Long-Face Craniofacial Morphology: Cause or Effect of Weak Masticatory Musculature?

A 3-dimensional comparative assessment of the dentoskeletal effects of clear aligners vs temporary skeletal anchorage device-assisted posterior intrusion in adolescents with anterior open bite: A single-center, retrospective, cohort study

INTRODUCTION

The dentoskeletal effects of clear aligner treatment (CAT) with Invisalign vs temporary skeletal anchorage device-anchored Sydney intrusion spring (SIS) were compared in consecutively treated growing patients with anterior open bite using cone-beam computed tomography scans.

METHODS

Fifteen adolescents treated exclusively with Invisalign, and 14 with SIS (first-phase treatment) were assessed retrospectively. Rigid-wise, voxel-based registration of pretreatment and posttreatment cone-beam computed tomography scans were performed using the anterior cranial base, maxillary plane, and mandibular body as reference regions. Treatment outcomes were compared between groups using median regression modeling.

RESULTS

Molar intrusion and incisor extrusion (millimeters), as well as buccolingual inclination changes (°), were not expressed as prescribed in the ClinChecks for Invisalign. Both treatment modalities resulted in similar improvement of anterior open bite; however, via different mechanics. Compared with CAT, SIS demonstrated significantly greater intrusion of the maxillary first molars when measured from the mesiobuccal (16: 2.09 mm [95% confidence interval {CI}, 1.05-3.12]; 26: 2.98 mm [95% CI, 2.00-3.96]) and palatal cusps (16: 2.08 mm [95% CI, 1.15-3.01], 26: 2.83 mm [95% CI, 1.92-3.74]) and less extrusion of the maxillary incisors (12: -1.30 mm [95% CI, -2.13 to -0.47], 11: -1.30 mm [95% CI, -2.40 to -0.20], 21: -0.92 mm [95% CI, -1.73 to -0.12], 22: -0.85 mm [95% CI, -1.71 to -0.00]). There was weak evidence of association with less extrusion of the mandibular incisors using SIS. Maxillary and mandibular incisors tipped lingually in both groups with no statistical difference across groups.

CONCLUSIONS

SIS demonstrated greater maxillary molar intrusion, whereas CAT was associated with incisor extrusion.

Trial data for precision analysis of a three-dimensional mandibular mechanical advantage

The data presented in this manuscript describe craniofacial landmark coordinate values, muscle and load moment arm lengths, and mechanical advantage rates for constructing a three-dimensional model of masticatory muscles. Cone-beam computed tomography scans from 30 subjects (aged 12-19 years, 16 females) were used. Thirty-six craniofacial landmarks were identified. Subsequently, the moment arms for 7 muscles and their corresponding load moment arms at incisor and molar positions were determined. Then, the three-dimensional mechanical advantage for each muscle and tooth position was calculated as the ratio of muscle moment arm to load moment arm. This procedure was repeated three times by a main examiner and once by two other examiners. The Friedman test and the square root of the 'method of moments' variance estimator were used to compare data among examiners and calculate random errors, respectively. Although the values for the craniofacial landmark coordinates and biomechanical variables are very close, differences were found between measurements, especially in the interexaminer comparisons. Values served as the basis for reliability (intraclass correlation coefficient) and errors (average mean of absolute differences) analysis in the research paper titled "A three-dimensional method to calculate mechanical advantage in mandibular function: Intra- and interexaminer reliability study," published in the Journal of Orofacial Orthopedics.

Unilateral Hypofunction of the Masseter Leads to Molecular and 3D Morphometric Signs of Atrophy in Ipsilateral Agonist Masticatory Muscles in Adult Mice

Mice are commonly used to study mandibular dynamics due to their similarity in chewing cycle patterns with humans. Adult mice treated unilaterally with botulinum toxin type A (BoNTA) in the masseter exhibit atrophy of this muscle characterized by an increase in the gene expression of atrophy-related molecular markers, and a reduction in both muscle fiber diameter and muscle mass at 14d. However, the impact of this muscle imbalance on the non-treated masticatory muscles remains unexplored. Here, we hypothesize that the unilateral masseter hypofunction leads to molecular and 3D morphometric signs of atrophy of the masseter and its agonist masticatory muscles in adult mice. Twenty-three 8-week-old male BALB/c mice received a single injection of BoNTA in the right masseter, whereas the left masseter received the same volume of saline solution (control side). Animals were euthanized at 2d, 7d, and 14d, and the masticatory muscles were analyzed for mRNA expression. Five heads were harvested at 14d, fixed, stained with a contrast-enhanced agent, and scanned using X-ray microtomography. The three-dimensional morphometric parameters (the volume and thickness) from muscles in situ were obtained. Atrogin-1/MAFbx, MuRF-1, and Myogenin mRNA gene expression were significantly increased at 2 and 7d for both the masseter and temporalis from the BoNTA side. For medial pterygoid, increased mRNA gene expression was found at 7d for Atrogin-1/MAFbx and at 2d-7d for Myogenin. Both the volume and thickness of the masseter, temporalis, and medial pterygoid muscles from the BoNTA side were significantly reduced at 14d. In contrast, the lateral pterygoid from the BoNTA side showed a significant increase in volume at 14d. Therefore, the unilateral hypofunction of the masseter leads to molecular and morphological signs of atrophy in both the BoNTA-injected muscle and its agonistic non-injected masticatory muscles. The generalized effect on the mouse masticatory apparatus when one of its components is intervened suggests the need for more clinical studies to determine the safety of BoNTA usage in clinical dentistry.

A three-dimensional method to calculate mechanical advantage in mandibular function : Intra- and interexaminer reliability study

PURPOSE

Masticatory muscles are physically affected by several skeletal features. The muscle performance depends on muscle size, intrinsic strength, fiber direction, moment arm, and neuromuscular control. To date, for the masticatory apparatus, only a two-dimensional cephalometric method for assessing the mechanical advantage, which is a measure for the ratio of the output force to the input force in a system, is available. This study determined the reliability and errors of a three-dimensional (3D) mechanical advantage calculation for the masticatory system.

METHODS

Using cone-beam computed tomography images from teenage patients undergoing orthodontic treatments, 36 craniofacial landmarks were identified, and the moment arms for seven muscles and their load moment arms (biomechanical variables) were determined. The 3D mechanical advantage for each muscle was calculated. This procedure was repeated by three examiners. Reliability was verified using the intraclass correlation coefficient (ICC) and the errors by calculating the absolute differences, variance estimator and coefficient of variation (CV).

RESULTS

Landmark coordinates demonstrated excellent intra- and interexaminer reliability (ICC 0.998-1.000; p < 0.0001). Intraexaminer data showed errors < 1.5 mm. Unsatisfactory interexaminer errors ranged from 1.51-5.83 mm. All biomechanical variables presented excellent intraexaminer reliability (ICC 0.919-1.000, p < 0.0001; CV < 7%). Interexaminer results were almost excellent, but with lower values (ICC 0.750-1.000, p < 0.0001; CV < 10%). However, the muscle moment arm and 3D mechanical advantage of the lateral pterygoid muscles had ICCs < 0.500 (p < 0.05) and CV < 30%. Intra- and interexaminer errors were ≤ 0.01 and ≤ 0.05, respectively.

CONCLUSIONS

Both landmarks and biomechanical variables showed high reliability and acceptable errors. The proposed method is viable for the 3D mechanical advantage measure.

Genetic Polymorphisms of Estrogen Receptors α and β are Associated with Craniofacial Measurements in Patients With Dentofacial Deformity

Dentofacial deformities are characterized by abnormalities in craniofacial development that affects the individual's skeletal and occlusion, often causing functional and esthetic problems. In literature, there is an involvement of polymorphisms in estrogen receptor 1 (ESR1) and estrogen receptor 2 (ESR2) genes in craniofacial measurements. The aim of this study was to evaluate a possible association between polymorphisms in ESR1 (rs2234693 and rs9340799) and ESR2 (rs1256049 and rs4986938) genes with cephalometric measurements in individuals with dentofacial deformities. This cross-sectional study was performed with 158 individuals in the preoperative period of orthognathic surgery. The cephalometric measurements obtained through lateral cephalogram using Dolphin Imaging software. For genetic analysis, the DNA extracted from epithelial cells of the oral mucosa and were genotyped using the real-time polymerase chain reaction. The data found submitted to statistical analysis, through the Kolmogorov-Smirnov, Mann-Whitney, and Kruskal-Wallis tests, using the IBM SPSS software version 24.0. Considered a significance level of 0.05. We found association between polymorphisms and cephalometric measurements just in the female sex. The polymorphisms ESR1/rs9340799 ( P= 0.003), ESR1/rs2234693 ( P= 0.026), and ESR2/rs1256049 ( P= 0.046) were associated with the upper gonial angle (Ar-Go-N). The polymorphism ESR2/rs1256049 was also associated with the facial axis-rickets (NBa-PtGn) ( P= 0.004), anterior cranial base (SN) ( P= 0.036), and Y-axis (SGn-SN) ( P= 0.031).

A comparative assessment of the dentoskeletal effects of clear aligners vs miniplate-supported posterior intrusion with fixed appliances in adult patients with anterior open bite. A multicenter, retrospective cohort study

INTRODUCTION

This study aimed to retrospectively evaluate the dentoskeletal effects of clear aligners (Invisalign) vs miniplate-supported posterior intrusion (MSPI) and identify factors associated with posttreatment overbite in adults with anterior open bite.

METHODS

Twenty-nine patients treated with Invisalign and 24 with MSPI combined with full-fixed orthodontic appliances were included from 5 orthodontic practices. Pretreatment and posttreatment lateral cephalometric measurements were included as outcomes. Comparisons across groups and identification of final overbite predictors were assessed with regression modeling and machine learning techniques.

RESULTS

MSPI induced significantly greater maxillary molar intrusion (1.5 mm; 95% confidence interval [CI], 0.83-2.17; P <0.001), with subsequent reduction of anterior face height (ANS-Me) (-2.77 mm; 95% CI, -3.64 to -1.91; P <0.001), Mp-SN° (-1.95°; 95% CI, -2.77 to -1.12; P <0.001), and ANB° (-1.69°; 95% CI, -2.44 to -0.94; P <0.001) compared with Invisalign. MSPI resulted in a significantly larger increase in SNB° (0.94°; 95% CI, 0.23-1.65; P = 0.01) and point-Pog projection (2.45 mm; 95% CI, 1.12-3.77; P = 0.001). Compared with MSPI, Invisalign had a significantly greater increase in the distance of maxillary (1.05 mm; 95% CI, 0.38-1.72; P = 0.003) and mandibular (0.9 mm; 95% CI, 0.19-1.60; P = 0.01) incisal edges relative to their apical bases, with borderline greater lingual tipping of only the maxillary incisors (2.82°; 95% CI, -0.44 to 6.09; P = 0.09). Appliance type and initial overbite were significant final overbite predictors across all models. However, this difference was only evident in male patients (males [1.65; 95% CI, 0.99-2.32; P <0.001]; female [-0.04; 95% CI, -0.52 to 0.44; P = 0.87]).

CONCLUSIONS

Both appliances effectively improve overbite. MSPI applied the correction via molar intrusion and counterclockwise mandibular autorotation, whereas Invisalign via maxillary and mandibular incisor extrusion.

Transverse Asymmetries of the Maxilla Even in Healthy and Apparently Symmetrical Subjects

In the formulation of an orthodontic treatment plan, the three-dimensional analysis of the dental arches represents a fundamental moment for the evaluation of all the morphological parameters necessary in order to have a correct and complete diagnosis. In this regard, the study of the dental arches on the horizontal plane is sometimes neglected or not thorough enough. When evaluating the transverse dimensions of the dental upper arche, the presence of an asymmetry is frequently found, and it means that an hemiarch is larger than the other. Furthermore, any variation in one of the three planes of space always involves an alteration also on the other two planes in order to have compensation. The morphology of a bone segment depends on various factors, mainly genetical, acquired and environmental. Regarding the environmental factors, the function determines the morphology, but this in turn determines the function. In the case of unilateral mastication, the upper maxilla will be asymmetrical, so growing patients will have compensation on other skull bones. From these considerations arises the need for a careful study of the horizontal plane of the maxilla in the presence of a malocclusion during diagnostic evaluations. These asymmetries, however, must be evaluated and quantified in the diagnostic phase in order to formulate a correct plan of treatment. The aim of this work is to demonstrate that there are almost always transverse asymmetries of the maxilla, albeit of a slight entity, even in healthy and apparently symmetrical subjects.

Treatment of adult patient with hyperdivergent retrognathic phenotype and anterior open bite: report of a case with non-surgical orthodontic approach

Adult patients with anterior open bite and hyperdivergent retrognathic phenotype demand complex treatments, as premolar extractions, molar intrusion or orthognathic surgery. In the present clinical case, a young adult patient without significant growth, with Class I and anterior open bite, was treated with four premolar extractions. The therapeutic result shows good intercuspation, good facial esthetic, good function balance, and stability in a two-year post-fixed treatment follow-up.

Changes in human mandibular shape during the Terminal Pleistocene-Holocene Levant

The transition to food production, exploitation of 'secondary' products (e.g., milk), and advances in cookware technology have affected all aspects of human life. The aim of the present study was to follow changes in mandibular form and shape throughout the terminal Pleistocene-Holocene Levant. The hemimandibles of four populations were included in this study: Natufian hunter-gatherers (n = 10), Pre-pottery Neolithic early farmers (n = 6), Chalcolithic farmers (n = 9), Roman-Byzantine (n = 16), and modern (n = 63) populations. A surface mesh of each mandible was reconstructed from CT or surface scans. Changes in mandibular form and shape were studied using the Procrustes-based geometric morphometrics method. Univariate and multivariate analyses were carried out to examine differences in size and shape between the studied populations. Our results reveal considerable temporal changes in mandibular shape throughout the Holocene Levant, mainly between the pre-agricultural population (the Natufian) and the succeeding ones, and between the post-industrial (the Modern) and the pre-industrial populations. A tendency for a reduction in mandibular size was identified between the pre-agricultural population and the farmers. Most regions of the mandible underwent shape changes. In conclusion, substantial changes in mandibular shape occurred throughout the Holocene Levant, especially following the agricultural revolution. These changes can be explained by the "masticatory-functional hypothesis".

Dental malocclusions are not just about small and weak bones: assessing the morphology of the mandible with cross-section analysis and geometric morphometrics

OBJECTIVES

Dental malocclusions in modern populations would be the result of small and weak jaws developing under low masticatory loads. We assess the validity of this by characterising the external and internal morphology of mandibles affected by class II and III malocclusions and comparing them with those from individuals with different masticatory load patterns.

MATERIALS AND METHODS

CTs from up to 118 individuals exerting intensive, medium and low masticatory loads with harmonic occlusion, and from class II and III individuals, were used to compare their external shape using geometric morphometrics, as well as their internal amount and distribution of cortical bone.

RESULTS

The low-load groups (harmonic, class II and III occlusion) are externally more gracile than the intense and medium load groups. But more relevant in shape variation is a marked allometric pattern, which differentiates class II (small) and III (large) mandibles. Despite gracility, the relative amount of cortical bone in the low-load groups is larger than in the remaining groups.

CONCLUSIONS

There is no evidence that the modern mandible, including class II and III individuals, is intrinsically small and weak. Instead, there is a rather large degree of morphological variation, which could be linked to a lack of constraints derived from low masticatory loads. Thus, the effect of other factors such as genetics, but also basal metabolism, should be looked in more depth.

CLINICAL RELEVANCE

Dental malocclusions are a common disorder whose aetiology has not been unravelled, and several to be considered in the prevention and therapy of malocclusion.

Resolution of obstructive sleep apnea after mandibular distraction osteogenesis in setting of delayed tongue-lip adhesion takedown: A case report

RATIONALE

There is a high prevalence of obstructive sleep apnea (OSA) in patients with Pierre Robin sequence (PRS), and treatment approaches are highly variable. One approach is a temporary tongue-lip adhesion (TLA) that acts as a temporizing measure while the mandible continues to grow and is usually taken down at 1 year of age.

PATIENT CONCERNS

Side effects of prolonged tongue-lip adhesion and optimal workup and treatment of persistent OSA in the setting of a tongue-lip adhesion.

DIAGNOSES

Pierre Robin sequence (PRS), persistent obstructive sleep apnea (OSA), and tongue-lip adhesion (TLA).

INTERVENTIONS

Mandibular distraction osteogenesis (MDO), adenotonsillectomy, and tongue-lip adhesion takedown.

OUTCOMES

Resolution of OSA.

LESSONS

This case puts into question the efficacy of isolated TLA in infants with Pierre Robin sequence and OSA, and places emphasis on the importance of considering an earlier workup of other potential causes of obstruction and the potential need for MDO as a primary or adjunctive approach to treatment.

Human mandibular shape is associated with masticatory muscle force

Understanding how and to what extent forces applied to the mandible by the masticatory muscles influence its form, is of considerable importance from clinical, anthropological and evolutionary perspectives. This study investigates these questions. Head CT scans of 382 adults were utilized to measure masseter and temporalis muscle cross-sectional areas (CSA) as a surrogate for muscle force, and 17 mandibular anthropometric measurements. Sixty-two mandibles of young individuals (20–40 years) whose scans were without artefacts (e.g., due to tooth filling) were segmented and landmarked for geometric morphometric analysis. The association between shape and muscle CSA (controlled for size) was assessed using two-block partial least squares analysis. Correlations were computed between mandibular variables and muscle CSAs (all controlled for size). A significant association was found between mandibular shape and muscle CSAs, i.e. larger CSAs are associated with a wider more trapezoidal ramus, more massive coronoid, more rectangular body and a more curved basal arch. Linear measurements yielded low correlations with muscle CSAs. In conclusion, this study demonstrates an association between mandibular muscle force and mandibular shape, which is not as readily identified from linear measurements. Retrodiction of masticatory muscle force and so of mandibular loading is therefore best based on overall mandibular shape.

Self-reported oral behaviour habits in hyperdivergent and normodivergent facial types

The relationship between facial morphology and jaw function remains controversial. The purpose of this study was to investigate differences in self-reported oral behaviour habits between individuals with normodivergent and hyperdivergent facial types. Some 80 cases and controls were individually matched on age, sex ethnicity and treatment stage. The participants were recruited from an orthodontic clinic, and included both adolescents and adults. Habitual oral activity was assessed using the Oral Behaviour Checklist (OBC) based on their experiences in the past 4 weeks. Univariate and bivariate analyses were performed. The sample had a mean age of 17·2 years (SD = 4·6; range = 12-49 years), and was predominantly female (65·0%) and of New Zealand European origin (91·3%). The prevalence of reporting one or more frequently performed habitual muscular behaviour in either study group was over 85% (P > 0·05). There was no difference in total OBC score between the hyperdivergent (25·6; SD: 9·0) and normodivergent group (25·3; SD: 9·9). Moreover, there was no difference in the prevalence of either nocturnal or daytime oral behaviours between the two groups. While this study did not include any objective measures of functional or habitual activity, we found no differences in self-reported oral behaviour habits between normodivergent and hyperdivergent individuals. The findings do not support an association between vertical facial form and habitual muscular activity.

Deformidades dentofaciais: características miofuncionais orofaciais

Resumo:OBJETIVO:analisar e descrever as funções estomatognáticas de acordo com os diferentes tipos de deformidades dentofaciais e confrontar as características dessas funções em sujeitos com deformidade dentofacial e sujeitos sem alterações do esqueleto facial.MÉTODOS:trata-se de um estudo descritivo, analítico e de caráter transversal, envolvendo uma amostra de 50 indivíduos portadores de deformidades dentofaciais frente ao grupo controle constituído por 46 indivíduos saudáveis. A coleta de dados aconteceu entre os meses de julho a setembro de 2013, foi realizada a avaliação miofuncional orofacial, mediante a aplicação do protocolo Marchesan, Berrentin-Felix, Genaro, Rehder. O protocolo estatístico fundamentou-se na análise descritiva dos dados.RESULTADOS:todos os sujeitos portadores de deformidades dentofaciais avaliados apresentaram alterações na execução das funções estomatognáticas sendo que tais alterações variaram de acordo com o tipo de deformidades dentofaciais apresentada.CONCLUSÃO:os diferentes tipos de deformidades dentofaciais estão relacionados às alterações detectadas no desempenho das funções estomatognáticas.

Identification of mastication organ muscle forces in the biocybernetic perspective

Purpose of the Paper. This paper is an attempt to mathematically describe the mastication organ muscle functioning, taking into consideration the impact of the central nervous system. Material. To conduct model tests, three types of craniums were prepared: short, normal, and long. The necessary numeric data, required to prepare the final calculation models of different craniofacial types, were used to identify muscle and occlusion forces generated by muscles in the area of incisors and molars. The mandible in model tests was treated as a nondeformable stiff form. Methods. The formal basis for the formulated research problem was reached using the laws and principles of mechanics and control theory. The proposed method treats muscles as “black boxes,” whose properties automatically adapt to the nature of the occlusion load. The identified values of occlusion forces referred to measurements made in clinical conditions. Results. The conducted verification demonstrated a very good consistency of model and clinical tests' results. The proposed method is an alternative approach to the so far applied methods of muscle force identification. Identification of muscle forces without taking into account the impact of the nervous system does not fully reflect the conditions of mastication organ muscle functioning.

The relationship between facial morphology and the structure of the alveolar part of the mandible in edentulous complete denture wearers. A preliminary study

OBJECTIVE

Although the effect of involutional processes that occurs in the maxilla and mandible of edentulous subjects is obvious, the problem of factors definitely determining the direction of changes still remains unsolved. This study was aimed at determining the relationship between facial morphology and the structure of the alveolar part and the body of the mandible in edentulous complete denture wearers.

MATERIALS AND METHODS

Twenty-five healthy edentulous Caucasian patients in the 70.5 ± 9 years of age group were examined. All patients underwent tele-X-ray examination with the presence of currently used dentures in the oral cavity. To assess morphological parameters of the facial skeleton, cephalograms were analyzed according to Ricketts and Mc Namara method. To assess the mandible morphology, the films were measured using the method of Tallgren.

RESULTS

The period of edentulism was found to be negatively correlated with the anterior segment of the body of the mandible within its symphysis. The parameter corresponding to the location of the first lower molar showed a directly proportional correlation with G'-Sn', G'-Me', Sn'-Me', N-Ans, N-Me, Ans-Me, Co-Gn and Co-Go. Positive correlations were found between the parameters describing contour of the alveolar part of the body of the mandible and mandibular symphysis and G'-Me', Sn'-Me', N-Me, Ans-Me describing the height of the occlusal vertical dimension.

CONCLUSION

The study showed a directly proportional correlation between the vertical occlusal dimension of the lower face conditioned by prosthetic rehabilitation and the height of the alveolar part in the lateral regions of the mandible.

Three-dimensional finite element analysis of the deformation of the human mandible: a preliminary study from the perspective of orthodontic mini-implant stability

OBJECTIVE

The aims of this study were to investigate mandibular deformation under clenching and to estimate its effect on the stability of orthodontic mini-implants (OMI).

METHODS

Three finite element models were constructed using computed tomography (CT) images of 3 adults with different mandibular plane angles (A, low; B, average; and C, high). An OMI was placed between #45 and #46 in each model. Mandibular deformation under premolar and molar clenching was simulated. Comparisons were made between peri-orthodontic mini-implant compressive strain (POMI-CSTN) under clenching and orthodontic traction forces (150 g and 200 g).

RESULTS

Three models with different mandibular plane angles demonstrated different functional deformation characteristics. The compressive strains around the OMI were distributed mesiodistally rather than occlusogingivally. In model A, the maximum POMI-CSTN under clenching was observed at the mesial aspect of #46 (1,401.75 microstrain [µE]), and similar maximum POMI-CSTN was observed under a traction force of 150 g (1,415 µE).

CONCLUSIONS

The maximum POMI-CSTN developed by clenching failed to exceed the normally allowed compressive cortical bone strains; however, additional orthodontic traction force to the OMI may increase POMI-CSTN to compromise OMI stability.

The face signature of fibrodysplasia ossificans progressiva

Fibrodysplasia ossificans progressiva (FOP) causes extensive heterotopic bone formation due to heterozygous mutations in the glycine-serine activation domain of ACVR1 (ALK2), a bone morphogenetic protein type I receptor. Anecdotal observations of facial similarity have been made by clinicians and parents, but no objective quantitative analysis of the faces of FOP patients has ever been undertaken. We delineated the common facial characteristics of 55 individuals with molecularly confirmed FOP by analyzing their face signature (face shape difference normalized against age and sex matched controls) and associated face signature graphs (with face signatures as vertices and adjacency corresponding to greatest similarity). Our analysis identified 10 affected individuals whose face signature is more homogeneous than others with FOP. This distinct subgroup showed the previously identified reduced mandible as well as newly identified features: underdevelopment of the upper orbit/supra-orbital ridge; infra-orbital prominence; and, low-set ears. These findings strongly suggest that the canonical FOP mutation variably affects the postnatal morphogenesis of the normotopic cranial skeleton in the upper midface and mandible and may have important diagnostic and functional implications.

Positional changes of the masseter and medial pterygoid muscles after surgical mandibular advancement procedures: an MRI study

This study evaluated whether surgical mandibular advancement procedures induced a change in the direction and the moment arms of the masseter (MAS) and medial pterygoid (MPM) muscles. Sixteen adults participated in this study. The sample was divided in two groups: Group I (n=8) with a mandibular plane angle (mpa) <39° and Group II (n=8) with an mpa >39°. Group I patients were treated with a bilateral sagittal split osteotomy (BSSO). Those in Group II were treated with a BSSO combined with a Le Fort I osteotomy. Pre- and postoperative direction and moment arms of MAS and MPM were compared in these groups. Postsurgically, MAS and MPM in Group II showed a significantly more vertical direction in the sagittal plane. Changes of direction in the frontal plane and changes of moment arms were insignificant in both groups. This study demonstrated that bimaxillary surgery in patients with an mpa >39° leads to a significant change of direction of MAS and MPM in the sagittal plane.