Purpose: Together with the increase of orthodontic treatment needs the use of functional apparatus has been increased. Furthermore, different studies has been done on skeletal and dental changes after the use of these functional appliances, but few studies discussed soft tissue changes in the field. So, this study was carried out in order to evaluate soft tissue changes following the use of TWIN BLOCK functional appliance.Methods & Materials: This study was quazi experimental done on 13 patients (7 girls and 6 boys) with 7 years and 7 months to 12 years and 6 months of age. All patients were Cl II Div.I malocclusion, Iranian, Muslim, resident of Tehran and with no previous orthodontic treatment and tooth extraction. The period of treatment with the apparatus varied between 7 to 17 months. The studied angular variables were nasolabial, nasofacial, facial convexity,H angle, mentocervical, nasomental and mentolabial. The liner variables were lower and upper lip to E line, upper and lower lip thickness, prominence and length, upper and lower face height. All variables were compared before and after the use of TWIN BLOCK and recorded in a questionnaire and were analyzed by T - test. Results: The study showed that nasolabial, nasofacial, Lower lip to E line and Upper lip length decreased slightly with the use of apparatus, while facial convexity, H angle, upper lip prominence, upper lip thickness and upper lip to E line decreased significantly. As well as, mentocervical, upper lip thickness, lower lip prominence and soft tissue lower face height increased slightly and nasomental, mentolabial, soft tissue upper face height and lower lip length increased significantly.Conclusion: Following the treatment with TWIN BLOCK, the lower face soft tissue moved anteriorly leading to decrease in profile convexity. The upper and lower face soft tissue height increases and their ratio improved. The upper and lower lip thickness reduced, but upper lip length did not change and lower lip length increased after the treatment. The space between upper and lower lip edge to E - line moved to a normal range and labiomental fold became wider.

Background and Aims: Functional therapy locates the mandible in a more anterior and inferior position. Tongue posture and oropharynx space have a considerable relationship with mandibular posture. The aim of the present study was to determine the changes of tongue posture and oropharynx space following treatment with TWIN BLOCK appliance in adolescent patients with class II division 1 ma1occlusion. Materials and Methods: Twenty two patients (14 girls mean age: 11. 5, 8 boys mean age: 12. 5 years) who were treated with TWIN-BLOCK appliance were enrolled. Cephalograms were used to assess the linear measurements. Graber pattern and McNamara parameter were used to evaluate the tongue posture and oropharynx space, respectively. Data analysis was performed by paired t-test. Results: The findings of the present study showed a significant increase in anterior position of tongue (P=0. 06). Oropharynx space was increased significantly (P<0. 001). There was a significant correlation between the decrease of ANB and anteroposterior increase of oropharynx space. Conclusion: TWIN-BLOCK appliance caused considerable forward movement of tongue and significant increase of oropharynx space in the sagittal plan.

Aim: Functional appliances such as TWIN BLOCKs are widely used to treat skeletal Cl II malocclusions. Myofunctional effects are one of the critical features of these appliances. The present study aimed to investigate the muscular effects of clear and traditional TWIN BLOCKs.Methods: In this randomized clinical trial, 60 skeletal Class II div 1 patients were randomly divided into two groups: clear TWIN BLOCK (CTB) and traditional TWIN BLOCK (TTB). Electromyographic (EMG) evaluation of masseter, anterior temporalis, orbicularis oris, and mentalis muscles was carried out during deglutition, rest, whistling, and forced occlusion before insertion (T1) and six months (T2) after insertion of the appliance. Data were analyzed using independent t-test, paired t-test, and Wilcoxon’s signed-rank test at the 0.05 significance level.Results: There were no significant differences in T2 values between the groups (P>0.05). The intragroup comparisons showed a significant change from T1 to T2 in the CTB group for the clenching of the masseter muscle and in the TTB group for swallowing and rest position of the anterior temporalis muscle and swallowing of the masseter muscle (P<0.05).Conclusion: Both CTB and TTB changed the muscular activity of circumoral muscles. No significant difference was found when the post-treatment muscular activity of the two groups was compared.

Unilateral temporomandibular joint (TMJ) dislocation is a rare condition often triggered by yawning, vomiting, or other activities involving wide opening of the mouth, resulting from the forward movement of the condylar head. This case report highlights a longstanding unilateral TMJ dislocation managed by the single injection of local anesthetics into the deep temporal and masseteric nerve peripheries, alleviating muscle spasm and pain to restore TMJ function.

Objectives: Aim of this study was to do a comparative post-treatment assessment, using three superimposition methods (Ricketts, Pancherz and Centrographic), in patients with Angle’ s Class II Division 1 malocclusion and functional retrusion of mandible following TWIN BLOCK appliance therapy. Methods: In this retrospective cross sectional study, pre and post-treatment lateral cephalometric radiographs of 33 cases were analyzed and compared using Ricketts, Pancherz and Centrographic superimpositionmethods. Changes were evaluated quantitatively for all three methods using a reference grid. The anteroposterior position of upper and lower centroids with respect to the centroid plane was evaluated. Results: Paired samples t-tests and intraclass correlation coefficient revealed excellent reliability of Ricketts, Pancherz and Centrographic superimposition techniques for all parameters. An advancement of 4. 14 + 2. 24 and 4. 18 + 2. 26 in Pancherz, 4. 30 + 2. 14 and 4. 38 + 2. 18 in Ricketts and 4. 36 + 2. 19 and 4. 50 + 2. 19 in Centrographic superimposition methods was shown by point B and pogonion respectively. The observed advancement of Point B and restriction of mesial movement of upper first molar (U6) was statistically significant for Centrographic method as compared to Pancherz. Advancement of lower centroid was seen in all cases with 72. 7% in level with centroid plane and 24. 2% within 1mm of it. Conclusions: All three superimposition methods (Ricketts, Pancherz and Centrographic) proved equally reliable in assessing treatment changes following TWIN BLOCK therapy. Forward movement of lower centroid was observed in 100% of the cases indicating true mandibular advancement following TWIN BLOCK appliance therapy in Skeletal Class II Division 1 malocclusions.

Dear Editor, I would like to present a case entitled “ Massive hydrocephalus and intraventricular hemorrhage (IVH) in monochorionic diamniotic (MCDA) TWIN pregnancy with TWIN‑ TWIN transfusion syndrome (TTTS) plus TWIN anemia‑ polycythemia sequence (TAPS). ”..

Background: Monochorionic diamniotic ,(MCDA) TWIN pregnancies are considered high‑, risk for several reasons, especially the risk of TWIN‑, to‑, TWIN transfusion syndrome ,(TTTS). Renal artery Doppler ,(RAD) is reported as a useful tool for predicting oligohydramnios in singleton pregnancies. We aimed to compare the RAD indices between MCDA TWINs with and without TTTS. Materials and Methods: In this case–, control study, all pregnant women aged 18–, 38 , years, with gestational age , ≥,  , 18 , weeks, who were referred to two Prenatal Clinics, Alzahra and Beheshti Educational Hospitals, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, October 2020–, March 2022 were enrolled,the women with MCDA TWIN pregnancies complicated by TTTS , (case group, n , = , 12) and without TTTS , (control group, n , = , 24). For each TWIN, biometric analysis, fetal weight, and Doppler study of fetal arteries, including RAD, middle cerebral artery , (MCA), umbilical artery, and ductus venosus were performed. Peak systolic velocity, Pulsatility index , (PI), resistance index , (RI), and systole/diastole , (S/D) were measured for all arteries. Results: The donors of the case group had a lower mean MCA S/D , (4. 48 , ±,  , 1. 89) than the control group , (6. 48 , ±,  , 1. 97) , (P , = , 0. 01) and higher mean umbilical parameters, including PI, RI, and S/D , (P , < , 0. 05). The recipients of the case group had a lower mean renal PI than the control , (P , = , 0. 008) and lower mean MCA PI, RI, and S/D , (P , < , 0. 05). The donor group had a higher mean umbilical RI and S/D than the recipient TWIN, while the mean fetal weight of the recipient group was higher , (P , < , 0. 05). Conclusion: Comparing the RAD parameters between the TWINs with and without TTTS in the present study did not identify significant results, which rejected the primary hypothesis. Among all RAD parameters, the only significant difference observed in the present study was the lower RAD PI in RT, which cannot suggest this measurement as a valuable tool for the prediction of TTTS in MCDA TWINs. Therefore, the results of the present study failed to show the additional value of RAD, compared with the conventional Doppler examination of fetal arteries. Further studies are required to prove this conclusion.