratio of males to females was 4:7. The median surgical time was 98±31.45 minutes, and the median duration of the postoperative intensive care unit stay was 3.81±2.4 days. There were no airway complications. Two patients (18.2%) had postoperative wound dehiscence; however, there was no nerve damage, recurrence, or other complications. Among the five patients who underwent postoperative speech evaluation, all showed normal speech development, except one patient who had brain dysfunction and developmental delay. Measurements of the A point-nasion-B point (ANB) angles and sella-nasion-B point (SNB) angles (point A is the most concave point of the anterior maxilla; point B is the most concave point on the mandibular symphysis) on plain X-rays showed a significant decrease in the postoperative SNB angle (P

Background/Aim. Mandibular prognathism (MPG) is a severe form of facial and jaw deformity. This kind of anomaly usually requires combined orthodontic-surgical treatment. The aim of this study was to determine the changes in the craniofacial complex after orthodontic-surgical treatment of patients with MPG by analyzing the cephalometric parameters on tele-radiography images before and after treatment. Methods. The study included a sample of 40 subjects (mean age 24.1 ± 4.1 years) who underwent orthodontic-surgical treatment of MPG. Vertical and sagittal parameters which characterize MPG were measured on profile teleradiography images before and 12 months after treatment. Based on the analysis of cephalometric parameters on preoperative and postoperative teleradiography images, dental and skeletal changes that occurred after treatment were determined. Results. After the end of the treatment, most of the parameter values that characterize MPG were significantly reduced. A drop in values was noted in the following parameters: SNB, SNPg, NS/SpP, NS/MP, SpP/MP, NSAr, ArGoMe, Bjork polygon, NMe, NSna, SnaMe, SSnp, I/SpP. There was a statistically significant increase in the values of the following parameters SNA, ANB, GoArNS, SGo and i/MP. No significant changes in values were recorded on the OP/NS and SArGo parameters. Conclusion. Orthodontic-surgical treatment of MPG leads to changes in the bone and dental structures of the craniofacial system. As a result of such treatment, there is a functional improvement and an improvement in the appearance of the face.

Background/Aim. Mandibular prognathism, as one of the more severe forms of dentofacial deformities, impairs the oral functions and appearance of the patient’s face and represents a psychosocial handicap with a negative impact on the quality of life (QoL). The aim of the study was to assess the impact of orthodontic-surgical (OS) treatment on the QoL of patients with mandibular prognathism. Methods. The study involved 40 patients (19 men and 21 women, with a mean age of 24.1 ± 4.1 years) who underwent the OS treatment for mandibular prognathism. All patients completed two questionnaires – the Oral Health Impact Profile (OHIP-14) and the Orthognathic Quality of Life Questionnaire (OQLQ), be-fore the start of treatment and 12 months after the completion of treatment. Results. The results of both questionnaires showed an improvement in the QoL compared to the condition before the treatment. According to the OQLQ questionnaire, there was a postoperative improvement in the QoL (score 24.8 ± 12.9) compared to the preoperative period (score 51.3 ± 15.2). According to the results of the OHIP-14 questionnaire, there was a postoperative improvement in the QoL (score 11.3 ± 2.9) compared to the preoperative period (score 20.8 ± 6.9). The improvement of the QoL, 12 months after the treatment, occurred in all life segments, measured by both questionnaires. Conclusion. OS treatment of mandibular prognathism improves all oral functions, including the appearance of the patient’s face, thus improving the QoL.

Abstract With advances in the ultrasound‐assisted esthetic procedures, filler injection can successfully be used for cosmetic correction of face structural imperfections. Here, we present a new filler injection method by targeting two anatomic landmarks which effectively improved the appearance of a mandibular prognathism case who was a maxillofacial cosmetic surgery candidate.

Abstract Background Skeletal mandibular protrusion would influence to the muscle fatigue of the masticatory muscles. Establishing a diagnostic procedures combining physiological and biochemical information is necessary for quantitative evaluation of masticatory muscle fatigue. Objective The transverse relaxation time (T2 time) of muscle functional magnetic resonance imaging (mfMRI), and 31P‐magnetic resonance spectroscopy (MRS) were used to investigate the reliability as parameters for measuring the masseter muscle in patients with skeletal mandibular prognathism. Method The subjects were 19 patients diagnosed as skeletal mandibular protrusions and 19 healthy subjects as a control group. Transverse relaxation time (T2 value) determined by mfMRI along with creatine phosphate (PCr) and inorganic phosphorus (Pi) determined by 31P‐MRS before, during, and after clenching were used for molecular imaging of muscle fatigue. Results The average T2 value of the patient group was significantly higher than that of the healthy control group at rest. Furthermore, the average T2 value transiently increased in both groups during experimental clenching. The PCr and Pi showed a tendency toward a transient decrease and increases, respectively. The pH in the masseter muscle showed a transient decrease in both groups prior to and following experimental clenching. The pH in the masseter muscle of the patient group was significantly lower than that in the healthy control group at rest and recovery. Conclusion We showed mfMRI and 31P‐MRS are useful for evaluating masseter fatigue during clenching, and the masseter muscle in the prognathic patients showed more severe fatigue than the healthy controls.

