RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION 1.

Name of the Candidate and Address

DR. MOHAMMED HANEEF H.NO 9-4-110/3/56, VIRASATH NAGAR, TOLICHOWKI, HYDERABAD-500008 ANDHRA PRADESH PHONE NO: 04023562340/04024571530

Temporary Address

DR. MOHAMMED HANEEF DEPARTMENT OF ORAL & MAXILLOFACIAL SURGERY, AL-BADAR RURAL DENTAL COLLEGE AND HOSPITAL, GULBARGA 585 102 KARNATAKA AL-BADAR RURAL DENTAL COLLEGE AND HOSPITAL, GULBARGA-585 102 KARNATAKA

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Name of the Institution

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Course of the study and subject

MASTER OF DENTAL SURGERY(M.D.S) IN ORAL & MAXILLOFACIAL SURGERY

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Date of admission to course Title of the Topic

20.04.2011 CLINICAL AND RADIOGRAPHIC EVALUATION OF HARD AND SOFT TISSUE CHANGES AFTER ORTHOGNATHIC SURGERY

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Brief resume of the intended work 6.1. Need for the study : Due to the improvement in orthodontic and surgical techniques during the last two decades, a combined approach has been widely accepted as the preferred method to correct moderate to severe skeletal deformity. Orthognathic surgery patients have been focusing more and more on postsurgical facial aesthetic outcomes. Findings in the recent literature suggest that aesthetic improvement is one of the most relevant motivations besides chewing function for patients undergoing orthognathic surgery. As a consequence planning with soft-to-hard tissue movement
ratios are now mandatory.

Consequently, the relationship between hard tissue surgery and the effect which it has on the overlying soft tissue is extremely important in predicting facial changes. Two dimensional Cephalometry have been more advantageous with regard to high
patient comfort, portability, costs, and accessibility, compared with three-dimensional cephalometry. Against this recent background, we aimed to compare the hard and soft tissue profile assessed by lateral cephalograms, posteroanterior cephalograms.

6.2

Review of literature: Moschos A conducted a study in the year 2009 to assess, by means of lateral cephalometric radiographs, any differences in the pretreatment soft and hard tissue facial profiles of patients who relatively recently underwent orthognathic surgery compared with those whose surgery occurred 20 years before. The pretreatment soft and hard tissue profiles of 91 orthognathic surgery patients were analyzed. These patients were divided into 2 groups. The first group consisted of 35 patients that were treated within the period from 1982 to 1986. The second group included 56 patients treated between 2000 and 2002. To assess patients hard and soft tissue profiles, 4 cephalometric variables were evaluated on their pretreatment lateral cephalograms. For each of the 4 variables used, the patients were divided into one of 3 different profile subgroups: orthognathic, retrognathic, or prognathic profile. According to the distribution of profiles in each of the 2 groups, a qualitative comparison was made. Descriptive statistics and chi-squared tests were performed to access the possible differences at P _ .05. By comparing pretreatment facial profiles between the 2 groups using the soft and hard tissue measurements, it was demonstrated that some changes actually occurred over the years. These differences in the profiles between the 2 groups indicated that orthodontic-surgical patients treated more recently exhibited smaller deviations from the norm than those treated in the earlier period. These findings may reflect possible changes in what is currently considered to be acceptable.1

