Papers by Reginald Goodday
Journal of Oral and Maxillofacial Surgery, 2018
There is no universally accepted method for determining the ideal sagittal position of the maxill... more There is no universally accepted method for determining the ideal sagittal position of the maxilla in orthognathic surgery. In ''Element II'' of ''The Six Elements of Orofacial Harmony,'' Andrews used the forehead to define the goal maxillary position. The purpose of this study was to compare how well this analysis correlated with postoperative findings in patients who underwent bimaxillary orthognathic surgery planned using other guidelines. We hypothesized that the Andrews analysis would more consistently reflect clinical outcomes than standard angular and linear measurements. Methods: This is a retrospective cohort study of patients who had bimaxillary orthognathic surgery and achieved an acceptable aesthetic outcome. Patients with no maxillary sagittal movement, obstructive sleep apnea, cleft or craniofacial diagnoses or who were non-Caucasian were excluded. Treatment plans were developed using photographs, radiographs, and standard cephalometric measurements. The Andrews analysis, measuring the distance from the maxillary incisor to the Goal Anterior Limit Line, and standard measurements were applied to end-treatment records. The Andrews analysis was statistically compared to standard methods. Results: There were 493 patients who had orthognathic surgery from 2007-2014, and 60 (62% female), with mean age 22.1 AE 6.8 years, met the criteria for inclusion in this study. The mean Andrews distances were-4.8 AE 2.9 mm for females and-8.6 AE 4.6 mm for males preoperatively, and-0.6 AE 2.1 mm for females, and-1.9 AE 3.4 mm for males postoperatively. For females, the Andrews analysis was closer to the goal value (0 mm) postoperatively than any standard measurement (p < 0.001). For males, AN Vert performed best (p < 0.001), followed by the Andrews analysis. Conclusion: The Andrews analysis correlated well with the final aesthetic sagittal maxillary position in our sample, particularly for females, and may be a useful tool for orthognathic surgical planning.
Oral and Maxillofacial Surgery Clinics of North America, 1997
Journal of Oral and Maxillofacial Surgery, 2016
A recent Cochrane review 1 concluded that long-term antibiotic prophylaxis (L-TAP) decreases the ... more A recent Cochrane review 1 concluded that long-term antibiotic prophylaxis (L-TAP) decreases the risk of a surgical site infection (SSI) compared to short-term antibiotic prophylaxis (S-TAP), in patients undergoing orthognathic surgery. Maxillomandibular advancement (MMA) surgery is a special application of orthognathic surgery used to treat obstructive sleep apnea (OSA). Currently, no data exist to define the most effective antibiotic regimen for preventing SSI in OSA patients treated by MMA; although this information is important as OSA patients may have more risk factors for SSI as they are generally older and have more medical comorbidities, than the typical orthognathic surgery patient who is generally young and healthy. The purpose of this study was to determine if there is a difference in SSI between short-term and long-term antibiotic prophylaxis in patients undergoing MMA for treatment of OSA. Materials and Methods: We performed a two-center retrospective cohort study consisting of 216 patients who underwent MMA for the treatment of OSA at either Vanderbilt University Medical Center (VUMC) between 1997 and 2007 (n=76) or Dalhousie University (DU) between 1997 and 2012 (n=140). The primary outcome measure was the rate of SSI. A comprehensive systematic review of the medical records for each study patient was completed to identify SSI and the antibiotic regimen. All patients had a minimum of six months of follow-up after MMA surgery. S-TAP was defined as antibiotic prophylaxis administered before and during surgery, and up to 24 hours after surgery. L-TAP was defined as antibiotic prophylaxis administered before and during surgery, and longer than 24 hours after surgery. The Centers for Disease Control and Prevention (CDC) criteria were used to define a SSI. 2 Statistical Analysis: c 2 test was used to test for group differences in rates of SSI and rates of fixation plate removal. The Mann-Whitney test was used to test for group differences in demographic characteristics and surgical variables. Results: The study cohort consisted primarily of middle age (45.1 AE 10.2, range: 17-68 years), obese (BMI,
