Orthognathic Surgical Correction Research Articles

Enhanced Precision in Genioplasty: A Novel Intraoperative Spatial Repositioning Using Computer-Aided Design and Manufacturing Technology and a Holographic Mixed Reality Application

Genioplasty is performed for the orthognathic surgical correction of dentofacial deformities. This article reports a safe and accurate method for genioplasty combining a novel three-dimensional (3D) device with mixed reality (MR)-assisted surgery using a registration marker and a head-mounted display. Four types of devices were designed based on the virtual operation: a surgical splint with a connector; an osteotomy device; a repositioning device; and a registration marker. Microsoft HoloLens 2 and Holoeyes MD were used to project holograms created using computed tomography (CT) data onto the surgical field to improve the accuracy of the computer-aided designed and manufactured (CAD/CAM) surgical guides. After making an incision on the oral vestibule, the splint was fitted on the teeth and the osteotomy device was mounted at the junction site, placed directly on the exposed mandible bone surface. Temporary screws were fixed into the screw hole. An ultrasonic cutting instrument was used for the osteotomy. After separating the bone, a repositioning device was connected to the splint junction and bone segment, and repositioning was performed. At the time of repositioning, the registration marker was connected to the splint junction, and mandible repositioning was confirmed three-dimensionally through HoloLens 2 into the position specified in the virtual surgery. The rate of overlay error between the preoperative virtual operation and one-month postoperative CT data within 2 mm was 100%. CAD/CAM combined with MR enabled accurate genioplasty.

Multidisciplinary approach to the treatment of children with congenital cleft lip and palate in Ukraine

Children with congenital cleft lip and palate (CLP) develop a composite complex of anatomical, functional and aesthetic disorders that increase with growth and require comprehensive and multi-stage treatment. Treatment and diagnostic measures require a multidisciplinary approach to overcome the identified problems. The main task of orthodontic support for children with CLP at the stages of primary surgical interventions is aimed at preventing orthognathic surgical correction in the future, by optimizing the choice and tactics of orthodontic treatment within the framework of multidisciplinary comprehensive rehabilitation measures. The purpose of the work is the substantiation, approval and introduction into clinical practice of a complex of medical and diagnostic measures aimed at the rehabilitation of children with CLP. It confirmed that providing the necessary conditions for sucking creates optimal conditions for surgical intervention on the lip and palate. The tactics of orthodontic treatment depended on the period of development of the dentognathic apparatus, age, type of cleft, staging, timing and volume of surgical interventions, quality and methods of surgery, severity of deformations in the transversal and sagittal planes and components of the symptom complex of anomalies and deformations complicating the pathology, psychological and emotional child state, factors of parents and patients communication with the doctor, social and economic components. Removable and fixed orthodontic appliances are used in most cases at the initial stage of treatment for the treatment of dentognathic deformities, obtaining satisfactory sagittal and vertical overlap and normalization of transversal ratios. A separate area of rehabilitation was prevention and treatment of diseases of hard tissues of teeth and periodontal tissues. Speech therapy and psychological support started from 2–3 months. The proposed complex of treatment and diagnostic measures, determined in time, terms, sequence and volume, aimed at the rehabilitation of children with CLP, made it possible to obtain positive anatomical, functional and aesthetic results in 87.6% of children. Keywords: therapeutic and diagnostic measures, orthodontic treatment, speech therapy and psychological support, rehabilitation algorithm.

An objective, quantitative, dynamic assessment of facial movement symmetry changes after orthognathic surgery

The aim of this study was to generate a quantitative dynamic assessment of facial movement symmetry changes after orthognathic surgery. Twenty-five patients diagnosed with skeletal class III malocclusion with facial asymmetry who underwent bimaxillary surgery were recruited. The patients were asked to perform a maximum smile that was recorded using a three-dimensional facial motion capture system preoperatively (T0), 6 months postoperatively (T1), and 12 months postoperatively (T2). Eleven facial landmarks were selected to analyse the cumulative distance and average speed during smiling. The absolute differences for the paired landmarks between the sides were analysed to reflect the symmetry changes. The results showed that the asymmetry index of the cheilions at T2 was significantly lower than that at T0 (P = 0.004), as was the index of the mid-lateral lower lips (P = 0.006). The mean difference in cheilions was 2.13 ± 1.41 mm at T0, 1.33 ± 1.09 mm at T1, and 1.00 ± 0.98 mm at T2. The facial total mobility at T1 was significantly lower than that at T0 (P < 0.001), while the total mobility at T2 was significantly higher than that at T1 (P = 0.012). The orthognathic surgical correction of facial asymmetry was able to improve the associated asymmetry of facial movements.

Orthognathic surgery for juvenile idiopathic arthritis of the temporomandibular joint: a critical reappraisal based on surgical experience

Juvenile idiopathic arthritis (JIA) involving the temporomandibular joint (TMJ) can result in significant dentofacial deformities that may require orthognathic surgical correction. The aim of this study was to assess the functional and aesthetic results relative to stability after bimaxillary surgery with counterclockwise rotation of the occlusal plane in patients with JIA. A retrospective chart review was conducted of all patients affected by JIA who underwent orthognathic surgery between January 2000 and December 2019 at the Face Surgery Centre (Parma, Italy). Patient records were evaluated for surgical indications, complications, and outcomes. The final study sample included 13 patients (12 female, one male). The mean age of the patients was 18.6 years (range 17–26 years) at the time of surgery; 12 patients had bilateral TMJ disease. At the 1-year follow-up, all patients except one had a stable occlusion with a natural, well-balanced morphology of the face and adequate dynamic excursion of the mandible. The 1-year postoperative cone beam computed tomography (CBCT) scan revealed complete ossification at all osteotomy sites. Bilateral sagittal split osteotomy with mandibular advancement is an effective procedure with a low rate of complications for patients with JIA with stable disease confirmed by preoperative CBCT or magnetic resonance imaging.

A conceptual framework for treating jaw deformities in patients with abnormal condyles: preservation versus replacement of the glenoid fossa–disc–condyle–ramus

This article outlines a conceptual approach to the reconstruction of jaw deformities associated with abnormalities in the mandibular condyle. The authors describe a hierarchy of reconstruction, emphasizing use of the least invasive and progressing to the most complex and invasive techniques, depending on the nature and severity of the underlying deformity, prior operations, patient age, and stage of growth. Consider joint preservation orthognathic surgical correction, followed by biological techniques for replacement of the condyle, and avoid replacing a functional temporomandibular joint based only on radiographic remodeling and concerns about potential future flare-ups of disease based on anecdotal data.

Outcomes of Maxillary Orthognathic Surgery in Patients with Cleft Lip and Palate: A Literature Review.

Cleft lip and palate (CLP) patients often require orthognathic surgical correction due to maxillary hypoplasia secondary to primary surgeries, through either distraction osteogenesis (DO) or conventional orthognathic surgery (CO). The objective was to evaluate both surgical techniques regarding functional, aesthetics and quality-of-life and stability outcomes for the patient. The PubMed database was searched with the inclusion criteria: studies in English detailing maxillary orthognathic surgery on non-syndromic patients with CLP. Clinical trials, systematic reviews, meta-analysis, reviews, randomized control trials were included. Studies with less than five patients and studies reporting bimaxillary surgery were excluded. References lists of these studies were consulted for more studies to be included. Studies were then evaluated for relevance, quality checked for risk of bias and divided based on the results studied. In total, 22 studies published between 1997 and 2017 were included. Most studies had low levels of bias. The evidence to support one surgical technique before the other was low. DO offered better stability. No clear evidence exists on which technique had the best aesthetic results and functional improvement. DO may cause higher levels of anxiety and distress in patients compared to CO. Regarding all outcomes studied, the scrutinized literature did not allow for the recommendation of one specific technique. Future multicentre collaboration may enable greater sample size and better statistical comparison of results of both techniques.