BACKGROUND: Monitoring the occlusal relationship of the infant’s gum pads is not a common practice in pediatric dentistry. In general, pediatric dentists are used to observe the conformation of the arches and clinical findings that may be outside of the infant’s normal oral anatomy. Here we tested the hypothesis that intervention before eruption of the primary dentition will minimize anterior crossbite in the primary dentition. To address our hypothesis, we used one case to demonstrate the importance of monitoring the relationship of the gum pads and primary teeth eruption to avoid possible deviations in the pattern of orofacial development and prevent future malocclusions. MATERIALS AND METHODS: After proper consenting and anamnesis, an inverted relationship of the gum pads was observed in a 7-month-old baby while sleeping and at occlusal rest. Given that the patient was exclusively breastfeeding, adjustments of the catch were made, such as a greater opening towards the areola and nipple, and adjustments in the position and posture of the baby. RESULTS: During the eruption phase of the anterior teeth, an anterior crossbite was observed. Caregivers were prescribed exercises that were to be performed in the maxillary and mandibular arches to stimulate maxillary growth and guide the posture of the mandible. The exercises were intensified during the eruption phase of the lateral incisors and molars and the occlusion was stabilized with bilateral masticatory guidance and different textures to be offered during food transition. CONCLUSION: Based on the results observed for this case, the interventions allowed for a more satisfactory occlusion.

الملخص: تهدف هذه الورقة إلى مناقشة دور جراحة تقويم الفك كعلاج بديل قابل للتطبيق في مريض مصاب بانعدام الأسنان المبكر. يقدم تقرير الحالة الحالي مريضا عمره ٣٢ عاما مصابا بانعدام الأسنان المبكر مع طقم أسنان مزدوج وتشوه سني وجهي. وساءت الحالة بسبب فقدان لأسنانه في وقت مبكر. جراحة تقويم الفك هي الإجراء الذي اكتسب شعبية في جراحة الوجه والفكين كما هو في الوقت الراهن أكثر سهولة للمرضى. حيث يقلل من تكاليف الجراحة مع تزايد عدد الجراحين لهذا النوع من الجراحة. الغالبية العظمى من المرضى الذين يخضعون لهذه الجراحة هم من البالغين الشباب؛ على الرغم من أن العمر ليس عائقا أمام الأداء التقويمي. لكن يفضل المرضى الأكبر سنا أنواعا أخرى من العلاج بسبب مراضته. جراحة تقويم الفك هي علاج قابل للتطبيق ويمكن التنبؤ بنتائجه لإعادة التأهيل بعد الجراحة التعويضية لمرضى انعدام الأسنان الكلي. Abstract: This paper aims to discuss orthognathic surgery in a precocious edentulous patient as a viable alternative treatment. The present article is a case report of a total edentulous patient 32 years ago, with a double denture and dentofacial deformity, aggravated due to the early loss of teeth. Orthognathic surgery is a procedure that has been gaining more and more space in the specialty of maxillofacial surgery and traumatology because it is currently more accessible to patients due to the reduction in surgery costs and the greater number of surgeons who perform it, among others. The vast majority of patients who undergo this surgery are young adults. However, age does not impede orthognathic performance, older patients prefer other types of treatment due to its morbidity. Orthognathic surgery is a viable and highly predictable treatment in cases of prosthetic rehabilitation of totally edentulous patients.

IntroductionAccording to Angle's classification, a correct bite should have, inter alia, the following regularities: the median line of the face should coincide with the line between the central incisors of the upper and lower arches, the lower incisors should be overlapped by the incisal edges of the upper incisors, the top of the canine in the upper arch is inserted between the lower canine and the tangent premolar, each tooth is in contact with two opposing teeth, adjacent teeth both in the upper and lower arch are in contact with each other. Any deviation from these rules may indicate the presence of a malocclusion. We can distinguish here, for example: posteroclusion, open bite, retrusive occlusion, protrusive occlusion, supraclusion bite. They seem to be important not only in terms of functionality, but also psychology. Research shows that the correction of mandibular prognathism increases the level of self-confidence and self-acceptance, which may improve the quality of life of patients.Purpose of researchThe aim of the study was to check the quality of life of orthodontic and surgical patients as well as what factors motivate these people to start treatment in the area of the masticatory system.Material and methods208 people aged 18 to 55 participated in the survey. They were both people with malocclusion and no malocclusion, who constituted the control group. The questionnaire was created on the basis of standardized OQLQ and OHIP-14 questionnaires. It also included questions about the factors that motivate to start treatment in the masticatory system.ResultsThe most common malocclusion among the respondents was progenia (58.8%), followed by retrogenia (34.3%), then open bite (4%) and posteroclusion (2.9%). According to the OHIP-14 form, statistically significant (p ConclusionsA malocclusion worsens the comfort and quality of life.Incorrect bite, face and smile aesthetics as well as psychological aspects are the most important factors motivating to undertake surgical and orthodontic treatment.Bruxism and facial pain are not factors prompting the initiation of treatment of malocclusion.

Congenital diffuse infiltrating lipomatosis of the face (CDIL-F) is a rare clinicopathological entity with an unknown etiology, in which mature adipose tissue infiltrates the soft tissue structures in one side, and causes considerable asymmetry. Herein, we report a case of CDIL-F who underwent many surgical procedures without definite diagnosis during 12 years. CDIL-F presents symptoms with various severity levels due to infiltration of adipose tissue that makes removal difficult. Thus, it is recommended to inform patients about the high rate of recurrence.

