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Musculoskeletal abnormalities in neonate equids represent a common condition, which includes angular limb deformities, defective carpal/tarsal bone ossification, contracted limb and mandibular/maxillary prognathism. The present case report described the presentation and surgical management of multiple musculoskeletal abnormalities in a mule foal. A newborn mule foal was presented for several musculoskeletal abnormalities, such as angular deviation from the sagittal plane of both carpal joints, hind limb ligament laxity, and severe mandibular prognathism. Surgical management of mandibular prognathism was then treated through the application of a tension orthodontic wire. Postoperatively, there was a significant improvement in the correction of mandibular malocclusion and no further correction was needed. Management of other anomalies was mainly conservative, with stall rest and exercise limitations, with a considerable improvement in the first month of life. Thus, jaw malformations might be observed also in mule foals, and might be associated with multiple congenital abnormalities. Early recognition, appropriate management, and surgical treatment were essential., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

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.

This systematic review aimed to investigate the factors that may contribute to the development of OSA after orthognathic surgery in patients with skeletal class III. Electronic searches of PubMed, Embase, Web of Science, and Cochrane databases were conducted up to December 10, 2022. In total, 277 studies were retrieved and screened according to the inclusion and exclusion criteria, and 14 were finally selected. All studies were of medium quality (moderate risk of bias). The occurrence of OSA after orthognathic surgery in patients with class III skeletal relationships depends on surgical factors and patient self-factors. Surgical factors include surgery type, amount of maxillary and mandibular movement, and the patient's postoperative swelling. Patient self-factors include weight, age, gender, and hypertrophy of the soft palate, tonsils, and tongue. According to information in the 14 selected articles, the incidences of OSA after Le Fort I impaction and BSSO setback, BSSO setback, and Le Fort I advancement and BSSO setback were 19.2%, 8.57%, and 0.7%, respectively, mostly accompanied with greater amounts of mandibular recession. However, no clear evidence exists to confirm that orthognathic surgery is a causative factor for postoperative sleep breathing disorders in patients with mandibular prognathism. The wider upper airway in patients with class III skeletal might be the reason for the rare occurrence of OSA after surgery. In addition, obesity and advanced age may lead to sleep apnea after orthognathic surgery. Obese patients should be advised to lose weight preoperatively., Competing Interests: Declaration of competing interest All authors declare no conflicting relationships., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

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.

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.

