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Sarna K, Sonigra K, Ngeow WC, Guthua S, Opondo F, Tay HW. Variations of the Lingula and Mandibular Ramus in the Context of Sagittal Split Ramus Osteotomy: A Cone Beam Computed Tomography Study Supporting an Ethnic-Centric Approach to Orthognathic Surgery. Cureus 2024; 16:e67715. [PMID: 39318915 PMCID: PMC11420995 DOI: 10.7759/cureus.67715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/26/2024] Open
Abstract
OBJECTIVES To investigate the ethnic variations concerning the lingula and ramus of the mandible, with particular emphasis on sagittal split ramus osteotomy (SSRO) in orthognathic surgery. MATERIALS AND METHODS This study examined Cone beam computed tomography (CBCT) scans from the Kenyan and Malay populations. Lingula morphology was classified into four categories. Morphometric measurements included lingula size, height above the occlusal plane, distance to the second mandibular molar, and distance from its apex to all four mandible borders. Regarding the ramus of the mandible, the thickness of each cortical plate, trabecular bone, and overall thickness were determined at two points. Furthermore, points of fusion of cortical plates were determined in both the vertical and horizontal planes. RESULTS Among Kenyans, the triangular shape was most common (46.5%, n = 80 sides), while truncated was most common among Malays (34.4%, n = 57 sides). The overall mean size of lingula differed significantly between Kenyan (7.37 ± 2.19 mm) and Malay (4.14 ± 2.50 mm) populations (p<0.001). The lingula was more located postero-superiorly in Kenyans compared to Malays (p < 0.001). The mean distance from the distal aspect of the second mandibular molar to the lingula was 38.37 ± 4.98 mm among Kenyans, in contrast to 31.95 ± 0.03 mm among Malays (p < 0.001). The Malays exhibited a thicker mandible with a larger trabecular distance (5.99 ± 1.41 mm and 3.41 ± 1.29 mm, respectively) than Kenyans (5.28 ± 1.39 mm and 1.98 ± 0.98 mm, respectively) (p < 0.001). The points of fusion of the cortical plates differed significantly between Kenyans and Malays. CONCLUSION This study focuses on two ethnic groups, Kenyans and Malays, and brings to light the ethnic-based differences in the position of the lingula and the dimensions of the mandibular ramus, both of which are essential considerations in orthognathic surgery. Preoperative consideration of such variations is warranted, potentially mitigating iatrogenic injuries and enhancing successful patient outcomes.
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Affiliation(s)
- Krishan Sarna
- Department of Oral and Maxillofacial Surgery, Department of Oral Pathology and Oral Medicine, University of Nairobi, Nairobi, KEN
| | - Khushboo Sonigra
- Department of Oral and Maxillofacial Surgery, Department of Oral Pathology and Oral Medicine, University of Nairobi, Nairobi, KEN
| | - Wei Cheong Ngeow
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, MYS
| | - Symon Guthua
- Department of Oral and Maxillofacial Surgery, Department of Oral Pathology and Oral Medicine, University of Nairobi, Nairobi, KEN
| | - Florence Opondo
- Department of Oral and Maxillofacial Surgery, Department of Dental and Maxillofacial Radiology, University of Nairobi, Nairobi, KEN
| | - Hui Wen Tay
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, MYS
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Hattori Y, Murali SP, Lo LJ. Avoiding Inferior Alveolar Nerve Injury During Sagittal Split Ramus Osteotomy. J Craniofac Surg 2023; 34:e706-e708. [PMID: 37622543 DOI: 10.1097/scs.0000000000009688] [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: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Orthognathic surgery is highly effective in improving overall facial esthetics, in addition to achieving an ideal occlusion. Sagittal split ramus osteotomy (SSRO) of the mandible is the mainstay of modern orthognathic surgery, but intraoperative injury to the inferior alveolar nerve (IAN) remains one of the common complications. The authors report a case of 19-year-old male patient with left cleft lip and palate who received orthognathic surgery involving SSRO. The patient's right IAN ran close to the outer cortex of the mandible, but SSRO was successfully performed without injuring the nerve. Detailed preoperative evaluation using computed tomography images is essential. Blind splitting maneuvers during SSRO may cause IAN injury, and direct visualization inside the ramus helps to prevent injury to the nerve. Sagittal split ramus osteotomy could be considered as a viable option even when the IAN runs close to the outer cortex. This article describes SSRO procedures, highlighting the methods to avoid nerve injury.