Abstract Maxillomandibular advancement (MMA) is effective for the treatment of obstructive sleep apnea (OSA). In previous studies, the airway was increased in the anteroposterior and transverse dimensions after MMA. However, the effect of the opposite of mandibular movement (mandibular setback) on the airway is still controversial. Mandibular setback surgery has been suggested to be one of the risk factors in the development of sleep apnea. Previous studies have found that mandibular setback surgery could reduce the total airway volume and posterior airway space significantly in both the one-jaw and two-jaw surgery groups. However, a direct cause-and-effect relationship between the mandibular setback and development of sleep apnea has not been clearly established. Moreover, there are only a few reported cases of postoperative OSA development after mandibular setback surgery. These findings may be attributed to a fundamental difference in demographic variables such as age, sex, and body mass index (BMI) between patients with mandibular prognathism and patients with OSA. Another possibility is that the site of obstruction or pattern of obstruction may be different between the awake and sleep status in patients with OSA and mandibular prognathism. In a case-controlled study, information including the BMI and other presurgical conditions potentially related to OSA should be considered when evaluating the airway. In conclusion, the preoperative evaluation and management of co-morbid conditions would be essential for the prevention of OSA after mandibular setback surgery despite its low incidence.

Mandibular prognathism (progenism, underbite) is a type of malocclusion characterised by an abnormally anterior position of the mandible or the underdevelopment of the maxilla. The profile of an individual with the pathology is significantly prolonged in the sagittal plane, which distorts facial aesthetics. Underbite also negatively affects the entire masticatory function and may cause numerous ailments. Patients with prognathism struggle not only with aesthetic problems, but with functional issues as well. What is more, it can lead to difficulties in the psychosocial area of life by causing lower self-esteem and distorted self-image. Mandibular prognathism is treated with the use of orthodontic camouflage or combined orthodontic-surgical treatment, the latter method, despite its invasiveness, being the more popular one. An important element in the process of patient rehabilitation during treatment is the physiotherapist, who selects the right rehabilitation procedures aiming at the stomatognathic system. Even before the surgery itself, proper therapy begins whose task is preparing the craniofacial area for surgical invasion. After surgery, on the other hand, the physiotherapeutic procedures aim at the reduction of swelling, activating temporomandibular joints (TMJ), myofascial therapy, and special exercises (myokinesthetic therapy) which are aimed at supporting the adaptation of the body to a new morphological structure. This dissertation presents the case of a 19-year-old female patient with mandibular prognathism who underwent combined orhodontic-surgical treatment. The treatment consisted of Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO). The overall results of treatment were evaluated as very good.

Background and Aim: Mandibular setback surgery is one of the common treatments in patients with mandibular prognathism. In this surgery, the mandible is placed backward from its original position, and as a result, the soft tissue, tongue, and hyoid bone are slightly displaced, all of which can affect the dimensions of the airway. Given that these changes in the dimensions of the airway can lead to obstructive sleep apnea, it is important to examine these changes and their stability. In this regard, cephalometric radiography can be used, which haslowcost and dose in comparison to 3D radiographs, to examine changes in airway dimensions. The aim of this study was to evaluate the short-term and long-term changes in airway dimensions following mandibular steback surgery with the help of cephalometric radiography. Materials and Methods: The study was conducted by review method. Using the keywords ‘orthognathic surgery,’ ‘mandibular setback,’ ‘Malocclusion angle class III,’ ‘prognathism,’ ‘airway,’ ‘posterior airway space,’ ‘PAS,’ ‘pharyngeal space, ‘hypopharynx, a review of articles in PubMed and Embase databases, Google Scholar, and Cochrane databases was performed. The range of article searches was from 2000 to 2020. Conclusion: The results of studies showed that in the first 6 months after surgery, the dimensions of the airway decrease, but over time, due to the adaptation of the surrounding tissues and relapse after surgery, there is an improvement in the dimensions of the airway; Also, the study of index-related breathing disorders during sleep disorders during sleep showed that this surgery does not necessarily lead to obstructive sleep apnea. Keywords: Orthognathic surgery; Mandibular setback; Malocclusion angle class III; Prognathism; Airway; Posterior airway space; PAS; Pharyngeal space; Hypopharynx.

Many complex molecular interactions are involved in the process of craniofacial development. Consequently, the network is sensitive to genetic mutations that may result in congenital malformations of varying severity. The most common birth anomalies within the head and neck are orofacial clefts (OFCs) and prognathism. Orofacial clefts are disorders with a range of phenotypes such as the cleft of the lip with or without cleft palate and isolated form of cleft palate with unilateral and bilateral variations. They may occur as an isolated abnormality (nonsyndromic—NSCLP) or coexist with syndromic disorders. Another cause of malformations, prognathism or skeletal class III malocclusion, is characterized by the disproportionate overgrowth of the mandible with or without the hypoplasia of maxilla. Both syndromes may be caused by the presence of environmental factors, but the majority of them are hereditary. Several mutations are linked to those phenotypes. In this review, we summarize the current knowledge regarding the genetics of those phenotypes and describe genotype–phenotype correlations. We then present the animal models used to study these defects.

