Double-jaw Surgery Research Articles

Surgery first orthognathic approach: a case series of 3D planning and pre-bent plates in patients with single- and double-jaw surgeries

Surgery first orthognathic approach: a case series of 3D planning and pre-bent plates in patients with single- and double-jaw surgeries

Impact of the orofacial muscular rehabilitation exercise on facial expression recovery post-orthognathic surgery

ObjectiveThis study aimed to evaluate the impact of myofunctional rehabilitation of the orofacial muscles through specific exercises on the recovery of facial expression in patients following orthognathic surgery. Material and MethodsThe study included 62 patients who underwent Le Fort I and sagittal split ramus osteotomy (SSRO). Patients were divided into two groups: the first group started immediate post-operative myofunctional rehabilitation of the orofacial muscles through specific exercises. In contrast, patients in Group II did not undergo any myofunctional rehabilitation post-operative exercises. The recovery of facial expressions postoperatively was evaluated in both calm and smiling states by comparing the differences between 3D facial scanning data of chosen facial anatomical structures collected at five key time points: pre-surgery (D0), 2 days (D2), 14 days (D14), 1 month (D30), and 3 months (D90) postoperatively. ResultsThe analysis revealed that characteristic angles and lengths experienced significant changes post-surgery, with ∠chRnchL and ∠chRsnchL decreasing at D2 and normalizing by D30 in the experimental group, while the control group showed a slower recovery, normalizing by D90. The ChL-R length decreased at D2, returning to normal by D30 in the experimental group and D90 in the control group. The height Li-Ls increased at D2 and normalized by D30 in calm and smiling expressions across single and double jaw surgery patients. These findings underscore the more rapid recovery in the experimental group compared to the control group (P < 0.05; P < 0.005; P < 0.0001). ConclusionInitiating myofunctional rehabilitation immediately following orthognathic surgery enhances facial muscle function recovery, improves patient confidence, and expedites social reintegration. This approach is crucial for functional and psychological benefits.

Assessment of mandibular bony healing, mandibular condyle and angulus after orthognathic surgery using fractal dimension method.

This study aims to compare the trabeculation changes in the bone structure observed at the mandibular osteotomy line and the mandibular condyle in patients after single and double-jaw orthognathic surgery. The study included 38 patients (23 female, 15 male) who underwent mandibular surgery with bilateral sagittal split ramus osteotomy technique. The patients were divided into two groups according to their surgical operation: single-jaw (bilateral sagittal split ramus osteotomy) or double-jaw (Le Fort I osteotomy and bilateral sagittal split ramus osteotomy) surgery. Trabecular changes seen in mandibular osteotomy lines, mandibular condyle and mandibular angulus were evaluated on panoramic radiographs of patients (preoperative, postoperative 2nd day, postoperative 3rd month and 12th month) using fractal analysis method. Fractal dimension analysis was calculated by box counting method. No statistically significant difference was found between the fractal analysis values in the mandibular condyle and angulus region preoperatively, postoperative 2nd day, postoperative 3rd month and postoperative 12th month in the single jaw group. There was no statistically significant difference between the fractal analysis values in the mandibular condyle and angulus region preoperatively, postoperative 2nd day, postoperative 3rd month and postoperative 12th month in the double jaw group. A significant difference was found in fractal analysis values in osteotomy lines in both groups. The lowest value was found on the 2nd postoperative day and reached the preoperative values in the 3rd and 12th months postoperatively. Fractal analysis values didn't show significant difference between the single, double-jaw groups in all periods. This result suggests that the fractal analysis method can be used to evaluate trabeculation in the bone healing process of the osteotomy lines and indirectly affected areas in the postoperative period after orthognathic surgery.

