Outcome Of Orthognathic Surgery Research Articles

Nasal profile changes after LeFort I osteotomy (maxillary advancement) with and without ANS reduction in class III skeletal patients: a study protocol for a randomized clinical trial

BackgroundDentofacial malformation is a common condition that affects a significant portion of the population, resulting in functional and aesthetic defects. Orthognathic surgeries, such as LeFort I osteotomy, are performed to correct these abnormalities. However, the impact of these surgeries on nasal profile changes remains unclear. Additionally, the role of anterior nasal spine (ANS) reduction in maxillary advancement surgeries of 3–5 mm range is yet to be determined. This study aims to investigate the effect of ANS reduction on soft tissue profile changes following LeFort I osteotomy with a maxillary advancement range of 3–5 mm in class III skeletal patients. The hypothesis is that the changes in nasolabial angle and upper lip length will not significantly differ between patients who undergo LeFort I osteotomy with and without ANS reduction.Method and designThis study is designed as a randomized controlled trial. A total of 26 class III skeletal patients with maxillofacial abnormalities will be recruited from the maxillofacial clinic of Bu-Ali and Farahikhtegan Hospitals in Tehran, Iran. Patients meeting the inclusion criteria will be randomly assigned to two groups: one group will undergo LeFort I osteotomy with ANS reduction, and the other group will undergo LeFort I osteotomy without ANS reduction. The soft tissue profile changes, specifically the nasolabial angle and upper lip length, will be evaluated and compared between the two groups.DiscussionAchieving facial harmony through orthognathic surgery requires careful planning and consideration of the impact on surrounding soft tissue. The primary objective is to predict and plan for the effects on the nasolabial region. LeFort I osteotomy is a common procedure used to correct dentofacial deformities, particularly in class III patients. Maxillary advancement during this surgery can lead to changes in nasal tip position, width, and rotation, potentially due to repositioning of the anterior nasal spine and soft tissue dissection. In this study, soft tissue changes will be assessed in non-growing class III patients using cephalometric radiographs. The impact of reducing the anterior nasal spine (ANS) on nasal profile changes will be investigated for maxillary advancements of 3–5 mm. Objective measurements and patient-reported outcomes will be evaluated to gain insights into the aesthetic outcomes of orthognathic surgery. The findings will provide valuable guidance for treatment decisions and alternative options based on expected nasal profile changes.Trial registrationThis project was registered at The Iranian Registry of Clinical Trials (Identifier No. IRCT20210928052625N1, Website: https://www.irct.ir/trial/59171) and Open Science Framework (OSF) (Registration https://doi.org/10.17605/OSF.IO/X3HD4). 2021-06-09.

The Association of Body Mass Index and Early Outcomes Following Orthognathic Surgery

The existing data on the link between body mass index (BMI), operative characteristics, and surgical outcomes across orthognathic surgery are limited. The purpose was to measure the association between BMI and early postoperative outcomes in orthognathic surgery. This is a retrospective cohort study of patients (n=118) aged > 14years undergoing bimaxillary orthognathic surgery between 2015 and 2018 by a single surgeon within the Kaiser Permanente Northern California-integrated healthcare system. Patients undergoing unilateral or additional procedures, history of prior orthognathic surgery, or pre-existing pain conditions were excluded. The predictor variable was BMI measured as a continuous (kg/m2) and categorical variable (underweight/normal, overweight, obese). The primary outcome variables were additional postoperative antibiotics, increased postoperative visits, wound dehiscence, and wound infection. The secondary outcome variables were total operative and anesthesia time. The demographic covariates included age, sex, and race/ethnicity. The clinical covariates included history of obstructive sleep apnea, Mallampati score, tobacco use, American Society of Anesthesia classification, thyromental distance, history of difficult intubation, and Angle's classification. Bivariate and multivariate analyses were performed to measure the associations between BMI and the primary and secondary outcomes. Multivariable logistic regression analyses were used to measure associations between BMI and the postoperative outcomes. Statistical significance was defined as P<.05. The study sample was composed of 118 subjects with a mean age of 26.91years (standard deviation 9.43). Forty-seven percent (n=55) were male, and the mean BMI was 25.13 (standard deviation 5.19). BMI category was significantly associated with age, with increasing age associated with higher BMI category (P=.02). According to the bivariate and multivariable logistic regression analyses, controlling for age, race/ethnicity, BMI, and total operative time, increased total operative time was associated with additional postoperative antibiotics (odds ratio=1.03, 95% confidence interval: 1.01, 1.05), and increased postoperative appointments (odds ratio=1.02, 95% confidence interval: 1.01, 1.04). No significant association between BMI and other clinical or operative characteristics was seen aside from American Society of Anesthesia classification. Elevated BMI was not associated with worsened operative characteristics or postoperative outcomes. This supports the suitability of orthognathic surgery in a BMI-diverse population.