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Affiliation(s)
- Yoshitsugu Hattori
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Srinisha P Murali
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Lun-Jou Lo
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
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Wong NSM, Leung YY. Comparison of the quality of life changes of patients receiving sagittal split ramus osteotomy or intraoral vertical subsigmoid osteotomy for mandibular prognathism. Clin Oral Investig 2023; 27:1435-1448. [PMID: 36881158 PMCID: PMC9989562 DOI: 10.1007/s00784-023-04933-3] [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: 03/03/2022] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE To investigate and compare the effect of two orthognathic procedures for mandibular setback, namely, sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO), on oral health, mental- and physical health-related quality of life across time. MATERIALS AND METHODS Patients with mandibular prognathism and planned for orthognathic surgery were recruited in this study. Patients were randomized into two groups (IVRO and SSRO groups). Quality of life (QoL) was assessed with the 14-item Short-Form Oral Health Impact Profile (OHIP-14) and the 36-item Short-Form Health Survey (SF-36) preoperatively (T0), postoperative 2 weeks (T1), 6 weeks (T2), 3 months (T3), 6 months (T4), 12 months (T5), and 24 months (T6). A comparison of OHIP-14 and SF-36 scores between two groups was conducted. RESULTS Ninety-eight patients (49 SSRO group, 49 IVRO group) participated in this study. There was no significant difference in OHIP-14 scores between SSRO and IVRO throughout the treatment process. SSRO group had significant reduction of OHIP-14 score (i.e., improving oral health-related QoL) since postoperative 2 weeks, whereas IVRO group had significant reduction since postoperative 6 weeks. Starting from postoperative 3 months, the oral health-related QoL of both groups was already significantly better than the baseline level and continued to steadily improve afterwards. For SF-36, both groups had increased physical health summary score starting from postoperative 2 weeks, indicating an early and gradual recovery of physical health-related QoL. The mental health summary score of the SSRO group began to increase from postoperative 2 weeks, but that of the IVRO group only began to increase from postoperative 6 weeks. Patient age at the time of surgery was positively correlated with OHIP scores in the postoperative period. CONCLUSIONS The study concludes that both SSRO and IVRO contributed to the improvement of QoL in the long term, but oral health- and mental health-related QoL of SSRO groups showed earlier improvement. CLINICAL RELEVANCE Undergoing orthognathic surgery at early ages is advised, as older age of patients appeared to have worse QoL. TRIAL REGISTRATION Clinical trial registration number: HKUCTR-1985. Date of Registration: 14 Apr 2015.
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Affiliation(s)
- Natalie Sui Miu Wong
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Pok Fu Lam, Hong Kong
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Pok Fu Lam, Hong Kong.
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Postoperative Steroid Dosing in Orthognathic Surgery, A Narrative Review of Literature. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2023. [DOI: 10.1016/j.ajoms.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Asha K, Thejeshwari H, Jagadish AB, Alghamdi MA, Vidya H, Muguregowda HT. An Anatomical Study of Dry Mandibles to Determine the Important Surgical Reference Points in Ramus Osteotomy - An Evaluative Study. Ann Maxillofac Surg 2023; 13:9-12. [PMID: 37711537 PMCID: PMC10499277 DOI: 10.4103/ams.ams_19_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction The variable relation and clinical significance of mandibular foramen (MF) and Lingula with inferior alveolar neurovascular bundle (IANB) is important for dental surgeons. Knowing the landmarks on the ramus of the mandible is of paramount importance to perform the surgery without causing damage to the neurovascular bundle. Materials and Methods This study was conducted on 85 dry adult mandibles of unknown sex and age. The distances were measured from the anatomical reference points (anti-Lingula, Lingula and MF) using digital callipers. Results The distance from the anti-Lingula to the anterior border of the ramus (A) was significantly longer on the right side (14.91 mm) than on the left side (14.5 mm). There was a significant difference in mean distances between the anti-Lingula and MF of both the sides (P ≤ 0.005). No significant difference was noted in the distances between the Lingula and the Anti-Lingula, observed for the posterior (B, P = 0.75) and the inferior margin of the mandible (D, P = 0.54). However we found correlation of vertical distances of anti-Lingula with Lingula and MF exhibited moderate positive correlation. Discussion The IANB is prone to damage during mandibular surgery. Using anti-Lingula alone as a reference point is not guaranteed, but it is still an important anatomical landmark for the surgeon to operate.
