Orthognathic Surgery Procedures Research Articles

Change in taste sensation after orthognathic surgery

ObjectiveThe objective of this study was to evaluate the effect of orthognathic surgery on taste sensation.Materials and methodsThirty-five patients scheduled to undergo Le Fort I osteotomy (LFIO), sagittal split ramus osteotomy (SSRO), and bimaxillary surgery (BMS) were evaluated by administering localized and whole-mouth taste tests preoperatively and postoperatively at months 1, 3, and 6. The patients were asked to identify the quality of four basic tastes applied to six locations on the palate and tongue and to rate the taste intensities they perceived. Taste recognition thresholds and taste intesity scores were evaluted according to operation groups and follow-ups.ResultsThere were significant decreases in the quinine HCl recognition thresholds at the postoperative follow-ups compared to the preoperative in LFIO patients (p = 0.043). There were significant decreases in sucrose taste intensity scores in the right posterolateral part of the tongue at months 3 and 6 compared to preoperative in SSRO patients (p = 0.046), and significant increases in quinine HCL taste intensity scores in the right and left anterior parts of the tongue at month 6 compared to preoperative in LFIO patients (p < 0.05).ConclusionTaste perception is affected due to potential damage to the chemosensory nerves during orthognathic surgical procedures. Generally, non-significant alterations have been observed in taste perception after orthognathic surgery, except for significant alterations in bitter and sweet taste perceptions.Clinical relevanceMaxillofacial surgeons should be aware of taste perception change after orthognathic surgery procedures and patients should be informed accordingly.The trial registration number (TRN)NCT06103422/Date of registration: 10.17.2023 (retrospectively registered).

Adjunctive aesthetic procedures in orthognathic surgery

In addition to function, occlusion and airway volume, aesthetics play an important role in the planning and execution of orthognathic surgery. To improve the aesthetic outcome of orthognathic surgery, there are several procedures that can be combined with orthognathic surgery secondarily, or in the same operation. These include: lipofilling, dermal fillers, facial implants, liposuction, ear corrections, eyelid corrections, or a lip lift. Patients often appreciate it when the options for additional procedures are discussed. However, both undertreatment and overtreatment can lead to unfavorable outcomes. Proper care and thoroughness are of course required, as to not change the characteristic facial aspects of a patient too much.

The Role of Orthodontics, Orthognathic Surgery and Adjunct Surgical Procedures in the Esthetic Rehabilitation of the Face and Smile: Potential and Limitations

For nearly a century, orthodontists have mainly focused on occlusion as the primary objective of orthodontic therapy. The introduction of the soft tissue paradigm has shifted treatment planning from hard tissue to soft tissue and reinforced the key role of facial esthetics in orthodontic diagnosis and treatment planning. Whereas occlusion is rooted in measurable definitions of Class I and other “keys to occlusion”, esthetics is more subjective, based not only on the orthodontist's assessment but also on personal and cultural preferences rather than rigid norms. The aim in this paper is to demonstrate that orthognathic surgery potentially narrows the gap between esthetics and function, even though surgery may have its own limitations. Three reports are presented on patients whose clinical examination, records evaluation and treatment planning have focused on facial and smile esthetics, and treatment approaches that combined orthodontics, orthognathic surgery and appropriate adjunct procedures to enhance the overall esthetic outcome.

Orthognathic surgery in class II patients and the treatment of obstructive sleep apnea syndrome: a concise systematic review of the clinical studies