Stability of skeletal class III surgical treatment. Affect of high condylectomy

Purpose: To evaluate the role of high condylectomy on surgical treatment stability of Class III patients with condylar hyperplasia. Materials and Methods: Twenty-four patients (9 females and 15 males) were paired according to gender, age, skeletal and dental characteristics in three groups. Group 1 (no condylar hyperplasia) underwent orthognathic surgery only, Group 2 (with unilateral or bilateral condylar hyperplasia) underwent high condylectomy, articular disc repositioning and orthognathic surgery in the same procedure and Group 3 (with unilateral or bilateral condylar hyperplasia) underwent orthognathic surgery only. Lateral cephalometric radiographs were selected at the immediately before surgery (T1), immediate after surgery (T2) and longest follow-up (T3). Results: Cephalometric comparison between the 3 groups showed no significant differences among the variables at the initial observation period (T1). During the observational period (T3-T2), patients in Group 3 showed significant relapse at SNB (mean = 2.18, sd = 1.39 degrees), ANB (mean = -2.68, sd = 2.24 degrees), SN.Pog (mean = -1.48, sd = 1.66 degrees), OJ (mean = -2.99, sd = 1.64 mm), OB (mean = 1.45, sd = 1.16 mm), Ar-Go (mean = 2.23, sd = 2.66 mm), Ar-Gn (mean = 3.76, sd = 1.48 mm), S-Gn (mean = 2.3, sd = 2.34 mm) and ANS-Me (mean = 2.06, sd = 2.2 mm) demonstrating that treatment adopted was insufficient for stable results within this Group. Groups 1 and 2 remained stable one year after surgery. Conclusions: Orthognathic surgery for correction of skeletal class III malocclusion is a stable procedure for patients without condylar growth abnormalities and for patients undergoing simultaneous high condylectomies and articular disc repositioning. Those patients with preoperative condylar hyperplasia who underwent double-jaw surgery and no TMJ intervention experienced significant relapse.

Efficacy of Tenoxicam, Paracetamol, and Their Combination in Postoperative Pain After Double-Jaw Surgery.

Introduction Orthognathic surgical procedures include a series of surgical operations in which interventions are applied to the maxilla, mandible, or both for occlusal or aesthetic concerns due to facial skeletal development deformities. Double-jaw surgeries have the highest pain scores, in which both maxilla and mandible bones are intervened. This study aimed to compare the efficacy of individual applications of paracetamol and tenoxicam with their combined application on postoperative pain and opioid consumption in patients undergoing double-jaw surgery. Methods In this randomized, double-blind study, 60 patients undergoing double-jaw surgery were allocated into three groups, with each having 20 patients: the paracetamol group, the tenoxicam group, and the paracetamol-tenoxicam combination group. Pain intensity was evaluated using the visual analogue scale (VAS) at intervals of 30 minutes, 60 minutes, 120 minutes, and again at the 24th postoperative hour. Additionally, the consumption of opioids and other rescue analgesics was documented over the 24-hour postoperative period. Results The VAS values at 30 minutes, 60 minutes, and 24 hours were lower in the paracetamol-tenoxicam group compared to the other groups (p<0.001). The need for a rescue analgesic drug in the first 24 hours was not observed in the tenoxicam and paracetamol-tenoxicam groups. Conclusion It was concluded that both tenoxicam and paracetamol-tenoxicam combinations, especially the tenoxicam-paracetamol combination, were good options for postoperative analgesia in patients with double-jaw surgery.

How Similar are the Dentoskeletal Characteristics of Class III Double-Jaw Surgery Patients with Ideal Post- Treatment Profiles and Class I Subjects?

To define the dental and skeletal characteristics of Class III surgery patients with ideal final soft-tissue profiles, and to compare them with those of Class I subjects. Also, to show how soft-tissues respond to surgical jaw movements and contribute to the outcome. This short-term, retrospective study was conducted using pre-treatment (T0), pre-surgery (T1), and post-treatment (T2) records of 50 double-jaw Class III surgery patients who presented with ideal cephalometric characteristics in sagittal (Holdaway and soft-tissue convexity angles) and vertical dimensions (GoGn. SN angle and upper-to-lower face harmony) at the end of treatment, and 50 control subjects. At T2, the horizontal distance between the vertical reference plane (a perpendicular plane to the horizontal reference plane that is angulated 7° clockwise to the SN plane) and hard-tissue A, B and Pog points, lower lip, soft-tissue B, and pogonion points were greater, Wits appraisal was more negative, U1.PP was higher, IMPA was lower, and soft-tissue chin (Pog-Pog') was thicker in Group 1 when compared to Group 2 (p<0.05). Moreover, upper lip and subnasal (A-A') thicknesses were decreased, and chin thickness (Pog-Pog') was increased significantly (p<0.05). Dentoskeletal characteristics of an ideally-treated Class III surgery patient differed from a Class I subject concerning a protrusive maxilla and soft-tissue pogonion, and incisors that were not fully-decompensated. Soft-tissues hindered the actual surgical correction to 66% and 73% in the mid- and lower-faces, respectively.

