Single-jaw Surgery Research Articles

Accuracy of Two Different Patient-Specific Drill/Cutting Guides for Maxillary Repositioning When Used for Minimally Invasive Bimaxillary Orthognathic Surgery.

Minimally invasive orthognathic surgery (MIOS) involves smaller incisions and minimal tissue dissection. Most MIOS is done using interim splints to position the first jaw. The application of patient-specific implants in MIOS is difficult due to the size of traditional cutting/drill guides, which require larger incisions. As a result, MIOS guides were redesigned for this study to fit into smaller incisions. The study purpose was to estimate and compare the accuracy of the smaller and redesigned bone-borne versus bone/tooth-borne (BTB) cutting/drilling guides used in minimally invasive bimaxillary orthognathic surgery. This retrospective cohort study included consecutive MIOS patients treated by a single surgeon at the University of Texas Health San Antonio from June 2023 to September 2024. It included patients that underwent bimaxillary MIOS with complete preoperative and postoperative cone-beam computed tomographic records. Exclusion criteria included craniofacial syndromes, severe medical comorbidities, or single-jaw surgery. The primary predictor variable was the type of cutting/drilling guide (BB vs BTB) used to perform maxillary osteotomy. The primary outcome variable was accuracy, defined as mean linear discrepancy that is closest to 0mm. Linear discrepancies between planned and actual maxillary movements were measured. Demographics and malocclusion type. χ2 tests compared categorical variables, and Student's t-tests assessed accuracy differences. A P value < .05 was considered significant, with a Bonferroni correction applied for multiple comparisons. The sample consisted of 20 patients (15 females, 75%; 5 males, 25%; mean age 24±11.3years) evenly divided into BB (n=10) and BTB (n=10) guide groups. The BTB guide demonstrated superior vertical accuracy for the upper incisor (mean difference: 0.67mm, standard deviation=0.33, P=.02) and the upper left canine (mean difference: 0.11mm, standard deviation=0.04, P=.03) when comparing means. However, no significant differences were found in root mean square discrepancies (P>.2) or other measurements (P>.06). Both guides achieved acceptable accuracy overall, with the BTB guide showing superior precision for 2 of the 11 landmarks.

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.

Ortognatik Cerrahi Komplikasyonlarının Nedenleri ve Literatür Karşılaştırılması: Retrospektif Kohort Araştırma

Objective: This paper investigated the incidence, types, and reasons for complications of orthognathic surgery (OS). Material and Methods: The sample consisted of the medical records of 250 OS (141 women; 109 men) patients from April 2011 to February 2017. This study retrospectively analyzed follow-up files, radiographic images, and surgery notes and then classified participants for gender, malocclusion type, OS method, and complication. Complications were classified as preoperative, intraoperative, and postoperative. Statistical analysis was performed using IBM SPSS Statistics 21.0 (IBM Corp, Armonk, NY, USA). Descriptive data were calculated for each variable. Results: The mean age was 22.9±6.5 (minimum: 17; maximum: 55). The majority of participants (n=166) had Class III dentofacial deformity. Only 24 participants underwent Le Fort I osteotomy alone (12%). Participants had undergone bimaxillary (n=167; 66.8%), single jaw surgery (Le Fort I or sagittal split ramus osteotomy) (n=48; 19.2%), or other types of surgery (n=35; 14%). The patients were followed up for 12 months in the postoperative period. The only preoperative complication (4 patients-1.4%) was errors in planning (occlusal split incompatibility). The major intraoperative complications (38 patients-15.2%) were bad splits, heavy bleeding, and ruptured inferior alveolar neurovascular bundle. The postoperative complications (43 patients-17.2%) were infection, fixation-related problems, neurosensory and temporomandibular joint disorders, facial paralysis, nasal septum deviation, and malunion-nonunion. The total rate of complications was 27.2% (68 patients). Conclusion: OS operations are generally safe operations that can be easily managed, although they may rarely cause serious life-threatening complications.

