elahe tohidi

We aimed to evaluate the possibility of temporomandibular joint (TMJ) dysfunction following mandibular advancement surgery in skeletal class 2 patients.

All healthy non-syndromic patients with Class 2 deformity, who were eligible for mandibular advancement surgery, were included in this before-after quasi-experimental study. The main intervention was mandibular advancement through bilateral sagittal split osteotomy (BSSO). Maxillary impaction or setback surgery using LeFort 1 osteotomy was simultaneously performed in some cases. Variables such as TMJ pain, clicking, crepitus, or any other type of sounds or complaint as well as the amount of maximum mouth opening (MMO) were evaluated before surgery and two months postoperatively.

Thirty patients including 15 men and 15 women with a mean age of 23.3 ±2.7 yr were studied. The mean amount of mandibular advancement displacement was 3.30 ± 0.87 mm. The rate of TMJ dysfunctions and complaints was relatively low two months postoperatively when compared to the preoperative state. Postoperative evaluation demonstrated that there was no significant correlation between the presence of TMJ symptoms and dysfunctions and the type of surgery. After treatment was completed, the mean MMO reduced significantly from 39.03±5.86 to 38.12±6.05 (P<0.001).

Mandibular advancement with BSSO surgery in skeletal class 2 patients did not clinically lead to TMJ dysfunctions. Among all the investigated factors, only preoperative pain, noises, or complaints were proven to have predictive value for postoperative TMJ dysfunction.

Surgical ciliated cysts of the maxilla arise from respiratory epithelium that lodges in the maxilla after radical maxillary or sinus surgery. This case report was conducted in 2020 in Mashhad Dental School, Mashhad University of Medical Science, Mashhad, Iran. We present here an unusual case of surgical ciliated cyst of a 73-year-old adult male patient with a history of nasal polyp surgery 40 years ago. Early diagnosis due to CBCT and Clinical examination was a residual cyst or OKC (odontogenic keratocyst). The histopathology result of this lesion surprised us after the excisional biopsy and enucleation. The clinical examinations and radiographs of the jaw lesions may lead the maxillofacial surgeons to misdiagnosis and mistreatment. Therefore, it is obligatory to notice all aspects of these lesions carefully.

Odontomas are the most common odontogenic benign tumors categorized as hamartomas. Odontoma is primarily made up of enamel and dentin, although it may also contain cementum and pulp tissue in various forms. It is known for having slow-growth and non-aggressive nature. It is made up of either dental tissues categorized as a complex or a compound odontoma based on radiological and histological characteristics. Complex odontomas are less prevalent among them, and they usually show as a tiny, silent radiopaque mass enclosed by a radiolucent border, seen on routine radiographic examinations. To avoid tooth eruption disturbances and additional clinical problems, odontomas should be managed and surgically removed once they have been detected. The present study describe a rare case of giant complex odontoma in the posterior mandible with an unusual dimension in a 16-year-old Iranian female patient referred to the Department of Oral and Maxillofacial, Mashhad Dental School, Mashhad, Iran, in May 2021 . The case was effectively treated with surgical curettage and tumor enucleation, emphasizing the significance of early detection to minimize complications. Additionally, the clinical, radiological, and histopathological aspects and probable surgical treatments were discussed.

We aimed to assess the incidence of bad split fractures during Bilateral Sagittal Split Osteotomy (BSSO) mandibular setback surgery using Dal Pont and Hunsuck techniques.

All healthy adults with skeletal class III discrepancy, who were candidates for mandibular setback surgery were enrolled in this randomized clinical trial in the Maxillofacial Surgery Department of Qaem Hospital, Mashhad, Iran; from 2018-2020. These patients were randomly divided into two equal groups; one group underwent BSSO using Dal Pont osteotomy while the Hunsuck osteotomy was employed for the other group. A bad split fracture which identified through intra-operative clinical and postoperative radiographic examination was the outcome variable. The significance level was set at 0.05 using SPSS 16.

Overall, 104 consecutive patients, comprising of 52 (50%) males with an average age of 23.09±3.08 were recruited. The average duration of osteotomy and splitting was reported to be 22.74±3.06 min. 10 bad split fractures (9.62%) were observed; 7 of which occurred in the Dal Pont group and 3 in the Hunsuck group. However, this difference was not significant. In 80% of the cases, bad split osteotomy occurred in the proximal segment, while this finding was identified in the distal segment in 20% of cases. The average duration of osteotomy and splitting was significantly longer in the Dal Pont group (P<0.001).

The duration of osteotomy and splitting is much shorter when the Hunsuck technique is employed, and the incidence of unfavorable fractures is also less compared to the Dal Pont osteotomy technique.

