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Pokrowiecki R, Šufliarsky B, Jagielak M. Esthetic Surgery of the Chin in Cis- and Transgender Patients-Application of T-Genioplasty vs. Single-Piece Segment Lateralization. Medicina (Kaunas) 2024; 60:139. [PMID: 38256399 PMCID: PMC10818947 DOI: 10.3390/medicina60010139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/16/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Correction of lower face asymmetry still remains challenging in maxillofacial surgery. This report describes techniques for the lateral transposition of the symphyseal segment to restore lower face symmetry while maintaining gender-related features in cis- and transgender patients. Materials and Methods: A retrospective review of medical records of 31 patients who attended for esthetic corrective surgery after orthodontic camouflage or orthognathic treatment, or during facial feminization of the lower face between June 2021 and June 2023 was performed. Result: All patients underwent lateralization genioplasty (with or without advancement or setback), either with or without narrowing T-osteotomy supplemented with necessary procedures in order to obtain proper facial balance and desired esthetical effects, such as bichectomy, liposuction, and face and neck lift. The mean asymmetry of the chin was 5.15 mm and was surgically corrected either by single segment lateralization or T-shape narrowing genioplasty depending on the gender and esthetical requirements. No complications were reported. Conclusions: Lateral shift genioplasty serves as a powerful tool in primary and secondary corrective surgery for lower face asymmetry that maintains gender-specific facial features. It may serve either as an additive to orthodontic camouflage or a way to correct previous orthognathic surgery pitfalls. The surgeon performing esthetic genioplasty associated with gender-specific expectations must be trained in facelift and facial liposculpting techniques in order to provide the best results and properly choose the right procedures for the right patients.
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Affiliation(s)
- Rafał Pokrowiecki
- Prive Esthetic and Facial Feminization Surgery Centre, 02-640 Warsaw, Poland
| | - Barbora Šufliarsky
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava and University Hospital, 81372 Bratislava, Slovakia;
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Omori M, Iwatani H, Fukuoka H. Genioplasty and Hyoid Advancement by Distraction Osteogenesis for the Correction of Obstructive Sleep Apnea in a Pediatric Patient. Cureus 2024; 16:e52458. [PMID: 38371017 PMCID: PMC10873134 DOI: 10.7759/cureus.52458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Advancement genioplasty is one variation of genioglossus advancement (GA) and GA is a surgical intervention that can be applied for obstructive sleep apnea (OSA) caused by hypopharyngeal collapse. The genioglossus muscle originates from the posterior surface of the midline mandible and inserts into the entire tongue mass and the body of the hyoid bone. Placing horizontal tension on the genioglossus muscle enlarges the posterior airway space. We use a modified GA that applies distraction osteogenesis to increase forward movement of the genioglossus muscle and also connects the bone transport segment to the hyoid bone with a thread to maximize the anterior movement of the hyoid bone. We used this technique on a young patient and obtained good results.
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Affiliation(s)
- Makoto Omori
- Plastic Surgery, Yodogawa Christian Hospital, Osaka, JPN
| | - Hiroatsu Iwatani
- Department of Plastic Surgery, Kakogawa Central City Hospital, Kakogawa, JPN
| | - Hiroki Fukuoka
- Department of Orthodontics, Kakogawa Central City Hospital, Kakogawa, JPN
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3
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Antúnez-Conde Hidalgo R, Silva Canal JL, Navarro Cuéllar C, Sánchez Gallego-Albertos C, Arias Gallo J, Navarro Cuéllar I, López Davis A, Demaria Martínez G, Naranjo Aspas N, Zamorano León J, Chamorro Pons M. Guided Genioplasty: Comparison between Conventional Technique and Customized Guided Surgery. J Pers Med 2023; 13:1702. [PMID: 38138929 PMCID: PMC10744815 DOI: 10.3390/jpm13121702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Genioplasty as an isolated surgical technique is a highly demanded procedure in the maxillofacial surgery area. Advances in facial reconstructive surgery have been associated with less morbidity and more predictable results. In this paper, "conventional" genioplasty and genioplasty by means of virtual surgical planning (VSP), CAD-CAM cutting guides, and patient custom-made plates are compared. METHODS A descriptive observational study was designed and implemented, and 43 patients were treated, differentiating two groups according to the technique: 18 patients were treated by conventional surgery, and 25 patients were treated through virtual surgical planning (VSP), CAD-CAM cutting guides, STL models, and titanium patient-specific plates. RESULTS The operation time ranged from 35 to 107 min. The mean operative time in the conventional group was 60.06 + 3.74 min.; in the custom treatment group it was 42.24 + 1.29 min (p < 0.001). The difference between planned and obtained chin changes in cases of advancement or retrusion was not statistically significant (p = 0.125; p = 0.216). In cases of chin rotation due to asymmetry, guided and personalized surgery was superior to conventional surgery (p < 0.01). The mean hospital stay was equal in both groups. A decrease in surgical complications was observed in the group undergoing VSP and customized treatment. CONCLUSIONS Multi-stage implementation of VSP with CAD-CAM cutting guides, STL models, and patient-specific plates increased the accuracy of the genioplasty surgery, particularly in cases of chin asymmetry, reducing operation time and potential complications.
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Affiliation(s)
- Raúl Antúnez-Conde Hidalgo
- Maxillofacial Surgery Department, Hospital Universitario Ruber Juan Bravo, 28006 Madrid, Spain; (R.A.-C.H.); (J.L.S.C.); (C.S.G.-A.); (J.A.G.); (A.L.D.); (G.D.M.); (N.N.A.); (M.C.P.)
| | - José Luis Silva Canal
- Maxillofacial Surgery Department, Hospital Universitario Ruber Juan Bravo, 28006 Madrid, Spain; (R.A.-C.H.); (J.L.S.C.); (C.S.G.-A.); (J.A.G.); (A.L.D.); (G.D.M.); (N.N.A.); (M.C.P.)
| | - Carlos Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
- Surgery Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Celia Sánchez Gallego-Albertos
- Maxillofacial Surgery Department, Hospital Universitario Ruber Juan Bravo, 28006 Madrid, Spain; (R.A.-C.H.); (J.L.S.C.); (C.S.G.-A.); (J.A.G.); (A.L.D.); (G.D.M.); (N.N.A.); (M.C.P.)
| | - Javier Arias Gallo
- Maxillofacial Surgery Department, Hospital Universitario Ruber Juan Bravo, 28006 Madrid, Spain; (R.A.-C.H.); (J.L.S.C.); (C.S.G.-A.); (J.A.G.); (A.L.D.); (G.D.M.); (N.N.A.); (M.C.P.)
| | - Ignacio Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Antonio López Davis
- Maxillofacial Surgery Department, Hospital Universitario Ruber Juan Bravo, 28006 Madrid, Spain; (R.A.-C.H.); (J.L.S.C.); (C.S.G.-A.); (J.A.G.); (A.L.D.); (G.D.M.); (N.N.A.); (M.C.P.)