Mandibular prognathism is one of the most concerning subjects in the oral and maxillofacial fields. In our previous studies, we attempted to clarify the etiology of mandibular prognathism. They revealed that one of the major characteristics of mandibular prognathism was the lower volume/length ratio of the mandibular condyle and body compared to normal, and the masseter muscle showed parallelism with this. This study aimed to evaluate the relationship between mandibular prognathism and the lateral pterygoid muscle by measuring the orientation and volume/length ratio of the lateral pterygoid muscle. Computed tomography was used to calculate the volume/length ratio of the lateral pterygoid muscle in 60 Korean individuals. Mimics 10.0 and Maya version 2018 were used to reconstruct the surface area and surface planes. The results showed that the prognathic group showed smaller lateral pterygoid volume/length ratios compared to the normal group (p < 0.05). In addition, the normal group displayed a larger horizontal angle (p < 0.05) to the mandibular and palatal planes than the prognathic group. This demonstrated that the mechanical drawback of the lateral pterygoid in the prognathic group is associated with mandibular prognathism.

Orthodontic camouflage provides an alternative treatment for angle III malocclusion since patients with limited economic resources cannot opt for orthognathic surgery, it being clear that correction will be achieved at the dental level and not at the bone complex. Objective: To determine an alternative treatment for patients who do not have the possibility of having orthognathic surgery. Clinical case: A 13-year-old female patient, dolico facial biotype with slightly concave profile, with Class III Skeletal by mandibular prognathism, anterior crossbite, anterior diastema, and large mandibular body, molar class, and canine III. Alexander technique brackets were placed; premolar extraction was not planned. Once the case was completed, the correction of the anterior crossbite was achieved, thanks to the use of the spaces that existed at the beginning of the treatment and also that a correct distalization of canines and retraction of the lower anterior segment were performed.

Crouzon syndrome is an autosomal dominant disorder characterized by craniosynostosis of coronal and sagittal sutures. Crouzon syndrome is caused by mutation in the fibroblast growth factor receptor-2 (FGFR-2) gene. Other characteristic features of Crouzon syndrome include exophthalmos, midfacial hypoplasia, and mandibular prognathism. The present article describes a case report of a 13-year-old male patient with characteristic skeletal and dental features of Crouzon syndrome.

Mandibular prognathism (progenism, underbite) is a type of malocclusion characterised by an abnormally anterior position of the mandible or the underdevelopment of the maxilla. The profile of an individual with the pathology is significantly prolonged in the sagittal plane, which distorts facial aesthetics. Underbite also negatively affects the entire masticatory function and may cause numerous ailments. Patients with prognathism struggle not only with aesthetic problems, but with functional issues as well. What is more, it can lead to difficulties in the psychosocial area of life by causing lower self-esteem and distorted self-image. Mandibular prognathism is treated with the use of orthodontic camouflage or combined orthodontic-surgical treatment, the latter method, despite its invasiveness, being the more popular one. An important element in the process of patient rehabilitation during treatment is the physiotherapist, who selects the right rehabilitation procedures aiming at the stomatognathic system. Even before the surgery itself, proper therapy begins whose task is preparing the craniofacial area for surgical invasion. After surgery, on the other hand, the physiotherapeutic procedures aim at the reduction of swelling, activating temporomandibular joints (TMJ), myofascial therapy, and special exercises (myokinesthetic therapy) which are aimed at supporting the adaptation of the body to a new morphological structure. This dissertation presents the case of a 19-year-old female patient with mandibular prognathism who underwent combined orhodontic-surgical treatment. The treatment consisted of Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO). The overall results of treatment were evaluated as very good.

Mandibular prognathism causes functional and esthetic problems. Therefore, many studies have been conducted to understand its etiology. Following our previous study, which revealed that the major characteristic of the mandible with prognathism is the volume/length ratio of the mandibular body and condyle, we analyzed the volume and orientation of the masseter muscle, which inserts into the mandibular body, expecting that the difference in the size of the masseter muscle causes the difference in the mandibular size. This study compared the masseter muscle of the participants in the prognathic group to those in the normal group on the volume/length ratio and orientation. The masseter muscle ratios (volume/length); the angle between the superficial and deep head of the masseter muscle; and the three planes (the palatal, occlusal, and mandibular) were analyzed. A total of 30 participants constituted the normal group (male: 15, female: 15) and 30 patients, the prognathic group (male: 15, female: 15). The results showed that the volume/length ratio of the masseter of the normal group was greater than that of the prognathic group (p < 0.05). In addition, the orientation of both the superficial and deep head of the masseter of the participants in the normal group was more vertical with respect to the mandibular plane than that of the prognathic group (p < 0.05). We concluded that the mechanical disadvantage of the masseter muscle of the prognathic group is attributed to mandibular prognathism.

The purpose of this study was to determine the position of the mandibular canal in relation to the buccal cortical bone in Chinese patients with three dentofacial relationships: normal dentition, retrognathism, and prognathism. Methods: Cone-beam computed tomography and lateral cephalograms of patients with normal dentation, retrognathism, and prognathism (n = 32 each group) were reviewed. Measurements of the shortest distance from the outer/buccal edge of the mandibular canal to the inner surface of the buccal cortex, and the distance from the lingula of the ramus to the dorsal root of the first molar were recorded. Results: No significant difference was observed between the three groups in the distribution of contact or fusion of the mandibular canal, or in the course of the mandibular canal on the right or left side. When the shortest distance at the lingula on the left side was >2.1 mm, no instances of contact or fusion were observed. On the right side, 100% of the patients had no contact or fusion when the shortest distance was >2.7 mm at the lingula. Conclusion: The shortest distance from the outer/buccal edge of the mandibular canal to the inner surface of the buccal cortex measured at the lingula can predict contact or fusion. During sagittal split ramus osteotomy, great care should be observed at the point halfway between the lingula and the anterior ramus border where the inferior alveolar nerve is the closest to the cortical bone.

