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"Le Fort I osteotomy is the surgery in the maksila similar to the live fracture of the Fort I. In the orthognathic surgery, Le Fort I osteotomy is the best choice for the correction of vertical dimension and relatively easy and middle and sufficient to reposisi and maksila. For the open bite case anteriory and postering in the patient could be performed. Le Fort I osteotomy in the posterior and repositioned part of maksila toward posuride so it could be occluded, functional and restored in the intended aesthetic."

"Patient with severe condition which single conventional orthodontic treatment cannot be carried out, it must be considered to undergo combination treatment between orthodontic and orthognathic surgery, so that patient's complaint about aesthetic, mastication and speech function can receive better correction. The aim of performing the orthodontic treatment before orthognathic surgery is to place teeth position ideally to the bone base before correcting the abnormality of its sceletal bone. After the orthognathic surgery there is still the orthodontic treatment to be done which has the aim to achieve good teeth occlusion, inclination and angulation. if possible comparable to the conditions described by Andrew in Six Keys of Normal Occlusion."

"In adult patients if the jaw discrepancy is too great to compensate for, and camouflage by tooth movement alone, surgery is the only way to obtain a resonable result. Before surgery, the orthodontist must establish not only anteropostrior and transverse position, but also the vertical position of the teeth. Inadequate orthodontic preparation can jeopardize the quality of the surgical result. Occlusion is important but satisfactory facial esthetic must accompany it. A good team work between orthodontist and oral surgeon is the key of succes of the treatment, which will be shown in case reports of 3 patients."

"Benteng Willem I Ambarawa merupakan bangunan militer Belanda yang dibangun pada abad 19 yang belum diteliti mengenai bentuk dan tata ruang masa lalu berdasarkan bangunan yang masih ada. Tujuan daripada penelitian ini adalah untuk mengetahui bentuk dan fungsi tata ruang benteng Willem I. Penelitian ini diawali dengan pengumpulan data yang dilanjutkan dengan analisis keruangan pada bangunan-bangunan benteng. Hasil penelitian ini menunjukan bahwa benteng Willem I merupakan benteng garnisun dengan rancang bentuk star fort Vauban dengan bastion dari tanah sebagai pertahanan dan kamuflase. Benteng ini juga memiliki berbagai fasilitas seperti barak pasukan, rumah petinggi pasukan, rumah sakit, istal kuda, gedung pertemuan, pos penjagaan, menara air, sumur, dapur, serta penjara bawah tanah. Selain itu distribusi ruang diatur berdasarkan kepangkatan serta ras dimana prajurit berpangkat rendah terletak di area luar benteng dan prajurit berpangkat tinggi terletak di area dalam benteng.

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Fort Willem I Ambarawa is a Dutch military building that was built in the 19th century that has not been studied regarding the shape and layout of the past based on extant buildings. The purpose of this study is to determine the shape and function of the Willem I fortress spatial planning. The research begins with data collection, followed by spatial analysis of fortress buildings. The results of this study indicate that the fort Willem I is a garrison fortress with the design of the Vauban star fort with bastions from the ground as defense and camouflage. This fort also has various facilities such as army barracks, high ranking officer houses, hospitals, horse stalls, meeting houses, guard posts, water towers, wells, kitchens, and underground prisons. In addition, the distribution of space is regulated based on rank and race where low-ranking soldiers are located in the outer area of the fort and high-ranking soldiers are located in the inner area of the fort."