| | - Gastón Demaria Martínez
- Maxillofacial Surgery Department, Hospital Universitario Ruber Juan Bravo, 28006 Madrid, Spain; (R.A.-C.H.); (J.L.S.C.); (C.S.G.-A.); (J.A.G.); (A.L.D.); (G.D.M.); (N.N.A.); (M.C.P.)
| | - Néstor Naranjo Aspas
- Maxillofacial Surgery Department, Hospital Universitario Ruber Juan Bravo, 28006 Madrid, Spain; (R.A.-C.H.); (J.L.S.C.); (C.S.G.-A.); (J.A.G.); (A.L.D.); (G.D.M.); (N.N.A.); (M.C.P.)
| | - José Zamorano León
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Manuel Chamorro Pons
- Maxillofacial Surgery Department, Hospital Universitario Ruber Juan Bravo, 28006 Madrid, Spain; (R.A.-C.H.); (J.L.S.C.); (C.S.G.-A.); (J.A.G.); (A.L.D.); (G.D.M.); (N.N.A.); (M.C.P.)
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Brisset M, Cambronne C, Ferrer M, Cousty S, Dubuc A. Surgical ciliated cysts of the mandible: A systematic review of case reports. Oral Dis 2023. [PMID: 37884395 DOI: 10.1111/odi.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Surgical ciliated cysts occur mainly in the maxillae after radical maxillary sinus surgery; they rarely develop in the mandible. This study aims to gather information on all the characteristics of patients suffering from mandibular surgical ciliated cysts. This article also reports two new cases. METHODS PubMed, Google Scholar and the International Clinical Trials Registry Platform were explored until 13 December 2022 for articles regarding mandibular surgical ciliated cysts. Maxillary ciliated cysts were excluded. RESULTS Fourteen original articles were included in a total of 16 cases. Maxillofacial surgeries are the first aetiology (94.4%). Surgical ciliated cysts of the mandibular region show a 1.25:1 male-to-female ratio with a protracted time to diagnosis (range: 2-56 years). Most patients are symptomatic (77.8%). Typically, radiology shows a radiolucency lesion (88.9%) and histology describes pseudostratified ciliated columnar epithelium. Enucleation has always been described as the treatment. DISCUSSION All results were case reports, thus a low level of evidence studies. Mandibular surgical ciliated cysts should be considered in patients presenting a mandibular swelling or radiolucency lesion with a maxillofacial surgery history. Meticulous surgical techniques can aid in the prevention of this lesion.
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Affiliation(s)
- Mathieu Brisset
- School of Dental Medicine and CHU de Toulouse, Toulouse Institute of Oral Medicine and Oral Surgery, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Clément Cambronne
- School of Dental Medicine and CHU de Toulouse, Toulouse Institute of Oral Medicine and Oral Surgery, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Mélanie Ferrer
- School of Dental Medicine and CHU de Toulouse, Toulouse Institute of Oral Medicine and Oral Surgery, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Sarah Cousty
- School of Dental Medicine and CHU de Toulouse, Toulouse Institute of Oral Medicine and Oral Surgery, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
- LAPLACE, UMR 5213 CNRS, Paul Sabatier University, Toulouse, France
| | - Antoine Dubuc
- School of Dental Medicine and CHU de Toulouse, Toulouse Institute of Oral Medicine and Oral Surgery, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
- Centre for Epidemiology and Research in Population Health (CERPOP), UMR 1295, Paul Sabatier University, Toulouse, France
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5
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Kumar M, Singh RS, Singh G, Raj P, Gupta H, Kasrija R. Hard and Soft Tissue Relapse After Different Genioplasty Procedures: A Scoping Review. Cureus 2023; 15:e41478. [PMID: 37551245 PMCID: PMC10404160 DOI: 10.7759/cureus.41478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
The chin is a crucial component of facial aesthetics, and 20% of craniofacial problems require repair of the chin size, shape, and position. Genioplasty is used to treat irregularities in all three planes of the chin. Specific hard and soft tissue relapses following various genioplasty techniques have not been adequately studied in the literature to date. The purpose of this scoping review was to investigate the stability of hard and soft tissue changes achieved by different genioplasty procedures, six months after the procedure. A literature search was performed on PubMed, Web of Science, Embase, Wiley Online, Scopus, Google Scholar, Science Direct, and Cochrane databases from January 1, 2011 to October 31, 2022. Prospective and retrospective cohorts, case-control studies, observational studies, and randomized control trials, with at least 10 patients, which were written in English and evaluated the stability of different genioplasty procedures, with a follow-up period of at least six months were included. The manual and electronic search yielded 523 articles, and after complete screening, seven articles were selected (five with advancement genioplasty and two with reduction genioplasty) that met the eligibility criteria for review. The patients undergoing reduction genioplasty had a mean age of 24.15 years, compared to 20.5 years for augmentation genioplasty. The average follow-up period was 18.64 months for augmentation genioplasty and 10.5 months for reduction genioplasty technique. The relapse was assessed at pogonion, and it was noted that the average surgical advancement at hard tissue pogonion was 7.04 mm with a relapse of 0.69 mm after six months post-treatment. The average vertical movement of the hard tissue pogonion was 1.8 mm with a relapse of 0.74 mm. The average reduction at hard tissue pogonion was 3.2 mm in the vertical direction with a relapse of 0.2 mm and 0.8 mm reduction in soft tissue pogonion with a relapse of 0.3 mm. The soft to hard tissue ratio mentioned in the different studies ranged from 0.89 to 0.97. Both reduction and augmentation genioplasty are stable and reliable for altering the chin position for aesthetic purposes. The recommended mode of fixation is rigid fixation.
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Affiliation(s)
- Munish Kumar
- Department of Oral and Maxillofacial Surgery, Guru Nanak Dev Dental College and Research Institute, Sunam, IND
| | - Rachel S Singh
- Department of Oral and Maxillofacial Surgery, Guru Nanak Dev Dental College and Research Institute, Sunam, IND
| | - Gagandeep Singh
- Department of Oral and Maxillofacial Surgery, Guru Nanak Dev Dental College and Research Institute, Sunam, IND
| | - Pritam Raj
- Department of Oral and Maxillofacial Surgery, Guru Nanak Dev Dental College and Research Institute, Sunam, IND
| | - Himanshi Gupta
- Department of Oral and Maxillofacial Surgery, Guru Nanak Dev Dental College and Research Institute, Sunam, IND
| | - Rishabh Kasrija
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysuru, IND
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6
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Sneha A, Krishnan M, Satheesh T, Dhasarathan P, Muralidoss H. Patient-Specific Plates for Genioplasty: A Case Report. Cureus 2023; 15:e38746. [PMID: 37303387 PMCID: PMC10248537 DOI: 10.7759/cureus.38746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
A 20-year-old male patient presented with a retruded chin and crowding of the upper front tooth region. The patient's problem list included skeletal class II malocclusion, retruded chin, and shallow mentolabial sulcus. A treatment plan was curated using clinical examination, cephalometric analysis, and 3D measurements, which included the advancement genioplasty of 5 mm. Osteotomy cut was planned digitally by computer-aided surgical simulation technology (Dolphin Software, Dolphin Imaging Systems, California, USA) and then transferred to Geomagic Software (3D Systems, North Carolina, USA) where patient-specific plates were designed. The patient-specific plates were 3D printed using selective laser melting. Intraoperatively, the osteotomy cut was given using a surgical guide, and an advancement of 5 mm was performed, fixing the segments using patient-specific plates. The outcome was compared with the curated treatment plan to assess accuracy. The primary objective of the case report is to provide a digital method of the treatment plan and surgical accuracy in genioplasty using patient-specific plates.