Background/Aim. Postoperative condylar position is a substantial concern in surgical correction of mandibular prognathism. Orthognathic surgery may change condylar position and this is considered a contributing factor for early skeletal relapse and the induction of temporomandibular disorders. The purpose of this study was to evaluate changes in condylar position, and to correlate angular skeletal measurements following bimaxillary surgery. Methods. On profile teleradiographs of 21 patients with mandibular angular and linear parametres, the changes in condylar position, were measured during preoperative orthodontic treatment and 6 months after the surgical treatment. Results. A statistically significant difference in values between the groups was found. The most distal point on the head of condyle point (DI) moved backward for 1.38 mm (p = 0.02), and the point of center of collum mandibulae point (DC) moved backward for 1.52 mm (p = 0.007). The amount of upward movement of the point DI was 1.62 mm (p = 0.04). Conclusion. In the patients with mandibular prognathism, the condyles tend to migrate upward and forward six months after bimaxillary surgery.

Orthognathic surgery alters the position of maxilla and mandible, and consequently changes the nasal shape. The nasal change remains a concern to Asian patients. The aim of this study was to measure the nasal changes using a novel three-dimensional photographic imaging method. Methods: A total of 38 patients with Class III malocclusion and prognathism were enrolled. All patients underwent two-jaw surgery with the standard technique. A nasal alar cinching suture was included at the end of procedure. Facial landmarks and nasal morphology were defined and measured from pre- and postoperative three-dimensional photographic images. Intra-rater errors on landmark identification were controlled. Patient's reports of perceptual nasal changes were recorded. Results: The average width of the alar base and subalare remained similar after surgery. Alar width was increased by 0.74 mm. Nasal height and length remained the same. Nasolabial angle increased significantly. The area of nostril show revealed a significant increase and was correlated with a decrease of columella inclination. Nasal tip projection decreased significantly, by 1.99 mm. Preoperative nasal morphology was different between patients with and without cleft lip/palate, but most nasal changes were concordant. In the self-perception, 37% of patients reported improved nasal appearance, 58% reported no change, and 5% were not satisfied with the nasal changes. Conclusion: After the surgery, characteristic nasal changes occurred with an increase of nasolabial angle and nostril show, but a preserved nasal width. The majority of patients did not perceive adverse nasal changes.

Bacground/Aim. The literature suggests different views on the correlation between the cranial base morphology and size and saggital intermaxillary relationships. The aim of this study was to investigate the cranial base morphology, including the frontal facial part in patients with mandibular prognathism, to clarify a certain ambiguities, in opposing viewspoints in the literature. Methods. Cephalometric radiographies of 60 patients were analyzed at the Dental Clinic of the Military Medical Academy, Belgrade, Serbia. All the patients were male, aged 18-35 years, with no previous orthodontic treatment. On the basis of dental and sceletal relations of jaws and teeth, the patients were divided into two groups: the group P (patients with mandibular prognathism) and the group E (the control group or eugnathic patients). A total of 15 cephalometric parametres related to the cranial base, frontal part of the face and sagittal intermaxillary relationships were measured and analyzed. Results. The results show that cranial base dimensions and the angle do not play a significant role in the development of mandibular prognathism. Interrelationship analysis indicated a statistically significant negative correlation between the cranial base angle (NSAr) and the angles of maxillary (SNA) and mandibular (SNB) prognathism, as well as a positive correlation between the angle of inclination of the ramus to the cranial base (GoArNS) and the angle of sagittal intermaxillary relationships (ANB). Sella turcica dimensions, its width and depth, as well as the nasal bone length were significantly increased in the patients with mandibular prognathism, while the other analyzed frontal part dimensions of the face were not changed by the malocclusion in comparison with the eugnathic patients. Conclusion. This study shows that the impact of the cranial base and the frontal part of the face on the development of profile in patients with mandibular prognathism is much smaller, but certainly more complex, so that morphogenetic tests of the maxillomandibular complex should be included in further assessment of this impact.

