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Background: We aimed to evaluate the possibility of temporomandibular joint (TMJ) dysfunction following mandibular advancement surgery in skeletal class 2 patients., Methods: All healthy non-syndromic patients with Class 2 deformity, who were eligible for mandibular advancement surgery, were included in this before-after quasi-experimental study. The main intervention was mandibular advancement through bilateral sagittal split osteotomy (BSSO). Maxillary impaction or setback surgery using LeFort 1 osteotomy was simultaneously performed in some cases. Variables such as TMJ pain, clicking, crepitus, or any other type of sounds or complaint as well as the amount of maximum mouth opening (MMO) were evaluated before surgery and two months postoperatively., Results: Thirty patients including 15 men and 15 women with a mean age of 23.3 ±2.7 yr were studied. The mean amount of mandibular advancement displacement was 3.30 ± 0.87 mm. The rate of TMJ dysfunctions and complaints was relatively low two months postoperatively when compared to the preoperative state. Postoperative evaluation demonstrated that there was no significant correlation between the presence of TMJ symptoms and dysfunctions and the type of surgery. After treatment was completed, the mean MMO reduced significantly from 39.03±5.86 to 38.12±6.05 ( P <0.001)., Conclusion: Mandibular advancement with BSSO surgery in skeletal class 2 patients did not clinically lead to TMJ dysfunctions. Among all the investigated factors, only preoperative pain, noises, or complaints were proven to have predictive value for postoperative TMJ dysfunction., Competing Interests: None declared.

Background: We aimed to assess the incidence of bad split fractures during Bilateral Sagittal Split Osteotomy (BSSO) mandibular setback surgery using Dal Pont and Hunsuck techniques., Methods: All healthy adults with skeletal class III discrepancy, who were candidates for mandibular setback surgery were enrolled in this randomized clinical trial in the Maxillofacial Surgery Department of Qaem Hospital, Mashhad, Iran; from 2018-2020. These patients were randomly divided into two equal groups; one group underwent BSSO using Dal Pont osteotomy while the Hunsuck osteotomy was employed for the other group. A bad split fracture which identified through intra-operative clinical and postoperative radiographic examination was the outcome variable. The significance level was set at 0.05 using SPSS 16., Results: Overall, 104 consecutive patients, comprising of 52 (50%) males with an average age of 23.09±3.08 were recruited. The average duration of osteotomy and splitting was reported to be 22.74±3.06 min. 10 bad split fractures (9.62%) were observed; 7 of which occurred in the Dal Pont group and 3 in the Hunsuck group. However, this difference was not significant. In 80% of the cases, bad split osteotomy occurred in the proximal segment, while this finding was identified in the distal segment in 20% of cases. The average duration of osteotomy and splitting was significantly longer in the Dal Pont group (P<0.001)., Conclusion: The duration of osteotomy and splitting is much shorter when the Hunsuck technique is employed, and the incidence of unfavorable fractures is also less compared to the Dal Pont osteotomy technique., Competing Interests: The authors have no conflicts of interest to disclose.

Background: This study aimed to investigate the positional changes of the hyoid bone following orthognathic surgery in skeletal class III patients., Methods: This double-blinded quasi-experimental study was carried out in Mashhad University of Medical Sciences, Iran, from Apr 2019 to Jun 2020. All skeletal Class III patients who were candidates for orthogenetic surgery were included. They underwent mandibular setback surgery using bilateral sagittal split osteotomy. Cephalometric assessments in relation to hyoid bone position and posterior airway space (PAS) were conducted one day preoperatively (T0), as well as one week (T1), six months (T2) and one year (T3) postoperatively, determining the parameters like the Long axis of the hyoid bone (LAH), Retrognation (RGn), Hyoidale (H), Palatal plane (PP), Mandibular plane (MP) and C3 Vertebrae (C3). All cephalograms were examined using AudaxCeph, Planmeca software. The data analysis was performed via SPSS-19 ( P <0.05)., Results: 25 class III patients, including 18 females (72%) and 7 males (28%) with a mean age of 24.32±5.87, were studied. The cephalometric analysis demonstrated significant decreases in variable angles during the follow-up periods, except for LAH-MP angle ( P <0.001). The hyoid bone moved downward and backward relative to its original position following the mandibular setback surgery. However, the bone gradually returned to the preoperative location between 6 to 12 months postoperatively., Conclusion: The findings revealed the downward and backward movement of the hyoid bone following the mandibular setback surgery, returned near to its preoperative position after 1 year, postoperatively., Competing Interests: The authors have no conflict of interests to declare.

Background: Obstructive sleep apnea is a disorder of repetitive complete or partial airway obstruction during sleep. The aim of this study was to assess the impact of alveolar cleft reconstruction on the obstructive sleep apnea (OSA) condition and apnea/hypopnea index (AHI)., Methods: In a double-blinded prospective quasi-experimental study, all healthy systemic children (n=30 female cleft patients) with unilateral alveolar cleft defects within the age range of 8-14 years and BMI less than 30 kg/m 2 who admitted for alveolar cleft repair were enrolled. OSA monitoring was performed one week before surgery, and 3 months postoperatively by Apnea Link device. Sleep apnea indices such as AHI, respiratory disturbance index (RDI), oxygen desaturation index (ODI) and oxyhemoglobin saturation (SpO2) as well as pulse rate (PR) and respiratory rate (RR) were the variables., Results: The patients' mean age was 11.0±1.4 years, and BMI average was 21.48±4.4 kg/m 2 . Mean AHI was 21.6±5.0 events/hour, preoperatively; which decreased significantly and reached 4.4±2.5 events/hour after alveolar cleft reconstruction surgery ( p =0.005). Moreover, the other OSA variables (SpO2, RDI, and ODI), as well as vital signs (PR, and RR) improved postoperatively ( p =0.005). In other words, the preoperative moderate OSA status relieved after alveolar cleft repair and reconstruction., Conclusion: Our study showed that the OSA and AHI ameliorated after bone graft surgery in alveolar cleft repair. More clinical trials including larger sample sizes may be required for relevancy.