Correction of Eyes and Lip Canting after Bimaxillary Orthognathic Surgery

Inferior Alveolar Nerve Repositioning With the Computer-Aided Design in Hemimandibular Hyperplasia

A 34-year-old man presented with facial asymmetry and was diagnosed with left-sided hemimandibular hyperplasia. Orthognathic surgery and mandibular angle osteotomy combined with inferior alveolar nerve repositioning were performed with computer-aided design. The facial asymmetry was successfully corrected with acceptable cosmetic results. Inferior alveolar nerve repositioning provided sufficient space for the osteotomy of the affected side with the abnormal mandibular canal. Inferior alveolar nerve repositioning with computer-aided design can be used as an effective and reliable technique for hemimandibular hyperplasia.

Idiopathic scoliosis in subjects with eye diseases: A systematic review with meta-analysis

Our aim was to find the best evidence on the prevalence of idiopathic scoliosis (IS) in subjects with eye diseases (EDs) and to determine the most common visual alterations that are present. Following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a bibliographic search up to June 2023 in the PubMed, PsycINFO, SCOPUS, and CINAHL Complete databases was performed. Observational studies were selected and the results were analyzed with prevalence odds ratio (OR). A total of six studies, including 18,396 subjects, were selected. The group of subjects with EDs was made up of 6048 individuals, of whom 655 (10.83%) had IS. The group of subjects without EDs was made up of 12,348 individuals of whom 444 (3.60%) presented with IS with an OR = 2.91, CI (95%) = [1.75, 4.83]. Blindness was assessed in a single study with an OR = 7.83, CI (95%) = [1.66, 36.90]; all three studies in the refractive error subgroup yielded an OR = 2.24, CI (95%) = [1.10, 4.58]; and the two studies that included subjects with strabismus showed an OR = 3.09, CI (95%) = [1.38, 7.00]. EDs were associated with an almost three times greater odds of having IS. We recommend the inclusion of vision testing in children with IS.

The relationship between eye canting and vertical craniofacial skeletal asymmetry in adult patients with dento-maxillofacial deformities

BACKGROUND

Whether eye canting in patients with asymmetric dento-maxillofacial deformities is the result of anatomical asymmetry or a compensatory head position remains controversial.

OBJECTIVE

This cross-sectional study aims to verify whether eye canting is correlated with craniofacial skeletal asymmetry.

METHODS & MATERIALS

This study was performed by measuring the computed tomographic scans of 223 patients with dento-maxillofacial deformities in Mimics 21.0 software. First grouping was determined based on the intersection angle between the line passing through bilateral lateral canthus point and Frankfurt horizontal plane, and final grouping was based on measurements of the pregroups.

RESULTS

The patients were finally categorized into three groups: symmetry group (n = 163), asymmetry subgroups 1 (n = 33) and asymmetry subgroups 2 (n = 27). The results of multiple linear regression and comparisons among groups suggests the presence of orbital skeletal asymmetry in patients with eye canting and the eye canting is partly increment dependent of orbital skeletal asymmetry when using bilateral ears as the reference. The result also reveals that there is a greater angle between the line through bilateral ocular landmarks and the line through the bilateral ear landmarks in patients with ocular canting compared to patient without eye canting.

CONCLUSION

Patients with asymmetric dento-maxillofacial deformities and with eye canting have vertical asymmetry of the orbital and cranial skeletal landmarks. These symmetry differences between the eyes and ears may affect the overall craniofacial symmetry after orthognathic surgery.

