Mandibular Prognathism by BSSO Study

Mandibular Prognathism by BSSO Study METHODOLOGY METHODOLOGY Population Consisted of all the patients who reported to the Out Patient Department of Oral And Maxillofacial Surgery for correction of facial deformity involving maxilla and mandible. Sample Consisted of 33 patients who underwent BSSO setback for mandibular prognathism followed by Rigid Internal Fixation at the Department Of Oral And Maxillofacial Surgery, Mar Baselios Dental College. Inclusion Criteria Patients above age of 20 years for males 18 years for females. Patients who were treated by BSSO setback along with Rigid Internal Fixation for mandibular prognathism. Exclusion Criteria Patients undergoing Bimaxillary surgeries. Patients undergoing Genioplasty along with BSSO. Patients with Medically compromised conditions. Patients with Craniofacial anomalies, Syndromes. A retrospective study was conducted on 33 patients (15 females and 18 males), with mean age of 22 years (age range of 19 28 years), who were operated for mandibular prognathism by BSSO at the department of oral and maxillofacial surgery, Mar Baselios Dental College, Kothamangalam. The patients were selected according to above mentioned inclution and exclusion criterias. The surgical procedure was done by one chief operating surgeon. No maxillomandibular fixation was used postoperatively. Pre and postsurgical orthodontics was carried out at the department of orthodontics and dentofacial orthopaedics, Mar Baselios Dental College, kothamangalam. A standardised lateral skull radiograph with adequate quality and exposure was taken pre operatively and after 6 months of follow up in natural head position [Frankfurt’s horizontal plane parallel to the floor, the tongue in relaxed position and the mandible in centric occlusion] with exposure values of 80 KVp, 10 mA, and 1.30 seconds. Tracings of the lateral cephalograms were pencil traced on acetate paper. To improve the consistency the tracings and measurements were taken by the same investigator. Horizontal reference line was taken as 7 ° to SN at nasion. Vertical reference line was constructed perpendicular to horizontal reference line through Sella. Superimposition of traced preoperative and postoperative lateral cephalogram was done with respect to the horizontal and vertical reference lines. The following cephalometric points and measurements were used. S Sella: Center of sella turcica N Nasion: Most anterior point of frontonasal suture ANS Anterior Nasal Spine: Anterior tip of the nasal spine PNS Posterior Nasal Spine: The most posterior aspect of the palatal bone A Point A: Innermost point on contour of maxilla between anterior nasal spine and incisor tooth Is Incision Superior: Midpoint of incisal edge of most prominent maxillary central incisor Ii Incision Inferior: Midpoint of incisal edge of most prominent mandibular central incisor B Point B: Innermost point on contour of mandible between incisor tooth and bony chin PG Pogonion: Most anterior point on osseous contour of chin ME Menton: Most inferior midline point on mandibular symphysis Cm Columella point: Midpoint of columella of nose Sn Subnasale: Point at which columella merges with upper lip in midsagittal plane SLS Superior Labial Sulcus: Point of greatest concavity in middle of upper lip between subnasale and labrale superius Ls Labrale Superius: Most anterior point of upper lip Li Labrale Inferius: Most anterior point of lower lip SLI Inferior Labial Sulcus: Point of greatest concavity in midline of lower lip between labrale inferius and soft tissue pogonion pg’ Soft Tissue Pogonion: Most prominent or anterior point on chin in midsagittal plane me’ Soft Tissue Menton: Lowest point on contour of soft tissue chin Stoms Stomion Superius: Most inferior point of upper lip Stomi Stomion Inferius: Most superior point of lower lip Sn-Stoms Upper lip length Stomi-me Lower lip length G-Sn-PG’ Facial Convexity: Angle between soft tissue glabella, subnasale and soft tissue pogonion Cm-Sn-Ls Nasolabial Angle: Angle between columella and labrale superius Li-SLI-pg’ Labiomental Fold: Angle between lower lip and chin contour Research methodology In the horizontal plane linear changes at following hard tissue [ANS, A, Is, Ii, B, PG, ME] and soft tissue [Sn, SLS, Ls, Li, SLI, pg’, me’, Stoms, Stomi] cephalometric points were measured in millimeters with mean and standard deviations were calculated. In the vertical plane linear changes at following hard tissue [ANS, A, Is, Ii, B, PG, ME] and soft tissue [Sn, SLS, Ls, Li, SLI, pg’, me’, Stoms, Stomi] cephalometric points were measured in millimeters with mean and standard deviations were calculated. Scatter plot diagram with Correlation Regression Analysis was done for the following