Amount Of Mouth Opening Research Articles

Classifications of Prominent Mandibular Angle and Surgical Considerations for Mandibuloplasty.

Contouring surgery is an operation that makes a smooth, oval-shaped face by removing protruding parts of the face. In particular, mandibuloplasty is a procedure that softens the shape of the mandible and is a popular procedure among Asians with a dominant mesocephalic profile. In this study, we tried to discuss the considerations before surgery by dividing the mandibular shape into morphologic aspects in the lateral and frontal views and anatomic considerations. In the lateral view, it is essential to consider the posterior ramal height and mandibular body length of each patient. These factors are closely related to the postoperative outcomes. Consideration of the mandibular plane angle is also essential. In the frontal view, the position of the gonial angle relative to the ramal body should be considered because the position of the gonial angle can affect the difficulty of operation. Anatomic considerations include antero-posterior ramal width, bucco-lingual width of mandibular body, amount of mouth opening, and location of inferior alveolar nerve. These are important factors that determine the difficulty of the operation. In this study, classification according to the shape and shape of the mandible was presented, and considerations for each classification were discussed. Cosmetic surgery is a socio-psychologically meaningful procedure that not only improves the esthetics but also improves the mental well-being of the patients. Therefore, it will be possible to provide better medical services to patients if clinicians are fully aware of the factors that can increase the difficulty of the operation and the factors that affect the surgical outcome.

Smart Driver Fatigue Detection System Using CNN

Abstract: Road accidents frequently result from fatigued or sleepy drivers. More people die and are killed worldwide each year. Driver fatigue is a major factor in many accidents. It is currently one of the major causes of accidents. Numerous facial expressions, such as frequent yawning, frequent eye blinking, and head positioning, might indicate how tired someone is. Computer vision is the most suitable and practical technology to solve this issue since it uses these sensory properties. The suggested methodology employs Dlib, CNN, and OpenCV. Dlib estimates the positions of 68 coordinates (x,y) that help in mapping the facial points on a person’s face. The 2904 pictures that make up the collections classified are Open Eyes, Closed Eyes, Yawning,or No-Yawning. A convolutional neural network (CNN) will be used to determine the mouth and eye states from the Regionof Interest (ROI) photographs. The amount of mouth opening (FOM) and the percentage of eyelid closure (PERCLOS) overthe pupil are the measures used to measure weariness over time. The recommended system determines whether the driver is sleepyand sounds a warning when it detects their eyes and yawns fora certain amount of time. The accuracy of the model has been discussed.

Evaluation of Temporomandibular Joint Dysfunction in Patients with Chronic Neck Pain

Objective: The aim of this study was to compare the presence of temporomandibular joint dysfunction (TMD) in individuals with and without chronic neck pain (CNP).
 Materials-Methods: The study included 41 subjects with neck pain and 41 subjects without neck pain. Temporomandibular Disorders were evaluated according to the Research Diagnostic Criteria (TMR). The amount of mouth opening was measured with a ruler (cm). Presence of voice in TMJ movements was evaluated. Pain intensity (Visual Analog Scale (VAS)) was evaluated on palpation of chewing muscles. Active joint motion of the cervical region was evaluated with a goniometer. Pain-related disability was assessed with the Neck Disability Indicator/NDI.
 Results: The results of our study showed that the pain intensity of the temporomandibular joint (TMJ) was significantly higher than the control group. The severity of pain felt during rest, activity (active mouth opening) and chewing in the study group was significantly higher than the control group (p

Ефективність засобів фізичної терапії у корекції функціонального статусу скронево-нижньощелепного суглоба при артрозі

