Mandibular Sagittal Split Osteotomy Research Articles

Effectiveness of hemocoagulase, tranexamic acid, and their combination for reducing blood loss in bimaxillary orthognathic surgery: a retrospective study.

Orthognathic surgery is a corrective intervention for maxillofacial deformities. Bleeding is a major concern for oral and maxillofacial surgeons. Various agents, such as hemocoagulase, tranexamic acid, and aprotinin have been developed to reduce intraoperative bleeding and transfusion requirements. Therefore, in this study we aimed to investigate the effects of hemocoagulase and tranexamic acid, as well as their simultaneous use, to reduce bleeding during orthognathic surgery. Patients and. This retrospective study included patients who had undergone simultaneous orthognathic surgery of the maxilla and mandible between January 2013 and September 2022 and were classified into three groups based on drugs administered: hemocoagulase (Botropase), tranexamic acid, and a combination of both drugs. We recorded patient age, sex, weight, blood loss, and duration of surgery. Red blood cell (RBC), hemoglobin, hematocrit, and platelet levels were measured before, immediately after, and one day after surgery. No statistically significant differences were found in blood loss, RBC, hemoglobin, hematocrit, or platelet levels between any of the groups. There were no differences in the drug effects between Le Fort I and bilateral mandibular sagittal split osteotomies, with or without double genioplasty. However, there were significant reductions in RBC, hemoglobin, hematocrit, and platelet levels during genioplasty. Tranexamic acid, hemocoagulase, and their combination had similar efficacy in patients who underwent Le Fort Ⅰ and bilateral mandibular sagittal split osteotomies with and without genioplasty.

Extensive Tophaceous Pseudogout of the Temporomandibular Joint, Reconstructed with Custom Alloplastic Temporomandibular Joint and Mandibular Sagittal Split Osteotomy

Extensive Tophaceous Pseudogout of the Temporomandibular Joint, Reconstructed with Custom Alloplastic Temporomandibular Joint and Mandibular Sagittal Split Osteotomy

Evaluation of treatment with unilateral mandibular sagittal split ramus osteotomy and maxillary osteotomy in patients with condylar osteochondroma and mandibular asymmetry: A retrospective case series

The aim of the study was to describe an approach where condylar resection with condylar neck preservation was combined with Le Fort I osteotomy and unilateral mandibular sagittal split ramus osteotomy (SSRO).Patients with a unilateral condylar osteochondroma combined with dentofacial deformity and facial asymmetry who underwent surgery between January 2020 and December 2020 were enrolled. The operation included condylar resection, Le Fort I osteotomy and contralateral mandibular sagittal split ramus osteotomy (SSRO). Simplant Pro 11.04 software was used to reconstruct and measure the preoperative and postoperative craniomaxillofacial CT images. The deviation and rotation of the mandible, change in the occlusal plane, position of the “new condyle” and facial symmetry were compared and evaluated during follow-up. Three patients were included in the present study. The patients were followed up for 9.6 months on average (range, 8–12). Immediate postoperative CT images showed that the mandible deviation and rotation and occlusion plane canting decreased significantly postoperatively; facial symmetry was improved but still compromised. During the follow-up, the mandible gradually rotated to the affected side, the position of the “new condyle” moved further inside toward the fossa, and both the mandible rotation and facial symmetry were more significantly improved.Within the limitations of the study it seems that for some patients a combination of condylectomy with condylar neck preservation and unilateral mandibular SSRO can be effective in achieving facial symmetry.

Reconstruction of Dentomaxillofacial Deformity Secondary to Mandibular Defect Using Concomitant Orthognathic Surgery and Fibula Free Flap.

