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    Effects of modified step Le Fort I advancement surgery on nostril area and inferior nasal structures volume in class III patients: a retrospective clinical study
    (Springer, 2023) Akbulut, Nihat; Akbulut, Sibel; Bayrak, Seval; Şen, Esengül; Altan, Ahmet; Kaymaz, Gizemnur; Çolak, Sefa
    Objective: The effect of the modified step Le Fort I osteotomy on the inferior nasal structures and the nostril area was evaluated. Materials and methods: This study included 24 patients who had modified step Le Fort I osteotomy. Inferior nasal concha volume (INCV), meatus nasi inferior volume (MNIV), the sum of both structures volume (TV), and nostril area (NA) were evaluated in pre- (T0) and postoperative (T1) periods. Results: For all patients, NA increased both on the right side (p = 0.011) and left side (p = 0.050) after surgery. The INCV and TV values were lower in T1 than those in T0; however, a statistically significant decrease of INCV and TV was found only in the right side of males (p = 0.039 and p = 0.050, respectively). No significant difference was found in MNIV between T0 and T1 measurements (p > 0.05). Conclusion: Maxillary advancement with the modified step Le Fort I osteotomy technique increased the NA, which may have a positive effect on breathing function. On the other hand, although TV tended to decrease, MNIV did not change after surgery as the same decreasing tendency also existed in INCV. Clinical relevance: Step Le Fort I advancement surgery technique usually afects nasal structures positively regarding the nasal airway.
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    Evaluation of bony changes observed in mandibular osteotomy lines and mandibular condyles following bilateral sagittal ramus osteotomy by fractal analysis
    (Springer Heidelberg, 2023) Colak, Sefa; Altan, Ahmet; Bayrak, Seval; Akbulut, Nihat
    Objectives This study aimed to evaluate the surgically impacted trabecular changes in mandibular osteotomy lines and mandibular condyles after bilateral sagittal split ramus osteotomy using the fractal analysis method. Materials and method The study population consisted of 30 patients (9 male, 21 female) diagnosed with mandibular prognathism and operated with bilateral sagittal split ramus osteotomy under general anesthesia. Fractal analyses observed the alterations on the trabecular structure of osteotomy lines, and mandibular condyles on panoramic radiographs obtained preoperatively, postoperatively, 1st week, 6th month, and 12th month. The box-counting method was used to evaluate the changes in trabecular structure by fractal analysis. P-values of less than 0.05 were considered significant. Results The fractal dimension values in both osteotomy lines and mandibular condyles were significantly decreased on postoperative 1st week regarding preoperative values. However, fractal dimension values commenced increasing in the following postoperative period. The fractal dimension values of the horizontal and vertical osteotomy lines reached their preoperative values on postoperative 6th and 12th month, respectively. The decreased fractal dimension values observed in the early postoperative period in the right and left condyles reached their preoperative values at the 6th postoperative month. Conclusion Fractal analyses performed postoperatively can provide information about trabecular changes and bone healing of structures such as osteotomy lines directly affected by bilateral sagittal split ramus osteotomy and indirectly affected mandibular condyles. The results support that fractal analysis can be used together with clinical data in the evaluation of bone healing process.
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    Ultrasonographic evaluation of changes in the thickness, width, elasticity index and echogenic pattern of the masseter muscle after mandibular set-back surgery
    (Elsevier, 2023) Akbulut, Nihat; Gokce, Erkan; Akbulut, Sibel; Sen, Esengul; Altan, Ahmed; Balel, Yunus
    Introduction: The masseter muscle is one of the structures that undergoes significant changes following jaw movements in orthognathic surgery. This study aims to investigate the effects of mandibular setback surgery, performed in patients with skeletal class III deformity, on the thickness, width, elasticity index, and echogenic pattern of the masseter muscle. Material and methods: This prospective case-control study enrolled patients with class III deformity who underwent mandibular setback surgery, while the control group consisted of class I patients. The predictor variable was the time measured at two different points: preoperative (T1) and postoperative 6 months (T2). The primary outcome variable focused on changes in the internal echogenic pattern of the masseter muscle. Secondary, tertiary, and quaternary outcome variables included changes in the thickness, width, and elasticity index of the masseter muscle, respectively. Gender, age, type of operation, and amount of movement were considered as covariates. Ultrasonography was employed to evaluate the outcome variables. Results: The study group comprised 31 patients, including 17 females (mean age 22.24 +/- 3.52 years) and 14 males (mean age 23.14 +/- 2.65 years). The control group consisted of 16 females (mean age 23.34 +/- 1.22 years) and 15 males (mean age 23.12 +/- 1.76 years). Masseter muscle thickness increased significantly after mandibular setback surgery (p = 0.015). However, there was no statistically significant difference in masseter muscle width before and after surgery (p = 0.627), nor in the elasticity index (p = 0.588). Furthermore, a statistically significant transformation from Type I to Type II was observed in the internal echogenic pattern of the muscle (p = 0.039). Additionally, there was no statistically significant correlation between the amount of mandibular movement performed and the changes in the masseter muscle. Conclusions: Mandibular setback surgery leads to changes in both the physical and structural properties of the masseter muscle. (C) 2023 Elsevier Masson SAS. All rights reserved.