Ellen wen ching conducted this study in year 2009 to identify the characteristics of facial asymmetry before surgery and to evaluate the facial skeletal changes and stability after 2-jaw orthognathic surgery. The ideal double-cross grid as fitting the key landmarks to the reference planes on posteroanterior cephalograms was set as the treatment goal. Twenty-seven adult patients, 18 female and 9 male subjects, were evaluated before and after surgery and at completion of orthodontic treatment. Cephalometric measurements of posteroanterior and lateral cephalograms were obtained at 3 timings. Measurements of frontal facial photographs were recorded before and after treatment. Data from each time set were compared to evaluate surgical achievement and postsurgical stability. All patients had original malocclusion of Class III in at least 1 side of the dentition except 1 patient. Total treatment duration was 15 +/- 3.5 months on average. Laterality of the patients demonstrated left-side dominance in 18 patients and right-side dominance in 9 patients. After surgery face symmetry was improved and Soft tissue presented similar correction by leveling oral Commissures and correcting chin deviation. 2 Je Uk P conducted study in 2008 to determine the relationship between the changes of soft and hard tissues after modified anterior segmental osteotomy on the maxilla and mandible and to evaluate unintended facial changes using cephalometric and photometric analyses. The subjects included 29 women and 1 man (22 to 50 years of age) who were diagnosed as bialveolar or bimaxillary protrusion and underwent modified anterior segmental osteotomy on the maxilla and mandible. Lateral cephalograms and lateral and frontal photographs taken preoperatively and postoperatively were analyzed. There was a significant change in all soft and hard tissue parameters except the labiomental angle. The ratio of upper lip to maxillary incisor retraction was 0.67:1 and the ratio of lower lip to mandibular incisor retraction was 0.89:1. Nasolabial angle and philtrum length were increased, and vermilion length and lip width were decreased. Nasal change could be kept as small as possible, although slight widening of the nasal width and anti-tip rotation of the nasal tip were observed. The study concluded that the Anterior segmental osteotomy might be recommended as the treatment modality of choice in patients with bimaxillary and/or dentoalveolar protrusion. Because the technique is simple, postoperative complications are minimal, relapse is limited, and soft tissue changes in response to surgery are more predictable. 3 Ming Tak Chew conducted a study in 2005 to evaluate hard and soft tissue changes in class III patients requiring surgical correction. The study had a sample size 20 women and 14 men. All the patients had combined lefort I and BSSO surgery and surgical stabilization with internal rigid fixation using titanium mini bone plates. The presurgical cephalograms were taken 2 months before surgery and post surgical cephalograms were obtained at six months after surgery. The cephalograms were analyzed using modified soft tissue analysis of Legan and Burstone and Lew et al. The hard and soft tissue landmarks were measured and any differences in the distance were recorded as the surgical change. The study concluded that there were stronger correlations between corresponding hard and soft tissue movements; more in horizontal direction compared to vertical direction.

This study was conducted by Reid W Montini in the year 2006 to compare the silhouettes generated from presurgical and five year post surgical radiographs to evaluate whether orthodontists, oral surgeons, and lay persons perceive changes in profile resulting from orthodontics and combined surgical treatment. Fifteen pair of silhouettes was used in this study. The study concluded that esthetic profile improvement for mandibular advancements ranging from 0.11 10.3 mm. However the in some cases orthodontists, oral surgeons, and lay persons perceived changes differently. 5 This study was done by Ming Tak Chew in 2008 to investigate whether a linear relationship exists between soft- to hard-tissue changes for both maxillary and mandibular landmarks over a wide range of skeletal changes The sample consisted of 30 Chinese patients with Class III malocclusion treated with bilateral sagittal split osteotomy and LeFort I advancement. Lateral cephalograms were taken within 2 months before surgery and at least 6 months after surgery. Soft- and hardtissue changes were recorded by computer supported measurements of presurgical and postsurgical lateral cephalograms. To evaluate the linear association between soft- and hard-tissue movements, a quadratic function of hard-tissue movement adjusted for sex was initially fitted to the data. This study concluded that Visual inspection of the scatter plots of the 5 pairs of corresponding soft- and hard-tissue landmarks showed that relationships between the soft and hard tissues were reasonably linear for both male and female subjects, except for the Sn-ANS pair that showed a curvilinear relationship.6
.Charles

J Burstone in the year 1978 designed a cephalometric analysis to use landmarks and measurements that can be altered by common surgical procedures in patients who required maxillofacial surgery. Because measurements are primarily linear they can be applied to prediction overlays and study cast mountings and may serve as the basis for the evaluation of post treatment stability.7

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Aims & Objective of the study To evaluate the clinical and radiographic outcome of orthognathic surgery Materials and Methods Source of data 1. The patients referred to the OPD Department of Oral & Maxillofacial Surgery of Al-Badar Rural Dental College, Gulbarga 2. Dept of orthodontics and dentofacial orthopaedics of Al-Badar Rural Dental College, Gulbarga.