Fibrous dysplasia is a rare bony disorder with recurrent character distinguished by abnormal fibro-osseous tissue. One or more bones may be involved in this lesion; however, the maxilla is the most commonly affected bone in the maxillofacial region. Here, we present an interesting case of a surgically treated 12-year-old adult female patient with a diagnosis of craniofacial fibrous dysplasia (CFD) in the maxillary bone with an invasive expansion to the orbital bone who was referred to the Department of Oral and Maxillofacial, Mashhad Dental School, Mashhad, Iran, in Apr 2021. The patient was treated under general anesthesia by the surgical recontouring and bone shaving of the tumor. Several factors should be considered in choosing the best treatment such as pathological features of the lesion, patient’s age, and risk of recurrence. However, surgical treatment, in this case, was beneficial to help the patient resuming a normal life. There is no published report describing bone recontouring and shaving management in an invasive case of craniomaxillofacial FD before the age of skeletal maturity due to the psychological effect of the deformity.

This study aimed to investigate the positional changes of the hyoid bone following orthognathic surgery in skeletal class III patients.

This double-blinded quasi-experimental study was carried out in Mashhad University of Medical Sciences, Iran, from Apr 2019 to Jun 2020. All skeletal Class III patients who were candidates for orthogenetic surgery were included. They underwent mandibular setback surgery using bilateral sagittal split osteotomy. Cephalometric assessments in relation to hyoid bone position and posterior airway space (PAS) were conducted one day preoperatively (T0), as well as one week (T1), six months (T2) and one year (T3) postoperatively, determining the parameters like the Long axis of the hyoid bone (LAH), Retrognation (RGn), Hyoidale (H), Palatal plane (PP), Mandibular plane (MP) and C3 Vertebrae (C3). All cephalograms were examined using AudaxCeph, Planmeca software. The data analysis was performed via SPSS-19
(P<0.05)

25 class III patients, including 18 females (72%) and 7 males (28%) with a mean age of 24.32±5.87, were studied. The cephalometric analysis demonstrated significant decreases in variable angles during the follow-up periods, except for LAH-MP angle (P<0.001). The hyoid bone moved downward and backward relative to its original position following the mandibular setback surgery. However, the bone gradually returned to the preoperative location between 6 to 12 months postoperatively.

The findings revealed the downward and backward movement of the hyoid bone following the mandibular setback surgery, returned near to its  preoperative position after 1 year, postoperatively.

The purpose of this study was to determine the mini-plate and screw removal rate and reasons in maxillofacial surgery patients under previous semi-rigid fixation treatment in the past five years at the main trauma center of Mashhad.

This was a census-based retrospective study. All the candidates who admitted to our department for maxillofacial plate removal due to symptomatic or infected mini-plates were included in this study. The patients’ age and gender, plate removal etiologies, and the time between plate insertion and removal were analyzed.

Mini-plates were inserted for 1026 patients. However, only 94 patients with a mean age of 29.4±11.1 years were candidates for plate removal. The plate removal rate was 9.16%. Infection and exposure were the most common causes of plate removal. The most prevalent removal site was the mandible (angle and body). The interval between mini-plate insertion and removal was an average of 12.9±5.6 months. It is noteworthy that the shortest lasting duration was when plate removal was secondary to pain (6.67 months) and infection (11.45 months).

This research showed that the routine removal of plates does not appear to be generally indicated in healthy subjects unless there is an obvious and definitive clinical indication.

Obstructive sleep apnea is a disorder of repetitive complete or partial airway obstruction during sleep. The aim of this study was to assess the impact of alveolar cleft reconstruction on the obstructive sleep apnea (OSA) condition and apnea/hypopnea index (AHI).

In a double-blinded prospective quasi-experimental study, all healthy systemic children (n=30 female cleft patients) with unilateral alveolar cleft defects within the age range of 8-14 years and BMI less than 30 kg/m2 who admitted for alveolar cleft repair were enrolled. OSA monitoring was performed one week before surgery, and 3 months postoperatively by Apnea Link device. Sleep apnea indices such as AHI, respiratory disturbance index (RDI), oxygen desaturation index (ODI) and oxyhemoglobin saturation (SpO2) as well as pulse rate (PR) and respiratory rate (RR) were the variables.

The patients’ mean age was 11.0±1.4 years, and BMI average was 21.48±4.4 kg/m2. Mean AHI was 21.6±5.0 events/hour, preoperatively; which decreased significantly and reached 4.4±2.5 events/hour after alveolar cleft reconstruction surgery (p=0.005). Moreover, the other OSA variables (SpO2, RDI, and ODI), as well as vital signs (PR, and RR) improved postoperatively (p=0.005). In other words, the preoperative moderate OSA status relieved after alveolar cleft repair and reconstruction.

Our study showed that the OSA and AHI ameliorated after bone graft surgery in alveolar cleft repair. More clinical trials including larger sample sizes may be required for relevancy.

