Maxillary metastasis from lung adenocarcinoma as an initial manifestation: A rare case report with review of literature

A Congenital Insensitivity to Pain with Anhidrosis (CIPA) in 1.5 Year Old Male

Ohoud Tawfig Zain Elabdeen

Congenital insensitivity to pain and anhidrosis (CIPA) it is a rare genetic syndrome also known as hereditary sensory and autonomic neuropathy type IV. Patients usually presented with: insensitivity to pain, inability to sweat (anhidrosis), various degrees of mental retardation, osteomylitis, deformities of joints that may lead to fractures. Also these Patients have the ability to severely injure themselves repeatedly which may result in permanent damage and often their condition is misdiagnosed as child abuse. We report a case of 1.5 years old male presenting with this type of syndrome.

Correlation between MRI and Biomodelling Analysis in Masseter Muscle Following Orthognathic Surgery

Fernando Duarte, João Neves Silva, Carina Ramos, Colin Hopper

Purpose: This pilot investigation was designed to apply several and innovative methods of measuring muscle area, volume, structure, function and fibre orientation to a situation where adaptation of muscle is pivotal to the success of a therapeutic approach.
Materials and Methods: Patients attending the combined orthodontic/orthognathic surgery clinic at Clitrofa – Centro Médico, Dentário e Cirúrgico, in Trofa - Portugal were screened using a standardized Magnetic Resonance Imaging protocol, with fine overlapping slices of 1 mm thickness and a spacing of 0.8 mm during 7 minutes. The software used was the AnatomicsTM that allows the correction of muscle and bone limits. The landmarks considered for this study were: a) the anterior angle from the long axis of masseter muscle versus angle between lower border of the zygomatic bone and the mastoid process; and b) the anterior angle from the long axis of the masseter muscle versus the mandibular plane. The angles were measured by two different observers. The values were registered (T0) and the procedure was repeated after 1 hour (T1), and 6 to 12 months after surgery (T2).
Conclusions: Significant statistical differences (p < 0,05) have been identified between Time 2 (1-6 months after surgery) and Times 0 and 1 (prior to surgery) in the mean P2 angle measured, both for Examiner F and C. These differences reveal the masseter muscle adaptation following bimaxillary osteotomy involving a combination of maxillary Le Fort I impaction procedure coupled with a sagittal split advancement of the mandible in this study-case. The measurement of “P1 Masseter Muscle/Zygomatic Bone/Process Mastoid Anterior Angle” and “P2 Masseter Muscle/Mandibular Angle” can therefore be a valuable tool for controlling the reworking of masseter muscle upon orthognathic surgery.

Oro Facial Digital Syndrome (MOHR SYNDROME)

Ohoud Tawfig Zain Elabdeen, Nuha Fathelrhman Yahya

Oro-facial digital syndrome is a group of related conditions that affect the development of oral cavity, facial structures and digits; along with different degrees of mental retardation and Additional signs involving (CNS) and visceral organs; there are at least 13 clinical types of OFDS. This is the case report of afive year old boy with OFDS type II (Mohr syndrome) presented with oral, facial and limbs deformities. Medical history, physical examination and genetic analysis play a major role in recognizing which type of OFDS. Management of patients with OFDS type II need multidisciplinary team approach (plastic and orthopedic surgeon, pediatric dentist and speech therapist).

Measurement of Pressure in Orthognathic Surgery using Pressurex®

Fernando Duarte, João Neves Silva, Carina Ramos, Colin Hopper

Purpose: Despite its importance, the measurement of pressure in orthognathic surgery often receives little attention. Pressurex® (SPL – Sensor Products LLC, USA) is one of a few pressure indicating sensor films that reveals pressure distribution and magnitude between any two contacting, mating or impacting surfaces, and is currently viewed as a golden standard for that purpose. This study was designed to apply other alternative and innovative methods of measuring muscle area, volume, structure, function and fibre orientation to a situation where adaptation of muscle is pivotal to the success of a therapeutic approach. Materials and Methods: Ten patients attending the combined orthodontic/orthognathic surgery clinic at the Clitrofa – Centro Médico, Dentário e Cirúrgico, in Trofa - Portugal were tested according to the following protocol: The pressure sensor film system was placed between the upper and lower dental arch, and the subjects were instructed to bite as forcefully as possible for about 3 seconds. The values were registered (T0) and the procedure was repeated after 10 minutes (T1), and after 1 month after surgery (T2). The occlusal pressure was measured by two different observers. The results have been measured by two different observers and the results analysis were performed using the Magics® RP software. These 10 patients were scheduled for a bimaxillary osteotomy involving a combination of maxillary Le Fort I impaction procedure coupled with a sagittal split advancement of the mandible.
Conclusions: Significant statistical differences in the mean bite pressure (psi) have been detected between pre-op (Times 0 and 1) and post-op (Time 2) periods for the film pressure areas Q2/P2, Q3/P3 and Q4/P4, irrespective of the Examiner (C or F) (p < 0,05). Interestingly, these differences in the mean bite pressure (psi) at different times are concentrated in the anterior and mid region of the maxilla/ mandible, whereas in the posterior region of the maxilla/ mandible (Q1/P1 and Q5/P5), no significant statistical differences have been detected throughout time (p > 0,05).