Objective: Maxillofacial Orthognathic surgery is performed to repair or correct the skeletal anomalies of the jaw and its associated dental and facial structures. There is a conflict on whether orthognathic surgery has a negative or positive effect on temporomandibular disorders (TMD). The aim of this study is to review the disorders of the temporomandibular joint after orthognathic surgery. Materials and Methods: Data for this review was obtained from the articles published between 2010-2020 via PubMed, Google scholar, Web of Sciences, and Scopus engines. The content keywords matched those used in PubMed and Mesh engines. Based on the inclusion and exclusion criteria,27 articles were included. Results: Most of the selected articles were retrospective reviews and performed on class II and class III patients. Ages ranged from 19-47 years. Pain reduction was reported in 11 studies, while 8 studies reported a click reduction post orthognathic operation. In 2 studies, decreased joint noises was reported after orthognathic operation, and 7 articles reported a decrease in maximum mouth opening. Three studies reported a Bilateral Sagittal split Osteotomy (BSSO) and in one study, reduced and improved symptoms after Le Fort I + (BSSO) were reported. One study exhibited that BSSO orthognathic surgery is less predictable in reducing TMD symptoms in retrognathic patients. Three articles showed that orthognathic patients with TMJ click have a high predictive value. Conclusion: To accomplish accurate results regarding temporomandibular joint disorders post orthognathic surgery,a larger number of subjects and clinical trial studies are required, as well as extended long term follow-up.

Introduction: Maxillofacial orthognathic surgery is performed to repair or correct the skeletal anomalies of the jaw and its associated dental and facial structures. There is a conflict on whether orthognathic surgery has a negative or positive effect on temporomandibular disorders (TMD). The aim of this study is to review disorders of temporomandibular joint (TMJ) after orthognathic surgery. Materials and Methods: Data for this review was obtained from the articles published between 2010-2020 via PubMed, Google Scholar, Web of Sciences, and Scopus. The content keywords matched those used in PubMed and Mesh engines. Results: Based on the inclusion and exclusion criteria, 27 articles were included. Most of the selected articles were retrospective reviews and performed on class II and class III patients. Ages ranged from 19-47 years. Pain reduction was reported in 11 studies, while 8 studies reported a click reduction post orthognathic operation. In two studies, decreased joint noises were reported after theorthognathic operation, and seven articles reported a decrease in maximum mouth opening. Three studies reported a bilateral sagittal split osteotomy (BSSO) and in one study, reduced and improved symptoms were reported after Le Fort I + (BSSO) surgery. One study exhibited that in retrognathic patients BSSO orthognathic surgery is less predictable in reducing TMD symptoms. Three articles showed that orthognathic patients with TMJ click have a high predictive value. Conclusion: To accomplish accurate results regarding TMD post orthognathic surgery, a larger number of subjects, as well as extended long term follow-up are required.

Introduction: Maxillary advancement is applied extensively for malocclusion class III correction. This procedure is done using one of the two methods, Conventional or High. Maxilla moves in both vertical and horizontal and only in the horizontal directions in Conventional and High method respectively, so expecting a difference in facial soft tissue changes. In present study is a case series that describes this issue. Materials and Methods: The cases included 30 patients with class III malocclusion due to maxillary deficiency, whom underwent Le Fort I osteotomy for maxillary advancement in Shahid Beheshti Hospital in Babol, Iran during 1995 to 1995. According to surgical technique, the cases were placed in group 1 (Conventional) or group 2 (High). Maxillary advancement and changes in hard and soft tissue of the middle and lower facial regions where measured through tracing on the lateral cephalometry. Intra-group and inter-group statistical comparisons were done using SPSS20 software at significance level as 0. 05. Result: The pre-surgical mean size of SNA, SNB, nasolabial and mentolabial angles was similar in two groups. In all patients, after surgery, SNA angle size was increased and SNB، nasolabial and Mentolabial angles size were decreased. The mean value of these change was similar in two groups. In group 2, the displacement of point A ‘ (mean difference: 1. 30 mm) and Labrale Superius (mean difference: 1. 40 mm) were significantly more than group 1. The amount of displacement of SN (mean difference: 1. 30 mm), Labrale Inferius (mean difference: 0. 88 mm) and Pogonion (mean difference: 0. 23 mm) points in group 2 was higher than that of group 1, but this difference was not statistically significant. Conclusion: It is needed strong evidence for decision about selecting High or Conventional approach maxillary advancement in terms of facial aesthetic aspects. So, further studies with larger sample sizes and cohort or quasi-experimental design is suggested.