The impact of orthognathic surgery on quality of life for class III dentofacial deformities

In this study, we aim to evaluate the quality of life in patients with Class III deformities after orthognathic surgery. A total of the 40 patients (26 female and 14 male) were included. The mean age of the patients was 24.85. Patients' ages ranged from 20 to 36 years. All patients received orthodontic treatment before surgery. Sagittal split ramus osteotomy was performed for single jaw patients. Le Fort I osteotomy and sagittal split ramus osteotomy was performed for double jaw patients. Patients completed the Oral Health Impact Profile 14 (OHIP-14) and Orthognathic Quality of Life Questionnaire (OQLQ) three times. [Preoperatively (T0), 1st week after orthognathic surgery (T1) and in the 6th - 12th months after orthognathic surgery (T2)]. There was a statistically significant difference in the dimensions of OHIP-14 when the preoperative (T0) score, postoperative 1st week (T1) score and postoperative 6th - 12th month (T3) score are compared among themselves except for psychological discomfort, physical disability, and handicap. OQLQ total score and preoperative (T0) score was greater than the postoperative 1st week (T1) score and the postoperative 1st week(T1) score was greater than the postoperative 6th - 12th month (T2) scores except oral function. When single jaw and double jaw surgeries were compared, no statistically significant difference was found between OHIP-14 and OQLQ total scores for preoperative, postoperative 1st week, and postoperative 6th - 12th months. When both OHIP-14 and OQLQ scores were examined after orthognathic surgery, the OHRQOL of patients with Class III dentofacial deformity improved significantly.

Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database

Orthognathic surgery (OS) is a frequently performed procedure for the correction of dentofacial deformities and malocclusion. Research on OS is mostly limited to single-surgeon experience or single-institutional reports. We, therefore, retrospectively analyzed a multi-institutional database to investigate outcomes of OS and identify risk factors for peri- and postoperative complications. We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008-2020) to identify patients who underwent OS for mandibular and maxillary hypo- and hyperplasia. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. We also evaluated risk factors for complications. The study population included 674 patients, 48% of whom underwent single jaw surgery, 40% double jaw surgery, and 5.5% triple jaw surgery. The average age was 29 ± 11 years, with an equal gender distribution (females: n = 336; 50%, males: n = 338; 50%). Adverse events were relatively rare, with a total of 29 (4.3%) complications reported. The most common surgical complication was superficial incisional infection (n = 14; 2.1%). While the multivariable analysis revealed isolated single lower jaw surgery (p = 0.03) to be independently associated with surgical complication occurrence, it also identified an association between the outpatient setting and the frequency of surgical complications (p = 0.03) and readmissions (p = 0.02). In addition, Asian ethnicity was identified as a risk factor for bleeding (p = 0.003) and readmission (p = 0.0009). Based on the information recorded by the ACS-NSQIP database, our analysis underscored the positive (short-term) safety profile of OS. We found OS of the mandible to be associated with higher complication rates. The calculated risk role of OS in the outpatient setting warrants further investigation. A significant correlation between Asian OS patients and postoperative adverse events was found. Implementation of these novel risk factors into the surgical workflow may help facial surgeons refine their patient selection and improve patient outcomes. Future studies are needed to investigate the causal relationships of the observed statistical correlations.

Pediatric Orthognathic Surgery: A NSQIP-P Comparison of Peri-Operative Factors and Outcome Differences Between Cleft and Noncleft Patients.

The present study aimed to investigate the risk factors, complication profiles, and clinical outcomes of cleft and noncleft patients undergoing single jaw (mandibular or LeFort 1) and bimaxillary (BSSO + LeFort 1). Retrospective Cross-sectional Study Setting: National Surgical Quality Improvement Program database 2018-2019. Pediatric patients. Outcomes for mandibular, LeFort 1, and bimaxillary osteotomy were retrospectively evaluated for cleft and noncleft patients. Multivariate logistic regression was used to determine the odds of complications and length of stay for cleft and noncleft patients undergoing single jaw and double jaw surgery. 669 pediatric patient underwent orthognathic surgery in the study period; the majority received LF1 only (n = 385; 58.3%), followed by mandible only (n = 179; 27.1%), and bimaxillary (n = 105; 15.9%%). Cleft differences were present in 56% of LFI patients, 32% of mandibular patients, and 22% of bimaxillary patients. After multivariate adjustment, ASA class III was associated with nearly 400% increased odds of any complication including readmission and reoperation (OR = 5.99; CI [[1.54-23.32]], p < 0.01, and 65% increased LOS (β-coefficient = 1.65, CI [1.37-1.99], p < 0.01). Presence of cleft was not significantly associated with odds of any complication (p = 0.69) nor increased LOS (p = 0.46) in this population. Complications remained low between surgery types among cleft and noncleft patients. The most significant risk factor in pediatric orthognathic surgery was not the presence of cleft but rather increased ASA class. Though common in patients seeking orthognathic surgery, cleft differences did not cause additional risk after adjustment for other variables.

