Postoperative changes in the pharyngeal airway space through computed tomography evaluation after mandibular setback surgery in skeletal class III patients: 1-year follow-up

Background This study evaluated the pharyngeal airway space changes up to 1 year after bilateral sagittal split osteotomy mandibular setback surgery and bimaxillary surgery with maxillary posterior impaction through three-dimensional computed tomography analysis. Methods A total of 37 patients diagnosed with skeletal class III malocclusion underwent bilateral sagittal split osteotomy setback surgery only (group 1, n = 23) or bimaxillary surgery with posterior impaction (group 2, n = 14). Cone-beam computed tomography scans were taken before surgery (T0), 2 months after surgery (T1), 6 months after surgery (T2), and 1 year after surgery (T3). The nasopharynx (Nph), oropharynx (Oph), hypopharynx (Hph) volume, and anteroposterior distance were measured through the InVivo Dental Application version 5. Results In group 1, Oph AP, Oph volume, Hph volume, and whole pharynx volume were significantly decreased after the surgery (T1) and maintained. In group 2, Oph volume and whole pharynx volume were decreased (T2) and relapsed at 1 year postoperatively (T3). Conclusion In class III malocclusion patients, mandibular setback surgery only showed a greater reduction in pharyngeal airway than bimaxillary surgery at 1 year postoperatively, and bimaxillary surgery was more stable in terms of airway. Therefore, it is important to evaluate the airway before surgery and include it in the surgical plan.

A combined Surgical-Orthodontic treatment in skeletal Class II malocclusion patients

Skeletal Class II malocclusion with mandibular deficiency is one of the most common problems that patients seek treatment. Adult patients with severe skeletal Class II malocclusion need orthognathic surgery for successful treatment. Bilateral sagittal split osteotomy (BSSO) is the most often preferred technique for these patients. This case report briefs about two male patient of age 24 years presented with Class II Skeletal relation, mesoprosopic facial form, horizontal growth pattern and Angle’s Class II div 1 malocclusion who were treated with Bilateral sagittal split osteotomy (BSSO) mandibular advancement. The ideal anteroposterior relation was established along with a Class I molar, incisor, canine relationship and ideal overjet, overbite and the overall facial esthetics were significantly improved. Combined surgical-orthodontic treatment aims to obtain a more harmonious facial, skeletal, dental and soft tissue relationship with an added patient self esteem.

Malignant Hyperthermia—A Case From Camp Humphreys, South Korea, and Lessons for the Military Health System

ABSTRACT Although malignant hyperthermia (MH) is a well-known complication of anesthesia, it presents unique considerations in the military health system. In this case report, the authors present a 26-year-old male active duty service member who experienced an MH crisis during a routine bilateral sagittal split osteotomy. The case presented here, which occurred at Brian D Allgood Army Community Hospital at Camp Humphreys, South Korea, highlights the challenges presented when caring for these patients in minimally staffed environments with frequent turnover of staff. The authors discuss the challenges to the military system such as the importance of adequate documentation of MH-susceptible service members, the benefits of rapidly dissolving dantrolene sodium nanosuspension, and the necessity for frequent training of military medical staff in the recognition and management of MH.

Cervicomental angle changes observed after mandibular advancement surgery – A systematic review

Purpose: In adults, correction of such a jaw base relation is done by bilateral sagittal split osteotomy and mandibular advancement which often causes change in the cervicomental angle that might not be within the acceptable and aesthetic range. The objective of this systematic review was to evaluate the changes observed in cervicomental angle after mandibular advancement surgery. Data Sources: Based on the available data, we conducted an electronic database PubMed search, based on the search of published data from 1994 to 2017, six strategies were designed using two keywords, and four articles were shortlisted for systematic review. Study Eligibility Criteria: Studies that provide information on cervicomental angle changes after mandibular advancement surgery, published from 1994 to 2017. Results: The search yielded 168 articles, of which four were included based on the selection criteria. These articles described that the cervicomental angle observed after mandibular advancement surgery falls between 95° and 125°. Conclusion: Cervicomental angle decreases as the mandible is advanced to correct the jaw base Class II relation to Class I. Acceptable range is found to be between 95° and 125°. Implications: An esthetic look is the desire of every patient that reports to the clinics for an orthodontic correction. Surgical correction is an integral part of the treatment. While advancing the mandible, change is observed in the cervicomental angle. Knowing the acceptable range of this angle will help the orthodontist and the oral surgeon to plan the advancement accordingly.