Complications associated with orthognathic surgery

Evidence gaps in orthognathic surgery: an international Delphi study

The aim of this study was to assess the evidence gaps identified in a recent mapping review of orthognathic surgery by evaluating them through consultation with maxillofacial surgeons. Using the Delphi technique, a panel of surgeons who regularly perform orthognathic surgery was engaged. Potential participants were identified through articles included in the mapping review, peer nominations, and social media platforms . Two rounds of surveys, incorporating Likert-type and open-ended questions, were conducted to gauge the clinical relevance of evidence gaps. Questions were refined based on responses from the initial round, with a consensus threshold set at 60%. Seventy-four surgeons participated in the first round and 55 in the second round (retention rate of 74%) . The intra-class correlation analysis revealed 'almost perfect' agreement in each round. Participants in the first round proposed 11 new evidence gaps. A list of 15 potentially clinically relevant research questions was compiled to guide future investigations in orthognathic surgery. This collaborative Delphi study between researchers and clinicians has explored the existing understanding of the clinical relevance of potential evidence gaps in orthognathic surgery. The study findings offer others a pathway to address information gaps and guide future research endeavours.

Pseudoaneurysm of the facial artery following mandibular bilateral sagittal split osteotomy: A case report

This article presents a case involving a 16-year-old female patient in whom a pseudoaneurysm of a facial artery branch was diagnosed two weeks after initial orthognathic surgery. The patient presented with a sensation of pressure, accompanied by pulsations synchronised with her heartbeat, located on the right side of the mandible. Ultrasound imaging, followed by CT angiography, confirmed the diagnosis of a pseudoaneurysm within the parotid region. Endovascular embolization effectively stopped blood flow to the pseudoaneurysm, leading to rapid recovery without any lasting complications. A pseudoaneurysm is a rare complication following orthognathic surgery. This complication, as a result of anatomical variation, can have serious consequences if not recognised and treated in time.

Reduction of Temporomandibular Joint Dislocation With Open Approach Using Prearticular Incision Following Sagittal Split Ramus Osteotomy

Bilateral sagittal split osteotomy (BSSO) is the most commonly performed in orthognathic surgery for jaw deformities. Temporomandibular joint (TMJ) dislocation is a rare intraoperative complication. Here, we present the case of a 22-year-old woman with a history of habitual TMJ dislocation who complained of a protruding lower jaw and underwent reduction of temporomandibular joint dislocation with open approach using prearticular incision following BSSO. Postoperative panoramic radiograph revealed that the right condylar head was dislocated anteriorly. In the second surgery, the proximal segment including the condyle, could not be reduced in the proper position. Therefore, we exposed and reduced the dislocated mandibular condyle while confirming the mandibular condylar head using intraoral and preauricular approaches. In this third surgery, mandibular condyle was successfully reduced using these approaches. To the best of our knowledge, this is the first case report describing a reduction in TMJ dislocation with a preauricular incision following BSSO.

A Novel Intraoral Mandibular Osteotomy For Set-Back Surgery In Complex Mandibular Anatomy

OBJECTIVE

Complex mandibular anatomy including rolled-out inferior mandibular border, thin rami with cortically adherent inferior alveolar nerve (IAN) complicate the application of the current mandibular osteotomies. This study aims to introduce an intraoral Inverted-L Ramus Osteotomy (ILRO) modified with IAN lateralization and intra-canal osteotomy for management of complex mandibular anatomical variations during mandibular setback surgery.

PATIENTS AND METHODS

This prospective study included 20 skeletal class III patients (mean age: 21.6 ± 3.3 years) with complex mandibular anatomy indicated for mandibular setback surgery (mean setback: 6.05 ± 1.1 mm). Preoperative CBCT imaging, digital planning, and fabrication of cutting / drilling guides were performed. Surgery involved mandibular setback through the application of the ILRO modified with nerve lateralization and intra-canal osteotomy. IAN function evaluated preoperatively at intervals up to one year postoperatively. Data on bad splits and surgical duration were also analyzed.

RESULTS

The mean surgical duration was 2.26 ± 0.21 h, with bilateral IAN exposure completed in 11 ± 3.2 min per side. All 40 osteotomy sites were separated without bad splits. Neurosensory deficits were observed in 90% of patients at two months, decreasing to 35% at six months and 5% at one year.

CONCLUSION

The introduced osteotomy overcomes the limitations of the traditional mandibular osteotomies in dealing with mandibular complex anatomy with adequate IAN protection and split segments integrity during mandibular setback surgery.

CLINICAL RELEVANCE

The introduced osteotomy provides a safe alternative to the current mandibular osteotomies utilized in mandibular setback surgery.

Comparison of patient testimonials of orthognathic surgery on YouTube and TikTok

OBJECTIVES

To investigate and compare the educational value of the most popular testimonials between TikTok (TT) and YouTube (YT), and to classify the emotional response of viewers through sentiment analysis of video comments on both platforms involving orthodontic patients who will undergo orthognathic surgery.

MATERIALS AND METHODS

Two distinct social media searches were conducted using specific search phrases on TT and YT. For each search phrase, 30 videos were gathered from each platform, and details such as number of views, likes, and comments were recorded for each video. Each video was then evaluated for completeness of information using an Information Completeness Score (ICS). A set of comments were collected for each video, and a Sentiment Analysis Score (SAS) was assigned using Azure Machine Learning.

RESULTS

TT had a higher number of views, likes, and comments. YT videos had a significantly higher ICS than TT (P < .0001). No statistically significant difference was found when evaluating SAS between the platforms or across phrase groups (P > .05), and no relationship was found between views, likes, comments, and SAS or ICS.

CONCLUSIONS

YT had higher-quality information within patient testimonials posted due to higher ICS values found than TT. Patient testimonials were not determined to have a positive or negative influence on potential patient opinions in either platform. Orthodontists should leverage their own TT profiles to help direct patients toward meaningful YT testimonials through informative video links.

High-fidelity surgical simulator for the performance of craniofacial osteotomies

PURPOSE

The oral and maxillofacial (OMF) surgical community is making an active effort to develop new approaches for surgical training in order to compensate for work-hour restrictions, mitigate differences between training standards, and improve the efficiency of learning while minimizing the risks for the patients. Simulation-based learning, a technology adopted in other training paradigms, has the potential to enhance surgeons' knowledge and psychomotor skills.

METHODS

We developed a fully immersive, high-fidelity virtual simulation trainer system based on Kitware's open-source visualization and interactive simulation libraries: the Interactive Medical Simulation Toolkit (iMSTK) and the Visualization Toolkit (VTK). This system allows surgeons to train for the crucial osteotomy step in bilateral sagittal split osteotomy (BSSO) using a pen-grasp oscillating saw that is controlled in the virtual environment using a 3D Systems Geomagic Touch haptic device. The simulator incorporates a proficiency-based progression evaluation system to assess the correctness of the cut and provide user feedback.

RESULTS

Three expert clinicians and two senior residents tested our pilot simulator to evaluate how the developed system compares to the performance of real-life surgery. The outcomes of the face and content validation study showed promising results with respect to the quality of the simulated images and the force feedback response they obtained from the device matched what they expected to feel.

CONCLUSION

The developed trainer has the potential to contribute to a reduction in the prevalence of adverse surgical outcomes after OMF surgeries involving osteotomies. Observing the clinicians and talking through some of the difficulties helped us identify key areas for improvement. Future work will focus on further clinical evaluation for the BSSO surgical scenario and extension of the trainer to include other craniofacial osteotomy procedures.

