Modified Approach to Segmental Maxillary Surgery: Midline Osteotomy and Parasagittal Soft Tissue Incisions.

Traditional surgical techniques for segmental maxillary surgery include a combination of interdental osteotomies with paramidline bony cuts while keeping the palatal soft tissue intact. Besides surgical complexity, segmental maxillary procedures have been associated with higher incidence of relapse and complications. We present our experience with specific hard- and soft-tissue modifications (midline bony osteotomy and reflection of palatal soft tissue with carefully designed incisions) which will allow surgeons to perform larger expansions with a low incidence of complications and decreased relapse.

Is three-piece maxillary segmentation surgery a stable procedure?

Objective: : The number of three-piece maxillary osteotomies has increased over the years; however, the literature remains controversial. The objective of this study was to evaluate the skeletal stability of this surgical modality compared with that of one-piece maxillary osteotomy.

Methods: : This retrospective cohort study included 39 individuals who underwent Le Fort I maxillary osteotomies and were divided into two groups: group 1 (three pieces, n = 22) and group 2 (one piece, n = 17).

Who Helps Children With Communication Disorders Access Sex Education? Practice Patterns of Speech-Language Pathologists and Psychologists.

Purpose: Children with communication disorders are often systematically excluded from sex education curricula. They may also have difficulty accessing the curricula because of the materials' linguistic and pragmatic complexity. Even curricula written for children with intellectual disabilities do not typically include considerations for communication disorders.

Health Consequences of Climate Change: Continuing Education Opportunities for Health Professionals in the United States.

Climate change is a looming public health challenge. The health consequences of climate change are increasingly recognized as contributing to negative health outcomes for individuals, families, communities, and populations. The education of health professionals in academic programs and continuing education in clinical practice settings is critical in today's world.

The Impact of Treating Bilingual Clients on Speech-Language Pathology Students' Cultural Responsiveness.

Purpose: Graduate programs often use practicum experience with clients from nonmajority cultures to improve students' cultural responsiveness. Yet, it is not clear whether simply working with a client from a nonmajority culture actually confers this benefit or whether students are thinking about how to include culturally responsive behaviors when they are considering how to address a clinical case.

Method: Twenty first-year speech-language pathology graduate students (10 Spanish-English bilinguals, 10 monolingual English speakers) were split into three groups: monolingual experimental ( 4), bilingual experimental ( 4), and control ( 12).

Tranexamic Acid Use Intra-Operatively Decreases the Need for Blood Transfusions and Post-Operative Edema in Temporomandibular Joint Surgeries.

Temporomandibular joint (TMJ) surgeries cover a vast assortment of surgical procedures such as tooth extractions, tissue biopsies, and extensive maxillofacial surgeries. Major complications that occur during and after TMJ surgeries include uncontrolled bleeding, considerable blood loss, serious infections, and edema. Tranexamic acid (TXA) is an antifibrinolytic agent that reduces blood loss by inhibiting the enzymatic breakdown of fibrin.

What Is Clinical Evidence in Speech-Language Pathology? A Scoping Review.

Purpose: Two disparate models drive American speech-language pathologists' views of evidence-based practice (EBP): the American Speech-Language-Hearing Association's (2004a, 2004b) and Dollaghan's (2007). These models discuss evidence derived from clinical practice but differ in the terms used, the definitions, and discussions of its role. These concepts, which we unify as , are an important part of EBP but lack consistent terminology and clear definitions in the literature.

The Role of Dental Occlusion Ties to Achieve Stable Maxillomandibular Fixation During Temporomandibular Joint Replacement.

Dental occlusion ties (Minne Ties®) are a new example of the concept of an oral zip tie used to establish maxillomandibular fixation (MMF). Each tie uses a blunt introducer that is easily passed between embrasures and fed through a self-locking, unidirectional clasp. Five to six ties are used to establish MMF.

Can Patients With Metal Hypersensitivity Requiring TMJ Total Joint Prostheses be Successfully Treated With All-Titanium Alloy Mandibular Components?

Purpose: Patients with documented metal hypersensitivity to cobalt-chromium-molybdenum (CoCrMo) alloy with trace nickel requiring temporomandibular joint (TMJ) total joint prosthesis (TJP) may have adverse reactions to the metals in the standard TMJ Concepts TJP. This study aimed to determine if these patients can be successfully treated by eliminating CoCrMo alloy and constructing the mandibular components of all-titanium (Ti) alloy.

Patients And Methods: This retrospective cohort study evaluated metal hypersensitive patients (MHG) that received the TMJ Concepts TJP modification of all-Ti alloy mandibular components with outcome results compared to a control group (CG) of non-metal-sensitive patients that received the standard TMJ Concepts prostheses.

