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Evaluation of the postoperative stability of a counter-clockwise rotation technique for skeletal class II patients by using a novel three- dimensional position-posture method. Sci Rep 2019; 9:13196. [PMID: 31519983 PMCID: PMC6744461 DOI: 10.1038/s41598-019-49335-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 08/23/2019] [Indexed: 11/09/2022] Open
Abstract
The aim of this study is to evaluate the postsurgical stability of skeletal class II patients after performing a counter-clockwise rotational (CCWR) procedure for the maxilla-mandibular complex (MMC) by using a novel Three-dimensional (3D) Position-Posture(P-P) measuring method. Twenty-five patients (5 males and 20 females) were included in this study. The postoperative CT scans of the skull were taken before surgery(T0), 3-7 days (T1), 3 months (T2), and 6 months (T3) after surgery. Specific anatomic landmarks were chosen to determine the position of the segments, while three equally perpendicular planes were created to describe their posture. The results show that the linear relapse of maxillary landmarks during the follow-up were acceptable (≤0.5 mm). The relapse of maxillary pitch plane at 6-months follow-up is 1.52°, which is acceptable. There was a significant pitch plane relapse of the mandibular-body segment with an average of 1.86° between T1 and T2 models, 3.28° between T1 and T3 models. There was no significant difference between roll and yaw planes during the follow-up. We therefore conclude that the P-P method could be used to accurately analyze the postsurgical stability of skeletal class II orthognathic surgery cases. For CCWR procedures, it was also shown that the there is a tendency for recurrence most specially on the body of the mandible.
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Stokbro K, Thygesen T, Marcussen L. Inferior Maxillary Repositioning Remains Stable 1 Year After Surgery but Entails a High Risk of Osteosynthesis Failure. J Oral Maxillofac Surg 2019; 78:118-126. [PMID: 31560868 DOI: 10.1016/j.joms.2019.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Inferior maxillary repositioning has continued to be among the most unstable orthognathic procedures. The overall purpose of the present study was to measure skeletal stability after inferior maxillary repositioning. MATERIALS AND METHODS We implemented a retrospective cohort study. The study cohort was derived from all orthognathic patients who had undergone treatment from January 2011 to December 2013 in Odense University Hospital. The inclusion criteria were orthognathic surgery with inferior maxillary repositioning in patients without maxillary segmentation or cleft lip/palate. The exclusion criteria were nonattendance at follow-up visits or requiring reoperation before the 1-year follow-up point. The primary predictor variable was the time from the 1-week follow-up examination to the 1-year follow-up examination. The primary outcome variable was maxillary skeletal movement. The other variables of interest were age, gender, preoperative occlusal relationship, maxillary movement obtained, and surgery type (mono- or bimaxillary procedure). Skeletal stability was measured at the centroid, anterior, and posterior nasal spines using the semiautomatic measurement technique. Skeletal stability was clinically defined as less than 2 mm of movement in any direction. The positive directions for the 3 axes were right, anterior, and superior. The data were analyzed using mixed model linear regression analysis and 1-sample t tests. RESULTS A total of 17 patients were included in the present study (mean age, 28 years; female gender, 35%; bimaxillary surgery, 59%). Inferior maxillary repositioning was stable with less than 0.3 mm mean skeletal movement in any direction. Only 1 patient had experienced a relapse of more than 1 mm in the posterior direction; no movement exceeded 2 mm. However, 3 patients were excluded from the present analysis, because they had required reoperation during the first year after surgery for osteosynthesis failure. CONCLUSIONS Inferior maxillary repositioning was stable during the first year after surgery; however, the complication rate was high (15%). Thus, this procedure might still benefit from the use of more rigid patient-specific printed plates to increase postoperative stability.
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Affiliation(s)
- Kasper Stokbro
- Consultant Surgeon, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark; and PhD Fellow, Department of Clinical Institute, Faculty of Health, University of Southern Denmark, Odense, Denmark.
| | - Torben Thygesen
- Consultant Surgeon, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
| | - Lillian Marcussen
- Associate Professor, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
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Corte GM, Hünigen H, Richardson KC, Niehues SM, Plendl J. Cephalometric studies of the mandible, its masticatory muscles and vasculature of growing Göttingen Minipigs-A comparative anatomical study to refine experimental mandibular surgery. PLoS One 2019; 14:e0215875. [PMID: 31022244 PMCID: PMC6483209 DOI: 10.1371/journal.pone.0215875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/09/2019] [Indexed: 12/30/2022] Open
Abstract
Over many decades, the Göttingen Minipig has been used as a large animal model in experimental surgical research of the mandible. Recently several authors have raised concerns over the use of the Göttingen Minipig in this research area, observing problems with post-operative wound healing and loosening implants. To reduce these complications during and after surgery and to improve animal welfare in mandibular surgery research, the present study elucidated how comparable the mandible of minipigs is to that of humans and whether these complications could be caused by specific anatomical characteristics of the minipigs' mandible, its masticatory muscles and associated vasculature. Twenty-two mandibular cephalometric parameters were measured on CT scans of Göttingen Minipigs aged between 12 and 21 months. Ultimately, we compared this data with human data reported in the scientific literature. In addition, image segmentation was used to determine the masticatory muscle morphology and the configuration of the mandibular blood vessels. Compared to data of humans, significant differences in the mandibular anatomy of minipigs were found. Of the 22 parameters measured only four were found to be highly comparable, whilst the others were not. The 3D examinations of the minipigs vasculature showed a very prominent deep facial vein directly medial to the mandibular ramus and potentially interfering with the sectional plane of mandibular distraction osteogenesis. Damage to this vessel could result in inaccessible bleeding. The findings of this study suggest that Göttingen Minipigs are not ideal animal models for experimental mandibular surgery research. Nevertheless if these minipigs are used the authors recommend that radiographic techniques, such as computed tomography, be used in the specific planning procedures for the mandibular surgical experiments. In addition, it is advisable to choose suitable age groups and customize implants based on the mandibular dimensions reported in this study.
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Affiliation(s)
- Giuliano Mario Corte
- Institute of Veterinary Anatomy, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Hana Hünigen
- Institute of Veterinary Anatomy, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Kenneth C. Richardson
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia
| | - Stefan M. Niehues
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johanna Plendl
- Institute of Veterinary Anatomy, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
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Functional stability analyses of maxillofacial skeleton bearing cleft deformities. Sci Rep 2019; 9:4261. [PMID: 30862870 PMCID: PMC6414651 DOI: 10.1038/s41598-019-40478-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/29/2019] [Indexed: 02/05/2023] Open
Abstract
The symmetrically stable craniofacial bony structure supports the complex functions and delicate contour of the face. Congenital craniofacial deformities are often accompanied by bony defects and have been repetitively correlated with compromised dento-maxillary stability, but neither the extent nor the pattern of cleft-related maxillary instability has been explored in detail. Furthermore, it is largely unknown if the bony defect and related instability are correlated with secondary maxillary deformity common among patients with orofacial clefts. With the aid of finite element modeling, we studied the detailed relationship between cleft-related bony defect and maxillary stability under occlusal loading. Craniofacial models were generated based on cone-beam computed tomography data and loaded with mimicked bite forces along the axial axis of each tooth. Our data showed that all cleft models exhibited more asymmetrical deformations under mastication compared with the normal. Models with palatal cleft demonstrated greater asymmetry, greater dental arch contraction, and less maxillary protrusion compared to models with alveolar cleft only. For unilateral cleft models, alveolus on non-cleft side tended to be more protruded and lifted than the cleft side. For bilateral cleft models, the most prominent feature was the seriously contracted alveolar arch and curved and pitched premaxillae. These findings indicated cleft type-specific pattern of maxillary instability, which were largely in accordance with dentoalveolar morphological features among patients. Collectively, our study elucidated the detailed relationship between cleft bony defect and the pattern of maxillary instability, and suggested a prototype for studying the abnormal maxillary and dental arch growth among patients with craniofacial deformities.
