Le livre des Malédictions (Littérature) (French Edition)

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Share on. They all underwent othognathic surgery thru the CCWR procedure in our department. The linear plane differences in the landmarks represent the changes in position and the differences in the angle planes represent the changes in posture. During the operation, the change in the mean pitch plane with counterclockwise rotation was 6. Postoperative follow-up showed the linear relapse of the maxillary landmarks between T1, T2 and T3 were less than 0. Compared with immediate postoperative maxillary pitch plane posture, there was average 6.

There was no significant angle changes in the roll plane and yaw plane between T1, T2, and T3 models, which is therefore acceptable. Postoperative follow-up showed that the largest positional linear relapse of the mandibular landmarks were less than 2. Then it further decreased to There was a statistically significant pitch plane relapse of the mandible with an average of 1. In conclusion, this novel three-dimensional Position-Posture measuring method can be a useful and reliable tool in measuring the linear and angular changes of target segments and in analyzing the three-dimensional recurrence trend after surgery quamtitatively.

Based on the results of the Position-Posture measuring method, it can conclude that the MMC had a clockwise relapse tendency after performing the counter-clockwise procedure for skeletal class II patients, most especially on the mandibular-body segment.

Sleep-wake cycle in shift workers on a "clockwise" and "counter-clockwise" rotation system.

Meanwhile, there were no significant changes on each segments on the vertical and transverse dimensions. Orthognathic surgery using the counterclockwise rotation technique, despite its esthetic and functional advantages, was not used to treat maxillofacial deformities during the mid s because of the uncertain postsurgical stability 1 , 2 , 3. Most of the previous studies that we encountered have used a two dimensional cephalometric evaluation to measure the postsurgical stability of the orthognathic surgery.

All the facial bone structures are projected on a single coronal or sagittal plane in frontal or lateral cephalograms. Computer-assisted-surgery, allowing 3D planning and simulation, offers a new option for 3D measurement and analysis. By reconstructing the skull model, the position changes of bony landmarks and posture changes of bone segments become more visible.

However, previous three-dimensional CT measurement system only represent the bony landmarks of craniofacial bone on CT images, but fail to analyze the bone relationship in three dimensional space 18 , Xia 20 et al. However, the positon and posture of the segment was defined by geometric method, which is different from the real anatomic landmarks. At the mean time, the error would be dispersed to three axes perpendicular to each other and could not reflect real changes enough. For any geometric object, four points and three planes are sufficient to define its position and posture in three dimension.

The same principle also can be applied to skull bone segments. This study determined four clinically significant anatomical landmarks which could represent the shape and position of the maxillary or mandibular segments and three postural planes to describe the posture and orientation. The linear and angular changes of the postural plane were measured to analyze the positional and postural changes observed every follow-up. The results of this retrospective study show that postoperative skeletal stability of the maxilla after counterclockwise rotation during orthognathic surgery were acceptable.

It also showed that the postoperative angular changes in the pitch plane is more prominent than the other two postural planes. The maxilla also had a clockwise rotation tendency. The linear relapse based on the landmarks on the maxilla during the follow-up revealed no statistical significance. The largest linear changes of mandible-body segments is 2. Many factors including articular diseases, age and sex of the patient, a high angle of the mandibular plane, condylar position, neuromuscular adaptation, instability of fixation, and the amount of forward advancement may contribute to the clockwise postoperative relapse 4 , 21 , These, in combination with the inferior and posterior traction forces originating from the suprahyoid muscles, tends to rotate the MMC clockwise and promote the relapse.

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To correct these problems, some technical modifications have been proposed, such as the detachment and sectioning of the pterygomasseteric sling 3 , as well as performing inverted L osteotomy. These interventions can preserve the connection of the pterygoid muscles with the proximal mandibular stump.

Meanwhile, the use of computer-aided surgical simulation technology could predicting the treatment outcomes in an accurate and effective way, giving reference for surgeons and patients when making a trade-off between the relapse risk and aesthetics outcomes 23 , 24 , In this study, twenty-three patients had a series of TMJ health problems. The magnetic resonance imaging confirmed the different degrees of disc displacement and condylar resorption in these patients, which may contribute to the mandibular-body segments relapse.

The Position-Posture measuring method established the mandibular coordinate system presuming that the condylion and coracoid process points remain unchanged after surgery and the positional relationship of the ramus bilaterally is stable. This shows the reliability of the coordinate system of the mandibular model.

The 3D CT scans of patients at different time points were chosen for evaluation because of the excellent visualization of craniofacial skeleton. Although the CT scan examination has higher amounts of radiation than 2D cephalometry and cone beam computed tomography, is generally extremely useful and necessary for pre-surgical simulation and postoperative observation for hard and soft tissue evaluation in clinical application The 3D CT scan gives more information about important microanatomy structures involving in orthognathic surgery and more detail about soft tissue changes, which could be essential to establish a universal 3D cephalometric system for both bony structures and soft tissue in the future.

Meanwhile, this study established a novel measurement method to analyze the postsurgical stability of hard tissues according to the experience of the clinicians. To promote its clinical application, we recommend to select more landmarks to serve as references. The clinical significance will be used to describe the position and posture of the craniofacial hard tissue. We suggest that further research is needed to establish the evaluation systems of bone and soft tissue segments by using the Position-Posture measuring method.

In conclusion, this Position-Posture measuring method has the advantage of revealing the linear and angular changes of the maxillary and mandibular models with great accuracy. It can also help in analyzing the three-dimensional postoperative relapse of hard tissues. By using this method, we can predict the skeletal stability of the maxilla after the counter-clockwise rotation procedure. This can also reveal the tendency for a clockwise relapse of the mandible in the skeletal class II patient.

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The study was conducted in accordance with the World Medical Association Declaration of Helsinki on medical research ethics. From January to October , 25 patients 5 males and 20 females with skeletal class II deformity have undergone orthognathic surgery with the CCWR procedure. Commercially available surgical simulation software SimPlant Pro All of the personalized virtual surgical planning included counterclockwise rotation of the MMC.

All patients underwent orthognathic surgery of the one-piece Lefort I osteotomy and bilateral sagittal split ramus osteotomy BSSRO under the guidance of a 3D printed occlusion splints. The skull model, was separated into two models, the cranio-maxiollofacial model and mandibular model. Through the use of the surface-best fit registration method 20 , the 3D cranio-maxiollofacial models and mandibular models of T1, T2, and T3 were superimposed on T0 ones Fig. Bony landmarks of the cranio-maxiollofacial models Fig.

Cranial segment, which remain unchanged before and after surgery, was defined as the reference coordinate system of the 3D cranio-maxiollofacial model Fig. The horizontal reference plane HP : parallel to the FH plane, which was constructed on both sides of Po and left side Or, passing through N. In order to precisely measure and analyze the changes, the target cranio-maxiollofacial model was defined as cranial segment and maxillary segment, and the target mandibular model was referred as mandibular-body segment and bilateral ramus segments. We can choose a series of remarkable anatomical landmarks for describing the position of each segments, while three mutually perpendicular planes for describing their posture were also used.

Therefore, position and posture of each segment could be defined separately as follows:.

So the landmarks of cranio-maxiollofacial model Fig. Maxillary segment: position: In order to describe the position of maxilla, several clinically significant anatomical landmarks were chosen by experienced surgeon. Maxillary segment: posture: Based on the these landmarks, we defined 3 posture planes Fig. Mandible-body segment: position: In order to describe the position of mandibular-body, several clinically significant anatomical landmarks were chosen by experienced surgeon. Mandible-body segment: posture: Based on the these landmarks, we defined 3 posture planes Fig.

Ramus segment: posture: Because of the shape of ramus segment, we defined its posture as one plane based on these landmarks Fig. Definition of angle between the posture planes PP, RP and YP and reference planes on cranio-maxiollofacial model and mandibular model. All measurements were tabulated and sequenced in the different time frame. All calculations were carried out using the software package SPSS The data that supports the findings reported herein are available upon request from the corresponding author.

Proffit, W. The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension. Wolford, L. Occlusal plane alteration in orthognathic surgery—Part I: Effects on function and esthetics. Dentofacial Orthop. Chemello, P.

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Occlusal plane alteration in orthognathic surgery—Part II: Long-term stability of results. Reyneke, J. Postoperative skeletal stability following clockwise and counter-clockwise rotation of the maxillomandibular complex compared to conventional orthognathic treatment. Oral Maxillofac. Gomes, L. Three-dimensional quantitative assessment of surgical stability and condylar displacement changes after counterclockwise maxillomandibular advancement surgery: Effect of simultaneous articular disc repositioning. Ueki, K.

A hypothesis on the desired postoperative position of the condyle in orthognathic surgery: a review. Oral Surg. Oral Med.

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Oral Pathol. Oral Radiol. Xi, T. The role of mandibular proximal segment rotations on skeletal relapse and condylar remodelling following bilateral sagittal split advancement osteotomies. Panula, K. Effects of orthognathic surgery on temporomandibular joint dysfunction. A controlled prospective 4-year follow-up study.

Goncalves, J. Temporomandibular joint condylar changes following maxillomandibular advancement and articular disc repositioning. Carvalho Fde, A. Three-dimensional assessment of mandibular advancement 1 year after surgery.