Influence of unfavourable osteotomy on skeletal stability and temporomandibular joint symptoms in sagittal split ramus osteotomy

This study was performed to investigate the impact of the split line on postoperative stability and temporomandibular joint (TMJ) disorders (TMD) after sagittal split ramus osteotomy. Skeletal Class III malocclusion patients who underwent mandibular osteotomy with/without plate fixation between August 2008 and March 2023 were enrolled retrospectively. The osteotomy lines were divided into original sagittal split ramus (SSRO), short lingual (SLO), and short buccal (SBO) osteotomies. Skeletal stability was evaluated, and TMDs were assessed preoperatively. Overall, 135 patients (270 TMJs) (87 female, 48 male; mean age 23.7 ± 7.8 years) were included. Mean mandibular setback was 6.2 ± 2.9 mm. Skeletal stability was observed in all patients. TMD were recorded in 47 joints (17.4%) preoperatively and 15 joints (5.6%) postoperatively. When TMD were compared between joints with and without plate fixation, preoperative TMD was found to be improved in non-fixed joints (P = 0.004). On multivariate analysis, segment fixation (P = 0.040), the osteotomy line (SBO vs SLO/SSRO, P = 0.043), and preoperative TMD (P = 0.030) were associated with postoperative TMD. The results of this study suggest that no plate fixation after mandibular osteotomy may be beneficial when the split line is SBO or preoperative TMD is observed.

Clients' experiences in their first entry to the operating room: a descriptive phenomenological study

BACKGROUND

The unfamiliar atmosphere of the operating room, waiting for anesthesia, and the process of surgery and anesthesia are some of the factors causing fear and anxiety in patients. It leads to physical and psychological pressure on patients. Better understanding of patients' feelings, beliefs, or fears and recording their experiences for optimal care after surgery is helpful. This study explains the experiences of clients in the first entry to the operating room.

METHODS

This qualitative study was conducted using a descriptive phenomenological method. In this study, 17 patients who had the experience of entering the operating room for the first time as an elective surgery under general anesthesia over the last 6 months were purposefully selected as participants. Then, they underwent an in-depth and semi-structured interview. After conducting the interview, the participants' statements were qualitatively analyzed using the seven-step Colaizzi method. During the steps of this study, Lincoln and Guba's four reliable criteria were observed.

RESULTS

By continuous analysis of interviews about patients' experiences, 308 codes, 10 sub-themes, 6 primary themes, and 3 general themes were obtained. Themes included unpleasant emotions experienced, unpleasant atmosphere factors, and the induction of relaxation and hope.

CONCLUSION

Patients' exposure to an unfamiliar place with new and unknown equipment, personnel with different clothing, stress, worry, psychosomatic reactions following stress, and annoying environmental factors can lead to an unpleasant experience for patients, if they are not managed. Also, the effective communication of the surgical team with the patients leads to reducing or removing the stress and complications caused by it.

Non-surgical Treatment of Severe Skeletal Class III Malocclusion in an Adolescent Patient: A Case Report

Class III malocclusion is one of the most challenging malocclusions in orthodontics. Its nature and multifactorial etiology should be taken into consideration, especially in growing and adolescent patients. Many treatment modalities have been proposed. The wide variety of underlying skeletal and dental components of this malocclusion justifies the different treatment options in the literature. The patient's decision, guided by the orthodontists and maxillofacial surgeons, is fundamental for choosing the appropriate treatment approach for this condition. A major component of this malocclusion is the maxillary transverse deficiency, which necessitates maxillary expansion. Rapid maxillary expansion (RME) has multiple advantages when incorporated into the treatment plan. RME is a type of maxillary expansion that separates the midpalatal suture using different appliances. This case report presents a borderline class III case where a non-surgical approach was adopted to treat an adolescent patient. The non-surgical approach was adopted based on the patient's skeletal age, in addition to the patient's desire and decision. RME was involved followed by a fixed orthodontics appliance with class III elastics. The duration of treatment was 15 months. Forward maxillary movement was observed post-RME. An impacted upper second premolar erupted spontaneously after space gaining, anterior crossbite was corrected, and the ANB angle improved from -2.2 degrees to 1.3 degrees. Esthetically pleasant and functional occlusion was achieved.

Pharyngeal Complications Following Two-Jaw Surgery

OBJECTIVE

Two-jaw surgery corrects jaw deformities by adjusting occlusion and reshaping the jaw. This technique carries a high risk of pharyngolaryngeal injury due to frequent head and neck movements during intraoperative maneuvers and prolonged intubation, although the details remain unclear. This study explored the frequency and causes of postoperative pharyngeal complications following maxillary translocation.

METHODOLOGY

Between September 2019 and July 2022, 133 cases of two-jaw surgery (36 males and 97 females; mean age: 26.4 years; age range: 17-55 years) were performed in our dental and oral surgery department. Postoperatively, patients with hoarseness or pharyngeal discomfort were immediately referred to the ear, nose, and throat department to assess the pharyngeal larynx by nasal endoscopy. Patients with and without pharyngeal lesions (such as vocal cord paralysis and laryngeal granulation) were compared.

RESULTS

The mean age, sex ratio, operative time, and blood loss were compared between groups with and without vocal cord paralysis. There was a statistically significant difference between the groups in terms of the sex ratio. No significant differences were found between groups with and without laryngeal granulation.

CONCLUSIONS

Vocal fold paralysis and laryngeal granulation were attributed to mechanical irritation of the larynx due to movement of the intubation tube during surgery, and perilaryngeal tissue compression due to hematoma and pharyngolaryngeal edema.

What comes first: teeth or face? Recommendations for an interdisciplinary collaboration between facial esthetic surgery and dentistry

OBJECTIVE

The aim of the present study was to provide recommendations in order to facilitate communication between dental professionals and surgeons who are collaborating in the field of dentofacial esthetics.

CLINICAL CONSIDERATIONS

Smile esthetics are beyond the scope, both of the surgeons who are collaborating with facial esthetics and of the dentists, as a wide range of treatment options from both sides is available. It can be difficult for the surgeon or the dentist that first comes in contact with the patient to conduct an individualized global treatment plan, in order to find out how the various phases of the treatment can be sequenced, as a workflow for an efficient interaction between facial surgery and dentistry still does not exist in the scientific literature.

CONCLUSIONS

Facial cosmetic procedures and dental treatment have to be planned as individual elements of the whole dentofacial esthetic rehabilitation. The treatment has to be initiated with the design of the smile and the intraoral mock-up, followed by the required surgical interventions, and to be finished with the delivery of the definitive dental restoration.

CLINICAL SIGNIFICANCE

Dentofacial esthetics require comprehensive communication between surgeons and dentists. Following the proposed recommendations, an individualized interdisciplinary treatment plan can be conducted, defining the role of each specialty.

Lefort 1 Osteotomy Study of Maxillary Bone in Caprine Skull Model: Comparison of Different Osteotomy Techniques (Piezo Versus Lindemann Bur Versus Manual Chisel)

OBJECTIVE

In this study, we aimed to compare the efficiency of different osteotomy techniques for Lefort 1 osteotomy in an experimental caprine skull model.

METHODS

Twelve caprine skulls were used for the study. Skulls were divided into 3 groups: (1) manual chisel group, (2) Lindemann bur group, and (3) piezo osteotomy group. Bilateral osteotomies were performed on each skull. Results were evaluated with three-dimensional computerized tomography scans and macroscopic observations of the mucosal tears and soft tissue.