The reconstruction of mandibular defects may be delayed or compromised for many reasons, especially in pediatric patients. With the growth of the remaining mandible and the maxilla in the malocclusion status, secondary dentomaxillofacial deformity is plausible. To treat the concomitant mandibular defect and secondary dentomaxillofacial deformity, a hierarchical algorithm using orthodontics, orthognathic surgery, and fibula free flap was developed. This retrospective case series included six patients with long-term mandibular defects caused by tumor resection without repair or with compromised costochondral reconstruction. All patients were treated using the same staged protocol, but with minor changes: (1) presurgical orthodontics, (2) virtual surgical planning, (3) fabrication of the guides and splints, (4) sequenced operations, and (5) postoperative care. The sequence of surgery included the Le Fort I osteotomy, mandibular sagittal split ramus osteotomy of the remaining ramus, final occlusion registration, repositioning of the distal segment of the mandible, segmented fibula reconstruction, and finally, the fixation of mandibular sagittal split ramus osteotomy. The operations and wound healing were uneventful in all patients, and no flap failure or severe complications were detected. Also, the patients exhibited no signs of temporomandibular joint ankylosis during the follow-up. The subspinale-nasion-supramental angle was significantly reduced after surgery. A significant improvement was detected in the facial contour symmetry measurements postoperatively. This proposed workflow of concomitant orthognathic surgery and the fibula free flap is effective and reliable for the reconstruction of dentomaxillofacial deformity secondary to the long-term mandibular defect.

Comparison of Early Post-Operative Hypoesthesia After a Low and Short or Traditional Sagittal Split Osteotomy

<h3>Purpose</h3> The purpose of this study was to determine if there is a difference in postoperative neurosensory testing (NST) score at 6-weeks between subjects that received a mandibular sagittal split osteotomy (SSO) using a low and short osteotomy (LSO) or traditional osteotomy (TRO). The null hypothesis was that no significant difference exists in post-operative NST score between subjects that received SSO with a TRO or LSO. <h3>Methods</h3> A retrospective chart review was conducted of subjects that received orthognathic surgery by the oral and maxillofacial surgery department at the University of Texas Southwestern Medical Center (UTSW) from 2017 to 2019. All subjects that received SSO by either TRO as defined by Hunsuck and Epker(1,2) or LSO defined by Posnick(3) were included. Subjects with syndromic conditions, prior injury to the inferior alveolar nerve, history of peripheral neuropathy or pain conditions, and those undergoing simultaneous genioplasty, repeat surgery or concomitant temporomandibular joint surgery were excluded. Neurosensory outcomes of the inferior alveolar nerve (IAN) were measured using clinical NST at the pre-operative and 6-week post-operative visit over a 1-centimeter area of the labiomental fold. Chi-squared analysis and t-tests were performed between the cohorts and their respective outcomes. Values of p < 0.05 were considered statistically significant. The primary predictor variable was osteotomy type, and the primary outcome variable was NST score at the 6 weeks post-operative visit. Secondary outcome variable was IAN location within the proximal or distal segment. <h3>Results</h3> A total of 26 subjects met the defined inclusion criteria for a total of 52 osteotomies. There were 32 osteotomies in the LSO group, and 20 in the TRO group. The average age of the LSO group was 23.1 years (SD=10), and the average age of the TRO group was 22.4 years (SD=6). There was no significant difference in age between the two groups (p=0.84). All subjects were NST level A pass bilaterally at the pre-operative visit. No nerve injury was witnessed at the time of surgery among either group. All IANs contained within the proximal segments were left in place. There was no statistically significant difference in NST score between the two groups at the 6-week post-operative visit (p = 0.40). Of the total 52 osteotomies, there was no significant difference between NST score at the 6 weeks post-operative visit in subjects with IAN located in the proximal segment or the distal segment regardless of technique used (p = 0.52). <h3>Conclusion</h3> There is no difference in post-operative NST score at 6-weeks between subjects that received a traditional osteotomy or low and short sagittal split osteotomy. Regardless of technique, there is no difference in post-operative NST score at 6 weeks if the IAN is in the proximal or distal segment after completion of sagittal split.

Finite element analysis between Hunsuck/Epker and novel modification of Low Z plasty technique of mandibular sagittal split osteotomy.

A novel modification of the Low Z plasty (NM-Low Z) technique for bilateral sagittal split osteotomy was recently proposed. The osteotomy line was modified more inferiorly than in the conventional Hunsuck-Epker (HE) approach. The NM-Low Z technique enhances the mandibular setback distance and degree of rotation in severe skeletal discrepancies. This study aimed to investigate the biomechanical behavior under simulated forces, and to compare the NM-Low Z and HE techniques on the mandible with Class III skeletal deformity at 1 week, 3 weeks, and 6 weeks post-operation. Physiological muscular and occlusal loads were simulated using the finite element (FE) method. Stresses on the miniplate, screws, and bone were observed and compared between the two models. The elastic strain at the fracture site was observed for the optimal bone-healing capacity. The NM-Low Z model exhibited a lower stress than the HE model at every stage post-operation. Both models demonstrated elastic strains within the normal range for bone healing. In summary, the biomechanical behavior of the NM-Low Z technique is comparable to that of the conventional EH technique. NM-Low Z could facilitate post-operation skeletal stability by reducing the stress on fixation materials during bone healing.

Changes and Remodeling of Intersegmental Interferences following Bilateral Sagittal Split Ramus Osteotomy in Patients with Mandibular Prognathism

Purpose: This study aimed to measure the amount of change in the mandibular angle, intergonial width, and ramus angulation due to intersegmental interference and changes in condyle position after mandibular bilateral sagittal split ramus osteotomy (BSSRO) in patients with mandibular prognathism and to evaluate the correlation between them. Materials and Methods: A total of 32 patients who underwent mandibular setback using the BSSRO of the mandible to manage skeletal prognathism during the years 2018 to 2020 at the Department of Oral and Maxillofacial Surgery, Pusan National University were followed both clinically and with cone beam computed tomography (CBCT) for at least one year. Those who were also treated with genioplasty or other orthognathic surgery were excluded from the study. The mandibular angle (gonial angle: Ar–Go–Me), intergonial width (Go–Go), and total angle (sum of left and right proximal segmental angle) were recorded. Changes in the ramus were compared and analyzed before surgery (T1), immediately after surgery (T2), and one year following surgery (T3). Results: The mandibular angle increased by an average of 0.14 degrees immediately after surgery (T2–T1) and increased by 0.97 degrees at 12 months postoperatively (T3–T2). No correlation was observed with the amount of change in each group relative to the amount of mandibular setback. The mandibular width decreased by 0.01 mm on average immediately after surgery (T2–T1), and by 4.2 mm on average at 12 months after surgery (T3–T2). The angle of the mesial fragment of the mandible increased by 1.04 degrees immediately after surgery (T2–T1), compared to the preoperative state. It decreased by 0.86 degrees at 12 months postoperatively (T3–T2). Conclusion: The increase in the mandibular angle from immediately after surgery to 12 months after BSSRO reflects the counterclockwise rotational tendency to prevent opening restriction when intentionally selecting the condylar position. The decrease in the intergonial width immediately after surgery is thought to be due to the effect of internal trimming to minimize the bone interference between the outer surface of the distal bone fragment and the inner surface of the mesial fragment, and the decrease 1 year after surgery can be considered to be due to bone remodeling. Interosseous interference during mandibular setback osteotomy does not necessarily cause an increase in the width of the mandibular angle after surgery.

Influence of the mandibular plane and magnitude of the movement in sagittal split ramus osteotomy: an in vitro study.

The aim of this study was to evaluate fixation resistance in mandibular sagittal split ramus osteotomy in standardized polyurethane hemimandibles with two types of advancement (6 and 12mm), with or without mandibular plane rotation, using a 2.0-mm plate/screw system. Seven groups were evaluated using a vertical compressive load in the first molar region, and the applied force in Newtons was recorded in 1mm, 5mm, and 10mm displacements, as well as the maximum force. There was a statistical intergroup difference and it was observed that increasing the advancement decreased fixation resistance with a single plate, and inserting an additional plate significantly increased osteosynthesis resistance. In the 12mm advancements, clockwise rotation proved to be more resistant when fixed with only one plate. By contrast, counterclockwise rotation was significantly more resistant in stabilizing the mandibular sagittal ramus osteotomy when two plates were used.

Virtual Reality and Three-Dimensional Printed Models Improve the Morphological Understanding in Learning Mandibular Sagittal Split Ramus Osteotomy: A Randomized Controlled Study.

Background: The mandibular sagittal split ramus osteotomy (SSRO) is a routine operation performed to correct mandibular deformity including mandibular retrusion, protrusion, deficiency, and asymmetry. The SSRO remains a challenging procedure for junior surgeons due to a lack of adequate morphological knowledge necessary for success in clinical practice. Virtual reality (VR) and three-dimensional printed (3DP) models have been widely applied in anatomy education. The present randomized, controlled study was performed to evaluate the effect of traditional educational instruments, VR models, and 3DP models on junior surgeons learning the morphological information required to perform SSRO.Methods: Eighty-one participants were randomly assigned to three learning groups: Control, VR, and 3DP. Objective and subjective tests were used to evaluate the learning effectiveness of each learning instrument. In the objective test, participants were asked to identify 10 anatomical landmarks on normal and deformed models, draw the osteotomy line, and determine the description of SSRO. In the subjective test, participants were asked to provide feedback regarding their subjective feelings about the learning instrument used in their group.Results: The objective test results showed that the VR and 3DP groups achieved better accuracy in drawing the osteotomy line (p = 0.027) and determining the description of SSRO (p = 0.023) than the Control group. However, there was no significant difference among the three groups regarding the identification of anatomical landmarks. The VR and 3DP groups gave satisfactory subjective feedback about the usefulness in learning, good presentation, and enjoyment. The Control and 3DP groups reported positive feelings about ease of use.Conclusion: The current findings suggest that VR and 3DP models were effective instruments that assisted in the morphological understanding of SSRO-related anatomical structures. Furthermore, 3DP models may be a promising supplementary instrument to bridge the gap between conventional learning and clinical practice.

Clinical Accuracy of Bimaxillary Surgery Completed with Custom Prefabricated Splints vs. Patient-specific Surgical Guides and Plates

Abstract Purpose Virtual surgical planning (VSP) has improved outcomes in bimaxillary orthognathic surgery when compared to traditional cephalometric analysis and model surgery. However, several studies have shown discrepancies between the planned and post-operative position of the maxilla with the use of VSP and splints. Patient-specific Implants (PSIs) have the maxillary movement and final position built into them as dictated by the virtual surgical plan, completely independent of the mandibular position and have shown promising results, but are limited in number and by sample size and no study to date has directly compared the accuracy of splints versus PSIs. The purpose of our study was to determine the accuracy of splints versus PSIs in executing a virtual surgical plan. Materials and Methods A retrospective analysis of patients who underwent bimaxillary orthognathic surgery with splints or PSIs planned with VSP at our institution from 2017 to present was completed. The difference in maxillary positions from the VSP to the post-operative CBCT were evaluated in both cohorts. The primary predictor variable was the planned 3D position of the maxillary mid-incisors, and right and left first molars in the antero-posterior, transverse, and vertical dimensions. The primary outcome variable was the post-operative 3D position of these points. The root mean square deviation (RMSD) was used to calculate the absolute value of the mean differences. A paired t test was used to determine if there were statistically significant differences between the predicted and observed positions with p < 0.05 Results A total of 65 patients (46 female, 19 male) aged 14 to 58 years (mean age, 23.3 years). 10 patients (8 female, 2 male) aged 14 to 54 years (mean age, 24.8 years) underwent bimaxillary surgery with a Le Fort 1 osteotomy and a mandibular sagittal split osteotomy or intraoral vertical ramus osteotomy and were rigidly fixated after the use of a splint to facilitate the final maxillary position, whereas 55 patients (38 female, 17 male) aged 14 to 58 years (mean age, 22.7 years) were rigidly fixated with the use of a PSI. The difference between the planned and actual movements varied in all dimensions in the splint cohort but was greatest in the anteroposterior dimension for all points in the PSI cohort. The only statistically significant differences in pre-operative and post-operative position of the splint group were the mid-incisor transverse and vertical dimensions, whereas all differences in the PSI cohort were found to be statistically significant with the exception of the maxillary right 1st molar in the transverse dimension and the maxillary left 1st molar in the vertical dimension. There was an overall tendency for undertreatment in all directions as shown in the deviation from 0 toward under (-) or over (+) correction, regardless of type of surgery performed. Also, there was no indication that posterior or anterior movements were more or less accurate in either group. The PSI group was more accurate at all 3 maxillary points in all 3 dimensions, ranging from 1% to 62.8% more accurate than the splint group. Conclusion The use of a PSI allows for greater control of the post-operative position of the maxilla when planned via VSP and is more accurate than the use of a splint.