The purpose of the study was to evaluate the effect of a physical therapy program on the state of functioning of the maxillofacial region in patients with arthrosis of the temporomandibular joint. Materials and methods. The study involved 33 people with arthrosis of the temporomandibular joint of the II-III degrees, which were divided into 2 groups – control and main. The control group consisted of 18 people who received arthrosis therapy only with non-steroidal anti-inflammatory drugs. The main group consisted of 15 people who additionally underwent the developed program of physical therapy (therapeutic exercises, massage, post-isometric relaxation, kinesiotaping of the masticatory muscles, neck muscles, cervical-collar zone; paraffin therapy course for the temporomandibular joint area, patient education). Complaints of patients, the intensity of pain in the temporomandibular joint on a visual analogue scale, the amount of mouth opening were determined, and auscultation of the joint was performed. Results and discussion. After the completion of the treatment course (for patients of the control group) and physical therapy (for the patients of the main group), pain in the temporomandibular joint did not manifest itself at rest and during movement. This is explained, in particular, by the fact that the basis of conservative treatment of arthrosis is the use of non-steroidal anti-inflammatory drugs with analgesic effects. At the same time, the usage of physical therapy, in comparison with medications, in the main group was statistically significant (p <0.05) in relation to control patients, it improved the functional activity of the jaw area and the functioning of the temporomandibular joint, which was manifested by a decrease in the number of persons with complaints of pathological sounds during jaw movements and their auscultatory detection, discomfort when chewing, as well as an increase in the magnitude of opening the mouth. Restoration of the condition of patients with diseases of the maxillofacial region, and, in particular, the temporomandibular joint, is an urgent problem not only for dentists, but also for specialists in the field of rehabilitation, in particular, physical therapists. The objectives of physical therapy in patients with arthrosis of the temporomandibular joint are to reduce the load on the joint, eliminate and reduce pain, synovitis, myalgia, improve joint function, stimulate and activate metabolic processes in cartilaginous and bone tissues, normalize blood flow, and thus improve quality of life. Conclusion. Physical therapy means improve the functional ability of the temporomandibular joint in the complex recovery of patients with arthrosis statistically significantly better than monotherapy with non-steroidal anti-inflammatory drugs

Effects of Chewing Exerciser on the Recovery of Masticatory Function Recovery after Orthognathic Surgery: A Single-Center Randomized Clinical Trial, a Preliminary Study.

Background and Objectives: The aim of this study was to evaluate the effects of the chewing exerciser (CE) on the functional recovery of the masticatory muscles after orthognathic surgery. Material and Methods: This randomized clinical trial was conducted in patients undergoing bimaxillary orthognathic surgery including bilateral sagittal split ramus osteotomy. Postoperative physiotherapy (PT) was performed for 3 weeks starting 3 weeks after the surgery. The patients were randomly divided into two groups: control (Con) (conventional PT) group and CE group (use of CE in addition to conventional PT). The masticatory function was evaluated based on three standards: bite force (BF), amount of mouth opening (MO), and surface electromyography (sEMG) of the anterior temporal muscle (TA), masseter muscle (MM), sternocleidomastoid muscle, and anterior belly of digastric muscle before, 3 weeks (before PT) and 6 weeks after the surgery (after PT). Results: Finally, 22 subjects participated in this study: 10 patients for Con group and 12 patients for CE group. In both groups, the BF, which was reduced significantly after the surgery, recovered after the PT similar to that before the surgery. In both groups, the MO was also significantly reduced by the surgery. However, it did not recover as much, as it was before the surgery after applying the PT. There was no difference in BF and MO between the two groups. All muscles did not show significant changes in sEMG by surgery and PT at both resting and clenching states. Conclusion: Applying CE as a PT after orthognathic surgery did not cause any harmful side effects. In both groups, the weakened muscle activity after orthognathic surgery (OGS) was adequately restored 6 weeks after the surgery. However, CE did not offer a statistically significant benefit to the masticatory function in the recovery process after OGS.

Efficacy of arthrocentesis and lavage for treatment of post-traumatic arthritis in temporomandibular joints.