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Affiliation(s)
- Alladi Sneha
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Tharini Satheesh
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Pradeep Dhasarathan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Hemavathy Muralidoss
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
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7
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Onică N, Onică CA, Tatarciuc M, Baciu ER, Vlasie GL, Ciofu M, Balan M, Gelețu GL. Managing Predicted Post-Orthognathic Surgical Defects Using Combined Digital Software: A Case Report. Healthcare (Basel) 2023; 11:healthcare11091219. [PMID: 37174761 PMCID: PMC10178701 DOI: 10.3390/healthcare11091219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
For facial abnormalities, recent developments in virtual surgical planning (VSP) and the virtual design of surgical splints are accessible. Software companies have worked closely with surgical teams for accurate outcomes, but they are only as reliable as the data provided to them. The current case's aim was to show a fully digitized workflow using a combination of three digital software to correct predicted post-upward sliding genioplasty defects. To reach our goal, we presented a 28-year-old man with long-face syndrome for orthodontic treatment. Before orthognathic surgery, a clinical and paraclinical examination was performed. For a virtual surgical plan, we used the dedicated surgical planning software NemoFab (Nemotec, Madrid, Spain) and Autodesk MeshMixer (Autodesk Inc., San Rafael, CA, USA). To create the design of the digital guides, DentalCAD 3.0 Galway (exocad GmbH, Darmstadt, Germany) and Autodesk MeshMixer (Autodesk Inc., San Rafael, CA, USA) were used. The patient had undergone bilateral sagittal split osteotomy in addition to Le Fort 1 osteotomy and genioplasty, followed by mandible base recontouring ostectomy. Stable fixation was used for each osteotomy. Based on our case, the current orthognathic surgery planning software was not able to perform all the necessary operations autonomously; therefore, future updates are eagerly awaited.
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Affiliation(s)
- Neculai Onică
- Specialist Oral and Maxillofacial Surgery, Private Practice, 700612 Iasi, Romania
| | | | - Monica Tatarciuc
- Department of Implantology, Removable Dentures, Dental Technology, Faculty of Dental Medicine, University of Medicine and Pharmacy, "Grigore T. Popa", 700115 Iasi, Romania
| | - Elena-Raluca Baciu
- Department of Implantology, Removable Dentures, Dental Technology, Faculty of Dental Medicine, University of Medicine and Pharmacy, "Grigore T. Popa", 700115 Iasi, Romania
| | | | - Mihai Ciofu
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
| | - Mihail Balan
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
| | - Gabriela Luminița Gelețu
- Department of Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
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8
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Chkadua TZ, Libin PV, Sufiomarov NS. [Surgical treatment of a patient with mandibular micrognathia accompanied by obstructive sleep apnea syndrome using extended genioplasty]. Stomatologiia (Mosk) 2023; 102:48-51. [PMID: 37997313 DOI: 10.17116/stomat202310206148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
A method for diagnosing, planning and surgical treatment of patients with micrognathia of the mandible with physiological occlusion is proposed, which makes it possible to objectively assess the severity of the anomaly and concomitant functional disorders of external respiration in the nasopharynx and oropharynx, as well as to identify the pathophysiological mechanisms of obstructive sleep apnea syndrome (OSAS) and develop an optimal surgical treatment plan with high functional and aesthetic results.
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Affiliation(s)
- T Z Chkadua
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - P V Libin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - N Sh Sufiomarov
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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9
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Wu J, Hui W, Huang J, Luan N, Lin Y, Zhang Y, Zhang S. The Feasibility of Robot-Assisted Chin Osteotomy on Skull Models: Comparison with Surgical Guides Technique. J Clin Med 2022; 11:jcm11226807. [PMID: 36431284 PMCID: PMC9696640 DOI: 10.3390/jcm11226807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Surgical robotic technology is characterized by its high accuracy, good stability, and repeatability. The accuracy of mandibular osteotomy is important in tumor resection, function reconstruction, and abnormality correction. This study is designed to compare the operative accuracy between robot-assisted osteotomy and surgical guide technique in the skull model trials which simulated the genioplasty. In an experimental group, robot-assisted chin osteotomy was automatically performed in 12 models of 12 patients according to the preoperative virtual surgical planning (VSP). In a control group, with the assistance of a surgical guide, a surgeon performed the chin osteotomy in another 12 models of the same patients. All the mandibular osteotomies were successfully completed, and then the distance error and direction error of the osteotomy plane were measured and analyzed. The overall distance errors of the osteotomy plane were 1.57 ± 0.26 mm in the experimental group and 1.55 ± 0.23 mm in the control group, and the direction errors were 7.99 ± 1.10° in the experimental group and 8.61 ± 1.05° in the control group. The Bland-Altman analysis results revealed that the distance error of 91.7% (11/12) and the direction error of 100% (12/12) of the osteotomy plane were within the 95% limits of agreement, suggesting the consistency of differences in the osteotomy planes between the two groups. Robot-assisted chin osteotomy is a feasible auxiliary technology and achieves the accuracy level of surgical guide-assisted manual operation.
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Affiliation(s)
- Jinyang Wu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Wenyu Hui
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
- Department of Stomatology, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Jianhua Huang
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Nan Luan
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yanping Lin
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yong Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
- Correspondence: (Y.Z.); (S.Z.); Tel.: +86-021-2327-1699-5656 (Y.Z. & S.Z.); Fax: +86-021-6313-6856 (Y.Z. & S.Z.)
| | - Shilei Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
- Correspondence: (Y.Z.); (S.Z.); Tel.: +86-021-2327-1699-5656 (Y.Z. & S.Z.); Fax: +86-021-6313-6856 (Y.Z. & S.Z.)