Bilateral Sagittal Split Mandibular Ramus Osteotomy Alters the Temporomandibular Joint.

In this retrospective analysis, we examined temporomandibular joint space volume and condyle position in 10 patients undergoing bilateral sagittal split mandibular ramus osteotomy plus Le Fort I osteotomy to correct mandibular asymmetry. Cone beam computed tomography was used to map temporomandibular joint prior to (T0), immediately after (T1), and at 1 year after surgery (T2). In the deviated side, we detected significant lateral shift of the condyle in 5 patients at T1, and the shift disappeared at T2. In the non-deviated side, we detected significant medial shift of the condyle in all 10 patients at T1; the shift continued in 9 patients at T2. Temporomandibular joint space volume increased significantly at T1 and returned to presurgical volume at T2. In conclusion, there is significant shift in position of condyle in majority of the patients after bilateral sagittal split mandibular ramus osteotomy. The most consistent and persisting change was medial shift on the nondeviated side.

Virtual Surgical Planning Combined With Intraoperative Navigation in Mandibular Bilateral Sagittal Split Osteotomy for Accurate Placement of Patient Specific Implants.

The aim of the study is to evaluate clinical methods to obtain a significantly improved fitting of patient specific implants (PSI) in bilateral sagittal split osteotomies and to evaluate the use of electromagnetic navigation as a potential guide for condyle positioning. A prospective study using (1) a solid bite registration index during preoperative computed tomography, (2) critical planning with regard to the condylar rotation, (3) a piezoelectric saw throughout the mandibular osteotomy, and (4) intraoperative navigation to determine the position of the PSIs and the mandibular segments intraoperatively was performed. Ten patients were treated. Five underwent bilateral sagittal split osteotomies and 5 bimaxillary osteotomy. All of the PSIs fitted precisely onto the mandible and the screws into the predrilled screw holes. The predetermined occlusion was obtained. A precise fitting of the PSIs in the lower jaw seems to be possible to achieve with above-mentioned methods. The intraoperative navigation system gives a possibility to verify the surgical outcome during surgery but is not accurate enough to be used as a virtual drill guide alone.

Color changes of maxillary and mandibular incisors following surgical orthodontic treatment : Aprospective controlled clinical pilot study.