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Affiliation(s)
- K.R Asha
- Department of Anatomy, Siddaganga Medical College and Research Institute, Tumakuru, Karnataka, India
| | - H.G Thejeshwari
- Department of Anatomy, Siddaganga Medical College and Research Institute, Tumakuru, Karnataka, India
| | - Archana Belavadi Jagadish
- Department of Anatomy, Siddaganga Medical College and Research Institute, Tumakuru, Karnataka, India
| | - Mansour A. Alghamdi
- Department of Anatomy, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - H.K Vidya
- Department of Anatomy, Siddaganga Medical College and Research Institute, Tumakuru, Karnataka, India
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Ng WH, Goh BT, Lim AAT, Tan MH. Mandibular asymmetry: Is there a difference in the bone and soft tissue thickness between both sides? Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:e299-e306. [PMID: 36229374 DOI: 10.1016/j.oooo.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/02/2022] [Accepted: 05/13/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The asymmetric mandible presents the clinician with unique anatomic challenges in orthognathic surgery correction. This study aims to investigate these characteristics of the asymmetric mandible: mandible bone thickness, soft tissue thickness, and the proximity of the bone cortex to the inferior alveolar nerve (IAN) canal. STUDY DESIGN Three-dimensional virtual models were created of 35 participants of Asian descent with mandibular asymmetry. Mandibular bone thicknesses and soft tissue thicknesses were measured at certain landmarks. Statistical analysis of the thicknesses of both sides of the mandible was performed. Comparison of thicknesses between patients with minor and major asymmetry were also performed. RESULTS The bone was significantly thinner at the longer side at all 4 mandible landmarks (P < .001). The bone lateral to the IAN was significantly thinner at the longer side, as well (P < .001). The soft tissue thickness did not differ significantly across sides, except at 1 landmark. These findings were even more exaggerated in the major asymmetry group. CONCLUSIONS The longer side of the asymmetric mandible bone was thinner, and the bone lateral to the IAN was also thinner as a result. This asymmetric thinness was exaggerated in patients with severe asymmetry, which may predispose the longer side to IAN injury and unfavorable fractures. The differences in bone thickness in the asymmetric mandible may also result in residual postoperative asymmetry.
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Affiliation(s)
- Wee Hsuan Ng
- Discipline of Oral Maxillofacial Surgery, Department of Dentistry, Khoo Teck Puat Hospital, Singapore
| | - Bee Tin Goh
- Department of Oral & Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | - Asher Ah Tong Lim
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, National University Centre for Oral Health, Singapore
| | - Mei Hui Tan
- Department of Oral & Maxillofacial Surgery, National Dental Centre Singapore, Singapore.
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Muacevic A, Adler JR, Rajenthiran A, Thirunavukkarasu R. The Versatility of Extraoral Vertical Ramus Osteotomy for Mandibular Prognathism: A Prospective Study. Cureus 2022; 14:e32673. [PMID: 36660517 PMCID: PMC9845803 DOI: 10.7759/cureus.32673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Orthognathic surgery simply means alignment of the jaws. The aim of orthognathic surgery is to normalize the relationship of the jaws between themselves and the rest of the craniofacial complex. Mandibular prognathism is a common clinical problem all over the world. Currently, sagittal ramus osteotomy is the primary choice for correcting most cases of mandibular retrognathism and prognathism. The surgical option for extreme cases of mandibular prognathism is extraoral vertical ramus osteotomy (EVRO) or intraoral vertical ramus osteotomy (IVRO) or inverted L osteotomy. AIM The aim of this study was to evaluate the versatility of EVRO for mandibular prognathism. MATERIALS AND METHODS Ten patients with the chief complaint of mandibular prognathism with no history of keloid tendency were included in the study. EVRO was done for all patients. The parameters based on which the outcome of the surgical procedure was assessed were time taken for the surgical procedure, facial harmony both in frontal and profile views postoperatively, and intraoperative and postoperative complications, and assessment of the postoperative results was done through orthopantomogram (OPG) and 3D CT scan. RESULTS The time taken for the entire surgical procedure, starting from incision to closure, varied between 80 and 94 minutes with the average time taken for the surgery being 90 ± 8.80 minutes. It was found that there was a statistically significant difference between preoperative (M = 53.4, SD = 5.854) and postoperative evaluation (M = 47.5, SD = 5.039) of the posterior nasal spine to nasion 1 (PNS-N 1) horizontal plane (HP) (mm) with p < 0.001. Similarly, there was a statistically significant difference between preoperative (M = 81.4, SD = 2.716) and postoperative evaluation (M = 74.4, SD = 3.627) of mandible body length (mm) with p < 0.001. However, no statistically significant difference exists between the preoperative and postoperative evaluation of anterior nasal spine (ANS) to PNS (mm) and ramus height Ar-Go (mm). CONCLUSION EVRO is an acceptable surgical procedure owing to the fact that it is relatively simple to carry out, its lack of complications, and its good results.
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Diagnosis and Treatment of Myogenous Temporomandibular Disorders: A Clinical Update. Diagnostics (Basel) 2022; 12:diagnostics12122914. [PMID: 36552921 PMCID: PMC9776546 DOI: 10.3390/diagnostics12122914] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022] Open
Abstract
Myogenous temporomandibular disorders (M-TMDs) are the most common chronic orofacial pain, affecting the masticatory muscles and, thus, jaw movement. While a concise diagnosis is crucial to formulate a rational treatment plan, the similarities in clinical presentations that M-TMDs share with other neuromuscular disorders affecting the temporomandibular joint (TMJ) could easily confuse physicians. In addition to the basics, such as thorough history taking and meticulous clinical examinations, different imaging techniques are useful adjuncts to facilitate the diagnostic process. This review presents an overview of the current understanding on a variety of diagnostic and treatment modalities for M-TMD patients. It is essential to highlight that there is not a single treatment for all, and the benefits of multidisciplinary strategies have been noted for the effective management of myogenous TMD pain. Treatment modalities ranging from conservative to minimally invasive options are discussed in this review.
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Peleg O, Mahmoud R, Shuster A, Arbel S, Kleinman S, Mijiritsky E, Ianculovici C. Vertical Ramus Osteotomy, Is It Still a Valid Tool in Orthognathic Surgery? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10171. [PMID: 36011805 PMCID: PMC9407762 DOI: 10.3390/ijerph191610171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this study is to evaluate mandibular osteotomy procedures during orthognathic surgery, with an emphasis on the complications of the two leading procedures: intraoral vertical ramus osteotomy (IVRO) and sagittal split osteotomy (SSO). We conducted a retrospective cohort study by extracting the records of patients who underwent either IVRO or SSO procedures during orthognathic surgery in a single center between January 2010 and December 2019. A total of 144 patients were included (median age of 20.5 years, 52 males). The IVRO:SSO ratio was 118:26 procedures. When referring to all surgeries performed, IVRO procedures were associated with shorter hospitalization than the SSO procedures, while the overall durations of surgery and follow-up periods were comparable. In contrast, when referring only to bimaxillary procedures, the duration of the IVRO bimaxillary procedures was significantly shorter than the SSO bimaxillary procedures. There were 53 complications altogether. Postoperative complications consisting of skeletal relapse, temporomandibular joint dysfunction, sensory impairment, and surgical-site infection were significantly fewer in the IVRO group. Both types of osteotomies have acceptable rates of complications. IVRO appears to be a safer, simpler, though less acceptable procedure in terms of patient compliance.
