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Kitagawa S, Habu M, Tsurushima H, Ohtani T, Sakamoto K, Yoshiga D, Yoshioka I, Tominaga K. Horseshoe osteotomy maintains the nasal cavity and function after superior repositioning. J Craniomaxillofac Surg 2023; 51:746-754. [PMID: 37816658 DOI: 10.1016/j.jcms.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 08/14/2023] [Indexed: 10/12/2023] Open
Abstract
The aim of this prospective cohort study was to compare changes in nasal cavity and function between Le Fort I with and without horseshoe osteotomy after superior repositioning of the maxilla. The patients were divided into 2 groups, a Le Fort I alone (LF alone) group and a combination Le Fort I and horseshoe osteotomy (HS) group. The nasal cavity volume was measured using 3-dimensional computed tomographic images, and nasal resistance was assessed by anterior active mask rhinomanometry. The HS group consisted of 17 patients, and the LF alone group consisted of 15 patients. The magnitude of change in nasal cavity volume was significantly smaller in the HS group than in the LF alone group (p < 0.001), even though the mean amount of superior maxillary movement was considerably larger in the HS group than in the LF alone group (p < 0.001). Mean nasal resistance was significantly smaller postoperatively than preoperatively in the HS group (p < 0.05). Furthermore, the change in nasal resistance was smaller in the HS group than in the LF alone group (p < 0.001). Within the limitations of this study, it seems that horseshoe osteotomy is useful for maintaining the nasal cavity and function after superior repositioning of the maxilla.
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Affiliation(s)
- Shota Kitagawa
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Japan.
| | - Manabu Habu
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Japan.
| | - Hiroki Tsurushima
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Japan.
| | - Taishi Ohtani
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Japan.
| | - Kikuo Sakamoto
- Sakamoto Clinic, Otolaryngology Head and Neck Surgery, Japan.
| | - Daigo Yoshiga
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Japan.
| | - Izumi Yoshioka
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Japan.
| | - Kazuhiro Tominaga
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Japan.
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Tomomatsu N, Nakamura T, Takahara N, Kurasawa Y, Kachi H, Yoda T. Study of Anatomical Changes of the Inferior Nasal Passage After Le Fort I Osteotomy With Superior Repositioning. J Craniofac Surg 2023; 34:e678-e682. [PMID: 37801719 DOI: 10.1097/scs.0000000000009585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/04/2023] [Indexed: 10/08/2023] Open
Abstract
The relationship between postoperative morphological changes in the inferior nasal cavity and inferior turbinate after Le Fort I osteotomy remains unclear. This study aimed to investigate how the bone volume of the inferior turbinate affects contact with the inferior nasal cavity of patients who underwent superior repositioning. We evaluated the 3-dimensional relationship between the anatomical changes in the inferior nasal passage before and after surgery in 51 patients who underwent Le Fort I osteotomy with an elevation of >4.0 mm in the first molar. The soft tissue and bone volumes of the inferior turbinate and airway volume of the inferior nasal passage were calculated using Proplan CMF 3.0 and compared according to the size of the bone volume of the inferior turbinate. In addition, we reclassified the maxillary movements in the pitch direction and compared the results. The contact rates of the postoperative inferior nasal airway and the inferior turbinate in the large-bone group was 72.3% and that in the small-bone group was 40.0% in the χ2 test. The reduction in the inferior nasal passage volume was significantly greater in the large-bone group (pitch+) than in the small-bone group (pitch+). For patients with well-developed bony tissue of the inferior turbinate, caution is advised if the maxillary elevation is ≥4.0 mm, because the possibility of postoperative obstruction of the inferior nasal passages exist, which may lead to deterioration of nasal ventilation.