Background/Aim. The middle part of the face, that is the maxilla, has always been mentioned as a possible etiologic factor of skeletal Class III. However, the importance of the relationship of maxillary retroposition towards the cranial base is still unclear, although it has been examined many times. The aim of this study was to conduct cephalometric analysis of the morphology of maxilla, including the whole middle part of the face in patients with divergent and convergent facial types of mandibular prognathism, as well as to determine differences betweeen them. Methods. Lateral cephalometric teleradiograph images of 90 patients were analyzed at the Dental Clinic of the Military Medical Academy, Belgrade, Serbia. All the patients were male, aged 18-35 years, not previously treated orthodontically. On the basis of dentalskeletal relations of jaws and teeth, the patients were divided into three groups: the group P1 (patients with divergent facial type of mandibular prognathism), P2 (patients with convergent facial type of mandibular pragmathism) and the group E (control group or eugnathic patients). A total of 9 cephalometric parameters related to the middle face were measured and analyzed: the length of the hard palate - SnaSnp, the length of the maxillary corpus - AptmPP, the length of the soft palate, the angle between the hard and soft palate - SnaSnpUt, the angle of inclination of the maxillary alveolar process, the angle of inclination of the upper front teeth, the effective maxillary length - CoA, the posterior maxillary alveolar hyperplasia - U6PP and the angle of maxillary prognathism. Results. The obtained results showed that the CoA, AptmPP and SnaSnp were significally shorter in patients with divergent facial type of mandibular prognathism compared to patients with convergent facial type of the mandibular prognathism and also in both experimental groups of patients compared to the control group. SnaSnp was significantly shorter in patients with divergent facial type of mandibular prognathism compared to the control group, whereas SnaSnp was significantly smaller in patients with convergent facial type of mandibular prognathism compared to the control group. Additionally, there was a pronounced incisor dentoalveolar compensation of skeletal discrepancy in both groups of patients with mandibular prognathism manifested in the form of a significant upper front teeth protrusion, but without significant differences among the groups, while the maxillary retrognathism was present in most patients of both experimental groups. A pronounced UGPP was found only in the patients with divergent type of mandibular prognathism. Conclusion. The maxilla is certainly one of the key factors which contributes to making the diagnosis, but primarily to making a plan for mandibular prognathism treatment. Accurate assessment of the manifestation of abnormality, localization of skeletal problems and understanding of the biological potential are key factors of the stability of the results of surgical-orthodontic treatment of this abnormality.

These case reports describe the surgical treatment of 2 male adult patients with severe mandibular prognathism. For both patients, anterior repositioning of the maxilla by Le Fort I osteotomies with and without impaction and mandibular posterior repositioning by sagittal split ramus osteotomies were performed. The aim of this case report is to identify successfully treated surgical cases maintaining the results throughout the follow-up period of 7 years.

Introduction/Aim. There are numerous factors that influence the formation of condylar processus: the growth and development of cranial base, growth and development of the jaws and alveolar extensions, teething, the way of intercuspidation, the overlap of incisors, functions of masticatory muscles, etc. Considering the fact that the above-mentioned factors significantly differ in persons with different morphological set of the face, we set a hypothesis that dimensions of condylar processus and the mandibular ramus considerably differ in persons with mandibular prognathism compared to eugnatic persons. The aim of this study was to establish the differences in dimensions of condylar processus between the above-mentioned groups. Methods. Six parameters representing the dimensions of the condylar processus were measured on profile teleradiographs of 30 eugnatic persons and 30 paersons with mandibular prognathism: the height of condylar processus, the height of head of the mandible, width of the head, width of the neck, height of the ramus without the condylar processus and the overall height of the ramus. Results. A considerable difference in the values of the parameters was found, as well as the distribution toward the values of reference. It was found that the height of the condylar processus was significantly greater in persons with mandibular prognathism, whereas the width of the head of the mandible, the width of the neck and the height of the ramus without the condylar processus was considerably decreased within the same group. The height of the head of the mandible and the overall height of the ramus was not significantly changed. Conclusion. In persons with mandibular prognathism, morphological features of the condylar processus are changed. The condylar processus lengthens on account of shortening of the lower part of the ramus, and the mentioned lengthening is the most prominent in its condylar neck area which is also the centre of its most intense growth.

Introduction/Aim. Patients with mandibular prognathism as dominant symptom have disordered sagittal interjaw relations that make prominent appearance to this dental craniofacial anomaly beside hyperplastic mandibles and inverted front teeth overlap. The aim of this study was to examine the differences in dimensions of sella turcica in patients with mandibular prognathism and in eugnathic. Methods. On profile teleradiographs of 30 eugnathic control and 30 patients with mandibular prognathism, three parameters, which represent dimensions of sella turcica, were measured (surface, width and depth). Results. Statistically significant difference in values between the groups was found. All the three measured parameters were significantly higher in the patients with mandibular prognathism (p < 0.01). Conclusion. In the patients with mandibular prognathism all the measured dimensions of sella turcica were bigger, and so was sella turcica, but that enlargement was not in correlation with the degree of anomaly itself.

The purpose of this longitudinal descriptive study was to evaluate the behavior of soft tissues in patients who underwent bimaxilar ortognatic surgery at the Hospital University San Vicente de Paul (HUSVP) by means of lateral cephalic headplates. A total of twenty one patients selected by convenience, with an average age of 22,8 years, were treated , all of them received lateral cephalic headplates pre and post surgery. All of the subjects had received pre-surgical orthodontic treatment, they also received LeFort I surgery of impactation and maxilar advance, the mandible was retruded using a sagittal technique of the ramus. A different behaviour to the one found in different ethnic groups was found in this population. The movement in the horizontal plane showed an ascending path from the nasal point up to the upper superior point of the lip. For the nasal point a 46.9% movement was found. For the sub nasal and the superior anterior point of the lip a movement of 63.5% and 73% respectively. For the mandible the movement was51.0 % for labralis superius, point point B followed with 82.9 % and pogonion with 75%. In the vertical direction the movement was 67% for the nasal point, 64% for sub nasal point and 50% for the labralis superior. The mandible showed a movement of 34, 7% for labralis inferior and an average of 67,7% for the remaining points of the mandible. In conclusion, it is important to consider the ethnic characteristics of our population and the type of surgery, since they presented a different behavior than the one reported in the literature.