Journal of Oral and Maxillofacial Surgery, 2019
Central sleep apnea (CSA) can develop after the treatment of obstructive sleep apnea (OSA) with c... more Central sleep apnea (CSA) can develop after the treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP). No studies have identified whether treatment of OSA with maxillomandibular advancement surgery (MMA) can result in CSA. The purpose of our study was to determine the incidence and clinical significance of CSA emerging after MMA surgery to treat OSA. Patients and Methods: A retrospective review was conducted of all patients who had undergone MMA surgery for OSA at the Department of Oral and Maxillofacial Surgery at the QEII Health Sciences Centre (Halifax, NS, Canada) from 1996 through 2016. All patients with preoperative level 1 polysomnography and follow-up level 1 study results available at least 6 months postoperatively were included the present study. The pre-and postoperative central apnea index (CAI) results were compared. Results: A total of 113 patients (84 men and 29 women) with an average age of 44.0 years were included in the present study. In 35 patients (31.0%), the emergence of CSA events were recorded on postoperative polysomnograms. Only 2 of the 113 patients experienced the emergence of clinically significant postoperative CSA (CAI >5). In our patient cohort, gender (P = .085), patient age (P = .238), and preoperative (P = .716) and postoperative (P = .209) Apnea-Hypopnea Index (AHI) results correlated with the postoperative development of CSA events after MMA surgery. The mean AHI values had decreased from 41.4 to 8.7 in all patients treated with MMA in our study. Conclusions: The emergence of CSA events occurred in 31% of patients after OSA treatment with MMA surgery. The rate of clinically significant CSA events emerging after MMA surgery in our study was 1.8%. These findings help to support the use of MMA surgery for OSA as a reasonable treatment alternative for patients unable to tolerate CPAP.
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, Jan 4, 2018
To comprehensively determine the effectiveness and safety of maxillomandibular advancement (MMA) ... more To comprehensively determine the effectiveness and safety of maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA). We designed and implemented a prospective multicenter cohort study to evaluate OSA patients who underwent MMA. The primary outcome measures and associated instruments included sleepiness (Epworth Sleepiness Scale [ESS]), quality of life (QOL) (Functional Outcomes of Sleep Questionnaire [FOSQ]), sleep-disordered breathing (apnea-hypopnea index), cardiovascular risk (office blood pressure and levels of high-sensitivity C-reactive protein), and neurocognitive performance (psychomotor vigilance testing [PVT]). The outcomes were measured preoperatively and approximately 6 months postoperatively. Other variables were grouped into the following categories: demographic and pre-MMA use of continuous positive airway pressure. Descriptive and bivariate statistics were computed. The sample was composed of 30 adult patients (63% men; mean age, 45.9 ...
Journal (Canadian Dental Association), 2001
The goals of primary closure of cleft lip and palate include not only re-establishing normal inse... more The goals of primary closure of cleft lip and palate include not only re-establishing normal insertions for all of the nasolabial muscles but also restoring the normal position of all the other soft tissues, including the mucocutaneous elements. Conventional surgical wisdom, which recommends waiting until growth is complete before undertaking surgical correction of the postoperative sequelae of primary cheiloplasty, carries with it many disadvantages. If, after primary surgery of the lip, orolabial dysfunctions remain, they will exert their nefarious influences during growth and will themselves lead to long term dentofacial imbalances. These imbalances can significantly influence facial harmony. Unless accurate, symmetric and functional reconstruction of the nasolabial muscles is achieved during the primary surgery, not only will the existing dentoskeletal imbalances be exaggerated, but other deformities will be caused during subsequent growth, among which the most important are nas...
Journal of Oral and Maxillofacial Surgery, 2012
Purpose: Inferior alveolar nerve (IAN) injury is 1 of the most important postoperative complicati... more Purpose: Inferior alveolar nerve (IAN) injury is 1 of the most important postoperative complications after sagittal split osteotomy (SSO). The purpose of our study was to investigate the effects of the presence or absence of a mandibular third molar on the neurosensory recovery of the IAN after SSO. Materials and Methods: A prospective cohort study enrolled a sample composed of patients who underwent SSO to correct mandibular deformities. The primary predictor variable was the status of the mandibular third molar at the time of SSO and it was divided into two levels, present at the time of SSO (Group I) or absent at the time of SSO (Group II). The primary outcome variable was neurosensory recovery of the IAN, assessed using the Medical Research Council scale, functional sensory recovery, and subjective evaluation. Neurosensory status was measured 3 times (preoperatively and 3 and 6 months postoperatively). Appropriate bivariate and multivariate statistics were computed, and the level of statistical significance was set at P Ͻ .05. Results: A total of 120 SSOs were performed in 60 patients. Group I included 64 SSOs (mean patient age Ϯ SD 19.3 Ϯ 8.0 years) and group II, 56 SSOs (mean patient age 24.9 Ϯ 10.0 years). The Medical Research Council scale scores showed that the presence of third molars during SSO was associated with a statistically significant decreased incidence of neurosensory disturbance of the IAN at 3 and 6 months postoperatively (all P Ͻ .01). Functional sensory recovery was achieved more frequently in group I, but this difference remained significant only at 3 months after adjusting (P ϭ .01). A "normal sensation" was subjectively reported more frequently in group I at 3 and 6 months postoperatively (P Յ .05). Conclusions: The presence of third molars during SSO minimizes postoperative neurosensory disturbance of the IAN.
Journal of Oral and Maxillofacial Surgery, 2003
Journal of Oral and Maxillofacial Surgery, 2012
The purpose of this study was to investigate prospectively the effects of the presence or absence... more The purpose of this study was to investigate prospectively the effects of the presence or absence of third molars during sagittal split osteotomies (SSOs) on the frequency of unfavorable fractures, degree of entrapment and manipulation of the inferior alveolar nerve (IAN), and procedural time. Materials and Methods: The investigators designed and implemented a prospective cohort study and enrolled a sample composed of patients who underwent SSOs to correct mandibular deformities. The primary predictor variable was the status of the mandibular third molar at the time of SSO, and it was divided into 2 levels, present at the time of SSO (group I) or absent at the time of SSO (group II). The primary outcome variable was unfavorable splits. The secondary outcome variables were the degree of entrapment/manipulation of the IAN and the procedural time. Appropriate bivariate and multivariate statistics were computed, and the level of statistical significance was set at P Ͻ .05. Results: Six hundred seventy-seven SSOs were performed in 339 patients: group I consisted of 331 SSOs (mean age Ϯ SD: 19.6 Ϯ 7.4 yrs), and group II consisted of 346 SSOs (30.4 Ϯ 12.1 yrs). The overall rate of unfavorable fractures was 3.1% (21 of 677), with frequencies of 2.4% (8 of 331) in group I, compared with 3.8% (13 of 346) in group II (P ϭ .3). The rate of IAN entrapment in the proximal segment was significantly lower in group I (37.2%) than in group II (46.5%; P ϭ .01). The degree of entrapment was also significantly more severe for group II (P Ͻ .001). Third molars increased procedural time by 1.7 minutes (P Ͻ .001). Conclusions: The presence of third molars during SSOs is not associated with an increased frequency of unfavorable fractures. Concomitant third molar removal in SSOs also decreases proximal segment IAN entrapment but only slightly increases operating time.
Journal of Oral and Maxillofacial Surgery, 2011
measures were changes in sleep disturbance (symptoms; respiratory disturbance index, RDI; need fo... more measures were changes in sleep disturbance (symptoms; respiratory disturbance index, RDI; need for continuous positive airway pressure, CPAP). Descriptive, bivariate, and regression statistics were computed. For all analyses, a P Ͻ 0.05 was considered significant. Results: The sample included 23 adult subjects with a mean age of 39.3 ϩ 12.1 years; 6 subjects were female. Pre-operatively, all subjects were symptomatic, required positive-pressure therapy, and were seeking an alternative to positive-pressure therapy. Seventeen subjects (73.9%) used CPAP preoperatively; 6 subjects were unable to tolerate the positive-pressure treatment. Subjects had average maxillary and mandibular advancements of 9.8 ϩ 2.0 and 10.8 ϩ 2.2 mm, respectively. The mean pre-and postoperative UALs were 75.8 ϩ 7.0 mm and 67.0 ϩ 5.7, respectively (P Ͻ .001). The mean pre-and postoperative PAS were 7.5 ϩ 2.5 mm and 13.0 ϩ 3.0 mm, respectively (P Ͻ .01). The mean pre-and postoperative HMP were 25.1 ϩ 6.8 and 22.1 ϩ 6.0, respectively (P ϭ .01). The mean pre-and post-operative RDI were 53.2 ϩ 22.4 and 19.0 ϩ 12.0 events/hr, respectively (P ϭ .003). All patients had improvement in OSA symptoms. Three patients who were on CPAP pre-operatively continued to require it postoperatively. There were no significant associations between the magnitude of maxillary or mandibular advancement and changes in cephalometric or polysomnographic parameters (P Ͼ .17). Conclusion: The results of this study suggest that UAL decreases as a result of MMA and confirm other studies that MMA is associated with objective and subjective improvement in OSA patients.
Case Reports in Surgery, 2019
Squamous cell carcinoma is the most common head and neck malignancy. It can occur in the mandible... more Squamous cell carcinoma is the most common head and neck malignancy. It can occur in the mandible or maxilla without a preexisting oral mucosal lesion. Often, the clinical and radiographic presentation of SCC directs the clinician to favour malignancy over other pathological conditions. However, SCC may also mimic an infectious condition and therefore can pose a diagnostic challenge even for the most experienced clinicians. Herein, we report a case of mandibular squamous cell carcinoma in a 53-year-old male who presented with symptoms of right facial swelling, trismus, pain, and right-sided lip paresthesia. The patient underwent a surgical removal of the presumed infected third molar of the right mandible, but histopathological analysis of the associated soft tissue unexpectedly yielded squamous cell carcinoma. Given the biopsy-proven diagnosis, the patient received a mandibular resection of the tumor followed by primary reconstruction with a fibular free flap. Patients presenting w...
Journal of Oral and Maxillofacial Surgery, 2012
nasal obstruction (NOSE score Ͼ 50) improved but this did not reach statistical significance (P Ͻ... more nasal obstruction (NOSE score Ͼ 50) improved but this did not reach statistical significance (P Ͻ 0.0625). NOSE scores worsened in 10 patients. Among these, half had minimal change while 5 had significant worsening. No predictor variables were identified in this small subgroup but individual case analyses revealed postoperative nasal septal deviation occurred in 3 subjects. Conclusions: Our overall findings suggest that nasal airway function improved following maxillary advancement and subjects with higher preoperative NOSE scores (Ͼ25) were more likely to experience relief of nasal obstructive symptoms. Additionally, care should be taken to ensure passive septal positioning to avoid postoperative septal deviation.
Journal of Oral and Maxillofacial Surgery, 2015
Journal of Cranio-Maxillofacial Surgery
Oral and Maxillofacial Surgery Clinics of North America, 2015
For patients at risk of osteonecrosis of the jaw (ONJ), information can be provided by the pharma... more For patients at risk of osteonecrosis of the jaw (ONJ), information can be provided by the pharmaceutical manufacturer, pharmacist, prescribing physician, dentist, and oral and maxillofacial surgeon. Prevention strategies to reduce the incidence of osteonecrosis should be applied as soon as it is determined that a patient will be placed on antiresorptive medication. Proper screening involves a comprehensive oral examination with radiographs followed by oral hygiene instruction and necessary dental treatment; surgical techniques and adjunctive therapies that favor optimum healing of bone and soft tissue decrease the risk of ONJ. No dental procedures are absolutely contraindicated.
Current Therapy In Oral and Maxillofacial Surgery, 2012
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Papers by Reginald Goodday