Orthognathic Surgical Correction in Patients with Cantu Syndrome: Medical Considerations

Orthognathic Surgical Correction in Patients with Cantu Syndrome: Medical Considerations

Bite force and Masticatory efficiency before and after Orthognathic Surgical Correction

Introduction: Correction of Dentofacial deformity or Orthognathic surgery can be described and classified, where the treatment goal is to reposition the maxilla, mandible, or chin for patients who have crossed the age for growth modification and for other dentofacial conditions or orthodontic camouflage. The treatment is projected more from the aesthetic point of view, where patients undergo a dramatic change in the skeletal morphology. However, it is important to consider from the aesthetic and functional point of view for the overall well -being of the patient. Hence, Orthognathic surgery in combination with orthodontic treatment, not only corrects the dentofacial deformity, it also improves occlusal contacts, masticatory efficiency, the electromyographic (EMG) activity of the masticatory muscles and the bite force for the patient. Various studies have identified the problems and changes in occlusal discrepancy following orthognathic surgery. Objective: To compare the bite force and masticatory efficacy before and after orthognathic surgical correction. Selection criteria: All studies and articles that evaluated bite force and masticatory efficiency before and after orthognathic surgical correction were selected for review. Data Collection: The parameters compared in both the groups included, the surgical time was taken, postoperative occlusion, IMF stability, oral -hygiene, intra and postoperative complications. Results: Orthognathic surgery can improve the functional deficits, including those of the bite force, but the improvement may not continue beyond the first year of surgery. Conclusion: An objective analysis of the masticatory efficiency is important in evaluating the success of orthognathic treatment of the jaw deformities.

Principles of Orthognathic Surgical Correction of Skeletal Anterior Open Bite

This article describes the principles of orthognathic surgical correction of skeletal anterior open bite (AOB), including a description of the aetiological factors involved in the development of predominantly skeletal AOBs, description of the presenting diagnostic features, the principles of treatment planning, orthodontic preparation, and postoperative requirements.

The Impact of Orthognathic Surgery on Facial Expressions

The aim of this study was to evaluate the impact of orthognathic surgical correction of facial asymmetry and maxillary hypoplasia on the magnitude and pattern of facial expressions. This study was carried out on 2 cohorts of patients: in group 1, 10 patients had surgical correction of facial asymmetry; in group 2, 13 patients had Le Fort I osteotomy to correct maxillary hypoplasia. The patients were asked to perform 3 facial expressions (maximal smile, lip purse, and cheek puff) that were recorded using the Di4D image-capture system before and after surgery. The capture of each expression generated 180 3-dimensional (3D) facial images. Twenty-seven facial soft tissue landmarks were digitized on the first frame of the 3D image of each expression and a mathematical generic mesh was applied on the 3D model to clone each patient's face. The cloned mesh was superimposed automatically on each sequence of the 3D images to evaluate the pattern of facial expressions. The digitization of facial landmarks was satisfactorily accurate and reproducible. In group 1, the asymmetry of facial expressions was significantly decreased after surgical correction (P= .0458). In group 2, Le Fort I osteotomy decreased the magnitude of facial expressions (P= .0267). This study confirmed that orthognathic surgery affects the dynamics of facial expressions; this should be considered when planning the surgery and informing patients about the surgical correction of dentofacial deformities.

Evaluation of pharyngeal airway space changes after bimaxillary orthognathic surgery with a 3-dimensional simulation and modeling program

The aims of this study were to use 3-dimensional simulation and modeling programs to evaluate the effects of bimaxillary orthognathic surgical correction of Class III malocclusions on pharyngeal airway space volume, and to compare them with the changes in obstructive sleep apnea measurements from polysomnography. Twenty-five male patients (mean age, 21.6years) with mandibular prognathism were treated with bilateral sagittal split osteotomy and LeFort I advancement. Polysomnography and computed tomography were performed before surgery and 1.4±0.2years after surgery. All computed tomography data were transferred to a computer, and the pharyngeal airway space was segmented using SimPlant OMS (Materialise Medical, Leuven, Belgium) programs. The pretreatment and posttreatment pharyngeal airway space determinants in volumetric, linear distance, and cross-sectional measurements, and polysomnography changes were compared with the paired samples t test. Pearson correlation was used to analyze the association between the computed tomography and polysomnography measurements. The results indicated that setback procedures produce anteroposterior narrowing of the pharyngeal airway space at the oropharyngeal and hypopharyngeal levels and the middle and inferior pharyngeal volumes (P<0.05). In contrast, advancement of the maxilla causes widening of the airway in the nasopharyngeal and retropalatal dimensions and increases the superior pharyngeal volume (P<0.05). Distinctively, bimaxillary orthognathic surgery induces significant increases in the total airway volume and the transverse dimensions of all airway areas (P<0.05). Significant correlations were found between the measurements on the computed tomography scans and crucial polysomnography parameters. Bimaxillary orthognathic surgery for correction of Class III malocclusion caused an increase of the total airway volume and improvement of polysomnography parameters. A proposed treatment plan can be modified according to the risk of potential airway compromise or even to improve it with 3-dimensional imaging techniques and polysomnography.