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Affiliation(s)
- Oren Peleg
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Reema Mahmoud
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Amir Shuster
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shimrit Arbel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shlomi Kleinman
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Eitan Mijiritsky
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Clariel Ianculovici
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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He Y, Zhang H, Qiao J, Fu X, Xu S, Jin Q, Liu J, Chen Y, Yu B, Niu F. Biomechanical Evaluation of Seven Fixation Methods for Sagittal Split Ramus Osteotomy with Four Advancement Levels by Finite Element Analysis. Front Surg 2022; 9:891747. [PMID: 35599806 PMCID: PMC9114864 DOI: 10.3389/fsurg.2022.891747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mandibular sagittal split ramus osteotomy (SSRO) is a routine surgery to correct mandibular deformities, such as mandibular retrusion, protrusion, deficiency, and asymmetry. However, nonunion/malunion of the fragments and relapse caused by fixation failure after SSRO are major concerns. Rigid fixation to maintain postosteotomy segmental stabilization is critical for success. Additionally, understanding the biomechanical characteristics of different fixation methods in SSRO with large advancements is extremely important for clinical guidance. Therefore, the aim of the present study was to evaluate the biomechanical characteristics of different SSRO methods by finite element analysis. Methods SSRO finite element models with 5-, 10-, 15-, and 20-mm advancements were developed. Seven fixation methods, namely, two types of bicortical screws, single miniplate, dual miniplates, grid plate, dual L-shaped plates, and hybrid fixation, were positioned into the SSRO models. Molar and incisal biomechanical loads were applied to all models to simulate bite forces. We then investigated the immediate postoperative stability from four aspects, namely, the stability of the distal osteotomy segment, osteotomy regional stability, stress distribution on the mandible, and implant stress performance. Results The stability of the distal osteotomy segment and osteotomy region decreased when the advancement increased. All seven fixation methods displayed favorable biomechanical stability under minor advancement (5 mm). With large advancements, bicortical screws, dual miniplates, and grid plates provided better stability. The von Mises stress was concentrated around the screws close to the osteotomy region for the proximal segment for all fixation methods, and the von Mises stress on implants increased with larger advancements. With small advancements, five fixation methods endured tolerable maximum stresses of <880 MPa. A single miniplate and dual L-shaped plates generally suffered high stresses using larger advancements. The biomechanical characteristics were similar under molar and incisal loads. Conclusions The current study investigated the biomechanical properties of seven fixation devices after SSRO under molar and incisal loads. Generally, bicortical screws, grid plates, and dual miniplates provided better biomechanical stability using finite element analysis.
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Tomic J, Wallner J, Mischak I, Sendlhofer G, Zemann W, Schanbacher M, Hassanzadeh H, Sandner-Kiesling A, Payer M, Zrnc TA. Intravenous ibuprofen versus diclofenac plus orphenadrine in orthognathic surgery: a prospective, randomized, double-blind, controlled clinical study. Clin Oral Investig 2022; 26:4117-4125. [PMID: 35103836 PMCID: PMC9072507 DOI: 10.1007/s00784-022-04381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Abstract
Objectives The aim of this prospective, randomized, double-blind, controlled clinical study was to evaluate the analgesic effect of ibuprofen versus diclofenac plus orphenadrine on postoperative pain in orthognathic surgery. Material and methods Patients who underwent orthognathic surgery were randomized into two groups to receive intravenously either 600 mg of ibuprofen (I-group) or 75 mg diclofenac plus 30 mg orphenadrine (D-group), both of which were given twice daily. Additionally, both groups were given metamizole 500 mg. Rescue pain medication consisted of acetaminophen 1000 mg and piritramide 7.5 mg as needed. To assess the pain intensity, the primary end point was the numeric rating scale (NRS) recorded over the course of the hospital stay three times daily for 3 days. Results One hundred nine patients were enrolled (age range, 18 to 61 years) between May 2019 and November 2020. Forty-eight bilateral sagittal split osteotomies (BSSO) and 51 bimaxillary osteotomies (BIMAX) were performed. Surgical subgroup analysis found a significant higher mean NRS (2.73 vs.1.23) in the BIMAX D-group vs. I-group (p = 0.015) on the third postoperative day. Additionally, as the patient’s body mass index (BMI) increased, the mean NRS (r = 0.517, p = 0.001) also increased. No differences were found between age, gender, length of hospital stay, weight, operating times, number of patients with complete pain relief, acetaminophen or piritramide intake, and NRS values. No adverse events were observed. Conclusion The results of this study demonstrate that ibuprofen administration and lower BMI were associated with less pain for patients who underwent bimaxillary osteotomy on the third postoperative day. Therefore, surgeons may prefer ibuprofen for more effective pain relief after orthognathic surgery. Clinical relevance Ibuprofen differs from diclofenac plus orphenadrine in class and is a powerful analgetic after orthognathic surgery.
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Affiliation(s)
- Josip Tomic
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria.