ObjectivesJoint injuries frequently lead to progressive joint degeneration that causes articular disc derangement, joint inflammation, and osteoarthritis. Such arthropathies that arise after trauma are defined as post-traumatic arthritis (PTA). Although PTA is well recognized in knee and elbow joints, PTA in the temporomandibular joint (TMJ) has not been clearly defined. Interestingly, patients experiencing head and neck trauma without direct jaw fracture have displayed TMJ disease symptoms; however, definitive diagnosis and treatment options are not available. This study will analyze clinical aspects of PTA in TMJ and their treatment outcomes after joint arthrocentesis and lavage.Materials and MethodsTwenty patients with history of trauma to the head and neck especially without jaw fracture were retrospectively studied. Those patients developed TMJ disease symptoms and were diagnosed by computed tomography or magnetic resonance imaging. To decrease TMJ discomfort, arthrocentesis and lavage with or without conservative therapy were applied, and efficacy was evaluated by amount of mouth opening and pain scale. Statistical differences between pre- and post-treatment values were evaluated by Wilcoxon signed-rank test.ResultsPatient age varied widely between 20 and 80 years, and causes of trauma were diverse. Duration of disease onset was measured as 508 posttrauma days, and 85% of the patients sought clinic visit within 2 years after trauma. In addition, 85% of the patients showed TMJ disc derangement without reduction, and osteoarthritis was accompanied at the traumatized side or at both sides in 40% of the patients. After arthrocentesis or lavage, maximal mouth opening was significantly increased (28-44 mm on average, P<0.001) and pain scale was dramatically decreased (7.8-3.5 of 10, P<0.001); however, concomitant conservative therapy showed no difference in treatment outcome.ConclusionThe results of this study clarify the disease identity of PTA in TMJ and suggest early diagnosis and treatment options to manage PTA in TMJ.

A Comparative Assessment of the Management of Mandibular Angle Fractures using 3D Plates and 2D Mini Plates

The aim of this study was to compare 2D plates with 3D miniplate system in the management of mandibular angle fractures. The study was conducted on 146 patients with mandibular angle fracture, who were equally divided into two groups of 73. Patients in group I were treated with 3D plating and in group II with 2D plating. In all cases, 2.0 mm titanium miniplates were used. The etiology of fracture, amount of mouth opening, and pain and sensory deficit were recorded. Clinical and radiographic assessment was done at 1, 3, and 6 months. The etiology of mandibular angle fracture is roadside accident (RSA) seen in 110 (75.3%) cases, fall in 24 (16.4%), and assault in 12 (2.6%) cases. There was significant (p < 0.05) mouth opening in group I at 1 month postoperatively (32.4 mm) as compared to group II (27.5 mm), at 3 months in group I (33.6 mm) as compared to group II (30.2 mm), and at 6 months in group I (36.4 mm) as compared to group II (31.6 mm). After 1 month, sensory deficit was present in six patients in group I and 10 patients in group II. After 3 months, group I had no patients and three patients in group II. Right angle fracture was found in 71 patients (group I-36, group II-35). Mandibular right angle fracture in 58 patients (group I-28, group II-30). The authors found that the 3D miniplate system is more useful in the management of cases of mandibular angle fracture as compared to 2D miniplates. There has been increase in mandibular fractures in the last few years. Appropriate management with 3D miniplates may be useful in providing better treatment outcomes.

Use of piezoelectric surgery and Er:YAG laser:which one is more effective during impacted third molar surgery?

BackgroundReduction in postoperative complications is of vital considerations in impacted third molar teeth surgery. The aim of this study was to compare postoperative complications of impacted third molar surgeries for bone removal using laser, piezoelectric equipment, and conventional rotary instruments.MethodsTo address the research purpose, the investigator designed the prospective double-blind clinical trial study. The sample size was determined 20 (40 teeth) by sampling formula in any kind of operation. The data of patients were obtained in the different periods in terms of pain, trismus, swelling, ecchymosis, and patient’s satisfaction and then analyzed using SPSS 20 software via paired t test and Wilcoxon and McNemar’s tests.ResultsThe pain immediately after surgery and 2 days and 7 days after surgery was higher in the laser group. The swelling immediately after surgery was more in the laser group but not significant. The amount of mouth opening immediately after surgery and 2 days and 7 days after surgery was significantly lower in the laser group than in the piezosurgery group. The total duration of surgery and duration of osteotomy were significantly longer in the laser group. The patient’s satisfaction from surgery with piezosurgery was more than that with laser, but this difference was not significant.ConclusionDue to the rising demand for impacted wisdom tooth surgery, the present study suggests that hard tissue laser surgery and piezosurgery can clear the future of impacted molar surgery, and these approaches are more efficient in reducing postoperative complications compared to the conventional surgeries.