Background and objectives: Maxillary advancement (MA) is a common surgical procedure for correcting facial-skeletal discrepancies in patients with cleft lip and palate. Despite its prevalence, the impact of MA on velopharyngeal insufficiency (VPI) remains a subject of debate. This systematic review and meta-analysis aims to evaluate the effect of MA on VPI in cleft palate patients. Materials and methods: Adhering to PRISMA 2020 guidelines this review included randomized controlled trials and observational studies assessing velopharyngeal function pre-and post-MA in cleft palate patients. Exclusion criteria encompassed studies on non-cleft palate patients and those lacking VPI assessments. Searches were conducted in databases like PubMed, MEDLINE, Embase, Scopus, and Cochrane Library, up to September 2023. Studies were selected and data was extracted by two independent reviewers, with disagreements resolved through consultation. The risk of bias was assessed using Cochrane's risk of bias tool. A meta-analysis was conducted using inverse variance meta-analysis with random effects for categorical data. Results: Eleven studies involving 524 patients were included. Studies varied in design, patient demographics, and type of cleft. MA procedures primarily involved LeFort I osteotomy. Speech and VPI assessments employed various methods. Analysis revealed a shift from normal to hypernasal speech postoperatively, with a general trend towards aggravated VPI, especially in cases of MA more than 6mm. The meta-regression (coefficient of-20. 35 with a standard error of 8. 63, a T-value of 2. 36, and a P-value of 0. 046) showed a significant relationship between the extent of MA and VPI outcomes. High heterogeneity was observed across studies. Conclusion: Maxillary advancement, especially when less than 6 mm, can negatively impact velopharyngeal insufficiency in patients with cleft palate. Successful outcomes require comprehensive preoperative assessment, precise surgical planning, collaborative care, and vigilant postoperative monitoring to minimize the risk of VPI and improve patient outcomes.

Background: Literature is controversial in regard with alterations in pharyngeal airway dimensions subsequent to maxillary protraction. The correlation between maxillary protraction and sagittal airway dimension was investigated in association with tongue and soft palate position in skeletal Class III children. The results were compared with those of an untreated Class III and a Class I malocclusion control group. Materials and Methods: In this cross‑ sectional study pre‑ and post‑ treatment cephalometric radiographs of 19 Class III patients (6 males, 13 females; mean age, 7. 93 ± 0. 96 years) treated with facemask were analyzed. The correlation between treatment changes in craniofacial morphology and those in the upper airway, tongue, and soft palate was evaluated. These results were compared with those of a group of 16 Class I malocclusion patients (1 male, 15 females; mean age, 7. 31 ± 0. 7 years) and a group of 15 untreated Class III patients (4 males and 11 females; mean age, 7. 46 ± 0. 1 years). A paired t‑ test, the Shapiro– Wilk test and Mann– Whitney U‑ test was used. The level of significance was established as P < 0. 05. Results: Nasopharyngeal airway measurements PNS‑ ad1 and PNS‑ ad2 significantly increased by 2 mm and 2. 1 mm, respectively. Statistical analysis revealed that maxillary protraction had a positive relationship with PNS‑ ad1 and PNS‑ ad2. Conclusion: Nasopharyngeal airway dimensions can be improved in the short term with maxillary protraction in skeletal Class III children.

Statement of the Problem: Due to shortage of ICU beds in hospitals, knowing what kind of orthognathic surgery patients more need ICU care after surgery would be important for surgeons and hospitals to prevent unnecessary ICU bed reservation.Purpose: The aim of the present study was to determine what kinds of orthognathic surgery patients would benefit more from ICU care after surgery.Materials and Method: 210 patients who were admitted to Chamran Hospital, Shiraz, for bimaxillary orthognathic surgery (2008-2013) were reviewed based on whether they had been admitted to ICU or maxillofacial surgery ward. Operation time, sex, intraoperative Estimated Blood Loss (EBL), postoperative complications, ICU admission, and unwanted complications resulting from staying in ICU were assessed.Results: Of 210 patients undergoing bimaxillary orthognathic surgery, 59 patients (28.1%) were postoperatively admitted to the ICU and 151 in the maxillofacial ward (71.9%). There was not statistically significant difference in age and sex between the two groups (p> 0.05). The groups were significantly different in terms of operation time (p< 0.001). Blood loss For ICU admitted patients was 600.00±293.621mL and for those who were hospitalized in the ward was 350.00±298.397 mL. Statistically significant differences were found between the two groups (p< 0.001). Moreover, there was a direct linear correlation between operation time and intraoperative estimated blood loss and this relationship was statistically significant (r=0.42, p< 0.001). Patients with maxillary impaction and setback plus mandibular advancement plus genioplasty were among the most ICU admitted patients (44%), while these patients were only 20% of all patients who were admitted to the ward. As a final point, the result illustrated that patients who were admitted to the ICU experienced more complication such as bleeding, postoperative nausea, and pain (p< 0.001).Conclusion: Orthognathic surgery patients (maxillary impaction and setback plus mandibular advancement plus genioplasty) due to more intraoperative bleeding and postoperative nausea and pain would benefit from ICU admission after surgery.