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Traditional face-bow transfer versus three-dimensional virtual reconstruction in orthognathic surgery. Int J Oral Maxillofac Surg 2019; 48:347-354. [DOI: 10.1016/j.ijom.2018.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/30/2018] [Accepted: 09/03/2018] [Indexed: 11/17/2022]
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Tan A, Chai Y, Mooi W, Chen X, Xu H, Zin MA, Lin L, Zhang Y, Yang X, Chai G. Computer-assisted surgery in therapeutic strategy distraction osteogenesis of hemifacial microsomia: Accuracy and predictability. J Craniomaxillofac Surg 2019; 47:204-218. [DOI: 10.1016/j.jcms.2018.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/16/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022] Open
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Customized virtual surgical planning in bimaxillary orthognathic surgery: a prospective randomized trial. Clin Oral Investig 2018; 23:3115-3122. [DOI: 10.1007/s00784-018-2732-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
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Xue C, Xu H, Tian Y, Yang X, Luo E, Bai D. Precise control of maxillary multidirectional movement in Le Fort I osteotomy using a surgical guiding device. Br J Oral Maxillofac Surg 2018; 56:797-804. [DOI: 10.1016/j.bjoms.2018.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 08/22/2018] [Indexed: 11/17/2022]
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Van der Cruyssen F, Meeus J, Schoenaers J, Politis C. Parry Romberg syndrome: A long-term retrospective cohort study of 10 patients. ORAL AND MAXILLOFACIAL SURGERY CASES 2018. [DOI: 10.1016/j.omsc.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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60
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Novel method of constructing a stable reference frame for 3-dimensional cephalometric analysis. Am J Orthod Dentofacial Orthop 2018; 154:397-404. [DOI: 10.1016/j.ajodo.2017.11.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/19/2022]
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Surgical guide and CAD/CAM prebent titanium plate for sagittal split ramus osteotomy in the correction of mandibular prognathism. Br J Oral Maxillofac Surg 2018; 56:586-593. [PMID: 29970262 DOI: 10.1016/j.bjoms.2018.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 06/13/2018] [Indexed: 02/05/2023]
Abstract
This study was designed to introduce and evaluate the clinical use of a surgical guide and a CAD/CAM prebent titanium plate for sagittal split ramus osteotomy (SSRO) in the correction of mandibular prognathism. We studied 14 patients who had been diagnosed, and treated by bilateral SSRO with the guide, during the period July 2015-January 2016. Surface deviations of distal segments from simulation until the end of the operation were measured on a coloured map. Deviations of position and orientation of the condyle and proximal segment from before to after operation, and those from simulation until the end of the operation, were measured with a 3-dimensional vector. All patients were followed up for at least a year. The coloured map showed that the mean (SD) distances were 0.40 (0.25)mm between the simulated and postoperative distal segments. The 3-dimensional vector showed that the mean values of mediolateral, anteroposterior, and superior-inferior translations of the condyles were less than 1mm (p<0.02) from before the operation until the end, and from simulation to the end of the operation, and the mean value of pitching for proximal segments was less than 1° (p<0.02) from simulation to the end of the operation. At the one year follow-up, the occlusions were stable. Based on accurate diagnosis and simulation, this guide takes the distal segment precisely to its planned position, and the condyle and proximal segment are well-controlled. This is a useful tool, which is comparatively easy to make and operate.
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dos Santos HLR, Barbosa IDS, de Oliveira TFL, Sarmento VA, Trindade SC. Evaluation of the maxillomandibular positioning in subjects with sickle-cell disease through 2- and 3-dimensional cephalometric analyses: A retrospective study. Medicine (Baltimore) 2018; 97:e11052. [PMID: 29923994 PMCID: PMC6023795 DOI: 10.1097/md.0000000000011052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Sickle-cell disease (SCD), which involves morphological changes to the red blood cells, is the most common hemoglobinopathy worldwide. This conformational change in erythrocytes affects multiple organs and systems, including the hard and soft tissues of the stomatognathic system. The objective of this study was to provide a description of the maxillomandibular positioning of patients using computed tomography in a case series of 40 patients with SCD. To define the facial profile of patients, 2-dimensional (2D) and 3-dimensional (3D) McNamara and Steiner cephalometric tracings were performed. The results showed that there is a tendency to maxillary protrusion in 2D and 3D analyses. There was no statistical difference between the 2D and 3D evaluations; additionally, sex affected the maxillomandibular positioning of patients, but only in McNamara evaluations.
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Affiliation(s)
| | | | | | - Viviane Almeida Sarmento
- State University of Feira de Santana, Salvador, Bahia
- Federal University of Bahia, Salvador, Brazil
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Udomlarptham N, Lin CH, Wang YC, Ko EWC. Does two-dimensional vs. three-dimensional surgical simulation produce better surgical outcomes among patients with class III facial asymmetry? Int J Oral Maxillofac Surg 2018; 47:1022-1031. [PMID: 29606563 DOI: 10.1016/j.ijom.2018.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/10/2018] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
Abstract
The aim of this study was to compare the outcomes of traditional two-dimensional planning (2DP) and three-dimensional surgical simulation (3DS) in the surgical correction of skeletal class III with facial asymmetry. This retrospective cohort study included 37 consecutive adult Taiwanese patients. Preoperative and postoperative three-dimensional cephalometric measurements were obtained from cone beam computed tomography scans. The outcome variables were the differences in preoperative and postoperative linear and angular measurements and the differences between the two groups after surgery. When the surgical result was compared between the 2DP and 3DS groups, significant differences were found for four cephalometric variables: the distance from gonion on the non-deviated side to the midsagittal plane (MSP), mid-gonion to the MSP, upper first molar on the non-deviated side to the Frankfort horizontal plane, and the yaw angle. In the 3DS group, mandibular symmetry was achieved because the centre between the bilateral gonions was improved, and because there was no significant difference in the horizontal gonion (Go to the MSP) between the deviated and non-deviated sides after surgery. 3DS provides all the necessary information for planned surgical movements for the correction of facial asymmetry; it should be considered during surgical planning to improve surgical outcomes, particularly the achievement of bilateral mandibular contour symmetry.
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Affiliation(s)
- N Udomlarptham
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
| | - C-H Lin
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Y-C Wang
- Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - E W-C Ko
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan.
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Zhu S, Keeling A, Hsung T, Yang Y, Khambay B. The difference between registered natural head position and estimated natural head position in three dimensions. Int J Oral Maxillofac Surg 2018; 47:276-282. [DOI: 10.1016/j.ijom.2017.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 06/09/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
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Cone-Beam Computed Tomography-Based Three-Dimensional McNamara Cephalometric Analysis. J Craniofac Surg 2018; 29:895-899. [PMID: 29381618 DOI: 10.1097/scs.0000000000004248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This article introduces a method that extends the McNamara cephalometric analysis to produce 3-dimensional (3D) measurement values from cone-beam computed tomography images. In the extended method, the cephalometric landmarks are represented by 3D points; the bilateral cephalometric landmarks are identified on both sides of the skull; the cephalometric lines, with the exception of the facial axis, are represented by 3D lines; the cephalometric planes, with the exception of the facial plane, are represented by planes; the effective mandibular length, the effective midfacial length, and the lower anterior facial height are measured as 3D point-to-point distances; the nasion perpendicular to point A, the pogonion to nasion perpendicular, the upper incisor to point A vertical, and the lower incisor to point A-pogonion line are measured each as components of a vector; the facial axis angle is measured as a line-to-plane angle; and the mandibular plane angle is measured as a plane-to-plane angle. As a result, the method provides real effective lengths of the maxilla and mandible on both sides of the skull; real height of the lower anterior face; directed distances from the point A to the nasion perpendicular, from the pogonion to the nasion perpendicular, from the left and right upper incisor to the point A vertical, and from the left and right lower incisor to the point A-pogonion line for both the lateral and posteroanterior views of the skull; and real angles of the facial axis and the mandibular plane. Additionality, the method enables the identification of craniofacial asymmetries.
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Yang Y, Yang K, Zhao Y. Three-Dimensional Changes in the Upper Airway of Skeletal Class III Patients After Different Orthognathic Surgical Procedures. J Oral Maxillofac Surg 2018; 76:155-164. [DOI: 10.1016/j.joms.2017.06.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/06/2017] [Accepted: 06/16/2017] [Indexed: 11/28/2022]
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Association between 3-dimensional mandibular morphology and condylar movement in subjects with mandibular asymmetry. Am J Orthod Dentofacial Orthop 2017; 151:324-334. [PMID: 28153162 DOI: 10.1016/j.ajodo.2016.06.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the hypothesis that 3-dimensional mandibular morphology is correlated with condylar movement in patients with mandibular asymmetry. METHODS Subjects were classified into 2 groups (n = 25 each): mandibular asymmetry with a menton deviation greater than 4 mm and no mandibular asymmetry with a menton deviation less than 4 mm. Linear and volumetric measurements of 3-dimensional mandibular morphology were recorded using computed tomography. Mandibular functional movement was recorded by computerized axiography (CADIAX; Gamma Dental, Klosterneuburg, Austria), and condylar path length, sagittal condylar inclination, and transverse condylar inclination on protrusion were measured. We calculated side-to-side asymmetry (shifted side vs nonshifted side) in mandibular morphology and assessed condylar movement by using an asymmetry ratio (nonshifted side/shifted side). RESULTS Significant differences in mandibular morphology and condylar movement were found between the 2 groups. In the group with menton deviation greater than 4 mm, significant correlations were found between the asymmetry ratio of mandibular morphology and condylar movement: ie, condylar path length and transverse condylar inclination. No significant correlations were found between any of these measurements in the group with menton deviation less than 4 mm. CONCLUSIONS In support of our hypothesis, the results suggested that 3-dimensional mandibular morphologic asymmetry is associated with condylar movement in subjects with mandibular asymmetry.
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Unilateral sagittal split ramus osteotomy: an alternative for some cases of asymmetric mandibular prognathism. Int J Oral Maxillofac Surg 2017; 47:630-637. [PMID: 29223700 DOI: 10.1016/j.ijom.2017.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/19/2017] [Accepted: 11/21/2017] [Indexed: 11/23/2022]
Abstract
The objective of this study was to propose a treatment protocol for patients with lateral prognathism based on the unilateral sagittal split ramus osteotomy (USSRO). This was a prospective study involving 31 patients with lateral prognathism, who required a bilateral sagittal split ramus osteotomy (BSSRO). Two groups were formed using the proposed protocol, with specific inclusion criteria for each group: BSSRO (n=17) and USSRO (n=14). Occlusal parameters (dental midline deviation, overbite, and overjet) were measured preoperatively (T0), at model surgery (T1), 1 month postoperative (T2), and 1year after surgery (T3) and compared. P-values of <0.05 were considered significant. No significant difference was found between the USSRO and BSSRO groups for all occlusal parameters (T0, T1, T2, and T3). In both groups, there was a significant difference between T0 and T1 and no significant difference between T1 and T2 or T1 and T3 in all of the occlusal parameters; the exception was overbite between T1 and T2 in the BSSRO group, which showed a significant difference. No patient in either group showed signs or symptoms of temporomandibular joint dysfunction at T0 or T3. USSRO was found to be a stable alternative in patients with asymmetric mandibular prognathism. At the same time, it reduced the operating time and morbidity when compared to BSSRO.
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Xiao Y, Sun X, Wang L, Zhang Y, Chen K, Wu G. The Application of 3D Printing Technology for Simultaneous Orthognathic Surgery and Mandibular Contour Osteoplasty in the Treatment of Craniofacial Deformities. Aesthetic Plast Surg 2017. [PMID: 28639069 DOI: 10.1007/s00266-017-0914-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Because of the limitation of specific preoperative design and surgical templates, orthognathic surgery and mandibular contour osteoplasty are generally performed in two stages. Three-dimensional printing technology has improved the accuracy of the surgery and results in good surgical predictability easily. This study aims to confirm the effectiveness, feasibility and precision of simultaneous mandibular contour osteoplasty and orthognathic surgery with the assistance of 3D printing technology. METHODS Ten patients, who were diagnosed with mandibular hypertrophy and bimaxillary deformities, were included in the study. In addition to conventional orthognathic surgery, mandibular angle ostectomy, mandibular outer cortex grinding or mandibular border ostectomy was designed for mandibular hypertrophy. Optimal osteotomy lines and simulated surgeries were designed according the 3D printing model of the mandible. Then, surgical templates were made on the 3D printing model. No muscle excision was performed in any patient. Preoperative, predicted and postoperative measurements were taken, including the gonial angle (Ar-Go-Me) and the mandibular width (Go-Go). RESULTS All the patients had a reposeful postoperative recovery, with no indication of obvious infection, facial paralysis, osteonecrosis or bone displacement. The gonial angle was improved from 110.3° ± 11.1 to 121.3° ± 2.9, and the mandibular width was improved from 117.5 mm ± 6.8 to 111.9 mm ± 4.2. The discrepancies between simulation and postoperation of the left gonial angle, the right gonial angle and the mandibular width were 0.56° ± 0.22, 0.65° ± 0.3 and 0.49 mm ± 0.43, respectively. CONCLUSIONS The results of our study illustrated the predictability, feasibility and reliability of simultaneous mandibular contour osteoplasty and orthognathic surgery with the assistance of 3D printing technology. Our technique could achieve functional improvement and an aesthetic profile at the same time. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yanju Xiao
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, No. 1500 Qinghua Road, Changchun, 130021, Jilin, China
| | - Xiumei Sun
- Department of Orthodontics, School and Hospital of Stomatology, Jilin University, Changchun, China
| | - Lin Wang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, No. 1500 Qinghua Road, Changchun, 130021, Jilin, China
| | - Yaoyao Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, No. 1500 Qinghua Road, Changchun, 130021, Jilin, China
| | - Kai Chen
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, No. 1500 Qinghua Road, Changchun, 130021, Jilin, China
| | - Guomin Wu
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, No. 1500 Qinghua Road, Changchun, 130021, Jilin, China.
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Enhanced Surgical Outcomes in Patients With Skeletal Class III Facial Asymmetry by 3-Dimensional Surgical Simulation. J Oral Maxillofac Surg 2017; 76:1073-1083. [PMID: 29031529 DOI: 10.1016/j.joms.2017.09.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 01/17/2023]
Abstract
PURPOSE With the advance of image fusion techniques, the creation of 3-dimensional (3D) virtual head and 3D surgical simulations has provided previews of surgical procedures. The aim of this study was to investigate the surgical outcomes in patients receiving orthognathic surgery (OGS) with the guidance of 3D computer-assisted surgical simulation. PATIENTS AND METHODS The study included 34 consecutive patients (15 men and 19 women; age, 18.1 to 33.0 yr) with skeletal Class III facial asymmetry who underwent bimaxillary OGS. One-week postoperative cone-beam computed tomographic craniofacial images (Ta) were constructed and superimposed on preoperative simulated virtual images (Ts) at the cranial base and surfaces of the frontal and periorbital regions. The 3D cephalometric landmarks were measured relative to 3 reference planes. The outcomes among different experience levels of surgeons also were compared. RESULTS Although the mean values between Ta and Ts were small, statistical differences were observed in the center of maxillary and mandibular incisors and the B point relative to the midline and in the maxillary first molar in vertical distances, sagittal dentoskeletal dimensions, and pitch angles. The root mean square deviations (RMSDL) of measurement variables relative to center landmark accuracy were 1.5 and less than 2 mm at the maxilla and mandible, respectively. RMSDL greater than 2 mm was located at the maxillary first molar in the vertical distance and in the sagittal dimension at the anterior nasal spine and B point. Variables related to centering the midline structures were highly inter-related. The roll angle deviation was associated with centering the midline landmarks. The yaw angle deviation was not associated with midline correction. CONCLUSION With guidance from 3D surgical simulation, surgeons could achieve similar outcomes to correct facial asymmetry regardless of their years of practice.
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Santos RMGD, De Martino JM, Haiter Neto F, Passeri LA. Influence of different setups of the Frankfort horizontal plane on 3-dimensional cephalometric measurements. Am J Orthod Dentofacial Orthop 2017; 152:242-249. [DOI: 10.1016/j.ajodo.2016.12.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 12/01/2016] [Accepted: 12/01/2016] [Indexed: 10/19/2022]
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Chin SJ, Wilde F, Neuhaus M, Schramm A, Gellrich NC, Rana M. Accuracy of virtual surgical planning of orthognathic surgery with aid of CAD/CAM fabricated surgical splint-A novel 3D analyzing algorithm. J Craniomaxillofac Surg 2017; 45:1962-1970. [PMID: 29066041 DOI: 10.1016/j.jcms.2017.07.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/31/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022] Open
Abstract
The benefit of computer-assisted planning in orthognathic surgery has been extensively documented over the last decade. This study aims to evaluate the accuracy of a virtual orthognathic surgical plan by a novel three dimensional (3D) analysis method. Ten patients who required orthognathic surgery were included in this study. A virtual surgical plan was achieved by the combination of a 3D skull model acquired from computed tomography (CT) and surface scanning of the upper and lower dental arch respectively and final occlusal position. Osteotomies and movement of maxilla and mandible were simulated by Dolphin Imaging 11.8 Premium® (Dolphin Imaging and Management Solutions, Chatsworth, CA). The surgical plan was transferred to surgical splints fabricated by means of Computer Aided Design/Computer Aided Manufacturing (CAD/CAM). Differences of three dimensional measurements between the virtual surgical plan and postoperative results were evaluated. The results from all parameters showed that the virtual surgical plans were successfully transferred by the assistance of CAD/CAM fabricated surgical splint. Wilcoxon's signed rank test showed that no statistically significant deviation between surgical plan and post-operational result could be detected. However, deviation of angle U1 axis-HP and distance of A-CP could not fulfill the clinical success criteria. Virtual surgical planning and CAD/CAM fabricated surgical splint are proven to facilitate treatment planning and offer an accurate surgical result in orthognathic surgery.
