Combined Orthognathic Surgery Research Articles

Simultaneous Orthognathic Surgery With Asian Double Eyelid Suture Blepharoplasty.

The main objective of contemporary orthognathic surgery is to correct dentofacial deformities. Nonetheless, many adjunct procedures to enhance the esthetic outcome in orthognathic surgical cases have been successfully incorporated to improve patient satisfaction. The authors report our preliminary experience of performing simultaneous orthognathic surgery with Asian double eyelid suture method blepharoplasty in the same surgical setting. This case series report includes all 19 consecutive cases presenting to the Chang Gung Craniofacial Center for combined orthognathic surgery with Asian double eyelid suture method blepharoplasty. The double eyelid crease height was measured as the vertical line between the upper eyelid margin (eyelid lash) and the upper eyelid crease, observed at the mid-pupillary line with the eyes in primary gaze. There were no complications or relapse reported within this time period. There was significant improvement in the left and right mid-pupillary double eyelid crease height postsurgery. There were no statistically significant differences between the left and right mid-pupillary double eyelid crease heights after surgery indicating good eyelid crease height symmetry bilaterally was obtained. Orthognathic surgery combined with suture method blepharoplasty can be safely performed in the same surgical setting without inappropriate rise in costs or operating room time. This case series demonstrates that excellent esthetic results can be obtained in simultaneous bimaxillary orthognathic surgery with suture method Asian blepharoplasty.

Submental intubation in combined orthognathic surgery and rhinoplasty

Submental intubation in combined orthognathic surgery and rhinoplasty

Volumetric Analysis of Fat Injection by Computerized Tomography in Orthognathic Surgery: Preliminary Report on a Novel Volumetric Analysis Process for the Quantification of Aesthetic Results.

Integrated approaches to orthognathic surgery should include accurate volumetric evaluation of the skull and soft tissues. In patients with dentofacial deformities, the most frequent aesthetic deficits are attributable to an underdevelopment of hard and soft tissues. Traditional osteotomic procedures often fail to guarantee a stability of soft tissues over time. For this reason, in selecting a surgical strategy, the surgeon should consider not only traditional osteotomies, but also soft-tissue improving procedures, such as lipofilling. Preoperative surgical planning systems, such as the Virtual surgical planning (VSP) protocol, are based mainly on skeletal movement prediction. Quantitative estimation of soft-tissue modifications is not part of common clinical practice. Most commonly, the evaluation of soft-tissue modifications after orthognathic procedures is instead performed by clinical qualitative means.The purpose of this study was to describe a novel computed tomography (CT)-based volumetric analysis process for the quantification of injected autologous adipose tissue in patients who have undergone simultaneous orthognathic and lipofilling procedures. This was a retrospective review of consecutive patients who underwent combined orthognathic surgery and lipofilling from June 2016 to May 2017 for malocclusion with functional and aesthetic impairments. Preoperative planning included clinical evaluation and virtual osteotomy planning according to the VSP protocol. The volume of fat to be injected was estimated clinically by comparing virtual renderings with preoperative clinical photographs. The surgical technique involved Le Fort I and sagittal split mandibular osteotomies, combined with autologous fat injection in the malar and perioral regions. Postoperative evaluation was performed with a novel imaging process based on CT image segmentation to quantify the exact volume of injected fat. Skeletal stability was also evaluated at 3 months. Sixteen patients were enrolled in the study, all females, with a mean age of 24.5 years (range, 18-36 years). The mean difference between the fat tissue injected and that quantified postoperatively was 6.01 cm. All patients had clinically satisfactory facial convexity, with complete restoration of the cheekbone contour, at 3 months. This study introduces a novel CT-image based technique to quantitatively assess the contribution of injected fat to the postoperative soft-tissue volume increase after combined orthognathic surgery with autologous lipofilling. In the future, this CT-based volumetric analysis technique could be the gold standard for evaluating facial lipofilling outcomes, and for assessing clinical aesthetic outcomes based on the injected volume of fat.

Influence of Electroacupuncture and Laser-Acupuncture on Treating Paresthesia in Patients Submitted to Combined Orthognathic Surgery and Genioplasty.

