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Larry M Wolford - One of the best experts on this subject based on the ideXlab platform.
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Counterclockwise Rotation of the maxillomandibular complex for the correction of dentofacial deformities and sleep apnea
2021Co-Authors: Larry M WolfordAbstract:Patients with obstructive sleep apnea (OSA) commonly have a retruded maxilla and mandible and a high occlusal plane angle (HOP) facial morphology creating a decrease in the oropharyngeal airway resulting in OSA. The focus of this chapter is on the HOP facial morphology; clinical, radiographic, and occlusal diagnostic characteristics; treatment protocols; and outcomes for surgical Counterclockwise Rotation (CCWR) of the maxillomandibular complex. Common temporomandibular joint (TMJ) pathologies are presented that can be contributory to the development of OSA as well as postsurgical relapse if the orthognathic surgery is performed and the TMJ pathology ignored. Treatment protocols are presented to address the jaw deformity requiring CCWR of the maxillomandibular complex as well as management protocols for coexisting TMJ pathologies in order to provide highly predictable outcomes.
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does temporomandibular joint pathology with or without surgical management affect the stability of Counterclockwise Rotation of the maxillomandibular complex in orthognathic surgery a systematic review and meta analysis
Journal of Oral and Maxillofacial Surgery, 2017Co-Authors: Essam Ahmed Almoraissi, Larry M WolfordAbstract:Purpose This study was designed to determine the stability of Counterclockwise Rotation (CCWR) of the maxillomandibular complex (MMC) in orthognathic surgery with or without surgical correction of coexisting temporomandibular joint (TMJ) pathology. Materials and Methods The authors implemented a systematic review and meta-analysis. A search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was performed. Inclusion criteria were studies that analyzed CCWR of the MMC in regard to skeletal stability after orthognathic surgery in patients with or without pre-existing TMJ pathology that was or was not surgically corrected concomitantly. The predictor variables were patients who underwent CCWR of the MMC in the following subgroups: 1) healthy TMJs (presumed healthy based on history, clinical evaluation, and radiographic analysis but without magnetic resonance imaging [MRI] confirmation), 2) no TMJ assessment, 3) untreated TMJ disc displacement (confirmed by MRI), 4) TMJ disc displacement (confirmed by MRI) repositioned using Mitek anchors, and 5) reconstruction with TMJ total joint prosthesis. Outcome variables were surgical relapse for angular and linear measurements. Postsurgical mean changes for the occlusal plane (OP) and linear measurements using a fixed-effects model with a 95% confidence interval were analyzed. Results A total of 345 patients enrolled in 12 studies were included in this study. There was significant OP relapse and horizontal relapse at the B point and menton for studies with untreated TMJ disc displacement and studies without TMJ assessment (P < .005). There was significant horizontal relapse at the A point for studies with healthy TMJs, without assessment of the TMJs, and with TMJ reconstruction with total joint prostheses (P < .005). There was no significant vertical relapse at the B and A points for all subgroup analyses (P < .005). Conclusion The result of the meta-analysis suggests that CCWR of the MMC is a stable procedure for patients with healthy TMJs, patients undergoing concomitant TMJ disc repositioning with Mitek anchors, and patients with TMJ patient-fitted total joint prostheses but unstable in the presence of untreated TMJ disc displacements and when TMJ status is not assessed.
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is Counterclockwise Rotation of the maxillomandibular complex stable compared with clockwise Rotation in the correction of dentofacial deformities a systematic review and meta analysis
Journal of Oral and Maxillofacial Surgery, 2016Co-Authors: Essam Ahmed Almoraissi, Larry M WolfordAbstract:Purpose To compare postsurgical skeletal stability between Counterclockwise Rotation (CCWR) of the maxillomandibular complex (MMC) and clockwise Rotation (CWR) of the MMC for the correction of dentofacial deformities. Materials and Methods To address the study purpose, we designed and implemented a systematic review with meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search strategy was developed, and a search of major databases—PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)—was conducted to find all pertinent articles published from inception through March 2016. The inclusion criteria were randomized controlled trials, controlled clinical trials, retrospective studies, and case series with the aim of comparing postsurgical stability of CCWR and CWR of the MMC. The analysis was performed using lateral cephalometric analysis of postsurgical mean values and correlation between the surgical and postsurgical changes of the occlusal plane angle and linear changes at A point and B point. A weighted mean difference analysis using a random-effects model with 95% confidence intervals was performed. Results A total of 133 patients were enrolled from 3 studies (CCWR, n = 83; CWR, n = 50). All included studies were at moderate risk of bias. There was a statistically significant difference between CCWR and CWR of the MMC in the postsurgical changes of the occlusal plane angle ( P = .034), but no statistically significant difference was found in the correlation between the surgical and postsurgical changes of the occlusal plane angle in the 2 groups. There was no statistically significant difference between CCWR and CWR of the MMC for stability between assessments immediately after surgery and at longest follow-up relative to the vertical and horizontal positions at A point and B point ( P > .05). Conclusions CCWR compared with CWR for the correction of dentofacial deformities in the absence of pre-existing temporomandibular joint pathology is skeletally stable relative to the postsurgical changes of the occlusal plane, as well as the vertical and horizontal changes of the maxilla and mandible.
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airway space changes after maxillomandibular Counterclockwise Rotation and mandibular advancement with tmj concepts total joint prostheses three dimensional assessment
International Journal of Oral and Maxillofacial Surgery, 2013Co-Authors: Joao Roberto Goncalves, Daniela Aparecida De Godoi Gonçalves, Larry M Wolford, Liliane Gomes, A P Vianna, D B RodriguesAbstract:This study focused on three-dimensional (3D) airway space changes and stability following simultaneous maxillomandibular Counterclockwise Rotation, mandibular advancement, and temporomandibular joint (TMJ) reconstruction with custom-made total joint prostheses (TMJ Concepts(®)). Cone beam computed tomography (CBCT) scans of 30 consecutive female patients with irreversibly compromised TMJs were obtained at the following intervals: T1, presurgery; T2, immediately after surgery; and T3, at least 6 months after surgery. The CBCT volumetric datasets were analysed with Dolphin Imaging(®) software to evaluate surgical and postsurgical changes to oropharyngeal airway parameters. The average changes in airway surface area (SA), volume (VOL), and minimum axial area (MAA) were, 179.50 mm(2), 6302.60 mm(3), and 92.23 mm(2), respectively, at the longest follow-up (T3-T1) (P≤0.001). Significant correlations between the amount of mandibular advancement and Counterclockwise Rotation of the occlusal plane and 3D airway changes were also found (P≤0.01). The results of this investigation showed a significant immediate 3D airway space increase after maxillomandibular Counterclockwise Rotation and mandibular advancement with TMJ Concepts total joint prostheses, which remained stable over the follow-up period.
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postsurgical stability of Counterclockwise maxillomandibular advancement surgery affect of articular disc repositioning
Journal of Oral and Maxillofacial Surgery, 2008Co-Authors: Joao Roberto Goncalves, Daniel Serra Cassano, Larry M Wolford, Ary Dos Santospinto, Iris Malagoni MarquezAbstract:Purpose This study evaluated the affect of disc displacement and articular disc repositioning on stability after surgical Counterclockwise Rotation and advancement of the maxillomandibular complex. Patients and Methods A total of 72 patients (59 females, 13 males), with an average age of 30 years (range, 15 to 60 years) were evaluated. The patients were divided into 3 groups. Group 1 (G1; n = 21), with healthy temporomandibular joints (TMJs), underwent double-jaw surgery only. Group 2 (G2; n = 35), with articular disc dislocation, underwent articular disc repositioning using the Mitek anchor (Mitek Surgical Products, Westwood, MA) technique concomitantly with orthognathic surgery. Group 3 (G3; n = 16), with articular disc dislocation, underwent orthognathic surgery only. Average postsurgical follow-up was 31 months. Each patient’s lateral cephalograms were traced, digitized twice, and averaged to estimate surgical changes and postsurgical stability. Results After surgery, the occlusal plane angle was decreased significantly in all 3 groups: by −6.3 ± 5.0° in G1, by −9.6 ± 4.8° in G2, and by −7.1 ± 4.8° in G3. The maxillomandibular complex was advanced and rotated Counterclockwise similarly in all 3 groups, with advancement at the menton of 12.4 ± 5.5 mm in G1, 13.5 ± 4.3 mm in G2, and 13.6 ± 5.0 mm in G3; advancement at the B point of 9.5 ± 4.9 mm in G1, 10.2 ± 3.7 mm in G2, and 10.8 ± 3.7 mm in G3; and advancement at the lower incisor edge of 7.1 ± 4.6 mm in G1, 6.6 ± 3.2 mm in G2, and 7.9 ± 3.0 mm in G3. Postsurgery, the occlusal plane angle increased in G3 (2.6 ± 3.8°; 37% relapse rate) but remained stable in G1 and G2. Postsurgical mandibular changes in the horizontal direction demonstrated a significant relapse in G3 at the menton (−3.8 ± 4.1 mm; 28%), the B point (−3.0 ± 3.4 mm; 28%), and the lower incisor edge (−2.3 ± 2.1 mm; 34%) but remained stable in G1 and G2. Conclusions Maxillomandibular advancement with Counterclockwise Rotation of the occlusal plane is a stable procedure for patients with healthy TMJs and for patients undergoing simultaneous TMJ disc repositioning using the Mitek anchor technique. Those patients with preoperative TMJ articular disc displacement who underwent double-jaw surgery and no TMJ intervention experienced significant relapse.
Soon Jung Hwang - One of the best experts on this subject based on the ideXlab platform.
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postoperative relapse after mandibular setback surgery with perioperative Counterclockwise Rotation of the mandibular proximal segment
Oral Surgery Oral Medicine Oral Pathology and Oral Radiology, 2016Co-Authors: Jae Bong Park, Im Geon Jin, Jeong Joon Han, Soon Jung HwangAbstract:Objective This study aimed to evaluate whether the perioperative Counterclockwise Rotation (CCWR) of the proximal segment (PS) can reduce relapse after mandibular setback surgery. Study Design Patients who underwent less than 1° of bilateral perioperative Rotation of the PS were assigned to group I (n = 15). Group II (n = 14) included patients who showed greater than 1° of perioperative CCWR bilaterally. To evaluate the PS Rotation and the relapse, three-dimensional computed tomography (CT) and lateral cephalography scans were analyzed. Results Even with significantly different perioperative CCWR of the PS (.07 ± .53° vs −3.47 ± 1.55°), the relapse was not significantly different between group I (1.96 ± 1.15 mm) and group II (1.81 ± .92 mm). However, postoperative CCWR of the PS was significantly greater in group I. The relapse was not influenced by the amount of setback. Conclusions A small degree of relapse is expected after mandibular setback surgery, even with perioperative CCWR of the PS.
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relapse of skeletal class iii with anterior open bite after bimaxillary orthognathic surgery depending on maxillary posterior impaction and mandibular Counterclockwise Rotation
Journal of Cranio-maxillofacial Surgery, 2014Co-Authors: Hok Sim Kor, Hoon Joo Yang, Soon Jung HwangAbstract:Abstract The goal of this study is to evaluate relapse after orthognathic surgery of skeletal class III with anterior open bite depending on the posterior impaction and mandibular Counterclockwise Rotation. Patients ( n = 29) were divided into two groups according to the change of mandibular occlusal plane angle (MnOP): Group A had a clockwise change of MnOP > 0° ( n = 11) and Group B had a Counterclockwise change of MnOP n = 18). Lateral cephalograms were analyzed preoperatively, and at immediate stage, six weeks, six months, and one year after surgery. One year after surgery, the stability of the maxilla was good in both groups. Upward movement of the mandible was observed six weeks after surgery due to mandibular autoRotation. The amount of mean relapse was small, although a significant difference was observed horizontally between groups. Group B demonstrated more forward movement of B point, pogonion, and menton than Group A ( p p
Caria Phf - One of the best experts on this subject based on the ideXlab platform.
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Pharyngeal airway space and frontal and sphenoid sinus changes after maxillomandibular advancement with Counterclockwise Rotation for class II anterior open bite malocclusions
British Inst Radiology, 2015Co-Authors: Fb Prado, De Moraes M., Ac Rossi, Ar Freire, Fc Groppo, Caria PhfAbstract:Objectives: The purpose of this study was to cephalometrically evaluate the pharyngeal airway space and frontal and sphenoid sinus changes after maxillomandibular advancement Counterclockwise Rotation for class II anterior open bite malocclusion. Methods: The study included 49 patients (98 lateral teleradiographs; 36 females and 13 males) who were analysed in the pre-operative (1 week before surgery) and post-operative (6 months after surgery) periods. In each lateral teleradiography, the dimensions of the inferior and superior pharyngeal airway space, TB-PhW1 [the point between the posterior aspect of the tongue to the dorsal pharyngeal wall (oropharynx) (TB) and the point on the dorsal pharyngeal wall closest to TB (PhW1)] and UP-PhW2 [and the point between the posterior aspect of the soft palate to the dorsal pharyngeal wall (nasopharynx) (UP) (PhW2)] measurements were evaluated, as well as the dimensions of the frontal and sphenoid sinuses. The differences between the two operative times were evaluated by Student's t-test. Results: All measurements showed excellent reproducibility for the intraclass correlation coefficient (ICC > 0.9; p < 0.0001). There was an increase in the measurements TB-PhW1 and UP-PhW2 and a decrease in the dimensions of the frontal and sphenoid sinuses after orthognathic surgery. Conclusions: The morphology of the superior and inferior pharyngeal airway space and frontal and sphenoid sinuses changes after 6 months of maxillomandibular advancement Counterclockwise Rotation for class II anterior open bite malocclusion. Dentomaxillofacial Radiology (2012) 41, 103-109. doi: 10.1259/dmfr/2241925
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Pharyngeal airway space and frontal and sphenoid sinus changes after maxillomandibular advancement with Counterclockwise Rotation for class II anterior open bite malocclusions
Inglaterra, 2015Co-Authors: Fb Prado, De Moraes M., Ac Rossi, Ar Freire, Fc Groppo, Caria PhfAbstract:Objectives: The purpose of this study was to cephalometrically evaluate the pharyngeal airway space and frontal and sphenoid sinus changes after maxillomandibular advancement Counterclockwise Rotation for class II anterior open bite malocclusion. Methods: The study included 49 patients (98 lateral teleradiographs; 36 females and 13 males) who were analysed in the pre-operative (1 week before surgery) and post-operative (6 months after surgery) periods. In each lateral teleradiography, the dimensions of the inferior and superior pharyngeal airway space, TB-PhW1 [the point between the posterior aspect of the tongue to the dorsal pharyngeal wall (oropharynx) (TB) and the point on the dorsal pharyngeal wall closest to TB (PhW1)] and UP-PhW2 [and the point between the posterior aspect of the soft palate to the dorsal pharyngeal wall (nasopharynx) (UP) (PhW2)] measurements were evaluated, as well as the dimensions of the frontal and sphenoid sinuses. The differences between the two operative times were evaluated by Student's t-test. Results: All measurements showed excellent reproducibility for the intraclass correlation coefficient (ICC > 0.9; p < 0.0001). There was an increase in the measurements TB-PhW1 and UP-PhW2 and a decrease in the dimensions of the frontal and sphenoid sinuses after orthognathic surgery. Conclusions: The morphology of the superior and inferior pharyngeal airway space and frontal and sphenoid sinuses changes after 6 months of maxillomandibular advancement Counterclockwise Rotation for class II anterior open bite malocclusion. Dentomaxillofacial Radiology (2012) 41, 103-109. doi: 10.1259/dmfr/22419253o TEXTO COMPLETO DESTE ARTIGO, ESTARÁ DISPONÍVEL À PARTIR DE AGOSTO DE 2015.412103109National Council for Scientific and Technological Development of Brazi
Hiroaki Hoshi - One of the best experts on this subject based on the ideXlab platform.