Optimizing Patient Outcomes in Orthognathic Surgery: A Proposed Nutritional Protocol for Weight Loss Control and Bone Formation

Objective: The primary objective of this research was to conduct a comprehensive literature review, offering an in-depth examination of the nutritional considerations associated with orthognathic surgery and suggest a perioperative nutritional protocol for enhanced recovery. Methods: To achieve this objective, the authors rigorously examined existing literature while adhering to the guidelines outlined in PRISMA-ScR. The scope of eligible studies encompassed various types, with the exclusion of case reports and reviews. The research applied specific inclusion criteria, concentrating on the nutritional aspects relevant to perioperative and/or postoperative phases of major maxillofacial surgery. Results: A total of 39 articles were identified that met the screening criteria. These articles were then used to generate a discussion and propose a protocol aimed at reducing body weight loss following major maxillofacial surgery and improving bone formation post-osteotomies. Conclusions: While the realm of maxillofacial surgery sees significant advancements in other fields, there exists a noticeable gap in addressing the nutritional status of surgical patients. This oversight can potentially lead to suboptimal postoperative outcomes. Recognizing the pivotal role of nutrition in enhancing surgical results, this paper emphasizes the importance of maintaining optimal nutritional status among orthognathic surgery patients.

Assessment of Patient Satisfaction and Functional Outcomes in Orthognathic Surgery.

Orthognathic surgery is a surgical procedure performed to correct severe jaw misalignments that can affect a patient's facial aesthetics and functional occlusion. While the primary goal of orthognathic surgery is to improve functional outcomes and facial appearance, it is essential to assess patient satisfaction as a crucial aspect of overall treatment success. Patient selection: We conducted a prospective study involving 50 patients who underwent orthognathic surgery. All patients had a confirmed diagnosis of severe jaw misalignment, as determined by clinical and radiographic assessments. The surgical procedures performed included maxillary advancement, mandibular setback, or a combination of both, depending on the patient's specific diagnosis. Preoperative orthodontic treatment was provided to align the teeth and prepare the patient for surgery. Patients were evaluated preoperatively and at postoperative intervals of 3 months, 6 months, and 1 year. Patient satisfaction scores and functional outcomes were as follows: aesthetics of facial profile (1-year post-op): mean score = 4.6, chewing function (1-year post-op): mean score = 4.4, speech function (1-year post-op): mean score = 4.3, and overall satisfaction with surgical outcome (1-year post-op): mean score = 4.5. Objective assessments revealed a significant improvement in occlusion and facial aesthetics. The mean reduction in overjet was 4.8 mm, and the mean reduction in overbite was 3.2 mm. Additionally, the mean postoperative ANB angle improved by 3.7°, indicating a better facial balance. Orthognathic surgery in our cohort of 50 patients resulted in high levels of patient satisfaction with both functional outcomes and facial aesthetics. Objective measurements also indicated significant improvements in occlusion and facial balance.

Treatment outcome and long-term stability of orthognathic surgery for facial asymmetry: A systematic review and meta-analysis.

: This systematic review aimed to provide a comparative analysis of the treatment outcomes, including hard and soft tissues, postoperative stability, temporomandibular disorders (TMD), and quality of life (QoL), in patients with facial asymmetry who underwent orthognathic surgery. : The primary objective was to address the question, "How do different factors related to surgery affect the outcomes and stability of orthognathic surgery in the correction of facial asymmetry?" A meta-analysis was conducted on the outcome parameters, such as skeletal, dental, and soft tissue symmetry, TMD, QoL, and relapse, using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Subgroup analyses were conducted considering surgery-related factors such as surgical techniques (one-jaw vs. two-jaw), use of the surgery-first approach, utilization of computer simulation, and analytical methods employed to evaluate asymmetry (2D vs. 3D). : Forty-nine articles met the inclusion criteria. The meta-analysis demonstrated a significant improvement in the symmetry of hard and soft tissues. The subgroup analysis indicated that the treatment outcomes showed significant improvement, regardless of the factors related to surgery. Changes in TMD signs and symptoms varied according to the surgical technique used. Quality of life improved in the facial, oral, and social domains. Skeletal relapse was observed during the follow-up. : Our findings support the positive outcomes of orthognathic surgery in the treatment of facial asymmetry in terms of skeletal and soft tissue improvements, stability, relief of TMD symptoms, and enhancement of QoL. However, most of the included studies showed a low certainty of evidence and high heterogeneity.

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.

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

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

Three-dimensional cephalometric outcome predictability of virtual orthodontic-surgical planning in surgery-first approach

ObjectivesThe aim of this study is to introduce a novel 3D cephalometric analysis (3DCA) and to validate its use in evaluating the reproducibility of virtual orthodontic-surgical planning (VOSP) in surgery-first approach (SF) comparing VOSP and post-operative outcome (PostOp).MethodsThe cohort of nineteen patients underwent bimaxillary orthognathic surgery following the VOSP designed in SimPlant O&O software by processing cone-beam computed tomography (CBCT) scans and intraoral digital scanning of the dental arches. Said records were re-acquired once the post-operative orthodontic treatment was completed. The 3DCA was performed by three expert operators on VOSP and PostOp 3D models. Descriptive statistics of 3DCA measures were evaluated, and outcomes were compared via Wilcoxon test.ResultsIn the comparison between cephalometric outcomes against planned ones, the following values showed significant differences: Wits Index, which suggests a tendency towards skeletal class III in PostOp (p = 0.033); decreased PFH/AFH ratio (p = 0.010); decreased upper incisors inclination (p < 0.001); and increased OVJ (p = 0.001). However not significant (p = 0.053), a tendency towards maxillary retroposition was found in PostOp (A/McNamara VOSP: 5.05 ± 2.64 mm; PostOp: 4.1 ± 2.6 mm). On average, however, when McNamara’s plane was considered as reference, a tendency to biprotrusion was found. Upper incisal protrusion was greater in PostOp as an orthodontic compensation for residual maxillary retrusion (VOSP: 5.68 ± 2.56 mm; PostOp: 6.53 ± 2.63 mm; p = 0.084). Finally, the frontal symmetry in relation to the median sagittal plane decreased in craniocaudal direction.LimitationsA potential limit of studies making use of closest point distance analysis is represented by the complexity that surgeons and orthodontists face in applying this three-dimensional evaluation of SF accuracy/predictability to everyday clinical practice and diagnosis. Also, heterogeneity and limited sample size may impact the results of the study comparison.ConclusionsThe presented 3DCA offers a valid aid in performing VOSP and analysing orthognathic surgery outcomes, especially in SF. Thanks to the cephalometric analysis, we found that surgery-first approach outcome unpredictability is mainly tied to the sagittal positioning of the maxilla and that the transverse symmetry is progressively less predictable in a craniocaudal direction.

Clinical Outcomes in Orthognathic Surgery for Craniofacial Microsomia Following Mandibular Distraction Using CBCT Analysis: A Retrospective Study.

The aim of this study was to evaluate the outcomes of orthognathic surgery (OGS) in patients with craniofacial microsomia (CFM) who had previously undergone mandibular distraction osteogenesis (MDO). A retrospective cohort study was performed including all patients with CFM who were treated with OGS at a single institution between 1996 and 2019. The clinical records, operative reports, and cone beam computed tomography (CBCT) scans were reviewed. CBCT data before OGS (T1), immediately after OGS (T2), and at long-term follow-up (T3) were analyzed using Dolphin three-dimensional software to measure the occlusal cant and chin point deviation. The study included 12 patients with CFM who underwent OGS (6 underwent OGS without MDO and 6 underwent OGS after MDO). There was a statistically significant improvement in occlusal cant and chin point deviation in both groups postoperatively. Occlusal cant relapsed by a mean of 0.6° (standard deviation [SD] 1.1°) in the patients who had OGS alone compared with 0.7° (SD 1.2°) in the patients who had OGS after MDO (P = .745) between T2 and T3. There was no statistically significant difference in chin point relapse between patients who had OGS alone compared with those who had OGS after MDO (0.1 mm [SD 2.5mm] vs 0.7mm [SD 2.2mm]; P = .808). Within the limitations of this study, these findings suggest that OGS after MDO in patients with CFM can produce stable results.

Is orthognathic surgery indicated for wind instrument players? A multiple case study.

Introduction For the ambitious wind instrument player with severe malocclusion, the decision to undergo orthognathic surgery can be difficult.Aim To qualitatively explore and reveal key aspects of considerations for and outcomes of orthognathic surgery by interviewing a group of advanced and professional wind instrumentalists.Materials and methods One investigator, using a standardised questionnaire, interviewed seven cases. The interviews were analysed by two investigators who are knowledgeable about embouchure.Outcomes An ideal jaw relationship is not a prerequisite to achieving a professional career in music. Complete embouchure loss after surgery can be experienced due to changes in the position of incisors, lip relationship and tongue position relative to the shape of the oral cavity and as a result of neurosensory changes. Neurosensory recovery and 'wind instrument rehabilitation' takes at least six months, which was achieved in three out of five cases. The following temporary or permanent difficulties during playing after surgery were reported: onset of notes, high notes, leaps and intervals, and stable and well-tuned sound.Conclusion In view of the risks involved, orthognathic surgery in wind instrumentalists should only be considered when there is an (oral) health indication.

Comprehensive virtual orthognathic planning concept in surgery-first patients

The surgery-first concept is becoming increasingly popular in orthognathic surgery since it offers major advantages such as a reduction of treatment duration and an increase in patient satisfaction by eliminating phases of presurgical orthodontic decompensation. Here, we present a novel interdisciplinary pathway of a fully virtual orthodontic-surgical planning concept in a surgery-first setting using a 3D-printed cutting guide and a customised maxillary implant for the Le Fort I osteotomy as well as a CAD/CAM-based stereolithographic final splint. Patient data from cone-beam computed tomography of the skull and a full arch dental scan were processed using the OnyxCeph3TM software (Image Instruments). A mutual computer-aided surgical simulation was conducted by the orthodontist and the oral and maxillofacial surgeon to determine the three-dimensional maxillary and mandibular movements. In a separate virtual planning session, the surgeon designed a customised maxillary guide and implant for precise intraoperative transfer (Geomagic Freeform Plus software, 3DSystems). A 3D-printed CAD/CAM-based final splint was fabricated by the orthodontist and used for accurate mandibular repositioning. We established a comprehensive virtual interdisciplinary orthognathic workflow and successfully applied this concept with a high level of accuracy in a series of surgery-first patients with different types of dentofacial anomalies. This novel fully computer-based pathway offers a high potential to improve the outcomes of orthognathic surgery and reduce total treatment time in the management of the orthognathic patient.

