Modern Surgery-First Approach Concept in Cleft-Orthognathic Surgery: A Comparative Cohort Study with 3D Quantitative Analysis of Surgical-Occlusion Setup.

Hyung Joon Seo,Rafael Denadai,Lun-Jou Lo,Betty Chien-Jung Pai

doi:10.3390/jcm8122116

Abstract

Despite the evident benefits of the modern surgery-first orthognathic surgery approach (reduced treatment time, efficient tooth decompensation, and early improvement in facial esthetics), the challenge of the surgical-occlusion setup acts as a hindering factor for the widespread and global adoption of this therapeutic modality, especially for the management of cleft-skeletofacial deformity. This is the first study to assess three-dimensional (3D) quantitative data of the surgical-occlusion setup in surgery-first cleft-orthognathic surgery. This comparative retrospective study was performed on 3D image datasets from consecutive patients with skeletal Class III deformity who had a unilateral cleft lip/palate (cleft cohort, n = 44) or a noncleft dentofacial deformity (noncleft cohort, n = 22) and underwent 3D computer-assisted single-splint two-jaw surgery by a single multidisciplinary team between 2014 and 2018. They received conventional orthodontics-first or surgery-first approaches. 3D quantitative characterization (linear, angular, and positional measurements) of the final surgical-occlusion setup was performed and adopted for comparative analyses. In the cleft cohort, the occlusion setup in the surgery-first approach had a significantly (all p < 0.05) smaller number of anterior teeth contacts and larger incisor overjet compared to the conventional approach. Considering the surgery-first approach, the cleft cohort presented significantly (all p < 0.05) larger (canine lateral overjet parameter) and smaller (incisor overjet, maxillary intercanine distance, maxillary intermolar distance, ratio of intercanine distance, and ratio of intermolar distance parameters) values than the noncleft cohort. This study contributes to the literature by providing 3D quantitative data of the surgical-occlusion setup in surgery-first cleft-orthognathic surgery, and delivers information that may assist multidisciplinary teams to adopt the surgery-first concept to optimize cleft care.

Highlights

Cleft lip, with or without a cleft palate, is the second most common global birth defect, affecting 1.7 in every 1000 births [1]
Demographics, orthodontic-surgical, and cone beam computed tomography (CBCT) scan data were retrieved from the Craniofacial Research Center database
All patients were treated by two-jaw orthognathic surgery, with no intraoperative problems with the 3D-printed final-occlusion splints

Summary

Introduction

With or without a cleft palate, is the second most common global birth defect, affecting 1.7 in every 1000 births [1]. The dental arches of patients with clefts have been orthodontically prepared before OGS [10,11] This conventional orthognathic pathway (or orthodontics-first approach) involves complete dental management, including 7–47 months of presurgical therapy for correction of dental compensation, arch alignment, maxillary-and mandibular-arch coordination, and the leveling of accentuated occlusal-plane discrepancies [11,12,13]. This therapeutic method has been associated with prolonged overall treatment time [12,13,14]

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