| | - Jürgen Wallner
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria
| | - Irene Mischak
- Department of Dental Medicine and Oral Health, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria
| | - Gerald Sendlhofer
- Executive Department for Quality and Risk ManagementDivision of Plastic, Aesthetic and Reconstructive SurgeryDepartment of Surgery, Research Unit for Safety in Health, Medical University of Graz, Graz, Austria
| | - Wolfgang Zemann
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria
| | - Monika Schanbacher
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Andreas Sandner-Kiesling
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Michael Payer
- Department of Dental Medicine and Oral Health, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria
| | - Tomislav A Zrnc
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria
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Toh AQJ, Leung YY. The effect of orthognathic surgery on temporomandibular disorder. J Craniomaxillofac Surg 2021; 50:218-224. [PMID: 34887170 DOI: 10.1016/j.jcms.2021.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/17/2021] [Accepted: 11/28/2021] [Indexed: 11/25/2022] Open
Abstract
This study aimed to evaluate the difference in prevalence of temporomandibular disorder (TMD) before and after orthognathic surgery (OGS), particularly in patients with mandibular asymmetry. A prospective cohort study of patients undergoing corrective orthognathic surgery was conducted. Pre-operative and post-operative (3 months, 6 months and 1 year) TMD assessment were performed according to the Diagnostic Criteria for TMD (DC/TMD) protocol. 64 patients were included in the study. Overall, there was a significant reduction of 26.5% in TMD prevalence from 60.9% pre-operatively to 34.4% 1-year post-operatively (p = 0.003). In all, 37.5% of patients had their TMD condition treated, 50% had no change in their symptoms while 12.5% experienced a worsening of their symptoms. No significant difference in terms of change in TMJ status was observed among the different ramus procedures, the type and magnitude of mandibular movement, skeletal class, and presence of mandibular asymmetry. In conclusion, it appears that corrective orthognathic surgery for dentofacial deformities might provide a secondary benefit of treating TMD. However, surgeons have to be aware that a small percentage of patients might experience a deterioration of their TMD condition, and that those who were previously asymptomatic may develop TMD symptoms after surgery.
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Affiliation(s)
- Aileen Qiu Jin Toh
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong.
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Bahmanyar S, Namin AW, Weiss RO, Vincent AG, Read-Fuller AM, Reddy LV. Orthognathic Surgery of the Mandible. Facial Plast Surg 2021; 37:716-721. [PMID: 34587642 DOI: 10.1055/s-0041-1735309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Orthognathic surgery performed in conjunction with orthodontic treatment is commonly performed to correct skeletal irregularities and realign the maxillomandibular relationship to improve occlusal function and facial esthetics. A thorough understanding of soft tissue esthetics, skeletal and occlusal relationships, and surgical techniques is required to obtain successful results. Surgical techniques have evolved greatly throughout history, as technological advances such as virtual surgical planning have become available and widely used to obtain predictable movements with minimized complications. The aim of this article is to review the orthognathic surgical procedures of the mandible, with particular attention to the indications, contraindications, preoperative assessment, surgical technique, and possible complications encountered.
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Affiliation(s)
- Sara Bahmanyar
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Arya W Namin
- Department of Otolaryngology, University of Missouri School of Medicine, University of Missouri, Columbia, Missouri
| | - Robert O Weiss
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Aurora G Vincent
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Andrew M Read-Fuller
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Likith V Reddy
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
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Correction of Condylar Displacement of the Mandible Using Early Screw Removal following Patient-Customized Orthognathic Surgery. J Clin Med 2021; 10:jcm10081597. [PMID: 33918920 PMCID: PMC8069139 DOI: 10.3390/jcm10081597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Orthognathic surgery (OGS) is a surgical intervention that corrects dentofacial deformities through the movement of maxillary and mandibular segments to achieve adequate masticatory function, joint health, and facial harmony. However, some patients present with occlusal discrepancies, condylar sag, and/or temporomandibular disorders after OGS. Various methods have been employed to solve these problems after surgery. This study aimed to evaluate the effectiveness of early screw removal in patients with occlusal discrepancies after OGS using three-dimensional cone-beam computed tomography (CBCT). METHODS In 44 patients with dentofacial deformities, patient-customized OGSs with customized plates were performed to correct facial deformities using customized guides with computer-aided surgical simulation. Of the 44 patients, eight patients complained of occlusal discrepancies and temporomandibular disorders after OGS. These eight patients underwent screw removal under local anesthesia around four weeks. The temporomandibular joint spaces at three time points (pre-surgical, post-surgical, and after screw removal) in the sagittal and coronal planes were compared using CBCT. RESULTS Eight patients showed an increase in joint space on CBCT images immediately after surgery (T1), but after early screw removal (T2), these spaces almost returned to their pre-surgical state, and the temporomandibular joint problem disappeared. CONCLUSIONS The removal of screws located in the distal segment under local anesthesia between three and four weeks post-surgically may be a treatment option for patients with post-OGS occlusal discrepancies, condylar sag, and/or temporomandibular disorder.
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