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Affiliation(s)
- Shih-Jan Chin
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Germany
| | - Frank Wilde
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital Ulm and Academic Hospital University, Ulm, Germany
| | - Michael Neuhaus
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Germany
| | - Alexander Schramm
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital Ulm and Academic Hospital University, Ulm, Germany
| | | | - Majeed Rana
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Germany.
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Application of A Novel Three-dimensional Printing Genioplasty Template System and Its Clinical Validation: A Control Study. Sci Rep 2017; 7:5431. [PMID: 28710459 PMCID: PMC5511285 DOI: 10.1038/s41598-017-05417-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/30/2017] [Indexed: 11/08/2022] Open
Abstract
The purpose of this control study was to assess the accuracy and clinical validation of a novel genioplasty template system. Eighty-eight patients were enrolled and divided into 2 groups: experimental group (using genioplasty templates) and control group (without genioplasty templates). For the experimental group, the templates were designed based on computerized surgical plan and manufactured using three-dimensional printing technique. The template system included a cutting guide and a pair of repositioning guides. For the control group, traditional intraoperative measurements were used without genioplasty templates. The outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. Linear and angular differences for the chin was measured and reported using root mean square deviation (RMSD) and the Bland-Altman method. All surgeries were successfully completed. There was no difficulty to use genioplasty templates. For the experimental group, the largest RMSDs were 1.1 mm in anteroposterior direction and 2.6° in pitch orientation. For the control group without templates, the largest RMSDs were 2.63 mm in superoinferior direction and 7.21° in pitch orientation. Our findings suggest that this genioplasty template system provides greater accuracy in repositioning the chin than traditional intraoperative measurements, and the computerized plan can be transferred accurately to the patient for genioplasty.
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Thiesen G, Gribel BF, Freitas MPM, Oliver DR, Kim KB. Craniofacial features affecting mandibular asymmetries in skeletal Class II patients. J Orofac Orthop 2017; 78:437-445. [PMID: 28667433 DOI: 10.1007/s00056-017-0100-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/14/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the characteristics affecting different intensities of mandibular asymmetry in skeletal Class II adults using three-dimensional images. This study is clinically relevant since it allows professionals to evaluate the morphological components related to these deformities and more carefully obtain correct diagnosis and treatment plan for such patients. METHODS Cone-beam computed tomography data of 120 Class II patients (40 with relative symmetry, 40 with moderate asymmetry, and 40 with severe asymmetry) were imported to SimPlant Ortho Pro® 2.0 software (Dental Materialise, Leuven, Belgium). Three reference planes were established and linear measurements were performed from specific landmarks to these planes, comparing the deviated side and the contralateral side in each group, as well as the differences between groups. The correlation between midline mandibular asymmetry and other variables was also evaluated. Statistical analyses considered a significance level of 5%. RESULTS Comparing the values obtained on the deviated side and on the contralateral side, there were significant differences for patients with moderate asymmetry and severe asymmetry. However, differences were seen more often in severe mandibular asymmetries. In those patients, there was a significant correlation of the gnathion deviation with lower dental midline deviation, difference in the lateral gonion positions, difference in the mandibular rami heights, and difference in the jugale vertical displacements. CONCLUSIONS For skeletal Class II patients with mandibular asymmetry, some craniofacial features are related to chin deviation and require proper evaluation, including the bilateral differences in the ramus height, mandibular body length, transverse and vertical positioning of the gonion and jugale points.
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Affiliation(s)
- Guilherme Thiesen
- Department of Orthodontics, University of Southern Santa Catarina, Av. Madre Benvenuta, 1285 Santa Monica, 88035-001, Florianopolis, SC, Brazil.
- Department of Orthodontics, Saint Louis University, St. Louis, MO, USA.
| | | | - M P M Freitas
- Department of Orthodontics, Luteran University of Brazil, Canoas, Brazil
| | - D R Oliver
- Department of Orthodontics, Saint Louis University, St. Louis, MO, USA
| | - K B Kim
- Department of Orthodontics, Saint Louis University, St. Louis, MO, USA
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Li B, Shen S, Jiang W, Li J, Jiang T, Xia JJ, Shen SG, Wang X. A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: A preliminary study. Int J Oral Maxillofac Surg 2017; 46:1298-1305. [PMID: 28552440 DOI: 10.1016/j.ijom.2017.03.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 10/15/2016] [Accepted: 03/20/2017] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to evaluate a personalized orthognathic surgical guide (POSG) system for bimaxillary surgery without the use of surgical splint. Ten patients with dentofacial deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation method. The POSG system was designed for both maxillary and mandibular surgery. Each consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates to guide the osteotomy and repositioning the bony segments without the use of the surgical splints. Finally, the outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. All operations were successfully completed using the POSG system. The largest root-mean-square deviations were 0.74mm and 1.93° for the maxillary dental arch, 1.10mm and 2.82° for the mandibular arch, 0.83mm and 2.59° for the mandibular body, and 0.98mm and 2.45° for the proximal segments. The results of the study indicated that our POSG system is capable of accurately and effectively transferring the surgical plan without the use of surgical splint. A significant advantage is that the repositioning of the bony segments is independent to the mandibular autorotation, thus eliminates the potential problems associated with the surgical splint.
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Affiliation(s)
- B Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - S Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - W Jiang
- Clinical Translation R&D Center of 3D Printing Technology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - T Jiang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J J Xia
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute for Academic Medicine, Houston Methodist Hospital, Texas, USA; Weill Medical College, Cornell University, New York, NY, USA
| | - S G Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China.
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Li J, Yuan P, Chang CM, Ho DCY, Lo YF, Shen S, Kim D, Teichgraeber JF, Alfi DM, Gateno J, Xia JJ. New approach to establish an object reference frame for dental arch in computer-aided surgical simulation. Int J Oral Maxillofac Surg 2017; 46:1193-1200. [PMID: 28499508 DOI: 10.1016/j.ijom.2017.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/06/2017] [Accepted: 04/13/2017] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to develop a principal component analysis-based adaptive minimum Euclidean distances (PAMED) approach to establish an optimal object reference frame for symmetrical alignment of the dental arch during computer-aided surgical simulation (CASS). It was compared with our triangular methods and the standard principal component analysis (PCA) method. Thirty sets of maxillary digital models were used. Midsagittal and occlusal planes were ranked by three experienced evaluators based on their clinical judgment. The results showed that for the midsagittal plane, all three evaluators ranked "ideal" for all 30 models with the PAMED method, 28 with the triangular method, and at least 11 with the PCA method. For the occlusal plane, one evaluator ranked all 30 models "ideal" with both the PAMED and the PCA methods while the other two evaluators ranked all 30 models "ideal" with the triangular method. However, the differences among the three methods were minimal. In conclusion, our PAMED method is the most reliable and consistent approach for establishing the object reference frame for the dental arch in orthognathic surgical planning. The triangular method should be used with caution because it can be affected by dental arch asymmetry. The standard PCA method is not recommended.
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Affiliation(s)
- J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - P Yuan
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - C-M Chang
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Maxillofacial Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - D C-Y Ho
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Maxillofacial Surgery, Taipei Municipal Wan Fang Hospital, Taipei, Taiwan, ROC
| | - Y-F Lo
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Maxillofacial Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - S Shen
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory Stomatology, Shanghai, China
| | - D Kim
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - J F Teichgraeber
- Department of Pediatric Surgery, The University of Texas Houston Health Science Center, Houston, TX, USA
| | - D M Alfi
- Department of Clinical Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY, USA; Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - J Gateno
- Department of Clinical Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY, USA; Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - J J Xia
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Clinical Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY, USA; Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA.
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Design, development and clinical validation of computer-aided surgical simulation system for streamlined orthognathic surgical planning. Int J Comput Assist Radiol Surg 2017; 12:2129-2143. [PMID: 28432489 DOI: 10.1007/s11548-017-1585-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE There are many proven problems associated with traditional surgical planning methods for orthognathic surgery. To address these problems, we developed a computer-aided surgical simulation (CASS) system, the AnatomicAligner, to plan orthognathic surgery following our streamlined clinical protocol. METHODS The system includes six modules: image segmentation and three-dimensional (3D) reconstruction, registration and reorientation of models to neutral head posture, 3D cephalometric analysis, virtual osteotomy, surgical simulation, and surgical splint generation. The accuracy of the system was validated in a stepwise fashion: first to evaluate the accuracy of AnatomicAligner using 30 sets of patient data, then to evaluate the fitting of splints generated by AnatomicAligner using 10 sets of patient data. The industrial gold standard system, Mimics, was used as the reference. RESULT When comparing the results of segmentation, virtual osteotomy and transformation achieved with AnatomicAligner to the ones achieved with Mimics, the absolute deviation between the two systems was clinically insignificant. The average surface deviation between the two models after 3D model reconstruction in AnatomicAligner and Mimics was 0.3 mm with a standard deviation (SD) of 0.03 mm. All the average surface deviations between the two models after virtual osteotomy and transformations were smaller than 0.01 mm with a SD of 0.01 mm. In addition, the fitting of splints generated by AnatomicAligner was at least as good as the ones generated by Mimics. CONCLUSION We successfully developed a CASS system, the AnatomicAligner, for planning orthognathic surgery following the streamlined planning protocol. The system has been proven accurate. AnatomicAligner will soon be available freely to the boarder clinical and research communities.
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Reproducibility of three-dimensional posterior cranial base angles using low-dose computed tomography. Clin Oral Investig 2016; 21:2407-2414. [PMID: 28004246 DOI: 10.1007/s00784-016-2036-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES One of the key aspects of three-dimensional (3D) craniofacial cephalometry is the measurement of posterior cranial base angle as this area is deeply involved in craniofacial development. The purpose of our retrospective study was to define the best reproducible 3D posterior cranial base angles among five 3D angles transposed from 2D cephalometry (Cousin, BL1 of Ross and Ravosa, Bjork, Delaire, CBA4 of Liberman) and seven 3D angles based on physical anthropology studies and on new concepts (R1 to R7). The null hypothesis was that all 3D posterior cranial base angles were equally reproducible. MATERIAL AND METHODS We used a preoperative low-dose computed tomography (CT) data from 20 adult patients undergoing orthognathic surgery after approval by local ethical committee. Two independent observers performed two series of 23 3D landmark identifications on 3D CT surface rendering of each patient using Maxilim software. Then, the same observers performed twice 3D cephalometric analyses (23 landmarks, 4 midpoints, 19 planes) that provided the automatic measurement of 12 posterior cranial base angles. RESULTS Inter-observer correlation coefficient varied from 0.545 (Cousin) to 0.695 (CBA4 of Liberman) and from -0.177 (R2) to 0.827 (R4). CONCLUSIONS The null hypothesis was rejected. The most reproducible angle was 3D angle R4 based on "basion," "superior optic" (right, left), and "crista galli inferior" landmarks. CLINICAL RELEVANCE R4 angle might be used as reference 3D posterior cranial base angle in further clinical studies involving 3D cephalometry as a diagnostic tool for orthodontics and for orthognathic surgery.
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Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Cadaver Simulation: The Culmination of Aesthetic, Craniofacial, and Microsurgery Principles. Plast Reconstr Surg 2016; 137:1569-1581. [PMID: 27119930 DOI: 10.1097/prs.0000000000002122] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The application of aesthetic, craniofacial, and microsurgical principles in the execution of face transplantation may improve outcomes. Optimal soft-tissue face transplantation can be achieved by incorporating subunit facial skeletal replacement and subsequent tissue resuspension. The purpose of this study was to establish a reconstructive solution for a full face and scalp burn and to evaluate outcome precision and consistency. METHODS Seven mock face transplants (14 cadavers) were completed in the span of 1 year. Components of the vascularized composite allograft included the eyelids, nose, lips, facial muscles, oral mucosa, total scalp, and ears; and skeletal subunits of the zygoma, nasal bone, and genial segment. Virtual surgical planning was used for osteotomy selection, and to evaluate postoperative precision of hard- and soft-tissue elements. RESULTS Each transplant experience decreased each subsequent transplant surgical time. Prefabricated cutting guides facilitated a faster dissection of both donor and recipient tissue, requiring minimal alteration to the allograft for proper fixation of bony segments during inset. Regardless of donor-to-recipient size discrepancy, ample soft tissue was available to achieve tension-free allograft inset. Differences between virtual transplant simulation and posttransplant measurements were minimal or insignificant, supporting replicable and precise outcomes. CONCLUSIONS This facial transplant model was designed to optimize reconstruction of extensive soft-tissue defects of the craniofacial region representative of electrical, thermal, and chemical burns, by incorporating skeletal subunits within the allograft. The implementation of aesthetic, craniofacial, and microsurgical principles and computer-assisted technology improves surgical precision, decreases operative time, and may optimize function.
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Lee ST, Choi NR, Song JM, Shin SH. Three-dimensional morphometric analysis of mandibule in coronal plane after bimaxillary rotational surgery. Maxillofac Plast Reconstr Surg 2016; 38:49. [PMID: 27995122 PMCID: PMC5122603 DOI: 10.1186/s40902-016-0096-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 11/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this report is to present a new reference for aesthetic mandible surgery using three-dimensional cone-beam computed tomography-based treatment planning for orthognathic surgery which can be implemented in surgical planning and perioperative procedure. Methods To make an objective standard for evaluating aesthetic mandibular outline, we make an aesthetic scoring criteria with consideration of asymmetry, broad mandibular border line, and prominent mandibular angle. Two maxillofacial surgeons and two orthodontists rated their aesthetical evaluation from 1 to 5. Experimental group consisting of 47 female and 38 male patients who had rotational orthognathic two-jaw surgery from 2010 to 2011 were chosen according to aesthetic scoring done by two maxillofacial surgeons and two orthodontists. A high aesthetic score (≥16) means the facial contour is symmetric, with no broad and narrow aesthetic mandible frontal profiles. Control A group consisted of ten female and ten male patients who had no orthognathic surgery experience and low aesthetic score (≤10). Control B group consisted of ten female and ten male patients who had no orthognathic surgery experience and had anaesthetic mandibular frontal profile and a high aesthetic score (≥16). The three-dimensional image of the patient was taken from dental cone-beam CT (DCT) scanning (experimental group and control A group: 6 months DCT after surgery, control B group: 1st visit DCT). Each DCT was reformatted to reorient the 3D image using 3D analyzing program (OnDemand3D, cybermed Inc, CA, USA). After selection of 12 landmarks and the construction of reoriented horizontal, vertical, and coronal reference lines, 15 measurements were taken in 3D analysis of frontal mandibular morphology. Afterwards, horizontal and vertical linear measurements and angular measurements, linear ratio were obtained. Results Mean Go’Rt-Me’-Go’Lt angular measurement was 100.74 ± 2.14 in female patients and 105.37 ± 3.62 in male patients. These showed significant difference with control A group in both genders. Ratio of Go’Rt,Go’Lt-Me’ length to some linear measurements (ratio of Me’-Cd’RtCd’Lt to Me’-Go’RtGo’Lt, ratio of Me’-Go’ to Me’-Go’RtGo’Lt, ratio of Go’Rt-Go’Lt to Me’-Go’RtGo’Lt) showed significant difference with control A group in both genders. Conclusion This study was intended to find some standard measurement of mandible frontal view in 3D analysis of aesthetic patient. So, these potential measurement value may be helpful for orthognathic treatment planning to have more aesthetic and perspective outcomes.
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Affiliation(s)
- Sung-Tak Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan, 626-870 Korea
| | - Na-Rae Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan, 626-870 Korea
| | - Jae-Min Song
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan, 626-870 Korea
| | - Sang-Hun Shin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan, 626-870 Korea
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Assessment of facial soft-tissue profiles based on lateral photographs versus three-dimensional face scans. J Orofac Orthop 2016; 78:70-76. [DOI: 10.1007/s00056-016-0055-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 05/11/2016] [Indexed: 10/20/2022]
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Xia JJ, Gateno J, Teichgraeber JF, Yuan P, Li J, Chen KC, Jajoo A, Nicol M, Alfi DM. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 2: three-dimensional cephalometry. Int J Oral Maxillofac Surg 2016; 44:1441-50. [PMID: 26573563 DOI: 10.1016/j.ijom.2015.06.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 11/25/2022]
Abstract
Three-dimensional (3D) cephalometry is not as simple as just adding a 'third' dimension to a traditional two-dimensional cephalometric analysis. There are more complex issues in 3D analysis. These include how reference frames are created, how size, position, orientation and shape are measured, and how symmetry is assessed. The main purpose of this article is to present the geometric principles of 3D cephalometry. In addition, the Gateno-Xia cephalometric analysis is presented; this is the first 3D cephalometric analysis to observe these principles.
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Affiliation(s)
- J J Xia
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Oral and Maxillofacial Surgery, Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, NY, USA.
| | - J Gateno
- Oral and Maxillofacial Surgery, Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, NY, USA; Department of Oral and Maxillofacial Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - J F Teichgraeber
- Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX, USA
| | - P Yuan
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - K-C Chen
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Maxillofacial Surgery, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan
| | - A Jajoo
- Department of Mathematics, University of Houston, TX, USA
| | - M Nicol
- Department of Mathematics, University of Houston, TX, USA
| | - D M Alfi
- Oral and Maxillofacial Surgery, Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, NY, USA; Department of Oral and Maxillofacial Surgery, Houston Methodist Hospital, Houston, TX, USA
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Individualized therapy for treating obstructive sleep apnea in pediatric Crouzon syndrome patients. Sleep Breath 2016; 20:1119-29. [DOI: 10.1007/s11325-016-1378-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 06/07/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
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84
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Computer-aided cephalometric landmark annotation for CBCT data. Int J Comput Assist Radiol Surg 2016; 12:113-121. [DOI: 10.1007/s11548-016-1453-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
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85
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Lonic D, Pai BCJ, Yamaguchi K, Chortrakarnkij P, Lin HH, Lo LJ. Computer-Assisted Orthognathic Surgery for Patients with Cleft Lip/Palate: From Traditional Planning to Three-Dimensional Surgical Simulation. PLoS One 2016; 11:e0152014. [PMID: 27002726 PMCID: PMC4803320 DOI: 10.1371/journal.pone.0152014] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although conventional two-dimensional (2D) methods for orthognathic surgery planning are still popular, the use of three-dimensional (3D) simulation is steadily increasing. In facial asymmetry cases such as in cleft lip/palate patients, the additional information can dramatically improve planning accuracy and outcome. The purpose of this study is to investigate which parameters are changed most frequently in transferring a traditional 2D plan to 3D simulation, and what planning parameters can be better adjusted by this method. PATIENTS AND METHODS This prospective study enrolled 30 consecutive patients with cleft lip and/or cleft palate (mean age 18.6±2.9 years, range 15 to 32 years). All patients received two-jaw single-splint orthognathic surgery. 2D orthodontic surgery plans were transferred into a 3D setting. Severe bony collisions in the ramus area after 2D plan transfer were noted. The position of the maxillo-mandibular complex was evaluated and eventually adjusted. Position changes of roll, midline, pitch, yaw, genioplasty and their frequency within the patient group were recorded as an alternation of the initial 2D plan. Patients were divided in groups of no change from the original 2D plan and changes in one, two, three and four of the aforementioned parameters as well as subgroups of unilateral, bilateral cleft lip/palate and isolated cleft palate cases. Postoperative OQLQ scores were obtained for 20 patients who finished orthodontic treatment. RESULTS 83.3% of 2D plans were modified, mostly concerning yaw (63.3%) and midline (36.7%) adjustments. Yaw adjustments had the highest mean values in total and in all subgroups. Severe bony collisions as a result of 2D planning were seen in 46.7% of patients. Possible asymmetry was regularly foreseen and corrected in the 3D simulation. CONCLUSION Based on our findings, 3D simulation renders important information for accurate planning in complex cleft lip/palate cases involving facial asymmetry that is regularly missed in conventional 2D planning.
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Affiliation(s)
- Daniel Lonic
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Betty Chien-Jung Pai
- Department of Craniofacial Orthodontics, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Kazuaki Yamaguchi
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | | | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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86
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Rubio-Palau J, Prieto-Gundin A, Cazalla AA, Serrano MB, Fructuoso GG, Ferrandis FP, Baró AR. Three-dimensional planning in craniomaxillofacial surgery. Ann Maxillofac Surg 2016; 6:281-286. [PMID: 28299272 PMCID: PMC5343642 DOI: 10.4103/2231-0746.200322] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Three-dimensional (3D) planning in oral and maxillofacial surgery has become a standard in the planification of a variety of conditions such as dental implants and orthognathic surgery. By using custom-made cutting and positioning guides, the virtual surgery is exported to the operating room, increasing precision and improving results. Materials and Methods: We present our experience in the treatment of craniofacial deformities with 3D planning. Software to plan the different procedures has been selected for each case, depending on the procedure (Nobel Clinician, Kodak 3DS, Simplant O&O, Dolphin 3D, Timeus, Mimics and 3-Matic). The treatment protocol is exposed step by step from virtual planning, design, and printing of the cutting and positioning guides to patients’ outcomes. Conclusions: 3D planning reduces the surgical time and allows predicting possible difficulties and complications. On the other hand, it increases preoperative planning time and needs a learning curve. The only drawback is the cost of the procedure. At present, the additional preoperative work can be justified because of surgical time reduction and more predictable results. In the future, the cost and time investment will be reduced. 3D planning is here to stay. It is already a fact in craniofacial surgery and the investment is completely justified by the risk reduction and precise results.
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Affiliation(s)
- Josep Rubio-Palau
- Department of Pediatric Surgery, Hospital Sant Joan de Déu (Barcelona Children's Hospital), Barcelona, Spain
| | - Alejandra Prieto-Gundin
- Department of Pediatric Anesthesiology, Hospital Sant Joan de Déu (Barcelona Children's Hospital), Barcelona, Spain
| | - Asteria Albert Cazalla
- Department of Pediatric Surgery, Hospital Sant Joan de Déu (Barcelona Children's Hospital), Barcelona, Spain
| | - Miguel Bejarano Serrano
- Department of Pediatric Surgery, Hospital Sant Joan de Déu (Barcelona Children's Hospital), Barcelona, Spain
| | - Gemma Garcia Fructuoso
- Department of Neurosurgery, Hospital Sant Joan de Déu (Barcelona Children's Hospital), Barcelona, Spain
| | - Francisco Parri Ferrandis
- Department of Pediatric Surgery, Hospital Sant Joan de Déu (Barcelona Children's Hospital), Barcelona, Spain
| | - Alejandro Rivera Baró
- Department of Orthodontics, Hospital Sant Joan de Déu (Barcelona Children's Hospital), Barcelona, Spain
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87
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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] [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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88
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Kim SJ, Baik HS, Hwang CJ, Yu HS. Diagnosis and evaluation of skeletal Class III patients with facial asymmetry for orthognathic surgery using three-dimensional computed tomography. Semin Orthod 2015. [DOI: 10.1053/j.sodo.2015.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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89
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Recording and Transferring Head Positions to the Virtual Head Using a Multicamera System and Laser Level. J Oral Maxillofac Surg 2015; 73:2039.e1-2039.e13. [DOI: 10.1016/j.joms.2015.06.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 11/21/2022]
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90
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Choi JW, Jung SY, Kim HJ, Lee SH. Positional symmetry of porion and external auditory meatus in facial asymmetry. Maxillofac Plast Reconstr Surg 2015; 37:33. [PMID: 26451361 PMCID: PMC4591197 DOI: 10.1186/s40902-015-0033-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022] Open
Abstract
Background The porion (Po) is used to construct the Frankfort horizontal (FH) plane for cephalometrics, and the external auditory meatus (EAM) is to transfer and mount the dental model with facebow. The classical assumption is that EAM represents Po by the parallel positioning. However, we are sometimes questioning about the possible positional disparity between Po and EAM, when the occlusal cant or facial midline is different from our clinical understandings. The purpose of this study was to evaluate the positional parallelism of Po and EAM in facial asymmetries, and also to investigate their relationship with the maxillary occlusal cant. Methods The 67 subjects were classified into three groups. Group I had normal subjects with facial symmetry (1.05 ± 0.52 mm of average chin deviation) with minimal occlusal cant (<1.5 mm). Asymmetry group II-A had no maxillary occlusal cant (average 0.60 ± 0.36), while asymmetry group II-B had occlusal cant (average 3.72 ± 1.47). The distances of bilateral Po, EAM, and mesiobuccal cusp tips of the maxillary first molars (Mx) from the horizontal orbital plane (Orb) and the coronal plane were measured on the three-dimensional computed tomographic images. Their right and left side distance discrepancies were calculated and statistically compared. Results EAM was located 10.3 mm below and 2.3 mm anterior to Po in group I. The vertical distances from Po to EAM of both sides were significantly different in group II-B (p = 0.001), while other groups were not. Interside discrepancy of the vertical distances from EAM to Mx in group II-B also showed the significant differences, as compared with those from Po to Mx and from Orb to Mx. Conclusions The subjects with facial asymmetry and prominent maxillary occlusal cant tend to have the symmetric position of Po but asymmetric EAM. Some caution or other measures will be helpful for them to be used during the clinical procedures.