Evaluation of the 3 mm Thickness Splint Therapy on Temporomandibular Joint Disorders (TMDs)

Objective. This study aimed at finding out whether the 3 mm thickness of stabilization splints has positive or negative effects on all temporomandibular disorder (TMD) symptoms. Materials and Methods. The statistical calculation included 25 (22 females; 3 males) TMD patients who received 3 mm thickness stabilization splint therapy. They were evaluated according to follow-up treatment period, TMD pain, muscle pain, mouth opening, diet score, and splint usage time per day. Results. There was important treatment success that 22 (88%) of patients were totally healed. There was not any remarkable effect or advancement of splints on total healings of TMDs in first 3 months' period (11/25 patients, 44%). The mouth opening mean reached 38, 67 mm at 6 months and 41 mm at 12 months with remarkable success. Except one (4%) patient, other 24 (96%) patients had a normal diet score of 3 at the end of splint therapy. There was no correlation between splint usage duration a day and total healing of TMDs. Conclusion. We conclude that 3 mm splint therapy should maintain at least 6 months to achieve remarkable results. Splint should be used at least 12 h a day consistent with our results. Finally, diet score should be incorporated with TMD pain and amount of mouth opening; hence, we advise to use in one term as “total healing.”

Force degradation of orthodontic latex elastics: An in-vivo study

Our objectives were to assess the force degradation of orthodontic latex elastics over 48hours invivo and to study the relationship between the amount of mouth opening and the degree of force decay. Fifty-two orthodontic patients wearing fixed appliances using Class II elastics were asked to wear premeasured-force 3/16-in heavy and medium intermaxillary elastics. The force amounts were measured and compared at different time intervals. Fifty percent of theforce was lost after 3.9hours for the medium elastics and after 4.9hours for the heavy elastics. A continuous significant force drop in all elastics was seen at all time intervals (P<0.05, P<0.001). There was greater force loss in the heavy elastics compared with the medium elastics invivo at all time intervals (P<0.001); the rates of force loss, however, were similar. Fifty percent of force degradation occurred in the first 4 to 5hours. Because of breakage and for oral hygiene purposes, orthodontic elastics should be changed daily; otherwise, elastics can be used for 48hours. Force decay of the elastics was correlated to the lateral distance between the maxillary canine and the mandibular first molar in occlusion.

An analysis of rate and factors affecting malignant transformation of oral submucous fibrosis in patients attending the Oral Medicine Clinic, Dental Hospital Peradeniya, Sri Lanka - A retrospective study

Background: Oral submucous fibrosis (OSF) is a chronic, progressive, scarring and potentially malignant disease of the oral mucosa seen primarily in the Indian subcontinent and in South East Asia. OSF is a premalignant condition with a malignant transformation rate varying from 7-12%. Even though OSF and oral cancer are common in Sri Lanka, malignant transformation potential and rate have not been studied in our population. Objectives: To identify the relationship of malignant transformation with age, gender, habits, amount of mouth opening, duration of follow up, presence of other oral potentially malignant disorders and dysplasia in a group of patients with OSF attending the Oral Medicine clinic, University Dental Hospital Peradeniya. Methods: All the clinical files of patients with OSF attending the Oral Medicine clinic, University Dental Hospital Peradeniya were selected. Cases with OSF where histopathological diagnosis was not available, patients who had developed oral cancer before the diagnosis of OSF and patients who were diagnosed with OSF and received prior surgical therapy were excluded. Data were analysed to identify any relationship of malignant transformation with other variables. Results: There were 135 patients with a follow up period ranging from 6 months to 23 years and average follow up period was 5.26 years. 75.6% of them were males. 42.2% of them presented with burning sensation as the main complaint. 96.3% of them chewed betel with all ingredients whereas the rest chewed only arecanut. Eight patients developed malignancy during the follow up period giving a malignant transformation rate of 5.9% after a mean follow up period of 6.5 years. Conclusions: Malignant transformation in patients with OSF is significantly associated with presence of dysplasia on the initial biopsy, presence of any other potentially malignant disorder and the duration of betel chewing.