RESULTS

The mean length of the bone gap in the manual, Lindemann, and piezo groups was 4.8 (±0.7), 3.38 (±1.49), and 1.39 (±0.3) mm, respectively ( P < 0.05). The mean number of comminuted fractures in the manual, Lindemann, and piezo groups was 5.5 (±1.4), 1.6 (±0.3), and 0.6 (±0.5), respectively ( P < 0.05). Mucosal tearing and soft tissue damage based on subjective inspection observations were negligible in the piezo technique. Soft tissue and mucosal damage were observed significantly more in the manual chisel osteotomy method compared with the other 2 techniques.

CONCLUSION

We anticipate that piezo, which has started to be used in new application areas besides rhinoplasty, will continue to be used more widely, especially in reconstructive orthognathic surgery, due to the minimal damage it causes to tissues. With the long-term results, much healthier interpretations can be made.

Strategic treatment planning for anterior open bite: A comprehensive approach

Anterior open bite (AOB), characterized by the lack of vertical overlap between upper and lower anterior teeth, poses a considerable challenge in orthodontics. The condition depends on many factors that combine to render it difficult to achieve post treatment stability. AOB is commonly classified as dental, skeletal, or functional on the basis of the clinical presentation and causative factors. Traditionally, skeletal AOB necessitates surgical intervention, whereas nonsurgical approaches such as extrusion arches and the Multiloop Edgewise Archwire Technique (MEAW) can be employed in more straightforward cases. Functional appliances are reserved for situations in which a patient's growth potential offers the possibility of effectively addressing AOB. This review presents a strategic treatment approach for addressing AOB, taking into account the classification and severity of the condition. The proposed SHE framework describes the use of mini-screws (S) for anchorage and vertical control, encouragement to correct habits (H), and the utilization of extractions and elastics (E). By incorporating extra-radicular mini-screws, AOB closure is achieved through anterior retraction in extraction cases or whole arch distalization of dentition with elastics in non-extraction cases. This framework emphasizes habit correction through a regimen of oral myofunctional therapy (OMT) and habit-correcting appliances to enhance posttreatment stability. This review suggests that nonsurgical correction is viable in the majority of cases, whereas surgical intervention should be reserved for severe cases of skeletal vertical overgrowth or horizontal discrepancies.

The online attention analysis on orthognathic surgery research

OBJECTIVES

Altmetrics is one of the fields of bibliometrics that seeks to assess the impact and interest of a given subject through Internet users. The aim of this study is to make an altmetric analysis of the orthognathic surgery literature.

METHODS

A literature search was conducted using Dimensions app up to December 2023. A list of the 100 most mentioned articles on the topic was compiled. A Google Trends search was performed with same strategy to visualize important data regarding internet search. Charts and tables were created using Microsoft Excel and VOSviewer software to allow bibliometric visualization.

RESULTS

There was a very poor correlation between the number of mentions and the number of citations (r = 0.0202). Most articles discussed on technical innovations associated to orthognathic surgery, majority related to virtual planning (n = 26). Other topics considered interesting to internet readers were complications (n = 18), surgical technique (n = 14), and psychological aspects/quality of life (n = 13).

CONCLUSION

Online interest in orthognathic surgery closely aligns with the level of academic interest but is also influenced by factors such as location and economic status. The internet is a powerful tool for disseminating scientific research to a broad audience, making it more accessible and engaging than traditional academic channels.

To what extent can mastication functionality be restored following mandibular reconstruction surgery? A computer modeling approach

STATEMENT OF PROBLEM

Advanced cases of head and neck cancer involving the mandible often require surgical removal of diseased sections and subsequent replacement with donor bone. During the procedure, the surgeon must make decisions regarding which bones or tissues to resect. This requires balancing tradeoffs related to issues such as surgical access and post-operative function; however, the latter is often difficult to predict, especially given that long-term functionality also depends on the impact of post-operative rehabilitation programs.

PURPOSE

To assist in surgical decision-making, we present an approach for estimating the effects of reconstruction on key aspects of post-operative mandible function.

MATERIAL AND METHODS

We develop dynamic biomechanical models of the reconstructed mandible considering different defect types and validate them using literature data. We use these models to estimate the degree of functionality that might be achieved following post-operative rehabilitation.

RESULTS

We find significant potential for restoring mandibular functionality, even in cases involving large defects. This entails an average trajectory error below 2 mm, bite force comparable to a healthy individual, improved condyle mobility, and a muscle activation change capped at a maximum of 20%.

CONCLUSION

These results suggest significant potential for adaptability in the masticatory system and improved post-operative rehabilitation, leading to greater restoration of jaw function.

Pediatric Orthognathic Surgery: A NSQIP-P Comparison of Peri-Operative Factors and Outcome Differences Between Cleft and Noncleft Patients

OBJECTIVE

The present study aimed to investigate the risk factors, complication profiles, and clinical outcomes of cleft and noncleft patients undergoing single jaw (mandibular or LeFort 1) and bimaxillary (BSSO + LeFort 1).

DESIGN

Retrospective Cross-sectional Study Setting: National Surgical Quality Improvement Program database 2018-2019.

PATIENTS

Pediatric patients.

INTERVENTIONS

Outcomes for mandibular, LeFort 1, and bimaxillary osteotomy were retrospectively evaluated for cleft and noncleft patients.

MAIN OUTCOME MEASURES

Multivariate logistic regression was used to determine the odds of complications and length of stay for cleft and noncleft patients undergoing single jaw and double jaw surgery.

RESULTS

669 pediatric patient underwent orthognathic surgery in the study period; the majority received LF1 only (n = 385; 58.3%), followed by mandible only (n = 179; 27.1%), and bimaxillary (n = 105; 15.9%%). Cleft differences were present in 56% of LFI patients, 32% of mandibular patients, and 22% of bimaxillary patients. After multivariate adjustment, ASA class III was associated with nearly 400% increased odds of any complication including readmission and reoperation (OR = 5.99; CI [[1.54-23.32]], p < 0.01, and 65% increased LOS (β-coefficient = 1.65, CI [1.37-1.99], p < 0.01). Presence of cleft was not significantly associated with odds of any complication (p = 0.69) nor increased LOS (p = 0.46) in this population.

CONCLUSION

Complications remained low between surgery types among cleft and noncleft patients. The most significant risk factor in pediatric orthognathic surgery was not the presence of cleft but rather increased ASA class. Though common in patients seeking orthognathic surgery, cleft differences did not cause additional risk after adjustment for other variables.

Intraoperative ultrasonography for the reposition of the condylar process during bilateral sagittal osteotomy of the mandible-A case report

INTRODUCTION

Ultrasonography (USG), being a safe, quick and relatively cheap examination, is used to diagnose various pathologic conditions. The application of ultrasound to assess the position of the condyle during bilateral sagittal split osteotomy (BSSO) may improve the treatment results.

CASE PRESENTATION

A 33-year-old patient, who was operated for a skeletal defect of maxilla and mandible with BSSO and Le Fort I maxillary osteotomy is discussed in this case report. The procedure was complicated with a mandibular head dislocation. The split segment was repositioned under ultrasound guidance, and a repeat osteosynthesis was performed.

CONCLUSIONS

The ultrasound method is useful for the intraoperative assessment of the condylar process' position. The use of ultrasound in the diagnosis of complications and for intraoperative monitoring should be promoted.