Introduction: Obstructive sleep apnea (OSA) is characterized by intermittent partial or complete obstruction of the airways during sleep, being called OSA syndrome (OSA) when associated with daytime/nighttime symptoms and/or comorbidities, such as systemic arterial hypertension or diabetes mellitus. The prevalence reaches 32% in the general population, varies between 1% and 20% when associated with COPD (overlap syndrome), and is described as above 60% in populations with COPD and obesity, Orthognathic Surgery (OS) corrects the deformities of the bones of the maxilla and mandible. Objective: It was to highlight the main considerations and outcomes of clinical studies on the importance of orthognathic surgery in class II patients and the treatment of obstructive sleep apnea syndrome. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from October to December 2022 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 2005 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed accordingly, according to the Cochrane instrument. Results and Conclusion: A total of 420 articles were found, 157 articles were evaluated and 25 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 103 studies with a high risk of bias and 42 studies that did not meet GRADE. It was concluded that obstructive sleep apnea syndrome is related to comorbidities such as systemic arterial hypertension or diabetes mellitus. Orthognathic surgery treats patients with moderate and severe facial deformities, enabling the achievement of functional balance and harmony in facial aesthetics. Maxillomandibular advancement is an orthognathic surgery procedure that has been used to treat obstructive sleep apnea syndrome. However, maxillomandibular advancement often leads to unsatisfactory esthetic results. Proper early diagnosis and treatment can significantly improve a patient's quality of life, reduce sudden death, and prevent various complications. significantly increased compared to those before surgery, which can significantly improve the symptoms of obstructive sleep apnea syndrome and even achieve complete disappearance of symptoms.

Accuracy Evaluation of an Alternative Approach for a CAD-AM Mandibular Reconstruction with a Fibular Free Flap via a Novel Hybrid Roto-Translational and Surface Comparison Analysis

Although the fibula free flap represents the gold standard for mandibular reconstructions, when implanted as a single barrel, this flap does not have the cross-sectional requisites to restore the native mandibular height, which is in turn required for the implant-supported dental rehabilitation of the patient. Our team has developed a design workflow that already considers the predicted dental rehabilitation, positioning the fibular free flap in the correct craniocaudal position to restore the native alveolar crest. The remaining height gap along the inferior mandibular margin is then filled by a patient-specific implant. The aim of this study is to evaluate the accuracy in transferring the planned mandibular anatomy resulting from said workflow on 10 patients by means of a new rigid body analysis method, derived from the evaluation of orthognathic surgery procedures. The analysis method has proved to be reliable and reproducible, and the results obtained show that the procedure already has satisfactory accuracy (4.6° mean total angular discrepancy, 2.7 mm total translational discrepancy, 1.04 mm mean neo-alveolar crest surface deviation), while also pointing out possible improvements to the virtual planning workflow.

Adjunctive Aesthetic Procedures in Orthognathic Surgery.

An important aesthetic goal in orthognathic planning is to improve facial balance, harmony, volume, and symmetry. It is therefore logical that adjunctive aesthetic procedures become a part of the overall orthognathic treatment plan and that their possibilities are discussed with orthognathic candidates. Such procedures help to improve the final outcome of the orthognathic treatment and enhance patient satisfaction. Training and experience are of utmost importance when offering and performing aesthetic facial surgery. This article discusses various facial aesthetic procedures that can be combined with orthognathic surgery, to the patient's benefit, to help them become the most beautiful version of themselves.

Le Fort I Osteotomy Complicated by Presence of Maxillary Sinus Septa.

Presence of maxillary sinus septa, an anatomical variant, has never been documented as a possible complication of Le Fort I orthognathic surgery procedure. This case report describes the difficulty faced by an experienced surgeon during Le Fort I down-fracture procedure. The osteotomized maxilla remained firm despite confirmation that all osteotomy cuts have been performed adequately. The presence of a bilateral sagittally oriented maxillary sinus septa extending from the floor to the roof of the sinus in this case had prevented separation of the lower maxilla during down-fracture maneuver. Such normal anatomical variant must be identified during orthognathic surgery treatment planning session to avoid grave complications.