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10
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Wang X, Chen XP, Zhao QM, Huang XX, Wang XW, Long XH. Effect of concentrated growth factor on lower lip hypoesthesia after osseous genioplasty: a prospective, split-mouth, double-blind randomized controlled trial. Int J Oral Maxillofac Surg 2022; 51:1050-1054. [PMID: 35210126 DOI: 10.1016/j.ijom.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/29/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
Abstract
Lower lip hypoesthesia is the most common complication following osseous genioplasty. Concentrated growth factor (CGF) has recently been shown to improve neural regeneration. The aim of this study was to evaluate the effect of concentrated growth factor on neurosensory recovery after osseous genioplasty. Patients who underwent osseous genioplasty between June 2017 and February 2020 were enrolled. CGF was applied to the mental nerve on one side. The treatment side was randomized, and the other side was considered as the control. Lower lip hypoesthesia was assessed preoperatively and postoperatively (1 week, 1, 3, 6, and 9 months) using the two-point discrimination test and a 10-point visual analogue scale (self-reported paresthesia). The assessor was blinded. Twenty-six female patients completed the study. At 1 and 3 months, both the mean two-point discrimination value and mean visual analogue scale score were significantly lower in the CGF group than in the control group (P < 0.001). At 3 months, the percentage of patients with lower lip hypoesthesia in the CGF group was significantly lower than that in the control group (P < 0.001). Both groups showed resolution of lower lip hypoesthesia at 6 months. Concentrated growth factor may accelerate the recovery of long-standing sensory nerve impairment following mental osteotomy.
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Affiliation(s)
- X Wang
- Department of Plastic Surgery, Zhejiang Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang, China.
| | - X-P Chen
- Department of Plastic Surgery, Zhejiang Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang, China
| | - Q-M Zhao
- Department of Plastic Surgery, Zhejiang Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang, China
| | - X-X Huang
- Department of Plastic Surgery, Zhejiang Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang, China
| | - X-W Wang
- Department of Plastic Surgery, Zhejiang Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang, China
| | - X-H Long
- Department of Plastic Surgery, Zhejiang Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang, China
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Au SW, Li DTS, Su YX, Leung YY. Accuracy of Self-designed 3D-Printed Patient-Specific Surgical Guides and Fixation Plates for Advancement Genioplasty<<<<<<. Int J Comput Dent 2022; 25:369-376. [PMID: 35072416 DOI: 10.3290/j.ijcd.b2599791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM We conducted a prospective study to evaluate the accuracy and complications of 3D-printed patient-specific surgical guides and plates that were designed and finished in-house. MATERIALS AND METHODS Eighteen patients who required advancement genioplasty, with or without concomitant orthognathic surgery, were enrolled in the study. Virtual surgical movements were simulated using the patients' cone-beam computed tomography (CBCT) scans, and computer-aided designing of patient-specific surgical guides and fixation plates were performed in our department. CBCT scans were taken at 1 month postoperatively, stereolithographic models of the preoperative virtual plan and the postoperative CBCT were registered. Part comparisons were done to assess the accuracy of the movements. The median, minimum and maximum differences were measured. Two landmarks, the Menton and Pogonion, were also used to compare the differences locally. RESULTS The median deviations for the 18 cases was 0.19mm. The median deviation at the Menton and Pogonion were 0.67mm and 0.41mm respectively. There was no significant correlation between the surgical movement of less than 7mm advancement and the transfer accuracy (p = 0.77). No adverse events or complications were reported within post-operative 6 months. CONCLUSIONS Our protocol of self-designed 3D-printed patient-specific surgical guides and plates provided an accurate method to transfer the virtual surgical plan to the operating theatre.
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Trindade PAK, Bueno PM, Scomparin L, Marzano-Rodrigues MN, Trindade-Suedam IK. The role of double-step advancement genioplasty and bilateral coronoidectomy in Nager Syndrome: A case report. Spec Care Dentist 2021; 41:512-518. [PMID: 33710648 DOI: 10.1111/scd.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
AIM To report the surgical management of bilateral mandibular coronoid processes hyperplasia and mandibular retrognathism associated with trismus and convex facial profile in an individual diagnosed with Nager syndrome (NS). CASE REPORT A 21 years old female was referred to the Department of Oral and Maxillofacial Surgery, presenting limited mouth opening and an unpleasant convex facial profile. The tomography exhibited hyperplasia of mandibular coronoid processes with no evidence of intracapsular ankylosis of the temporomandibular joint. The treatment objectives were to increase mouth opening through a bilateral coronoidectomy and gain chin projection using the double-step advancement genioplasty technique. The 9-month postoperative follow-up revealed a 22.22% (6 mm) gain in jaw opening, improved masticatory function, and facial profile. CONCLUSIONS The NS is a complex craniofacial anomaly due to its clinical heterogeneity. Thus, treatment planning must be done individually, considering the patients' main complaints and respecting the limitations regarding anatomy and availability of proper surgical materials. In the present case, a bilateral coronoidectomy associated with immediate physiotherapy improved the patient's mouth opening, and the double-step genioplasty promoted a much more significant chin advancement than would be obtained with the single-step traditional osteotomy.
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Affiliation(s)
| | - Patricia Martins Bueno
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Leandro Scomparin
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Ivy Kiemle Trindade-Suedam
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil.,Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
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Balaji SM, Balaji P. Square Face Correction by Gonial Angle and Masseter Reduction. Ann Maxillofac Surg 2020; 10:66-72. [PMID: 32855918 PMCID: PMC7433933 DOI: 10.4103/ams.ams_22_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/06/2020] [Accepted: 03/16/2020] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- S M Balaji
- Director and Consultant, Department of Craniomaxillofacial Surgery, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India
| | - Preetha Balaji
- Director and Consultant, Department of Craniomaxillofacial Surgery, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India
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14
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Oth O, Orellana MF, Glineur R. The Minimally Invasive-Guided Genioplasty Technique using Piezosurgery and 3D printed surgical guide: An innovative technique. Ann Maxillofac Surg 2020; 10:178-181. [PMID: 32855936 PMCID: PMC7433983 DOI: 10.4103/ams.ams_78_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/18/2019] [Accepted: 11/14/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Mental nerve injuries with neurosensory deficits, asymmetries, and intra-operative bleeding are the main immediate complications of genioplasty. Following a recent systematic review, three-dimensional (3D)-printed cutting guide could improve the predictability and accuracy of this surgical technique avoiding postoperative asymmetries. Furthermore, anatomical structures in the surgical area (mental nerve and teeth roots) are better protected, reducing the morbidity and providing safer results. Ultrasonic piezoelectric osteotomy allows by its intrinsic characteristics, a selective cut of mineralized structure with a lower risk of vascular and nervous damage (microvibrations), intra-operative precision (thin cutting scalpel and no macro-vibrations), and blood-free site (cavitation effect). The aim of this article is to present a new minimally invasive technique: the minimally invasive-guided genioplasty technique (aka MIGG technique). This technique combines the advantages of piezosurgery and of a space-saving 3D-printed cutting guide, requiring open-source programs and an affordable 3D printing technology. Materials and Methods All the steps of this technique are described: preoperative surgical planning (CT scanner, segmentation with 3D slicer®, and design of the cutting guide with Blender®) and 3D printing of the guide and sterilization of it. The surgical procedure is presented in detail as well as the postoperative care. Conclusion The MIGG technique offers, according to the authors, a better postoperative recuperation, a reduction in operating time, less complications, and protection of the anatomical structures (mental nerve, teeth, lingual soft tissue and vessels). This minimally invasive technique for genioplasty is a promising approach to perform a chin osteotomy.
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Affiliation(s)
- Olivier Oth
- Department of Oral and Maxillofacial Surgery, Hospital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Maria Fernanda Orellana
- Department of Oral and Maxillofacial Surgery, Hospital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Régine Glineur
- Department of Oral and Maxillofacial Surgery, Hospital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
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15
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Oth O, Mestrallet P, Glineur R. Clinical Study on the Minimally Invasive-Guided Genioplasty Using Piezosurgery and 3D Printed Surgical Guide. Ann Maxillofac Surg 2020; 10:91-95. [PMID: 32855922 PMCID: PMC7433970 DOI: 10.4103/ams.ams_79_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 02/18/2020] [Accepted: 03/11/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A retrospective clinical study was performed regarding the minimally invasive-guided genioplasty technique (MIGG technique) described in a previous clinical note. The aims of this clinical study were to study the incidence of immediate complications with this technique compared with a control group using a nonminimally genioplasty technique, to validate the accuracy of the three-dimensional (3D) printed cutting guide, and to evaluate the duration of the surgery and the satisfaction of the surgeons with this technique. MATERIALS AND METHODS One controlled group, including 56 patients, operated with a classical genioplasty and one group, including 24 patients operated with the MIGG technique. The inclusion criteria were patients from 18 years old benefiting from orthognathic surgery for dysmorphic maxillofacial disorders, sleep apneas, or posttraumatic malocclusion; operated by the three same surgeons. A database was retrospectively made, including the demographics parameters, the indication, the type and the duration of surgery, the incidence of complication, and the type of complication. The accuracy of the cutting guide was also studied by the comparison of two distances in the MIGG group on the preoperative surgical simulation and on the postoperative cephalometric radiography. A satisfaction survey for the surgeons of the department regarding the MIGG technique was also analyzed. CONCLUSION No statistical difference was found in the incidence of complications between the MIGG group and the control group. Using a guide does not cause more surgical infection. The protection of the inferior alveolar nerve is obvious. The absence of statistical difference is due to the fact that the majority of patients also benefited from the bilateral sagittal split osteotomy during surgery. The 3D-cutting guide used is very accurate: There is indeed no significative difference in the measurements A and B before and after the genioplasty. The MIGG technique is thus a predictable, safe, and easy-to-use technique that should be used routinely by maxillofacial surgeons. It combines the latest technologies in piezosurgery and in 3D-guided surgery by the creation of a validated-accurate 3D-printed cutting guide. This technique is affordable by the use of open-source program and a desktop fused deposit Modeling 3D-printer. Finally, the comfort of the surgeon is improved, and the operating time is decreased.
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Affiliation(s)
- Olivier Oth
- Department of Oral and Maxillofacial Surgery, Erasme Hospital, Université Libre De Bruxelles, Brussels, Belgium
| | - Pierre Mestrallet
- Department of Oral and Maxillofacial Surgery, Erasme Hospital, Université Libre De Bruxelles, Brussels, Belgium
| | - Régine Glineur
- Department of Oral and Maxillofacial Surgery, Erasme Hospital, Université Libre De Bruxelles, Brussels, Belgium
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Li B, Wang S, Wei H, Zeng F, Wang X. The use of patient-specific implants in genioplasty and its clinical accuracy: a preliminary study. Int J Oral Maxillofac Surg 2019; 49:461-465. [PMID: 31353173 DOI: 10.1016/j.ijom.2019.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/23/2019] [Accepted: 06/04/2019] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to assess the accuracy and clinical validation of patient-specific implants (PSI) in genioplasty. Fifteen patients with chin deformities were enrolled. Virtual planning was performed with the computer-aided surgical simulation method. The three-dimensional-printed titanium cutting guide and patient-specific plate were designed to guide the osteotomy and allow repositioning and fixation of the chin. The outcome was evaluated by comparing the plan with actual outcomes. All operations were successfully completed with PSIs. There was no difficulty in using patient-specific plates. The largest root-mean-square difference of the chin position was 0.69 mm in mediolateral translation and 2.01° in the yaw orientation. The results of the study indicated that the PSI technique was an accurate method of transferring the virtual plan to the operation field with great efficiency in genioplasty. A significant advantage of the PSI technique is that the patient-specific plate could simultaneously complete the repositioning and fixation of the chin. Intraoperative measurements and reposition guides were no longer required. Operative procedures were greatly simplified.
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Affiliation(s)
- B Li
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - S Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - H Wei
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - F Zeng
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
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Badiali G, Marcelli E, Bortolani B, Marchetti C, Cercenelli L. An average three-dimensional virtual human skull for a template-assisted maxillofacial surgery. Int J Artif Organs 2019; 42:566-574. [PMID: 31117867 DOI: 10.1177/0391398819849075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Although many advances have been made in three-dimensional virtual planning in maxillofacial surgery, facial harmony is still difficult to achieve and is heavily dependent on the surgeon's experience. The aim of the study is to present a method to build up an average three-dimensional virtual human skull to be used as a reference template for bone repositioning and reconstruction during maxillofacial surgical interventions. METHODS A total of 20 patients (10 females and 10 males) were selected for the optimal outcome after orthognathic surgery. Postoperative cone-beam computed tomography scans were collected and processed in order to obtain three-dimensional digital models of each skull. For male and female subgroups, the three-dimensional skull models were registered and an average three-dimensional virtual skull model was computed. Deviation color maps were calculated to show differences between each postoperative skull model in the population and the obtained average three-dimensional skull. A clinical use case of genioplasty treatment assisted by the provided average three-dimensional skull template was presented. RESULTS The overall mean deviation from the average three-dimensional skull model was 1.3 ± 0.6 and 1.6 ± 0.5 mm in male and female subgroups, respectively. For both groups, the greatest deviations were at the area of the mandible, while almost no deviation was found at the zygomatic and orbital areas. In the presented use case, the female average three-dimensional skull model was effectively used for guiding surgical planning. CONCLUSION The presented method of obtaining an average three-dimensional virtual human skull may offer the interesting perspective of performing an innovative template-assisted maxillofacial surgery.
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Affiliation(s)
- Giovanni Badiali
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Barbara Bortolani
- Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudio Marchetti
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Laura Cercenelli
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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18
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Shen S, Jiang T, Shen SG, Wang X. A reversed approach for simultaneous mandibular symphyseal split osteotomy and genioplasty. Int J Oral Maxillofac Surg 2019; 48:1209-1212. [PMID: 30799056 DOI: 10.1016/j.ijom.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/15/2018] [Accepted: 01/21/2019] [Indexed: 11/28/2022]
Abstract
Performing a mandibular symphyseal split and genioplasty simultaneously and accurately is a technical challenge for the surgeon. The aim of this study was to validate a reversed approach for simultaneous symphyseal split and genioplasty. A cutting guide and a repositioning guide were designed and printed three-dimensionally in titanium. The symphyseal split and genioplasty were performed successfully. The accuracy of the technique appears to be appropriate for clinical application.