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CARDIAC Counterclockwise Rotation IS A RISK FACTOR FOR HIGH-DOSE IRRADIATION TO THE LEFT ANTERIOR DESCENDING CORONARY ARTERY IN PATIENTS WITH LEFT-SIDED BREAST CANCER WHO RECEIVING ADJUVANT RADIOTHERAPY AFTER BREAST-CONSERVING SURGERY
2016Co-Authors: Hidekazu Tanaka, Shinya Hayashi, Hiroaki HoshiAbstract:Patients irradiated for left-sided breast cancer have higher incidence of cardiovascular disease than those receiving irradiation for right-sided breast cancer. Most abnormalities were in the left anterior descending (LAD) coronary artery territory. We analyzed the relationships between preoperative examination results and irradiation dose to the LAD artery in patients with left-sided breast cancer. Seventy-one patients receiving breast radiotherapy were analyzed. The heart may rotate around longitudinal axis, showing either clockwise or Counterclockwise Rotation (CCWR). On electrocardiography, the transition zone (TZ) was judged in precordial leads. CCWR was considered to be present if TZ was at or to the right of V3. The prescribed dose was 50 Gy in 25 fractions. The maximum (Dmax) and mean (Dmean) doses to the LAD artery and the volumes of the LAD artery receiving at least 20 Gy, 30 Gy and 40 Gy (V20Gy, V30Gy and V40Gy, respectively) were significantly higher in CCWR than in the non-CCWR patients. On multivariate analysis, TZ was significantly associated with Dmax, Dmean, V20Gy, V30Gy, and V40Gy. CCWR is a risk factor for high-dose irradiation to the LAD artery. Electrocardiography is useful for evaluating the cardiovascular risk of high-dose irradiation to the LAD artery. Key Words: breast cancer, breast-conserving surgery, breast radiotherapy, cardiac toxicity, coronary arter
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cardiac Counterclockwise Rotation is a risk factor for high dose irradiation to the left anterior descending coronary artery in patients with left sided breast cancer who receiving adjuvant radiotherapy after breast conserving surgery
Nagoya Journal of Medical Science, 2014Co-Authors: Hidekazu Tanaka, Shinya Hayashi, Hiroaki HoshiAbstract:Patients irradiated for left-sided breast cancer have higher incidence of cardiovascular disease than those receiving irradiation for right-sided breast cancer. Most abnormalities were in the left anterior descending (LAD) coronary artery territory. We analyzed the relationships between preoperative examination results and irradiation dose to the LAD artery in patients with left-sided breast cancer. Seventy-one patients receiving breast radiotherapy were analyzed. The heart may rotate around longitudinal axis, showing either clockwise or Counterclockwise Rotation (CCWR). On electrocardiography, the transition zone (TZ) was judged in precordial leads. CCWR was considered to be present if TZ was at or to the right of V3. The prescribed dose was 50 Gy in 25 fractions. The maximum (Dmax) and mean (Dmean) doses to the LAD artery and the volumes of the LAD artery receiving at least 20 Gy, 30 Gy and 40 Gy (V20Gy, V30Gy and V40Gy, respectively) were significantly higher in CCWR than in the non-CCWR patients. On multivariate analysis, TZ was significantly associated with Dmax, Dmean, V20Gy, V30Gy, and V40Gy. CCWR is a risk factor for high-dose irradiation to the LAD artery. Electrocardiography is useful for evaluating the cardiovascular risk of high-dose irradiation to the LAD artery.
Francisco Verissimo Mellofilho - One of the best experts on this subject based on the ideXlab platform.
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impact of Counterclockwise Rotation of the occlusal plane on the mandibular advancement pharynx morphology and polysomnography results in maxillomandibular advancement surgery for the treatment of obstructive sleep apnea patients
Sleep and Breathing, 2021Co-Authors: Mariana Christino, Pedro Pileggi Vinha, Ana Celia Faria, Denny Marcos Garcia, Francisco Verissimo MellofilhoAbstract:Evaluate the impact of Counterclockwise Rotation of the occlusal plane (CCWROP) on pharynx morphology and polysomnography in maxillomandibular advancement (MMA) surgery to treat obstructive sleep apnea (OSA) patients. Prospective clinical trial of patients with OSA treated by MMA. Computed tomography and polysomnography were performed pre- and postoperatively and the parameters were compared. The surgery classified the patients into two groups: with (R) and without (NR) CCWROP. The study sample comprised 38 individuals: R (n = 19) and NR (n = 19). An anterior mandible advancement of 0.71 mm was identified for each degree of CCWROP (p < 0.001). As for polysomnography, the apnea-hypopnea index was reduced by 80% and 62% in R and NR, showing final values of 6.8 and 13.0, respectively. The apnea index changed equally in both groups. Reduction of 68 and 26% in the hypopnea index was observed for R and NR, respectively, with no statistically significant difference. Total volume increased by 45% in R and 30% in NR. Retropalatal and retrolingual volumes increased by 49% and 4% in R and 43% and 15% in NR, respectively. The minimum axial area increased by 92% in the retropalatal region and 97% in the retrolingual region in R, whereas these increases were of 76% and 31% in NR, respectively. Anterior mandibular advancement of 0.71 mm for each degree of CCWROP is of great importance for surgical planning. As a result of this resource, individuals in R presented better results than those in NR in all parameters assessed, especially regarding the retrolingual region.