Does Liposomal Bupivicaine Injection Decrease Postoperative Opioid Usage following Bimaxillary Surgery?

PurposeAmong patients undergoing bimaxillary surgery, does the use of liposomal bupivacaine injection reduce the use of opioid analgesics and/or length of hospital admission in the postoperative period? MethodsA retrospective cohort analysis was conducted on subjects who received orthognathic surgery from 2017 to 2019 at Parkland Memorial Hospital. Inclusion criteria were a maxillary Le Fort I procedure and simultaneous bilateral sagittal split osteotomy. Exclusion criteria were a syndromic condition, repeat surgery, concomitant genioplasty or temporomandibular joint surgery, or single-jaw surgery. The predictor variable was the administration of a standard dosage of 266mg (20mL) of liposomal bupivacaine distributed equally among all 4 surgical sites. The primary outcome variable was the total milligram morphine equivalent (MME) of opioids administered to the subject in the immediate postoperative period. Secondary predictor variables were postoperative hospital stay length, defined in days, age, and sex, defined as male or female. Statistical analysis was performed with P < .05 used to determine statistical significance. ResultsNineteen patients met the defined inclusion criteria. The age at the time of surgery ranged from 17 to 51, with the average age being 26 years old. The cohort consisted of 8 males and 11 females. Ten subjects received an injection of 266mg of liposomal bupivacaine, divided equally among all 4 surgical sites (2 maxillary and 2 mandibular) at the completion of surgery, and 9 subjects received no liposomal bupivacaine.Postoperatively, subjects received varying combinations of PRN opioids, including: codeine, hydrocodone, oxycodone, fentanyl, and hydromorphone. MME for each of these medications was then calculated. Patients in the group who received a liposomal bupivacaine injection required a mean of 9.3 MME during their postoperative course, while the group who did not receive liposomal bupivacaine required a mean of 25 MME. Statistical analysis revealed a significant difference in MME usage between the 2 groups (P =.0243). The average postoperative hospital admission duration was 1.32 days, with no significant difference between the 2 study groups (P = .884). There was no significant difference between sex or age and postoperative MME usage (P = .566 and P = .381, respectively). DiscussionManagement of postoperative pain is not only vital to patients’ surgical experiences, but is imperative in preserving hospital resources, decreasing hospital stay, and decreasing readmission rates. In total, 20-80% of patients experience moderate to severe pain during their postoperative course. Opioids remain the leading modality to manage postoperative pain, but the recent opioid epidemic has motivated clinicians to pursue other pathways, including liposomal bupivacaine for pain management to mitigate the use of large doses of opioids. The results of the present study suggest that administration of 266mg of liposomal bupivacaine, given equally in all 4 surgical sites following bilateral Le Fort I and sagittal split osteotomies, leads to a statistically significant decrease in postoperative opioid usage. Future prospective studies utilizing liposomal bupivacaine and standard multimodal pain control regimens following orthognathic procedures will further explore the efficacy of liposomal bupivacaine in opioid reduction and management of postsurgical pain.

A Comparative Analysis of Orthognathic Surgical Stability between Fixed Appliances and Clear Aligner Orthodontic Therapy

BackgroundSkeletal relapse etiology in orthognathic surgery (OGS) is multifactorial. The role of differing orthodontic mechanics, such as fixed appliances and clear aligners in relapse, has not been explored. The adoption of clear aligner orthodontic therapy in surgical-orthodontic cases is slow due to concerns regarding surgical protocol and postoperative stability. Patients seeking surgical orthodontic treatment with clear aligner therapy is increasing, and outcomes require investigation. ObjectiveThe study's objective is to compare the degree of skeletal relapse in the sagittal and vertical dimension following OGS between cases managed with fixed appliance and clear aligner orthodontic therapy. MethodologyA retrospective chart review was conducted to include patients undergoing OGS with surgical-orthodontic therapy. The intervention group consisted of patients with clear aligner orthodontic therapy. The matched-control group was comprised of patients treated by conventional fixed appliances and were selected based on corresponding age, sex, medical status, and surgical treatment plan to the intervention group. A lateral cephalogram with standard cephalometric analysis was obtained at 2 postoperative time periods: within 7 days (T1) and 1 year (T2), postoperatively. Differences in linear and angular references were calculated. The degree of skeletal relapse measured the difference between the 2 time periods. Statistical analysis: parametric method with standard T-tests and a significance level of .05. ResultsTwenty-six orthognathic surgery patients were included in the study: 13 patients treated by fixed appliances (control) and 13 patients treated by clear aligner therapy (intervention). There was no statistically significant difference in age or surgical movement (P < .05) between the 2 groups; 18 patients had bimaxillary surgery, and 8 had single-jaw surgery (6 BSSO and 2 Le Fort). The mean surgical movements were 4.13mm advancement and 0.44mm impaction in the maxilla, with a 1.3mm setback in the mandible. Cephalometric analysis in the control group demonstrated a -0.20mm posterior relapse of A point and a -0.28mm relapse of B point. Angular measurement differences of SNA and SNB were -1.4 and -2.3, respectively. In the intervention group, cephalometric analysis revealed skeletal relapse between the time periods of a -0.22mm posterior relapse of A point and a -0.31mm of B point occurred. Angular changes of SNA and SNB were -1.1 and -1.9, respectively. There was no statistically significant difference in surgical relapse between both groups. ConclusionThe results of this study demonstrate that skeletal relapse following OGS may not be affected by the mechanism of orthodontic therapy. Both fixed orthodontic appliances and clear aligner therapy patients displayed minimal postoperative skeletal changes. Although a small sample size, this initial evaluation does provide support in the use of clear aligner orthodontic therapy as a viable treatment option in surgical orthodontics.

Quasi-least squares regression method with dentistry data.

In dentistry, single-jaw surgery or double-jaw surgery is performed depending on the patient's need to correct severe skeletal malocclusions. The effect of these surgical methods used in treatment is to be investigated with quasi-least squares regression (QLS), which is a new data analysis method for correlated data obtained by extending generalized estimating equations (GEE). The aim of this study is to investigate whether jaw surgery methods (single jaw and double jaw) and time are effective on some outcome variables (C point menton distance, cervical plane angle, distance from point C to pogonion perpendicular, angle between cervical plane and facial plane) using QLS method. In application, 114 measurements were performed on the lateral cephalometric radiographs of 34 patients aged 18 years and older who received orthodontic treatment and underwent surgery in the period of 2000-2018. The effects of time and group variables on four dependent variables were investigated and evaluated using QLS and GEE methods. Single-jaw surgery and double-jaw surgery as a group variable on all outcome variables were not significant. Among the working correlation structures used in QLS, the highest correlation value was obtained by "Markov" working correlation structure. Single-jaw surgery and double-jaw surgery were found to be statistically insignificant for outcome variables examined. QLS is superior to GEE in cases where repeated measurements are performed at unequal time intervals and there are missing observations.

Predictors of Opioid Prescription After Orthognathic Surgery in Opioid Naive Adults From a Large Database.