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Affiliation(s)
- S Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - T Jiang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - S G Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Centre for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.
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Frid P, Resnick C, Abramowicz S, Stoustrup P, Nørholt SE. Surgical correction of dentofacial deformities in juvenile idiopathic arthritis: a systematic literature review. Int J Oral Maxillofac Surg 2019; 48:1032-1042. [PMID: 30704836 DOI: 10.1016/j.ijom.2019.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/19/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
The aim of this study was to assess current evidence for the surgical correction of dentofacial deformities in patients with temporomandibular joint (TMJ) involvement from juvenile idiopathic arthritis (JIA). A systematic literature review, according to the PRISMA guidelines, was conducted. Meta-analyses, randomized controlled trials, cohort studies, observational studies, and case reports were eligible for inclusion. Exclusion criteria were no JIA diagnosis, no clearly defined outcomes, dual publications (except meta-analyses), non peer-reviewed studies, non English language publications, and animal studies. The outcome measures assessed were TMJ function, skeletal alignment, and morbidity. The database search identified 255 citations, of which 28 met the eligibility criteria. Of these, 24 were case reports or case series with a low level of evidence that did not allow for meta-analysis. Extrapolated evidence supports orthognathic surgery in skeletally mature patients with controlled or quiescent JIA and a stable dentofacial deformity. Distraction osteogenesis was recommended for severe deformities. Some authors demonstrated unpredictable postoperative mandibular growth with costochondral grafts. Alloplastic TMJ reconstruction was efficacious, but should be used cautiously in skeletally immature patients. TMJ function and skeletal alignment was improved with reconstruction by any technique and morbidity was low. The surgical correction of arthritis-induced dentofacial deformities is indicated but the level of evidence is low. Prospective multicenter studies are needed.
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Affiliation(s)
- P Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway and Public Dental Service Competence Centre of North Norway and Department of Clinical Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway.
| | - C Resnick
- Harvard School of Dental Medicine and Harvard Medical School, Boston, MS, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MS, USA
| | - S Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, and Section of Dentistry/Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - P Stoustrup
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - S E Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital and Section of Oral Surgery and Oral Pathology, Aarhus University, Aarhus, Denmark
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Dulong A, Bornert F, Gros CI, Garnier JF, Van Bellinghen X, Fioretti F, Lutz JC. Diagnosis and Innovative Multidisciplinary Management of Hallermann-Streiff Syndrome: 20-Year Follow-Up of a Patient. Cleft Palate Craniofac J 2018; 55:1458-1466. [PMID: 29578805 DOI: 10.1177/1055665618765829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hallermann-Streiff syndrome (HSS) is a rare congenital disorder that mainly affects head and face development. We described the different patterns of the disease throughout the whole growth period and provided innovative treatment steps. Indeed, early genioplasty and dental implantation before growth completion were performed. These steps allowed to improve facial growth and to provide orthodontic anchorage, respectively. Complementary orthognathic surgery achieved satisfactory occlusion and refined aesthetics. We believe such an approach could be considered as a relevant treatment modality to complete multidisciplinary care in patients with HSS.
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Affiliation(s)
- Anand Dulong
- 1 Faculty of Dentistry, University of Reims-Champagne-Ardennes, Reims, France.,2 Maxillofacial and Plastic Surgery Department, Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Fabien Bornert
- 3 Oral Surgery and Oral Medicine Unit, Department of Dentistry, Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.,4 Faculty of Dentistry, University of Strasbourg, Strasbourg, France.,5 INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), Strasbourg, France
| | - Catherine Isabelle Gros
- 3 Oral Surgery and Oral Medicine Unit, Department of Dentistry, Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.,4 Faculty of Dentistry, University of Strasbourg, Strasbourg, France.,5 INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), Strasbourg, France
| | - Jean-Francois Garnier
- 2 Maxillofacial and Plastic Surgery Department, Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Xavier Van Bellinghen
- 3 Oral Surgery and Oral Medicine Unit, Department of Dentistry, Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.,5 INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), Strasbourg, France
| | - Florence Fioretti
- 3 Oral Surgery and Oral Medicine Unit, Department of Dentistry, Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.,4 Faculty of Dentistry, University of Strasbourg, Strasbourg, France.,5 INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), Strasbourg, France
| | - Jean-Christophe Lutz
- 2 Maxillofacial and Plastic Surgery Department, Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.,5 INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), Strasbourg, France.,6 Faculty of Medicine, University of Strasbourg, Strasbourg, France
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21
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Posnick JC, Choi E, Chavda A. Method of osteotomy fixation and need for removal following bimaxillary orthognathic, osseous genioplasty, and intranasal surgery: a retrospective cohort study. Int J Oral Maxillofac Surg 2017; 46:1276-1283. [PMID: 28669486 DOI: 10.1016/j.ijom.2017.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/07/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to determine the incidence and causes of fixation hardware removal after bimaxillary orthognathic, osseous genioplasty, and intranasal surgery. A retrospective study was performed, involving subjects with a bimaxillary developmental dentofacial deformity (DFD) and symptomatic chronic obstructive nasal breathing. At a minimum, subjects underwent Le Fort I osteotomy, bilateral sagittal ramus osteotomies (SROs), septoplasty, inferior turbinate reduction, and osseous genioplasty. The primary outcome variable studied was fixation hardware removal. Demographic, anatomical, and surgical predictor variables were assessed. Two hundred sixty-two subjects met the inclusion criteria. Their mean age at operation was 25 years (range 13-63 years); 134 were female (51.1%). Simultaneous removal of a third molar was performed in 39.9% of SROs. Three of 262 Le Fort I procedures (1.1%) and two of 524 SROs (0.4%) required hardware removal. There were four cases of ramus wound dehiscence, four of ramus surgical site infection (SSI), one of chin SSI, two of maxillary sinusitis, and one of lingual nerve injury; none of these subjects underwent hardware removal. A limited need for fixation hardware removal after orthognathic procedures was confirmed. There was no statistical correlation between hardware removal and patient sex, age, pattern of DFD, simultaneous removal of a third molar, or occurrence of wound dehiscence, SSI, or lingual nerve injury.
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Affiliation(s)
- J C Posnick
- Posnick Center for Facial Plastic Surgery, Chevy Chase, MD, USA; Georgetown University, Washington, DC, USA; University of Maryland School of Dentistry, Baltimore, Maryland, USA; Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC, USA.
| | - E Choi
- Past Chief Resident, Howard University Hospital, Washington, DC, USA; Currently Private Practice, Stockton and Modesto, California, USA
| | - A Chavda
- Past Chief Resident, Howard University Hospital, Washington, DC, USA; Currently Private Practice, Houston, Texas, USA
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22
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Abstract
There is too much individual patient variation in mandibular anatomy for any single described genioglossus advancement technique to be used consistently. Virtual surgical planning allows surgeons to design genioglossus osteotomy that captures the structures of interest. Intraoperative osteotomy and positioning guides mitigate known risks of the procedure while maximizing the reproducibility and efficacy of the procedure. In this report, we demonstrate the protocol step by step as it had been used on 10 patients, and we highlight 3 clinical scenarios that exemplify its utility.