A Rare Complication of Maxillomandibular Advancement Surgery: Postoperative Plate Bending Following Emergency Intubation

Maxillomandibular advancement surgery is a recognized technique for the management of obstructive sleep apnea. Complications for this surgery are not well-documented in the literature. The authors report an unusual case of mandibular plate bending following unplanned postoperative airway management using an oral endotracheal tube in a 65-year-old male. The bent mandibular plate and airway concern required a return to the theater for the replacement of bent plates and tracheostomy placement. This case documents the importance of multidisciplinary team planning for airway-related surgery as well as the need for multidisciplinary team management of postoperative airway management following orthognathic surgery.

Risk factors for postoperative infection after bilateral sagittal split ramus osteotomy: A retrospective analysis

BACKGROUND

This retrospective clinical study investigated risk factors for infection following bilateral sagittal split ramus osteotomy (BSSO) as orthognathic surgery, including the patients' general condition, local factors, and surgical factors.

PATIENTS AND METHODS

The cases of 160 mandibular sites of 80 Japanese patients (26 males, 54 females; mean ± SD age: 25.3 ± 7.7 years, range 16-55 yrs) with a jaw deformity who underwent BSSO orthognathic surgery at our Department of Oral and Maxillofacial Surgery between Jan. 2017 and Dec. 2022 were analyzed. Potential risk factors were classified as clinical predictive variables. Descriptive and univariate statistics were computed. A multivariate analysis was performed with logistic regression.

RESULTS

Fifteen mandibular sites (9.4 %) were complicated with postoperative infection. The multivariate analysis revealed significant differences in facial asymmetry (OR 24.0, p = 0.0002) and the amount of mandibular movement (OR 0.664, p = 0.011) between the sites with and without infection.

CONCLUSIONS

Among clinical variables, facial asymmetry was the strongest risk factor for post-BSSO infection, followed by the amount of mandibular movement.

Male and Female Discrepancies in Anxiety, Depressive Symptoms, and Coping Strategies among Orthognathic Patients: A Cross-Sectional Analysis

With an increasing understanding of the differences between men and women's psychological experiences, this study aimed to probe the sex-based differences in anxiety, depressive symptoms, and coping strategies among orthognathic patients. The study hypothesis was that female patients would show higher levels of anxiety and depressive symptoms than males, and that coping mechanisms would differ between male and female sexes. A cross-sectional design was adopted, examining orthognathic patients from the Department of Oral and Maxillo-Facial Surgery at the Emergency Clinical Municipal Hospital in Timisoara, Romania, from 2020 to 2023. Eligible participants (18+ years with no prior orthognathic treatment) completed a comprehensive online questionnaire 6 weeks before scheduled surgery. This was composed of validated self-report instruments comprising the SF-36, GAD-7, and the PHQ-9, and the COPE-60, along with additional sociodemographic data. Of the 127 orthognathic patients analyzed (68 men and 59 women, aged 18 to 65 years, mean age 32), men rated their physical health status slightly better on the SF-36 scale. However, the most notable difference was in mental health, with females scoring higher on both the PHQ-9 (indicative of depression) and the GAD-7 (indicative of anxiety) scales. Specifically, female participants exhibited average PHQ-9 scores 1.8 points higher and GAD-7 scores 1.5 points higher than their male counterparts. Coping mechanisms also varied: 42% of male patients primarily employed "Disengagement" strategies, while 58% of females predominantly used "Engagement" and "Emotion Focused" strategies. Emotion-focused coping was associated with a 1.6-fold increased risk of depressive symptoms. Sex differences play a crucial role in the psychological experiences of orthognathic patients, evident in anxiety and depression levels, perceived health status, and coping strategies. This underlines the importance of sex-tailored psychological support in the preoperative phase for orthognathic surgery patients.

Sphenoid Sinus Foreign Body After Le Fort I Osteotomy

This report describes a rare case of a foreign body in the sphenoid sinus from the tip of an osteotome, which was lodged during the Le Fort I osteotomy. After surgery, a 2-mm-diameter round-shaped foreign body was seen as an opaque image in the right sphenoid sinus on computed tomography. The tip of the broken osteotome (Bauer) was confirmed after the intraoperative instruments were investigated. The foreign body was removed using an interventional endoscope and navigation computed tomography, and a good prognosis was obtained.

Clinical Analysis of Patients who Underwent Reoperation After Orthognathic Surgery: A 14-Year Retrospective Study

PURPOSE

The purpose of this study was to analyze the patients clinically who underwent reoperation after certain Orthognathic procedures, and to assess the reoperation rate. Furthermore, the authors also evaluated the incidence of intraoperative and postoperative complications that led to the need for reoperation.

METHODS

Total 526 patients were selected who underwent Orthognathic surgery between July 2008 and February 2022 at the Department of Oral and Maxillofacial Surgery in Pusan National University Dental Hospital by single surgeon. All the patients information were extracted from electronic database of our university. Demographic, radiologic, intraoperative, and postoperative data were recorded and compiled.

RESULTS

Out of 526 patients, 265 (50.3%) were males and 261 (49.6%) were females. The total number of patients who showed complication is 89 (16.9%) and the patients who underwent reoperation are 17 (3.2%). The common complications that occurred were postoperative sensory disturbance (31; 5.8%), unwanted fractures (17; 3.2%), intraoperative nerve injury (11; 2%), wound dehiscence (11; 2%), infection (10; 1.9%), tooth injury (2; 0.3%), and others (18; 3.4%). The serious complications that led to reoperation include severe bleeding (6; 1.1%), unesthetic results (5; 0.9%), non-union of maxilla (4; 0.7%), and failed osteosynthesis (2; 0.3%). After 2018, all the orthognathic surgeries were performed with the help of virtual surgical planning. After application of virtual surgical planning, the number of patients with complications statistically decreased.

CONCLUSION

The present study showed that the reoperation rate after orthognathic surgery was low, this rate was more decreased after applying 3-dimensional virtual surgery and 3-dimensional printed plate, especially in unesthetic cases.

Occlusal Plane Angle as a Key Factor for Chin Protrusion After Mandibular Osteotomy in Skeletal Class III

There is no treatment algorithm to decide whether maxillomandibular or mandibular osteotomy alone should be performed in borderline cases. This study assessed the factors that affect the changes in soft tissue after mandibular setback. Patients who underwent mandibular osteotomy alone to correct mandibular protrusion were included in this study. Hard and soft tissue analyses were performed on lateral cephalograms before and 12±3 months after surgery. The popular points were set for referencing hard and soft tissues on the lateral cephalogram. Nasolabial, labiomental, and soft tissue facial plane angles were measured for the soft tissue assessment. To assess the mandibular setback amount, SNB was calculated. Twenty-one patients were included in this study. The nasolabial angle was increased after surgery and its change significantly correlated with the change in SNB ( P =0.00815). The change in soft tissue facial plane angle after surgery per change in SNB significantly correlated with the occlusal plane angle ( P =0.0009). An occlusal plane angle of at least 15.45 degrees was required for the SNB and soft tissue facial plane angle to change to the same degree. The occlusal plane angle (whether or not it was ≥15.45 degrees) may help in determining the surgical approach in borderline cases, specifically on whether maxillomandibular or mandibular osteotomy alone should be performed if the mandibular setback is simple.