Does Combined Temporomandibular Joint Reconstruction With Patient Fitted Total Joint Prosthesis and Orthognathic Surgery Reduce Symptoms in Juvenile Idiopathic Arthritis Patients?

Purpose: Patients with juvenile idiopathic arthritis (JIA) and TMJ involvement may have major dentofacial deformities, pain, and jaw dysfunction. The aim of this study was to evaluate surgical outcomes for JIA patients relative to TMJ pain, headache, jaw function, diet, disability, and quality-of-life (QOL) after TMJ reconstruction with patient-fitted total joint prostheses (TJP) and concomitant orthognathic surgery.

Methods: A retrospective cohort study was conducted on a JIA patient group (JIAG) with significant dentofacial deformity, reconstructed with TJP and concomitant orthognathic surgery, and was compared to a control group (CG) of non-JIA patients that received the same surgical protocol with similar surgical movements.

Does Combined Temporomandibular Joint Reconstruction With Patient-Fitted Total Joint Prosthesis and Orthognathic Surgery Provide Stable Skeletal and Occlusal Outcomes in Juvenile Idiopathic Arthritis Patients?

Purpose: To determine skeletal and occlusal surgical changes and long-term stability outcomes for patients diagnosed with juvenile idiopathic arthritis (JIA) after TMJ reconstruction with TMJ Concepts patient-fitted total joint prostheses (TJP) and concomitant maxillary orthognathic surgery.

Material/methods: A retrospective cohort study was conducted of all patients diagnosed with JIA, receiving TJP, and concomitant maxillary orthognathic surgery between 1991 and 2019, at Baylor University Medical Center treated by 1 surgeon. Patient evaluations presurgery (T1), immediate postsurgery (T2), and at longest follow-up (LFU) (T3) were analyzed using 20 cephalometric landmarks to compute 29 linear and angular measurements to determine surgical changes, long-term skeletal and occlusal stability, as well as oropharyngeal airway changes.

Mini-Anchors to Surgically Treat the Chronic Mandibular Dislocation.

Purpose: Evaluate the feasibility of using mini-anchors for the treatment of chronic mandibular dislocation and to identify the variables that affect the success of this approach.

Patients And Methods: A retrospective cohort study evaluated 9 patients with bilateral recurrent dislocation of the mandible (18 operated joints), treated by a mandibular translation control system using the mini-anchor technique. Data was collected using a Visual Analog Scale (VAS) for subjective parameters and measurements for objective parameters prior to surgery (T1) and at the longest available follow-up (T2) with a minimum of a 12 months interval.

A comparison of the head lift exercise and recline exercise in patients with chronic head and neck cancer post-radiation.

Background: Patients who undergo surgery and adjuvant radiation treatment for head and neck cancer often develop dysphagia as a result of this treatment. Improvements in swallow function may be achieved with exercise. The goal of this pilot study was to compare the effectiveness and perceived difficulty of using the head lift exercise and the recline exercise to activate the suprahyoid musculature in 8 individuals with a history of head and neck cancer.

LOXL2 promotes aggrecan and gender-specific anabolic differences to TMJ cartilage.

In the United States, 5-12% of adults have at least one symptom of temporomandibular joint (TMJ) disorders, including TMJ osteoarthritis (TMJ-OA). However, there is no chondroprotective agent that is approved for clinical application. We showed that LOXL2 is elevated in the regenerative response during fracture healing in mice and has a critical role in chondrogenic differentiation.

The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials.

Purpose: Different treatment options for patients with arthrogenous Temporomandibular Disorders (TMDs) have been reported. However, evidence regarding the most effective intervention using network meta-analysis (NMA) has not been performed. Thus, we conducted a NMA of randomized clinical trials (RCTs) to identify the most effective treatment of arthrogenous TMDs with respect to pain reduction and improved mouth opening, and to generate a ranking according to their effectiveness.

Nasolabial Changes Following Double Jaw Surgery.

Background: This study aimed to analyze 3-dimensional nasolabial soft tissue changes following double jaw surgery with Le Fort I maxillary advancement and relate them to underlying surgical movements.

Methods: Pre- and post-surgical cone-beam computed tomography images of 37 maxillomandibular surgery patients with ≥2 mm of advancement at A-point were analyzed. Lateral cephalograms were constructed to determine horizontal and vertical surgical movements and 3-dimensional facial images were created from the CBCTs to calculate linear and angular changes.

Comprehensive Post Orthognathic Surgery Orthodontics: Complications, Misconceptions, and Management.

Post orthognathic surgery patient management is critical for high-quality and predictable outcomes. Surgeons and orthodontists must have the knowledge and ability to implement postsurgical management protocols and strategies to provide the best care and outcomes possible. This article presents basic concepts, philosophies, treatment protocols, risks, and potential complications associated with postsurgical patient management.

