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Biomedical subjects

B N Epker

Publications and source records attributed to B N Epker.

At least 55 records · Page 3Linked to original sources
PubMed1984

Temporomandibular joint function and morphology: observations on the spectra of normalcy.

Improved knowledge of "normal" temporomandibular joint function and morphology is a basic requisite for the recognition and diagnosis of TMJ abnormalities. Indeed, until such knowledge exists, care must be exercised in the clinical, radiographic, arthrographic, and histologic diagnosis of abnormal temporomandibular structure and/or function. This article discusses variations in TMJ function and morphology in Class I persons and those with skeletal Class II open-bite and Class II deep-bite dentofacial morphologies. These differences are explained on the basis of accepted principles of biomechanics and its influences on cartilaginous growth and bone modeling.

Dental Occlusion↗
PubMed1984

Changes of the hyoid bone and tongue following advancement of the mandible.

Little is known concerning the adaptation of the tongue and hyoid bone after surgical mandibular advancement. This study was undertaken to evaluate the relationship between tongue and hyoid bone posture and their adaptation following mandibular advancement in fourteen adults. The data indicate that (1) there is no statistically significant correlation between changes in the posture of the tongue and hyoid bone; (2) the hyoid bone returns toward its presurgical posture; and (3) the tongue assumes a new position relative to both the cranial base and the mandible. The changes in tongue position occurred immediately after surgery and persisted 2 years postoperatively.

Adolescent↗
PubMed1984

Vascular considerations in orthognathic surgery. I. Mandibular osteotomies.

Numerous studies have been conducted on the vasculature of the mandible and the effects of its surgical alteration. These illustrations have improved our knowledge considerably. However, much additional information regarding the effects of orthognathic surgery upon the vasculature of the mandible is essential before various mandibular surgical procedures can be casually and categorically stated to be biologically sound. In this article several germane issues regarding vascular considerations in mandibular orthognathic surgery are discussed: (1) What are the shortcomings of published studies addressing the effects of orthognathic surgery on the vascular supply to the mandible and/or the maxilla? (2) What are the potential sequelae of vascular compromise? (3) What is the vascular supply to the mandible? (4) What recommendations are there for minimizing vascular compromise in mandibular orthognathic surgery? In Part II of the study these issues will be discussed as they relate to maxillary orthognathic surgery.

Humans↗
PubMed1984

Vascular considerations in orthognathic surgery. II. Maxillary osteotomies.

In this article vascular considerations for orthognathic procedures in the maxilla will be discussed. Specific topics to be included are as follows: (1) What are the potential sequelae from vascular compromise? (2) What is the normal vascular supply to the maxilla? (3) What recommendations are there for minimizing avascular sequelae in maxillary surgery? (4) What does one do when significant avascular sequelae occur? It is the intent of this article to help the orthognathic surgeon reduce the potential for avascular complications when performing the various maxillary osteotomies and ostectomies via a better appreciation for the important subtleties of surgical technique.

Cleft Palate↗
PubMed1983

The surgical-orthodontic correction of mandibular deficiency. Part II.

As discussed in Part I of this study, persons with mandibular deficiency and Class II malocclusions exhibit a wide spectrum of esthetic, cephalometric, and occlusal characteristics. In many such patients optimal overall results are best obtained via a combined orthodontic-surgical approach. In such patients a critical evaluation is essential to decide (1) the optimal operation and (2) the appropriate orthodontic-surgical sequencing. Our method of making these two basic decisions was presented in Part I. In this article the indications for mandibular advancement with or without genioplasty, total subapical mandibular advancement, superior repositioning of the maxilla, and inferior repositioning of the maxilla are discussed in detail. These alternatives are illustrated with representative cases, and the results are discussed. The intention of these two presentations is to illustrate an orthodontic-surgical approach to the correction of mandibular deficiency and Class II malocclusion that is predicated on a systematic evaluation of the individual patient rather than a standard approach.

Adolescent↗
PubMed1983

Surgical orthodontics and the temporomandibular joint. I. Superior repositioning of the maxilla.