Orthognathic surgery often requires postoperative opioid pain management. The goal of this study was to examine opioid prescribing patterns in adults after orthognathic surgery and to analyze factors associated with high-dose postoperative opioid administration and persistent opioid use. We included opioid naive adults in the IBM MarketScan Databases who had undergone orthognathic surgery from 2003 to 2017. Three outcomes were examined: presence of a perioperative outpatient opioid claim; total oral morphine milliequivalents (MMEs) in the perioperative period; and persistent opioid use. Univariate analysis and multiple regression were used to determine associations between the outcomes and independent variables. Our study yielded a cohort of 8163 opioid naive adults, 45.6% of whom had an opioid claim in the perioperative period. The average prescribed MMEs in the perioperative period was 466 MMEs total, and 66 MMEs daily. Of patients with an opioid claim, 17.9% had persistent opioid use past 90 days. The presence of a complication was a predictor of having an opioid claim (P<0.001). Increasing age (P<0.001) and days hospitalized (P < 0.001) were associated with increased opioid usage. Persistent opioid use was associated with being prescribed more than 600 MMEs in the perioperative period (P < 0.001), as well as increasing age and days hospitalized. Interestingly, patients undergoing double-jaw surgery did not have significantly more opioids prescribed than those undergoing single-jaw surgery. Prescription opioids are relatively uncommon after jaw surgery, although 17.9% of patients continue to use opioids beyond 3 months after surgery. Predictors of persistent opioid use in this population include the number of days hospitalized, increasing age, and increasing amount of opioid prescribed postoperatively.

Management of Class II Hyperdivergent Mandible by Surgically Altering Occlusal Plane Pattern through Counterclockwise Rotation of Mandible

To evaluate the facial esthetic of class II hyperdivergent mandible by altering the high mandibular plane angle into an orthognathic mandibular plane angle by counterclockwise (CCW) rotation of the mandible. Five patients with class II hyperdivergent mandible were selected for this study. Initially, preorthodontics was done by aligning the teeth. Then, surgically, bilateral sagittal split osteotomy (BSSO) advancement with CCW rotation of mandible with a posterior open bite of 4 mm was done. Eleven linear and 11 angular measurements were taken. Pre- and postsurgical values were evaluated by composite cephalometric analysis, and the changes in the occlusal plane and facial height were statistically analyzed by using paired t-test. Jarabak ratio was calculated for facial height measurements. Further finishing will be done by postsurgical orthodontic procedures to get functional occlusion. Change in occlusion to class I is seen in values of Jarabak ratio and Go-Gn. Jarabak ratio shows an increase in posterior and decreases in anterior facial height. Go-Gn, which implies the CCW movement of the mandible, has reduced the anterior open bite and created a posterior open bite of 4 mm for the supraeruption of teeth. BSSO with CCW rotation of mandible with a posterior open bite has conservatively involved in single-jaw surgery, thereby improving the facial esthetics of all the patients taken this study. This innovative method of CCW rotation of mandible with open bite mainly prevents the bi-jaw surgery, improves the stability, and gives an esthetically good appearance.

Evaluation of Condylar Positional, Structural, and Volumetric Status in Class III Orthognathic Surgery Patients.

Background and objectives: The need to evaluate the condylar remodeling after orthognathic surgery, using three-dimensional (3D) images and volume rendering techniques in skeletal Class III patients has been emphasized. The study examined condylar positional, structural, and volumetric changes after bimaxillary or single-jaw maxillary orthognathic surgeries in skeletal Class III patients using the cone-beam computed tomography. Materials and Methods: Presurgical, postsurgical, and one-year post-surgical full field of view (FOV) cone-beam computed tomography (CBCT) images of 44 patients with skeletal Class III deformities were obtained. Group 1 underwent a bimaxillary surgery (28 patients: 24 females and 4 males), with mean age at the time of surgery being 23.8 ± 6.0 years, and Group 2 underwent maxillary single-jaw surgery (16 patients: 8 females and 8 males), with mean age at the time of surgery being 23.7 ± 5.1 years. After the orthognathic surgery, the CBCT images of 88 condyles were evaluated to assess their displacement and radiological signs of bone degeneration. Three-dimensional (3D) condylar models were constructed and superimposed pre- and postoperatively to compare changes in condylar volume. Results: Condylar position was found to be immediately altered after surgery in the maxillary single-jaw surgery group, but at the one-year follow-up, the condyles returned to their pre-surgical position. There was no significant difference in condylar position when comparing between pre-surgery and one-year follow-up in any of the study groups. Condylar rotations in the axial and coronal planes were significant in the bimaxillary surgery group. No radiological signs of condylar bone degeneration were detected one year after the surgery. Changes in condylar volume after surgery were found to be insignificant in both study groups. Conclusions: At one year after orthognathic surgery, there were no significant changes in positional, structural, or volumetric statuses of condyles.

The 5-Minute Splint (5MS): In-House 3D Printing of an Orthognathic Splint for Single-Jaw Cases

The benefits of computer-assisted surgical simulation (CASS) have been proven, including visualization of the osteotomies and interferences, increasing intra-operative efficiency, and producing reliable and accurate outcomes.1 However, the manual fabrication of orthognathic splints for single-jaw surgery using acrylic is still common today, despite being vulnerable to intrinsic inaccuracies.2 The purpose of this study was to demonstrate a novel, rapid, simple CASS protocol for in-house 3D-printing of orthognathic splints for use during single-jaw orthognathic surgery. A specific protocol, the 5 Minute Splint (5MS) protocol, was performed for consecutive patients requiring single-jaw orthognathic surgery. Using an intraoral scanner and computer-aided surgical simulation, computer-designed splints were fabricated by a rapid prototyping machine in-house. The primary outcome variable was the time associated with the design, manufacturing, and processing of the splints. The secondary outcome variable was the cost associated with the rapid prototyping of the splints. The 5 Minute Splint (5MS) protocol was utilized for 33 consecutive patients (21 female and 12 male; mean age 28.1 years) requiring single-jaw orthognathic surgery between January 2019 and February 2020. Of these patients, 10 underwent a Le Fort I osteotomy procedure and 23 a bilateral sagittal split osteotomy (BSSO) (both regardless of genioplasty). The mean time for each case was between 5 to 9 hours, including 3 minutes for scanning of models, 4.5 minutes for development of the splint, and 4-8 hours for rapid prototyping and post-processing. This time varied based on the complexity of the design and the number of splints printed simultaneously. The average cost for each splint was $0.73 Canadian dollars (CAD). The average time and cost for producing each splint using the 5MS protocol is significantly less than that seen in the literature. An average total cost of $2380.26 U.S. dollars (USD) reported in 1 study for a virtual surgical planning (VSP) session and fabrication of splints with an external company.3 The results of this study confirm that the design and rapid prototyping of orthognathic splints for single-jaw surgery can be performed in an efficient, cost-effective manner in-house using the 5MS protocol.

An Objective Assessment of Orthognathic Surgery Patients.

To retrospectively assess malocclusions, skeletal relationships and the functional needs of orthognathic patients treated in a University teaching hospital. This study used clinical records of 100 consecutive patients [51 female, 49 males, mean (SD) age =21.5 (2.71) years] who had orthognathic surgery in a Shahid Beheshti University of Medical Sciences affiliated hospital (9/2014-7/2017). Malocclusion type (incisor classification), sagittal skeletal pattern (ANB angle), index of orthognathic functional treatment need (IOFTN) score, and osteotomy type were recorded. Overall, 66%, 31%, and 3% had Class III, II, and Class I malocclusions, respectively. Similarly, 68% and 32% had Class III and II sagittal skeletal relationships, respectively. Overall, 95% of patients scored IOFTN 4 or 5. The most prevalent IOFTN score were 4.3 (37%), 5.3 (16%), 5.4 (16%), and 4.2 (10%). There were no gender differences (P >0.05) for the distribution of malocclusions, sagittal skeletal relationships, different IOFTN scores, or when IOFTN scores were re-grouped (5, 4, and ≤3). When IOFTN scores were re-grouped (5, 4, and ≤3), they were equally distributed among patients with Class II or III skeletal relationships (P >0.05), but when the authors looked at different malocclusions, there were significant differences in IOFTN score distribution (P = 0.006). The use of genioplasty (4%) or distraction osteogenesis (2%) was limited. Single jaw surgery of either maxilla or mandible was used in 15% and 22% of patients, respectively. About 63% had undergone double-jaw surgery. Retrospective assessment using IOFTN identified 95% of patients as having great and very great functional needs, but prospective studies using IOFTN is needed to assess the need for orthognathic surgery. Class III malocclusions and Class III sagittal skeletal relationships were more common in this sample.