"PendahuluanSuprakondiler humerus merupakan fraktur terbanyak kedua pada anak setelah distal radius, menjadikannya fraktur yang paling banyak membutuhkan intervensi bedah pada anak. Malunion merupakan salah satu komplikasi yang banyak terjadi di negara berkembang. Cubitus varus sering terjadi pada malunion supracondylar humerus anak, yang menyebabkan masalah kosmetik dan fungsional. Teknik osteotomi korektif pada cubitus varus meliputi lateral closing-wedge, step-cut, dome, distraksi osteogenesis, dan osteotomi multiplanar 3D dengan bantuan komputer. Sampai saat ini, belum terdapat systematic review terupdate mengenai luaran dari berbagai teknik osteotomi korektif terhadap cubitus varus pada malunion supracondylar humerus anak. Penelitian ini dilakukan untuk mengetahui teknik osteotomi korektif yang memiliki luaran paling baik terhadap cubitus varus pada malunion supracondylar humerus anak berdasarkan telaah sistematis literatur yang ada.MetodePencarian literatur secara sistematis dilakukan pada database PubMed, EMBASE, Scopus, dan Cochrane Library, yang diterbitkan hingga April 2023 dengan mengikuti pedoman PRISMA. Artikel yang telah lolos seleksi dilakukan review oleh dua orang reviewer untuk dinilai kembali eligibilitas nya sesuai kriteria inklusi yang telah ditentukan. Kualitas dan bias masing-masing artikel dinilai menggunakan The Newcastle- Ottawa Scale (NOS) untuk studi non-randomized dan Cochrane Risk of Bias Tool untuk studi randomized.HasilSebanyak 39 dari total 754 artikel yang teridentifikasi disertakan dalam penelitian telaah sistematis ini, meliputi 2 studi Randomized Controlled Trial dan 37 studi Cohort Prospective. Didapatkan total 863 pasien yang telah dilakukan berbagai macam osteotomi korektif, terdiri atas 348 (40,3%) pasien lateral wedge osteotomy, 225 (26,0%) pasien step-cut osteotomy, 132 (15,3%) pasien dome osteotomy, 120 (13,9%) pasien multiplanar 3D osteotomy, dan 38 (4,4%) pasien distraction osteogenesis. Rerata usia saat dilakukan koreksi 9 tahun dengan usia paling muda 2 tahun dan paling tua 17 tahun. Keseluruhan pasien dalam sample dilakukan follow-up minimal 6 bulan hingga 61 bulan dengan rerata 27,3 bulan. Data mengenai peningkatan lingkup gerak sendi, besar koreksi humerus-elbow-wrist angle dan Baumann angle sebagai variabel luaran klinis dikumpulkan dan dibandingkan secara statistik. Kriteria penilaian luaran fungsional yang digunakan cukup beragam, sebanyak 3 studi menggunakan Mayo Elbow Performance Index (MEPI), 3 studi Flynn criteria, 11 studi Oppenheim criteria, 3 studi Bellemore criteria. Komplikasi yang dilaporkan meliputi infeksi sebanyak 34 pasien, cidera saraf 19 pasien, re-operasi 7 pasien, deformitas varus tersisa pada 1 pasien, serta tidak ada penonjolan lateral condyle berdasarkan LCPI (lateral condyle prominence index).DiskusiDesain penelitian Randomized controlled trial ditemukan sangat sedikit pada telaah sistematik osteotomi korektif untuk tatalaksana cubitus varus. Kesulitan dalam pembuatan RCT terkait dengan kendala randomisasi, surgical learning curve untuk teknik operasi yang berbeda, kesetaraan atau keberimbangan pasien dan operator (patient and surgeon equipoise) yang secara langsung berkorelasi dengan pertimbangan etik. Telaah sistematis ini hanya melibatkan studi prospektif untuk menghindari kekurangan yang dapat ditemukan pada studi retrospektif seperti pengaruh confounding factor yang tidak diperhatikan sehingga mempengaruhi bias dalam menarik kesimpulan pada studi tersebut. Hasil luaran fungsional yang excellent dapat dicapai dengan berbagai teknik osteotomi korektif dan tidak ada satu teknik yang unggul dalam segala aspek. Pemilihan teknik osteotomi suprakondiler humerus dapat dilakukan dengan mempertimbangkan kelebihan dan kekurangan dari masing-masing teknik. Lateral closing wedge dapat direkomendasikan pada pasien dengan defisit ruang lingkup sendi pre operasi karena terbukti memberikan peningkatan paling tinggi post operasi. Selain itu, peningkatan HEW angle juga cukup tinggi. Proporsi tidak memuaskan secara luaran fungsional pun paling rendah dibandikan teknik lainnya meskipun memiliki proporsi kejadian ulnar nerve injury paling tinggi. Oleh karena itu, penulis menilai bahwa preservasi ulnar nerve penting untuk dilakukan pada teknik ini. Step-cut osteotomy memiliki kemampuan koreksi Humerus-elbow-wrist angle yang paling tinggi. Komplikasi berupa ulnar nerve injury juga banyak ditemui pada dome osteotomy. Teknik ini juga memiliki risiko infeksi paling tinggi bila dibandingkan teknik osteotomy lainnya, hal ini mungkin disebabkan karena permukaan osteotomy yang luas dan membentuk hematoma yang massif. Meta- analisis hanya dapat dilakukan pada sebagian kecil studi yang membandingkan dome dan lateral closing wedge osteotomy serta multiplanar 3D dan lateral closing wedge osteotomy. Uji statistic menunjukkan perbedaan bermakna hasil memuaskan (satisfactory) luaran fungsional berdasarkan Oppenheim criteria yang 1,8 lebih tinggi pada teknik lateral closing wedge osteotomy dibandingkan dome osteotomy. Hasil ini masih harus dipahami dengan lebih berhati-hati mengingat keterbatasan studi yang dapat disertakan dalam meta-analisis tersebut.