Factors affecting progressive facial swelling immediately after orthognathic surgery: A retrospective cohort study

The aim of this study was to identify clinical factors associated with progressive facial swelling after orthognathic surgery. Patients diagnosed with jaw deformities and undergoing orthognathic surgery were retrospectively evaluated, and those with surgical site infection, Le Fort I osteotomy, or genioplasty only were excluded. Facial swelling volume was calculated by comparing facial volume preoperatively and three days postoperatively using 3D images and image analysis software (VECTRA H2). FXIII was measured within three days after surgery in only patients with unexplained postoperative bleeding or hematoma. The correlation between facial swelling volume and clinical factors was statistically analyzed. Facial swelling volume was examined in 78 patients. Univariate analysis showed a significant difference between facial swelling volume (mean = 41.6 cm3) and operation time (mean = 209.3 min, r = 0.283, p = 0.012), ΔHb level (mean = 1.18 g/dL, r = 0.235, p = 0.039), as well as decreased factor XIII activity (mean = 75.3%, p = 0.012). Multivariate analysis showed a significant difference between facial swelling volume and FXIII deficiency (standard error = 6.44, p = 0.031).Progressive facial swelling immediately after orthognathic surgery may be due to factor XIII deficiency.

Readmission after orthognathic surgery

OBJECTIVE

To evaluate the readmission rate after orthognathic surgery and identify associated risk factors.

STUDY DESIGN

Retrospective analysis of patients who underwent orthognathic surgery and had an unexpected hospital admission, with or without return to the operating room (OR), within the first postoperative year. Study variables included sex, age, American Society of Anesthesiologists (ASA) status, type of surgery, concomitant third molar extraction, concomitant genioplasty, duration of surgery, first assistant experience, and duration of hospitalization. Bivariate associations were calculated between variables and readmission status. Chi-square and Fisher's Exact tests were used to compare categorical variables, and a 2-sample t test was used to compare continuous variables.

RESULTS

There were 701 patients included in the study. The readmission rate was 9.70%. Twelve patients were managed non-surgically, and 56 patients required an OR procedure. The most common reason for readmission without return to the OR was an infection, and for reoperation was hardware removal. Age, sex, type of surgery, third molar extraction, genioplasty, duration of surgery, and experience of first assistant were not found to be predictors for readmission.

CONCLUSIONS

Only ASA classification and duration of initial hospitalization were significant risk factors for readmission of patients within the first postoperative year after orthognathic surgery.

The Influence of Bolus of Methylprednisolone on Postorthognathic Surgery Symptoms: A Controlled Clinical Trial

OBJECTIVE

Despite improvements in maxillary and mandibular osteotomy, complications still result in around 20%. Post and intraoperative standard therapies, based on the use of betamethasone and tranexamic acid, could help to minimize the onset of side effects. The aim of the study was to compare the role of a supplementary bolus of methylprednisolone rather than the standard therapy in the onset of postoperative symptoms.

METHODS

The authors enrolled 10 patients, affected by class 2 and 3 Dentoskeletal, submitted to the institution for maxillomandibular repositioning osteotomy between October 2020 and April 2021. Patients were divided into 2 groups as follows: 5 patients (group A ) received standard therapy consisting of the administration of 4 mg of betamethasone, intraoperatively, and 1 g of tranexamic acid in 2 administrations. The remaining 5 patients (group B ) received a supplementary bolus of 20 mg methylprednisolone before the end of the surgery.All patients received, in the postoperative period, 4 mg of betamethasone every 12 hours, for 3 days. Postoperative outcomes were evaluated with a questionnaire evaluating speaking discomfort, pain when swallowing, feeding discomfort, drinking discomfort, swelling, and ache. Each parameter was associated with a numeric rating scale ranging from 0 to 5.

RESULTS

The authors observed that patients treated with a supplementary bolus of methylprednisolone (group B ) had a statistically significant reduction of all postoperative symptoms as compared with patients of group A (* P < 0.05, ** P <0.01 Fig. 1 ).

CONCLUSION

The study highlighted that the additional bolus of methylprednisolone improved all of the 6 parameters investigated by the questionnaire submitted to patients, resulting in a faster recovery and improvement of the patient's compliance with surgery. Further studies with a larger population are needed to confirm preliminary results.

Prevalence of Temporomandibular Disorders in Orthognathic Surgery patients: A systematic review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions

BACKGROUND

Orthognathic surgery is done to treat a variety of dentofacial abnormalities, but a wide gap still remains on how it can result in temporomandibular joint dysfunction (TMD). The primary goal of this review was to assess the effects of various orthognathic surgical techniques on the emergence or exacerbation of TMJ dysfunction.

METHODS

A comprehensive search was conducted across several databases using Boolean operators and MeSH keywords related to temporomandibular joint disorders (TMDs) and orthognathic surgical interventions, with no limitation on the year of publication. Two independent reviewers screened the identified studies based on predetermined inclusion and exclusion criteria, followed by a risk of bias assessment using a standardised tool.

RESULTS

Five articles were considered for inclusion in this review. A greater number of females opted for surgical options than their male cohorts. Three studies were of prospective design, 1 of retrospective and 1 of observational type. Mobility on lateral excursion, tenderness on palpation, arthralgia and popping sounds were the TMD characteristics that showed significant differences. Overall, orthognathic surgical intervention did not show an increase in TMD signs and symptoms as compared to nonsurgical counterparts.

CONCLUSION

Though orthognathic surgery reported greater cases of some TMD symptoms and signs as compared to the nonsurgical cohorts in four studies, the conclusive evidence is debatable. Further studies are recommended with a longer follow-up period and greater sample size to determine the impact of orthognathic surgery on TMJ.

Causes of Reoperation Consultation and Clinical Review of Actual Reoperation After Previous Orthognathic Surgery

OBJECTIVE

To investigate the causes of reoperation consultation, and the actual percentage and procedures of reoperation after previous orthognathic surgery.

METHODS

The samples consisted of 30 patients who visited our clinic for reoperation consultation from October 2015 to September 2021 (6 males and 24 females; mean age at reoperation consultation, 28.4 y). Patient's causes of reoperation consultation were divided into "esthetic dissatisfaction," "airway changes," "temporomandibular disorders," "uncomfortable occlusion," and "other complications". In terms of esthetic dissatisfaction, the more detailed esthetic problem was evaluated by the clinical chart, facial photographs, and radiographs. In patients who actually underwent reoperation, the actual percentage and procedures of reoperation were investigated.

RESULTS

The most prevalent causes for reoperation consultation were "esthetic dissatisfaction" (n = 21, 70.0%), followed by "airway changes" (n = 11, 36.7%), "uncomfortable occlusion" (n = 8, 26.7%), "other complications" (n = 5, 16.7%), and "temporomandibular disorder" (n = 4, 13.3%). Less than half of patients actually underwent reoperation (n = 13, 43.3%). Actual reoperation procedures included minor revision surgery, reconstruction surgery, or complete reoperation according to the patient's need. In case of complete reoperation, more accurate and predictable results were obtained by using virtual surgical planning, customized surgical guides, titanium surgical plates made with computer-aided design and computer-aided manufacturing technique, and a 3-dimensional printing method.

CONCLUSION

It is important to communicate with patients about expectations for facial esthetic improvement by orthognathic surgery for obtaining the patient's postoperative satisfaction.

Does Social Media Affect a Patient's Decision to Undergo Orthognathic Surgery?