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Affiliation(s)
- Ji Wook Choi
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu 120-752 Seoul, Korea
| | - Seo Yeon Jung
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu 120-752 Seoul, Korea
| | - Hak-Jin Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu 120-752 Seoul, Korea
| | - Sang-Hwy Lee
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu 120-752 Seoul, Korea
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91
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Reproducibility of natural head position in normal Chinese people. Am J Orthod Dentofacial Orthop 2015; 148:503-10. [DOI: 10.1016/j.ajodo.2015.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 05/01/2015] [Accepted: 05/01/2015] [Indexed: 11/22/2022]
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92
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Lin HH, Chuang YF, Weng JL, Lo LJ. Comparative validity and reproducibility study of various landmark-oriented reference planes in 3-dimensional computed tomographic analysis for patients receiving orthognathic surgery. PLoS One 2015; 10:e0117604. [PMID: 25668209 PMCID: PMC4323243 DOI: 10.1371/journal.pone.0117604] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/29/2014] [Indexed: 11/18/2022] Open
Abstract
Background Three-dimensional computed tomographic imaging has become popular in clinical evaluation, treatment planning, surgical simulation, and outcome assessment for maxillofacial intervention. The purposes of this study were to investigate whether there is any correlation among landmark-based horizontal reference planes and to validate the reproducibility and reliability of landmark identification. Materials and Methods Preoperative and postoperative cone-beam computed tomographic images of patients who had undergone orthognathic surgery were collected. Landmark-oriented reference planes including the Frankfort horizontal plane (FHP) and the lateral semicircular canal plane (LSP) were established. Four FHPs were defined by selecting 3 points from the orbitale, porion, or midpoint of paired points. The LSP passed through both the lateral semicircular canal points and nasion. The distances between the maxillary or mandibular teeth and the reference planes were measured, and the differences between the 2 sides were calculated and compared. The precision in locating the landmarks was evaluated by performing repeated tests, and the intraobserver reproducibility and interobserver reliability were assessed. Results A total of 30 patients with facial deformity and malocclusion—10 patients with facial symmetry, 10 patients with facial asymmetry, and 10 patients with cleft lip and palate—were recruited. Comparing the differences among the 5 reference planes showed no statistically significant difference among all patient groups. Regarding intraobserver reproducibility, the mean differences in the 3 coordinates varied from 0 to 0.35 mm, with correlation coefficients between 0.96 and 1.0, showing high correlation between repeated tests. Regarding interobserver reliability, the mean differences among the 3 coordinates varied from 0 to 0.47 mm, with correlation coefficients between 0.88 and 1.0, exhibiting high correlation between the different examiners. Conclusions The 5 horizontal reference planes were reliable and comparable for 3D craniomaxillofacial analysis. These reference planes were useful in standardizing the orientation of 3D skull models.
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Affiliation(s)
- Hsiu-Hsia Lin
- Assistant Research Fellow, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Fang Chuang
- Research Assistant, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jing-Ling Weng
- Research Assistant, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Professor, Department of Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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93
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Im J, Kang SH, Lee JY, Kim MK, Kim JH. Surgery-first approach using a three-dimensional virtual setup and surgical simulation for skeletal Class III correction. Korean J Orthod 2014; 44:330-41. [PMID: 25473649 PMCID: PMC4250667 DOI: 10.4041/kjod.2014.44.6.330] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 03/12/2014] [Accepted: 03/18/2014] [Indexed: 11/10/2022] Open
Abstract
A 19-year-old woman presented to our dental clinic with anterior crossbite and mandibular prognathism. She had a concave profile, long face, and Angle Class III molar relationship. She showed disharmony in the crowding of the maxillomandibular dentition and midline deviation. The diagnosis and treatment plan were established by a three-dimensional (3D) virtual setup and 3D surgical simulation, and a surgical wafer was produced using the stereolithography technique. No presurgical orthodontic treatment was performed. Using the surgery-first approach, Le Fort I maxillary osteotomy and mandibular bilateral intraoral vertical ramus osteotomy setback were carried out. Treatment was completed with postorthodontic treatment. Thus, symmetrical and balanced facial soft tissue and facial form as well as stabilized and well-balanced occlusion were achieved.
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Affiliation(s)
- Joon Im
- Department of Orthodontics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ji Yeon Lee
- Department of Orthodontics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Moon Key Kim
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jung Hoon Kim
- Department of Orthodontics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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94
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Seres L, Varga E, Kocsis A, Rasko Z, Bago B, Varga E, Piffko J. Correction of a severe facial asymmetry with computerized planning and with the use of a rapid prototyped surgical template: a case report/technique article. Head Face Med 2014; 10:27. [PMID: 25014992 PMCID: PMC4121308 DOI: 10.1186/1746-160x-10-27] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/06/2014] [Indexed: 11/23/2022] Open
Abstract
Management of significant facial asymmetry presents a challenge due to the geometric complexity of the bony and other facial structures. Manual model surgery is an essential part of treatment planning but it can be complicated, time-consuming and may contain potential errors. Computer-aided surgery has revolutionized the correction of maxillofacial deformities. The aim of this study was to report a case of facial asymmetry when computerised simulation surgery was performed instead of manual model surgery and a virtually planned wafer splint was fabricated. A 26-year-old male was presented with a severe right-sided hemimandibular elongation. Following presurgical orthodontics high-resolution computer tomography scan was performed. The stack images were reformatted into a three-dimensional structure. Virtual Le Fort-I osteotomy was performed and the symmetry of the maxilla was corrected with the help of a three-dimensional planning software. A virtual intermediate surgical wafer was designed and produced with three-dimensional rapid prototyping technology. The mandible was rotated into the correct position following virtual bilateral sagittal split osteotomy to visualize the movements of the osteotomised mandibular segments. The two-jaw procedure was performed according to the virtual plan. The facial symmetry was improved significantly and stable occlusion was achieved. This complex case shows the advantages of computer-aided surgical planning and three-dimensional rapid prototyping for the correction of facial asymmetries.
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Affiliation(s)
- Laszlo Seres
- Department of Oral and Maxillofacial Surgery, University of Szeged, Kalvaria sgt, 57, 6725 Szeged, Hungary.
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95
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Abstract
Orthognathic surgery can eliminate severe esthetic and functional deformities and be a life-changing event for a patient. An orthodontist's role in orthognathic surgery can be divided into several phases: the initial evaluation, presurgical orthodontics, surgical planning, and postsurgical orthodontics. At each of these phases, collaboration between the orthodontist and the surgeon is critical. The ability of an orthodontist and a surgeon to coordinate their efforts during this time is what will lead to a successful outcome.