Background: Bilateral sagittal split osteotomy (BSSO) is one of the most frequently used treatments for jaw deformity worldwide. However, lower lip hypoesthesia is a postoperative complication of BSSO. Trigeminal somatosensory evoked potential can be used to evaluate neural pathway abnormalities by measuring latency. The purposes of this study were to measure latency before and after BSSO and to examine the relationship between latency and the duration of hypoesthesia recovery., Study Design and Methods: This observational retrospective case-control study analyzed data recorded from 2013 to 2018. We divided the patient data into 5 groups according to recovery time. Using the latency obtained in trigeminal somatosensory evoked potential as the main outcome, we examined the relationship between hypoesthesia recovery time and latency., Results: The group with unresolved postoperative hypoesthesia 6 months after surgery had significantly greater latency values extension than the group without postoperative hypoesthesia., Conclusion: By measuring the degree of prolongation of latency before and after surgery, it is possible not only to indicate the presence of hypoesthesia but also to predict the hypoesthesia recovery period., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: In the present study, we assessed the rate of complications and morbidity after mandibular setback with bilateral intraoral vertical ramus osteotomy (IVRO)., Study Design: In total, 133 patients were included. The prevalence of neurosensory disturbance (NSD), surgical site infection (SSI), and other complications were registered 2 months and 1 year after surgery. The correlations between complications and age, sex, American Society of Anesthesiologists classification, body mass index, blood loss, and operative time were evaluated., Results: NSD was reported for 6.8% of the patients (9 of 133) 2 months after surgery (3.8% of the operated sites). The prevalence was significantly higher in female patients (P < .05). Two patients described persistent unilateral reduced sensibility after 1 year (1.5%). In total, 0.8% of the operated sites (2 of 266) had persistent NSD after 1 year. None of the patients required prolonged hospitalization, and 95.5% (127 of 133) were discharged the day after surgery. None of the patients experienced severe bleeding, and only 1 patient developed SSI. There were no significant correlations between patient-specific or intraoperative parameters evaluated and registered complications., Conclusions: This study shows that IVRO is a safe surgical technique associated with a low complication rate. IVRO can be an alternative technique for mandibular setback in patients who can tolerate postoperative maxillomandibular fixation., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: This study aimed to evaluate postoperative changes in the condyle after unilateral sagittal split ramus osteotomy (USSRO) and to compare them with changes occurring after bilateral sagittal split ramus osteotomy (BSSRO)., Study Design: For 50 condyles from 25 patients, positional and volumetric changes of condyle were analyzed by using computed tomography images taken before, immediately after, and 6 months after surgery and compared between the USRRO and BSSRO groups., Results: The condyle showed lateral and inferior displacement immediately after surgery and medial and superior movement at 6 months after surgery in the USSRO and BSSRO groups. No statistically significant difference was found between the 2 groups in the time-course positional change and rotation of the condyle. In the comparison of bodily shift and rotation between operated and nonoperated sides in USSRO group, there were no significant differences between the 2 sides, except for the perioperative rotation pattern on the coronal plane. At 6 months after surgery, the changed volume relative to preoperative condylar volume was only 5.2% in the USSRO group and 2.7% in the BSSRO group., Conclusions: The findings from this study suggest that USSRO can be used effectively in appropriately selected patients; however, temporomandibular joint (TMJ) problems may arise when condylar displacement is excessive enough to exceed physiologic tolerances., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: To clarify whether intraoral vertical ramus osteotomy (IVRO) or short lingual osteotomy (SLO) induces less proximal segmental movement after surgery without bone fixation., Methods: This study included patients who underwent IVRO or SLO without bone fixation. Cephalograms were taken before surgery (T1), immediately after surgery (T2), and >6 months after surgery (T3) to assess postoperative movement of the proximal segment and skeletal stability. The condylar angle was measured using computed tomography images taken at T1 and T3 to assess rotation., Results: Ninety patients were included (IVRO, n = 25; SLO, n = 65). The proximal segment swung laterally on the frontal cephalogram in the asymmetrical IVRO group at T3. The condylar head was rotated outwardly 6.52 ± 4.49° (p < 0.0001) in the symmetrical IVRO group and 8.06 ± 6.88° (p = 0.030) on the non-deviated side in the asymmetrical IVRO group at T3. The condyles were almost stable in the SLO group. Temporomandibular joint disorders were found in 2 of 22 IVRO patients and in 2 of 42 SLO patients with asymmetry at T3., Conclusion: This study suggests that SLO with the physiological positioning strategy (PPS) should be preferred over IVRO with the PPS whenever possible., (Copyright © 2020 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to investigate postoperative horizontal relapse of the mandible in terms of the effects of the magnitude of mandibular setback movement and ramus inclination after LeFort I osteotomy and sagittal split ramus osteotomy., Study Design: A retrospective study of patients who underwent orthognathic surgery for mandibular prognathism was performed. Postoperative relapse at point B was analyzed with regard to the magnitude of mandibular setback and the ramus inclination. Serial cephalograms were used to measure surgical changes and evaluate postoperative relapse., Results: Nineteen men and 31 women (mean age 23.1 years) were retrospectively enrolled. Mean surgical backward movement of the mandible at point B was 8.2 mm, mean ramus inclination was 3.56 degrees, and mean relapse 1 year postoperatively was 0.95 mm (11.6%). Horizontal relapse of the mandible was significantly correlated with the magnitude of mandibular setback (r = -0.52; P = .007) and ramus inclination (r = 0.48; P = .014)., Conclusions: Increased horizontal mandibular relapse after bimaxillary surgery was associated with greater mandibular setback movement and increased proximal segment clockwise rotation. Mandibular relapse after bimaxillary surgery may be minimized via adequate control of intraoperative clockwise rotation of the proximal segment., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: This study was conducted to characterize the effects of the changes in the condylar long axis and position