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Affiliation(s)
- Stanley Yung-Chuan Liu
- 1 Division of Sleep Surgery, Department of Otolaryngology, School of Medicine, Stanford University, Stanford, California, USA
| | - Leh-Kiong Huon
- 1 Division of Sleep Surgery, Department of Otolaryngology, School of Medicine, Stanford University, Stanford, California, USA
- 2 Department of Otolaryngology-Head and Neck Surgery, Cathay General Hospital, Taipei, Taiwan
- 3 School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Soroush Zaghi
- 1 Division of Sleep Surgery, Department of Otolaryngology, School of Medicine, Stanford University, Stanford, California, USA
| | - Robert Riley
- 1 Division of Sleep Surgery, Department of Otolaryngology, School of Medicine, Stanford University, Stanford, California, USA
| | - Carlos Torre
- 1 Division of Sleep Surgery, Department of Otolaryngology, School of Medicine, Stanford University, Stanford, California, USA
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23
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Song SA, Chang ET, Certal V, Del Do M, Zaghi S, Liu SY, Capasso R, Camacho M. Genial tubercle advancement and genioplasty for obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope 2016; 127:984-992. [PMID: 27546467 DOI: 10.1002/lary.26218] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/04/2016] [Accepted: 07/11/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis for studies evaluating genioplasty alone, genial tubercle advancement (GTA) alone, and GTA with hyoid surgery (GTA-HS) to treat obstructive sleep apnea (OSA). DATA SOURCES Ten databases. REVIEW METHODS Three authors searched through November 15, 2015. RESULTS 1,207 studies were screened; 69 were downloaded; and 13 studies met inclusion criteria. A total of 111 patients were included, with 27 standard genioplasty, 10 modified genioplasty, 24 GTA, and 50 GTA-HS patients. For standard genioplasty, the apnea-hypopnea index (AHI) reduced from a mean ± standard deviation (M ± SD) of 18.8 ± 3.8 (95% confidence interval [CI] 17.6, 20.0) to 10.8 ± 4.0 (95% CI 9.5, 12.1) events/hour (relative reduction 43.8%), P value = 0.0001. Genioplasty improved lowest oxygen saturation (LSAT) from 82.3 ± 7.3% (95% CI 80.0, 84.7) to 86.8 ± 5.2% (95% CI 85.1, 88.5), P value = 0.0032. For modified genioplasty AHI increased by 37.3%. For GTA, the AHI reduced from an M ± SD of 37.6 ± 24.2 (95% CI 27.9, 47.3) to 20.4 ± 15.1 (95% CI 14.4, 26.4) events/hour (relative reduction 45.7%), P value = 0.0049. GTA improved LSAT from 83.1 ± 8.3% (95% CI 79.8, 86.4) to 85.5 ± 6.8% (95% CI 82.8, 88.2), P value = 0.2789. For GTA-HS, the AHI reduced from an M ± SD of 34.5 ± 22.1 (95% CI 28.4, 40.6) to 15.3 ± 17.6 (95% CI 10.4, 20.2) events/hour (relative reduction 55.7%), P value < 0.0001; GTA-HS improved LSAT from 80.1 ± 16.6% (95% CI 75.5, 84.7) to 88.3 ± 6.9% (95% CI 86.4, 90.2), P value = 0.0017. CONCLUSION Standard genioplasty, GTA and GTA-HS can improve OSA outcomes such as AHI and LSAT. Given the low number of studies, these procedures remain as an area for additional OSA research. Laryngoscope, 127:984-992, 2017.
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Affiliation(s)
- Sungjin A Song
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A
| | - Edward T Chang
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A
| | - Victor Certal
- Department of Otorhinolaryngology, Sleep Medicine Centre-Hospital CUF, Porto, Portugal.,Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Porto, Portugal
| | - Michael Del Do
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Soroush Zaghi
- Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, California, U.S.A
| | - Stanley Yung Liu
- Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, California, U.S.A
| | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, California, U.S.A
| | - Macario Camacho
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.,Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, California, U.S.A
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24
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Abstract
This case report describes the successful treatment of a patient with mandibular laterognathism and associated facial asymmetry with combined surgical orthodontic approach. After 7 months of presurgical orthodontic treatment, intraoral vertical ramus osteotomy, and straightening genioplasty were performed as two step surgeries to reposition the deviated mandible and chin, respectively. The total active treatment period was 14 months. After surgical orthodontic treatment, significant improvement in occlusion, masticatory function, and facial appearance was discernible. Posttreatment records at 3 years showed stable results with good occlusion.
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Affiliation(s)
- Harpreet Singh
- Department of Orthodontics and Dentofacial Orthopedics, ESIC Dental College and Hospital, Rohini, New Delhi, India
| | - Dhirendra Srivastava
- Department of Oral and Cranio-Maxillofacial Surgery, ESIC Dental College and Hospital, Rohini, New Delhi, India
| | - Pranav Kapoor
- Department of Orthodontics and Dentofacial Orthopedics, ESIC Dental College and Hospital, Rohini, New Delhi, India
| | - Poonam Sharma
- Department of Orthodontics and Dentofacial Orthopedics, ESIC Dental College and Hospital, Rohini, New Delhi, India
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25
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Posnick JC, Choi E, Chang RP. Osseous genioplasty in conjunction with bimaxillary orthognathic surgery: a review of 262 consecutive cases. Int J Oral Maxillofac Surg 2016; 45:904-13. [PMID: 26972157 DOI: 10.1016/j.ijom.2016.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/05/2016] [Accepted: 02/15/2016] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to evaluate the results of osseous genioplasty with bimaxillary orthognathic surgery. A retrospective consecutive case series of patients treated by a single surgeon between 2004 and 2013 was studied. All underwent Le Fort I, sagittal ramus osteotomies, septoplasty, inferior turbinate reduction, and osseous genioplasty. The outcome variables included the presenting chin dysmorphology, complications, and assessment of morphologic change. A Steiner analysis was completed for each subject's interval cephalogram. Two hundred sixty-two subjects met the inclusion criteria. Their mean age at operation was 25 (range 13-63) years. Chin osteotomy complications included one wound infection (0.4%), and two of the 1572 mandibular anterior teeth at risk sustained a pulpal injury. None of the subjects required revision. For subjects undergoing chin advancement, the mean change was +3.5 (range +3 to +6) mm. A majority also underwent counterclockwise rotation of the mandible (62%). For those undergoing chin lengthening, the mean change was +5 (range +3 to +12mm) mm, and for those undergoing vertical shortening, the mean change was -3.5 (range -3 to -7) mm. Osseous genioplasty is confirmed to be a safe method to reshape the chin. When osseous genioplasty is performed in conjunction with bimaxillary orthognathic surgery, only a modest horizontal change is required to achieve the preferred pogonion projection.
