Orthognathic Surgery Patients Research Articles

Impact of orthognathic surgery on quality of life in patients with different dentofacial deformities: longitudinal study of the Oral Health Impact Profile (OHIP-14) with at least 1 year of follow-up

ObjectiveThe objective of this study was to assess the impact of orthognathic surgery for dental facial deformities on oral health-related quality of life (OHRQoL) in the immediate postoperative period up to at least 1 year after surgery.Study designThis prospective study evaluated data from 85 patients. OHRQoL was assessed using the Dutch version of the Oral Health Impact Profile questionnaire (OHIP-14NL) preoperatively (T0), each day for 7 days postoperatively (T1–T7) and 4 weeks (T8), 6 months (T9), and at least 1 year (T10) after surgery. The total OHIP score was calculated for each patient, with higher OHIP scores indicating a worse impact on oral health. Patients also completed an extra questionnaire about self-care, discomfort, and experienced pain (rated on a 10-point scale) in the postoperative period (T1–T10).ResultsThe mean OHIP score increased sharply at T1 compared to T0 but decreased significantly in the first postoperative week. The mean OHIP score at T8 was still higher than before surgery. However, at T9 and T10, the mean OHIP score was significantly lower than at T0 (P < .05). No significant difference in OHIP score was found between gender, age, type of surgery, and indication for surgery. Pain significantly decreased from T6 to T0. The OHIP and pain scores significantly positively correlated at every time point except T9.ConclusionThe findings indicate that OHRQoL is reduced from baseline in the immediate postoperative period but improves over time. By 1 year, OHRQoL improves significantly after orthognathic surgery in patients with dentofacial deformities.

Orthognathic Surgery Rate in Cleft Care.

To determine the true need for orthognathic surgery in patients with repaired cleft lip and/or palate (CL/P) at a high-volume craniofacial center. An institutional retrospective review of patients with CL/P born between 1975 and 2008 was performed. Patients with adequate documentation reflecting cleft care who were ≥ 18 years at the time of last craniofacial/dentistry follow-up were included. Patients with non-paramedian clefts or a comorbid craniofacial syndrome were excluded. Primary outcome variable was the total proportion of patients with CL/P who either underwent or were referred for orthognathic surgery Le Fort I (LF1) to correct midface hypoplasia. Secondary outcome variables were associations between cleft phenotype, midface hypoplasia severity, and number of cleft related surgeries with the eventual LF1 referral/recipiency. One hundred seventy-seven patients with CL/P met inclusion criteria. A total of 90/177 (51%) patients underwent corrective LF1; however, 110/177 (62%) of patients were referred for surgery. Patients with secondary cleft palate involvement were referred for and underwent LF1 at significantly greater rates than those without secondary palate involvement (referred: 65% versus 13%, P = 0.001; underwent: 55% versus 0%, P < 0.001). Patients with bilateral cleft lip/palate were referred for and underwent LF1 at significantly higher rates than those with unilateral cleft lip/palate (referred: 71.0% versus 50.4%, P= 0.04; underwent: 84% versus 71%, P = 0.02). Number of secondary palate surgeries was positively correlated with increased LF1 referral (P = 0.02) but not LF1 recipiency (P = 0.15). The incidence of orthognathic surgery redundant in patients with repaired CL/P was 51% at our institution, marginally above the higher end of previously reported rates. However, this number is an underrepresentation of the true requirement for LF1 as 62% of patients were referred for surgical intervention of midface hypoplasia. This distinction should be considered when counseling families.

A simple questionnaire for virtual follow‐up of orthognathic surgery patients during the COVID‐19 pandemic

Abstract The outbreak of COVID -19 pandemic has affected the health care infrastructure and wellness of health care workers in several ways1. Ever since its emergence, various guidelines and protocols have been proposed to curb its spread and increase the awareness among people. As the bulk of hospital and health care resources have been diverted to manage this pandemic outbreak, elective procedures like Orthognathic surgeries have been halted. In South India, as the cases were on gradual raise post the first wave of COVID-19, immediate lock downs were announced by the Government to prevent full blown second wave of COVID-192. As the strict lock downs were prevalent and number of COVID-19 cases increased, the hospital management of our Tertiary Reference Centre decided to reduce the number of reviews and Out-Patient cases. With the majority of the areas given red alert and marked as containment zones, the number of patients reporting for follow up reduced drastically. Telemedicine has gained popularity and practice among the various aspects of Medicine especially during this pandemic due to its efficiency and cost-effectiveness3. Hence, we decided to follow up the patients who underwent orthognathic surgery and could not report for review physically, via telemedicine (Phone/video calls) with the aid of contact numbers from the hospital registry.

A cross-sectional study of physical and psychosocial expectations of orthognathic surgery patients based on their typology

AimsOrthognathic surgery corrects craniofacial and dentofacial disproportion that compromises breathing, masticatory function, and aesthetics. A patient's typology influences their psychosocial and physical pre-operative expectations and post-operative perceptions and is an emerging area of research. This study aims to evaluate subjective expectations and/or perceived outcomes of orthognathic surgery; and whether orthognathic surgery meets patient expectations. MethodA questionnaire-based cross-sectional survey was administered pre- and post-operatively. Typologically, patients were classified as metamorphosisers – those with high expectation of psychosocial and physical transformation; evolvers – opposite of metamorphosisers; pragmatists – those with low expectation of psychosocial and high expectation of physical transformation; or shedders – the opposite of pragmatists. A Chi-Square goodness fit test with p < .01 considered significant was used to evaluate whether orthognathic surgery met patient expectations. ResultsA total of 27 patients consisting of 19 pre- and 8 post-operative groups completed the survey over an 11-month study period. Metamorphosisers numerically dominated in both pre- and post-operative groups, indicating that most patients in this study had high expectations and high perceptions of psychosocial and physical transformation after orthognathic surgery. Chi-Squared testing showed statistical significance for psychosocial transformation (X2 pre-operative group = 46.3; X2 post-operative group = 67.4) and physical transformation (X2 pre-operative group = 78.4; X2 post-operative group = 32.1), p = .000001 respectively. ConclusionsMost patients had high expectations of physical and psychosocial transformation following orthognathic surgery. Treatment outcomes met these expectations. Patient typology can help orthognathic teams understand and manage these expectations.

Airway Volume Changes after Orthognathic Surgery in Patients with Down Syndrome: A Diagnostic-Therapeutic Algorithm

Down syndrome (DS) patients tend to suffer severe dentofacial and skeletal deformities leading to severe occlusal, speech and respiratory problems. The increase in life expectancy of these subjects opens new horizons for improvement of their oral, dental and facial functions, among others.

Quality of Life After Class III Repair Orthognathic Surgery: Five-Year Retrospective Study.

To evaluate the effect of orthognathic surgery on the long-term quality of life of patients with presurgical skeletal Class III and to identify its strongest effect-whether esthetic, social, or functional. In this retrospective cohort study, the subjects were patients after orthognathic surgery for repairing skeletal Class III. Fifty-five patients who had undergone orthognathic surgery from 2013 to 2018 in the oral and maxillofacial surgery department participated in this study. Each participant completed a modified questionnaire used to assess the patient's esthetic, social, and functional abilities after orthognathic surgery. The rate of esthetic improvement in orthognathic surgery patients was 88%. More than four-fifths (81.8%) of the patients reported improvement in their personal and social self-esteem and confidence. Finally, 40.7% of the patients reported functional improvement. No significant differences between male and female patients were found. All but one of the patients recommended orthognathic surgery for patients with similar problems. One in six (17.3%) patients was dissatisfied with the nasal appearance after the surgical procedure, while almost a quarter (21.8%) reported worsening of their mouth opening, and 25.4% reported worsening of TMJ (Temporo-Mandibular Joint) symptoms. Analysis of the results revealed no statistically significant pattern connecting preoperative overjet or overbite measures with satisfaction rates. In this study, patient satisfaction with the orthognathic surgical procedure was mostly a result of improvements in facial esthetics, followed by psychological well-being and functional abilities. Most dissatisfaction after the orthognathic surgical procedure was related to nasal appearance, mouth opening, and TMJ complaints.

Automatic segmentation of the pharyngeal airway space with convolutional neural network

ObjectivesThis study proposed and investigated the performance of a deep learning based three-dimensional (3D) convolutional neural network (CNN) model for automatic segmentation of the pharyngeal airway space (PAS). MethodsA dataset of 103 computed tomography (CT) and cone-beam CT (CBCT) scans was acquired from an orthognathic surgery patients database. The acquisition devices consisted of 1 CT (128-slice multi-slice spiral CT, Siemens Somatom Definition Flash, Siemens AG, Erlangen, Germany) and 2 CBCT devices (Promax 3D Max, Planmeca, Helsinki, Finland and Newtom VGi evo, Cefla, Imola, Italy) with different scanning parameters. A 3D CNN-based model (3D U-Net) was built for automatic segmentation of the PAS. The complete CT/CBCT dataset was split into three sets, training set (n = 48) for training the model based on the ground-truth observer-based manual segmentation, test set (n = 25) for getting the final performance of the model and validation set (n = 30) for evaluating the model's performance versus observer-based segmentation. ResultsThe CNN model was able to identify the segmented region with optimal precision (0.97±0.01) and recall (0.96±0.03). The maximal difference between the automatic segmentation and ground truth based on 95% hausdorff distance score was 0.98±0.74mm. The dice score of 0.97±0.02 confirmed the high similarity of the segmented region to the ground truth. The Intersection over union (IoU) metric was also found to be high (0.93±0.03). Based on the acquisition devices, Newtom VGi evo CBCT showed improved performance compared to the Promax 3D Max and CT device. ConclusionThe proposed 3D U-Net model offered an accurate and time-efficient method for the segmentation of PAS from CT/CBCT images. Clinical significanceThe proposed method can allow clinicians to accurately and efficiently diagnose, plan treatment and follow-up patients with dento-skeletal deformities and obstructive sleep apnea which might influence the upper airway space, thereby further improving patient care.

Decision Making from the Experience of Orthognathic Surgery Patients: A Grounded Theory Approach.

Introduction:Patients’ decisions to undergo major surgery such as orthognathic treatment are not just about how the decision is made but what influences the decision.Objectives:The primary objective of the study was to identify the key processes involved in patients’ experience of decision making for orthognathic treatment.Methods:This study reports some of the findings of a larger grounded theory study. Data were collected through face-to-face interviews of patients who were seen for orthognathic treatment at a teaching hospital in the United Kingdom. Twenty-two participants were recruited (age range 18–66 y), of whom 12 (male = 2, female = 10) were 6 to 8 wk postsurgery, 6 (male = 2, female = 4) were in the decision-making stage, and 4 (male = 0, female = 4) were 1 to 2 y postsurgery. Additional data were also collected from online blogs and forums on jaw surgery. The data analysis stages of grounded theory methodology were undertaken, including open and selective coding.Results:The study identified the central role of dental care professionals (DCPs) in several underlying processes associated with decision making, including legitimating, mediating, scheduling, projecting, and supporting patients’ decisions. Six categories were related to key aspects of decision making. These were awareness about their underlying dentofacial problems and treatment options available, the information available about the treatment, the temporality of when surgery would be undertaken, the motivations and expectation of patients, social support, and fear of the surgery, hospitalization, and potentially disliking their new face.Conclusion:The decision-making process for orthognathic treatment is complex, multifactorial, and heavily influenced by the role of DCPs in patient care. Understanding the magnitude of this role will enable DCPs to more clearly participate in improving patients’ decision-making process. The findings of this study can inform future quantitative studies.Knowledge Transfer Statement:The results of this study can be used both for informing clinical practice around enabling decision making for orthognathic treatment and also for designing future research. The findings can better inform clinicians about the importance of their role in the patients’ decision-making process for orthognathic treatment and the means to improve the patient experience. It is suggested that further research could be conducted to measure some of the key constructs identified within our grounded theory and assess how these change during the treatment process.

Orthognathic Surgery Impression on Quality of life: Integral Perception

Background: Patients with severe functional abnormalities are disappointed with their real facial appearance. Assessing the different perceptions and motivations influence in patients seeking orthognathic surgeries on their quality of life are the aims of this clinical study. This done by applying specific questioners' forms before and after treatment for demonstrates the patient's satisfaction with the result too. This can improve the success rate of orthognathic surgeries by improve patients expectations and satisfactions. Material and Method: Fifty participants are chosen to share in this retrospective study attained the Multi- Disciplinary Team Committee in Al-Salam Teaching Hospital. Patients' age groups are from 17-40 years, no specific gender included in the study. Patients agree to participate and answering the uestioners pre and post surgeries. Patients are nonsmokers with no medical disease history. Out of these inclusion criteria; patients excluded from the study. Patients with cleft lip and palate or any other syndromes that affect the dentofacial growth are also excluded. Result: Age, gender, education level and marital status as social variables intended in this study; show no statistical differences concerning the questioner's answers as reached by statistical analysis by Independent Sample t Test and One Way Anova Test. Significant differences (0.000) have been observed between preoperative and postoperative satisfaction according to Paired Sample t Test. Conclusion: Reaching optimum patients satisfaction is challenge as well as changing quality of life of our patients are provocation. In this article by using of different multiple questioners for integral perception in orthognathic surgery patients are crucial and more suitable for good understanding of patient's willing.

Upper airways after mandibular advancement orthognathic surgery: A 4-year follow-up

<h3>Introduction</h3> The purpose of this study was to assess the stability of changes in the upper airways 4 years after orthognathic surgery in patients with skeletal Class II malocclusion. <h3>Methods</h3> A retrospective clinical study was conducted including 33 cone-beam computed tomography images from 11 patients (average age of 35.91 years) followed up longitudinally for 4 years. The airways were measured with the help of the Dolphin Imaging software (Dolphin Imaging and Management Systems, Chatsworth, Calif) at 3 points: T1 (preoperative), T2 (6 months after surgery), and T3 (4 years after surgery). The parameters assessed were surface area (SA), minimum axial area, and volume (VOL) of the pharyngeal airway space. The times were compared using analysis of variance and Tukey's test. Pearson's analysis was performed to assess the correlation with surgical changes and age (<i>P</i> <0.05). <h3>Results</h3> Four years after operating on the airway spaces, the means of SA and VOL were significantly higher than those observed before the surgery (<i>P</i> <0.05). The means at 6 months were intermediate, with no significant difference before the surgery and 4 years after it (<i>P</i> >0.05). There was no significant correlation of the changes in SA, VOL, and minimum axial area with the amount of mandibular advancement, counterclockwise rotation of the occlusal plane, and age of the patient (<i>P</i> >0.05). <h3>Conclusions</h3> Four years after mandibular advancement surgery in patients with skeletal Class II malocclusion, the increases in the airways remained stable.

Orthodontists' knowledge and experience on referring orthognathic surgery patients to psychological support.

The aim of this study was to evaluate orthodontists' knowledge and experience on referring orthognathic surgery patients to psychological support. A15-question questionnaire was sent to orthodontists who were members of the Turkish Orthodontic Society via e‑mail. The participants were informed about the purpose of the study and were provided alink to access the questionnaire via the internet. In order to increase the feedback rate, two reminders were sent to all addresses. Members who did not perform orthognathic surgery were not included in the study. Of the 1615 members who were sent the link, 233 responded and filled out the electronic questionnaire, while 12participants who stated that they did not treat orthognathic patients were excluded. Most of the participants stated that they did not refer their patients to psychological support. The main reasons for not recommending psychological support to patients was fear about the reaction of the patients and that patients might refuse to visit the psychologist/psychiatrist. The most common reasons for referring patients to psychological support were the following: patient had past/current psychological problem, unrealistic expectations, recent concerns regarding orthognathic surgery and see no significant need for surgery. In all, 98% of participants stated that they did not use psychological questionnaire forms for their patients. The vast majority of participants stated that they were not trained in psychological assessment/treatment, and alarge majority of participants thought that it would be beneficial to receive training in this field. Most orthodontists do not receive adequate training in psychology and do not refer orthognathic surgery patients to psychological support. It would be beneficial to offer clinicians training in this field.

Variation between natural head orientation and Frankfort horizontal planes in orthognathic surgery patients: 187 consecutive cases

The purpose of this study was to assess the relationship between the Frankfort horizontal (FH) and natural head orientation (NHO), their correlation between patients’ malocclusion, and the impact of counterclockwise rotation (CCW) on the FH-NHO angle variation after orthognathic surgery. An evaluation of 187 consecutive patients was performed at the Maxillofacial Institute (Teknon Medical Center, Barcelona). FH-NHO° was measured pre- and postoperatively at 1 and 12 months, after three-dimensional (3D) superimposition using a software (Dolphin®). Patients were classified as follows: 3.2%, 48.7% and 48.1%, class I, II and III, respectively. Baseline FH-NHO° was significantly positive for patients with dentofacial deformities (2.73°±4.19 (2.12–3.33°, P<0.001). The impact of orthognathic surgery in FH-NHO° was greater in class II when compared with class III patients, with a variation of 2.04°±4.79 (P<0.001) and −1.20°±3.03 (P<0.001), respectively. FH-NHO° increased when CCW rotational movements were performed (P=0.006). The results of this study suggest that pre- and postoperative NHO differs from FH in orthognathic patients. The angle between FH and NHO is significantly larger in class III than in class II patients at baseline, which converges after orthognathic surgery when CCW rotation is performed. Therefore, NHO should be used as the real horizontal plane when planning for orthognathic surgery.

Posterior bending osteotomy: An effective measure to secure facial symmetry in orthognathic surgery

This study aimed to compare the effectiveness of posterior bending osteotomy and grinding techniques for orthognathic surgery in patients with facial asymmetry. Patients who had undergone Le Fort I osteotomy and bilateral sagittal split ramus osteotomy, and who presented with a menton shift and setback difference exceeding 4 mm, were enrolled. Cone-beam computed tomography was performed before surgery (T0), immediately after surgery (T1), and 6 months after surgery (T2). Overall, 38 patients were included and divided into posterior bending osteotomy (n = 23) and grinding (n = 15) groups.Significant differences were observed between the posterior bending osteotomy and grinding groups on the treated side. In the grinding group, the gonion on the treated side was displaced slightly outward, resulting in a significant difference between both sides (non-treated side: 50.52 ± 4.20 [T0] and 48.67 ± 4.37 [T2]; treated side: 50.88 ± 4.55 [T0] and 51.00 ± 3.95 [T2]; p = 0.038). In the posterior bending osteotomy group, bilateral inward movements of the gonion were observed, and the distance from the midsagittal plane to the gonion did not differ significantly between the sides (non-treated side: 46.74 ± 4.41 [T0] and 45.54 ± 3.95 [T2]; treated side: 47.43 ± 4.93 [T0] and 45.18 ± 3.52 [T2]; p = 0.224). The yawing movement of the proximal segment was greater in the grinding group than in the posterior bending osteotomy group (non-treated side: p = 0.839; treated side: p = 0.025).Posterior bending osteotomy is recommended over the grinding method for patients with severe facial asymmetry, in order to ensure a symmetric and esthetic facial profile by allowing passive adaptation between the mandibular segments.

Dentofacial deformity and orthognatic surgery: Influence on self-esteem and aspects of quality of life

This study aimed to assess the extent to which psychosocial and functional aspects are affected in orthognathic surgery patients. The Oral Health Impact Profile (OHIP-CRO14), Orthognathic Quality of Life Questionnaire and Self-Esteem (SE) Scale were used. The sample included 110 Caucasian subjects (73% females) aged 19–54 years. Fifty-five patients with dentofacial deformities were treated by combined orthodontic-orthognathic surgical treatment, and 55 others, matched by sex and age, were untreated controls without dentofacial deformities. In comparison with the untreated subjects, patients before surgery had a poorer quality of life, with the largest effect size in oral function (OF) and OHIP (average differences 8.0 and 14.7, respectively; p < 0.001; r = 0.65 and 0.63), while the lowest effect sizes were in awareness of facial aesthetics (AW) and SE. The treatment induced statistically significant changes in all psychosocial and functional aspects, mainly with a large effect size (p < 0.001; r = 0.48–0.78). The major effect size was a decrease in facial aesthetic concerns (FE; 7.6 ± 6.2; p < 0.001; r = 0.78), followed by a decrease in impairment of OF and OHIP (8.0 ± 7.1 and 16.6 ± 14.6; p < 0.001; r = 0.75). The lowest effect size was in the decrease in AW and increase in SE. After surgery, all aspects were similar to those in the untreated subjects. In conclusion, facial deformity raises many issues, primarily related to aesthetic concerns and functional impairment; however, orthognathic surgery manages to improve quality of life to be similar to that of the population without deformities.

Computational Fluid Dynamic Analysis of the Pharyngeal Airway after Bimaxillary Orthognathic Surgery in Patients with Mandibular Prognathism

This study aimed to analyze pharyngeal airflow characteristics and their relationship with the skeletal movement of the maxilla and mandible after bimaxillary orthognathic surgery in patients with skeletal class III (mandibular prognathism) malocclusion. Cone-beam computed tomography (CBCT) was conducted before surgery (T0), immediately after surgery (T1), and at least six months after surgery (T2). Digital imaging and communications in medicine files were transferred to InVivo (Anatomage) software to measure the skeletal changes after surgery. The changes in the maxillary and mandibular position, tongue position, and hyoid bone position were analyzed. Patient-specific models were reconstructed using 3D-Doctor software. The models after converting to the stereolithography (STL) file for Ansys integrated computer engineering and manufacturing code for computational fluid dynamics (ICEM CFD), commercial software were used for calculating the geometry, pressure drop and adjusted pressure coefficient value. The total volume of the upper airway including nasal cavity was reduced by 23% immediately after surgery and recovered to 92.2% of the initial volume six months after surgery. The airflow computation analysis showed a decrease in the pressure drop values immediately after surgery and six months after surgery. The adjusted pressure coefficients were slightly different but the change was statistically insignificant. The airflow characteristics computed using the computational fluid dynamics were correlated to the surgical changes. The surgical changes can affect the aerodynamics of the pharyngeal airway. In clinical practice, this knowledge is useful for developing a suitable orthognathic surgery treatment plan.

Orthognathic surgery in class II patients: a longitudinal study on quality of life, TMD, and psychological aspects.

To evaluate, longitudinally, the impacts of orthognathic surgery in patients with skeletal class II malocclusion on oral health-related quality of life (OHRQoL), temporomandibular disorders (TMD) and psychological symptoms. Forty-three patients with skeletal class II malocclusion who were submitted to orthognathic surgery were evaluated during their preoperative and postoperative periods. They answered the short version of the Oral Health Impact Profile (OHIP-14) and were also diagnosed according to Axes I and II of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The evolution of OHRQoL and TMD before and after surgery was verified, and the relationships among these variables were found through statistical analysis using Wilcoxon, McNemar, chi-square, and Mann-Whitney tests, with a 5% significance level. The median of the overall OHIP-14 score and five domains decreased after orthognathic surgery (p< 0.05), the functional limitation domain increased (p= 0.014), and the physical disability domain did not show an association (p= 0.133). There were improvements in articular pain (p= 0.016), chronic pain (p= 0.019), and nonspecific physical symptoms excluding pain (p= 0.013). In addition, an association was found between poorer OHRQoL (overall scale and domains) and the Axis II variables of the RDC/TMD (p< 0.05). Orthognathic surgery improved perceived OHRQoL, articular pain, and chronic pain. The conditions of Axis II of the RDC/TMD interfered with OHRQoL postoperatively. Although orthognathic surgery improves QoL and some TMD conditions in skeletal class II patients, poorer postoperative outcomes are observed when psychological conditions are present.

Orthognathic Surgery for Patients with Gender Identity Disorder

Orthognathic Surgery for Patients with Gender Identity Disorder

Evaluation of surface changes of stainless steel miniplates and screws following retrieval from maxillofacial trauma and orthognathic surgery patients: A comparative study.

Background:Metal implants have the potential to degrade body fluids. Corrosive degradation has been demonstrated in laboratory tests, both under simulated clinical conditions and by electrochemical methods, as well as in studies of retrieved metal implants. The clinical importance of degradation of metal implants is evidenced by particulate corrosion and wear products in tissue surrounding the implant, which may ultimately lead to bone loss.Materials and Methods:The present study is to evaluate the surface changes such as corrosion, surface roughness, and microfractures and for the tensile strength of 18 stainless steel miniplates and 18 stainless steel screws which were used as rigid internal fixation in the management of maxillofacial fractures and orthognathic surgeries.Results:In this study, surface roughness and microfractures were found in all the miniplates and screws that is 100%. Corrosion degradation was found in 12 of 18 plates that is 66.66%.Conclusion:Our results through scanning electron microscopy and stereo electron microscopy showed surface roughness, microfractures, and corrosion. However, tensile strength was not affected when the plates were in situ. Through our study, we recommend their retrieval after the purposes of rigid fixation have been fulfilled.

Comparison of Explanatory Orientation and Experience Orientation for Intermaxillary Fixation in Nursing of Orthognathic Surgery Patients

Comparison of Explanatory Orientation and Experience Orientation for Intermaxillary Fixation in Nursing of Orthognathic Surgery Patients

Videofluoroscopic Findings as Predictors of Velopharyngeal Insufficiency After Orthognathic Surgery in Patients With Cleft Lip and Palate.

Midface retrusion is a common problem in patients with cleft lip and palate owing to the lack of adequate growth of the maxilla. Midface advancement surgery is a definite treatment for midface retrusion; however, the subsequent oropharyngeal airway changes might result in velopharyngeal insufficiency (VPI) in affected patients. Determining the predictors of VPI beforehand and modifying the surgical procedure would be beneficial. A retrospective review of 42 patients with cleft lip and palate who underwent orthognathic surgery from 2013 to 2014 was performed. A total of 25 patients met the inclusion criteria and had undergone complete pre- and postsurgery videofluoroscopy, nasopharyngoscopy (NPS), and speech assessment. We compared 2 groups of patients, those who showed NPS finding changes of more than 0.1 (8 patients) and those without changes (17 patients), by measuring the distances of the contact point to the tip of the velum, gap size at maximum closure (MC) and rest, contact area length, lateral wall closure rate, closure velocity, and 2 angles (from the velum to the hard palate and genu) at MC and rest. The amount of maxillary advancement was also recorded. Among the 8 patients with NPS finding changes, 3 underwent Furlow palatoplasty for VPI. No significant difference was found in the amount of maxillary advancement between the groups (5.8 vs 5.7 mm). Significant differences were found in the preoperative gap size at MC and angle at the genu at MC (P = 0.035 and .012). These could be considered as the predictors before surgery. After surgery, a significant difference was found in the contact area, lateral wall closure rate, and gap size at MC (P = 0.005, 0.018, and 0.01). Videofluoroscopy is a relatively applicable method of determining dynamic changes in the velum function. By performing videofluoroscopy before midface advancement surgery in patients with cleft lip and palate, we may predict the risk of VPI and consider alternative surgical strategies.