Orthognathic surgery, also known as corrective jaw surgery, is a procedure that corrects abnormalities of the jaw and face. It is used to treat malocclusions, where the teeth and jaws are misaligned. This surgery can improve the function and appearance of the jaw and face, leading to improved mastication, speech, and quality of life for the patients. To assess if social media had any effect on the patients' decision to undergo orthognathic surgery, a self-administered online questionnaire was distributed to patients who had undergone orthognathic surgery at the Oral and Maxillofacial department through the health information system (BESTCare, 2.0A) to participate in the study. In total, 111 responses were recorded from the patients, with 107 agreeing to answer the questionnaire and 4 refusing to answer. Twitter was a source of information about orthognathic surgery for 61 patients (57%). When using a social media platform, 3 patients (2.8%) were influenced by an advertisement or an educational post on social media that presented the surgical correction of the jaws, while 15 (14%) believed that they had been somewhat influenced, and 25 (23.4%) picked their surgeon through social media. Fifty-six patients (52.3%) took the neutral position regarding whether information on social media had answered their questions and concerns regarding the surgical procedure. Social media did not influence patients' decision to undergo the procedure. Surgeons and specialists must utilize their platforms to answer any concerns or questions from any patient undergoing or having undergone this corrective jaw surgery.

Systematic mapping review of interventions to prevent blood loss, infection and relapse in orthognathic surgery

BACKGROUND

This systematic mapping review aims to identify, describe, and organize the currently available evidence in systematic reviews (SR) and primary studies regarding orthognathic surgery (OS) co-interventions and surgical modalities, focusing on the outcomes blood loss, infection and relapse.

MATERIAL AND METHODS

A comprehensive search strategy was performed to identify all SRs, randomized controlled trials and observational studies that evaluate surgical modalities and perioperative co-interventions in OS that evaluate the outcomes blood loss, infection and relapse, regardless of language or publication date. Searches were conducted in MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. In addition, grey literature was screened.

RESULTS

27 SRs and 150 primary studies fulfilled the inclusion criteria, 91 from SRs, and 59 from our search strategy. Overall, the quality of the SRs was graded as "Critically low," and only two SRs were rated as "High" quality. 11 PICO questions were extracted from SRs and 31 from primary studies, which focused on osteosynthesis methods, surgical cutting devices, use of antibiotics, and induced hypotension. In addition, evidence bubble maps for each outcome were created to analyze in a visual manner the existing evidence.

CONCLUSIONS

Future primary and secondary high-quality research should be addressed focused on the eight knowledge gaps identified in this mapping review. We concluded that the evidence mapping approach is a practical methodology for organizing the current evidence and identifying knowledge gaps in OS, helping to reduce research waste and canalize future efforts in developing studies for unsolved questions.

Applications of regenerative techniques in adult orthodontics

Management of the growing adult orthodontic patient population must contend with challenges particular to orthodontic treatment in adults. These include a limited rate of tooth movement, increased incidence of periodontal complications, higher risk of iatrogenic root resorption and pulp devitalisation, resorbed edentulous ridges, and lack of growth potential. The field of regenerative dentistry has evolved numerous methods of manipulating cellular and molecular processes to rebuild functional oral and dental tissues, and research continues to advance our understanding of stem cells, signalling factors that stimulate repair and extracellular scaffold interactions for the purposes of tissue engineering. We discuss recent findings in the literature to synthesise our understanding of current and prospective approaches based on biological repair that have the potential to improve orthodontic treatment outcomes in adult patients. Methods such as mesenchymal stem cell transplantation, biomimetic scaffold manipulation, and growth factor control may be employed to overcome the challenges described above, thereby reducing adverse sequelae and improving orthodontic treatment outcomes in adult patients. The overarching goal of such research is to eventually translate these regenerative techniques into clinical practice, and establish a new gold standard of safe, effective, autologous therapies.

Continued persistent facial pain despite several surgical interventions in the temporomandibular joint

This article describes a woman in her forties who spontaneously developed facial pain 19 years after double-jaw orthognathic surgery. The focus of her pain was the left side of the face, including the temporomandibular joint (TMJ). Conservative treatment was initiated, including several occlusal splints, in addition to injections with local anesthesia, botulinum toxin, and corticosteroids, with limited effects. Surgical treatments with arthroscopy and discectomy, and ultimately a TMJ prosthesis, improved the patient's joint function but did not reduce pain. The question is whether the degenerated joint was due to progression of the original disease process or to multiple surgical procedures.

Management of A Bad Split Complication: A Systematic Review

Introduction:

Bad split is one of the well-known intra-operative complications that occur during the bilateral sagittal split osteotomy (BSSO) procedure, which is a rehabilitation procedure for patients with mandibular deformities. The prevention of further post-surgery complications required sufficient management of bad split complications.

Objective:

This study aimed to analyze the management of bad split complications during a BSSO procedure.

Methods:

The literature review was conducted in the form of library research in the field of bad split complications' management by a BSSO based on the Preferred Reporting Items for Systematic Reviews (PRISMA). Related studies were found through using a manual search using Pubmed, ScienceDirect, Ebscohost, Scopus, Medline, Embase, and Web of Science, among other search engines. The inception of incorporation standards, the process of data extraction, and the determination of the risk of bias were carried out by the authors. The process of data screening was conducted by applying the inclusion and exclusion criteria.

Results:

This paper systematically reviewed seven related studies, four of which were case series and two of which were cross-sectional. The utilization of additional osteosynthetic plates was revealed throughout the extraction process as the most acquainted course of action to manage the bad split complications during the BSSO procedure.

Conclusion:

The osteosynthetic plate and miniplate application with bicortical or monocortical screws were exposed as the most used treatment for bad split complications.

The consequences of living with a severe malocclusion: A review of the literature

AIM

To facilitate the orthognathic shared decision-making process by identifying and applying existing research evidence to establish the potential consequences of living with a severe malocclusion.

METHODS

A comprehensive narrative literature review was conducted to explore the potential complications of severe malocclusion. A systematic electronic literature search of four databases combined with supplementary hand searching identified 1024 articles of interest. A total of 799 articles were included in the narrative literature review, which was divided into 10 themes: Oral Health Related Quality Of Life; Temporomandibular Joint Dysfunction; Masticatory Limitation; Sleep Apnoea; Traumatic Dental Injury; Tooth Surface Loss; Change Over Time; Periodontal Injury; Restorative Difficulty; and Functional Shift and Dual Bite. A deductive approach was used to draw conclusions from the evidence available within each theme.

RESULTS

The narrative literature review established 27 conclusions, indicating that those living with a severe malocclusion may be predisposed to a range of potential consequences. With the exception of Oral Health Related Quality Of Life, which is poorer in adults with severe malocclusion than those with normal occlusions, and the risk of Traumatic Dental Injury, which increases when the overjet is >5 mm in the permanent and 3 mm in the primary dentition, the evidence supporting the remaining conclusions was found to be of low to moderate quality and at high risk of bias.

CONCLUSION

This article summarises the findings of a comprehensive narrative literature review in which all of the relevant research evidence within a substantive investigative area is established and evaluated. Notwithstanding limitations regarding the quality of the available evidence; when combined with clinical expertise and an awareness of individual patient preferences, the conclusions presented may facilitate the orthognathic shared decision-making process and furthermore, may guide the development of the high-quality longitudinal research required to validate them.

The Liability of Performing Orthognathic Surgery

Study Design:

This is a retrospective case series using the Thomson Reuters Westlaw Edge database, an online subscription-based database of over 40,000 state and federal records.

Objective:

There is growing academic interest in the medical malpractice literature. The primary objective of this study was to examine medical malpractice in orthognathic procedures in order to characterize factors that determine legal responsibility and help make the craniomaxillofacial (CMF) surgeon more comfortable when treating this patient population.

