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Posterior Maxillary Surgery: Its Place in the Treatment of Dentofacial Deformities
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
Greg J Knepil, Graham R Oliver
In modern practice, and referenced in this article, transverse discrepancies in the presence of a significant vertical or antero-posterior discrepancy can often be corrected in the pre-surgical orthodontic phase, allowing for appropriate arch coordination at the time of surgery. In cases where there is transverse coordination issue beyond the limits of orthodontics alone, then surgical expansion is indicated.11,12 As reported in the article, this can be carried out as a segmental procedure; however, surgically assisted rapid maxillary/palatal expansion (SARME/SARPE) has become the mainstay for surgical maxillary expansion.13,14 This may well be due to its basis and familiarity to a subtotal Le Fort I osteotomy; however, there is no agreed ideal surgical approach with variations based on release of the mid-palatal suture, pterygoid disjunction, length of corticotomy cuts, and type of distractor.15 The evidence appears to suggest that a more invasive approach results in more predictable expansion with fewer complications.15 Stability of any expansion-based procedure remains a key concern reported both in the article and in modern techniques.16
Clefts and craniofacial
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Active technique, e.g. Latham device, that is adjusted daily. Some say that active devices restrict maxillary growth more than passive devices. They are said to be preferred in bilateral clefts for more premaxillary retrusion and palatal expansion; however, they require a general anaesthesia for fitting (with a 1% risk of it falling out).
Case 111
Published in Vincent J Palusci, Dena Nazer, Patricia O Brennan, Diagnosis of Non-accidental Injury, 2015
This 8-year-old boy was undergoing orthodontia with a palatal expander. He came in with the expander broken and the ecchymosis shown. There was no history of thumb sucking, falling with something in his mouth or other accidental trauma. There was no disclosure of abuse, but the examining dentist was concerned about possible sexual assault and collected specimens for pharyngeal gonorrhea. What does Image 111a show?What is the possible aetiology of these injuries?A large bruise is noted over the hard palate in a pattern similar to the plastic frame of the expander. No active bleeding is noted. The shape of a similar expander is shown in a child without a bruise (Image 111b).Any palatal bruising should be viewed with suspicion. Palatal expansion is used to correct cross bites and to relieve crowding in the maxillary arch. While petechial hemorrhages of the soft palate have been noted in fellatio,1 the palatal inflammation is located under the palatal acrylic strap that fractured, most likely during the assault. The child firmly denied being assaulted, and it was only because of his being positive for oral gonorrhea that sexual assault was confirmed.
Adverse effects of orthodontic forces on dental pulp. Appearance and character. A systematic review
Published in Acta Odontologica Scandinavica, 2023
Jukka Huokuna, Vuokko Loimaranta, Merja A. Laine, Anna-Liisa Svedström-Oristo
In the recent studies reporting findings of histological changes in the pulp related to orthodontic treatment [35,36,50–52], the most common finding was fibrotic tissue formation. Additionally, disruption of the odontoblastic layer and vascular changes as well as pulp stone formation and reduction in pulp volume were reported. Similar changes have been reported previously. Mostafa et al. [53] looked at the histological changes resulting from 1–4 weeks of extrusion of maxillary premolars. They found vacuolisation, congestion and dilation of the blood vessels, degeneration of odontoblasts, and oedema. Also pulp fibrosis was found after 4 weeks. Kayhan et al. [54] observed increases in blood vessel diameter as a result of 1–3 months of rapid palatal expansion. Additionally, some fibrosis formation was observed after 3 months, but no inflammatory cell infiltration was found. Taspinar et al. [55] observed significant increases in blood vessel diameter, haemorrhage, congestion and inflammatory cell infiltration after 3 months of rapid palatal expansion. Sübay et al. [56] found no signs of inflammatory responses following the application of extrusive forces but did find pulp stone formation and odontoblast aspiration into the dentine tubules.
Correlation of palatal volume with nasopharyngeal volume on computed tomography scans of an Iranian subpopulation
Published in Orthodontic Waves, 2020
Ali Moshajari, Azin Irannezhad, Zahra Dalili Kajan, Navid Karimi Nasab, Elahe Rafiei, Pejman Kiani
In the present study, no significant correlation was noted between the palatal volume and nasopharyngeal volume. Search of the literature by the authors yielded no study on the correlation of palatal volume and nasopharyngeal volume. Thus, the present study seems to be the first to quantitatively assess the correlation of palatal volume and nasopharyngeal volume using CT. Therefore, herein, we discuss the correlation between palatal expansion and airway volume. Almuzian et al. [17] demonstrated expansion of the nasopharynx and its increased volume following palatal expansion. Smith et al. [18] showed a significant increase in nasal and nasopharyngeal volume after palatal expansion. In contrast, Ribeiro et al. [19] observed no significant change in nasopharyngeal volume. However, the change in oropharyngeal airway volume was significant. Zhao et al. [20] found no significant difference in nasopharyngeal and oropharyngeal volume. Usumez et al. [21] observed an increase in nasopharyngeal airway dimensions, although this increase was not significant. In the examined area of airways (nasopharynx) in our study, there was no correlation between palatal volume and airway volume. Thus, the comparative studies in other airway areas (oropharynx or hypopharynx) and/or the total airway volume with palatal volume might be helpful to find a potential correlation which can be considered for future studies.
Three-dimensional finite element analysis of initial displacement and stress on the craniofacial structures of unilateral cleft lip and palate model during protraction therapy with variable forces and directions
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Shahistha Parveen, Akhter Husain, Srinivas Gosla Reddy, Rohan Mascarenhas, Satish Shenoy
Maxillary deficiency in individuals with CLP due to surgical repair can be corrected with protraction with and without expansion. RME facilitates the correction of a mild midfacial deficiency by the forward displacement of the maxilla. Turley (1988) stated that palatal expansion disarticulates the maxilla and initiates cellular responses in these circummaxillary sutures allowing a more positive reaction to protraction forces. In this study, initial displacement of various craniofacial structures was considerably more during application of protraction with expansion forces as compared to protraction-only force (Tables 2–5). It was similar to results reported by several FEM studies (Gautam et al. 2009; Zhang et al. 2015).