Background/Aim. To establish the influence of surgical corrections of mandibular prognathism upon the position of the lower and upper anterior teeth (incisors). Methods. The changes in position of the lower and upper anterior teeth (incisors) after the surgical correction of mandibular prognathism were analyzed by means of x-ray craniometry in 183 patients (female: n = 110, male: n = 73) in which the correction had been made in accordance with the principles of sagital osteotomy of the mandibular ramus. There were 4 angular and 2 linear parameters determined in the pre- and postoperative tele-xray-pictures. The changes of these parameters were tested by means of the parametric statistic tests. Results. The performed surgical procedures did not cause statistically significant changes in the angular parameters. The changes of both linear parameters were thought highly statistically significant. Conclusion. Under the influence of the performed surgical procedures no changes were found in the position of anterior teeth (incisors) in relation to SN and the mandibular plane. They were actually moved along with the medium fragment of the lower jaw and that fragment was moved linearly backwards along the occlusal plane with a practically insignificant rotation in the cranial direction.

A clinical case report of a fifteen-year-old female with an Angle class III malocclusion and with maxillary deficiency and mandibular prognathism is presented. The patient initially consulted at an early age and a decision was made to delay comprehensive treatment until her skeletal growth ended. Alexander’s prescription (Ormco) was used for orthodontic treatment and a mandibular surgical set back only with oblique ramous osteotomy was performed achieving an adequate occlusal relationship and facial balance. This patient was treated according to the protocol established for the orthodontic and oral and maxillofacial surgery postgraduate programs of the Dental Faculty of the University of Antioquia.

This study analyzed the changes that occurred in the articulation of oral phonemes (AP), the levels of stridence and hissing in patients with class III malocclusion and / or anterior open bite and that were subjected to orthognathic surgery. The sample consisted of 16 patients (12 females and 4 males), 12 of them were treated at the Stomatological and Maxillofacial Surgery Unit of the Hospital Universitario San Vicente de Paul, the other 4 were selected from private practice during the period of March and December 2001. The age range was between 16 and 37 years of age, with an average of 23,8 years. The sample included patients with class III malocclusion and / or anterior open bite that underwent orthognathic surgery. A Sound Forge 5.0® software, property of the radio station of University of Antioquia was used to look for changes in the articulation of various phonemes that imply dentoalveolar pronunciation. The results suggest that after the surgical correction of the skeletal discrepancies there is a positive change of the phonemes for the majority of patients.

OBJETIVO: o diagnóstico e o tratamento precoce do Padrão III são temas ainda muito discutidos na literatura ortodôntica. A tração reversa associada à expansão rápida da maxila constitui a abordagem mais popular e estudada, produzindo os melhores resultados no menor período de tempo. O foco deste estudo foi avaliar as mudanças gradativas ocorridas no complexo dentofacial em crianças com Padrão III de crescimento tratadas com tração reversa da maxila associada à mecânica intermaxilar. MÉTODOS: a amostra foi constituída por 10 pacientes Padrão III, com média de idade de 8 anos e 2 meses ao início do tratamento, tratados consecutivamente com aparelho expansor de Haas modificado, arco lingual modificado, elásticos intermaxilares e máscara de Petit para tração reversa da maxila por 9 meses. Foram realizadas 4 telerradiografias em norma lateral de cada paciente, uma correspondente ao início do tratamento e as demais em intervalos regulares de 3 meses (T1, T2, T3 e T4). As grandezas cefalométricas foram comparadas entre os tempos através de Análise de Variância de Medidas Repetidas, complementada pelo Teste de Comparações Múltiplas de Tukey. RESULTADOS: pôde-se observar que as alterações esqueléticas mais significativas ocorreram nos primeiros 3 meses de tratamento, sendo que, após esse período, elas se mantiveram constantes até o final do tratamento. Ocorreram poucas compensações dentárias e as alterações verticais ocorridas apresentaram significado clínico reduzido. CONCLUSÃO: a terapia empregada obteve não só uma correção do trespasse horizontal entre as arcadas, mas também uma melhora no relacionamento sagital entre as bases ósseas e na estética tegumentar.OBJECTIVE: The early diagnosis and treatment of skeletal Class III (Pattern III) is still a much debated topic in orthodontic literature. Maxillary protraction associated with rapid maxillary expansion is the most popular and widely researched approach, producing the best results in the shortest period of time. This study aimed to evaluate the gradual changes that occur in the dentofacial complex in children with Pattern III growth treated with maxillary protraction associated with intermaxillary mechanics. METHODS: The sample consisted of 10 patients with Pattern III, whose mean age was 8 years and 2 months at the beginning of treatment, consecutively treated with a modified Haas expander, modified lingual arch, intermaxillary elastics and Petit facemask for maxillary protraction during a 9-month period. Four lateral cephalograms were taken of each patient, one at the beginning of treatment and the other three at regular 3-month intervals (T1, T2, T3 and T4). Cephalometric measurements at each of the four times were compared using ANOVA variance for repeated measures and supplemented by Tukey's multiple comparisons test. RESULTS: It was observed that the most significant skeletal changes occurred in the first 3 months of treatment. After that period the changes remained constant until the end of treatment. There were few dental compensations and the vertical changes which occurred showed reduced clinical significance. CONCLUSIONS: The therapy used in this study accomplished not only the correction of overjet but also improvements in the sagittal relationship of the basal bones and in soft tissue esthetics.