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Introduction

Supracondylar humerus fractures are the second most common fractures in children after distal radius fractures, making them the most frequently requiring surgical intervention in pediatric patients. Malunion is a prevalent complication, particularly in developing countries. Cubitus varus frequently ensues as a consequence of malunion in supracondylar humerus fractures in children, leading to cosmetic and functional issues. Corrective osteotomy techniques for cubitus varus include lateral closing-wedge, step- cut, dome, distraction osteogenesis, and computer-assisted multiplanar 3D osteotomies. To date, there is no up-to-date systematic review available on the outcomes of various corrective osteotomy techniques for cubitus varus in pediatric malunion of the supracondylar humerus. This study aims to ascertain the most effective corrective osteotomy technique for cubitus varus in paediatric malunion of the supracondylar humerus based on a systematic literature review.

Method

A systematic literature search was conducted across the PubMed, EMBASE, Scopus, and Cochrane Library databases, encompassing publications up to January 2023, following the PRISMA guidelines. Selected articles underwent a review process by two independent reviewers to reassess their eligibility based on predefined inclusion criteria. The quality and potential biases of each article were assessed utilizing The Newcastle-Ottawa Scale (NOS) for non-randomized studies and the Cochrane Risk of Bias Tool for randomized studies.

Result

A total of 39 out of 754 identified articles were included in this systematic review, comprising of 2 RCTs and 37 Prospective Cohort Studies. The cumulative study population consisted of 863 patients who underwent various corrective osteotomies, comprising of 348 (40.3%) patients undergoing lateral wedge osteotomy, 225 (26.0%) undergoing step-cut osteotomy, 132 (15.3%) undergoing dome osteotomy, 120 (13.9%) undergoing multiplanar 3D osteotomy, and 38 (4.4%) undergoing distraction osteogenesis. The mean age at the time of correction was 9 years, with the youngest patient being 2 years old and the oldest 17 years. All patients in the sample were followed up for a minimum of 6 months to a maximum of 61 months, with an average follow-up duration of 27.3 months. Data regarding the improvement in range of motion, the extent of humerus-elbow-wrist angle correction, and Baumann angle as clinical outcome variables were collected and statistically compared. The assessment criteria used for functional outcomes were quite diverse, with 3 studies using the Mayo Elbow Performance Index (MEPI), 3 studies using the Flynn criteria, 11 studies using the Oppenheim criteria, and 3 studies using the Bellemore criteria. Reported complications included infections in 34 patients, nerve injuries in 19 patients, re-operations in 7 patients, residual varus deformity in 1 patient, and no lateral condyle prominence based on the LCPI (lateral condyle prominence index).

Discussion

The design of RCTs was found to be notably scarce in the systematic review of corrective osteotomies for the management of cubitus varus. The challenges associated with conducting RCTs in this context include difficulties in achieving randomization, navigating the surgical learning curve for different operative techniques, and ensuring patient and surgeon equipoise, which directly correlates with ethical considerations. This systematic review exclusively incorporated prospective studies to circumvent the limitations that may be encountered in retrospective studies, such as the influence of unaccounted confounding factors, thereby mitigating bias in drawing conclusions from the studies. Excellent functional outcomes can be achieved with various corrective osteotomy techniques, with no single technique demonstrating superiority in all aspects. The selection of a supracondylar humerus osteotomy technique can be made by considering the advantages and disadvantages of each technique. Lateral closing wedge osteotomy can be recommended for patients with preoperative joint range of motion (ROM) deficits, as it has been shown to provide the highest postoperative improvement. Additionally, it yields a substantial increase in the HEW angle. The proportion of unsatisfactory functional outcomes is also the lowest compared to other techniques, despite a higher incidence of ulnar nerve injury. Therefore, preserving the ulnar nerve is deemed crucial for this technique. Step-cut osteotomy exhibits the highest capability for correcting the HEW angle. Ulnar nerve injuries are also frequently observed with dome osteotomy. This technique carries the highest risk of infection compared to other osteotomy techniques, possibly due to its extensive osteotomy surface and the formation of massive hematomas. Meta-analysis could only be performed on a small subset of studies comparing dome and lateral closing wedge osteotomy, as well as multiplanar 3D and lateral closing wedge osteotomy. Statistical tests indicated a significant difference in satisfactory functional outcomes based on the Oppenheim criteria, with a 1.8-fold higher rate in favor of lateral closing wedge osteotomy over dome osteotomy. These results should be interpreted cautiously, due to the limitations of the studies eligible for inclusion in the meta-analysis."