3. Centers selected by Al Badar Dental College, Gulbarga.

Criteria for selection of subjects: Patients having dentofacial deformity that requires surgical correction either to improve function or aesthetics or both. Inclusion criteria: 1. Patients with maxillomandibular discrepancy that requires surgical correction. 2. Patients who have completed their pre surgical orthodontic treatment. 3. Dentulous patients. 4. Patients in whom growth has ceased to occur 5. Patients within the age group of 20-45 years. Exclusion criteria: 1. Patients where growth has not ceased to occur 2. Edentulous patients and patients having craniofacial syndromes and clefting. 3. Patients having any systemic disease where in surgery are contraindicated. 4. Orthognathic surgeries associated with distraction osteogenesis.

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Method of collection of data(Including sampling procedure, if any : This study will be conducted in the Department of oral and maxillofacial surgery, Al-Badar Rural Dental College & Hospital with a sample size of 10 cases. Informed/written consent will be taken from the subjects/caretakers. Routine pre-surgical investigations will be done. Following radiographs, photographs will be taken pre-operatively (T-1) and post operatively at 3 months (T-2). 1. LATERAL CEPHALOGRAM. 2. POSTERO ANTERIOR CEPHALOGRAM. 3. FRONTAL, PROFILE PHOTOGRAPHS. 1. Pre and post surgery hard and soft tissue profiles will be compared using lateral cephalograms and posteroanterior cephalograms. 2. The photographs will be used for VAS; patients and lay persons will assess the esthetic change from values of 1-100 and will also further note the change as attractive or unattractive. 3. The amount of change in hard and soft tissue required for perception of change and the relative attractiveness in comparison to pre surgical photographs will be recorded and evaluated.

Duration of study: Three months follow up with regular intervals at each month.

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Does the study need any investigation or interactions to be conducted on patients or animals? Yes Has the ethical clearance been obtained from your institution (in case of 7.3)? Yes

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8.

List of References 1.Moschos A. Papadopoulos,a Theodora Lazaridou-Terzoudi,b Jesper land,c Athanasios E. Athanasiou,a and Birte Melsen,b Thessaloniki, Greece; and Aarhus, Denmark. Comparison of soft and hard tissue profiles of orthognathic surgery patients treated recently and 20 years earlier.(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:e8-e13)
2.

Ellen Wen-Ching Ko, DDS, MS,Chiung Shing Huang, DDS, PhD, and Yu Ray Chen, MD. Characteristics and Corrective Outcome of Face Asymmetry by Orthognathic Surgery.( J Oral Maxillofac Surg 67:2201-2209, 2009) 3. Je Uk Park, DDS, PhD, MS,* and Young-Sook Hwang, DDS. Evaluation of the Soft and Hard Tissue Changes After Anterior Segmental Osteotomy on the Maxilla and Mandible.( J Oral Maxillofac Surg 66:98-103, 2008)
4.

Ming Tak Chewa. Soft and Hard Tissue Changes after Bimaxillary Surgery In Chinese Class III Patients. (Angle Orthod 2005;75:959963.)
5.

Reid W. Montinia; Susan P. McGorrayb; Timothy T. Wheelerc; Calogero Dolce. Perceptions of Orthognathic Surgery Patients Change in Profile.( Angle Orthodontist, Vol 77, No 1, 2007)

6. Ming Tak Chew,a Andrew Sandham,b and Hwee Bee Wongc. Evaluation
of the linearity of soft- to hardtissue movement after orthognathic surgery. (Am J Orthod Dentofacial Orthop 2008;134:665-70) 7. Charles J Burstone, Henry Legan, Randall B James,

G. A. Murphy and Louis A Norton. Cephalometrics for Orthognathic Surgery.( J Oral Surgery 36:269-278, 1978)

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Signature of the candidate GOOD

10. 11. 1

Remarks of the Guide Name and Designation of the Guide

DR.NEELAKAMAL. H. HALLUR PROFESSOR & H.O.D. DEPT. OF ORAL & MAXILLO FACIAL SURGERY,AL-BADAR RURAL DENTAL COLLEGE AND HOSPITAL, GULBARGA PH NO:9845074198 EMAIL ID:neelakamal hallur@hotmail.com

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Signature

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Co-guide Signature: Head of the Department: DR.NEELAKAMAL. H. HALLUR PROFESSOR & H.O.D. DEPT. OF ORAL & MAXILLO FACIAL SURGERY,AL-BADAR RURAL DENTAL COLLEGE AND HOSPITAL, GULBARGA PH NO:9845074198 EMAIL ID:neelakamal hallur@hotmail.com

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Signature Remarks of Principal: Chairman and

Signature of Principal