Methods:

The database was queried for medical malpractice cases involving orthognathic surgery from 1985-2021. The characteristics of each lawsuit were identified, and descriptive statistics were reported.

Results:

A total of 42 CMF malpractice cases were available for review, and total of 15 cases were included in the final sample. Verdict decisions and settlements occurred between 1991 and 2012. Of the 15 cases, the highest concentration of cases occurred in California (6) and Pennsylvania (2). 53% of cases were ruled in favor of the defendant, 7% of cases were settled, 27% of cases were ruled in favor of the plaintiff against the surgeon, and 13% were ruled in favor of the plaintiff against the hospital with the surgeon being found not liable. The minimum award of damages was $29,999 and the maximum was $550,000.

Conclusion:

Litigation experience can be very time consuming and troublesome for medical practitioners. The risk of litigation and complications might be a prohibiting factor as to why CMF surgeons may not be preforming orthognathic surgery. The best defense against a malpractice case is to avoid one altogether. Learning from past mistakes is one way of ensuring that goal.

Retrospective examination of complications observed in orthognathic surgical surgery in 85 patients

BACKGROUND

The aim of our study is to examine the possible complications, risk factors, and solutions encountered in orthog-nathic surgery in the light of the cases; we performed in our clinic.

METHODS

This study includes a retrospective analysis of the records of 85 patients who underwent orthognathic surgery between 2015 and 2020 in Istanbul Pendik District Hospital Oral and Maxillofacial Surgery Service. The types of complications encountered during the operations were recorded in the study. Independent variables such as gender, age, number of operations, surgical site, and type of osteotomy were evaluated. Complications were evaluated according to the Clavien-Dindo classification. The data were pre-sented for statistical analysis with a significance level of 0.05.

RESULTS

Of the 85 patients included in the study, 40 were male and 45 were female. Of these patients, 65 had double chin operation and 20 had single chin operation. A total of 150 jaw osteotomies were performed, 78 of them in the maxilla and 72 in the mandible. While the maxilla was operated in 13 of the cases, in which single jaw operation was performed, only the mandible was treated in 7 of them. Complications were observed in 24 (10.57%) of a total of 227 osteotomies. Among the complications encountered, bleeding (8), nerve damage (7), malocclusion (3), infection (2), TMJ problems (2), bad split (1), and deviation at the tip of the nose (1) stand out, while complications were observed equally in men and women, complications were observed more frequently in cases with longer operative time (p<0.05). Complications were observed more frequently in bilateral sagittal split osteotomies (p<0.001) compared to Le Fort 1 osteotomies. Clavien-Dindo grade I complications were most common (72.04%) depending on the treatment. According to the Clavien-Dindo classification, there was no relationship between gender, age, duration of surgery, length of hospital stay, or surgical site, and the degree of complications (p≥0.05).

CONCLUSION

Post-operative malocclusion, bleeding, inferior alveolar nerve injury, infection, poor division, and infection are the most common complications in orthognathic surgery. It can be associated with factors such as the duration of the operation, the number of operations, the site of the operation, and the type of osteotomy which performed. It is thought that positive contributions can be made to the success of the surgery by considering these factors in the treatment planning, during the operation and in the post-operative follow-up part.

The Frequency of Temporomandibular Disorders, Surgical Complications, and Self-Reported Mental Health Problems in Orthognathic Patients

OBJECTIVE

To evaluate the frequency of signs and symptoms of temporomandibular disorders (TMD), surgical complications, and patient's self-reported mental health problems during orthognathic treatment.

MATERIAL AND METHODS

The clinical records of 145 patients treated with orthognathic treatment were retrospectively studied. Variables regarding occlusal parameters, treatment duration, TMD symptoms, complications, and self-reported mental health status at time points of T0 (beginning of the treatment), T1 (before surgery), and T2 (final examination) were evaluated. The variables were statistically compared with significance level of P < 0.05.

RESULTS

A total of 51% (n = 74) of the patients had TMD symptoms at 1 or several time points, women having significantly more TMD signs and symptoms (P = 0.002). Temporomandibular disorder signs and symptoms decreased significantly after orthognathic treatment (P=0.001). At least 1 self-reported mental health-related factor during 1 or several time points (T0-T2) was recorded in 17.2% (n = 25) of the patients. There was no significant difference in frequency of self-reported mental health problems in patients with TMD signs and symptoms compared with patients without TMD signs and symptoms (P > 0.05). The frequency of postoperative complications was 39.3%, being significantly higher after Bilateral Sagittal Split Osteothomy (BSSO, 48.7%). There was no difference in treatment duration of patients with self-reported mental health problems compared with patients without (P > 0.05).

CONCLUSIONS

In this study population, TMD signs and symptoms seem to be typical both in patients with or without self-reported mental health problems. Women had significantly more TMD symptoms. Orthognathic surgery treatment seems to have a positive effect on TMD signs and symptoms.

Intraoperative condylar positioning techniques on mandible in orthognathic surgery

PURPOSE

The surgical condylar displacement often resulted in relapse and serious symptoms of temporomandibular joint disorders (TMD) after orthognathic surgery. To minimize the displacement, numerous techniques have been proposed. To verify their accuracy in positioning and effectiveness in preventing postoperative TMD and relapse, we reviewed the literature related to intraoperative condylar positioning techniques on the mandible in this study.

METHODS

The literature on condylar positioning techniques was reviewed with 2 charts, including the non-computer-assisted and the computer-assisted positioning methods. The pre- and postoperative alterations of condyles, the postoperative temporomandibular joint (TMJ) function, and surgical relapse were analyzed regarding the techniques. The clinical usage and characteristics were reviewed as well.

RESULTS

A total of 22 articles, including 907 patients, have been reported since 2001. Nearly all methods reach a considerable positioning accuracy within the range of 1-2 mm and 1-2° from the preoperative position. We ranked the accuracy of the methods from high to low: CAD/CAM CPDs>CAD/CAM titanium plate positioning>manual positioning>computer-assisted navigation systems>imaging positioning systems. Most skeletal class II and class III patients achieved great occlusion and had no TMJ dysfunction or relapse after condylar positioning.

CONCLUSION

Both the non-computer-assisted and computer-assisted condylar positioning techniques reach considerable accuracy in locating the preoperative condyle position and preventing TMJ dysfunction and surgical relapse. Different levels of surgeons and cases can benefit from multiple suggested positioning methods. Further research with large samples and long-term follow-up is worth looking forward to upgrading the current methods, improving the clinical utility, and developing new positioning techniques.

Three-dimensional morphological and biomechanical analysis of temporomandibular joint in mandibular and bi-maxillary osteotomies

Orthognathic surgery is a typical approach for treating maxillofacial deformities. However, orthognathic surgery results in positional changes in the condyles. In a previous review, the effects of orthognathic surgery on temporomandibular joints (TMJs) are not provided. Hence, in this study, we investigate the morphological changes in TMJs after mandibular and bi-maxillary osteotomies. The relationship between the morphological parameters of TMJs and symptoms of temporomandibular disorders (TMDs) is discussed. Finite element contact stress analysis is performed, and the results show that the two abovementioned surgeries can improve maxillofacial deformities, although the positions of the condyles are changed. Moreover, preoperative stress asymmetry of the left and right TMJs is observed, which remain after the surgeries. TMD patient-specific analysis shows that three joint spaces (medial joint space, lateral joint space, superior joint space) are significantly correlated with TMD symptoms.

