title: Functional and morphologic changes after combined maxillary intrusion and mandibular advancement surgery.
abstract: OBJECTIVE
  The purposes of this investigation were 1) to compare the morphology and function of patients with combined vertical maxillary excess (VME) and mandibular retrognathia with that of controls, and 2) to examine how these parameters change after combined maxillary intrusion and mandibular advancement surgery.
  
  
  METHODS
  Fifteen female VME/retrognathic patients were compared with 26 female controls before and for up to 3 years after orthognathic surgery. Facial skeletal morphology, mandibular range of motion, maximum isometric bite force, and levels of electromyographic activity (EMG) in selected muscles of mastication were measured on all subjects. Where appropriate, one-way analysis of variance (ANOVA) or t-tests were used to compare the patients with controls. Univariate repeated-measures ANOVA was used to study longitudinal changes.
  
  
  RESULTS
  Preoperatively, patients' morphologic measurements were characteristic of VME compounded by mandibular retrognathia. At surgery, the maxilla was elevated an average of 2.8 mm, and the mandible was lengthened by an average of 7.1 mm. All of the postoperative morphologic measurements were closer to normal values. The patients' masseter mechanical advantage was significantly lower than that of controls both before and after surgery. Surgically induced changes in mechanical advantage were very small. The patients' maximum range of motion and excursion during mastication were all lower than those of controls before surgery. All measurements of mobility decreased immediately after surgery, with a gradual return to preoperative values. However, even 3 years after surgery, all of the motion measurements remained smaller than those of the controls. Before surgery, the patients had maximum isometric bite forces significantly lower than those of controls. Bite forces increased significantly after surgery, approaching normal values within 2 years. The activity levels in the muscles of mastication during isometric bites were not significantly altered by surgery.
  
  
  CONCLUSIONS
  This study confirms that VME/retrognathia patients suffer from substantial deficiencies in their oromotor function. Surgical correction of this particular type of dentofacial deformity improves both the morphologic and functional deficits. Although some changes were not statistically significant, all were toward normalization of the presurgical values.
authors.affiliation: University of Texas South-western Medical Center, Dallas 75235-9109, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Zarrinkelk
authors.forename: G S
authors.initials: GS
authors.lastname: Throckmorton
authors.forename: E
authors.initials: E
authors.lastname: Ellis
authors.forename: D P
authors.initials: DP
authors.lastname: Sinn
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D001732:Bite Force; D002508:Cephalometry; D004576:Electromyography; D005260:Female; D006801:Humans; D008334:Mandible / Q000503:physiopathology / Q000601:surgery*; D008437:Maxilla / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D016059:Range of Motion, Articular; D063173:Retrognathia / Q000503:physiopathology / Q000601:surgery; D014716:Vertical Dimension