IMMEDIATE AND SHORT-TERM EFFECT OF HAMSTRING STATIC STRETCHING ON ACTIVE MOUTH OPENING

Background and Aim: Human body is an integrated unit that acts as a whole in such a way that the function of every part may influence the other parts. In this study the effect of hamstring muscle stretching on the amount of mouth opening in healthy people was investigated as a component of this integrated body. Materials and Methods: Eighty volunteers, 54 men and 26 women, aged 18 to 30 years old, participated in this study. Subjects were divided randomly into two groups. Group 1 underwent a single 60-second hamstring muscle static stretching for dominant leg. The control group received passive patellar mobilization as a placebo intervention for dominant leg. Outcome measure was maximum active mouth opening and popliteal angle which were measured by a digital caliper and a hand goniometer respectively. These measurements were done at baseline, 5 minutes, 1 hour and 24 hours, post intervention by an examiner blinded to the intervention allocated to each subject. Results: Repeated measures ANOVA revealed significant decrease in mouth opening in group 1 (p<0.05); that was also significant when compared to control group (p<0.05). Popliteal angle was not significantly changed in both groups. In addition positive correlation was found between the active mouth opening and popliteal angle. Conclusion: The present study demonstrated an decrease in active mouth opening in response to the static stretching of hamstring muscles which confirms the hypothesis of a functional relationship between the masticatory and hamstring muscle. This relationship can be explained through myofascial meredians, nervous system, muscle chains and biomechanical linkage Key words: hamstring muscles, static stretching, active mouth opening

Low-level laser therapy for management of TMJ osteoarthritis

Aims:This study investigated the efficacy of low-level laser therapy (LLLT) for the management of temporomandibular joint (TMJ) osteoarthritis.Methodology:In a double-blind clinical trial, 20 patients with TMJ osteoarthritis were randomly divided into laser and placebo groups. The patients in the laser group received irradiation from an 810 nm low-level laser (Peak power 80 W, average power 50 mW, 1500 Hz, 1 μs pulse width, 120 seconds, 6 J, 3·4 J/cm2 per point), which was applied on four points around the TMJs and on painful muscles three times a week for 4 weeks. In the placebo group, the treatment was the same as that in the laser group, but with laser simulation. The patients were evaluated before laser therapy (T1), after 6 (T2) and 12 (T3) laser applications and 1 month after the last application (T4), and the amount of mouth opening and the pain intensity were recorded.Results:No significant differences were found in mouth opening either between the study groups or between the different evaluation times in each group (P>0·05). There was no significant difference in pain symptoms of the masticatory muscles and TMJ between the laser and the placebo groups (P>0·05), but some significant within-group improvements were present for Visual Analogue Scale (VAS) scores of the body of the masseter and TMJ in both groups.Conclusions:LLLT using the present laser parameters was no more effective than the placebo treatment for reducing pain and improving mouth opening in patients with TMJ osteoarthritis.

