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Hernando Martín G, Rubio Bueno P, Capote Moreno A, Albarracín Arjona B, Durán Cantolla J, Wyx R. Monitoring of Home Respiratory Polygraphy During Mandibular Distraction Osteogenesis Succeeded by LeFort I Osteotomy in Adult Patients With Obstructive Sleep Apnea. J Oral Maxillofac Surg 2024; 82:761-770. [PMID: 38677325 DOI: 10.1016/j.joms.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Bilateral internal ramus distraction (BIRD) is now part of select protocols for treating obstructive sleep apnea (OSA). Introducing a home monitoring protocol offers a valuable alternative to overnight laboratory polysomnography (PSG). PURPOSE The purpose of this study was to evaluate and compare OSA parameters obtained via home respiratory polygraphy (HRP) and hospital PSG in a cohort of patients undergoing mandibular distraction for OSA management. STUDY DESIGN, SETTING, SAMPLE Hospital Universitario La Princesa (Madrid) researchers conducted a prospective cohort study with patients diagnosed with moderate (apnea-hypopnea index (AHI) = 15 to 30) to severe (AHI>30) OSA undergoing BIRD followed by LeFort maxillary osteotomy. Exclusion criteria were as follows: severe systemic diseases, central apneas, smoking, poor dental hygiene, or prior OSA interventions. PREDICTOR VARIABLE The predictor variable was PSG and HRP techniques. MAIN OUTCOME VARIABLES The main outcome variable comprises a collection of OSA parameters, including the AHI, oxygen desaturation index (ODI), and time spent below 90% oxygen saturation (T90). These data were measured both before and after distraction, as well as after 6 mm, 9 mm, and 12 mm of mandibular distraction. COVARIATES The covariates were age, sex, cardiovascular risk parameters, and the Epworth sleepiness scale. ANALYSES Pearson's correlation analyzed AHI, ODI, and T90 values from PSG and HRP. Wilcoxon Signed Rank-Sum Test compared 2 distraction stages, and the Friedman Test evaluated 3 stages (P < .05). Multiple regression analysis assessed if covariates were independent risk factors for postoperative persistent OSA. RESULTS The study included 32 patients (25% with moderate and 75% with severe OSA). Final AHI was 10.9 ± 8.9 (events/hour) with HRP, compared to 15.2 ± 13.4 with PSG (r = 0.7, P < .05). ODI was 9.0 ± 8.1 (des/h) with HRP and 8.7 ± 9.5 with PSG (r = 0.85, P < .05). T90 was 1.6 ± 2.2 with HRP and 1.3 ± 3.0 with PSG (r = 0.6, P < .05). Based on HRP data, AHI improved from D1 (34.0 ± 19.5) to D2 (20.8 ± 14.1) and D3 (12.5 ± 10.4) (P < .05). ODI decreased from D1 (26.1 ± 19.0) to D2 (16.0 ± 12.6) and D3 (9.4 ± 8.8) (P < .05). T90 reduced from D1 (8.2 ± 12.6) to D2 (4.1 ± 5.2) and D3 (1.9 ± 2.8) (P < .05). Multiple regression analysis of comorbidities produced nonsignificant results. CONCLUSION AND RELEVANCE Monitoring BIRD through HRP has demonstrated efficacy in yielding results that align with PSG.
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Affiliation(s)
- Galder Hernando Martín
- Orthodontist, Researcher in the Department of Medicine of the University of Basque Country, Leioa.
| | - Pilar Rubio Bueno
- Oral Surgeon and Researcher, Oral and Maxillofacial Department of the Hospital Universitario de la Princesa, Madrid
| | - Ana Capote Moreno
- Oral Surgeon and Researcher, Oral and Maxillofacial Department of the Hospital Universitario de la Princesa, Madrid
| | | | - Joaquín Durán Cantolla
- Professor and Researcher, Research Institute, OSI Araba, Araba University Hospital, Vitoria
| | - Rybel Wyx
- Neurophysiologist and Researcher, Neurophysiology Department of the Hospital de La Princesa, Madrid
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Le Y, Li F, Wu S, Li M, Zhu C, Wan Q. Influence of differences in mandibular incisor inclination on skeletal stability after orthognathic surgery in patients with skeletal Class III malocclusion. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 125:101747. [PMID: 38141825 DOI: 10.1016/j.jormas.2023.101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/10/2023] [Accepted: 12/20/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE The preoperative inclination angle of mandibular incisors was crucial for surgical and postoperative stability while the effect of proclined mandibular incisors on skeletal stability has not been investigated. This study aimed to evaluate the effects of differences in presurgical mandibular incisor inclination on skeletal stability after orthognathic surgery in patients with skeletal Class III malocclusion. METHODS A retrospective cohort study of 80 consecutive patients with skeletal Class III malocclusion who underwent bimaxillary orthognathic surgery was conducted. According to incisor mandibular plane angle (IMPA), patients were divided into 3 groups: retroclined inclination (IMPA < 87°), normal inclination (87° ≤ IMPA < 93°) and proclined inclination (IMPA ≥ 93°). Preoperative characteristics, surgical changes and postoperative stability were compared based on lateral cephalograms obtained 1 week before surgery (T0), 1 week after surgery (T1), and at 6 to 12 months postoperatively (T2). RESULTS The mandible demonstrated a forward and upward relapse in all three groups. No significant differences in skeletal relapse were observed in the 3 groups of patients. However, the proclined inclination group showed a negative overbite tendency postoperatively compared with the other two groups and a clinically significant mandibular relapse pattern. Proclined IMPA both pre- and postoperatively was correlated with mandibular relapse. CONCLUSION Sufficient presurgical mandibular incisor decompensation was of crucial importance for the maintenance of skeletal stability in patients with skeletal Class III malocclusion who subsequently underwent orthognathic surgery.
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Affiliation(s)
- Yushi Le
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University; Department of Orthognathic & Cleft Lip and Palate Plastic Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Feng Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University; Department of Orthognathic & Cleft Lip and Palate Plastic Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Shuxuan Wu
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Mingjuan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University; Department of Orthognathic & Cleft Lip and Palate Plastic Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Chongjie Zhu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University; Department of Orthognathic & Cleft Lip and Palate Plastic Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qilong Wan
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University; Department of Orthognathic & Cleft Lip and Palate Plastic Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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Ban A, Roman R, Bran S, Băciuț M, Dinu C, Crasnean E, Almășan O, Hedeșiu M. Botulinum Toxin Injection into the Digastric Muscle: Current Clinical Use and a Report of Five Cases. Biomedicines 2023; 11:2767. [PMID: 37893140 PMCID: PMC10604337 DOI: 10.3390/biomedicines11102767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
The present research aimed to review the clinical applications of botulinum toxin-A (BTX-A) injection into the anterior belly of the digastric muscle (ABDM) and to highlight the potential role of the BTX-A injection into ABDM in preventing postsurgical relapse. Five Class II malocclusion patients who underwent orthognathic surgery received BTX-A injections into both ABDM for the prevention of postoperative relapse. The relapse was evaluated using lateral cephalometric radiographs by comparing the postoperative cephalometric analyses at two different time points, postoperatively at 2 weeks (T1), and long-term, at 9 months after the surgical intervention (T2). The results demonstrated no significant differences between T2 and T1 for the Selle-Nasion-point A (SNA) angle, Selle-Nasion-point B (SNB) angle, point A-Nasion-point B (ANB) angle, mandibular length, and sagittal mandibular position. The patients exhibited stable occlusion without any signs of relapse after the surgery. A single BTX-A injection into the ABDM can effectively prevent postoperative relapse in Class II malocclusion patients, following orthognathic surgery. From a clinical perspective, in case of optimal dosage and procedure, BTX-A injection could be considered as the primary option for the prevention of postsurgical relapse for Class II malocclusion patients.
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Affiliation(s)
- Alina Ban
- Department of Maxillofacial Surgery and Radiology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Raluca Roman
- Department of Maxillofacial Surgery and Radiology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Simion Bran
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Mihaela Băciuț
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Cristian Dinu
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Emil Crasnean
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Oana Almășan
- Department of Prosthetic Dentistry and Dental Materials, Iuliu Hațieganu University of Medicine and Pharmacy, 32 Clinicilor Street, 400006 Cluj-Napoca, Romania
| | - Mihaela Hedeșiu
- Department of Maxillofacial Surgery and Radiology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
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Çoban G, Öztürk T, Bilge S, Canger EM, Demirbaş AE. Evaluation of trabecular changes following advancement genioplasty combined with or without bilateral sagittal split osteotomy by fractal analysis: a retrospective cohort study. BMC Oral Health 2023; 23:160. [PMID: 36934234 PMCID: PMC10024858 DOI: 10.1186/s12903-023-02860-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/06/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND It is aimed to investigate whether there was a difference in radiographic changes in the operational areas between genioplasty alone and genioplasty combined with mandibular advancement and to evaluate the fractal dimension (FD) to assess trabecular changes after genioplasty surgery. METHODS Preoperative-(T0) and postoperative-(T1) panoramic radiographs of 26 patients without any complications who underwent genioplasty combined with bilateral sagittal osteotomy and mandibular advancement or genioplasty alone were selected. In the panoramic radiographs of both groups, the genial segment, mandibular angulus, and surgical osteotomy line were examined using FD. The box-counting method was used for FD evaluation. RESULTS It was determined that FD values before and after treatment were similar in both groups for all regions where measurements were made. After surgery, the FD values of the middle region of the genial segment were found to be significantly lower than the other regions. At T1, the FD values at the osteotomy area were found to be significantly higher than those in the middle region of the genial segment. CONCLUSION Trabecular structure does not differ in patients undergoing genioplasty alone or in combination with mandibular advancement osteotomy. The middle region of the genial segment heals later than other regions.
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Affiliation(s)
- Gökhan Çoban
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Türkiye
| | - Taner Öztürk
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Türkiye.
| | - Süheyb Bilge
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Kayseri, Türkiye
| | - Emin Murat Canger
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Türkiye
| | - Ahmet Emin Demirbaş
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Kayseri, Türkiye
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Wang M, Qian Y, Zhao H, Zhu M, Yu H, Shen SG. Mandibular stability and condylar changes following orthognathic surgery in mandibular hypoplasia patients associated with preoperative condylar resorption. Clin Oral Investig 2022; 26:7083-7093. [PMID: 36151404 DOI: 10.1007/s00784-022-04668-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate postoperative mandibular stability and condylar changes in patients with mandibular hypoplasia and preoperative condylar resorption (CR) undergoing orthognathic surgery. MATERIALS AND METHODS Fifty-four patients were included in this retrospective study. Computed tomography (CT) scans were acquired preoperatively (T0), 2-7 days immediate postoperatively (T1), and at least 1 year postoperatively (T2). Three-dimensional (3D) cephalometric analysis and measurements of condylar angle, volume, and position (joint spaces) were performed. A 2-mm mandibular relapse was deemed clinically acceptable. We also analyzed the correlations between relapse and postoperative CR and susceptible factors using a multivariate logistic regression model. RESULTS The results showed one year after the surgery, the average mandibular relapse was 1.0 mm (p < 0.05), and the average reduction of condylar volume was 152.4 mm3 (12.7%). Condyle-fossa relationships were improved immediately after the surgery, with a tendency of returning to their original state in the follow-up (p < 0.05). Anteroposterior advancement at point B (B-CP advancement) at T1 and superior joint space (SJS) at T0 were significantly correlated with mandibular relapse, and postoperative CR was mainly associated with vertical increasement at point B (B-AP increasement) at T1. The optimal cut-off values were as follows: 1.6 mm for SJS, 4.2 mm for B-CP advancement, and 1.8 mm for B-AP increasement. Concomitant advancement Genioplasty showed no significant correlation with relapse and postoperative CR. CONCLUSIONS While patients with mandibular hypoplasia and preoperative CR were vulnerable to further condylar resorption after mandibular advancement, the treatment outcomes were generally clinically acceptable. Postoperative relapse was associated with a larger than 4.2 mm of mandibular advancement measured at B-CP and a larger than 1.6 mm of superior joint space measured at SJS, and postoperative CR was associated with a larger than 1.8 mm of mandibular vertical increasement measured at B-AP. CLINICAL RELEVANCE The findings of this study suggested that the mandibular advancement might be limited to 5 mm for patients with preoperative CR. A concomitant advancement genioplasty might also be considered to achieve a better facial profile in these patients.
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Affiliation(s)
- Minjiao Wang
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China
| | - Yifeng Qian
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China
| | - Hanjiang Zhao
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China
| | - Min Zhu
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China
| | - Hongbo Yu
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China.
| | - Steve Gf Shen
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China. .,Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China.
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Raffaini M, Magri A, Conti M, Arcuri F. Advanced Facial Rejuvenation After Bimaxillary Surgery in Three Different Facial Types. Aesthetic Plast Surg 2022; 46:183-193. [PMID: 34131790 DOI: 10.1007/s00266-021-02399-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/03/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Facial aging is the consequence of many mechanisms involving the bones and the "soft tissue" (skin, fat, ligaments, muscles, and periosteum) of the face such as downward migration of the soft tissue, adipose and muscular tissue atrophy, and skeletal resorption. The potential of orthognathic surgery (double jaw surgical advancement) of expanding the skeletal foundation to increase the facial drape support is now recognized and widely popularized by several authors. The aim of this study was to analyze the rejuvenation change of the face after bimaxillary advancement for orthognathic surgery, focusing on the previously mentioned stigmata of the middle and the lower third of the aging face. MATERIALS AND METHODS A retrospective monocentric chart review was conducted for all patients affected by aging signs of the face who underwent orthognathic surgery between January 2015 and December 2019 at the Face Surgery Center (Parma, Italy). During the postoperative follow-up examination, all patients underwent anthropometric photographs and esthetic assessment to evaluate facial rejuvenation after double jaw surgical advancement. RESULTS After application of the exclusion criteria, the final study sample included 85 patients (53 females, 32 males). Eighty-three patients (97%) showed a degree of rejuvenation after maxillo-mandibular advancement (MMA); the score of the postoperative face was less than the score of the preoperative face. Two patients reported no significant postoperative change; none reported a more aging face, with a successful "reverse face-lift" occurred in 97% of our cases. CONCLUSION "Reverse face-lift" by bimaxillary advancement is a surgical procedure which is indicated for a selected group of middle-aged patients with a diagnosis of bimaxillary skeletal retrusion or posterior divergence very motivated to an extreme rejuvenation; this procedure provides support for the facial mask resulting in whole facial rejuvenation.
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Affiliation(s)
| | - Alice Magri
- Private practitioner "Facesurgery" center, Parma, Italy
| | - Marco Conti
- Consultant of the Unit of of Maxillo-Facial Surgery, AOUC "Careggi", Florence, Italy
| | - Francesco Arcuri
- Consultant of the Unit of Maxillo-Facial Surgery, IRCCS "Policlinico San Martino", Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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Van den Bempt M, Vinayahalingam S, Han MD, Bergé SJ, Xi T. The role of muscular traction in the occurrence of skeletal relapse after advancement bilateral sagittal split osteotomy (BSSO): A systematic review. Orthod Craniofac Res 2021; 25:1-13. [PMID: 33938136 PMCID: PMC9292715 DOI: 10.1111/ocr.12488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/13/2021] [Accepted: 04/25/2021] [Indexed: 11/27/2022]
Abstract
The aim of this systematic review was (i) to determine the role of muscular traction in the occurrence of skeletal relapse after advancement BSSO and (ii) to investigate the effect of advancement BSSO on the perimandibular muscles. This systematic review reports in accordance with the recommendations proposed by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Electronic database searches were performed in the databases MEDLINE, Embase and Cochrane Library. Inclusion criteria were as follows: assessment of relapse after advancement BSSO; assessment of morphological and functional change of the muscles after advancement BSSO; and clinical studies on human subjects. Exclusion criteria were as follows: surgery other than advancement BSSO; studies in which muscle activity/traction was not investigated; and case reports with a sample of five cases or fewer, review articles, meta‐analyses, letters, congress abstracts or commentaries. Of the initial 1006 unique articles, 11 studies were finally included. In four studies, an intervention involving the musculature was performed with subsequent assessment of skeletal relapse. The changes in the morphological and functional properties of the muscles after BSSO were studied in seven studies. The findings of this review demonstrate that the perimandibular musculature plays a role in skeletal relapse after advancement BSSO and may serve as a target for preventive strategies to reduce this complication. However, further research is necessary to (i) develop a better understanding of the role of each muscle group, (ii) to develop new therapeutic strategies and (iii) to define criteria that allow identification of patients at risk.
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Affiliation(s)
- Maxim Van den Bempt
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Shankeeth Vinayahalingam
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Michael D Han
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Stefaan J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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Kongsong W, Rochanavibhata S. Reoperative genioplasty: a 10-year retrospective study. Oral Maxillofac Surg 2021; 26:91-98. [PMID: 33905017 DOI: 10.1007/s10006-021-00964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this retrospective cohort study was to identify the causes of requiring reoperative genioplasty and determine the factors associated with reoperation. METHODS Medical records and radiographs of patients who underwent genioplasty were reviewed. The demographic data, characteristics of operation, and treatment outcomes were gathered to analyze the causes that required reoperation. Descriptive statistics and logistic regression analysis were computed to evaluate the study. RESULTS Of the 157 patients included, there were 12 patients (7.6%) who needed reoperation after genioplasty. Age ≤ 25 years significantly decreased the likelihood for the need for reoperative genioplasty compared with age > 35 years. However, the need for reoperative genioplasty was not directly associated with gender, simultaneous orthognathic operation, direction and amount of movement, method of fixation, or bone graft interposition. Fixation failure, esthetic problems, residual obstructive sleep apnea, and palpable step at the inferior border of the mandible were the causes that required a second operation by reposition and re-fixation with rigid fixation, recontouring, or reoperation by genioplasty. CONCLUSION Genioplasty procedure provided a predictive result. A reoperative rate was only 7.6% and younger age decreased the risk of reoperative genioplasty.
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Affiliation(s)
- Wichuda Kongsong
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wang Mai, Patumwan, Bangkok, 10330, Thailand.
| | - Sunisa Rochanavibhata
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wang Mai, Patumwan, Bangkok, 10330, Thailand
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Jermwiwatkul W, Boonsiriseth K, Viwattanatipa N. Treacher Collins syndrome: Orthodontic treatment with mandibular distraction osteogenesis and orthognathic surgery. Am J Orthod Dentofacial Orthop 2021; 159:836-851. [PMID: 33840530 DOI: 10.1016/j.ajodo.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 11/26/2022]
Abstract
Interdisciplinary treatment for patients with Treacher Collins syndrome is challenging because of the rarity of the condition and the wide variety of phenotypic expression. A 23-year-old male was diagnosed with Treacher Collins syndrome with a history of severe obstructive sleep apnea. He presented with a Pruzansky-Kaban classification grade I mandible, skeletal type II pattern with a hyperdivergent mandibular plane, severe convex profile, and Class II malocclusion with a missing mandibular incisor. Improvement of facial esthetics was achieved by a combination of orthodontics, mandibular distraction osteogenesis, and 2-jaw maxillomandibular advancement surgery. Presurgical orthodontic treatment involved permanent tooth extraction to relieve severe crowding, and Class III mechanics were employed to increase overjet. Correction of mandibular hypoplasia by increasing ramal height and the mandibular length was done by intraoral mandibular distraction osteogenesis. Counterclockwise rotation of the mandibular plane angle and a Class III occlusion with negative overjet were achieved after mandibular distraction osteogenesis. A postdistraction posterior open bite was maintained with a biteplane during the consolidation period. Subsequently, 2-jaw orthognathic surgery was performed. LeFort I osteotomy was done for maxillary advancement to correct an anterior crossbite, eliminate canting, and reestablish occlusal contact at the mandibular occlusal plane. Bilateral sagittal split ramus osteotomy was done to correct the residual mandibular deviation. A genioplasty was also performed to improve chin projection. Postoperatively, the oropharyngeal airway was enlarged. The patient's facial profile and obstructive sleep apnea problem were improved as a result of advancement and counterclockwise rotation of the maxillomandibular complex.
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Şimşek B, Efeoglu C, Özden Yüce M, Akay MC, Çelen S. Biomechanical validation of a modified genioplasty distractor. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:e33-e37. [PMID: 33706028 DOI: 10.1016/j.jormas.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 01/05/2021] [Accepted: 03/01/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Genioplasty is a surgical procedure that is used to enhance the shape and appearance of the chin. It can be performed alone or in combination with other jaw-related surgeries either for medical or cosmetic purposes. Recently many studies have been reported for mandibular reconstruction with distraction osteogenesis. However, these distractors can cause some complications such as incorrect prolongation of hard tissues due to the lack of guiding section. The purpose of this study is to manufacture a novel genioplasty distractor and measure its biomechanical stability and reliability for different activation lengths in mandibular bone. METHODS The modified genioplasty distractor was manufactured from grade 2 and grade 5 (Ti6AI4V) titanium alpha + beta alloy which was biocompatible and adequately rigid for possible in situ application in the future and a sample holder was manufactured for compressive strength testing. RESULTS Test results showed that our modified genioplasty distractors withstood 300 N compression force for activation lengths from 0 to 11 mm. Recorded stress values were in the range of 0.110 MPa to 0.389 MPa. CONCLUSION The modified genioplasty distractor developed and tested here is a promising surgical tool that has the potential to reduce genioplasty related complications especially in demanding cases.
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Affiliation(s)
- Birant Şimşek
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Ege University, Izmir, Turkey
| | - Candan Efeoglu
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Ege University, Izmir, Turkey
| | - Meltem Özden Yüce
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Ege University, Izmir, Turkey.
| | - Mehmet Cemal Akay
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Ege University, Izmir, Turkey
| | - Serap Çelen
- Faculty of Engineering, Mechanical Engineering Department, Ege University, Izmir, Turkey
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11
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Torgersbråten N, Stenvik A, Espeland L. Bimaxillary surgery to correct high-angle class II malocclusion: does a simultaneous genioplasty affect long-term stability? Eur J Orthod 2020; 42:426-433. [PMID: 31369666 DOI: 10.1093/ejo/cjz055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES High-angle skeletal Class II malocclusion is one of the most challenging dentofacial deviations to treat and, in adults, a combination of orthodontic treatment and bimaxillary orthognathic surgery is often indicated. This study examines the rate of clinically significant relapse and whether a genioplasty affects the treatment outcome of high-angle Class II malocclusions. MATERIAL AND METHODS Cephalometric tracings of 36 consecutively treated high-angle Class II patients were evaluated from pre-surgery to 3 years post-surgery. All patients had undergone bimaxillary surgery (Le Fort I and BSSO), 13 of them had in addition a genioplasty. RESULTS The maxilla remained stable, whereas relapse (greater than or equal to 2 mm) of the mandibular advancement was seen in 40 per cent of the patients. Advancement greater than 10 mm increased the risk for horizontal relapse. The overjet was normalized and remained stable despite mandibular relapse. Half of the patients had an anterior open bite 3 years post-surgery. A supplemental genioplasty did not affect the relapse rate. CONCLUSIONS AND IMPLICATIONS Overjet was normalized and remained stable long term; there was an open bite in half of the patients. Combined orthodontic and bimaxillary surgical treatment of high-angle Class II patients showed skeletal relapse (greater than or equal to 2 mm) of the mandible in 40 per cent of patients. Mandibular advancement greater than 10 mm increased the risk for relapse. There was no increased risk for dental or skeletal instability associated with a genioplasty in combination with maxillary and mandibular surgery in the treatment of high-angle skeletal Class II malocclusion.
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Affiliation(s)
| | - Arild Stenvik
- Department of Orthodontics, University of Oslo, Norway
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12
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Chen Y, Zhang J, Rao N, Han Y, Ferraro N, August M. Do Patients With Different Mandibular Plane Angles Have Different Time to Relapse After Bilateral Sagittal Osteotomy With Mandibular Advancement? J Oral Maxillofac Surg 2019; 78:455-466. [PMID: 31629758 DOI: 10.1016/j.joms.2019.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE This study sought to answer the following question: Do patients with different mandibular plane angles (MPAs) have a different time to relapse after mandibular advancement with bilateral sagittal split osteotomy? MATERIALS AND METHODS We performed a retrospective cohort study of patients who underwent bilateral sagittal split osteotomy advancement at Massachusetts General Hospital between 2005 and 2017. The primary predictor variable was MPA, categorized as low (<25°), medium (between 25° and 35°), or high (>35°). The outcome variable was time to relapse (≥2-mm posterior change at the B point). Other covariates included gender, age, temporomandibular joint symptoms, bimaxillary surgery, direction of mandibular rotation, magnitude of advancement, genioplasty, and fixation method. Time to relapse was estimated using the Kaplan-Meier method. Cox and parametric regressions for interval-censored data were performed. P < .05 was considered statistically significant. RESULTS The sample was composed of 58 patients (40 female patients), with a mean age of 26.1 ± 4.9 years, grouped as follows: low MPA, n = 15; medium MPA, n = 26; and high MPA, n = 17. Clinically significant relapse was found in 18 patients (31%). Age, temporomandibular joint symptoms, counterclockwise rotation, and magnitude of advancement were statistically significantly different among the 3 groups. When we assessed time to relapse, the Kaplan-Meier method showed that high-MPA patients had a longer mean time at risk and higher estimated probabilities of relapse at different time points compared with low- and medium-MPA patients (P < .05). However, this association was not significant in Cox and parametric regressions. CONCLUSIONS Our results suggest that clinically significant relapse was found during the first postoperative year in low-MPA patients and from 2 to 5 years postoperatively in high-MPA patients. Multivariate regression analyses did not show a significant association between MPA and time to relapse, suggesting that other covariates may play a role in the observed time to relapse.
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Affiliation(s)
- Youbai Chen
- Resident, Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China; Fellow, Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA; and MS Candidate in Clinical Investigation, Harvard Medical School, Boston, MA
| | - Jie Zhang
- Research Fellow, Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Naman Rao
- Student, MS Candidate in Clinical Investigation, Harvard Medical School, Boston, MA
| | - Yan Han
- Department Head and Professor, Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Nalton Ferraro
- Associate Professor, Harvard School of Dental Medicine, Boston, MA
| | - Meredith August
- Director, Center for Applied Clinical Investigation, and Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA; and Associate Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA.
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13
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Chen Y, Zhang J, Rao N, Han Y, Ferraro N, August M. Independent risk factors for long-term skeletal relapse after mandibular advancement with bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2019; 49:779-786. [PMID: 31601473 DOI: 10.1016/j.ijom.2019.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/03/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
The purpose of this retrospective cohort study was to identify the independent risk factors for long-term skeletal relapse following mandibular advancement with bilateral sagittal split osteotomy. Univariate and multivariate linear regression analyses were performed including nine common risk factors for relapse as independent variables and horizontal/vertical long-term (≥2 years) skeletal relapse as dependent variables. Ninety-six patients were analyzed; 66 were female (68.8%) and the average age of the patients was 29.7±10.5 years. Over an average follow-up of 3.8±1.8 years after an initial mandibular advancement of 8.8±2.4 mm, long-term skeletal relapse of 1.6±1.0 mm horizontal and 0.9±0.7 mm vertical was found. Multivariate analysis identified age, preoperative mandibular plane angle (MPA), bimaxillary surgery, counterclockwise mandibular rotation, and the magnitude of mandibular advancement to be significantly associated with horizontal long-term skeletal relapse. Preoperative MPA, counterclockwise mandibular rotation, and the magnitude of mandibular advancement were significantly associated with vertical long-term skeletal relapse. Thus preoperative MPA, the magnitude of mandibular advancement, and counterclockwise mandibular rotation of the mandible were found to be independent risk factors for both horizontal and vertical long-term skeletal relapse. Although long-term skeletal relapse cannot be avoided entirely, understanding the independent risk factors and their contributions will optimize treatment planning and long-term stability.
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Affiliation(s)
- Y Chen
- Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China; Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - J Zhang
- Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - N Rao
- Harvard Medical School, Boston, Massachusetts, USA
| | - Y Han
- Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - N Ferraro
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - M August
- Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard School of Dental Medicine, Boston, Massachusetts, USA.
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Hassan SAEH, Mohamed FI. Distraction osteogenesis in the management of mandibular hypoplasia secondary to temporomandibular joint ankylosis. Long term follow up. J Craniomaxillofac Surg 2019; 47:1510-1520. [DOI: 10.1016/j.jcms.2019.07.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/08/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022] Open
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Furche S, Edwards SP, Aronovich S, Hummon G, Shah KB, Conley RS. 3D Airway changes using cone beam computed tomography in patients following mandibular advancement surgery with and without constriction. Orthod Craniofac Res 2019; 22 Suppl 1:36-42. [PMID: 31074130 DOI: 10.1111/ocr.12292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to compare three-dimensional airway changes resulting from mandibular advancement surgery and mandibular advancement surgery with constriction. SETTING AND SAMPLE POPULATION The University of Michigan School of Dentistry and Medical Center. A total of 42 patients undergoing mandibular advancement with or without simultaneous constriction. MATERIALS AND METHODS A retrospective airway evaluation of patients undergoing mandibular advancement with or without simultaneous mandibular constriction was performed. Cross-sectional evaluation at standardized locations, minimum cross section and volumetric analysis were performed using Dolphin Imaging TM Version 11.7. RESULTS Patients undergoing mandibular advancement with or without constriction experienced significant airway increases (P < 0.05). Patients who underwent mandibular advancement only gained nearly twice as much airway volume as mandibular advancement with simultaneous constriction (8.69 mm3 vs 4.3 mm3 ). The largest increase for both groups was observed in the minimum axial area in the oropharynx segment (119.5 mm2 ) and the axial area of the retroglossal region (137.2 mm2 ). CONCLUSIONS The findings demonstrate mandibular advancement with constriction results in airway enlargement following surgery.
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Affiliation(s)
| | - Sean P Edwards
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gregory Hummon
- Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, Michigan
| | | | - R Scott Conley
- Department of Orthodontics, University at Buffalo, Buffalo, New York
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16
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Aesthetic outcomes and morphological changes in chin parameters after mandibular distraction and subsequent advancement genioplasty in patients with mandibular micrognathia. Int J Oral Maxillofac Surg 2018; 47:1572-1580. [DOI: 10.1016/j.ijom.2018.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/23/2018] [Accepted: 06/28/2018] [Indexed: 12/12/2022]
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