Cone-beam computed tomography airway measurements: Can we trust them?

Introduction: Pharyngeal airway space (PAS) assessment has been used in the past for a better understanding of orthodontic and surgical outcomes; however, this analysis could be unreliable. Our objective was to evaluate possible changes in the PAS reading in the same patient from their consecutive cone-beam computed tomography (CBCT) scans.

Methods: We evaluated a total of 27 patients' CBCT scans obtained at 2 time points with the use of a standardized acquisition protocol.

3D Printing Custom Bioactive and Absorbable Surgical Screws, Pins, and Bone Plates for Localized Drug Delivery.

Additive manufacturing has great potential for personalized medicine in osseous fixation surgery, including maxillofacial and orthopedic applications. The purpose of this study was to demonstrate 3D printing methods for the fabrication of patient-specific fixation implants that allow for localized drug delivery. 3D printing was used to fabricate gentamicin (GS) and methotrexate (MTX)-loaded fixation devices, including screws, pins, and bone plates.

Three-dimensional quantitative assessment of surgical stability and condylar displacement changes after counterclockwise maxillomandibular advancement surgery: Effect of simultaneous articular disc repositioning.

Introduction: In this study, we quantitatively assessed 3-dimensional condylar displacement during counterclockwise maxillomandibular advancement surgery (CMMA) with or without articular disc repositioning, focusing on surgical stability in the follow-up period.

Methods: The 79 patients treated with CMMA had cone-beam computed tomography scans taken before surgery, immediately after surgery, and, on average, 15 months postsurgery. We divided the 142 condyles into 3 groups: group 1 (n = 105), condyles of patients diagnosed with symptomatic presurgical temporomandibular joint articular disc displacement who had articular disc repositioning concomitantly with CMMA; group 2 (n = 23), condyles of patients with clinical verification of presurgical articular disc displacement who had only CMMA; and group 3 (n = 14), condyles of patients with healthy temporomandibular joints who had CMMA.

Three-dimensional stability analysis of maxillomandibular advancement surgery with and without articular disc repositioning.

This retrospective cohort study aimed to assess, three-dimensionally, mandible and maxilla changes following maxillomandibular advancement (MMA), with and without repositioning of TMJ articular discs. The sample comprised cone-beam computed tomography data from 32 subjects: group 1 (n = 12) without disc displacement and group 2 (n = 20) with bilateral disc repositioning. An automatic cranial base superimposition method was used to register the images at three time points: T1 (preoperative), T2 (postoperative), and T3 (at least 11 months follow-up).

Maxillary Interdental Osteotomies Have Low Morbidity for Alveolar Crestal Bone and Adjacent Teeth: A Cone Beam Computed Tomography-Based Study.

Purpose: Maxillary segmentation involving interdental osteotomies can have an adverse effect on the interdental crestal bone and adjacent teeth. The purpose of the present study was to evaluate the effect of interdental osteotomies on surrounding osseous and dental structures, including adjacent teeth, using cone beam computed tomography (CBCT), in patients who underwent segmental maxillary osteotomies.

Patients And Methods: The present retrospective cohort study evaluated interdental osteotomy (IDO) sites between the lateral incisors and canines in patients treated with 3-piece Le Fort I osteotomies.

Pharyngeal Airway Space Changes After Condylar Replacement and Mandibular Advancement Surgery.

Purpose: The aim of this study was to examine the total volume and cross-sectional areas of the pharyngeal airway after bilateral condylar replacement and mandibular advancement surgery.

Materials And Methods: A total of 137 patients (126 women and 11 men) underwent bilateral temporomandibular joint total joint replacement performed by 1 surgeon. A subsample of 30 patients who underwent condylar replacement and only mandibular advancement were evaluated for impact on the airway.

Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches.

Purpose: The purpose of this study was to determine the rate of facial nerve injury (FNI) when performing (ORIF) of mandibular condylar fractures by different surgical approaches.

Materials And Methods: A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when (ORIF) of mandibular condylar fractures was performed using different surgical approaches.

Adolescent internal condylar resorption (AICR) of the temporomandibular joint, part 1: A review for diagnosis and treatment considerations.

Background: Adolescent internal condylar resorption (AICR) is a temporomandibular joint (TMJ) pathology that develops predominately in teenage females during pubertal growth (onset between ages 11 and 15 years), with a distinct clinical, radiographic, and magnetic resonance imaging (MRI) presentation. Clinical and imaging presentation: The condition usually occurs bilaterally with: (1) Progressive retrusion of the mandible; (2) High occlusal plane angle facial morphology; (3) Worsening Class II occlusion; and (4) TMJ symptoms such as pain, headaches, noises, etc. MRI imaging demonstrates decreased condylar head size and anterior disc displacement.