points Li vs Ii, SLI vs B, PG vs pg’, ME vs me’ were done in both horizontal and vertical plane. Change in length of lower third of face; upper lip [Sn-Stoms] length and lower lip [Stomi-me] length were calculated along with mean and standard deviation. The mean change in facial profile, Nasolabial angle and mentolabial fold were calculated. The ratio of change in the soft tissue reference points will be compared with movements of corresponding 4 hard tissue references: Li to Ii, SLI to B, PG to pg’ and ME to me’ in the horizontal plane. SURGICAL PROCEDURE All the patients had undergone BSSO for correction of horizontal mandibular excess [mandibular prognathism]. All surgeries were carried out by the same surgeon. During the positioning of the patient before surgery the head end of the table is tilted by about 15 °. Hypotensive anaesthesia technique was used. Both these are intended to reduce intra operative bleeding. At the beginning of the procedure 2% lignocaine hydrochloride with 1: 2,00,000 epinephrine is infiltrated into the buccal vestibule upto the midramus region of the mandible on both sides. Incision and dissection The incision is placed over the anterior aspect of the ramus extending from the midramus region running down over the external oblique ridge upto the first molar region where it curves down to the buccal vestibule. Retracting the soft tissues buccally, before placing the incision prevents the initial exposure of the buccal fat pad. A sharp dissection is done in the ramus upto the periosteum. Periosteal dissection is started on the lateral aspect of the mandibular body from anterior ramus upto the second molar region extending to the inferior border. On the lateral aspect of the ramus dissection may be minimal only to achieve proper access and visibility. Medial dissection is done subperiosteally with a Howarth’s periosteal elevator and should be above the level of lingula and mandibular foramen which usually coincides with the deepest concavity of the anterior border of ramus. Later a channel retractor is inserted for medial retraction so as to protect the mandibular neurovascular bundle. Osteotomy Osteotomy is done with surgical micromotor and burs. Its initiated on the cortical bone of the medial side of ramus above the lingula extending from behind the mandibular foramen [half to two-third of the anteroposterior dimension of the ramus] running down onto the superior aspect of the body of the mandible and then extended to the external oblique ridge over the lateral aspect of the mandibular body upto the 1st molar region. Extending the cut towards the 1st molar region gives better accessibility for intraoral plating. The depth of the cut should be minimal only to reach the cancellous bone. The vertical cut is extended to include the inferior border so that the direction of the split is controlled. During the vertical cut a channel retractor is placed on the lateral aspect so as to protect the buccal soft tissues and facial artery. Following the osteotomy, a small spatula osteotome is malleted into the site beginning from the medial cut, down the ramus, over the body upto the vertical cut. The spatula osteotome is directed laterally beneath the cortical plate so that the neurovascular bundle is protected. Later larger osteotomes are used and finally the fragments are prised apart using a Smith spreader. As the fragments are prised the neurovascular bundle is visualized and care is taken to maintain it to the medial tooth bearing fragment. If the neurovascular bundle is found to be attached to the proximal condylar segment a small periosteal elevator is used to free the bundle and bring it to the medial fragment. Once this is done osteotomes in a wedging fashion or the Smith spreader is used vigourously until the spilt of the fragments are completed. The osteotomy is repeated on the opposite side of the mandible. When the mandible is setback, release of the medial pterygoid and masseter muscle is stripped, if needed to prevent the displacement of the condylar segment posteriorly. Later the tooth bearing medial segment is pushed back as much as needed and the overlapping buccal plate of the proximal condylar segment is trimmed such that the proximal segment rest passively on the cancellous part of medial segment with condyle in proper position. Stabilization and fixation The position of jaw is adjusted and intermaxillary fixation is done with splint in position. Rigid internal fixation using 2mm four hole mini plate with gap and 2 Ãâ€" 6mm monocortical screws is the preferred way of fixation. The intermaxillary fixation is removed after the rigid fixation. Wound closure Wounds are irrigated and bleeding is controlled. Wounds are closed with 3-0 vicryl sutures in layers. 1

control in brave new world :: essays research papers

Control in Brave New World   Ã‚  Ã‚  Ã‚  Ã‚  In his novel Brave New World, Aldous Huxley illustrates ways in which government and advanced science control society. Through actual visualization of this Utopian society, the reader is able to see how this state affects Huxley’s characters. Throughout the book, the author deals with many different aspects of control. Whether it is of his subjects’ feelings and emotions or of the society’s restraint of population growth, Huxley depicts government’s and science’s role in the brave new world of tomorrow.   Ã‚  Ã‚  Ã‚  Ã‚  One aspect of control that is touched upon from the beginning of the novel until the end is the control of the population birth and growth. As a way to maintain the society’s motto of â€Å"Community, Identity and Stability,† the number of inhabitants is managed through the artificiality of the brave new world’s use of technology. In the first chapter of the novel, the reader is introduced to the process of creating humans in this Utopia. The advancement of science made it possible for the building of an artificial arrangement with the reproductive glands and equipment needed for fertilizing and hatching the resulting eggs. The fact that machines do what is done by human reproductive systems shows how science has dominated over man in this world.   Ã‚  Ã‚  Ã‚  Ã‚  The actual process of creating humans is made possible through the use of a single ovary which makes thousands of identical people. Since these people are similar in appearance, thought and relations, they are able to live in perfect harmony with each other. Huxley uses Lenina and Fanny, two of his female characters who are distant relatives from the same ovary, as people who get along well and are on the same page on issues concerning Utopian lifestyles. This is how the government of Utopia, made up of only ten controllers, is able to maintain stability among its people. Since stability is part of the brave new world’s motto, it is a crucial deal for the government to uphold.   Ã‚  Ã‚  Ã‚  Ã‚  Something else that is controlled by government and science is any thing to do with marriage, romance and pregnancy. It is a rule by the government for everyone to freely have sex with anybody at anytime they want. It is against the rules of the Utopia to date anyone regularly. Government forbids anyone to go towards thoughts of monogamy and romance because they require too much time and bring no stability to life.

Comparison Between Macbeth and Banquo’s Response

Macbeth and Banquo’s reaction to the prophecy told to them by the witch’s gave way for two opposing opinions on both the validity and manifesting of the prophecy. Although their opinions throughout the unveiling of the prophecy were opposing throughout, at all times they both rendered the prophecy in contrastive ways, whether they contemplated on its benefit or hindrance towards their gleaming future. â€Å"All hail, Macbeth, that shalt be king hereafter! † Great fear was shown on Macbeth’s face suggesting he was very hesitant toward the idea of him becoming King.However Banquo was much more optimistic about the words of the witch’s, questioning Macbeth, â€Å"why do you start and seem to fear things that do sound so fair? † Macbeth is still in shock which gives time for Banquo to question the witch’s about his future. He became quite intrigued by what the witch’s had told Macbeth so he could not withhold the opportunity to be a cquainted with his children’s faith and discover â€Å"which grain will grow and which will not†. Banquo seemed to be quite optimistic in his willingness to indulge in the witch’s prophecies. Stay you imperfect speakers, tell me more! † This portrays to us that Macbeth has now become fond of the prophecy and is thirsts to know more about his future. As Macbeth continues to cry out for the witch’s return after their abrupt disappearing, he cries out â€Å"Would they had stayed! † It now becomes apparent that Macbeth is engulfed in what the witches have told both him and Banquo. Suddenly Banquo begins to revisit the whole situation and begins to speculate if the entire ordeal actually occurred. â€Å" Or have we eaten on the insane root that takes the reason prisoner? he continues to question the possibility that they could be hallucinating. This is the beginning of Banquo’s now hesitance towards indulging in the witch’s propheci es, and Macbeth’s now apparent obsession with the witch’s prophecy. Macbeth attempts to persuade Banquo by regurgitating the witch’s prophecy and reminding Banquo that his children â€Å"shall be kings†. And what better could Banquo have replied to Macbeth with to continue to hold Macbeth prisoner to the prophecy other than â€Å"You shall be king†.It is now seen that the tides have shifted, and Macbeth is now very much engulfed in the prophecy, as Macbeth discovers that a portion of the prophecy has been fulfilled with the title ‘Thane of Cawdor’ being placed unto him. As Macbeth continues to be animated about the possibility of the entire prophecy being fulfilled, Banquo becomes hesitant towards the prophecy. It is this speech by Banquo that defines his reasons for being so cautious in his reaction to the prophecy. â€Å"oftentimes to win us to our harm the instruments of darkness tell us truths, win us with honest trifles, to betra y’s in deepest consequence. This speech portrays Banquo’s new found reluctance towards the witch’s forecast of the future. He now sees what Macbeth is blind too, the possibility of knowledge becoming more harmful to the men rather than helpful in Macbeth’s want for more, particularly pertaining to him becoming King. As Macbeth begins to weigh the prophecy against logic and the now present, he accepts the fact that if â€Å"two truths are told, as happy prologues to the swelling act of the imperial theme. Macbeth is now beginning to assume that if portions of the prophecy are being fulfilled as the witch’s had said, it is only a matter of time before he shall become king. As Macbeth continues to be engulfed by what will be his future downfall, he assumes that all of his new found fortune â€Å"Cannot be ill, cannot be good†. Macbeth begins to wonder if the prophecy is so good, then why is it now that he is considering killing Duncan in order to receive the throne.And sadly he is willing to do whatever he believes it takes to become, completely being unaware to the fact that he did not have to intervene in order for him to become Thane of Cawdor as the witch’s had prophesised. â€Å"Come what come may† Macbeth says, proposing that he is willing to kill Duncan if necessary. It was clear that before scrutinizing the prophecy Banquo was much aroused by the witches’ foretelling of the future, but after close examination he became tentative towards him possibly becoming a victim of the new found knowledge.Sadly it is very apparent that Macbeth is now engulfed in his plans to becoming King using any means necessary. What makes it so unfortunate is that he doesn’t realize it, â€Å" Think upon what hath chanced, and at more time, the interim having weighed it, let us speak our free hearts to each other â€Å", he says this not realizing that his mind is already made up on the fact that he will sto p at nothing to gain the crown.Banquo’s hesitance towards the witches is well justified in the fact that witches seldom inform us completely on the future, leaving us to pursue and conclude the fantasy with our devilish wishes. Both Banquo and Macbeth share their reasons in an attempt to justify their reaction towards the witch’s speech, but it is apparent that Macbeth is engulfed by greed and his wishes to become King.