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Affiliation(s)
- John O Wirthlin
- Division of Plastic Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Pradip R Shetye
- Craniofacial Dental Center, NYU Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, New York
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96
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Dorafshar AH, Brazio PS, Mundinger GS, Mohan R, Brown EN, Rodriguez ED. Found in space: computer-assisted orthognathic alignment of a total face allograft in six degrees of freedom. J Oral Maxillofac Surg 2014; 72:1788-800. [PMID: 24656428 DOI: 10.1016/j.joms.2014.01.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/18/2014] [Accepted: 01/18/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE Full facial osteomyocutaneous transplantation requires correct 3-dimensional (3D) alignment of donor osseous structures to a new cranial base with minimal reference points and 6 degrees of potential movement. We investigated whether computer-assisted design and manufacturing (CAD/CAM) could enable accurate placement of the facial skeleton. MATERIALS AND METHODS A prospective single-cohort study of Le Fort III-based maxillary-mandibular segment allotransplantation was performed in 5 cadaver pairs and 1 clinical pair. The osteotomies were modeled using computed tomography (CT) data and 3D modeling software and then translated to the donor-recipient pairs using surgical navigation and osteotomy cutting guides. The predicted values were calculated about all rotational axes (pitch, yaw, and roll) and along all translational axes (vertical, horizontal, and anteroposterior) and used as the independent variable. The primary outcome variable of the actual postoperative CT values was compared for fidelity to the prediction using the intraclass correlation coefficient (ICC). The similarity to the donor versus recipient values was calculated as a secondary independent variable, and both predicted and actual measurements were compared with it as a percentage. RESULTS The postoperative fidelity to the plan was adequate to excellent (ICC 0.520 to 0.975) with the exception of lateral translation (2.94 ± 1.31 mm predicted left vs 3.92 ± 2.17 mm right actual displacement; ICC 0.243). The predicted and actual values were not consistently skewed toward the donor or recipient values. CONCLUSIONS We have demonstrated a novel application of CAD/CAM that enables orthognathic alignment of a maxillary-mandibular segment to a new cranial base. Quantification of the alignment in all 6 degrees of freedom delivers precise control compared with the planned changes and allows postoperative quality control.
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Affiliation(s)
- Amir H Dorafshar
- Assistant Professor, Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
| | - Philip S Brazio
- Resident, Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Gerhard S Mundinger
- Resident, Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD
| | - Raja Mohan
- Resident, Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD
| | - Emile N Brown
- Resident, Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD
| | - Eduardo D Rodriguez
- Professor, Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD
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97
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Kim EJ, Ki EJ, Cheon HM, Choi EJ, Kwon KH. 3-Dimensional analysis for class III malocclusion patients with facial asymmetry. J Korean Assoc Oral Maxillofac Surg 2013; 39:168-74. [PMID: 24471038 PMCID: PMC3858129 DOI: 10.5125/jkaoms.2013.39.4.168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/12/2013] [Accepted: 08/12/2013] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The aim of this study is to investigate the correlation between 2-dimensional (2D) cephalometric measurement and 3-dimensional (3D) cone beam computed tomography (CBCT) measurement, and to evaluate the availability of 3D analysis for asymmetry patients. MATERIALS AND METHODS A total of Twenty-seven patients were evaluated for facial asymmetry by photograph and cephalometric radiograph, and CBCT. The 14 measurements values were evaluated and those for 2D and 3D were compared. The patients were classified into two groups. Patients in group 1 were evaluated for symmetry in the middle 1/3 of the face and asymmetry in the lower 1/3 of the face, and those in group 2 for asymmetry of both the middle and lower 1/3 of the face. RESULTS In group 1, significant differences were observed in nine values out of 14 values. Values included three from anteroposterior cephalometric radiograph measurement values (cant and both body height) and six from lateral cephalometric radiographs (both ramus length, both lateral ramal inclination, and both gonial angles). In group 2, comparison between 2D and 3D showed significant difference in 10 factors. Values included four from anteroposterior cephalometric radiograph measurement values (both maxillary height, both body height) and six from lateral cephalometric radiographs (both ramus length, both lateral ramal inclination, and both gonial angles). CONCLUSION Information from 2D analysis was inaccurate in several measurements. Therefore, in asymmetry patients, 3D analysis is useful in diagnosis of asymmetry.
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Affiliation(s)
- Eun-Ja Kim
- Department of Oral and Maxillofacial Surgery, Wonkwang University Dental Hospital, Iksan, Korea
| | - Eun-Jung Ki
- Department of Oral and Maxillofacial Surgery, Wonkwang University Dental Hospital, Iksan, Korea
| | - Hae-Myung Cheon
- Department of Oral and Maxillofacial Surgery, Wonkwang University Dental Hospital, Iksan, Korea
| | - Eun-Joo Choi
- Department of Oral and Maxillofacial Surgery, Wonkwang University Dental Hospital, Iksan, Korea. ; Wonkwang University Dental Research Institute, Iksan, Korea
| | - Kyung-Hwan Kwon
- Department of Oral and Maxillofacial Surgery, Wonkwang University Dental Hospital, Iksan, Korea. ; Wonkwang University Dental Research Institute, Iksan, Korea
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Clinical recommendations regarding use of cone beam computed tomography in orthodontics. Position statement by the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:238-57. [DOI: 10.1016/j.oooo.2013.06.002] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 06/03/2013] [Indexed: 12/13/2022]
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99
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Lee ST, Mori Y, Minami K, An CH, Park JW, Kwon TG. Does skeletal surgery for asymmetric mandibular prognathism influence the soft tissue contour and thickness? J Oral Maxillofac Surg 2013; 71:1577-87. [PMID: 23800674 DOI: 10.1016/j.joms.2013.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/09/2013] [Accepted: 04/09/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the present study was to investigate whether asymmetric mandibular prognathism accompanies a fundamental difference in soft tissue thickness and whether asymmetric mandibular setback surgery would influence the contour and thickness of the soft tissue of the chin. MATERIALS AND METHODS The present retrospective study included skeletal class III patients with significant mandibular chin deviation greater than 6 mm at the pogonion, who had undergone cone-beam computed tomography before and 6 months after surgery during a 2-year period. The predictor variables were timing (pre- and postoperatively) and side (asymmetric vs contralateral). The outcome measures were the hard and soft tissue contours and soft tissue thickness of the chin at the infradentale, B-point, and pogonion level evaluated with reformatted computed tomography images. The study variables were statistically compared using regression model and correlation analysis. RESULTS The present study consisted of 20 patients (10 males and 10 females; average age 20.2 years; range, 18 to 25). Preoperatively, the chin deviation side showed a more prominent hard and soft tissue outline but had a thinner soft tissue thickness, which camouflaged the hard tissue asymmetry. After surgery, the hard and soft tissue outline was greatly improved, and the soft tissue thickness had become nearly symmetric. Most of the soft tissue thickness changes correlated negatively with the hard tissue changes. CONCLUSIONS Asymmetric mandibular prognathism accompanied the 3-dimensional soft tissue contour and thickness asymmetry. Because the soft tissue responds favorably after skeletal surgery, the correction of 3-dimensional asymmetry of bone should be emphasized in patients with asymmetric mandibular prognathism.
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Affiliation(s)
- Sung-Tak Lee
- Center for Orthognathic surgery, Department of Oral and Maxillofacial Surgery, Kyungpook National University School of Dentistry, Daegu, Korea
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Effect of mandibular advancement on the natural position of the head: a preliminary study of 3-dimensional cephalometric analysis. Br J Oral Maxillofac Surg 2013; 51:e178-82. [PMID: 23566537 DOI: 10.1016/j.bjoms.2012.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 08/20/2012] [Indexed: 11/21/2022]
Abstract
Our aim was to investigate the potential effect of advancement by bilateral sagittal split osteotomy (BSSO) on the natural position of the head by using 3-dimensional cephalomentric analysis. Seven consecutive patients who had had only BSSO advancement, and had had preoperative and 6-week postoperative cone beam computed tomography (CT) scans, were recruited to this retrospective study. Two variables, SNB and SNC2, were used to indicate the craniomandibular alignment and craniocervical inclination, respectively, in the midsagittal plane. Using 3-dimensional cephalometric analysis software, the SNB and the SNC2 were recorded in volume and measured in the midsagittal plane at 3 independent time-points. The reliability was measured and a paired t test used to assess the significance of differences between the means of SNB and SNC2 before and after operation. The 3-dimensional cephalometric measurement showed good reliability. The SNB was increased as planned in all the mandibles that were advanced, the cervical vertebrae were brought forward after BSSO, and the SNC2 was significantly increased in 6 of the 7 patients. Three-dimensional cephalometric analysis may provide an alternative way of assessing cephalometrics. After BSSO advancement, the natural position of the head changed by increasing the craniocervical inclination in an anteroposterior direction.
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