Michael J Gunson, William Arnett, Bent Formby Charles Falzone, Ruchi Mathur and Carolyn Alexander
Over a 3-year period, 27 women without history of autoimmune disease found their way to the offices of these authors (oral & maxillofacial surgeons) with complaints of increasing open bite, receding chin and severe condylar resorption. Their average age was only 26 years, most had Class II malocclusion and mandibular condyles with flat surfaces and cortical erosions. What could have possibly caused these dramatic changes over such a short time?
A standardized in-depth history of each patient's medical history was used to evaluate sex hormone dysfunction. Information on each woman's growth and development, onset of menses, disruption of menstrual cycle, need for hormone replacement and use of hormonal birth control was obtained. A number of other diagnostic tests were applied in the effort to determine the cause of these dramatic changes. Note the authors, "In the inflammatory model of periodontal disease, studies consistently show increased alveolar bone loss and inflammatory tissue associated with ethinyl estradiol (EE) use as compared with non users. We also know that EE suppresses the production and availability of naturally occurring 17b-estradiol resulting in increased osteoclast activity and increased inflammatory cytokine production."
It is likely that a number of local stress factors that were not considered in this study also influenced the condylar change. Whether induced by ethinyl estradiol birth control or through premature ovarian failure, low circulating 17b-estradiol appears to make it impossible for the natural reparative capacity of the bony condyle to take place in the face of local inflammatory factors. This then leads to cortical and medullary condylar lysis. In conclusion these authors believe the clinician must be careful with female patients who have symptoms of 17b-estradiol deficiency. If an association between oral contraceptive pill (OCP) use and condylar resorption seems to exist, one might suggest cessation of the OCP to the patient's physician.
Ceib Phillips, Se Hee Kim, Greg Essick, Myron Tucker, and Timothy A Turvey
Your most recent jaw surgery patient had just returned for his post-surgical check with only one complaint…all sensation in his lower lip and chin seemed to be gone. Now that I mention it, this always seemed to be the complaint of my surgery patients. Does the fact that most patients have this problem make it any less important, especially to the 60% who fail to see full improvement within the first 6 months? The authors of this study thought it to be of sufficient importance to design a study that would assess whether demographic, clinical, or pre-surgical psychological factors are related to self-reporting of the presence of altered sensation 2 years following bilateral sagittal split osteotomy (BSSO) and whether sensory re-training has a long-term effect on patient's perception of altered facial sensation.
One hundred eighty-six patients, 13 to 50 years of age, were randomized into a multi-center, double blind, two-arm parallel group, clinical trial. The patients were scheduled for a BSSO alone or with LeFort I osteotomy to correct a severe malocclusion and/or a developmental disharmony. The clinical trial was designed to evaluate sensory retraining, a non-invasive rehabilitative type of therapy. You may want to read the entire article online to understand the full extent of psychological testing that was a part of the overall evaluation. Subjects were randomized to receive either instruction on standard training exercises only after surgery or the opening exercises plus a 3-level progressive series of sensory re-training exercises. The 3 levels were designed to increasingly challenge patients to discriminate moving from non-moving touch, the orientation of moving touch, and the direction of moving touch.
Age and the severity of pre-surgical psychological distress were significantly associated with the report of altered sensation after controlling for the exercise training received. After controlling for age and psychological distress, patients who received opening exercises only were approximately 2.2 times more likely to report post-operative altered sensation compared to patients who received sensory retraining exercises.
Dan Grauer, Lucia S Cevidanes, Martin A STyner, James L Ackerman, and William R Proffit
When examining a new patient with very delicate features combined with long face height, do you wonder whether or not a constricted airway may be related to this differing facial morphology? Reasons for growth disharmonies have long been subject to speculation, but now some think we may be closer to an answer with availability of cone beam technology. The goal of this study from the University of North Carolina was to examine the hypothesis that pharynx volumes and shape would differ among various facial morphologies, controlling for differences due to facial size. A sample of 62 subjects ages 17 to 46 that had cone beam computed tomograms along with facial photographs and lateral cephalometric radiographs were selected for the study.
Care was taken by these researchers to obtain the true shape of the airways being measured in 3-D with the CBCTs available for the subjects in the sample. The shape of the airway was analyzed qualitatively by visual inspection and frequency count. The average volume of the pharyngeal airway was determined in both superior and inferior components. In calculating this number no linear or angular measurements were used. With 62 subjects divided into three groups for analysis, the sample size in each group was around 20. With plans to increase the size of this sample in the future, the authors of this article believe 3-D images of the airway have allowed for an improved evaluation of sites of airway obstruction. New registration methods for growing patients and inter-patient comparison have been used in preliminary studies involving surgical and orthopedic changes. In conclusion, head posture, mandibular rotation, hyoid position and patency of the airway are interrelated…and further 3-D studies of the airway should serve to clarify these relationships.