PSYCHOLOGICAL, SOCIAL AND ECONOMIC, SATISFACTION OF DOUBLE JAW SURGERY VS. SINGLE JAW SURGERY: A RETROSPECTIVE CLINICAL STUDY.

16Sep 2019 PSYCHOLOGICAL, SOCIAL AND ECONOMIC, SATISFACTION OF DOUBLE JAW SURGERY VS. SINGLE JAW SURGERY: A RETROSPECTIVE CLINICAL STUDY. Maryam Al-Hindi , Mohammed Alkindi , Noura AlOtaibi , Safa Alrashed and Syed Sirajul Hassan. Assistant Professor and Consultant Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, King Saud University. Associate Professor and Chairman of Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, King Saud University. Lecturer, Faculty of Dentistry, King Saud University. Private Sector King Saud University. Assistant Consultant Oral & Maxillofacial Surgery (Surgical Dentistry) King Saud University.

A Comparative Evaluation of Changes in Soft Tissues After Single-Jaw Surgery and Bimaxillary Surgery in Skeletal Class III Patients.

The aim of this study was to compare cephalograms for the hard and soft tissue changes observed in skeletal Class III patients of Indian origin who had undergone either single-jaw mandibular setback (BSSO) or bimaxillary surgery (Le Fort I advancement+BSSO setback) and also to derive a correlation between the changes brought about in the soft tissues by the surgical alteration in hard tissue. The study included records comprising 18 treated skeletal Class III patients, who were divided into two groups based on the surgical procedures advocated: Group I: single-jaw procedure comprised of only mandibular set back, Group II: bimaxillary surgery. Presurgical and post-treatment cephalograms were calibrated and traced using Ilexis FACAD AB-2014 Version 3.8.0.0 software and analyzed with COGS hard tissue analysis and soft tissue analysis. All values for the hard tissue and soft tissue measurements were compared with the norms prescribed for the Indian population. Upper lip changes were evident in both groups but greater significance was observed in bi-jaw group. Single-jaw patients showed positive correlation for hard to soft tissue mandibular position. Bi-jaw surgical cases exhibited positive correlations between changes Wits variable to soft tissue convexity as well as mandibular position. The soft tissues changes between Class III patients treated by single-jaw surgery and those treated by bimaxillary surgery when compared revealed that significant differences were observed only in relation to certain measurements such as facial convexity, maxillary prognathism, and upper lip protrusion.

Is Virtual Surgical Planning in Orthognathic Surgery Faster Than Conventional Planning? A Time and Workflow Analysis of an Office-Based Workflow for Single- and Double-Jaw Surgery

The purpose of this study was to measure and compare the working time for virtual surgical planning (VSP) in orthognathic surgery in a largely office-based workflow in comparison with conventional surgical planning (CSP) regarding the type of surgery, staff involved, and working location. This prospective cohort study included patients treated with orthognathic surgery from May to December 2016. For each patient, both CSP with manual splint fabrication and VSP with fabrication of computer-aided design-computer-aided manufacturing splints were performed. The predictor variables were planning method (CSP or VSP) and type of surgery (single or double jaw), and the outcome was time. Descriptive and analytic statistics, including analysis of variance for repeated measures, were computed. The sample was composed of 40 patients (25 female and 15 male patients; mean age, 24.6years) treated with single-jaw surgery (n=18) or double-jaw surgery (n=22). The mean times for planning single-jaw surgery were 145.5±11.5minutes for CSP and 109.3±10.8minutes for VSP, and those for planning double-jaw surgery were 224.1±11.2minutes and 149.6±15.3minutes, respectively. Besides the expected result that the working time was shorter for single-versus double-jaw surgery (P<.001), it was shown that VSP shortened the working time significantly versus CSP (P<.001). The reduction of time through VSP was relatively stronger for double-jaw surgery (P<.001 for interaction). All differences between CSP and VSP regarding profession (except for the surgeon's time investment) and location were statistically significant (P<.01). The surgeon's time to plan single-jaw surgery was 37.0minutes for CSP and 41.2minutes for VSP; for double-jaw surgery, it was 53.8minutes and 53.6minutes, respectively. Office-based VSP for orthognathic surgery was significantly faster for single- and double-jaw surgery. The time investment of the surgeon was equal for both methods, and all other steps of the workflow differed significantly compared with CSP.