on temporomandibular symptoms with respect proximal segment position after intraoral vertical ramus osteotomy (IVRO)., Study Design: Twenty Japanese patients with diagnosed jaw deformity underwent IVRO without internal fixation. Long-term changes in condylar long axis and position were assessed during postoperative follow-up examinations by using computed tomography, and t tests were performed for comparison. In addition, changes in temporomandibular symptoms were examined., Results: The degree of axial rotation of the proximal segment changed significantly when the proximal segment was located laterally. Downward changes in condylar position significantly differed when the proximal segment was located posterolaterally. Forward changes in condylar position significantly differed when the proximal segment was located laterally; moreover, when the proximal segment was located laterally, temporomandibular symptoms disappeared., Conclusions: Lateral location of the proximal segment may be an important factor in the positive effects of IVRO, with respect to temporomandibular symptoms., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The purpose of this study was to compare different internal fixation techniques with resorbable or titanium fixation system used in sagittal split ramus osteotomy (SSRO) for mandibular setback. Synthetic polyurethane hemimandible replicas were used. The distal segment was repositioned in a 5-mm setback position. The hemimandibles were divided into the following eight groups: resorbable miniplate (A), titanium miniplate (B), resorbable hybrid; resorbable miniplate and bicortical screw (C), titanium hybrid; titanium miniplate and bicortical screw (D), resorbable mixed hybrid; resorbable bicortical screw and titanium miniplate (E), titanium mixed hybrid; titanium bicortical screw and resorbable miniplate (F), three resorbable bicortical screws (G) and three titanium bicortical screws (H). The compression loads were applied on the incisal edge. The compression loads (N) at 5- and 10-mm displacement were analyzed (P < 0.05). Miniplate groups (A and B) were significantly weaker than the other groups (C ∼ H). Group (H) had greatest biomechanical stability. There was no significant difference between group (D) and group (H) at 10-mm displacement. Group (G) showed a lower load than group (H) and group (D). There was no significant difference between the hybrid and mixed hybrid groups. It was concluded that additional placement of a bicortical screw, either titanium or resorbable with a miniplate may provide significantly better stabilization., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: Headgears have been used to treat Class II malocclusions for over a century. The purpose of this retrospective study was to investigate the profile esthetic changes resulting from headgear use in growing Class II patients with protrusive, normal, and retrusive maxillae., Methods: Profile silhouettes were created from pretreatment and posttreatment lateral cephalometric tracings of growing Class II patients treated with headgear followed by conventional fixed appliances. Ten patients had an initially protrusive maxilla (FH:NA, >92°), 10 had an initially normally positioned maxilla (FH:NA, 88°-92°), and 10 had an initially retrusive maxilla (FH:NA, <88°). A panel of 20 laypersons judged the profile esthetics of the randomly sorted silhouettes. Descriptive statistics, correlation analysis, and anlaysis of variance (ANOVA) with post-hoc Tukey-Kramer tests were used to ascertain differences between groups and the effects of treatment., Results: A significant moderate correlation was found between initial ANB magnitude and the improvement in profile esthetic score with treatment (r = 0.49, P <0.01). No significant correlations were found between the initial anteroposterior position of the maxilla (FH:NA) and the initial, final, or change in profile esthetic scores. There were average improvements with headgear treatment in profile esthetics for all groups., Conclusions: In Class II growing patients with protrusive, normally positioned, or retrusive maxillae, headgear treatment used with fixed orthodontic appliances is effective in improving facial profile esthetics: the greater the initial ANB angle, the greater the profile esthetic improvement with treatment., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: The purpose of this study was to describe the craniofacial growth changes of subjects with Class II malocclusion associated with maxillary skeletal protrusion at the circumpubertal growth period., Methods: The records of 25 untreated subjects with normal Class I occlusion and 25 untreated Class II subjects (14 boys and 11 girls in each group) were selected from the longitudinal records of the University of Michigan Growth Study. All Class II subjects had maxillary protrusion. Measurements were made on lateral and posteroanterior cephalograms and on dental casts at 2 times. The first observation (T1) was during the prepubertal growth phase (vertebral stages CS1 to CS3). The second observation (T2) was during the postpubertal phase of growth (vertebral stages CS4 to CS6). The following comparisons were made: Class I vs Class II at T1, Class I vs Class II at T2, and growth changes in Class I vs Class II., Results: No dentofacial feature studied showed any statistically significant difference when comparing the growth changes between the Class II and the Class I groups., Conclusions: These results suggest that dentofacial features of Class II malocclusion associated with maxillary skeletal protrusion are maintained during the circumpubertal period, and that growth changes in this type of Class II disharmony are similar to those in subjects with normal occlusion.

A case report about the orthodontic treatment of a Class III malocclusion in a black man 22 years 8 months old. The patient's chief complaint concerned the space left by the traumatic loss of the maxillary left central incisor. Not desiring changes in facial appearance, the patient sought an orthodontic solution to his problem. An acceptable result was achieved through maxillary expansion and the reduction of mandibular space. [This case was presented to the American Board of Orthodontics in partial fulfillment of the requirements for the certification process conducted by the Board.]

Twenty-three male juvenile rhesus monkeys (Macaca mulatta) were used in an experimental study of long-term mandibular adaptations to induced protrusive function. Serial protrusive appliances were placed in 11 experimental animals and mandibular adaptations were monitored cephalometrically. Twelve animals were used as controls. After 48 weeks significant increases in increments of condylar growth and in overall mandibular length were noted in the treated animals. At the end of the 144-week experimental period, the mandibles of the treated animals were 5 to 6 mm longer than those of the control animals. The results of this study do not support the hypothesis that the mandible has a genetically predetermined length.