"Latar belakang: Evaluasi asimetri dentokraniofasial merupakan hal yang penting dalam perawatan ortodonti dan bedah ortognati. Evaluasi ini berfungsi dalam diagnosis, rencana perawatan, dan evaluasi hasil perawatan. Penggunaan perhitungan indeks asimetri Katsumata secara tiiga dimensi menjadi hal yang marak digunakan dalam penilaian asimetri dentokraniofasial. Tujuan: Penelitian ini bertujuan dalam membandingkan hasil diagnosis kesimetrisan dentokaniofasial yang didapatkan dari perhitungan indeks asimetri Katsumata secara tiga dimensi pada CBCT dan analisis komparasi linier dua dimensi Grummon pada sefalogram posteroanterior yang direkonstruksi dari hasil CBCT. Metode: Penelitian ini merupakan penelitian potong lintang pada lima belas CBCT . Sefalogram posteroanterior pada penelitian ini direkonstruksi dari hasil CBCT yang sama. Perhitungan indeks asimetri pada lima belas titik kraniometri dilakukan pada hasil CBCT dan dilakukan pengambilan diagnosis pada masing-masing parameter sesuai dengan tabel Katsumata. Perbandingan linear dua dimensi dilakukan pada lima belas titik yang sama pada sefalogram posteroanterior. Diagnosis ditegakan sesuai standar Grummon. Uji Kohen Kappa dilakukan untuk melihar reliabilitas intereksaminer dan uji McNemar untuk melihar reliabilitas intraeksaminer. Uji Fisher dilakukan untuk melihat beda diagnosis dan Uji Kohen Kappa dilakukan untuk melihat kuat kesepakatan diagnosis. Hasil: Hasil penelitian menunjukan tidak ada perbedaan diagnosis antara kedua metode pada lima belas parameter yang diukur. Tingkat kesepakatan beragam pada lima belas parameter. Kesimpulan : Penelitian ini menunjukan tidak ada perbedaan diagnosis kesimetrisan dentokraniofasial pada metode dua dan tiga dimensi sehingga diharapkan ortodontis dapat menggunakan analisis tiga dimensi secara langsung pada hasil CBCT.

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The evaluation of dentoskeletal asymmetry is essential in orthodontics and orthognathic surgery, as it aids in diagnosis, treatment planning, and monitoring treatment outcomes. The asymmetry index developed by Katsumata is widely used in assessing craniofacial asymmetry. This study focuses on the comparative diagnosis between Katsumata asymmetry index in three-dimensional (3D) CBCT evaluations and conventional two-dimensional (2D) analysis comparing linear parameters on 2D reconstructed posteroanterior cephalogram. This research is aimed to widely share information and discuss further about utilization latest  three dimensinonal method especially measurement of asymmetry index by Katsumata for diagnosing dentocraniofacial asymmetry using cone beam computed tomography. A cross-sectional study was conducted on 15 CBCT data imaging. Posteroanterior cephalograms were reconstructed CBCT data imaging. Asymmetry index of fifteen anatomical parameter was measured on CBCT data imaging. Diagnosis was risen according to table of Katsumata.  Comparison of linear measurement on 2D reconstructed posteroanterior cephalogram was done on fifteen parameters. Diagnosis was risen accoding to the standard of Grummon analysis. Kappa Kohens were used to asses interexaminer reliabilities and Mc Nemar tests were used to asses intraexaminer reliabilities. The data was tested using Fisher’s exact test. Results showed no significant differences between diagnosis achieved by comparison in two-dimensional analysis (2D) and Katsumata’s asymmetry index in three-dimensional(3D) analysis. Kappa Kohen analysis was performed to every parameter for analyzing strength agreement in diagnosis between both methods. Better agreements are showed in maxillary parameter than mandible parameter. Newer method to evaluate dentoskeletal asymmetry using measurement asymmetry index in three-dimensional(3D) analysis CBCT is considered to have same result in diagnosis with two dimensional Grummon’s analysis."