The existance of the relationships between cranial base flexure and prognathizm had been demonstrated by several authors. Present study reevaluates these associations by the use of a cephalometric analysis based on Natural Head Position, (NHP), and extracranial true HOR and VER reference lines. The study sample comprised NHP cephalograms of 106 dental students with an age range of 19-29 years. Results showed that the rotational orientation of the cranial base in the natural position of the head could be a determining factor for the degree of prognathism, while the cranial base flexion was found to be associated with the sagittal dimension of maxilla. Nevertheless, this effect did not result with an increase in maxillary prognathism.

Objective: The aim of this study was to assess skeletal relapse in patients who underwent mandibular setback by bilateral sagittal split ramus osteotomy (BSSRO) and osteosynthesis wiring techniques. Materials and Methods: In this semi-experimental study, 10 patients (8 women, 2 men) with 3-8 millimeters overjet underwent mandibular setback with BSSRO, osteosynthesis wiring and inter maxillary fixation (IMF) techniques for 6-8 weeks. They were studied before (T0), immediately after (T1), and 6 months after surgery (T2) using clinical and cephalometric indices. Then, the maximum changes occurred in sagittal, rotational and vertical planes were evaluated in three time intervals (T1-T0), (T2-T0), and (T2-T1). Wilcoxon paired test was used as a statistical approach for data analysis. Results: The highest degree of relapse occurred in the sagittal plane in mandibular setback surgery with BSSRO and osteosynthesis wiring and IMF techniques. The degree of relapse was irrelevant of setback. In addition, no patient showed the amount of relapse warranting another surgery after six months. Conclusion: BSSRO surgery with osteosynthesis wiring and IMF provides acceptable stability in mandibular setback.

Abstract Background When simple sequence repeats are integrated into functional genes, they can potentially act as evolutionary ‘tuning knobs’, supplying abundant genetic variation with minimal risk of pleiotropic deleterious effects. The genetic basis of variation in facial shape and length represents a possible example of this phenomenon. Runt-related transcription factor 2 (RUNX2), which is involved in osteoblast differentiation, contains a functionally-important tandem repeat of glutamine and alanine amino acids. The ratio of glutamines to alanines (the QA ratio) in this protein seemingly influences the regulation of bone development. Notably, in domestic breeds of dog, and in carnivorans in general, the ratio of glutamines to alanines is strongly correlated with facial length. Results In this study we examine whether this correlation holds true across placental mammals, particularly those mammals for which facial length is highly variable and related to adaptive behavior and lifestyle (e.g., primates, afrotherians, xenarthrans). We obtained relative facial length measurements and RUNX2 sequences for 41 mammalian species representing 12 orders. Using both a phylogenetic generalized least squares model and a recently-developed Bayesian comparative method, we tested for a correlation between genetic and morphometric data while controlling for phylogeny, evolutionary rates, and divergence times. Non-carnivoran taxa generally had substantially lower glutamine-alanine ratios than carnivorans (primates and xenarthrans with means of 1.34 and 1.25, respectively, compared to a mean of 3.1 for carnivorans), and we found no correlation between RUNX2 sequence and face length across placental mammals. Conclusions Results of our diverse comparative phylogenetic analyses indicate that QA ratio does not consistently correlate with face length across the 41 mammalian taxa considered. Thus, although RUNX2 might function as a ‘tuning knob’ modifying face length in carnivorans, this relationship is not conserved across mammals in general.

Se realizó un estudio prospectivo y longitudinal de 24 pacientes tratados con retroposición mandibular y reposición superior del mentón, en el período comprendido entre 1990 y 1997, para lo cual se aplicaron las técnicas de osteotomía sagital modificada de la rama y ostectomía oblicua del mentón con pedículo de tejido blando en su porción anterior. El movimiento posterior del incisivo inferior se asoció con el movimiento anteroposterior del labio inferior y el pogonion blando, en una relación de 1:0,76 y 1:0,91 mm, respectivamente. El pogonion óseo se asoció con el movimiento posterior de su homólogo blando en una relación de 1:0,86 mm. El punto B acompaño a su contraparte ósea en una proporción de 1:0,88 mm. Asimismo, la reducción vertical del mentón disminuyó la longitud del labio inferior en 0,68 mm por cada milímetro de reducción del primero; mientras que el pogonion blando se desplazó superiormente en 0,96 mm por cada milímetro en que se redujo la altura del mentón. Se establecen otros valores pronósticos para el componente mantolabial, de importancia en la planificación cefalométrica.A prospective and longitudinal study of 24 patients treated with mandibular retroposition and upper reposition of the chin by the techniques of modified branch sagital osteotomy and oblique osteotomy of the chin with pedicle of soft tissue in its anterior portion, from 1990 to 1997, was conducted. The posterior movement of the inferior incisor was associated with the anteroposterior movement of the lower lip and the soft pogonion in a ratio of 1:0.76 and 1:091 mm. The osteal pogonion was associated with the posterior movement of its soft homologue in a ratio of 1:086 mm. Point B accompanied its osteal counterpart in a proportion of 1:0.88 mm. Likewise, the vertical reduction of the chin decreased the length of the lower lip in 0.68 mm per every millimiter of reduction of the first;| whereas the soft pogonion upperly displaced 0.96 mm per each millimeter of reduction of the chin height. Other prognostic values were established for the mentolabial component that are important for cephalometric planning.