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Affiliation(s)
- Nobuyoshi Tomomatsu
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Goguet Q, Mercier J, Longis J, Bonnet R, Perrin JP, Corre P, Bertin H. Long-term vertical stability of horseshoe osteotomy for the correction of large vertical excess of the maxilla, a retrospective assessment in 15 patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101474. [PMID: 37072077 DOI: 10.1016/j.jormas.2023.101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Vertical stability after a Le Fort I (LF1) osteotomy with substantial upward movement can be compromised by the position and the volume of the inferior turbinate. A horseshoe (HS) osteotomy represents then an alternative as it preserves the hard palate and the intranasal volume. The aim of this study was to assess the vertical stability of the maxilla after HS osteotomy. MATERIALS AND METHODS Patients who underwent a HS osteotomy for the correction of long-face syndrome were retrospectively analyzed. The vertical stability was assessed on lateral cephalograms performed preoperatively (T0), immediately postoperatively (T1), and at the last follow-up (T2) by studying points C (the distal cusp of the first maxillary molar), point P (the prosthion, the lowest edge of the maxillary alveolus of the central incisor), and point I (the upper central incisor edge) in a coordinate system. Postoperative complications and aesthetics of the smile were also investigated. RESULTS Fifteen patients were included (7 females, 8 males, mean age 25.5 ± 9.8 yeras). The mean impaction ranged from 5 mm on point P to 6.1 mm on point C, with a maximal movement of 9.5 mm. A non-significant relapse of 0.8 ± 1.7, 0.6 ± 0.8, and 0.5 ± 1.8 mm was observed after a mean 20.7 months on point C, P, and I respectively. Smile parameters were significantly improved by the procedure, mainly regarding the correction of the gum smile. CONCLUSION HS osteotomy represents a good alternative to total LF1 osteotomy for substantial maxillary upward movement in long face syndrome deformities.
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Affiliation(s)
- Quentin Goguet
- CHU Nantes, Service de Chirurgie Maxillo-Faciale et Stomatologie, Nantes Université, Nantes F-44000, France
| | - Jacques Mercier
- CHU Nantes, Service de Chirurgie Maxillo-Faciale et Stomatologie, Nantes Université, Nantes F-44000, France
| | - Julie Longis
- CHU Nantes, Service de Chirurgie Maxillo-Faciale et Stomatologie, Nantes Université, Nantes F-44000, France
| | - Raphael Bonnet
- CHU Nantes, Service de Chirurgie Maxillo-Faciale et Stomatologie, Nantes Université, Nantes F-44000, France
| | - Jean Philippe Perrin
- CHU Nantes, Service de Chirurgie Maxillo-Faciale et Stomatologie, Nantes Université, Nantes F-44000, France
| | - Pierre Corre
- CHU Nantes, Service de Chirurgie Maxillo-Faciale et Stomatologie, Nantes Université, Nantes F-44000, France; Oniris, UnivAngers, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, Nantes Université, Nantes F-44000, France
| | - Hélios Bertin
- CHU Nantes, Service de Chirurgie Maxillo-Faciale et Stomatologie, Nantes Université, Nantes F-44000, France; UnivAngers, CHU Nantes, INSERM, CNRS, CRCI2NA, Nantes Université, Nantes F-44000, France.
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Khojasteh A, Mohaghegh S. Orthognathic Surgery for Management of Gummy Smile. Dent Clin North Am 2022; 66:385-398. [PMID: 35738734 DOI: 10.1016/j.cden.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Excessive gingival show is mainly caused by hypermobility of the upper lip, altered passive eruption, gingival hyperplasia, and bony maxillary vertical excess. Orthognathic surgery is the optimal treatment option for patients with moderate and severe vertical maxillary excess. Surrounding anatomic structures and soft tissue changes such as alternation in the nasal morphology confine the amount of impaction. Therefore, Le Fort 1 may be performed in conjunction with horseshoe osteotomy or partial turbinectomy. The possible necessity of further mandibular orthognathic surgeries and chin repositioning has to be considered. No common major complication and long-term relapse have been reported for maxillary impaction.
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Affiliation(s)
- Arash Khojasteh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Daneshjou Blvd, District 1, Tehran, Tehran Province, Iran; Department of Health and Medical Sciences, University of Antwerp, Antwerp, Belgium.
| | - Sadra Mohaghegh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Daneshjou Blvd, District 1, Tehran, Tehran Province, Iran
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Schneider B, Pfaffeneder-Mantai F, Grün P, Meller O, Dobbertin K, Turhani D. Melolabial interpolated island flap for reconstruction of an anterior oronasal fistula after horseshoe Le Fort I osteotomy with iliac bone grafts interposition - A case report. Int J Surg Case Rep 2022; 93:106939. [PMID: 35303603 PMCID: PMC8928081 DOI: 10.1016/j.ijscr.2022.106939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Horseshoe Le Fort I osteotomy (HLFO) in combination with iliac bone grafts interposition is an established and very effective procedure for reconstructing the severely atrophic maxilla. However potential complications connected to this method, such as oronasal fistula (ONF), have not been described in the literature to date. CASE PRESENTATION We report the case of a female patient with severe atrophy of the edentulous maxillary alveolar ridge with type 2 diabetes (T2D). Initially, a sinus floor augmentation was performed, followed by a failed placement of dental implants. Afterwards, HLFO with simultaneous interposition of iliac bone grafts was conducted. Subsequently, an oronasal communication occurred in the antral maxilla. As several local flaps had not achieved sufficient results, a melolabial interpolated island flap was carried out, yielding satisfactory results. DISCUSSION Failed implant treatment or bone augmentation procedures in combination with T2D may have resulted in significant tissue irritation and subsequent wound healing complications in the antral maxilla, leading to an ONF. CONCLUSION In this case, an ONF occurring after HLFO was described for the first time. The melolabial interpolated island flap proved to be an outstanding long-term solution for the management of an anterior ONF occurring after HLFO over a period of 10 years. Less invasive treatment options including zygomatic implants should be taken into consideration for the treatment of such patients.