To assess possible color changes of natural teeth after surgical orthodontic treatment. This prospective controlled clinical pilot trial included 6consecutively treated surgical orthodontic patients with classIII malocclusion and neutral vertical relation (ST: surgical treatment), 3of which received double jaw osteotomies (SGI: surgical subgroupI) and 3received single mandibular sagittal split ramus osteotomies (SGII: surgical subgroupII). Eleven untreated individuals (UC: untreated control) and 9individuals who received conventional comprehensive orthodontic treatment only (OC: orthodontic control) served as controls. Tooth color measurements were performed using areflectance spectrophotometer on the upper and lower incisors before the initiation of the surgical orthodontic treatment (T1) and after its completion (T2). Primary endpoint was ∆E* (T1-T2) of summarized CIE-L*a*b* color differences. The null hypothesis of this study was that there is no statistically significant change in total tooth color difference ∆E* CIE-(L*a*b*) in vivo at baseline and following surgical orthodontic treatment. There was a statistically significant increase in ∆E* (T1-T2) in the ST group compared to the UC and OC groups. Single mandibular surgery had astronger effect on the lower teeth in comparison to double jaw surgery, while Le FortI osteotomy, as part SGI, had astronger effect on the upper teeth. Despite statistical significance, the majority of mean values of these color changes were lower than the threshold value of color alterations considered to be perceivable by the naked eye in aclinical setting (3.7 ∆E units), with the exception of the mandibular incisors in SGII, where this threshold value was slightly exceeded. Orthognathic surgery showed ameasurable effect on tooth color. However, esthetic disturbance or patient discomfort based on these color and lightness alterations are unlikely, due to their small impact and low perceptibility in aclinical setting.

Effects of rs958804 and rs7858836 single‐nucleotide polymorphisms of the ASTN2 gene on pain‐related phenotypes in patients who underwent laparoscopic colectomy and mandibular sagittal split ramus osteotomy

BackgroundOpioids are widely used as effective analgesics, but opioid sensitivity varies widely among individuals. The underlying genetic and nongenetic factors are not fully understood. Based on the results of our previous genome‐wide association study, we investigated the effects of single nucleotide polymorphisms (SNPs) of the astrotactin 2 (ASTN2) gene on pain‐related phenotypes in surgical patients.MethodsWe investigated the effects of two SNPs, rs958804 T/C and rs7858836 C/T, of the ASTN2 gene on eight and seven pain‐related phenotypes in 350 patients who underwent laparoscopic colectomy (LAC) and 358 patients who underwent mandibular sagittal split ramus osteotomy (SSRO), respectively. In both surgical groups, intravenous fentanyl patient‐controlled analgesia (PCA) was used for postoperative analgesia, and 24‐hour postoperative PCA fentanyl use was the primary endpoint.ResultsThe association analyses among the two SNPs and pain‐related traits showed that 24‐hour fentanyl use was significantly associated with the two SNP genotypes in both surgical groups. The Mann‐Whitney test showed that 24‐hour fentanyl use was lower in patients with the C allele than in patients with the TT genotype of the rs958804 T/C SNP (P = .0019 and .0200 in LAC and SSRO patients, respectively), and it was lower in patients with the T allele than in patients with the CC genotype of the rs7858836 C/T SNP (P = .0017 and .0098 in LAC and SSRO patients, respectively).ConclusionThe two SNPs of the ASTN2 gene were consistently associated with fentanyl requirements after two different types of surgery. These findings may contribute to personalized pain control.

Do positional changes of the inferior alveolar canal after sagittal split mandibular osteotomy affect neurosensory recovery?

The purpose of this study was to assess the pre- and postoperative position and dimensions of the inferior alveolar canal (IAC) following sagittal split osteotomy (SSO) and identify any association with postoperative neurosensory deficit (NSD) at 1 year. This retrospective cohort study enrolled consecutive patients who had SSO performed to correct skeletal malocclusion. The pre- and postoperative cone beam computed tomography data were superimposed to visualize differences in IAC position and dimensions. Subjective and objective neurosensory tests were used to determine NSD in the inferior alveolar nerve distribution. A total of 20 subjects were included. The preoperative distance from the lateral cortex of the IAC to the inner aspect of the lateral cortex of the mandible was significantly greater in sides with NSD when compared to sides without NSD (P = 0.01). A significantly greater reduction in the postoperative distance measurement was seen in sides with NSD when compared to sides without NSD (P = 0.01). The magnitude of mandibular movement was significantly increased in sides with NSD (P = 0.02). The preoperative location of the IAC, as well as certain changes in the mediolateral and vertical positions as a result of SSO, are risk factors for postoperative NSD.