The efficacy of low-level laser therapy for the treatment of myogenous temporomandibular joint disorder

Low-level laser therapy (LLLT) has been commonly used for the treatment of painful musculoskeletal conditions, but the results of previous studies on this subject are controversial. The aim of this study was to evaluate the efficacy of LLLT in the management of patients with myogenic temporomandibular joint disorders (TMDs). In this randomized, double-blind clinical trial, 20 patients with myogenic TMD were randomly divided into laser and placebo groups. In the laser group, a pulsed 810-nm low-level laser (average power 50mW, peak power 80W, 1,500Hz, 120s, 6J, and 3.4J/cm(2) per point) was used on painful muscles three times a week for 4weeks. In the placebo group, the treatment was the same as that in the laser group, but without energy output. The patients were evaluated before laser therapy (T1), after six sessions of laser application (T2), at the end of treatment (T3), and 1month after the last application (T4), and the level of pain and the amount of mouth opening were measured. There was a significant increase in mouth opening and a significant reduction of pain symptoms in the laser group (p < 0.05). A similar improvement was not observed in the placebo group (p > 0.05). Between-group comparisons revealed no significant difference in pain intensity and mouth opening measurement at any of the evaluation time points (p > 0.05). LLLT can produce a significant improvement in pain level and mouth opening in patients affected with myogenic TMD.

顎関節障害を認めた混合性結合組織病の1例

Mixed connective tissue disease (MCTD) was defined in 1972 by Sharp et al. as a connective tissue disorder characterized by overlapping features of systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS), and high titers of anti U1-ribonucleoprotein (RNP) antibody. In this report, a case of MCTD associated with temporomandibular joint (TMJ) disturbances is described. The patient was a 30-year-old woman who was given a diagnosis of MCTD 7 years previously. At the first visit, the amount of mouth opening was about 24 mm, with jaw opening pain, palpation tenderness of the TMJ and masseter muscle tenderness on both sides. She also had a habit of chewing on one side. MRI revealed deformity of the condyles, bilateral anterior disc displacement without reduction, and related findings. She was treated by conservative methods, including muscle relaxants, massage, jaw-opening training, eliminating bad habits, and a stabilization splint. During treatment, the symptoms improved gradually except for trismus, which continues at present. If it is therefore necessary for her to receive conservative therapy hereafter.

CIRNE III Abstracts: Congresso Internacional de Reabilitação Neuromusculoesquelética e Esportiva, May 18–21, 2011, Vitória, Brazil

CIRNE III Abstracts: Congresso Internacional de Reabilitação Neuromusculoesquelética e Esportiva, May 18–21, 2011, Vitória, Brazil

The Relationship Between Mouth Opening and Sleep Stage-Related Sleep Disordered Breathing

To evaluate mouth opening during sleep and the possible correlations between mouth opening and specific patient characteristics. A total of 55 patients consecutively referred to assess snoring and suspected obstructive sleep apnea (OSA) were included. Sensors to record mouth opening were attached to each patient's face and synchronized with a standard polysomnogram. Mouth opening data were evaluated for each sleep stage as a percentage of maximum mouth opening. The patients were divided into 2 groups: patients with REM apnea hypopnea index (AHI) > NREM AHI (REM-dependent group = RD group), and patients with NREM AHI > REM AHI (NREM-dependent group = ND group). A total of 42 patients (male 69.0%, mean age 51.4 ± 12.9 years) underwent successful data collection. The amount of mouth opening during stage 1 (18.8% ± 14.6%) was significantly smaller than stage 2 (23.7% ± 16.4%, p < 0.01) and REM (29.2% ± 20.3%, p < 0.01). Age, body mass index (BMI), Epworth Sleepiness Scale (ESS) score, and AHI exhibited no correlation with mouth opening. The RD and the ND groups exhibited similar age, BMI, ESS, and AHI variables, but the ND group opened their mouths significantly more than the RD group during total sleep time (28.3% ± 13.6% vs 17.8% ± 17.3%, p < 0.01), stage 1 (23.2% ± 13.5% vs 12.9% ± 14.3%, p < 0.01), stage 2 (28.1% ± 17.9% vs 17.9% ± 17.4%, p < 0.01), and REM (34.7% ± 19.2% vs 21.9% ± 19.8%, p < 0.05). The ND patients opened their mouths wider than the RD patients during most sleep stages. The relationship between REM-dependent AHI and the amount of mouth opening may be a factor in the pathogenesis of OSA.