Objective: The goal of this research was to observe the influence of electroacupuncture (EA) and laser-acupuncture on the return of tactile/pain sensitivity in patients who underwent orthognathic surgery. Materials and Methods: Thirty volunteers subjected to orthognathic surgery were evaluated and randomly divided into 2 groups, in which 3 treatments were evaluated: control (n = 30) (G0, medication + placebo laser treatment) and 2 experimental treatments (n = 15) (G1, medication + EA) or G2 (medication + laser-acupuncture). The control group had n = 30 because for each experimental treatment conducted on a volunteer's hemi-face, there was a control treatment on the other hemi-face. In G1, medication was given with EA, with needles placed at predetermined points (ST 4 [Dicang], M-HN-18 [Jiachengjiang], CV 24 [Chengjiang], ST 5 [Daying], ST 6 [Jiache], and point A1 [YNSA]). For electrostimulation, the device used delivered transcutaneous electrical nerve stimulation of a burst type, with intensity and frequency variations of T = 220 ms and F = 4 Hz (30 minutes, 2 × /week). In G2, in addition to the medication, laser irradiation (at 780 nm) was applied on acupuncture points (at 0.04 cm2, 70 mW, 6 s/point, 0.42 J/point, 10 J/cm2, 2 × /week). All volunteers were evaluated before and during the 4 months following the surgery. Tactile sensitivity was assessed by mechanical brushing (brush #s 2 and 12) and by a 2-point discrimination test, using a bow compass. A pain test was performed with a pulp electrical test that stimulates intact nerves of the dentin-pulp complex. A Kaplan-Meier test was performed, and survival curves were plotted for comparison between groups. Cox regression analysis was also conducted (α = 0.05). Results: There were no statistically significant differences among the groups for the 2-point discrimination test (brushes #2 and #12) on the buccal mucosa region and for the pulp test on all evaluated regions. However, the tactile test using brush #12 revealed significant differences between G1 and the other groups when considering the lower lip (P = 0.024) and chin (P = 0.028) areas. Conclusions: Only EA was able to influence-using the brushing test (brush #12)-the return of tactile sensitivity on the chin and lower lip positively after combined orthognathic surgery and genioplasty.

Orthognathic Surgery with Simultaneous Autologous Fat Transfer for Correction of Facial Asymmetry.

Most patients treated with orthognathic surgery for facial asymmetry would value improvement in residual soft-tissue asymmetry. Autologous fat transfer is widely used to augment facial soft tissue. The authors assessed the effect of combining orthognathic surgery with autologous fat transfer for treating patients with facial asymmetry. In this retrospective study, 15 consecutive adults underwent combined orthognathic surgery and autologous fat transfer between January of 2013 and December of 2015. Lower facial profile symmetry was assessed using postoperative standard frontal photographs. Lower facial symmetry was much improved by combining orthognathic surgery and autologous fat injection. The combined use of orthognathic surgery and autologous fat transfer is a promising technique for improving facial symmetry in patients with facial asymmetry. Therapeutic, IV.

Correction of facial asymmetry associated with vertical maxillary excess and mandibular prognathism by combined orthognathic surgery and guiding templates and splints fabricated by rapid prototype technique

Correction of facial asymmetry associated with vertical maxillary excess and mandibular prognathism by combined orthognathic surgery and guiding templates and splints fabricated by rapid prototype technique

Correction of facial asymmetry associated with vertical maxillary excess and mandibular prognathism by combined orthognathic surgery and guiding templates and splints fabricated by rapid prototyping technique

The facial asymmetry associated with vertical maxillary excess and mandibular prognathism is one of the more complicated types in the field of oral and maxillofacial surgery. The purpose of this study was to investigate the efficacy of combined orthognathic surgeries, together with guiding templates and splints fabricated by rapid prototyping technique, for the correction of facial asymmetry. Fourteen patients with facial asymmetry associated with vertical maxillary excess and mandibular prognathism were included. A maxillary Le Fort I osteotomy, a sagittal split ramus osteotomy on the shorter side of the face, and an intraoral vertical ramus osteotomy on the longer side of the face were performed with the aid of guiding templates and splints fabricated by rapid prototyping technique. Parameters reflecting maxillary canting, ramal inclination, mandibular deviation, and chin inclination were measured before surgery, 7 days after surgery, and 1 year after surgery, and compared. Significant differences in these parameters were found between the two sides preoperatively, whereas no differences were observed postoperatively. Facial asymmetry was corrected in all patients with satisfactory outcomes. In conclusion, combined orthognathic surgery and guiding templates and splints can offer improvements in accuracy, complexity, and duration over traditional procedures for the correction of facial asymmetry associated with vertical maxillary excess and mandibular prognathism.

Cephalometric evaluation of the predictability of bimaxillary surgical-orthodontic treatment outcomes in long face pattern patients: a retrospective study

The aim of this study was to compare by means of McNamara as well as Legan and Burstone's cephalometric analyses, both manual and digitized (by Dentofacial Planner Plus and Dolphin Image software) prediction tracings to post-surgical results. Pre and post-surgical teleradiographs (6 months) of 25 long face patients subjected to combined orthognathic surgery were selected. Manual and computerized prediction tracings of each patient were performed and cephalometrically compared to post-surgical outcomes. This protocol was repeated in order to evaluate the method error and statistical evaluation was conducted by means of analysis of variance and Tukey's test. A higher frequency of cephalometric variables, which were not statistically different from the actual post-surgical results for the manual method, was observed. It was followed by DFPlus and Dolphin software; in which similar cephalometric values for most variables were observed. It was concluded that the manual method seemed more reliable, although the predictability of the evaluated methods (computerized and manual) proved to be reasonably satisfactory and similar.