Severity and long-term complications of surgical site infections after orthognathic surgery: a retrospective study

Surgical site infections (SSI) occur in 1.4% to 33.4% of cases after orthognathic surgery. This type of complication is a major concern to surgical teams, but there is no consensus for the prevention and treatment of SSI in orthognathic surgery. The purpose of this descriptive study was to evaluate the severity and the consequences of postoperative infections. The charts of all the patients operated on by the orthognathic surgery team between January 2015 and July 2017 were collected. All types of orthognathic procedures (Le Fort I maxillary osteotomy, bilateral sagittal split mandibular osteotomy, and genioplasty) were screened, and patients diagnosed with SSI were included. Demographic data, timing and severity of the infection, as well as long-term complications were recorded. Five hundred and twelve patients were screened. Forty-one patients (8%) presenting with SSI were included. There were 18 men and 23 women. The site of the infection was mandibular for 38 patients (92.7%) and maxillary for 3 patients (7.3%). The average time between surgery and infection was 31.5 days. Twenty-four patients received isolated oral antibiotics for inflammatory cellulitic reaction (58.8%), 15 patients had a localized collection treated by incision and drainage under local anesthesia (36.6%), and 2 patients had an extensive collection requiring surgical drainage under general anesthesia (4.9%). Five patients (12.2%) needed hardware removal for plate loosening, and 2 patients (4.9%) developed chronic osteomyelitis. Infection following orthognathic surgery is easily treated most of the time with no long-term complications. In cases of patients with potential risk factors for severe infection, antibiotics may be given with curative intents.

Technical Modifications Specific to the Cleft Le Fort I Osteotomy.

To discuss technical modifications specific to the cleft Le Fort I osteotomy that improve mobilization and demonstrate the stability of the maxilla at the Le Fort I level in a cohort of patients with cleft palate (with or without cleft lip) who underwent traditional maxillary advancement. This was a retrospective evaluation of patients with cleft palate (+/- cleft lip) who underwent orthognathic surgery for management of skeletal malocclusions. All study subjects had a Le Fort I osteotomy +/- bilateral mandibular sagittal split osteotomies. The cleft Le Fort I osteotomy technique is modified to extensively release fibrous tissue and scar from the posterior maxilla, including around the tuberosity, along the posterior maxillary sinus wall, and circumferentially around the descending palatine canal. Maxillary position was assessed using angular and linear measurements pre-operatively (T0), immediately post-operatively (T1), and at 1-year post-operatively (T2). Descriptive and bivariate statistics were computed; a P < 0.05 was considered significant. Twenty-eight patients with cleft palate (with or without cleft lip) were included. The sample's mean age was 18.9 ± 1.4 years and included 11 females. The majority of subjects (64.3%) underwent bimaxillary surgery; eight subjects (28.6%) had segmental maxillary surgery and 14 subjects (50%) had simultaneous maxillary interpositional bone grafting. The mean maxillary sagittal advancement was 6.1 mm (range: 0-10 mm). At 1-year post-operatively, the absolute change in SNA was 0.7 ± 0.9 degrees; the absolute change in maxillary sagittal position was 0.8 ± 0.6 mm. There was no association between the magnitude of advancement and the magnitude of position change (P = 0.86). Stability was not influenced by segmental surgery, bone grafting, or bimaxillary surgery (P > 0.33). Using a modified technique with extensive release of posterior scar and graduated intra-operative traction, maxillary advancement of up to 10 mm can be performed in patients with cleft palate (± cleft lip) with sagittal relapse of < 1 mm at 1-year post-operatively.