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Affiliation(s)
- Benedikt Schneider
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
| | - Florian Pfaffeneder-Mantai
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria; Division for Chemistry and Physics of Materials, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
| | - Pascal Grün
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
| | - Oliver Meller
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
| | - Katharina Dobbertin
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
| | - Dritan Turhani
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria.
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Nasrun NE, Takeda S, Minamida Y, Hiraki D, Horie N, Nagayasu H, Shimo T. Surgical procedures for correcting vertical maxillary excess: A review. Int J Surg Case Rep 2021; 86:106354. [PMID: 34507191 PMCID: PMC8430375 DOI: 10.1016/j.ijscr.2021.106354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Vertical maxillary excess, a common orthodontic problem that leads to long faces and open bites, can be repositioned with a Le Fort I osteotomy. However, the Le Fort I osteotomy poses the risk of a variety of complications including descending palatine artery (DPA) injury. Although several Le Fort I osteotomy modifications were reported to avoid complications associated with this osteotomy, only a few of such studies were conducted in Japan, and details remain scarce. PATIENTS AND METHODS We performed a literature review regarding modifications of Le Fort I osteotomies, including Le Fort I with a horseshoe osteotomy, modified horseshoe osteotomy, unilateral horseshoe osteotomy, pyramidal osteotomy, and U-shaped osteotomy. We identified eight relevant studies conducted in Japan; one study did not provide the number of patients examined. The 77 patients (seven studies) with vertical maxillary excess who underwent orthognathic surgery were ≥17 years old. DISCUSSION There were no severe complications after the modified Le Fort I osteotomies. The postoperative maxillary changes obtained by the conventional horseshoe, modified horseshoe, unilateral type of horseshoe, pyramidal, and U-shaped osteotomies were nearly repositioned to the planned position and remained stable for ≥12 months post-surgery. CONCLUSION Our review indicates that preserving the DPA can lower the incidence of intra- and post-operative complications. Each modification of the Le Fort I osteotomy (i.e., conventional horseshoe, modified horseshoe, unilateral horseshoe, pyramidal, and U-shaped osteotomy) has its respective advantages and indications.
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Affiliation(s)
- Nisrina Ekayani Nasrun
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Shigehiro Takeda
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Yasuhito Minamida
- Division of Oral and Maxillofacial Surgery, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Daichi Hiraki
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Naohiro Horie
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Hiroki Nagayasu
- Division of Oral and Maxillofacial Surgery, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Tsuyoshi Shimo
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan.
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7
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Xiang Z, Wang Y, He Y, Wang Y, Bi R, Li J. Comparison of maxillary setback by maxillary tuberosity removal or intentional pterygoid plate fracture in Le Fort I osteotomy: a long-term evaluation. Int J Oral Maxillofac Surg 2020; 50:487-493. [PMID: 32863089 DOI: 10.1016/j.ijom.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/13/2020] [Accepted: 08/07/2020] [Indexed: 02/08/2023]
Abstract
The purpose of the study was to investigate the clinical application and long-term stability of maxillary setback in Le Fort I osteotomy using maxillary tuberosity removal or intentional pterygoid plate fracture (IPPF). Eighty adult class II patients who underwent Le Fort I osteotomy with bilateral sagittal split ramus osteotomy by the same surgeon between January 2013 and January 2019 were included in this retrospective study. Traditional maxillary tuberosity removal was performed in 40 patients (group I), and the other 40 patients (group II) underwent IPPF to set back the maxilla according to surgeon preference. An obvious change in profile was observed for all of the patients, with no significant relapse at 1year postoperative. The operation time and intraoperative blood loss were significantly higher in group I than in group II (P= 0.037 and P= 0.021, respectively). In group II, the most superior point of the fracture line was at a mean distance of 12.25 ± 2.04 mm above the most inferior point of the pterygoid plate. More bone fragments were noted when the fracture level was low than when it was high. In conclusion, both maxillary tuberosity removal and IPPF resulted in sufficient and stable maxillary setback, with IPPF showing less blood loss and a shorter operative time.