Skeletal stability of maxillary advancement with and without a mandibular reduction in the cleft lip and palate patient

The stability of surgical maxillary advancement in a consecutive series of patients with cleft lip and palate who underwent Le Fort I osteotomy with and without simultaneous mandibular setback surgery was evaluated. Preoperative, postoperative, and follow-up lateral cephalograms of 21 patients were assessed to compare differences in surgical movement and postoperative relapse between two groups: those who underwent maxillary surgery alone and those who underwent bimaxillary surgery. Differences in the number of patients who experienced relapse of <2mm, 2–4mm, and >4mm between the groups were also compared. Mean advancement of the cleft maxilla was 5.5mm in the maxilla only group and 3.6mm in the bimaxillary group, with a mean horizontal relapse of 0.8mm and 0.2mm, respectively. Mean surgical movement in the vertical dimension was comparable in the two groups and the magnitude of vertical relapse was less than 0.4mm overall. Approximately 80% of patients in both groups experienced horizontal relapse of less than 2mm. There was no significant difference in the degree of postoperative relapse between those who had single-jaw surgery and those who had two-jaw surgery.

“Converting a bi-jaw surgery to a single-jaw surgery:” Posterior maxillary dentoalveolar intrusion with microimplants to avoid the need of a maxillary surgery in the surgical management of skeletal Class III vertical malocclusion

The management of a vertical skeletal Class III malocclusion with mandibular prognathism revolves around the protocol of bi-jaw surgery (maxillary LeFort I impaction and mandibular bilateral sagittal split osteotomy with setback). The maxillary surgery not only provides increased stability to the ultimate surgical outcome but also increases the amount by which the mandibular set back can be done, therefore aiding in greater profile improvement. With the need of maxillary surgery almost inevitable in treating such situations, the complexity and the increased discomfort associated with such surgery can never be ignored. Is it at all possible to convert a bi-jaw surgery into a single-jaw surgery with the aid of microimplants? With increasing number of patients being treated with microimplants for anterior openbite and gummy smiles, our idea was to incorporate this novel protocol in treating Class III vertical situations and therefore avoid the need of a maxillary surgery in treating such a situation, together with achieving optimum treatment outcome.

Prevalence and risk factors of tooth discolouration after orthognathic surgery: a retrospective study of 1455 patients

This study was conducted to evaluate the prevalence of tooth discolouration and to examine the factors that may pose a higher risk for tooth discolouration after orthognathic surgery. This was a retrospective study of 1455 orthognathic surgeries. The following data were collected for analysis: presence of discoloured teeth, sex, age at operation, the extent of the surgical displacement of the maxilla, and whether patients had undergone genioplasty, zygomaplasty, or descending palatine artery (DPA) ligation. Out of 1339 patients who underwent double-jaw surgery, 49 received root canal treatment due to tooth discolouration. No tooth discolouration was found in the 116 patients undergoing single-jaw surgery. DPA ligation, genioplasty, and mandibular sub-apical osteotomy were associated with a significant risk of tooth discolouration. Patients should be informed preoperatively of the possibility of tooth discolouration. Additionally, the DPA should be preserved during Le Fort I osteotomy to reduce the risk of tooth discolouration.

Maxillary single-jaw surgery combining Le Fort I and modified horseshoe osteotomies for the correction of maxillary excess

A modified technique of horseshoe osteotomy combined with Le Fort I osteotomy for superior and posterior repositioning of the maxilla is presented. Eight patients with maxillary excess associated with retrogenia or microgenia were treated with this technique in combination with genioplasty. The maxillary segment was repositioned a maximum of 5.0mm posteriorly and 7.0mm superiorly at point A. The mandible autorotated anterosuperiorly to achieve sound occlusion. Point B moved 2.0–10.0mm anteriorly and 5.0–10.0mm superiorly. The pogonion moved 7.0–17.0mm anteriorly in combination with genioplasty. All patients obtained sound occlusion and a good profile after the operation. Almost no skeletal relapse was observed during 1 year of postoperative follow-up. Patients with long faces with maxillary excess and retrogenia often have small, unstable condyles. In these cases, because surgical intervention to the ramus can result in postoperative progressive condylar resorption, maxillary single-jaw surgery with a horseshoe osteotomy, thereby avoiding ramus intervention, is a less invasive option.

Predictores de dolor y tiempo de internación prolongado tras cirugía ortognática: estudio de cohorte retrospectivo

IntroductionOrthognathic treatment has assumed an important role in orthodontics and maxillofacial surgery in the last years, however, little has been investigated about this type of treatment. ObjectivesThe main purpose of this study was to identify major factors and/or predictors associated with postoperative pain (PP) and hospital length of stay (LOS) after orthognathic surgery. Materials and methods52 patients who underwent orthognathic surgery from 2008 to 2010 at the University Hospital of São Paulo University were investigated. Study variables such as patient characteristics, preoperative, intraoperative and postoperative data were collected. The outcome variables were PP and LOS. Descriptive and analytical statistics was computed for all variables. Results27.6% of patients had pain in the postoperative period. Lidocaine used in general anesthesia was an associated factor of PP. The overall mean LOS was 2days; gender, location of procedure, type and duration of anesthesia were identified as probable predisposing factors. There was a significant correlation between anesthesia time and discharge. Anesthesia variables were more predictably related with postoperative pain and hospitalization time. Location of orthognathic procedure, however, was an important surgical variable that influenced in LOS. ConclusionsIntravenous lidocaine boluses used during general anesthesia was associated with PP. Male patients, single-jaw surgery, inhalational anesthesia and duration of anesthesia were predisposing factors that improve LOS.

Predictors of pain and prolonged length of stay after orthognathic surgery: A retrospective cohort study

IntroductionOrthognathic treatment has assumed an important role in orthodontics and maxillofacial surgery in the last years; however, little has been investigated about this type of treatment. ObjectivesThe main purpose of this study was to identify major factors and/or predictors associated with postoperative pain (PP) and hospital length of stay (LOS) after orthognathic surgery. Materials and methods52 patients who underwent orthognathic surgery from 2008 to 2010 at the University Hospital of São Paulo University were investigated. Study variables such as patient characteristics, preoperative, intraoperative and postoperative data were collected. The outcome variables were PP and LOS. Descriptive and analytical statistics was computed for all variables. Results27.6% of patients had pain in the postoperative period. Lidocaine used in general anesthesia was an associated factor of PP. The overall mean LOS was 2 days; gender, location of procedure, type and duration of anesthesia were identified as probable predisposing factors. There was a significant correlation between anesthesia time and discharge. Anesthesia variables were more predictably related with postoperative pain and hospitalization time. Location of orthognathic procedure, however, was an important surgical variable that influenced in LOS. ConclusionsIntravenous lidocaine boluses used during general anesthesia were associated with PP. Male patients, single-jaw surgery, inhalational anesthesia and duration of anesthesia were predisposing factors that improve LOS.