Residents' journal review

Residents' journal review

Perceived changes by peer group of social impact associated with combined orthodontic-surgical correction of class III malocclusion

ObjectivesWhereas the psychosocial benefits of orthognathic treatment for the individual patient are established, there is little data relating to social perceptions in relation to changes in facial appearance as a result of combined orthodontic and orthognathic treatment. This study aimed to investigate the social impact of combined orthodontic–orthognathic surgical correction for class III malocclusion in Caucasian subjects. MethodsThis cross-sectional study compared perceptions of facial appearance prior to and after orthognathic correction of class III malocclusion. Eighty undergraduate students were shown photographs of four Caucasian subjects (2 male and 2 female) pre- and post-orthognathic class III correction. Observers were asked to rate these subjects in relation to four different outcomes: (i) social competence (SC); (ii) intellectual ability (IA); (iii) psychological adjustment (PA); (iv) attractiveness. A mixed-model analysis of variance (ANOVA) was calculated to determine the effect of each variable. ResultsStatistically significant differences were found in ratings of the same face before and after treatment. After treatment, faces were rated as more psychologically adjusted, more sociable, more likely to be successful and more attractive; with the mean psychological adjustment rating being associated with the most change (before treatment=8.06 [SD 2.30]; after treatment=6.64 [SD 2.03], t=2.04, p<0.001). ConclusionsAfter combined orthodontic–orthognathic correction of class III malocclusion in Caucasians, individuals are rated by young adults as being better adjusted both psychologically and socially, more likely to be successful and more attractive.

Prosthetic Rehabilitation of a Cleidocranial Dysplasia Patient with Vertical Maxillofacial Deficiency: A Clinical Report

Cleidocranial dysplasia (CCD) is a rare congenital disorder characterized by skeletal and dental anomalies. This clinical report describes the prosthodontic approach to treating a CCD patient who presented with decreased facial height and relative mandibular protrusion due to maxillary hypoplasia after orthodontic treatment. Functional and esthetic rehabilitation was achieved using telescopic detachable prostheses in the maxilla and osseointegrated implants and metal-ceramic fixed dental prostheses in the mandible. These treatment approaches precluded the need for orthognathic surgical correction and presented a favorable prognosis during the 5-year observation period.

Nonsurgical orthodontic treatment for an adult with skeletal open bite, class III malocclusion and posterior crossbite: A case report

Class III malocclusion associated with skeletal anterior open bite pattern in adults can be a challenging orthodontic problem, especially for the nonsurgical treatment. Conventionally, several treatment alternatives are available such as tooth extraction, molar intrusion, and absolute anchorage system or orthognathic surgical correction. Although correction with surgery may be the most effective and stable way, many patients refused surgical treatment plan because of the costs and traumas it may bring. We reported a nonsurgical orthopedic treatment of 22-year-old male with severe skeletal anterior open bite, dental Class III malocclusion, posterior crossbite and a high mandibular plane angle. The patient refused surgery and extraction. So we formulated a treatment plan consisting of using rapid palatal expansion appliance to expand the maxilla, standard edgewise brackets to align the teeth, Class III elastics to correct the canines, premolars, and molars relationship, reverse curve of the nickel-titanium wire combined with anterior vertical elastics to intrude molars and correct open bite. In this case, without suffering of surgery, the posterior crossbite was ideally corrected, and ideal overjet and overbite relationships and functional occlusion were all achieved. The patient obtained satisfactory occlusal as well as functional and stable results.