Ten randomly selected adults who had undergone orthodontic treatment and isolated superior repositioning of the maxilla for vertical maxillary excess (VME) were evaluated clinically and radiographically (mean, 48.7 months postsurgery) for signs and symptoms of masticatory and temporomandibular joint dysfunction. The patients ranged from 18 years to 37 years of age (mean, 26.2 years) when evaluated. A three-part evaluation of the subjects was performed. This consisted of an anamnestic evaluation (previous medical history), a clinical examination, and a radiographic evaluation. The anamnestic evaluation revealed that, prior to surgery, facial pain was reported by one patient and was not present in any of the patients upon follow-up examination. We believed that the pain was not related to the masticatory musculature and/or the temporomandibular joint. No patients reported pain or sounds in their joints preoperatively, while 30 percent (3/10) of the patients related a history of temporomandibular joint sounds immediately after release of intermaxillary fixation, which subsequently was reported to have resolved in all instances without treatment. Clinical examination of the temporomandibular joints at the time of recall evaluated mandibular movements and the presence of pain or sounds during joint function. These examinations revealed that clinical measures of mandibular movements were somewhat reduced relative to normal. All patients were free of temporomandibular joint and masticatory muscle pain during function, upon contralateral masticatory loading, and upon palpation. Fifteen percent (3/20) of the joints examined demonstrated sounds (popping or crepitation) via auscultation. Masticatory loading in the contralateral premolar region did not induce noise in any of the joints examined. Cephalometric laminagraphic radiographs were obtained of each of the twenty temporomandibular joints with the mandible in three positions; maximum intercuspation, mandibular rest position, and maximal opening. Numerous anatomic relations were quantified from these radiographs. However, only three parameters (condylar position, movement, and evidence of arthrosis) were compared to normative data available in the literature. These comparative data suggested that persons who had undergone orthodontic treatment in conjunction with superior maxillary repositioning demonstrated (1) a relatively retropositional condyle within the fossa and (2) reduced condylar movement during maximal mandibular opening. Two of twenty temporomandibular joints demonstrated radiographic evidence of arthrosis; one condyle demonstrated articular surface erosions, and another exhibited articular surface sclerosis. The overall incidence of arthrosis was not much greater than normal, with 20 percent (4/20) of the joints demonstrating a reduced interarticular joint space. Overall, the clinical findings revealed a low incidence of pathologic masticatory muscle and temporomandibular joint symptoms and signs compared to normative data in the literature...

Adolescent↗
PubMed1983

The surgical-orthodontic correction of mandibular deficiency. Part I.

Persons with mandibular deficiency and Class II malocclusions have a spectrum of esthetic, skeletal, and occlusal characteristics. In many of these patients optimal overall results are best obtained via a combined orthodontic-surgical approach. In such cases a critical patient evaluation is essential to decide (1) the optimal operation and (2) the appropriate orthodontic-surgical sequencing. In Part I of this article our method of making these two basic decisions is presented, the decisions being predicated upon achieving optimal esthetic, functional, and stable results. In addition, two of the possible orthodontic-surgical approaches--the augmentation genioplasty and the anterior maxillary ostectomy are discussed in detail. These approaches are illustrated with representative cases. In Part II of the article additional options for combined orthodontic surgical-management of this patient population will be discussed.

Adolescent↗
PubMed1983

Reverse sagittal split of the mandibular ramus for an unusual deformity.

A reverse sagittal split osteotomy of the mandible for advancement or retraction of the mandible is described to be used in selected instances when the transoral modified sagittal ramus osteotomy would probably result in a pathologic fracture or an inadequate proximal segment. This procedure provides the same benefits as does the modified sagittal split osteotomy. A disadvantage of the procedure is that it requires both intraoral and extraoral incisions.

Adult↗
PubMed1983

Improvement in the augmentation genioplasty via suprahyoid muscle repositioning.

The surgical correction of chin deficiency has been accomplished by a variety of surgical procedures. In most instances the surgical augmentation of the chin produces good improvement in chin-lips-nose balance as well as the neck-chin angle. However, in certain patients, the neck-chin angle is not satisfactorily improved with augmentation genioplasty alone, due to an aberrant position of the hyoid bone and its associated suprahyoid muscles. In such instances, one should consider simultaneous suprahyoid muscle repositioning additionally, to improve the neck-chin angle. The indications, surgical technique and a representative case are presented.

Cephalometry↗