Aristophanes the Ancient Greek Comedy Writer

Aristophanes is important today because his work is still relevant. People still laugh at modern performances of his comedies. In particular, his famous womens sex strike for peace comedy, Lysistrata, continues to resonate. Pronunciation:  /à ¦.rÉ ª.sta.fÉ™.niz/ Examples:  In Aristophanes  Frogs, Dionysus, like Hercules before him, goes to the Underworld to bring back Euripides. The Old Comedy Old Comedy had been performed for 60 years prior to Aristophanes. In his time, as his work shows, Old Comedy was changing. It was bawdy and topically political, taking license with living people in the public eye. Ordinary humans played the most heroic characters. Gods and heroes could play buffoons. His style of Old Comedy is described as over-the-top, more like Animal House than How I Met Your Mother. The latter has a lineage that could be traced to an important comedy genre that came after Aristophanes. This was New Comedy, the stock character-filled comedy of manners, written by the Greek Menander and his Roman imitators. To be more completely accurate, New Comedy followed Middle Comedy, a little-known genre to which Aristophanes contributed at the end of his career. Aristophanes wrote comedies from 427-386 B.C., which gives us approximate dates for his life: (c. 448-385 B.C.). Unfortunately, we know very little about him, although he lived in Athens during periods of turmoil, beginning his writing career after the death of Pericles, during the Peloponnesian War. In A Handbook of Greek Literature, H.J. Rose says his father was named Philippos. Rose calls Aristophanes a member of the Athenian conservative party. Aristophanes Makes Fun of Socrates Aristophanes knew Socrates and poked fun at him in The Clouds, as an example of a sophist. From the other side, Aristophanes appears in Platos Symposium, comically hiccuping before he comes up with an inspired explanation for why there are are people with different sexual orientations. Of more than 40 plays written by Aristophanes, 11 survive. He won prizes at least six times -- but not all firsts -- four at the Lenaea (held roughly, in January), where comedy was added to the events in about 440 B.C., and two at the City Dionysia (roughly, in March), where only tragedy had been performed until about 486 B.C. While Aristophanes produced most of his own plays, he did not initially do so. Not until the Acharnians, a pro-peace play and one of those featuring the character of the great tragedian Euripides, won a prize at the Lenaea, in 425, did he start producing. His previous two plays, the Banqueteers, and the Babylonians do not survive. The Knights (Lenaea of 424), an attack on the political figure Cleon, and Frogs (Lenaia of 405), which also features the character of Euripides in a contest with Aeschylus, also won first prize. The generally irreverent, creative Aristophanes made fun of the gods and of real people. His portrayal of Socrates in The Clouds has been criticized for contributing to the atmosphere that condemned Socrates since he portrays Socrates as a ridiculous sophist teaching the morally worthless topics of philosophy for money. Old Comedy Structure A typical structure for Aristophanes Old Comedy would be prologue, parados, agon, parabasis, episodes, and Exodus, with a chorus of 24. Actors wore masks and had padding front and back. Costumes might include giant phalluses. He used equipment like the mechane or crane and the ekkyklema or platform. He made up long, complicated, compound words where appropriate, like cloudcuckooland. Surviving Comedies by Aristophanes The AcharniansThe BirdsThe CloudsThe EcclesiazusaeThe FrogsThe KnightsLysistrataPeacePlutusThe ThesmophoriazusaeThe Wasps