Factors associated with restricted mouth opening and its relationship to health-related quality of life in patients attending a Maxillofacial Oncology clinic

Trismus can be a problematic consequence of treatment for oral and oropharyngeal cancer. The aim of this study was to investigate the relationship between trismus, subjective function and health-related quality of life, in order to postulate a clinically relevant cut-off that might be useful as an indicator of patients who might benefit from intervention. One hundred consecutive patients attending the Maxillofacial Oncology clinic at the University Hospital Aintree were assessed during a period of four months. Mouth opening was recorded in millimetres. Subjective outcomes were evaluated using UW-QOL questionnaire for chewing, saliva, mood, anxiety and overall quality of life. The median age of patients was 63 (IQR 56-69) years. The median time since treatment was 16 (IQR 6-34) months. The median mouth opening (32 mm; range 6-53, IQR 24-40) was associated strongly with clinical T stage (Tis/T1-2 35 mm, T3-4 24 mm), radiotherapy (no 38 mm, yes 27 mm) and type of primary surgery (primary closure 38 mm, soft-tissue flaps 30 mm, composite flaps 24 mm). The amount of mouth opening and of the single question (about how much less mouth opening since treatment) was significantly associated with patients perception of chewing deficit, less than full diet and less than good overall quality of life. This study supports a 35 mm cut-off for trismus. There is merit including the two elements together (opening in mm and the single item question on mouth opening since treatment) as outcome parameters.

Prognostic factors in arthrocentesis of the temporomandibular joint: Evaluation of 100 patients with internal derangement

Purpose: The goal of this study was to analyze the prognostic factors for successful arthrocentesis for internal derangement (ID) of the temporomandibular joint (TMJ). Patients and Methods: Arthrocentesis was carried out as the initial treatment in 103 TMJs of 100 patients with ID. The effectiveness of the treatment was evaluated in terms of the postoperative range of maximal mouth opening (MMO) and the degree of preoperative pain on a visual analog scale (VAS). Prognostic factors analyzed were age, sex, duration of painful locking, preoperative and postoperative range of MMO, preoperative degree of pain, preoperative clicking on opening mouth before becoming locked, and magnetic resonance imaging (MRI) findings. These factors were statistically analyzed. Results: Seventy-three cases (71%) satisfied the criteria for success. One week after the procedure, the mean range of MMO in the successful cases (43.8 ± 5.5 mm) was significantly greater than that in unsuccessful cases (36.9 ± 6.6 mm) (P <.05). The mean preoperative degree of pain on a VAS in successful cases (4.7 ± 2.9) was significantly smaller than that in unsuccessful cases (6.2 ± 2.1) (P <.05). The preoperative incidence of morphologic changes in the mandibular condyle seen on MRI of successful cases was significantly less than that in unsuccessful cases (P <.05). Conclusion: Severe preoperative pain, relapse in the amount of mouth opening within 1 week after arthrocentesis, and preoperative bony changes in the condyle may be predictors of the effectiveness of arthrocentesis for ID of the TMJ. © 2001 American Association of Oral and Maxillofacial Surgeons