Determining Morbidity of Adding Genioplasty to Bimaxillary Orthognathic Surgery.

Patients with dentofacial anomalies may undergo orthognathic surgery to address functional and aesthetic concerns. Past works have evaluated determinants affecting length of stay (LOS) in patients undergoing upper and/or lower jaw surgery alone. No studies have assessed the addition of genioplasty to double-jaw (Lefort I, bilateral sagittal split osteotomy (BSSO))) surgery and its effect on LOS and other outcomes. This study investigates whether the addition of genioplasty incurs additional morbidity to patients undergoing complex orthognathic surgery. This was a retrospective cohort study of patients undergoing orthognathic surgery at Yale-New Haven Hospital. Clinical and demographic information were compared across the "double"- and "triple"-jaw cohorts with t tests and Chi-squared analyses. Multivariable linear and logistic regression analyses were utilized to assess the impact of genioplasty when controlling for baseline patient differences. A total of 27 patients received Lefort I and BSSO (double-jaw), and 224 received Lefort I, BSSO, and genioplasty (triple-jaw). Six (22.2%) double-jaw patients were segmental and fifty-eight (25.9%) triple-jaw patients were segmental (p > 0.05), during the study period. Triple-jaw surgery was associated with increased operative time (+ 41.1min, p < 0.01). There was no increase in LOS, postoperative nausea and vomiting, opioid use, hematoma, or infection (p > 0.05). This study attempted to determine if triple-jaw surgery could influence patients' LOS and other surgical outcomes compared to double-jaw surgery. Only the operative time was significantly affected. This indicates that incorporation of a genioplasty can provide aesthetic benefit without incurring significant additional morbidity to the patient. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of patient satisfaction with pharyngeal airway changes after orthognathic surgery in patients with Class III skeletal anomalies.

The aims of our study were to determine the changes in the pharyngeal airway after treating patients with Class III malocclusion who received double jaw surgery, to determine the hard tissue and soft tissue parameters and the hyoid bone and tongue positions after surgery, to determine the changes to compare the pretreatment and post-treatment measurements of the patients in the double jaw group with the measurements of the control group patients, and to evaluate postoperative patient satisfaction. The study included thirty-two Class III adult patients that received double jaw surgery and twenty-five Class I patients. Cephalometric records were taken before treatment (T1) and after treatment (T2). After double jaw orthognathic surgery, there were statistically significant changes in all pharyngeal airway linear and areal parameters (p<0.001). There were significant superior and posterior movements of the tongue and hyoid bone post-surgery. The post-treatment analysis of the double jaw surgery group and control group were compared, with statistically significant differences in the mandibular dental parameters and pharyngeal airway measurements in patients in the double jaw surgery group. Despite the narrowings detected, high satisfaction scores were observed in the patient satisfaction questionnaire and the patients did not experience respiratory problems.

Correlation between levels of patient satisfaction and the value of cephalometric skeletal analysis in post-orthognatic surgery patients

Objective: The purpose of this study was to analyze the level of patient satisfaction after orthognathic surgery and the correlation between the patient satisfaction level after orthognathic surgery and the results of the cephalometric skeletal analysis. &#x0D; Material and Methods: This study were patients who had orthognathic surgery either BSSO, Osteotomy Le Fort 1, or Double Jaw Surgery. First, the subjects filled out a questionnaire about patient satisfaction after orthognathic surgery, the second was taking cephalometric radiographs which were then analyzed by the Steiner method by measuring the angles of SNA, SNB, ANB, and GoGN-SN.&#x0D; Results: The results of the study on 10 research subjects showed that all questionnaire scores were in the "satisfied" category. Cephalometric skeletal analysis of all cephalograms showed 50% normal SNA angle, 10% normal SNB angle, 80% normal ANB angle, and 90% normal GoGN-SN angle. The Concordal Kendall test results show the correlation coefficient value of 0.534 or 53.4%.&#x0D; Conclusion: On average, patients are very satisfied with the orthognathic surgery they have undergone. There is a correlation between the level of patient satisfaction after orthognathic surgery and the results of the cephalometric skeletal analysis.