Efficiency of using visualized treatment objectives in orthodontics

Lateral skull radiographs are used to perform cephalometric measurements and to evaluate the skeletal component of the orthodontic anomalies. It is difficult for the patients to imagine the expected outcome of their orthodontic treatments. so visual treatment objectives (VTO) can be a significant motivating factor. It can be used to illustrate the expected growth. the outcome of orthognathic surgery and the amount of teeth movements. This study was aimed to evaluate the accuracy of the visual treatment objectives through analysis of predicted and actual treatment outcomes. The second objective was the comparison of the initial cephalometric measurements with the final ones and the visualized treatment objectives prediction accuracy. Material and methods: Using the AudaxCeph cephalometric program and Roth-Jarabak analysis, lateral skull radiographs of 27 patients were analyzed. Visual treatment objectives were assessed by modification of the dental parameters as well as of the skeletal bases where indicated. Results: Lateral skull radiographs taken after the orthodontic treatment were used to evaluate the final cephalometric measurements. Statistical comparison of the dental and skeletal measurements of the final radiographs and the visual treatment objectives did not show statistically significant differences of the most important parameters. However, the following measurements were significantly different when compared with the visual treatment objectives Ar-Go-N angle (degrees), Go-Ar distance (mm) and S-Ar / Ar-Go ratio. Conclusions: Using the VTO, the expected orthodontic outcome can be well estimated, and it can be considered an effective tool for planning.

HANDBOOK OF PULMONARY REHABILITATION. Editors: Paraschiva A. Postolache (Romania), Darcy D. Marciniuk (Canada). Nova Science Publishers, Inc., New York, USA

Lateral skull radiographs are used to perform cephalometric measurements and to evaluate the skeletal component of the orthodontic anomalies. It is difficult for the patients to imagine the expected outcome of their orthodontic treatments. so visual treatment objectives (VTO) can be a significant motivating factor. It can be used to illustrate the expected growth. the outcome of orthognathic surgery and the amount of teeth movements. This study was aimed to evaluate the accuracy of the visual treatment objectives through analysis of predicted and actual treatment outcomes. The second objective was the comparison of the initial cephalometric measurements with the final ones and the visualized treatment objectives prediction accuracy. Material and methods: Using the AudaxCeph cephalometric program and Roth-Jarabak analysis, lateral skull radiographs of 27 patients were analyzed. Visual treatment objectives were assessed by modification of the dental parameters as well as of the skeletal bases where indicated. Results: Lateral skull radiographs taken after the orthodontic treatment were used to evaluate the final cephalometric measurements. Statistical comparison of the dental and skeletal measurements of the final radiographs and the visual treatment objectives did not show statistically significant differences of the most important parameters. However, the following measurements were significantly different when compared with the visual treatment objectives Ar-Go-N angle (degrees), Go-Ar distance (mm) and S-Ar / Ar-Go ratio. Conclusions: Using the VTO, the expected orthodontic outcome can be well estimated, and it can be considered an effective tool for planning.

Computed tomography imaging superimposition protocols to assess outcomes in orthognathic surgery: a systematic review with comprehensive recommendations.

A systematic review was performed to analyze the current evidence on three-dimensional (3D) computed tomography (CT) superimposition protocols used to assess dentomaxillofacial changes after orthognathic and orthofacial surgery. Accuracy, reproducibility, and efficiency were evaluated. The search was divided into Main Search (PubMed, EMBASE, Cochrane Library, LILACS, and SciELO), Grey Literature search (Google Scholar and Open Grey), and Manual search. Thirteen studies were included. Of these, 10 reported data on accuracy, 10 on reproducibility and five on efficiency. Seven proposed or evaluated methods of voxel-based superimposition, three focused on the surface-based technique, one compared surface- and voxel-based superimposition protocols, one used the maximum mutual information algorithm, and one described a landmark-based superimposition method. Cone-beam computed tomography (CBCT) was the most common imaging technique, being used in 10 studies. The accuracy of most methods was high, showing mean differences smaller than voxels' dimensions, ranging between 0.05 and 1.76 mm for translational accuracy, and 0.10-1.09° for rotational accuracy. The overall reproducibility was considered good as demonstrated by the small mean error (range: 0.01-0.26 mm) and high correlation coefficients (range: 0.53-1.00). Timing to complete virtual superimposition techniques ranged between a few seconds up to 40 min. Voxel-based superimposition protocols presented the highest accuracy and reproducibility. Moreover, superimposition protocols that used automated processes and involved only one software were the most efficient.

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.

Nasal Dorsum Reduction Simultaneous to Orthognathic Surgery: A Proof-of-Concept Report.