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Ungari C, Riccardi E, Reale G, Agrillo A, Rinna C, Mitro V, Filiaci F. Aesthetic restoration in maxillo-mandibular malformations: the role of genioplasty. Ann Stomatol (Roma) 2016; 6:110-2. [PMID: 26941899 DOI: 10.11138/ads/2015.6.3.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The aim of this study was to determinate how orthognatic surgery aids to cure many skull and face abnormalities and to help re-establishing the correct occlusive relation thanks to the repositioning of the maxillo-mandibular skeleton basis. METHODS The study included 183 male patients and 338 female patients, with an average age of 23 years. The sample series was divided according to specific pathologies. All patients underwent surgical procedures and the therapeutic strategy was determined based on the anomalies presented. RESULTS 113 patients had a II class dental skeletal occlusion, 180 patients had a III class dental-skeletal occlusion and 222 patients had skull-facial abnormalities. 5 patients underwent only a genioplasty, 82 patients underwent a genioplasty associated with BSSO, 175 patients underwent a genioplasty associated with Le Fort I osteotomy and the remaining 253 patients underwent a genioplasty associated with BSSO and Le Fort I osteotomy. CONCLUSION The experience shows that genioplasty has been successfully introduced in orthognathic surgical therapeutic procedures, for dental-skeleton abnormalities and mandibular asymmetries treatment. In recent years, the evolution of computer systems has allowed an accurate assessment and programming, by means of the three-dimensional display, which are of great help in the course of diagnosis and evaluation of the displacements to be carried out, in order to obtain optimal aesthetic results.
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Affiliation(s)
- Claudio Ungari
- Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Italy
| | - Emiliano Riccardi
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Gabriele Reale
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Alessandro Agrillo
- Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Italy
| | - Claudio Rinna
- Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Italy
| | - Valeria Mitro
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Fabio Filiaci
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Italy
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27
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Li B, Shen SG, Yu H, Li J, Xia JJ, Wang X. A new design of CAD/CAM surgical template system for two-piece narrowing genioplasty. Int J Oral Maxillofac Surg 2015; 45:560-6. [PMID: 26725914 DOI: 10.1016/j.ijom.2015.10.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/28/2015] [Accepted: 10/15/2015] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to develop and validate a new chin template system for a two-piece narrowing genioplasty. Nine patients with wide chin deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation (CASS) planning method. Surgical splints and chin templates were designed in a computer and fabricated using a three-dimensional printing technique. The chin template system included a cutting guide and a repositioning guide for a two-piece narrowing genioplasty. These guides were also designed to avoid the mental foramen area and inferior alveolar nerve loops during the osteotomy, for nerve protection. After surgery, the outcome evaluation was completed by first superimposing the postoperative computed tomography model onto the planned model, and then measuring the differences between the planned and actual outcomes. All surgeries were completed successfully using the chin template system. No inferior alveolar nerve damage was seen in this study. With the use of the chin templates, the largest linear root mean square deviation (RMSD) between the planned and the postoperative chin segments was 0.7mm and the largest angular RMSD was 4.5°. The results showed that the chin template system provides a reliable method of transfer for two-piece osseous narrowing genioplasty planning.
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Affiliation(s)
- B Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China
| | - S G Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China
| | - H Yu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China
| | - J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - J J Xia
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China; Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, New York, NY, USA
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China.
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Abstract
BACKGROUND Aesthetic skeletal surgery of the face is a powerful tool to alter the facial skeleton; the facial form is enhanced through the use of alloplastic implants and osteotomies of the facial bones. However, the ultimate aesthetic appearance is dictated by how the soft tissue envelope drapes over the altered skeletal foundation. Intraoperative and postoperative fat grafting enhances the final aesthetic result in patients who undergo skeletal aesthetic procedures. OBJECTIVES The authors describe cases in which selective fat grafting has been successful in optimizing facial soft tissue symmetry in patients undergoing skeletal aesthetic surgery of the face. METHODS A retrospective chart review of all patients who underwent aesthetic skeletal surgery of the face between November 1, 2003, and October 31, 2011, in the Department of Surgery at Georgetown University Hospital was performed, and any patient who required fat grafting either at the time of aesthetic facial skeletal surgery or in the postoperative period was identified (n = 21). Common indications for fat grafting and the surgical plans are reviewed and presented in this article. RESULTS Twenty-one patients were identified who required 37 fat grafting procedures either at the time of aesthetic skeletal surgery of the face or in the postoperative period. The procedures most frequently requiring fat grafting were genioplasty, facial shape modifications, and facial symmetry improvement. Fat grafting most commonly corrected irregularities or asymmetries and improved the soft tissue contour overlying repositioned bone or alloplastic implants. Most patients were female (72%) with a mean age of 42 years (range, 4-58 years). There were 4 complications in total: 3 surgical site infections (managed conservatively in 1 patient and with incision and drainage in the remaining 2) and 1 hematoma requiring drainage and closure on the day of surgery. CONCLUSIONS Knowledge of which procedures are likely to require fat grafting and the techniques for doing so can improve the plastic surgeon's ability to provide optimal aesthetic results following facial skeletal alterations.
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Affiliation(s)
- Matthew R Endara
- Department of Plastic Surgery, Georgetown University Hospital, Washington, DC
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29
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Abstract
Genioplasty, the alteration of the chin through either osseous manipulation or implant augmentation, is an integral component of aesthetic surgery of the face. When performed with proper preoperative assessment and technical execution, the results can harmonize and restore balance between skeletal, soft tissue, and dental components of the lower face. To this end, proper understanding of the underlying anatomy and the changes associated with movement of the chin, alone or in conjunction with formal orthognathic surgery, is paramount. The author presents pertinent points on proper assessment, treatment planning, and a description of the surgical technique, and discusses complications and outcomes to optimize outcome.
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Affiliation(s)
- Edward I. Lee
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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30
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Abstract
PURPOSE The purpose of this study was to measure the anteroinferior changes and the degree of vertical changes to facilitate the prediction of treatment outcome in patients undergoing genioplasty only, genioplasty with bilateral sagittal split ramus osteotomy (BSSRO), genioplasty, or BSSRO and Lefort I osteotomy. MATERIALS AND METHODS Serial cephalometry was performed on 25 patients at 1-year follow-up after genioplasty, to assess skeletal changes and relapse. Surgery was performed using conventional techniques. RESULTS The mean ratio was 0.9:1 of soft tissue to skeletal movement at pogonion, but the average difference between hard and soft tissue was large; thus, the prediction of anteroposterior soft tissue changes was quite inaccurate. CONCLUSION We observed a good correlation between the amount of hard versus soft tissue change with surgery in the horizontal direction, but a poor correlation in the vertical plane.
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Affiliation(s)
- Su-Kwon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Chosun University, Gwangju, Korea
| | - Su-Gwan Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Chosun University, Gwangju, Korea
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