A modified mandibular ramus osteotomy for orthognathic surgery

Several procedures have been described for correction of orthognathic deformities of the mandible. Currently, the bilateral sagittal split osteotomy (BSSO) maintains its popularity because of its versatility and its amenability to rigid fixation techniques. The distal segment of the mandible can be repositioned in all planes of space, and the bony interface along the osteotomy results in predictable healing. However, there are well-known disadvantages to the procedure, which include neurosensory disturbance, 1 Pratt CA Labial sensory function following sagittal split osteotomy. Br J Oral Maxillofac Surg. 1996; 34: 75 Abstract Full Text PDF PubMed Scopus (43) Google Scholar , 2 Posnick J Alteration in facial sensibility in adolescents following sagittal split and chin osteotomies of the mandible. Plast Reconstr Surg. 1996; 97: 920 Crossref PubMed Scopus (67) Google Scholar , 3 Lemke RR Effects of hypesthesia on oral behaviors of the orthognathic surgery patient. J Oral Maxillofac Surg. 1998; 56: 153 Abstract Full Text PDF PubMed Scopus (26) Google Scholar , 4 Jacks SC A retrospective analysis of lingual nerve sensory changes after mandibular bilateral sagittal split osteotomy. J Oral Maxillofac Surg. 1998; 56: 700 Abstract Full Text PDF PubMed Scopus (50) Google Scholar , 5 Fujioka M Comparative study of inferior alveolar disturbance restoration after sagittal split osteotomy by means of bicortical versus monocortical osteosynthesis. Plast Reconstr Surg. 1998; 102: 37 Crossref PubMed Scopus (45) Google Scholar , 6 Blomqvist JE Sensibility following sagittal split osteotomy in the mandible: A prospective clinical study. Plast Reconstr Surg. 1998; 102: 325 Crossref PubMed Scopus (52) Google Scholar , 7 August M Neurosensory deficit and functional impairment after sagittal ramus osteotomy: A long-term follow-up study. J Oral Maxillofac Surg. 1998; 56: 1231 Abstract Full Text PDF PubMed Google Scholar , 8 Westermark A Inferior nerve function after mandibular osteotomies. Br J Oral Maxillofac Surg. 1998; 36: 425 Abstract Full Text PDF PubMed Scopus (174) Google Scholar , 9 Westermark A Inferior alveolar nerve function after sagittal split osteotomy of the mandible: Correlation with degree of intraoperative nerve encounter and other variables in 496 operations. Br J Oral Maxillofac Surg. 1998; 36: 429 Abstract Full Text PDF PubMed Scopus (139) Google Scholar condylar displacement, 10 Magalh-aes AE Changes in condylar position following bilateral sagittal split ramus osteotomy with setback. Int J Adult Ortho Orthognath Surg. 1995; 10: 137 PubMed Google Scholar , 11 Van Sickels JE Condylar torque as a possible cause of hypomobility after sagittal split osteotomy: Report of three cases. J Oral Maxillofac Surg. 1997; 55: 398 Abstract Full Text PDF PubMed Scopus (20) Google Scholar , 12 Nishimura A Positional changes in the mandibular condyle and amount of mouth opening after sagittal split ramus osteotomy with rigid or nonrigid osteosynthesis. J Oral Maxillofac Surg. 1997; 55: 672 Abstract Full Text PDF PubMed Scopus (33) Google Scholar , 13 Van Sickels JE Condylar position with rigid fixation versus wire osteosynthesis of a sagittal split advancement. J Oral Maxillofac Surg. 1999; 57: 31 Abstract Full Text PDF PubMed Scopus (32) Google Scholar and unfavorable splits. 14 Martis CS Complications of the mandibular sagittal split osteotomy. J Oral Maxillofac Surg. 1984; 42: 101 Abstract Full Text PDF PubMed Scopus (146) Google Scholar , 15 Van Sickels JE Jeter JE Theriot BA Management of an unfavorable lingual fracture during a sagittal split osteotomy. J Oral Maxillofac Surg. 1985; 43: 808 Abstract Full Text PDF PubMed Scopus (26) Google Scholar , 16 Turvey TA Intraoperative complications of sagittal osteotomy of the mandibular ramus: Incidence and management. J Oral Maxillofac Surg. 1985; 43: 504 Abstract Full Text PDF PubMed Scopus (104) Google Scholar , 17 Marquez IM Modification of the sagittal split osteotomy to avoid unfavorable fracture around impacted third molars. Int J Adult Ortho Orthognath Surg. 1998; 13: 183 PubMed Google Scholar