Dentoskeletal effects and facial profile changes in Class III patient treated with protraction facemask appliance: a case report

IntroductionTreatment of skeletal Class III malocclusion with an anterior crossbite is challenging due to unpredictable results and potentially unfavorable growth. Growth modification in growing patients is an alternative approach to orthognathic surgical correction. ObjectiveCase report of a patient with Class III malocclusion and anterior crossbite was treated with maxillary protraction facemask to illustrate that treatment has to be started during growth period and patient compliance is a determining factor. Treatment procedureTreatment of anterior crossbite was completed in two phases. The first phase was to correct the skeletal discrepancy with rapid palatal expansion, miniscrews and protraction facemask. The second phase was to correct the dental alignment with fixed orthodontic appliance. ConclusionsProtraction facemask therapy started at growing age with good patient compliance is a good approach in treating anterior crossbite relating to skeletal problems in the mixed dentition period.

Midfacial trauma and facial growth: A longitudinal case study of monozygotic twins

The purpose of this article is to present a long-term follow-up of the growth of the face and the nasomaxillary complex in a pair of identical twins, one of whom had suffered severe midfacial trauma at age 2 years. Growth of the face and the nasomaxillary complex was longitudinally assessed and compared by means of facial photographs and cephalometric x-rays. Twin A suffered Le Fort II and III fractures with an associated frontal bone injury in early childhood and subsequently developed significant midface hypoplasia; twin B had no trauma and normal facial growth and development. Facial profile difference between the twins gradually became more pronounced until age 19. Twin A had obvious retrusion of the midfacial region, including the nasal bones on visual examination and radiographic study. At age 20, she underwent orthognathic surgical correction of the traumatic deformity. Her unaffected sibling, twin B, provided the genetic facial phenotype for the surgical orthognathic reconstruction.

Orthodontic and Orthognathic Surgical Correction of a Skeletal Class III Malocclusion

Orthodontic and Orthognathic Surgical Correction of a Skeletal Class III Malocclusion

Oral contraceptive pill use and abnormal menstrual cycles in women with severe condylar resorption: A case for low serum 17β-estradiol as a major factor in progressive condylar resorption

Progressive condylar resorption has been described for many years. Because condylar resorption favors women over men, many have thought that a prominent systemic factor for the pathogenesis of this disease might be related to sex hormones. Over a 3-year period, 27 women without autoimmune disease came to our office for orthognathic surgical correction of their skeletal deformity secondary to severe condylar resorption. They all showed radiographic evidence of severe condylar resorption. Sex hormone dysfunction was evaluated, and midcycle serum levels of 17beta-estradiol were measured. Use of exogenous hormones was also documented. Twenty-six of the 27 women with severe condylar resorption had either laboratory findings of low 17beta-estradiol or a history of extremely irregular menstrual cycles. Of the 27 women, 25 showed abnormally low levels of serum 17beta-estradiol at midcycle. Two subsets were identified in the group with low 17beta-estradiol. The first did not produce estrogen naturally (8 of 27), and the second had low 17beta-estradiol levels secondary to oral contraceptive pill (OCP) use (19 of 27). Of the 19 OCP users, all 19 reported that chin regression and open bite changes occurred after starting OCP use. Nine of the 19 reported these condylar resorption symptoms within the first 6 months of starting the OCP. Whether induced by ethinyl estradiol birth control or by premature ovarian failure, low circulating 17beta-estradiol makes it impossible for the natural reparative capacity of the condyle to take place in the face of local inflammatory factors. This leads to cortical and medullary condylar lysis.

Relationship of body mass index to stability of mandibular advancement surgery with rigid fixation

Obesity is a growing problem in the United States. We examined patients undergoing orthognathic surgical correction for Class II skeletal malocclusions and assessed outcomes in relation to body mass index. The patients (n = 78) were divided into 3 groups (obese, overweight, and normal or thin) based on body mass index score. They were treated with mandibular advancement (mean, 4.9 mm) with rigid fixation and evaluated cephalometrically for postsurgical changes over a 2-year period; a subset of 54 patients was followed for 5 years. Obese and overweight patients experienced relative postsurgical forward movements at B-point (means, 2.6 and 1.0 mm, respectively), whereas the normal or thin patients had relapses (mean, -0.7 mm) over the 2 years. This trend held up at 5 years, with the obese patients experiencing 3 mm of forward movement compared with the normal or thin patients. Potential reasons for this difference in postsurgical response are orthopedic effects of tongue posture and hormonal and biochemical differences caused by obesity. Obese and overweight patients have different responses to mandibular advancement with rigid fixation compared with normal or thin patients. These data should enable orthodontists and surgeons to more appropriately treat obese patients.