Assessing the need for a protocol in monitoring weight loss and nutritional status in orthognathic surgery based on patients experiences

To investigate retrospectively the orthognathic surgery (OGS) patients experience in weight loss and the influence of gender, age, duration of the surgical procedure, length of hospital stay, location of surgery and use of intermaxillary fixation (IMF) or without IMF on postoperative weight loss. A total of 4487 patients treated by OGS where all patients visited the outpatient clinic one, three and six weeks after the surgical procedure. After six weeks, patients filled out a questionnaire in which weight loss was addressed. The patients were asked to give an estimate of their experiences weight loss. The population was first divided in two groups weight loss and no weight loss. In the weight loss group there is no significant difference in weight loss between patients with IMF and patients without IMF. In the weight loss group there were significantly more females then males. Further, in the subgroup IMF the operation time was significantly longer compared with the subgroup without IMF. The other parameters including age and hospital stay were not different in the groups. IMF in orthognathic treatment does not result in a difference self-reported loss of body weight compared to patients without IMF. Treatment protocols should include pre- and post-operative dietician consultations and possible indications for medical nutrition and vitamins

The surgical management of post-traumatic malocclusion

Facial skeleton fractures should be reduced as early as possible to restore optimal function and minimize skeletal and soft-tissue deformity. With unsatisfactory outcome from delayed treatment because of comorbidity, or despite optimal management, late reconstruction can succeed with conventional orthognathic surgical procedures. Management follows well-established principles of correcting dentofacial deformities, coordinated with orthodontic and prosthodontic support. Planning should include dental records when available, and clinical photographs. The late deformity of midfacial fractures can be corrected by following initial fracture lines; condylar fracture patients can be treated by remote osteotomies. Before surgical intervention, diminished temporomandibular joint (TMJ) mobility should be managed with aggressive physiotherapy to maximize stomal opening. Additionally, successful outcome will depend on a stable TMJ relation without ongoing remodelin

Transgender feminization of the facial skeleton

In transsexualism, there is a strong and ongoing cross-gender identification, and a desire to live and be accepted as a member of the opposite gender; thus there is a wish for somatic treatment to make one's body as congruent as possible with gender identity. Makeup and change in hairstyle and accessories further feminize the face, and in time, most persons became more adapted to their life as a member of the opposite gender. There is a need for more objective standardization of the differences in the facial features of the two sexes, to facilitate surgical treatment planning and more objectively assess the outcome of the facial surgery on psychosocial functioning and appearanc

Adaptation of jaw closing muscles after surgical mandibular advancement procedures in different vertical craniofacial types: a magnetic resonance imaging study

Objective: Surgical mandibular advancement influences the biomechanics of the mandible and as a result may provoke relapse. In this study, the adaptation of the masseter (MAS) and medial pterygoid muscles (MPM) after surgical mandibular advancement was evaluated. Study design: Of 12 patients with mandibular retrognathia and varying vertical craniofacial morphology, axial and 30° angulated magnetic resonance imaging (MRI) scan series were taken preoperatively and 10 to 48 months postoperatively. Using cluster analysis, subjects were assigned to a long-face (LF) and a short-face (SF) cluster. Subsequently, preoperative and postoperative maximum cross-sectional areas and volumes of the MAS and MPM were compared in these groups. Results: The cross-sectional area and volume of the MAS decreased significantly in both the SF and LF cluster (up to 18%). Although not significantly, this phenomenon tended to be more pronounced in LF patients. The cross-sectional area of the MPM showed less adaptation. Conclusion: The jaw-closing muscles become significantly smaller after surgical mandibular advancement, irrespective of the vertical craniofacial type. © 2007 Mosby, Inc. All rights reserved

Adaptation of jaw closing muscles after surgical mandibular advancement procedures in different vertical craniofacial types: a magnetic resonance imaging study

Objective. Surgical mandibular advancement influences the biomechanics of the mandible and as a result may provoke relapse. In this study, the adaptation of the masseter (MAS) and medial pterygoid muscles (MPM) after surgical mandibular advancement was evaluated. Study design. Of 12 patients with mandibular retrognathia and varying vertical craniofacial morphology, axial and 30 degrees angulated magnetic resonance imaging (MRI) scan series were taken preoperatively and 10 to 48 months postoperatively. Using cluster analysis, subjects were assigned to a long-face (LF) and a short-face (SF) cluster. Subsequently, preoperative and postoperative maximum cross-sectional areas and volumes of the MAS and MPM were compared in these groups. Results. The cross-sectional area and volume of the MAS decreased significantly in both the SF and LF cluster (up to 18%). Although not significantly, this phenomenon tended to be more pronounced in LF patients. The cross-sectional area of the MPM showed less adaptation. Conclusion. The jaw-closing muscles become significantly smaller after surgical mandibular advancement, irrespective of the vertical craniofacial type

Impact of Bone Volume Upon Condylar Activity in Patients With Unilateral Condylar Hyperplasia

Purpose: Unilateral condylar hyperplasia or hyperactivity (UCH) is a bone overgrowth disorder affecting the mandible. The purpose of this study was to determine the relations among age, condylar bone structure, condylar bone volume, and condylar bone activity on single-photon emission computed tomographic (SPECT) scans in patients with UCH. Materials and Methods: This study included 20 patients with a clinical presentation of progressive mandibular asymmetry and a positive bone SPECT scan. A bone SPECT-derived standardized uptake value (bSUV) for the condylar region was determined. All patients underwent condylectomy to arrest further progression of the disease. The resected condyles were scanned with a micro-computed tomographic scanner (18-μm resolution). Bone architectural parameters were calculated with routine morphometric software. Results: The mean bSUV of the condyle on the affected side was 15.32 (standard deviation [SD], 8.98) compared with 9.85 (SD, 4.40) on the nonaffected side (P =.0007). For trabecular bone structure, there was a nonsignificant correlation between the SUV of the affected condyle and the measured bone volume fraction (r = 0.13; P =.58) and trabecular thickness (r = 0.03; P =.90). Conclusion: No meaningful relation was found between condylar bone volume fraction and condylar activity on bone scan; therefore, the impact of bone volume fraction on the results of bone scans is limited. The measured condylar activity on SPECT scan seems to be primarily a reflection of the remodeling rate of bone

Adaptation of lateral pterygoid and anterior digastric muscles after surgical mandibular advancement procedures in different vertical craniofacial types:A magnetic resonance imaging study

Objective. Surgical mandibular advancement procedures induce major adaptations of jaw-closing muscles. In this study, adaptation of antagonist muscles, the lateral pterygoid (LPM) and anterior digastric (DigA) muscles, was evaluated. Study design. Eighteen adult patients with mandibular retrognathia and individually varying vertical craniofacial dimensions were treated with bilateral sagittal split osteotomies (BSSO), in some cases combined with a Le Fort I osteotomy (LF Bimax). The sample was divided into 1 short-face (SF, n = 7) and 2 long-face groups (LF BSSO, n = 3; and LF Bimax, n = 8). Pre- and postoperative maximum cross-sectional areas (CSA) and volumes were compared in these groups. Results. Postoperatively, CSA and volume of LPM increased in BSSO cases and decreased in bimaxillary cases. Inconsistent increases and decreases of CSA and volume of DigA were seen in all groups. Conclusions. The LPM became larger in SF and LF BSSO patients and smaller in LF Bimax patients. The DigA adapted unpredictably