4th industrial revolution in Orthognahtic surgery

Historically, the emergence of new technologies has had a major impact on industries as a whole. The field of orthodontic surgery was no different, especially with the advent of computers in the 20th century, oral andmaxillofacial surgeons and orthodontists were able to make more accurate and precise diagnoses, resulting inimproved results of double jaw surgery. In this manuscript, I will introduce some studies on how robots and artificial intelligence, which are said to be two new technologies in the era of the 4th industrial revolution, are being applied to the field of orthognathic surgery.

Evaluation of Nasal Tip Projection and Rotation of Nasal Tip after Orthognathic Surgery by Using Goode's Method.

The aim of this study was to evaluate the projection and rotational tipping(upturning) changes in the nose after orthognathic surgery by using the Goode Method. In this retrospective study, 21 adult patients (12 males, 9 females) who had double jaw surgery (Lefort I Maxillary Advancement and Impaction + Mandibular Setback) were evaluated by using Goode's method(nasal projection) and by evaluation of NLA(Nasolabial Angle)(Nasal rotation) on pre-op and post-op standardized photographs. There was no statistically significant difference between NLA baseline and outcome mean values (p: 0.519), while there was a statistically significant difference between Goode ratios baseline and outcome values (p: 0.025). There was no statistically significant relationship between NLA values and Goode ratios changes and, age, Maxillary Advancement, Impaction and Setback. Gender did not have an effect on the changes of NLA values and Goode ratios. The results of this study presented significant sagittal direction nasal changes in the form of nasal tip protrusion after double jaw surgery, while no statistical effect was found on nasal tip rotation in the vertical direction.

Vertical bony step between proximal and distal segments after mandibular setback is related with relapse: A cone-beam computed tomographic study

Vertical bony step (VBS) occurs between proximal and distal segments of the mandible during mandibular setback surgery with bilateral sagittal split ramus osteotomy. The purpose of this study was to investigate whether VBS is correlated with the relapse of mandibular setback using 3-dimensional models constructed from cone-beam computed tomography. The subjects consisted of 30 patients who underwent bilateral sagittal split ramus osteotomy for a mandibular setback. Double jaw surgery was performed in 18 patients, and isolated mandibular setback surgery was performed in 12 patients. Cone-beam computed tomography scans were taken at pretreatment (T0), postsurgery (T1), and posttreatment (T2). Treatment changes and the correlations between measurements were evaluated. The mean mandibular setback was -11.9 mm, and the mean VBS was -5.6 mm. Correlations with the relapse of mandibular setback were found in the amount of mandibular setback (T1 - T0), development of VBS (T1 - T0), posterior movement of the proximal segment (T1 - T0), counterclockwise rotation of symphysis (T2 - T1), and the resolution of VBS (T2 - T1). The development and resolution of VBS were correlated with the relapse of mandibular setback. Minimizing VBS is recommended to reduce the relapse of mandibular setback.

Clinical feasibility evaluation of digital dental articulation for three-piece maxillary orthognathic surgery: a proof-of-concept study

Digital dental articulation for three-piece maxillary orthognathic surgery is challenging. The purpose of this proof-of-concept study was to evaluate the clinical feasibility of a newly developed mathematical algorithm to digitally establish the final occlusion for three-piece maxillary surgery. Five patients with jaw deformities who had undergone a three-piece double-jaw surgery that was planned virtually were randomly selected for this study. The final occlusion had been hand-articulated using stone casts, scanned into the computer and used in the surgery. These hand-articulated occlusions served as the control group. To form the experimental group, the three-piece maxillary dental arch was articulated again automatically from the patient’s original occlusion using the mathematical algorithm. The hand- and algorithm-articulated occlusions were then evaluated qualitatively by two experienced orthodontists. A quantitative evaluation was also performed. The results of the qualitative evaluation showed that all of the three-piece occlusions, hand- and algorithm-articulated, were clinically acceptable based on the American Board of Orthodontics grading system. When compared, two of the algorithm-articulated occlusions were clearly better (40%), one was the same (20%), and two were slightly worse (40%) than the hand-articulated occlusions. All of the quantitative measurements were comparable between the two articulation methods. In conclusion, the results of this study demonstrate that it is clinically feasible to digitally articulate the three-piece maxillary arch to the intact mandibular dental arch.