The mental nerve is a sensory nerve which traverses through mental foramen to innervate the lower lip, chin skin and the mandibular labial gingiva. Interestingly, it’s variant such as the accessory mental foramen (AMF) was described as an unusual finding in the recent literature. Hereby, we reported a patient who was operated to treat the mandibular bisphosphonate-related osteonecrosis of the jaw (BRONJ) lesion. Intraoperatively, an accessory mental foramen was detected posterior to the main foramen and nerve, on the right side of the mandible. This case report highlighted the necessity for proper radiological and clinical evaluation of mental foramina in order to avoid nerve injury and postoperative paresthesia. The review of the literature and the clinical findings were also discussed in this article.

Augmentation of atrophic alveolar ridges is an important aspect of functional restoration in modern oral rehabilitation. Vertical bone resorption of the dentoalveolar ridges remains a serious challenge for successful dental implant placement. The premaxilla region is one of the most challenging areas for implant restoration. Nasal floor approximation in anterior maxilla in concomitant with atrophy made where sufficient amount of augmentation is not possible make nasal lifting as an alternative technique.

In this report, we described a successful case of nasal floor lifting for dental implant placement in an atrophic premaxilla.

 It might be concluded that nasal floor membrane lifting may be a reliable technique for implant recipient site rehabilitation in severe vertically atrophied premaxilla. However, further clinical trials are needed to support its relevancy.

Abstract The prevalence of mandibular fracture is relatively lower in the pediatric population compared to adults. The treatment of these fractures is more challenging for oral and maxillofacial surgeons due to the concerns regarding mandible growth and the presence of developing tooth buds. According to the literature, conventional methods (e.g., soft diets or closed reduction) are more effective in the treatment of nondisplaced pediatric mandibular fractures. There are few case reports regarding the treatment of mandibular fractures in infants, which have mainly introduced new technique using double-crossed direct skeletal wires to reinforce circummandibular wirings for the conservative treatment of infantile mandibular fractures. The present study aimed to describe the case of a 12-month male infant with significant dislocated right mandibular parasymphysis fracture. Initially, two circummandibular wires were passed bilaterally to pull the mandibular segments for their vertical alignment. Afterwards, the skeletal buccal and lingual direct wires reinforced the previous circummandibular wiring to fit the fracture segments. Finally, all the wires were tightened simultaneously to maintain satisfactory bone reduction. Furthermore, the addition of skeletal buccal and lingual direct wires could reinforce the previous circummandibular wiring to fit the fracture segments anteroposteriorly. The fracture healed uneventfully with no complications, and intermaxillary fixation was not required in the patient. Moreover, the alveolar segments were in an appropriate position, and the maximum mouth opening of the patient was normal with no deviation, indicating a successful clinical outcome. This method was relatively reliable, noninvasive, and inexpensive, associated with the decreased discomfort and morbidity associated with maxillomandibular fixation, open reduction, and internal fixation in infants.

Ridge atrophy accompanied by the pneumatization of maxillary sinus in the maxillary posterior region may lead to inadequate bone height, thereby precluding implant placement. Therefore, it may be mandatory to perform a sinus membrane elevation procedure and augmentation in the bone. The present study aimed to introduce a novel modification method for sinus floor elevation using a gelatin sponge (Gelatamp, COLTÈNE ROEKO, India) in order for better visualization, hemostasis, and conservative maxillary sinus membrane dissection with the low risk of complications. Implant placement was performed in a case series of 28 patients with hyperpneumatized sinus or a moderately resorbed posterior maxillary alveolus.
According to the findings, implant placement caused no complications in the patients. Furthermore, none of the patients experienced infections, sinusitis or graft and implant failure clinically and radiographically at the three- and six-month follow-up. Therefore, it could be concluded that gelatamp-assisted sinus lift is a simple, safe, noninvasive, and innovative technique for sinus membrane elevation. In addition, it is predictable and efficient, especially in the cases where piezoelectric surgery armamentarium is not available.

Armored removable connector tubes are not always available in operating rooms for routine Altemir submental intubation (SMI) technique. The present study addresses a fiber-optic glidoscopy assisted 2-tubes modification of Green & Moore sequence for submandibular intubation.
The sample was composed of 11 patients (8 males and 3 females) with panfacial fractures where neither the oral and nasal intubation techniques nor tracheostomy were feasible. The inter-operative procedure duration was recorded and a comparison was made between the present results with those obtained in similar studies. Moreover, postoperative complications were assessed over a duration of 6 months.
The average duration of this modified procedure was 8–13 min. (Mean, 10.54 ± 1.75 min). No perioperative or postoperative complications were observed. Based on the findings in this study, it is suggested that this new technique is safe, quick and reliable for submandibular intubation.
This modification establishes a secure airway for treatment of maxillofacial panfacial fractures, where traditional methods are impossible due to non-detachable connector tubes. No perioperative or postoperative complications were observed. This study suggests that this new technique is safe, quick and reliable for submandibular intubation