Hardware Removal in Orthognathic Surgery Patients: A 20 Year Retrospective Study

In the United States, the standard of care for rigid fixation in orthognathic surgery is titanium plates and screws. This hardware is meant to remain implanted indefinitely, but the potential for hardware removal is always mentioned in preoperative discussions. The incidence of titanium hardware removal after orthognathic surgery has been reported to range from 0.4% to 27%, and the largest study previously published included 570 patients over 5 years.1,2 The purpose of this study is to examine the incidence of titanium hardware removal after orthognathic surgery over a 20-year period and to identify factors associated with removal. A retrospective study was performed involving subjects who underwent orthognathic surgery including a combination of Le Fort osteotomy, bilateral sagittal split osteotomy, genioplasty, subapical osteotomy, and vertical ramus osteotomy. The primary outcome variable was titanium hardware removal. Other predictor variables included age, sex, simultaneous removal of third molars, simultaneous bone grafting, and medical comorbidities. Patients met inclusion criteria if they had undergone orthognathic surgery with titanium fixation at a single institution by a single surgeon between the years of 2000 and 2020. Patients with cleft and craniofacial syndromes and those fixated with resorbable hardware were excluded. A total of 738 patients met inclusion criteria with 1,483 orthognathic surgery procedures performed. The mean age at the time of surgery was 23.2 years, and 57% of subjects were female. Ultimately, 43 of the 738 patients required hardware removal (5.8% of patients), and 48 of the 1,483 procedures resulted in hardware removal (3.4%). The average time to hardware removal was 2.3 years (ranging 6 weeks to 9.7 years) with a median of 1.3 years. The most common indication for removal was surgical site infection (17 patients), followed by palpable, painful hardware (12 patients), exposed hardware (6 patients), maxillary sinusitis (4 patients), adjacent tooth external root resorption (1 patient), loose hardware (1 patient), prophylactic removal after previous infection (1 patient), and thermal sensitivity (1 patient). Patients who required hardware removal were more often female (69.8%), were older (average 29.9 years), and were more likely to have multiple jaws operated (79.1%). Of the 43 patients with hardware removed, 19 had hardware removed from the mandible (44.2%), 18 from the maxilla (41.9%), 2 from the genioplasty (4.6%), and the remainder had multiple sites removed (9.3%). The laterality of hardware-associated symptoms was more often right-sided (51.1%) than left-sided (39.5%), and bilateral symptoms were less common (9.3%). A history of obstructive sleep apnea was documented in 9.3% of patients with hardware removed, as compared to 4.5% of the general population of orthognathic surgery patients. The population of patients with cleft and craniofacial syndromes was examined separately, and the rate of removal in this population of 121 patients was slightly lower than that of the general population (5%). The incidence of titanium hardware removal in this population of orthognathic surgery patients was 5.8%. Our findings suggest that there are patient-specific and procedure-specific factors associated with increased rates of titanium hardware removal after orthognathic surgery. Based on descriptive and multivariate analyses, higher risk groups include female patients, older patients, patients with obstructive sleep apnea, and patients in whom multiple jaws are operated. These patients may be counseled accordingly about the risk of future hardware removal.

The Effect of Orthognathic Surgery on the Hourglass Appearance of the Neck.

In frontal view, the transition from the upper aspect of the neck to the inferior border of the mandible has a subtle hourglass appearance. The aim of this study was to evaluate the effect of the orthognathic surgery on the hourglass appearance of the neck in patients with Class II dentofacial deformity. Twenty-six patients with Class II dentofacial deformity who underwent bilateral sagittal split osteotomy alone or in combination with Le Fort I osteotomy and/or genioplasty were included in this study. The width of the most upper part, the width of the narrowest part, the length of the upper part, the height of the upper part, the depth, and the angle of the hourglass were measured on frontal facial photographs obtained preoperatively and at sixth months postoperatively. The decrease in the width of the narrowest part ( P =0.012) and the right ( P <0.001) and left ( P <0.001) angles of the hourglass were statistically significant. Also, increase in the right ( P =0.036) and the left ( P =0.004) depths of the hourglass were statistically significant. Orthognathic surgery procedures performed to correct Class II dentofacial deformity positively affects the hourglass appearance of the neck, therefore neck esthetics should also be considered in the preoperative evaluation of facial esthetics.

Effect of a digital guide on the positional accuracy of intermaxillary fixation screw implantation in orthognathic surgery

Intermaxillary fixation screw (IMFS) implantation is a common procedure in orthognathic surgery (OGS) performed to the temporary maxillary-mandibular fixation and stable bite relationships. The study aims to assess the accuracy of IMFS implantation with a digital guide to reduce the occurrence of root damage. This prospective study involved 40 patients undergoing OGS at the Affiliated Hospital of Qingdao University from August 2017 to May 2021. The patients were randomly divided into two groups according to whether the IMFS implantation was with or without digital guide (20 patients in the experimental group and 20 controls). The digital guides used in the experimental group were designed according to a virtual implantation plan and printed using stereolithography. In the control group, IMFSs were directly implanted by a surgeon based on clinical experience. Postoperatively, cone-beam computed tomography was performed to compare root proximity of IMFSs between the two groups and verify the accuracy of IMFS placement. In the experimental group, there was no case of root damage, the incidence of the periodontal ligament (PDL) injured was 22.1%, and 77.9% IMFSs were placed without contacting adjacent anatomic structures. In the control group, the incidence of root damage had been up to 20.8%, 31.7% IMFSs injured the PDL, and only 47.5% IMFSs were placed between the roots (P<0.001). IMFSs can be placed more accurately with surgical guides, reducing the incidence of root and PDL damages.

Surgical Ciliated Cyst of the Maxilla: A Case-Series of Three Cases

The surgical ciliated cyst is an iatrogenic lesion occurring after surgeries in which the Schneiderian membrane has been exposed, such as in orthognathic surgery or maxillary sinus procedures. This lesion has been infrequently documented in western countries. In this case series, we present three cases of surgical ciliated cysts of the maxilla.

Outcomes and Stability of Anterior Open Bite Treatment with Skeletal Anchorage in Non-Growing Patients and Adults Compared to the Results of Orthognathic Surgery Procedures: A Systematic Review.

The objective of this review is to evaluate, on the basis of the available literature, if anterior open bite (AOB) can be successfully treated with the intrusion of molar teeth using skeletal anchorage in non-growing patients and adults and if this treatment modality provides comparable results to those obtained by orthognathic surgery procedures. Methods: A systematic review of published data in major databases from 2000 to 2021 was performed. Results: In total, 92 articles were included in title and abstract screening, and only 16 articles (11 concerning AOB correction by molar intrusion with skeletal anchorage, and five considering AOB treatment by orthognathic surgical intervention) qualified for thorough data extraction and analysis. Conclusions: On the basis of this review, it seems to be possible to obtain successful results for AOB treatment in non-growing patients and adults by means of the intrusion of molar teeth with skeletal anchorage. However, due to the different methods of assessing treatment outcomes used by different authors, it is not possible to state conclusively whether the treatment of AOB by means of molar intrusion with skeletal anchorage provides long-term results that are comparable to orthognathic surgery procedures.

What is the accuracy of the surgical guide in the planning of orthognathic surgeries? A systematic review.

Background To investigate the true accuracy of the surgical guide in the planning of orthognathic surgeries, which are performed worldwide.Material and Methods A systematic search was conducted in the PubMed database, Web of science, Scopus and Embase, covering August 2020 to January 2021. Studies that included patients with dentofacial deformity including anteroposterior, vertical and asymmetry problems who were undergoing an orthognathic surgery procedure were included; QUADAS-2 was used to determine the risk of bias by analyzing the quality of the studies. A PRISMA (flowchart) was created to show the study selection, keywords, nomination processes, and inclusion and exclusion criteria.Results Eleven studies were selected for qualitative and quantitative synthesis. All studies evaluated described high precision of the surgical guide, where the lowest error values were represented by the CAD/CAM technique.Conclusions The planning and printing errors related to the guide were all less than 2 mm, and the absolute averages of the errors related to virtual planning in the analysis of the different plans were less than 1 mm. Finally, the measurement of the ANB angle obtained equivalent results between the virtual planning and the traditional. Key words:Orthognathic surgery, splints, data accuracy, 3-D printing.

The Impact of Virtual Surgical Planning on the Value of Orthognathic Surgery for the Maxillofacial Surgeon

Background: The practice of orthognathic surgery traditionally involved time-intensive presurgical planning that was associated with decreased compensation relative to other procedures within the specialty. This limited reimbursement and subsequent reduction in the incidence of these procedures has been described in the literature. The introduction of VSP has streamlined the presurgical planning process. The purpose of this study is to provide a reevaluation of the relative value units (RVUs) per unit time for orthognathic surgery and to make a comparison to other commonly performed plastic surgery procedures in the context of recent developments in VSP. Methods: RVU data for both orthognathic and common plastic surgery procedures were collected using Current Procedural Terminology (CPT) codes. A range of operative times was then used to calculate work RVUs per hour of both orthognathic surgery and other procedures commonly performed by plastic surgeons including: unilateral deep inferior epigastric perforator (DIEP) flap breast reconstruction, bilateral breast tissue expander placement, bilateral breast reduction, bilateral breast reconstruction using latissimus dorsi muscle flaps, and panniculectomy. Results: Hourly RVUs for orthognathic procedures compare favorably to hourly RVUs for other commonly performed plastic surgery procedures when examined within a range of expected average operative times. Conclusions: Accounting for the reduced time commitment to preoperative planning that VSP achieves, the authors demonstrate a significant RVU/hour increase in orthognathic procedures than that described in the literature published prior to the implementation of VSP. Orthognathic surgery remains competitive for maxillofacial surgeons when compared to other procedures in plastic surgery when RVUs/hour is the metric of comparison.

Biomechanical Evaluation of a New Fixation Method for Stabilization of Sagittal Split Ramus Osteotomy After Mandibular Advancement

Study Design: Biomechanical in vitro study. Mandibular advancement after sagittal split ramus osteotomy (SSRO) is a common procedure in orthognathic surgery. Several fixation methods are used for stabilization of SSRO. Objective: The aim of this study was to compare a new fixation method (gridplate) with more contemporary applied methods of fixation. Material and Methods: In this study, 50 polyurethane hemimandibles with a prefabricated SSRO were used as specimens. All hemimandibles were advanced by 8 mm and divided into 5 groups with different fixation methods: (A) one 4-hole miniplate with 4 monocortical screws; (B) two 4-hole miniplates with 8 monocortical screws; (C) one 4-hole miniplate with 4 monocortical screws and 1 bicortical screw in the retromolar area (hybrid method); (D) 3 bicortical screws in an inverted-L pattern; and (E) one 8-hole gridplate with 8 monocortical screws. Loads in newtons were recorded at displacements of the mandibular incisive edge at 1 mm, 3 mm and 5 mm. Results: Fixation with 3 bicortical screws and the gridplate presented the most stability, followed by two 4-hole miniplates. Fixation with the hybrid method or the single miniplate showed the least stability. Conclusion: According to the results of this study, the 8-hole gridplate design appears a sufficient fixation method regarding stabilization of SSRO with larger mandibular advancement.

Operative time, length of stay and reoperation rates for orthognathic surgery

Orthognathic surgery improves quality of life in terms of oral function and facial aesthetics. Our aim was to establish and compare operative time and length of inpatient stay for orthognathic procedures, and to assess the reoperation rate. Departmental electronic data base was used to identify all patients undergoing orthognathic surgery in a single unit between the 01/01/2016 and the 01/08/2018. 251 patients were identified who underwent 409 orthognathic surgery procedures. The mean operating time for a bimaxillary osteotomy (n=107) was 139.3 min. For single jaw procedures, the mean operating time for a Le Fort I osteotomy (n= 42) was 82.2 min and for a bilateral sagittal split osteotomy (BSSO) (n= 102) was 80.3min. Bimaxillary osteotomy combined with genioplasty (n=17) this increased the operating time on average by 31 min. and of a BSSO combined with a genioplasty (n=14) by 27 mins. The mean postoperative hospital stay was 1.2 ± 0.2 days. 96.4% patients spent only one postoperative night in hospital. 6/251 (2.4%) patients required re-operation. In regression analysis, age was the only significant factor in increasing length of stay (p<0.008), 95% CI 0.03-0.2). Our review shows short operating times and postoperative inpatient stays in a large cohort of patients undergoing orthognathic surgery. This is combined with a low reoperation rate. This may point to a patient benefit from high volume orthognathic centres.

A simple technique to facilitate the recording of intraoral scan data on cone-beam computed tomographic images during three-dimensional planning.

When using digital planning, 3-dimensional datasets must be accurately superimposed. The success of such planning (before the placement of implants, orthognathic surgery, and other procedures that require the fitting of tooth guides) is heavily reliant on the accurate superimposition of stereolithographic (STL) files on to cone-beam computed tomographic (CT) images.

Chirurgies secondaires dans le cadre des ostéotomies de la face : 10 cas

Orthognathic surgery, now well known to the general public, is becoming increasingly successful. It is the most predictable approach to the treatment of dento-maxillo-facial deformities. As with plastic surgery the number of indications increasing the number of difficult cases follows as well as the searching for perfection. The aim of these treatments must be triple and take into account the functional elements of the face, the dental occlusion and the aesthetic objectives of the patient and therapists. Orthognathic surgery procedures having become quite bearable patients who feel that the result is not up to their requirement easily require a reoperation to achieve their objective. PATIENTS AND METHODS: We studied 10 cases of facial redone osteotomies from 4 different surgeons. We looked at the initial indication, the type of surgery, the initial orofacial functions, the delay of the reoperation, the technique of redo and the result. RESULTS AND DISCUSSION: Like other authors, we found that there are surgeries and at-risk patients. The patients who were re-operated all had at least one of the three negative factors: OSAS, lingual dysfunction, oral ventilation. We have not been able to highlight an overall frequency of surgical resumption in the studied literature which is poor about reoperations after osteotomies of the face.

Short osteotomy use in orthognathic surgery:benefit, disadvantage and perspective

The short osteotomy was first reported by Blair in 1907 and was later described and characterized by Kater and Paulus in 2013. The technique involves an oblique supra-lingular osteotomy from internal to external, from top to bottom and from back to front. It is designed to divide the ramus into two segments, the joint and the mandibular body, and to ensure minimal valve equivalents. Both osseous valves were maintained in contact by obtaining surface contact proportional to the angle of the osteotomy. We present a series of 82patients to demonstrate the benefits of this technique in terms of stability and conservation of sensitivity. 82patients were included, of which 74 (90%) described normal sensitivity and 8 (10%) reported modified sensitivity two years post-surgery. On account of the nature and height of the short osteotomy cut, it is possible to avoid direct manipulation of the lower alveolar nerve. The postoperative sensitivity level is identical to the pre-operative level in more than 90% of cases. In good indications, this technique could be used preferentially to optimize postoperative nerve recovery. We also discuss the current limitations of this orthognathic surgery procedure, as well as the perspectives linked to the development of 3D printing and preoperative planning.

Orthognathic Surgery Treatment Need in a Turkish Adult Population: A Retrospective Study.

Objectives: Limited information exists on orthognathic procedures and respective dentofacial deformities in Turkey. This retrospective study assessed the orthognathic surgery procedures in two universities, using the Index of Orthognathic Functional Treatment Need (IOFTN), and compared the IOFTN grades according to gender as well as sagittal and vertical skeletal relationships. Material and Methods: Records of 200 consecutive patients (120 females, 80 males, mean age = 23.4 (SD: 5.4) years) who received orthognathic treatment (2014–2018) were analyzed. Sagittal (ANB angle) and vertical skeletal type (GoGnSN angle), osteotomies, and IOFTN scores were recorded. Results: Class III, II, and I malocclusions formed 69%, 17.5%, and 13.5% of the samples, respectively. Class III skeletal relationships (69%) and high-angle cases (64%) were the most prevalent (p < 0.05). IOFTN scores were unevenly distributed among genders (p < 0.05) and the prevalent scores were 5.3 (40.5%), 4.3 (15.5%), 5.4 (13%), and 5.2 (7.5%), with 94% scoring 4 or 5 (great and very great functional need). Bimaxillary osteotomies were the most prevalent (55%), followed by LeFort I (32%), and 26% had genioplasty. Conclusion: IOFTN is a reliable tool to identify patients in need of orthognathic surgery. Class III malocclusions and Class III sagittal skeletal relationships were more common in this sample. Comparatively, a higher number of patients had genioplasty as a part of their treatment.