Skeletal Class III Treated with Double Jaw Surgery: A Case Report

Skeletal Class III Treated with Double Jaw Surgery: A Case Report

Genel Anestezi Altındaki Ortognatik Cerrahi Prosedürlerinin Perioperatif Olarak Değerlendirilmesi: Retrospektif Bir Çalışma

Objective: The reconstruction of dentofacial deformities via orthognathic surgery is one of the procedures in oral and maxillofacial surgery. Several complications can occur-related to general anesthesia and prolonged operating time. The aim of this study was to investigate the effect of type of the skeletal deformity and the type of orthognathic surgery on anesthesia-related complications. Two hundred and two patients who underwent orthognathic surgery under general anesthesia were evaluated retrospectively. Material and Methods: According to inclusion criteria, 114 patients were included in the study. The patients were divided into two groups according to their surgical operations as single jaw (n=41) and double jaw (n=73) surgery. Ninety seven patients have skeletal Class 3 deformity and 17 patients have Class 2 deformity. The incidence of intraoperative surgical complications, duration of surgery, intubation difficulty, blood transfusion, postoperative intensive care and/or usage of additional medication were descriptively analyzed. Anesthesia-related complications were statistically compared between the groups. Results: The most common surgery-related complication was bad split. The incidence of life-threatening complications such as extensive blood loss or pulmonary edema was slightly higher in skeletal Class 2 patients and in double jaw surgery group. Although there was no statistically significant difference between the groups, both Mallampati score and difficult intubation scores were higher in skeletal Class 2 groups. Conclusion: Surgeon should be aware of prolonged surgery time can increase the complication risk while anesthesiologist should be aware of the Class 2 skeletal deformity-related intubation difficulties.

Correction of Severe Skeletal Class II High Angle with Mandibular Retrusion and Gummy Smile by Double-Jaw Surgery.

This report describes the treatment of severe skeletal Class II malocclusion in a young woman with a gummy smile and pronounced lower anterior facial height. Overjet and overbite were +12.0 mm and -1.0 mm, respectively. Cephalometric analysis revealed inferior positioning of the maxilla and severe mandibular retrusion with clockwise rotation. Both the upper and lower anterior teeth showed labial inclination. Based on a diagnosis of a skeletal Class II high angle with mandibular retrusion and a gummy smile, double-jaw orthognathic surgeries for upper and lower premolar extraction were chosen to gain ideal occlusion and an improvement in the esthetic facial profile. Le Fort I osteotomy was performed to move the anterior and posterior teeth upward by 4.0 mm and achieve mandibular counterclockwise rotation. Short lingual sagittal split ramus osteotomy was performed to move the mandible forward by 3.0 mm. As a result, normal overjet and overbite were achieved together with a straight profile and a good smile. After surgery, electromyographic evaluation of anterior temporal muscle activity showed an improvement in the percentage overlapping coefficient value (a symmetric index of bilateral muscle activity) from 28.1% to 63.2% compared to at pre-treatment. The pattern of jaw movement also showed an improvement. These results suggest that orthognathic surgery in skeletal Class II cases can improve not only malocclusion and the skeletal relationship of the jaws, but also masticatory function and jaw movement.

Utilizing virtual surgical planning and orthognathic surgery to correct severe facial asymmetry without orthodontic treatment

Combining double-jaw surgery and orthodontic treatment to correct dentofacial asymmetry is a standard procedure but time consuming and costly. In order to provide alternative solutions, previewing the possible results with precise virtual surgical planning (VSP) system can help clinicians select patients suited for correcting facial asymmetry surgically without orthodontic treatment. In our experiences, after rigid or semirigid fixation of the maxilla, using intermaxillary fixation (IMF) without mandibular bony fixation is another key. This kind of fixation can minimize the chances of changing the condylar position and occlusion after the rotation of the maxillomandibular complex. If the original occlusion can be maintained, then orthodontic treatment can be avoided. Here we presented two facial asymmetry cases who requested surgical correction and refused orthodontic treatment. With careful preoperative planning using VSP, double-jaw surgery with maxillary bony fixation and IMF was conducted and both patients were satisfied by their aesthetic outcomes. With minimal dental compensation, the long-term results were relatively stable.