Stability of Orthognathic Surgery in the Treatment of Condylar Osteochondroma Combined With Jaw Deformity by CT Measurements

We evaluated the stability of orthognathic surgery in the treatment of unilateral condylar osteochondroma combined with jaw deformity. Patients with unilateral condylar osteochondroma and jaw deviation deformity who had undergone surgery at the Ninth People's Hospital of Shanghai Jiaotong University School of Medicine from July 2014 to March 2017 were enrolled. The operation included a low condylectomy and both Le Fort I osteotomy and bilateral mandibular sagittal split osteotomies. ProPlan CMF, version 1.4, software (Materialise, Leuven, Belgium) was used to reconstruct and measure the preoperative, immediately postoperative, and follow-up (>6months) maxillofacial computed tomography images. The position of the jaw and contralateral condyle and remodeling of the affected side were compared during follow-up. Eight patients were included in the present study. The canting of the maxilla was significantly decreased postoperatively, and the contralateral condyle had rotated inward. The position of the maxillary and contralateral condyles was stable during follow-up, and the posterior aspect of the affected condyle demonstrated significant resorption. The results of single-stage surgery combined with orthognathic surgery and condylar osteochondroma resection were stable, and the affected condyle stump had adaptively reconstructed.

Is It Necessary to Free the Inferior Alveolar Nerve From the Proximal Segment in the Sagittal Split Osteotomy?

When the inferior alveolar nerve (IAN) is contained within the proximal segment after a mandibular sagittal split osteotomy (SSO), conventional teaching is to release the nerve so that it freely enters the distal segment. However, manipulation of the IAN may cause further injury. The purpose of this study was to measure IAN neurosensory recovery in SSOs when the nerve was not freed from the proximal segment. This was a prospective split-mouth study of patients undergoing bilateral sagittal split osteotomy (BSSO). The sample was composed of patients who underwent a BSSO in which the IAN was intact bilaterally but freely entering the distal segment on one side (IANDI) and contained within the proximal segment on the other (IANPR). The outcome of interest was time to functional sensory recovery (FSR) of the IAN, measured in days. Descriptive, bivariate, and Kaplan-Meier statistics were computed. P≤.05 was considered statistically significant. Twenty patients undergoing 40 SSOs were included as study patients. The sample's mean age was 19.0±2.4years (range, 15 to 26years); there were 13 female patients. Of these patients, 15 underwent BSSO whereas 5 underwent BSSO plus genioplasty. The planned mean composite 3-dimensional mandibular movements for IANDI and IANPR were 6.3±2.8mm (range, 2.5 to 12.3mm) and 6.3±2.3mm (range, 2.7 to 10.8mm), respectively (P=.96). All patients achieved FSR in the bilateral IAN distributions within 1year of surgery (range, 34 to 284days). The median times to FSR were 100days for IANDI and 101days for IANPR (P=.64). In patients undergoing SSOs, maintaining the IAN within the proximal segment of the mandible may not affect neurosensory recovery.

Craniofacial Deformities in Patients With Beta-Thalassemia: Orthodontic Versus Surgical Correction-A Systematic Review.

Rapid blood cell turnover and bone marrow expansion caused by beta-thalassemia (βT) result in craniofacial and dentoalveolar anomalies. This report presents a systematic review of the literature over the past 50 years on orthodontic and surgical considerations in the management of βT-affected patients. Seventeen publications encompassed 24 patients, 11 male individuals and 13 female individuals, 7 to 43 years of age. Eleven patients underwent only surgical treatment, eleven combined orthodontic-surgical treatment, and 2 orthodontic treatment. Surgical treatment primarily addressed typical maxillary overgrowth by maxillary reshaping, premaxillary segmental repositioning, or complete Le Fort I impaction and set back osteotomy. In severe maxilla-mandibular discrepancy and/or increased lower facial height, a bilateral sagittal split mandibular osteotomy is the treatment of choice. Although surgery involves risks of excessive bleeding, morbidity, and impaired nasal esthetics, little attention is given to the orthodontic modality. In conclusion, the current literature recommends early interceptive orthodontics aimed to decrease dentoskeletal deformities, severe malocclusion, and soft tissue imbalance. Treatment includes maxillo-mandibular orthopedic and functional manipulation with dentoalveolar treatment, which might either prevent orthosurgical procedures later or reduce its extent. This suggested a multidisciplinary approach comprising a hematologist, a pediatrician, a pediatric dentist, and an orthodontist, which might also significantly improve the patient's quality of life.