Effect of Orthognathic Surgery on Movement of the Cheilion

The cheilion (Ch), corner of the mouth, is the soft-tissue landmark where the upper and lower lips intersect. Orthognathic surgery can modify Ch position, which can affect facial esthetics. The aims were to evaluate Ch movements resulting from Le Fort I maxillary advancement with maxillary impaction or downgrafting, and with mandibular advancement or setback, and to investigate relationships between surgical movements and Ch movements. The 45 patients had undergone bilateral sagittal split ramus osteotomy with Le Fort I advancement surgery. They were divided into 4 groups according to surgical movement direction. Preoperative and postoperative photographs were calibrated. Standardized methods were used to identify and measure preoperative and postoperative Ch positions. Significant correlations were detected between extent of maxillary downgrafting and inferior movement of the Ch in group 1 (r=0.988, P=0.001) and group 3 (r=0.915, P=0.001). Also, significant correlations were detected between extent of mandibular advancement and anterior movement of the Ch in group 3 (r=0.561, P=0.046) and group 4 (r=0.661, P=0.005). The findings indicate that, in patients who undergo bilateral sagittal split ramus osteotomy/Le Fort I surgeries, mandibular advancement moves Ch anteriorly and maxillary downgrafting moves Ch inferiorly.

Ideal Nasal Radix Position in Fluctuating Facial Asymmetry

BACKGROUND

Augmentation rhinoplasty had become increasingly popular among Asians. Failure to recognize nasal deviation before surgery may engender unsatisfactory outcomes because the deviation becomes prominently visible after surgery due to the central position of the nose. Ideal nasal radix positioning has yet to be addressed. The head position affects facial asymmetry judgements; however, its effect on rhinoplasty has never been studied. This study determined the ideal nasal radix position in facial fluctuating asymmetry and investigated the effects of the natural head position (NHP) on nasal deviation perceptions.

METHODS

A survey was conducted to compare different head and nasal radix horizontal positions using images of patients who underwent augmentation rhinoplasty. Images were retouched using editing software to adjust the head and nasal radix positions. The survey was performed using questionnaires involving 3 plastic surgeons and 3 laypersons, who were asked to determine the presence of nasal deviation and select the ideal nasal radix position among the retouched images.

RESULTS

Twenty patients who underwent primary rhinoplasty were included in this study. The recognition of nasal deviation was significantly higher in the NHP than in the compensatory head position. The surgeons and the laypersons considered the midsagittal line the most appropriate position of the nasal radix.

CONCLUSIONS

Facial analysis for augmentation rhinoplasty should be performed with the patient's head in the NHP to prevent nasal deviation masking. The preferred nasal radix position in facial fluctuating asymmetry is the midsagittal line.Level of Evidence: Level V, descriptive study.

Effectiveness of Selegiline Hydrochlorate in Treating Neurosensory Disorders of the Lower Alveolar Nerve Resulting From Mandibular Sagittal Osteotomy: Preliminary Study

INTRODUCTION

Peripheral nerves transmit nerve signals between periphery and the spinal cord or brain stem. Its function can be compromised by trauma to the nerve, such as those that occur in surgical procedures such as orthognathic surgery. Depending on the type of injury, treatment may be proposed, but this is still a controversial point in literature. Alternative methods that assist in the treatment of paresthesia should be studied, and in this context, selegiline hydrochloride seems to be a promising drug.

AIM

Based on the above, the aim of this study was to evaluate the effectiveness of selegiline hydrochloride in the treatment of facial sensory changes resulting from nerve injuries in patients undergoing maxillary orthognathic surgery.

METHODS

This was a double-blind randomized clinical trial with the voluntary participation of individuals who underwent orthognathic surgery. The facial sensitivity of these patients was evaluated by 2-point discrimination tests and directional perception in the region related to the lower alveolar nerve. Tests were comparatively applied at times T0 (before surgery), T8 (8 days after surgery), T15 (15 days after surgery), T30 (30 days after surgery), T60 (60 days after surgery), and T90 (90 days after surgery).

RESULTS

The mean age of patients was 31.14 years. With the comparative analysis of the 2-point static test on the chin, difference was observed between groups at times T15 (P = 0.007), T30 (P = 0.010), and T90 (P = 0.027) in the intergroup evaluation. Regarding results of the comparative analysis of the 2-point static test on the lip, difference was observed between groups at times T30 (P = 0.023), T60 (P < 0.001), and T90 (P = 0.005) in the intergroup evaluation. In the direction test on the chin, difference was observed between groups at times T30 (P = 0.015), T60 (P = 0.001), and T90 (P < 0.001) in the intergroup evaluation.

CONCLUSIONS

Selegiline hydrochloride has shown promising results in the treatment of neurosensory disorders resulting from maxillary orthognathic surgery.