This report describes a technique to reduce nasal dorsum excess simultaneously to orthognathic surgery (OS) through a Le Fort I osteotomy. It avoids the need to change from endonasal intubation to intraoral intubation. It also eliminates the need to open the dorsum, preserving the integrity of the triangular cartilages at the nasal dorsum keystone area, avoiding iatrogenic nasal dorsum deformities. A sample of five patients referred for OS who also sought improvement of their nasal aesthetics was selected to implement the technique. The aim of this proof-of-concept study was to evaluate the clinical outcome of simultaneous OS and nasal dorsum reduction. The following measurements were used to evaluate the procedure: patient satisfaction with a visual analog scale, photographic assessment, additional operative time, and complications related to the procedure. The average patient age was 23 years (range: 19-32 years). Three patients were women and two were men. In all patients, a high degree of patient satisfaction was observed with the aesthetic result of the nose and OS. No undesirable side effects or surgical complications occurred in any case. Total surgery time was increased by an average of 25 minutes. Nasal dorsum reduction through a Le Fort I approach during OS is a reliable and effective method to reduce nasal dorsum excess in patients seeking simultaneous OS and rhinoplasty.

Automatic Assessment of 3-Dimensional Facial Soft Tissue Symmetry Before and After Orthognathic Surgery Using a Machine Learning Model: A Preliminary Experience.

An objective and quantitative assessment of facial symmetry is essential for the surgical planning and evaluation of treatment outcomes in orthognathic surgery (OGS). This study applied the transfer learning model with a convolutional neural network based on 3-dimensional (3D) contour line features to evaluate the facial symmetry before and after OGS. A total of 158 patients were recruited in a retrospective cohort study for the assessment and comparison of facial symmetry before and after OGS from January 2018 to March 2020. Three-dimensional facial photographs were captured by the 3dMD face system in a natural head position, with eyes looking forward, relaxed facial muscles, and habitual dental occlusion before and at least 6 months after surgery. Three-dimensional contour images were extracted from 3D facial images for the subsequent Web-based automatic assessment of facial symmetry by using the transfer learning with a convolutional neural network model. The mean score of postoperative facial symmetry showed significant improvements from 2.74 to 3.52, and the improvement degree of facial symmetry (in percentage) after surgery was 21% using the constructed machine learning model. A Web-based system provided a user-friendly interface and quick assessment results for clinicians and was an effective doctor-patient communication tool. This work was the first attempt to automatically assess the facial symmetry before and after surgery in an objective and quantitative value by using a machine learning model based on the 3D contour feature map.

Predictability and Accuracy between 3D Virtual Surgical Planning and Actual Outcomes in Orthognathic Surgery

Introduction: We are living a paradigm shift in orthognathic surgery. Several tools and technological advances are being implemented to help improve surgical experience and to offer better functional and aesthetical results. Virtual surgical planning is a revolutionary tool which helps us design the surgical plan preoperatively and establish a surgical protocol specifically designed for that patient. In this study, our goal is to validate the predictability of virtual surgical planning in orthognathic surgery, comparing the final results with the virtual plan. Material and methods: We performed an ICP based super imposition of 3D models of the virtual planning preoperatively designed and the 3D model of the postoperative CBCT using free software (Slicer) in patients who underwent bimaxillary orthognathic surgery. The results of the super imposition were saved on the postoperative model and presented as a color-coded map. This was generated as a .vtk file that was exported to another free software that displayed the difference in mm in relevant cephalometric points (point A, point B, pogonion, left and right gonion and first upper molars) in the three axis (x, y and z) between the postoperative result and the virtual plan. Then, we registered these results for all patients and analysed these data. Results: A total of 41 patients were included. The median of the differences in mm between virtual planning and postoperative results were less than 1mm for all cephalometric points, except for both gonion, where greater than 1mm differences were found in the mediolateral (horizontal) direction. For the rest of landmarks, the highest differences were found at A point and pogonion in the anteroposterior direction (0,83mm and 0,78mm, respectively). Conclusions: We found overall small and tolerable differences (&lt;1mm) between the planned movements and the postoperative results. The highest were found at the gonion in the mediolateral direction and mandibular rami, which could be explained by the torque of the proximal segment. The differences in A point and pogonion in the anteroposterior direction were the highest among the rest, which may be related to inaccuracy of the splint in this direction.

Quality and outcomes in orthognathic surgery, oral and maxillofacial surgery department at Oxford University Hospitals

Introduction/aims: Outcomes measures following orthognathic surgery have historically been based on PROM using patient satisfaction questionnaires. Following the recent emphasis on improving quality and outcome measures in OMFS, we were encouraged to assess how our practice compares to any national data. A national review of mandibular orthognathic surgery activity in the NHS in England over a nine-year period showed that the mean inpatient stay was 3.2 days and is gradually reducing. We aimed to compare our average stay to the national average and assess if we were experiencing a higher number of readmissions/RTT compared to national average.

The Impact of Virtual Surgical Planning on Orthognathic Surgery: A Comparison of 2 Specialties

PURPOSE: Virtual surgical planning (VSP) is the gold standard for preoperative treatment planning for orthognathic surgery.1 Prior to the implementation of VSP, traditional orthognathic preoperative preparation required hours of labor and utilization of a dental laboratory. This often limited orthognathic surgery to providers with dental training. The combination of VSP and 3-dimensional printing has allowed orthognathic surgeons the ability to more accurately and efficiently create treatment plans for these cases.2 This technology has also allowed practitioners such as plastic surgeons to begin to perform orthognathic procedures. This review serves to illustrate how plastic surgeons use VSP and highlight its impact on surgical outcomes and research output within orthognathic surgery. METHODS: A literature search was conducted in the PubMed database to identify all articles published before January 2020 that report perioperative use of VSP technology in orthognathic surgeries. Only articles that were written in English, involved operations on live human patients, and used VSP to plan or assist with orthognathic surgery were included in the analysis. All articles that fit inclusion criteria were reviewed to determine the year of publication, type of orthognathic surgery performed, how VSP was used, and the primary outcomes measured. RESULTS: A total of 419 publications regarding VSP in orthognathic surgery resulted from initial search. Of them, 244 publications were authored by oral and maxillofacial surgeons, 28 publications by plastic surgeons, and 34 by surgeons with training in both fields. TEMPORAL TREND OF PUBLICATIONS: Prior to the late 1990s, VSP in orthognathic surgery publications was primarily authored by oral and maxillofacial surgeons. Plastic surgeons first began publishing on VSP technology for orthognathic surgery in 1998. Since then, there has been a rising trend in plastic surgery usage of VSP paralleled by increasing VSP publications in the field, with 2 publications before the year 2010 (7.2%), 9 from 2010 to 2015 (32%), and 18 between 2015 and 2019 (64%). CATEGORIES OF PUBLICATIONS: Most publications from oral and maxillofacial trained surgeons highlight optimal positioning of craniofacial bones, anticipated stability and functionality of occlusion, and the interplay between orthodontic treatments and orthognathic surgery. In contrast, plastic surgeon authored papers often discuss postoperative facial aesthetics by ensuring facial symmetry and treatment especially in the cases of congenital craniofacial abnormalities like cleft lip/palate, Treacher-Collins, and hemifacial microsomia. CONCLUSIONS: VSP is an increasingly utilized tool that reduces the workflow without compromising accuracy and outcomes in orthognathic surgery. This is the first paper to create a temporal relationship between a new technology and the emergence of plastic surgeons into a field typically predominated by oral and maxillofacial surgeons. As plastic surgeons become more familiar with this technology, they have produced literature that provides alternative perspectives on orthognathic surgery that will push the field forward. REFERENCES: 1. Langdon J, Patel M, Brennan P. Operative Oral and Maxillofacial Surgery. 2nd ed. CRC Press; 2010. 2. Baker SB, Goldstein JA, Seruya M. Outcomes in computer-assisted surgical simulation for orthognathic surgery. J Craniofac Surg. 2012;23:509–513.