Surgical and orthodontic treatment of skeletal Class III featuring severe transversal and sagittal discrepancy

Anterior cross-bite is a difficult malocclusion to treat in adult patients, especially if compounded by skeletal discrepancy. The present study describes a dentoskeletal Class III case and aims to provide the clinician with rational guidelines for presurgical orthodontic preparation and postsurgical finishing. In this case, a 20-year-old male patient, R.M, was treated for severe dental and skeletal Class III malocclusion on both the transversal and anteroposterior planes via combined orthodontics and surgery. Initially, the treatment involved surgically-assisted expansion of the upper jaw (total 1 month), followed by a fixed-orthodontics phase to decompensate for the malocclusion in preparation for movement of the osseous bases with the aim of achieving maximum coordination of the dental arches. After 19 months of orthodontic preparation, the patient underwent combined orthognathic surgery (upper and lower jaws). In the subsequent 4 months, orthodontic stabilization and finishing were performed, and debonding was carried out 24 months after the start of active treatment. The combined orthodontic and surgical treatment adequately corrected the severe Class III over a period of 2 years, leading to a satisfactory occlusal, functional and aesthetic result. Thorough diagnosis and close communication between the orthodontist and maxillofacial surgeon, operating as an interdisciplinary team, ensures good outcomes, even in complex orthodontic and surgical cases.

Lip Competence in Class III Patients Undergoing Orthognathic Surgery: An Electromyographic Study

The aim of this study was to compare the presurgical and postsurgical electromyographic (EMG) activities of the lips in patients with skeletal Class III treated with combined orthognathic surgery and contrast these data with those obtained from a control group with skeletal Class I. Ten patients with skeletal Class III underwent the registration of EMG activity before an orthognathic surgical procedure and 4 months after surgery. The results were compared with a control group of 11 healthy patients with skeletal Class I and clinical and EMG lip competence. EMG activity was recorded from the upper orbicularis oris and mentalis muscles during swallowing, lips in contact (LC), and lips apart (LA) using bipolar surface electrodes. The competence condition was assessed by determining the difference in the EMG activity of the mentalis muscle (LC-LA ≤0 for lip competence). Patients with skeletal Class III showed greater EMG activity than the control group before and after surgery. Patients with skeletal Class III showed a significantly greater difference in LC-LA than the control group before surgery for the 2 muscles (P < .05). No significant difference was found between the skeletal Class III group after surgery and the control group for the mentalis muscle (P > .05). Four months after treatment with orthognathic surgery, patients with skeletal Class III and an initial muscle activity pattern of lip incompetence different from the control group (P < .05) showed EMG values compatible with lip competence. These values were similar to the control group.

Clinical management of angioneurotic edema patient post orthognathic surgery

Angioneurotic edema is an acute swelling involving the submucosal or subcutaneous tissues, being most often located in the oral and maxillofacial region, which can result in upper airway obstruction. Its etiology is frequently associated with immunoglobulin-mediated hypersensitivity reactions that elicit a heightened inflammatory response. The objective of this study was to report the case of a patient who developed an episode of angioneurotic edema following combined orthognathic surgery. Pharmacological and nonpharmacological interventions used in the treatment of this important clinical condition are described and discussed.

Clinical management of angioneurotic oedema patient post-orthognathic surgery

Angioneurotic oedema is an acute swelling involving the submucosal or subcutaneous tissues; it is most often located in the oral and maxillofacial region, which can result in upper airway obstruction. Its aetiology is frequently associated with immunoglobulin-mediated hypersensitivity reactions that elicit a heightened inflammatory response. The objective of this study was to report the case of a patient who developed an episode of angioneurotic oedema following combined orthognathic surgery. Pharmacological and nonpharmacological interventions used in the treatment of this important clinical condition are described and discussed.

ADJUNCTIVE ORTHODONTIC THERAPY IN RESTORATIVE DENTISTRY

This article focuses on the interaction between the orthodontist and other dental specialists to facilitate combined treatment of permanent dentition and mutilated dentition. The importance of careful and precise treatment planning of such malocclusions, including a thorough restorative and periodontal treatment plan, is emphasized. Clinical examples that range from adjunctive minor orthodontic therapy to combined orthognathic surgery treatment are presented.