Classification and Clinical Treatments for Unfavorable Fractures of the Proximal Segment in Sagittal Spilt Ramus Osteotomy: A Retrospective Study of 964 Cases

ABSTRACT

Unfavorable fractures in sagittal split ramus osteotomy are hard to manage. The aim of this study is to develop a new classification method for unfavorable fractures of the proximal segment to guide clinical managements. After reviewing 964 cases of sagittal split ramus osteotomy, we found that the unfavorable fractures can be divided into 3 types: mandibular ramus transverse fractures (Type 1), bad fractures accompanied by free fragments (Type 2), and unexpected separation patterns without free fragments (Type 3). We calculated the incidence of each fracture type and provided instructions for their corresponding treatments. Thirty-six patients suffered from unfavorable fractures (7.4% of patients), among which 32 patients had unilateral fractures and 4 patients had bilateral fractures. There were 2 Type 1 fractures (0.2% of split sites), 8 Type 2 fractures (0.8% of split sites), and twenty-six Type 3 fractures (2.3% of split sites). Type 1 unfavorable fractures are difficult to deal with, but Types 2 and 3 are generally manageable and they have no significant impact on the final outcomes. The new classification can effectively guide treatment strategies for unfavorable fractures. Severe cases of unfavorable fractures are rare, and most unfavorable fracture cases have a positive prognosis if correctly treated in time.

A Modified Procedure for Anterior Maxillary Osteotomy

ABSTRACT

Anterior maxillary osteotomy is a traditional operation in the treatment of maxillary protrusion. Varies fields about operation have been changed or improved in those years to avoid different kinds of complications. In our study, the authors would present 1 kind of improved anterior maxillary osteotomy surgical method. The study was conducted at the Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Guangzhou, Guangdong province. Patients are divided into improved group and general group. Patients after surgery were claimed to have regular return visits. Occlusion, tooth vitalities, postoperative complications would be well evaluated. The operative time, blood losses, complications showed no different at maxillary operation. Our procedure could give much better and direct sight of anterior maxillary bone, and the simplified osteotomy lines could help maxilla move, reduce the times spent on hard tissue cut off or grind. The modified procedure can meet clinical command, improve dentofacial deformities, and gives convenience to surgeon.

Pediatric Orthognathic Surgery: National Analysis of Perioperative Complications

BACKGROUND

Orthognathic surgery has traditionally been performed after skeletal maturity. Although these procedures are also being performed in children, the implications of earlier intervention and specific risk factors in this younger population remain unknown.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program Pediatric dataset was queried for orthognathic procedures performed in 2018. Complications, readmissions, and reoperations were analyzed with appropriate statistics.

RESULTS

Overall adverse event rate after orthognathic surgery in pediatric patients was 7.8% (n = 22 of 281), which were associated with having any comorbidity (P < 0.001), overall respiratory comorbidities (P = 0.004), structural pulmonary abnormality (P < 0.001), developmental delay (P = 0.035), structural central nervous system abnormality (P < 0.001), and neuromuscular disorder (P = 0.035). Most common complications were excessive bleeding (2.5%), surgical site infection (1.1%), and pneumonia (0.7%). Orthognathic surgery in children below 6 years of age is associated with significantly increased adverse events (P < 0.001), including surgical site infection (P < 0.001), pneumonia (P = 0.022), readmission (P < 0.001), and reoperation (P < 0.001). Le Fort I osteotomies (P < 0.001) and bilateral sagittal split osteotomies (P = 0.009) took significantly longer for older patients in the years of permanent dentition than younger patients in the years of deciduous dentition. Single- and double-jaw procedures in pediatric patients have similarly low adverse events (P all ≥0.130). Interestingly, bilateral sagittal split osteotomies performed before 13.5 years of age were associated with a higher risk of adverse events (P = 0.012), such that these younger patients were 7.1 times more likely to experience adverse events if their procedure was performed earlier.

CONCLUSIONS

Orthognathic surgery is relatively safe, but children in the years of deciduous dentition under 6 years of age have significantly increased risk of adverse events.

Pain in Oral and Maxillofacial Surgery and Implant Dentistry: Types and Management

Over the years, the pain has been defined numerous times in several ways. In oral and maxillofacial surgery, the occurrence of pain, especially postoperatively, is anticipated. Pain arises as a combination of various processes after tissue damage. Distinct pain experiences in oral surgery were depicted in several previous studies, adding knowledge to the field. The management of these encounters has been suggested over time, improving treatment approaches in the clinical setting. This review aims to understand the pain and its types and intervention in the field of oral and maxillofacial surgery.

Relapse and temporomandibular joint dysfunction (TMD) as postoperative complication in skeletal class III patients undergoing bimaxillary orthognathic surgery: A systematic review

Objectives

The aim of this study was to determine Relapse and TMD as postoperative complication in skeletal class III patients undergoing bimaxillary orthognathic surgery.

Materials and methods

Data was obtained by database searching using The Cochrane Central Register of Controlled Trials (central), PUBMED, SCOPUS, EMBASE, Google scholar, National Medical library, New Delhi. The titles and abstracts of the electronic search results were screened and evaluated by two observers for eligibility according to the inclusion and exclusion criteria.

Results

5261 articles were retrieved for the review. Among these, 3474 duplicate articles were removed. 418 studies were selected based on the eligibility criteria. For the present review, 30 articles were included after elimination according to the inclusion criteria. The Prisma diagram flowchart demonstrates our selection scheme. Quality assessment criteria to evaluate the studies were decided by two review authors in accordance with CONSORT guidelines. Each study was assessed using the evaluation method described in the Cochrane Handbook for Systematic Reviews. Among the 30 studies included in the review, marked degree of relapse in the mandible was noted from 3 months - 1 year postoperatively in 8 studies, 5 studies reported both TMD prevalence and relapse, whereas only 4 studies reported TMD disorder alone.

Conclusion

Complications of relapse and TMD are associated with bimaxillary orthognathic surgery procedures. More RCTs and CCTs are needed in this regard to get better quality evidence. This review was registered with PROSPERO: CRD42020211342.

Hilotherapy following orthognathic surgery - patient and cost perspective

A meta-analysis evaluating the effect of hilotherapy following orthognathic surgery demonstrated improvements in postoperative pain and swelling.¹ In this prospective survey, we investigated the patient experience with hilotherapy following orthognathic surgery. Forty-five respondents completed the questionnaire. A high proportion of respondents found the Hilotherm mask to be comfortable (n = 40), were willing to wear it at home (n = 37) and were willing to pay for the rental service (n = 35). This highly positive patient-reported experience suggests that at-home use of hilotherapy following orthognathic surgery should be explored to enhance recovery and improve patients' comfort.

Postoperative CT findings of orthognathic surgery and its complications: A guide for radiologists

Orthognathic surgery is the standard procedure to correct congenital, developmental, or acquired dentofacial deformities. The maxillomandibular relationship corrected by orthognathic surgery can improve facial esthetics, masticatory function, articulation, and breathing. The most common types of osteotomies include the combination of Le Fort I osteotomy, bilateral sagittal split mandibular ramus osteotomy, and genioplasty. High-resolution low-dose computed tomography is useful for evaluating the facial skeleton and soft tissues after surgery as well as for depicting a variety of possible complications. This article reviews the postoperative imaging findings of the most common orthognathic surgeries and their potential complications on multidetector-row computed tomography.