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Affiliation(s)
- Z Xiang
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, and Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, and Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y He
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, and Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, and Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - R Bi
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, and Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - J Li
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, and Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Tomomatsu N, Kurohara K, Nakakuki K, Yoshitake H, Kanemaru T, Yamaguchi S, Yoda T. Influence of the anatomical form of the posterior maxilla on the reliability of superior maxillary repositioning by Le Fort I osteotomy. Int J Oral Maxillofac Surg 2018; 48:612-619. [PMID: 30503635 DOI: 10.1016/j.ijom.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/03/2018] [Accepted: 11/13/2018] [Indexed: 11/18/2022]
Abstract
Certain patients with facial deformities require superior repositioning of the maxilla via Le Fort I osteotomy; however, the magnitude of superior repositioning of the maxilla is often less than expected. In this study, the correlation between the accuracy of superior repositioning of the maxilla and the anatomical form of the maxillary posterior region was examined. Seventy-five patients who underwent Le Fort I osteotomy without forward movement of the maxilla but with superior repositioning of the maxilla were included in this study. The bone volume around the descending palatine artery (DPA), the angle of the junction between the pterygoid process and the tuberosity, and the distance between the upper second molar and the pterygoid process were measured via three-dimensional analysis. A significant negative correlation (r=-0.566) was found between the bone volume around the DPA and the ratio of repositioning (actual movement divided by expected movement). It is possible that the superior repositioning of the maxilla expected prior to surgery was not sufficiently attained because of the large volume of bone around the DPA. The results of this study show that in some patients, superior repositioning was not achieved at the expected level because of bone interference attributable to the anatomical form of the maxillary posterior region.
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Affiliation(s)
- N Tomomatsu
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Kurohara
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan; Department of Oral and Maxillofacial Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - K Nakakuki
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Yoshitake
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Kanemaru
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - S Yamaguchi
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Yoda
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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9
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CAD/CAM splint based on soft tissue 3D simulation for treatment of facial asymmetry. Maxillofac Plast Reconstr Surg 2016; 38:4. [PMID: 26878021 PMCID: PMC4729783 DOI: 10.1186/s40902-016-0050-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most cases of facial asymmetry involve yaw deformity, and determination of the yaw correction level is very difficult. METHODS We use three-dimensional soft tissue simulation to determine the yaw correction level. This three-dimensional simulation is based on the addition of cephalometric prediction to gradual yaw correction. Optimal yaw correction is determined visually, and an intermediate splint is fabricated with computer-aided design and computer-aided manufacturing. Application of positioning devices and the performance of horseshoe osteotomy are advisable. RESULTS With this procedure, accurate repositioning of jaws was confirmed and patients obtained fairly good facial contour. CONCLUSIONS This procedure is a promising method for a widespread, predictable treatment of facial asymmetry.
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10
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Tominaga K, Habu M, Iwanaga K, Kodama M, Tsurushima H, Kokuryo S, Miyamoto I, Fukudome Y, Yoshioka I. Maxillary single-jaw surgery combining Le Fort I and modified horseshoe osteotomies for the correction of maxillary excess. Int J Oral Maxillofac Surg 2015; 45:194-9. [PMID: 26599693 DOI: 10.1016/j.ijom.2015.10.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 08/14/2015] [Accepted: 10/23/2015] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- K Tominaga
- Division of Oral and Maxillofacial Surgery, Department of Science of Physical Function, Kyushu Dental University, Kitakyushu, Japan.
| | - M Habu
- Division of Oral and Maxillofacial Surgery, Department of Science of Physical Function, Kyushu Dental University, Kitakyushu, Japan
| | - K Iwanaga
- Division of Oral and Maxillofacial Surgery, Department of Science of Physical Function, Kyushu Dental University, Kitakyushu, Japan
| | - M Kodama
- Division of Oral and Maxillofacial Surgery, Department of Science of Physical Function, Kyushu Dental University, Kitakyushu, Japan
| | - H Tsurushima
- Division of Oral Medicine, Department of Science of Physical Function, Kyushu Dental University, Kitakyushu, Japan
| | - S Kokuryo
- Division of Oral Medicine, Department of Science of Physical Function, Kyushu Dental University, Kitakyushu, Japan
| | - I Miyamoto
- Division of Oral Medicine, Department of Science of Physical Function, Kyushu Dental University, Kitakyushu, Japan
| | - Y Fukudome
- Division of Orofacial Function and Orthodontics, Department of Science of Health Improvement, Kyushu Dental University, Kitakyushu, Japan
| | - I Yoshioka
- Division of Oral Medicine, Department of Science of Physical Function, Kyushu Dental University, Kitakyushu, Japan
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11
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U-shaped Osteotomy Around the Descending Palatine Artery to Prevent Posterior Osseous Interference for Superior/Posterior Repositioning of the Maxilla in Le Fort I Osteotomy. J Craniofac Surg 2015; 26:1613-5. [DOI: 10.1097/scs.0000000000001787] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Vital Staining of Palatal Soft Tissue in Horseshoe Le Fort I Osteotomy for Superior Repositioning of the Maxilla. J Craniofac Surg 2015; 26:911-3. [DOI: 10.1097/scs.0000000000001420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Kokuryo S, Habu M, Miyamoto I, Uehara M, Kodama M, Iwanaga K, Yoshioka I, Tominaga K. Predictability and accuracy of maxillary repositioning during bimaxillary surgery using a three-dimensional positioning technique. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:187-93. [PMID: 25047927 DOI: 10.1016/j.oooo.2014.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/04/2014] [Accepted: 03/04/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Shinya Kokuryo
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
| | - Manabu Habu
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
| | - Ikuya Miyamoto
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
| | - Masataka Uehara
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
| | - Masaaki Kodama
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
| | - Kenjiro Iwanaga
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
| | - Izumi Yoshioka
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan.
| | - Kazuhiro Tominaga
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
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14
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[Horseshoe Le Fort I osteotomy]. ACTA ACUST UNITED AC 2013; 114:327-30. [PMID: 24176691 DOI: 10.1016/j.revsto.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 11/28/2012] [Accepted: 03/11/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Performing Le Fort I impaction osteotomy can be compromised or impossible. The intranasal volume of the lower turbinates prevents an important maxillary impaction. In this case, horseshoe osteotomy is an alternative. SURGICAL TECHNIQUE The first step is to lower the inferior edge of the pyriform aperture and the anterior floor of the nasal fossae with a bur. The palatine alveolar wall is cut through resection of the maxillary sinus anterior and lateral walls. The maxillary dental arch may be impacted without freeing the vomer or cutting through lateral walls of the nasal fossa, after having dissected the palatine fibrous mucosa and disjoined the pterygomaxillary suture. DISCUSSION This technique has mainly been used in pre-implantation surgery to lower the maxillary crest in edentulate patients, and to increase the crestal height after bone grafting without modifying the position of the hard palate. It is a good alternative to the usual Le Fort I osteotomy for important impactions when the alveolar bone height is sufficient.
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Shehab MF, Barakat AA, AbdElghany K, Mostafa Y, Baur DA. A novel design of a computer-generated splint for vertical repositioning of the maxilla after Le Fort I osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115:e16-25. [PMID: 23312923 DOI: 10.1016/j.oooo.2011.09.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/22/2011] [Accepted: 09/30/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy of a novel tooth/bony-supported virtual splint design to control the maxillary vertical, rotational, and anteroposterior intraoperative movements. STUDY DESIGN A tooth/bone-borne splint was designed to position the osteotomized maxilla intraoperatively. Lateral cephalometric radiographs were obtained 1 week before the operation and 1 week after to compare the planned and actual movements of the maxilla. RESULTS The paired t test showed no significant difference between the planned and actual movements in both the vertical and horizontal measurements (P ≤ .05). The difference between the planned and actual horizontal movements in 4 (66.7%) of the 6 patients was 1 mm or less. For the vertical movements, 5 (83.3%) of the 6 patients showed a difference equal to or less than 1 mm. CONCLUSIONS The 2-piece surgical stent showed accurate control on the osteotomized maxilla and succeeded its repositioning to the preplanned positions.
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Affiliation(s)
- Mohamed F Shehab
- Faculty of Oral and Dental Medicine, Oral & Maxillofacial Surgery Department, Cairo University, Cairo, Egypt.
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