Pediatric mandibular fractures have been successfully managed in various ways. The use of a lingual splint is an option. This article presents a 4-year old boy who was treated by an alternative conservative method with a combination of an arch bar plus a lingual splint, circum-mandibular wiring and IMF for the reduction, stabilization and fixation of a severely displaced bilateral mandibular body fracture. This technique is a reliable, noninvasive procedure; it also limits the discomfort and morbidity associated with maxillomandibular fixation or open reduction and internal fixation in pediatric patients.

The aim of this study was to investigate the prevalence of stylohyoid ligament complex elongation in a group of Iranian patients using digital panoramic radiographs. Panoramic radiographs of 1211 patients (684 females and 527 males) referred to the dental school of Hamadan university of medical science were selected from 2011 to 2013. The stylohyoid ligament complexes were investigated. This abnormality was seen in both sexes. A calcified complex was found in 632 (52.2 %) of the patients. Both-sided (right and left) type 1 calcified complex (according to O’Carroll classification) was observed in 207 patients, while types 2–4 were found in 204, 112, and 109 patients, respectively. The results suggest that stylohyoid ligament calcification complex is frequent in Iranian population and present in both sexes with equal distribution. In addition, calcifications were seen more often at age of 20-40 years, and the extent of calcification did not show a tendency to increase with age.

This study aims to evaluate the dentomaxillofacial radiographic changes in end stage renal disease (ESRD) patients who were on hemodialysis. Parathyroid hormone (PTH), calcium, phosphorus and alkaline phosphatase (ALP) measurements, as well as Panoramic and periapical radiographs were obtained from seventy four patients with a history of end stage renal disease (ESRD). 74 patients examined with age range of 15 to 68 years, and a mean age of 41.4±14.6 years. The duration of dialysis ranged between 3 to 156 months with a mean duration of 40.4 months. Thinning or loss of lamina dura was observed in 16 patients (51.4%) and calcification of the pulp in 28 patients (40%). Changes in trabecular pattern was observed in 30 patients (40.6%), alterations in jaw bone density in 29 patients (39.2%) and bilateral calcification of stylohyoid ligaments in 13 patients (17.6%). We did not notice any non periapical origin radiolucent lesion. There was a significant relationship between bone trabecular pattern with P level, age and duration of dialysis. Changes in bone density showed significant relationship with frequency and hours of dialysis per week. No correlation was found between the radiographic changes and Ca level. Although changes in trabecular pattern and density were observed mostly in those who were on hemodialysis for a relatively long time, but we could not establish a definitive relation of radiographic manifestations in ESRD patients with the duration and frequency of dialysis.

Osteopetrosis represents a heterogeneous group of rare, hereditary bone dysplasias that share the hallmark of increased bone density caused by osteoclast dysfunction. It can manifest through a spectrum of symptoms and severity, from neonatal onset with life-threatening complications («malignant» autosomal recessive osteopetrosis) to two more benign conditions with the incidental radiographic findings, principally affecting adults (autosomal dominant osteopetrosis type I and type II). We report 2 new cases of autosomal dominant osteopetrosis type II. Both subjects were short in stature. Multiple healed fractures of long bones, diminished marrow spaces and hypoplastic maxillary sinuses were remarkable findings. To our knowledge they are the first reported cases of autosomal dominant type II of this disease in Iran.

Age estimation of the children usually is assessed using tooth developmental stages in radiographs. The Demirjian’s method is one of them. This study was done with the aim of assessment of the Demirjian’s developmental age stages of the permanent mandibular teeth in panoramic radiographs of 6-13 years old patients attended to Radiology Department of Mashhad dental school. In this descriptive cross-sectional study, a sample of 310 orthopantomographs taken from 169 girls and 141 boys between 6 and 13 years old referred to Mashhad dental school was selected. The chronological age of each child was calculated by subtracting her or his birth date from the date on which the radiograph had been obtained and the developmental stages of each of the seven left mandibular permanent teeth were recorded using the Demirjian method. Independent-sample t test was applied for comparison of the mean age of different developmental stages in both genders. The mean chronological age of stage G of teeth 32 and 33, stage F of tooth 34 and stages D and F of tooth 35 was different between the two genders (P<0.05). The mean chronological age of teeth 31, 36 and 37 in both sexes and in different developmental stages showed no statistically significant difference (P>0.05). The mean ages of different developmental stages of permanent mandibular teeth using the Demirjian method were similar to former studies. Also, the stage of mandibular teeth development was higher in girls than boys with similar chronological ages. Key words: