Combined Use of Facial Osteoplasty and Orthognathic Surgery for Treatment of Dentofacial Deformities

Mandibular Contouring in Subjects With Class II or Class III Dentofacial Deformities and Treatment Needs

Facial contouring relates to hard and soft structures that make up the face. Skeletal class II and III subjects present bone structure and position changes, significantly impacting the soft tissues. This study aims to analyze the morphology of the mandible at mandibular ramus and angle level in subjects with skeletal facial deformity class II and III who are candidates for orthognathic surgery and to define implications in facial contour. A cross-sectional study used cone beam computed tomography to compare the mandibular contour (mandibular angle and ramus region) in orthognathic surgery candidates. One hundred sixty orthognathic surgery candidates were analyzed, ranging in age from 18 to 58 years (31.29 ± 11.97). Regarding the skeletal class, 95 (59.37%) were skeletal class II, and 65 (40.62%) were skeletal class III. Class II subjects had a larger antegonial notch than class III subjects. Concerning the mandibular contour, class II subjects presented less vertical distance than class III subjects, but both presented similar gonial angles. Concerning the ideas to assess the need for mandibular contouring surgery, the 2 proposals to determine the need for mandibular contouring surgery in class II and III subjects present a similar distribution. The mandibular notch is an objective element and is commonly present in subjects with a class II facial pattern; this element can be used in contour analysis to define expected facial characteristics, including the patient's facial sex, in the decision of surgical techniques for lower facial contour augmentation or reduction.

Visualization Mapping and Current Trends of Facial Contouring Procedures: A Bibliometric Analysis Based on Web of Science

BACKGROUND

Facial contouring procedures become popular in recent years, but there has been no bibliometric analysis focused on this field.

OBJECTIVE

Construct visualization maps and analyze the hotspots and current trends in this field using bibliometric analysis.

METHODS

Publications on facial contouring procedures were extracted from the Web of Science Core Collection database from 2003 to 2022. VOSviewer, CiteSpace, and "Bibliometrix" R package were used to analyze data.

RESULTS

Seven hundred and twenty-one publications on facial contouring procedures between 2003 and 2022 were included. The United States was the leading country both in publications (206) and citations (3941). Shanghai Jiao Tong University was the institution with the greatest contribution (35 publications with 379 citations). Hu J (17 publications) from China had the most outputs, while the most cited author was Rohrich RJ (321 citations) from the United States. The Journal of Craniofacial Surgery (135 documents) published the most research, and Plastic and Reconstructive Surgery was the most cited journal (2755 citations). The most cited article focused on virtual surgical planning in mandibular reconstruction. Keywords co-occurrence analysis identified five clusters centered on "reconstruction," "augmentation," "reduction malarplasty," "face rejuvenation," and "orthognathic surgery," separately. "Hyaluronic acid," "facial feminization," and "orthognathic surgery" might be related to trend topics.

CONCLUSIONS

The research on facial contouring procedures is booming. In the past 2 decades, hotspots in this field included: facial defects reconstruction, facial augmentation cosmetology, facial skeletal contour plasty, and facial rejuvenation surgery. The following aspects may be trend frontiers: precision and personalization, combined treatments, transgender facial contour, and facial contour shaping with fat and hyaluronic acid.

3-dimensional analysis of hard- and soft-tissue symmetry in a Chinese population

BACKGROUND

Facial symmetry severely affects appearance and function. Large numbers of patients seek orthodontic treatment to improve facial symmetry. However, the correlation between hard- and soft-tissue symmetry is still unclear. Our aim was to investigate the hard- and soft-tissue symmetry in subjects with different levels of menton deviation and sagittal skeletal classes with 3D digital analysis and to investigate the relationship between the entire and individual hard- and soft-tissues.

METHODS

A total of 270 adults (135 males and 135 females) consisting of 45 subjects of each sex in each sagittal skeletal classification group. All subjects were further classified into relative symmetry (RS), moderate asymmetry (MA) and severe asymmetry (SA) groups based on the degree of menton deviation from the mid-sagittal plane (MSP). The 3D images were segmented into anatomical structures and mirrored across the MSP after establishing a coordinate system. Original and mirrored images were registered by a best-fit algorithm, and the corresponding root mean square (RMS) values and colormap were obtained. The Mann‒Whitney U test and Spearman correlation were conducted for statistical analysis.

RESULTS

The RMS increased with greater deviations with regard to the deviation of the menton in most of anatomical structures. Asymmetry was represented in the same way regardless of sagittal skeletal pattern. The soft-tissue asymmetry had a significant correlation with dentition in the RS group (0.409), while in the SA group, it was related to the ramus (0.526) and corpus (0.417) in males and was related to the ramus in the MA (0.332) and SA (0.359) groups in females.

CONCLUSIONS

The mirroring method combining CBCT and 3dMD provides a new approach for symmetry analysis. Asymmetry might not be influenced by sagittal skeletal patterns. Soft-tissue asymmetry might be reduced by improving the dentition in individuals with RS group, while among those with MA or SA, whose menton deviation was larger than 2 mm, orthognathic treatment should be considered.

Hard and Soft Tissue Asymmetry in Patients with Skeletal Class III Malocclusion: A Cone-Beam Computed Tomography Study

This study aims to investigate hard and soft tissue asymmetry in skeletal Class III patients to elucidate how soft tissue thickness alters overall asymmetry and whether menton deviation is correlated with bilateral differences in hard and soft tissue prominence and soft tissue thickness. The cone-beam computed tomography data of 50 skeletal Class III adults were divided based on menton deviation into symmetric (n = 25; deviation ≤ 2.0 mm) and asymmetric (n = 25; deviation > 2.0 mm) groups. Forty-four corresponding hard and soft tissue points were identified. Bilateral hard and soft tissue prominence and soft tissue thickness were compared using paired t-tests. The correlations between bilateral differences in these variables and menton deviation were examined using Pearson's correlation analysis. In the symmetric group, no significant bilateral differences in soft and hard tissue prominence and soft tissue thickness were observed. In the asymmetric group, both hard and soft tissue prominence were significantly greater on the deviated side than the non-deviated side at most of the points; however, no significant differences in soft tissue thickness were detected except at point 9 (ST9/ST'9, p = 0.011). The difference of hard and soft tissue prominence at point 8 (H8/H'8 and S8/S'8) was positively correlated with menton deviation, whereas the soft tissue thickness at point 5 (ST5/ST'5) and point 9 (ST9/ST'9) was negatively correlated with menton deviation (p = 0.05). Soft tissue thickness does not affect overall asymmetry in the presence of underlying hard tissue asymmetry. Soft tissue thickness at the centre of the ramus may be correlated with the degree of menton deviation in patients with asymmetry; however, this correlation needs to be confirmed by further studies.

Simultaneous Fat Injection for Nasal Contouring in Orthognathic Patients

BACKGROUND

Augmentation rhinoplasty with autologous fat grafting is a useful procedure to meet the demand for facial harmonization in the Asian population. We used this procedure during orthognathic surgery to address inadequate dorsum projection. This prospective study was conducted to determine the fat retention rate in patients undergoing simultaneous autologous fat injection augmentation rhinoplasty and orthognathic surgery.

METHODS

Nineteen patients were treated with simultaneous bimaxillary orthognathic surgery and autologous fat grafting of the nasal dorsum and tip. The paired t test was used to compare the nasal volumes before and at least 6 months after surgery measured by 3-dimensional computer tomography scans. All measurements were performed twice by the same evaluator at least 2 weeks apart for intrarater consistency.

RESULTS

Seventeen patients completed the study. The volume means before and after surgery were 22.3 ± 4.6 cm³ and 23.3 ± 4.7 cm³, respectively, with a mean difference of 1.0 ± 0.3 cm³ (P < .001). The mean retention rate was calculated to be 50.5% ± 7.0% (range: 40.5%-64.7%). Intrarater consistency was high with a Cronbach α of .97 (P < .001) and .98 (P < .001), respectively.

CONCLUSION

This prospective study provides objective graft retention measurements for fat injection augmentation rhinoplasty combined with orthognathic surgery. All patients were satisfied with the results and no complications or additional morbidity was noted in the postoperative course. We consider this procedure to be a safe, reliable, and powerful adjunct to improve the aesthetic results of orthognathic surgery.

Facial Contour Refining after Surgery-First SSRO with Computer-Assisted Design in East Asians

BACKGROUND

Surgery-first sagittal split ramus osteotomies (SF-SSRO) are an effective treatment for patients with dental malocclusion. However, some patients with mandibular prognathism usually have facial deficiencies which cannot be corrected completely after orthognathic surgery. These are not accepted because the remaining facial contours are in disharmony.

METHODS

Twenty-five patients, who were unsatisfied with their appearances after SF-SSRO and orthodontics, were included. The preoperative CTs were used to investigate patients for facial deformity. To achieve a harmonious facial contour, mandible long-curve osteotomy/mandible U-shaped osteotomy, genioplasty or facial autologous fat grafting was selected depending on patients' contour deformities with the assistance of CAD.

RESULTS

Among the patients who underwent osteotomy, the gonial angle was improved from 111.16° ± 9 to 111.58° ± 9.06 after SF-SSRO because of distal fragment setback and rotation. After facial refine surgery, the gonial angle was significantly increased to 121.69°±2.41 (p < 0.05). And the mandibular width was decreased from 11.29 cm ± 0.44 to 10.45 cm ± 0.39 (p < 0.05) after mandibular outer plate griding. All patients were shown no signs of infection, massive bleeding, and osteonecrosis in the early stage. After follow-up time, they were all satisfied with their results and most of them recovered from lip numbness.

CONCLUSIONS

This study indicated the clinical feasibility of two-stage orthognathic and facial bone contouring surgery for the treatment of dentofacial deformities. Two-stage facial contouring surgery can provide esthetic improvement for more accuracy in refining the facial contour.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Correction of the Deepened Labiomental Groove Using Silicone Implants in Advancement Genioplasty

ABSTRACT

Advancement genioplasty is performed to aesthetically improve the lower third of the facial profile. Excessive chin advancement alone may lead to deepened labiomental sulcus and deformed aesthetic results. The purpose of this study was to assess the efficacy of silicone prosthesis placement as an alternative method for effacing an excessively deepened labiomental groove after advancement genioplasty. Three hundred and seventy-six patients underwent genioplasty between January 2014 and October 2017. Among these were 216 cases of advancement genioplasty, of which 79 (62 females and 17 males) underwent advancement procedures using silicone implants. Inserting the silicone implant at the sulcus easily removes the deepened groove. This procedure could be an easy and reliable method for attaining an aesthetically pleasing result in excessive advancement genioplasty.

Comprehensive correction of maxillofacial bone deformity-consideration and combined application of orthognathic surgery and facial contouring surgery

The maxillofacial skeleton is the basis of the contour of the face. Orthognathic surgery and facial contouring surgery change jaw tissue and affect facial appearance in different manners. Orthognathic surgery is the main method to correct dental and maxillofacial deformities. It changes the shape of the jaw and improves the occlusal relationship by changing the three-dimensional position of the jaw. Facial contouring surgery mainly adopts the method of "bone reduction", which changes the "amount"of the jawbone by cutting a part of the bone tissue to improve the facial appearance, generally without changing oral function. The combined use of orthognathic surgery and facial contouring surgery is becoming increasingly common in clinical practice. This also requires oral and maxillofacial surgeons to have a holistic consideration of the comprehensive correction of maxillofacial bone deformity, and to perform comprehensive analysis of jaw deformities and jaw plastic surgery to achieve the most ideal results. The author's team has been engaged in the clinical work of orthognathic surgery and facial contouring surgery and accumulated rich clinical experience in the comprehensive correction of maxillofacial bone deformity. In this article, the indications, treatment goals, treatment modes, treatment methods, and key points in the surgical operations of comprehensive maxillofacial bone surgery were summarized.

Square Face Correction by Gonial Angle and Masseter Reduction

Introduction

The association of mandibular gonial angle, facial height, and jaw relationship in masseteric hypertrophy (MH) has not been adequately described for the typical Indian population. The aim of this study was to report the gonial angle relationship with facial height parameters in cases diagnosed with bilateral MH and its possible influence on the treatment plan.

Materials and Methods

This is a retrospective study based on archival records of bilateral MH cases surgically treated over a 10-year period at the author's center. Patients' records fulfilling inclusion and exclusion criteria were considered for the study. Age, gender, upper anterior facial height (UAFH), lower anterior facial height (LAFH), upper posterior facial height (UPFH), ramus height (also a reflection of the lower posterior facial height), and gonial angle were collected along with the type of bite (open/normal/deep), surgical procedure (debulking with/without bone removal), and concomitant jaw bone corrections (yes/no). These were subjected to statistical analysis using SPSS, and P ≤ 0.05 was taken as statistically significant.

Results

Overall, 21 patients formed the study group comprising 9 females and 12 males. Gender influenced the UAFH, LAFH, UPFH, ramus height, and gonial angle significantly. Males had higher values than females. Normal bite had an obtuse gonial angle than the deep bite, and the difference was statistically significant (P = 0.036). When the gonial angle was acute or square faced, the need for other surgical procedures was high and the difference was statistically significant (P = 00.048).

Discussion and Conclusion

The results are discussed in the light of Indian skeletal anthropometry. The relationship of the gonial angle with facial height parameters in bilateral MH cases in this part of the world is presented.

Hard- and soft-tissue symmetry comparison in patients with Class III malocclusion

OBJECTIVE

Our aim was to describe hard- and soft-tissue asymmetry in people who have a skeletal Class III malocclusion, and to compare with those without asymmetry. We also performed a regional analysis of a possible correlation between facial soft- and hard-tissue asymmetries.

METHODS

This retrospective study was performed with the use of the computed tomographic scans of 60 subjects. The skeletal Class III subjects were categorized into 2 subgroups: soft-tissue menton deviation ≤4 mm (n = 20) versus >4 mm (n = 20). The Class III groups were compared with a Class I symmetry group (n = 20). Hard and soft tissues were segmented into different morphologic areas and deviation calculated. Pearson correlation coefficients were obtained, and 1-way analysis of variance was conducted for statistical analysis.

RESULTS

The highest deviation in the hard tissues of the Class III asymmetry group was in the corpus region (5.55 ± 3.05 mm), with the second highest in the angulus region (4.70 ± 2.43 mm). The highest average deviation in the soft tissues was seen in the lower cheek (7.04 ± 3.46 mm). In the different study groups, the amounts of asymmetry measured in anatomic structures on the mandible were found to be highly correlated between neighboring structures.

CONCLUSIONS

Clinically and statistically significant differences were found in the anatomic regions located in the middle and lower thirds of the face. There was a medium or high correlation between condyle, coronoid process, ramus, and angulus regions. A low level of correlation was observed between middle face and mandibular asymmetries in hard-tissue upper cheek and lower cheek regions were correlated with different mandibular regions.

The Precise Repositioning Instrument for Genioplasty and a Three-Dimensional Printing Technique for Treatment of Complex Facial Asymmetry

BACKGROUND

Facial asymmetry is very common in maxillofacial deformities. It is difficult to achieve accurate reconstruction. With the help of 3D printing models and surgical templates, the osteotomy line and the amount of bone grinding can be accurate. Also, by means of the precise repositioning instrument, the repositioning of genioplasty can be accurate and quick. In this study, we present a three-dimensional printing technique and the precise repositioning instrument to guide the osteotomy and repositioning, and illustrate their feasibility and validity.

METHODS

Eight patients with complex facial asymmetries were studied. A precise 3D printing model was obtained. We made the preoperative design and surgical templates according to it. The surgical templates and precise repositioning instrument were used to obtain an accurate osteotomy and repositioning during the operation. Postoperative measurements were made based on computed tomographic data, including chin point deviation as well as the symmetry of the mandible evaluated by 3D curve functions.

RESULTS

All patients obtained satisfactory esthetic results, and no recurrences occurred during follow-up. The results showed that we achieved clinically acceptable precision for the mandible and chin. The mean and SD of ICC between R-Post and L-Post were 0.973 ± 0.007. The mean and SD of chin point deviation 6 months after the operation were 0.63 ± 0.19 mm.

CONCLUSION

The results of this study suggest that the three-dimensional printing technique and the precise repositioning instrument could aid in making better operation designs and more accurate manipulation in orthognathic surgery for complex facial asymmetry.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .